HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 15 LT 7· I
'O6
Municipality of Anchorage
Community Development Department Page 1 of 2
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
Permit Number OSP171119 PID Number: 051-064-06 ❑ New I] Upgrade
Name:
DEBRA KINDRED ABSORPTION FIELD
Address
❑ Deep Trench El Shallow Trench 0 Bed 0 Mound
21750 SHELTERING SPRUCE, CHUGIAK AK ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 GPD/SF F t.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lol Ft. Ft
NORTH WOODS UNIT 4 15 7 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft
To Septic I Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line Ft2 Ft.
Well 100+ N/A N/A N/A 25+ TANK 0 Septic ❑S.T.E.P. ❑ Holding ❑Other
Manufacturer Capacity
Surface Water 100+ N/A N/A N/A Anchorage Tank 1000Gal
Material Number of compartments
•
Lot Line 28.5 N/A N/A N/A STEEL 2
NA -
Foundation 19.3 N/A N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ N/A : N/A N/A Gal.
Remarks Pump on level at Pump off level at High water alarm al
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer drainfield
JR's Septic Drainfield CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft
Inspection s, Location and description
dates: 1 26JUN17 2" 06JUL17
s'° 4th House Trim near foundation cleanout
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: _ Date ,�dczts •
OF Aki
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1 ••tteven •. I annoRe ci
O++4,•. CE 8149
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Approved Lf",✓N Date 7-7^( 7tki;-e441:5;5Qik*t___---
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RECORD DRAWING E PANNONE ENG SVC, LLC of/i Da;/a6/20,7
P.O. BOX 102954 ANCHORAGE, AK 99510 p'4•••' •.
PHONE (907) 272-8218 FAX (907) 272-8211 e• 'y Scale
*_, ‘ .* 1" = 50'
-
NORTH WOODS UNIT 4 B15 L7 ,-,•• • P.I.D. NO
-06
SITE: 21750 SHELTERING SPRUCE os1 osa
•��eJeii•i2'•�aririoiie� PERMIT NO.
DRAWN JRL DEBRA KINDREDCE 8149 OSP171119
PO BOX 6706410;••.,,, .••':,' Sheet
SITE PLAN CHUGIAK, AK 99567 ''iiGFt
2 OF 2
trnr,,""` AL,, o MUNICIPALITY OF ANCHORAGE7
On-Site Water&Wastewater Program Aft'
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997
hltp://www.muni.org/onsite '
I) 1,11 t;ncnt
4"`.0µ,4i.
On-Site Wastewater Disposal System Permit
Permit Number: OSP171119 Effective Date: 6/12/2017
Work Type: SepticTank Upgrade Expiration Date: 6/12/2018
Tax Code Number: 05106406000
Site Legal Address: NORTH WOODS UNIT 4 BLK 15 LT 7 G:1460
Site Mailing Address: 21750 SHELTERING SPRUCE LOOP, Chugiak
Owner: KINDRED DEBRA J Lot Size in Sq Ft: 27055
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field El Septic Tank ❑ Holding Tank El Privy 0 Private Well El Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Le / .
Received By: • 4e."9- �• '� ,___-Data;
I
Issued By: / GA-'07 , Date: to 7Z- /
MUNICIPALITY OF ANCHORAGE
Community Development Department \: i 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. 051-064-06
Property owner(s) Debra Kindred Day phone
Mailing addressPO Box 670641 Chugiak, AK 99567
Site address 21750 Sheltering Spruce Loop
Legal description (Sub'd., Block & Lot) North Woods #4 B15 L7
Legal description (Township, Range & Section)
Lot Size 27,055 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) 0
(w/wo ADU)
Septic Tank N Upgrade lI
Duplex (D) ❑
Holding Tank ❑ Renewal El Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: (if1"--- Waiver Fees:
Date of Payment: iciai Date of Payment:
Receipt Number: 03(43615 Receipt Number:
Permit No. (;SPIT-/119 Waiver No.
Permit App__-'• :: .c
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
June 2, 2017
Subject: North Woods#4 B15 L7
Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 1,000g Septic Tank to replace an existing
1,000g tank to be issued for this property. The existing tank is failing. It will be decommissioned per code.
Currently the lot is developed. The proposed system will utilize a replacement 1,000g Septic tank that will
be connected to the existing drain field. The existing tank is located approximately 100'+ from the well.
The proposed tank will be placed outside the existing well radius. All required separation distances will be
met.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5'+ from any property line or building foundation
10'+ from any water line
100'+from any surface water
100'+ from any private wells
200'+from any public wells
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 907.272.8218.
Sincerely,
/ H •4 ,
r
Steven R.Pannone : '?:
• 8149•
r �i
1W-6
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage. AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
' ' 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
IPHONE ' ' [] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION .~
LOCATION
-
~ell Absorption area Dwelling / PERMIT NO.
~ DISTANCE TO: l~, ~ ~/~ /~ ~
~ ~ Manufacturer
~ ~ Ge ~:r_ ~ Materia~¢.~/ No, of compartments
Liq. capacity in gallons ~ Inside length Width
/OD D I 'r HOMEMADE: Liquid depth
~ ~ DISTANCE TO' jWell Dwelling
~ Oz ' PERMIT NO.
O Z ~ Manufacturer
~ -~ ' Material Liquid capacity in gallons
~ Well Foundation
~ ~ DISTANCE TO: Nearest lot line PERMIT NO.
~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines
~ inches
Top of tile to finish grade Material beneath tile
h~~ ~ ~ ~X ~/ t' Total effective absorption area
m inches
~ Lengt~ / ~. W,dt Depth ~ ~/ PERMIT~O.~
~ of crib~/~ Crib diameter ~ Crib depth ~/A Total effective absorption are,~,
~¢ Type
Building foundation Nearest lot line
DISTANCE TO: We~l ~/A ~ 3~'
~ , ~ Distance to lot line PERMIT NO.
~ DISTANCE TO: ~ Building foundation Sewer line Septic tank Absorption area(s)
OTHER
baaed
SOl L TEST RATING
INSTALLER
~ K,, I , ~1'
· ~ ~x~ef~, ~(~ c,~;:4~ / . ,
,
,,,,... ....
DEF'FIRTMENt" OF HEFILTH FIND E.N,' ',,'IF:-NMENTRL] F'ROTEC'TION
......... L .=,TREET, RNC:HORFIGE. FIK
2~4-4720
PER.MIT NO'
DFITE ISSJE[,:
84002S
d..~.,.- Etd..,... U4
F'ER~'-I 17-f"
HF F I.. I _.HI ,IT:
FI D E:,R E ::.-'.;:E; -
C-~NTFICT PHONE:
FIRCTIC DEVELOPMENT
4460 BUSINESS PFIRK
RNCHORFIGE., RK 99502
56±-8076
LEGRL [:,ESC:RIP: SUB[:,IVISIDN. NORTHI4OOD ~LI. ,- LOT:
.:,E..TI UN:
LOT SIZE: ('SCL FT_ OR flC:RE~7::,
MFh.~ BEDROOMS:
BLC3K: 15
LISTED BELOH RRE THE OPTIONS R',' - ' ._ ,- ', ...
,_ ,,_ , ',FIILPBLE TO ~.'1-11t IN [:'ESIGNING '¢OLIR .:,EFTIU
.=,T..':,TEM. CH']n'qE THE OF'TION THFII" BEST FITS
..... · .u~. SITE
DEPTH TO PIPE BOTTOM (FT. )
GRFIVE[_ DEPTH (FT.)
TOTFIL DEPTH '.'.' FT.
GRRVEL HIDTH (FT. )
GRFIMEL L. ENG]"H (FT.)
GRFI'v'EL 'v'OL LiME ( CU.
TRNK SIZE (GFiL'.=.;)
'.:..;,OIL F.'.FITING '::SC, L Fl". ,."BR
0.5
4.0
27.
5±.
5%
000.
205
:+::+: [:,EF'TH TO F'IF'E B'-ITTUtl-" '::] 4. 0 FT. t"lFl'¢ REQUIRE R LIFT STFITION
:+::+: :TFINI<: MLI:.:.!;T HFI'v'E fit LEFr:];T ]"HCI CCff'IPRF.:TMENT$
I CEF..:I'IF'.,.' THFIT:
±. I FIM F'FIMIL..IF~R HITH THE: RE..,qUIREME:NTS Ff]R ON-SITE SEb. IER:5 FIND HELL=, "~
-' H~ '--]ET
FORTH B'¢ T'HE MJt,II...IPPL. IT'¢ OF RNCHORFIGE (MOFI) FIN[:, THE STFITE. OF
;.Z I NILL INS]'FILL THE c,,,--
-,~=,FEM IN FICCORE:,FINCE NITH FILL MOFI CODES FIND REGULFITICN$.,
FIND IN COMF'LIFINCE NITH THE DESIGN CRITERIFI OF THIS F'ERMIT.
.7:':I 14ILL FtDHERE TO FILL MOth FIND STFITE OF FIL. FI?.,KR F.'E.nt IR ' '"E ,~ ....
.... EtlEIqI_-. FOR THE SET BHUK.
DISTFINCES F'F.'3M FIN'¢ EXISTING NELL., HFISTEb. IRTER DIz, FUz, ML =,~_,TEi'I _]E' PUBLIC
-Et~EF:M=E S~-'STEM ON THIS OR FIN'¢ RDJRCENT OR NERRB'.r' LOT,
4. I UNDERSTFIND. THRT ]"HI.'-_-; FEF..IIIT' "" IS ',,"FILID F']F.' R t'IFIXIMUM OF 2 BEE,ROOMS FIND
FIN'¢ ENLFIF.':GEMENT NILL F.:Ek]UIF.:E FIN RDDITIONRL FEF.'.MIT."' "
I:~ Ft LIFT STFITION IrE; INSTFILI F[, IN RN FIF:EFI ¢~P,?E-
-,--, ..... _:Z N:ED MOFI BUILDING CODES.,
FHEN (::L) ~N ELECTRICFIL FEF..MIT FIND INSPECTION MUST E:E OBTFIINED.~ (2',
~ILL. NCT BE HFFF.._,E[. 14ITHOI.JT FIN EL. ECTt;.:ICFIL II~_,FEL. TIuN REFJR. I.~ fiND ,..:.., THE
F. LELT:]"RICFIL ........ [j4E E:'~ H LIUE. Nz, ED ELEL:TRIL:IFIN.
L. ORb' ill '=T BE ',r't : ,,, '- --- ,
IPPLICRNT: ~: DE'v'EO.ZCF'MENT - ' ' ---
[:,EPFIRTHF'NT OF' HEFILTH F~ND ENVIF~ONHENTF~L. F RJTEL. T IUN' F -' -
....... · "L'" STF~:EET., RNC:HFR'SI3E., FII<
':": .......... '" I ....' .... :,:; 4- ~t.~.1 : EFIGLE ~'.IVER
=~.,4 4, ~: :, HN_.HL ~:P UE F-,. '". ="
F'ERI"IIT NO. ':'~ ....
........ Lt El4
FIPF'L I E:FINT: SI':::FIGG~ C:CIN'~TR I-
t:t[:,E:,~IE~NX ' F'O E:CI~.:', g' F I' I JNE: -, ,:,,:, ~ ~ ,':, '~.t
C: H U G t FII<., R K 9 9 E;,5 ~
LEGFtL E'EqFEIIF'TION_. - '- I:',:LEE. I ~ I:,ILN'- -I : NO~:THI.,~OOD ~ E:LOCg:: 15 LOT: 7
LOT ~GIZE Cl SQ. FT. TO~,.IN&:HIP: - ~:FINGE: - $EI::TICIN: -
LI:,TEg [3ELOH FIRE THE OPTION:5 R',,,'FiILFIBLE 1-O '~.'OLI IN E:,ESIGNZNG YOUR SEPTIC
$'T'$TEP't. C:t"tOOS;E THE OPTZF&'.~ THFIT BENRT FI'T:5 'F~ ....
- · - -,r,~ ~I. TE.
~: ~ [::~ [:, ~ ~ ~ ~ ~-~ - ........................................
HI[:,TH ......
=:,'. ~l FT.
LENGTH = ~4. ~ FT.
'TOTFqL [:,EPTH = ~. Ct FT.
G~:t~',,,'EL [:dEPTH : O.._~ FT. ~ NOTE ' - P'lFt"r' ~:EQLIIRE LIFT S;TFtTION
G~:Ft',,,'EL F, $~ C~ C:U. "'-
~ _~ LI. JP1E : [. :,.
.... ,j. Ci GFILLCINS:
gII[:,TH = S. E~ FT.
LENGTH = '2C1~5 Ci FT. NOTE ' -' ~ ' F' '-
- - . .... F'F: ~:EQUIP. E'5 TNO TREN_.HE:,
TOT~L DEF'TH = ~. C~ FT. NOTE ' - REQLtIP. ES- INSLILFITION
GRFt',,,'EL. [:'EF'TH : ~. El FT. NOTE ' - HFI'¥' ~:EQLII~:E LIFT 'S;TRTION
Ci~:FI',,,'EL,~.,_F~ UI"iE : .-,~= 2 C:LI. '.~.'[:,~S.
TFINK ~;I2~ = I, ~E~Z~ ~ GFILL3NS; '[THO I]OI"iF'Ff~'.THENI" TRNK>
I [:ERT~F'.F 1-HFIT:
· . I ~l'"l FFffiILIFI~: HITH 'THE RE~LIIREHENTS F'CI~ ON-:~;ITE SEI.~E~'.S FIN[:, I.~ELLS ~S; :qET
FO~:TH E:'~.' THE PII...INIC:IF'FILIT'.~' OF FINC:FIOI~FIGE FIN[:, THE STFITE CIF FIL~SKFI.
2. I HILL INE;TFIL. L THE E~"FN=TEP1 IN FICC:OIR[:,FINCE I,~ITH THE C:CIDES RND Ht~',,,'E R:EC:EI',,,'ED
Ft [:OF"~.' OF THE CCI[:,E :SIJt"il"iFl~:N.' FIN[:, DIFtISRFIPI FITTFtC:HHENTS I.,.IHIC:H IS; PFIRT OF THIS
PER:H I T
~:. I.INDE~:.:,THN[:,"~ - ~ THFtT THE ON"-.E;ITE ..ELfERr - , c .-. , ,T,
:,' :,TEH PtFI ~:EQLIIR:E ENLFtRGEP1ENT IF I'HE
..E:,I[.E~L.E I:~; REHI3[:,ELED TO INC:LLI[:,E HORE THI~N ]: E~E[:,ROOHN;.
F'E~:HIT FIPF'LIC:FINI" HFtE; THE ~:ESF'ONSIBILIT'~.' TO INF_I~H' I- ' FE~.: 9NNEL'"'. ' -I ' [,II~:ING_
THE INS;TFIL. LF:tTIOI'.~ IN:FE.~.TIUN:,' '-" 'F' - '- OF FtN'.F HELLS Ft[:'JFICENT TO THISq r~,:._rm~<i~~"'Pt]~'~" I~ND
THE NLIHE:E~: OF:' EE:I[.E.~LE.:, THFIT THE $'.IELL I.qILL
IF I~ LIFT ~iTFITION IS INSTFILLE[:,., t~N EL. EC:T~:IC:I~L F'E~:HIT FINE:' INSPECTION P1U'$T
]~E OE:TFIINEE:,. FI:5'""E I~_T'q_ I~:FtNNC~T BE FtF'F'~i']~'E[:,_, · HITHOUT RN ELE-.TKIL. ltL-IN:,FE_.TIUNF' ' -'- · ,- , '-. -
~:EiF'O~:"I' THE .EL. ECTI~:ICFIL HORK PtLIS;T E~E [:'ONE E$~' ~ LICENS;E[:, ELECT~'.I[:IFIN.
$ I GNE[:':
iF'F'L. IC:FtNT: SKFIGGS F'-'_.bhl~,T~.'- '
DIRT.F-:
F~MUNICIPALITY Of ANCHORAG~_.~,
Department ; Health and Environment~ ~rotection
825 ~ Street, Anchorage, AK. J~501
264-4720
Permit ~ ~//C~' * * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Location: Phone Numbe~,~~ ~ /
Legal Description: L~ ~ ~.~, /o~- /~3~o~ ~/~m='L~o~t Size: -
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed~ ~ Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
LENGTH - ._ . GRAVEL DEPTH ~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
REQUIRED SEPTIC(HOLDING) TANK SIZE = I~20~-~ GALLONS * *
*
*
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
· * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Hinimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
Df public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
9ther requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER n, 1 9 s 3 * * *
Z certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to inslude m~a~r~3~Lmooms.
ApPlicant ~ ~% Date: ~ ~' ~-~/~.-~/ ~
SWP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
,~ SOILS LOG
/-
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED: ~C"~"'¢- 2,.~~ J~ ~..~
LEGAL DESCRIPTION:.,, ~,~OF1~v.~gg.C '~IOC~-- trC
1
"-'~ 3 -
~4
5
6
7
10
11
13
14-
15-
16
17
18
1
C.
-No. 225 ].E
COMMENTS
PERFORMED
SLOPE
SITE PLAN
WAS GROUNO~INATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading ])ate Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE '~'~ '~ (minutes/inch)
TEST RUN BETWEEN "~ FT AND ~ ~/"~--FT
, % -
CERTIFIED BY:
DATE:
72;008 (6/79)
Parcel I.D. 051-064-06ZI/
Certificate of On -Site Systems Approval
Expiration Date: - 20`Z /
Legal description NORTH WOODS UNIT 4 BILK 15 LT 7
Site address 21750 Sheltering Spruce Chugiak
Current property owner(s) Tim and Sabine Thomas
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
M
bedrooms, with the following stipulations:
Original Certificate Date: 4/7/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
M MA
UHICIPAUTY OF
0
Development Services Department 1
On -Site Water & Wastewater Section
ANcHo GE
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-064-06
Complete legal description NORTHWOODS S/D PHASE 4; BLOCK 15, LOT 7
Location (site address) 21750 SHELTERING SPRUCE, CHUGIAK, AK
Current property owner(s) TIM & SABINE THOMAS
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone 1-808-499-4253
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units X Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age <6 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ Waiver Fee $
Date of Payment'
�312�, Date of Payment
COSA # 05(. 7 /n 7Waiver #
COSA Application—June 2022
_1A
COSA Checklist
Legal Description: NORTHWOODS S/D PHASE 4; BLOCK 15, LOT 7
Parcel ID: 051-064-06
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
-LL DATA SERVEDBY AMU WATE,
R
❑ Well log I with Onsite (or attached) Well production at time of test pm
Date drilled depth ft Water storage tank a gallons
Cased to ft -1*4%
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground)
Date of flow test for COS
Static water ISeginning of test ft.
1B. TANK DATA
Measured operating fluid level in septic tank 49.5"
Date of pumping
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/2/1984
X ALL standpipes present per record drawing
Total measured depth from grade 4.3 ft (max)
Measured depth to pipe invert from grade * ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
* ❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
X Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 2019 gallons 3/21/23 date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Well disi d for coliform test? ❑ Yes ❑ No
Coliform bacteria is Negative
Na.r.ate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date
STATION
❑ Require
Age of lift station
Lift station maW
Adequacy test date 3/21/2023
Results Q Pass
Fluid depth prior to test *4.25 in
Water added 486 gal
New fluid depth 6 in
Elapsed time 138 min
Final fluid depth
Absorption rate 450+ and
FIELD STATUS — POST RE
Effective depth (per
RY
gs) 6 in
Effective depth used ° _ in,,)
Effective depth remaining **5 5 in
Comments/Deficiencies: 'THERE IS ONLY A 4" MONITORING TUBE (MT) IN DRAINFIELD - NO CLEANOUTS. MEASURED 10" OFF BOTTOM
OF MT TO FIRST PERFORATION IN PIPE (PIPE TRANSITION FROM SOLID TO PERF.). 2017 COSA TEST WAS APPROVED WITH ONLY MT IN DRAINFIELD.
PRIOR TO ADDING WATER, THE MT WAS DRY. INTRODUCED 2019 -GALLON PRESOAK TO DOUBLE CLENOUT WHICH CAUSED A 4.25" LIQUID LEVEL
RISE IN MT. ADDTIONAL 486 GALLONS ADDED TO DRAINFIELD THROUGH DOBLE CO, WHICH CAUSED AN ADDTIONAL 1.75 RISE. ** 0.5" OF LIQUID
DEPTH 990 MINUTES AFTER WATER HAD STOPPED BEING ADDED. 5.5" OF ASSUMED EFFECTIVE DEPTH LEFT FROM LAST RECOVERY READING.
COSA Checklist June 2022
8
E. SEPARATION DISTANCES
ivate Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Li on Lot > 100' Community Sewer Manhol Gk; out > 100'
Yes if No ft ❑ Yes if No ft
Neighboring Tank > 100' Yes i ft ewer/Septic Line > 25' Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if N ft Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fiel . Animal Contain 0' Yes if No ft
LJ Yes if No ft
Manure/Animal Excreta Storage > 9'
Sewer Main > 75' ❑ Yes if No ft [:] Yes
W■ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q Yes
if No
ft
Surface Water > 100'
❑E Yes if No _
Tank to Property Line > 5'
FmiI Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
n■ Yes
if No
ft
Private Wells > 100'
0 Yes if No _
Water Main > 10'
no Yes
if No
ft
Community Wells > 200'
0 Yes if No _
Water Service Line > 10'
no Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
*PER 2017 STEVE PANNONE RECORD DRAWING DATED 7/06/2017.
Q Qa�am1.► �vQ��-� Ort pat _ d,J MOA- (Zr G®2.pJ
ft
ft
ft
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Garness Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the systems on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding
the future performance of the well or septic system. GEG makes no representation whether an alternative well
or septic system can be installed on the property in the event either of the current systems fail to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
COSA Checklist June 2022
o* O H
(%Q •_J A. Gorness:
Q E-795
Qn f e V A�G
lIC£NS a Ar o f
#A£CC884
r 1
• 61‘,21) 6 $ 9 1(,"�E!
•`t _� Municipality of Anchorage •
r- t
On-Site Water and Wastewater Program MA 5 it
(907) 343-7904 n. JUL 7 +iii
Certificate of On-Site Systems Approval < .✓4'�
oil e
Parcel I.D. 051-064-06 Expiration Date: 7- 7- (�
1. GENERAL INFORMATION
Complete legal description North Woods Unit 4 Block 15 Lot 7
Location (site address) 21750 Sheltering Spruce Loop
Current Property owner(s) Debra Kindred Day phone
Mailing address PO Box 640641 Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
❑ Duplex 9 G
❑ Multiple Dwellings (Single Family and/or Duplex) S ;,
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received b : �i1 . ��_ Date: -7�// -
COSA to be released to the engineer, s 9 e se-r q,9 by the engineer.
COSA Fee $ 594.0t �� - I 'b Waiver Fee $
Date of Payment 1 l 11 Date of Payment
Receipt Number O`nDSD..Ci Receipt Number
COSA# O�CI1 r-1-161 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 dispAar'-syiem 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 regujations.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.
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 Date 717/2017
0".*: 49 TH /\ * 9
6. DSD SIGNATURE f"""
J6 System #1 Approved for 3 bedrooms � %Steven R. Pannone
r fig.
CE-8149
System #2 Approved for bedrooms
Disapproved FtiOFESSO
Conditional approval for bedrooms, with the following stipulations:
ON j ,.
WATER ANC
STEIr1 r-
WA
�CCRq^
B � Original Certificate Date: 7--7-i7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheeti. - .
If more than 1 septic system is on the lot:
COSA Checklist# 1 of
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: North Woods Unit 4 Block 15 Lot 7 Parcel ID: 051-064-06
A. WELL DATA
Well type A If A, B, or C provide PWSID# Well Log (YIN)
Date completed _ Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 6/26/2017
Tank size 1 000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 4/2/1984 Soil rating (g.p d./ft2 or ft2/bdrm) 306 SF/BDRM System type BED
Length 52 ft Width 28 ft. Gravel below pipe 0.5 ft.
Total depth 4 ft. E(ffabsorption area 1377 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5f.L��l1l[1" Results (Pass/Fail) ISS For bedrooms
Fluid depth in absorption fieldllllbefore test 0 in. Water added 4150 gal. New depth 0 in.
Elapsed Time: ` D min. Final fluid depth V in. Absorption rate >= 4 J+g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date
D. LIFT STATION
Date installed Size in gallons_ Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 1 O+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
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 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION '��"`\
' OF A�qS'k��
ii
I certify that l have determined through field inspections and .h.":70 .g -• .4 . .r T4
review of Municipal records that the above systems are in 0*: 49 TH /\ ••* o
conformance with MOA COSA guidelines in effect on this date. - ' .,. IA
Steven Pannone /� ! -----i -
Engineer's Printed Name I�• .��even �nnnone
7//7/2017 6 CE-8149
Date +�'4s•• ,. �
COSA canary sheet_2-6-15.doc
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
i HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE' %yG+ $„womb qty
FOLLOWING DESCRIBED PROPERTY: .407.V...... ,. ,1 O4
I'a41.N!d 1 tG //!/!�_�ZTa�DT. /S DATE- ; • 5. 4•q
�•
AND THAT NO ENCROACHMENTS {X1ST r"7.QCEP't AS � ��T�B-�.�' �c.;:-� H A.
• -g,
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID i �" I
EASEMENTS, COVENANTS, OR RESTRICTIONS ' -d ' f
we.,. ,.krr se,.r.e e
WHICH DO NOT APPEAR ON THE RE-CORDED SLIBDI- 1 •. ,�
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FD /y�.�) f� .s-7,/
ANY DATA HEREON i USED FOR CONSTRUCTION "7,1,44,;,
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN, `a,, 4�a
ARY LINES. . •;...s"
MUNICIPALITY OF ANCHORAGE
DMSION OF 5Z~zIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH ALTi~HORITY APPROVAL CERTIFICATE
1. General Information A~pplication Date
(a) Legal Description (include. lot, block, subdivision, section, township, range)
Location (adck~ss cr directions)
(b) Applicants Narm.;~_O_.'/--;C. b~-u'[lo~'/"~lf.~,,C~ Telephone<T-~/-~OT~
Applicants Address ~ O
(c) Applicant is (cho~ om) ~ndin~ ~nstitution
Bu~ ~; ~e~
(d) ~ndin~ Institution ~lepho~
Ad,ess
(e) t~al Estate Co. & Agent
Address
Te le phone
2. Type of l~sidence
Single-Family ~-~
Number of Bedrooms
3. Water Suppl7
Individual h%ll ~
Multi-Family~
Other (describe)
C~m~unity~,/ Public~-~ ,
Note: If c~m.,nity ~11 system, must have written confirmation frcm the State
Department of Environmental Conservation attesting to the legality and status.
Is the ~11 adequate for the number of bedrccras specified in this BAA O/N)
4. SewaGe Disposal
Onsite ~ Public ~ Cor~munity ~ Holding Ta~k ~-~
Is the wastewater disposal system adequate for the number of bedrocks O/N)
[Paoe 1 of 2]
2-15-84
5. Engineering Firm Providing Inspections, ~sts, Data and Information
I certify that I have checked, verified, c~ conformed to all FDA HAA Guidelines in
effect on the date of this inspection.
Signed by
Date
( ENGINEER SEAL)
6. DHEP Approval
Approved for
Appro~d ~
Date /~//'~/~y
Telephone
Conditional ~-~
Terms of Conditional Approval
The Municipality of Anchorage Dapa~tment of Health and Envirormental P~otection dces
not guarantee the continued satisfactory perfcm~mance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation, date
shown abo~, based on the data and infom~ation furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of kedrocms and type of structure indicated.
~ (DflEP
SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
Well Classification ~;~
Well Log P~esent .(..Y/N) ~/~
Total Depth ~3[/~_ Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distanoes f~cm W~ll:
To Septic/Holding Tank on Lot
To'Nearest Edge of Absorption Field on Lot /t)~
TO Nearest Public Se~ Line
MUNICIPALITY OF ANCHORAGE ~'~(MOA) AdUN;¢IFAL[TY OF ANCHO~AG~
D~PT. OF H~ALTH &
H~.~L~ ~]~0~ ~P~O~ ( [-t~ ) ENVIRONmENTAl. PROTEcTIoI~
c,
Dat~m~pleted ~ Yield.~ ~/~
Pump Set At
Depth of G~outing
Sanita~-f.seal on Casing (Y/N)~/~
Depression A~ound Wellhead (.Y/N)
; On Adjoining Lots
; On Adjoining Lots
C leanout/Manhole
Wate~ Sample Collected By
Wate/~ Sample Test l%~sults
C~-t~t~ nts
To Nearest Public Sewe~
To Nearest Se~ Service Line on Lot A)//{
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~/~ Size /0OO ' No. of C~,%)a~tments ~.
Standpipes ~) Ai~-ti~t Caps ~) Fou~tion Clea~o~t ~)
~ession o~ Ta~ (.Y~ ~te ~st P~d ~ ~
P~ing~inte~n~ ~n~a~ ~ File ~y~).,~ ~ fo~ ~/~
Holding Ta~ High-Wate~ ~a~ (Y~) ~/~ ~a~y Holdin~ Tank Pe~t (Y~) ~
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well
To P~ope~ty Line
To Water Main/Service
Course A3
__ To Building Foundation ~c [~,~- / To Disposal Field .~('
To Stream, Pond, Lake, c~ Majo~ D~ainage
Co~,'~tents
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~3~.~.~ Type of system Design
Date Installed ~.
Width of Field ~ ' ~
Square Feet of Absorption A~ea
Depression over Field (Y~
Results of Last A~equacy Test
To Water-Supply Well
To Building Foundation
Lot ~/~-
To Water Main/Service Line
Length of Field <JR ~
Depth of Field ~ I
Gravel Bed Thickness , ~-!
D. LIFT STATION
/$77~ Standpipes P~esent
Date of Last Ax~quacy Test
Separation Distance f~cm Absc~ption Field:
!
'~3//9-- To P~operty Line
~O~ To Existing c~ Abandoned System
; ~ ~j~ninG ~ts ~/~
~~ To ~t~(if p~e~nt)
To St~e~ond~ke/~ ~jo~ ~ai~ ~ ~/~
To ~i~way, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea
M~ets MOA
Date Installed
Size. in Gallons
"PuK~ O~" Level at
High Water Alarm Level at
Tested for
Electrical Co~s (Y~)
Cc~m~nts
Di~nsions
Manhole/Access (Y/N)
"Pump Off" Level at ~/~
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
** Check Peln~itted Bedroom Rating Against HAA Request
I certify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
COmPany /~'C~ ~ ~7
KB1/d5/s
[Page 2 of 2]
2-15-84