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HomeMy WebLinkAboutKLEMETSEN LT 2Klernetsen Lot 2 #015-521-15 Development Services Department Building Safety Division On -Site Water & Wastewater Program ' a 4700 Elmore Road FL P.O. Box 196650 a Mark Begich Anchorage, AK 99507 s a e r r Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: ©15- 521 - 15 Legal Description Property Owner Name & Address: CZY 10MIe }{erne �5e+1 Z ass ase .Ate— �/c Pump Installation Date: $/,5( /t Pump Intake Depth Below Top of Well Casing: feet Pump Manufacturer's Name: Aect Pump Model: 6NIZ S/ef Pump Size / hp Pitless Adapter Burial Depth: ( 7i- feet Pitless Adapter Manufacturer's Name: 9A. ksx_--5 . Pitless Adapter Installer: Well Disinfected Upon Completion? es ❑ No Method of Disinfection: Comments: Pump Installer Name: t ANCHORAGE WELL & PUMP SERV. 330 EAST 76 TH AVENUE .MW ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pu np installation log to the DSD within 30 days of pump installation. Inspection Report_1-1-12.doc - Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151201 PID Number: 015-52T-1$ ❑ New ❑✓ Upgrade Name: Robert & Pamela Renkert ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench []Bed ❑ Mound Address 10951 Totem Rd. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 13 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5 Ft. Gravel depth beneath pipe 8Ft. Subdivision Block Lot Klemetsen 2 Fill added above original grade 0 Ft. Gravel length 25 Ft. Township Range Section Gravel width 2.5Ft. Beds: Number of Lines NIA Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 830 Fez 2 16.1 Ft. well 150.9 157.8 N/A N/A N/A TANK ❑p Septic ❑ S.T.E.P, ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,250Gal. Surface water 100+ 100+ N/A N/A Material Steel Number of compartments 2 Lot Line 42.8 20.1 NIA NIA NA Foundation 18.5 41.0 N/A NIA LIFT STATION Manufacturer Capacity Gal. Curtain Drain N/A N/A N/A N/A - - Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer A+ Home Services Drainfleld 3034 CO/MT 3034. Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection1s 7/28/2015 m 2 7/29/2015 Location and description dates: Bottom of Trim Southwest corner. 30 7/29/2015 4'" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ,t.• qg 7H evennoRe CE $149— Approved y (}� Dated f /5 '(�•,_ Tt t►14_ h\ Inspection Report_1-1-12.doc - SPECIAL PROVISIONS TO SPECIFICATIONS 1-. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPEOFWORK: INSTALLED NEW 12509 SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 19.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. NO APPARENT WATER TABLE WAS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19.0 FEET BELOW EXISTING GRADE. - i WELL (E) TZ. RESERVE DRAIN FIELD (P) - �/ 1OLE x 2.5'W x 9.0'ED x 13.0'TD (BASED ON CAT III) / i �41 *1250g SEPTIC TANK WAS REMOVED 50.9 2 Q B - FC 4BR UPGRADED DRAIN FIELD NEW :' C4 (2EA) 25LF x 2.5'W x 8.0'ED x 13.01DM4�� !y TH-1 HOUSE ' WITH MONITOR TUBE AND CLEAN OUT AT C2 V (E) :L EACH D. EXISTING CRIBS REMOVED. I I -1x12, A �A M M �� \�\ 20.1 C4 �n- MDC T2T WW� WELL (E) 16.1 `C1 /DRIVEWAY- / LINSTALLED 1250g SEPTIC TANK NEW T WITH DOUBLE CLEAN OUT AND - —FLOW SPLITTER _ WELL (E) DESIGN PARAMETERS DESIGN PARAMETERS RESERVE SEPTIC SYSTEM PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) NO. BEDROOM: 4 1"600 gpd) TANK SIZE: 1500g ADVANTEX - TANK SIZE: 1250g - W/ AX20 POD - PERC RATE: 8.7 MPI PERC RATE: 8.7 MPI - SOIL RATING: 0.8 GPD/SF SOIL RATING: 4 GPD/SF �� ABBREVIATIONS AREA ROD: 750 SF AREA ROD: 150 SF / - TH TEST HOLE .SYS. TYPE: DEEP TRENCH 8.0'ED SYS. TYPE: DEEP TRENCH 9.0'ED . (P) PROPOSED MIN LENGTH: 47 LF MIN LENGTH: 8.3 LF (E) EXISTING USED: - USE: - \ - CO CLEAN OUT NO. (2EA) 25 LFx2. 5'Wx8.0' E.D., 13.0' TD 10 LFx2.5'Wx9.O' E.D., 13.0' TD MT MONITOR TUBE NO. TOTAL AREA: 830 SF TOTAL AREA: 180 SF - TYP TYPICAL NOTES: PANNONE ENG SVC, LLC Date P.O. BOX 100217 ANCHORAGE, AK 99510 RECORD DRAWING ' . . G:q li+ 8/13/2015 r�P�•'s¢ + Scale PHONE (907) 272-8218 FAX (907) 272-8211 DRAWN BY: *; 49 NJC - ....... .. .. P.1, . NO- KLEMETSEN, LOT 2 .. 015-521-15 ROBERT & PAMELA RENKERT S'te'ven . an'none PERMIT NO. 10951 TOTEM ROAD �I+P's CE 8149 OSP151201 PLAN ANCHORAGE, AK 99516osso�a� Sheet 2 OF 3 1,250g NEW I -- SEPTIC TANK FLOW NOTES: RECORD DRAWING DRAWN BY: NJC DESIGN DETAILS PAMONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KLEMETSEN, LOT 2 ROBERT & PAMELA RENKERT 10951 TOTEM ROAD ANCHORAGE, AK 99516 TH-1 R 90.0 900 SM/ SW 82.0 820 76.0 OFaScale �zo15 NTS ...... ... ..... II P.I.D. NO 015-521-15 Steven R. Pannone / PERMIT N0. +PFc,P CE 8149 OSP151201 +<<�F�PROFESSIONP�'� Sheet 3OF3 5 m m 0 z zwa z > r FILTER FABRIC > 4" m DRAIN PIPE z U Ea) 0G u oo ww DRAIN ROCK 6' ABDVE PIPE INV II pp II / EAST 95EG/FG WEST 950 n5 nV n 11 1,250g NEW I -- SEPTIC TANK FLOW NOTES: RECORD DRAWING DRAWN BY: NJC DESIGN DETAILS PAMONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KLEMETSEN, LOT 2 ROBERT & PAMELA RENKERT 10951 TOTEM ROAD ANCHORAGE, AK 99516 TH-1 R 90.0 900 SM/ SW 82.0 820 76.0 OFaScale �zo15 NTS ...... ... ..... II P.I.D. NO 015-521-15 Steven R. Pannone / PERMIT N0. +PFc,P CE 8149 OSP151201 +<<�F�PROFESSIONP�'� Sheet 3OF3 SOILS LOG - PERCOLATION TEST TEST HOLE 1 SLOPE �> ' E PLAN y� OR ORGANICS i 1 � Q O \ 4 o - TH-1 6 X TH SM! SAND AND SILTY • 9 SW SAND I Z. W 10 11 12 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? N - 15 IF YES, AT WHAT TH DEPTH? -DRY - X 16 17 DEPTH TO WATER AFTER MONITORING? -DRY 18 DATE: 6123/15 19 READING GATE CLOCK BOH TIME WATER NET TIME LEVEL NET DROP READING DATE PERFORMED: 6!16M5 1 6116!15 12:00 --- 5.58 --- z 12:10 10 MIN 7.23 1.65 a 12:10 --- 5.58 -- a 12:20 10 MIN 6.75 1.17 5 12:20 --- 5.58 ___ 6 12:30 10 MIN 6.73 1.15 PEROLATION RATE 8.7 (mintinch) PERC HOLE DIAMETER 6 inches - TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported _ PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ENG SVC; LLC - of q �h Cgsl�1 Date 7 n/zols FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211*�P JqE."' TH �y*�) "-" / Scale - NTS KLEMETSEN, LOT 2: - P.I.D. NO ms-szl-u ROBERT & PAMELA RENKERT 10951 TOTEM ROAD S'te'ven R. Pannone P CE 8149 .. ��� � ++Il��\FE... PERMIT NO. OSPI51201 SheetOF SOILS LOG ANCHORAGE, AK 99516 _ O 2 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151201 Tax Code Number: 01552115000 Work Type: Septic Upgrade Permit Effective Dates: July 22, 2015 to July 21, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: KLEMETSEN Site Legal Address: KLEMETSEN LT 2 G:2637 Owner/Address: RENKERT ROBERT A & PAMELA M 4620 MARS DRIVE ANCHORAGE AK 995073723 Site Mailing Address: 10951 TOTEM RD, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 50922 Total Bedrooms: 4 N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Remove parts of existing cribs that are within 16' of proposed trench. See design. Received Issued By: Date: /S Date: 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. 015-521-15 Property owner(s) Robert & Pamela Benkert Mailing address 4620 Mars Drive, Anchorage, AK 99507 Site address 10951 Totem Road Legal description (Sub'd., Block & Lot) Klemetsen, Lot 2 Day phone Legal description (Township, Range & Section) Lot Size 50,933 So. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: IS all that apply) Absorption Field ❑x Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further cdTtifythat this is in accordance with applicable Municipal Codes. Permit/Rush Fees: 6\,,0( Date of Payment: (Q l3oliS c%b,_ Receipt Number: OA9 tm Permit No. myll5 P -O, Permit App_ :-;L�c. Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve2@oaneneak.com July 17, 2015 Subject: Klemetsen, Lot 2 Septic System Permit Request Design Narrative This is a design narrative for a permit to install a septic system to be issued for this property. The proposed systems will serve an existing three (3) bedroom trailer, and in the future, a proposed four (4) bedroom house. Currently the lot is developed. The owner has requested we install a system to accommodate 4 bedrooms in the future. This lot is served by a Class 'C' wellbcated on Lot 1, to the north. The surrounding developed lots are served by private wells. There are no wells within 100' of the proposed septic system, and the Class'C' well is located over 150' from the proposed system. 1. Soils. One test holes were performed in the vicinity of this system by Pannone Engineering Services in June of 2015, and groundwater was monitored for at least seven days. Grcwnd water was not observed to a depth of 19.0' below the surface in the test hole monitor tube in June of 2015. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 gallons/day/square feet was used for a conventional wastewater system in the area of these test holes. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from the east to the west at approximately 6%-7% in the area of the septic system. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of th is or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: INSTALL NEW 1250g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 19.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. - - / DECOMMISSION EXISTING SEPTIC SYSTEM PER CODE[] / REMOVE ANY PART OF SYSTEM FOUND WITHIN 16. OF PROPOSED DRAIN FIELD AND REPLACE WITH \ NAriVe��1� 2 Q �\ 4, a o TH-1 -/ UPGRADE DRAIN FIELD (P) (2EA) 25LF x 2.5'W x 8.0'ED x 13.0'TD �y WITH MONITOR TUBE AND CLEAN OUT AT a EACH END w /M—M1 M / 1 31 9 1X WELL (E) J / PRIMARY SEPTIC SYSTEM N0, BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE: 8.7 MPI SOIL RATING: 0.8 GPD/SF AREA ROD: 750 SF ,SYS. TYPE: DEEP TRENCH 8.0'ED MIN LENGTH: 47 LF USE: (2EA) 25 LFx2.5'Wx8.0' E.D .TOTAL AREA: 800 SF NOTES: FOR CONSTRUCTION PLAN WELL (E) i / INSTALL /150.0FOUNDATION CLEAN OUT 2 / 48R / w HOUSE / (E) M M RESERVE DRAIN FIELD (P) 2X i DRIVEWAY Cr IOLF x 2.5'W x 9.0'ED x 13.0'TD - (BASED ON CAT III) • - / *1250g SEPTIC TANK WILL BE REMOVED INSTALL 1250g SEPTIC TANK (P) / \ WITH DOUBLE CLEAN OUT AND 1 0) FLOW SPLITTER DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 4(600 gpd) TANK SIZE: 15OOg ADVANTEX W/ AX20 POD PERC RATE: 8.7 MPI SOIL RATING: 4 GPD/SF AREA ROD: 150 SF SYS. TYPE: DEEP TRENCH 9.0'ED/ MIN LENGTH: 8.3 LF USE: 13.0' TD,/10 LFx2.5'Wx9.O' E.D., 13.0' TD TOTAL AREA: 180 SF PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KLEMETSEN, LOT 2 ROBERT & PAMELA RENKERT 10951 TOTEM ROAD ANCHORAGE, AK 99516 WELL (E) Scale - r.�p.'• '•'� I C ^ ••Steven •12� Pannone• j 15-521-15 ABBREVIATIONS / TH TEST HOLE (P) PROPOSED (E) ,EXISTING \ CO MT CLEAN OUT NO. MONITOR TUBE NO. kY TYP TYPICAL PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KLEMETSEN, LOT 2 ROBERT & PAMELA RENKERT 10951 TOTEM ROAD ANCHORAGE, AK 99516 7/17/2015 Scale - r.�p.'• '•'� I * *��/� P.I.D.NO ••Steven •12� Pannone• j 15-521-15 PERMIT N0 . OSP151201 , E 49 .'�% PF6� �s�•.Z? 1�1i`�PROFES9QAl' Sheet eOF 2 TEST HOLEE11 OR ORGANICS 2 3 4 5 6 7 8 SM/ SAND AND SILTY 9 SW SAND 10 11 12 13 14 15 16 17 18 19 BOH DATE PERFORMED: 6/16/15 SOILS LOG - PERCOLATION TEST SLOPE X TH VYMJ VRV VIVV VV III GR ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER MONITORING? -DRY DATE: 6/23/15 COMMENTS: Test hole excavated by A+ Test run for at least one hour. Last 3 ri PERFORMED BY: Steven R. Pannone, F F,WE PLAN % X I r / i w i W— i SLOPE TH X READING DATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 6/16/15 12:00 --- 5.58 --- 2 12:10 10 MIN 7.23 1.65 3 12:10 --- 5.58 -- 4 12:20 10 MIN 6.75 1.17 5 12:20 --- 5.58 --- 6 12:30 1 10 MIN 1 6.73 1.15 PEROLATION RATE 6.7 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND 5 FT NOTES:, ENG SVC; LIC -' OF A� �1t 7/172015 FOR CONSTRUCTIONP.O. BOX. 102954 ANCHORAGE, AK 99510 � '. - '4S la) PHONE (907) 272-8218 FAX (907) 272-8211 ig�P �y++ Scale- PHONE j� Ttl� NTS Qr� P.LD. NO KLEMETSEN, LOT 2?�--✓ 015-521-15 ROBERT & PAMELA RENKERT St e've'n R. Pannone PERMIT NO. PF. CE 8149 .'�� OSP151201 10951 TOTEM ROAD �?_r SOILS LOG ANCHORAGE, AK 99516 `II��F�PNOFES510�P�� Sheet 2 OF 2 NAME SEPTIC TANK: GWTER ANCHORAGE AREA BOR011H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM IEArr )te-,C i 4r5ig�IV ADDRESS— MAILING DDRESS 159: 2.7 ,fit , ! ;. 4�910" ._LEGAL DESCRIPTION 51f e-07- -�+ NUMBER OF � G - % - DISTANCE FROM WELL MATERIAL COMPARTMENTS ` LIQUID CAPACITY �o GALLONS. INSIDE LENGTH _INSIDE WIDTH DEPTHD � SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS_ ;z OUTSIDE DIAMETER—OR WIDTH LENGTH —S, DEPTH LINING MATERIAL ..DISTANCE FROM WELL �/ /45�6 , BUILDING FOUNDATION , NEARESTLOTLINE . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 100—SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL _ , FOUNDATION. , NEAREST LOT LINE - NUMBER OF LINES DISTANCE BETWEEN LINES. _ TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. - LENGTH OF EACH LINE _ DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE. IN. ABOVE TILE WELL: Y DISTANCE FROM - -. WATER TYPE DEPTH BUILDING FOUNDATION. SAMPLE NEAREST NEAREST SEPTIC SEEPAGE OTHER LOT LINE , SEWER LINE , TANK , SYSTEM—, CESSPOOL - , SOURCES— OURCES_DIAGRAM-OF DIAGRAM OFSYSTEM DISTANCES: DATE [ APPROVED ob - 4 HEALTH AUTHORITY G,AB-11D°2� ` GREATEI*ANCHORAGE AREA ROUGH Case No.l HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM — APPLICATION & PERMIT [� /%/J c^ 17/7]r NAME OF APPLICAr��i1�AX&40=' A MAILING ADDRES9vPHONE N035�5"V�� RESIDENCE ADDRESS LEGAL DESCRIPTIO APPLICATION TO INSTALL: SEPTIC TANK V SEEPAGE PIT , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY -3 0-42� rn2 FINANCED THROUGH TO BE INSTALLED BY'—CDS PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETIONS �+ d LOCATION OF INSTALLATIO � N /� 3 W BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS /nQ �'' �"� PERMIT TO INSTALL A " E SYS7� AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED . SEPTIC TANK SIZE 1026TYPE CM . SEEPAGE, OF SYSTEM S7O1L, DISTANCES: iv EL L 'u Ywt-�l ell Health Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATURE`"' UBMITTAL AUG 47 2015 �Lr Municipality of Ancho stuuer � a Y� r On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-521-15 Expiration Date: J 1. GENERAL INFORMATION Complete legal description Klemetsen, Lot 2 Location (site address) 10951 Totem Rd. Current Property owner(s) Robert & Pamela Renkert Day phone Mailing address 4620 Mars Dr. Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fx_1 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: Individual Well ❑ Individual Fx] Individual Water Storage ❑ Holding Tank ❑ Community Class V Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: COSA to be released to the unless otherwise requested by the engineer. COSA Fee $ d (A.?® Date of Payment ?111 115 Receipt Number ala -R36 COSA# (315CI51 gItG Date: 9 11 V I Z6 (S Waiver Fee $ Date of Payment 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 sail condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907).272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE _A_�_ System #1 Approved for A bedrooms System #2 Approved for bedrooms Disapproved Date 8/5/2015 • • ; ��everi �. � f�aririsjl CE -8149 Conditional approval for bedrooms, with the following stipulations: o- I LL -r h By: vv" a r Original Certificate Cate: i 3 1 1 The nicip§ lty rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist LegarDescription: Klemetsen, Lot 2 A. WELL DATA Well type Class 'C' If A, B, or C provide PWSID # Date completed Sanitary sear (Y/N)— Total depth ft. Date of test Static water level Well production - Cased to ft. FROM WELL LOG ft. g.p.m. WATER SAMPLE RESULTS: Coliformp colonies/1t10mL Nitrate —kLmg/L Arsenic�, : ` ug/L Date of sample, 711.56flzcls B. SEPTIC/HOLDING TANK DATA Tank Type/Material $eptIC/Steel Tank size 1,250 gal. Number of Compartments Foundation cleanout (YIN) Y Depression over tank (Y/N) N Date of pumping New Pumper N/A Parcel ID: 015-521-15 Well Log (YIN) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION fG. g.p.m. Collected by: ! L� g Date installed 7%28/2015 Cleanouts (Y/N) Y High water alarm (YIN) N C. ABSORPTION FIELD DATA Date installed 7/2g/2015 z z 0.8 GPD/SF Deep Trench . Soil rating, (g.p.d./ft or ft /bdrm) System type Length 50 ft. - Width 2.5 ft. Gravel below pipe 88 ft. Total depth 13 ft. I Eff. absorption area 830 fe Monitoring tube:� Depression ever field- N Date.vf adequacy test" `ew Results (Pass/Fail) Pigs& For 4 bedrooms Fluid depth -In absorption field before test New in. Water added New gal. Naw,depth New in. Elapsed Time. New min. Final fluid depth New in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on -lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 1B+ Water service line 10+ Surface water 100+ 150+ Wells on adjacent lots ABSORPTION FIELD ON LOT TO:. Property line 10+ Building foundation 10+ Water main 10+ 10+ 100+ 10+ Water Service line Surface water Driveway, parking/vehicle storage Curtain drain 50+ Wells on adjacent lots 150+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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 8/5/2015 COSA canary sheet -2-6-1 5.doc u Municipality of Anchorage , Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 151416 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2 of Klemetsen Subdivision. This inspection revealed an arsenic concentration of 11.9 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. LOT 1 Community Well for Lot 1 & Lot 2in a Wood Well House NbS b Pb' Found 5/8" Rebar -cp� —Wood Service Post for Electric Meter on V) K) TRACT A c6 1—Level Wood Pq P C'4 0 33, 4 Frame Residence 0 (See Detail Below) V) is 8 Frame ve D I R Detail W Residence Wood dd e E3nce Below) 0 LOT 2 " we 9:�'� Clean Out (Typ.)---- 0I -*--1 14.8' Mobile Home With o Wood Roof Cover P (See Detail Below) y 0 1 -?'vel DrivewayE- 0 0 0 U� zf_ E ­i b 0 z CID 296.66' N89 -59'04 W �Found 5/8" Rebar LOT 29 LOT 30 Wood Deck & & Steps 16._11 0.4 V: 10.0 0.4' 16. 1, Zo Covered Wood SCALE: 1 "=40' ?, 0 0, Deck 10 01 20' 40' 80, 1 Wood ood S 4 �z teps Brick Pad DETAIL: Scale: 1 "=20' NOTE: PREPARED FOR: Dimensions are measured to the wood trim. PANNONE ENGINEERING 1 hereby certify that an accurate survey of the following described property: LOTM2 FAq1PKLEMETSEN SUBDIVISION (79-201) AS-13UI .. LT . H % :;9. was made on August 4, 2015 and that the improvements DWN. DATE GRID-- ... .. ........ ... .... ... situated thereon are within the property lines and do not overlap or JSP 8/5/2015 SW 2637 encroach on the property lying adjacent thereto, that no .... ......... ... W. Lee Kmrabetnlk improvements on the property lying adjacent thereto encroach on FILE NO. F.B. 2015 JOB NO. the premises in question and that there are no roadways, 1541 PG. 32 1577 No. 3143-S transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the maw record plot may not appear on this drawing. KARABELNIKOFF Anchorage Alaska, this 5th day of-... August .2015. SURVEYING (sol) -v37-34s4 X L . d N to LU M V)