HomeMy WebLinkAboutTUXEDNI PARK BLK 3 LT 3Tuxedni*
Park
Block 3
Lot 3
#041-022-17
Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite• (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171245 PID Number: 041-022-17 ❑ New E1 Upgrade
Name:
DONALD POWELL LIVING TRUST ABSORPTION FIELD
Address ❑Q Deep Trench ❑ Shallow Trench ❑ Bed El Mound
9710 COPPER DRIVE ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 0.8GPD/SF 11.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.5 Ft. 7.0Ft
TUXEDNI PARK 3 3 Fill added above original grade Gravel length
Township Range Section 0.0 Ft 54 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 2.5Ft Ft
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches
From Tank Field Tank Line 756 Ft2 1 Ft.
Well N/A 146.4 N/A N/A 25+ TANK ❑ Septic ❑S.T.E.R. ❑ Holding ❑Other
Manufacturer Capacity
Surface Water N/A 100+ N/A N/A Gal.
Material Number of compartments
Lot Line N/A 31.5 N/A N/A
-- NA
Foundation N/A 55.1 N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain N/A 50+ I N/A N/A Gal.
Remarks Pump on level at Pump off level at High water alarm at
in. in. in.
Pump make and model Electrical Inspections performed by
to
PIPE MATERIAL House to tank Tank drainfield 3034
Installer
WILCO Drainfield 3034 CO/MT r tir,
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 7 5 14
Inspections, Location and description
dates: 1 8/29 /17 2n1 8/30/17
4°' House Trim (Deck)
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
.47,101016.116.100,,
Conditional Approval: Date4' .OF AL'4 �
5+� i
- __ j*' TH i t .AA
F .
'Vteven •FL.•vannorRe•A
{141. E 81
Approved 4*--, Date 9-2,C)-(7 ll , ,14
t A\t�
Inspection Report_1-1-12.doc
-DESIGN PARAMETERS N\ -* �w —WATER1LINE I/ ABBREVIATIONS \ \• \
RESERVE AREA SEPTIC SYSTEM \ \ WELL.-R1ADIU� TH TEST HOLE f-
TO BE USED AS PRIMARY \ .;I I r(P) PROPOSED
NO. BEDROOM: 4(600 gpd) E
TANK SIZE: 1250g \ F2 l NE+I+ s�EP1flC j 1 (E) EXISTING r% ***** I
PERC RATE: 11.4 MPI ® CO CLEAN OUT NO. OK ** •4
SOIL RATING: 0.8 GPD/SF 1 \ / 11 MT MONITOR TUBE NO. ,
AREA RQD: 750 SF 1 / 17s61Em TYP TYPICAL
SYS. TYPE: DEEP TRENCH 7.0'ED 1 ) / / * 36a1 1 ` \
MIN LENGTH: 53.6 LF ) / / / \ \ \ TRUE NORTH SCALE : 1'F 50
/ (iii.
� %
'USED: / / / if
\ , \
54.0LFx2.5'Wx7.0' E.D., 11.0' TD / / / v 17681 \ 1
TOTAL AREA: 756 SF 3/ / i A B
/- / / / v \ 1 DV 38.1 37.0
i /
/ / r f I / // r /� 721 1 • Cl 66.1 _ 56-5
( / WE_L E / J ' C2 72.5 73.4 /
\ I 14.8 1� 146.4 / / � \
1 \ II 4BR _ /
ito 4 .IS" . SF D(E) 4
/4"-,./ TA/2 1994 ATI iH i 7994 ) \\ \ N` / � / \ \ \ '
/ ,; /
/ '," INSTALLED PLANNED RESERVE FIELD(
/ 54LFx2.5Wx7.0'E.D., 11.0'T.D. /
/ / / 1 WITH DV AFTER TANK, MTs & COs AT I
/ / / 1 ENDS OF FIELD
/31.5 ) \ I/ / /
// //
C.1f) 1 76,8 / / / / /
/ 1 � � � 1 r / �� /
l r r (� , \ l C ..,6c!:,!:////
re /
11 1r r! \ / /1 • // / /
m ------- ,.)
1 ) I / /
I i
m
Y FILTER FABRIC,1 § i
DRAIN ROCK 6"ABOVE PIPE INV _
4"•DRAIN PIPE 0.G./F.G. EL.752
-_- - -_--.-- - - )52.0
1.0 OR
2.0 ML
4t,,:_ +\748.QI _
DRAIN ROCK
M1 -
-
SW
54.0 \741QPROFILE -
SCALE 1"=10' -
MO
-SW
16.0 0,, 734.0
NO
GROUNDWATER
NOTES: PANNONE ENG SVC, LLC Dote
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 995100' 09/01/2017
PHONE (907) 272-8218 FAX (907) 272-8211 ete.
Scale
*I• • 1- '.* 1" = 50'
• �, �t
•'• .. + P.I.D. NO
TUXEDNI PARK B3 L3 / • - . _041-022-1/
DONALD POWELL LIVING TRUST �Id�even P. Pannone PERMIT NO.
DRAWN JRL 8149
9710 COPPER DRIVE �R'• ••. osP171245
•
SITE PLAN ANCHORAGE, AK 99507 '1 Sheet
1
I 1 1..
"„ ,,AL, � MUNICIPALITY OF ANCHORAGE rt,e n t
---��R
On-Site Water &Wastewater Program tia 5^..
- PO Box 196650 4700 Elmore Road ,.
Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.orglonsite
IlL•p.ii tin, lir
4N(MORPVE
On-Site Wastewater Disposal System Permit
Permit Number: OSP171245 Effective Date: 8/25/2017
Work Type: Septic Upgrade Expiration Date: 8/25/2018
Tax Code Number: 04102217000 Vila 7 80H Ne.0r
Site Legal Address: TUXEDNI PARK BLK 3 LT 3 G:2042
Site Mailing Address: 9710 COPPER DR, Anchorage
Owner: POWELL DONALD S LIVING TRUST Lot Size in Sq Ft: 97734
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field LI Septic Tank ❑ Holding Tank ❑ Privy 0 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
lowSpecial Provisions:
The permit will be issued to construct a 4 bedroom system. MOA Property Appraisal currently lists the dwelling
as a 5 bedroom house. This must be resolved with Property Appraisal prior to Inspection Report approval.
”`"" Proceed at your own risk. """
•
I
Received By: I 4r� / I Date: `a
J•
Issued By: a:"'�� 10 Date: SA5
MUNICIPALITY OF ANCHORAGE
r �• t � 11
. _ 1
Community Development Department ,ll► Phone: n 0
Development Services Division Fa :617
On-Site Water& Wastewater Program
a AUG 22 2017
ON-SITE SEWER/WELL PERMIT APPLICATION lit. 4J5 ,ti
w
Parcel I.D. 041-022-17 a 6 8 t.
Property owner(s) DONALD & KATHY POWELL Day phone
Mailing address 9710 COPPER DRIVE, ANCHORAGE AK 99507
Site address 9710 COPPER DRIVE, ANCHORAGE AK 99507
Legal description (Sub'd., Block & Lot) TUXEDNI PARK B3 L3
Legal description (Township, Range & Section)
Lot Size 97,734 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(IN all that apply)
Absorption Field Initial ❑ Single Family (SF) 0
(w/wo ADU)
Septic Tank ❑ Upgrade ❑X Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Munic.•- od s.
ignature of property owner or authorized agent)
p (!a
Permit/Rush Fees: S(I3 r 3y/ I/O Waiver Fees:
Date of Payment: �(Z3 /7 Date of Payment:
Receipt Number: n`l1 (C$ Receipt Number:
Permit No. o5e11 Waiver No.
Permit App_ - .:.,c
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
August 23, 2017
Subject: TUXEDNI PARK B3 L3
Upgrade Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install the reserve absorption field to be issued for this property.
The proposed system will serve an existing four (4) bedroom house. The existing drain field is in failure
and will be re-used as a reserve. The system will utilize the existing 1250g septic tank and conventional
drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100' of
the proposed septic system.
1. Soils. Test holes were conducted by S&S Engineering in February 1994, and groundwater was
monitored for at least seven days. Ground water was not observed to a depth of 18' below the surface
in the test hole monitor tube in February 1994. Bedrock was not encountered in the test hole to 18'.
Based on the results of the percolation tests and overall soils appearance; an application rate of 0.8
gallons/day/square was used for a conventional wastewater system in the area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography on the lot generally slopes from east to west, with a slope
of approximately 5%-10% in the area of the drain field. There are no steep slopes in the vicinity of this
system. The proposed drain field will maintain 50' separation all steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
\ N
N.
v '` \ `N. ` 'N. \ \ \i
\ N \
J
W \to / *** y
\ \ \ I / / // / i —" � �� \\
\ \ \ ` I / / / / / / �TRUE NORTH SCALE fir- 50'\
17401 \ \--. f l I t/ / \
\\ A 1 t;/ A / /
• / /
) I /
\ // 17561I
/ �f-! M\ .� (M
/ I } / / 1S` [754 1
J / / / I 1 \• \\ �'
/ / / / ED \
J _ _ � � � 3/ , , \ \
/ / / v \ 1
/ / / , /..,
_ . / c 17721 �1 . J (- A
`) (' I ( �' // 46R W J � '�
\ 1 �= *( SFD(E) / ` / 1 ` ,
1 \
J 1 Villiwi.
- 144.5 - ._�� \
(
/ I / 1 ' '
tik
r y/ / / 4 l
TH Z(i9wl2 lift 1994 / ` ` /
• �,,�►
/ INSTALL PLANNED RESERVE FIELD P )
/ 54LFx2.5Wx7.0'E.D.. 11.0'T.D. . . /
/ 1 WITH DV AFTER TANK, MTs & COs AT I
/ / / 1 ENDS OF FIELD
•
/ / 21.1 ( )' / ) /
' cy/////
/ / / /
// / �/ 1 N -...
\ 41161.6 W �_ / �O�\� / / /
/
/ / V' \ ' ( ) /
Il rr Il I \ / /r / ' /
? DESIGN PARAMETERS i) 1 ) 1 r ,'
' RESERVE AREA SEPTIC SYSTEM ) I r /
I
TO BE USED AS PRIMARY \ J I /
/NO. BEDROOM: 4(600 gpd) / ' I /
ITANK SIZE: 1250g `_- �? / I / I
PERC RATE: 11.4 MPI / J/ / — f- —
SOIL RATING: 0.8 GPD/SF / / / / (ABBREVIATIONS
AREA ROD: 750 SF / w ATER LINE TH TEST HOLE
SYS. TYPE: DEEP TRENCH 7.0'ED WELL RADII
� \ (P) PROPOSED
MIN LENGTH: 53.6 LF --._/ / / ) (E) EXISTING
sS(—mss — NF 7 S TIC i CO CLEAN OUT NO.
USE:
1,/,‹ V SMT MONITOR TUBE NO.
54.OLFx2.5'Wx7.0' E.D.. 11.0' TD / I TYP TYPICAL
TOTAL AREA: 756 SF / ' I / / �\ 1
) T r;
NOTES: 4 PANNONE ENG SVC, LLC pF Date
FOR CONSTRUCTION �C,�e08/21/2017
P.O. BOX 102954 ANCHORAGE, AK 99510 ,�' '•"
PHONE (907) 272-8218 FAX (907) 272-8211 �. 1 Scole
\lir l'' = 50'
, •
•• •••• P.I.D. NO
TUXEDNI PARK B3 L3 � + .. ` - 0 022-17
DONALD POWELL LIVING TRUST -:156"."0". °�
DRAWN JRL CE 8149 PERMIT NO.
9710 COPPER DRIVE ^•' .4 v:08/24/20v OSP171245
SITE PLAN ANCHORAGE, AK 99507 ':�� �` Sheet
1 OF 2
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL RESERVE SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 18 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS TO THE
ENGINEER. THE RED-LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN-OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS-BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE:
NOTES: _ PANNONE ENG SVC, LLCDate
�(rG,
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 08/21/2017
PHONE (907) 272-8218 FAX (907) 272-8211 .• 4 . Scale
*I :* NTS
••• .�a • ••• P.I.D. NO
TUXEDNI PARK B3 L3 1, 041-022- 17
DONALD POWELL LIVING TRUST ••tleV°^• OO^^O"e PERMIT No.
DRAWN JRL :R CE 8149
9710 COPPER DRIVE .�v 08/24/2q1, OSP171245
DESIGN NOTES ANCHORAGE, AK 99507 •'v� Sheet
2 OF 2
Municipality of Anchorage Page I of Z_
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SV9y00y0 PID Number: 09/022/7
Name:
Wastewater System: XNew ❑ upgrade
Address:
ABSORPTION FIELD
R/DGE
FYten6l
No. of Bedrooms:
X Deep Trench D Shallow Trench ❑ Bed ❑ Mound 0 Other
E
LEGAL DESCRIPTION
Soil Rating:
P
Total Depth from original grade:
GPD/SqFI,
Lot: Block: Subdivision::
Depth W pipe bottom from original grade:
Gravel depth beneath pipe
9 3 E
Ft
7Ft.
Township:
Range:
Section:
Fill added above origfnal grade:
Gravel length:
1.7 Ft.
/�
1S–/ Ft.
WELL: XNew ❑ Upgrade
Gravel width:
Numberoflines: DishnabeMenrina:
Ft
Ft.
Classification (Private. A,8,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: Feb FE,1jF•
(of Ft.
06. Ft.
766 so Ft.
.n D30?4lP.Y.C.
DrIII r
Da� rilled
Slat Water Tavel:
Installer.
E0U1P
Date installed:
j V1-X�I.v /V
6 Ft.
EGr4DE
Yield:
Pump Set at: Casing Rmght Above Ground:
,
TANK
GPM
1✓` Ft. , S Ft.
SEPARATION
DISTANCES
JSSeptic 0Holding ❑S.T.E.P.
To
Sptic
Absorption
Lit
Holding
Capacity In gallons:
From
Tank
Field
Station
Tank
/? co
WeIY
r
al:
5
Number of Compartments:
/2
t37'
EWatery
/� t
i� �-
LIFT STATIONLot
gallons:
Manufacturer.Line
70'
2G'Foundation
4a'*aunufa,cturer.
�3r
3� v
on" level at: Pu level at:
High water alarm at:
Curtain
NONQWNak
I
Electrical Inspections performed by:
DrainRemarks:
BENCH MARK
on and Description:
♦» — A"
Assumed Elevation:
/06.00
•
ENGINEER'S SEAL
`�ader4Cii
aOF 2:
-`•�G
... ;
S & S ENGINELKINQ
^1
17034 Eagle River Loop Road, No. 204
if
Inspections performed by: agla Rirer. Alaska 99577 Dates:
F
1
2nd 10.6--9ziP.
I' -�\
r�
ROCERT C. COWAN
CE-IIII01
Department of Health -and Human�rvices approval
,.,
Reviewed and approved b�_� A -2+ / - Date: �
tt��lyt;` "_1;»
72-010 (Rev. a/at) MOA 25
Permit NO§W940040 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 * Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Descriptio�YXEDNI PARK SUBD., BLOCK 3, LOT 3 PID No.: 04102217
03.2'
lc6�&
COICO2
t 0
1 FINAL GRADE
....................... ............ .. .......... .. ........... ......................................... . ........................................ . ....................... ..... . ........ ................... .........................................
NEW
89.61, 1250 GAL 89.4'
,9
S.T. SR 88.5'
(CO3&
C04)
.................. NJ's . ...... ..................... . ........................................ . ............. .... . .. .. ....... .. .................... .........................................
. ......................... ............... . ..........
:A75.5' NO WATER FOUND
NEW 1250 GAL.._
_SEPTIC TANK
NEW TRENCH
. .ENCROACHMENTS
STRUCTURES. EASEMENTS. OR
SHOWN ON %,S SITE PLAN ARE AS SHOWN ON
A AS -BUTT SURVEY DRAWN BY:
CHARLES E. FORDES
4 BDRM t IT IS THE RESPONVRILTTY Or THE CONTRACTOR
IQ VM" LASwLmlr� REQUIRED SLPARAT . . ............
.......... . ............ . ........ . .................. . . . .......... .. ................... ......... ...... ....... ...... .
03 INSTANCES, MO PROPER" ONES PRIOR TO t N
FCO HOUSE CONSTRUCTION.
a
WELL
CO1
02
BL ED
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YT
C
............. ......... ...... ........... . . .............. ....... ........... - . ................. ..... ........... . . ....... . .......... 7- . .......... . ........... . .. .....
L
. •.. . . . ........ . . . . . . . . . . . . . .
W
SCALE 1" 40'
. .............
L- - - - - - - - - -
72-013 A (1/93) '
Nou.15 '94 11:01 3333 BCI Y. TEL 907-345-1354 P. 1 -
M -W DRILLING, Inc. 94-151
P.O. Bax 110318 • 10330 Old Snwald Highway .
(901)349.8535 -
ANCHORAGE, ALASKA 99ri 1
DRILLING LOG
Well Owner. Pat atxl Kathy Archie
Use of Walt Domestic
location (address of: Township, Range, Section, If ]mown; or distance twain road
Tnt 1 Blank Mut in -L Park.
Size of casing 6 *1-pth of Hola--;101 feet Cased to 100.46
..��x., . set
Static water lever 36 et, (j>y low) land surfacer Finish of well (check one) open end ( X );
Screen ( ); Perforated I..;, a. -
Describe screen or perfosati. xA
Well pumping test at 10 `
g`;PtF . (minute) for---Z---hours with_ 1flfP/ enr
of drawdown from static. 1a, r� :.'
"`' •.+rl As Built Note: W(Al dry grouted with 2
Date o! completio J Backs of bentonite
;� _ granules .
WELL 100
Depth 1n feet from
ground surface
0 TO 2
TO :::�
TO
TO
TO
TO
TO
TO
TO
of formations penetrated, size of material, color and hardness
aWlt"sv
Cit1a[S
i y
Certificate No's, 811 JF: 613
1 —CUSTOMER
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
JX' /°/''j(rw Co /o -3-t
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM,PERMIT
PERMIT NUMBER:SW940040
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:SINGLETON JAMES K &
OWNER ADDRESS:11531 ROCKRIDGE DR.
ANCHORAGE, AK 99516
PARCEL ID:04102217
LEGAL DESCRIPTION: TUXEDNI PARK BLK
LOT SIZE: 97734 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
3 LT 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 3/01/94
EXPIRATION DATE: 3/01/95
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY: 4'-m-'-'
DATE • I �I
DATE /`�
:0 0
/
M
F-
O
J
Z
H O O Z
W Z U 2 0
�3 WaF
a� Zzao
�4 Z�tWi a
Z2W� V1
x
WWa,m F•F�Z
rrazUWS�
OZ3=)Oo
Ng�rr��
r-aoNf W
W W>-Oq? a
F- W m `- O
�in�UZ�a
W N N p a N 0
rx-��W az
Q W o
7 O m W W itW O
r7-01 m r K Z w
=3 N�FZ
. mz 000
00< -.-oo
O
x
'+`: ..•�
� n fit. t',
Y
W
�-
F
(�
N
_
O
a
� O
s
:0 0
/
M
F-
O
J
Z
H O O Z
W Z U 2 0
�3 WaF
a� Zzao
�4 Z�tWi a
Z2W� V1
x
WWa,m F•F�Z
rrazUWS�
OZ3=)Oo
Ng�rr��
r-aoNf W
W W>-Oq? a
F- W m `- O
�in�UZ�a
W N N p a N 0
rx-��W az
Q W o
7 O m W W itW O
r7-01 m r K Z w
=3 N�FZ
. mz 000
00< -.-oo
T
NVId 311S
a
W
l~i
Q: p N
W0ovai
d
a' o 0 1
COr.
tl o II
II CR
C7 Ir o
I) mJ O
W v N to
Q
.0S = 'j
O
x
O
Y
W
�-
F
(�
N
_
O
a
� O
T
NVId 311S
a
W
l~i
Q: p N
W0ovai
d
a' o 0 1
COr.
tl o II
II CR
C7 Ir o
I) mJ O
W v N to
Q
.0S = 'j
a 4 Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: f:�4NK &7HAl2D DAT
LEGAL DESCRIPTION: 1uxEln.2 PqeL �J. 1_3, &-? Township, Range, Section:
SLOPE
1 "';F +�
ORGIcS
Ma2 A&L - ORGV-he Sr4Ty COAD
_a
3 c '
4-
5-
7
5 7 i
9 D'.1
9-
10
11 b•
12
13 1 ti
14 a)
1 '
J i
15-
16-
17
5 16 17 ° 3•ci. K .
18-
19-
20-
COMMENTS
81920COMMENTS
[S'rcry S�uo fa
WAS GROUND WATER No
ENCOUNTERED?
S
v 7')) IF YES. AT WHAT J L
DEPTH? P
707-- E
Depth to Wrier After
Monitoring? � D g c1q
(ENGINEER'S SEAL)
or h
�y
1
PERCOLATION RATE epi_ (mmv
utemch(6
PERC HOLE DIAMETER
TEST RUN BETWEEN F) r/
AND h.5 FT
J 6 i CIY V IIYL' CR IIY V
PERFORMED BFnn�,014 K-91- •.11 ppi e6�' River', '1 ^-F Road Ille- 204 aop X77 1 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCAMA AIY%TA'4V CDA QCIPAL GUIDELINE/ /Ic
T ON THIS DATE. DATE:
72-M (Rev. 4185)
(ENGINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 ;
SOILS LOG — PERCOLATION TEST ~ i
L�.,�
PERFORMED FOR: 28NIC KGTi4AX7 DATE PERFO •��+• °^
LEGAL DESCRIPTION: IUxELWI�RfLc l0,
L3A3Township, Range, Section: ���' °•�"'
DI:P77 SLOPE SITE PLAN
(FEET) 0
n'^,,1"
Iffi
A
3-
4-
5 45
6-
7-
8-
9-
to -
12
7 89 10
12 -,rr
slct% Sd>✓D {b
LuElL 6aavw Sifr•IO,
fnkf 7Q
20
3
13-
14
14-
16-
16
20
COMMENTS
WAS GROUND WATER (�\O
ENCOUNTERED? 1v
IF YES, AT WHAT
DEPTH?
Depot to wrier
Monitoring? li t may,
C e,
PERCOLATION RATE C (mmutesimch) PERC HOLE DIAMETER
i v
TEST RUN BETWEEN � /� AND LL 5 FT
PERFORMED d:7034 Eagle Rivar Loop Road No. 20d
Eagle River, Alaska 99577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN
72 -MB (Rev. 4/95)
[ ~/ CERTIFY THAT THIS TEST WAS PERFORMED IN
'ON THIS DATE. DATE:
, s77, fa,
•
• _� Municipality of Anchorage . „ .
On-Site Water and Wastewater Program • i- : �,A'a i i
(907) 343-7904 . i SEP t s x lap”, a
A c"
Certificate of On-Site Systems Approval 1� oc l; s Lc5'
Parcel I.D. 041-022-17 Expiration Date: 1 Z`2\-(o —I 1
1. GENERAL INFORMATION
Complete legal description Tuxedni Park Block 3 Lot 3
Location (site address) 9710 Copper Dr.
Current Property owner(s) Donald Powell Living Trust Day phone
Mailing address 9710 Copper Dr. Anchorage, AK 99507
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: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
---
Received
Received b : At i419:111/.�1. _ , !J Date: �/2C/17-
COSA to be released to the engineer,unless otherwise reque. -. ,y the engineer.
COSA Fee $ ca Waiver Fee $
Date of Payment CJ jot.l i a Date of Payment
Receipt Number oa5Lect4 Receipt Number
COSA# QSC.I-3-1 tAu Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. ! 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.
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 9/1/2017
i�P��OF A•Lgs�l
6. DSD SIGNATURE • M. r ' ' •
A. System #1 Approved for y bedrooms >� .Seven R.*'.niton' —
/# CE-8149
System #2 Approved for bedrooms /���s'. =�
Disapproved �k\ ?OF S`c
Conditional approval for bedrooms, with the following stipulations:
``j
�JG\e yo
ON-Sfl-
WAT
WASTm
EW \-
ER ANDATER o
PROGRAM
?SERV\CES.
By: \ >�r ��- ��• CI 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.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f
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: Tuxedni Park Block 3 Lot 3 _ Parcel ID: 041-022-17
A. WELL DATA
Well type Private If A, B, or C provide PWSID# _ Well Log (YIN) Y
Date completed 10/24/1994 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 101 ft. Cased to 100.46 ft. Casing height (above ground) 1 2+ in
FROM WELL LOG AT INSPECTION
Date of test 10/24/1994 8/15/2017
Static water level 36 ft 31 ft.
Well production 10 g.p.m. 4+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 4 47 mg/L
Arsenic ND ug/L Date of sample: 8/15/2017 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 10/4-5/1994
Tank size 1250 gal Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N/A
Date of pumping 8/14/2017pumper Northland Pumping
C. ABSORPTION FIELD DATA
Date installed 8/30/2017 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Deep Trench
Length 54 ft. Width 2 5 ft Gravel below pipe 7 ft.
Total depth 1 1 ft. Eff. absorption area 756 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) VA.5,...5 For 11 bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
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 1 00+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 1�+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ~�`"`ik
,l of A/:,1kk,
I certify that l have determined through field inspections and ��kP 1,911.-A
review of Municipal records that the above systems are in A#• . 1 '.--,\ S
conformance with MOA COSA guidelines in effect on this date. 0••• ••_V
Engineer's Printed Name Steven Pannone ,- :t}even ..•annone
Date 9/1/2017 t+�;i4y� . CE-8149. '
COSA canary sheet_2-6-15.doc
/
8341Z
co
co
°p LOT 4
N
11
J
o 4'6o
Lri 80
^v OOOO-1'L
11 SSS /
9) /
/
/
/
/
LOT 3
I /
Shed �'
2.0 O /
I aft 22? / ..
Cleanou
16:3''m �o / ��
•
Septic vent •
=-,,-•,
;,�' �,�, �� 04.0 gspha� / /QQ
tis8o •
de�ke� ..Z •0 o Well oo GP
11/ y • i s
% ��
A'4•81 CJCbe'
\
, 9-21-17/1#:
Q / RECERTIFIED
��' 1\ AS-BUILT NO CORNERS SET THIS DATE
17
LOT 2 �j `�N\% I hereby certify that I have performed a Mortgagee's inspection
�►� 44. OF of the following described property: LOT 3. BLOCK 3.
O6. / �� • • • . • :;(1 +i TUXEDNI PARK SUBDIVISION
O4,/ �' 49th '� • 7 I Anchorage Recording Precinct,Alaska,and that the
�� .. ..* / improvements situated thereon are within the property lines
0�� �!` •• •••• and do not overlap or encroach on the property lying
(f / adjacent thereto,that no improvements on the property tying
'� / Q� 1� t! / adjacent thereto encroach on the premises in question and
OC Q Q / .Fred Wal a tk o., / that there are no roadways,transmission lines or other
Q , o
;sr*• 3255 - s ••,-' - visible easements on said property except as indicated
O es • •• , ' hereon.
SCALE: 50' (///.0
V '� �° • • • . • • ,,,,c) ` Dated at Anchorage,Alaska
EASEMENTS OF RECORD, OTHER THAN / kp / � 1 1 1,
...re this 15th day of JULY 2009
THOSE SHOWN ON THE RECORDED / J FRED WALATKA&ASSOCIATES
PIAT ARE NOT SHOWN HEREON. Forbes Engineers and Surveyors
/ BE (907-248-1666)
Municipality of anchorage "
: . ,
-- l Development Services Department ; 4 r-
Building Safety Division r., •,-'
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
FOR A SINGLE FAMILY DWELLING
Parcell.D.- o91-Oaa-1-7 _ COSA#M0o203
1. GENERAL INFORMATION Expiration Date: / 0 —
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TUXEDNI PARK: BLOCK 3, LOT 3
9710 COPPER DRIVE ' ANCHORAGE. AK • 99507
PATRICK AND KATHY ARCHEY Day phone
9710 COPPER DRIVE ' ANCHORAGE. AK • 99507
Day phone
240-8035
MARK SOOUET W/ SOOUET REALTY Day phone 727-1616
4155 TUDOR CENTRE 0208 + ANCHORAGE. AK * 99508
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
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 samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) 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.
4. 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) sale, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 2 09
Engineer's Comments:
In conducting this evaluation, GEG. LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, not do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations:
Attachments: /
COSA Checklist (/
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By. RX
1a•+ rimst
..""`�tYtZturrr,
OF Aty�y.
ON-SITE
WATER AND •: �r''
WASTEWATER
PROGRAM '
Original Certificate Date: -7 - -7 - 05
... ........
......
' f ey A.
9
ess.:
CFr 953
7 Oc,.•'c
j
F
ff
cA
Conditional approval for bedrooms, with the flowing stipulations:
Attachments: /
COSA Checklist (/
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By. RX
1a•+ rimst
..""`�tYtZturrr,
OF Aty�y.
ON-SITE
WATER AND •: �r''
WASTEWATER
PROGRAM '
Original Certificate Date: -7 - -7 - 05
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: TUXEDNI PARK; BLOCK 3, LOT 3 Parcel ID: OW -02% -.17
A. WELL DATA
Well type PRNATE If A, B, or C provide PWSIDN N/A
Date completed 10/24/1994 Sanitary seal (YIN) YES
Total depth 101 ft. Cased to 100.46 ft,
FROM WELL LOG
Date of test 10/24/1994
Static water level 36 ft.
Well production 10 g.p.m.
WATER SAMPLE RESULTS:
Well Log (YIN) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
6/23/2009
32 ft.
4.52 g.p.m.
Coliform Q colonies/100 ml. Nitrate• -rTg./L. Other bacteria 0 colonies/100 ml.
Arsenic: /VO ug./L. Date of sample: 6/23/2009 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 10/4-5/1994
Tank size 1250 gal. Number of Compartments E Cleanouts'(Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alamt (YIN) N/A
I
Date of pumping 6/22/2009 Pumper NORTHLAND PUMPING
C. ABSORPTION FIELD DATA I'SELOW EXISTING GRADE
Date installed 10/4-5/1994 Soil rating .p.d./ rft'/bdrm) 0_8 System type DEEP TRENCH
Length 64 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth *11 ft. Eff. absorption area 756 ft' Monitoring lube YES Depression over field NO
Date of adequacy test 6/23/2009 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 53 In. Water added690 gal. New depth 79 in.
Elapsed Time: 220 min. Final fluid depth67 in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 me.) (YIN & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump oft" level High water alarm level at in.
DatumCycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding lank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+ 1
Water main N/A Water service line t o'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t o'+ Building foundation 10'+ Water main N/A
Water service line t o'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
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.
Engineers Printed Name JEFFREY A. GARNESS
Date -71Z/O9
t�
COSA Fee $ LJq
Date of Payment -7r � 1 09
Receipt Number ori C) 7 L{g
(Rev. 11105)
Waiver Fee $
Date of Payment
I
Receipt Number
U
u
/aZZi7A
r
O
0
�'n`..R.•'.�..K g�'o o n p
e a �n �..n�R•i sen V n ry rt p
O •1 • W n H Ri
? n O i n• O Y K • K 10 R h !Y� � Z
O n e n [ p n• •� r •' m 6so
• �! b 0• 6 b n K� '• b . j VI
y o O n b n •C O� -•j b U j �'
O K O n y G n
S"D�3�:S5S3 .H,
.. �• c o;r nen p
,- y n K• a n K
V � � 11 • 6 � O .T n
n> �O O b O Y• n• n
a• n y a^ 0•� n
t n
J � O b •y
ns ^
•<'� no �� j :Ah NM p.. N j ami• T O> W O W O A
`n oo inw .nt a0. A
0•
>K ^OU
O O
Sm
nr o
n > o 0 o n a> n• a
n e�.on .+a a • <
O G o O 0 0 0 00
VIO X 1 p
I �I^IY I -... YMT 1 .. .... �. .. � �.,r♦ I .... ... I ♦ -In• - 1 i.. � .. ...-ry
1
11
N
.. I"
6
MUNICIPALITY OF ANCHORAGE
•EEO— I RTMENT;OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -bite Services Section
. -,IPO. Box 196650 Anchorage. Alaska 99519-6650
343-4744q,
7ter
CERTIFICATE OF HEALTH AUTHORITY Int
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.#:: .0 HAA#
j-__.�_GENERAL INFORMATION
Lot 3; Btack 3; Tuxedni PaAk
Complete legal description
Location (site address or directions) NHN Twut%a Loop D4.ive
AncAo4aae. AK
.
at 9 K A,%chie
' PKathy)p .
erty."owner
n er
Day phone:* 345-1615
III -C/O Bethajtd Co"tr4action
12801
i ngjadd�:_'_
ress.-
R&ta D)cjye: An ho
AK
99516
Iding ad6ricy.
Day
phone
fing-address
Day phone
dress
Unless otherwise re
jpless-otherwisare P r
quested, HAA will be held for Icku
ER OF BEDROOMS"
NUMB :
w.
jt_Z_ :_7
Pu
NOTE::Llfcommunity well system, provide written conflrmai tion from
._'4i'%Wng to the legality and status of system. I
4.
TYPE OF WASTEWATER DISPOSAL -
X"
Holding tank
Public sewer
NOTE: If community wastewateisystem,'prdvlde written 6onfirmatic
attesting to the legallty end status of system-"..
7Z-=(RwAM) Fae W0AW24
. No.,
Z
0
IEC attest- Z
A,
tate'ADEC
5. STATEMENT OF INSPECTION BY.ENGINEER,ti ell`1: Yir.+ {
�F .+,r•
As certified by my seal attixed hereto end as of theT alTdation date a ownrbe.
low, I veritythat my
investigatloh of this Health Authority Approval epp11 Ill on shows that the on-site water supply
and/or wastewater disposal system is sate, functional an"a dequate forlhe numberot bedrooms
and type of structure Indicated herein'. I further Verity that based on the lniormation obtained from
the Municipalit�l.of Anchorage tiles and from my investigation and.inspection, the on-site water.
4 t supply and/or wastewater itisposa -system I; In compliance wSth all Municipal and State codes, 9
ordinances, and regulations in effect on the date of tflis �nspectio t; j f I 1 y r
1-cl
�i .11x�lflla •. :.y f;r r �1./_ �
S a 5 ERGWEERLN , t ^ Phone
Name of Firm
!r' , '17034EeyleRiverL dfJo. i) ':6 ({;,t,°�'•Ilq'.t°"1
Address '
{Date
Engineers signature 1
.. .. .. .I , .,�..r r+ .i Fi..rw♦ 4 ,•. �.� ..r.. j• .1� • r !
-
- � .._. ., .. �i '' •! :., .ya l' Rt. r{I d�I i \tl.^,.-� fltla .l � .'. ::`.
OF A�
,
' - I , \q. .. ,. _ . '{ /'• '. 1 1 t. i i,l { 1�'r7 �. \ ,.wn .:w� 1'
G,COWA�Nrr✓11wr�_.
��+1 Gy'ti.1EE-8801 €p�J
6 DHHS SIGNATURE i 1,_1
1? 'F �LILL
.. t 111 EJ `r
r 1'FOfESS1 {
—bL Approved for I bedrooms.�r
Disapproved"
• .11 .
t {
0hefollowing stip
Conditional approval for
'fibedroomst,witYulations
t qn q , 1 f.tY fl il. 14, N
, ��, vt� 7 , i. 1 In'j �. d '.'i :.�+t :�i {ZY. .23q :1Crl •10 , ai Yq .ITq, t'. { !, :
+ 4. '. � �•r�1, L.' � 1 ''1}: '. .' d �. Krr,.,{ ,i� 1.4. •+r�r 1'I ih�itri
ILL
1 , ) , i ' 7 II f •.q ,,� a1 ','}r :,!<1.T'. t,t Yt fiW 1'�%i9 /a,, , ,. i ,., It ��'t
f-4
1 `' • �. 1
1 1 ♦--7-77777777777711 't�rZ 1 '>il��'�'-='Iqf �, C {'{
{ I
wit .t rjj%,1 li 1i sit 'm r. 4
'Additional Comments'
tif,{JIY .f fi
= I: ...•� ,.. , I " S • .f rl,, V`. ]r r{ Irtit f l r-, n41i 2d II
. , , , , � "'/ 1 tl {'.. �{.. t. ^:I+ItiA5i1 q`lti(',y �, +r.in.4?ird .t 1�111`'1:1'if I i •. sl -
• h ,, tf,14 t�5 ,Z,Tt qt v:.CP tI \ ,�+i �M T.f M'nf :r:{ � IV., r• .
Date .
By:
141.
: , O'_•Y'1 ) loll- I ,.. ....,...
The Municipality of Anchorage Department of Health and Human Service (DHHS) Issues Health Authority
-Approval ltertiflcates based only upon the representations given, in paragraph,6,ab6ve by an independent
professional eq registered in the State of Alaska: The DHHS does this as a courtesy to purchasers of homes
and their lending Institutions In order to satisfy certain federal aind state regiiirements. Employees of DHHS do not
conduct Inspections or analyze data before a ckficate �s; lasued .Tuhe;TMunicipaliry of Anchorage is not
i responsible for errors or omissions In the professional engl jeer s w4 rk t; �In! Lt, te<
724n Mw..1/Rt) Bolick MOA V21I,- ... .
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:.L1 4 ill I TAy5L-,o_ T ?R2K Parcel I.D. ()1Y/0,2/ 3t
A. Well Data
Well type 'f'RIUP, 7F- If A. B, or C, attach ADEC letter. ADEC water system number LJ/4
Log present (YIN) i/%S Date completed 10641941 Driller M -W DRi(4.iu;
Total depth X01 '—Cased to loo's, Casing height /� �4 4 -
Sanitary
Sanitary seat '�P N) YES Wires properly protected &4) y,5S
FROM WELL LOG
Date of test I6 �aN I9 `i
Static water level �6 4
Well flow 10 g.p,m,
1
Pump levell
SEPARATION DISTANCES FROM WELL TO:
\ AT INSPECTION 2
6Z
g.�T fr o � :Z
T T
M
Vl N C
in G'
Septiclholding tank on lot Ila ;On adjacent lots /00 Z
Absorption field on lot 13� 1 ; On adjacent lots /001
Public sewer main 101A Public sewer manhole/cleanout NIA -
Sewer service line 16,1 Petroleum tank I�/A
WATER SAMPLE RESULTS:
Date of
B. SEPTIC/HOWMG TANK DATA
//--Other bacteria
by: S d S ENGINEERING
17034 Eagle River Loop Read fl(Q gH'
Eagle River, Alaska 99572
Date installed 10 IS 191 Tank size 1AS0 Compartments o;Z
Cleanouts (Y/N) Y6S Foundation cleanout (Y/N) YE Depression (Y/N)
High water alarm (Y/N) NI'A Alarm tested (YM) ,J 1A
Date of pumping NSA /VE W TANK Pumper Al�i4 6Ur cv TANr,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1A, On adjacent lots /00 4� Foundation 13 4
To property line 16 44 Absorption field /O Water main/service line ;is
Surface water/drainage /00,-/
72-026(fM*Flom CONTINUED ON BACK PAGE
C. LIFT ST ON N//*
Date installed
Size in gallons
Vent (YM)
High water alarm level
Meets MOA electrical E
-Pump on- level
FROM LIFT STATION TO:
:ss (Y/N)
'Pump off" Levet at
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed ID�SI9`I Soil rating(GPD/Ftz) n.13 Systemtype T,'zEnhcN
Length sEi Width 3 Gravel thickness L q Total depth
Total absorption area ' 56 S r • Cleanout present (Y/M Depression over field NO
41
Date of adequacy test /U£W -ST. Results (passtfal) _a% 4_for _-L-Bedrooms
Water level In absorption field before test (Ifs After test 14K
Peroxide treatment (past 12 months) (Y/t# Na If yes, give date ,EVA
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot R;1 , On adjacent lots /od '4 Property line a6 '
To building foundation 3 g To existing or abandoned system on lot /l/1A
On adjacent lots oZ t,4 Cutbank ii Water main/service line
/O �L
Surface water I00 '.I Driveway, parkingivehicle storage area / )
Curtain drain Al/A
E. ENGINEER'S CERTIFICATION
I cerUfy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
_t. OF AL.'kh.
Signature
Engineers Name
OratAr C.
Date o / /
HAA Fee$
Date of Payment
Receipt Number
72-028 (last Back
C
!� ROBERT C. COWAN
CE -8801
Waiver Fee $
Date of Payment
Receipt Number