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HomeMy WebLinkAboutKNIK HEIGHTS BLK K LT 3Knl*k Heights Block K Lot 3 #018-232-20 Apr 28 21 91:34p Ancho age \yell & Pur ip Ser 9072430742 p.1 Wel! DrUling Permit l�u=nber: Parcel [dentMicalion Number: 0 I -232- �O i,egat Description w. Block %ot 13 Pump Installation Date:: Z- Date, of Issue: - - Property Owner dame & Address: Pump Intake Depth Below Top of Well Casil►a: 311D feet r � Pump 'Manufacturer's :`lame: 111ttup Model: Pump Size: --r-- Pitless Adapter Burial Depth; Q� _feet Pitless Adapter ManufacturerN Name: Pidess Adapter installer Well Disinfected Upon Cotgplel:ion'; - Yes _ No .Method of Disinfection:! ?f� Comments, Pa mp Installer dame: _ ANCHORAGE WELL & PUMp SERVICE 7640 King, Street company, ---- Anchorage, AK 995,, PH: (907) 243.01-40 Mailing Address: �— City; State —.--Zip: Attention: Thepurnp a pump inslahaLen to t� On -size v.githir_ 30 clays ofDUnIp ins:allrtiOtt. Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT it Number: OSPI41344 PID Number: 018-232-20 fl New M Ilnnrarfe & Mary Richard 13330 Bainbridge Road of Bedrooms 4 I Knik Heiqhts K 4 SEPARATION DISTANCES - To From Septic Tank Absorption Field Lift Sfation Holding Tank Sewer Line Well 106.6 101.9 N/A N/A 70 Surface Water 100+ 100+ N/A N/A Lot Line 33.4 38.3 N/A NIA NA Foundation 36.0 26.4 31.9 NIA Curtain Drain N/A N/A N/A N/A Remarks 3SORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound ❑ Other I Rating Total depth from original grade 1 . 2 GPDlS F 8.0 Ft. pth to pipe invert from original grade Gravel depth beneath pipe 4.0 Ft. 4.OFt. added above original grade Gravel length 0 Ft. 50.0 Ft. rvel width Beds: Number of Lines Distance between lines 5.OFt. N/A N/A Ft. al absorption area Number of trenches Dist. between trenches 500Ft2 1 N/A Ft kNK I] Septic ❑ S.T.E.P. ❑ Holding ❑ Other Tank E Steel I 2 I LIFT STATION on level at (Pump off level at IHigh water alarm at make and model Inspections performed by I PIPE MATERIAL House to tank Tanto Installer 3034 drainfiedeld 3034 A+ Home Services Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection t g/19/2013 �a Location and description dates: 2 8/20/2014 3m 0 Top of Deck COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp itional Approval: Approved nspection Date .!!.%7.H even'nnorae' i w j WELL (E) v DRAIN FIELD (E) IN FAILURE, RE -USE AS RESERVE / /`t _ / SUMP (E) !� WELL (E) ^ \ Wim._ W W ALJ SEPTIC AREA (E) LW�10' UTILITY EASEMENT W T1 NEW 1250g SEPTIC TANK T2 ABANDONED EXISTING TANK BY REMOVAL TCO INSTALLED DCO AND DV JVI . W TH-1 NOTES: RECORD DRAWING PLAN � A 1016 DRIVEWAY -6 z 1 \ B 4BR pp 1 C HOUSE } IIII D (E) 101.9 LOTS .\ M2 Y L NEW UPGRADE DRAIN FIELD • 2 5OLF x 5'W x 4.0'ED x 8.0'TD SEPTIC AREA (EE) i I I WELL (E) X o m A B C D T1 36.7 41.0 m z T2 44.8 47.6 DCO 4677 49.1 DV 47.0 48.5 C 1 40.9 38.0 M 1 43.2 39.7 C2 47.6 38.3 M2 48.7 40.1 SUMP (E) 54.7 53.7 i w j WELL (E) v DRAIN FIELD (E) IN FAILURE, RE -USE AS RESERVE / /`t _ / SUMP (E) !� WELL (E) ^ \ Wim._ W W ALJ SEPTIC AREA (E) LW�10' UTILITY EASEMENT W T1 NEW 1250g SEPTIC TANK T2 ABANDONED EXISTING TANK BY REMOVAL TCO INSTALLED DCO AND DV JVI . W TH-1 NOTES: RECORD DRAWING PLAN � A 1016 DRIVEWAY -6 z 1 \ B 4BR pp 1 C HOUSE } IIII D (E) 101.9 LOTS .\ M2 Y L NEW UPGRADE DRAIN FIELD • 2 5OLF x 5'W x 4.0'ED x 8.0'TD SEPTIC AREA (EE) i I I WELL (E) X o m I / w c� O o' ' .SEPTIC m z - -.. 4 /_ WELL (E) � I PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907)272-8211 KNIK HEIGHTS, BLOCK K, LOT 3 CRAIG & MARY RICHARD 13330 BAINBRIDGE ROAD ANCHORAGE, AK 99516 *: 49 T1H Steven R* Pannone' CE 8149 4 r'=50' -.I.D. NO 018-232-20 DERMIT NO. 2 OF SPECIAL PROVISIONS TO SPECIFICATIONS 1 . ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: REPLACED EXISTING 1250g SEPTIC TANK WITH NEW 1250g SEPTIC TANK. INSTALLED UPGRADE DRAIN FIELD. 3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 15.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 1 4.0 FEET BELOW EXISTING GRADE. TH-1979 TH-1 4" 0 PERF PIPE FILTER FABRIC DRAIN ROCK 6' ABOVE PIPE INVERT SM OR/OL - -_ -ib 40 1+3 =•a' CW GW � � 84.9 DRAIN ROCK -12.5 -12.0 4/30/1979 SECTION -15.0 w > w m m Q 4" 0 PERF PIPE QO 0 o wOw o �O O z z z z z FILTER FABRIC z zQ a W ma w w z zw �z w w O? O DRAIN ROCK U V U OU O U r `� / ABOVE PIPE INVERT U _ _ NEW 1250 g SEPTIC TANK DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = 1.0 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: WIDE TRENCH 4.0'ED MIN LENGTH: 50 LF USED: 50 LF X 5' WIDE, 4.0 E.D., 8.0' TD TOTAL AREA: 500 SF PROFILE LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC NOTES: PANNONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KNIK HEIGHTS, BLOCK K, LOT 3 CRAIG & MARY RICHARD 13330 BAINBRIDGE ROAD DESIGN DETAILS ANCHORAGE, AK 99516 ROCK ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT N0. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV OIVERTER VALVE FS FLOW SPLITTER BEG BELOW FINISH GRADE OG ORIGINAL GRADE FG - FINISH GRADE TS&V TOPSOIL & VEGETATE n R. Pannone• CE 8149 .-.tea; Dote 8/26/2014 Scale NTS P.I.D. NO 418=232-20 'ERMIT N0. OSP141344 Sheet 3 OF On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141344 Tax Code Number: 01823220000 Work Type: Septic Upgrade Permit Effective Dates: August 20, 2014 to August 20, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: KNIKHEIGHTS Site Legal Address: KNIK HEIGHTS BLK K LT 3 G:2936 g_z-0- /y 8�2 Ul' K yf, Owner/Address: RICHARD CRAIG L & MARY JOHANNAH RICHARD 13330 BAINBRIDGE ROAD ANCHORAGE AK 995163049 Site Mailing Address: 13330 BAINBRIDGE RD, Anchorage Lot Size in Sq Ft: 2 Total Bedrooms: This permit is for the construction of: �;e Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By os� e6sli MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-232-20 Property owner(s) Craig & Mary Richard Day phone Mailing address 13330 Bainbridge Road, Anchorage, AK 99516 Site address 13330 Bainbridge Road Legal description (Sub'd., Block & Lot) Knik Heights, Block K, Lot 3 Legal description (Township, Range & Section) Lot Size 25,600 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Absorption Field ❑X Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X (w/wo ADU) Upgrade ❑X Duplex (D) ❑ Renewal F-1 Multiple Dwellings ❑ (SF and/or D) 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. owner or autnorizec agent) Permit/Rush Fees�'S69ed3919 : i10 4D Date of Payment: 8119 by Receipt Number: Mgol & Permit No. OSP/ y 13 yy Permit App__ Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@r)anengak.com August 18, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Knik Heights, Block K, Lot 3 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install an upgrade septic system be issued for this property. The proposed systems will serve a existing four (4) bedroom house. Currently the existing field is in failure . The existing 1250gseptic tank will be verified and will be replaced if found to be leaking. A new field will be installed and the existing field will be re -used as a reserve. This lot is served by a private well. The surrounding lots are also served by private wells. There are no wells within 100' of this system. Soils. Pannone Engineering performed one test hole on this lot in August of 2014, and groundwater was monitored for at least seven days. The test hole monitor tube was dry after the seven day monitoring period. It is my opinion, based on the results of the soils tests and overall soils appearance; an application rate of 1.2 gallon/day/square feet should be used for a conventional wastewater system. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The proposed drain field is located on the central portion of the lot. The surrounding topography generally slopes from east to west at approximately 5%. There are no steep slopes within 50 feet of the proposed drain field. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 WELL (E) 4A SEPTIC AREA (E) —M �M 10' UTILITY EASEMENT W - W w 1250g SEPTIC TANK (E) VERIFY INTEGRITY AND REPLACE IF FOUND TO BE LEAKING WELL (E) 3X�_`(,�,. INSTALL DCO AND DV DRIVEWAY w z P=4BR .-- _--- wHOUSE JW'P IN I (E) DRAIN FIELD (E) IN FAILURE, RE -USE AS RESERVE 104Lj4 .7WELL (E) J TH 1 LOT S / UPGRADE DRAIN FIELD (P) I a0 • \ 5OLF x 5'W x 4.0'ED x -F-9 TD ( -- / SEPTIC A ' m z �'`�� ' SEPTIC AREA (• a - E\ \ - I o •� u � WELL (E) I3 NOTES: PA—MOoNE7 ENHORASVC, ���� \\ OF A�gSI') Date 8/19/2014 FOR CONSTRUCTION 9LL0 (E �y��+ Scale PHONE (907) 272-8218 FAX (907) 272-8211 /ioj�P 49 / � ......... .... ..... 50 KNIK HEIGHTS, BLOCK K, LOT 3 P.I.D. NO 018-232-20 CRAIG & MARY RICHARD 13330 BAINBRIDGE ROAD Steven R� Pan one' . CE 8149 f c _ S ����1�\ PERMIT N0. OSP141344 PLAN ANCHORAGE, AK 99516 oFES SneeoF � 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON–SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: VERIFY INTEGRITY OF EXISTING 1250g SEPTIC TANK AND REPLACE IF FOUND TO BE LEAKING. INSTALL UPGRADE DRAIN FIELD. 3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 15.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. TH-1979 TH-1 0 PERF PIPE FILTER FABRIC DRAIN ROCK 6" ABOVE PIPE INVERT sm OR/OL -1S - -15 4.0 4,0 cw cw DRAIN ROCK -125 -12.0 4/30/1979 SECTION -15-D VERIFY 1250 g SEPTIC TANK ROCK PROFILE w > w w CU COPPER DESIGN PARAMETERS DIP DUCTILE IRON PIPE UPGRADE SEPTIC SYSTEM m -4'e PERF PIPE m Qo 0 o a o PERC RATE = 1.0 MPI o w z zQ z z Jo z moW ¢ z R. 1. RIGID INSULATION FILTER FABRIC z Dw a w w o� > w z o DRAIN ROCK 6 z J o �:i v v 00 0ABOVE OG ORIGINAL GRADE PIPE INVERT u VERIFY 1250 g SEPTIC TANK ROCK PROFILE ABBREVIATIONS CU COPPER DESIGN PARAMETERS DIP DUCTILE IRON PIPE UPGRADE SEPTIC SYSTEM LEGEND TH TEST HOLE NO. BEDROOM: 4 (600 gpd) WATER LINE/ FC FOUNDATION CLEAN OUT TANK SIZE: 12JOg W_ WELL RADIUS T# TANK CLEAN OUT NO. PERC RATE = 1.0 MPI C# CLEAN OUT N0. SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF — SS NEW SEPTIC M MONITOR TUBE NO. # - SYS. TYPE: WIDE TRENCH 4.0'ED R. 1. RIGID INSULATION MIN LENGTH: 50 LF DCO DOUBLE CLEAN OUT DV DIVERTER VALVE USE: FS FLOW SPLITTER 50 LF X 5' WIDE, 4.0 E.D., 8.0' TO - BEG BELOW FINISH GRADE TOTAL AREA: 500 SF OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE NOTES: PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �`oF a ��\ ��,... C•4st`� �...... .. ..:.. / Date 8/19/2014 FOR CONSTRUCTION Scale NTS P.I.D. NO KNIK HEIGHTS, BLOCK K, LOT 3 / 018-232-20 CRAIG & MARY RICHARD Steven R. Pannone PERMIT NO. 13330 BAINBRIDGE ROAD 11k 01 CE 8149 \'r/ +'��F�F19 OSP141344 DESIGN DETAILS ANCHORAGE, AK 99516 Sheet O' SsoNP 2 OF 3 TEST HOLE 1 1 OR/ ORGANICS OL ORGANIC SILTS 2 3 4 5 6 7 GW WELL GRADED 8 GRAVEL 9 10 11 12 13 14 15 BOH 16 17 18 DATE PERFORMED: 8/11/14 SOILS LOG - PERCOLATION TEST SLOPE x TH SITE PLAN I - 1 O' UTILITY EASLMENT W U I U C� O O O i I s WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? DRY DEPTH TO WATER AFTER MONITORING? DRY' DATE: 8/18/2014 46R HOUSE (L) \ -3 LOT SLOPE TH X DRIVEWAY, WE READING DATE CLOCK NETTIME WATERTIME LEVEL READING NET DROP 1 8/11114 11:40 --- 4.01 -- 2 11:45 5 MIN 10.01 6.00 3 11:45 -- 4.01 --- 4 11:45:50 5.8 MIN 10.01 6.00 5 11:46 --- 4.01 -- 6 11:46:10 6.2 MIN 10.01 6.00 PEROLATION RATE 1.02 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. Pere hole was Dresoaked. Perc test ran for at least 1 hour. Water absorbed too fast to take reading. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ENG SVC, LLC of A���ll Date 014 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 J �� '""' qS �� PHONE (907) 272-8218 FAX (907) 272-8211 %g�P Scale SOILS LOG KNIK HEIGHTS, BLOCK K, LOT 3 CRAIG & MARY RICHARD 13330 BAINBRIDGE ROAD ANCHORAGE, AK 99516 NTS ....... .. ...... P.I.D. NO r/ 018-232-20 Steven K. annane PERMIT NO. ' CE 8149 •,��� OSP141344 PROFESSIOO- Sheet 30F3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ea q. ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT (`TAME - PHONE I_.°'I'iUEW w �U/r' }'�L� UPGRADE --------------------- MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS , � Well Absorption area R DISTANCE TO: lot)_ /—r Dwelling �dj//fJ, _ PERMIT NO. .4,1vo,q/� C7 O (v U Y x7 Material , No. of compartments N Z Manufacturer "> N Liq. rapacity in gallons /9�U I IF HOMEMADEDISTANCE Width Liquid depth juZ TO: pinsideength g PERMIT NO. z Q T Manufacturer Material Liquid capacity in gallons ® g DISTANCE TO: Well I (('(JJ)%v Foundation �/� Nearest lot line / �Gl PERMIT NO. 1(}(+,K, 1 Z ti � w No. of lines Length of each line , y3 Total length of lines r / .3 Trench width -..�(,� inches Distance between lines b-Top _—� __— __ _—_ .__ of the to finish grade f Material beneath tile Total effective absorption area p y ,�{ / 4 inches Length Width a Depth PERMIT NO. w (7 QN Type of crib Crib diameter Crib depth Total effective absorption area uj Lu - DISTANCE TO: Well Building foundation Nearest lot line r Class Depth Driller Distance to lot line PERMIT NO. w ��V>t DISTANCE TO: - Building foundation --- Sewer line — Septic tank Absorption areas) OTHER PIPE MATERIALS y— �p L..aL_ liOW — t SOIL TEST RATING INSTALLER REMARKS _ APPROVED DATE LEGAL^T T1T,F­,T-. Or SOI L. FIE15ORPT I ON 1:--; : TRENCH NUMEW11P. OF EN"U'ROOMS 4 SOIL, RFITINCC +.; '-,:L! THE REECIU I RET"., I ;.EF OF TFIL SO I.A.. ION SYSTEM I I.-:; : W W 1-1 ­, 1__ Q 1141 K -WA If, I. -VT m4. :E• : CA *vo FE k"... U,":4 11"41 " � —1 t --j, "I"HE LENCITH G-MENSIM 15 ITIF LT."KI'10TH UN FUEET.,) OF TT:FiNCH OR TIME DEFTITI oF." ri m%:rial OP'., PIT 1.,,'3 THE r,,F_TWFF_N "HU"] .-AJRF1`-1C1_-: OF THEI:', GROUND Mr.) TFIF: NCITTOM OF THE' EX.GAVA"FION (IN THERE IS NO '5'ET WL)TH FCIR 1TW:NCHES, THF-.* GRAVEL, DEPTH 1.=• THE MINIMUM DEF:`Yll OF GIF'.1nW,1. OUTF411-1- V`1ff`: FINE;- THE.",,: B(ITTEAq OF THEE E:,;:C,FI VF1TION CIN FEE"T), � � - 1 � � A, �2 Cifi M KRE Gh R -A 1: :E'^ J: 1c, I F1 1`4 Y (:Lo It._ I PSI ITERVI17, M51001COMN'T HAS THE ITESPONS1 Ell L. I"ri, TO mr:,mm TFW.r.: C.A-IRING 1,1S TO 1111 I. -K IrA 1., Pa,. 'Y" 1._.. 1: .. 1 NUVIteF_6! OF RESIDENCES THAT 0 1"1 U-- r!l PA C: q—.,p P fl CIFFIAR I'MEN4, HU11.31-1 1 -NLN E.NIVIRONMI NTAL, 0 TE', CTI Cl N OF ONY HIT FIC) UT FINAL. INSF1,".1"TION AND 11r-,pf"!0VAL, U"Y TI -11"". F!K. 995if-11 TCI 1"ROSTECUTION. RAJ W U U!" 9-,H: *L-, 0 1 C F,; 0 pU., NO. I L -Y FIPF�I_ I CANT B-IFTHARD 'SRA L-OC-1AT 1 ON F.".11BIGE"IdOor.) In , \j I.U,C.ML L.T. -t-i" Ell J(. K VIM& IrM SAD L,OT 1511% 135160 S I WRIT MET T1T,F­,T-. Or SOI L. FIE15ORPT I ON 1:--; : TRENCH NUMEW11P. OF EN"U'ROOMS 4 SOIL, RFITINCC +.; '-,:L! THE REECIU I RET"., I ;.EF OF TFIL SO I.A.. ION SYSTEM I I.-:; : W W 1-1 ­, 1__ Q 1141 K -WA If, I. -VT m4. :E• : CA *vo FE k"... U,":4 11"41 " � —1 t --j, "I"HE LENCITH G-MENSIM 15 ITIF LT."KI'10TH UN FUEET.,) OF TT:FiNCH OR TIME DEFTITI oF." ri m%:rial OP'., PIT 1.,,'3 THE r,,F_TWFF_N "HU"] .-AJRF1`-1C1_-: OF THEI:', GROUND Mr.) TFIF: NCITTOM OF THE' EX.GAVA"FION (IN THERE IS NO '5'ET WL)TH FCIR 1TW:NCHES, THF-.* GRAVEL, DEPTH 1.=• THE MINIMUM DEF:`Yll OF GIF'.1nW,1. OUTF411-1- V`1ff`: FINE;- THE.",,: B(ITTEAq OF THEE E:,;:C,FI VF1TION CIN FEE"T), � � - 1 � � A, �2 Cifi M KRE Gh R -A 1: :E'^ J: 1c, I F1 1`4 Y (:Lo It._ I PSI ITERVI17, M51001COMN'T HAS THE ITESPONS1 Ell L. I"ri, TO mr:,mm TFW.r.: C.A-IRING Of" ANY 140.1.5 00JACTAT TO THIS I"R0F`,'EFjTY AND TF*-. NUVIteF_6! OF RESIDENCES THAT THE, WEI ... L. MIIA.. ',-.3(EVV. I" 1A Co < ,> J: Ir, -j ".Ez,- p:. 4 UE, C! 1" ,1,: CA P "F» 9:--a F:." Gm K. -H 1: R .......... OF ONY HIT FIC) UT FINAL. INSF1,".1"TION AND 11r-,pf"!0VAL, U"Y TI -11"". DEPARTMEE"NT tIIL.,L BF:; TCI 1"ROSTECUTION. MINIMUM DII.,31TINCE A WFIA., ANI) ANY DI' .4"O'S'AL, Sy".331,11 f5." 101D FET'".1' C"OR f1i VRIVIA-TE WEIA., C)R TC1 ;2,00 ITEEM FROM A MBLAIC, W[EIA. UPON THE TYF`F' OF PUBLAC! MINIMUM 01 FROM F1 PRIVATE TO (I F-VIYFITE SUMU.'R I INF.': J*: 2El' FEET Atll) TO A SEWER L.T.Nr IS 'eT5 FEEFT, WEL.L. LOW."' ARE FIND MU,5­1' RETURNEE.) TO TFIU DUl"ARTMENT WIT14161 A) OF' THE WELL, C,!OM I-'[- V:T 10N. OTHER FIF"PI-Y. SF`E13IFXr.4TTI('.4N,' MC -3 CONS.,TRUCTION ARE TO INS'LIRF PROPE:R. INST AL,LATION. 1=4 EEL 110M X -T" FEE X Q I lot M Q 10" R m.F_, J1 F�n PH'. F;� fo_,.� A.. 9 4, ��4 ::: I - I CEWTIFY THAI "; FOR TF: S -.11F -,J 'i -5,E]" 1: 1 AM F"FIVIVIM WITH THE, Rfi:QUIR(-T1FNT.'-_ OW -S, I & 7:RS, AND HF,' A_S, 115' VCIRTH BY THE OF ANCHO1,__,FIGF:. 2: 1 WILE. IN51491,1, THE IN ACCORDANC.1H, WITH THE', A--+,:STANI3 THAT THP OW -SITE EWHER MAY If.:' THE I UND RESIDENCE U-', TO INMUC:4z: MORE THAN 4 AFAVICANT BE&F-Ir-IRE;, V4, C) 1551JED 9%1_4,z Decem,er 3= 1.979 '3ethard Construction Star Route A 13o,l 1989-K hnchoracie, %1 1s;ka 9 Y _5 07 Per -lit = 790163 S'ubiecti31OCK 1': !.nik IIeigilts sul-Kili-V is 1011 A permit issued bythis dei ,DartI71ent for l-ol�.. anO/or sewer sys: el;l has expired. Pe'7"I.1J_-S are issued on a calendar year basis, as stat -c-1 on the permit, by authority of `Municipal ordinance. If you have drilled `he 7.11ell , a ✓e].1. log should be sent: to this depa.rtP,lenC to document the Instal_la-tion date. If an engineer gids inspected ';.hE� �.IistdllC ta.On Of the On-site sewer system, -.Dledse have t'i:e.il send us the as -buil'.', for our riles. If there are any farther questions, please contract this office at 264-•4720. Sincerely, f Iles 'J. Buchholz, R.S. r__�,l!;--- Senior Env:i..L'Onmenta 1. Scec:-+'''1St LNB/ljw eric : copy 0` Permit ��, 141 1 00 1 11", TA V.. 1.`5`" In fit 4-7 171141 k U(A Q NQ IS I 7m DEPHRTMEHT OF HEHLTH HND ENYIRONMENTHL PROTECT{ON 825 /L' STREET/ RNCHORHGE/ HK99501 264~4720 .I PERMIT NO ( 790167 ) HPPLICHNT BETHRRD COH 1998 K ]44~8006 LOCHTION RIDGEWOOD ST LEGHL L I B K 6'^1J J�� r\�jLOT SIZE 4�568 SQUHRE FEET TYPE OF SUIL 1418SOR8[I01' .1 SYSTEM IS: T��NCH MHXIMUM NUMBER OF BEDROOMS - 4 SUIL RHTlNG (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTIOld SYSTEM IS� �lF.-:7 lF��� :;:_ �l ����TV, ��� 11 -0 via vs "v" 47 1 . . 1 �0 �0 7 "lU0�� ml� THE LENGTH DlNEW IC&A IS THE LENGllf (lN FEET) OF THE TRENC|i OR DRH/NFIELD, THE DEPTH OF H TRENCH OR PIT IS THE DISTONCE BETNEEN THE SURFHCE OF THE GROUND HNF) THE BOT?OM OF THE EXC0VHTION (IN FEET) THERE IS NO SET 101) 111 FOR TRENCHE�. THE GRHVEL DEPTH IS THE MINIMUM |)EPTH OF GRHVEL BFTNEEN THE OUTFALL PlPE HND THE BOTTOM OF THE EXCRVRTION (IN FEET) win to: �H. .0 X pit RE: Vy Q Y E � R WN^0 - :1 17 . Y 1 1141 p< ST X 72 PRE= :1. &a 774 AS ���K_�wk 4 S � PERMlT HPPLI(MME HHS THE RESPONSIBIiIT9 TU INFORM THIS DEPHRTMENT III Rlfib THE INSTHLLHT[ON IHYMN IONS OF HNY WELLS HDJHCENT TU THIS PROPERTY HNo THE NUMBER OF RESI1 :,FNC[ES THHT THE WELL WlLL SERVE I- Up Kit Wv & J ���Q El I. � -1, : 1: 13 414 Y� Tom Q 47 XQ KA� H14 1 1: Q`Vt V �� j T. BHCKFILLING OF HNY SYSTEM WITHUUT FINHL INSPECTION RND HPPR0VHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. ����X - I - 1571-c�1 WKST �1 7K0 K 1-0 KEY TH I?, ZA It.. J. _,�: ,� I CERTIFY THHT 1� I HM FHMILIHk WIEM THE REQUlREMENTS FOR OuSITE SEWERS HND WELLS HS SE[ FORTH BY THE MUNICIMR. ITY OF HNCHORHGE. 2� I WILL INSTRLL THE SYSTEM IN HCC0RDHNCE WlTH THE CODESi ]� I UNDERSTHND THHT THE U E� "07101 MHY REQUIRE ENLARGEMENT IF THE RESIDEN HHN 4 BEDROOMS ISSUE0 Ey�./����L, - �~DRTE`/../. SOILS LOG J MUNICIPALITY OF ANCHORAGE 1-1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch G650, Anchorage, Alaska 99602 276.2221 SOILS LOG - PERCOLATION TEST PE=RFORMED FOR: Ij� �5� DATE PERFORMED:_ � u LEGAL DESCRIPTION:�r- DEPTH (FEET) 5MA S M W 6 7 8 9 10- 11 F -- 12. - 13 14- 1516 15-- 16 17 18- 19- 20- COMMENTS 81920 COMMENTS PERFORMED BY: 72-008 (7/76) WAS GROUND WATER C/1Q /� S _ ENCOUNTERED? /�_ L 0 P IF YES, AT WHAT I'/�— DEPTH? I Reacting Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED B FT AND (minutes/inch) — FT DATE: �U 2() 71AT3R WELL LOG MUNICIPALITY L;- ANCHORAGE OSS DRILLING ASSOCIATED DEPT. c, ,-it 909 CHUGACH DR. #37 FNVJ'.or;,,L; IAL -., 11_cnoN ANCHORAGE, ALASKA 99503 JUL. 9 1979 WELL OWNER Greg ush USE OF WELL Domesti1c` WELL LOCATION -Lot Blk. K Knik Hts. Subdiv. � R Q SIZE OF CASING 6" DEPTH OF HOLE 400 FT, CASED TO 183 FT. STATIC WATER LEVEL 208 FT. G. P. M. 2 'r"rITH 190 FT. OF DRAWDOWN. REMARKS DATE COMPLETED 6/7/79 PUMP TO BE SET AT 399' 0 to 20 Till; grey color and very hard 20 tom Alluvium; grey color, medium hardness 30 tom Till ;L�r_ey color and hard 0­�—to-.D Alluvium; grey color, medium hardness 'e� to_�L Alluvium; blue --grey color, medium hardness 8-to0L Till; grey color and hard to 120 Alluvium; grey color, medium hardness 120 tom 1 `oto 180 180 to 200 200 to 278 Z8to 8 28Lto 350 -� 0 to 1-00 to to to to to Till; light brown color and hard Alluvium; light brown color of medium hardness Bedrock; grey Color and hard Bedrock; white and hard Bedrock; dark blue -grey color and very hard (trace of water) Bedrock; grey color and hard Bedrock; light blue color of medium hardness with gradual accumulation of water to 2 G.P.M. Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 Certificate of On—Site Systems Approval Parcel I.D. 1396-063-17 - Expiration Date: 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent KNIK HEIGHTS' BLOCK K LOT 3 13330 Bainbridge Road'Anchorage 99611 Lucky Wilson Day phone 210-355-0414 Tiffany Johnson Day phone 907-376-0270 2. TYPE OF DWELLING: ® Single Family (w/w0 ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage Community Class Well Public Water System ❑ ❑ ❑ Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ WeNeWadmw reuesttr.. N/A 4 Distenm - Received b: Date: COSA m be released Wtheen q lessothe ed by theenglneer. COSA Fee $ _V 6J (1) Waiver Fee $ Date of Payment 11 %S' /4 Date of Payment Receipt Number to z 76 Receipt Number COSA# 05C 114,,4ss 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducbrgthis evaluation, GEGpmvkedan antim wbgevaluation ofths nil anNorsep& system ineanrdanw with Ne guidelines endregWatiwu esfa shed by Ne MunidpabtyofArdwneandlydusbypactcss. Thersportedresutisdesorbs the condNdn of Me systen✓s an the datds of be evaluation. Separation dustencres were measured to maddylde oliable features Hidden defects orenwoachments may erid Net ware not Identified during the evaluation.The operadonallds ofag wets andsapuc systems depantl on a variey of vadablesindudirg, but not funded to, sngarMA'ons, gwromferlevels (that may fiudude during the year), qualilyo/mnsbudion (materials and workmanship), malls water usage of Ma famiy Olaing Pre systanvs. These conabcas ran very, and are ovlske the coned of GEG. Sabsfatin test results do not guarantee future performance of the sysfarNs,'therefwe, GEG makesno wwrenty(egress vimplao ragwdirg Ne futumpedwmema ofthe well vwptk system. GEG makes no representation wheN ran attemssm wall orsepficsystem can be Installed on Ne property in Me event eiiheroffhe wrtantSystem hal. The content of this report isfor the sole benefit of NepetsuNpady Kho retained GEG. Reliance upon Ne Information provided In this report by my wherpersoo npary, tiro'udirg but not limited to subsequant pmperypumhasers, isnot euNw¢ed. InsW, GEG disarows any legal duy to anyone other Man the persaYparty wbo paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms. Phone 337-6179 Date 1111D /b System #2 Approved for bedrooms. �llllilU (i(!(/f/ Disapproved.`NUTY pF�i,` Conditional approval for bedrooms, with the following stip` \K ON CyO i CD ' grF��r i m A A Original Certificate The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paregreph 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (fiev. 10112/12) _ , Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist olk--A4 ' 10 Legal Description: KNIK HEIGHTS; BLOCK K, LOT 3 Parcel ID: 0915--943-1.7 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 6/7/79 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 400 ft. Cased to 183 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/7/79 10/27/16 Static water level 208 ft. 191.1 ft. Well production 2 -9 P.M. 1.2+ 9 -p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 4.94 mg./L. Collected by: GEG Ltd Arsenic: NO ug./L. Date of sample: 10/26/16 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/20/14 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/ N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/26/16 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE Date installed 8/20/14 Soil rating CzD5or ft'/bdrm) 1_2 System type SHALLOW TRENCH Length 50 ft. Width 5 ft. Gravel below pipe $ Li ft. Total depth *9.9+ ft. Eff-absorption area 500 ft' Monitoring tube YES Depression over field NO 41 3 Date of adequacy test 10/27/16 Results (Pass/Fail) PASS For bedrooms Fluid depth in absorption field before test 0 in. Water added 555 gal. New depth 0 in. Elapsed Time: o min. Final fluid depth 0 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date SUMP FOR 1981 TRENCH IS NON-FUNCTIONAL. CONDITION OF 1981 TRENCH IS UNKNOWN, INFORMATION FOR 1981 TRENCH IS IN MOA RECORDS. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/NJ "Pump on" level at in. "Pump off' level High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 75'+ 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 5' (ASSUMED) Water main 10'+ 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 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. 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. Engineer's Printed Name JEFFREY A. GARNESS Date rl Ila &b (Rev. 11/05) IAT 2 SCALE 0' 10' 20' 40• I hereby certify that an accurate survey of the following described property: KNIK HEIGHTS SUBDIVISION (P -452B) LOT 3, BLOCK K was made on August 25. 2014 and that the improvements situated thereon are within the property Tines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the retard plat may not appear on this drawing. PANNONE ENGINEERING, LLC I AS -BUILT I Sw 2936 14M PQ IPG ♦5 ` 1JOB 1458X0. w.6pAPF/ w1wnlc:-r- Parcel I.D. 018-232-20 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: % It -p - L7_ Complete legal description Knik Heights, Block K, Lot 3 Location (site address) 13330 Bainbridge Rd. Current Property owner(s) Craig & Mary Richard Mailing address Real Estate Agent 13330 Bainbridge Rd. 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ rlOmmu.nity Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by: COSA to be released to the unless otherwise requested by the engineer. COSA Fee $ q? -q.&6 Date of Payment LA? /4 Receipt Number tlo 1(05,,..--..,\\ COSA# 05C ItiNst Date: Waiver Fee $ _ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy tgst, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulation.. reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distagceS„measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground Wt'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. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 8/27/2014 Conditional approval for bedrooms, with the following stipulations: By: P Original Certificate Date: The M icip nc age 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 Septic System Advisory Well Flow Advisory COSA blue sheet r - Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Knik Heights, Block K, Lot 3 A. WELL DATA Well type Private Date completed 6/7/1979 Total depth 400 ft. Date of test If A, B, or C provide PWSID # Sanitary seal (YIN) Y Cased to 183 ft. FROM WELL LOG 6/7/1979 Static water level 208 Well production 2 in WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 4.03 mg/L Arsenic ND ug/L Date of sample: 8/6/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping New Depression over tank (Y/N) N Pumper Parcel ID: 018-232-20 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 8/6/2014 189 ft. 2.0 Collected by: PES Date installed 8/19/2014 Cleanouts(Y/N) Y High water alarm (Y/N) N Date installed 8/20/2014 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 8 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test New in. Water added New gal. New depth New in. Elapsed Time: New min. Final fluid depth New in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at — Cycles tested Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ G. ENGINEER'S CERTIFICATION w+� WN �v 9 p ig'�P4i 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in ,�*;•49TH ;* conformance with MOA COSA guidelines in effect on this date. Pannone Engineers Printed Name Steven R. 1even aririune Date 8/27/2014 ��GyCE-8149` COSA brown sheet 10-10-12.doc in. ;,.N _' O, e MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) /-of .3 �3�/f kIirlllT fora S'C.' Location (address or directions) 13 3.30 Gain 6 r�G /R SC _ 0I ((}}- _ p fng n un %i "CAc?'W- e — (b) Applicant Name _:-� f�"elephone: Home �� S'�1�1"3 Business _ Applicant Address (c) Applicant is (check one): Lending Institution 19`Owner/builder 0 ; Buyer 11 ; Other Cl (explain); (d) Lending Institution I �� 'f __ 1��u1/�A{ _ Telephone Address env ��• o—< _ _. (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE- Single-Family ESIDENCE Single-Family fit Multi -Family D Other Number of Bedrooms 3. WATER SUPPLY Individual Well 1R Community D Public E] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite IN Public D Community D Holding Tank D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 1`.o`5 i ©+ 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm!� T_&ch n t ca i Yerv*ic of Telephone 3146"- 136-S Address 1`(530 &cAfg SA Ae, �)A0ree >e_Air 99,3 l,( -- Date 6. DHEP APPROVAL Approved for '-'/ bedrooms by Approved Disapprove Terms of Conditional Approval EEi-Seal 47 000 �oeoe6 s606**060 oeoee0a*e �e�'� 9..e.a...e*..e. •eoeaee0e06g �A °e THEODMC F. vooj� " !` y °°*°° CE - 3589 0•°° Ad n�L� sf� *0006° VAV Date Conditionh -- n CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DFIEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 AdUNIOPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONML'NTAL PROTECTION 1985 a20 f � E D Legal l DDescription: A. WELL DATA Well Classification Prlva�e If A, B, C, D.E.C. Approved (Y/N) N,tq. Well Log Present (Y/N) _ Y Date Completed (5'171W _ Yield Total Depth q6V Cased to !®; Depth of Grouting N..�__ Static Water Level __5Ect —Pump Set At __329 Casing Height Above Ground 28 u Sanitary Seal on Casing (Y/N) �( Electrical Wiring in Conduit (Y/N) Y' Depression Around Wellhead (Y/N) �( Separation Distances from Well: To Septic/Holding 'Tank on Lot On Adjoining Lots / + To Nearest Edge of Absorption Field on Lot On Adjoining Lots —f (�30 To Nearest Public Sewer Line _-N-14• To Nearest Public Sewer Cleanout/Manhole _ N. ri. To Nearest Sewer Service Line on Lot MA. _ Water Sample Collected by —_ ; Date cle i Water Sample Test Results safcrr�T� ��'Ir�vrn Comments B. SEPTIC/HOLDING TANK DATA Date Installed y 1161191 _ Size f e3U No. of Compartments _ 2 Standpipes (Y/N) _ Y Air -tight Caps (Y/N) — Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) —_N_— _ Date Last Pumped G! 2-5'AgS:7 Purnping/Maintenance Contract on File (Y/N) __Cif►• _ ; for N,A . Holding Tank High -Water Alarm (Y/N) __M_,4- _ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 107' To Property Line is -1 To Water Main/Service Line Course �;! t00'` Comments Page 1 of 2 72-026111/841 To Building Foundation _ c - To Disposal Field S To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 6,5-A31/130RM Type of System Design Date Installed g116 /C91 Length of Field 413 Width of Field 3r? r� Depth of Field qgr Gravel Bed Thickness yd " C6 Square Feet of Absorption Area 3 yY 00 Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test.�lvfwc/V Separation Distance from Absorption Field: To Water -Supply Well ! 'e' (� To Property Line la r To Building Foundation y% To Existing or Abandoned System on Lot M,14. ; On Adjoining Lots j 53s To Water Main/Service Line Ni A. To Cutbank (if present) N,A- To Stream/Pond/Lake/or Major Drainage Course (0 1 To Driveway, Parking Area, or Vehicle Storage Area (UG 1 Comments Minor dr-afog4e CoLlae cr(01191 ,So"fh ptrA)Ler�y Zine , Cctrrel)kly D. LIFT STATION Nd,4. Date Installed Size in Gallons "Pump On" Level at High. Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify thattII have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 1 �"`a�e^t 'o'� Date 6'1- y%-5�5' Company 1=(coop %c/tn ecx( SerV�✓MOA No. RS: -0 -6e - Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11184) OF A4'4"4 Ar t T41111.1, THEODORE F. MOORED '^ CE -3589 oo I 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE - NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One '-K7 Four ❑ Other _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY DO,-- INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** _YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY PEJ.1M-0(-091\OC)'�'L NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME' V ' DATE -- DATE04 `N��, ' INSPECTOR INSPECTOR INSPEC Qi• — JnMTF'A=FO ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HFALIH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEb'1YWI`1MENTAL P ;OTECIION 825 L Street - Anchorage, Alaska 99501 � MAR 1081�F�1 3 1 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RE CE I VE �) REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ,- - 1. PROPERTY OWNER - - PHONE MAILING ADDRESS —%%-- - PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILINGADDRESS 0- S fe A - -- P. ) y 7 3. LENDING INSTITUTION —HONE MAILINGADDRESS 1, % 4. REALTOR/AGENT _ HONE -7 MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE - NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One '-K7 Four ❑ Other _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY DO,-- INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** _YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY PEJ.1M-0(-091\OC)'�'L NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Se/Holding Tank ptic Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS - l 11�1/APPROVEDFOR �— BED ODMS ❑ CC NDITIONAL APPROVAL (tette ust a LTJ' DISAPPROVED 1� an certificate) DATE u V_3�-� l BY