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HomeMy WebLinkAboutFALLING WATER BLK 2 LT 3Falling Water
Block 2
Lot 3
#050-772-04
Municipality of Anchorage
Development Services Department =�=� `
Building Safety Division :•_�. '•' _
On -Site Water & Wastewater Program, 4700 South Bragaw St. , , ; T ;
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW020044 PID Number. 050-772-04
Name: MARTHA REINHOLD
Wastewater System: ■ New ❑ Upgrade
Address:
3755 WEST 100TH AVENUE * ANCHORAGE, AK 99515
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 622-0160 3
O Deep Trench f Shallow Trench O Bed OMound OOther
LEGAL DESCRIPTION
Soft Rathp:
1.2
Total Depth from "Irnal grade:
7.5 MAXIMUM
GPD/Sy. Ft
rt.
Block: lot: Subdivision:
Depth to pipe bottom from ortylml prods:
Drawl depth beneath pipe:
2 3 FALLING WATER
3.89 MAXIMUM FL
3.61 FL
Township: Range: Section:
Fol added above oryml grade:
Growl length:
SEE DWG rt
53 FL
WELL: ■ New ❑ Upgrade
Groh width:
5
Nurnber of groes.
1
Distance between Iln«:
1 —
R
pt,
fYoeNnoatbn Private. A.B.0 :
Total Depth:
Costa To:
Total absorption ono:
It" motafth
D 3034/ F-810
PRIVATE
235 it
235 Ft
500 so. it
Dryer.
SULLIVAN WATER WELLS
Dole DAled:
5/21 02
Static water Level:
73
Installer.
GLW ENTERPRISES
Date McWiMd:
10/9-11/02
FL
Yleld:
Pump Set AL
Cc" Height Man Ground:
TANK
50 IiPY
UNKNOWN ix
2 R
SEPARATION
DISTANCES
■Septic OHolding OS.T.E.P. OOther
To
Septic
Tank
Abso tion
Fid
Ut
Station
Holding
Tank
Publk/PrIwG
sewn un«
womfoctunr.
ANCHORAGE TANK
Copadly h potions:
1500
From
Well
100'+
loo'+
—
—
25'+
Mate": FIBERGLASS
Number of compartments
2
Surface Water
100'+
loot+
-
-
-
LIFT STATION
Lot Line
5'+
101+
—
—
—
Size N gallons:
Yanufoelurer:
Foundation
5'+
10'+
—
—
—
'Pump on level at:'Pump o at:
Mqh water alarm at
Curtain Drain
NONE
KNOW
Punta Yate
Decfrkol Inepecuorr performed W.
Remarks:
BENCH MARK
Laeaeon and Deeerlptfon:
TOP OF CMU FOUNDATION NEAR FCO
Adeumed Eweaaora.
100.00
., FL
ENGINEER'S SOL
i1
d4p
o '•q
Inspections performed by: AKWWC, INC. Dates: 1st 10/9/2002
p'. 4...�
2nd 10/9/2002
0
3rd 10/11/2002
e e A. arne s:'
Qdp�
DevelopmentSe ices Department Approval
i ' . -79
RReviewi�-ed and approved by: Date: ) Z 03
4°p°d�'rafeesta�ooQ�v
N
t16�
�DOO�000
AM
PERMIT NUMBER: PARCEL ID NUMBER:
SW020044 AS -BUILT DRAWING 050-772-04
•'• *. NEW '
A 3 HOUSE M
� Fro B /
o�
NEW 1500 GALLON
FIBERGLASS OPTIC TANK
FCO
ST1
NEW DRAINFlELD ST2
ALTERNATE SITE \ \ DBL1
� DBL2
C01
MT1
CO2
MT2
DATE:
1:
....___.._ _._ DRAWN BY:
ALASKA «'ATL'R & ZVASTL'R'ATL'RSCALE Z.T.G.
--^---------�-�-
CONSULTANTS, INC. 1" = 40�
6901 OFBARR ROAD. SUITE 29 • ANCHORAGE. AK 90504 • PHONF (007)337.6179 • FAX (907)538-32f.6
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MARTHA REINHOLD (907) 563-3003 2 OF 3
LEGAL DESCRIPTION:
LOT 3, BLOCK 2; FALLING WATER SUBDIVISION
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
A
B
32.77
22.42
31.58
54.58
38.28
64.24
41.03
67.37
42.27
68.24
53.89
63.03
53.62
64.20
51.40
96.73
52.23
197.13
as GIMP
Ci0fI1 3.'
•• �cFa
PERMIT NUMBER:�nT PARCEL ID NUMBER:
SWO20044 AS -BUILT DRAWING ING 050-772-04
TOP OF TANK
- 91.08-
INVERT
1.08-
INVERT OF INLET
- 90.17 —
FINAL GRADE -
93.6+ (AVG.)
FILTER
NOTE: TANK AND FIELD
INSULATED PER GENERAL
CONTRACTOR GREG BOOTHE.
—INSULATION PER
GENERAL CONTRACTOR
P OF TANK
- 91.06
,•� 1300 GALLO•—
FIBERGLASS
TANK
s
FINN. GRADE -
92,21-95.94
rORIGINAL GRADE
- 9729 O
HIGH SPOT
INVERT OF PIPE
- e9.37 (AVG.)
BOTTOM OF
TRENCH -
83.76 (AVG.)
RELATIVE ELEVATION OF BOTTOM OF
TESTHOLE - 79.26 (TESTHOLE DRY)
IT OF OUTLET
- 89.83
TH/2
003
DRAWN BY: QO ��!• 7 ��0
ALASKA «'ATER & `VASTE«'ATER SCALE: Z.T.G. oaf: I yV(
CONSULTANTS, INC. *.:.. ... ... ....... ....
6901 DFSARR ROAD. SUITE 28 • ANCHORAGE. AK 9050L • PHONE (907)337-6179 • PAX (9071338.3246 N.T.S.
OA
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
0.MARTHA REINHOLD 907 563-3003 3 OF 3
00 .. f y e
LEGAL DESCRIPTION: Q�'o •, C 7953 o�G
LOT 3, BLOCK 2; FALLING WATER SUBDIVISION
TYPE OF WORK: vu4 Zcfprofe691o('oVx O
PROFILE AS -BUILT DRAWING OF NEW SEPTIC SYSTEM ��OO000�d
Certifieb Dritting log
by
DOC CO. dba
r^ SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 668-2750
OWNER OF LAND: XaAfrm r /t r f 0Jj3a <d BORE HOLE DATA
DEPTH
ADDRESS: Flom TO
LEGAL DESCRIPTION: F&!&, PA uMn g dg<
DATE:4A
X021
PERMIT NUMBER: 00104Date of Issue
TAX IDENTIFICATION NUMBER: (Z$ O Is well located at approved permit location? f� U No
Method of Drilling: trair rotary U cable tool
Depth of well: 07:5
so*� -
Casing Typeyt Wall Thickness inches
Diameter 411 inches, depth 01-3s feet
Liner Type: /1) J ^J4
r�'ig Stickup Above Ground: C ' feet
Static Water Level: %13 feet
Recover Rate: So gpm
Method of Testing: /41 /z
Well Intake Opening Type: G open end U open hole
�j Screened; Start -feet, Stopped feet
UPerforations SW -feet Stopped feet
Grout Type: _!. '.�To "�'TE 'Volum /SO < as
Depth: from feet, to J_ feet
Well Disinfected Upon Completion? 6-<s O No
Method of Disinfection: 0 P aJ&&#IE TO Agei
Comments:
Driller's Name
C/9 -S i..1C ST'/Gt.JA
O Jct /3' .Jre4:F=�'
I
.OYA,<a 0a--1 ' coda< p r
13-C CC rii 044
��a 664jJd�c'
NTION, It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
.ichorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW020044
r Legal Description: FALLING WATER BLK 2 LT 3
Design Engineer. 0041 AK Water & Wastewater Consultan,
Owner Name: Martha Reinbold
Owner Address: 3755 W. 100th Ave.
Anchorage , AK 99515 -
tolq 5 � „I
Date Issued: Mar 29, 2002
Expiration Date: Mar 29, 2003
Parcel ID: 050-772-04
Site Address:
Lot Size: 100181 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑✓ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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:
Date: 3 " ?L7 — QZ
Issued By: _(Z / Date: _3 _2 y— 02
Municipality of Anchorage
<+•i4•cecn,�
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program ' Al I T'
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
1
Parcel I.D. 50 - /�f % 2 —04 Permit Number 5 W02-004 if
Property owner(s) MARTHA REINBOLD Day phone 563-3003
Mailing address (1) 37rr W 1 oo m AVE.
Mailing address (2) A61CH08116 1; !4/< 9%S'/,S— Zip Code f95/r
Legal description (Lot, Block & Sub'd.) —LOT 3. BLOCK 2: FALLING WATER SUBDIVISION
Legal description (Section, Township & Range) N/A
Lot Size LO -0.4161 Acres/Sq.Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER & WASTEWATER CONSULTANTS INC.
Permit Fees: k$ 55b`t $ 160 . '0
Date of Payment: 3 - am- o
Waiver Fees:
Date of Payment:
Receipt Number: 017t04-4 Receipt Number:
ALASKA WATER & WASTEWATER
� CONSULTANTS, INC,
April 1, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed and Well Septic System Design for Lot 3, Block 2, Falling Water Subdivision
To whom it may concern:
The proposed 4 -bedroom hoose will be served by a private well and septic system. Two test
holes were excavated in the area of the proposed septic system. The septic system will be
designed around the 30 -foot radii of these test holes. We are proposing that a 1250 -gallon
concrete septic tank and a five-foot wide drainfield be installed. Comments regarding the design
are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/ft2
should be used. When the test holes were excavated, they were relatively stable and vertical.
This is an indication that there is enough of a silt binder to provide some cohesion to the soil;
therefore, it is our opinion that a sand filter is not necessary. Soil logs have been modified to
reflect some silt content.
2. TRENCH DESIGN:
a. Percolation Rate: <1 & <1 minutes/inch
b. Allowable Application Rate: 1,2 gallons/day/fl2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e, Minimum Absorption Area: 500 fe
f. Total Depth: 7.5 feet (max.)
g. Effective Depth: 4 feet
h. Width: 5 feet
i. Reduction Factor: 0.50
j. Minimum Length: 52 feet long
k. Effective absorption area = 520 fl2
6901 Deban Road, Suite 2B' Anchorage, AK 99504
Ph: (907) 337-6179 " Fax: (907) 338-3246 • Website: akwwc.com
3. SURFACE RATERS: There is a small creek approximately 170 feet from the proposed
septic site. In, short there are no surface waters within 100 feet of the proposed upgrade.
4. TOPOGRAPHY: The area for the proposed septic system is a 5% to 10% slope running
approximately northeast to southwest; in short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
4.S.
NOTE: Attached is a site plan drawing, a design drawing, two soils log, and a 7 page
constnrction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 213 * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
1
1
1W MOUS
FLOTFAWNC WATER S/D
4 BLOCK 2
I
TH/2 f
ROAD
1
I
I
I I
PROPOSED SEPTIC
SYSTEM (SEE DESIG
PAGE 2 OF 21
\ �'Iy ALTERNATE SITE
\ \ NC%
\
\ \ 1
MME
1/
/ � I
f�T' wEt�eniu 1
♦♦� I ' OPTIC
ARaD
I
FALLING WATER S/D
LOT 2 BLOCK 2
ALASJU NVAT i R & NNIASTLIVATL,R
CONSULTANTS, INC." --
MARTHA REINBOLD
PHONE NUMBER:
563-3003
FALLING WATER S/D
LOT 1 BLOCK 2
DATE:
3/29/2002
DRAWN BY:
C.J.G.
SCALE:
1" = 100'
'AGE NUMBER:
1 OF 2
LOT 3, BLOCK 2; FALLING WATER SUBDIVISION I
OF WORK:
SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
LOT 1 MCALOON S/D
t yD
.3I.3
e
;' o t e s sio���`
NOTE: THE CONTRACTOR SHALL HAVE -THE 100
WELL FOOT RADIUS ON THE REFERENCED
PROPERTY FLAGGED PRIOR TO CONSTRUCTION.
INSTALL DOUBLE •.':`�°�"�.'.> //PROPOSED CLEANOUTS (DBL)PROPOSED 4 HOUSE M /I 4
ALTERNATE SffE 1 17.5'
INSTALLFOUNDATION
(0)
\ \ PROPOSED 1250 CALLON
\ / CONCRETE SEPTIC TANK
11
PROPOSED DRAINFlELD. EXCAVATE ATRENCH
THAT IS 7.5 FEET DEEP MAXIMUM BY 5 FEET
WIDE BY 52 FEET LONG. ADD 4 FEET OF
CLEAN. WASHED SEWER DRAINROCKNSTALL
21js� TRENCH PARALLEL TO SLOPE CONTOURS.
DATE:
r' 3/29/2002
-�$ ♦� __. _ DRAWN BY:
ALASKA WATER R NVAST.ENVATER SCALE: C.J.G.
CONSULTANTS, INC. �" 50�
6901 DESARR ROAD. SUITE 28 • ANCHORAGE. AK 99506 • PHONE (907)337.6179 • FAX (907)338-3246
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
MARTHA REINBOLD (907) 563-3003 2 OF 2
LEGAL DESCRIPTION:
LOT 3, BLOCK 2; FALLING WATER SUBDIVISION
TYPE OF WORK:
DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM
�4p
` y Go ness,
to ��� • CE 7953
e�froressiv\
�0040Caoo�
X40 q foo
.. �. .` ......- _. _ _.. v�'� . •• • .....-9540
r
ALASKA N'VATI✓R & NN ASTRWATI✓R
CONSULTANTS, INC. .. . . ... .........:....0
6901 OEWR ROAD, SURE 2B • ANCHORAGE. /JC. 99— • VNONE: 907 337-6179 • rA%: 907 338-32c6 •WEBSITE: o4vwc.com
SOIL LOG — PERCOLATION TEST ...............
FALLING WATER SUBDIVISION; LOT 3, BLOCK 2 J r y A. Gorness,
LEGAL DESCRIPTION: E-7953 cZ"P
PERFORMED FOR: KEN BRAZ DATE• 8/8/2001
DEPTHpRGANICS rofessm
(feet) "— TEST HOLE #11
O0000
1 4, so
�` '•' SOIL CLASSIFICATIONS
2 ---------------
GW zzzz:\
••• Y
. �,n.—�•.r�
GP ML
3 GM CL i
• `^i•: 1
;,�� • / GC OL — FALLING WATER 5/D
4 •_r'go SW MH LOT 3 BLOCK 2
GP -GM SP CH
5 t<;"'.•:� w/LARGE SM , OH TH#1
;:. 0;• BOULDERSlilt
6
Sc TH(/2
"' ••• TEST HOLE LOCATIONS
7=^••. ARE APPROXIMATE.
-. '`;•
8 ..,n,•. • 10
��w �y ` ,
••"'•`•.8/15Z2001> SITE PLAN
•:` ►•:
10 • `�• TWO LARGE
II.O.II. BOULDERS CLOCK NET TIME WATER LEVEL NET DROP
11
PREVENTED
FU THERD DATE READING TIME (MINUTES) READING (INCHES)
EXCAVATION
12
13 qjv
50
14 Gp\�ON
EO �
15 PeSORO
OAF'
16 9 N
17 0 200,
0
18
19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6w (INCHES)
TEST RUN BETWEEN 4 FT. AND 4.5 FT.
20
COMMENTS: PERCOLATION TEST PERFORMED BY CALEB GALL •VERTICAL SIDE WALLS ON
TEST PIT INDICATE PRESENSE OF COHESIVE SOIL (SILT)
PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERFORMED
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
DEPTH TO
GROUNDWATER
DATE
DRY
8
8 2001
DRY
ALASKA. R'ATER & «'AS1'I✓WATI✓R
T....."-,.,• CONSULTANTS, INC. ..,,"-.�.^.
6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, AK. 99504 • PHONE: (907)337-6179 • FAX; (907)338-3246 • WEBSITE: a4n.c.com
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: FALLING WATER SUBDIVISION; LOT 3, BLOCK 2
PERFORMED FOR: KEN BRAZ DATE: 8/8/2001
DEPTH ��__
(feet) ORGANICS
%�� - TEST HOLE #2
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
"SP -SM
GP -GM
w/ LARGE
BOULDERS
SOIL CLASSIFICATION
:q,O
GW
ORG
?
GP
ML
DRY
8/15/2001
GM
GC
SW
SP
CL
OL
MH
CH
°a o°a o
SM
OH
SC
DEPTH TO
GROUNDWATER
DATE
DRY
8/8/2001
DRY
8/15/2001
--------------
1 �
I
I
FALLING WATER S/0
LOT 3 BLOCK 2
TH#1
TH#2
TEST HOLE LOCATIONS
�s ARE APPROXIMATE.
'so
i
�o� ? SITE PLAN
•�
1"=100'
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME I (MINUTES) I READING (INCHES)
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES)
20 1 TEST RUN BETWEEN 4 FT. AND 4.5 FT.
COMMENTS: PERCOLATION TEST PERFORMED BY CALEB GALL. "VERTICAL SIDE WALLS ON
TEST PIT INDICATE PRESENSE OF COHESNE SOIL (SILT).
PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS AS PERFORMED
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 7- Z
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WS
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Parcel I.D. 050-772-04
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 s , F E 7
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Falling Water, Block 2, Lot 3
Location (site address) 2947 Misty Mountain Rd.
Current Property owner(s) Martha Reinbold
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Day phone.
PO Box 772033 Eagle River, AK 99577
Day phone
E Single Family (w/wo ADU)
❑ Duplex ONSPEC'nON FEE O)
❑ Multiple Dwellings (Single Family and/or Duplex)
SEP 16 2V'143. NUMBER OF BEDROOMS: 3
Od/8T° g
OEP�B,�tr €�
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWAI'ER"DPSP69AL:
Individual Well 0 Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver/Variance
f ta" In
Received by: ' t Date: o ! U `
COSA to be released to th64gineer, unless otherwise requested by the engineer.
COSA Fee $ aJ" 2,(,'
Date of Payment 111 �-/ty
Receipt Number '0-101,3
COSA 4— 0Wq !t'I3D
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
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
Phone (907) 272-8218
Date 9/15/2014
System #1 Approved for� bedrooms ! • • • • n • -
y pp 1 • • � Sleven a
12.•F�nnane
CE 8149
System #2 Approved for bedrooms s�,•,• r
4
Disapproved ��%�DOFESSItL
Conditional approval for bedrooms, with the following stipulations:
By: i /If • Original Certificate Date:
Th un�cipalitynchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f : ..
If more than 1 septic system is on the lot:
COSA Checklist # 1 of
Structure served by this system I
Certificate of On -Site Systems Approval Checklist
Legal Description: Falling Water, Block 2, Lot 3
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 3/29/02 Sanitary seal (Y/N) Y
Total depth 235 ft. Cased to 235 ft.
FROM WELL LOG
Date of test 3/29/02
Static water level 73
Well production
50
WATER SAMPLE RESULTS
ft.
Coliform Par colonies/100 mL Nitrate N a� mg/L
Arsenic �.. P ug/L Date of sample: 9/9/2014
B. SEPTIC/HOLDING TANK DATA
TankType/Material Septic/Fiberglass
Tank size 1'500 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date of pumping 8/29/2014
C. ABSORPTION FIELD DATA
Depression over tank (Y/N) N
Pumper JR's Pumping
Parcel tD: 050-772-04
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 30 in.
AT INSPECTION
11/11/13
72
3.1+
Collected by: PES
in
Date installed 10/11/02
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date installed 10/11/02 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/BR System type Shallow Trench
Length 53 ft. Width 5 ft. Gravel below pipe 3.6 ft.
Total depth 6.7 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 11 /11 /13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 3 in. Water added 468 gal. New depth 3 in.
Elapsed Time: 160 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons _
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 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
Manhole/Access (YIN) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 1.00+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t 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 9/15/2014
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
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