HomeMy WebLinkAboutVALHALLA BLK 4 LT 1 Onsite File
Valhalla
Block 4
Lot 1
#015 - 211 - 02
kISCv VJ/VL! 16)
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191404
PID Number: 015-211-02
Dwelling: FE Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
West Vera Locille Revocable Trust
ABSORPTION FIELD
❑® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
12325 Wildnerness Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
4
5.0 GPD/SF
JTotal
11.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
8.0 Ft.
Subdivision
Block Lot
Valhallla
4 1
Fill added above original grade
0.5 Ft.
Gravel length
15 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
n/a
Distance between lines
n/a Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
240 Ft2
1
n/a Ft.
Well
66.7
83.1
254
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Advantex
Capacity
1500 Gal.
Surface Water
1004
100'+
Material
Number of compartments
Lot Line
11.1'
9.6
I
NA
Fiberglass
2
Foundation
17.6
43.3
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
A+ Home Services
Drainfield 3034 co/MT3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 97 ft
Inspdeation vt 10/28/19
10/28/19
Location and description
3rd
Zed
4th
door jam
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
OF. Al_U4k�
49TH
i
Septic System
r. 1-119 .1a e- -5r
�� erCE
Approved
Date l 2-{ Zo
Note: this approva
oes not include well permit requirements.
kISCv VJ/VL! 16)
n -'; -; i
0-- a:
>
CC)
I I
--1 6;
Orn
--
-0 1 -0
zK If <, ;>u (il I > OZ �u
ID
co
i
>
M
z
1> F ;,u)
r- � ()) §
cp
r-11 10, 11-2) XM ;;ou ml
FT
r-
>
�b
M
c - ) - I N
0
5 m> U"
C) x
F11
-j -Z ml o
z
* �
> (n 0 z 2 0 T
0
oTi
01
M
> x
02
-0 > 0 C) U) 0
x rri
CLEAN OUT
f'j 90
1-1 m 'cj,
r-
--1 0 m
c 0
z
07
M:;o
0
0
0
m
m
c' -u X> o ' m
(10 01 0-;U
>
m p
z
_Tl
C;� <
>
z m
O >
M rl
:E r-
M
>
m >
c" -0 o
z 0 m
z
0
r-
m
0 < Lo
C) > -0 -0
FTI
c:
u >
2 2
T Z 0-
00 1—
f/MA
O c m
m
m
0 x V)
I
m
m
m
m 0
> x
-TI
r W I L D E'N D
,ja
0v >
� 0
m
K
F;
c1r)
C) x
FOUNDATION
oTi
01
M
CLEAN OUT
x
'
CLEAN OUT
00
> 0
>
f/MA
m
I
m
NI
MANHOLE
m
m 0
> x
-TI
r W I L D E'N D
,ja
0v >
� 0
-
M
r—
0
00
> ;0
, 0 -n
> <
C)
22
M 0m
--p-
cz
a > C)ADZ
z C)
c/)
F Z
0
0
(nm
m x
0 Lo
0')
z m
MANHOLE
MANHOLE
m
DOUBLE
CLEAN OUT
m >
ff6: >
0
0 m
m
]CLEAN OUT
00
MONITOR TUBE
WC)
>
l
;;u
:Ern
t
_Tl
0')
m
>
-T-1
cn 41
T1
�;o ;2�- --I
m > >
C-11
c/)
m
F
>0
0)
O?�
;U
>
z
0 c > 7\
--i
-
>
r-
_Tl
m
C/)
m
<
no
Z
z
> r-
F_
xM
o
:6
8)
�;u
m n m --,,m
.NJ<
a, z
-u
m
2cy
N
0
---1 0 >
0 F_
(ji
m
z
6:5
m
< l
>
c <
> n N) >
cil 0
x
m
0
FD
0
DO
>
N)
CA
to
n
n
7
W -00
C OZ,
z c) 00
<0
MONITOR TUBE
M
>
-1
(D
CA
C4
0
C4
0)1-1
1
CLEAN OUT
z
--1
.
0
o
m
X
_p�
CD
-p.
(,n
-,j
Cooo
J
N)
0
Cn
-j
CO
co
0
ID
p
c)
.....-
cl,
... .
_XA
— --- vv
NOTES:
PANNONE
P.O.
ENG SVC LLC
BOX 1807 PALMER, AK !)9645
Al
REVISIONS
DATE
11/07/19
RECORD DRAWING
PHONE (907) 745-8200 FAX
(907) 745-8201
SCALE
:*1"
= 40'
VALHALLA, BLOCK
4, LOT 1
.......
P.I.D. NO
DRAWN JRL
WEST VERA LOCILLE RIVOC TRUST
a on * e
015-211-02
12591 BEACHCOMBER
DRIVE
CE8149 A*&
PERMIT NO.
OSP191404
SITE PLAN
ANCHORAGE, AK
99516
.....
SHEET
2 OF 3
m Z N n 2 D1 V O) N A W N O N i O O m V o) U A W N Q N A W N O
A WOO Zm-i MO >0O-1D--1-i-I s'Tt D -I (n>- zi 0-00mmc)wo Own> 00 m
ti FOZ yJmm0�tmnDrm--mmmmmmom Trm D O.OZ n�rn �OmDiO�ZOZrr-CO�m-D-��ntT�iAm OOr O�0 OO Om ZV)Kr m �
A tm+mmn mKzzmmOZCZ')ZZQOgO�W�O➢�O O OpOZO��ZDND--��-xiAc�OOmm<< U'iZODmcx'i -+ �CACZIpm�Dr0 W ZZ O
*O �OmD-o3 AD'�DDSD mODZZD m mc.SOm�r Cmm mcznrDZmxmOmA�O-DimOZO0-iAD Z zmZ�DO-Ai�T~iZ-Z-f� m �
ri70 zn-Qiz,- 02-0 O0Oi 00 M592NOi 'D Z"0m�zyxDrr- OW� =mZD=r DDmOOrn AO T O0rWM.'f07Zz`O�O
DSy 1,<A-� fn zOJDAZ A ODZ'amZ O mDD Zi/12 �� DOA rA-o �Arorr'i�-�;u a) Z mmr'-+ ZN pDA-_+
almr ZD D o -� Z 'O� DD N OZA VI 'OA �D V1A- rDNmF' pal Dm➢mDCO r'O (llba.mD �a70A0 D
-1 'AO0 00D020 ODODD A pZpfQ'1�D W 0,=q omw Om cmc WO�UlW �'DO O,'Im7OmZZ�� D r" CA,Z L2,6 zDtn O r
al�O ZZm-�m'T7 ZmSmrr- m Otn=lnmm rr-O a7 T��Z> r 0 3:=*ammW nm -OD ZOZ mm2 OOy �O Dv F>zOD N
A<-4 0OXNam OOmm> o {JACmAN➢m N OmZDZD DZ� DM'*op 00 m:M'0 000r�SP�OA O �ZNmZmp S2 <mmODr O
zom mm2ml O_+tn0� z �mrA c�-pop-a-�o rc�-n =� CMz -a cm�mOm o �p+QOcn_OMM 0-{m G
Z-Om Dp0Otr7ZZ 0�=0m W ADD ZmD Om FWD aO7Z mZ� AO2mOZ Om-�rO�zO m �^OO CCZ OZAZ
OK_ Z"O 'D Aiw r=rNA m zz X00 0- ;0
OZ n<, rZZ OC= WNZ �r �'0 ZOmOv� �={im�G1pmv>'1 O
A -�'2 Om0 Z=2 �mmAO O �Aczm om mi jmO �A➢i m�A A-m�O A -i G7 xn OOZ�ZO ➢mW. ANO _V*cr Z
o m mzczlpn>� D�'p� A or� f°m c�oz pig z�z zQ��vp <m o �O<� pZfn��Oz=oo (n
m m➢ "UZOmA� CZIO om�zp DO '< Nm aO K Lu l .d mAz oz zZ Omy 00 m 00-<m2G �ZX�Z pfn mnZAn
m�A Dm C�bj OOmOo 0 ;uz 'Om 0ZS _Z3 �mi zmiO�OzO Z� Z�QNOO A�a7➢ Zm y D Om DZ �(nOm
N Z=1 Z0 O-1 f�Tt '� fQ�ir ODS �� Qpm M'_',i ROO >mz 0OW <(n D<a)oO0m 0AO aI�ZN K-"-
Zp--��77 0m mp ZDW r D V/ZO O rm mm N 'D r_ DA m ,-Dmz -I m Z2tiffO W
DD-ji
Cc -=I-0 U5 A'<OOm 0 „Oo {= Om, yor OF �Zr rmA r0 r0 nfn 20 „<j050 oxtn Z➢cm
Nm m2 r zlOW A$z '< a7D- O r0 mm m O m SOW r D m-{ ZO
O Om0 a7 ZS c DC7
O A ➢ rC �"aSA pr.'C- fTM 'ZZ (0m zi '� <NO 0-aal OZ M. mrA-mm "OO 0OAN D-0 �O5Z
Z2� z� Zr OOOmO m rn Nm m�Z rm*ImD D m AO mOm ZO mDOrCm pZZ�Za�]rA-CPZ,
OZF 0- 00 Cmozc m Zyo V7 j20 000 Z m m oAm� NO �{�Wfn� O�mm DO c7+Orn
SmD Z� �� zZ�m=� m ooh !�O zZo AOC+ yOi p m Sm AZ 0D�maom�q �m�Amrm ➢p�O�
-0X p0 0 -I
on
CZ�7N Q moo �Z' �Z rO DQE m Q r � mal �Aj� Z�OO�OZ m -1m -n �mz (I
M m0 AD mm =mO•D• m r<*i2D DO_ = m mOX N_ Z Z mAO yz O1+ZDalO OSmO�r O -iC
2Nr Cr ZO Z�=al O '< r Z-� OR7Z >MK Z U m yx O-1 alr "10>0� �mzmm03 S m;[7
m_ r m0 O 00 b a7 z7 m Om DD Dm0v7xW O yyal
Q>W mO rZ mmmA m0A 2� -l0o m2� D 00 m A �O h#N UZQn'm 002-05 A NZ
Orn Z0 000 O-4zO Own >Z omp OTo 0 O a) zm Am mn0�mK < alOO� N �mm
O
ZOS, DO ZI �mmD to Mm-ZG K� mAO' Krr"m N m O pZ pA Ommmoo k 3ZO0 D �-1
>Om mr OF '+pO''���:17 .Z�1 O �mm mo O=N m=Z C `--i4 N O mr �0 �m.,V7m 'I mz>t/� D AO
cmm0 O0 m-� K:0 Om mm mzP K-_ Z m Zr0 lmTt m0 Em
OT. S�<OzO mpA<my 0 00
O m <0 �� -i -i�r ZZ D m OrZ O mi D =Z m Sm0 m CZrn O N"*�
„�j Z A+D mm O S 0"i0 �(n mmW Z r �S mza7 -� rimr(-aN'� OS
O O O >7 n SO c c oc +0 = moo. = Drn
Z Z z -�z>' K� -� rl0 "'�� r m c m rK
5110 mW0 2 12: Z >OA
N OZ O
> Z O
D OD
Z Om o O O V O V A G N O p p V O N A W N
.i7 -0
Om
in Z I m
00 m C ti
F1 * z/ O O
bg: 2 n a 2
C) mm o
�1 alp m
C) �a p
nz
-1 C-) m O oN
O r�
N
Z �
(n _
C�A 0 OA pO mm Zy
O tDi� -^ � Z � Om
- Q
Z m X m = mw C O
ma7K Z ZA
2x11 ..{ a`2 4„ mou 0
m7:{ m A 2 O r'
m O O S Z zl "i > �..
O D s m < 00> I m 0
z C)c z
=0 ➢ 12r:
I
m x m m
0�
o D 0 m
_' Z o n. p
mm� < DrT~i tT�im2 Mr
Om � D WW oala m
z7 -�
Oo (DO
==m =ccSE mr-+
X
WD A zIZZ W`o.m>z7
mrm mmmmO tnoW
-�� < omo(n3Zc
m
m D m gg D
n Dp }> D cn
D� omz-�� mD
- z m
0 = Oz7A'"DQ A A
n (AD o c
Cm -uz�� 3
nM z
� 5Qo
c ,,,
Cn
n
a �A4
r O
NOTES: PANNONE ENG SVC LLC �������� REVISIONS DATE
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510=OF!aLgst� 11/21/19
PHONE 907 272-8218 FAX 907) 272-8211 �.:�r,P• ' 4,++ SCALE
VALHALLA, BLOCK 4, LOT 1 *' • •••... P.I.D. NO
DRAWN JRL WEST VERA LOCILLE REVOC TRUST �� 'tteven'F�:'I5ennorie'� 015-211-02
SOILS LOG 8C 12591 BEACHCOMBER DRIVE r1��4•
CE s1a9 ,.,'� PERMIT
NOTES ANCHORAGE, AK 99516 arta=,pEE T OF 3
m
Oi N A W �
0
o n
m
w
m
z I z z I m
o in o
A
o 0
o
in
o
o<-+
0
0 0
N
N
o
u+
o
Zia
n
m
y
o
o
�
N 89 59'W 148 57
i
l
i
i
i
I
i
HUFFMAN ROAD
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
AS -BUILT SURVEY 1" =20'
NO CORNERS SET THIS DATE
000000�0�
OF qL°0p
49
�.0
1` v SHANE A. HOLT �a
f
Qp LS -6914 4
Ofessiona�
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 1, BLOCA-4, VALHALLA SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 1ST DAY OF
NOVEMBER , 2019
14377 FB 199-77201-35
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
345-5513
•
MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program
c et�l
PO Box 196650 4700 Elmore Road
,jl I Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 n
n
http://www.muni.org/onsite '^
(amu
Department
41 cH ORO*.
On-Site Wastewater Disposal System Permit
Permit Number: OSP191404 Effective Date: 9/17/2019
Work Type: Septic Upgrade Expiration Date: 9/16/2020
Tax Code Number: 01521102000
Site Legal Address: VALHALLA BLK 4 LT 1 G:2736
Site Mailing Address: 12325 WILDERNESS RD, Anchorage
Owner: WEST VERA LUCILLE REVOC TRST Lot Size in Sq Ft: 18541
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
CEJ Disposal Field E1 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
g Special Provisions:
The Engineer needs to do an additional test hole prior to the construction of the septic field. Construction may
proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed
results with the As-built Inspection Report. If the results require a design change, construction of the system will
stop pending On-Site review and approval.
•
•
Received By: (67 Date:
Issued By: , /g_% Date:
EPL44MS
MUNICIPALITY OF ANCHORAGE
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. 015-211-02
Property owner(s) West Vera Lucille Revoc Trust Day phone
Mailing address 12591 Beachcomber Drive, Anchorage, AK 99516
Site address 12325 Wilderness Road
Legal description (Sub'd., Block & Lot) Valhalla, Block 4, Lot 1
Legal description (Township, Range & Section)
Lot Size 18,541 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field (XI Initial _ Single Family (SF) (XI
(w/wo ADU)
Septic Tank ❑X Upgrade n Duplex (D) n
Holding Tank ❑ Renewal U Multiple Dwellings n
Privy (1 (SF and/or D)
Private Well n
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.
wie "40
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5Q6- Waiver Fees:
Date of Payment: 9/9//9 Date of Payment:
Receipt Number: 075756 Receipt Number:
Permit No. OSPONOV Waiver No.
Permit App_:- :: ,c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191404, Deb Wockenfuss, 09/17/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191404, Deb Wockenfuss, 09/17/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191404, Deb Wockenfuss, 09/17/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191404, Deb Wockenfuss, 09/17/19
E p(_P j'
UMUPAUTY OF .ANCHORAGE
_ ty A� 1
Development Services Department j Phone: 907-343-7904
On -Site Water & Wastewater Section --
Fax: 907-343-7997
Parcel I.D. 015-211-02
1
Certificate of On -Site Systems Approval
GENERAL INFORMATION
Complete legal description Valhalla B4 L1
Location (site address) 12325 Wilderness Road
Expiration Date:� Zq av
/
Current property owner(s) West Vera Locille Revoc Trust
Mailing address 12591 Beachcomber Drive
Day phone
Real estate agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
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:
L,uaH to De reteaseo to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment it t f 131 tui Date of Payment
Receipt Number
COSA#__-_- 85Clq fb�l
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 Steven R. Pannone P.E.
6. DSD SIGNATURE
Date
OF
.S
49 TH w �r
._.
_V System #1 Approved for bedrooms j.en .R. Pennone
CE 814.g
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: (N Original Certificate Date:
The Municipality of Anchorag evelopment 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 Checklist blue sheet
Legal Description: Valhalla B4 L1
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled unknown
Total depth 121'+* ft
Cased to unknown ft
FEW Sanitary seal is functioning correctly
OF Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 9112/19
Parcel ID: 015-211-02
Structure served by this system 1
Well production at time of test 9.5 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑✓ No
E Coliform bacteria is Negative
Nitrate 1.60 mg/L ❑ Nitrate less than MRL (ND)
Arsenic 7.27 ug/L ❑ Arsenic less than MRL (ND)
Collected by Sullivan Water Wells
Date of Sample 10/19/19
Static water level at beginning of test 80 ft.
Comments * max draw -down during well flow test was measured to be 121'.
B. TANK DATA
Age of tank(s) 1010"9 years
Tank type/material Advantex/ Fiberglass
Measured operating fluid level in septic tank n/a
H Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 10/28/19
0 ALL standpipes present per record drawing
Total measured depth from grade 11 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field
0 Monitor tubes go to bottom of effective. if not, state
depth into effective
R 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:
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date n/a
Results a 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
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'
66.7
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No ft
7 Yes
if No ft
Neighboring Tank > 100' ❑✓ Yes
if No ft
Private Sewer/Septic Line > 25' Q Yes
if No ft
Absorption Field on Lot > 100'
p _ ❑Yes
83.1
if No ft
Holding Tank > 100' 121 Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
Animal Containment > 50' ✓❑ Yes
if No ft
Z Yes
if No ft
Water Main > 10'
ft
Yes
if No
Manure/Animal Excreta Storage > 100'
Community Wells > 200'
Community Sewer Main > 75' Yes
if No ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
Q Yes if No ft
Property Line > 5'✓❑
Yes
Yes
if No
ft
Wells on Adjacent Lots:
❑
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'
ft
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 9.6
ft
Wells on Adjacent Lots:
Water Main > 10'
❑
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
Upgrades to well Performed by Sullivan Water wells.
G. ENGINEER'S CERTIFICATION
l certify that l 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
M/ 1 Z (
COSA Checklist yellow sheet
'�evan R. .Pa. r cii..
Carroll, Rebecca M.
U'`� L1
From: Ecklund, Timothy J
Sent: Tuesday, October 15, 2019 7:51 AM
To: Steve Pannone
Cc: Wockenfuss, Deborah M.; Carroll, Rebecca M.
Subject: RE: 12325 wilderness
Steve,
Your email looks good and works for me. I'm going to cc Deb and Becca just in case they end up reviewing this COSA.
Thanks
Tim
-----Original Message -----
From: Steve Pannone <Steve@panengak.com>
Sent: Monday, October 14, 2019 4:47 PM
To: Ecklund, Timothy J <timothy.ecklund@anchorageak.gov>
Cc: Cole Sullivan <ColeSullivan_21@hotmail.com>; Pannone Customer Service <Customersvc@panengak.com>;
kclemens@mtaonline.net
Subject: RE: 12325 wilderness
Good afternoon Tim,
Thank you for calling me about this well issue. I wanted to memorialize our conversation and let you know how we will be
addressing your concerns.
1. This well is in a space off the garage. The slab of this well space is at the same elevation of the garage slab. There is no
possibility of this well space flooding due to the entire garage would have to flood to raise the water level in this space.
2. The well casing will be extended to 18 inches above the slab level. The well line will be rerouted for this casing extension.
3. The annulus space between the well casing and the concrete slab will be filled with bentonite grout to prevent any water
from seeping down around the well casing.
The work is going to be performed by Sullivan Water wells and a complete report will be submitted documenting that this
work was performed.
I believe I have documented correctly our conversation. Please let me know if this is not an accurate documentation of our
conversation.
Thank you again for your assistance. It is appreciated.
Steven R. Pannone, P.E.
Pannone Engineering Services, LLC
Office: (907) 745-8200
Fax (907) 745-8201
www.Panengak.com
-----Original Message -----
From: Steve Pannone
Sent: Monday, October 14, 2019 4:03 PM
1
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENI ANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this' -7 - Day of tt G t�. U-�r � o
�L�_ of 20 - . by and between
(ot�1 SSe �3-herein the "O\VNIER." and the \Municipality of
Anchorage, he, the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein; the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWT'S),
described as 1500 gallon Advantex
ocated at (legal description)
Valhalla Block 4 Lot 1
2. Maintenance, Repairs and Alteralions.
(Owner is required to read; understand and initial each section)
1 Throughout the term of this Agreement. the Owvner shall enter into a service agreement
with an AWWTS service and maintenance provider- approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
r
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the. Owner during the term of this Agreement to pay for all
repair(s), maintenance, adiustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically 5400 to S600)_
1 Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative wvill inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
IJ" d Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drain .field
replacement.
(rev. 05/18/2018) Page I of 3
I Owner acknowledges that the Municipalivy may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWW fS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWW'*FS, The Municipality will give at least 24-hour notice.
Owner agrees that ani, sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction; maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain rernote monitoring of the AW���TS as required by the
A'WWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the ANVWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any Garay affect
the validity of the Agreement or any part hereof; or the right of the Municipahty
thereafter to enforce every provision hereof,
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt- to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
! 0r ?l�-L(pZ_o
By: (signature) Date:
name)
STATE OF ALASKA }
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this X �iy of )k �
!STATE OF ALASKIA r.
NOTARY PUBLIC POR ,,LASKA
Nly Commission expires: -� 1
MLINICIPALI'I'Y:
Bv: (signature)
(print name)
(rev. 05/18/2018)
i NOTARY PUBLIC ,:�{
Victoria L. Harrell \ 'f
!mp, or,?m�sston &riires. September 11, 20201
Date:
Title:
Page 3 of 3