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Home My WebLink AboutBIRCH HILLS TERRACE #2 BLK 1 LT 6Birch H1*11s Terrace #2 Block 1 Lot 6 #050-141-29 tKev u5/ul/1b) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: PID Number: 050-141-29 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New K Upgrade Name Andrew & Jennifer Heater ABSORPTION FIELD El Deep Trench E] Wide Trench ❑Bed El Mound Site Address 17707 Lacey Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Birch Hills Terrace #2 1 6 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100,+ TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100,+ Material Number of compartments Lot Line 10'+ NA Steel 2 Foundation 5 LIFT STATION Manufacturer Capacity Remarks Documentation of homeowner Gal. installed tank in 2015. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer Previous Homeowner Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 495.0 ft Inspection 1�' 10/04/19 Location and description 2 d SW corner bottom house trim 3 4'' ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional OF A(,jk�k Approval: Date �P�� ( �. 9 �; aTH anrr�� .P..Pin� Septic System -(k Approved C 41a Date Note: this approval does not include well permit requirements. tKev u5/ul/1b) �m-non^-3- Ln 0CD c ;7 -i K -n -n 0 n m m --{ HT1 <0o00mxm tmn _G z c c F,o n �o07r'z-o x D r O ._y m 0 0 N C) --� t Om 0mO Om mr1lD p V7 r � m D r n cm N� I Oi 1 o I o> U)p O r # In D\ m `C, \ / Dom\ oz � �F o+ o y O avy_ W cn r d0 m. L4 —1 gC \✓ / g p O N \ O I -n z �z I — G i A I Co o v/ r �J\ 1 \` O / o cn / \ Ln cn o 0o \ 3 / � `1 o -a Ln NOTES: PANNONE P.O. BOX 1807 ENG SVC, LLC PALMER, REVISIONS DATE 10/24/2019 RECORD DRAWING AK 99645 PHONE (907 745-8200 FAX (907) 745-8201 .. ? r �P• tf r/r SCALE SEPTIC TANK j* ' y 1" = 50' DOCUMENTATION BIRCH HILL TERRACE #2 B1 L6 P.I.D. NO DRAWN ACP ANDREW & JENNIFER HEATER Steven' 'I�onrioR'e'j 050-141-29 SITE PLAN 17707 LUCY STREET 8140 % l�+'it SoEPxzxxxx EAGLE \\ \�� 1 OF 1 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage. Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 DePartmene http://www.muni.om/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCEIWAIVER REVIEW **** Waiver#: OSP141493 COSA#: Permit#: PID#:050-141-29 Legal Description: Birch Hills Terrace #2. Block 1. Lot 6 Engineer: PES Applicant: Larry & Sherilyn Teague Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 78.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: i Approved b . Name of Reviewer ............................................................................. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevePpanengak.com November 19, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd. P. O. Box 196650 Anchorage, Alaska 99519 Subject: Birch Hills Terrace #2, Block 1, Lot 6 Septic System Waiver Request Ladies and Gentlemen: I am writing to document an existing system on this property. The existing system serves as an agricultural well for this property. The existing three (3) bedroom house is served by AWWU. Currently the lot is developed. The existing system was installed by the owner under an approved permit in August of 1975. PES documented the system and tested it in September of 2014. The system appears to be installed as permitted and is functioning adequately. The lots to the west are also served by AWWU water with septics, and the lots to the north, south, and east have private wells and septic systems. The private wells on the surrounding lots are located over 100' from this system. The agricultural well on this lot is located 78 feet from the drainfield on this lot. See waiver request. 1. Soils. One test holes were performed by 0&E Geotechnical & Development Co. August of 1976. The engineer recommended an absorption area of 100 square feet per bedroom at that time. 2. Soil Absorption System Design. a. See Sheet 2 of the Documentation package. 3. Surface Water: There is no surface water within 100 feet of the existing septic tank and drain field. 4. Topography: The existing topography slopes from the northeast to the southwest at approximately 10%. There are no steep slopes in the vicinity of the drain field. S. Waiver Request: I request a waiver for the minimum distance from the drainfield and the agricultural well on this lot to 78 feet. As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 pii®0VQ 8 Ci Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 Lot 6 Seotic Svstem to Aericultural Well Distance from sewer system bottom to groundwater 3.0 Soil sorption below sewage system 3.5 Soil permeability below the system 3.0 Water table gradient 0.5 Horizontal separation 2_1 Total Points 12.1 "The sum of the above values could equate to the following conditions: 12-16 no bacteriological pollution, possible chemical pollution but unlikely from household chemicals." It is in my opinion, this waiver request meets the above criteria for approval and does not constitute risk to health. C hope the above information will assist you in determining that the waiver should be granted. The existing installation does not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Inspection Rep _1-1-12.doc Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 N- TE WASTEWATER INSPECTION REPORT Permit Number: 5- f PID Number: 050-141-29 ❑✓ New ❑ Upgrade Name: �N S•t'. Larry & Sherilyn Teague ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed ❑Mound Address 17707 Lacey Drive ❑✓ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 100sfbrGPD/SF 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft. Gravel depth beneath pipe 6.0Ft. Subdivision Block Lot Birch Hills Terrace #2 1 6 Fill added above original grade- 0 Ft. Gravel length 16 Ft. Township Range Section Gravel width 12Ft. Beds: Number of Lines NIA Distance between lines N/A Ft, SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 336Fe 1 crib ' N/A Ft. Well 102.5 78 NIA N/A 90+ TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity 1000Gal. Surface water 100+ 100+ N/A N/A Material STEEL Number of compartments 2 Lot Line 36.7 20.7 N/A NIA NA Foundation 4 10.0 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain NIA I N/A I NIA N/A Gal. RemarksPES exposed the existing system on Lot 6 on Pump on level at in. Pump off level at in. High water alarm at in. September 10, 2014 and verified the dimensions and Condition. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank CITank to drainfield CI Homeowner Drameeld CI CO/MT Cl/3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection 1 9/10/2014 Location and description dates: 2�a Carport FF 3,d 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF Conditional Approval: Date - �:glill ;F2 •.• � ;F2. " seven 'F� .pan'riome CE 149 Approved Date % �11, q?tt�+ Inspection Rep _1-1-12.doc 10' UTILITY EASEMENT 33' BI M SECTION LINE EASEMENT I 1000, SEPTIC TANK (E) 7 T2 TI DCO 'Y CRIB, BRIAN FIELD (E) 12'W x 161 x 6'ED x 1C'TD 1' 0.i V SEPTIC AREA (E) 3BR HOUSE (E) B iM II M 115-� _102V 78A FT, A B 2A 71.0 T2 23.8 14.6 DCO 25.1 17.7 C17.8 25.0 —17-3 46.3 SEPTIC AREA (E) I I LOT 6 I M —�M �M �M \ 7> / I AGRICULTURAL II M _ WELL (E) w� w r w w w ku— w� h NOTES: PANNONE ENG SVC, LLC 8/25/75 PERMIT P.O. BOX 100217 ANCHORAGE, AK 99510 DOCUMENTATION PHONE (907) 272-8218 FAX (907) 272-8211 BIRCH HILLS TERRACE y2, BLOCK 1, LOT 6 LARRY & SHERILYN TEAGUE 17707 LACEY DRIVE PLAN EAGLE RIVER, AK 99577 ..H�4 AJ, 11/20/14 *:49TH N *rl 1.'=50' "' P.LD. D50-141-1- 29 Steven R. Ponnorae PERMIT NO. CE 8149 �� 8/25/75 PERM 1`ll i OFES�` Sheet 2eOF 3 Z COPPER Z DUCTILE IRON PIPE 0J TEST HOLE FC FOUNDATION CLEAN OUT ¢O O r J w0 M# Z R. 1. RIGID INSULATION 7w w DV mW liU U J DU 1000 g SEPTIC TANK (E) DESIGN PARAMETERS SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000a SEPTIC SOIL RATING: 100 SF/BR AREA ROD: 300 SF SYS. TYPE: CRIB 6-O'ED MIN SIDE'NALL LENGTH: 50 LF USED CRIB: 12' x 16', 6' E.D., 8.0' TO TOTAL .AREA: 336 SF NOTES: 8/25/75 PERMIT DOCUMENTATION 90.9 PROFILE LEGEND W WATER LINE WELL RADIUS SS NEW SEPTIC ROCK PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 BIRCH HILLS TERRACE #2, BLOCK 1, LOT 6 LARRY & SHERILYN TEAGUE 17707 LACEY DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 RIGID INSULATION -FILTER FABRIC 0&E GEOTECH TH-1 (8/1975) RINGS -12.0 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT N0, C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE oF ...4.,lIll, 11/20/14 *r,49 TM. ..� *l,� P.LD TNO -050-141-29 StevenR. Pannone ,;o' PERMIT N0. -S CE 8149 -U� 'OFESSIOPI�V�`.�: Sheet 3 GRE/ :.R ANCHORAGE AREA �'�-��•• h 330 -C- STREETENT ENVIRONMENTALANCHORAGE, ,ALASKA !' � ]710 "C" STREET ANCHORAGE, ALASKA 99307 •7 r4J '� 1 TELEPHONE 274.4561 w,,.•, SEWAGE DISPOSAL SYSTEM PPLICATION D PERMITAr • ��T/ NAME OF APPLICANT rut`�Q"y G e/G�y�4E MAILING ADDRESS ( PHONE 4 .Z72/ Uer ' INSTALLATION LOCATION / LEGAL DESCRIPTION ��% •' �LCGK //iIG.V A /ci. �12/9GE -I�Ln - I• INSTALLATION OF; SEPTIC TANK AGE PIT CDR �IjN FIELD rn - OTHER \ TYPE AND SIZE OF FACILITY TO BE SERVED 1 -3o<," -71 -3o<," -7S r= /� i'I-F/ AI,S FINANCED THROUGH TO 6E INSTALLED BY SOIL TEST RESULTS 4 TO NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST S',�..r 9.l ZA/t77¢LL A/& oLWPrcx COMPLETION DATE ANTICIPATED Alo ul.o rew 7'n % 2 / FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /��L TYPE SEEPAGE AREA SIZE TYPE /1/mus 300d/ -107-rJt MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK S / I FOUNDATION TO SEEPAGE PIT 20 DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL I / SEPTIC TANK SEEPAGE PIT 20 / DRAIN FIELD TO NEAREST LOT LINE. / WELL TO SEPTIC TANK (/e / SEEPAGE PIT /'" / DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK. /&-S / SEEPAGE PIT TO RIVER. LAKE. STREAM. SEEPAGE PIT DRAIN FIELD i CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON IDES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABL CAPS. - p // ._ _. GRAVEL BACKFILL �Z �Z. �Z $G�[EE.VEa" �72AUtL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 7• j /A/S P&-VW0A/s X'EZZ ttfRt o ,zl� �' . &ems OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. / j/(J /-/ /�/� DATE APPLICANT'S APPLICANT'S SIGNATURE/` //I'/ZLLLJ��f A /, / 1'.Q'�',C•(,P FORM NO. 90.015 �'lf O -8-'E GEOTECHNI CAL Et DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Ead fNs 694.2774 688.2280 Soils Er Foundations Land Development SOIL LOG Performed for: Name:SAG U?— Tel . No. 77 7- 3%4 Mailing Address: W -Z,j ,, ccq-S'-%75 Legal Description: � 3,rr�� 11\x., s1'gQQA�Sr�vB� Death (feet) Soil Characteristics 0 27;Q�c3rz 2 3 4 5 5 Gly- 5n 7yw/Caggt�s `��t'%sV1 C> 7 8 . g 10 11 12 _ �oo tet: Ground Water Encountered: Yes No '� If yes, what depth Proposed Installation: Seepage Pit ✓ Drain Field Comments: 7 thi>iSu—tzz -ecfl AVC,cz-xtM41!� —N1!=V (o�x Performed by: ^? . �r �� •. Date: `v t, A VC: 'Ta LOG OF.DIALING by A & L DRILLPG COMPANY OWNER OP LAND-. I'lix1f, . ..... ..... .. . .......... DEPTH OF WELL....40 .... ADDRESS ....................... ..... .................................... .............. ... .. .... .. . STATIC LEVEL OF WATER FT. WELL SITE /4 ..... i ......... b7fiqe4LHlf(4-f ........... DRAW DOWN FT . .............. .................... ............ DATE—STARTED .......... .... .. ............. ..... ................. GALS. PER HR. ..... 3o ................... DATE—ENDED ......... ......................................................... KIND OF CASING ...... KIND or FORMATION: FROM...... _0 ............ FT. TO ...... 3 .............. FROM ........................ FT, TO ........................ FT .............................. FROM......... 3 ............ FT. TO........7 ............ FROM ........................FT. TO ........................ FT .............................. rnom ........ 7 ........... FT. TO ..... 27 ......... FROM ........................FT. TO ........................ FT .......... .. ............... FROM ..... 7....... FT. TO .... S-9 ........... FT. 24040r, FROM ........................FT. TO... -----................FT.................... .... rnR014 Old ........ ....... FT. TO...Z.,? ............ FT).SAO�.:rV?? 4) JROL-Ar ' 'ej ........................ FT. TO ........................FT.............................. igvrr is-ce�� FROM ...... X�� ........ FT. TO.....ft� .......... I �OFROM ..... . ...... FT. TO ........................ ............ FT .......... ................... FROM ..... �!!r ..... XT. TO..J.15 ........... FT. r:44TYie•40 __lfRoM'.6 .................... FT. To ........................FT.............................. FROM ... J.I..!r ......... FT. TO_PtR .......... FT ...... FROM ........................FT. TO ........................ FT ........................... MISCL. INFORMATION: Dq 1 8- " 7° roll CASi •"G DRILLER'S NAME ....................... .... .......................... Parcel I.D. 050-141-29 Complete legal description Certificate of On -Site Systems Approval Expiration Date: - �Aaj i U 0 Location (site address) 17707 Lacey Drive Current property owner(s) Andrew & Jennifer Heater Da v t)hone Mailing address Real estate agent 17707 Lacey Drive Eagle River, AK 99577 2. TYPE OF DWELLING: Fx1 Single Family (w/wo ADLI) F1 Duplex 171 Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well EJ Private Septic n. Water Storage n Holding Tank El Community Well El Community F1 Public Water System nX Public Sewer F! Waiver request for: Distance: . unless otherwise requested by the engineer. COSA Fee $_ 1 o136 //9 Date of Payment 556) Receipt Number COSA# Date: I/ Z�ivern� E - ee Date of Payment Receipt Number u4nca Waiver # 0,5 pIq 1 q / r25 Se,`tv 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date 4� OF A_ jq�k� 6. DSD/SIGNATURE 0 J System #1 Approved for bedrooms4, W �'.avLe. n R. Pa �? CE 8149 System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: l lc� �rA 114 2 -�II��-� `v� LAS l CC i�al1� U1 szC v < c e _ waA-e.�- uSES cx-,ti , o r --o ` kQ- 1 S t de_,� ce r By: 9, �C�'IJLi� 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: OF < Aj i COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory _1 ON-SITE. Well Flow Advisory Other WATER AND o WASTEWATER 2= COSA Checklist blue sheetJ r+ [] AM C PRO Legal Description: Birch Hills Terrace #2 B1 L6 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Parcel ID: Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments Agricultural well on poperty, house is served by AWWU B. TANK DATA Age of tank(s) 4 years Tank type/material s"s" Measured operating fluid level in septic tank 4 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 10/23/2019 D. ABSORPTION FIELD DATA Crib Which system tested (date installed) 1976+!_ ❑ ALL standpipes present per record drawing Total measured depth from grade 10.1 ft (max) Measured depth to pipe invert from grade 4.1 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective W 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 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: See attached document of construction Adequacy test date 10/4/19 Results 2 Pass For 3 bedrooms Fluid depth prior to test 28 in Water added 450 gal New depth 37 in Elapsed time 180 min Final fluid depth 28 in Absorption rate >450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 10.1 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' [/� Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No ft 0 Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5.0 ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' [/� Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓❑ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' ✓❑ 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' ✓❑ 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' M Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ED Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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 Jtev r? Pannone ft ft SGS Rcf.# 1196646001 Client Name Pannone Eng. Srv. Printed Date/Time 11/07/2019 14:15 Project Name/# 17707 LACEY Collected Date/Time 11/05/2019 9:30 Client Sample ID 17707 LACEY Received Date/Time 11/05/2019 11:39 ]Matrix Drinking Water Technical Director Stephen C. Ede Microbiology Laboratory Sample Remarks: E. Coli Negative 1 100mL SM21 9223B A 11/05/19 A.L Total Coliform Negative 1 100mL SM21 9223B A 11/05/19 AI Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date snit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 11/05/19 11/06/19 DMM Waters Department Total Nitrate/Nitrite-N 0.216 0.200 mg/L SM21 450ONO3-F C (<10) 11/05/19 EWW Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 11/05/19 A.L Total Coliform Negative 1 100mL SM21 9223B A 11/05/19 AI Municipality of Anchorage P g x� On -Situ Water and Wastewater Program ;P n (907)343-7904 saEE . Certificate of On -Site Systems. Approval Parcel I.D. 050-141-29,Expiration Date: 12.-10 `i% 1. GENERAL INFORMATION Complete legal description Birch Hills Terrace #2; Block 1, Lot 6 Location (site address) 17707 Lacey Dr. Current Property owners) Larry & Sherllyn Teague Day phone Mailing address 17707 Lacey Dr. Eagle River, AK 99577 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: 3 4. TYPE OF WATER SUPPLY: Individual Well, ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System 0 TYPE OF WASTEWATER DISPOSAL: Individual F Holding Tank ❑ Community ❑ " Public Sewer WaiverNariance request for: Distance: Received bDate: 0 r' COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ /� Waiver Fee $ Date eFPapm - 1 a 01 1� 3/ 2— 6� Date of Payment. Receipt Number (17 Receipt Number COSA# Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed heretoandas 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from myinvestigation 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 fime 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 hot 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 12/9/2015 AW rrg�cQ 6. DSD�SIGNATURE t/ System #1 Approved for bedrooms t S�eJen 12: Pannone.-- ' f System #2 Approved for bedrooms �� CE -8149/ 1� Disapproved Conditional approval for bedrooms, with the following stipulations: B�� Original Certificate Date: S7�417 15- 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' Septic System Advisory Well Flow Advisory COSAbluesheet,E - ", X Nitrate Advisory Arsenic Advisory Other ff more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Birch, Hills Terrace #2, Block 1., Lot 6 Parcel ID:050-141-29 A. WELL DATA Well type Rub c Agricu to af If A; B, or C provide PWSID # p`WWU Well Log (Y/N) Y Date completed 2/10/1976 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 140 , ft.. Cased to 29'8" ft. Casing height (above ground) 121k in. FROM WELL LOG AT INSPECTION Date of test 2/10/1976 N/A Static water level Unknown ft N/A ft Well production 0.5 9 -p.m. IN/A g.p.m. WATER SAMPLE RESULTS:, Coliform Neg colonies/100 mL Nitrate 9.03 mg/L Arsenic ND ug/L Date of sample: 12/1/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA TahkType/Material Septic/Steel Date installed Before 7/16/1976 Tank size 11000 gal. - Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 9/24/2014 Pumper .JR's Pumping C. ABSORPTION FIELD DATA Be'ore]HBHB76 - - z 100. SF/BR - - Crib - Date installed Soil rating (g.p,d.lft orftz/bdrm) $ystem_type Length 16 ft. Width 12 ft. Gravel below pipe 5.6 ft. Total depth 9.1 ft. Eff. absorption area 313 ftZ Monitoring tube Y Depression over field N Date of adequacy test 9/24/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 20 in. Water added 515 gal, New depth 30 in. Elapsed Time: 1 10 min. Final fluid depth 20 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &,type) No If yes, give dater D. LIFT STATION Date installed Size in, gallons "Pump on" level at in. "Pump off' level at in. Manhole/Access (Y/N) 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 78* 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 O+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS *WR#OSP14.1493 Property vacant since November 2014 G. ENGINEER'S CERTIFICATION I.certify that l 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 12/9/2015 COSA canary sheet 2-&15.doc Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # osc151103 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 6 of Birch Hills Terrace #2 subdivision. This inspection revealed a nitrate concentration of 9.03 milligrams per liter (mg/L) was reported for the property's well water sample. 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. Parcel I.D. 050-141-29 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Expiration Date: 6 " 2 7`f Z Birch Hills Terrace #2, Block 1, Lot 6 Location (site address) 17707 Lacey Dr. Current Property owners) Larry 8c Sherllyn Teague Day phone_ Mailing address 17707 Lacey Dr. Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Z Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver/Variance Received by: —` J( 1 Date: he en COSA to be released to tneer, unless otherwise requested by the engineer. - COSA Fee $ 591ea, cv Date of Payment 44ab 15 Receipt Number 0 75?16 COSA# 5c/5/103 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. 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 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 3/17/2015 Conditional approval for bedrooms, with the following stipulations: By: 7 Original Certificate Date: 3 `- 7' /3 The f icipa d An orage 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f - If more than 1 septic system is on the lot: COSA Checklist # t of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Birch Hills Terrace #2, Block 1, Lot 6 A. WELL DATA Well type Public/Agricultural If A, B, or C provide PWSID # AWWU Parcel ID: 050-141-29 Well Log (YIN) N Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth unknown ft. Cased to Ynxnownft. Casing height (above ground) 18+ in. Date of test Static water level Well production FROM WELL LOG Unknown Unknown Unknown ft. 9.p -m. AT INSPECTION N/A N/A ft. N/A g.p.m. WATER SAMPLE RESULTS: Coliform 4) 9= mL NitrateQ Qo _S mg/L Arsenic 1U3 ug/L Date of sample: 3/13/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 9/24/2014 Pumper JR's Pumping Date installed Before 7/16/1976 Cleanouts(Y/N) Y High water alarm (YM) N C. ABSORPTION FIELDDATA Date Installed Beore]nv,we Soil rating (g.p.d./ft2 or ft2/bdrm) 100 SF/BR System type Crib Length 16 ft. Width 12 ft. Gravel below pipe 5.6 ft. Total depth 9.1 ft. Eff. absorption area 313 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/24/2014 Results (Pass/Fail) PASS - For 3 bedrooms Fluid depth in absorption field before test 20 in. Water added 515 gal. New depth 30 in. Elapsed Time: 110 min. Final fluid depth 20 in. Absorption rate x 450+ g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off" level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100+ Absorption field on lot 78 Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (Y/N) in. High water alarm level Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/anim"xcrete storage areas. 100r + 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 * WR#OSP141493 G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Steven R. Pannone Date 3/17/2015 COSA brown sheet 10-10-12.doc a...... Y CE -8149 ,,,,� -.:0'61 ran ��8,y' �✓�B J� 'lc/ //7%. Cid s v�ok 8S�'� t=ice 93 ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY OF �! $ O/ CI<////�f7Y9f 9�0 y✓�'GpT6 BEf RATE - AND THAT NO ENCROACHMENTS EXISI�EXCEPT AS m /�� • `f 3 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE rHJh EXISTENCE OF ANY GRID r... ' ... EASEMENTS, COVENANTS, OR RESTRICTIONS i WHICH DO NOT APPEAR ON THE RECORDED SUSDI- Duan. Mark Sawar VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' �P*IF'•. X5_5 18� ANY DATA HEREON BE USED FOR CQNSTRUCTION �� t:"'�/s�jl�' � OF FENCE LINE%OR FOR ESTABLISHING BOUND- ARY LINES. N; x xw O: Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99507-6650 WWW.muni.org/onsite (907)343-7904 Well Drilling Permit Number: SW Parcel Identification Number: Pump Installation Log Date of Issue Legal Description Property Owner Name & Address Birch Hills Blk 1 Lot 6 LarryTeague (77,0"7 LaceV Drl"1e tvar,4K Pump Installation Date: 10/6/14 Pump Intake Depth Below Top of Well Casing: 132 Pump manufacturer's Name: Goulds Pump Model: 5SBO5422C Pump Size: 1/2 Pitless Adapter Burial Depth: 10 Pitless Adapter Installer: Unknown Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50ppm Comments: Matinson Pitless Pump Installers Name: Cole Sullivan & Terry Worrell Sullivan Water Wells feet hp feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Well Disinfected Upon Completion?