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T12N R3W SEC 33 LT 29
Onsite File T12N R3W Sec 33 Lot 29 PID# 018 - 181 - 12 The 1996 field may not be tested for future COSAs . Municipality of Anchorage, On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181334 PID Number: 018-181-12 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ■❑ Upgrade Name GOMEZ ABSORPTION FIELD ❑ Deep Trench Wide Trench ❑ Bed ❑ Mound Site Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade FIVE 1.2 GPD/SF 4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.0 Ft. Gravel depth beneath pipe 3.0 Ft. Subdivision Block Lot T1 2N R3W SEC 33 LT 29 Fill added above original grade 2+ Ft. Gravel length 74 Ft. Township Range Section Gravel width 5 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 625+ Ft2 1.0 Ft. Well 100'+ 100'+ 50'+ TANK Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCH TANK 1500 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 10'+ NA STEEL 2.0 Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspeection 15` 11/1/18 11/1/18 Location and description ction 2�a DECK DOOR STOOP 3`d 4"' ON-SITE WATER AND WASTEWATER SECTION APPROVAL _ kaq�Lakski��mp Conditional Approval: Date �,•e �._ °•o..,,� r 1 .rt • 49TVt 6 , ............. °o e e• e o e••�° <�}I 6 ,• o o e o 0 0 0 � e e o v v o o e e o o v n � ,�°• MICHAEL N. ANDERSON 1 Se tic S ste App ( t �^- � G� Date -� '° CE) 9469 �•�' �� w � �f°``� •`�le�(p� ° i Note: this approval does not include well permit requirements.�p�.m•���' (Hev ub/u2/1 a) Permit No. OSP181334 Page 2 of 2 Municipality of Anchorage 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 Legal Description: T12N R3W SEC 33 LT 29 RK A B CO2 33 26 23 31 qo1 C92 25 37 VPLVE 28 47 C04 45 6 c0 46 8 cod 55 Cod 95 MT1 54 MT2� 96 7 / TC01 TCO2 \ \ / o CO2 \ / 1 C01 'DOOR STOOP, BENCH // Cq4 / _10\ MT1 \\TH 1 EXISTING WELL RADIUS i' / j —� RESERVE AREA MTS # C06 • / H 2 I PID No.: 051-351-22 NEW 1500 GALLON STEEL TANK ASBUILT SCALE: 1"=30' rFCO �TCO1 rC0}CO�VALVr CYC04 rMT1 C05 ?'.T2 Il TCO2 Il II /l I( Il /I OF 1 FlNI H CRA �l�P'\• c•'�S�♦I♦ FlLTER FABRIC AV $ ♦♦. e p Aff 49 TH 93 1GALLON STEEL GM ......./'!!4 ...................... STEEL TANK 1 B9B9♦ "'.MICHAEL N. ANDERSON.- Ti ♦ No. (4E • SEPTIC SECTION 82, WATER AT 83 NOV. 2018 ♦♦ • ry�� �• N.T.S. ���DESS= :.�� Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section �.� 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Soils Log - Percolation Test 4! �,. a aeon : ®• • • o • • o • e • • e ��f S i 3 i • p 0 • • • • ........... s MICHAEL N. ANDERSCrN CE y9 9 Performed For: I'7Vi-n'8 Date PerforQ'� Legal Description: \'j t.. 4" Z Township, Range, Section: 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS (PVCA , G V' WAS GROUND WATER ENCOUNTERED?"t' lj Gross Time s &P wo-o", IF YES, AT WHAT DEPTH? L Depth to Water After O P Monitoring? 7 E Date: /1 Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN L FT AND FT PERFORMED BY: t' -k N-'� I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section a, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 (ENGINE EgtS SF -AV) A iCHAEF•ND)DI25CN� s� `� F Soils Log - Percolation Test1'�� Performed For: ZC9wh �- Date Performed Legal Description:�j(,. %� L.. V-{- 2 Township, Range, Section: -rt4 Depth (Feet) 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS %rq 5P !>o9®ei" Site Plan WAS GROUND WATER Date ENCOUNTERED? Yt IF YES, AT WHAT DEPTH? r s Z L Depth to Water After P P Monitoring? E Date: Reading Date Gross Time Net Time Depth to Water Net Drop /IZ111 v �% L If 5- n L t� K.ir PERCOLATION RATE ?_ (minutes/inch) PERC HOLE DIAMETER 4 TEST RUN BETWEEN 'Z„_- FT AND _? FT PERFORMED BY: M j\( I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7iaA e, 7„..---., ' ''O,� MUNICIPALITY OF ANCHORAGE \\� On-Site Water&Wastewater Program �•�.`r S .a,,,� PO Box 196650 4700 Elmore Road ` i .• ' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 �� �" httpalwww.muni.org/onsite \ I)c pa r tmen t NCM OP AGE 1 I� / 'a4c f On-Site Wastewater Disposal System Permit �� N Permit Number: OSP181334 Effective Date: 11/1/2018 Work Type: Septic Upgrade Expiration Date: 11/1/2019 Tax Code Number: 01818112000 Site Legal Address: T12N R3W SEC 33 LT 29 G:3035 Site Mailing Address: 14121 THUNDER RD, Anchorage Owner: GOMEZ SCOTT LIFE ESTATE Lot Size in Sq Ft: 108900 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 5 This permit is for the construction of: 0 Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The Engineer needs to do two additional test holes prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. 11/ ig Co ' 1 De51Jc4 G)10,1A9a ci koke. -1"D I1,5 � c{foanAwateY, .4...- Received By: Date: / / le( Issued By: I . / , LL -" Date: II i(0J MUNICIPALITY OF ANCHORAGE Development Services Department % Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 018-181-12 Property owner(s) GOMEZ SCOTT LIFE ESTATE Day phone Mailing address 14121 THUNDER RD ANCH AK 99516 Site address SAME Legal description (Sub'd., Block & Lot) T12N R3W SEC 33 LT 29 Legal description (Township, Range & Section) Lot Size 108900 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field Q Initial ❑ Single Family (SF) 0 Septic Tank Q Upgrade ❑ (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewa g 4 5 51. � 8 Multiple Dwellings ❑ Privy ❑ � , 90 (SF and/or D) Private Well ❑ Q SF,o • N Water Storage Eleo N 1 - THIS APPLICATION INCLUDES A WAI s� QUEST F 4957Zu Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. e//4114 (Signature of property owner or authorized agent) Permit/Rush Fees: X14 GM 6(0 Waiver Fees: Date of Payment: OMB Date of Payment: Receipt Number: Receipt Number: Permit No. ose 181334- Waiver No. G:1Development Services\Building SafetylOn Site Water and Wastewater\FormslClient Forms\Permit Application.doc C041 Nov.2,2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Permit,Change order Legal: T12N R3W SEC 33 LT 29 To Whom it may concern: This is a request for a change order on the above referenced lot. Two test hole will be excavated prior to the installation and found poorly graded gravels for the entire 10 foot depth with water at 7 feet..The perc rate was 2 minutes per inch therefore a new 5-wide trench has been re-designed due to the higher water table. The new trench will be installed into the hill as the design shows with 1 extra foot added to the water table elevation per the new MOA code for November. A bed system has been shown for the reserve area,see the site plan. This system will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: N COQ I GRADE te l _ s 5 BDRM X 150 = 750 GPD - 44,r00 N SOILS = 750/1.2 = 625 GPD -5 .. — �/ 625 GA/5*0.58 = 73' GRADE dP. -1.0 •''' FILTER FABRIC ORG 4"O PIPE 4 ID 1.0 -40 (1) TRENCH I 5.0' EWER ROCK , 1_ 5 4.0' DEEP -1 3.0' EFFECTIVE GP BOTTOM ELEVATION 1qK I 5.0'WIDE !!/0 (o t'`' N 73' LONG 10 191 A /00 e WATER AT 7'NOV.2018,ELEVATION 100' �'/Y�(• SEPTIC FIELD SECTION II I I - - - L - - - - - - - - - - - ' I --� - - - — = -I I -DE ARMOUN ROAD- - I = — ci ; I I I I 1 i I "I \ I I•' I \'I I ' I II _ I EXISTING HOUSE I SAI ` i A I 1 //'�_ I J EXISTING SEPTIC \ \1 4 i I �- PROPOSED 1 I`I ,„' ,t„ "'t .�—DRAINAGE FIELD I EXISTING WELL / •. 1 I / `\ 1-- 100'RADIUS I t`_ \-V.-)�� PROPERTY LINE I I ( � I 1 I I \ \ , ' 4' \ \ , 1 -EAST 142ND AVE-/ J \ '\ r .-_---'\� 71 r - s--\ --r i II • 1\ 1 \ y, ; t I `\ ,, 1\1' I I I I � w ! I i I � I 11',� 1 Septic Design Prepared for ''„",1, SCOTT GOMEZ 7 O `44 T12N, R3W, SECTION 33, LOT 29 :4 '° �1, ' .t Anchorage, Alaska a • • 49 TH• 1' * -i • • Michael N. Anderson, P.E •.EDATE: 11/2/2018 ♦ :MICHAEL N. ANDERSON; I• 4601 NATRONA AVE �•0,':,. No. CE 9 69 i DRAWN: DJR "�� ANCHORAGE,ALASKA 99516 �1•� .'lf�i( ....... i (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=200' .44 ESSj �4. I , .�yc CO ( , 11 • I I 1 C 'X I 1 Q I _-----_ _ MARIE ACRES I \ CC 0 LOT 2 1 - ' I CC /-i �\\ / \ Wa I I , / I\gyi/ / A , '1\ I ` \ I / \ I /7-- \\\`\ — `g's `1" ---- \ N I �\ / EXISTING WELL I \\I / 100'RADIUS ® ' I ` 1 // WELL I — \ 1 \\ 1DECK BUILT ON WOOD 11 \ SLEEPERS, NO PILES EXISTING / NEW 1500 GALLON TANK 5' I / / FROM ANY DECK SUPPORTS SUPPORTS HOUSE / \ ` AND 10'FROM FOUNDATION. \ \ / EXISTING TANK \\ 11 VALVE FOR NEW AND OLD _ / \ DECOMMISSIONED PER UPC \ I I SYSTEM ,15C• < \\ 'CO ` ` 4 BEDROOM SYSTEM , 'Co -;� \\ wo- I i - 1 O i' i 1 i'.... -- L / O- Z i MT„..---", \ - w NLu / o '— / Q I / o `.. � / �` • Lu "' \ \ \\ % / I \ --1 \ / /0 / z i ," 1 \\ - RESERVE BED, o ° v \� / 15'X50X0.5' w h9� ♦ C� -'30 \-` -moi go J f')J t7 --� CC z I CL SMALL 4'VERTICAL DROP IN z YARD, NEW SYSTEM TO BE g i AT THE TOE 1 T12N.R3W.SECTION 33 LOT 29 /..•-- --__ `\ // , PROPERTY LINE ``S T12N.R3W.SECTION 33 / / I LOT 36A 1! // I \.' I Septic Design Prepared for ..''"" 111, SCOTT GOMEZ •0�P�� OF /14`44. T12N, R3W, SECTION 33, LOT 29 TH �� ♦0 Anchorage, Alaska % 44.. • • �9 • Michael N. Anderson, P.E. DATE: 11/2/2018 0� :MICHAEL N. ANDERSON; • a 4601 NATRONA AVE �4�': No. 46 .,z DRAWN: DJR °�• ANCHORAGE,ALASKA 99516 �•� •'' +! �. 4. (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 41111ES5,� �•. b�:;:,,.:e__ter,, CO-41 OF /11. :;‘.‘i Municipality of AnchorageA„,.•TENGINJ R's ),/ oi 47.*,/-----;-----"\ Development Services Department *: 9TH ": •• sr On-Site Water and Wastewater Section 0 • , I., (ir 4700 Elmore St �•P.O. Box 196650 Anchorage.AK 99519-6650 ••• 0-fl MICHAcL N. ANDERSON : 'qc-h.e, — j • www.muni.orq/onsite „ �_J-' (907)343-7904 ��f t' ,l•• CE-9469 •...47-. ,; i9,��, ••. • •�., Soils Log Percolation Test `�RkE`s ��~ Performed For: lj?0 fi C*I0.11‘ T - Date Performed: y/2/../ Legal Description: -r 0.....1..../ 112... 3%,J Cr L 3 3 Township, Range,Section: . 2.-w Slope Site Plan Depth (Feet) , 1-' 2- h t' 'G ei/4e p Q11, 3- 4- 5- , 6- 7- Z 8- WAS GROUND WATER 9- ENCOUNTERED? 4 I S 10_______-- ?,,d vie, IF YES,AT WHAT DEPTH? L V Depth to Water After p 11- Monitoring? E 12- /4-0 \ems Date: - 13- 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- iqz (ii /Oh r✓1 6, 11 // 16 (r X 5 /I 17- Gn 5N 18- 19- 20- PERCOLATION RATE -z� (m nutesnnch) PERC HOLE DIAMETER G TEST RUN BETWEEN ( FT AND "tom FT COMMENTS PERFORMED BY: 1"-41`� I CERTIFY THAT THIS TEST W S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: // Z / _M_unic.1pality of Anchorage Department of Health and Human Services Building Safety Division On -Site Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 vA,vw.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW960194 PID Number.- 018-181-12 Name: Charles Hiqqin,-; Wastewater System: ® New ❑ Upgrade Address: ABSORPTION FIELD Phone: Number of Bedrooms: ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Soil Rating: I Total Depth from original grade: Block: Lot: Subdivision: v.v GPD/Ft` Depth to pipe bottom from original grade: U Ft. Gravel depth beneath pipe: 29 3 Ft. 6.1 Ft. Townshio: Rance: Section: 12N 3W 33 Fill added above original grade: 2.4 Gravel Lenoth: Ft. 59.5 Ft. Well: ❑ New ❑ Upgrade Gravel width: Number of lines: Distance between lines - Classification (Private, A, B, C): Total Depth: Cased to: Private 5 Total absorption area: Ft. 1 0 Ft. Pipe Material: 60 Ft. 60 Ft. 726 FY' f810/3034 arc Driller: Date Drilled: Static Water Level: Alaine 7/28/1996 41 Installer: Owner Date Installed: Ft. 7/21/1996 Yield: Pump Set at: Casing Height Above Ground: 8 GPM 58 Ft. 3 Ft. TANK SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Greer 1250 Gal. Well 121 141.3 108 Material: Steel Number of Compartments: 2 Surface Water 100+ 100+ LIFT STATION Lot Line 100 80 Size. Manufacturer: Gal. FoundajDrain 7 30 "Pump on" level at: in. "Pump off' level at: in. High water alarm at: in. Curtain 100 + •1 00+ i Pump Make 8 Model Electrical Inspections performed by: Remarks: Updated As -built. System is constructed for 4 BENCH MARK Bedrooms Not 3 Bedrooms. Location and Description: Lower Door Threshold Assumed Elevation: 50/.14 Ft. Engineer's Stamp �v�aa�l�ppp OF ♦♦ .. .•• ll•Z__ . 7 :•.•..• •L Inspections performed by.- Pannone Eng. SVC Dates: 1'7/21/1996 ? 4 ':� -9TH 0 2"'05/24/1997 ........ .— . .. ..................0 Department of Health and Human Services approval ••.......... =•.... ♦�N ;Steven• R. Pannone � All Reviewed and approved by: 26" - 5ee 60 5A 2,5)07F -Date: �1 ;• No. C 81 49 (Rev. 11/99) �: ♦♦ ,� f» •�•. ��.AW n a •r -- , r — -1 v —.r •cu — r .... / "vG 1Y i 1L UG r{jNrQ0Art .l Driveway AS-BUILT WASTEWATER ABSORPTION SYSTEM LOT 29, S33o T12N, R3W TIES co ^ B FC 43.2' 324' TI 3 ~.~, 47.~_' I2 28,0' 53.1' CI 242' 61.6~ c_el e6.0, 65.6, {MT 30.9' 69.0' 'C3 23.1' 90.3' C4 61.4' 59.1' New 12509 New Drain Fletd 59.5' Long, 5' Wide 6.1' EFF., 9' Deep TANK ELEVATION Deep Trench 59.5' ~ TRENCH PROFILE NT (:04 Revised 5/22/02 C,\Vork\29S33. OVG PREPARED FOR, Ch~rtes Higgins P,O. Box 111463 Anchoroge, AK 99511-1463 (907) 345-0302 TRENCH SECTION NO VATER Irau~l PANNONE ENG. SVC P. O. BOX 142085 ANCHORAGE, ALASKA 99514 872-8218 Phone 8, DATE, 6-e-97 I AS-BUILT PANNONE i~qOINE~RI~Q SERVICi~, I,LC P.O. BOX 10~954 ANCHORAGe, AK 99510 (907] 27'2-8~ 18 I,,~3AL DECal,PI'ION: Lot 99e T121q It~V 8 'WA8 GI~OUND WATER ~COUNI'lf:~? No IF Y~8, AT WHAT DEPIlt? DEPTH TO WAlleR A~ t/ONITOR~NG I~.,RFORM~D BY: ~.,..~. R. l:~,,,~,,w~e, p.E I C~R'FIFY THAT TH~ ~ WA~ I~3~ORM~D IN AC(~ORDANCE WITH AX~ ~TA'f~ AND MUNICIPAL OUIDLINI~ IN ~I~F~-'T ON TH~ DAT~ O1~ TH~ T~T. Pannone Engineering Services, LLC P.O. Box 102954 Anchorage, AK 99510-2954 (907) 272-8218 May 15, 2002 Mr. Dan Roth Municipality of Anchorage On-Site Water and Wastewater 4700 South Bragaw Anchorage, Alaska Re: Lot 29, TI2N, R3W, Sec. 33. AKA 14121 Thunder Road In July of 1996 1 oversaw the installation ora new septic system at the above referenced property and submitted an as-built oftbe new system to your office. In the process of filling out the inspection report form two errors were made: 1. The size oftbe tank that was installed is 1250 gallons, not 1000. 2. The number of bedrooms is 4, not 3. The original permit issued 7/15/96 (attached) was for a 1250 gallon tank and 4 bedrooms. Attached is a copy oftbe pumping receipt for the tank, dated 5/I 1/02, in which 1200 gallons were pumped. All other data on the inspection report form is correct. Please call me at 227-3522 if there are any questions. Sincerely, Municipality of Anchorage Page ~ of ~-~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: <cNN c~,¢,[¢~f PIDNumber:~l~- /~-I1~ ~ ~A~ ~4,~ Wastewater System: ~New ~ Upgrade Address: Phone:~_ ~--O~ No. of~Bedrooms:~ ~DeepTrench E~ Shallow Trench ~ Bed ~ Mound ~Other LEGAL DESCRI PTI O N Sol, Rating:o · ~ _ GPD/Sq. Ft. Total Depth~fro~ original grade: Lot: Block: Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe J J Fill added above original grade: Gravel length: Township:/~ Range:~ ~J Section:~ ~ ~ Ft ~,~ Ft Gravel width~ t Number of lines: Distance between lines: WELL: ~New ~ Upgrade ~~ Ft ( Fb Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area; Pipe material; Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPM J Pump Set at: Ft J c~,i.g Height Above Ground:Ft. TANK SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. Well. l~t/~//.~¢ ~ /.¢l Material: Number of Compa.ments: W~ter /~ /¢.¢ LIFT STATION Lot SizeingaUons:J M~.¢~o,u.~: F°undati°n ~' ~0' / ( ( "PumP°n"'evo'at: ~~ I Highwater a'arm ab Pump Make ~ctrical Inspections performed by: Remarks: I~ F~¢~ ~&s ¢o~2~pu~ _BENCH MARK Location and Description: Assumed Elevatiom Inspections pedormed by: %,~ ~&¢~¢~ ~ ,~, ¢ Dates: 1st ~-'zt- ~~' ~ Department of Health and M uma~Services approval ~"~', ~ . CE. 8149_ Reviewed and approved by:, Date: ~~ · '~*~*?o~'~ss~o~ 72-013 (Rev. g/gl) MOA 25 '~'~TEWATER ABSORPTIDN SYS'FEM t~T 29, g33, T12N, R3~ New New Hog New // SWING TIES FC 43,2' ! 32,1' ! T2 28,0' 53,1' Ici' - ~8~4~_· IC~' "' ~'t;,i~i''T iHT 30,9' ~9,~' ~ C · 23,1 90,3 ~3 TANK ELEVATIBN ,C3 New Drcdn Fletd 59,5' L. oniD, 5' Wide 6,1' E??,, 9' Deep CiNWorkN29S33,DWG MT C04 FIFI . , PREPARED FDR~ Charles Hloolns P,U, ]Box 111463 Anchor~oe, AK 99511-1463 (907> 345-0302 PANNDNE ENG, SVC P, 0, 30X 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & F~x DATE,, .6-B-97 I AS-BUILT ~CAL[ 1~=50' / WASTEWATER ABSORPTION SYSTy ~ Lo~ 29, ~33, T18N, RDW / Existing Septic Sytem / / X~ Lo~ 2 Narle/~cres .. ~ ~ NDTEm !0% Im~LL~lom, I~'~ me~ InciSion doe~ ~'x~ ~ ~ no% and will no~ I~pacg ~urren~ or ~ ?u~ure developnen~ on ~hm~ or o Existing ~ett / ,, 1 // J \ Reserve Brain FieLd 59,5' Long, 5' Wide 6.1' EF?., 9' lleep Existing WeU o 85 PREPARED FOR, Mr, Ch~rtes Hlgglms 14041 Thunder Anchorage, AK 99516 (907) 345-0302 _New lO00g Septic Tank New grain FieLd 59,5' Long, 5' Wide E??,, 9' lle~p No weLLs wit;hit ].00' o¢ propo., septic syste~ Lo't; 29 Sec'Won 33 T12N, R3W SoiLs= 250s?/br 4 ]]edroon House lOOO SF Rqd AS-BUILTI 6,1' E??ective 9' Tot~[ Depth 5' Wide, 59,5' Long Total Absorption = 363 s? ed P~nnone Eng, Svc, Pi 0, BOX 142025 ANCHDRAGE, ALASKA 99514 272-8218, 272-8218 FAX BATE, 10-~6-97 AS-B iL-J' ~CALE' 1'=60' I U Steven R. Pannone, P.E. consulting Engineer October 25, 1997 P.O. Box 142025 Anchorage, Alaska 99514 (907) 272-8218 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 29 Section 33, Township 12N, Range 3W Well Relocation Attn: Mr. Dan Rotb Dear Mr. Roth: The new well was installed in a different area than was shown on the original design. The new well location is in the northwest corner of the lot. This location does not affect any surrounding septic system within 200 feet of the new well. Future development is not impacted by locating the well on this lot in its current location. In fact, it is a more desirable location. Lot 2 Marie Subd. ltas a septic system located on the southeast portion of the lot. Even though the design location was over 100 feet away, it was still down gradient from this existing system. The new well location does not have this condition. Please contact me if you have any questions. Sincerely, .E. - Civil Engineer C:\WORK~29S33.002 ~: ~_PINE DRILLIHG Fi~X 14]. : 9~,7 ~$ ~2. Mae. 15 2~02 10:23:~1 Pi LOCATIC~ DF WELL STATE OF ALASx. A DEPARTMENT~OF NATURAL RESOURCES DiV~$:ON OF Mfi',flNG & WATE]::: MGMT WATER WELL RECORD LOCATION!SKETCH: WELL 0~74 ER: MEASURED FROM:t']casLq~ tOD i-lgrou~ BOREHOLE DATA: \ . Oep~ Ty~ a~ C~or. , ' From TO WELL DEPTH: OepU~ of ea~ing: DATE OF COMPLETION METHOD OF DRILLING: USE OF ~ ~qc'dome$:ic I'1 Irrigation I-I mo.:or ' ~ ~ICK * Dilm: TYPE: ~open ~AKE O~O Debts of DPC~OS: to ' tt 8~ TYPE; $lo~Mesh Stze: ~V~ P~K TY~: .~' Oe~ to QRO~ ~PE: Vol~e: D~MI Durad~: Fair rotarf , r-f c~O.e'teel "' LEVEL AN D.,,~IEI.I~: PUMP INTAKE DEPTH: ft Horzepo~ver:. W~LL DI~:INI~CTED UPON COMPL~? ~ NO ~~ MAll. WH~E COPY OF LOG ' ' * . A~GE AK 99503-6935 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 ON SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960194 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:FALK HELEN M OWNER ADDRESS:14041 THUNDER ROAD ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/15/96 EXPIRATION DATE: 7/15/97 PARCEL ID:01818112 LEGAL DESCRIPTION: T12N R3W SEC 33 LT 29 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IlS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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 (iSAAC80) . THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343 4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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 THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY.L ..~ DATE: ISSUED BY: ~, DATE: Steven R. Pannone, P.E. Consulling Engineer June 29, 1996 1LO. Box 142025 Anchorage, Alaska 99514 (907) 272-8218 Muuicipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 29 Section 33, Township 12N, Range 3W Request for Well & Septic System Permit Attn: Mr. James Cross, P.E. Dear Mr. Cross: The owner of the above lot contacted me to investigate installing a well and septic system on this Int. I conducted a soil's investigation on June 21, 1996. A+ Home Se~wice excavated two test holes. The soil's logs are attached. The lot is 2.5 acres in size and currently undeveloped. Existing wells surround the lot, but do not affect the proposed location m' secondary location of the septic system. Existing septic systems will not be affected by drilling a new well on the lot. See the attached site plan and septic system design. The proposed septic system will be installed on the southern portion of the lot. It will be located on a flat bench. Slopes leading down to this bench and away fi'om this bench are gentle 10-15 percent slopes. The system will be installed in silty gravels having a percolation rate of 16 minutes per inch. Please contact me if you have any questions. Sincerely, '~S~even R. Pannone, P.E~~' Civil Engineer C:\WORK'x29 S33.00l v DESIGN VASTEVATFR AI~SORPTI~]N Lot Eg0 S33, T1EN, 0 ~xls~lng Veil V Existing Sep*Ic Sytem Lo~ ~ M~rle 0 Existing ;/eU ~osed °Proposed WeLt 4g~ Steven R. E14g New gntton Sept;lc To, nk. 100' of septk= sys't;efl Test PIt: I No welts wi'[:hit 100' o? propo,. septic sys'tem .isz Lo'~ P9 Sec'~lon 33 TI~'N, R3V ed Exls'tlnO Ve[t Mr. Chmr[es Htgglns 14041Thundep Romd Anchopm~e, AK 99516 C907) 345-0302 BS' Soils= ESOs?/br 4 ~edroom House 1000 SF Rqct DESIGN. 6' EFFec'tlve 9' To'tnt l]ep'th P_' Vide, B5' Long Tot;mt AIosor-p'tlon = 10~!0 s? P~nnone Eng. Svc. p, n. ])OX 14E025 ANCH~RAGr'o ALASKA 99514 E7~-BEIB E7E-BEI8 FAX ATE, &-E4-96 I]ESIGN DESIGN WASTEWATEtR ABSORPTION Lo~ 29, S33, Ti~N, R3W © E xis'l;l~g WeLL EN F_-xlstln§ Septl~ Sy'ter~ Lot 2 Narle o :xlstlng WeLt 3r~wlng 'oposed 'lveway ° Proposed Well ed ~o. ry System 85 L,F, New ~T_2~ ¢7;. No weLLs go, lion Septic Test; Pit 1 . log' 0¢ ~'- T<ink, - DESIGN DETAILS WASTEWATER A]DSORPTIBN SYSTEM Lot 2.9, g33, T12N, R3W mum Z PREPARED FORI Mp~ Cho~'~es HigBims id041Thundep Rood Anchop~ge~ Al< 99516 (907) 345--0302 P~nmo~e E~§, Svc, P, B, D~X 14~02~ I ANCHDRAGE, ALASKA 99514 L274-0308~ 272-8218 FAX IBATEI6-23-96 J .INI]:T TH ~CAL~ DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORN LEGAL DESCRIPTION: 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16- 17- 18- 19- 20- Township, Range, Section: 'r-I~.~ ~2. '~.,D ._~ ~,~. SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT Beplh to Waler Alter Moniloring? Reading Date Gross Net Depth to Net Time Time Water Drop I PERCOLATION RATE ~'~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~'~-. FT AND ~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. 72-008 (Rev, 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: (~¢¢~ '~t-- ~[f~ , ® Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: �'t12- C 4hkh ,/v LEGAL DESCRIPTION: l rt DEPTH (FEET) Li���i.•l.N� C ✓LORI t 1 '- 2 y� L 3 4- 5 6 7 8 C?,Otii 9 10- 11 12 13- 14- 15-- 16- 17- 18- 19- 'q f 31415 - - 16171819 'qf c7 CTs Cr'raiz-C. AV L OA S 0, yrs DATE PER FORj�}�D:r 3^.( - -•1K Township, Range, Section: Tl2 i"JL SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? (ALV L IF YES, AT WHAT 0 DEPTH? P E � Depth to Water After Monitoring? Date: i] Reading Date Gross Time Net Time Depth to Water Net Drop V Z cr Z 3�. V ( -Z :3 •� E:' fie 20 L-1 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER ---�� TEST RUN BETWEEN 51 FT AND FT COMMENTS rl ` rd f aC--' C 06 PERFORMED BY: S `�L ,1JAA)A.) 9,yLL. �_ —rh'— CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Development Services Department .- Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Parcel I.D. 018-181-12 Certificate of On -Site Systems Approval Expiration Date: ) I — & —1 1. GENERAL INFORMATION Complete legal description T1 2N R3W SEC 33 LT 29 Location (site address) 14121 THUNDER RD Current property owners) GOMEZ Day phone Mailing address SAME 3456 ZRReal estate agent ti Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Waiver Fee $ Date of Payment _ ��� %%q Date of Payment Receipt Number Receipt Number COSA # 05(AI36 Waiver # 2. TYPE OF DWELLING: mr qUG�� - � ❑ Single Family (w/wo ADU) I //q F-1Duplexo� �a ❑ Multiple Dwellings (Single Family and/or Duplex) 6' 957E 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Waiver Fee $ Date of Payment _ ��� %%q Date of Payment Receipt Number Receipt Number COSA # 05(AI36 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 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-27-19 6. DSD SIGNATURE System #1 Approved for _� bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, `1`; • 4 7 T �e•a ••e e�•,e ,�.e of a"e'e:�e ee •o�I • e e e e • e •• •'.e e e. e e e e a v • MICHAEL N. ANDERSON ; It c CE 9 69 �kb pROFESSIO����4 with the following stipu�d+t�ti� WATER AND r" J� WASTEWATER o J�JJJ �1 SERV�G�� Vis,`, Original Certificate Date: 'I 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 Checklist blue sheet COSA Checklist Legal Description: T12N R3W SEC 33 LT 29 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 7-261996 Total depth 60 ft Cased to 60 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 6/16/19 Static water level at beginning of test 44 ft. Comments B. TANK DATA Age of tank(s) 2019 years Tank type/material STEEL Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW 5 BEDROOM SYSTEM D. ABSORPTION FIELD DATA Which system tested (date installed) 11/1/18 ❑ ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 018-181-12 Structure served by this system Well production at time of test 2.5 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 9.58 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by M NA Date of Sample 7/16/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW Results [DPass For 5 bedrooms Fluid depth prior to test 0 in Water added NEW gal New depth 0 in Elapsed time NEW min Final fluid depth 0 in Absorption rate NEW gpd Any rejuvenation treatment (past 12 months) UN If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F✓ Yes Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' ✓1 Yes if No _ Water Main > 10' Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft 2✓ Yes if No. Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 0 Yes if No ft R Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F✓ Yes if No ft Surface Water > 100' Yes if No _ Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: Q✓ Absorption Field > 5' E✓ Yes if No ft Private Wells > 100' ✓1 Yes if No _ Water Main > 10' 0✓ Yes if No ft Community Wells > 200' 2✓ Yes if No. Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0✓ Yes if No Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' p✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet r• ,< s� owl, M r1 49 ... rr . rro.r.r A,NCERSON CE - 69 ft ft ft ft ft A411-111 § DEVELOPMENT SERVICES DEPARTMENT ( � On -Site water and wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC191358 Subdivision: T12N R3W Sec 33, Lot: 29 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 9.58 milligrams per liter (mg/Q. 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 Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. BOBBYE BURNETT 2941 Carriage Drive Anchorage, Alaska 99507 (90 7) 350-5541 GRAPHIC SCALE 25 0 2` N 89 °59' 30" W 329.74 EAST 142ND AVENUE Date Scale Legal Description 7/57/2019 lit = 50' GSW0 2 3035 AS -BUILT SECTION 3 T12N, R Drawn by Field Book S.M., ALASKA BFB ASB2019 f N 89°59'38 W 329.76 ; WOOL F EIN 13 C3 129. CF-IAIN LINK FENCE ASFl AL_i i. Z• WELL y ri O D to 10 0 I O dj { 10 ^C Ctt! dC.LL RADI 1 SHED IO 10 €O BOBBYE BURNETT 2941 Carriage Drive Anchorage, Alaska 99507 (90 7) 350-5541 GRAPHIC SCALE 25 0 2` N 89 °59' 30" W 329.74 EAST 142ND AVENUE Date Scale Legal Description 7/57/2019 lit = 50' GSW0 2 3035 AS -BUILT SECTION 3 T12N, R Drawn by Field Book S.M., ALASKA BFB ASB2019 • 1s)• G Municipality of Anchorage •,1 �c °P15 ' "'. >> On-Site Water and Wastewater Program 9 • A� .:, .. Y c� ,o (907) 343-7904 yL" ='' cl JUL 1 a 2018 Certificate of On-Site Systems Approval w 018-181-12 Parcel I.D. Expiration Date: — I G •• 0 9�' 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 33 Lot 29 Location (site address) 14121 Thunder Road Current Property owner(s) Scott Gomez Life Estate Day phone Mailing address 14121 Thunder Road Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: O 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 Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: cc, Received by:( 3C , k Date: In n I 1 COSA to be released to the engineer,unless otherwise requested by he en ineer. COSA Fee $ c24 .CO Waiver Fee $ Date of Payment 7/12/61 Date of Payment Receipt Number 00,53 G Receipt Number COSA# b S Ci 12l ; C) 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 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 7/11/2018 ��•pFA•IS 6. DSSIGNATURE •••e• •••• .� v••• • 0 . System #1 Approved for (-( bedrooms �j •Steven R. 0annone• • 6- .•. CE-8149 System #2 Approved for bedrooms s .• ,? Disapproved �l1 ` 'PROF•ESS1• .00 -11— +'� Conditional approval for bedrooms, with the following stipulations: E Z.) /A rER c WA SrEwq kir.' R �. pp 4 £z _� GR r• tt � � � Q By: J f w. I^ Original Certificate Date: / I v 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 c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system i Certificate of On-Site Systems Approval Checklist Legal Description: T12N R3W Sec 33 Lot 29 Parcel ID:018-181-12 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 7/28/1996 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 60 ft. Cased to 60 ft. Casing height(above ground) 33 in. FROM WELL LOG AT INSPECTION Date of test 7/28/1996 6/23/2017 Static water level 41 ft. 55 ft. Well production 8 g.p.m. 4'6 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 7.03 mg/L Arsenic ND ug/L Date of sample: 6/26/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/21/1996 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cl n (Y/N) Depres .• •ver tan N N A Hi• /': - - . • (Y/N) N/A Date of pump 7-2-0 IS) Pumper �0- J rdclC I • C. ABSORPTION FIELD DATA Date installed 7/21/1996 Soil rating (g.p.d./ft2 or 2/bdrm) 0.6 GPD/SF System type Deep Trench Length 59'5 ft. Wid • ii% ft. Gravel below pipe 6.1 ft. Total depth 9 ft. Eff. absorptio area `'I�' _ �i'q» ring tube Y Depression over field N Date of adequacy test 6/23/2017 , ,:• 1�-ass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 612 gal. New depth 5 in. Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "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 100+ 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 10+ 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 — OFA l I certify that I have determined through field inspections and review of Municipal records that the above systems are in *: 4 ! 4\ ••* , conformance with MOA COSA guidelines in effect on this date. 4•• •• • •• ti o •• 0,0 Engineer's Printed Name Steven Pannone '•:S1everi�2.•0aririari :' Date 7/11/2018 i ' CE-8149 0'/ COSA canary sheet_2-6-15.doc ‘C1PALI1, r___,_,,, Municipality of Anchorage .menr s On-Site Water and Wastewater Program �° "^ • ,'' r.. 1 P.O. Box 196550 4700 Elmore Road g �� �'� Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax: (907)343-7997 http://www.muni.org/onsite 44.Ck0nP6t' I elm r tnlcnt Review Comments Engineer: Pannone 7/17/2018 Legal Description: T12N R3W SEC 33 LT 29 Parcel ID: 01818112000 Permit: OSC181330 WellSeptic Report Type: COSA Completed By: T.Ecklund The application has been reviewed and the following comments have been generated. These are to be satisfactorily addressed prior to MOA approval: 1. This system is actually undersized for 3 bedrooms, There was a revised IR on file but never approved. Please justify why this should now pass as a 4 bedroom 2. Please verify effective area# . tour a septic pumper receipt ate provi e-a-new survey V 7 714-is - .sSoa UvAS P Sb2c - --C 640 /tl iqAY cwt 7� 2 acs c U$.S ‘A-1-'pd►N (7o 74- - S‘-lle,, (---e-T" $Z (XIS.Qdt 12 ..----b2 A w'.4"c-, 44 A62.e2z �{ u)Ks ' �2w t6 0 N 5735/0 "FF - —8 0c)�""ti s , • 8475 Lot 2 Marie Acres /Wood fence S89°59'380E 329.75 (P83-322) `Chain link fence ei et Asphalt 104.5 30.0 Wello ° M N N 5.0 � 7.3 _i ti,•o 03 me o 75.30 117,2"„1: 2Story frame House o Oe M 0 M 138.1 :s 27.0 32.3 M 0) r,,:i::S. N CO° 2.0011 N Lot 30 M °deck e ° M CO e Cr) c? ops ° o_ a. o ®� �� eQ 2 a U) in ID :1- C\I to N r 0cc O z = LOT 29 z D U 7 I— 0- w ,,5 W T X I— Po CO .O X p W• Q Z• M I I— L 33'Roadway&Public Utility Reservation E.142nd Avenue S89°59'00"E 329.74 (P71-235) Note: Distances and bearings are record per referenced plat numbers. ```Av k\1 AS-BUILT NO CORNERS SET THIS DATE OF•A 11 I hereoy tardy Nal I nave performed a Mortgagees inspection •.•'".1-•:":•• 'P'\, • •�.� or the following described properly:LOT 29. SECTION 3$, T12N, R3W,S.M„AK 49th „ ••• / • •* Anchorage Recording District,Alaska,and that the 0 h ��,/''7 improvements situated thereon are within ere property Mea -wc.v:v�4 r and do not overlap or encroach on the property lying • •. zabeth L.Waiotkd.• / adjacent thereto.that no improvements on the property lying �• 8036-LS ...1,..,•". adjacent thereto encroach on me premises in question and '''t,,• sthat there are no roadways.transmission lines or other o— visible easements on said properly except as Indicated SCALE: 1"=40' f reon. 1%�5N.N.N.` Dated at Anchorage.Alaska EASEMENTS OF RECORD,OTHER THAN this 9th day of JULY .2018. THOSE SHOWN ON THE RECORDED 7-I U•16 FRED WALATKA 8 ASSOCIATES.L.L.C. PLAT ARE NOT SHOWN HEREON FB 18-5. pg 22 BE Engineers and Surveyors UNLESS OTHERWISE NOTED. 907-248-1666 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT /• 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181330 Subdivision: T12N R1W Sec 33, Lot: 29 A water sample revealed a nitrate concentration of 7.03 milligrams per liter (mg/L). 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 Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P. 0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen,which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT j• '�: 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181330 Subdivision: T12N R1W Sec33, Lot: 29 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 22 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. a A - �.i ....... .t. t ( - '.O' toOttV 3, n 205)8 Mailing Address: P.0. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-181-12 1. GENERAL INFORMATION Complete legal description Lot 29~ T12N~ R3W~ Sec. 33 Location (site address er directions) 14121 Thunder Road, Anchorage, AK 99516 Current Property owner(s) William Charles Hifl.qins Day phone.345~302 Mailing address Lending agency 14121 Thunder Road~ Anchora.qe~ AK 99516 Day phone' ' .'~-~': ' - Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) 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. DSD 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 redly 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. Name of Firm Pannone En.q. Svc. Phone 272-8218 Address P.O. Box 102954~ AnchT AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adcquaey test, I atterapt to provide a thorough, conscientious angineeri~g analysis otthe system in acoord~ee vdth MOA DSD Guidelines & Regulations. The reported ~sults d e.,.,.,.,.,.,.,.,.~ fib c the perfermancc of the s~t c'm un&'r the condit/ons encountorcd at the time of the test, and soparation distances me.~sm'cd to readily identifiable feat'ares. Thc opcratioanl life of all wells and septic systems dc!~md on thc local soil condition, ground water levels that may fluctuate during thc year, and the '.~ater nsage of the family being sorvcd by the s)~tcrrL These conditions are outside the control of the evaluator of this s~crm All s-~tcms evmtually hil and satisfactory test results do not guarantee future l:~rformance of the system, nor do they guarantee that thcro am no hidden defcots or encroachments. PES can therefore not provide any ,~arronty for future performance nor give any estimate ofliow long the ~em will continue to meet the oporatioanl requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the ov,'nor listed above. Any rclianea upon or use of this relX~ by any other pct~on or pan'7 is not authorized nor bill it coffer any legal right ~tmtseeven 6. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for __ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: ,~-, ~' Expiration D.a. te: r- o~ X Original Certificate Date: ,~',/r¢,/~'~ Reissue Date: Maintenance Agreements Supplemental Engineer's Report Other Municipality .of Anchorage Development ,Services D. epartment Building Safety Division . On-Site Water and. Wastewater Program 4700 South Bregaw Street P.O. Sox 196650 Anchorage. AK 99519-665~' www.ci.anchorege.ak.us (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 29. T12N. R3W. Sec. 3~ Parcel I.D.: 018-t81-12 A. WELL DATA Well type P If A, B, or C provide PWSID # Well Leg Y Date completed ?128/1996 Sanitary seal Y Wires propady proteoted Y Total depth 6o ft Cased to 60 ff Casing height (above ground) 33" in. FROM WELL LOG ATINSPECTION Date of test 7128/1996 6/1312002 Static water level 41 ft Well production 8 g.p.m g.p.m WATER SAMPLE RESULTS: Coliform ~,onies/100ml Nitrate' ~'~0 rog/! Other bacteria ~lonies/100 mi Date of sample: 6/13/2002 Collected by: Laura Pannone B. SEPTIC/HOLDING TANK DATA ;T' ,., _..._~t ..... ( Tank Type/Material Gmer Steel .... ' ;~ ~ ' ' ' '~" ' ~ *" ~" ' ' Date installed 712t11996 Tank size 1250 gal Number of Compartments ~ Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm Date of pumping 6/1tl2002 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 712111996 Total depth ~/I '-~ ff Eff~ ~ ,r~ ~ D~e of ~ua~ t~ ~I~00~ R~s (PA~ai~ Flu~ de~h in a~ion fie~ ~om t~ ~ in Ela~ ~me: ~ min Fi~l flu~ de~h ~ in Any mj~e~ion tre~me~ (~ 12 mo.) ~ & ty~) N Soil rating (g.p.d./ft2 or ~/bdrm) .6 System type Deep Trench Gravel below pipe ~ I__ fl Monitoring tube Y Depressio~ over field FI P For_4 beclroom~ " Water edded600 gal. New depth18 in. Absorplion rate >= 600+ g.p.d. · If yes. give date (Rev. 1 I~) h !i · ~"'~.. ' .. D. UFT STATION ole/Access Date installed 'Pump on' level at _ ~ level at in High water alarm level at in Datum ../" Cycles tested Meets alarm & ~ircuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ,~ptic fan.lift ~ion on lot '1~$' On ~dja~nt ~ t00+ Absorption field on lot 141 Public sewer main 11~0+ Sewer/septic s~rvice line On adjacent lots 100+ Public sewer manhole/cteanout 100+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Buildi~gfoundation 7' Pmpertyline 100' ' Absorption field t4' Water main 100+ Water sewice line 25+ Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO' Property line I10' - Building .foundation 30' Water main 100+ Water Service I~ne'~,H." Surface water 100+ Driveway, perking/vehicle sto~e ~ Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS; A,~:.'~. ~'~..~, .,'~,~.. '~.~ ~ ~.~lr4:z~.q '~.. G. ENGINEER'S CERTIFI~TION I cer#fy that I have daterm/ned mrough ~ek~ inspect/ons and review of Municipal records that the above systems are in conformance w~h MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. Date ,~-//.-q"(O ~-- (Rev. 11/g9) ~T~.,; ....... 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