HomeMy WebLinkAboutPENNINGTON PARK BLK 2 LT 2APennington
Park
Block 2
Lot 2A
#020-181-53
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.cianchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. Swosoloo PID Number. 020-181-53
Wastewater System: ❑ New 0 Upgrade
N.
Steven & Marilynn Belanger
17205MarijaneStreet Anchorage, AK 99516
ABSORPTION FIELD
Pn Numo•r of o 15 11 4
D 0w Trr1" ldswW n `f 08w ❑ Mara D Om
317.9589
ad R+trq
TOW O•M ken r7^r?•E•
LEGAL DESCRIPTION
1.2 GR a
5.6 FL
810tic La
D.Ptri n PP• eomxn frgrn argot V•er
Grnr e.PN esn•.m pP•
4
2 2A• Pennington Park
1.2 Ft.
FL
TowftV Rrp• sacogn;
FN,100•e WON rtptw grW
Grn L,npN',
50
A-1.6 Ft.
Ft.
Gntw
of w.:
D,Mrw a,w••n IMI
Well: ❑ New ❑ Upgrade
5 Ft.
1
1 FL
c,itso ,gn tPmr•. A e.C)
T,xr DWit.
Gue n:
T°W jDt01P°0^•'••
500
ASTM D3034 PVC
Existing
Ft.
FL
FP
DOWWI•DIWW.
$UYCW"LM.
N. W
A Plus Home Services
Dr.'4 W:
7/6-9/2009
FL
Y,F,O.
Ptmp SO u
C•.rw ttrg^t Aoo.. Gtgute
TANK
GPM
Ft.
FL
SEPARATION DISTANCES
0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
—Poiding
VZFU4,W.
Anchorage Tank
Y.
1,250 Gr.
From
Tank
Field
Station
Tank
Sr W,,,
ewe
4rrW
Nu dCO•prvnrM
W+
>100'
>100'
NIA
NIA
>25'
Steel
Two (2)
LIFT STATION
suttee wow
>100'
>100'
NIA
NIA
to UM
>5'
>10'
NIA
NIA
Gr
'Poop W' Nw r.
PP or rw •L
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>10'
NIA
NIA
h
n
h
PMOP Mas 6 MoeN
Ei•cmrW InFp•Lv,na Frlgmiee er
C~Drat
None
Noted
R•^•,Wt
BENCH MARK
Existing Septic Tank Pumped, Crushed and Backfilled.
Louoan w pwpurt.
Insulation Over Line From Tank to Absorption Trench.
Southside Door Threshold Northeast Comer.
I•V•4011.
Insulation Over Northern Half of Absorption Trench.
100.0 FL
Existing Trench Tied In For Future Use.
Inspections performed by: M. Anderson Dates: 11 7/6/2009
P�:'•e•••••••e;Qs111
71712009
• •''9,jI
2nd
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Development Services Department Approval
Conditional Approval Date:.........:
••
>p : MKKM E ANDERWN. v i
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a% ,I Date:
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MARIJANE STREET
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO90100
U
.76
1,250 Gallon
Sepbe Tank
81.1
i
Page 3 of 3
PID No. 020-11811-53
U
No Grounawa[er
7/6/09
PROFILE AS -BUILT
No Scale
MICHAEL E. ANDERMN
II7
4
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 2A, BLOCK 2, PENNINGTON PARK SUB.
PERFORMED FOR: HU
DATE: 7/6/2009 PROIECTNo.: M. ANDERSON
PARCEL ID#: TECHNICIAN:
DEPnf TEST HOLE
(feet)
( OL/OG
2.a CLEAN WELL GRADED
SAND WITH GRAVEL
3 4 SSW/SM
4 BOH @4'
TEST PERFORMED TO
S VERIFY PERCOLATION RATE
7
WAS GROUND WATER ENCOLWMRED' No
1 O IF YES @ WHAT DEPTH'
DEPTH OF WATER AFTER MONITORING: NONE
1 1 DATE OF MONITORING:
12
14
17
49th
NIONEL L ANDERSON
PERCOLATION RATED 1_8 (MININC10 PERC. HOLE DIA`fINCHE`.
TEST RUN BETWEEN: 3_5 FT. and 4_5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. SOILS VERIFICATION SAME AS TEST HOLE I.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE 7/11/2009
GREM ER ANCHORAGE AREA BOR0jGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME MAILING ADDRESS PHONE =217
LOCATIONS -LEGAL�''`Z d" J�
DESCRIPTION Va
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WEL MANUFACTURER MATERIAL COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH_. LIQUID CAPACITY ,16-04 GALLONS.
$ . iJ/ < / /
NUMBER OF PITS DIAMETER OR WIDTH _sL, LENGTH_, DEPTHS .
LINING MATERIALS 8-tc Aj" CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL _.
✓ / TOTAL EFFECTIVE
BUILDING FOUNDATION �� NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION S/' 4 e� L1 / 1� - #-.1T rgy2F�/�
WELL:
TYPE
CONSTRUCTION
BUILDING
NEAREST NEAREST
FOUNDATION
LOT LINE -,SEWER LINE
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMAR
DISTANCES:
DEPTH
SEPTIC
TANK_
DIAGRAM OF SYSTEM
d`� l
INSTALLED BY:
N J
PIPE MATERIAL:
6
LOT SLOPE:
REMARKS:
DATE
Form No. EQ -031
DISTANCE FROM:
SEEPAGE
SYSTEM
e
,r
I�loe7d
I/ r,. 0, r_.a�U `" U
APPROVED
A.A.B.
GREAT 2 ANCHORAGE AREA BORC 3H
� DEPARTMENT OF ENVIRONMENTAL QUALITY r� iO PERMIT NO.
3330 "moi' STREET ANCHORAGE, ALASKA.9ft0�}/w V ,`, �» (9-Z
TELEPHONE
p / TELEPHONE 274-4561�}tl^�
SEWAGE DISPOSAL SYSTEM - APPLICION A4u PERMIT
NAME OF APPLICANT CI MAILING ADDRESS' , 0 �Y 's • HONE
INSTALLATION LOCATION 4
/a
LEGAL DESCRIPTION Z -4 �
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD � OTHER ,
TYPE AND SIZE OF FACILITY TO BE SERVED - �� / �/ -� - -
FINANCED THROUGH T BE INST'�A'`LLEDDvBY
SOIL TEST RESULTS
~ G✓j/"7 `� / /NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SI
TY
MINIMUM DISTANCES, REQUIREMENTS
s
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
IA9 i
DRAIN FIELD
EE A ` 17 11411)1) I'l- '
P GE EA SIZE pT/PE �1 y
771 ei
7- Ij ,2,/M OF YSTE IeI - �/�
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT
i3 f
"DRAIN FIELD �� 4� ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT ,
DRAIN FIELD
�
J f �
SEPTIC TANK,v SEEPAGE PIT e��49, DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS I �
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING I TALLATION.
G.A.A.B.
!� OR
// LICENSED DESIGNER
t i
17
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I
1 i L
...t__ n.4..-.
d.. .. � '- n-.._..���..............1 .........fit._
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y
..._..�_.-
...�._._._
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
I_
DATE APPLICANT'S SIGNATURE �� / �� 'has t �7t�Ae
"' - hS
rr
FORM N . EQ -016
GREATER ANCHOkAU. ARLA BOROUGH
Department of Cnvironmental Quality
3330 "C" Street
Anchorage, Alaska 99A31
Qt)II 5 I O(' - I'FKOI AT[ON
L �Q/�� o��/e. I -)ate Perforri�.�j
_G�.iw
Performed for --__-_ _ _._-- _1_d .TS_
Legal l ~W
This form reports: Soils log_ Percolation test_--_ _ _ _ _w_ __ —___
Depth
Feet
1-
2- 10rsolL
3 - (mc)
SANJ GrA�e�
5
6 -
7-
N
9-
S L4-1 S /qND CSMJ
to 6 WL_
I'- G reel
12 -
13 -
14 -
Was ground water encountered?
If yes, at what death?
(leading
Date
Gross Time
Net Time
Depth to Water
Net Urop
1was�
If yes, at what death?
(leading
Date
Gross Time
Net Time
Depth to Water
Net Urop
Percolation rate-_ ininute.
Proposedinstallation: Seepage Pit Drain Field
Depth of Inlet . Depth to bottom of pit or trencii _
coMMeNTs:.__8 S
Performed By __.,:r^Liil_ Certified [3y:G�_A1_S7
EQ-040 (6/74) .T E'ST �.�'�► `'7 _
—
N IC�� U-17iLITY-:15A'5M�i".
Z
Q
.4
wl_t. t_ N
3
PACED CL,
FIN► HD 7&4
It is the responsibility of the owner or
builder, prior to construction, to verify
pproposed building gracie relative to fin•
ished grade and utility connections and
to determine the existence of any ease-
ments, covenants, or restrictions which
do not appear on the retarded subdivi-
sion plat.
-- LOT SURVEY CERTIFICATION
Lot ZA , Block
—.e'er .
Anchorage Recording Precinct, Alaska
Y G Of: At
A+
01
,. '' is �..d••ca st•
LEGEND:
® Brass Cap Monument
O Iron Pipe
• Steel Pin
o Survey Hub S Tack
Prepared By: DICKINSON CXWRLD-WNLCH-LEE Residence of:
ENGINEERS ANCHORAGE. ALASKA _ =
Dale - Sy. - _: - Sco/a: I— ICY F8. W -
MUNIMPALITY OF ANCHORAGE
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-181-53
1. GENERAL INFORMATION
Expiration Date: /1-/ 0- Zo?_y
Complete legal description PENNINGTON PARK BLOCK 2, LOT 2A
Location (site address) 17205 MARIJANE STREET, ANCHORAGE, AK 99516
Current property owner(s) DEREK ESPELAND Day phone
Mailing address
Real estate agent
17205 MARIJANE STREET. ANCHORAGE. AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Private Well
Private Septic
Water Storage
❑
Community Well
❑
Public Water System
❑
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
Holding Tank
❑
Community
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ q 56 (COV 1 �1 Waiver Fee $
Date of Payment2 �-?r/
Receipt Number -7 -3 _Z3 �(
COSA # --- - d S C -D -0-I-3 5.5 -
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/21/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the �' •�
well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • . �9 ���
for current or future occupants or guarantee that no unseen encroachments, deficiencies or J
discrepancies exist can be given by First Water Consulting & FWrS .*• 9TH •'* r
6. DSD SIGNATURE Curtis Huffman j
System #1 Approved for bedrooms rr� �Fc, CE 128991 ��
Y Pp � �� sTF,p••.�12�1�0�0;���
System #2 Approved for bedrooms 111F�"ROFEWQA
Disapproved
Conditional approval for bedrooms, with the following st p\le, irk OF((�
trr(/�i
ti n�
Wp,TER AND Z
o WA , I
DRpGFA
JJJ Q
SERII�\����
Original Certificate Date:
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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic -Advisory
Well Flow Advisory Other
s -
Legal Description: PENNINGTON PARK BLOCK 2 LOT 2A Parcel ID: 020-181-53
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons
Date drilled 1/1976 Well disinfected for coliform test? ❑ Yes ® No
Total depth 82 ft ® Coliform bacteria is Negative
Cased to 80 ft Nitrate 13 mg/L ❑ Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND)
® Wires are properly protected
NCS
Collected b
Casing height (above ground) 18+ in. y
Date of flow test for COSA 7/14/2020
Static water level at beginning of test 50 ft. Date of Sample 7/14/2020
Well production at time of test 5.2 gpm
Comments WELL SCOPED BY COLE SULLIVAN — SEE ATTACHED LETTER.
B. TANK DATA
Age of tank(s) 11 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 48"
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/14/2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/7/2009
® ALL standpipes present per record drawing
Total measured depth from grade 7 ft (max)
Measured depth to pipe invert from grade 3 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 7/14/2020
Results 2 Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 7 in
Elapsed time 1320 min
® Code -required soil cover over field.* Final fluid depth 0 in
❑ System presoaked Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: *Field partially insulated per MOA IR docs. F� x
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
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Water Service Line > 10'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100' ® Yes if No _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100' ® Yes if No .
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No .
Water Service Line > 10'
® 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'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
WATER SERVICE LINE EXITS WELL AT TOP OF WELLHEAD. — Wellhead serviced by Sullivan Water Wells.
G. ENGINEER'S CERTIFICATION
1 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.
W •� ��
TH
...... ..........
• • Curtis Huffman
��� �'���•. CE 128991 .•�ti;01
PROFESSO���
ft
ft
ft
ft
ft
ft
ft
ft
t0 AM XXI" WMACc
F. ■t:.R e.1.aNa SM&OC
30`
3,07.
1 �
L _2,,q d
lF l
�K �C
l o
-
�AST 2 7-5-, 73'
The location of the strudture(s)as
shown on this record drawing
;as -built} complies With Title 21, A -MC.
19
UNDER NO CIRCUIWSTANCA'7
AN AS-9UILT SE USED FCRCCNSTRUCi1CN OR FOR ESTABLISHING SOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONWE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UlBIUTY ONLY FCR THE COST OF THE SURREY.
LISTED EVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SUR%EY =L0TTCP0GftAMY
SYMBOLS
FOMATPW A9—etRLT ..
❑ FINAL SIRM-R)I E T e SET DREREEADRAINAGE ASPHALT
o FOUND REBAR
❑ PLaT Pl1Jt ... AS—SMT .'e"�a 14OOD FENCE •..:n•:•... CONCttE1E.
IT IS THE RESPONSIBILITY
CONSTRUCTION, TO VERIFY
TO FINISHED GRADE AND U'
THE EXISTENCE OF ANY E
WHICH. DO NOT APPEAR C
SURVEY CERTlFICATI
PLOT PLAN
W4 .w 6W-d.e > e- t
Mw htYN � rti+lit� d H'tM bl wrn.n
inw{Jf..w
IYMi.f.d bW .d .efrcL
FIDLMA11M A3 •BUILT -- .. .
J tRib.,tLJ*�r,j.M,-. +.�t
r�. tA.-!•+t..t� ., of tns
,.f .,a tttr..
FINAL S7MXIURE AS--13V2T
r.. h --r o..4`r tlxt
tt... FwHnrwd ,n A_&A% two d tM
wwar. trot tot .w etas a[ x,.
wnw,iww. n! Yrlelr.�Ve., « r�wn h..on
QQN VA -BMT 001. ASSUMED ELEV. x n—„- WUAL FENCE LLGZlJ ` COO DECK
NOTE:
THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
90POSED BUILDING GRADE RELATIVE SHORN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALXS, DRIVEWAYS,
TY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
TENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROMSEING SEEN AND LOCATED.
THE RECORDED St1F3,DIVI510N PLAT. ALL DISTANCES AttE C3.E.CCIRp. VNI.ES.S. QTHERwISE. N.OT£D.
Prepared by
OF Robert E. Johns, Jr. & Assoc.
Profesonalamend Surveyors
ANCHORAGF_
/ t • ��e. Scala 0 Roc Lot S.F. Rec. Plat File No.
.n�Data Survayodr Drawn by. Chocked by.
R JOHNS m trte Drawn:
a ' 4121--�. a4j� 7-22-09 T437 IT049/9157
♦a, Legal Dearr.
�.�! a .....*`• � a ya44� �tlor.
'�{�a-',feznlonat �"�+''es J�,OT 2—A, BLOCK 2, PENNINGTON PARK SUBD
\
rUG<
�J
c'&N y
3,07.
1 �
L _2,,q d
lF l
�K �C
l o
-
�AST 2 7-5-, 73'
The location of the strudture(s)as
shown on this record drawing
;as -built} complies With Title 21, A -MC.
19
UNDER NO CIRCUIWSTANCA'7
AN AS-9UILT SE USED FCRCCNSTRUCi1CN OR FOR ESTABLISHING SOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONWE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UlBIUTY ONLY FCR THE COST OF THE SURREY.
LISTED EVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SUR%EY =L0TTCP0GftAMY
SYMBOLS
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IT IS THE RESPONSIBILITY
CONSTRUCTION, TO VERIFY
TO FINISHED GRADE AND U'
THE EXISTENCE OF ANY E
WHICH. DO NOT APPEAR C
SURVEY CERTlFICATI
PLOT PLAN
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NOTE:
THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
90POSED BUILDING GRADE RELATIVE SHORN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALXS, DRIVEWAYS,
TY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
TENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROMSEING SEEN AND LOCATED.
THE RECORDED St1F3,DIVI510N PLAT. ALL DISTANCES AttE C3.E.CCIRp. VNI.ES.S. QTHERwISE. N.OT£D.
Prepared by
OF Robert E. Johns, Jr. & Assoc.
Profesonalamend Surveyors
ANCHORAGF_
/ t • ��e. Scala 0 Roc Lot S.F. Rec. Plat File No.
.n�Data Survayodr Drawn by. Chocked by.
R JOHNS m trte Drawn:
a ' 4121--�. a4j� 7-22-09 T437 IT049/9157
♦a, Legal Dearr.
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'�{�a-',feznlonat �"�+''es J�,OT 2—A, BLOCK 2, PENNINGTON PARK SUBD
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 201355
Subdivision: Pennington Park Block 2 Lot 2A
A water sample revealed a nitrate concentration of 13.0 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
MA e�fr1�:��.z"� ���". � �'�s.� � �zs; ' a;�:,� ' 777
�.� -� ��` y
,� Mailing Address P O Box 19660"�° AnchorageAlaska 99519 6650 WWW muni org=
�t',t<'- NU ice.. ,rA .;
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
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KTMad�ng Address? O Box 19650 Anchorage, „Aaska 99519 6650 *www murnog
s,:��:�.�,,,,�".��..�'�.�.v�,...�zr:,,.�,��u,�„�..,�, ��..��.�t��.*..y..��.x-�:,..:�",�� �.�. ti�_..,�..�;�.aM�.�:
i��r Lel
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval j
Parcel I.D. 020-181-53 Expiration Date: _ J
1. GENERAL INFORMATION
Complete legal description Pennington Park, Block 2, Lot 2A
Location (site address) 17205 Marijane Street Anchorage, AK 99516
Current Property owner(s) Steven & Marilyn Belanger Day phone 317-9589
Mailing address 17205 Marijane Street Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
lubl:c %Af-. , c...�.....,
F uiw "v L= .�yaLciii
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u
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u
Waiver/Variance request for:
Received by: Date: S
COSA to be relea$ed to the engineer, unless otherwise requested by the engineer.
COSA Fee $�?Waiver Fee $
Date of PaymentDate of Payment
Receipt Number % r �✓ Receipt Number
COSA # 0 S 6- 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Phone 522-7773
Date 7/6/20,1",M
49 Inbw` 117
6. DSD SIATURE
System #1 Approved for L bedrooms®®? ,Mlc- _t --A
® % CE -4381
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: y Z��:G4 Original Certificate Date: ! E I –/3
Th unici, lit f Drage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the repre entations 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 sheet S L. c
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
Legal Description: Pennington Park Subdivision, Block 2, Lot 2A Parcel ID: 020-181-53
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 1/76 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 82 ft. Cased to 80 ft. Casing height (above ground) >18 in.
FROM WELL LOG
Date of test 1/76
Static water level 49.5 ft.
Well production 12 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 9.44 mg/L
Arsenic N/D ug/L Date of sample: 6/19/13
AT INSPECTION
7/1/13
51 ft.
6.1
g.p.m.
Collected by: Anderson Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 7/6/2009
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N)
Date of pumping 5/8/13 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Y
R
Date installed 7/7/2009 Soil rating (g.p.d./ft2 or ftz/bdrm) 1.2 GPD/SF System type 5' Wide Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7-8 ft. Eff. absorption area 500 fe Monitoring tube Y Depression over field N
Date of adequacy test 7/1113 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption Feld before test 0 in. Water added 600 gal. New depth 0 in.
Elapsed Time: 60 min. Final fluid depth 0 in. Absorption rate >= 600 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
hitL�lAl�i7►�Si�iC�71
Size in gallons
in. "Pump off' level at in.
Cycles tested
Manhole/Access(Y/N)
High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot
>100
On adjacent lots >100
Absorption field on lot
>100
On adjacent lots >100
Public sewer main N/A
Public sewer manhole/cleanout N/A
Sewer /septic service line
>25
Holding tank N/A
Animal containment areas
>50
Manure/animal excrete storage areas >100
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5
Water main N/A Water service line >10'
,
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation 0
Water Service line >10 Surface water 0
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
Water Service Line Exits Well at Well Head.
G. ENGINEER'S CERTIFICATION
I certify that l 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 Michael E. Anderson, P. E.
Date 7/8/2013
COSA brown sheet 10-10-12.doc
Absorption field >5
Surface water >100'
Water main
N/A
Driveway, parking/vehicle storage >25
. . A
.•MICHAEL E. ANDERSON
CE -4381
pROrESS10N='�
Municipality of Anchorage o> E
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 131304
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 2A
of Pennington Park subdivision. This inspection revealed a nitrate
concentration of 9.44 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
�a n E 11t a
ENKINS WELL DRILLING Zc an�r �AAF--�
P.O. BOX 3-147 ECB
ANCHORAGE, AK 99501 / 1C
PHONE 344-3792
D R I L L E R I S WELL LOG
001
CUSTOMER
LOCATION
II0I+I1ts brlve
nchornre Alt 59504
SIZE C" DEPTH 01' CASING DEPTH PIO" GROUTING DEPTH ITA
YIELD 1? rnn STATIC WATER LEVEL HOW TESTED Ir
PUMP INSTALLED( dnn 70 -TYPE Hfla 3aOket 3't,I-,AD
FORMATIONS ENCOUNTERED AND APPROPRIATE DEPTHS
1 TO 12
TO 1_ 4ruvel
14 TO 67 clay WAiaVel OCCA3510n4p41 16ou]Aeru
G7 TO 75 gravel —
75 TO 77 hardpcin clay vj/, revol
77 TO 82 courdo 04nd w/fine blaok sand %vgter
02 TO
TO
TO
TO
TO
TO
rook
E CCiTT^di�i
Q
e
30
BAST
L -//7/
307.A,5-'
11 � The location of the strul6ture(s)as
C v shown on this record drawing
as -built} complies with Title 21, AMC,
UNDER NO CIRCUMSTANCES SHOULD AN AS-&J0.T BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOLINDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE
Lm BEY SURVEY TYPE SYMBOLS
1oVNOATKN ASI-nA.T ..
❑ FM, SMUCM1IgE AS-0.iT SET REBAR 7= W DRAINAGE ASPHALT
-❑
O FOUND REBAR - -wow lDT 4UNM ... TCPaatIPNY - PENCE CONCRETE
OIl ASSUMED ELEV.;-„—r METAL FENCE®wOGp.
PECK
PLOT PLANS k LOT SURVEYS NOTE
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO - ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS.
TO. FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH. DD NOT APPEAR ON. THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS nTwcavncc u11
E_9: rA-A4tiviFiTliIT:a
DT RAN
f M�MMi1W AN -M KK..m
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FWAL STRVCNRE AS-BUGT
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w br «.� .vwN.riY ,all vl.w
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
E42 E 12 AVE
ANCHORAGE ALAH(A 99M
11 = tin
by.
7-22-09 1"ff437 27049/9157
Lpal DeeciPSbrc:
1AT 2-A,13liOCK 2, PENNINGTON PARK SO
