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HomeMy WebLinkAboutT12N R3W SEC 22 LT 22AT12N R3W Sec 22 Lot 22A #015-141-67 MunicipalityofAnchorage Page __�_or— DEPARTMENT OF HEALTH AND'HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 9 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Sw T,5 -c> PID Number: Name: Wastewater System: ❑New ,"Upgrade -SAN E.tt Bcsor,t Addreas: Te6 ABSORPTION FIELD Phone: -34(4,-fr No. of B tlrooms: C Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: - Total Depth from original grade: • GPD/Sq. Fl. Lot: Block: Subdivision Depth to pipee'bottom from original grade: Gravel depth beneath pipe 2 r 7iZ (Q 71 Ft. Fl. Township: Range'3 Section: Fill added above original grade: Gravel length: 1'2 t,4 w ZZ O — Ft. JF1 FL WELL: D New O Upgrade Gravel width: b Number of lines: Distance between lines : � ' moi— FL Z Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: FL Ft. /;/ 6 SG. Fl. 30 3 Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. C (2lS G. Yield Pump Set at: Casing Height Above Ground: �( TANK GPM FL Ft. SEPARATION DISTANCES Lrseptic 0Holding DS.T.E.P. To Septic Absorption W1 Holding Public/Private Manufacturer: Capacity in gallons: /Z�s-d From Tank Field Station Tank Sewer Lines 4 Material: Number of Compartments: - well /40 !�-� S c 2 Surfac loo LIFT STATION Lot6� `� Size in gallons: Manufacturer: Line Foundation r /c) 'Pump on" level at: .'Pump oft" level at: High water alarm at : Curtain "lh Pump Make 8 Model I Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: q2A a � Assumed Elevation: Fta ENGINEER'S SEAL j %5 Inspections performed by: 6 •IS�q v � oN� � Dates: 1st A XY:.N Yll '.n /n v➢K91M�a� 2nd ,7:i, Steven P Pannone Q dServices approval Department of H71(1 CE- 1A9 � f�.4 Reviewed and approved Date: 72-013 (Rev. 9/91) MOA 25 AS—BUILT WASTEWATER ABSORPTION SYSTEM N1/2, N1/2 Gov't Lot 22, S 22, T12N, R3W Tes Newrench-Type Soil Absorption System A-TH1=19' B-TH1=63' 491H B '=-ThA....................PREPARED FOR ,en R. Ponnonee No. CE 8149 w Jan & Trish Nielson .: 4741 East 112th Utz �o� Anchorage, Alaska 99516 ,9 ss (907) 346-3311 NYAYA �� Well 00' Well Radius Well Exist. Bel -Type Soil Abso ption System STEVEN R. PANNONE, P.E. P. O. BOX 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-8218 Fax VTEE7-12-95 AS -BUILT ALE. 1"=50' A-6=39.7 A-7=30.3 C-1=41.1 / A-8=44.6 C-7=57.9 i / / / / Zai/ i\C.O. 'z / �y ' C.O. 51 T. 53 '•49TH .9 ............ ......................... ;Steven R. Ponnone No. CE 8149 J 'e, • C EXISTING 4 BEDROOM HOUSE rm 7T STREAT „L„ — C.O. 41 Jan & Trish Nelson 4741 East 112th Anchorage, Alaska 99516 (907) 346-3311 5e -rl3rn B pSL" ,5« EXISTING 1250 GAL. 'SEPTIC TANK DIVERSION VALVE(LI) EXISTING BED -TYPE SOIL ABSORPTION SYSTEM STEVEN R. PANNONE, P.E. P. O. BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 ate 7-12-95 AS -BUILT tale 1"- DISTANCE TABLE A-1=28.0 13-2=54.1 A-2=90.0 B-3=33.9 A-3=24.6 B-4=32.9 A-4=25.6 B-5=31.2 A-5=25.7 B-8=43.2 A-6=39.7 A-7=30.3 C-1=41.1 / A-8=44.6 C-7=57.9 i / / / / Zai/ i\C.O. 'z / �y ' C.O. 51 T. 53 '•49TH .9 ............ ......................... ;Steven R. Ponnone No. CE 8149 J 'e, • C EXISTING 4 BEDROOM HOUSE rm 7T STREAT „L„ — C.O. 41 Jan & Trish Nelson 4741 East 112th Anchorage, Alaska 99516 (907) 346-3311 5e -rl3rn B pSL" ,5« EXISTING 1250 GAL. 'SEPTIC TANK DIVERSION VALVE(LI) EXISTING BED -TYPE SOIL ABSORPTION SYSTEM STEVEN R. PANNONE, P.E. P. O. BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 ate 7-12-95 AS -BUILT tale 1"- AS -BUILT DETAILS WASTEWATER ABSORPTION SYSTEM N1/2, N1/2 Gov't Lot 22, S 22, T12N, R3W NI 0 v V 7 e a 1nnNV313 a ¢ a a a ON �� A V co 00 0o a� $ °oa°oo c 2.0' v 0p00 °oO i H 0000 L� �I 3an1 ?J011NOW � 00 tt Z U O• �• Q d Li (r E d f L7 � W V 1H 0 0' 1now3l3 000 00N M co °N 0 00 � a inoNv313 0. Rie 1nONV310 a.yu., oolsaan!a a - a W � s 1nONV3-0 rs 6 Wim~ V 1noNv310 W.yN .•'�E .FiflONV3-0 :r 4p.`• �' NOI1VQNnoi 491—H ,.....5. .........1...../ ............••• .. r REPARED FOR STEVEN R PANNONE, P.E. .Steven R. Pannone: rcii ♦� •. ff Jan & Trish Nielson P. O. BOX 142025 ♦ e, No CE 8149 a 4741 East 112th ANCHORAGE, ALASKA 99514 ♦���"r^ �� F ��� Anchorage, Alaska, 99516 274-0308, 272-8218 FAX p�i;; �•� (907) 346-3311 DATE 7-12-95 AS -BUNT NOT TO SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES R t ` 825 "L" Street, Anchorage, Alaska 99502-0650 s SOILS LOG — PERCOLATION TEST PERFORMED FOR: -:U&) I �>—Lse- DATE PERFORMED;:"'%4z T � LEGAL DESCRIPTION: ZZl4,{ Township Range, Section: -�-fZ 11t (Z'z w S B+.'Z SLOPE SITE PLAN DEPTH FEET) 1 F, -C N 2 «�_ CaLzA",cS 3- 4 5 (,� M 6 7 BoA- 8 9 10- 11 12 13- 14- 15- 16- 17 314151617 18 19 20 COMMENTS ltill39. �a2NSrTY WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Ager Monitoring? Date: rt S L O P E 5 Gross Reading Date Time Net Time Depth to Water Net Drop e So A -7L- O 12- 2 -Off- c> +S X314 r/4 - 6 74b /O 71.4 3116 4S 1 ` !� 3//6 C:' ix, T o Z o g r 4 3116 O?SS 2 ' �'1� �Ilt O p� 5/g V PERCOLATION RATE Z} (minuteslinch) PERC HOLE DIAMETER 440 TEST RUN BETWEEN FT AND FT . PERFORMED BY: '�ow r2. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 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:SW950127 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:NIELSEN JAN E & PATRICIA K OWNER ADDRESS:4741 E. 112 TH. ANCHORAGE, AK 99516 PARCEL ID:01514167 LEGAL DESCRIPTION: T12N R3W SEC 22 LT- 22A LOT SIZE: 54428 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/20/95 EXPIRATION DATE: 6/20/96 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 ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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. SPECIAL PROVISIONS: A PERC TEST MUST BE PERFORMED DURING CONSTRUCTION OF THE TRENCH TO CONFIRM THAT THE SOIL STRATUM FROM 3.4 TO 7.0 FEET WILL PERC AT 40 MIN/IN OR LESS. RECEIVED ISSUED BY DATE:- DATE: ATE: DATE: �/Z f%-- Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, AK 99514 (907)274-0308,272-8218 Fax June 11, 1995 Municipality of Anchorage Department of Health and Human Services Environmental Services P.O. Box 196650 Anchorage, AK, 99519-6650 ATTN: Mr. James E. Cross RE: N1/2, NI/2 Govt. Lot, Section 22, Township 12N, Range 3W. Request for Sewer Permit Dear Mr. Cross; On May 27, 1995 my firm was requested to conduct a Health Authority Investigation of the existing water and wastewater system located on the above property for an up coming sale. An investigation of the existing bed type system showed that it was in failure. Water was observed standing in the laterals eight inches deep. After the tank was pumped, water levels in the laterals lowered to three inches deep. We informed the owner of the situation. My firm was requested to determine a plan to replace the system with a new one. Carls Excavating was hired to excavate a test hole. See the attached site plan. I would like to request a permit be issued to construct a new soil absorption system in the front yard as shown on the attached site plan and in accordance with the attached engineering plans and details The new system will be a deep trench system 108 total feet long, 7 feet deep and 2 feet wide. It will be start approximately four feet below existing ground level, and will be located in the material identified as course gravels and silty sands, having a peculation rate of approximately 40 minutes per inch. Existing soil absorption systems serving adjacent lots are greater than 20 feet away from the proposed system. A Private water system serves the property, and the service line is located on the east side of the property, well away from the new system. There will be no conflicts with any existing water or soil absorption system. If you have any further questions, please give me a call Sincerely, f- !— Steven R.R. Pann _ DESIGN WASTEWATER ABSORPTION SYSTEM N1/2, N1/2 Gov't Lot 22, S 22, T12N, R3W 4PZ R. yoO's us Lfprvtw/r^;CP = 1331 GIF ft � r�DeBn-cR�acR C(.S�1 Q2&&'to C.1:N47P �!-'QILC�Nti. 49TH ,en R. Ponnor No. CE 8149 ?3Sob ro �FESS� �e 11 T.H. 0' Tes ------------ New e h -Type Soil Absorption System A-TH1=19' B-TH1=63' REPARED FOR: Jan & Trish Nelson 4741 East 112th Anchorage, Alaska 99516 (907) 346-3311 Well )0' Well Radius Well Exist. Beck -Type Soil Abso ption System STEVEN R. PANNONE, P.E. P. O. BOX 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-8218 Fax JE: 6-5-9s DESIGN ,ALE: 1`=50' DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM N1/2, N1/2 Gov't Lot 22, S 22, T12N, R3W a o 1nONV31J v C d M. R O q Co IS C N 2.0' o o 4.0' 7.0' 39n1 d0lwoN J 9 z U o w O E d E U Ld Wo J a o00 .2.0 1nONV310 r a 1nONV31D s 0 rna� C l] V lnonv313 V �p• �, inONVIID NO[1VQNn03 49TH •e,'31. %.....::.......... ...... ............ ..... ...........^•••••••••••••••••••••••••••••gam PREPARED FOR STEVEN R. PANNONE, P.E. �� .Steven R. Pannone:t� �c ., 8149 Jan & Trish Nielson P. ❑. BOX 142025 0 o No. CE 1�•.,,gSG�,1 D •,.\� 4741 East 112th ANCHORAGE, ALASKA 99514 �j �� � Anchorage, Alaska, (907) 346-3311 99516 274-0308, 272-8218 DATE 6-5-95 FAX `�; DESIGN NOT TO SCALE e Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " U' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: k --,zla1 DATE PER SZZ?T12NI113W LEGAL DESCRIPTION: �1I1L 11112 GOVT L&M 22- Township, Range, Section: S r� SLOPE 1 2 3 61 7 8 9 10 11. 12 13 14 15 16 17 18 19 F t L L /r, f•,t 1r2at✓N/q r21 -4Y Caq k AN tCS ca L-tJ -c-aQ3 Ro L� e1 CT r'k J\A t> .D -D e.r.7sr-'Y C vv(LSc3 {Nl e-- it, lJ b e-f')G r-ry WAS GROUND WATER ENCOUNTERED? b S L IF YES, AT WHAT O DEPTH? P E Depth to Water Atter Monilorinp7 (g --T-45 gate:A>eY Reading Date Gross Time Net Time Depth to Water Net Drop soA l24S .S 2 Izsp .S -4 1 0 o S -S 1/14 `/B 20� I� JI PERCOLATION RATE y� (minutesiinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND '? FT COMMENTS b`c[AV/A-r 'L7() V3 `C CAS) -S L`AC GiM MATe12r✓a L- MU4 Moo-, SvIT&gL d. r4, L_ \ PERFORMED BY: �. `j n7cqN CL- j ' t—� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage Page of 3— 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 Permit Number: Sw 9/b2SCI PIDNumber: oIS�N!6 Name: Wastewater System: ❑ New Upgrade St-rtF E.w H ETN 4. Address: K ABSORPTION FIELD K$y/ E /!2�-• /ave Phone: .3Y(v- No. of Bedrooms: I# ❑ Deep Trench ❑ Shallow Trench X,Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 2 GPD/S . Ft. 1N S= A Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ;y -Z ?—A 41v` MA .5 Ft. ©• S Ft. Township: Range: Section: Fill added above original grade: Gravel length: / . m Z ° k% I 2 Z— '3 m Ft. 6 Ft. WELL: ❑ Ne6w`PtG ❑ Upgrade Gravel depth: Number of lines: Distance between lines. Ft Class' ication (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: 4MO-Bi1r TRvUaD I, V A'7-t� 160. Ft. 1,50 R. /574is SG. Ft. &(.Y E"V P_t-t 6 Driller: Date Drilled: Static Water Level: Installer: Date installed: 14aV- -e-OnILLtNin 6-2q-g7- 1004 Ft. c ft `s exCA%4A-nn/ a -tjit, Yield:Pump Set at: I Casing Height Above Ground: TANK GPM Ft. 2 • S' Ft. .SEPARATION DISTANCES y,,( �eptic El Holding ❑S.T.E.P. To Septic Absorption]4Staltiton Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Tank Sewer Lines 4517M .R. l2SoCm AL Well L8 14.134 (A N/A Material: Number of Co�artments: r $ T6E. LSurface„,,IA^ 4 LIFT STATION WaterLot / Size in gallons: Manufacturer:/n�Line A /Cot 3S� L N/� "Pump on” level at: "Pump off' level at: High water alarm at: Foundation /• 3 $'t Curtain ^/// 4 Pump Make & Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: is • R_14 2 o f N T r3 P E R VN L _N-YTZAN C 'TO R&U SE Assumed Elevation: 6-0 0 ENGINEER'S SEAL OF AW 0 49th "" Inspections performed by: S•t2V-"raNNoAja.P-E Dates:lst��/6-�/ "° �•°°�� •••� 2nd �'r�-9l a p A�;- g even R. Pannone ° g Q dp Department of Healt Hum ices approval '•, CE-8149 '�`�® 0osfF��,9 Reviewed and approved b Date: " 72-013 (1/91) MOA 25 Permit No. 4"A g t oz Sq Page 2 of 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 Description: N'/ -L G,0\"1 Go< zz szz,T�2r(�23L. PID No.: c>/,S 67 72-013 A (2/91) MOA 25 O 0 � 10 Sia %LF GA /.y �. SfbGE� 6- APA2T. 1 h i ?, G10<— kos— St=Fi'�L TAN1G 'IN VEST ',� nm � e�cv =sm•o 1 1'x`5 A w f\ a� D \\ d D �G 0 q p EKEAL a 9 c�`����� OI la - -- --j �; stoven R, Pannone[^e•8<� f���r�g••. Y �17 9 i L s�� r /• •Vea ,•' y FES S S-'Cgs1c.T ' •`='tom, _.m�>^a�fi. 72-013 A (2/91) MOA 25 Permit No. S -u 9/oz84 Page 3 of 3 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 Description: I :4 S 2 IQ U3 PID No.: a/SlNl6,z Z FP J tom% 10 rh P Q N c I � w w 0 9 C a m if, 0 1 ro v� T W_ n Td co 49th !P`% Steven R. Pannone :2 �Q . J, � CE - 8149 ���igAPROFF,,..""�. 72-013 A (2/91) MOA 25 n � t 3 0 a I' 49th !P`% Steven R. Pannone :2 �Q . J, � CE - 8149 ���igAPROFF,,..""�. 72-013 A (2/91) MOA 25 PAGE 1 OF MUNICIPALITY OF ANCHORAGE &IYj DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 9-)T9) ANCHORAGE, ALASKA 99519-6650 u S e t4 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910289 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:SMITH KENNETH J JR & GLORI A OWNER ADDRESS:4741 E.112TH AVE ANCHORAGE, AK 99516 PARCEL ID:01514167 LEGAL DESCRIPTION: T12N R3W SEC 22 LT 22A LOT SIZE: 54428 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 DATE ISSUED: 9/13/91 EXPIRATION DATE: 9/13/92 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY DATE: (�)1O9 DATE: 11 MEMORANDUM TO: Municipality of Anchorage, Dept. of Health & Human Services FROM: Steven R. Pannone P.E. DATE: September 5, 1991 SUBJECT: Drain Field Replacement (NI/2 N1/2 Gov't Lot 22, S22 T12N R3V) 14?4 i E r 12, T_�+—,*AtW The following is a narrative of the work to be performed in the replacement of the drain field at . kavI Z. The Existing drain field is not working. There is reported sewage bubbling up from the far end of the drain field. I suspect that the existing drain field was not in- stalled level. The project to replace the existing drain field entails abandoning the existing drain field in place, and installing a new drain field 10 feet north of the driveway, run- ning southwest from the existing septic tank, along the driveway. The new drain field would be connected to the existing septic tank. The ground slopes downward at about 5% grade north of the drive way. The drain field would be located a minimum of four feet bellow the slope at its shal- lowest point. I see no adverse effects in placing the drain field in this location. The ground south of the driveway slopes up at an approximate slope of 5% to the neighbors house located about 300 feet south. The new drain field is moved up hill from the existing drain field and there are no houses, wells or septic systems within 200 feet of the new system down slope, so there should be no adverse ef- fect on the down slope property. The new drain field is not located within any private well radius's. The existing well for this property is located 130 feet uphill from the new drain field. Architecture Anchorage X11 ring • Land Surveying • Planning Fairbanks VStnJt,. wAs-r�wA-rc-? `t�isPosiac. 2✓=G,`s _..-S�G`t-oma /5,:laS•OC�O : 1�6- /(q T/d l$Lam' ( r1 T'S 4- Q-fi/.o nJ /S PL 6A Q- C-- Q MLsJvtS: X02. �'NDIV I'DdAL: r?aF IU1?" C- 4B�,s /.9, 6C, 'rla �- � �A i2-ir4`A - �f Ra' x�So Soo sv F=•o-2 C3�o / 8 gR/ I 163 s�=/P— 3 2uNS �i�r /aP�rd2i, pj,s'�LON4,. : /i":AR.ra N 2©'CIC /8'"•J�DC++.� S��LO�V S, 0�p--TI-I b. -ta a, c.®rte aw's—f-, �p A4:1sg�@ C� c n11 X A 49 h BA -;0 R. Pannone �eokh PROFESSOV " Op' Project Title Z�-AAJ N I -��� r .1 Page Title g T L sYs r &fG J O-ALcS W.O. # Date "a I c R Q 9 By Page of 03' 30`u/ LO rl N ( �' ♦ 9°k o n V' '�N 00 —0 ° ?s jp� { 6 „ c� �a i - o 'u co 1 R ji tv�';!�`� � u� j ��y N D� D4� Q" y✓ tiLS.04 — — Y, t Permit No. Page -3 of 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 Description: N'12 N'r'z `,OV'r Lo -r szz, ("I k I 9-3 w PID No.: 72-013 A (2/91) MOA 25 V 711 J o 6� qJ q Sre�m:. '. 7err.on.� is Cr cl-81 i9 j S i se"q ,k tA < , T$ a I rt U N t 3 r g IQ E r H -v 72-013 A (2/91) MOA 25 V 711 J 6� qJ q Sre�m:. '. 7err.on.� is Cr cl-81 i9 j S i se"q e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: ---A t -G N I EL S 01a DATE PERFORMED: S9cvcn R. Pcnnone CE -3149 t LEGAL DESCRIPTION: II2tI Ih- G,oVT LP`r 7_ -Z Township, Range, Section: 5 ZZ.7 "r 1214 ) 2-3 U-? DEPTH ) `SYH-oLE 1 SLOPE SITE PLAN (FEET)-)--oPSoIL 1 2 /' '—/, ,N -% % J T.3 4 6 T/ 5 (S M ) 6- 7 7 8 ; 9- 10- 12- 13- 14- 15- 16- 17 10121314151617 18- 19 20 2a 5 PERCOLATION RATE Z. -Z.o3 (minutes/inch) PERC HOLE DIAMETER 411 41 Ll TEST RUN BETWEEN FT AND �' D FT COMMENTS S©t r_ L D 'T:�1�. €'.+t.! r—raeD l" 144 t c- Ioc' I^I &-X r TO "7LLJ�i Ali. .Go wA-rkL;n- w/AS 4A/cOu,�T`eA—b4A Zr-Aj `p�r-�0,4LTE2. +o�Hwns OQY. PERFORMED BY: STl_VC'-ti Fi'• lr I iO..IGa"i' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) WAS GROUND WATER ENCOUNTERED? S Qo"f'TOM p� / L IF YES, AT WHAT O DEPTH? P E Depth (a Water After Monitoring? NB (5 Vj Date: ■■■■■■.R■■ Depth to Water Net Drop li) ■■■■■■N"N■ k SS MMM■■,' 3/ 13/ L_ N POWNEFFEWER NoffiffiENEMEN MEREMMEMEN Reading Date Gross Net Time Time Depth to Water Net Drop li) k SS /V'-1 b 3/ 13/ I' C, I" S Ft {vP' tLNUINt TAS ? t ime � T'i a.na e Municipality of Anchorage 7�< •> DEPARTMENT OF HEALTH & HUMAN SERVICES1, o Steven P. Pannone 825 "L" Street, Anchorage, Alaska 99502-0650 ; a -8149 SOILS s SOILS LOG — PERCOLATION TEST 4 g''<x)4.".' NQ PERFORMED PROfESS10`�ta PERFORMED FOR: �A !&1 SpeJ DATE PERFORMED: 9'9--p1l LEGAL DESCRIPTION: 0-9 NIk [,OV 1 tO-r Township, Range, Section: s az'Z—fz�, �Z Lns �D-Z=Si�{-1OLE '.0 SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 i � o2tiANIC 5 AN1� -Q oTr-oM c r` No4t ■■■■■■■N■■ Date GrossNet Time Time Depth to Water Net Drop ■■.■■■■��©I ®®■■./E(. EffiRMEENEEN MM M■■.URNM■■ ■■®NNE■■■■ ■EMMM,■■■■ REMEE MENUMENEEN WEEMENEMEN ME■E■E■■■■ ■■■■■■■■■■ WAS GROUND WATER o i ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water After Monitoring? Dale: Reading Date GrossNet Time Time Depth to Water Net Drop 20 PERCOLATION RATE (minuses/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS C' 67, G7 WAS f�CO.` "M] -M f?f3 "'T2] V e -1-f11 F- -r' sC CPtLr.eu. 01,. luT` &ejb i91= S r,Fy`F- t C- "a 61.� PERFORMED BY: S'T I_V �n-1 I2. pANNpN I 6-Y? \ P�U N is CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: q e �"M0 72-008 (Rev. 4/85) PERFORMED FOR: -7 PAJ N is t- .r 9 r DATE PERFORMED: C� — /-"—C) / LEGAL DESCRIPTION: N I/2 IU 117- 40 u'CG[a-r Z_2 -Township, Range, Section: S'ZZ (F�DEPTH - �}®�,� SLOPE SI E PLAN Tt9fes-pI r 1 / z / 514 Nv �"s M'�S l c. I- 3 3 �ML) 4 saropy $rLr .�l ( 5 M) 5 6 PoTiOM Df- 7 8 9- 1011 10- 11 12- 13- 14- 15- 16- 17 21314151617 18 19 WAS GROUND WATER ENCOUNTERED? N O IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? Date: S L O P E ■■■■■■■N■■ P'A Depth to Water Net Drop Municipality of Anchorage : 30 DEPARTMENT OF HEALTH R HUMAN SERVICES T� + Steven R. Pannone �. 825 "L" Street, Anchorage, Alaska 99502-0650 iJ s CE - 8149 t of—j3 mil,,.•, �� SOILS LOG - PERCOLATION TEST '<'" PERFORMED FOR: -7 PAJ N is t- .r 9 r DATE PERFORMED: C� — /-"—C) / LEGAL DESCRIPTION: N I/2 IU 117- 40 u'CG[a-r Z_2 -Township, Range, Section: S'ZZ (F�DEPTH - �}®�,� SLOPE SI E PLAN Tt9fes-pI r 1 / z / 514 Nv �"s M'�S l c. I- 3 3 �ML) 4 saropy $rLr .�l ( 5 M) 5 6 PoTiOM Df- 7 8 9- 1011 10- 11 12- 13- 14- 15- 16- 17 21314151617 18 19 WAS GROUND WATER ENCOUNTERED? N O IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? Date: S L O P E ■■■■■■■N■■ Gross Net Time Time Depth to Water Net Drop 1 -it- : 30 MENEEMENIN y MEMMEi\■\■ r 11 ENEENWINUMME ■■■■M®®■■■ ■■M®E■©®E■ NEEMMEMMEN ENEEMEN EN ■MMEMNE 0 Reading Date Gross Net Time Time Depth to Water Net Drop 1 -it- : 30 y �/ice 3�6 r 11 20 PERCOLATION RATE z�'� (minutes/inch) PERC HOLE DIAMETER Lit TEST RUN BETWEEN y FT AND /P FT '^OMMENTS -P t� �"t LC.E� iso LG To E>L% -r-4 Y"n/OI CA -t -EO -T-a R.J,y PERFORMED BY: -'"`tt' I S 'iZ ` y—R"��b'� IE� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C) — r3 9f 72-008 (Rev. 4785) Date Drilled: 5-29-87 WELL LOG Lot 22 Static Water Level 100' Draw Down I)/A feet feet Gallons Per Minute 6 TOtal Feet of Casi.ng' i'80 ' Type Material Drilled: 0 feet to 6 O,;erb,_~r dcn 6 ft. to ?q Ft~ S~lt 23 ft. to 56 re_ .~l~y ~n~ 56 ft, ' to 6~5 f~- ~qtl~_y ~mn~ 65 ft. to 70 ft. Silty ~lmy w./~ gpm 70 ft to ~m_. ft. Silty ~3 84 ft to 86.f~Rock, g~ 9~ to !20'ft. C~mcntc~ Rc~k~ 120 f~_ to l~n ~+ c~,, 160 ft. to 1809ft. Rocks & San~ y/waaer HEFTY DRILLING 3540 AKULA DRIVE ANCHORAGE, AK 9,(1516 (907) 345-0593 e GREA.cR ANCHORAGE AREA BORIJGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 Q j INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING ADDRESSarGA.l_L p �p PHON5222P p LOCATION (�i/� ✓ /��'��` Q'% LEGAL DESCRIPTIONPO �/. �C "" L SEPTIC TANK: DISTANCE NUMBER OF rAee - '7 FROM WELL v1� MANUFACTURER ( MATERIAL /'���s( COMPARTMENTS vS /2S0 " PEQAA/ Lard 0 -27 INSIDE LENGTH'-- INSIDE WIDTH_ ��- LIQUID DEPTH ^- LIQUID CAPACITY ALLONS.� tc7 f / TOTAL LENGTH DISTANCE FROM WELL �� FOUNDATION -aS NEAREST LOT LINE OF LINES _ q.q NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILEWIN. ABOVE TILEC-51 IN. WELL: _ TYPE 1I 4A CONSTRUCTION—�t DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTICSEEPAGE % FOUNDATION ff//JJ��11 LOT LINE , SEWER LINE TANK �, SYSTEM- CESSPOOL--, YSTEM CESSPOOL— , OTHER SOURCES APPROVED__t_ DISAPPROVED DISTANCES:— �a INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL:_ t/c LOT SLOPE: REMARKS: •9 - Form EQ -032 REMARKS DIAGRAM OF SYSTEM %''8 6i� ,atel" DATE1A4K 7b APPROV .����C."; 1 � 0.3 F_ U=L, PA C., k -A � r? 43 ro DEPARTMENT Or ERLTH AND ENVIRONMENTAL Pi .ECTION 2516 E. TUDOR RD./ HNCHORHGE, HK. 99507 ^- ' . 276-2221 / �FE: �L_ �E�-g E> L3 PA_�3 -F �.E ������ �-If / 5 7- , ] w~� « APPLICANT KEN SMITH LOCATION SO LEY LEGHL N0EC 201'12N R]W SM 2513 GLENWOOD 272,5068% LOT SIZE 108000 SQUARE FEET ` TYPE OF SOIL HRSORBTIDN SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR 245 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��E P4 H-- 1-0 L- THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OFTHE HRENCH MR PRHINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE B.EljEEN\THE S RFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN . THERE IS NO SET WIDTH FOR TRENCHES. / THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF ORML BETWEEHE OUTFHLL PIPE AND THE BOTTOM OF THE EXCAVATION 0N FEET). \\ X x ������Fe. �� ����X 17' X F0 �1 2.-' E�_� -lL 10 [G.�fl �f:-11 0 _ L_ 0!�� BACKFILLING OF ANY SYSTEM W � ION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT T(} PRO5E[U\ � MINlM|/M DISTANCE BETWEEN H WELL AND SEWAGE DISPOSRL SYSTEM 15 100 FEET FOR H PRIVH ELL 0 FEET FOR PUBLIC WELL WELL LOGS ARE REQUIR D AND MUST YE RETURNED THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETI N. � SPECIFICATIONS AND C NSTRUCTION bIHGRHMSHRE AVAILABLE TO INSURE PROPER | ' � \ INSTALLATION. ' / � ������ F,- - -� ������ I CERTIFY THAT i: I HM FAMILIAR WIT4 THE REUUIRQMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPH TY OF 8NCPORAOE. 2: I WILL INSTALL THE YSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT T E I SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED\TO INCLUJE MORE THAN ] BEDROOMS. APPLICANT KEN SMI1TT y ISSUED BY.. -..--0 ........DHTE_, -10._'�� 2516 E. 7 udor Road Anchorage, Alaska 99507 5' 276-2221 Performed for Legal Description: This form reports: SOILS LOU - PEROI,A'PION' TEST -Mr,.%sn-.Swith_--- _ ----------_---.. ILrte Perforri"d 7/29/76 -Nor! _0, _ _ot_221_ ec 22T. 1 N. R_ W.t. Anchora e Ak. Soils log _ X 4 _ Percolation test_ X—y— Depth Feet 1 - ML (275) 2 - ML (275) 3 - ML (275) 4 SM (250) 5 _ SM (250) 6 - SM (250) 7 - SM (250) 8 - SM (250) 9 - S14 ( 250 ) 10 - SM (250) 11 - SM (250) 12 - SM (250) 13 - 14 S/Oko 2% Was ground water encountered? _ _ If yes, at wiiat depth? Reading Da to Gross Time Not Time Depth to water flet drop - -- --- --=- --- - 11125-- -- ----- ------ ---9n - ---- ---- ---' -----• --- ------------11s.26.------------------------�-7�i6�� ----------7�16u----_: —------- - .. - - - - 11:78 - --- - -- - --- ---9-3L4 --- 4. 10" 1" — -- 103L811_ i.3/$ f _ id- 11/16" - i 11/1" 1 1116, - --- -�_.�_ Percolation rate 28. -2_ ---minutes per inch --- -- - -- --- — Proposed installaCTon: Seepage Pit Drain Field Depth of Inlet Depth to bottom of pit or trenci ---- — _ -- coi,iru'irs: - pQrcglatjgn-Lest-(lgne_in-12 _hole_between_6!_xnd_J�.__ _ Performed (iv: Certified By:_ :rlte: -- 1'Q-090 (6/74) Richard A. Drahn, P.F. Richard A. Drahn, P.E. Municipality of Anchorage • Development Services Department Building Safety Division +. ' On-Sde Water 8 Wastewater Program , 4700 Bragaw Street ` P.O. Box 196650 Anchorage, AK 99519519-6650 www.muni.org/onsfe (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. V I5 r + r— �Q "f COSA# 1. GENERAL INFORMATION Expiration Date: I o2 D Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address T12N R3W SECTION 22• LOT 22A 4741 EAST 112TH AVENUE • ANCHORAGE AK * 99516 TIMOTHY FAGGIONATO Day phone 261-2878 4741 EAST 112TH AVENUE • ANCHORAGE AK * 99516 Day phone RANNA FEKRAT W/ PRUDENTIAL JW Day phone XXX 3801 CENTERPOINT DRIVE 4200 • ANCHORAGE AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal axed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certiricate 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date 2 d Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering anaWs of the system in accordance with ADEC and MOA DSD Guidelines & Regulation. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily idenfiflable features. The operational He of ell wells and septic systems depend on the local soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE Approved for L' bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Arsenic Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Reort '-%1tOFtAN6, QPM,.,,....,... � %PJERA N� cam: PROGRAM :A Nitr e Advisor Other B Original Certificate Date: _40 *t- lilw HM1 Municipality of Anchorage -•1 Development Services Department Building Safety Division 4,,, _ On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T12N R3W SECTION 22; LOT 22A Parcel ID: A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (YIN) YES Date completed 5/29/1987 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 180.9 ft. Cased to 180 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT.INSPECTION Date of test 5/29/1987 9/12/2008 Static water level 100 ft, 86 ft• Well production 6 g.p.m. 4.37 9•P m. WATER SAMP E RESULTS: Coliform colonies/100 ml. Nitrate 4mg./L. Other bacteria _))colonies/100 ml. Arsenic: ug.IL. Date of sample: 9/12/2008 Collected by GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/16/1991 Tank size 7250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 9/12/2008 Pumper AROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA eELow EXISTING GRADE BED 9/17/1991 0.4 $ DUAL TRENCH Date installed 7/6/1995 Soil rating (g.p.d./Wo /bdr System, type 1 0.5 Length' 51+536 104 ft. Width 2 ft. Gravelbelow pipe 7—ft. 14 Total depth • •11.8/9.9ft. Eff. absorption area 1456 n' Monitoring tube YES Depression over field NO Date of adequacy test "9/12/2008 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 700 gal. New depth? 11 In. Elapsed Time: 225 min. Final fluid depth 1 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **TESTED 1995 SYSTEM SOUTH TRENCH ONLY. ***TOTAL DEPTH WAS NOT CHECKED FOR THE BED D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size In gallons "Pump off" Manhole/Access water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main 100'+ Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field '3' Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway,g g parkin /vehicle storage 7' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS Date 9 J,37,0 S COSA Fee `r Date of Payment_ /0/1/68 Receipt Number— (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program y. {,. I IK 4700 Bragaw Street --y P.O. Box 196650 ZU cid Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. X15-141- jov:1 COSA# F)UMIF)1- Expiration Date: / D - 15? - 0a 1. GENERAL INFORMATION Complete legal description Lot 22A Sec 22 T12N R3W S.M. Location (site address) 4741 E 1121' Current Property owner(s) Nancy TA-t,5Y St Elm Day phone 346-3364 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 4741 E 112"' Ave Anchorage AK 99516 Day phone Jan Pennington/Dynamic Day phone 244-3099 3111 C Street Anchorage AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 19 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 102954, Anchorage AK 99510 Engineer's Printed Name _Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the tat, and separation distances measured to readily identifiable features. 71c operational life of all wells and septic systems depend on the local soil condition, ground water too levels that may fluctuate during the year, and the water usage of the family being served by the system. •• PSE These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory tat results do not guarantee future performance of the system, nor do they guarantee that t1 49TH_ +s�0 there are no hidden defects or encroachments. PES can therefore not provide any warranty for future $ 0 -- performance nor give any estimate of how long the system will continue to meet the operational 0 �.0 above. Any reliance upon or use of this report by any other person or party is not authorized nor will it requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed 0 Steven Ponnooe : confer any legal right whatsoever. Q�`�Ya��l(�. 5. DSD SIGNATURE O��aata:••• �....... Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date:_ (Rev. 1185) Municipality of Anchorage • .. Development Services Department Building Safety Division :. ... On -Sits Water i Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-850 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T12N R3W S9» n u r *t ns Parcel ID: O i S' I 'I, I —6 A. WELL DATA Well type P If A. B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 5MM937 Sanitary seal (YIN) Y Wires properly protected (Y/N) Total depth180 ft. Cased to 180 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 5011987 Static water level 100 ft. Well production 6.0 g.p.m. WATER SAMPLE RESULTS: Coliform - oolontes/100 mL Nitrate —Ji3.L mg/L Arsenic: 1&.& mgll Date of sample: 6-29A B. SEPTICIHOLDING TANK DATA Tank Type/Material Greer Steel Tank sae 1250_ gal. Number of Compartments j AT INSPECTION 612912008 87 ft. 9.9 g.p.m. Other bacteria 'e� colonies/1 00 mL Collected by: Laura Pannone Date installed 1012611986 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) _N High water alarm (Y/N) NIA Date of pumping 612811006 Pumper At Home Ser aces C. ABSORPTION FIELD DATA Date installed TW995 Soil rating (g.p.d.fle or felbdrm) 0.4 System hype Deep Trench Length 104 ft. Width 20 ft Gravel below pipe 7 ft. Total depth 11 ft. Eff. absorption area 14&fe Monitoring tube Y Depression over field )y Date of adequacy test 6/29/1006 Results (Pass/Fail) Pesa For 4 bedrooms Fluid depth in absorption field before test Q in. Water addedia gal. New depthl1 in. Elapsed Time: $Q min. Final fluid depth 9 in. Absorption rate >= 600+ g p -d• Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT Date installed Size Manhole/Access (Y/N) `Pump on" level at _ in. um$in. HiORValW41arm level at in. Datum CycleslestedMasts alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 140 On adjacent lots too+ Absorption field on lot 150 Public sewer main _too+ Sewer /septic service line 25+ On adjacent lots 100+ Public sewer manhole/cleanout 190+ Holding tank too+ Animal containment areas 100+ Manure/animal excrete storage areas 100► SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1S Property line _K Absorption field_ 5+ Water main 190+ Water service line 25+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Ifir Building foundation to' Water main 100► Water Service line _ 25+ Surface water 100+ Driveway, parkingNehide storage 15► Curtain drain None observed Wells on adjacent lots 1_ 0p+ F. COMMENTS G. ENGINEER'S CERTIFICATION ♦O*�- OF "ee•• I Certify that I have determined through field inspections and :��' •� review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. i Engineer's Printed Name Steven R Pannone P EI Steven R. Ponnonel C -- •I�a+, �No. CE 1•��/ a Date ej'bcJ6S.. COSA Fee $ O Waiver Fee $ Date of Payment / Date of Payment Receipt Number ! % Receipt Number (Rev. 11/05) ,Rat wAoe.o TAA.IX vcc ewwo �n.aL It.A..LwY 91 M M 0 0 O //6 //G ,.., .. 499 R/' N CT7 c 7 ori rr I ft 1� Ckl I f� ' � yVELG I • I //690 4-9• w'w 226 SURVEY CERnncAnON.���• Tyr,9 i --- Prepared by A.•"•�� ♦f Profcssionnl Land Surveyors Robert E. Johns, Jr. & Assoc. P.•,,.•••••'• PLOT PLAN I Ir.f1 NeW Ml 1 Mw mMwmr e.'+M M a •a� M IwveN MNn. eN ML l (� :' O` ) 70O BRINK CR. rN w.a a .rmwwa r a m. w) N.N. ANCHORAGE:. ALASKA 99504 AN..Cr. M maw. r mnww.. AUN Lan � � i _ R". Lot S.F. Nec. PIUI fie No. a....N e...a ..Nm I 1' �, :' ScoK: n l FOUNDATION AS–BUILT - ;;roan !y._– 0,e M,_d by L em.l a Ja..A a• .•mr «raM MLI o DcIB SUrrcyM: b m M -MN •.Nr a M 5.... ./... . ...... . .. ... .:.....D %-5-06 ' rL ma wm a.✓rINS.•Jk ••: I W.U. �#. o� ' 4121--- b 7-6-06 _ 2636 6220 FINAL STRUCTURE AS -BUILT 4 �•'•'•., c�a :.gal LeccripFar. l ILm.n a sun., r. nw+r :aM ea I �, •v •............••. luy .Ms.nN w .FYM Y+Y M M mw.. a ww a as •eL a M f• pFO fSi610R'A �•� .� lAT 2 �R$��siR++�•" T12N P3:T SFX: 22 w+N .W.NN G LOT SURVEY SURVEY TYPE SWLOL.S ❑ F"DATWN AS -BURT • RET REBAR w waa.a DRAINAGE 0 ASPHALT Ll FINAL STRUCTURE AS -B ULT n� FOUD AP NRFRQ..y.._p. WOOD FENCE CONCRETE El PLAT U PT PN ... AS-BOLV—T ... LOT WRK ... ICPONIAKNY . _ _�..-• .�. Ix++l A F: MCD ELEV. _X -7f. -N- METAL FENCE W)On FCK IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMCUT3 ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS. 3EPTIO CLEANOUTS. SIDEWALKS, CRIVEWAYS, TO FINISHED GRACE AND UTILITY CONNECTIONS AND TO OEILHMiNE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONI.Y. SNOW THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RCSTRICTiONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATEO. WHICH 00 NOT APPEAR ON THE RFCORDFD SUBDIVISION PLAT. I ALL Dl9TAN CrS ARF. gcOPR, UN! cgs n HrR• PSc NQT` UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION Ok FOR EST.AEL"ITIO BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES nNANCIAL UAS:.'.Y ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAI'_ OVEN SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE. MUNICIPALITY OFANCHORAGE • � DEPARTMENT OF HEALTH &HUMAN SERVICES 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.# O«' c(_ X67 HAA# W�g3ori11 1. GENERAL INFORMATION Complete legal description_ L -2-2(A f T12t-4/ Q_ -,S S Z2 Location (site address or directions) 4(2511 Cz el?,--r4 Property owner�fJr✓�-MsSP k(Q-t-10 ✓so ✓ Day phone 3 NG - 3s y Mailing address RAY( '' !17-12' krlog , AA (c��v CC Lending agency Mailing address. Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Lit i Community well Public water NOTE: If community well system, provide written confirmation from =State AdEaattest-' ing to the legality and status of system.Iv 4. TYPE OF WASTEWATER DISPOSAL: rri�l' (' 1i`�� ;t, ,• ` Individual on-site 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 (Ru. 1/91) Front MOA #21 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 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 Phone���� Address °*/ u20 2s A N CO- A lc Cb �?)s-t a EngineerDate 6. DHHS SIGNATURE Approved for By: -� bedrooms. Disapproved. Conditional approval for Steven R. Pannone CE -8149 bedrooms, with the following stipulations: 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 pu rchasers of homes and their lending institutions in order to 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 engineers work. 72-025(Rw.1/91) Back MOAA21 Municipality of Anchorage ARL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-ZzA TtzM 1L31-,, 'E, zZ Parcel I.D. ©l S- l4 —!6 -�7- A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (YIN) N Date completed t5,0lr� Driller ugle_�� Total depth ! ` Cased to SO t Casing height !8 u Sanitary seal (YIN) Wires properly protected (YIN) i FROM WELL LOG AT INSPECTION Date of test MUNICIPALITY OF ANCHORAGE 88 ENVIRONMENTAL SERVICES DIVISION Static water level Well flow g,p.m, g.p.M(ll_ ' 1935 Pump levels ����'`�`" J RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /40 ; On adjacent lots lyo Absorption field on lot l S0 ; On adjacent lots Public sewer main IV(A Public sewer manhole/cleanout N (A r Sewer service line /C70 Petroleum Petroleum tank A, WATER SAMPLE RESULTS: Coliform — C, — Nitrate ___C:, — Other bacteria Cn — Date of sample: 7,-1 a Collected by: S • CO 5 WA rt— B. SEPTIC/HOLDING TANK DATA Date installed /Cg- -,? -86 Tank size I ZSu Compartments Z Cleanouts (YIN) 7' Foundation cleanout (YIN) 1_1� Depression (YIN) r1+ High water alarm (YIN) Alarm tested (YIN) i✓M Date of pumping Pumper N*0_-cl L,ArJt-, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /t(0t On adjacent lots /20 ` Foundation To property line r, -S` Absorption field s of Water main/service line k Surface water/drainage _WA 72-026(8/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed �l�o Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANe5-FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Manhole/Access(Y/N) off' Level at tested On adjacent lots Surface water Date installed 7- S - 'QS- Soil rating (GPD/Ft) a' Lf System type Length ,i/ oe( Width 2 6 Gravel thickness -icI Total depth Total absorption area M -5'L Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test l,� 0 c- J Results (pass/fail) for � Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: After test n If yes, give date C - Well on lot /,:5-0 r On adjacent lots / 40 Property line To building foundation _ /01 To existing or abandoned system on lot /0 t IN On adjacent lots s od f- Cutbank ^ (A Water main/service line s o C Surface water N« Driveway, parking/vehicle storage area 30 r Curtain drain f2� - E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect orof this inspection. Signature -� Engineer's Name Sz C�J� c 4 i2�1 Sao vc ,1� z Date HAA Fee $ 3cY .00 Waiver Fee $ Date of Payment ��-13- iS Receipt Number (')LC�10 72-026 (3193)' Back Date of Payment Receipt Number �> ,mss•, ; Voven R. Pannw CE -8149 MUNICIPALITY OFANCHORAGE 41110;2` DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section On P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # VAP910JAC i 1. GENERAL INFORMATION Complete legal description T12N R3W Section 22 Lot 22A Location (site address or directions) 4741 E. 112th Avenue Anchorage, Alaska Property owner Mailing address Ken Smith. Jr. unknov,n Day phone (801) 224-0360 Lending agency City Mortgage Day phone 277-0743 Mailing address 121 W. Fireweed Lane, Suite 120, Anchorage, AK 99503 Agent Jack Green Day phone 277-0743 Address Same as above Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water 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 — 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 MOA 921 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 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 Gilfilian Engineering, Inc. Phone 277-2021 Address 255 E. Fir Engineer's signature V'Rober 6. DHHS SIGNATURE Approved for Disapproved. 0 Conditional approval for Additional Comments Lane. Suite 102. Ancho bedrooms. AK 99503 Date 8/21/91 .c OF A4,41 bedrooms, with the following stipulations: 111Th 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 courtesyto 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. 72-025 Rev. 1/91) Back MOA k21 Legal Description A. WELL DATA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lot 22A Section 22 Parcel I.D. Private N/A Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Yes Date completed 5/29/87 Driller Hefty Dri I I i ng Total depth 189 Cased to 180 f t . Casing height 14 inches above ground Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes Date of test Static water level Well flow Pump level FROM WELL LOG 6 Unknown SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot over 100 f t . Absorption field on lot over 100 f t . Public sewer main Unknown Public sewer service line Unknown WATER SAMPLE RESULTS: Coliform 0 Date of sample: 8/14/5 B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Nitrate ■ 0 Other bacteria Collected by: Kent Sheets, Gi If i I ian Engineering —Tank size Compartments — Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots To property line Absorption field Surface water/drainage Foundation_ Water main/service 72-026 (Se, 3/91) Front MOA 21 CONTINUED ON BACK PAGE Z wo AT INSPECTION00 " 8/14/91 > ^� LLJ 91 ft. 4 inches Q LL w O w 5 �� W g.p.m. g.p.rm Z 0- U 180 ft. approximate u Z c�i LLJ w On adjacent lots over 100 f t . On adjacent lots over 100 f t . Public sewer manhole/cleanout Unknown, Petroleum tank None visible within 100 ft. ■ 0 Other bacteria Collected by: Kent Sheets, Gi If i I ian Engineering —Tank size Compartments — Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots To property line Absorption field Surface water/drainage Foundation_ Water main/service 72-026 (Se, 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) — High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed Length Total absorption area Width Depression over field (Y/N) Results (pass/fail) On adjacent lots Peroxide treatment (past 12 months) (Y/N) Cycles tested Soil rating —Gravel thickness Surface water System type - -Total depth Cleanouts present (Y/N) . _ Date of adequacy test for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION On adjacent Cut If yes, give date Property line To existing or abandoned system on lot Water main/service line_ Driveway, parking/vehicle storage area 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineer'sNname Date HAA Fee $ Waiver Fee: $ Date of Payment - l ri = yI / h \ Date of Payment Receipt Number ? (� s�� l I l Receipt Number 72-026 (Rev. 3/91) Beck MOA 21 bedrooms q,% this inspection. �, '., doge.• c::S.�rnma'.' t t1 '�fur..�c;,v" Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1,k1/2ftitth L&T2*_ SZ27T12µ, ParcelI.D. O1 -5/y/6-7 A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal(Y/N) Date'of;test . . Static water level Well flow Pump level Date completed Cased to FROM WILL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot _ Absorption field on lot — Public sewer main Sewer service line WATER SAMPLE RESULTS Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Driller Casing height_ Wires properly protected (Y/N) _ AT INSPECTION g.p.m. On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria 0 vis CC N A N� SAA r rn rn gi co m= a c�C1 rn N0 o N 0.� nN Date installed G Tank size 12sn GAL- Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) /, High water alarm (Y/N) Alarm tested (Y/N) Date of pumping Pumper SE:Atz.S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage —On adjacent lots Foundation — Absorption field Water main/service line 72-026 (Rev. 7/91) Front - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) _ High water alarm level . "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water O• Cl 6; WD/SF Date installed tel- I? Soil rating Z tn'ZM' i/Fi System type m Length _Width X87 Gravel thickness t1 Totaldepthmk-i, 0" Total absorption area / S'q sCQ F r- Cleanouts present (Y/N) Y Depression over field (Y/N) I-4 Date of adequacy test N&W F; aL-b�NSTAllr�1 Results (pass/fail) N�A Peroxide treatment (past 12 months) (Y/N) •^'IA for If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1413 t On adjacent lots /0-7-e 0 -Se Property line To building foundation On adjacent lots Surface water Curtain drain IV O Cut NI A A/ /A E. ENGINEER'S CERTIFICATION o existing or abandoned system on lot N/A Water main/service line /t'/A Driveway, parking/vehicle storage area BF bedrooms 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature �--�-- Engineer's Name S_1-6z'VLN t�•nj AA/NGN La - Date g — I --?-- g I HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 49eh 9 9 Steven R. Pannone 8 Q CE - 8149 d �RnF Sr,vf1P����. August 20, 1991 Mr. Jan Nielson 4741 E. 112th Avenue Anchorage, AK 99516 Gilfilian Engineering, Inc. Professional Environmental Consultants Main Office: 255 E. Fireweed Lane, Suite 102, Anchorage, Alaska 99503 (907) 277-2021 • Fax (907) 274-8683 Mat -Su Office: 5751 Mayflower Court, Wasilla, Alaska 99654-7880 (907) 376-3005 • Fax (907) 373-5686 RE: Lot 22A Section 22, 4741 E. Engineer's Report GEI Project No. 191114 (Doc Dear Mr. Nielson: 112th Avenue, Anchorage, AK No. 191 114.1 KS #1) This letter is to provide you with a report on the results of a sewage system adequacy test and well flow test that were recently completed on the above referenced property. In response to a request made by Mrs. Trish Nielson on August 9, 1991, a field representative from Gilfilian Engineering, Inc. visited your property on August 14, 1991, and made this observation. During the site visit, we conducted an adequacy test on the septic system and a 4 -hour test on the water well pumping system. We also collected a representative sample from the water supply system and analyzed the sample for total coliform bacteria and nitrate. Upon completion of the work, we prepared the appropriate Municipality of Anchorage Health Authority Approval forms which are enclosed with this letter. The following sections describe our site visit field findings. SEPTIC TANK AND SOIL ABSORPTION SYSTEM Starting the initial water flow into the septic tank and soil absorption system, it was noted that there was already several inches of water standing in the absorption system monitor tube above the ground surface. This indicated that there was a problem with the system's ability to absorb wastewater flow. After introducing 600 gallons of water (based on 150 gallons per bedroom) into the septic tank. The water started percolating above the ground over the soil absorption field. The above observations confirm the soil absorption system is in a state of failure and should be replaced. Also, there was some backup of water into the septic tank above the outlet pipe from the tank to the absorption field which indicates there is some sort of blockage occurring. This line should be repaired when the work on the soil absorption field is undertaken. Mr. Jan Nielson Engineer's Report, Lot 22A Section 22 Page 2, August 20, 1991 WATER SUPPLY WELL SYSTEM Our inspection revealed that the well consists of a 6 -inch diameter steel casing which is covered with a suitable well seal. The casing extends 14 inches above the ground surface, and the drainage appears to be adequate within a 10 -foot radius around the well. According to the attached well log, the well has a total depth of approximately - 195 feet. The static water level was measured at 91 feet below the top of the casing at the time of the well flow test. To determine the yield of the well, a pump test was conducted utilizing the existing well pump (size and type are unknown). During the test, we measured the pump discharge rate and monitored the drawdown of the water level in the well. The recovery of the water level in the well was also monitored after the pump test was completed. The results of the pump test indicate the well, as equipped with the existing well pump, is capable of producing 5 gallons per minute for a minimum of 4 hours. The water samples collected from the well pumping system were tested for total coliform bacteria and nitrate by our affiliate firm, Mat -Su Test Lab, Inc. The attached test results indicate that the water quality is acceptable and satisfies the Municipality of Anchorage minimum requirements. If you have any questions or need advise concerning your sewage disposal system, please do not hesitate to contact me at 376-3005. Sincerely, GILFILIAN ENGINEERING, INC. Kent Sheets Environmental Technician Attachments KS/pko/191114.2 KS #1 AS,BUILT CERTIFICATE: I hereby certify that I have surveyed the following described property: H~ ~ ~ ~vr.~or ZZ T,%~/Za~ ~.~,' ' ' ' and that no encroachments exist except as indicated. EXCLUSION NOTE: It is the responsibility of the owner to determine the existence of any easements, covenants, or'restrictions which do not appear on the recorded Subdivision plat. Under no cireumstances, should any data hereon be used for construction or for establishing boundary or fence lines. AGUA FRIA SURVEYORS 9024 VANGUARD DRIVE Anchorage, Alaska 99507 549- 4688