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HomeMy WebLinkAboutEMERALD GROVE LT 1Onsite File Emerald Grove Lot 1 #015-521-47 Municipality of Anchorage On-Site Water and Wastewater Section o (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211092 PID Number: 015-521-47 Dwelling: R Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: X New ❑ Upgrade Name Hultquist Homes Inc. ABSORPTION FIELD 10 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10900 Baronik St ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 105 1 0.45 GPD/SFI 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 5.0 Ft. Subdivision Block Lot Emerald Grove 1 Fill added above original grade 1.0 Ft. Gravel length 180 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number N/A of Lines 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 472g 1 P00 Ft2 3 11.0+ Ft. Well 147.4 209.2 NA NA 125'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ 100'+ NA NA Material Number of compartments Lot Line ! 34.9 13.3 NA NA NA HDPE 2 Foundation 14.9 78.3 NA NA LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield BTH Construction Drainfield 3034 CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100 ft Inspectiones: vt 9127/21 9/28/21 Location and description 2nd 31d 9/30/21 4th Bottom of Siding / SW Corner of House ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF Akgs t( g Tf"I�� Septic System Approved —V Date 6�- + Note: this approval does not include well permit requirements.��� .�v DESIGN PARAMETERS DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM RESERVE SEPTIC SYSTEM WATER LINE / W NO. BEDROOM: 5(750 gpd) NO. BEDROOM: 5(750 gpd) WELL RADIUS TANK SIZE: 1500g TANK SIZE: AS REQ'D FOR CAT III SS NEW SEPTIC PERC RATE: 37 MPI PERC RATE: 37 MPI SOIL RATING: 0.45 GPD/SF SOIL RATING: 2 GPD/SF ABBREVIATIONS AREA RQD: 1,667 SF AREA ROD: 375 SF TH TEST HOLE SYS. TYPE: DEEP TRENCH 5.0'ED SYS. TYPE: DEEP TRENCH 5.0'ED (P) PROPOSED MIN LENGTH: 167 LF MIN LENGTH: 37.5 LF (E) EXISTING CO CLEAN OUT NO. USED:FC USE: FOUNDATION (3EA) 60LFx2.5'Wx5.0' E.D., 8.0' TD 40LFx2.5'Wx5.0' E.D., 8.0' TD CLEANOUT FS FLOW SPLITTER TOTAL AREA: 1,200 SF TOTAL AREA: 400 SF MT MONITOR TUBE NO. TYP TYPICAL / A B C O'MALLEY ROAD -----1 -- -- . 11 FC 10.9 10' T&E EASEMENT 10.0 T1 18.6 24.0 T2 22.8 27.5 TH-2 r DCO 25.0 29.1 M 1 -- I Cl 102.4 136.4 M j SCALE: M1 103.1 136.6 '- ' � / 1"=50' M / C2 100.0 104.1 s + TH-1 \ M` i / M2 98.6 103.5 RESERVE DRAIN FIELD (P) C3 115.5 147.1 � M5 M3 116.0 146.6 40LF x 2.5'W x 5.0'ED x 8.0'TD C5 INSTALL MONITOR TUBE AND CLEAN OUT \ SEPTIC AREA C4 113.9 119.4 AT EACH END M3 �' / M4 112.5 118.8 C \ J C5 133.6 161.8 M5 132.1 159.8 C6 127.5 132.2 M / M M M C6 1 1 .1 13.3` / M6 126.4 131.3 M6 Cl NEW PRIMARY DRAIN FIELD (3EA) 60LF x 2.5'W x 5.0'ED x 8.0'TD / CM4 - , M 1 1 3 INSTALLED MONITOR TUBE AND CLEAN OUT l M2 / \ AT EACH END 41 C2 /NEW 1500g SEPTIC TANK LOT 1 DCO INSTALLED FOUNDATION CLEAN OUT INSTALLED DOUBLE CLEAN OUT AFTER T2" INSTALLED FLOW SPLITTER I / I I // f w w O / 3 � T1 WELL (E)J � _-145.9- / � h A / 3 5BR 3 o HOUSE g / a / m -- -- LLJ - w' / J3 C / (P) ' 3 NEW WELL �:5 / g w cLLJ f) w W 86 DRIVEWAY w IN - T 3/ NOTES: PANNONE ENG SVC LLC (C.1. 1088) """ii REVISIONS DATE RECORD DRAWING P.OPHONE O. B)X71807 PAL8200 MER, 907)745-8201==y�?�� oR A<9s�r'4 SCALE 30/2021 1 „ = 50' EMERALD GROVE, LOT 1 = - P.I.D. NO DRAWN DRM HULTQeven UIST HOMES i StR. pd -015-521-47 BARONIK STREET �-8t49 -- PERMIT NO. SITE PLAN - OSP211092 �« SHEET ANCHORAGE, AK "a ....... 2 OF 3 —icnz CD m 0 C--= z0 CD ccn CLEAN OUT oM z � N o -u , RISER CD _ cn z moo: D� O CLEAN OUT DOUBLE o CLEAN OUT zmcn zmcn ozo ozo X c m rn c FLOW SPLITTER D7coco 0007 Co — NW OV-` V CON V CON CLEAN OUT MONITOR TUBE w z m cn D ozo ;u-ic m Oo110(0 o (O o O cf) V(ONGi c Oz PTt Cn ozo m �D m --ii = ?0 _ O � CO CO CO V (O N G7 MONITOR TUBE CLEAN OUT zncn zOcn Omo omo mzc mzc =m==m= ?p..?p- w�Co O 00 07 O_ 1� V TH —1 0 cn o NOTES: PAMMONE EMG SVC LLC (C.I. 1088) ` "` + , REVISIONS DATE RECORD DRAWING P.O. BOX 1807 PALMIER, AK 99645 ?qE OF A4 11/30/2021 PHONE (907) 745--8200 FAX 907 745--8201 SCALE NTS EMERALD GROVE, LOT 1 s DRAWN DRM HULTQUIST HOMES P.I.D. No 015-521-47 Stwen R. Ponrwne .._._— PERMIT NO. BARONIK STREET SITE osP211os2 SITE PLAN ...... _ 2 ANCHORAGE, AK E°` SNEEof 3 S 4 E s Permit Number: #SW211092 Date of Issue: 4-7-21 Parcel Identification Number: 01552147000 Date Started: 6-29-21 Date Completed: 6-30-21 Is well located at approved permit Iocation? x Yes ❑ No Legal Description: Emerald Grove Lot 1 Property Owner Name chi Address: Hultquist Homes Inc Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: steel stick-up 0 2 Wall Thickness:.250 inches gravel fill & silt 2 4 Diameter: 6 inches Depth: 161 feet silt 4 6 Liner Type: Diameter: inches Depth: feet gravelly silt 6 11 Casing stickup above ground: 2 feet Static water level (fi•om ground level): 66 feet gravelly sandy silt 11 13 silty sand 13 16 Pumping level: 160 feet after gravelly silt 16 81 2 hours pumping 20 gpm Recovery Rate: 20 gpm silty sand & gravel H2O 81 84 Method of Testing: air li1 gravelly silt 84 135 Well Intake Opening Type: silty gravel wet 135 155 x Open End ❑ Open Hole water sand & gravel 155 161 ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: Bentonite granules Volume: 1 bg Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet WATER QLALITY TESTING CCNWM NA - COU1 QOfY4L Pump size hp Brand Name NftMO N L Well Disinfected Upon Completion? x Yes ❑ No Alleft N 3) Z� Method of Disinfection: chlorine tablets t � 2y Comments: WeII Driller: Alpine Drilling & Enterprises PO .Box 110496 Anchorage AK 99511 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Legg Well Drilling Permit Number: 21 1 a92' Date of Issue: 4 -7 '2021 Parcel Identification Number: /- -moo C)l5 Legal Description. Block .Lot Property Owner Name & Address: Emerald Grove 1 Hultquist Homes 12580 Old Seward Hwy., Anchorage, AK 99515 Pump Installation hate: 19 -09 __2021 Pump Intake Depth Below Top of Well Casing: _155 feet - Pump Manufacturer's Name' Goulds I aBH07 Pump Model: 3/4 Pautp Size: hp Pitless Adapter Burial Depth: NIA feet Vitless Adapter Manufacturer's Name: N, kitless Adapter Installer; N/A Well Disinfected Upon Completion? k ices © No Method of Disinfection: chlorine tablets Comments: PLEASE SAVE FOR COSA. Pump Installer Hanle; Co,pauy: Aarow Pump & Well Service, LLC Mailing Address: P.O. Bax 110496 city; Anchorage st,te• AK Zip. 99511 Attention; The pump installer shall provide a pump iostallatioa log to tin. -site within 30 days ofpunip installation- r,1 nstallation_ � ' 1 .1771 O cn N 41 O J JGGJJS �!UOJ E] O 3„1 Z,ZO.00S IUC-WGSD3 3781.. QI — �Wl W a) C (D 7 d a a N 0 0 3 J 00 0 .> (DLn p _ 3 `o c) 00 O t� 00 O J d- 0) N n. V9Z (D 00 LO b) co a) J ml: Y C N 0 U v 1 L Q) ami to o O O s' U J 0 cr- W 00 o '75 �j }UvUJDSD3 3-'1 ,LZ O � I ------------------------------------------------- IUGWJ )SC3 T?i ,0! i ,SL ,LS•Z6Z M„69,tr0,00N 0 I 1 a) J ml: Z 7:� r � Li N Y C N 0 U v 1 L Q) ami to o O O s' U J Z 7:� r � Li N 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://4vww.muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP211092 Work Type: WellSeptic Initial Tax Code Number: 01552147000 Site Legal Address: EMERALD GROVE LT 1 G:2637 Site Mailing Address: Owner: HULTQUIST HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: �1»cnt u � 1 Department 4/7/2021 4/7/2022 This permit is for the construction of: Q 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 Received By: _ Date: Issued By: 4-�tIlk"llell-i Date: 5 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211092, Rebecca Carroll, 04/07/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211092, Rebecca Carroll, 04/07/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211092, Rebecca Carroll, 04/07/21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 TEST HOLE 1 BOH ORGANICS SILTY SAND WITH TRACES OF GRAVEL DATE PERFORMED: 6/28119 SOILS LOG - PERCOLATION TEST SLOPE x TH WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY SITE PLAN M M...i.. TH-2 Lot 2 a) �i 43,893sf� C�)H - w o nI /•-MM�yt 1 �6 a L sf 0 i DEPTH TO WATER AFTER MONITORING? -DRY DATE: 7/12/19 DEPTH TO WATER AFTER MONITORING? -DRY DATE: 10/1/19 SLOPE x TH READING DATE CLOCK NETTIME WATERTIME LEVEL READING NETDROP 1 6/28/19 1:30 — 5.66 -- 2 2:00 30 MIN 7.16 1.50 3 2:00 --- 5.66 - 4 2:30 30 MIN 6.50 0.84 5 2:30 --- 5.66 -- 6 3:00 30 MIN 6.48 0.82 PEROLATION RATE 37 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS: Test hole excavated by WHITE RAVEN DEVELOPMENT. PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: P VNE ENG WC, LLC ��®®a \ Date SOILS REPORT P.O. BOX 102954 ANCHORAGE, AK 99510°F A� 4stt o/�0/2019 PHONE (907) 272-8218 FAX (907) 272-821NTS AF 149 y �d� Scale EMERALD GROVE, LOTS 1-4 P.I.D. No SUBDIVISION OF BOB WEST, TR A TH ®w 015-521-16 Steven F2. Ponnone • ®PERMIT N0. HULTQUIST HOMES INC. ���� . CE 8149 ,®� s12505 ST SOILS LOG ANIK NCOHORAGEREAK Ilk eA et OfESSIpN� � SheOF 5 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCa)panengak.com October 10, 2019 State of Alaska Department of Environmental Conservation 555 Cordova Street Anchorage, Alaska 99503 Subject: Waiver Request for Separation Distance Septic System to Transient Non -Community Well Bob West, Tract A / Emerald Grove, Lot 1 to T12N, R3W, Sec 22, L4 N2 Less N75' Ladies and Gentlemen: I am writing to request a separation distance waiver from a proposed septic system, on a proposed lot, to a "Transient Non -Community Well". The current lot Bob West, Tract A is being subdivided into four new lots — designated Emerald Grove Subdivision and per Anchorage Municipal Code 15.65 a septic reserve area must be established on each lot. The proposed lot Emerald Grove, Lot 1 will be almost entirely within 200' of the Well Located on T12N, R3W, Sec 22, L4 N2 Less N75' serving the existing New Grace Christian Church. We are requesting a separation distance waiver from the well serving the church to any future septic system serving Emerald Grove, Lot 1. 1. Waiver: We would like to request a waiver for separation distance for the proposed septic system to the well located on the neighboring lot. a. Drain Field (P) to Well (E): A separation distance waiver between the existing Transient Non - Community Well on T12N, R3W, Sec 22, L4 N2 Less N75' to the proposed drain field on the subject property. The distance between the proposed drain field and the well will be 100' or greater. We are requesting a waiver for the drain field to the existing well for a distance of 100'. DEC Criteria: The well on T12N, R3W, Sec 22, L4 N2 Less N75' is a Transient Non -Community Well with a depth of 300 feet and a static water level of 222 feet. The known data for this well is summarized as follows and the Well Log is attached: LOT # WELL STATIC YIELD Well Data H2O Test Soil Well Nitrate DEPTH WATER Date Date Characteristics Log Level LEVEL Data T12N R3W 300' 222' 30gpm 10/4/1985 12-22- Y Y Unknown Sec22 N2 Less 2008 N75' Nitrates: 0.1 MG/L Pi-ysi4cak 33'32 East Manor, AnVl:s^J iwi Clloi (910 7) Crr,X: "' 90 ii _71"2 mo+ Page 2 of 2 The ground water in this area typically flows from the east to the west. The soil cross-sections from the well log were used to calculate the DEC criteria for all components. As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: HANSHEW HTS L4C&4D Sentic Svstem to Well: Distance from sewer system bottom to groundwater 6.0 Soil sorption below sewage system 4.0 Soil permeability below the system 3.0 Water table gradient 0.3 Horizontal separation 3.0 Total Points 16.3 "The sum of the above values could equate to the following conditions: 12-16 - Almost sure to be free from any form of contamination from household sewage." In my opinion, this waiver request meets the above criteria for approval and does not constitute risk to health. I hope the above information will assist you in determining that the waiver should be granted. The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, ®e®* ®1aan®ta E OF A4"'11440 Steven R. Pannone CE 8149 i I4®ESS®��Q,®4® Steven R. Pannone, P.E. Owner/Civil Engineer it a;�Ili9 0, B0X �4 tb t2.', t r::fch ,'-ri %'�� s: [, s� +r's (3f""�% }'iii;/�I i?:,.1„�`�! i'a, f"Vita o '.i , �':ii {-?LrCt -,yr>i`ti.1 _�`.'�i.=- Telelsi one: t-9 i) !?- -,^ FAX, [907j 2/2-� 11. 2 _ i'r!ra. SZ1. 01ALASKA. GOVERNOR BILI, I-VALKER October 31, 2019 Mr. Steve Pannone, RE Pannone Engineering Services, LLC. P.O. Box 100217 Anchorage, AK 99510 Department of Environmental Conservation DIVISION OF ENVIRONMENTAL HEALTH Drinking Water Program 555 Cordova Street Anchorage, Alaska 99501 Main: 907.269.3076 Fax: 907.269.7650 thomas.brannan@alaska.gov File: New Grace Christian Church PWSID: 215867 Class: Community Source: Groundwater Re: Emerald Grove Lot 1(Subdivision of Bob West Tract A) Separation Distance Waiver - Source to Proposed Septic Reserve Area Dear Mr. Steve Pannone: On October 10, 2019, this office received your submittal requesting a reduction of the State's minimum separation distance requirements between a community drinking water source and a potential source of contamination. This letter approves the requested reduction in the State's minimum separation distance requirements from 200' to 100' between the drinking water well serving the New Grace Christian Church (NGCC) Public Water System (PWS) and a proposed septic system reserve area for Emerald Grove (EG) Lot 1(a proposed new lot subdivided from Bob West Tract A). The exact location of the proposed septic system and its components to serve the proposed lot 1 will be determined sometime in the future, with this, under this Separation Distance Waiver no component of the noted trench style septic system shall be within 100' of the well serving NGCC. Background Bob West Tract A is existing and is currently being subdivided into EG, Lots 1-4. EG Lot 1 is almost entirely within the 200' protective radius for the drinking water well serving NGCC. Based on existing conditions and Municipal Code, a 16,000 ft' Septic Reserve Area is required. To meet this area requirement, a reduction of the State's minimum separation distance requirement from 200' to 100' has been requested. Waiver Determination As indicated in your submittal, the septic system to serve EG Lot 1 will consist of a trench style drainfield and septic tank with an application rate of 0.45 gallons per day / fe. At its nearest, the septic system and its related appurtenances shall be no closer than 100' from the well serving the NGCC PWS. The NGCC PWS well was drilled in October of 1985; it's casing extends to 296' below ground surface (BGS) and penetrates lenses of sand, gravel, hardpan, and mixes thereof with a static water level of 222' BGS. The following additional items were taken into consideration as part of this waiver approval: 1. From January 2014 to January 2019, source water sampling results for nitrate -nitrite concentration have been non -detect. This suggests that the well is not currently influenced by septic system exfiltration, decomposition of organic matter in soils, and/or erosion of natural deposits. The presence of nitrates in the future may warrant a reevaluation of this Mr. Steve Pannone, P.E. 2 November 1, 2019 waiver at that time. The Maximum Contaminant Level (MCL)/MCL Goals nitrate -nitrite concentrations remain is 10 mg/L; 2. From April 2009 to July 2019, Total Coliform Rule sampling for the presence of total coliform and e. coli found no positive (un -satisfactory) sample results.; 3. In the septic reserve area both the surface topography and the groundwater gradient in the area slope generally away from the well; 4. Site constraints such as grade, layout, and existing utilities limit the location of the proposed septic system components, it's proposed location maximizes horizontal separation to nearly the greatest extent practical; and 5. The well accesses a presumed confined/semi-confined aquifer. Based on an evaluation of the available information and in accordance with the State's Drinking Water Regulations, 18 AAC 80, a Separation Distance Waiver for the encroachments detailed herein is issued. Limitations and Appeal Process This determination is not approval of omissions or oversights by this office or non-compliance with any regulation. This does not imply the granting of additional authorizations, nor obligate any federal, state, or local regulatory body to grant future authorizations. This determination does not guarantee correctness of functional design or waiver the owner's responsibility for continued compliance with state, federal, and local regulations. Before proceeding you are advised to obtain any other necessary project authorizations/permits. Any person who disagrees with this decision may request by mail, e-mail, or facsimile an informal review in accordance with 18 AAC 15.185 or an adjudicatory hearing in accordance with 18 AAC 15.195-15.340. Informal review requests must be delivered to Division Director within 15 days of receipt of this decision. Adjudicatory hearing requests must be delivered to the Commissioner within 30 days of this decision, otherwise, the right to appeal is waived. For more information, visit www.dec.state.ak.us/commish/­Review-Gi3idance.htm. If you have any questions regarding this plan review please do not hesitate to contact me. Sincerely, T.W. In, P:E. eer I Cc.: Joel Harmon New Grace Community Church 10821 Totem Rd. Anchorage, AK 99516 Bcc: Dan Moran, Pannone Engineering Services, dannapanengak.com Darryl Stepien, DEC -EH -DW, daMLI.stepienCc�r�,alaska.gov Jessica Cahill, DEC -EH -DW, jessica.cahill@alaska.gov 191101_Nmv Grace Christian Church— Emerald Grove, Lot 1(subdivision of Bob West, Tr. A) - Source-Septic_215867_WA.docx MUNMPAUTIO'r OF ANCHORAGE 9 V S �* y� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Parcel I.D. 01552147000 Certificate of On -Site Systems Approval Expiration Date: -%WA� �, lna 1. GENERAL INFORMATION -C-O-SA-.Fee $_7 Y-' --- ----- -- - - - ---- Complete legal description Emerald Grove L1 Location (site address) 10900 BARO N I K ST Current property owner(s) Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. WaiverFee$- -- ---- - Date of Payment 2 �l �2 I Date of Payment Receipt Number O %a Q r Receipt Number COSA # a5) C 7 1 I (, 91-1 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. y1 System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved Date 2_t i2d l Conditional approval for bedrooms, with the following stipulations: OFf -- �� WATER AND WAST.V,lATER oz 0 JJ�/JJ SER\J 1\11 BY �`1�V�16\ 1� 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 State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ------7.----A-T-T-ACHMENTS:-- -- - --------- __ . __ __ .. -------- COSA -._ .COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Emerald Grove 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 6129/21 Total depth 161 ft Cased to 161 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA new Static water level at beginning of test 66 ft. Comments pump log turned into the MOA by Alpine Drilling B. TANK DATA Age of tank(s) °`"II' I1'_' years Tank type/material /�' Measured operating fluid level in septic tank new ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ` x a j ALL standpipes present per record drawing Total measured depth from grade 9'-Oft(max) Measured depth to pipe invert from grade "-'/ O 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: COSA Checklist yellow sheet Parcel ID: 01552147000 Structure served by this system 1 Well production at time of test 20 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes I© • ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by PES Date of Sample 11`22`2' C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date %(�d Results xPass 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 From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Fv� Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25' F71 Yes if No Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' R✓ Yes if No Neighboring Absorption Fields > 100' Yes if No IV,5- ft Water Service Line > 10' Animal Containment > 50'[]✓ Yes if No F✓ Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Manure/Animal Excreta Storage > 100' U Community Sewer Main > 75' F/ Yes if No ft 0 Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' M Yes if No ft Property Line > 5' Fv� Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100'✓l Yes if No ft Water Main > 10' 0 Y s if No ft Community Wells > 200' Yes if No IV,5- 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' U Yes if No ft If absorption field is under driveway comment below Property Line > 10' r7l Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓/ Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' F/� Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I 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. mo( COSA Checklist yellow sheet ................. er n n �t`.I one 10 CL