HomeMy WebLinkAboutGROVER PLACE LT 3Onsite File
Municipality of Anchorage
Community Development Department Page 1 of 2
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Municipality of Anchorage
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: OSP181068 PID Number: 015-081-45 New
❑ E] Upgrade
Name:
WHITE RAVEN DEVELOPMENT
ABSORPTION FIELD
Dee
❑ p Trench El Shallow Trench EJ Bed El Mound
Address
E 99TH AVENUE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
5
0.8 GPD/SF
10.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft.
Gravel depth beneath pipe
6.0 Ft.
Subdivision Block Lot
GROVER PLACE 3
Fill added above original grade
0 Ft.
Gravel length
45/45 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
1,080 z
Ft
2
14.5 Ft.
Well
116.1
133.7
N/A
N/A
85.3
TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1500Gai.
Surface Water
100+
100+
N/A
N/A
Material
Number of compartments
Lot Line
65.5
39.8
N/A
N/A
STEEL
2
NA
Foundation
34.8
56.2
N/A
N/A
LIFT STATION
Manufacturer
Capacit
Curtain Drain
50+
50+
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pum evel at
in.
High water alarm at
in.
Pump m k6 -and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank 3034 Tank l0
drainfield 3034
BRAIN HARTEN / WHITE RAVEN
Drainfield 3034 CO/MT 3034
Inspector PANNONE ENGINEERING SERVICES
BENCH MARK (Assumed elevation) 98.Oft
InspectionLocation
dates: 7/14/18 2'd 7/16/18
and description
3m 7/16/18 4`h 10/25/18
NW BOTTOM HOUSE TRIM
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF A�,����
Conditional Approval: Date
.:
Steven F. I�annotae*
Approved Date 1 a 1$
1 A\ -
_
inspection Repon_i-i--i2.coc
V V
DES!GN
GN PARAMETERS _90l
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 5 (750 gpd) TH-1
TANK SIZE: 1,500g (MICHAEL E ANDERSON)
PERC RATE: 12 MPI
SOIL RATING: 0.8 GPD/SF
AREA RQD: 937.5 SF
SYS. TYPE: DEEP TRENCH - 6.0'ED
-MIN LENGTH: 78.1 LF
USED: 12.0' THi -
LI(2EA) 45 LFx2.5'Wx6.0' E.D., 10.0' TD_ I
TOTAL AREA: 1,080 SF m
4
14.5 M-2Mr
%N OUT LOT 2 F I
JT
F '41
----1 7 A
5BR
HOUSE -
EL
6?
TH-5
92 �(MICHAEL E ANDERSON)
94 j
1 96-
!� INSTALLED.. DRAIN FlFLD
(2EA) 45LF x 2,5'W x 6.0'ED x 1 O.O'TD
INSTALLED CLEAN OUT AND MONITOR
TUBE AT EACH END
INSTALLED 1500, SEPTIC TANK
WITH FOUNDATION CLEANOUT
AND DOUBLE CLEAN OUT AFTER
.100-
,77
AFTER
104
1.06
08 WELL
z
0 0 -
0 0
0z z z Wow
Z < -j-f
:3 <
w Li co
0- 1 <
0 W 0 0
0 0 FILTER FABRIC Z
FG. Do. FG,
95-0 n 0 DRAIN ROCK 6" ABOVE PIPE INV TRENCH 1-93.5
_H - DRAIN
PIPE flr4' 0 DRAIN PIPE TRENCH 2-93.0 PES
1500 g SEPTIC CONNECT
� TO 11111CILE GM
TANK 1�10F EACH 6 sm/
7
FIELD Tl- 6.0' DRAIN ROCK
-11.0 a
T2:89.0 T2.. �. DRY:
cl 7/17/18
PROFILE s I
DATE PERF(
10JUL2018
NOTES: PANNONE ENG SVC, LLC Dote
'[RECORD DRAWING _ OF A-Cqkk� 10/26/2018
P.O. BOX 100217 ANCHORAGE, AK 99510 ,q
PHONE (907) 272-8218 FAX (907) 272-8211 _Scale
AQ 1"=50'
. ...... ... ... rd LD. NO
G ER PACE, LOT 3 !, .......... OVE IV,
WHITERRAVENLDEVELOPMENT Steven R:
PERMIT -01'5-081-45 NO.
E 99TH AVENUE CE 8149 OSP181068
_sheet
PLAN ANCHORAGE, AK 0 ss'k 2 OF 3
A
B
FC
12.1
38.2
Tl
39.6
50.0
T2
49.5
56.1
DCO
52.8
58.2
Cl
66.8
56.5
mi
66.7
58.3
C2
63.7
85.3
M2
62.8
81.5
C3
82.2
71.8
M3
81.4
74,7
C4
80-2
96.9
M4
78.5
92.6
F '41
----1 7 A
5BR
HOUSE -
EL
6?
TH-5
92 �(MICHAEL E ANDERSON)
94 j
1 96-
!� INSTALLED.. DRAIN FlFLD
(2EA) 45LF x 2,5'W x 6.0'ED x 1 O.O'TD
INSTALLED CLEAN OUT AND MONITOR
TUBE AT EACH END
INSTALLED 1500, SEPTIC TANK
WITH FOUNDATION CLEANOUT
AND DOUBLE CLEAN OUT AFTER
.100-
,77
AFTER
104
1.06
08 WELL
z
0 0 -
0 0
0z z z Wow
Z < -j-f
:3 <
w Li co
0- 1 <
0 W 0 0
0 0 FILTER FABRIC Z
FG. Do. FG,
95-0 n 0 DRAIN ROCK 6" ABOVE PIPE INV TRENCH 1-93.5
_H - DRAIN
PIPE flr4' 0 DRAIN PIPE TRENCH 2-93.0 PES
1500 g SEPTIC CONNECT
� TO 11111CILE GM
TANK 1�10F EACH 6 sm/
7
FIELD Tl- 6.0' DRAIN ROCK
-11.0 a
T2:89.0 T2.. �. DRY:
cl 7/17/18
PROFILE s I
DATE PERF(
10JUL2018
NOTES: PANNONE ENG SVC, LLC Dote
'[RECORD DRAWING _ OF A-Cqkk� 10/26/2018
P.O. BOX 100217 ANCHORAGE, AK 99510 ,q
PHONE (907) 272-8218 FAX (907) 272-8211 _Scale
AQ 1"=50'
. ...... ... ... rd LD. NO
G ER PACE, LOT 3 !, .......... OVE IV,
WHITERRAVENLDEVELOPMENT Steven R:
PERMIT -01'5-081-45 NO.
E 99TH AVENUE CE 8149 OSP181068
_sheet
PLAN ANCHORAGE, AK 0 ss'k 2 OF 3
TEST HOLE 1
OR ORGANICS
Sm
2
3
4
GM/ SILTY GRAVEL
5 Sm AND SAND
6
7
8
9
10
11
12
13
14
15
16
BON
DATE PERFORMED: 07/10/18
SOILS LOG - PERCOLATION TEST
SLOPE
9.9
(MICHAEL E ANDERSON)
-i
(M
94.
it/� . ,�.�,,.���--,,_�-r
98
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH?
DEPTH TO WATER AFTER
MONITORING? -DRY
DATE: 07/17/18
SLOPE
TH
X
COMMENTS: CONFIRMATION TEST HOLE TO ENSURE SOIL PROFILE WITHIN PARAMETERS OF EXISTING
TESTHOLES WITHIN THE SUBDIVISION. SOIL TYPE AND STRATA IS SIMILAR TO OTHER TEST HOLES
NOTES: PA24NONEP.O. ENG SVC, LLC Dote —
RECORD DRAWING — OF A�,qk�k
BOX 102954 ANCHORAGE, AK 99510 10/26/2018
PHONE (907) 272-8218 FAX (907) 272-8211 v Scale
1"=50'
...... . ...... �P-.I.D. NO
GROVER PLACE, LOT 3
015-081-45
WHITE RAVEN DEVELOPMENT teven R. 'Pannone w PERMIT No.
E
E 99TH AVENUE 8149 OSP181068
SOILS LOG ANCHORAGE, AK
3 OF 3
OWNER OFLAND: Hultquist Homes
ADDRESS:
Bore Hole
Data
Depth
From
To
LEGAL DESCRIPTION Grover Place Lot 3
DATE: 9-20'18
psnMITmumacn: Oopzozoso DATE npISSUE: 5-29'I8
TAX IDENTIFICATION NUMBER 01508145000 -------
is well located atapproved permit location: iXJYes| |Nu
Method ofDrilling: 771airrotary F—lcab|etoo|
Depth ofWell: 124'
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches' depth 124 feet
Liner type
Static Water Level: 57 feet
Recovery Rate 25 [\7 9pm | | gph
Method ofTesting Ai,
Well Intake Opening Type: iXJopen end | |openho|e
F—| Screened Start feet Stopped
F� --' ---'
�� Pe��ration� Start feet Stopped
Grout Type: Bentonite Volume: 501bs
Depth: from l feet, to 42 feet
Well Disinfected Upon Completion: [X]yes Ono
no
Method ofDisinfection: Chlorine 5OPPM
Comments:
4
18
18
41
41
72
95
110
110
118
118
124
Casing Stickup
Overburden
Silty Sand &Gravel
Silt & Sand w/Some Gravel
Silty Sand &Gravel
Wet Silt Sand & Gravel
Clay Silt Sand & Gravel Water
Clay &Gravel
Sand&Grave| Water
Drillers Name: Cole Sullivan
ATTENTION: Itbthe responsibility of the property owner msubmit acopy ofthe well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/o, Department of Environmental Conservation.
Well Drilling Permit Number: SW OSPI81068 Date of Issue 5-29-18
Parcel Identification Number: 01508145000
Legal Description
Grover Place Lot 3
Pump Installation Date: 10'2-18
Pump Intake Depth Below Top ofWell Casing:
Pump manufacturer's Name: F&\0
Pump Model: 4F11PO5301S
Pump Size: 1/2
Pit|essAdapter Burial Depth: 10
PidessAdapter Installer: White Raven
Disinfected Upon Completion? M yes
Method ofDisinfection: Chlorine 5OPPM
Comments: Pitless Manufacturer: Martinson
UPump Installers Name: Sullivan Water Wells
Property Owner Name &Address
Hultquist Homes
hp
feet
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
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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: OSP181068
Work Type: WellSeptic Initial
Tax Code Number: 01508145000
Site Legal Address: GROVER PLACE LT 3 G:2439
Site Mailing Address:
Owner: HULTQUIST HOMES INC
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
aI- tIIIellt
5/29/2018
5/29/2019
46528
2 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q 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
`7 11 I 1 Cc7 e � o cJ c (A e- � J 5 .
ktn s�Q c �\'c r\ rec' 'C
Received By:
� f"o
Issued By:
Date:
Date: 5 ��
5
7r!,,,, L
UMCPAUTY OF J17NCHORAGE
Community Development Department 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. 015-081-45
Property owner(s) Hultquist Homes Inc. Day phone _
Mailing address 12570 Old Seward Highway, Ste 204, Anchorage, AK 99515
Site address NHN E. 99th Avenue
Legal description (Sub'd., Block & Lot) Grover Place, Lot 3
Legal description (Township, Range & Section)
Lot Size 46,528 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial n
Single Family (SF) ❑X
Septic Tank
❑X
Upgrade ❑
(wlwo ADU)
Holding Tank
❑
Renewal ❑
Duplex (D) El
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑X
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.
nature of property owner or authorized agent)
Permit/Rush Fees: ag . — Waiver Fees:
Date of Payment: q IB Date of Payment:
Receipt Number:��JJ�IC-� Receipt Number:
Permit No. 6SPI�2 1d)(�;B Waiver No.
Permit App__• : ._..:c;
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181068, Rebecca Carroll, 05/29/18
FIELD CP)
D x 1 .O'TD \ 1
JNITO TUBE
`N 25' NON DISTURB EASEMENT
I
—90
TH-1 /
(MICHAEL E ANDERSON) PRIMARY / RESERVE DRAINFIELD (P)
Z / (NSTALLSLF CLEAN OUT AND MONITOR TOUBE
l AT EACH END
TH-5
�J 12.0 (MICHAEL E ANDERSON)
--' TH-2
12.0 92 _ (PES) /
12.0 r
FLOW SPLITTER (P)1500g SEPTIC TANK (P) f
WITH FOUNDATION CLEAN OUT
I / 4 \ AND DOUBLE CLEAN OUT /
_OT 2/--�_�
3 96-
9 8
58R .100—
HOUSE
100—HOUSE
-77 77 (P)
¢�
/ .102 w
_ —
Z
04()106ELL P / 108 7WELL
(P)
J / 10' T&E EASEME T
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM EAST 99TH AVENUE
NO. BEDROOM: 5 (750 gpd)
TANK SIZE: 1,500g
PERC RATE: 12 MPI /
,SOIL RATING:
AREA RQD 9375 SPD/SF ��0._LEGEND ��( ABBREVIATIONS
-SYS. TYPE: DEEP TRENCH - 6.O'ED WATER LINE/ TH TEST HOLE
MIN LENGTH: 78.1 LF WELL RADIUS (P) PROPOSED
USE: (E) EXISTING
(2EA) 45 LFx2.5'Wx6.0' E.D., 10.0' TD SS NEW SEPTIC CO CLEAN OUT NO.
TOTAL AREA: 1,080 SF MT MONITOR TUBE NO.
TYP TYPICAL
NOTES:����
FOR CONSTRUCTION PANNONE ENG SVC, LLC D
QF /��\\�, 4a27/2018
�•..
P.O. BOX 100217 ANCHORAGE, AK 99510 �,�Q� • �s� (,
PHONE (907) 272-8218 FAX (907) 272-8211 /Oj •' y +
Scale
*: * II
1"=50'
.... ... ..... P.I.D. NO
GROVER PLACE, LOT 3=081-45
WHITE RAVEN DEVELOPMENT / Steven f2. Pannone PERMIT N0.
�F CE 8149 c�/� OSP181068
E 99TH AVENUE 0s REV:07/10/1..•�hr
PLAN ANCHORAGE, AK ,t1ll�PR0 SSI`AN SheetOF 2
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181068, Rebecca Carroll, 05/29/18
11,1 lc-� 33
DFVFL (POWN r Mimms DwAim wim
AM) 11RAWSW QYTK� /-\K
SOILLS f._0G - PERCMATIONTEST
LU;GAL DESCRIPTION: Lot 4, Grover Subdivision
PERFORMED FOR: ----tl!OltlltYL!Icmlies
DATE: __ 10/ 1 /20l5___________ PROJECT No.:
TECHNICIAN, W.Roberts
6'.. _..
7
Silty Gravel
(� Nm
49th
.. NO. MUNI
off— Q
i E s*i it Z` 0 -
WAS M RAI) U A 1 ER 1AMA I MU1 _ No
' AF � Ht Mt �N! 10MV "
DEN 11 A i, R TO (tic
DA 1 f i W NUM U M M 0 _9 1116 !p-
12-- -------
N_ T DRUP
T I H �,l I -
"Awn,
A D!,,�,,�
13-- (M�NUI_
10/1 TESJ H0,LE
13�0.11 11:55 30 4�25" 17/5"
3 11:56 Icy,
17 i
OTTI
4 12:26 3.75-
5 12:27 1�50"
19 4AW 50" 1
12:57--- 10
2 0
PER(XN.ATRJN RA- I__..1 _JklIVINCH) PFR(HC)( F, DIA= 6 __CINCIII-_S)
TI STRUN HFTWFFN`�
M� FT. and 15FT,
ihIL-r '-W Yaw Ppop to
`IESPERFORMED BY ANDFASON F",N(ANFIATINU 1, N3ICTIA11, I`_ ANDERSON C-TAZT11"Y TIIAT
TI IIS "'AS PIMINIMIA) IN ACCORDANCE NVIM ALT. STATE', AND MUNICIPLE GUMFLINNES IN F+_F_FC/T ON THIS
MUNICIPALI ( Y OF ANCHORAGE
[_)E- VFLC)PMENII' 'SEPV10E..<S DEF'/i.R1_MENT_
/,_70)0 BRA(. -,AW Sll FREE -i At:HORAGF, AK 991,519.6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Lot 3, Grover SUbdivision
PERFORMED FOR: HultgUist Homes
DATE: 10/ 1 /2015 PROJECT No.:
I"ARCE1, ID#: TECHNICIAN: W. Roberts
DLPTH
(f,eet) L=
2
3
4
5
6
7
8
9
1
I2
13
0 1 FR I (I / -)t;
Silty Gravel
GM
1516----� B.O.H.
17
18
19
20
SI C,,.)PF
WAS OROL"NWVATER ENCOUN I FRED? No q
11, YES WHAT D111 I'll
[ATTI I OF WA] ER Ai TFR NIONI 1 ORING: None Y
IWILOVNION11'(RING: 5/15!16
4.4 �`l OF
...........
N
#
11. 4 9 t h
.. ..... .....
MICHAEL E. ANDERSON
No, CE -4381
...............
4i.f'�ESS —
SIFE PLAN
See Site Plan
D,�'�F
RE4,,DiNG'
"-ROSS Tlf�,117-
(MINUTES)
N: -:-,T HE-
(M I N U T ES)
L.
E)EFITH
�VAT
(INCHES)
NET DROF
(I N CH F s),
10/1
_FEST HOLE SOAK F D PRIOR 10 -FEST! ING:
1
1:04
O.75"
2
1:34
30
3.75"
3.00"
3
1:35
1.t)0„
4
2:05
30
4.00"
3.00"
5
2:06
1.25"
6
2:36
30
4,25"
PERCOLATION RATE: 10 (NNIIN/INCH) PERC. HOLE DIA,�)(INCHES)
TEST RUN BETWEEN:4.0 FT. and 5`.0 FTC
CONIMENTS: _VES -i- HOLE PPE 'S.OAKFD PRIOR To TEST.
EST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
TIJIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: I I/2/ 15
S89'58'1 2"E 155.00'
N89'59'25"E 155.00'
East 99th A
Proposed Finish Grade PFG 579.0'
Drainage
Notes: Elevation 100.0'
1. All elevations are from approved grading plan.
Ordered by:
Hultquist Homes Inc.
Legal Description: Plot Plan
Lot 3.
Grover Place Subdivision
Survey Certification: I hereby certify that a Mortgagee's
Inspection was performed on the described property.
Notes: It is the owner's responsibility to determine the
existence of any easements, covenants, or restriction which
are not on the recorded subdivision plat.
It is the contractor's responsibility to check top of foundation
grade & building setbacks in relation to property lines and
easements
OF A ww0p
F � 49TH .�f
.................................
.................................
9 -.Thomas H. Dreyer s
04 LS -7625 G
p�a ••• d o
�Ar app
�n°fessiono�
Expanded Redwood
Legend:
Proposed Well
Septic Q
Pavement
Overhang
Wood Deck
Concrete
Checked by: THD Drawn by: CB Scale 1" = 40' Grid SW2439
Job 2018-18 Field Book: XXX Plat 2016-74 Date: 4/25/2018
ePLIWZ
•
; ;_ Municipality of Anchorage 61
On-Site Water and Wastewater Program .id
I 111
(907)343-7904 SAICTY
Certificate of On-Site Systems Approval
Parcel I.D. 015-081-45 Expiration Date: 3 `Z-
1. GENERAL INFORMATION
Complete legal description Grover Place Lot 3
Location(site address) E. 99th Ave.
Current Property owner(s) HUItgUISt Homes INC Day phone
Mailing address 12570 Old Seward Hwy Anchorage, AK 99515
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings(Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment �c �3/12 Date of Payment
Receipt Number Receipt Number
COSA# 05C-I MO 9)3 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is(are)safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes,ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 11/27/18
•� OF
6. DSD SIGNATURE �40U • • •-
System#1 Approved for 5— bedrooms • Sleveri V.•Paririone:
CE-8149 ?..
System#2 Approved for bedrooms
Disapproved .FESSICtt
Conditional approval for bedrooms, with the following stipulations:
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By Original Certificate Date: Z -(
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 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 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Grover Place Lot 3 Parcel ID:015-081-45
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log(Y/N) Y
Date completed 9/20/18 Sanitary seal (YIN) Y Wires properly protected(Y/N) Y
Total depth 124 ft. Cased to 124 ft. Casing height(above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 9/20/18 new
Static water level 57 ft. ft.
Well production 25 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform neg colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 1 1/20/18 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic / Steel Date installed 7/16/18
Tank size 1500 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(YIN) Y Depression over tank(Y/N) N High water alarm(Y/N) N/A
Date of pumping N/A (new) Pumper
C. ABSORPTION FIELD DATA
Date installed 7/16/18 Soil rating2 z 0.8 Deep Trench
(g.p.d./ft or ft2/bdrm) System type
Length 45/45 ft. Width 2.5/2.5 ft. Gravel below pipe 6/6 ft.
Total depth 10 ft. Eff. absorption area 1080 ft2 Monitoring tube Y Depression over field N
Date of adequacy test N/A (new) ResultsPass/Fail pa SS 5
( ) For 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.)(Y/N&type) If yes, give date
D. LIFT STATION
Date installed N/A 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 TO:
Septic tank/lift station on lot 1001+ 4., On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 751+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank N/A
Animal containment areas N/A Manure/animal excrete storage areas N/A
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10i+ Property line 10'+ Absorption field 10'+
Water main 25'+ Water service line 25'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 1 01+ Building foundation 10'+ Water main 101+
Water Service line 25'+ Surface water 100'+ Driveway,parking/vehicle storage 101+
Curtain drain 50'+ Wells on adjacent lots 100'+
F. COMMENTS
Survey on file
G. ENGINEER'S CERTIFICATION 4••"`' A[\v\
I certify that l have determined through field inspections and ofCoo.• )4•111 --*y�.y'F
review of Municipal records that the above systems are in "4:',9 1- �\ •*y
conformance with MOA COSA guidelines in effect on this date. 0•••• =:�'��`` 0
Steven R. Pannone
Engineer's Printed Name i••:S1eWn PonnOne• Af
Date #0(I-2
CE-8149 �,�
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COSA canary sheet,2-6.15.doc