HomeMy WebLinkAboutPARKSIDE BLK 2 LT 2Onsite File
Parkside
Block 2
Lot 2
#050-591-09
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: PID Number: 050-591-09
Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Paul Zahorik
ABSORPTION FIELD
❑ Deep Trench ❑Wide Trench El Bed ❑Mound
Site Address
23475 Glacier View Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Parkside 2 2
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
100'+
I
TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1000 Gal.
Surface Water
100 +
Material
Steel
Number of compartments
2
Lot Line
51+
NA
Foundationg,Q'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Septic Tank Being Documented at this time
**Tank cleanouts are (3034) dco constructed of (ABS)
Alarm location
Electrical installed by
A I'�> 2 69 �e 1 613,r
PIPE MATERIAL House to tank 3034 Tank to ABS
drainfield
Installer
Homeowner
Drainfield CO/MT**
Inspector Pannone Engineering
BENCH MARK (Assumed elevation) 1021.5 ft
Inspection7/23/2020
1s` 5/13/2020
Location and description
2nd
11
3"' 41
Bottom Trim @ B
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
��oF.?��s��
Steveii R. F'arrione
Septic Syste
Approved Date/D 8 2�
CE 8149
�sTF
��� ,FO;rSSI01�°�.®
Note: this approval d s not include well permit requirements.
(Rev 05/02/18)
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NOTES: PANNONE ENG SVC, LLC C.I. 1088) REVISIONS DATE
RECORD DRAWING P.O. BOX 1807 PALME, AK 9945 C.- A4
PHONE 00 �2FAXR6
(907) 745-8201 REV 1: 8/4/2020 SCALE 7/29/2020
1 40'
PARKSIDE 132 L2 .... .. .......
P.I.D. NO
050-291-09
DRAWN ACP PAUL ZAHORIK
�A- Steven R. Pannom
PERMIT NO.
23475 GLACIER VIEW DRIVE CE -8149 Ospxxxxxx
SITE PLANSHEET
EAGLE RIVER, AK
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NOTES: PANNONE ENG SVC, LLC C.I. 1088) REVISIONS DATE
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PHONE 00 �2FAXR6
(907) 745-8201 REV 1: 8/4/2020 SCALE 7/29/2020
1 40'
PARKSIDE 132 L2 .... .. .......
P.I.D. NO
050-291-09
DRAWN ACP PAUL ZAHORIK
�A- Steven R. Pannom
PERMIT NO.
23475 GLACIER VIEW DRIVE CE -8149 Ospxxxxxx
SITE PLANSHEET
EAGLE RIVER, AK
1 2 OF 3
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NOTES:
PANNONE ENG SVC, LLC (C.l. 1088)
P.O. BOX 18 PALMER, AK 99645
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REVISIONSDATE
8/4/2020
RECORD DRAWING
' SVI
74597
NE (907) 8200 FAX (907) 745-8201
-�SCALE
PARKSIDE 132 L2
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23475 GLACIER VIEW DRIVE
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MtJNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl, PROTECTION
ENVIRONMENTAL ENGINEEI-IING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WEI.L INSPECTION REPORT
[] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
Ne. OF ~EDROOMS
LOCATION
L/F NOMEMADE:
No, of lines ---'~len~th of each line
Top of tile to finish grade
Width
Inside length
Total length o lines ~T~e~er~th -
PERMIT NO.
No, of compartments
Liquid dept h_~.__
PERMIT NO.
Liquid capacity in gallons
PERMIT NO. ~-~O ¢O/~
Distance between lines
Total effective absorption area
PERMIT NO.
Crib diameter Crib depth Total effective ahsorption area
Well Building foundation Nearest lot line
Driller
Distance to lot line
DISTANCE TO; Building foundation Sewer line Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED
72~0~3 (Rev. 3/78>
DATE LEGAL
IIEFJL.TH Fib!I) EN'v'IF;;:Ed"q'/_b:h!TF~I .....
THE [..EI',IGllf'FI !):t: I"ItlEII',I::; I Obi .1_' S 'THE: I..[:-:NCFI'H ( :1: N F'EE:q' ::, OF:: "['1~1[:_:: 'TF?.EI',ICFlt 01:;?. [:,[~:f:t ;[ bff:: ]: IZ[.D.
THE DE:F:'TH OF: Ft TI;~:E:i".ICH OF: F':(T :I::E; ff't"l[~: [::' :[ E;TI:aI",II:::E DE'Tb.!EE:N '[hie SI..II~:F:FIC:E: OF::' THE:
(:~[~:(}lJblD FINE) THE !~[nZi'l"TOH CIF= TI'IE
THE GI::;:t::I',,,'[~2.. [:'E:F'TH Z::}:; i-HE: H:[NIHUH [:,EF"I"FI Eft= I::)[~:l::l'v'[i[l.... E:I}}:"f'I,.!E:I:}}:I",I 't"HE OI_ITF:FIL.L.. F':[I:::'E
FIt'-iII;)-['~IE t~H:?'f'"I'OH :::IF' 'T'FIE: E',:':;E:f:¥v'FflIZOF:I ':::[lq F'EE;-I").
I ' ' ' ':'':' :1 '" ' I: :' I ' I' !.[ --. [)[!i:F:'I::IF;FI''P'IE;MT r, IF' Z H ":i 'i'HE:
F:'EF;:H:!:T -ti I"1_ _.-i,ll I-If::lS THE; [.L....[ ..[']_iL. ZL.I I ~ "1'O II",lF::Ol:;~ff'l ' '"
:1: NSTFILL.F:IT :[ I::jlllll :[ f",t:!ii;F::'!E: T ]:: I'.l':j OF' FIi":I"? l II .L.i.L:, FI[).JY:ICE:I",I"I" TO I I I.[ :1 Ii I -- F I:: I I ~ FIHD
NUI'"IL:~EF;: OF' £'L.....LL EJ'IL[ ..... THFIT THIZ HE!LL.[. I"JII..! ........ E.F'.'
I'"111: I",t I HUH [):t: :!J;"I"FII~ltI:[:I!~[ E:E'f'Iqt!i[E:I",! I:::l MEI..L f:]l".~[) Flllq'¥' ([lll',l-':!~; 1 1%
::LI~)E~ t:::'!EET l:=Ed:;;: 1::1 t::'F;'.IVFI'T[~: I,IEL[. OF?. :[J::.:.iE~ 'TCI ;?.[~C~ FEET I:::F;:E~P1 F:! F'I...IE4L. IC HEI....!.._
I..JF:'Cd",I THE T'¢F'E OF: F'I..IE:I..IC !,.IELL.
Ill'I :[ I'-;I :[ pIII,.,IP'I [:, ]: '5 'I"FII",E:E[ F'F[CII"I f:~ f::l[;: :[ ',,,'[:l"[If:: 1,1[~:[.,L,. I'Ei FI F'[;~ Z ",i'FIT[[ :~;l~[I,,IEfi: L :[ hlt[~: :[ :E; ;;::~:.; I:=[~[ET FIll'iII)
TO F1 C:OP!I'"tLINiT'.r' SE::I,IE[F;: L:[!',!E: /IS I;;:' II.~i F:'IEE:T.
OTH[[F~: ~;'.E~6:¢J :!: I;;:El"l[~:hl"l"~; I'"~FP'r' I=ff:'F'L."?. t[;~;I'::'E:C I ~::' :[ E:f::IT :[ OI",IS I::1[".![::' C:Cd",ISTI:~:UC T
& E ENG.NEERING & DEVFLO,
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
MENT CO.
Russell Oyster
694-2774
Performed for:
SOIL LOG
Earl EIll~
688-2280
Legal Description: Z~'z' .2,
Mailing Address: ,P.O. ~O~. .Z/'~'-~/
Depth (feet)
0
5__
6__
7__
8__
9__
10
11__
'12 __
'13 __
'14 __
15__
Soil Characteristics
Ground Water Encountered: Yes. _No f
Proposed Installation: Seepage Pit Drain Field.__
Comments:
Performed by: .X~/~ / '~'
PLOT PLAN
PERC. TEST
l y~, 4~r r
If yes, what depth
Date: ~//$~/~ 7~
Municipality of Anchorage
Department of Health and Human Services
:~ ,:Division of EnvironmentaIServices
On-Site Services Section 825 "L" Street Room 502
',, P.O.' Box 196650 Anchorage. AK 99519-6650
; ~ i;" ¢~:: r www. cL'anchorage.ak.us; ~ ¢
· : (907) 343-4.744
CERTIFICATE OF HEAI;TH,AU~O~IT¥,.A. BPROVAL hO~ A'SINGLE FA~i~ M~ELL'Ih~ ':'
,.: ',', ~" '; .......... 7'", ' ' -
4< :';,, ",," A '"" '"
/?;1/," GENERAL INFORMATION
,, Complete ega~descnpt~on Bot 2,: Block
~ ':"'' "-~'":~'": ~:';~ '" ' ' 23475 Glacier View Drive
· '...~, bocadu. (rote address or d rect cna) .,~ .,.
::; CurrentPrepe~yowner(s) Seff & ~l~zabeth Johnson Dhyphdn® '694-7675
M~¢iia~: ~dress ' '
Fi'AA#-~/~) ~ ,~'/
Expiration Date:
Lending agency
Mailing address
Day phone
RealEstateAgentPa_r~ners Real Estate/Cindy Wilson Day phone 694-4994
MailingAddress11940 Buslness Blvd. Sulte 100, Eagle Rlver, Ag: 99577
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
' 2, NUMBER OF BEDROOMS: ' 3 : :
TYPE OF WATER sUppLY:
Individual Well ~
Individual Water Storage
Community Class
Public Water System
TYPE oF wASTEWATER DiSpOSAL:
[] ' Individual On-site ' []
- [] Individual Holding Tank · []
Well [] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. OliO0)'
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
S & S ENGINEERING
17034'Eagle River Loop Road NO, 204
Name of Firm
Eagle River,, Alaska g9577
Phone
Address
Engineer's Printed Name
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
':" ....-¢'.~. c. O~-
, ~ ROBERT
' ,% CE-8801
bedrooms, with the following stipulations.
Conditional approval for
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
o
75-025 (Rev. 01/00)*
u .
unicipal,ty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICESdU
[Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501
Legal Description:
A. WELL DATA
Health Authority Approval Checklist
i Parce,,.D.:
Well type
Log present (Y~))_ /v ~
Total depth u'l ¢
Sanitary sea~)
FROM WELL LOG
/~/' V'Z'""~r-~ If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to '~
/./-
Date of test
Static water level
Well production
Casing height (above ground) //"/"
Wires properly protectedON)
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ¢/,~ ~-,-' Tank size
/
Foundation eleanou (~N)
D ate of P u mping ~/.~/////~
Date installed
Length ¢~ Width
Nitrate" Other bacteria
$ & $ ENGINEERING
Collected by: !7nr~4 ~,,91,~ m~,,.. I ,~,,p
Eagle River, Alaska 9~577
/~/~) Number ofComparlments ~'...-- Cleanout~:~'N)~
Depression (¥/¢ /~ I-li§h water alarm (Y/lq) /~//.~-
Pumper k.~/~3
Soil rating (g.p.d./fForfF/bdrm),~.;~O~Systemtype ~ Gravel thickness below pipe ~'=- /Total depth
Effective absorption area ~~ Monitoring Tube present, N)~ Depression over field (y~ ./V/~
¢~/~/ bedrooms
Date of adequacy test Result~Fail) ~-¢ For_ ~~ ~/'
Fluid depth in absorption field before test (in.); / ~ Immediately after'al, water added (in.):
Fluid depth (ins) Minutes later:__ ~ Absorption rate = .g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~[~ If yes. give date ~
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
"Pump off" level at*
E, SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
9-
/
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~ ¢- Property line ~- /'>"- Absorption field
Water main/service line ~--~- ~ Surface water/drainage ,//~ .~ Wells on adjacent lots
/
/0/+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line f~ /'~- Building foundation t/~) z./_ .
Water main/service line
Surface water / ~(~
Driveway, parking/vehicle storage area
Curtain drain ,/~0/k/"~F ,//~/¢r74/,,,~ Wells on adjacent lots
ENGINEER'S CERTIFICATION
..?~ ~;: OF,
. ~.. ~ -, .......
I certify that l have determined thru field inspections and review of Munic,pal reco~.t~:~,t~ a~o; ~ are
in conformance with MO~ HAA ~uidelines in effect on this date. 5~ ~ /' ~ ~".~
Signature ~ ~, [~ :.~,~.,~ .....
Enn neer's Name /[ 80¢~ ~ ~. LO~ ?j ~ ROBERT C COWAN
., / / ~¢,~ CE-880]
Date ~ / l~/OO ~¢~* .........
HAA Fee $ ~
Date of Payment
Receipt N.mber
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number