HomeMy WebLinkAboutTUXEDNI PARK WEST BLK 1 LT 12is Tuxedni Park w Municipality of Anchorage liana,. On-Site Water and Wastewater Program • (907) 343-7904 Pad&•'I rily ON-SITE WASTEWATER INSPECTION REPORT JQN 1 U 2019 Permit Number: OSP181008 PID Number: 041-022-50 Dwelling: 0 Single Family (SF) ❑ Duplex(D) El Multiple (SF and/or D) Project: ■❑ New ❑ Upgrade Name: DAVID BARBEAU (ABSORPTION FIELD Address ❑ Deep Trench CI Shallow Trench N Bed ❑ Mound El Other Phone Number of Bedrooms Soil Rating Total depth from original grade :4 1.0 GPD/SF 1.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 'Gravel depth beneath pipe Subdivision Block Lot 0.5 Ft. 0.5 Ft. TUXEDNI PART WEST BLK 1, LOT 12 Fill added above original grade Gravel length Township Range Section 2.0'+ Ft. 50 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 15 Ft. 3 4.5 Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 750 Ft2 Ft. Well 100'+ 100'+ 50'+ TANK ❑■ Septic ❑S.T.E.P. ❑Holding ❑Other Manufacturer Capacity Surface Water 100'+ 100'+ ANCH TANK 1250 Gal. Material Number of compartments Lot Line 10'+ 10'+ 1 NA STEEL 2.0 Foundation 10'+ 101+ LIFT STATION Manufacturer Capacity Curtain Drain UN UN Gal. Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by ,PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield RED DOG Drainfield 3034 CO/MT 3034 Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 108.8 ft Inspection ection 15' 9-12-18 2nd 9-13-18 Location and description 3r" ath GARAGE SLAB COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ®Fi Conditional Approval: Date ,.�~��••""••:� . . .c 49TH ,',\ • z.��+" --. • ••• • ��•MICHAEL N. ANDLRSCNi:ti e' �_ 31--/F — R�,< E 9469 •: Approve. �(`' ld_e Date /Fy�j 1 x!t•►°'.,��,• , , Inspection Report_9-1-12.doc Permit No. OSP181008 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: TUXEDNI PARK WEST S/D BLK 1, LOT 12 PID No.: 041-022-50 MARK A B FCO 5 39 '-- TCO2 3 — 59 � 10' GAS EASEMENT COT -- -36 — --CO3 37 63 \ \ M T1 55 82 \ \ M T2 59 83 — — �, — — — — — -- — — — — — MT3 95 123 \ �� .— — — —. — -- MT4 92 123 C04 103 13020' TELE & ELECTRICAL EAS NT C05 98 127 CO6 95 126 W�L— — 'z I �� /! „HAL?, I // L- _1 \\ / 1 0 GALLON EEL TANK \ lid#3, / / jp,„..,„ ,\ , , , , ,, \ , , • TCb2 TCt,1 01 1 __)61kMT/2,-,. C t / \\ MT/2,-,. 0 �e \ 1 \ 1 i1ELL \ . 1 \ X05\ , / 1 / Mt HOUSE •• 4 • I \ e .31 \ / ` ., 'mum .• Ii -_ \ / \ TH#2 — ' '--- REStRVE AREA •' • e . e / \\ / \ = C � \ \ #, GE 1B"/ / / / \ / \ / i � N • 1 - - - -//��— -- - - -- \ \\ r T — 10' TELE & ELECTRICAL EASEMENT 1 \ �� i _ ASBUILT r�v _--- v- SCALE: 1"=50' [C01 TC01 CO2 005 TI M -2 004103-4 ..��MIU\liI� 225 F/ maw / FINISILGF/,QE �•��•• .•V`_ ♦ • j F C ORG •47.1: ***** `** �Ap .....Ly mTgLT FILTER FABRIC&INSULATION / %t '' •. 102.2/ 1.750 GALLON \102•• \ nw Aa zs STA/GM • • STEEL TANK �� \.39.5 qR /04/. • ' MICHAEL N. ANDERSON: i• se__/ _ 90 — 1.% No. CE 9469 N WATER O5.l S'l�18 ♦•.♦ •••/��,.� •.... SEPTIC SECTIO F{ N.T.S. tti,�tSS UwIL 4 Jan 11 19, 10:51a p.1 Certified Drilling Log / O DOC CO dba BILL 8& COLE ,,,•ULLIVAN WATER WELLS 1 ..„..-1k P.O. Box 670269, Chugiak,AK 99567 688-2759 OWNER OF LAND: David &Jessica Barbeau Bore Hole Data ADDRESS: Depth LEGAL DESCRIPTION Tuxedni Park West B1 L12 From To DATE: 5-1.3-18 'j ' 2 Cas;ng$%CA PERMIT NUMBER: OSP181008 DATE OF ISSUE: 1-25-18 TAX IDENTIFICATION NUMBER 04102250000 2 4 Overburden Is well located at approved permit location: FiYes 0 N 4 12 Silty Sand &Gravel Method of Drilling: ®air rotary ucable tool 12 24 Silty Sand &Gravel Tight Depth of Well: 400' 24 32 Silty Sand &Gravel Water Casing Type: Steel Watt thickness ,250 inches y 32 8. Grave( &S',It w/Ca/ Diameter: 6 inches, depth 104 feet 81 i 99 Soft Rotten Bedrock Liner type 320' of 4.5" PVC Static Water Level: feet 99 161 Shale Soft Recovery Rate gpm gph 161 182 Yellow Broken Bedrock Method of Testing Air 182 241 Soft Bedrock Gray Well Intake Opening Type: ❑open end ®open hole 'Li Screened Star: ree+: S,oppen , 241 269 Fractured Bedrock Yellow ❑ Perforations Start feet Stopped 269 379 Soft Bedrock Gray Grout Type: Bentonite Volume: 50 lbs 379 400 Bedrock Depth:from 2 feet,to 42 feet Well Disinfected Upon Completion: Eyes n no Method of Disinfection: Chlorine 50 PPM Comments: WATER QUALITY TESTING Coilform Co1/100m1" Nitrates '�\ m/L arsenic Ug(L Jan 10 19,04:30p p•1 -- coc Co doa ..10BILTIIAN LATER WELLS 4' A.O.Box 670269.Chugiak.AK 99567 B88-2759 www.su l liva nwate ravel ls.corn Pump Installation Log Well Drilling Permit Number:SW DSP181008 Date of Issue 1-25-18 Parcel Identification Number: 04102250000 I A1 1 1 Legal Description Property Owner Name&Address Tuxedni Pad((West 811.12 Jessica&David$arbeau Pump Installation Date: 8-13-18 Pump Intake Depth Below Top of Wefl Casing: 370 feet' ! Pump manufacturer's Name: F&W Pump Model: TVS/510LT Pump Size: 1.5 hp Pitless Adapter Burial Depth: 10 feet Al Pitless Adapter Installer: Red Dog Excavating Disinfected Upon Completion? E yes ❑ no( Method of Disinfection: Chlorine 50 PPM J Comments: Pitless Manufacturer:MartFnson I Pump Installers Name: Sullivan Water Welts Attention:The pump installer shall provide a pump installation logto the DSD within 30 days of pump installation. 1 '44'\ U.S. MILITARY RESERVATION i . 7 N89°58'31 "E 562.43 — X9.33 _ o 20, r 35 . X2.0 N \ \ EAS y� — I— • c� E fN r /../11 20' T & E EASEMENT ` , 24.0 � � _ z � • / N 100' WELL RADI I— `� • • U 4 e0 1 °-,,Irn -,.:.,:,.,.0::,.....,-t;',4:::::::,...o a T `4 ;<z;. - ..:5 1 FB f - / \ I, k, p V p s Im N 0\ V Z Q WELL • 4g 3 N S� / . , : ' ,••• ORAVEL,DRIVEW�41' � .. rn 3 LO I • • / / , BUILDING DETAIL Pi m 35 N.T.S. N -P co / I 47.67 "'' T.E EASEMENT 250.06 WEST 520. 00 +�`•� 50' Tempo ary Turn Aroun ..----/ /�<S� OF '.&.(-'46, \ i . 'j- '7 # / .opro; - 1 . t GRAPHIC SCALE: 1 Inch = 50 Feet HOBBY F. HuxxETT 1T7 11 •♦ /7-2-; /e NOTE: 12/18/2018 Revised Street Name. 25 25 0 O '\ S3IONAL 1%' Illik 1116.111.."41:1111P- Date Scale Legal Description 11/20/2018 1" — 50' I hereby certify that the property described hereon has been surveyed BOBBY F. B URNETTGrid L L LOT T 12 3 I O C,/ 1 by me, or at my direction, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the 2941 Carriage Drive SW 2042 AS—BUILT property lying adjacent thereto unless otherwise shown. That no Anchorage, Alaska 99507 TU X E D N I PA. K WEST improvements on the property lying adjacent thereto encroach on the (907) 350-5541 Drawn by Field Book premises in question and that there are no roadways, transmission BFB ASB 2018 PLAT # 2004- 155 lines or other easements on said property except as shown. 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 Water & Wastewater System Permit Permit Number: OSP181008 Work Type: WellSeptic Initial Tax Code Number: 04102250000 Site Legal Address: TUXEDNI PARK WEST BLK 1 LT 12 G:2042 Site Mailing Address: Owner: BARBEAU DAVID J & JESSICA L Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: nc S, I■ J ))eIYICTtIleI1C 1/25/2018 1/25/2019 147018 0 Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy R1 Private Well ❑ Water Storage 4 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 -�'Xtpecial Provisions: A test hole is required prior to the construction of the drainfield to confirm percolation rate and separations to impermeables and groundwater (including 7 -day monitoring). Construction may proceed at your own risk before the 7 -day water monitoring is complete. If the results require a design change, construction of the drainfield shall stop pending On-site review and approval of a change order. Please submit stamped and signed test hole with the Inspection Report. g/3/1$ CO # 1 bra' -t 7uzA k moKd. P4ew -kSi11 ��eS Provialed . Received By: Date: Issued By: Date: 25 /ZO18 MUNICIPALITY OF ANCHORAGE Community0 Development Department EPhone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 041-022-50 Property owner(s) BARBEAU DAVID J & JESSICA L Day phone Mailing address 1359 NORTHBLUFF DR ANCHORAGE AK, 99501 Site address Legal description (Sub'd., Block & Lot) TUXEDNI PARK WEST BLK 1 LT 12 Legal description (Township, Range & Section) Lot Size 147,018 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field E Initial 0 Single Family (SF) x❑ (w/wo ADU) Septic Tank ❑x Upgrade ❑ ,Ipgxg �g ❑ Holding Tank ❑ Renewal ❑ Ns . Dwe9�l ;s ❑ Privy ❑ Q`. ✓ � , •r e Private Well ® Z qN4� l� Water Storage ❑ u • THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQ 9 Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. "AA k (Signature of property owner or authorized agent) Permit/Rush Fees: 77(.1' Waiver Fees: Date of Payment: I ja2-iii j.2-iiiDate of Payment: Receipt Number: 220g51:) Receipt Number: Permit No. 01Pf?fO6' Waiver No. Permit App__•:• ,_...c ]uh/ 31,2018 Municipalities of/\oohuru�c Dcpailmcn*ofUea|thand Human Services P.O. Box 196650 Anchnru�c Alaska Y95|9 -665O Fax 249-7847 Kc: Y4uvWell 6tSeptic Permit, Cboo�c{)rdcr To Whom i\ muyconooro: This iyorcqucmLfor ochao�corder oothe wU �andsc[uicpcnnil�xdneobovcpc[crcnccd\ot. Tv/onew o�t holes were excavated and fbuudsi|tysands and ai|ty�ov6afhrthe ondrcdepth. VV�crwas mcondodatjj f�eu| in May 20|8. The pco m10 was K`und be 2 minutce (hcn:fbrc u simple \5-nido bed was designed with ail effective depth ofO.5 feet. The slope around the site is flat with 110 CLIt banks within 100 feet. This chan-c order will not impact any ofthe neighboring properties dUe to tile lot la�OUL Please call mc ifVou have any qucdinny. � Sincerel\ ��hA ��ichue|l�.Anderson. P.E. 4661 Natrona &nch./\k9oj\6 • Jan. 22,2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage,Alaska 99519-6650 Fax 249-7847 Re: New Well& Septic Permit Legal: TUXEDNI PARK WEST BLK 1 LT 12 To Whom it may concern: This is a request for a well and septic permit on the above referenced lot. A test hole was excavated by DHI Consulting Engineering's and found sandy gravel for the entire depth. Water was recorded at 11.5 feet. The perc rate was found be 1.25 minutes therefore a simple 5-wide trench was designed with an effective depth 0ooff feet. From the perc test data it is shown hard digging we have assumed that to be bedrock therefore the �maximum depth is 5 feet. A new test hole will be completed prior to installation to verify the soils, water table and the hard digging elevation. Due the health of Dee High it was not possible to get a signed soils log, therefore it will be verified in the field. The slope around the site is flat with no cut banks within 100 feet. This system will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely `% 01- Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: OUOVER 4BOFlIVIXi5O=6OUGPD ''~ '~ ORG FILTER FABRIC S}|LS=0OO/U.8=750�PO 3.0 SM & INSULATION 4"0 PIPE �s 750BA/15 =BI om mw SID -1— sm GM oo `����ERROCw (1) BED sp ' / 1.0' DEEP 11 | | m | | m.s L� L� 05EFFECT|VE GM 15.O'VV|DE 50'LONG wL_] SEPTIC FIELD SECTION PROPOSED ~~~C''~^'~~~ SECONDARY PROPERTY LINE DRAINAGE FIELD ______ PROPOSED PROPOSED WELL DRAINAGE FIELD 100'RADIUS TUXEDNJ PARK WEST A BLOCK 2. LOT 3 / �~^ PRO POSED HOUSE—/ muwICipALITvopANCHORAGE JTUXEDNI PARK WEST N ^C�r �' mXEDwPARK Wm mXEDmPARK WEST BLOCK 1, LOT 9 Septic Design Prepared for DAVID 8 JESSICA AARAEAU TU)(EDN| PARK WEST, BLOCK 1,LOT 12 Anchorage, Alaska AV 49 TJ4 000 8/1/2018 MICHAEL N. ANDERST�'* /Z DJR CHUGACH STATE PARK PROPERTY LINE 41 t T W y' 25' HOUSE SET -BACK- - -- I I TUXECNIPARK WEST 1 / BLOCK 1. LOT 12 f ----,-------=----=----- --� r i 10' TEL/ELEC EASEMENT / PROPERTY LINE ` tri TUXEDNIPARK WEST •/ BLOCK 1, LOT 11 SEPTIC \� � I Septic Design Prepared for DAVID & JESSICA BARBEAUCD TUXEDNI PARK WEST, BLOCK 1, LOT 12Aw Anchorage, Alaska LH - * H 9 > 49 — ............ ...... 0. ".Michael N. Anderson, P.E.• DATE: 8/1/2018 MICHAEL Nm ANDERSON,;u 4601 NATRONA AVE DRAWN: DJR No. 4 9 ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: 907 345-1391 SCALE: 1 "=50'� ��� DH1 CONSULTING ENGINEERS • .`c,.... 44 800 E. DIMOND BLVD. SUITE 3-545 r t,: , .•• ••. 41 ANCHORAGE. ALASKA 99515 r • ( •S.� • SOILS LOG-PERCOLATION TEST /4 • 1H ?� %.*•` TEST HOLE LOG #12 • • • •••• • c`�1` • 0.. • •• • ••• •. �. .ar .DENNIS "EE . e .�r PERFORMED FOR: ROGER CREMO DATE PERFORMED: 4/08/03 �4 re .. �E 580 :_�,+� LEGAL DESCRIPTION. LOT 12 BLOCK 1 TUXEDNI PARK WEST Kai 02558 �'%`� fea�:. SLOPE SITE PLAN „4� FROZEN ORGANIC MAT 1 '�' ; w 2 ,� REDDISH BROWN ORGANIC SILTY SAND \� yyW/ GRAVEL, ROCK TO 2" Q /' r` _ 3 _ , ee • BROWN SANDY GRAVEL 4 " ROCK TO 3" .- : J �"'� r � S1LTY SAND LENS, GRAY _ �� 6 -,•: �� r.":�; ; MINOR SEEP (TRICKLE) STOPPED DURING TEST 7 � ,` -"•:'"" WAS GROUND WATER S 8 '• ';. : . r. GRAY GRAVELLY SAND "...!.. f,•:-.•� ROCK TO 4" • ENCOUNTERED ? YES L , 9 �;�i.;:..". IF YES. AT WHAT P •T'' � . DEPTH ? 11.5 E 10 DEPTH OF WATER .. ../., AFTER MONITORING ? 11.5' DATE: NO WATER 11 -/''Y � HARD DIGGINGv ic�o.a wa aiaee we ma vie °'wAytp wt oua ra in - I./ /./ 1 4/8/03 6:20 e• r 1.oe 12 `/ Y', GRAY SANDY SILT 4/8/D3 7:30 °• T •• 1-23 'l,/' FINE SANDS, MOIST 3 4/6/03 &33 a• r 1.4,313 -/.•y// 14 'Y../ . / B.O.T. 15 , - 16 - 17 - - PERCOLATION RATE:_1.25 (MINUTES/INCH.) PERCHOLE DIAMETER:, 6" 18 TEST RUN BETWEEN: 5,0 FT. AND 6.0 FT. 19 - - THIS SOIL LOG IS PROVIDED FOR THE SOLE PURPOSE OF COMPLYING WITH AMC 15.65.180 Sc AMC 21.15.110. REUSE OF THIS INFORMATION FOR ANY 20 OTHER PURPOSE OTHER THAT OBTAINING SUBDIVISION APPROVAL IS STRICTLY PROHIBITED. COMMENTS-SOILS PRESOAKED PRIOR TO STARTING TE.S . PERFORMED BY: I. DEE HIGH CERTIFY •4 This • • • • MED IN ACCORDAN ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE. ti . -Y. .��. DATE: y 17 558STR12 SIGNA 6-E U Performed For: Legal Description Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.qLqfonsite (907) 343-7904 (ENWNEE, SEA [tell M-1 %_-`b.". 4 Soils Log - Percolation Test 113rd-tie",/ (Ail 1 El 'zt- Date Performed: S L IF YES, AT WHAT DEPTH? Ao w 4A Township, Range, Section: 1 - 1 --4- 10 VCA - 2- 3- 4- 5- 6- 7- 8- 9- 10--L11— -4$1- — f I 12- 13- 14- 15- 16- 17- 18- 19- 20 - WAS GROUND WATER ENCOUNTERED? Date Gross Time Net Time Depth to Water S L IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? 471 L: 5 0 P E Date: /I � Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop V t Is, /I � It Z PERCOLATION RATE Z,1 !minutes/inch) PERC HOLE DIAMETER to TEST RUN BETWEEN FT AND FT COMMENTS— r 4 )LI Ks' Ir, PERFORMED BY: i,'.X1'JA c I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 419TH MICHAEL N. ANDERSON :Okz, CE - 9469 Soils Log - Percolation Test Performed For: 6jrtA t1e.,' kko k �\k 61.E Date Performed: Legal Description -tu -)t- g 1-/ (—'_ Township, Range, Section: flpt "L L L- v 4, 1 0 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 00 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS Site Plan WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 0 L Depth to Water After P Monitoring? 0 E Dat Reading Municipality of Anchorage Gross Time Development Services Department Depth to Water On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orq/qnsite (907) 343-7904 419TH MICHAEL N. ANDERSON :Okz, CE - 9469 Soils Log - Percolation Test Performed For: 6jrtA t1e.,' kko k �\k 61.E Date Performed: Legal Description -tu -)t- g 1-/ (—'_ Township, Range, Section: flpt "L L L- v 4, 1 0 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 00 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS Site Plan WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 0 L Depth to Water After P Monitoring? 0 E Dat Reading Date Gross Time Net Time Depth to Water Net Drop & LO ft II I & ifs 0 If 95 PERCOLATION RATE _Z---_�minutesiinch) PERC HOLE DIAMETER LP TEST RUN BETWEEN FT AND -Z_,, FT PERFORMED BY: r,.r &/A I CERTIFY THAT THIS TEST W PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: UNICI PAS T Y O ANCHORIAGE Development Services Department Phone: 907-343-7904 On-Site Water.: Wastewater Section Fax: 907-343-7997 Parcel I.D. 041-022-50 Certificate of On -Site Systems Approval Expiration Date: f I- I Z -zo Z.O 1. GENERAL INFORMATION Complete legal description Tuxedni Park WEst 131 L12 Location (site address) 9770 Atelier Dr Current property owner(s) David Barbeau Mailing address Real estate agent 9770 Atelier Dr 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1 OM 5 ( coy %- 19 Date of Payment D.2 d Receipt Number COSA # © S C ZO 1 { 9 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. 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 6. DSD SIGNATURE Steven R. Pannone P.E. Date f 0FALgs��� VF IA. �=:.. .. ..... ......... System #1 Approved for bedrooms �� S'teven P. , Fcnnot �,. cc -L 81,19 System #2 Approved for bedrooms`3;' Disapproved �������� 42-0 Conditional approval for bedr000ms, with the following stipulations: (i, SOyy✓j�Z-Q1.4 %`23'Z� �_1csWa/CD�_f4 ,illlll(((f-((((((((/�, z In Z OV4SITE '1/11111fttI- BOriginal Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other " If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: TUXEDNI PARK TEST BLK 1 LT 1.2 Parcel ID: 041-022-50 A. WELL. DATA Well type PRIVATE If A, B, or C provide PWSID # Well Log (YIN) Y Date completed -6/13/18— Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 400 ft. Cased to .104 ft. Casing height (above ground) 24"+ FROM WELL LOG AT INSPECTION Date of test _6/13/18 NEW Static water level A( ft. NEW ft. Well production 1.2 g.p.m. NEW g. p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate _ 4 mg/L Arsenic: ND ug/L Date of sample: 1.9-19 Collected by: MNA B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 9.12.18 Tank size 1250 gal. Number of Compartments 2 Cieanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping NEW Pumper NEW C. ABSORPTION FIELD DATA Date installed 9-12-18 Soil rating(GPD/SF) 1.0 System type BED Length 50 ft. Width 15.0 ft. Gravel below pipe 0.5 ft. Total depth 5_0 ft. Eff. absorption area 750 fe Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test in. Water added_gal. new depth in. Elapsed Time: - min. Final fluid depth — in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo;) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in.High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT T0: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 100'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 100'+ Holding tank NA Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ SEPTIC TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Absorption field 10' 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 100'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 200'+ F. COMMENTS 0W. v fQ T f-,4 G. ENGINEER'S CERTIFICATION IiFltCi'AEL N. AM), S:vwV d f.j I certify that I have; determined through field inspections and CE -9469 review of Municipal records That the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name MIKE N. ANDERSON PE Date 11812019 COSA canary sheet_2-6-15.doc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCcDpanengak.com DATE 7/23/2020 Subject: Expired COSA COSA Renewal Request Permit Number: OSC191012 Legal Description: Tuxedni Park West B1 L12 This is a request to renew the COSA for the above mentioned lot. All site conditions remain the same. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 180;, P 5 'alnner, AK 996 -15'07 T ele'phone: (907) 7415-5200 FAX: (907) 745-8201