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T12N R3W SEC 27 LT 49
Onsite File TI 2N R3W SEC 27 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 oft ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211007 PID Number: 018-092-28 Dwelling: E Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: FE-M] New ❑ Upgrade Name Hulquist Homes ABSORPTION FIELD El Deep Trench © Wide Trench ❑ Bed ❑ Mound A Site Address Site East 138th Avenue ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 0.8 GPD/SF 8.0 Ft, LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot T12N R3W Sec 27 49 Fill added above original grade 0 Ft. Gravel length 2 @ 50 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines NA Distance between lines NA Ft. SEPARATION DISTANCES To Septic Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1,000 Ft2 2 10.0 Ft. Well L100'+ ( 100'+ i NA NA 25'+ TANK 9 Septic ElS.T.E.P. El Holding [I Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ i 100'+ NA I NA Material Number of compartments I Lot Line 10'+ i 10'+ NA NA NA HDPE 2 Foundation I 10'+ I 10'+ NA I NA I LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to3034 drainfield Hulquist Homes, Inc. Drainfield 3034 co/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100.0 ft Inspdection im 3/12/21 3/15/21 Location and description 3`d 3/17/21 2�d 4"' 3/19/21 South East Corner Top Of Foundation Wall ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date�P�� OF. A�gs�a .C�. TH 9 ¢ �� fie.. ...— .. ...:.; — ^tevcr Septic System i �aririci; ��' �r of (f /.M. Approved Date Note: this approval does not include well permit requirements. y -p-0 ^ —I O"�=CC) CO ZJ M o-6�*Zvi-0 > 21 0 Ln c— `-0C a ; O (--J z O m O m A P Z Z O O 0 0 rn Dcn D� — Z Q z Q ON 1 m O �� a70 mD Z .. (n Z �l >0.. r-, Z m �\ N Dr C)X Z m O m m— A rp Dr (7ZW D m r- ;0xn 4? W N �7mmc)m -P (..i N A 2 m �z mm0 (n O N = '2): .. D O m -''• 6,0-02 p 0 C7 9 p m �� ��C 110O co -A 0o (,.I 00 .P Cb -P CA CA c.i (A ml�jm-u DCntj 00-, n m O C-4 00 00 c0 O J O (0 rn ? CA D V O Cc (.0 -P N N V (a Co / O / m O L O(.n i C O m (A N N O N .p cp 07 -P N O -, Ui O CO p N N ('0 v N -P N m m 0 0 rn Dcn D� — Z Q z Q ON 1 m cn �� a70 mD Z .. (n Z �l >0.. r-, Z m �\ N Dr C)X Z m P�� m m— A rp Dr (7ZW D m r- ;0xn m� I mA �'0D-Di DONOm u ZO mcn��AAcnmA� - � Cc) r''):j>m- �7mmc)m m mO -1m �f'' NOto Dm A 2 m �z mm0 (n z y� x = '2): .. D O m -''• 6,0-02 p 0 x Xp 9 p m �� ��C 110O 0 r- -1�1l 0 Ln— OM 060) OO n Opp o CJiM G�0U (7 D Fr �� -1 to O - n m F�',�Q'0 Ln Lo W ml�jm-u DCntj 00-, n m (n0 1m 0 n \ m > O = Z- O 2 0 O D 50' ROADWAY & UTILITY v pX a O O m / r —j p D / r / / m J cl7 n � � z ]= WELL m z >200' D � m x I i�J D �D { < / a I �1 J I � I � r — r -O . _O —� - O I // N -1 Z cn + JN' m I M ��� 41 I z O 1 _ LC - too NOTES: P,ANNON9E ENG SVC LLC (C.1. 1088) "" REVISIONS DATE RECORD DRAWINGS P.O. BOX 1807 POEP,, AK 99645 OF A(q''1, 08/17/2021 PHONE (907) 745-8200 FAX (907) 745-8201 = �P•'' S/r'h SCALE 50' T12N, RX Sec 27, LOT 49 = P.I.D. NO DRAWN Lac HULTQUIST HOMES INC 018-092-28 •• Steven R. Pannone ..4- SITE:4370 EAST 138th AVENUE cE-alae: PERMIT NO. '�`���� OSP211007 SITE PLAN ANCHORAGE, AK 99516 '4� (�`�;o��� SHEET 2 OF 2 o K Z Z N Z n� �m O (n U) - Z- -Iy-i m D Z oZ� -_< — drD-�`�rD-- O - SOD _m �7mmc)m (nor Z> -{OOr-O ��m 0 vm D CC)mx 0 m D\\ - �rM m 11 m D 0 l of 2 z 0 r- m0 u Z m D n� r0M_ 70 Z --i O / -:71 =Dm — OZ C - -. - z0Z:OX Z �n Cor z O D 50' ROADWAY & UTILITY Z O C / r / r / / m J it > Ln r, i O_ m NOTES: P,ANNON9E ENG SVC LLC (C.1. 1088) "" REVISIONS DATE RECORD DRAWINGS P.O. BOX 1807 POEP,, AK 99645 OF A(q''1, 08/17/2021 PHONE (907) 745-8200 FAX (907) 745-8201 = �P•'' S/r'h SCALE 50' T12N, RX Sec 27, LOT 49 = P.I.D. NO DRAWN Lac HULTQUIST HOMES INC 018-092-28 •• Steven R. Pannone ..4- SITE:4370 EAST 138th AVENUE cE-alae: PERMIT NO. '�`���� OSP211007 SITE PLAN ANCHORAGE, AK 99516 '4� (�`�;o��� SHEET 2 OF 2 o I.. n nl IO v mcn cn I . r �_ I Ip / 70 m C) 50' ROADWAY & UTILITY EASEMENT Ln it > Ln r, O_ m i C/1 \ I n % lyJl� I3 > II > / I / / NOTES: P,ANNON9E ENG SVC LLC (C.1. 1088) "" REVISIONS DATE RECORD DRAWINGS P.O. BOX 1807 POEP,, AK 99645 OF A(q''1, 08/17/2021 PHONE (907) 745-8200 FAX (907) 745-8201 = �P•'' S/r'h SCALE 50' T12N, RX Sec 27, LOT 49 = P.I.D. NO DRAWN Lac HULTQUIST HOMES INC 018-092-28 •• Steven R. Pannone ..4- SITE:4370 EAST 138th AVENUE cE-alae: PERMIT NO. '�`���� OSP211007 SITE PLAN ANCHORAGE, AK 99516 '4� (�`�;o��� SHEET 2 OF 2 C- 0 -1 :5r- o@ 0 CD X to (D �j* -0 0 0 -0 CD -D ID :3 ('C'D (D 0- o C7 o CD Q 0 CD 3 a o e -J CD = ,D c) (D a (D co CD D CD CD 0 3 ID 0 CD 0 n 0 0 1-1 co :5� co CQ 00 (D -I 3 1-3 M CD CD , 0 CD - cf) 0-0 rn co Co (D oo- o-, 0 0- Ll C) o -.-0 <0:3 0 rQ CD CD a - 5- (D-< 41- 0 _0 0 6-,P — 3. 0 0-0 0 *0 -0 00 3 -6 -u 0- ;,-- (D CD 4 CD (D- o in ZE 0 :T O m La C" co (D in (4 1 =3 �A A -0 41- ,, C-1 Oa EO 0 NO. N00*00'45"W 329.92' PJ O M Z%7 00 ro 80 m 60 CD...... Q < @Mb 50 Roadway Reserve U) N00*01'00"W 329.87' r- 0 V) = 0 0 a (D -t 0 -9 C) (D0 (D:3 :5r- o@ 0 0 M 0 0 0 -0 0 -TI 0 (D Cn CD 0 LO (D CTI Q (71 3 a o e -J CD (D (D 0 CD D < CD =F CD 0 3 a - :5� co CQ v CD , 0 CD - cf) C) 0 co rQ C" co (D in (4 1 =3 �A A -0 41- ,, C-1 Oa EO 0 NO. N00*00'45"W 329.92' PJ O M Z%7 00 ro 80 m 60 CD...... 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Q < @Mb 50 Roadway Reserve U) N00*01'00"W 329.87' r- 0 V) = 0 0 a (D -t 0 Y NNI U E 4:.ii C I Pt. !3 TY OF �`� FAr � c PO R !'• ,•%^S Development Services Department MEk Phone:907-343-7904 On -Site Water CO, WasietPt�a>er Section Fax: 907-343-7997 Permit Number: # 211007 Date of Issue: 01/26/21 Parcel Identification Number: Date Started: 05/17/21 Date Completed: 05/19/21 Is well located at approved permit location? Yes 0 No ❑ Legal Description: T1 2N R3W SEC 27 Lot 49 G: 2936 Property Owner Name & Address: Hultquist Homes, Inc. 138th Ave Anchorage, AK Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To casing stick up 0 2 gravel pad 2 3 overburden 3 5 silt & gravel 5 20 moist silt & gravel 20 35 wet silt & gravel 35 37 silty gravel w/ H2O 37 39 dry silt & gravel 39 82 boulder 82 85 clay silt & gravel 85 131 silt & gravel 131 167 silty gravel w/ H2O 167 187 clay 187 192 silty gravel w/H20 192 193 coarse gravel w/ H2O 193 196 N 610 05.746 W 1490 48.075 Water Sample Results: Arsenic: 1 ug/L Nitrates: mg/L I V Total Coliform Bacteria: colonies/100mL c9 I 1 'Z0 D Method of Drilling H air rotary ❑ cable tool Casing type: steel Wall Thickness: •250 inches Diameter:6 inches Depth: 196 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 140 feet Pumping level: feet after- hours pumping _fpm Recovery Rate: 34 gpm Method of Testing: airlift wen rntaxe vpenmg type: (] Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet : dentonoe Volume: 20 Start 0 feet .S`tnnnPri 20 Well Disinfected Upon Completion? Yes No Method of Disinfection: tabs Comments: Well Driller: Jomn, Kay F1 0 Company: Hefty Drilling, Inc_ Mailing Address: P.O. Box 112130 Anch. AK 99511 Attention: The well driller shall provide a well log to the On-site Water and Wastewater Section within 30 days of completion. Sery cesc-'pay'°tnient a � W 4700 R.-nore Road P.O. 60;: � 90650 Mad(Begich � ichorage, Alm 99507 s A E T Y Mayor .vwv,1.muni.ora/onsitg- (907) 343-7904 Pump Mstaflateon Log Well Drilling Permit Number: SW- bu7 Date of Isst€e: Parcel Identification Number: _ Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE On -Site Woter& Wastewater Program POBox 196650 4700Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 Permit Number: OSP211007 Work Type: VVeUSephc|nitia/ Tax Code Number: 01809228000 Site Legal Address: T12NR3VVSEC 27LT 49 G:2838 Site Mailing Address: Owner HULTQU|STHOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit isfor the construction of: Z Disposal Field Z Septic Tank Holding Tank- 0 Privy Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: 1/2G/2O21 1/20/2O22 171 Private Well ElWater Storage All construction shall bminaccordance with: 1. The attached approved 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18A\C72)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 bycalling (007)343-7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall baeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received 13� Issued By: MUNICIPALITY F ANCHORAGE s Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 018-092-28 Property owner(s) Hultquist Homes, Inc. Day phone _ Mailing address 12570 Old Seward Highway, Ste. 204, Anchorage, AK 99515 Site address NSN 138th Avenue Legal description (Sub'd., Block & Lot) T12NI R3W, Sec 27, Lot 49 Legal description (Township, Range & Section) Lot Size 54,450 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 (w/wo ADU) Septic Tank ❑X Upgrade ❑ (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (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. (Signature of property owner or authorized agent) Permit/Rush Fees: $820 Waiver Fees: Date of Payment. 1 2 I 20.2 1 Date of Payment: Receipt Number: Od 19 q G Receipt Number: Permit No. OSP211007 Waiver No. Permit App_ :- ::--,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211007, Deb Wockenfuss, 01/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211007, Deb Wockenfuss, 01/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211007, Deb Wockenfuss, 01/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211007, Deb Wockenfuss, 01/26/21 hurIUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-092-28 1. GENERAL INFORMATION Complete legal description T1 2N R3W Sec 27 L49 Location (site address) 4370 East 138th Avenue Current property owner(s) HulquiSt Homes, Inc. Mailing address Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Expiration Date: 4(—z3-21 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ iPublic Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 Waiver Fee $ Date of Payment 8J714- Date of Payment Receipt Number 02.502-G Receipt Number COSA # I / y q � 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 KSystem #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date p Co. \ ?�C E 81 i`F `',1 10,0 Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 9-23 rZ (_ 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: COSA ChecUst T1 2N R3W Sec 27 L49 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled 0"19/21 Total depth 196 ft Cased to 196 ft ❑Q Sanitary seal is functioning correctly FE -1 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 L0 ft. Comments NEW WELL c]a AN11,411EUVA Age of tank(s) <1 years Tank type/material HDPE Measured operating fluid level in septic tank NEW FEE Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 315121 R ALL standpipes present per record drawing Total measured depth from grade 8.0 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ N/A — pressurized field X 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 SEPTIC COSA Checklist yellow sheet Parcel ID: 018-092-28 Structure served by this system 1 Weil production at time of test �" gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes R No Coliform bacteria is Negative Nitrate 1.D-?' mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L tKArsenic less than MRL (ND) Collected by PES Date of Sample 8/11/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: Adequacy test date N/A Results ❑✓, Pass For 5 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' Q Yes if No Community Sewer Manhole/Cleanout > 100' [, Yes if No ft 0 Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' [D Yes if No Absorption Field on Lot > 100' 2] Yes if No ft Holding Tank > 100' Fv� Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' R Yes if No F/I Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [� Yes if No ft [D Yes if No 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' ft ft ft ft ft ❑✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Fv� Yes if No ft Private Wells > 100' rv� Yes if No Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No Water Service Line > 10' F/I 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' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 1.00' B Yes if No Water Service Line > 10' Fv� Yes if No ft Community Wells > 200' Rv Yes if No Surface Water > 100' Fl Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF AC l certify that l have determined through field inspections and review C�' of Municipal records that the above systems are in conformance with,: -� MOA COSA guidelines in effect on this date. , . ... �+ eve n (=. F'rnnorae 1 COSA Checklist yellow sheet ft ft ft ft