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HomeMy WebLinkAboutGREAT DANE PARK LT 4Great Dane Park Lot 4 #015-273-49 AI IRUITT®1 mspeWun Report_ Municipality of Anchorage Community Development Department JAN 21 "M 1 o 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: OSP131260 PID Number: 015-273-49 ❑ New ❑✓ Upgrade Name: Gregory & Tamra Holt ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 11011 Great Dane Circle ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 12 GPD/SF 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeGravel 5.0 Ft. depth beneath pipe - 5.OFt. Subdivision Block Lot Great Date Park 4 Fill added above original grade 0 Ft. Gravel length 50.0 Ft. Township Range Section Gravel width 3.0FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trendies From Tank Field Tank Line 500.00 Ftz 1 Ft. Well N/A N/A N/A N/A N/A TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1250Gal. Surface Water 100+ 100+ NIA N/A Material Number of compartments Lot Line 30.1 12.2 N/A N/A Steel 2 NA Foundation 18.5 15.7 N/A NIA LIFT STATION Manufacturer Capacity Curtain Drain NIA 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 PIPEMATERIAL Housetotank 3034 Tankto drainfield 3034 Pomraning Excavation, LLC Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection , dates: t' 10/22/13 2M 11/7/13 Location and description 3'" 11/7/13 0 Garage FF COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date OF,1� . V TH �� 814 pp Approved1-3 Date L �l'2D ;pFE TMP.+s .1-/ mspeWun Report_ II -- WELL (E) 0 -� - NO WELLS OR SEPTICS ON LOT WITHIN 200' / _ 149.6 NEW UPGRADE DRAIN FIELD !y 50LF x 3'W x 5.0'ED x 10.O'TD W W/ TH_1 �_ N v10' T&E ESMT M1 :. DRAIN FIELD (E) IN FAILURE .� M2 DV REUSE AS RESERVE C2 T2 ABANDONED 1250g SEPTIC TANK (E) PER CODE T1 C1(E) '•z_ - INSTALLED NEW 1250g SEPTIC TANK DCO 1 A DCO2 = B _ - DECK DRIVEWAY 4BR HOUSE (E) 1 44.7 135.9 , SEPTIC AREA E) " 3 NOTES: PAMONE ENG SVC,LLC �` �� Date RECORD DRAWINGOF A�,9ll 1/26/2013 P.O. BOX 100217 ANCHORAGE, AK 99510 S S l+ PHONE (907) 272-8218 FAX (907) 272-8211 iaj�Py�` Scale TH .... .. ... .... P.I.D. NO GREAT DANE PARK, LOT 45-273-49 GREGORY & TAMRA HOLT Steve R' Pannone' j PERMIT No. 11011 GREAT DANE CIRCLE �, P CE 8149r OSP131260 PLAN ANCHORAGE, AK 99516 (��� \\ "= ee Sheet 3 A B DC01 12.6 18.8 T1 14.5 21.1 T2 18.1 27.3 DCO2 19.3 29.0 DV 20.1 32.2 C1(E) 16.2 33.7 C1 23.3 45.4 M1 24.3 46.0 C2 35.1 17.1 M2 35.8 17.9 NOTES: PAMONE ENG SVC,LLC �` �� Date RECORD DRAWINGOF A�,9ll 1/26/2013 P.O. BOX 100217 ANCHORAGE, AK 99510 S S l+ PHONE (907) 272-8218 FAX (907) 272-8211 iaj�Py�` Scale TH .... .. ... .... P.I.D. NO GREAT DANE PARK, LOT 45-273-49 GREGORY & TAMRA HOLT Steve R' Pannone' j PERMIT No. 11011 GREAT DANE CIRCLE �, P CE 8149r OSP131260 PLAN ANCHORAGE, AK 99516 (��� \\ "= ee Sheet 3 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. SCOPE OF WORK: REPLACED 1250g SEPTIC TANK. INSTALLED NEW SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 16 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16.0 FEET BELOW EXISTING GRADE. DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = 4.05 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: DEEP TRENCH 5.0' E.D MIN LENGTH: 50 LF USED: 50 LF X 3' WIDE, 5.0' E.D., 10.0' TO TOTAL AREA: 500 SF PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PAMONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 GREAT DANE PARK, LOT 4 GREGORY & TAMRA HOLT 11011 GREAT DANE CIRCLE DESIGN DETAILS ANCHORAGE, AK 99516 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH -().5-OR- 0.50 TH-1 101.5 METER FABRIC DRAIN ROCK 6" ABOVE PIPE INV 4" 9 PERF PIPE TANK CLEAN OUT NO. C# vq`�.,� M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV OL OL FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE -2.5 5.D 96.5,. 0.5 am/ 5.0 DRAIN ROCK BM 91.5 SECTION 6.0 a a S 5 -16.0 BOH 85.5 z z z z oo' ,J, z o FILTER FABRIC o 0 o1 o OU U J U 'o � > DUD 5 0 U0.1 �rDRAIN ROCK 6" ABOVE PIPE INV iiil o EV DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = 4.05 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: DEEP TRENCH 5.0' E.D MIN LENGTH: 50 LF USED: 50 LF X 3' WIDE, 5.0' E.D., 10.0' TO TOTAL AREA: 500 SF PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PAMONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 GREAT DANE PARK, LOT 4 GREGORY & TAMRA HOLT 11011 GREAT DANE CIRCLE DESIGN DETAILS ANCHORAGE, AK 99516 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE Date 1/26/2013 *.' 9 pi. ... *(, .. .... . .. ..... NTS P.I.D. NO vtiv. .V .Pannone j litP<n�:� CE 8149�� �OFES$.OtSP" RMSS �>\ 015-273-49 PERMIT NO. OSP131260 Sheet 3 OF 3 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: OSP131260 Tax Code Number: 01527349000 Work Type: Septic Permit Effective Dates: August 09, 2013 Design Engineer: PANNONE ENGINEI Subdivision: GREAT DANE PARK to August 09, 2014 SERVICE Site Legal Address: GREAT DANE PARK LT 4 G:2635 Owner/Address: HOLT GREGORY J & TAMRA L 11011 GREAT DANE CIR ANCHORAGE AK 995161468 Site Mailing Address: 11011 GREAT DANE CIR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 52450 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. Issued By: 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 ^H! J J Parcel I.D. 015-273-49 Property owner(s) Gregory & Tamra Holt Day phone Mailing address 11011 Great Dane Cir, Anchorage, AK 99516 Site address 11011 Great Dane Cir Legal description (Sub'd., Block & Lot) Great Dane Park, Lot 4 Legal description (Township, Range & Section) Lot Size 52,450 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑x (w/wo ADU) Duplex Duplex (D) El Tank El Renewal El 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 unicipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Sao �$ �tZwSh Waiver Fees: _ Date of Payment: it l t 1) C Date of Payment: Receipt Number: 0132aGt Receipt Number: Permit No. Ube 1511a(ao Waiver No. Permit App_-'-:. Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveftPaneneak.com August 08, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Great Dane Park, Lot 4 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install an upgrade septic system be issued for this property. The proposed systems will serve an existing four (4) bedroom house. Currently the lot is developed. The existing field is in failure and will be re -used as a reserve. The existing 1250g will be exposed and the integrity will be verified. It will be replaced if found to be leaking. This lot is served by a private well that is over 100 feet from the existing and proposed system. The surrounding developed lots are also served by private wells. There are no wells within 100 feet of this system. 1. Soils. One test hole was excavated in the area of this drain filed by Pannone Engineering Services in July of 2013, and groundwater was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used for a conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 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 north to south at approximately 8% in the area of the proposed drain field. There are no steep slopes in the vicinity of this system. 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. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments -Soils Log -Septic System Design Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 W w L (E) NO WELLS OR SEPTICS ON LOT WITHIN 200' UPGRADE DRAIN FIELD (P) 50LF x 3'W x 5.0'ED x 1 O.O'TD 146.4 \N TH- -� vv 0 .10' T&E ESMT Cv .7 REUSE AS RESERVE DRAIN FIELD (E) IN FAILURE Z A (E) 12508 SEPTIC TANK E) VERIFY INTEGRITY A REPLACE IF FOUND TO BE LEAKIN DRIVEWAY 4BR HOUSE (E) 140.5 2 133.4 lz SEPTIC AREA (E) 3 1 -Z M• 4 Ld vt, K.WELL (E) 48 o 4", vlv� W� %N NOTES: PAMONE ENG SVC, LLC Date OF Ak,4hk 8/9/2013 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 C2 Scale 1 =50 P.I.D. NO GREAT DANE PARK, LOT 4 k -73-as GREGORY & TAMRA HOLT Vteve R.* a*nW •e" PERMIT NO. , -V,, *. CE 8149 11011 GREAT DANE CIRCLE ooqT,, I .. OSPI31260 PLAN ANCHORAGE, AK 99516 kT/4FD--' - Sheet kii�' PRO�s� 1 OF 3 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: VERIFY INTEGRITY OF EXISTING 1250g SEPTIC TANK AND REPLACE IF FOUND TO BE LEAKING. INSTALL NEW SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 16 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 16.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. TH-1 =0.5 - OL 2.5 R FABRIC IN ROCK 6" ABOVE PIPE INV 0 PERF PIPE =+0.5 R.70 DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = 4.05 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: DEEP TRENCH 5.0' E.D MIN LENGTH: 50 LF USE: 50 LF X 3' WIDE, 5.0' E.D., 10.0' TO TOTAL AREA: 500 SF PROFILE LEGEND w WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PANONE ENG SVC, LLA. FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 GREAT DANE PARK, LOT 4 GREGORY & TAMRA HOLT 11011 GREAT DANE CIRCLE DESIGN DETAILS ANCHORAGE, AK 99516 ra0491Tn_1rc•1►10 CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE 6!1 FOUNDATION CLEAN OUT SECTION TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FSa ¢o 'o o 'o -16.0 EON FG FINISH GRADE TS&V z z w F rc FILTER FABRIC a z z qz z 0 ROCK 6' ABOVE PIPE INV 0 U V OUO UO fF rDRAIN / fV DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE = 4.05 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: DEEP TRENCH 5.0' E.D MIN LENGTH: 50 LF USE: 50 LF X 3' WIDE, 5.0' E.D., 10.0' TO TOTAL AREA: 500 SF PROFILE LEGEND w WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PANONE ENG SVC, LLA. FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 GREAT DANE PARK, LOT 4 GREGORY & TAMRA HOLT 11011 GREAT DANE CIRCLE DESIGN DETAILS ANCHORAGE, AK 99516 ra0491Tn_1rc•1►10 CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE 8/9/2013 PERMIT NO. CE 8149 fir/ OSP131260 OROFES9ONP�Sheet ��"`�� 2 OF 3 SOILS LOG - PERCOLATION TEST TEST HOLE I OR ORGANICS SLOPE SITE PLAN' ORGANIC OL SILTS 2 3 4 4 TH-1 6— X -10,'T&E E_SMT TH 7 8 GM/ SILTY SAND SM AND GRAVEL 9- 10 11 1SDRIVEWAY 12 4BR HOUSE (E) 13 WAS GROUND WATER SLOPE 14 — ENCOUNTERED? IN 15 — IF YES, AT WHAT TH DEPTH? x 16 — BOH 17 — DEPTH TO WATER AFTER MONITORING? -DRY- 18 — DATE: 8/1/2013 I READING DATE CLOCK DATE PERFORMED: 7114/13 TIME WATER NET TIME LEVEL NET DROP READING 1 7/14113 9:00 — 4.41 -- 2 9:10 10 MIN 7.06 2.65 3 9:10 -- 4.41 — 4 9:20 10 MIN 6.90 2A9 5 9:20 — 4.41 — 6 9:30 10 MIN 6.88 2.47 PEROLATION RATE 4.05 (minlinch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. Prec hole was presoaked. Perc test ran for at least 1 hour. Last three 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 EKG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 .*l, Vt*e'v*e'n* *R' Pannone Date 8/9/2013 FOR CONSTRUCTION Scale NITS GREAT DANE PARK, LOT 4 GREGORY & TAIVRA HOLT P. I.D. NO -G15-273-49 HERMIT NO 11011 GREAT DANE CIRCLE CE 8149 ft OSP131260 SOILS LOG ANCHORAGE, AK 99516 ki,)WOFES �Ikl' Sheet 3 OF 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 *0 ENVIRONMENTAL ENGINEERING DIVISION ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME �,(j // A� C !h C PHONE b ) I 5 S d I.3 EW El UPGRADE MAILING ADDRPo �OX Z�y6� AnChora •e �jAS/Ca ( ! SO Ci ''99 // LEGAL DESCRIPTION 6rewl 10.t Lf T(2(J (z- -SLZ I LOCATION L � NO. OF BEDROOMS(. I U Y DISTANCE TO: Well nou - in Absorption area (� Dwelling Z1' PERMIT NO. �` V � d S 6' _ F - Manufacturer A PLr: dor Material S j �� T'- No, of compartment Liq. capacity irLgallon/s'G IF HOMEMADE: Inside length Width Liquid depth �-' DISTANCE TO: Well Dwelling PERMIT NO. = 2`1 Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well �L���h Foundation �� Nearest lot line SOLU PERMIT NO. g u U S 6 1 F Z w No. of lines Length of eacchli e Total length of lines Trench wi5ith8 `� inches Distance between CC F O Top of tile to finish gradeMaterial 31_ beneath tile p / / G inches Total effective absorption area S6� LU a Length Width Depth PERMIT NO. a F wa Type of crib Crib diameter Crib depth Total effective absorption area LU TO: Well - Building foundation Nearest lot line _j Class VLo Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation - Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS L SOI L TEST RATING /3e9 i INSTALLER REMARKS tj 1 1.., ! S}Incl bl';DeLJCI '-I ©%Vl a I�.s" arc/11 011-4 `y s 35 O N &T- L/f �l Y APPROVED ,/DDATE LEGAL \ 2 � �y��//[' At - -2A / J P LI. _ _ 4- ) /i AP 1,,+4 'i2 .. �l�f. 10 �W �sc 21 LOCATION OF WELL (Please complete either la, Ib or le.) la. Borough Subdivision Lot Block rof 1/4 gtrs. —of—of 1 I.1 DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 2. WELL LOG WATER WELL RECORD STATE OF ALASKA DEPARTMENTOF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. A.D.L. No. Section No. Township N ❑ Range E ❑ Merldion s❑ W❑ 3. OWNER OF WELL: - Address: - - Feet Below Surface Bottom 4. WELL DEPTH: (final) 5. DATE OF COMPLETION ft. 6, ❑ Cable tool Rotary ❑ Driven ❑ Dug ❑ Auger ❑Jetted ❑ Bored ❑ Other �)( 7. USE: ❑Domestic _❑ Public Supply Industry O Irrigation O Recharge Commerical ❑ Test Well ❑ Other: S. CASING: E] Threaded ❑ Welded diem. - in. to tt. Depth Weight lbs. i diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Backfilling Gravel pock 10. STATIC WATER LEVEL: :(�.. ft.� Above or ,❑.Below land surface Date Equipment used: -- '- - -'I; • I I . PUMPING LEVEL below land surface and YIELD r: ' - it. after -- hrs. Pumping _ g.p.m. w_-- NCHORA®E DEPT. OF HEALTH & ft. after hrs. pumping g.p.m. ENVIRONPAENIAt. PROTECTION 12.GROUTING Well Grouted: [j Yes E] No 1 Material _� Neat Cement O Other: '- 13, PUMP: ( if available) HP Length of Drop Pipe ft. capacity 9 -p.m ❑ Subm. - ❑ Jet ❑ Centrifical Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature — This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Registered Business Name Signed:_ /rl 'Ci i,� �_ �.7 ���'.�- i �•-°.-Z Authorized Representative " Contract License Number Date: Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY -customer a ❑ F ❑ C f I. ^ ` � ��I irNL- I -r V �3 F::" �) 1�4 C:�'" C3 F:� W:'% C-1 E=-: ^~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 WUFFU_L_ F�F—=FRVI 17T PERMIT NO: 840561 DATE ISSUED: 07/11/84 APpLICANT: AMC INC. ADDRESS: P.O, BOX 4~2882 . ANCHORAGE, AK 99509 , CONTACT PHONE': 345~5813 - LEGAL UE:'SCRIP: SUBDIVISION: GREAT DANE LOT: 4 BLOCK- NA SECTION: 21 �TOWNSHIP: 12N RANGE: 3W LO SIZE: 52450 (SQ"FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options avilable to you in designing your septic system. Choose the option that best fits your site. -r FRG=-�P4K:� t~i 1-30:--- n K*i = TD F-C!r-h ][ "1 DEPTH TO PIPE BOTTOM (FT.) 4.0 5.0 4"0 GRAVEL DEPTH (FT.) 8.0 0,5 3°5 TOTAL DEPTH (FT.) 12.0 5.5 7.5 GRAVEL WIDTH (FT") 2~5 21"0 5^0 / GRAVEL LENGTH (FT") 35"0 40.0 ,60.0 GRAVEL VOLUME (CU.'YDS° ) 27.5 31.1 44"4 TANK SIZE (GALS) 11258"0 ** 1,250"0 1,250.0 ** SOIL RATING (SQ.FT./BR) 138 138 138 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ' I certify that: 1. I am familiar with the requirements for on-site sewers andwells as- set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I will install the system in accordance with all MOA codes and regulations` and in compliance with thedesign criteria of this permit" 3. I will adhere to all MOA and State of Alaska requirements fop the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot, 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL. PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS^~BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WOM* MUST BE DONE BY A LICENSED ELECTRICIAN~ SIGNED APPLICANT: AMC I ISSUED BY � DATE: DATE: � SOILS LOG � J r 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SHEET-�5_OF !- PROJECT TEST HOLE NO.�_ CLIENT rlJ sil`/ ELEV. TOP OF HOLE W.O.IsZd(o DATE-/r'i-�Z F1 fy: 1 f1 UNWIN a SCHEE3EIV a KORYNTA a HUETTL 0 1 2 3 4 5 6 7 B 10 11 12 13 14 15 16 17 18 19 z0 zl >2 z3 !4 15 gROwrV 5 i�1'�1 G�tvavl�c— sA� s m ��-z � , sA'►'t'�Pt,i� Aio. �U�- . o+E OF .44'411 B 4TH ; w .. .. ... o Ea :Kor �•—�_ �'. cP o 1823-E i��i�,eAO.°•••���AV l �p FESS�ON�e rho 64VLArXl wiz puO�A'1'►u►v RAT,,?,5.� m,wys Pyr F1 fy: 1 f1 UNWIN a SCHEE3EIV a KORYNTA a HUETTL 0 1 2 3 4 5 6 7 B 10 11 12 13 14 15 16 17 18 19 z0 zl >2 z3 !4 15 Parcel I.D. 015-273-49 IZ 0 C. # A:ow Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Great Dane Park, Lot 4 Location (site address) 11011 Great Dane Cir Tp£ Q b4i SAI E I Y Expiration Date: 11 -2) -/JO Current Property owner(s) Tony & Margaret Harris Day phone Mailing address 11011 Great Dane Cir. Anchorage, AK Real Estate Agent Relocation Company Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 99516 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well (] Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ CCSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 Zb Waiver Fee $ Date of Payment Date of Payment Receipt Number (%� �1" S�'a Receipt Number COSA # dSC 1 12--3 Z Waiver # 8-... T 5. STATEMENT OF INSPECTION BY ENGfNJEER. c As certified by my seal affixed hereto and as of tthe validation date shown below, I verify that my investigation, based on procedures outlined in the Cerfificate 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. 1 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. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms Phone (907)272-8218 Date 09/14/2016 100 j*co *� At S even far rior e : 10#00 System #2 Approved for bedrooms r+} 1q, CE -8149 Disapproved }!it i,�t..... . Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: b—l�o—jb 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheer t %, c If more than. 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Great Dane Park, Lot 4 A. WELL DATA -Well type Private _ If A, B, or C provide PWS ID # _ Date completed 11/5/1984 Sanitary seal (YIN) Y Total depth'190 ft. Cased to 190 ft. FROM WELL LOG 11 /5/1984 m Parcel ID: 015-273-49 _ I Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION Date of test 5/1114 10 Static water level 168 ft. 158 ft Well production 8.0 g.p.m. 5.6+ g.p.m. . WATER SAMPLE RESULTS: �qq o.i00t'tCt r N �h` Coliform colonies/100 mL Nitrate mg/L t 1 y ��b{ Arsenic ND ug/L Date of sample: 5/11/2016 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/22/2013 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 06/08/2016 Pumper A+ Home and Services, INC... C. ABSORPTION FIELD DATA 11/7/2013 z 1.2 GPD/SF Deep Trench Date installed Soil rating (g.p.d./fe or ft /bdrm) System type Length 50 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 12.8 ft. • Eff. absorption area 500 ft2 Monitoring tube Y_ Depression over field N Date of adequacy test 5/1 1/2016 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption. field before test 0 in. Water added 607 gal. New depth 6 in, Elapsed Time: 160 min_ Final fluid depth 0 in. Absorption rate >= 600+ NO Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATJON Date installed "Pump on" level at in. Datum Size in gallons Manhole/Access (Y/N) "Pump off" level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100"+ Sewer /septic service line 25± Holding taiik 100± Animal containment areas 50± Manure/animal excrete storage areas 100± SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service.line 10+ Surface water 400+ Wells on adjacent lots 100+ ABSORPTION. FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on File 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 Pannone Date 09/14/2016. COSA canary sheet_2-6-15.doc Parcel I.D. 015-273-49 Municipality of Anchore JUN 14 20115 On -Site Water and Wastewater Progra (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Great Dane Park, Lot 4 Location (site address) 11011 Great Dane Cir. Current Property owner(s) Mailing address Real Estate Agent Tony & Margaret Harris Expiration Date: Day phone 11011 Great Dane Cir. Anchorage, AK 99516 Relocation Company Day phone 2. TYPE OF DWELLING: 0 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 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5X'0 Date of Payment (, 115-1a, Receipt Number COSA # 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 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 6. DSD SIGNATURE Phone (907)272-8218 Date 6/12/2016 System #1 Approved for bedrooms System #2 Approved for bedrooms �� *, CE -8149 Disapproved Conditional approval for bedrooms, with the following stipulations: vv,,! �_, . , ., - By: , h (`�e� ��� 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 Septic System Advisory Well Flow Advisory COSA blue sheet r .. Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _L_of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Great Dane Park, Lot 4 Parcel ID: 015-273-49 A. WELL DATA " Well type Private If A, D; or C provide PWS1D # Well Log (Y/N) Y Date completed 11 /5/1984 Sanitary seal (Y/N) Y. Wires properly protected (Y/N) Y Total depth 190- < ft, Cased to 190 ft. Casing height (above ground) 18+ in. FROM WELL 4OG AT INSPECTION Date of test 11/5/1984 5/11/2016 Static water level 168 ft 158 ft Well production 8.0 9 P m 5.6+ g.p.m. WATER SAMPLE RESULTS: Colifdrm Meg colonies/100 mL Nitrate ND mg/L ND 5/11/2016 PES Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 1°0/22/20113 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping Q g Pumper A -t HD o E S my ices t Nc ...: C. ABSORPTION FIELD TA 11/x/201 z z 1.2 GPD/SF Deep Trench Date installetllp ' Soil rating (g.p.d./ft or ft /bdrm) System type Length 50 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 12.8 ft.. 'Eff. absorption area 500 ft2 ' Monitoring tube Y Depression over field N Date Of.adequa�y test 5/11/201'6 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth inI:absorption field before test 0 in. Water added 607 gal. New depth 6 in. Elapsed Time: 160 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date G. ENGINEER'S CERTIFICATION !.certify that 1 have determined through field inspections and �,.,• 4V A Aof Munieipal;:rewids thatthe, abovegystems are in , conformance with M6A COSA guidelines-in.effect on this date. Engineer's Printed Name Steven, Pann0he .. Data 6/12/2016 COSA canary sheet 2-6-15.doc D. LIFT STATION Date installext 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 requirement§?-_ +e E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+. On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 400+ _ Sewer /septic service line 25+ T Holding tank Animal containment areas 50+ Manure/animal excrete storage areas 100+` 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 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foyndation 10+ Water main 10+ Water Service line Surface water 100+ Driveway, parking/vehicle storage 1. Q+ Curtain drain 50+ Wells on adjacent lots 100+ _F. COMMENTS `.'Y G. ENGINEER'S CERTIFICATION !.certify that 1 have determined through field inspections and �,.,• 4V A Aof Munieipal;:rewids thatthe, abovegystems are in , conformance with M6A COSA guidelines-in.effect on this date. Engineer's Printed Name Steven, Pann0he .. Data 6/12/2016 COSA canary sheet 2-6-15.doc 0 Parcel I.D. 015-273-49 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s e , Y Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Great Dane Park, Lot 4 Location (site address) 11011 Great Dane cir. Current Property owners) Gregory & Tamra Holt Mailing address 11011 Great Dane Cir. Real Estate Agent 2. TYPE OF DWELLING: I] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Expiration Date: 7- .21 12 — Ll Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: ' 'a' -'t Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ I 1 0 Waiver Fee $ _ Date of Payment /1511 L/ Date of Payment Receipt Number G`� Receipt Number. COSA# 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. 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 VSISystem #1 Approved for —+—bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Date 11/27/13 .. oIE AL. RlI 4XPXk .. X 0 ...AJ �:S�everi ��. �panriatie: bedrooms, with the following stipulations: By: Original Certificate Date: Th?the i it of nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only uporepresentations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet E ., c If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system i Certificate of On -Site Systems Approval Checklist Legal Description: Great Dane Park, Lot 4 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 1115/84 Sanitary seal (YIN) Y Total depth 190 ft. Cased to 190 ft. FROM WELL LOG Date of test 11/5/84 Static water level 168 Well production Parcel ID: 015-273-49 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 24 AT INSPECTION 5/29/13 152 9.p -m. 4_9 FIN WATER SAMPLE RESULTS: Coliform—colonies/100 mL Nitrate R/J mg/L Arsenic A)b— ug/L Date of sample: q/7/)L61'1 Collected by: Pf5 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Date installed 11/7/13 Cleanouts(YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping New Pumper C. ABSORPTION FIELD DATA Date installed 11/7/13 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPDIBR System type Deep Trench Length 50 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 10.0 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test New in. Water added.New gal. New depth NeW in. Elapsed Time: New min. Final fluid depth New 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 in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons _ "Pump off' level at Cycles tested _ Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: 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+ Holding tank 100+ Manure/animal excrete storage areas 100+ 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 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 COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 11/26/13 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ ICI 2 7 N89" 57'04"E 292.45 10' ELECT. & TELECOM. ESMT S 53.3" Q Q I � l5J o 37.2' 37.0 0 I o 26.0 2.5 EXISTING HOUSE .* \•�: I,y, $ `0 252.4.6 0 m0-0 Q 27.0 W °v)m Jt L6 ( 82.7' r ,y � ~ O WI LOT 0� 0 I p 0 0 Be �I a 0 Q I �� 3 I Imoo`-dc�oo�4 .�F..q�gS�4 10' SLOPE ESMT f'�Q. '•� q�j p�* 4 THQ �....:....f......... ....... .. O 40.00 �................. S89 52' 00V �O JOHN D. HA N o` O 7C 1 LS-1281�z�G b essiontlt i GREAT DANE CIRCLE NOTE: 1. THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. 2. SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES. ORDERED BY. MICHAEL PIKE WITH REAL ESTATE BROKERS OF ALASKA SURVEY CERTIFICATION: LCGLANTECH, INC HAS CONDUCTEDA PHYSICAL SURVEY OF THE PROPERTYAs SHOWN ON THIS DRAWING AND CERTIFIES THAT THE LEGAL DESCRIPTION: IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO AS-BUILT ENCROACHMENTS EXIST OTHER THAN NOTED, EXCLUSIOLOT 4, EXISTENCE OF MY EASEMENTS, CY NOTE: IT IS THE COOVENANIRT � RENST RICMONLITY TS ORDETERMINE T.OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT, UNDER NO GREAT DANE PARK SUBDIVISION CIRCUMSTANCES SHOULD ANY DATA HEREON DE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT-PLAN PURPOSES. "R.....°, 250 H Street O Anchorage, Alaska 99501 SEPTIC STANDPIPE QWATER WELL Dtierilan9 ;=Aephalt;Y;;Ft.. FENCE —X— X— Woo _ eck ^�•iCon�ate:,;:'•', Survey Department Phone 562-5291 DRAWN DATE: 4/15/2014 WORK ORDER: 2014-L-41 B MON I �nc Mainline DRAWN 8Y: MH PLAT: 89-278 zj,CX,iCpGbiAe *� ^fig Fhone 243-8985 CHECKED BY: TE GRID: 2635 SCALE: 1�-- 40' FB/PG• 79rfln.'d1 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D.# 015-273-49 HAA#' FM A44:1- 1. GENERAL INFORMATION Complete legal description GREAT DANE ARK SID' LOT 4 Location (site address or directions) 11011 GREAT DANE CIRCLE ANCHORAGE AK 99516 Property owner CRAIG AND CRICKETT SCHMIDT Day phone(907) 344-0686/522-3994 (RESPECTIVELY) Mailing address 11011 GREAT DANE CIRCLE ANCHORAGE AK 99516 Lending agency Mailing address Day phone Agent BOB BEAR wZTOTEM REALTY Day phone (907) 272-0571 Address7 4�AVENUE ANCHORAGE AK 99501 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX 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 xxx Holding Tank Community on-site Public sewer NOTE: If community, wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA 921 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1100.00 at, or prior to, closing for the engineering services provided. 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 Municip and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's Signature Phone (907)337-6179 In conducting this evaluation, AWWC, Uhalatt� pied to provide a thorough, conscientious engineering analysis of the system in accordance with ADE C and MOA HS Guidelines & Regulations. The reported results described 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 soils 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 the system. Satisfactory test results do not guarantee future performance , F ...ib0� of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, Opp ............ ....... nor will it confer any legal right whatsoever. `0 • Je fre A. ess 6. DHHS SIGNATURE U44s a, QJ -7953_)Z Approved for 3 bedrooms 4f�4pO'?rofcastor Disapproved `\�IZNS Conditional approval for bedrooms, with the following stipulations: Additional A Date y -/c''00 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. 1/91) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ®C (� 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 3 ARI 17(aW Health Authority Approval ChecklistMUNJOPALnv oe - n/iRONMENTAI sEBvti-`": Legal Description: GREAT DANE PARK S/D; LOT 4 Parcel I.D.: 015-273-49 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 11/3/84 Total depth 190' Cased to 190' Casing height (above ground) 13" Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG AT INSPECTION Date of test 11/3/84 4/12/2000 Static water level Well production 8 —9 -P.M. WATER SAMPLE RESULTS: Coliform B Nitrate C. 15 Other bacteria Date of sample: 4/12/2000 Collected by: A.W.W.C. g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed 10/26/84 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 4/12/2000 Pumper McDONLALD'S PUMPING C. ABSORPTION FIELD DATA Date installed 10/26/84 Soil rating (g.p.d./ft2 or ft2/bdrm 138 System type TRENCH Length 35' Width 4' Gravel thickness below pipe 8' Total depth 12' Effective absorption area 560 SQ Fr Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 4/12/2000 Results (Pass/Fail) PASS For Bedrooms Fluid depth in absorption field before test (in.); 34" Immediately after 868 gal. water added (in.): 51" Fluid depth 42" (ins) Minutes later: 100 Absorption rate = 450+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date ----- 72-026 (Rev. 3/98)• Computer Version D. LIFT STATION Date installed Manhole/Access High water alarm level at* "Pump off' level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot_ 100'+ On adjacent lots 100'+ Absorption field on lot_ 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line_ 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field Water main/service line_ 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10'+ Curtain drain F. ENGINEER'S 1 certify that / of Municipal n with MOA HA, Signature—' Engineer's R>o, HAA Fee $ C-)�U0• NONE KNOWN 'd inspections and review stems are in conformance this date. Date of Payment c^>�G —� 7 —° C�) Receipt Number 72.026 (Rev. 3/96)" Computer Version Wells on a Waiver Fee $ Date of Payment Receipt Number 04-17-00 14:41 FROM -CTE ENVIRONMENTAL 5615301 CTU Environmental Services Ittc. Laboratory Division 200 W. Potter Drivt: Anchorage, AK 99:.18 Tel: (907) 562-234 Fax. (907) 561-5301 T-311 P.01/02 F-527 CT&E Ref. B 1001566001 Client POB. n/a Client Name: AK Water & Wastewater Cons. Panted Dateffime: 04/17/00 14:30 Project Name: n/a Collected Date/time 04/12/00 17:30 Client Sample ID: Great Dane Park Lot 4 Received Dateffime, 04/13/00 13:30 Matrix: Drinking Water Technical Director: Stephen Ede PWSID nfa Remarks Released By: A1lowabi•e Prep Analysis Parameter Results POL uro15 Method Limas Date Date Mit Total Coliform (MF) 0 col/100 ml SM9222B 04/13/00 KAP Nitrate 0.5 U 0.5 mg/1- EPA 300 10.0 04/13/00 SCL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES t 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 I.D. # Ol 5 97'3 LFq HAA # GENERAL INFORMATION Complete legal description 6-0.-C ?CSA, Location (site address or directions) 11 D f l Property owner t r1i Day phone�— Mailing address IlO it q4t5 /(� FNM A � S� Lending agency ��Y� Day phone Mailing Agent Address Day phone 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 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 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 #21 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 thedatedate of this inspection. ! D�7p NameofFirmbb{?✓1 �tD�r�t-�ctu �� Phone Address 03 Ll�l / +IA Engineer's signature Date •,r 6. DHHS SIGNATURE XApproved for bedrooms. M Disapproved. Conditional approval for Additional Comments rdir` bedrooms, with the following stipulations: Date ? . 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. 1/91) Back MOA .21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:7r Parcel I.D. 015 P-73 9 A. WELL DATA NIA Well type If A, B, or C, attach ADEC letter. ADEC water jsystem number Log present (Y/N) �z Date completed (� b 72* 8 CI Driller {—OSS it Total depth Cased to Q Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) - FROM WELL LOG AT INSPECTION M 1 f' D 'Zlg3 OJ01W �3 Date of test o z 6 g I C_ Static water level a 3 Well flow 9•p•m• g y o < Pump level $� �q-I -- wcc a W „n, M Y 00 SEPARATION DISTANCES FROM WELL TO: y Septic/holding tank on lot j 3 g ; On adjacent lots Absorption field on lot On adjacent lots 7 l l q Public sewer main N/141 Public sewer manhole/cleanout N/A Sewer service line > 1 YV Petroleum tank N O WATER SAMPLE RESULTS: Coliform / Nitrate �� 1% Other bacteria Date of sample: o f r -��� Collected by: 5",+ B. SEPTIC/HOLDING TANK DATA Dateinstalled 00$X, R�Tanksize 1P-50 Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) iY High water alarm (Y/N) K/A Alarm tested (Y/N) K/mac Date of pumping lam Ali 1 RR 3 Pumper jA a.tt.c" SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wel I(s) on lot139 On adjacent lots Z /C -O Foundation ac To property line % AO Absorption field q Water main/service line>60 Surface water/drainage Ni 0 72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE C. LIFT STATION Jq 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 DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ Date installed—!'� 02Z 1 q 8 q Soil rating 13 9 System type A1C Lj Length —35 Width V9 Gravel thickness Total depth 2. Total absorption area 5&n Cleanouts present (Y/N) __ \/ Depression over field (Y/N) ri Date of adequacy test. '/ Results (pass/fail) for `� bedrooms �I N.t/.� `� rA. 7�•- 'C�_E'((�YU r•-„✓� �l�'Ll�-L L✓I.f �� GL Peroxide treatment (Past tz months) (Y/N) If yes, give date �/-2 >` ✓e - SEPARATION DISTANCE FROM ABSORPTION FIELD TO:'T r ��r-ca.-t `�zc?-�v /lit • Well on lot 10 On adjacent lots Property line > 2 T5 To building foundation�✓�T,o/�A existing or abandoned system on lot On adjacent lots � ! Cutbank 1`L flW -e-Water main/service line, >/ .6 o Surface water _ P4/D Driveway, parking/vehicle storage area �v Curtain drain NI t% ^,'p OK�4'`� E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,on the,date of this inspection. Signature Engineer's Nam ��y I Date 9St HAA Fee $ �� v Waiver Fee: $ Date of Payment Z��7-7 _!� // Date of Payment Receipt Number may^ l [���� Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FAX: (907) 561-5301 Chemlab Ref .# :93.0297-1 REPORT of ANALYSIS Client Sample ID :L4 GREAT DANE PARK Matrix : WATER Client Name :TOBBEN SPURKLAND, P.E. Collected :01/21/93 @ 13:40 his. Ordered By Received :01/21/93 0 14:30 hrs. Project Name WORK Order :62523 Project# Report Completed :01/25/93 PWSID :UA Technical Director By� :STEPHEN C. EDE Released -------�------------- Sample ROUTINE ------------.—�—�-----. SANTLI' COLLECTED BY: STUART. Remarks: QC Allowable Extract Analysis Parameter Results-- ual. Units Method Limits Date Date Inst ----------------------------- NITRATE -N ------------- - -------------------- ------------------ 0.10 U rm3,/i EPA 353.2/300.0 10 01/25/93 01/25/93 LLB sa,.a ee. ma v.See Special Instructions Above rma �m969II1O UA - Unavailable See Sample Remarks Above NA - Not Analyzed U - Undetected, Reported value is the practical quantification limit. LT - Less Than D - Secondary dilution.�±��++ GT - Greater Than ��NSGS Member of the SGS Group (Societe Gdnerale de Surveillance) , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�7_ �U9� OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 'V/:F*2 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L q GREAT DAAIE Am,- T/zl/ 9310 Location (address or directions) J1011 GRE&f;.%,DftE CIRC (b) Applicant Name76M "RE96040AI Telephone: Home of 1'2-657r Business Applicant Address, FSR q M5 A1j' 72 AV / (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,"; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution At& Telephone i Address N (e) Real Estate Company and Agent //FD WM6 REA(. E. -5747t- KA1?511 Address / Telephone __ X62 _m5 3 (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-FamilyDr Multi -Family[:] Other Number of Bedrooms 3. WATER SUPPLY Individual Well• Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsiteg Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-02e 11 Ii84l L Z/ Aim 5., 'ENGINEERING FIRM PROVIDIN. INSPECTIONS, TESTS, FILE SEARCH, DAIA AND INFORMATION 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 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 AEE Telephone Address 1 2o2 W 3-_-5—.P0 Aae Date 2 h 9 / y/> 0•A4.1�,e♦ ,••4C. REIb, �9ar00 8 IFR JR. / j '�,�•. E - 2251 It s VA 6. DHEP APPROVAL �, �./2'L � 17 Approved for bedrooms by �� L Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANMMCIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVIC111ifEWDOWKUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 FEB 2 0 1987 264-4720 Legal Description: Z 7 G16Ei#T ®4"/YA5 g6wx RECEIVED r/2 /V Rsyscc, 2/ A. WELL DATA Well Classification PA t/q7 If A, B, C, D.E.C. Approved (Y/N) /V/A Well Log Present Y Date Completed %�-��c�7 Yield GPM, Total Depth _E -f1— Cased to Depth of Grouting 4(/,4 Static Water Level Pump Set At U/IA/i10WIt Casing Height Above Ground — Electrical Wiring in Conduit(@N) Separation Distances from Well: Sanitary Seal on Casing ON) Depression Around Wellhead (Ye To Septic/Holding Tank on Lot 132"i ; On Adjoining Lots 100" -14 - To Nearest Edge of Absorption Field on Lot 105 ; On Adjoining Lots f) C1 To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole IV / To Nearest Sewer Service Line on Lot Water Sample Collected by �J /+�TGI�uGK ; Date2/ 6/g% "' Water Sample Test Results SJT �_S Fa4CT©l4 7 Comments B. SEPTIC/HOLDING TANK DATA Date Installed �� 6 Size 120 No. of Compartments Z Standpipes (DN) Air -tight Caps I©N) Foundation Cleanout (DN) Depression over Tank (Y/® Date Last Pumped >6' &-1,4 Pumping/Maintenance Contract on File (Y/N) �1/�/� for A114 Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i To Water -Supply Well I _-�Z To Property Line To Building Foundation G To Disposal Field i To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Page 1 of 2 0/91)/46 Pel*< C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 13S' Type of System Design 76AIC H Date Installed 10 z g Length of Field r ✓ Width of Field y Depth of Field i Square Feet of Absorption Area Depression over Field (Y® — Results of Last Adequacy Test Gravel Bed Thickness sFiD r _ Standpipes Present 940N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well �QJ� To Property Line �D To Building Foundation Z J1 To Existing or Abandoned System on Lot N4 ; On Adjoining Lots N/ A To Water Main/Service Line N To Cutbank (if present) Nl4 To Stream/Pond/Lake/or Major Drainage Course JOCK r, f / f– To Driveway, Parking Area, or Vehicle Storage Area �E Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pumw;�#f vel at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify thatI ave eked a fied, rconformed to all OA and HAA guidelines in effect on the date of this inspection. Signed Date �j�/ Company MOA NO. Y –©2i ��®�a�r� OF A %4 Receipt No. � 6 O /-06-3 r�����°•°.•°, �el�C'Ig� Date of Payment ° e •� �O?J co �� •' �� gi r'sn.� Amount: $ ® ®°e• Sia •s•e oee••ao •if AT7#c#1WE-41s 4/ c, 0, Page 2 of 2 #Z 6VU4 GOG `3 wik-rFK 72-026 (11/84) &� St7'�-7. >® °)?r Crave Al 4- a ek.e C. REID, JR. e° a E - 2251 0 ` seia ALASKA ENVIRONMENTAL CONTROL SERVICE INC. ! 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907)361.5040 SEPTIC TANK Mi 4ousE J9 OF C.Lcuu.ee SY_ .iiK - DATE 2 CHEC.E: tr_ II M SCALE 4 s=: • '_o-'4 �': c/0 Tro,1NCTAxLL ��� _S/PL Ilio i �ovv�a� MA ° 92'1 ��= y a LOS t - 3 wel 1 �. �U a�€.,.�; r key-:• ;r1�"� r"� a' 1�'.>- it 01 x T. h • 'N � Q i'S• r ) ORrrEwAy ta,'s4 :. g ikv1 t x .1 "fit M � � ALASKA ENVIRONMENTAL CONTROL SERVICE 'INC. j 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907)561-5040 JOB L q GREAT, DAVE PARK SHEET NO. OF CALCULATED BY J-rK DATE��9�P7 CHECKED BY DATE SCALE ' //� 30' ISSUE DATE: 02-19-87 COND T IONAL CERTIFICATE OF OCCUPANCY Municipality of Anchorage BUILDING SAFETY DIVISION 3500 East Tudor Road CERTIFICATE EXPIRES: 06-30-87 This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code certifying that at the time of issuance this structure, or portion thereof, was in compliance with the various ordinances of the Municipality regulating building construction or use, for the following: Building Permit No. 84-3183 Lot: 4 Blk: 1 Subdivision: Great Dane Sub _ Site Address: 11011 Cread Dane Circle Owner: R. Bradley Jordon Street Address:1101 1 Great Dane CircZ)4ty. Anchorage State _Alaska FINAL STR: 02-19-87 BY Ruhl FINAL MECH: 05-21-86 ✓ BY FINAL ELECOI E1 BY Tatum FINAL FIRE: N/A BY FINAL PLBG:08-04-86 ✓ BY Comeau FINAL ZONE: N A BY ME Comeau This Conditional Certificate of Occupancy has been issued pending completion of Ihefollowing items by the dates indicated: 1. Approved for Conditional C.O. pending completion of Final Crade by 06-30-87. By acceptance of this Conditional Certificate of Occupancy, I agree to comply with and complete the conditions listed hereon by the date indicated. Signature of Builder PREPARED BY: O., "L.. , , 01) Nat London AUTHORIZED OFFICI