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.•••. ' '••• ( "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 _£L•�6!r - PA,.OL,Z!.ON ^! I F � � 1 03 0� c m 00 rn C) noran It N. rr, O � R. N fm Io ' I O ( 1'6 �l O � o 1 C:50 ^ L I o 0 N N n Il l � ONE uJ !� fI� 00 O rlDj uo ro it O L, E z l.�it J J •- O) / ZS Lei z 3„0£,90.:N p�flUjag i 4 ` � 1 II rr, O � R. N fm Io � o � 6 N V C � ONE .E E6 JG D o G fI� L, E z S. f?.nw °o o� G1yo r. u Vt iiLv V O V V � 1 II u a o N a J � G Y 0I 9 T H•N-•< E t V