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HomeMy WebLinkAboutPELENOR BLK 1 LT 2Onsite File
Pelenor
Block 1
Lot 2
PID# 060-321-40
(Formerly Bernard Blk 1 Tr D)
swmau,bb
Municipality of Anchorage JANI 3
Community Development Department Page 1 of 2
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSPI71139 PID Number: 060-321-05 ❑✓ New ❑ Upgrade
Name:
MICHAEL WIGHT & RACHEL CUMMINGS
ABSORPTION FIELD
❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound
Address
NHN BERNARD ROAD
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
10.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
6.0 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
BERNARD 1 TR D
Fill added above original grade
0.0 Ft
Gravel length
50.0 Ft.
Township Range Section
Gravel width
5.OFt.
Beds: Number of Lines
N/A
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
250 Ftz
1
N/A Ft.
Well
154.3
221.4
N/A
N/A
115.9
TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1250Gal.
Surface Water
100+
100+
N/A
N/A
Material
STEEL
Number of compartments
2
Lot Line
13.3
55.3
N/A
NIA
NA
Foundation
37.9
72.9
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
I 50+
50+
N/A
N/A
Pump on level at
off level at
High water alarm at
Remarks
jPump
in.
in.
Pump make odel
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
SCOTT'S SERVICES
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 685.5ft
Inspection 1st
8/6/2017 8/7/2017
Location and description
dates: 2`�
NE BOTTOM TRIM OF ADU
3"' 8/7/2017 4`h 12/18/17
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF
Conditional Approval: Date
'®"C: • k�
tteven . Panriorie'
�,•, CE 8149
law
Approved Date
Inspection Report_1-1-12.doc
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4(600 gpd)
TANK SIZE: 1250g -- —
PERC RATE: <1 MPI -- — — — —
SOIL RATING: 1.2 GPD/SF
AREA RQD: 500 SF
REDUCTION FACTOR: 0.5 TRACT B
ADJUSTED ABSORPTION AREA: 250 _ — --
SYS. TYPE: WIDE TRENCH 4.0'ED 66s INSTALLED 1250G SEPTIC TA
MIN LENGTH: 50 LF6_+_ _ W/ FC BEFORE AND DCO AF
-- ._-- T2 =
/USED: 6so – 13.3 — _-
} 685
50LFx5.0'Wx4.0' E.D., 10.0' TD \
TOTAL AREA: 250 SF
TI DCO 55.3
C1 -
�/ / 154.3 FC1
/ A CID rl
I48R of I
WELL � � SFD FC2 '
\
J
1 TH?_
TRACT D C2
M2
TRUE NORTH ,`,-_SCALE 1"= 601_
JK t�dl
FER =_–
x5.O'Wx4.O'E.D.,10.O'T.D.
F x 5.0'W 4.0'ED,1
L 1 ADU MOVEABLE BUILDING
ALL MEASURMENTS ARE ± 1.0'
DRIVEWAY
NOTE:
REMOVED MONITOR TUBE
AT BEGINNING OF DRAIN FIELD
z
A
B
D E
T1
40.4
56.1
T2
41.4
62.3
DCO
41.4
63.3
0
CO
21.5
60.0
C 1
79.2
14.2
M1
0
FI T R FABRIC
S
C2
w
U
w
U
39.1 11.2
M2
6" AB V PIP INV
o
a
37.5 10.2
AT BEGINNING OF DRAIN FIELD
z
Qo
0
0
m
zw
0
FI T R FABRIC
S
�U
w
U
w
U
ma
6" AB V PIP INV
o
a
n
n
685.5 O.G./F.G.
o U
n n
/[DERMINROCK
O.G./F.G. 4"0 DRAIN PIPE
685.5
F
:
1250 g SEPTIC
TANK
PROFILE
SCALE: NTS
4.0' DRAIN ROCK
NOTES: PANNONE ENG SVC, LLC
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
BERNARD B1 TR D
SITE: NHN BERNARD RD
DRAWN ACP MICHAEL WIGHT & RACHEL CUMMINGS
SITE PLAN 4201 O'MALLEY ROAD
ANCHORAGE, AK 99507
1
GM/
8 SM
9-
10-
11-
12—
101112 8
13
14
15
i6 BOH 8/7/2017
DATE PERFORMED: 01AUG17
GROUNDWATER 9 16'
Date
7/30/2019
Scale
1" = 60'
P.I.D. NO
060-321-05
PERMIT NO.
OSP171139
Sheet
2OF2
06/14/2017 00:49 907-345-0202 ALPINE DRILLING F,=,GE 02'02
Alpine Drilling & Enterprises
Well Log
Permit Number: #SW 71139 :fat€; MO Issue: 6-29-j'-7 Parcel Identification Number: 0603 105000
Date Started; 9-•26-77 Date Conipieted: €�-27-17 Is well located at approved peny-it location? x des ❑ .No
LegalDesextption.- Bertrard 31()r
,k 1 Tract.p
ProlMrty OwIx.ter Name & Address: Michael Wight
Borehole Data:
Depth (ft)
Soil Type, :.Phickness S, MrateY' r&,a
From To
stick-up
0
L
organics & silt
y
S
gravelly- .silt
;
13
cohbly gravelle silt w1br-ul:lci s
13
i.'
r. -welly sandy silt
411
52
bec rock
51
&
306
WATER QUALITY TESTING
Coliform ileo C0V100ML
Nitrates _ Nt,\ mg/L
Arsenic h1 ug/L .718A
J . -rl
Method of Drilling x air rotate ❑ cable tool
Casing type: steel --- —------- -___
Wall Thickness: .2.50 i aches
Diameter: 6 inches Depth: 561 feet
Liner Type:
Diametetr: -_ inches Depth: __ feet
Casing skicltinp above groa�ratl.: ?feet
Static water iOVel (from ground level): 27 feet
FPunaping after
boors pumping 3 gprx.
Recovery Rate: 3 gpxn
-Method of Testing: czir_lilt
Well Intake Opening Type;
[] Open E;7.d x Open Role
(--1 Semened Start feet Shipped feet
EJ Perforations Start — fcet Stopped � feet
Grout Type: hentolli arrules Volume:._?, bis
Pump- Intake Depth _ feet
Pump size lip Brazed Narne
Well DWafeeted Upon Completion? x Yes ❑ No
Afethcd of chlorLnv tablets
li Comments:
Well Driller: Alpirr.e Drilling & Entef prises
PO Box 110496
-4nchol•age,4YriIcrska
01/271"2019 2,_:4 "1 907-345-0202 ALPIHE DRILI-ING PAGE 01/02
MUNICIPALITY OF ANCHORAGE
Development Services DepartMentPhone- 907-343-7904
On -Site Water & Wastewater Section
. . . . . . . . Fax: 907-343-7997
Pump Installation Log
Wen Drilling Permit Number: 171139
Date of issue-. 15 __29 17
Parcel Identification Number: 06032 1-05w, 0
Legal Description Block Lot
Owner Name & Ad&ess:
Bernard Sub. Tractr) MZC1.1P..0,T,%,,h,
11r,10 lronvvwd Comstruo�on
P11113P Installation jftt.e:
.16 -2019
Pump Intake Depth Pscloly Top of Well Casing: 291 feet
PurapManufad....I.N.y... Goulds
Pump Model. JOSH10
Pump Size; 1 -hp
Pitlem Adapter Burial Depth: N/A feet
Fitless Adapter Manufacturers$ NameN/A
Pitless Adupter J."Staller,N/A
Well Minfected Upon (:1ompletion? Cj Ve5 Cj ,No
Method of Disinfectiou: chlorine tebte-,s
Coromenti.
PLEASE SAVE FOR 00SA.
Pump Installer Nowe:
Alpine Drilling & Enterprises
Malling Address, P.O. Box 110496
c1
Anchorage q.; - 2 site.: AK
.99511
Attention: The pLunp jMtaij,_r S.fj,_,jjj rwovide a puirT) insta"Ation 1()g to 011_sir4 wkhin 10 day', of pump histaflati-Dr)..
July 12, 2019
To Whom It May Concern:
The accessory dwelling unit (ADU) that is being constructed on Bernard subdivision Tract D is
not intended to be permanently on that lot. Our plan is to move the ADU to Bernard Block 1 Lot
5 where it will serve as an ADU to the primary structure that will be constructed on that lot,
serving as a mother-in-law unit.
Regards,
Michael Wight
Richard Wight
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP171139
Work Type: Septic Initial
Tax Code Number: 06032105000
Site Legal Address: BERNARD BLK 1 TR D G:0254
Site Mailing Address:
Owner: WIGHT MICHAEL &
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
nr
S,.
r.
Department
6/29/2017
6/29/2018
267284
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65 Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Co Ak I , �a� k
Received By:
1
F"
&0_�d -0 Y\ P -0-b U" q
Date:
Date:
MUNICIPALITY OF ANCHORAGE
ro,
Community Development Department orhi Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 060-321-05
Property owner(s) MICHAEL WIGHT & RACHEL CUMMINGS Day phone
Mailing address 4201 O'MALLEY RD, ANCHORAGE AK 99507
Site address NHN BERNARD RD
Legal description (Sub'd., Block & Lot) BERNARD B1 TR D
Legal description (Township, Range & Section)
Lot Size 267,284 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field Initial Q
Single Family (SF) 0
(w/wo ADU)
Septic Tank Upgrade ❑ Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5k(1 915— Waiver Fees:
Date of Payment: 10- _ 11 (o1 111 Date of Payment:
Receipt Number: (A 106 6635/G Receipt Number:
Permit No. 051'1`111 ',`1 Waiver No.
Permit App_ ._ c
Pannone Engineering Services LIc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve(a@panengak.com
June 27, 2017
Subject: BERNARD B1 TRD
Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install an initial septic system and well to be issued for this
property. The proposed system will serve a proposed four bedroom (4) house. Currently the lot and all
surrounding lots are undeveloped. A new 1250-gallon tank, absorption field and well will be installed.
There are no wells within 100' of the proposed septic system.
1. Soils. One test holes was conducted in the area by PES in May of 2017. Bedrock was not encountered
in those test holes. Ground water was not encountered to a depth of 14 feet in May of 2017. Based
on the results of the percolation tests and overall soils appearance; an application rate of 0.7
gallons/day/square was used for a conventional bed style wastewater system in the area of the test
hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography on the lot generally slopes from south to north, with a slope
of approximately 0%to 1% in the area of the drain field. There are no steep slopes within 50' of the
proposed drain field. The proposed drain field will maintain 50' separation all steep slopes.
5. Drawing Markings:The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site Department,
the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
o �
��---------- ---- ----------------------
TRACT B
-- - - - - - - - -- >
TRUE NORTH I SCALE : 1"= 60' INSTALL 1250G SEPTIC TANK P `es — — — — — — — — — — — — — — — — — — — — — — — —
---------W/ FC BEFORE AND DCO AFTER__ — — — — — —— --- -.�— ^i—_---
_ — ---- ----------------
--
r
j
r 56.1 INSTALL ABSORPTION FIELD P
50LFx5.0 x4.0 E -D.,10.0 T.D.
W/ CO AND MT AT ENDS
IIS 7�
48R RESERVE E
I I SFD(P)
f I �
I f \
f I \ 297.5
I I
II
WELL P
I I TH2
I � TH1
• r --1 DESIGN PARAMETERS
\ \ TRACT D PRIMARY SEPTIC SYSTEM
\ NO. BEDROOM: 4(600 gpd)
� TANK SIZE: 1250g
!y �e�R/v \ PERC RATE: <- MPI (.,R PA=S
\ _ I Dr�V \ ' \ SOIL RATING: 1.2 GPD/SFo AREA RQD: 500 SF
.REDUCTION FACTOR: 0.5
W _ W- \ ADJUSTED ABSORPTION AREA: 250
\ \ SYS. TYPE: WIDE TRENCH 4.0'ED
MIN LENGTH: 50 LF
-
— - - - - - - -- -.USE:
50LFx5.0'Wx4.0' E.D., 10.0' TD
TOTAL AREA: 250 SF
-- - - - - - - - - - - - - - - - -- -- - - - - - - - - - -- ------ ----------- ----------
,LOTS UNDEVELOPED
------ -------------------------
— ------ ---
RACT B
--1 - -- -- ------------------
TRACT C-1 i 4 1 5
LOTS UNDEVELOPItD1'! `•=`'
- - - - ----- i._ _ , - __-, `��% TRACT D _ _---•-•-•-•-
--.-•-•—
-_---�--- -___ _� - _�./- TRACT E-1�\��--------. -- — — -.-- - _—_--
LOTS UNDEVELOPED
-_---
SGptE: 1"=25D,' -- -___ ---_
I I -
NOTES: PAMONE ENG SVC, LLC
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
BERNARD 131 TR D ••• Z-
SITE: NHN BERNARD RD "$;•evert •f2: anriome•
DRAWN JRL MICHAEL WIGHT & RACHEL CUMMINGS CE 8149 .:
4201 O'MALLEY ROAD REv:07Auc17.•
SITE PLAN
ANCHORAGE, AK 99507
Date
06/12/2017
Scale
1" = 50'
P.I.D. NO
060-321-05
PERMIT NO.
OSP171139
Sheet
1 OF 4
i
TEST HOLE 1 SOILS LOG — PERCOLATION TEST
TOPSOIL SLOPE 1685 SLiE PLAN
OR
1 .
Brown Silty
2 GM/SM SAND &
GRAVEL
3
OR
4
4BR
5 SFD(P)
0
6 ----, TEST
HOLE
7
SANDY
8 GM/SM GRAVEL
9
TH
10
11
12 TRACT D
13
WAS GROUND WATER SLOPE
14
BOH ENCOUNTERED? N
DATE PERFORMED: 23MAY17 TH 1
NO GROUNDWATER IF YES, AT WHAT
DEPTH? —NA—' X
DEPTH TO WATER AFTER
MONITORING? — DRY —
DATE: 31MAY2017
CLOCK WATER RATE SOIL TEST RESULTS/ANALYSIS
READING DATE TIME NET TIME LEVEL NET DROP (Mel} • PERCOLATION RATE 1 (min/inch)
READING (Hydrologic Soils Group: HSG A)
1 23MAY17 1105 5.900" • PERC HOLE DIAMETER 6"
2 1111 5.45 MIN 11.900" 6.0" 1.0 • TEST RUN BETWEEN 5.5 FT AND 6.5 FT.
3 1112 5.900" • TEST RUN FOR OVER AN HOUR, LAST
— - THREE READINGS PROVIDED.
4 1116 5.45 MIN 11.900" 6.0" 1.0
5 1119 5.900"
6 1125 5.45 MIN 11.900" 6.0" 1.0
COMMENTS:Test hole excavated by the homeowner.
PERFORMED BY:Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: PANNONE ENG SVC, LLC -,. Date
FOR CONSTRUCTION 06/12/2017
P.O. BOX 102954 ANCHORAGE, AK 99510 4.99•'"•.
PHONE (907) 272-8218 FAX (907) 272-8211 _ (r'• 1 Scale
— *x'40 t. %' --•.* NTS
BERNARD B1 TR D ' ••' ' 1 • t ' P.I.D. NO
•. " 060-321-05
SITE: NHN BERNARD RD ' " I,
41ay6"' '15b."."6 e' PERMIT NO.
DRAWN JRL MICHAEL WIGHT & RACHEL CUMMINGS °^' 4E CE 8149 OSPXXXXXX
•, V.)fi.,uN1 i;•
SOILS LOGS 4201 O'MALLEY ROAD r:'•..•• Sheet
ANCHORAGE, AK 99507 ''PRFES 2 OF 3
TEST HOLE 2
OR I
TOPSOIL
1
OTIMEK
Brown Silty
2
GP/SP
SAND &
1 23MAY17
1105
GRAVEL
3
P.I.D. NO
DBO —321-05
4-
1111
10 MIN
56 5-
5.795"
1.73
6
1112
7
4
1118
SANDY
8
GM/SM
GRAVEL
9
1119
10
11
1125
10 MIN
12
5.505"
1.81
13
14
15
16
BOH
DATE PERFORMED:
01AUG17
GROUNDWATER
® 16'
SOILS LOG — PERCOLATION TEST
SLOPE
TEST
HOLE
WAS GROUND WA
ENCOUNTERED?
IF YES. AT WHAT
DEPTH? —
DEPTH TO WATER
MONITORING?
DATE: 07AUGwi i
READING DATE
OTIMEK
NET TIME
WATER
LEVEL
READING
NET DROP
RATE
(MPI)
1 23MAY17
1105
5.900"
P.I.D. NO
DBO —321-05
2
1111
10 MIN
11.695"
5.795"
1.73
3
1112
5.900"
4
1118
10 MIN
11.415"
5.515"
1.81
5
1119
5.900"
6
1125
10 MIN
11.405°
5.505"
1.81
SOIL TEST RESULTS/ANALYSIS
• PERCOLATION RATE 1.8 (min/inch)
(Hydrologic Soils Group: HSG A)
• PERC HOLE DIAMETER 6"
• TEST RUN BETWEEN 5.5 FT AND 6.5 FT.
• TEST RUN FOR OVER AN HOUR, LAST
THREE READINGS PROVIDED.
COMMENTS: Test hole excavated by the SCOTT SERVICES.
PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:T
T
PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
••
�'�••" ••.
••
*� �*
"' .. • •••• (
•• �8V8n • •�Onn011e
CE 8149 .�
REV: 07ALIG17.•
.SFE
Date
06/12/2017
FOR CONSTRUCTION
Scale
NTS
BERNARD B1 TR D
SITE: NHN BERNARD RD
WIGHT & RACHEL CUMMINGS
4201 0 MALLEY ROAD
ANCHORAGE, AK 99507
P.I.D. NO
DBO —321-05
DRAWN JRLMICHAEL
PERMIT NO.
OSP171139
SOILS LOGS
Sheet
3 of 4
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW 1250g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM. INSTALL WELL
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 14 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED -LINE AS -BUILT DRAWINGS TO THE
ENGINEER. THE RED -LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN -OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS -BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE:
_w W —WATER LINE/
WELL RADIUS
— ss — ss — NEW SEPTIC
F... MEMO] \
TH
TEST HOLE
(P)
PROPOSED
(E)
EXISTING
CO
CLEAN OUT NO.
MT
MONITOR TUBE NO.
TYP
TYPICAL
iv
NOTES:
PANNONE ENG SVC, LLC
BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
P�(rG.•••.
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"t}e�' "panrioRe'
CE 8149 .�
jREV: 07AUG17•.
Date
os/t2/2ot7
FOR CONSTRUCTIONP.O.
Scale
NTS
BERNARD B1 TR D
SITE: NHN BERNARD RD
MICHAEL WIGHT & RACHEL CUMMINGS
4201 0 MALLEY ROAD
ANCHORAGE, AK 99507
P�I. .-NO
060-321-05
MIT N
PERMIT N0.
71139
DRAWN JRL
DESIGN NOTES
Sheet
4 OF 4
E.- AU0,43
MUMCIPAUTY OF ANCHORAGE
r ;
Development Services Department , Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
119
Parcel I.D. 060-321-0r5
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: _ ` ^ —2—©�
Complete legal description ger 1 Fe leti aP'
Location (site address) 18721 Bernard Rd g
Current property owner(s) Michael Wight & Rachel Cummings Day phone
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. TYPE OF WATER SUPPLY:
Private Well
Water Storage
Community Well
Public Water System
Waiver request for:
0
TYPE OF WASTEWATER DISPOSAL:
El
Private Septic,
n
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $J Waiver Fee $
Date of Payment _"( iq It q Date of Payment i
Receipt Number_ (0l Receipt Number
COSA /_5 i aJ �q Waiver #
Distance:
S. STATEMENT OF INSPECTION BY ENGINErER
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 sale
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
OF A(,qs��
6. DSD SIGNATURE .. t ��
System #1 Approved for........bedrooms "S=_even R. F:,•:�s
CE $149 : ti
System #2 Approved for bedrooms
Disapproved F _B®ui-�.�-�-
Conditional approval for bedrooms, with the following stipulations:
M
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 Stateof Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Bernard B1 TrD
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
H Well log is filed with Onsite (or attached)
Date drilled 9126/17
Total depth 306 ft
Cased to 56 ft
Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA n/a
Static water level at beginning of test 27 ft.
Comments New Well
B. TANK DATA
Age of tank(s) 8110117 years
Tank typelmaterial s" "s!°'
Measured operating fluid level in septic tank NIA
Standpipes/foundation cleanout per record drawing
Date of pumping New System
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) 8/10/17
ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 6 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies: New
COSA Checklist yellow sheet
Parcel ID: 060-321-05
Structure served by this system
Well production at time of test 3 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? J❑ Yes ❑ Nc
FOR Coliform bacteria is Negative
Nitrate mg/L M Nitrate less than MRL (ND)
Arsenic ug/L Q Arsenic less than MRL (ND)
Collected by PES
Date of Sample 07/08119
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date N/A
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
I
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
F/I
Yes
Community Sewer Manhole/Cleanout > 100'
[✓ Yes
if No
ft
❑✓ Yes
if No fl
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25'[D Yes
if No fl
Absorption Field on Lot > 100' 1-71 Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
✓� Yes if No ft
Water Main > 10'
Animal Containment > 50' 0 Yes
if No ft
❑✓ Yes
if No
ft
® Yes if No ft
Water Service Line > 10'
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' MYes
if No
ft
n✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
F/I
Yes
if No
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
if No
Yes
if No
ft
Private Wells > 100'
✓� Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'
® Yes if No ft
Water Service Line > 10'
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
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'✓Q
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
Q
Yes
if No
ft
Community Wells > 200'[]✓ Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
All Standpipes are present per the approved Record Drawings.
G. ENGINEER'S CERTIFICATION
I 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. 7/31/2019
COSA Checklist yellow sheet
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