HomeMy WebLinkAboutREED LT 3Block
Lot 3
#051 -102 -SO
Municipality of Anchorage
Community Development Department Page 1 of 2
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: OSP161017 PID Number: 051-102-10 ❑ New ❑✓_Upgrade
Name: -
-
_
Kenneth Orr
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
23114 Homestead Rd. Chugiak, AK 99567
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3 -
GPD/SF
Ft.
- LEGAL DESCRIPTION -
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Reed - 3
Fill added above original grade
_ Ft.
Gravel length
- Ft.
Township Range Section
Gravel Moth-
Ft:
Beds: Number of Lines
Distawe between lines
Ft.
SEPARATION DISTANCES
_ To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft'
_ Ft.
Well
N/A
N/A
- N/A
N/A
N/A'
TANK I] Septic ❑ S.T.E.P. ❑ Holding ❑ Other -
Manufacturer
Ancorage Tank
Capacity
1,000Ga1.
Surface Water
100+
N/A
N/A
N/A
Material
Number of compartments
Lot Line
29.9
N/A
N/A
N/ASteel
2
NA
Foundation
17.6
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity -
Curtain Drain
50+
N/A
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank Tank to
3034 drainfield 3034
Moosehorn Construction
Drainfield 3034 co/MT 3034
Inspector Pannone Engineering Services LLC.
BENCH MARK (Assumed elevation) 100ft
Inspection ectio1" 2/5/2016
Location and description
2m
3 I 4th
Finished Floor
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineers Stamp
Conditional Approval: Date
^. tit
Me'ven R. 'Pannom
77::::7'
CE 8149
i
it
ApprovedDate 2'2ZA
"+►
inspection Report_1-1-12.doc
SPECIAL PROVISIONS TO SPECIFICATIONS
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. SCOPE OF WORK: INSTALLED NEW 1,000g SEPTIC TANK AND DECOMMISSIONED EXISTING TANK PER CODE.
- O� I o
as Wa o z Wo
Z Ug
6:5 Z
O J
Z¢ m6 a p= a 1Z.
W W 3
_ -
pJ O� U NZ V OJ
IiU OU OU
.LOTS SERVED BY PUBLIC WATER FROM NORTH
L95.0
AL
WATER MAIN
93.4 1,000g SEPTIC 932
W W� W W W W W�
TANK NEW
-_ HOMESTEAD ROAD 3
4_ DRIVEWAY
LOT 3
1 2
3BR
"�E�E_J_j]
5 4
_
DECOMMISSIONED TANK E PER CODE A DECK e
INSTALLED NEW 1000g SEPTIC TANK
WITH DOUBLE CLEAN OUT T2 Dco1 T1
29.. - 5.4
oDCO2
SEPTIC AREA (E)
c �MT EDGE OF DRAIN FIELD E
I001
SEPTIC AREA (E) MT DRAIN FIELD
E
CO2
A B
DC01 19.0 34.0
SEPTIC AREA (E)5;�"�7
C SEPTIC AREA (E) T1 23.3 33.0
T2 28.5 37.5
12
DCO2 29.9 39.0
13 458
CO2 54.4 60.4
DESIGN PARAMETERS
ABBREVIATIONS
INSTALLED NEW TANK LEGEND
FC FOUNDATION CLEAN OUT
N0. BEDROOM: 3
T# TANK CLEAN OUT NO.
TANK SIZE: 1,0009 W WATER LINE/
C# CLEAN OUT NO.
WELL RADIUS
_
DCO DOUBLE CLEAN OUT
USEED: -
OG ORIGINAL GRADE
NEW 1,000g SEPTIC TANK SS — NEW SEPTIC
E EXISTING - -
NOTES:
T
PANNONE ENG SVC, LLCOF
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
AG \`l
"'•"'qS�t
r'�P' ` '•�
....... .. .. ...
DDate
/19/2016
RECORD DRAWING
Scale
1"=50'
NO
REED, LOT 3'
KENNETH ORR
23114 HOMESTEAD ROAD
CHUGIAK, AK 99567
R. ,•,,,
'Steven R. Pannone
CE 8149, ..��
1�1FROFESSON
i'\�
051-102-10
PERMIT NO.
OSP161017
DRAWN BY: NJC
PLAN
sheet
CS%
2 OF 2
HOMESTEAD ROAD
co M
M co
N89°59'00"W 83.64
k40.0
l driveway I
ll
V). ,,;L6I LO
t m 21.17.0oe o oLOt 2
Lot 4 o(6 0t o
ZZ
Lot 3 o
o Chain link fence
aCL
o0
og �
Tenf
,U
e
Lot 11 N89059'00"W 83.64
Lot 1.2
OF
00
0* • 49th ��.•�'.*`%'
0U..00
00 V. Fred Walatka: ff /
�,`s�� • 3255 - S • Sri '�
9F4 • ....'alp �
SCALE: 1 "= 30' (� ``s"``��
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. Fb 15-15, pg 25
0
8431L
Lot 13
RECERTIFIED 2.15 -16 W -
AS -BUILT
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: LOT 3.
REED SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property yang
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 18th day of JANUARY ,2016.
FRED WALATKA & ASSOCIATES
(907-248-1666) Engineers and Surveyors
On -Site Water and/or Wastewater 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:
OSP161017
Tax Code Number:
06110210000
Work Type:
SepticTank Upgrade
Permit Effective Dates: January 29, 2016 to January28, 2017
Design Engineer:
PANNONE ENGINEERING SERVICE
Subdivision:
REED
Site Legal Address:
REED LT 3 G:1359
Owner/Address:
ORR KENNETH L
PO BOX 671033 CHUGIAK AK 995671033
Site Mailing Address:
23114 HOMESTEAD RD, Chugiak Lot Size in Sq Ft:
Total Bedrooms:
This permit is for the construction of:
a
ipartment
n
�
e
N Disposal Field Y Septic Tank N Holding Tank N Privy 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 subsurf
11166
ace 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.
Received Bi
Issued By:
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ANCHORAGE
Phone:
ON-SITE SEWER/WELL PERMIT APPLICATION
RUSH
Parcel I.D. 051-102-10
JAN 2 9 2016
-- —
Property ownerKenneth Orr s) Day phone -
Mailing address P.O. Box 671033, Chugiak, AK 99567
Site address 23114 Homestead Road
Legal description (Sub'd., Block & Lot) Reed, Lot 3
Legal description (Township, Range & Section)
Lot Size 11,166 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
F-1
InitialF-1
Single Family (SF)
19
(w/wo ADU)
Septic Tank
❑x
Upgrade R
Duplex (fl)
❑
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 certify that this is in accordance with
applicable Municipal Codes.
Lim
(Signature of property owner or
Permit/Rush Fees: al�Ji� = 3`i`f Waiver Fees`
Date of Payment: r1 t! (o -T Date of Payment:
Receipt Number: 6-7 3l2 G Receipt Number.
Permit No. 05 \0 1to Ibl-1 Waiver No.
Permit App_.;-:. ;:...:c
Pannone Engineering Services Lac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@i)aneneak.com
January 29, 2016
Subject: Reed, Lot 3
Septic Tank Replace Permit Request
Design Narrative RUSH
This is a design narrative for a permit to install an upgrade 10008 septic tank to be issued for this
property. The existing 1000g tank is collapsing. It will be decommissioned per code. Currently the lot is
developed. The proposed system will utilize a replacement 1000 septic tank that will be connected to the
existing drain field. This lot and the surrounding lots are served by private public water. There are no
wells within 200 feet of this system.
1. Upgrade Tank Design.
- a. See Sheet 1 of the design package.
2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed
septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: The existing topography slopes from north to south at approximately 5% in the
vicinity of the system.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no surrounding wells within 100 feet of the proposed septic location.
I
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
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. SCOPE OF WORK: INSTALL NEW 1,000g SEPTIC TANK AND DECOMMISSION EXISTING TANK PER CODE.
-A)oTc . Ala 616-4/ OP HAl ; OL -0 Wcli-s Re.'141^1 1.✓ rme ARBA.
U
WATER MAIN
w -I W W w W w� wT W w W W W
HOMESTEAD ROAD 3 3
C
SEPTIC AREA
SEPTIC AREA (E)��
MAINTAIN 5'
1 ,Y I TO DRAINFIELD
r
DRAIN FIELD (E)
Yom// 1
C
12
SEPTIC AREA (E)
1
COLLAPSING 1000g SEPTIC TANK (E)
_ DECOMMISSION PER CODE
INSTALL 1000g SEPTIC TANK -(P)
WITH DOUBLE CLEAN OUT
SEPTIC AREA (E)�
C �
SEPTIC AREA (E)J
13 14
DESIGN PARAMETERS ABBREVIATIONS
INSTALL NEW TANK - LEGEND FC FOUNDATION CLEAN OUT
NO.BEDROOM:3 - T# TANK CLEAN OUT NO.
TANK SIZE: 1,000g - —W— - WATER LINE/ C# CLEAN OUT NO.
WELL RADIUS OCO DOUBLE CLEAN OUT
USE- - OG ORIGINAL GRADE
NEW 1,000g SEPTIC TANK �7�7-� SS — NEW SEPTIC. E EXISTING -
NOTES: PANNONE ENG SVC, LLC �" OF.4(ate
`>>( 01/29/2016 -
TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 �...... 4s i)11
�
PHONE (907) 272-8218 FAX (907) 272-8211'\' I Scale
/iaj,• y f�
DRAWN BY:
..... ... .. .. ... P.I.D. NO
DRM REED, LOT 3 • , • • • • , • . 051-102-10
Steven R. Pannone / PERMIT NO.
KENNETH ORR P CE 8149
OSPXXXXXX
23114 HOMESTEAD ROAD _
PLAN CHUGIAK, AK 99567 t'l�9FUPROFES510�P�r sheet
MUNICIPALITY OF ANCHORAGE
® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME�//�/r
;cf
PHONE
NEW
/ / 'S `_ ) 77,
❑ UPGRADE
MAILING ADDRF y� /
LEGAL DESCRIPTION
j
LOCATION
NO. OF BEDROOMS
J
_ id
Well !�
/
Absorption areae-
Dwelling l /
PERMIT NO.
t- Z
W
Manufacturer _
6 %'-%fL
Material
EJ
No. of compartments.
p Z.
a
-
/'gy L
to
in gallons
Liq. ca %CJ (l aF ity'U
IF HOMEMADE:
Inside length
Width -= - ----_L_'—__---
Liquid deptl
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J0Z
_ Q
Manufacturer
Material
Liquid capacity in gallons
w g
DISTANCE TO:
Well
oundation
Nearest lot line
PERMIT NO.
u- 2!
z w
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
F-
_
inches
aa
a-
To of rile to finish lade
p g
Material beneath the
Total effective absorption area
inches
LLJ^
Length ,�-�
Width I
Dep41 j y a
to
PERMIT NO. --,
5 s x u Z�°�
.
w hk?
Type of crib
Crib diameter
Crib depth
Total effective absorption area f%
_
m
DISTANCE TO:
Well Bn /
C�
Building fond�atiory
Nearest lot line
Class
Dept }_ _
Dille
Distance to lot line
PERMIT NO.
J
�
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
r
Vc,
SOIL TEST RATING_
n
INSTALLER
d. .S C7 77 ali-
✓E..
REMAp/RKS
-ry Cwt rl ,a j
f I„
APPR D DA E LEGAL y�q/-y p y.��u 5� fit'
i 10�I��C�.VVIIQ
>A t fer+es
1
> , r, „ ",
12- A Tev. 3/78) / /
MUNICIPALITY OF ANCHORAGE
Department Health and Environmenta' protection
825 L Street, Anchorage, AK. 0501
264-4720t
HANDWRITTEN PERMIT
Permit (ALL AND/OR ON-SITE SEWER PERMIT, �, n
Applicant: Mailing Address. j
?� 6 �cF '
Location: � Phone Number: �-
Legal Description: f/ Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) Z__S
The Required Size of the Soil Absorption System Is:
DEPTH LENGTH GRAVEL DEPTH v AI411 G 67WIDTH
S"' e e /)
The length dimension is the en t (in feet) of the nch or drainfield. The
depth of a trench or pit is t e distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
REQUIRED SEPTIC(HOLDING) TANK SIZE _ zce ? GALLONS #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
#. TWO(2) INSPECTIONS ARE REQUIRED # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 #
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the ystem in accordance with codes.
(3) I u er to d that e on-site sewer system may require enlargement if
t o re e i emodeled to include more tha/ 3 bedro m
Signed: Issued by:�� ,
t plicant `
Date:
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
Department Health and Environmental rotection
825 Z Street, Anchorage, AK. y9501
264-4720
/ # # HANDWRITTEN PERMIT #
Permit # -�--- 6zj
ELL AND/O"R� ON-SITE SEWER PERMIT C'
Applicant: t % `f �J % Mailing Address:
r
Location: Phone Number:!lil
Legal Description: /_5 Ewe
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
The Required Size of the Soil Absorptionystem Is -
4_2
��/
DEPTH -� LENGTH GRAVEL DEPTH �� ``GUS -f WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet)
* * REQUIRED SEPTIC(HOLZLNG) TANK SIZE _ .1L) GALLONS # #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
# TWO(2) INSPECTIONS ARE REQUIRED #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
/0 Lot Size:
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set fort jta�ll
the Municipality of Anchorage.
(2) I will, 'in the system in accordance with codes.
(3) I unders that e on-site sewer system may require enlare ent if
the'res"e kZ emodeled to include more that4 3 jb d ooms ./
Signed:�
>' ��-i//!�
licant
SWP/024(1/81)
Issued by:
Date:
P �r
_- MUNICIPALITY OF ANCHORAGE
o' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
-.1 825 L. Street, Anchorage, Alaska 99501 264-4720
�SOILS LOG - PERCOLATION TEST
!>� SOILS LOG
❑ PERCOLATION
TEST
PERFORMED FOR: O -S' J LC' S•�� DATE PERFORMED:_" T -5
LEGAL DESCRIPTION: L-07— oe(E—� -- �za
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER S
ENCOUNTERED? L_
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/43
PERCOLATION RATE A (minutes/inch)
--
TEST RUN BETWEEN FT AND - ----- FT
72-008 (6/79)
eg
ig
LyUiii F f
't
DOC co"
Uba
KLIMA% VI IBM W -ELLS
PLO. 13OX 272, CHUGIAK, ALASKA 99567 o l-ELEPHONE 688-2759
OWNER OF LAND
ADDRESS -- --
LEGAL DESCRIPTION--'-' .---_---- _------_. -__ _
DATE -Started _ - ' _ Ended -- --
PERMIT NUMBER ------------ -- --- -
KIND OF FORMATION
DEPTH OF WELL
STATIC LEVEL- OF WATER FL
DRAWDOWN FT.
GALS. PER HR ._ c -----
IUND OF CASING
From ---Ft.
to-
Ft.
-'_-- From- -
-- -Ft.
to_-
Ft.__.-_-- -_-
Prom---_Ft.to._-_�Ft.
-, = From --
-_Pt.[o----lt.---
From ----Ft.
to_
- - -Ft.=--'
- - - ---' -- From -
Ft.
to -----
Ft. ---- - -
From -=--Ft.
to-
Ft.—)
- -- '` - From ---
Ft.
to
- Ft-_
From'
to--
.__.-Ft._
- - - _. -- - - --- Front __
Pt.
to _ _ -
---Ft.---- ---- _ _- _
-Pt.
From ---Ft.
to
_- _Ft.—_
-------_-_-_ -- - From_
-Ft.
to
1't.
team -
--Ft. to ---
--Ft.---
---- -- Front,
_ - Ft.
to
Ft.
From ----Ft.
to '
-Ft'
--- -- From-
Ft.
to
Ft.
From__•.Ft.
to_-
- _Ft._-
_- - _-- Frum_
Ft.
to
F t.
From ---_Ft.
to--
Ft.
__--_---__-- From_
Ft.
to
Ft.
From -__Ft.
ko--
Ft.--___.___-.
- - Front___
--Ft.
to---
__Ft. - --- -_ --
--
From ---_.-_Ft.
ta_-.-___Ft.
____-----------.__ -- From_-..__
_Ft.
to_-
- -Ft. --- _--
From
Ft. to__._
Ft. ----_.-_-_---_-_--
- From- _-__--Ft.
to-- -----Ft.---
--
From
Ft. to ------Ft.---_
_------------_- -- From- -
_Ft.
to--
-Ft. -- _ -
From -_-Ft.
to ---Ft.
----- -- ---- -_--- From
Ft.
to
i t.
Froin—Ft.
toFL
_----._---_
----_--_.-_-- From____
Ft.
to
k t.
From
Ft. to_--
___ Ft.
-_------ From_--_--
-li.
to-
Ft..
MISCL. INFORMATION:
DRILLER'S NAME _ -- _-,----------___-
Parcel I.D. 051-102-10
a?ce P�
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 s • E
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description Reed, Lot 3
Location (site address)
23114 Homestead Rd.
Expiration Date: S-- ZZ -19
Currant Prnnarfv nwner(s) Kenneth Orr Dav phone
Mailing address
Real Estate Agent
PO Box 671033 Chugiak, AK 99567
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
i1
Public Sewer
❑
WaiverNariance request for:
Received by: P �. Date: O t (n
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 02 8 a 5? S Z ip Waiver Fee $
Date of Payment �� j l S� Date of Payment
Receipt Number cy-k-i 2D G1 Receipt Number
COSA # o5u �o 163 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 lime 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.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Phone (907) 272-8218
Date 2/12/2016
4,9 n -i rXN
6. DSD SIGNATURE A
System #1 Approved for bedrooms t Steve `R.' am
t♦ CE -8149
System #2 Approved for bedrooms ,
Disapproved �Ay a?OfESSSW
Conditional approval for bedrooms, with the following stipulations:
By: VIAA, 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet S ..,
If more than d septic system is on the lot:
COSA Checklist # + of 1
Structure served by this system
Certificate of On=Site Systems Approval Checklist
Legal Description: Reef iQt 3 Parcel ID:051-0
A. WELL DATA
Well typePublic If A, B, or C provide PWSID # AWWU Well Log (Y/N)
Date completed Sanitary seal_ (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased` to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
8. SEPTIC/HOLDING TANK DATA
Tank Type/Material-Septic/Steel Date installed 2/5/2016,
Tank size 1,000: gal. Number of.Compartments __ Cleanouts (YhN) Y
Foundation cleanoutMN) `N Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping New Pumper N/A: _
C: ABSORPTION FIELD DATA '
$/6/19$3 g (g.p.d./ft2 orftz/bdrm) 85 SF/BR System type Beds
Date installed ?- Soil 7atin
Length 32 ft:. Width 12 it. Gravel below pipe 0.5 ft
Total de th 3`5 i *' ET absorption area- 37� ft2 Monitoring tube Y Depression over field N
Date of acjetl a8y-J6
st � - g 12016 ., Results (Pass/Fail) Pe S For 3 — bedrooms
Fluid death in absorption+field before test 0 in. Water added 536 gal. New depth—O-- in.
Elapsed Time: 70 min. ' Final fluid depth in. Absorption rate >= 450+ 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/clearlout
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 10+
Water service line
10+ Surface water 100+
Wells on adjacent lots 200+
ABSORPTION FIELD ON LOTTO:
Property line 10+
Building foundation TO+ Water main 10+
Water Service line .10+
Surface water 100+
Driveway, parkingNehicle_storage .10+
Curtain drain 50+
Wells on adjacent lots
200+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
t 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 Pannone
Date 2/12/2016
COSA canary sheet 2-6-15.doc
1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES }{
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.# bSi- IO-Z-10-ooac c,
HAA # Q
1. GENERAL INFORMATION
Complete legal description L 3 K ,.;I Svb
Location (site address or directions) R�
Property owner Day phone
Mailing address
Lending agency Day phone
Mailina address
-
Agent $2 Zo 17b�/�^� i� �, e Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water Avvw 0 -
NOTE:
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 421
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Cir ST�'c,c E"S' ^mss
Address 9G0� '3-'�
4c 83 (3
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments —
By: jL<_ i,
Phone 3�'�O /99-9e9H
AxAc
951
Date
;ter§'
'3 a ��aansrr,.veo...�eaa/+ase3^ "',rs
bedrooms, with the following stipulations:
Date v ? I /u
The Municipality of Anchorage Department of Health and Human Services (DHHS', issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev- 1/911 Back ?A0A ;21
Legal Description
A. WELL DATA
Well type
Log present(Y/N)_
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Municipality of Anchorage
Department of Health & Human Services��
WEALTH AUTHORITY APPROVAL CHECKLIST
L.3 'We -e- 1 Sib Parcel 1. D. 05)- 1 oz-- to -000
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing heigh
FROM WELL LOG
SEPARATION DISTANCES FROM WEL
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER
ColiforA
of sample:
E RESULTS:
S. SEPTIC/HOLDING TANK DATA
IN
Nitrate
Wires properly protected( ) _
AT SPECTION
VV
`9.1
; On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Date installed Tank size t "<)o Compartments Z'
Cleanouts (Y/N) % Foundation cleanout (Y/N) Y Depression (Y/N) N
High water alarm (Y/N) N'4 Alarm tested (Y/N) _ NA
Date of pumping "17 e._ 16,t99Pumper. 791`-pime)"6—
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots Loo _Foundation
rr
To property line 5 Absorption field Water main/service line
Surface water/drainage i 10 o
i;
+45,
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
M
z
U Z
7 n
t
^ v
r 1
g.p.m<
D
z
(t
0
rn s0
cn0
O m
z
Date installed Tank size t "<)o Compartments Z'
Cleanouts (Y/N) % Foundation cleanout (Y/N) Y Depression (Y/N) N
High water alarm (Y/N) N'4 Alarm tested (Y/N) _ NA
Date of pumping "17 e._ 16,t99Pumper. 791`-pime)"6—
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots Loo _Foundation
rr
To property line 5 Absorption field Water main/service line
Surface water/drainage i 10 o
i;
+45,
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANGE'�ROM LIFT STATION TO:
Well on
-D. ABSORPTION FIELD DATA
On adjacent lots
G"Pump off' level at
Cycles tested
Surface water _
Date installed !J(.-8� Soil rating 1 z$ System type t: �
IbIMETiSl01%Si"'2.cJ,.h-19-NI-n G -6-Z3 513�,1<TNi'L'2rNCr
Length 3L, Width tL' Gravel thickness $p-IotAD Total depth
Total absorption area 3845,� Cleanouts present (Y/N) M°N'TW, -r4G oe\,)_-/
Depression over field (Y/N)
Results (pass/fail) ?A5
1
Date of adequacy test 7-e� � 99''
for
3
Peroxide treatment (past 12 months) (Y/N) rJ If yes, give date
Nc>'re Lb9' LING vJA-ivCYZ_ --�-O S\ ota A-S-aiu'�-r 'I�o&N Mo Pr r-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
bedrooms
Well on lot ty R On adjacent lots -+ Property line S
i
To building foundation
On adjacent lots t ) O
Surface water --koo
Curtain drain + 50
E. ENGINEER'S CERTIFICATION
To existing or abandoned system on lot
tbank +50Water main/service line
Driveway, parking/vehicle storage area +So
+50 '
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect,op the date of this inspection.
Signature
�ghS4YJ _4Ih� �lsiPQPNl i /V/,wJ a. (7�.
Engineer's Name 9/oot ���� Vva.o.,.)o,
A-r,c,k--b
Date "z--- L —;'L -
HAA
Z.
HAA Fee $ Waiver Fee: $
Date of Payment "%� Date of Payment
Receipt Number Receipt Number
72-026 (Rev. 3/91) Back MOA 21
APPLIG IT
FILLS OUT UPPER HAL' ` NLY
Property Owner
Time
Time
Date
Date
Mailing Address '''. j ' jr- -
'- - -'.-- Zip Code
Inspector
Buyer
Address
Zip Code
Lending Institution .`
. j .-, �.. Phone
_
Address -l��f. � �� � �f� '� +�,�
�F-41 Zip Code
lr��
_
Really Co. & Agent - _ _.
_ _ Phone
Q M KEPT. OF H'f1111 °.
ENVIRON"A"\41AL PROTEO ION
Address "ii ' r/ �. (� �'
Zip Code
Legal Description
Street Location
O APPROVED BEDROOMS
Type of Residence ,!
( ) DISAPPROVED
-Q. Single Family ;
( ) CONDITIONAL APPHOVAL'
DATE
Va"�
❑ Multiple Family No. of Bedrooms
BY:
❑ Other
Soils Hating Date Sewer Installed
"]m' j
Water Supply
,\K Individual - I
PCI.
_
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
r, Community F,-�,
❑ Public Utility 1
—
Sewer Disposal
:"Individual
Year Individual Installed:—
�❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date -}
Inspector
Inspector
Inspector
Inspector
Sj-k-,,o
Field Notes: ! dna
MUNICIPALITY OF ANCHORAGE
('> ll (rC1a^►1`
Q M KEPT. OF H'f1111 °.
ENVIRON"A"\41AL PROTEO ION
,-..-I
r
O APPROVED BEDROOMS
ITIONS OF VAL
( ) DISAPPROVED
( ) CONDITIONAL APPHOVAL'
DATE
Va"�
BY:
Soils Hating Date Sewer Installed
"]m' j
!�
Well To Absorption Area �i� Well Log Received C—:�LA
Septic Tank Size
_
Well to Tanko,
2023 131621
C o
at j to :1 01m: , , ,i`001
a 1111 j wco 1 Am'd An. UoL -�
4AW . W -,'.ilk i AM; 111r.1J.VIAWO L KU4101Y t100 WA CC] G _—tk: J.
ltltl lulva inn)" CXWO)ICIASI�
1,0qw; wayll, d1w %jai YKIwILL hof) r,l !-'(1 J ubpocl 1-1011 Willil WO
1Wium, mull corym;Ond. 3, 1 It arw arl"
1: 0 i 1.1(:'-:, W)SKWIIK, Annse mill 1010 arlim m Aaw-OvAu.
Wc li: ! 1: 1.,1.111;
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