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Home My WebLink AboutDENALY BLK 1 LT 24Densly Block 1 Lot 24 #067-062-04 Municipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite ON-SITE WASTEWATER INSPECTION REPORT Permit Number: SW000191 PID Number: 067-062-04 til,/ 43.1 2 Page 1 of 3 • (907) 343-7904 ✓ New ❑ Upgrade Name: Dave Warner ABSORPTION FIELD Address 25542 Denaina Drive ❑ Deep Trench ✓ ❑ Other Shallow Trench ❑ Bed ❑ Mound Phone Number of Bedrooms 4 Soil Rating 1.2 GPD/SF Total depth from original grade 9.0 Fl. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 5.0 Ft. 4.0*Ft Denaly 1 24 Fill added above original grade Gravel length Township Range Section 1.0* Ft. 50.0* Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 5.0*Ft. N/A N/A Ft. To From Septic Tank AbsorptionHolding Field Lift Station Tank Sewer Line Total absorption area 500* Ft' Number of trenches 1 Dist. between trenches N/A Ft. Well 127 147 N/A N/A 83 TANK o Septic • S.T.E.P. ■ Holding • Other Manufacturer Capacity Surface Water 100+ 100+ N/A N/A Unknown 1250GaI. Material Number of compartments Lot Line 65 36 N/A N/A NA Unknown 2* Foundation 42 65 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks System installation was inspected by S&S Pump on level at Pump off level at High water alarm at Engineering. Engineer of record is no longer available. in. in. in. Field observations were taken on features visible from Pump make and model Electrical Inspections performed by the surface during adequacy test. Installer PIPE MATERIAL House to lank Tank to * * drainfield Unknown Drainfield * CO/MT * Inspector S&S Engineering / Pannone Engineering* BENCH MARK (Assumed elevation) ft Inspection, dates: 1' Unknown 2nd 9/18/13* Location and description p 3rd 41h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date Engineers Stamp ✓' A• Cdr .i *•TF# /\ iF�/ -,46.N �/[/ / jP/t� /� Approved � Date /0-3 43 f Ven J%. 4nnoiZe'yl oiZpCE a8149 �iik' POFE5 0 \- ` %its..- ' nspection Report_1-1=1 I,t N OTE: SYSTEM INFORMATION VISIBLE FROM THE SURFACE WAS ACQUIRED THROUGH FIELD OBSERVATIONS DURING ADEQUACY TEST. TOTAL DEPTH OF MONITORING TUBE FROM SURFACE AND DEPTH TO CLEAN OUT INVERT FROM SURFACE WERE MEASURED. DUE TO THE UNAVAILABILITY OF THE ENGINEER OF RECORD IT IS ASSUMED THAT THE SYSTEM WAS INSTALLED PER CODE AT THE TIME OF CONSTRUCTION. 1 SOT& <441/6 SEPTIC AREA (E) /� 1 �\ 2 /N, M —_MIS IF 1 7 �� WELL (E) DRIVEWAY GARAGE 4 BR HOUSE (E) O4;.FlOp SFA FO .35.9 m1 DRAIN FIELD (E) *SOLE x 5'W x 4.0'ED x 9.0'TD* • —w LOT 24 1250g SEPTIC TANK (E) W/ DCO DC1 N� DC2 NOTES: SEPTIC AREA (E) RECORD DRAWING PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 PLAN DENALY, BLOCK 1, LOT 24 DAVE WARNER 25542 DENAINA DRIVE EAGLE RIVER, AK 99577 '*:m /\ *? % star 11\7 A Steven R. I'annore• 6 8149 . ' RW, °got-Ess01* Date 0/30/2013 Scale P.I.D. NO 067-062-04 PERMIT NO. SW000191 Sheet 2 OF 3 A B Ti 44,4 37.5 T2 51.7 44.4 DC1 57.8 50.2 DC2 61.9 54.2 01 79.2 51.7 M1 80.8 54.3 . C2 68.5 79.0 M2 66.7 77.1 NOTES: SEPTIC AREA (E) RECORD DRAWING PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 PLAN DENALY, BLOCK 1, LOT 24 DAVE WARNER 25542 DENAINA DRIVE EAGLE RIVER, AK 99577 '*:m /\ *? % star 11\7 A Steven R. I'annore• 6 8149 . ' RW, °got-Ess01* Date 0/30/2013 Scale P.I.D. NO 067-062-04 PERMIT NO. SW000191 Sheet 2 OF 3 NOTE: SECTION AND PROFILE INFORMATION VISIBLE FROM THE SURFACE WAS ACQUIRED THROUGH FIELD OBSERVATIONS DURING ADEQUACY TEST. TOTAL DEPTH OF MONITORING TUBE FROM SURFACE AND DEPTH TO CLEAN OUT INVERT FROM SURFACE WERE MEASURED. DUE TO THE UNAVAILABILITY OF THE ENGINEER OF RECORD IT IS ASSUMED THAT THE SYSTEM WAS INSTALLED PER CODE AT THE TIME OF CONSTRUCTION. 4" 0 DRAIN PIPE 0 0 0 0U 3.0 14.0 = wo J Z 0 0 0 O U SECTION w CO OW r4" 0 DRAIN PIPE j 0 1 U E 2509 SEPTIC TANK (P) LEGEND w w WATER LINE/ WELL RADIUS ss NEW SEPTIC PROFILE DESIGN PARAMETERS EXISTING SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = 1-5 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 500 SF SYS. TYPE: WIDE TRENCH 4.0' E.D. RE: 0.50 MIN LENGTH: 50 LF ABBREVIATIONS CU COPPER DIP TH FC T# C# M# R.I. DCO DV FS BFG OG FG TS&V DUCTILE IRON PIPE TEST HOLE FOUNDATION CLEAN OUT TANK CLEAN OUT NO. CLEAN OUT NO. MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEAN OUT DIVERTER VALVE FLOW SPLITTER BELOW FINISH GRADE ORIGINAL GRADE FINISH GRADE TOPSOIL Sc VEGETATE NOTES: RECORD DRAWING PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DESIGN DETAILS DENALY, BLOCK 1, LOT 24 DAVE WARNER 25542 DENAINA DRIVE EAGLE RIVER, AK 99577 ��\� Date `� OF A��SlII1 0/30/2013 A 0).• o- �t/ Scole i* 43 •*, lit lit•® P.I.D. NO 067-062-04 Steven R. Pannone CE 8149 +V4. FESSI rim PERMIT NO. SW000191 Shee 3 OF 3 C�ertifieb grilling s by DOC Co dba SULLIVAN WATER WELLS P O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND /)AUiil W� IJn ADDRESS /7o3&£04(Y s-z-attibla LEGAL DESCRIPTION 1910J r4 LY /3t /C 1 La -4 PERMIT NUMBER DO 19 % Date of Issue 7 -o -200a TAX INDENTIFICATION NUMBER O it / - O%aZ - tiq Is well located at approved pennd Ioc nate ? Method of Dnlhn @��/ 9 Depth of well 111 Casing Type STI: h_f Wall Thickness inches Diameter 6H inches, depth % ! feet Liner Type /1� t.S i'. Casing Stickup Above Ground tPteis Q No r rotary Q cable tool Fd. Static Water Level (from ground level) cit. ca nib feet feet Pumping level feet after hrs pumping qpm Recover Rate rat' qpm Method of Testing 4112. Well Intake Opening Type pen End Q Open Hole Q Screened, Start feet Stopped feet Perforations Start- tYStopped " feet Grout Type Dsa,ra-J I c 4V' o uu'�me /St ' Depth from a feet, to feet Pump Intake Depth feet Pump Size hp Brand Name Well Disinfected Upon Completion? tYenQ No Method of Disinfection Cq;0ietid= P//i' BORE HOLE DATA DEPTH From To O Cin.Jc Si rccU, EB Qs erns kJ 3S ,s. i i 54.44 ?6;44.1.6t .37 so nor l to 17' - 17S Si4"14 6R4JA_ { Cl�d7flc' Comments E?cacti. Dnller's Name ,B..:.,c.(/ f«.�--�' ATTENTION It is the responsibility of the property owner to submit a copy of the well log to the proper authonty Municipality of Anchorage Department of Health & Human Services and/or Department of Environmental Conservation MatSu Borough Department of Environmental Conservation MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P 0 Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 5-7-oo hi` - 3: o O sa,.-i r/$/ 4p w, ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number. SW000191 Legal Description DENALY BLK 1 LT 24 , Design Engineer 0003 S & S Engineering Owner Name David Warner Owner Address 17032 Easy St , #A-10 Eagle River , AK 99577 - This permit is for the construction of n Disposal Field ✓ Septic Tank n Holding Tank Date Issued Jun 23, 2000 Expiration Date Jun 23, 2001 Parcel ID 067-062-04 Site Address Lot Size 40252 SQ FT Total Bedrooms 4 Permit Bedrooms 4 Privy Q Private Well — Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection Provide notification by calling (907) 343-4744 (24 hours) ( Not required for a Water Supply Permit only ) 4 From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either A Open and closed on the same day B Covered, sealed, and heated to prevent freezing Received By Issued By )1zi7ty' t t4,7(—/ Date e/ ?-74 Date —23 —00 HEALTH AUTHORITY APPROVALS SEWER BWATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL S. MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C COWAN, P E June 8, 2000 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O Box 196650 Anchorage, AK 99519 REFERENCE. Lot 24, Block 1, DenalYS/D CML ENGINEERS (907) 694-2979 FAX(907)694-1211 It is requested that you issue a permit to install a septic system & well to serve the proposed four bedroom dwelling ori the referenced property. Two tests holes were excavated and percolation tests were performed The approximate location of the test holes are located on the attached site plan At the time of excavation on 4/23/99 water was not found After momtonng on 5/15/99 they were found to still be dry. A third test hole is planned at the time of construction We do not anticipate any adverse effects on neighbormg wells, septic systems, reserve areas or drainage patterns by the mstallation of the proposed septic system The construction of this system will not prevent any future development on any of the adjacent properties If you require additional information, please contact us Sincerely, 2 Robert C Cowan, P E RCC/jhm Enclosure +DECEIVED JUN 14 2000 MUNICIPALITY OF ANCHORAGE \ JPnNA4ENTALSERVICES DIV'SI^ 17034 NORTH EAGLE RIVER LOOP 6 SUITE 204 • EAGLE RIVER, ALASKA 99577 = 60' SCALE SITE PLAN DESIGN /ap zZ Z r0 a Z z Z \ g Z ® /yZ c 3 / Z z �rnrn �rnrntit \ § 4 r 0 § � « a O �!& Z Z Z Z Z Z nom a AD W 331 0 / 0 Q « r I hFRPUnMEbtoh M tihlcfpalily bi Anchorage bEPAhtMENt OP t-IEALtHI & HUMAN StMVICES b25 "L" Street, Anchorage, Alaska 99502-5050 soils Lbt — hthcoLATIoN TEST C 0.t%aVl LVa/nQ✓„ Il I I1.J1l1 l Ili, J AI 1 .e•cc OF 4i,7S11 it 14 g Q�y e 4, 1-1// GATE PERFORMED S lel Lic. .. LEGAL bESCRIPIION L01 Z41glxk! DelQr1cr s/Q r, g Seclioh llrC , ` Tbwnshl Flange, i SLOPE SITE PLAN �Z1? �RkT r r,- • '1 2- b'Sarl`►C5 - sg,,d (sr) G.14444o CAAv'bc w arY SILT WAS GROUND WATER ENCOUNTERED? IP YES AT WIIAt btrtli? bept11 lo *alar Aller Monitoring? hale S L 0 P E w heading bale %/a I ha Groat Time 0 Ne tote – b pill o Water ��(=51 O�- /• Net brop F I/// 3, 6-" AfrFr,.1. 3.8 " RLC,,.r- S.S•• , o , o r.,,,, 8 u II — ,o 0I IN — 'l -S' $ " Z/, " m I a 3'7- ,o a+,.' tr, I'EhcbLAtloH hAlt a • $ (mmulee,l chl PERC DOLE DIAMETER 6 f sf hUN bEtwtth ' Pt ANb Pt bbMMENT§ hEhrbhMEb by 5 & S ENGINEERING _ `I7 17 — GEM. IPY tiIAI 71115 7E51 WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 Act'bhbANCE WItrjoi4l�iiFEiNIfiI AL GUIDELINES 114 EPPEcf oN?His bA?E bAtE 12 Wd Kiev '44351 `i,[C V D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER/ AK 99577-8736 SOILS PERCOLATION TEST Performed for: F. Robert Bell & Associates Project. Depth (Peet) 1- 2- a- 4- 5- 6- 7- 8- 9- 10- 11- 12- i3- 14- 15- 16- 17- 18- 19- •,4.19,, i * 49 lit Pi e••• • 1••••• .e.«••••••• 3 R`: �. • CE 7116 =i Date Performed 4/23/99 20- Lot 28 McIntyre TEST HOLE 0 99-28 Org— soft, black/brown, moist SM — soft, bm, slightly gravelly sandy silt, moist SP — Med dense, gray slightly gravelly sand moist B.0 H. HOLE PRESOAKED PRIOR TO PERCOLATION TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? DRY What depth? N/A Date? 5/15/99 Reading Date Gross Time Net Time Depth to Water Net Drop 1 4/26/99 1 20 - 8" - 2 1.25 5 min DRY 8"+ 3 1 4 126 - 8" - 4' 131 5 min DRY 8"+ 5' 1.32 - 8" - 6 137 5 min DRY 8"+ 7 e 138 - 8" - 8 L43 5 min DRY 8"+ + Water Added Percolation Rate > 1 (min/in) Perc Hole Diameter 6„ Test Run Between 3 feet and ___4,__ feet Kenneth M Duffus, certify that this lest was performed in accordance with all State and Municipal guidelines In effect on this date SOILS PERCOLATION TEST '1iepve PAoFESS1� P4. pY performed for: F. Robert Bell & Associates ' Date Performed' 4/23/99 Lot 2713 McIntyre Project Depth (Peet) 8-' 9- 10- 11- 12- 13- 14- 15- 16- 17- TGSI HOLE # Org — soft, brown, moist SM- med dense, silty sand,moist GP—med dense, gray, sandy gravel, moist ML — soft, brown silt, moist GP — Med dense, gray slightly silty, sandy gravel, moist SP - Med dense, gray sbghtly silty, gravelly sand, moist B.O H HOLE PRESOAKED PRIOR 18- TO PERCOLATION TEST 19- 20- 99-2711 SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NQ Depth to water after monitoring? pRY What depth? N/A pate? 5//5/99 heading Pate Gross Time Net Time Pepth to Water Net Drop 1 4/27/99 11.00- 8" - 2 1105 5min 4/16" 712/16" 3 7 1106 - 8" - 4 1111 5min 3/16" 713/16" 5 t 1112 - 8" - 6 11.17 5min 3/16" 713/16" 7 t 11.18 - 8" - 8 11:23 5 min 2/16" 7 14/16" 9 1124 - 8" - 10 1129 5min 1/16" 715/16" 11 11.30 - 8" - 12 11.35 5mm 1/16" 715/16" * Water Added Percolation Rate ...LL (mm/m0 Perc Hole Piameter_6" Test Run Between 35 feet and 4 5 feet I, Kenneth M Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on flus date ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 24, Block 1, DenalY S/D June 8, 2000 GENERAL: 1 The scope of this project includes the installation of a 1250 gallon (minimum) septic tank and three shallow trenches to serve the proposed four bedroom residence located on the referenced property. 2 Construction shall be m accordance with the approved site plan and design drawings, Municipal permt with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations 3 The contractor shall be responsible for obtaining any necessary underground utility locates 4 Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settlmg 5 Contractors mstallmg wastewater disposal systems must be certified by the Municipal Health Department for system installations Owners installing their own systems must also receive pnor approval from the Municipal Health Department SEPTIC TANK INSTALLATION: 1 A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access 2 The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank Page 2 Lot 24, Block 1, Denali6/D June 7, 2000 3 All standpipes on the septic tank shall extend a muumum of 12 mches above final grade 4 Septic tanks installed with less than 4 ft. of cover shall be insulated 5 A foundation cleanout shall be mstalled one to four feet from the building foundation In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank) These cleanouts shall be located on undisturbed soil not more than 10 ft from the tank The first cleanout, in tine, shall be to clean toward the leachfield The second cleanout shall be to clean toward the septic tank 6 Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCHIDRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design The bottom of the excavation shall be within 2 inches of level If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement 2 Once the gravel is mstalled, the distribution pipe is to be mstalled level with the perforations faced downward Gravel is then to be placed over the distribution pipe to provide a muumum of 2 inches of cover over the pipe 3 A silt bamer must be installed between the final gravel layer and the native soil backfill Ensure the silt barrier covers the entire gravel surface before placing backfill 4 Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a muumum of 12 mches above final grade. The portion of the momtonng tube extendmg through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe This is equivalent to the effective depth of the gravel as noted on the design 5 Backfill over the final gravel layer must not be less than twenty-four (24) inches Insulation must be mstalled when the backfill depth is less than thirty-six (36) inches The finish grade over the trench must be mounded to prevent the formation of a depression after settling •Page3 Lot 24, Block 1, Dana1VS/D June 7, 2000 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2 The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage TvneofPine Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than fisted above must be approved by the inspecting engineer 3 Insulation shall be at least 2" thick extruded direct bunal polystyrene (Dow Chemical Company Styrofoam HI or equal) 4 Septic tank mlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal) 5 A permeable nontoxic silt bamer (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill 6 All leachfield gravel (sewer rock) shall be 0 5"-2 5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is bemg used as a filter material, its gradation specifications must conform to current M 0 A or D E C. requirements, which ever requirement applies INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system These inspections will occur as follows • { r Page 4 Lot 24, Block 1, DenalyS/D Juni 7, 2000 1. The first mspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the mstallation of any gravel A septic tank may be set m place, but may not be backfilled before this inspection 2. The second inspection must be conducted after the placement of the silt banner, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill 3 The final inspection is to occur upon final grading of the property Often there will be more than these 3 inspections required Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction If necessary, a pre - construction meeting will take place on-site The mspectmg engineer will not coordmate, direct or control m any way the contractors activities The owner shall contract with the contractor to perform the work outlined m these specifications and plans and m accordance with the attached M 0 A. permit There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineenng shall be the owner's representative and will inspect the work as stated above to document the contractors activities Final acceptance of the contractors work rests with the owner and the M 0 A S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work m accordance with these construction documents S & S Engmeenng's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project CONTRACTOR / INSTALLER IN , IL Mu"NICIPALITY OF ANCHORAGE Development Services Department `ti Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 067-062-04 1. GENERAL INFORMATION Expiration Date: Jr ^ Z ('V Complete legal description Denaly, Block 1, Lot 24 Location (site address) 25542 Denaina Drive Eagle River, AK Current property owner(s) Jeanne Reilly Mailing address Real estate agent Day phone 223-5784 4811 White Birch Lane, Eagle River, AK 99517 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 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 $ -990 Date of Payment 2-12311q Receipt Number 060 16 D COSA # 65C Q 1331 Waiver Fee $ Date of Payment Receipt Number 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/22/19 6. DSD SIGNATURE _4� System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: ��cn PRd�'R O IJJJJ)))))11111�1 By: 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 Checklist blue sheet Legal Description: Denaly, Block 1, Lot 24 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled $/$/2000 Total depth 171 ft Cased to 171 ft ON Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 30 in. Date of flow test for COSA 7/15/19 Static water level at beginning of test n/a ft. Comments Artesian well B. TANK DATA Age of tank(s) 19* years Tank type/material Septic/Unknown* Measured operating fluid level in septic tank 13 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/12/19 - House mostly vacant since pumping. D. ABSORPTION FIELD DATA 5' Wide Trench Which system tested (date installed) 8/8/00* ❑ ALL standpipes present per record drawing Total measured depth from grade 8.9/8.3 ft (max) Measured depth to pipe invert from grade 4'9/4'3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 067-062-04 of Structure served by this system Well production at time of test 1.95 gpm Water storage tank volume 600 gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 07/12/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/15/19 Results 2✓ Pass For 4 Fluid depth prior to test 0 Water added 621 gal New depth 0 in Elapsed time 0 min bedrooms in ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate +600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) None date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' P/1 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' P/� Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 2] Yes if No ft Holding Tank > 100' [71 Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Q Yes if No ft F/� Yes if No ft 0 Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' F71 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' P/1 Yes if No ft Surface Water > 100' ®✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' El Yes if No ft Private Wells > 100'✓71 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 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' EJ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓[] Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' F� Yes if No ft Surface Water > 100'✓� Yes if No ft F. ENGINEER'S COMMENTS *System information taken from MOA records. G. ENGINEER'S CERTIFICATION l certify that / 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 AW . 49th_ tit tlICHAEt E. ANDERSON : ti No. CE -4389 r' °7/22/19 419'� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 067-062-04 1. GENERAL INFORMATION Complete legal description Denaly, Block 1, Lot 24 Expiration Date: -3o—/ Location (site address) 25542 Denaina Dr. Eagle River, AK 99577 Current Property owner(s) Dave Warner Day phone 25542 Denaina Dr. Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: El 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 i] Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer E WaiverNariance request for: Distance: Received by: COSA to be released to the engine/unless otherwise requested by the engineer. Date: f .15)0 COSA Fee $ ttq 0 __ Date of Payment (O ati13 Receipt Number °MI0 to COSA # 05C4 i'51# Waiver Fee $ Date of Payment Receipt Number 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. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE VSystem #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms Phone (907) 272-8218 Date 9119/13 a'4 r ar g41a AQP••'' 1 Aicbt'4gTh it *'�l .even IR. rNinnone . e 4��, CE -8149 �/Awe bedrooms, with the following stipulations: �Q1/4 0,,0 , J2 ON-SITE WATEK AND o�sy WASTEWATn 4 PROGRAMER jNT SERA By: The.r'nifge 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. Original Certificate Date: / 0 - 3 O —/3 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet ( - If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Denaly, Block 1, Lot 24 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 8/8/2000 Sanitary seal (Y/N) Y Total depth 171 ft. Cased to 171 ft. FROM WELL LOG Date of test 8/8/2000 Static water level Artesian ft. Well production 50+ g.p.m. WATER SAMPLE RESULTS: Coliform/aV! colonies/100 mL Arsenic Ali> ug/L Date of sample: /0/g11-5 Nitrate /V P mg/L B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Date of pumping Q/ i y/26/ 3 C. ABSORPTION FIELD DATA Date installed Length 50 ft. After 7/24/00 Depression over tank (Y/N) N Pumper k 1S PLt M p 1 Parcel ID: 067-062-04 Well Log (Y/N) Y Wires properly protected (WN) Y Casing height (above ground) 24 in. AT INSPECTION 9/18/13 Artesian* 3.2+ g.p.m. ft. Collected by: 17f: Date installed After 7/24/00 Cleanouts (Y/N) High water alarm (Y/N) N Soil rating (g.p.d./112 or ft2/bdrm) 1.2 GPD/SF Width 5 System type Shallow Trench ft. Gravel below pipe 4 ft. Total depth 101 ft. Eff. absorption area 500 ft2 Monitoring tube Y_ Date of adequacy test 9/18/13 D....,.I+. (Pass/Fail) Pass Fluid depth in absorption field before test 0 in. Water added 614 Elapsed Time: 180 min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No Depression over field N For 4 bedrooms New depth 0 in. 600+ gal. Absorption rate If yes, give date g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: 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+ Building foundation 5+ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ F. COMMENTS * Well Plug at 3 feet, assumed artesian G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 9/18/13 COSA brown sheet 10-10-12.doc stsdift.cw• fter 4.9;9 agla".4,1'44, ASBUILT 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY! "7 -2't dens" tri"elad.." AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTSt OR RESTRICTIONS WHICH 00 NOT APPEAR ON THE SUBDI- VIS1ON _YkSIONP1417,,LUNPER'NO CIRCUMSTANCES S. ANYiDA, ,TktIEREON":13EititEDkFlikGONSTEOCTI , „ OF FENCE LINES, OR FpFt5-:ErAELisiiista,ARY LINES.„ "")-- TATES LAND SURVEYING 694-0824 ailislip=1.1111.1..1111•1111111111111Millinry".• Parcel I.D. 067-062-04 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval /F e- 'T s s Expiration Date: - / 1. GENERAL INFORMATION Complete legal description Denaly, Block 1, Lot 24 Location (site address) 25542 Denaina Dr. Eagle River, AK 99577 Current Property owner(s) Dave Warner Day phone Mailing address 25542 Denaina Dr. Real Estate Agent Day phone 2. TYPE OF DWELLING: 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 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: �-r Received by. COSA to be released to the engineer, unless otherwise requested by the engineer. Date: i COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number 6 6 Receipt Number COSA# ! 3 /5" 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. Name of Firm Pannone Engineering Services LLCPhone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 5/29/2014 . —SOFA Oli1 *'4▪ 9?H i iFAe il • }even R.'Pannane +a so: ▪ CE -8149 ow Ikki,/*OfES9 -Or bedrooms, with the following stipulations: ON-SITE Ga. WATER AND "t7 WASTEWATCR ozz1 ponrRAM 1-775:,::'-, By: The uni Original Certificate Date: !' of '.chorage Development Services Division (DSO) 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 Septic System Advisory Well Flow Advisory COSA blue sheet(c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Denaly, Block 1, Lot 24 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 8/8/2000 Total depth 171 ft. Date of test Static water level Well production Sanitary seal (Y/N) Cased to 171 ft. FROM WELL LOG 8/8/2000 Artesian 50+ ft. g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND uglL Date of sample: 5/21 /2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Date of pumping 9/14/2013 C. ABSORPTION FIELD DATA Date installed After 24i00 Length 50 ft. Total depth 101 ft Depression over tank (Y/N) N Pumper JR's Pumping Parcel ID: 067-062-04 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 AT INSPECTION 9/18/13 Artesian* 3.2+ ft. g.p.m. Collected by: PES in. Date installed After 7/24/00 Cleanouts (Y/N) Y High water alarm (Y/N) N Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF Width 5 Eff. absorption area 500 ftz Date of adequacy test 9/18/13 System type Shallow Trench ft. Gravel below pipe 4 ft. Monitoring tube Y Depression over field Results (Pass/Fail) Pass Fluid depth in absorption field before test 0 in. Water added 614 Elapsed Time: 180 min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) No For 4 bedrooms gal. New depth 0 in. Absorption rate >= 600+ If yes, give date g.p.d. 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+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ On adjacent lots 100+ On adjacent lots 100+ 100+ Public sewer manhole/cleanout Holding tank 100+ 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+ Water Service line 10+ Curtain drain 50+ Building foundation 10+ Surface water 100+ Wells on adjacent lots 100+ F. COMMENTS * Well Plug at 3 feet, assumed artesian Water main 10+ Driveway, parking/vehicle storage 10+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 5/29/2014 COSA brown sheet 10-10-12.doc 0,414151H...7.4"":"64416*Irl i\ sr% 4.., t1everi annone: CE -8149