HomeMy WebLinkAboutT15N R1W SEC 30 LT 72 W2T15 RIW
ec. 30
Lot 72 w2
#051-302-13
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
:- Environmental Health Division 0.~/ ? a ?-
825 "L' Street. Anchorage. Alaska 99502. Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
..me , D,ST^.CES
/e--~~/ ~/;~ ,'* ~ee ;~ ~ drlveway.AS'BUILTw*terDIAGRAMbodles, etc'Sh°wl°cati°~°fweil'sepQcsystem'pr°Peityhnes'i°undat)
TANKS
M~ nu~) ~ ~' Capac,ty ~n gallo~s . ·
TYPE OF SYSTEM
TRENCH ~ BED ~ W. DRAIN ~OTHER ~1
~ / ~ FT ~,~ FT '~ ~ ~
FT /~ FT '*_
~PRIVATE ~ OTHER,Identify, C' ~ ~i'~,
17034 Eagle Ei~e~ L~p Rea~ Ne, 2~ smily that~is inspmio~/w~s peHorm~d according ~ ~lt
72-013 (3/85)
i¥1 LJ N i C ]; F:' A L. I T Y 0 F A N C FI 0 R A G E
Depar, trnent, o{' H~,alt. h & Human Services
d,~ L.. Stl"eet~ Anchorage~ Alaska 99501
0 N ..... S I l' E S E W E R P E R M I T
SEPI'iC 'i'ANI<: Mirlimum t. otal septic tank capac:i,t¥~ 1,000 gallons~ Each septic
!~:ili',: ~,.~'i l"lavl~i, ~'1:. ].[~t~,'i'. ~ i::oii][)al'-t, fil~li~.~ Dt~;'.[~t.N to top of !i~ep-Lic; t. arik(~) <: 4,,0
tN:.;IAI.i I'ER EIqGINEERS AI-I'ACI4ED DESIGN. NOI"IFY DI-IHS PRIOF-~ TO
I}:AtX.I INSF'ECTI[)N BY IHE Ei~IGINEER,, ]HIS F'E:RIdIT iS iSSUED FEIR THE:
EX !i3'T )tgE) 3 BEDR[IOH SINGLiE F'AMII-Y RESIDENCE AND EXF'iI::i'.EES ON
I CER'I]:F:Y THAI':
I. I am iamiliar, ~,,d,'Lh thE, i'(i~,l::ll.i:i.l"~i~lllt~l]'~.~: i'OP c)n-,.,~ite s~wers
iorth by 'Lix::~ Mun:icipaJ. iLy oi Anchor'age (MOA) arid t. he St. ate of Alaska.
2. i ~,~.~.]i i~istaJ.,l t. h6) system in accor'dancc~ wit. h all MOA ecsc:les ancl pegulat, ions,
arid ~,r'l Coi~):l].J, al-i~:~ Iwi'Lh tJ"ll~, d~sJ. gFi cr:i'Ler';i,a of:' 'Ll'lis pE!P[iiit,,
:],,, i wi],J, adl"ier, i;~ l'.o ail MOA and Statx~ ot Alaska r'eqLlir'el~(i~l'lt.s fop the ~!iet back
(:!:i':~,:{i[ii.:l:~s5 [l"iDfli any c~xist, ing we].l, wastewa'L~,p dispc]sal s~ystem
4,, I Lu'id~rs'l:,artd th;i.~ i:)er-rlli't:. :i.s valid l'~i' a maxiillu, r~i
a:!,~i;o urlcler'.!?i d 'Ll'iat, i.l'~.~ c.apac:iLy pi t,l"l~ 't..ot.a]. sys'i..~m :i.~.il :5 bedl"l:lOiil!i!i ar'id
any en].ar'g~ Il:. 14:i.J.], r'iL?i'_]LlJl'i~! afl ~i~[Jd:L! iClFIiE].
~Owner'.) HAROLD SCHI-L Zi.,E
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGA' DES0R'PT'ON:
1
3-
4-
5-
7-
8-
10-
13-
14-
15-
16-
17-
18-
19-
20-
.-,' C ~%' ..
SLOPE SITE PLAN
WAS GROUND WATER
S
DEPTH? p
E
Depth to Water Alter
Monitoring? ~-J Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~' 7 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN~T AND '~ FT
COMMENTS
72-008 {Rev. 4/85)
MUNICIPALITY OF ANCHORAGE DEPT. OF U~ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTF~:~J~jMENTAL J::F~OFECTION
82E LStreet-Anchorage, Alaska 99501 APR 2 0 979
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
:)IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing.
1. PROPERTY OWNER
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2, BUYER PHONE
MAI El NG ADDR ESS
3. LENDING INSTITUTION
PHONE
274'-
MAILING ADDRESS
4. REALTOR/AGENT
IPHONE
MAI LING AD DR ESS
5. LEGAL DESCRIPTION
7'154/ /~1 ~ _~'c~/a,,~ .3,~ zaT" ~'~ l~'~
STREET LOCATION
/-t'/z~ ~-/z ,~/Z) ~'~,~.,q.4/,4,'/0',4 ?'
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other
[] SINGLE FAMILY J~ Two [] Five
[] MULTIPLE FAMILY E~ Three [] Six
7. WATER SUPPLY [] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* ATTACH WELL LOG. A well Icg is requ'ired for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.) ,5'"0 '~ ~/,~ ,fi- ,/~/7z
8. SEWAGE DISPOSAL SYSTEM
J;~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
**If individual/on-site, give installation date //?~
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TiME
DATE DATE CATE
INSPECTOR INSPECTOR iNSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
E~ COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
EDPUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELL TO: Septic/Ho]ding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
[] APPROVED FO~ ~EDROG~S
[] CONDITIONAL APPROVAL Ila~e~ m~s~ accompany
~- DISAPPROVED
DATE BY (Title) //
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 !slate) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 200217. Anchorage, AK gg5io
Engineer's Printed Name Steven R. Pannone, P.E. Date /OC76-71
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
••••• aaa4
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
P�"^"'•""'.,
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
test do future of the system, nor do they that
. �.+`
: G •qg.H 'I
•••
satisfactory results not guarantee performance guarantee
0-;U
there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future
•• •••• • ••^-•-r'••"0
performance nor give any estimate of how long the system will continue to meet the operational
0_
•
requirements of the h10A DSD. The content of this report is for the sole benefit of the owner listed
o tK ° Steven R Ponnone!
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
•��'Jjz, No eE e t q9 j
••• •``�.�
confer any legal right whatsoever.
5. DSD SIGNATURE
•'••+.......••'e'
•�aassta: `�
��Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
X Other
By: Original Certificate Date:
(Rev I1105)
\ Municipality of Anchorage
' Development Services Department
Building Safety Division '
On -Site Water & Wastewater Program '
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: T1rN R2W Sec. ao Lotn W 212 Parcel ID: 0 2• 024
A. WELL DATA
Well type p If A, B, or C provide PWSID # _ Well Log (YIN) *T�SeG
Date completed Sliliq74 Sanitary seal (Y/N) Y
Wires properly protected (Y/N) Y
Total depth _So ft. Cased to So ft.
Casing height (above ground) 12+ in.
FROM WELL LOG
AT INSPECTION
Date of test
2 2010
Static water level ft.
2.0 ft.
Well production g.p.m.
as g.p.m.
WATER SAMPLE RESULTS:
Coliform " tT' colonies/100 mL Nitrate `J 6 ZmgIL
Other bacteria G' colonies/100 mL
Arsenic: -N&
ugfl Date of sample: r,11612020
Collected by: Laura Pannone
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Anchorage Tank Steel Date
installed sol77/i988
Tank size %000 gal. Number of Compartments 2
Cleanouts (Y/N) 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) 1N
High water alarm (YIN) N/A
Date of pumping 51-14f2020 Pumper Jr's Pumping
C. ABSORPTION FIELD DATA
Date Installed 20/21/2988 Soil rating (g.p.d.e or f&drm) 210
System type Bed
Length 3S ft. Width 28 ft.
Gravel below pipe o.s ft.
Total depth &s ft. Eff. absorption area ¢30 ftZ; . Monitoring tube Y Depression over field N
Date of adequacy test 5liSl2oio Results (Pass/Fail) Pass
For 3 bedrooms
Fluid depth in absorption field before test o in. Water addedg5o gal New depthz in.
Elapsed Time: ;S min. Final fluid depth g in.
Absorption rate >= kso+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No
If yes, give date
D. LIFT STATION
Date Installed
"Pump on" level at
Datum
In.
Size in`gal!phs Manhole/Access (YIN)
at _ In. High water alarm level at
tested \ Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot aoo+
Absorption field on lot soo+
Public sewer main N/A
Sewer /septic service line 25+
Animal containment areas loo+
On adjacent lots soo+
On adjacent lots zoo+
Public sewer manhole/cleanout NIA
Holding tank _loo+
Manure/animal excrete storage areas soo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation %o+ Property line so+ Absorption field s+
Water main NIA Water service line 25+ Surface water zoo+
Wells on adjacent lots aoo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line zo+ Building foundation %o+ Water main NIA
Water Service line 25+ Surface water soo+ Driveway, parking/vehicle storage zo+
Curtain drain None Known Wells on adjacent lots loo+
F. COMMENTS �YLQ III e. the
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone, P.E.
Date lmm S2
In.
COSA Fee $ —1 (J Waiver Fee $ _
Date of Payment LCA Date of Payment
Receipt Number _ U D t1c S Receipt Number,
(Rev. 11/05)
51.•vPn r Punn<
No CE 8W,
Municipality of Anchorage
Development Services Department
Building Safety 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 # 101066
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
72 W1/2 of T15N R1W Section 30 subdivision. This inspection revealed a
nitrate concentration of 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 Pact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
SGS
SCS ReEN
1102173001
Client lame
Pannone Eng. Srv.
Project Name/9
19107 Darby Rd Eagle River
Client Sample ID
19107 Darby Rd Eagle River
Matrix
Drinking Water
Printed Date/time
Collected Date/rime
Received Date/rime
Technical Director
Sample Remarks:
450ONO3 - MS recovery does not meet QC criteria, biased low. LCS meets QC limits.
05/21/2010 14:54
05116/2010 15:00
05117/2010 10:10
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date ]nit
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/17/10 05/18/10 KDC
Waters Department
Total Nitratc,Nitrite-N
5.62
0.100 mg/L
SM2045DONO3-F D (<10) 05/17/10 AYC
Microbiology Laboratory
E. Coli
Negative
I 100mL
SM209223B A 05/17/10 DLC
Total Coliform
Negative
1 100mL
SM209223B A 05/17/10 DLC
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
1.9107 Darby Rd. Chugiak, AK.
Well camera was run to 42' with no perforations noted. Well casing was extended to 18" and new
well seal and conduit installed. Wire trenched to house by customer. Inspected by Aarow Pump &
Well Service and found to be good.
Brian R. Wille
Aarow Pump & Well Service LLC
MAY.28.2010 15:28 9072617670
DYNAMIC PROPERTIES
#5242 P.002 /002
UNDER NO CW UMSTANCES SMOULO AN AI -GUILT
M SURVETOR TAKES RE � TFANFOR M 'NMAL TRA
CES PKVA0. OVER S
Im jL-, 5URVEY TYPE
,O{N"TIOT AS -AA T
IN& S"LCNAE A9 -0-T
PLOT MM ... AS -"Ulf
IT IS TME RESPONS191LITY OF TNC DOILULR UR I
CONSTROCTICN. TO VERIFY PROPOSED 9UILDINO
TO FNISHED GRADE PNOCOVCI
UTILITY
CONNECTIONS
TME POSTENCE Or AN NTS.
ANTS
VA•MCH DO NOT APPEAR ON THE RECORDED SI
mtvEy ceRnncATloN
COT PLAN
TUNDATKN AS -HILT
.'.
4121
FOR I
ONLY
DARBY ROAD
:ONSTMODTION OR FoR ESTABLMWC BOUNDARY OR FENCE L94M
AND A59UMES ►NANOAL VAgkm ONLY FOR TME DOST OF THE SURWY.
OVCTION MAT CAUSE ERRORS N SCAIE.
SYMBOL$
• SET REBAR " r ORAMACE�• ASPMALT
o FOUND REBAR 1-64 ROOD FENOE ..,:•'::.. CONCRETE
® ASSUMED EIEV. y--R-{F METAL CC`E ® WOOD DECK
40TE:
ONLY 7110SE IMIROV MLNT5 AOOve G MF40 AND MWRLE PALL SE
smowN. MNCES. HELLS. SCATC CLEANOUTS SIDEWALKS. DRIVEWAYS -
M.. ARE SHOWN IN TMCIR APPROXIMATC LOCATION. ONLY. SNOW
MAT ALL 045 kN�sNOha SEEN AND AT LOCATED.
APE RECORD S! C�+IERWISE NO
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional_ Land Surveyors
stow 1" = 6L0' -- --- -
OO4r an.•r•m 5/25/1D D...R 1010 �1�L•a sP
w— 5/27/10 "'NW0654 MK
"JP 1150
L•qd Dl'wV0.O: W 1/2 BLM LOT 72
SEC. 30 Tl 5N, R9 W, S.M. ALASKA
V7/L//L01V 14.V1
JRs Pumping
Po Box 773415
EaglcRivcr.AK 99577
(907)6946454
OurJ44JOL1
Dillino Information
Pannone Engineering
Po Box 100217
Job Description: 1000g
P.O. Number:
Anchorage, AK 99510-0217 Terms: Net 30
(907) 272.8248 Salesr•p: Karlia
Office 0 Map Book:
Job Site Information Cross Streets: Old Glenn Hwy
Laura Job Comments:
19107 Darby Road
Eagle River, AK 99577
(907)272-8218
Additional Location Comments
Tan color home whvhite trim
3rd house on right
Septic C the east side of home
Service Type
Septic Sery 1000K
Service Agreement
Number.
030913
Order Date:
13 -May -2010
Service Date:
14 -May -2010 12:0
Technician:
Mike
Tax %: 0
Job Type: Repeat
Map Grid: 67 - -
Sery '12/092008' 1000g
----SERV & BILL
PUMP TANK ONLY
sped & Cked Tank - Go - Good
-2 X's
Diagram: S:\Dlaaramst2044911omb
• a
Qty Price Each Tax?
1 $185.00 No
Gallons Planned: 1000
Gal. Actual:
Hose Length:
Double Tank: ❑
Pump System: E
Baffles Inlet: D
Baffles Outlet: G
Extension Actual
$185.00
NonTaxable Total Taxable Total Tax Total Grand Total
Estimated Charges: 5195.00 $0.00 $0.00 slas.00
Actual Charges:
Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT.
r
Signature and Title or Customer Representative Date
Accepted by JRs pumping Date Accepted
For your added convenience we accept: American Express. Dicover, Nsa and Master Card payments over the phone
Aller 30 Days account will be turned over to COLLECTION]. $30.00 For NSF Checks Returned.