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HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 2 LT 3Prospect Heights #5 Block 2 Lot 3 #015-135-11 Municipality of Anchorage Page of `I DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 ID Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 49 LO ` Fdo �� PID Number: --� Name: Wastewater System: [$New ❑Upgrade Address: z ZO "vt-rrrzzot FIELD__ Phone: �No. of toms: _ABSORPTION Deep Trench ' O Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTIONi, Soil Rating: Z Total Depth from original grade: ' GPD/So, Ft._ _ Lot: Block: �1...a '� Subdivision: 1�,, 3 Z Depth to pipe bottom from original grade: L'I d _ Gravel depth beneath pipe 6.71 C�fi f�2GT fi'`' Ft. .7 Ft. Township: Range:Section: _ Fill added above original grade: Gravel length: r -- —•� --- 'Z r ^ L✓. (LAA Ft. Z2> Ft. WELL: �j New ❑Upgrade Gravel width: Number of lines: ! Distance between lines: '30 Ft. Ft. Classification (Private, A,B,C): �}�l "(•'(� Total Depth: .j�u� Ft. Cased -T' q?109— Ft. Total absorption area: 7Z!> Ft. Pipe material:/ F Ad `3034( Driller: Date Drilled: Static Water Level: A�{�INt-1JaILUA) .S_Ft. —SO. Installer: •1 0A) I�Af_wwta2 �a Date installytl: Yield: Pump Set at: Casing Height Above Ground: 6 GPM Ft Z t Ft. TANK — V ---- SEPARATION DISTANCES Xseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ANCY /Sar) Well- Ito lia` z i/o Material: s � Number of Compartment s -2- Surface Water lOt7� _ SOOT` _ LIFT STATION Lot Line f?7l CiC? Size in gallons: Manufacturer: Foundation !G , 1 6 "Pump on" level at: "P o f' vy,hat: High water alarm at: �� Curtain _ Pump Mak �I Electrical Inspections performed by: Drain Remarks: BENCH MARK _ _ — Location and Description: ttir & F^laoA 0r 0-,W P-0 --- Ass)Elevation: --/ o 16 ENGINEER'SSEAL �—� } 4SIrh t' Inspections performed by: s •R�awadNr� B_ Dates: 1st_`�4�/Q4 s •�� ••.. a .•<,m•...,.«,..t 2nd FIA)A ( 1 .Z/4Q Steven R.wPannono ,�tp 2X Department of Health and Human Services approval 149 ;;+ •. CE - 0s� � �•;; Reviewed and approved by:yn Date: /°'� g1e��°PRsAa}z iay:, waw 72-013 (Rev. 9/91) MOA 25 PERMIT NO, SW990062 AS -BUILT PJ.D, NO, 015-135-11 WASTEWATER ABSORPTION SYSTEM 7/4 LOT 3 BLOCK 2 PROSPECT HEIGHTS N0,5 S/D y3� EXIST'G WELL C,\Work\3-2PROS,DWG 49TH Panni 8149 NO WELLS OR SEPTICS WITHIN 200 FEET OF NEW SYSTEM, LOT UNDEVELOPED, EXIST'G WELL DRIVe4/qy SEW NO WELLS OR SEPTICS WITHIN 200 FEET OF NEW SYSTEM. WELL NEW PF;IMARY SYSTEM fl_4_-6,7' EFF x 58 LF DEEP SEE TYPICAL SECTION, DESIGNi PERC RATE 5.7 MIN/INCH SOIL RATING] 1,2 GPD/SF e0 125 SF/BR, 5 BEDROOM HOUSE 625 SF REQUIRED ♦� DEEP TRENCH, 6.7' EFFT'V, �....., 50 LF OF TRENCH ® 670 CF _ PREPARED FOR; PANNONE ENG. SVC Al John HagNeler P, 0. BOX 102954 Ar Hagroeler Construction ANCHORAGE, ALASKA 99510 2204 Cleveland, Suite 201 Anchorage, AK 99516 272-8218 Phone & Fax (907) 248-6789 DATE 9-17--99 TAS -BUILT SCALEi 1'=100' CO A D �""--..��`•- FC 14,0 13,2 Tl 30.5 10.8 T2 40.6 18.5 NO WELLS OR SEPTICS WITHIN 200C1 - 47.9 251 FEET OF NEW SYSTEM. LOT I C2 52.8 29.6 UNDEVELOPED. C3 85.8 63,6 11 MT 93.7 68.3 I C2 -C4=627' II C3 -C4=50.0' DESIGNi PERC RATE 5.7 MIN/INCH SOIL RATING] 1,2 GPD/SF e0 125 SF/BR, 5 BEDROOM HOUSE 625 SF REQUIRED ♦� DEEP TRENCH, 6.7' EFFT'V, �....., 50 LF OF TRENCH ® 670 CF _ PREPARED FOR; PANNONE ENG. SVC Al John HagNeler P, 0. BOX 102954 Ar Hagroeler Construction ANCHORAGE, ALASKA 99510 2204 Cleveland, Suite 201 Anchorage, AK 99516 272-8218 Phone & Fax (907) 248-6789 DATE 9-17--99 TAS -BUILT SCALEi 1'=100' PERMIT N0: SW990062 OS --BUILT DETAILS PJ,D, N0: 015-135-11 WASTEWATER ABSORPTION SYSTEM 31y LOT 3 BLOCK 2 PIRDS13ECT HEIGHTS NO.5 S/D m a U t d 9 tl U Ltl q La P L i d L n !r 3Hn1 MEOW G;.•'" V Nn[1tl([Nnod 49R PREPARED FOR: m Ln 149 Ar John Haomeler �,. Hagneler Construction 2204 Cleveland, Suite 201 Anchorage, AK 99516 <907) 24H-6709 _.1 L7 m i0 k Z m 1nONV3ln z m < M Q1 � W R W i c —4' 7 f— �V Ll LD __To Toa jZ iN..y LilOH a I- l LD El LLJ m Z N G% v C o I LnONV3-13 =j 1nONV3"17 1noNV3 10 M C:\Work\3-2PR11S.DWG innNe3_13 G;.•'" V Nn[1tl([Nnod 49R L'1 O =o U Z Ln W of W Ld LI a Ld W r R D h PREPARED FOR: �nnono•; 1e Ln 149 Ar John Haomeler �,. Hagneler Construction 2204 Cleveland, Suite 201 Anchorage, AK 99516 <907) 24H-6709 L'1 O =o U Z Ln W of W Ld LI a Ld W r R D h Ln N 00 0 I— W Z _.1 L7 V J W F_ z < M oa D_ a R W i c Ll0 ~ �V Ll LD LJZ Toa jZ iN..y LilOH I- l LD El LLJ m Z N G% W H El Cz a_ PANNONE ENG. SVC. P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX fTEI 9-17-99 AS -BUILT IT T❑ SCALE 11LI /® Mu' nicipalnty of Anchorage Department of Health and Human Services 825 V Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Mystrom http:l/www.cl.anchorege.ak.us Mayor Permit Number: #SW 990062 Date of Issue: 4-16-99 Parcel Identification Number: 015-135-11 Date Started: 8-1L99 Date Completed: 8-2-99 Is well located at approved permit location? N Yes ❑ No Legal Dcscr�lJiogt Posnect Hqhts # 5 Blk 2 lot 3 Property Owner Name & Address: John Hagmeier Company 2204 Cleveland, Suite 201 Anchorage, Ak 99517 Borehole Data: Depth (ft) Method of Drilling M air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: Steel Stick-up 0 2 Wall Thickness: .25 inches organics and silt 2 6 Diameter: 6 inches Depth: 73 feet gravelly silt 6 23 Liner Type: gravel 23 29 Diameter: inches Depth: feet Casing stickup above ground: 2 feet silty gravelly sand 29 36 — Static water level (from ground level): 65 feet silt 36 50 Pumping level: 525 feet after silty, sandy gravel 50 61 2 hours pumping 6 gpm Bedrock 61 525 Recovery Rate: 6 gpm Method of Testing: airlift H2O f 495 525 Well Intake Opening Type: ❑ Open End ® Open Hole ❑ Screened Start_ feet Stopped feet ❑ Perforations Start feet Stopped __ feet Grout Type: Bentonite # 8 Volume: 1 bug Depth: Start 0 feet Stopped - feet Pump: Intake Depth feet Pump size hp Brand Name _ Well Disinfected Upon Completion? Z Yes ❑ No Method of Disinfection: clorox Comments: RECEIVED Well Driller: Alpine Drilling & Enterprises P.O. Box 110496 SEP 22 1999 Anchorage, AK 99511 0Mumclpelity of Anchorage opt.1'lealth & Human Services Attention: The wel#4hs.Itershaf1A"vide a -well fog tante propeaEyownor within Mdays ofoomplotion and the property nurnrr nr t6r uirll Ari II or A 11 nrnviAr a ' r'A inn to tiir Tirn1 nMMth R. 14nman Crrvirrc uiith in fl) Ao"e of rmmn lMinn ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW990062 Legal Description: PROSPECT HEIGHTS #5 BLK 2 LT 3 Design Engineer: 0062 Pannone Engineering Services Owner Name: John Hagmeier Company Owner Address: 2204 Cleveland, Suite 201 Anchorage , AK 99517- Date Issued: Apr 16, 1999 Expiration Date: Apr 15, 2000 ParcelID: 015-135-11 Site Address: 008100 ONEY CIR Lot Size: 105955 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: 1] Disposal Field [✓] Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑✓ Private Well ❑ Water Storage 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: (r4 X I �L ). Date: l /09 Date: �� MUNICIPALITY OF ANCHORAGE Department of Health and Human Services cG� On -Site Services Program 825 L Street, Room 502 n C P.O. Box 196650, Anchorage, AK 99519-6650 343-4744 (907) ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW990062 Legal Description: PROSPECT HEIGHTS #5 BLK 2 LT 3 Design Engineer: 0062 Pannone Engineering Services Owner Name: John Hagmeier Company Owner Address: 2204 Cleveland, Suite 201 Anchorage , AK 99517- Date Issued: Apr 16, 1999 Expiration Date: Apr 15, 2000 ParcelID: 015-135-11 Site Address: 008100 ONEY CIR Lot Size: 105955 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: 1] Disposal Field [✓] Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑✓ Private Well ❑ Water Storage 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: (r4 X I �L ). Date: l /09 Date: �� Steven R. Pannone, P.L. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907) 272-8218 (907)272-8218 Fax April 11, 1999 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 3, Block 2 Prospect Ileights Subdivision, Well & Septic System Permit Request Gentlemen: My firm was contacted to design and install a new septic system and well for the referenced lot. We conducted a field investigation to locate existing wells and septic system before designing the proposed system. Two test holes were excavated on April 3, 1999 for the system design. No ground water or bedrock was encountered in either testhole. The lot is approximately 3 acres in size. Lot 3 slopes to the southwest at a rate of approximately 3-5 percent with rolling hils throughout the lot. The proposed drain -field installation will be located in the central portion of the lot. Double clean -outs will be installed after the tank. The proposed location is greater than 100 feet away from any wells. The proposed system will be greater than 10 feet from the water service lines. 'fire proposed well for this lot will be located nosh east of the proposed house, greater than 100 feet from the proposed drain -field. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation. Sincerely, Qac Steven Attachments: Steven R. Pannone FE - 8149 C%WORK\3-2Prospectnts.00l.mpd PERMIT NO, SW ---- ---- -- DESIGN P.LD, NO, WASTEWATER ABSORPTION SYSTEM LOT 3 BLOCK 2 PROSPECT HEIGHTS NO.5 S/D NO WELLS OR SEPTICS WITHIN 200 FEET OF PROPOSED SYSTEM. LOT UNDEVELOPED, .._ 6A_........ �....,...._...._....._.._... NO WELLS OR SEPTICS WITHIN 200 OF PROPOSED SYSTEM, --FEET EXIST'G"^, ROPOSED WELL WELL El ix� PROPOSED 5 BR HOUSE "... `. �''" '`• ''- Y PROPOSED 15008 l\ 5 .+ TP SEPTIC TANK Ffeg ''f tltb.' .,,.. EXIST'G L-. �T4 TPF--`- WELL M� ' Ir / -- PROPOSED PRIMARYSYSTEM N„ %� DRlVFWAV_- .,, ES T EFF x 50 LF DEEP TRENCH. ! SEE TYPICAL SECTION. RVE AREA i eo NO WELLS OR SEPTICS WITHIN 200 FEET OF PROPOSED SYSTEM, LOT UNDEVELOPED. ups 1 .l\Work\3-2PROS,DWS ao a� OFPEC rle�b� DESIGNj RATEi 5.7 MIN/INCH w ,.........;q •• !# L RA(� SORIMG 1,2 GPD/SF 125 SF/BR, 5 BEDROOM HOUSE ♦•�P'•• �0 i 625 SF REQUIRED '� '• 49TH �'•�0 DEEP TRENCH, 7' EFFT'V, %.....i.. ..}v�y.�.� .......:.....is 50 LF OF TRENCH - 700 CF PREPARED FOR, John Hagrleler — PANNONE ENG, SVC `f'.�...Y..:.1, .. L........... :•,•... f1 : �® ;Steven R. Pannone:r 0� '•. No. CE 8149 P, O. BOX 102954 o Hagmeler 2204 Constructlon Cleveland, Sulte 201 ANCHORAGE, ALASKA 99510 ,.•''a"� 272-8218 Phone & Fax . as Anchorage, AK 99516 DATE, 4-7-99 DESIGN _— oil <9075 <9075 248-6789 PERMIT NO SW DESIGN DETAILS P.I.D. NO WASTEWATER ABSORPTION SYSTEM LOT 3 BLOCK 2 PROSPECT HEIGHTS NO.5 S/D 1noNU-13FL C � ?Ia 'f I ; e, a a f u c L U tl tl U K z Z tln c Z. CI z J `r A 1-1 �-- 311n1 iIOlINnW C T w In LLI hi (� II• i w. fly. an 3 } J E ; 13 1noNv313 - 7'— H CL ns d IJ13 rn -1 II o a, z o o0 o N o 0 a7 wZ F1 J J L-1 Y H Z L` inONv313 d 1nONV3'13,– oQ 1nONv3-10 WZ CI\Work\3-2PRDS.DWG inONv3i:1 >;d ZZ — z'i',vwi Woz ,ss aQF uok�,• Z a pq �. . ....... q ��� ° 000 NouvaNno s.....: ...� s �L••— i PREPARED FOR, — ---- "' "" PANNONE ENG. SVC, .Steven R. Pannone: ■ No. CE 8149 John Hagneler P. 0. BOX 102954 0 II AV Hagroeler Construction ANCHORAGE, ALASKA 99510 016Y r�.�••n�, (� 2204 Cleveland, Sulte 201 OOODt�.,.�U off• Anchorage, AK 99516 272-8218 PHONE & FAX 0�ki 'a 'L wraaa4 (907) 248-6789 DATEI 4-7-99 NOT To SCALE DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH &HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: blN ill VA4a1A C3l(�=_ _DATE LEGAL DESCRIPTION: �..�( ��-V'�O�C B i,�r� � Township, Range, Section: _ DEPTH SLOPE SITE PLAN (FEET) TTT rT1-fT�l-TT"T1 cra (�)21,ANt6-5;IML 2 3 4 5 G,P �h�aLY Grz�� �( IiZIJ c c3 5� Q nll� 6 7 8 9 10 �'ocr2 L Yl RAt m 12 sq up w( -pap" 13 5P+.'-/��1taCS Ky MSfa 14- 15 r. 17 yvj L S cn S r Lz-S 18 k�T(zQcS S.ANI] 1914 MvvxsS * &I L;-cz WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water A ter Monitoring? RY Date: 4 ((t14� Reading Date Gross Time Net Time Depth teoP Water Net Drop 3 4 /iib — 6° /11 : 13 '1 O 4' r/y -- I lit 23 /et z3 --- 6'8 /N 3 /sem 73/6 !N 3:5 6 '/V _ 111 43 q / (-1 et -3 -- ry 93 / yYy 20 t__] PERCOLATION RATE � (minutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN 6 FT AND 2- FT COMMENTS�T trC7 LE3 WAS �QF3S�A K,( __ PERFORMED BY: S ` 2- 2- LV - I — CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ! } fIV'• •4'• Municipality of Anchorage {+'fr. t DEPARTMENT OF HEALTH & HUMAN SERVICES 4%11 d,; 'A 825 "L" Street, Anchorage, Alaska 99502-0650 ... " ' 'w.'°. SOILS LOG — PERCOLATION TEST sloven_ R.`'Pannone iqv PERFORMED FOR: --"� V' ' V"' ° �`�`�r r �- DATE PERFOR Ff?�•"•�-� —2 Q�2ost�c G-7- .;.:.._ LEGAL DESCRIPTION: t Township, Range, Section: FETE PTHp SLOPE SITE PLAN r— r T (FEET) `� \ F-F—� �-1 I I I II 1 4J 62,gI JrLT1 1ti0-,AV&CS 10 Net Time WAS GROUND WATER Net Drop ENCOUNTERED? 11 /C7 /_ VJ IF YES, AT WHAT J _�_• DEPTH? 12 --- 13 Cl iL( Depth to Waler Aver f ! dOX Monitoring? gale: 41516 14- 15- 16 71819 17- 18- 19 S L O P E Reading Date Gross Time Net Time Depth t A= Water Net Drop /C7 41 20 ,r PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST �R�U�N�B/�ETWEEN FT ANDFT COMMENTS _r -f4' ��s_�(2 C7'��%n K -UL PERFORMED BY:` �:.% c<� ___ CERTIFY THA THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL. GUIDELINES IN EFFECT ON THIS DATE. DATE: -3 72-008 (Rev. 4/85) • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-135-11 1. GENERAL INFORMATION Complete legal description Expiration Date: Z -21I Prospect Heights #5, Block 2, Lot 3 Location (site address) 8100 Oney Cir. Current Property owner(s) Stanek Family Trust Day phone Mailing address Real Estate Agent 8100 Oney Cir. Anchorage, AK 99507 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone • 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fxl Individual E Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: Date: COSA to be released to the eng , unless otherwise requested by the engineer. COSA Fee $ t6 Waiver Fee $ Date of Payment Et hqx Date of Payment Receipt Number Receipt_Number . COSA # SSC 15l !39 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 ofbedroomsand 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 Slate codes, ordinances, and regulations in effect at the time of installation.. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 04/x/15 6. DSD SIGNATURE System #1 Approved for bedrooms -S eGer k.' annone - " System #2 Approved for bedrooms +��5 CE -8149 Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: The un' alt of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory - Arsenic Advisory Well Flow Advisory Other COSAbleeaheetf 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: Prospect Heights #5, Block 2, Lot 3 Parcel ID: 015-135-11 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 08/02/1999 Sanitary seal (Y/N) Y Totafdepth 525 ft. Cased to 73 ft. WelfLog (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. - FROM WELL LOG AT INSPECTION - Date of test 08/02/1999 04/02/2015 Static water level 65 ft. 73 $ Well production 6 9.p -m. 1.2+ WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate t�• 6-7 mg/L Arsenic N fl ug/L Date of sample: N 21 Z DI s Collected by: ?0-S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 09/08/1999 Tank size 1,500 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (WN) N(j High waters alarm (Y/N)-N Date of pumping 'Z i S Pumper�Pmx&_ t .Ixef- p V a cm 5Q"Q-2_ C. ABSORPTION FIELD DATA Date installed 09/08/1999 ( rating ('g.p.d./ft2 or fe/bdrm) 1.2 g.p.d./sf System type Deep Trench Length 50 ft. Width 3 ft. Gravel below pipe 6.7 ft. Total depth 11.3 ` ft. Eff. absorption area 670 ftp Monitoring tube Y Depression over field N Date of adequacy test 04/02/2015 Results (Pass/Fail) Pass For -5 bedrooms Fluid depth in absorption field before test 10 in. Water added 784 gal. New depth 17 in. Elapsed Time: 280 min. Final fluid depth 10 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25� Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 1-0+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 cert/fy 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 Date 4�(� 2� 015 COSA canary sheet 2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ :Steven .� none;•• CE 8149 Y 82-313 PROSPECT HEIGHTS SUBD., ADDN. NO. 5 LOT 3 BLOCK 2 105,955 S.F. <1 ONEY CIRCLE 150' FINAL STRUCTURE AS -BUILT GASTALDI LAND SURVEYING JEFF A. CASTAI.DI. R.L.S. 4726 WEST 89TH AVENUE ANCHORAGE, ALASKA 99502 PHONE 248-5454 CRID DATE 2540 9/20/99 F,S. JOS N0. AA ... a cl)Pr71 I HEREBY CERTIFY TFIAT I HAVE 5URVEYEO THE PROPERTY DEPICTED ABOA AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. R IS THE RESPONStBILf Y OF THE OWNER TO DETERMINE THE EKISTENCE OF ANY EASEMENTS COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECOROEO SUSOMSION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE UNES. ANCHORAGE RECORDING Dtsmia, AL4KA NOTE. NO CORNERS SET THIS DATE. Engineer: _egal Description: permit: teport Type: Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997 htto://www.mun i.oro/onsite Planning and Development Services Department On -Site Water and Wastewater Program On -Site SewerlWell Submittal Comment Sheet PANNONE ENGINEERING SERVICE PROSPECT HEIGHTS #5 B2 L3 OSC151139 WellSeptic COSA Completed By: -he attached paperwork has been reviewed and 's being returned for the following reasons: 1. Survey not to scale. ��� _ ) 4/21/2015 J.Poet 2. Pumper only stated 1350 gallons pumped out of a 1500 gallon tank. Did tech verify tank is not leaking? �%S r VIS i TAIU V Z 1AJ v LS ?A t=TFW t' MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLI'N`G Parcel I. D.# HAA# 1. GENERAL INFORMATION L6T Cocl� Z73 o1 cT Complete legal description ; -t Location (site address or directions) Property "ownIar t)a I A4mP_tLW- C©. Day phone cCfg_ L? -D.. 9 Mailing address ,Z�a� CLc3ug-LAC ib A✓& Su17-a zv! 99S�/� Lending agency — Day phone Mailing address -- ---. Agent _ Day phone Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well k - Community well _ Public water _ NOTE: Itcommunity well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL.: Individual on-site k Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rw.1/91) Front MOA121 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 of this Health Authority Approval application 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�A ON a L3NG.S V C Phone 7?- Z l Addressy'- d � 0X- /0 2- 9-5_z-1. AN �� ✓d iL oJ9S/0 Engineer's signature C___44 Date — , NLS Co�v�RUc-r7-ON , 6. DHHS SIGNATURE 1� Approved for EL� bedrooms. Disapproved. Conditional approval for Additional Comments M Steven R. Pannone h CE -Q149 ��� 4 F�pAOfESSO 0.4• bedrooms, with the following stipulations: Date /D -S" a/7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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. 72-M(Aw.1/91) Back MOAa21 Municipality of Anchorage C I C C E*DD DEPARTMENT OF HEALTH & HUMAN SERVICESri Environmental Services Division 1999 82.5 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34V744 Municipality of Anchorage Health Authority Approval Checklist Dopt. Health & Human Services Legal Description: _L -3'T32':710 +--c _ Parcel 1.D.: 01.5/36-1/ A. WELL DATA Well type `prz tL)A—F a If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth �n 2 Sanitary seal (Y/N) Date of test Static water level Well production Y Date completed F) /-z/ C? T Cased to _ 3 Casing height (above ground) FROM WELL LOG 012/'? T WATER SAMPLE RESULTS: Coliform MR Date of sample: _ ? /z6( 4 B. SEPTIC/HOLDING TANK DATA Wires properly protected (Y/N) AT INSPECTION 2` g.p.m. Nitrate sC) Other bacteria 17 g.p.m. Collected by: _ S •R54�✓MfwoN v Date installed `t 0 / 4 2 Tank size _tSz7n Number of Compartments 2 Cleanouts (Y/N) l v Foundation cleanout (Y/N) _ l _ Depression (Y/N) __ High water alarm (Y/N) Date of Pumping _ /U�awPumper C. ABSORPTION FIELD DATA Date installed _?D (9 R Soil rating (g.p.d./ft2 or ft2/bdrm) 2 Length . �5�� _Width _ Gravel thickness below pipe �' 3 System type "b Total depth & Effective absorption area 670 Monitoring Tube present (Y/N) ?' Depression over field (Y/N) _ #AJ _ Date of adequacy test _ 0(h)( `! N/% Results (Pass/Fail) _9�)A SQ, —For _ s _ bedro Fluid depth in absorption field before test (in.); '— Immediately after= -gal. water added (in.): Fluid depth _ — (ins) Minutes later:_ — Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 72.026 (Rev. 3/96)' If yes, give date _= D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES Size in gallons on' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot //D Absorption field on lot //01 Public sewer main Vt) A Sewer /septic service line 1 / D e On adjacent lots On adjacent lots "Pump off" level at* l 067 -t- Public sewer manhole/cleanout -r- ,t,,�M Lift station lOo -r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /U t Property line � '�, Absorption field �/-/3 I Water main/service line '06— Surface water/drainage Wells on adjacent lots /©c SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: - Property line `Po t Building foundation 6 3 6 Water main/service line ZS t Surface water / C,,,, -r Curtain drain /oo`I- F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. Signaturo- �-V Engineer's Name A19 t3, Date HAA Fee $ -))(Yl r c) Waiver Fee $ Date of Payment ufl_ 1-0,5 p Receipt Number 72-026 (Rev. 3/96)* Date of Payment Receipt Number R�li N l'R�1H/lNNIMY �4P .Stevan-R.�eg�n`9none�h ' SEP -30-99 14:19 FROM -CTE ENVIRONMENTAL CM Environmental Services Inc. �rvrirara��s.vo.v�oaar,.ar� 6018301 T-439 P.02/03 F-940 CT&E Ref.B 995271001 Client PC1A Client Name Pannone Eng, Srv. Priat04 DateMme 09/30/99 13:55 Project Name/A' L3 R2 Prospect His Callused Date/Thee 09/26/99 16.00 Client Sample Ill Pressure Tank lleceived Date/Time 09/27/99 13:05 Matrlx Drinking Wow Tachnical Director' Stehen C. Ede Ordered By lteJeased MIDaw IA 0 Sample Remarks: Al L0ye1t10 Prep Analysis Para111etar � Results _ VOL units Poete, o!i.imiirss Osco Date Init Nitrate -N 0.500 u OMD ma/L LPA 300.0 10 max 09/27/99 09/27/99 SCL Total ColiPOrn 9 Oa/100 NL, NO Coli SKIS 93220 09/27!99 KAP