Loading...
HomeMy WebLinkAboutHOMESTEAD HILLS #1 BLK 3 LT 8Onsite File Homestead Hills #1 Block 3 Lot 8 #015-173-30 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191525 PID Number: 015-173-30 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New F Upgrade Name John & Carol Boyt ABSORPTION FIELD El Deep Trench El Wide Trench ❑Bed E:1 Mound Site Address 11421 Bear Paw Street ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Homestead Hills #1 3 8 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'I TANK Septic ElS.T.E.P. ❑ Holding E]Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100'+ I Material Number of compartments Lot Line 5.0'+ NA Poly 2 Foundation 10.0'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Deans Construction Drainfield COIMT3034 inspector Pannone Engineering BENCH MARK (Assumed elevation) 408.0 ft Inspection 15' 1/8/2020 1/20/2020 Location and description es: 2�a 3,d 4n, SE Bottom House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: OF Date ,�� �....... .... ... ... "Steveii 'R* Ptin'rione'� CE 8144 s<`p2' �• Septic System Approved Date f) 7) .. Note: this approval does not include well permit requirements. tnev voruu_10) z m �Wy (f) m N � �0m z 0- > n^< r> m D om mourn �---i ---I n n M (A�U U) (n 4 m 4 m b z .-mli o -'imay_ � c x (a — —EAR BPASttee+' I ZE r z� �m r +1 O ^ m m m ( � O O O ccU j N, � I n \ D� cn -m0 < CD D O� m Q Z -I n m m O m ZN 00 o 0 71 0 O DD mm D � �Yv v I 00 CD m w C) - 000 n OO D D 0 000 m — — _ -- m m cn p _--- _'_ _ a a i C L - C� j -+ D TSS �a,j-'- - - - O C - _ D n _ m _ � z�_ ---_�z n - D m avry y m z n (0wu z � ® I cf) m rn ;o _ _ D m CI ? N � CIS cD � O O_ NOTES: PANNONE ENG SVC LLC PHONE (907)X745-8200 1807 PALMER, 907) 745-8201 __�����a1 :�P� oFALAS'tfil� j _ 9 r"... r (even Ff.�P nope CE 81 +� 1, � .y REVISIONS DATE SCALE SCALE: 1"=50' RECORD DRAWINGS REV 1: 1/27/2020 HOMESTEAD HILLS #1 B3 L8 JOHN & CAROL BOYT 11421 BEAPAW ST. iii P.I.D. NO 015-173-30 DRAWN ACP SITE PLAN PERMIT N0. ANCHORA GER AK 9 516 S EEP191525 2 0 L:o o< CD CD a ��aN. o r ,z c 0 0, 0 tan 3 0 CD 4 CL -0 55- 00 2 ,o M Cr CD D :r (D 0 0 3 = 5 c * Z3 w CL CL ET 0 Ei a Z5 CD m S 5 = M 3 3 o cr c CD 0 m 3 as CD M La 0 (D 00 C, 0 o a 47 ccs (n IC CD =r D C, (n 5 , CD C: 0 M- SI, 0 =a -0 (A 6 C, (D CD @ a (D a 0") a :-4 M Er a 4s 0, in-' CD =1 r 3 (D 0 2 W. 0 CD 0 0 3 cr -9 -n 0c ID Q_ 0 M CD 0 c -0 2 CD zr rw- C: CD cn (n w :3 to CDff CD 2 CL - :3 0 6,0 EO 6 -n 1p I 1-0< > O3 a 0 0 =r < o 3rn 3 o< rn r3 m 0 , 0 = o o O :L U) CA (D (D w 0 :017O CL m > 1w, CL C=lr 0 - :01 CL ca m w -0 3 E3 a (D 0 "D am) o< m- 5 — CD in cn > ;:� CD (D 0 07 r- C- < 3-o 3 m > CD Fn* CL x cn 3(D ca 0 U—Io 90 ((CAnD 0:3 > Cj) D (D . m 5, a CD (D o CO En .0.0 0 c CL, � , a z 8 0 '0 5-0 (D CD CO CD aro D m w :3 CA (D 0 M z - & -, 0 CD 3 CD CD 6 0 CL > ,iQ9 w cn (D CO ij <±acD (D cD 3 CD z BEARPAW STREET Y- ,::::5().00 NOO'06'189"W 47.59 R=:50.00 L=75-33 0 nor (D CD CD C� <D CD to I I tj Fr n r I I CD (0 Cr (D 0 (D -Y- 1`01 Cp CL MOTS CD21 0 CL 0 X, asliokAua 2.9-- CD 0 CL ? 90 0 0 0 00 CD 6- 0 zr 0, 0 m Co (D CDcn 137 CD 0 0 < + CD CD 0- 0 CD D ZV.90N 0 0 A OD (D 0 cn I r- 0 CD W 0 IN MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program FOBox 186650 4700 Elmore Road Anchorage, Alaska 89519-6650Phone: 343-7904 Fax: (907)343-7897 Permit Number: DSP181525 Work Type: 3eptioTankUpgnade Tax Code Number: 01517330000 Site Legal Address: HOMESTEAD HILLS #1BLK 3 L 8 B:2638 Site Mailing Address: 11421BEAF<PAVVST, Anchorage Owner: 8OYTJOHN SQCAROL A Design Engineer: PANNONEENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 12/23/2O18 12/22/2O2D El Disposal Field 0 Septic Tank El Holding Tank 0 Privy 171 Private Well M Water Storage All construction shall beinaccordance 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 VVaobawobyr Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC8O) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.85.Provide notification bycalling (S07)343 -70O4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a' Opened and Closed onthe same day, Vr b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date; 3 E_P&PNE 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. 015-173-30 Property owner(s) JOHN & CAROL BOYT Day phone Mailing address 11421 BEAR PAW ST, ANCHORAGE AK 99516 Site address 11421 BEAR PAW ST Legal description (Sub'd., Block & Lot) HOMESTEAD HILLS #1 B3 L8 Legal description (Township, Range & Section) Lot Size 54,536 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank �_ ❑X Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicabl nicipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 195 - Date of Payment: Ig pito 09 r �9 Receipt Number: �9 6.39'80 [� Permit No. g pf'g t' � Permit App_-'- : .'.:c: Waiver Fees: Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191525, Rebecca Carroll, 12/23/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191525, Rebecca Carroll, 12/23/19 ~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ,., NAME PHONE [~ LEGAL DESOHIPTI~N ]~elJ _ AbsorPtion ~rea, Dwelling ~ P,~M~ NO. D, TANC TO: I t0' ;~ Menufacturer , 1. - -- ~ Materi~ No. ofcom~ments a We~ ~ Foundation~, , Nearest lot line PERMIT NO. ~ DISTANCETO: ~ ~ ~ ~ '~ Trench wide/ Distance bet~e~s No. o~i~ Length of eac~n~ Total length of lin~ ( O~ inches ~Q Top of tile to finish grade Q{ Material beneath tile ¢i~s¢~ Total effective ~b~.~n~rea Length Width Depth PERMIT NO. ~ Tgp:~ Cr,b diameter ~ -- Tot*l effective absorption aro~ ~ C~. ~ J) } ~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation , Sewer line Septic tank~ ~ Absorption area(s)~ [ ~ ~ OTHfi~ PIPE MATERIALS SOIL TEST RATING [)EF'F'tRTPIENT bt': FiEFILTFI FINE:' EN'v' :[ RONi'iEF,FT'I::iL. P?~!::)'T!ECT ]: C)N 825 "'L." STREET., FiNC:HOF.:F1GE., Fff:::. ,. 264- 4 ? :.:;i: PEi:;?.i"! l' T NO. ( ';-"':i~el~[.':.;::~:;-'~!'. ) F:!PPL.. :i: '2 :::IF~T P '" N 14 t .LE~Fff',ff(?]; P 0 i:3CI:~-:: ::l..e[ "'"t?'~ 4::) i.. (] CF"I'T' Z (')N E~E F':tRF'I:::Ii4 L.l!ii'.(]iF:!L L8 B}]': HO!"IE'~ST[.:.']FI[:, H]:L[...S L. CIT '.i:T,):i~:]:E 546:~:C'; S(~:!!..tFIR[i: l"::i:i!:ET "FY?E OF :i.T,O!L. FtB'SORI:::'TI. ON S'~"STEH Z~L:;: 'TF.:ENCH i"lFti,.:',ii'"!t. JM NUHI:£~ER OF BEL':,F:OOtflS = :~: SO]iL.. RFFT']:NG (:ii~;G F'T,.'"[ii~F~:)= THE F,i:E~]:!I...tIRED SIZE OF THE SOIL RBS()RF:'T~ON S¥S'i'EH THE L. ENG'TH D IMEN:E;ION tS THE: LENC'iTPi ,:: I h,l F'I!~:;ET,':' OF THE TRENCI'"! OF: !}Rfai[NF!Ei..D. THE DEP]"H OF' ta T!:;.':ENCF! OF.'. PIT IS THE DtSTFtNCE E!:ETi,ff'::..'EN Ti'"I[::. :ii!;iJ!:;.:f':'FiC:E OF THE GF.:OLtND F:I!"4D THE E:OTTOM OF THE E,';':',CF!VF!TZOf',i ,::IN FEET). TFtEF:E i'S NO S;ET W:[DTH F:OF:': TRENCHES. THE GRFP.."EL DEI::'T!"! I S THE M :[ Bt I. !"ItjM DEPTH (IF C'iR..':::I',/E]... !:?,E]"k!EEN THE Ot..rT'F'F:&..L P Fi!'.,iD TFIE BOTTOH OF THE E',:.:',C:FF,.?FFT' .'I ON (Ii'-,~ FEET). F'ER.H t 'T' F':tPPL. :t.: CF'i!'.,tT HF!S THE RESPONS I B I L t T'.? T(] I NFOF:'.M 'T'H I S, [)EPFiRTF!Ifii:NT DUI:;i: :[ N(.'.:i 'T'FiEi: ]: NSTF:iLL. FIT t ON I NSPE(.:T t ONS OF FIN'-? NEI.._[...S F!DJFICE!'.,IT TO TH I S PRO!:::'EI:;?.TY' F[!'-~D THE ;".&.!HE~Ei:;..' OF RESIDENCES TI...ti::!T T?.tFE 14ELL. !4IL. L SE'i:;~?,/E. ........................... "]1'"' ~4 C.~ ,,:C ;~i~: '2,, ][ ~..,,~ :..'~ F:'-" E.T::] C: ""ii.'"' :~: C:~ .,iP..,,I! ::!i~; ~:::~ .'.iF;?.: Eib.: ~'::;~:.". iFi::'~: ~::;;::~ tL..~ ][: F;R: ~.:.'!ili',: ~:::::', ............................. E:FtC:t<F ILL :[ t'.,iC:i 0t::' FIN'.? S"r'STEM F.i I 'T'HOL.iT P" ! NF!L :[ NSPECT ! ON Fff',ID FtF'F'ROVF!L. Ei'?'? T'H I '.iii; DEPF:IF:THEI:,IT 14 i LL BE SUS..TECT "i"O PF.:OSEC.':LIT I ON. i"! :[ N Z i"!L.IH E:' I STI:~I'-,IOE BE'TF!EEN Fi t.,.!ELL. FIND Ftt'.,!¥ ON-S I. TE :ii:';E:".NF!C'iE D !' SPOS":F[L S?:E:TE]"! ::i.,':Z!,(i!i FEET F'OR la PF.t!',/F;FI'E':' F!E!....L OR Z5¢.."i TCi ..'..;~:ii!)~ii FEET FF?.Oh! Ft F'LIBL..ZO NELL. L.IF'ON THE TY'F"I:~: OF PUBLIC .t4ELi. .... F.[iEi...L LOGS FiRE RE(::!LI.'~F~:ED FINE:, I"tI..L':ST E:E F?.ETUF:NED TO T!.-!E~: DEF'FiF,?."t"ff!I::~:NT !,i!THiN :::i:i;a DF:i?? (}F' Tl'"li:!!} I4EL..L COMPLET :[ ON. EYTHEF..: RE('::!U :i: REMENTS MFI"r' F:~F'F~L.'T'. SPEC I F' ).' CFFT' i OBiS F:INE:' CCIN'.:?TRUC:T I O1":! i} I Fi(:iil:;:l::!hIS !:::fi:;tE F:~:CFI:[Lf'::iE;LE TO INSURE PRI:]PER INSTFtLLFIT):ON. :t: ci:~:i';ir'r ]: FV THFiT ::L: ]: i::IH Fi::iMILIFiR kIITH THE RE(.::.!Ui[i;~:EHENT:i.S F'Oi:~'. ()N-'SITE :SEk!EF:tE; FIND I,.tEL. LS F::!S FORTH B',;' THE P! !J i'.,! ]: C :[ F' Fi L. IT'.~.' 0!:::' F!N(.'.':HC'iRF:IGE. 2: Z !.,.iZM.~ ZN:L:;TF!L.L. THE S'.r'STEPI if',! !hCC:OF;.tDRi",!C.:E i.,.!ZTH THE C:ODES. 3: :[ L.tNDE!;.:'.E;TF:ii',fD 'T'HI::IT THE ON-SITE SE[,.!ER S"r'S'T'E!"! HF":!Y' F;?.EC-:[U:[!:;;:['f.:. ENI....F::!?(:!iEHENT IF:' "!"!'"!i!::: i:;~'.E::'.:i; 1[ E:,ENC:E I S F-'.EHODE-';LEP TO it: ?,!C!.j...IDE MOI:-:::E 'T'!'..h'::!N 3 BEDF.".OOP!S. S !' G f,!E:".D: F:~Pl::'d... Z C:FINT l.')Oi'-,! i.,.t I :i::E;S iii;[;:, [.:.Y'rL .................................................................................................................... [)FFT'E .............................................................. F'ERM I'T NO. LOCRT ION ~¢ r ~¢~- q. TYPE OF SOIL RBSORBTION SYSTEM I_. r-lUr4 I g--': I F'AL I T"r' ElF A~-.tC:HL]F~AOE ~ :~). DEPARTMENT /'-x~ HERLTF~ FIND' ENV I RONMENTRL/~"~'C TEC T I ON 825 "L STREET., RNC:HORFtGE., BK. 9~,_,,-;31 L~JI~5)-A'L~'?~) PIELL A~-~P CIP~--5 [ TI SEI,-IE;R F'ER~'I Z f - LOT SIZES~L(..~'-~ ~ SQUARE FEET MRXIMUM NUMBER OF BEDROOMS = _~ SOIL RRTING <SQ FT,.'BR)= THE REQI_IIRED SIZE OF THE SOIL BBSORPTION SYSTEM I [)EPI-H= ~ , LE~-~G'TH=~ GRR%'EL [)EPTH THE LENGT IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEF'~H OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OLITFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). RELq. LIIRED SEPTIC: TRI'-.Ik: SIZE= /~(} 0 ,3FtLLI]I'~S PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORbl THIS DEPRRTMENT DURING THE , ~ INSTFILLRTION INSFECTION_ OF FINY WELLS RDJFICENT TO THIS PROPERTY FIND THE NUMBER OF RESIDENCES THFIT THE WELL WILL SERVE. TI-.-IC~ ( 2 ) I I'-ISF'EE:T I ~]l'-.IS RRE REQLI I REP_-, BRCKFILLING OF FIN"/ SYSTEM WITHOUT FINRL INSPECTION RND FIF'PROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSEC:UTION. MINIMLIM DISTFINCE BETWEEN R WELL RND RNY ON-SITE SEWBGE :DISPOSRL SYSTEM IS IL00 FEET FOR Ft PRIVRTE WELL.; OR 'l ±50 TO 200 FEET FROM R FLBLIC WELL DEPENDING UPON THE T~PE OF PUBLIC WELL. WELL LOGS RRE RECJ. UIRED RND MLST BE RETURN]ED .TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL C:OMPLETION. OTHER REQUIREMENTS MR9 FIPPL"r'. SPECIFICRTIONS RND CONSTRUCTION DIFIGRFtMS FIRE RVFIILFIBLE TO INSURE PROPER INSTRLLFITION. PERI~I I T EXP I RES [:,EE:EI'IBE~: 3---±.- l:-:~- ?~*'~=~ I CERTIFY THRT IL: IRM FFIMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FiND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. · -~: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. ........... RPPL I CRNT /O ~ vz. 2 ISSUED BY ..... DRTE ...... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-6B0, Anchorage, Alaska 99502 276-222l[ SOILS LOG - PERCOLATION TEST I-I SOILS LOG PERCOLATION TEST ' PERFORMED FOR: ~O~/ ~' ,~NI~'~'~ ~./~.e.~.-~-~~ DATE PERFORMED: /O LEGAL DESCRIPTION: ~.~-'7.~ ' '" SLOPE SITE PLAN ENCOUNTERED? DEPTH? Reading Date Gross Net Depth to ' - Net Time Time , Water '! ', Drop TEST RUN BETWEEN ~ FT AND z~o~'ro,~'! .,~ F' TIt-E) AMI ¸17 :{MED BY: 72 00a 17/76) CERTIFIED BY: EorJ E. B~rn~rd  DA~E RECEIVED '" ,. INSPECTION APPOINTMJ~NTS DATE DATE ~ ~y DATE~_A3 INSPECTOR INSPECTOR I NSPEC~.~ / ~UNiCIPALITY MUNICIPALITY OF ANCHORAGE DEPT. OF DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IRONM[-; ENVl RONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI R ECTI ONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days fo r processing. . PHONE MAI LING ADDR~S PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING MAILING ADDRESS PHONE MAILING ADDRESS ~1, ~ /- 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~ SINGLE FAMILY ,~-~Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON'SITE** /~' 7 ? [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: ~!~ If Tank is homemade give dimensions: TYPE OF TANK NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER [] OTHER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line 1 WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS ~J~]~'PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) DATE This well is producing gallons ¢~--~ater per nour. INVOICE MOON DRILLING SR BOX 668, BOGARD RD. "PALMER, ALASKA 99645 TELEPHONE 745-4071 Set pump @~-- feet, INVOICE NO, DATE yOUR P. O. NUMEER. TERMS SALESMAN Sub WELL LOG DEPTH CASIN FORMATION DEPTH DEPTH IN FT, CA$1N FORMATION IN FT. CASIN FORMATION IN FT. 101 __201__ ~ __l...m 102 202 m2~ --103~ _~208-- __-- -- --8~ ~104-- --204-- __4~ --105-- 205 m S._.~ ~ m206 --107-- m207~ S~ ~109-- --209-- ~ --110~ --210 ,..1~_ ~114~ --214 14 --11§~ ~215'-~ __24~ ~125 --225 · -~?~ --128 --228 ..,,.~8~ --129 --229 _.29~ --1SO--~ --280 ~67 s2 '~ 34 184 ~84__~ --86 185 ,~ 285-- ~89 189 289 --to9 -200 , '~. soo PLEASE PAY FROM THIS iNVOiCE po=foot. AMOUNT Certificate of On -Site Systems Approval Parcel I.D. 015-173-30 1. GENERAL INFORMATION Expiration Date: I r 7- Complete legal description Homstead Hills #1 133 L8 Location (site address) 11421 Bear Paw Street Current property owner(s) John & Carol Boyt Mailing address . Same Real estate agent 2. TYPE OF DWELLING: � Single Family (w/wo ADU) Fj Duplex El Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic C] Water Storage El : Holding Tank El Community Well 0 Community ❑ Public Water System 0 Public Sewer: • 0 Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Waiver Fee $ Date of Payment Date of Payment Receipt Number 7, �Vl Receipt Number COSA # 656 26165N Waiver 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify` that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit -of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 i Date Z- 43 OF. A�qs�� AV Q)� :v %... Steven P. Ponone 7 -,99' CE -0149 Conditional approval for bedrooms, with the followinb stipulations: c'luuul<rr BOriginal Certificate Date: -Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Sy?tems 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 Checklist blue sheet Nitrate Advisory Arsenic Advisory Other l i Legal Description: Homestead Hills #1 B3 L8 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled unknown Total depth unknown ft Cased to unknown ft © Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 12/12119 Static water level at beginning of test 229.6 ft. Comments B. TANK DATA Age of tank(s) 12.20211 years Tank type/material poly Measured operating fluid level in septic tank n/a ❑® Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 1979 0 ALL standpipes present per record drawing Total measured depth from grade 14 ft (max) Measured depth to pipe invert from grade 6.0 ft (min) ❑ N/A — pressurized field Q Monitor tubes go to bottom of effective. If not, state depth into effective ❑E Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: Structure served by this system 1 015-17,i_i0 Well production at time of test 1.4 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑✓ No RE Coliform bacteria is Ne ative pp,. 6S Nitrate- � g/L [] Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 7/7/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 12/12/19 Results [D Pass For 3 bedrooms Fluid depth prior to test 39 in Water added 450 gal New depth 39 in Elapsed time 330 min Final fluid depth 39 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ®✓ Yes Community Sewer Manhole/Cleanout > 100' -/ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' F,71 Yes if No Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' El Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑✓ Yes if No ✓0 Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓Q Yes if No ft F,/� Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ✓l Yes if No ft Surface Water > 100' ft ft ft ft ft �✓ Yes if No ft Property Line > 5'✓J ®✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5'[]✓ Q Yes if No ft Private Wells > 100'f❑ Yes if No Water Main > 10'✓Q 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ®✓ Yes if No ft if absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' U Yes if No Water Service Line > 10' ✓l Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF. l certify that I have determined through field inspections and review Municipal low, �. 9 4 of records that the above systems are in conformance with: MOA COSHguidelines in this date.- effect on �' F. Steven annone CE 8-149- COSA Checklist yellow sheet ft ft ft ft Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(cDpanengak.com DATE 7/15/2020 Subject: Expired COSA Permit Permit Renewal Request Permit Number: OSC201054 Legal Description: Homestead Hills #1 B3 L8 This is a request to renew the COSA for the above mentioned lot. All site conditions remain the carne. Sincerely, Steven . annone, P.E. Owner/Civil Engineer Mailing: P.O. Box 1807; Pah-ler, AK 9964,5-1507 }e?_-O1,one: (9107) 745-82001 FAX: 1,907., 7-45-820 1.