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HomeMy WebLinkAboutBONNIE LT B13 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241052 PID Number: 051-283-31 Dwelling: ❑e Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name Thomas Rollman ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 15712 Sims Street ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Bonnie B Ft. Ft. 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 Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface water 100'+ Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks Tank replacement only Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D2665 Tank to D2665 drainfield Green General Contracting Drainfield CO/MT D2665 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 102.0 ft Inspection ection 1v 5/7/24 2�d 5/20/24 Location and description 3rd 4th Bottom House Trim @ A ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Dater •.. .... .. .. ....... •even annome •,• CE 8149 °5.2�. Septic System /- Approved Date fj[ Note: this approval does not include well permit requirement . ioe„ nwn�i� o� 1500 GAL GREER POLY TANK PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) A SCALE: NTS SEPTIC TANK PROFILE n Development Services Department ry J Phone: 907-343-7904 u On -Site Water & Wastewater Section Fax: 907-343-7997 Permit Number: #241052 Well Log Date of Issue: 4/15/24 Parcel Identification Number: 051-283-31 Date Started: 5/15/124 Date Completed: 5/16/24 Is well located at approved permit location? Yes ❑ No 0 Legal Description: Bonnie, Lot B, 15712 Shims Street, Eagle River, AK Property Owner Name & Address: Tom Rollman 15712 Shims Street Eagle River, AK 99577 Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Topsoil 0 3 Gravel - Sand 2 15 Gravel - wet silty sand 15 35 Blue weathered rock 35 45 Blue Rock - medium 68 80 Blue/grayBlue/gray rock 80 92 Brown rock 92 110 Blue/gray rock 110 200 Jade green rock 200 290 Black rock 290 365 Water Sample Results: Arsenic: Nitrates: Coliform Bacteria: _ ug/L mg/L colonies/100mL Method of Drilling FM-] air rotary ❑ cable tool Casing type: A53B Steel Wall Thickness: •25 inches Diameter:6 inches Depth:60 feet Liner Type: PVC Diameter:4•5 inches Depth:340 feet Casing stickup above ground: 3 feet Static water level (from ground level): 145 feet Pumping level: feet after 1 hours pumping !I—gpm Recovery Rate: gpm Method of Testing: Well Intake Opening Type: ❑ Open End 0 Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Depth: Start feet Stopped feet Well Disinfected Upon Completion? Yes No Method of Disinfection: Comments: Well Driller: Milo Pitner ❑ ❑ Company: E & D Water Wells Mailing Address: 3530 W. Spence Lane, Wasilla, AK 99623 Attention: The well driller shall provide a well log to the On -site Water and Wastewater Section within 30 days of completion. Anc'nc Pump & WEI-I. Iruc. JimSullivan, CPI PO Box 770197 Eagle River, AK99577 (907) 68E-2510 (9W)243-2282 iim@arcticpumo.com Well Decommissioning Log Legal Address: Subdivision: Bonnie T:R Block: Section Lot: B Lot: On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: Signature: Jim Sullivan Company: Arctic Pump & Well,Inc Well Decommissioning Date 5-23-24 Method of Decommissioning: AMC 15.55.060L1 a.f] b.n c.E Location: Use the space below to provide a drawing of the property showing the following items: o North Arrow o Decommissioned well o Other water wells on the prope4y r Two separate swing tie distances for each well shown on the drawing Note: the swing tie distances shall be measured from either perrnanent structures or the property comers. l/cw testl Arctic Pump & WelI,Inc. Page I of I Pump Installation Log Arctic Pump & Well Inc . Jim Sullivan PO Box 770197 Eagle River, AK 99577 (907) 688 -2510 (907) 243 -2282 jim@arcticpump.com OSP241052 051-283-31 4/15/2024 Bonnie LB B Tom Rollman PO BX 770776 Eagle River AK 99577 5/23/2024 345 Feet Franklin 10FRD1P4-2W230 268 PSI 14 Feet ss Well Drilling Permit Number: Parcel Identification Number: Date Of Issue: Legal Description Lot: Block: Property Owner Name Address: Pump Installaion Date: Pump Intake Depth Below Top of Well Casing: Pump Manufacturer's Name Pump Model: Pump Size: Pitless Adapter Burial Depth: Pitless Adapter Manufacturer's Name Pitless Adapter Installer: Well Disinfected Upon Completion? Method of Disinfection: Green Yes Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. 5Y Thursday, May 23, 2024 16.0' x 20.1' SHED 1 STORY RESIDENCE WITH WALKOUT BASEMENT n � / 10.4 x 1 6.3' w WOODSHED Lot 90 oo / N y. O �ry Z 79.4' 1.1' x 2.0' CANT ` 100' PROTECTIVE I Lot 115 I I Lot A S 89'51'03"E 298.55' SEPTIC MANHOLE 8.8' x 16.0' SHED Lot B 44,688 s.f. xSEPT C P'f S 1.7' x 4.0' CANT \ ASPHALT PAVEMENT: RADIUS o..:'... ... <' , 'NELL N 89'50'15"W 298.62 Lot 116 4' 30' UTILITY EASEMENT— '�' II 53 of d- M E PLOT PLAN AS BUILT _X SCALE 1_= 30' GRID SW _2226 Project No. 424-027L3 Associates, � P.O. Box 210005 Lang & A S S o C I a t e S, i n C, Anchorage, Alaska 99521-0005 (907) 522-6476 a � F � Professional Land S u rV e o rS kenOlongsurvey.com ��' Y Ion athanOlangsurvey.com I hereby certify that I have surveyed the following described property: rH �VVO LOT B, BONNIE SUBDIVISION (Plat No. 8-110) © 9— Q Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a""' "' "" "" "� representation of the conditions that were found on the date the survey was performed. Q This survey does not constitute a boundary survey and Is subject to any inaccuracies Q G JONAT C. LANG , that a subsequent boundary survey may disclose. The information contained hereon shall o� not be used to establish any fence, structure, or other improvements. 4 Z`z 0/U Z�yZOj- ler, � A0 ' .� S-9944. • ' yJp© Dated this the _ Day of — _, at Anchorage, Alaska BAR Noa 44� 0gSSf0NA%- � A It is the responsibility of the owner to determine the existence of any easements, 0�ppp©�Q covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241052 Work Type: SepticTank Upgrade Tax Code Number: 05128331000 Site Legal Address: BONNIE LT B G:0753 Site Mailing Address: 15712 SHIMS ST, Eagle River Owner: ROLLMAN THOMAS MICHAEL FAMILY Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: �tipc'n t �. S, 1)elY�cttllenC 4/22/2024 4/22/2025 44688 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ 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 Special Provisions: • Submit the Well Decommissioning Log with the Inspection Report. n Received By: t,'� Date: Issued By: Date: 5 I�v�IUHG C )AA LL ! OFHC J0G�L\G77 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. 051-283-31 Property owner(s) THOMAS ROLLMAN Mailing address Site address 15712 SHIMS STREET, EAGLE RIVER Day phone Legal description (Sub'd., Block & Lot) BONNIE, QT (' Legal description (Township, Range & Section) Lot Size 44,688 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X❑ Septic Tank ElUpgrade ❑X (w/wo ADU) Holding Tank El Renewal Renewal ❑ (D) ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X 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: 5 V Waiver Fees: _ Date of Payment: ' S L y Date of Payment: Receipt Number: Receipt Number: Permit No. Waiver No. Permit App_'- : .,:c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Bonnie Lot B Well and Septic Tank Upgrade Permit Request Design Narrative This is a design narrative for a permit to install a 1,500-gallon septic tank to replace an existing 1500-gallon septic tank, and the decommissioning and replacement of the well on the lot. The existing tank is 43 years old and is likely perforated and leaking, it will be abandoned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,500-gallon septic tank that will be connected to the existing drain field. The existing well has high nitrates and perforations shallower than 40’. The well will be decommissioned per code and a new well will be installed. This lot and the surrounding lots are served by private wells. There are no wells within 100’ of this upgrade. 1. Upgrade Tank Design. A double clean out installed before and after the proposed septic tank. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 5’+ from any drain field. 10’+ from 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 this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, SRP Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer 12 April, 2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241052, Curtis Townsend, 04/22/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241052, Curtis Townsend, 04/22/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241052, Curtis Townsend, 04/22/24  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 MAILING ADDRESS LEGAL DESCRIPTION LOCAT,ON NO. OF BEDROOMS ,Well/~¢ , ' I Absorption area / ~T~ D~STA~C~ TO: I ~ Manufacturer ~ ~ Mate No. of compartments ~ giq. capac~t~ in gallons ............ ~ ~ ~ nu~w:m~u:: Inside length Width Liquid depth ~ -- ~ Manufacturer Material Liquid capacity in gallons ~ !Well ] Foundation Nearest lot tine PERMIT NO. ~ ~ DISTANCE TO: ~ ~ ~ No. of i in es ~//~ Length of e a ch lipa T otaltength o fline~ Trench width Distance b etwee~ ~ ~~ ~ Top of tile to finish grade Material beneath tile . ~ ~~ ~ Total effectives/absorption~ area Length 'Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer tine Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING 100 ~fiMABKS ED / / DATE LEGAL ]-013 (Rev. 3/78) Applicant: Location: Department 825 264-4720 * * * HANDWRITTEN PERMIT * * * .~ON-SITE SEWER PERMIT ~OC ~'/~ Mailing Address: MUNICIPALITY OF ANCHORAGE Health and Environmental rotection L Street, Anchorage, AK. 99501 Legal Description: ~' g Type of Soil Absorption System Is: Trench: _~3c~ Drainfield: Maximum Number of Bedrooms:. ~ .. Lot Size: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) DEPTH The Required Size of the Soil Absorption System Is: /,~Q~ , LENGTH 5~ GRAVEL DEPTH ¢~CP 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 = /~CP 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. Minimum 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 of 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. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 * * * I 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 th~/~esidence is remodeled to inClude more Signe~: /~ ~~/-~(~ Issued by: Applicant Date: that,) bedrooms. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE DATE PERFORMED: SITE PLAN SOILS LOG [] PERCOLATION TEST 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop P~F~O LATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT ALASKA I FIUIROFImglTAL CONTROL $1 IgUICIB, Il'lC. Hr. John Lynn Municipality off Anchorage 825 L. Street Anchorage, Ak. 99501 ~n§ineefin§ ~ ~nuir'onmental Studies March 29, 1981 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL p~::OTECTION MAR $1 RECEIVED Dear John: Enclosed is a soils test for lot ~ Bonnie Subdivision. This is located off Hill Crest Drive. This lot is adequate for onsite~sewage disposal. Lot ~ has a permitted on-site system inspected by Mr. Tim Rumfmlt, Permit # 632, dated July 9, 1971. I have enclosed the pink copy of the report. Please return it to Mr. Tom Rollman. The lot appears to be gravel. you have any questions please let me know. Sincerely, Leroy C. Reid Jr., PhD, PE President 1220 LUest 25th J~uenue · Anchoracj¢, P~laska 99503 · (907) 276-1361 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 ~.,.,..~ 4 ~' 5 6 7 8 10 14 15 16 17 18 19 20 COMMENTS DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) -- FT PERFORMED BY: 72-008 (6/79) 0 0 0 0 0 0 0 0 0 0 © 0 [:,EPARTMENT OF HEALTH FIND ENVIRONMENTRL PROTECTION '="-.' %,., ,=. . ...... "L '" .= TEEET. ANCHORAGE., AK. 264-4720 I..,.IEL_L F"EF~:r-1 ][ T' PERMIT NO. < 8iA42i ) BONNIE ROLLMRN SH I MS RI.', RPPL I CANT L. OE:AT I ON LEGAL POB ??8 ER ~ BONNIE S,."D LT-B OF BLMLT. 89 LOT SIZE 688-2380 30000 SQUARE; FEET MINIMUM DISTRNCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL. SYSTEM IS i¢30 FEET FOR R PRIVATE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE 'TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVATE WELL TO R PR I ',,,'RTE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. 1.4ELL LOGS ARE REQUIRED AN[:, MUST BE RETURNED TO THE DEPARTMENT WITHIN 3:0 DRYS OF THE WELL COMPLETION. OTHEF,' REE!UIREMENTS MAY APF'LY. SPECIFICATIONS AN[.', CONSTRUCTION DIAGRAMS ARE A',,,'RIL. ABLE TO INSURE PROPER INSTALLATION. F"EF:f.11 T E::-:::F' I E:E':-] [:,E~]:Er. IE:ER :3:1.. I CERTIFY THAT t: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELI_S RS SE]" FORTH 8Y THE MUNIE:IPALITY OF ANCHORAGE. 2: I HILL INSTALL THE SYSTEM IN FICCORDANCE WITH THE CODES. flPF'L I E:RNT BONN I E R~?L~r'IRN V4. E~ Certificate of On -Site Systems Approval Parcel I.D. 051-283-31 Legal description BONNIE LT B Site address 15712 SHIMS ST Eagle River AK Current property owner(s) ROLLMAN FAMILYTRUST Expiration Date: 5/20/2025 X The On -site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: In Original Certificate Date: 6/27/2024 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 ApprovaIjune 2022 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 05128331000 Complete legal description Bonnie Lot B Location (site address) 15712 Shims St. Current property owner(s) Thomas Rollman Family Trust Day phone 907-441-4341 2. ON -SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: RE Private Well R Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units 1771 Community Well or Public El Water Storage 4. TYPE OF WASTEWATER DISPOSAL: � Private Septic 171 Private Septic serving 2 dwelling units El Holding Tank r_1 Community Septic or Public Sewer 5. SEPTIC TANK: F] Steel nE Plastic n Concrete n Fiberglass Age New - See advisory if steel older than 20 years 6. ABSORPTION FIELD: R AWWTS E] Bed RN Deep Trench 0 Wide Trench R 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 $ S 5-D Waiver Fee $ Date of Payment 2 Date of Payment COSA # I Waiver # COSA Applicationjune 2022 COSA Checklist Legal Description: Bonnie Lot B Parcel ID: 05128331000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 5/16/24 Total depth 365 ft Cased to 60 ft 0 Sanitary seal is functioning correctly FNI Wires are properly protected Casing height (above ground) in. Date of flow test for COSA 5/16/24 Static water level at beginning of test 145 ft Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: New tank installed on 5/7/24 D. ABSORPTION FIELD DATA Which system tested (date installed) 10/23/81 ❑Q ALL standpipes present per record drawing Total measured depth from grade 12.3 ft (max) Measured depth to pipe invert from grade 5.6 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 6.7' ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) no If yes, enter date Well production at time of test 1.5 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes 0 Nc ❑■ Coliform bacteria is Negative Nitrate mg/L❑ Nitrate less than MRL (ND) Arsenic ug/L❑ Arsenic less than MRL (ND) Collected by Brandon's On -Site Services LLC. Date 6/4/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/25/24 Results Q Pass Fluid depth prior to test Water added 754.6 gal New fluid depth 67 it Elapsed time 98 min 35 in Final fluid depth 35 in Absorption rate 754.6 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used 35 in Effective depth remaining 61 in Comments/Deficiencies: The fill found inside the monitoring tube was added to the recorded fluid depths for an accurate representation of the liquid level found in the leach field. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' DYes if No ft DYes if No ft Neighboring Tank > 100' no Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' ❑m Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑i Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ril Yes if No ❑ 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' 0 Yes if No ft Surface Water > 100' E Yes if No Tank to Property Line > 5' Q Yes Field to Property Line > 10' ❑o Yes Water Main > 10' no Yes Water Service Line > 10' E Yes F. ENGINEER'S COMMENTS if No ft Wells on Adjacent Lots: if No ft Private Wells > 100' if No ft if No ft Community Wells > 200' Fil Yes if No Yes if No If tank or field is under driveway comment below ft 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 Finn Walden Const. Cons. & Eng., LLC. Engineer's Printed Name Robert Walden Phone 907-354-6661 Date 6/17/2024 COSA Checklist June 2022 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date "') ~ ~ 1, GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Applicant Address (c) Applicant is (check one): Lending Institution [] ' Owner/builder[~; Buyer []; Other [] Telephone: Home ¢~,.¢~ .~ .'~¢C") Business (explain); .. _ (d) Lending Institution ~_.tT'lf (~C~PJT6~'E,~~ Telephone (e) Real Estate Company and Agent ____~/J~r_ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms ,'~' ' Other WATER SUPPLY Individual Well,J~] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /t}/~.,_,-.-j-- J,j,, ~.,,, ~ ~ Z~-~,. ~ ? Telephone Address -7 t,~ -7 __ /~"'~ ~"' ./-/,~J 'y . ./~v~ d, ~ /'~ Date ___ ~ /~/j'?~' WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. DHEP APPROVALC~''~ Approved for /~/~'-/~ .. bedrooms by ~~-¢,<--m'~'. C'~J'Date Approved ~ Disapprov;/, Condition ~"~/*: Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o25 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION If A. B, C, D.E.C. Approved (Y/N) Well Classification Well Log Present (Y/N) I/~_.~ Total Depth /"~J' Cased to ~ Depth of Grouting - Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) , On Adjoining Lots /~)~) ' /~)" ~' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ,~..//~/4 Static Water Level .-~) ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by "/~ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~'~;..~'~'/ Standpipes (Y/N) ~/~...~ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~z3/ ~' To Property Line ~-~O / To Water Main/Service Line ~'~ Course ~/"/~ Size ~ No. of Compartments Air-tight Caps (Y/N) _~--~'-~ Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ,'~"'~'~ ~ To Disposal Field _~ ¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84~' C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area ,~"/Z Depression over Field (Y/N) Results of Last Adequacy Test / Separation Distance from Absorption Field: To Water-Supply Well f,~ / To Building Foundation ~"~' Lot ~,',~,x/~ ~,~,~'~'~ To Water Main/Service Line ~.~'~:;~" ~' Type of System Design Length of Field ~"~.. / Depth of Field /~' / Gravel Bed Thickness ~ / Standpipes Present (Y/N) Date of Last Adequacy Test Y~ To Property Line ,=,.7,~)/.v- To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that~/c~~~~.0nformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed " /~11~.,./I ./t-./~.z/c./"u~ Date Receipt No. ~ ~ We Date of Payment _~/~--~ 72-026 (11/84) DATE RECEIVED ' · INSPECTION APPOINTMENTS TIME TIME TIME INSPECTOR INSPECTOR INSPECTOR _ MI. I~IC~A"L"I~ ~ ,ANCHORAOE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION  DEPARTME.T Op ,EALT, & ENW.O.ME.TAL PROTECT~O. 825 L Street - Anchorage, Alaska 99501NOV '!. 8 1981 ENVl RONMENTAL SANITATION DIVISION Telephone 264-4720R EC El V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER j MAI LING ADDRESS RESIDENT (If different from above) PHONE 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION '~--'~"'J~,,~'/'~--'" J.~PHONE MAI LING ADDRESS 4. REALTOR/AGENT } PHONE" MAI LING ADDRESS '5. LEGAL DESCRIPTION $'~ ~EET LOCAT. ION ,r'do/- 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] ~wo ~ Five [] Three [] Six [] Other 7. WATER SUPPLY iNDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS I.~ALLED. NOTE: THE INSPECTION FEE I~IUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) t ~ 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 [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: /_~"Oo If Tank is homemade give dimensions: [] ONE [] TWO PERMIT NUMBER NUMBER OF BEDROOMS DEPTH OF WELL DATE DRILLED LOG RECEIVED [] THREE [] FIVE [] FOUR [] SlX PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line MATERIAL ~ Septic/Holding Tank ]Absorption Area lSewer Line [] OTHER Nearest Lot Line 5. COMMENTS [~~i~ O V E D FOR _..~'"'-' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET [-~ PLATTING BOARD ~_] PLANNING & ZONING CASE NUMBER NAME S-5606 Lots A, B Bonnie Subdivision DATE RECEIVED February 25, 1981 COMMENT TO PLANNING BY March 13, 1981 FOR MEETING OF CASE OF [~ PUBLIC WATER NOT AVAILABLE TO PETITION~ARE~i~ E~ PUBLIC SEWER NOT AVAILABLE TO PETITION~R~A?i,' REVIEWER'S COMMENTS: / / 71-014 (Rev. 2/78) J d '0:-I(01 I-I@)