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HomeMy WebLinkAboutJEWEL LAKE SHORE LT 2Shore Lot 2 #011-213-66 Cot, 11 1912.-55p Anchorarga VVei; & Pump Ser ct)72430742 p.2 ' M i�. ?f;� sir; 47CQ ��fTiCr� �?ord - _ • :- .1 v, P.C.;C. nr; lc.iS5 Mork Begioh :-Inc; oriage. AK 45.50 "'feva' prn,c`n�ra nra ens ;> Pump Installation Log ----Well-Drilling Fei srsit rb�rrt�ser; '�«'--- Bate of Issue: Parcel Ildentificatiou ',Nunifoer: d 1 -2 1 3 -- Legal-Property"-Ov-aer-ijName&-Address: Pump Installation Date- • { i ,/ %- ver Lel Pump Intake Depth Below TOP of Welt C.asing:i`�� feet Pomp Manufacturer's Name r' -- " Pump Model: I v 1 � Pump Size `?' j -_hp Pitless Adnpter Burial Depth: `7 fees Pitless t dapster ?�larufasturer's �:elne: � � � /11 Pitless Adapter Ir_stxiHer: ))'ell Disinfected L'Pon C:ocupleii R� —; ' des %J :40 Method of Disinfection: F•') n j � Comments: i &V L Fume Installer Name: i r Attention: The pump Inst shall pro,,Jde a bump installation Jog to the DSD within 30 days of pMflp uistal''ation. Permit Number: Tax Code Number: Work Type: Permit Effective Dates: Design Engineer: Subdivision: Site Legal Address: Owner/Address: Site Mailing Address: On-Site Wastewater Disposal System Permit OSP161021 01121366000 Septic 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 Upgrade February 17, 2016 to February 16, 2017 PANNONE ENGINEERING SERVICE JEWEL LAKE SHORE JEWEL LAKE SHORE LT 2 G:2325 RISCH GENEVIEVE 8945 EMERALD DR ANCHORAGE AK 995020000 8933 EMERALD DR, Anchorage Lot Size in Sq Ft: Total Bedrooms: eparttnent 47806 4 This permit is for the construction of: Y 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 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 Development Services Division On-Site Water & Wastewater Program Phone: 907-343-79'04 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-213-66 Property owner(s) Genevieve Risch Mailing add[ess 8945 Emerald Drive, Anchorage, AK 99502 Day phone Site address 8933 Emerald Drive, Anchorage, AK_99502 Legal description (Sub'd., Block & Lot) JEWEL LAKE SHORE L2 Legal description (Township, Range & Section) Lot Size 46,459 .Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: ([~ all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] APPLICATION IS AN: Initial [] Upgrade [] Renewal [] TYPE OF DWELLING: Single Family (SF) [] (w/we ADU) Duplex (D) [] Multiple Dwellings [] (SF and/or D) 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. (Signature of property owner or authorized agent) Permit/Rush Fees: ,~"~,~ ," Date of Payment: ~/~/I ~, Receipt Number: 0 ~(¢~ Permit NO. O/'~j¢! i Waiver FeeS: Date of Payment: Receipt Number: Waiver Ne. Permit App_L'- :.: 2.CC ~' Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve~., panengak.com Subject: JEWEL LAKE SHORE LT 2 Septic System Upgrade Permit Request Design Narrative 12 February 2016 This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed system will serve an existing four-bedroom (4) house. Currently the lot is developed. This lot and the surrounding lots are served by private wells. The well on this lot and the surrounding wells are over 100' from the septic system. ~.. Soils. Three test holes were performed on this lot by PES in January of 2016, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 14.0' below the surface in the test hole monitor tube in test hole one, 11.0' below the surface in the test hole monitor tube in test hole two and 15.0' below the surface in the test hole monitor tube in test hole three after the 7-day monitoring period. Bedrock was'not encountered in the test hole. Based on the results of the percolation tests, overall soils appearance and the selection of the proposed drain field; an application rate of 1.0 gallons/day/square feet was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The overall existing topography for Lot 2 and the surrounding area consists of gently rolling hills to the west of the property and changes to a gentle slope running from the west by northwest direction to the east by southeast direction. The slope then increases sharply as it approaches the edge of Jewel Lake (approximately 50' from the water's edge). The slope in the area surroonding the septic system is at approximately 2-5% in all directions immediately surrounding the proposed drain field. There is a slight change in slope in the area eas~ of the proposed field possibly due to grading of the area prior to construction of the house where the slope changes to approximately 15-20% and then returns to a 2-5% slope until the sharp change in slope to the lake's edge. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. 5. Drawin§ Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. · The proposed installation will not affect the futu re development of this or the surrounding Iot-s. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 h ~ I~ ~ ~ ~ / ~TANK W/ FCO AT 8LDG x/' ~ [, %~ ~8 ' ~: a / / '& 4" RIGID I~SULATION 860S?O.SE.D., 4.0T.D,; (SEE ~ETAILS) ~ ~ ~' / / /~/ / ~ ~ ~ / ~ II - 1.~ ~ ~ w/o.1~ ~,~E~ ,o~s / ~ ~x / ~A~',O~D~ 18" O.C. W/ MT IN 4 CO~NERS AND IN / ~~F'~ ~'55E [ CENTER OF FIELD a 2.0 SAND FILTER y / /~.., ' ~'~ ........ I , / ~ SX ~ / WELL (E)~- / ~/~ ' ,' / ',' z ' '-~/~ ~ : ' ',~ ~ ~ ~N / ,' _~ /~ ~ I ./ / · / . ~ / / e ~/~x ,/ /I I ~1 I/~ ,' S-,'~7 I : I · . FOR CONSTRUCHON P,O. BOX 102954 ANCHOEASE, AK 99510 o2/~a/~6 PHONE (907) 272-8218 FAX (907) 272-8211~ Sc~e j' :" = 50' :.1,~. NO JEWEL LAKE SHORE LT 2 o~1-2~3-8. O N V, W 8933 EMERALD DRIVE osP161o21 SITE PLAN ANCHORAGE, AK 99502'~~ ISheet 1 OF6 1.25"¢ PIPE W/ 0.~25" 71.2 DETAIL 1.25"¢ PiPE W/ -- SECTION ~ DRAIN ROCK 6" ~ ~ PiP[ INV ~ / / FILTER FABRIC EL 106 0 0~ ~ ,NSULATION ~ '~ 1500g S.T.E.P. DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM TANK PROFILE NO. BEDROOM: 4(600 gpd) TAN~ SIZE: 1500g STEP PERC RATE: <1 MPI AD~NEVIATIONS SO~L RATING: 0.7 GPD/SF TH TEST HOLE AREA RQD: 857.14 SF (P) PROPOSED SYS. ~PE: BED 0.5'ED MIN SIZE: 57.1LFxlS.0'W (E) EXISTING WATER L/NE / CO CLaN OUT NO. WELL RADIUB USE: MT MONITOR TUBE NO. 860SFx0.5' E.D. (SEE D~AILS), 4.0' TD ~P ~PICAL NEW SEPTIC TOTAL AR~: 860 SF Fo8 co~smuc~o~ P.O. 80X 102054 ~CSO~G[, ~ 0¢510 ~,0~[ {~07) 272-8218 [~X (~07) 272-8211 JEWEE LAKE SHORE LT 2 ~11--213-66 GENEVIEVE RISCH ~~--~j PERMIT NO. DRAWN ~ JRL 8955 EMERALD DRIVE ' OSPlSlOm PROFILE / SECTION · ANCHORAGE, AK 99502 4 6 7 8 9 TEST HOLE OR TOPSOIL Brown Silty SP SAND & 2 GRAVEL 3 SM ; Sflty SAND BOH DATE PERFORMED: llJAN16 SOILS LOG - PERCOLATION TEST SLOPE TEST HOLE WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -0-' DEPTH TO WATER AFTER MONITORING? - DRY - DATE: 18JAN2016 SLOPE TH 1 WATER RATE REABING DATE CLOCK NET TIME LEVEL NET DROP (MPI) ~ME READING 1 llJAN16 1105 6.268" 2 1135 30 MIN 7.130" 0,862" 3¢.8" 3 1156 6.268" 4 1206 30 MIN 6,880" 0,612~ 49.02" 5 1207 6.268" .6 ~237 30 MIN 6,875" 0.607" ¢9.42" SOIL TEST RESULTS/ANALYSIS · PERCOLATION RATE 49 (rain/inch) (Hydrologic Soils Group: HSG A) · PERC HOLE DIAMETER 6" · TEST RUN BETWEEN 6FTANDT'FT. · TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. COMMENTS: Test hole excavated by A+ HOME SERVICES. Test Hole was presoaked before Perc test. PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: FOR CONSTRUCTION DRAWN I JRL SOILS LO(;; PAN-NONE ENG SVC, ! JC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 JEWEL LAKE SHORE LT 2 GENEVIEVE RISCH 8955 EMERALD DRIVE ANCHORAGE, AK 99502 Date 02/11/16 Scale NTS P.I.D. NO ----Off"i~-215- 66 PERMIT NO. OSP161021 Sheet 3 OF6 SOILS LOG - PERCOLATION TEST TEST HOLE 2 5 ', TEST 7 HOLE GP LOOSE SILTY 2 8 SANDY GRAVEL 9 DATE PERFORMED: 18JAN16 F SLOPE WAS GROUND WATER ENCOUNTERED? N TH 2 IF YES, AT WHAT DEPTH? -0-' DEPTH TO WATER AFTER MONITORING? - DRY - DATE: 26JAN16 i WATER SOIL TEST RESULTS/ANALYSES READING DAI~ CLOCK NET RME LEVEL NET DROP RATE ' TIME (MPI) i · PERCOLATION RATE <t (rain/inch) READING (Hydrologic Soils Group: HSG A) 1 18JAN16 1150 6.268" · PERC HOLE DIAMETER 6" 2 1151 < 1MIN DRY 6,286" < 1.0 · TEST RUN BETWEEN 4FTANDSFT. 5 1152 6.268" · TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. COMMENTS: Test hole excavated by A+ HOME SERVICES. Test Hole was presoaked before Perc test. PERFORMED BY: Joseph Lawendowski. 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 ] 24G SVC, 1,I ] FOR CONSTRUCTION P.O, BOX 102954 ANCHORAGE, AK 99510 o2/11/16 PHONE (907) 272-8218 FAX (907) 272-8211 Sca~e , NTS PJ.D, NO JEWEL [~AKE SHORE LT 2 o11-215-66 DRAWN I JRL GENEVIEVE RISCH ~..~e~L~nn~~ PERMIT NO, 89~5 EMERALD DRIVE~ 0SP161021 SOILS LOG ANCHORAGE, AK 99502 Sheet ~OF6 WATER RATE READING DAI~ CLOCK NET lIME LEVEL NET DROP TIME READING 1 18dAN16 1150 5.268" TEST HOLE OR TOPSOIL SILTY 2 CP/SP SANDY GRAVEL 5 5 6 7 GP LOOSE SILTY 8 SANDY GRAVEL 9 10 12 15 BOH DATE PERFORMED: 11JAN16 SOILS LOG - PERCOLATION TEST TEST ~ ~ HOLE WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -0-' DEPTH TO WATER AFTER MONITORING? - DRY DATE: 18JAN16 SLOPE TH 5 CLOCK WATER RATE READING DATE TIME NET TIME LEVEL NET DROP (MPI} READING 1 11JAN16 1245 6.268" SOIL TES~ RESULTS/ANALYSIS · PERCOLATION RATE <1 (minlinch) (Hydrologic Soils Group: HSG A) · PERC HOLE DIAMETER 6" · TEST RUN BETWEEN 4FTANDSFT. · TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. COMMENTS: Test hole excavated by A+ HOME SERVICES. Test Hole was presoaked before Perc test, PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS T'EST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: FOR CONSTRUCTION DRAWN I JRL SOILS LOG PAN-NONE ENO SVC, f JC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 JEWEL LAKE SHORE LT 2 GENEVIEVE RISCH 8955 EMERALD DRIVE ANCHORAGE, AK 99502 ate 6 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (blASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: INSTALL NEW 1500g STEP TANK, AND SOIL ABSORPTION SYSTEM. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 11 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TES¥ HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN I 1 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 50 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE A~rACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 2z~ HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER, 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND sSITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS TO THE ENGINEER. THE RED-LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE Bo]roM OF EXCAVATION, TOP OF PIPE WITH CLEAN-OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS-BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: DATE: NOTES: FOR CONSTRUC~ON DRAWN I JRL DESIGN NOTES PANNONE SVC, I I'D°'"o2×-×16 P.O. B0X 102954 ANCHORAGE, AK 99510 I ~ .... ~, PSc~le PHONE (~ 272-8~8 FAX (907)272-8211 ;~~~ NO NTS 011-213-66 JEWEL LAKE SHORE LT 2 ~~~=.gD. GENEVIEVE RISCH I% ~~2"~=ERBIT NO. 8955 EMERALD DRIVE ~ ~,. ~ ~%-~ L 0SP161021 ANCHORAGE, AK 99~ '~ L,h-, or HEALTH AUTHORITy MININIUM DIS'lANCES, [~IEQUIRIEMENT$ ................ ALSO CON~IDER AREA PFDM1 I _VAI ID f~NF YFAR GI~'~TER ANCHORAGE AREA BOROIZ~-~;'I D~-,,ARTMENT OF ENVIRONMENTAL nUALh r 3500 TUDOR ROAD ANCHOFIAGE, ALASKA gg507 27g-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME SEPTIC TANK: DISTANCE FROM WELl LIQUID CAPACITY MAILING ADDRESS LEGAL DESCRIPIION NUMBER OF MATERIAL "~'/"~'Z~Z~' COMPARTMENTS LIQUID GALLONS. INSIDE LENGTH. ~ INSIDE WIDiH. DEPTH SEEPAGE SYSTEM: NUMBER OF PIIS LiNiNG MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH ~ / · LENGTH_ "~-~ / ., DEPTH DISTANCE FROM WELL ~/ / ~'~Y , BUILDING FOUNDAT ON TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '~'~'~ / SQ./'u'"~'-/("/~'~/'6'~'~FT. ~TIL~IELD: WELL DISTANCE FROM ~ NUMBER OF LINES_ DISTANCE BETWEEN LINES ABSORPTION AREA SQ. FT. NEAREST LOT LINE DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH OF LINES ~ IN. TOTAL EFFECTIVE LENGTH OF EACH LINE ~ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE ~ WELL: T y p E ~.,~////.~7/Z~ DEPTH NEAREST SEPTIC LOT LINE /~/~,z_ ., SEWER LINE -- TANK DISTANCE FROM WATER , BUILDING FOUNDATION. SAMPLE NEAREST SEEPAGE / OTHER ~-~/~' , SYSTEM ~'/ , CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM APPROVED s ,01111 -- MUNICIPALITY OF ANCHORAGE Development Services Department .v Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-213-66 1. GENERAL INFORMATION Complete legal description Jewel Lake L2 Location (site address) 8933 Emerald Street Expiration Date: 2 — d b ^1 Current property owner(s) Risch Genevieve Day phone Mailing address PO Box 220512 Anchorage, AK 99522 Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ JrJ� Waiver Fee $ Date of Payment �15/ Date of Payment Receipt Number I Receipt Number COSA# �5������� 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. 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 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for q bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date /Q OZ—Z T Conditional approval for bedrooms, with the following stipulations: B Original Certificate Date: r� 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 -- COSA Checklist blue sheet SA Checklist Legal Description: Jewel Lake L2 Parcel ID: 011-213-66 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 4.4 gpm Date drilled * Water storage tank volume n/a gallons Total depth ft Well disinfected for coliform test? ❑ Yes n Nc Cased to ft ®Q Coliform bacteria is Negative n Sanitary seal is functioning correctly Nitrate ND mg/L Fffl] Nitrate less than MRL (ND) © Wires are properly protected Arsenic 104 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 29 in. Collected by PES Date of flow test for COSA 3/29/19 Date of Sample 3/29/19 Static water level at beginning of test 73.1 ft. Comments * No Well Log B. TANK DATA Age of tank(s) 3 years Tank type/material Steel Measured operating fluid level in septic tank 48 Q Standpipes/foundation cleanout per record drawing Date of pumping 4/2119 D. ABSORPTION FIELD DATA Bed Which system tested (date installed) 6/15/16 ® ALL standpipes present per record drawing Total measured depth from grade 4-8 ft (max) Measured depth to pipe invert from grade ft (min) ® N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective n Code -required soil cover over field ® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION 0 Required maintenance completed Age of lift station 3 years Lift station material Steel Comments: Adequacy test date 3/29/19 Results D Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 0 in Elapsed time 140 min Final fluid depth 0 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) n/a If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ®✓ Yes Community Sewer Manhole/Cleanout > 100' ft If absorption field is under driveway comment below ✓[] Yes if No ft (✓ Yes if No ft Neighboring Tank > 100' FV-] Yes if No ft Private Sewer/Septic Line > 25' 71 Yes if No ft Absorption Field on Lot > 100' [77 Yes if No ft Holding Tank > 100' ✓1 Yes if No ft Neighboring Absorption Fields > 100' ft Animal Containment > 50'[ ]✓ Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Fv Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' P/ Yes if No ft Community Wells > 200' ✓Q Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ®✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' R 49 THr Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓� Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100'✓71 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF ,A�4sAk l certify that l have determined through field inspections and review R 49 THr of Municipal records that the above systems are in conformance with MOA COSA in this date. : { guidelines effect on 61261C;� COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site water arta wastewater Section + `„ Fax: 343-7997 www.muni.org/onsite Certificate of On -Site Systems Approval # OSC191096 Subdivision: Jewel Lake Shores Lot 2 A water sample revealed an arsenic concentration of 104 micrograms per liter (ug/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. 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Phone in completed iso HPur�p 9 Sludge level �nches -pumping'. required y�9 o ,�1'r A© i c� t'!� Effluent filter craned •Pump basket cleaned •Proper float settimgs:,canfirmed .Control floats cleaned 00peration satisfactory � A i—Sy Q Audible and visual alarm ins►de dwelling fir_ - x •pedicated electrical alarm circuit 's t r� -Alarm system operation i hole functional. n`? water intrusion at riser to tank:r�ontxection -tAleep �--. .Ground e enetration§ es Properly Secured�� Ground water intrusion around►iP l' insulated - .Manhole lid: Funaftnal 09),Q 9 and maintenance completer) -All manufacturer required inspections ••- - Technician P Company Signature - Date of maintenance-'�