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HomeMy WebLinkAboutLEOS LT 11Leos Lot I I #051-053-33 Municipality of Anchorage Development Services Department J Building Safety Division 5., r,. On-Site Water and Wastewater Program, 4700 S. Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-790.4 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S w U 3 0 L,5- 9' PID Number: 0 S`1 -- 0,S3 •- 33 Name: 0,4 PAA vK Wastewater System: ❑ New ❑ Upgrade Address: 1 p 0) 00 C<3 a f//h-_,.i 13-lve-e gci'S-77 ABSORPTION FIELD Phone: Number of Bedrooms: Deep Trench O Shallow Trench 138ed ❑Mound ❑Other 1. LEGAL DESCRIPTION Sot Rafing T0131 Depth from original grade: GPD/Fe Fl Block: Lot: Subdivision: Depth to pipe bottom from original grade:th pipe_ I I )_ r_ 0 Ft. Ft. Township: Range: Section: Fill added above origi Gravel LenW Ft. Ft. Well: (�. New ❑Upgrade Gravel width: Number of lines: Distance between lines: Ft. Ft. Classification (Private, A. 8, C): Total Depth: Cased to: Total ab lien area: Pipe Material. t t 1 I Cn i FL 'a 17 FL Ftp Driller. Svl�ivrl;v Date Drilled: dbW ©3 Static Water Level: S 0 Installer. Twf-ca X Date Installed: FL Yield:GPM `` ' J Pump Set at V m K Casing Height Above Ground: TANK Fl. FL SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. ❑ other. To Septic Absorption Lift Holding ublic/Private Manufacturer Capaory: From Tank Field Station Tank Sewer Line %`� e C., /}. ,j )`J G .3 /00 C3 Gal. Well Number of Compartments: Surface Water ) �tl rte. LIFT STATION Lot Line a ) ©Gal. ie: Man purer. / Foundation �'h J -++ 'Pump on' level at: 'Pump off' lev High water alar at: in, in. Pump Make & Bectrico Inspections performed by. Curtain DrainI.0 — N o NSG .vowN Remarks: ,s4 poi r c 7 .4 BENCH MARK '� Location and Descnpucn: I'N l ,1 r C rB ;+ Assumed Eievauon: (i s +*+ J iT Ft. EY `. h� 1. �ss.,,e..s <:f. rr r�*•'\ . `t S & S ENGINEERING Inspections '7/X q lo-3 performed by: c.� t s: 1st 17034 Eagle River Loop Roai Eagle River, Alaska 99577 P r" A1- 2"d Gf / 3 V 'o ROEERT G COWAN .� r r�i, Develo ment Services De artment A rove! p P PP CL' 8801 �� „ Reviewed and approved by: � ,{� "SMA ,K Date: 1 oZ 1 R D 3 ,% U C" 0>1 w/ CCS nj PERMIT NO. SW030258 PAGE 2 OF 3 Municipalit of Anchoraqe DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.0 Box 196650 • Anchorage, Alaska 99519-6650 • Te'l'ephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 11, LEOS S/D P.I.D. NO. 051-053-33 v' •a o •a � 70 rf LOT 3 LOT 2 Z N J THA E (STING TRENCH SEPTIC SEPTIC • 100 WELL RADIUSC01 C AREA c EA D8L1 do DBL2 MT � TMT . ST2 � N W 1000 GALLON HDPE SEPTIC TANK FCO A B N O � O 3 BEDR LOT 12 0 LOT 10 A 3 yz A�4 PORCH o Q a NN j U O p � J if ` o a " Q SCALE: 1• 140' a " �` 1 Atp LEO'S ROA ^� `•••• R ... .•......:.........r -a LOT ROBERT C. COWAN LOT 7 .,6 a� is si: •, s del `::� ,.':.t�•�.,-� PERMIT NO. SW030258 PACE 3 OF 3 Municipaht of Anchora e DEPARTMENT OF HEATH AND HUN�IAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. hon: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM e, AtQska LAND/OR e1WELLe INSPECTION REPORT LEGAL LOT 11, LEOS S/D P.I.D. NO. 051-053-33 ST 1 ST2 100.8' FINAL GRADE 2" INSULATION NEW 96.4' 100ON GALLON POLYETHYLENE 96.1' SEPTIC TANK A B S,h 7 %e Q `�• .rte.,... • V�' tti_ 111 0:--IV,,��N' FCO 15.5 9.0 ST1 23.5 21.5' ST2 26.0 24.0 TMT 24.5 26.5 N. T. S. DBL1 29.0 29.0 DBL2 29.5 30.0 C01 39.5 41 .5' MT1 45.0 29.0' ROBERT C. COWAN CE -8801 GEC -:9-2003 14:28 FROWOLP.DIAN CO 9076887768 TO:6941L=A P:1/1 Certifieb ;Drilling Tog by roc CO. dA SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2750 OWNER OF LAND: t5r 4 _ ADDRESS: _ LEGAL DESCRI?TION: Lf:P5 6 -a' DATE: _ - PcRMIT NUMB'cR: ,G�� t'Uato of Issua�-�- TAX IDSNORCATION NUMBER: P-;zL Q..S3-- Is j_ -Is well located at approved permit location? (1,% 's i.t No Method of Drilling: ary U cable tocl Depth of wol:: _(11-;; Cas`ng Type Wall Thickness! 25 Inches Diamet6r- (7 Inches, depth _ f;z( _foot ! mer Typc:_t4l:1_^4n Casing Stickup Above Grourd:_24— feet Static Water Level: /$7ol feel Recover Rate: —jS— g pm Method of Testing: .041 n^ - Well intake Oponing Type: men end D open holo .j Screened; Start foe, Stopped feet W Perforations Start feet Sped feet Grouttype:� a.jrri C-11IVolume7z W. Depth: from _. fest, to_' r __ foot Wall Disinfected Upon Completion? 6*95ri] No Method of Disin`ection: Comments: r'r4Sr.•.t 6 .� ! f r,., Kul �' •— 7C 4FA� Driller's Name ATTENTION: It Is the responsibllity of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorago: Department of Health & Human Services and/or Department of Envirorim enta I Cc'nservatlon. MatSu Borough: Department of Environmental Conservatlon. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT Initial Permit Number: SW030258 Legal Description: ALEOS LT ;11' Design Engineer: 0003 S & S Engineering Owner Name: Linda Frank Owner Address: 10900 Corrie Way Eagle River , AK 99577-1527 Date Issued: Jul 17, 2003 Expiration Date: Jul 16, 2004 Parcel ID: 051-053-33 Site Address: 024225 LEO'S RD Lot Size: 10185 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: z. Date: / 1-7 /p 3 Date: 4% 03 • _ �- bovelopmwit §bI-i 6s bopartmwit building Safely bivision On -Site Water and Wasle%kaler program 4700 Soulh braga* SI. b.0. box 196650 Anchotage, Ak 99519-6650 Wv4w.cl.anthotage.ak.us (907) J4J-7904 ON -SITZ= StVVER/WLLL pr-RMIT APPLICATION rok A SINGLt FAMILY LIWELLINO Parcel I.D. s' I — d S- 3 — 3 3 permit Number SWO"25-8 Property owner(s) LI N 0 6 rA 4'-1< . bay phone '-4f 0 - EIJ-J S - Mailing address (i) 1 0 a V o C O 2 Ar 4. wrf y Mailing address (2) hr, 4 -t -r. -L 4 t v 4•e Arc zip Code 9 `1 S` 7 7 Legal description (Lot, block & Sub,d.) L-Oii/,L�DSS 1: Legal descripli-ohh (Section, T�hship & kange)%\ L ZyZZ - LLO's Lot Size 10 vS � I � S Acr /Scj.p . Number of Bedrooms tNts APPLICAtiON Is Poo: Sewer Only 171 Well Only ❑ Sewer and Well ( Water Storage ❑ Sewer Upgrade ❑ tNIS 011OPIERtY bONTAINs: liol tub ❑ Jacuzzi ❑ Swimming pool d Water Softening Unit ❑ therapy pool n I cbttily that the above Inlormatioh Is correct. I Iddhet cet(ity (fiat this application Is being made for a §1Ngle Pghiily b*ellihd and Is in accotdahce with applicable Municipal Codes. S & S ENGINEERING ( i — 17034 Eagle River Loop Road No. 204 --'-tet -- A• - (Signature of propetly owhet of authorized agent) aetmll trees: P-1001" 1- I SO, o ° Waivtt L=ees: bale of payment: -7 11(110.3 bale bl Payment: Receipt NUmbbf'11N b 3 9 S 3 3 �� hecbtpl HUmbeh (Rev. 12/00) '1'1,1 3 gCgSZ- ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. .0 A CIVILENGINEERS (907) 694-2979 FAX(907)694-1211 July 7, 2003 IEALTHMAHOMrY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWERBWATER Anchorage, AK 99519 MAINDRENSIONS REFERENCE: Lot 11, Leo's Subdivision SEWERAWATER INSPECTION It is requested that you issue a permit to install a well and a septic tank to serve the existing three bedroom dwelling on the referenced property. ENGINEERINGSTUDIES A septic adequacy test was performed on 6-18-3. The septic system was found suitable for AM REPORTS 3 bedrooms. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve WELLNSPECHON areas or drainage patterns by the installation of the proposed septic system. The a FLOW TEST construction of this system will not prevent any future development on any of the adjacent properties. SITE PLANS If you require additional information, please contact us. Sincerely, ROAD DESIGN Robert C. Cowan, P.E. SOILTEST RCC/bjj Enclosure PERCOLATION TEST STRuCTURALa LIECHANICAL INSPECTIONS ONSITE , WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP SURE 204 • EAGLE RIVER, ALASKA 99577 1 " = 40' DESIGN SITE—PLAN _ V � 4 .ISS' >Om ALE kyr mS PO \.mA N m YOB 1 rVNp «% � o •"S y F m t • ►� L m C m f L D �� � aaavl r— m r xo A°t O mZ� z o (N° soda ��3M o�z x A o sn � 0 ;mN vN O �1 co o OA m m ll1 Zmr GOZN --0io > " CAD W !�/ AZ r OC 4 �" n c 2�� H A _ X00 i Z • NAO mpm r s N o DRIVEWAY Ams�� Z -4 I m o K m y _+ Ln c " Z O Om = w C •-1 r 0 z m o O r moyZ N Dm O Z > m D 0Cy z _. o ��! �" - O i (o X o A sno >yC c9r�oGs lV y N m Y o c z 0 tA a1 sni°tla 333M r' m ' inj y Y O r?� I l •-n 9• W 1-3 ^• 1 �II' �..' L �y'•y� ..�� ...•.. Z S& ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694.2979 FAX (907) 694-1211 HEJILTHAITHOPotr APPROVALS ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and SEWER&WATER MATERIAL SPECIFICATIONS MAIN EXTENSIONS REFERENCE: Lot 11, Leo's Subdivision July uly 7, 2003 NSPECTION GENERAL: ENGNEERING STUDIES 1. The scope of this project includes the installation of a new 1000 gallon ANDREPORTS minimum septic tank to serve the Nzar�sothree bedroom residence located on the referenced property. WELL*r.PECTXM 2. Construction shall be in accordance with the approved site plan and design &PLOW TEST drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. SITE PIANS 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be ROAD DESIGN responsible for final grading areas subsequently depressed from soil - settling. SOIL TEST 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. PERcourXxT TEST SEPTIC TANK INSTALLATION: STRUCTURAL& icc Wm x 1. A septic tank is to be constructed by a certified septic tank manufacturer. WSPE`"i0NS Construction shall include two 4" cleanouts for pumping access. CNSITE WASTEWATER DISPOSALSYSTEAI ! DESIGN 17034 NORTH EAGLE RIVER LOOP � SURE 2o4 - EAGLE RIVER. ALASKA 99577 Page 2 Lot 11, Leo's Subdivision July 7, 2003 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Page 3 Lot 11, Leo's Subdivision July 7, 2003 INSPECTIONS: Typically there will be a minimum of two (2) inspections required during the installation of the septic tank. These inspections will occur as follows: The first inspection must be conducted after the septic tank is set in place, but may not be backfilled until after this inspection. 2. The final inspection is to occur upon final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING AD DL~S LOCATION DISTANCE TO: Manufaoturel Inside length IF HOMEMADE: Well Dwelling PHONE [] NEW Dwelling ~)__ / IWidth ._ _ NO, OF BEDROOMS~ No, of co/npartments ~ Liquid depth PERMIT NO. DISTANCE TO: No. of lines / / Top of tile to fl,nls Length Width Type of crib Crib diameter Material Liquid capacity in gallons Foundation-~r'~ o, IUearest Ip~ine . PE~,T~N/~./¢ ~ C.~ ~ Total le~g~of ~nes I Trenc~th tt Distance betW~line~ ~ M~a~ beneafl~ tile - - .~ ~ I Total effective absorption area depth Totel effective ebsorption ar~e DISTANCE TO: Class DIS;TANCE TO: Well Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PiPE MATERIALS SOIL TEST RATJJ¢4~ ¢ /'7 I NSTA REMARKS '; F'> lie $ APPROVED DATE 72-013 (Rev, 3/78) .......................... DEF'ARTMEI',tT [)F HEAL.]'I-{ AND EENVIROI',IME]',I'T'AL. PF~C) IEC [.I. 01',1 825 L S'I"REI.ET, ANCHC)R(.tGE, Al'::: 9950 264-4'720 F'ISRM I T NC): DATE I SSLIED, APPI.. I C Alxl'¥: ADDRESS: CON"FAC'l" F:'I"JONE: LEGAL DIESCF~IP: I..OT SIZE:.. LOT LOCAT' I OIq: MAX BEDIRGEIME.~: tell IN1 ........ ~S-~ ][ 'T' lEE: ~ E!: I~,.dl IEE: I1:;;~ 840598 o7/Eh/84. C/El S &. S ENG'G. GIBSON SRB 196X EAGLE RIVER, 'AF.] 99577 694-~2979 SLIBDIVIE;ION: LEO'S SECTION: 3 TOWNSFIIF',', 15N 32000 (SQ.F'¥. OR ACRES) LOT SIZE: IS 3 LOTS TOGETHER 4 LILT: 9~ 10, I 1 ~:L,O[.,I':,.:. NA RANGE: 1W DEPTH TO PIPE BOTTOM (F:T.) GRAVEL DEPTH (FT.) TOTAL :OISF'TI'~ (F'T.) GRAVEl- WIDTH (FT.) GRAVEL LENGTH (FT,) GRAVEL VOLUME (CU.YDS.) 'I~ANI< SIZE (GALS) SI]IL RATIN[-~ (S[~.F'¥./BR) L. is'Led be.,].ow are tine ol~tions ava !..l ab l e ,to you in designing your '~ept:i.c: system. Choose 'Lhe eption tha'L'best {it~s your site,, / 4.. 0 ~ 4.0 4.0 / ~ :[ 2.0 0. ~, ...). ,J  16.0 4.5 , 7.5 2.5 ~:.S ,, ) 5 ,, 0 48.0 54.,, C) ' ~' " k55.5 56.0 9 :t. 8 ~, 250.0 -~' / 1 '"'=c~ C) ,~. 287 '~'~ GRAVEL. LENGTH > 75 FT. RE[~U]:RES MULTIPLE ~[,IN.~ (NOT EXCEE. D.[H~ 7[5 FT. EACH) '~'~ TANK MUST HAVE AT LEAST TWO COMF~AF~TMENTS I certify 'Lhat: 1. I am ~'amiliar with the requirements fop eh-site sewers and wells as~ set rot'Lb by the Municipality o[ Anchorage (MOA) and the State o~ Alaska,, 2. I will install the system in accordance with all MDA codes and regu:l, at. ionss~ and in compliance with the design c~itepia o~ this per'mit. 3. I wi].], adhere to all MOA and State of Alasl<a requirernent, s~ for the set back ', dist, ar~ces from any existing well, wastewater d:i. sl:)Osal sys'Lem or pul:)],ic sewerage system on this er any adjacerrL or nearby lot. 4. I underst, and tha'L this per, mit is valid [or' a maximum o~ 4. bedreoms and any enlargement will requ:Lre an additienal permil,. IF A I.,.IF'¥ STATION IS IIISTALLED IN AN AREA COVERED BY MDA BUILDING CODES, ]"HEN (1) AN ELEC]'F~I_ PERMIT AbD I~S~EC, TIDN MUST BE OBTAINED, (2) AS-BUILTD WILL NOT BE APPR~gED/WITHOUT AN ELECTRICAL INSF'ECTIGN REF'ORT;'AND (3) TIdE ELECTI~ICAL WE]Iq~MUEi~CINE BY A LICENSED ELE:C'¥1RICIAN, '1 / , ..............................., ................ ........ AI='PI_~CANT. ~/O~S & S ENG G. G~SON MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: LFGAL DESCRIPTION: SLOPE SITE PLAN oo 10 11 12 13 14 15 16 17 18 19 2£ COMMENTS PERFORMED BY: 72-008 (6/79) W^S GROUND WATER ,4}~ t ENCOUNTERED? O P E AT WHAT ,"PTH? Gross Net Depth to Net Reading Date Time Time Water Drop / PERCOLATION RATE ,~0 (minutes/inch} / // TEST RUN BETWEEN g'~ FT AND ~ FT DATE: Parcel I.D. 051-053-33 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 , Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Leo S, Lot 11 Location (site address) 24225 Leo's Rd. Expiration Date: Current Property owner(s) John & Adrian BlaStick Day phone Mailing address 24225 Leo's Rd. Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: EEs M l `` 0 Single Family (w/wo ADU) S` U1 A L ❑ Duplex JUN Q 9 2014 ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual Fx I Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System n I Publ,c Sewer n u WaiverNariance request for: wsH to oe released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5z -co Waiver Fee $ _ Date of Payment --�, I '� I I q r Date of Payment Receipt Number 032(1 G ` Receipt Number. COSA# OSCiy 1a�-1 Waiver# 6. 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. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone Date 2/28/2014 6. DSD SIGNATURE _Lf�_ System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: /.''%/ u/� � Original Certificate Date: The u Ip ity of horage 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheets'- 1, E If more than 1 septic system is on the lot: COSA Checklist # _Lof + Structure served by this system + Certificate of On -Site Systems Approval Checklist Legal Description: Leds, Lot 11 A. WELL DATA Well type Private If A. B, or C provide PWSID # Date completed 8/25/2003 Sanitary seal (Y/N) Y Total depth 217 ft. Cased to 217 ft. FROM WELL LOG Date of test 8/25/2003 Static water level 152 Well production 15 ft. Parcel ID: 051-053-33 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 2/27/2014 144 ft. 9.p -m. 2.4+ g.p.m. WATER SAMPLE RESULTS: Coliform �olonies/100 mL Nitrate mg/L Arsenic /(1 ug/L Date of sample: �G i B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/HDPE Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 12/3/2013 Pumper JR's Pumping C. ABSORPTION FIELD DATA Collected by: ILL Date installed 7/29/2003 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 7/21/1984 Soil ratio z z 287 SF/BR Deep Trench g (g.p.d./ft orft /bdrm) System type Length 48 ft. Width 2.5 ft. Gravel below pipe 12 ft. Total depth 17 ft. Eff. absorption area 1 152 ft Monitoring tube Y Depression over field N Date of adequacy test 2/27/2014 Results (Pass/Fail) PASS For3bedrooms Fluid depth in absorption field before test 0 in. Water added 604 gal. New depth 0 in. Elapsed Time: 260 min. Final fluid depth 0 in. Absorption rate 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. 'Pump off' level at _ Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS ,FIs -R, -;k o 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. Engineer's Printed Name Steven R. Pannone Date 3/2/2014 COSA brown sheet 10-10-12.doe Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ r1l Municipality of Anchorage • Development Services Department'#A9 Building Safety DivisionOn-Site Water and Wastewater Program 4700 South Bragaw St 900 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL y FOR A SINGLE FAMILY DWELLING Parcell.D. 051-053-33 1. GENERAL INFORMATION HAA# 03o(D5Z Expiration Date: 3/11 r 41 Complete legal description Lot 11; Leos Subdivision Location (site address or directions) 24225 Leo's Road Current Property owner(s) Linda Frank Day phone 240-8585 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. --7WL^ 4," I .;k./►' f'o 3 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 4. 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 Health Authority Approval Guidelines for this application, shows that the on- site water suppT�',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, oT 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, ,arid.fegulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River Engineer's Printed Name _Robert C. Cowan Date AK 99577 lJLJI S/a3 OF Y. 3. DSD SIGNATURE ItOB RT c. COWANApprove� 4; 0 if ••e � w for Bedrooms. +;l=ii � Disapproved. F�i�z�'Ty Conditional approval.for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements . Supplemental Engineer's Report Other By: Original Certificate Date: ?/.1 (Pw ovoz) -� Municipality of Anchorage 4„ Development Services Department' Building Safety Division iOL-4. + On -Site Water & Wastewater Program ' •' •' 4700 South Bragaw St. , P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: G eo 5i Parcel ID: D j'/ — oS7 3 —33 A. WELL DATA Well typeIf A, B, or C provide PWSID # _ Well Lo o J) % 712- Date completed 6ZS/0 3 Sanitary seal(J N) Wires properly protected (Y/ ) Total depth Z145_ft.' / Cased to ( 7 ft. Casing height (above ground) 2 in. FROM WELL LOG \T INSPECTIOW Date of test Z 3 Static water level ft. `w ft. Well production �� g.p.m. g.p.m. WATER SAMPLE RESULTS: / 6f T Coliform colonies/100 ml. Nitrate �+ 1 mrl./L Other bacteiia colonies/100 ml. Arsenic: mg./l. Date of sample: /Z -lb_ 3 Collected by: 't S . ��'l-t B.. SEPTIC/HOLDING TANK DAT i2—I t� c�3 2> Tank Type/Material Q1 l �✓1 Date installed 03 Tank size 000 gal Number of Compartments Cleanout Foundation cleanou (Y 1) Depression over tank (ye A High water alarm (YIN) '4 Date of pumping Pumper eft/ // C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftp r ft2Podrm 2v / System typeIt'i4 i Length ft. Width Z. c`J ft. Gravel below pipe ft. Total depth AL ft. Eff. absorption areatZ Monitoring tube Pl Depression overtfield /% v Date of adequacy test l I D 3 Results Pass Fail) �e For; bedrooms ZOOO Fluid depth in absorption field before test J in. Water added_ gal. New depthq/47in. Elapsed Time: 56 Final fluid depth Q in. Absorption rate >f/ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y If type) If yes, give date, -- D. LIFT STATION ~ •� Date installed Size n g Ions Manhole/Access (Y/N) "Pump on" level at "P ff" le el a in. High water alarm le el at-- f Cycles test d �ts rm & circuit requirements? _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO. Septic tank/lift station on lot l� 2 Absorption field on lot _ _ /1 1�1C? Public sewer main /" A 'Sewer /septic service line r On adjacent lots On adjacent lots /00 �4 Public sewer manhole/cleanout _ Ar ,q Holding tank _ /14 SEPARATION DISTANCES FROM SEPTIC/11'iG TANK ON LOT TO: I i I Building foundation Property line Absorption field Water main /U Water service line Surface water /f% D AJ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line At A Surface water Driveway, parking/vehicle storage Curtain drain W.01t/Cf Wells on adjacent lots /DD F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect onthisdate. Engineer's Printed Name �� ���' C. 1 Z / IV/03 Date n 4 POURT C. 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