Loading...
HomeMy WebLinkAboutDENALI HEIGHTS LT 1benali Heights Lot 1 #068-031-01 MUNICIPALITY OF ANCHORAGE -- DE. ,TMENT OF HEALTH AND HUMAN SER' .S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name CZr1 DISTANCES `Sc -Et (1 TO SEPTIC ABSORPTION Address '? FROM TANK FIELD WELL 5 9Z8S Phones) Permit No. No of Bedrooms WELL 100 + 1t /+ �'V 6 94 S-797 8 -0696 3 W,(. ' LEGAL DESCRIPTION LOT LINE 2-6 5 A 50 I —I - Lot 1 Block Subdivision t , iN zl -, HF x441-1- FOUNDATION 10 /4_ 2.54.' 40 r 4' Township, Range, Section AS -BUILT DIAGRAM (Show location of well, driveway, water bodies, etc.) septic system, property lines, foundation, TANKS SEPTIC • HOLDING Manuracturer Capacity in gallons ArNc_I,or25e 16o d Material No_ of Compartments ' Z -_ TYPE OF SYSTEM r Sc... Van+, L FRENCH ❑ BED • W. DRAIN ■ OTHER Depth to pipe bottom from original grade Total depth from original grade ..• . ' L'a •�Q� 54,-. FT T 14- FT -I•,ri. , Fill added above ongnal grade Gravel depth beneath pipe fr FT `r) FT 1.041.1 - Gravel length 3S FT Gravel width 301/ FT Total absorption area —74::27 Distance between lines e 4�r, SQ FT 1•f A FT Number of lines Soil rating Pipe material `5 SQ FT D 3034 Installer De C2t)-".$4- Date Installed c:- 8 WELLS ®' PRIVATE ■ OTHER (Identify) pppr Classification (A,B,C) Total Depth Cased to 73 FT -73 FT Installer 6e4,2_,5..il€ l/va i 1„1 Date Installed. 0 ce > ''e ts REMARKS: N ev.) Seas-herr I n S -6. Ned ed t r a c rc2ree a' . `. , 1 - va f (%k ",,�, l \S4 . i �{"e.,c l f nS.61 Scale: '�� � I too +� Inspeceooais P Ormed by. ` EN�d1NEER ° S SLAC it f f '"� `Z:1-6"4"4-6:.14.0 C IZ I 410 5% -1-1,1"e � CA par %IN/ Date I Car vin -1; %a < _ certify that thiiss-inspection was performed according to all r124.5., Municipal and State guidel� in effectt on I 07- QL�36� /9g `� Health Department Approval: )-1.-, Date 1 6 72-013 (3, 85) P'111_11 POLL C2: TO' d�K_I F- 44 N C21E1 C1 EN: 44 C3 IF- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 850690 DATE ISSUED: 10/22/85 APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: SUBDIVISION'�. `~ � SECTION: 3��'' '�VS�IP: 14N LOT SIZE: 2.5A (SQ.FT. OR ACRES) MAX BEDROOMS: 3 LEE: 11.4 LEE: L_._ ���1:4:4". P1 1:� CARL DISOTEL SR 192A MYRTLE DRIVE EAGLE RIVER, AK 99577 694-5797 - RANGE: 1W BLOCK: NA Listed below are the options available to yob in designind your septic system. Choose the option that best fits your site. -IF F-CEE P4C21-1 Ei:EEIDI 4,14~ EDI FR44 1: NI DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 10.0 0.5 3.5 TOTAL DEPTH (FT.) 14.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 19.0 5.0 GRAVEL LENGTH (FT.) 23.0 36.0 49.0 GRAVEL VOLUME (CU.YDS.) 22.4 25.4 36.3 TANK SIZE (GALS) 1,000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING (SQ.FT./BR) 149 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-site sewers and wells 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 the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for 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 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (I) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED • APPLICANT: CARL DISOTEL ISSUED BY /1 • ~.�' -_____-____-+______ DATE: DATE: /c'-2-2—�� PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST CO r- / D/ s o -fie / LEGAL DESCRIPTION: Z -1 DATE PERFORMED: e SOILS LOG ❑ PERCOLATION TEST 5 -�dct3 0 r'. r4. - SITE ✓..SITE PLAN .,k( V44.4401 71) T ff ate soc Som ¢ cab b i cS .� 12". WAS GROUND WATER ENCOUNTERED? COMMENTS $'c / .S r al.41n- ism C' 4" .1-121.411/ A11146 IS PERFORMED BY: (2,0w'Ci,�.�G0•4'. 72-008 (6/79) IF YES, AT WHAT DEPTH? fi N0 s L 0 P E .47 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT • (3 6e k -o 44A 11 are /So S P-/ 25edrvo•,, CERTIFIED BY: r"Q101:4—e"o' t Lip') /ATE: S T A 5-023 LOCATION OF WELL (Please complete either la, Ib or lc.) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. Tc:711Borough S,u,bcliyi,sion .C.I...:/.. Lot Block ri.j, Ti[ 1/4 qtrs. —of—of—of — Section No. Township NE SO Range E • WO Meridian 71 DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 3. OWNER OF WELL: Address: .....,. I .c.;:o• '•,'2.,;::. 0 S. T - 1' ' ? • ' 2. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION ' '• ..... — i — Material Type : . . ft Top Bottom ., 6. I Cable tool :ID Ro ary 0 Driven 0 Dug ".r...'2V•r:: 1-i-f;)::m1,,,---i.' ; II Auger (2Jet ed 112 Bored El Other 1,..i T. USE: 0 Domestic 0 Public Supply 0 Industry 0 Irrigation 0 Recharge 0 Commerical 0 Test Well • other: 8. CASING: 0 Threaded (2 Welded diam. . In. to 1..) ft. Depth Weight lbs./ft. dlom. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: '')cr. Diameter: 41111V/C/pAt Slot/Mesh Size: Length: Opp r Op EMIJR0A., OP Set between ft. and ft. k _kVekio "MENTAZiAl. rif , RA GZ• Backfilling Gravel pack ett,Jrecr'. i I 10. STATIC WATER LEVEL: ,5 ft. . ' j.- / 9 to 46 . 4 Date R ECE/ED 0 Above or LI Below land surface Equipment used: 11. PUMPING LEVEL below land surface and YIELD ft. after . hrs. pumping . g.p.m. ft. after hrs. pumping 9.p.m. 12.GROUTING Well Grouted: • Yes n No Material: El Neat Cement 0 Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. 0 Subm. 0 Jet 0 Centrifical 0 Other 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature —___° 0 F 0 C This well was drilled under my Jurisdiction and this report is true to the best of my knowledge and belief; i Registered Business Name Contract License Number , ...- Signed: - ... `..,''.. '',-,.'. ' '- - , Date: " ' . • , ,.. Authorized Representative ' ... Form 02- WWR (11/81) Copy Distribution: WHITE- State DGGS, PINK -Driller, CANARY- Customer 'ON 10301 SOSn OWNER OF LAND (hrtifiri riLLtng ung by /4\/> /1 DOC Co. dba f( ) l�i l SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 L..) ADDRESS '�� ,/'`r1 -. Ill `Uj -� LEGAL DESCRIPTION cY > l ' ;"*71L 1 ti' , ! 3 DATE - Started Ended ///`'f--' / n PERMIT NUMBER _ _ 1'St\ 2 c'\/.-0)(.----) DEPTH OF WELL r'. _.5 ( <,4 STATIC LEVEL OF WATER FT DRAW DOWN FT GALS. PER HR KIND OF CASING KIND OF FORMATION: From % Ft to Ft — `�'1°v �� ''~ v From Ft to Ft From Ft to LL! ,r' Ft. ,r'i` ,..fir` , `� N..,°` L`' 4..„rom Ft. to Ft. From I Ft to :' Ft. t- `< , 'a` �. ro_Fm Ft. to Ft From -} Ft. to 741 Ft i / °' h i Ot,)t- " Z rom Ft. to Ft, From 74 Ft to/ L� Ft /`71/f4:.i1)r j'`�1'" From, Ft to Ft _-' f �' - - 1 .J C_..' From 1 / .i.,, Ft. to 1 ..i Ft. J' -;,,,) K ti a+"t-- From Ft. to Ft. From_ -' ,) Ft. to ' `�• Ft. /...4 % ; '? { From Ft. to Ft. _ w,. _) From ! 3 Ft. to / t Ft. _'a �`f`'� o (..:.-•,,,4 L"-=� i' � {from Ft. to Ft. From Ft. to Ft. it' \ -').'4 T 1:5- }.2, 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 Ft From Ft to Ft From Ft to� F From Ft to Ft From RtE1C E r `���F D From Ft. to Ft. From Ftitgc 4443616 From Ft. to Ft. From Ft. to f ��,g p Municipality o an Services From Ft to Ft From pptdalth & Hui MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950183 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:WINDOUS LANCE KIM OWNER ADDRESS:9826 HILAND ROAD EAGLE RIVER, ALASKA 99577 PARCEL ID:06803101 LEGAL DESCRIPTION: DENALI HEIGHTS LT 1 LOT SIZE: 127282 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/01/95 EXPIRATION DATE: 8/01/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ISSUED BY: DATE: '499+ cc' DATE : 6 Prop hereby certify that a survey of Lot_ l_, Block_ • c2 ra•zI, VI ('.t...) Ole rq\ Subdivision was made on Nov $S and CASE S 8043 -Submii+eci Ge Fast 411i►,q .o -es) 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 property lying 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. It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines. Dated at Anchorage, Alaska, this • CONSTRUCTING ENGIN' ERS, INC. 9601 Buddy Werner Dr. Anchorage, Alaska 346.2000 694.9098 I 622 day of _Nick) *.do-l t pir°• -� r���tra � •� g..4%••••••mtm••••Iptics t40,30824 :A5"tri 0 ttrA gc AS BUILT SURVEY SCALE I".100' RI -8 boo Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Ke 1SJt✓-e— COSA # COSA# O5C ft<�[75 Parcel I.D. 068-031-01 1. GENERAL INFORMATION Complete legal description Denali Heights Lots. Expiration Date: - Location (site address) /728 Cottongrass Road, Eagle River, AK 90577 Current Property owner(s) Lance Windous & Elisabeth Mitten Day phone Mailing address Same Lending agency Day phone Mailing address Real Estate Agent Eva Loken Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217. Anchorage. AK gg510 Engineer's Printed Name Steven R. Pannone, P.E. Phone 272-8218 Date 1/24./12 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. .,,���„1 The operational life of all wells and septic systems depend on the local soil condition, ground water O� QF q* *.*�� levels that may fluctuate during the year, and the water usage of the family being served by the system. 4���Q- .................. ^ These conditions are outside the control of the evaluator of this system. All systems eventually fail and O 7 `1.- satisfactory test results do not guarantee future performance of the system, nor do they guarantee that C 4 a 49 rH /\ there are no hidden defects or encroachments. PES can therefore not provide any warranty for future „„ir, uslIP itiZia d • performance nor give any estimate of how long the system will continue to meet the operational•'S, \�„ t„��IIII---„� requirements of the MOA DSD. Thecontentof this report is for the sole benefit of the owner listed ��'ssteven R. Pannonei r. above. Any reliance upon or use of this report by any other person or party is not authorized nor will it I. 111 No. CE 8149 G\ a, F%O confer any legal right whatsoever. ..1%.> ,,..•'` � 5. DSD SIGNATURE % . ss�G�`::•' V Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 1 1t By: (Rev. 11105) Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory l/ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 1 — a -/.2._ • Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Denali Heights Lot 1 A. WELL DATA Well type P Parcel ID: o68-ou-o1 If A, B, or C provide PWSID # Well Log (Y/N) Y/Y Date completed a/1/•5/10/25/84 Sanitary seal (Y/N) yff Wires properly protected (Y/N) Y/Y Total depth 154/73 ft. Cased to 154173 ft. Casing height (above ground) 12+112+ in. FROM WELL LOG AT INSPECTION Date of test 9/1/n5 / 1o/25/85 5/3/11 / 6/1111 Static water level54165 ft. 78 / 83 ft. Well production yo I2 g.p.m. 5.4/1.5 g.p.m. WATER SAMPLE RESULTS: Coliform Neq colonies/100 mL Nitrate o.1a4 mg/L Arsenic: ND ug/I Date of sample:../3J-• ; Collected by: Dan Moran B. SEPTIC/HOLDING TANK DATA 1fro iZ Tank Type/Material Anchorage Tank Steel Date installed 10/30/1986 Tank size woo gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 4/17/2o11 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 10/30/1986 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type Deep Trench Length /5 ft. Width 2.5 ft. Gravel below pipe 10 Total depth 10.24 ft. Eff. absorption area 70o ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/3/2o11 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test fig in. Water added45o gal. New depth86 in. Elapsed Time: 1440 min. Final fluid depth fig in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date ft. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot too+ On adjacent lots Absorption field on lot too+ On adjacent lots Public sewer main N/A Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? too+ too+ Public sewer manhole/cleanout N/A Sewer /septic service line 25+ Holding tank Animal containment areas too+ too+ Manure/animal excrete storage areas too+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation to+ Property line to+ Water main N/A Water service line as+ Wells on adjacent lots too+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line to+ Building foundation to+ Water Service line 25+ Curtain drain None Known F. COMMENTS Re -Certification Absorption field q+ Surface water too+ Water main N/A Surface water too+ Driveway, parking/vehicle storage to+ Wells on adjacent lots too+ 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. P.E. Date h 2 - I C� Steven R. Pannone �j-`u� Vs) No. CE 8149 .. -, �I In r •�SSIC�• COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) • Waiver Fee $ Date of Payment Receipt Number SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1120126001 Pannone Eng. Srv. Denali Heights Lot 1 Denali Heights Lot 1 Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 01/23/2012 15:49 01/11/2012 10:00 01/11/2012 10:50 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform 0.334 0.100 mg/L SM20 4500NO3-F 11 (<10) Negative Negative 1 100mL SM20 9223B A 01/13/12 CMA 01/11/12 DLC 100mL SM20 9223B A 01/11/12 DLC Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 068-031-01 1. GENERAL INFORMATION COSA# C'5' 1\1 ✓ Expiration Date: 9 -- I i Complete legal description Denali Heights Lot 1 Location (site address) 3728 Cottongrass Road, Eagle River, AK 98577 Current Property owner(s) Lance Windous & Elisabeth Mitten Day phone Mailing address Same Lending agency Day phone Mailing address Real Estate Agent Eva Loken Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF lEDROOMS: 1. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval - are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 100217, Anchorage, AK gg510 Engineer's Printed Name Steven R. Pannone, P.E. Date 5/25/11 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accor`dante with MOA DSD i uidelines & Regulations. The reported results describe the performance of the system under the conditions encbunMer'ed at the tirrie 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. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. 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 nor will it confer any legal right whatsoever. 5. DSD SIGNATURE By: V Approved for 3 Disapproved. Conditional approval for bedrooms. OF 44 4. •• • •j ;Steven R, annone; .0 • No. CE 8149 ° �i • bedrooms, with the following stipulations: ,• A0 l OF (Iii I�I,- \`4 .•'' '•• "Ori = ON-SITE .0 WATER AND • � r� WASTEWATER PROGRAM JJ' • •MSp1�V Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11 /05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Denali Heights Lot]. A. WELL DATA Parcel I D:068-031-01 Well type P If A, B, or C provide PWSID # Well Log (Y/N) Y/y Date completed 9/1/1994/10/25/sanitary seal (Y/N) Y 1 ' Wires properly protected (Y/N) Y/y Total depth 154 ftt Cased to ss4 ft./73 Casing height (above ground) 12+ in.//Zt FROM WELL LOG AT INSPECTION Date of test 9/1/1995 /io125/f 5/3/20121 4(%oi) Static water level 54/6 ft. 78 h3 ft. Well production 4o/2-- g.p.m. 5.4 / WATER SAMPLE RESULTS: Coliform NEI,— colonies/100 mL Nitrate O,3gl mg/L Arsenic: IVC) ug/I Date of sample: 5/3/2011 Collected by: Dan Moran B. SEPTIC/HOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Date installed 10/30/1986 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 5/17/2011 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 10/30/1986 Soil rating (g.p.d./ft2 or ft2/bdrm) ico System type Deep Trench Length 1,5 ft. Width 2.5 ft. Gravel below pipe 10 ft. Total depth 10.25 ft. Eff. absorption area 700 ftZ Monitoring tube Y Depression over field N Date of adequacy test 5/3/2011 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 69 in. Water added/A° gal. New depth86 in. Elapsed Time: 3.44.0 min. Final fluid depth A9 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 "Pump on" level at in. "Pump off level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main N/A Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout N/A Holding tank 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Water main N/A Water service line 25+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 25+ Curtain drain None Known Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main N/A Surface water 100+ Driveway, parking/vehicle storage 10+ 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. Engineers Printed Name Steven R. Pannone. P.E. Date l/®62� COSA Fee $ X90 Date of Payment Receipt Number (Rev. 11/05) o (2© At • 44.71.7_ J- •.: 0 o:Steven R. Pannone i 01% No. CE 8149 : ,, i . .••° • E ...... c g TH SS\ Waiver Fee $ Date of Payment Receipt Number SGS SGS Ref.# Client Name Project Name/# Client Sample ID Matrix PW SID 1111677001 Pannone Eng. Srv. Denali Heights Lot 1 Denali Heights Lot 1 Drinking Water 0 Printed Date/Time Collected Date/Time Received Date/Time Technical Director 05/13/2011 8:11 05/03/2011 17:00 05/04/2011 8:58 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date ]nit Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform ND 5.00 ug/L EP200.8 C (<10) 05/05/11 05/09/11 NRB 0.391 0.100 mg/L SM20 4500NO3-F B (<10) 05/04/11 AYC Negative 1 100mL SM20 9223B A 05/04/11 SDP Negative 1 100mL SM20 9223B A 05/04/11 SDP AS BU I LT SEWARD & ASSOCIATES ND SEJRVEY 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RE;TRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT, UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR cousrRucrtoN OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE // DATE - RID: FB: /*- DRAWN: F / k•-• . • • • • , • • • cC . • • .4 - *C") 7 M m.iird ; # - ;WA 8 y • 4, JRs Pumping PO Box 773415 Eagle River, AK 99577 (907) 694-6454 Invoice Number: 33364 Date: 20 -May -2011 P.O. Number: Job Description: 1000g BILL TO: 2626 Pannone Engineering Po Box 100217 Anchorage, AK 99510-0217 Order Num 33364 Serviced 17 -May -2011 Manifest JOB SITE Dan 3728 Cottongrass Drive Eagle River, AK 99577 Quantity ServiceType Amount Tax Extension 1 Septic Sery 1000K $270.00 No $270.00 Taxable Amount Tax Rate Tax Description $0.00 0 $0.00 Payment Terms Net 30 Payment Adjustment Late Charge $0.00 $0.00 $0.00 Subtotal NonTaxed: Subtotal Taxable: Subtotal Tax: $270.00 $0.00 $0.00 P @ease Pay: $270.00 Last Sery *06/08/2010* 1000g SERV - BILL Pumped & Cked Tank had a lot of solids - Rec repump- 45-60 days back flushed 4 X's - Stand pipe For your added convenience we accept; Dicover, Visa and Master Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS. $30.00 For NSF Checks Returned. From: To: Please detach here and return the bottom portion with your payment. Pannone Engineering Po Box 100217 Anchorage, AK 99510-0217 JRs Pumping PO Box 773415 Eagle River, AK 99577 Order No. Invoice No. Date 43:4-o mt Du 33364 33364 20 -May -2011 $270.00 . !, MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Application Date 1--20-g 1. General Information (a) Legal Description (include lot, block, subdivision, section, township, range) L -Der, ( Location (addre s or directions) (b) Applicants Name C•r1 `rtj) ktA Applicants Address -RD B15?, sesess Telephone - Home '7Busines8 (c) Applicant is (check one) Lending Institution Buyer ; Other ((explain); (d) Lending Institution Address Owner/builder Telephone (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: GIncl r exa,e. L&J Up \`I 2. Type of Residence Single -Family 7-1 Multi -Family+ 1 Other (describe) Number of Bedrooms '? 3. Water Supply - Individual Well Community Public 11 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 Onsite Public Community Holding Tank 1 f 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] 5. Engineering Firm Providing Inspections, Tests, File Search, Data 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 regula- tions in effect on the date of this inspection. Name of Address Date t 1- 10- pIL 6. DHEP Approval ApproveefOlr'+yh!' 69bedrooms Approved Disap Terms of 'Conditional Approval , Telephone 346-24:00 4- 99SK .*SI yoaa•om•y•r • or (ENGINE E,. SEAL }o. 7;7 ; ��s °�i ��.,, Jugs 22, 1468 .•'l��o By J ` Q '7`'%�-� Date - oved Condit c4na1 CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA .-� MtaNrCrPgLr}'V Of ENVIRONMENTAL. R TM Ch'AGF MUNICIPALITY OF ANCHORAGE (MOA) �''J CTrON HEALTH AUTHORITY APPROVAL (HAA) 0 CHECKLIST - FEBRUARY 1984 ivF C R�C� r,at Legal Description: IDin{$ i Well Classification Pti..)ak If A, B, cr C, D.E.C. Approved(Y/N) ' A Well Log Present (Y/N) >1 Date Completed dam+ )6)198.5 Yield 5 Pn-- Total Depth -7:3 Cased to 73 Depth of Grouting Static Water Level W. Pump Set At ? 1' Casing Height Above Ground Zr Electrical Wiring in Conduit (Y/N) Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N)Nj Separation. Distances from Well: To Septic/Holding Tank on Lot IcX)r+ ; On Adjoining Lots IC) 'f - To Nearest Edge of Absorption Field on Lot 1:&-f- ; On Adjoining Lots )(D0/ -t To Nearest Public Sewer Lire N To Nearest Public Sewer Cleanout/Manhole N ( To Nearest Sewer Service Line on Lot J C ''1' Water Sample Collected By CSTS , x,, c ,uei I cidW Date H I (0- 86 Water Sample Test Results "pAs,sEilD Comments N&) (AJ) fiz1LW) UN) erPgkNAII BS- c:.90 B. SEPTIC/HOLDING TANK DATA Date Installed (5c)k-FY; Size {coo No. of Compartments Standpipes (Y/N) j1 Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) IQ Date Last Pumped tves.)J Pumping/Maintenance Contract on File (Y/N)Nf1 ; for Holding Tank High -Water Alarm (Y/N) NA Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Wa11 k0044- To Building Foundation ZS To Property Line 31 To Water Main/Service Line -`r Course iv l]r To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments KJes.,o s�s ., } 11exA v,n &e.r tint 4.- - 0690 Receipt # 1 D' -V 1 Date Paid: Amount: toa [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 150 5-(/,}, ra)..-Type of System Design Date Installed iv- Z4-8 j Length of Field Width of Field 3di Depth of Field Square Feet of Absorption Area 7C, tQ' Gravel Bed Thickness id -70D0 Standpipes Present (Y/NY Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test New Separation Distance from Absorption Field: To Water -Supply Wb 11 I ck) 4+ To Property Line z To Building Foundation S To Existing or Abandoned System cn Lot N A ; On Adjoining Lots bap /'F To Water Main/Service Line! To Cutbank(if present) Nfj To Stream/Pond/Lake/or Major Drainage Course 1\14\ To Driveway, Parking Area, or Vehicle Storage Area -1S1-4- Comments S'+ Comments N S�S- �►rr, t Y\S i� �� Qr m, B D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for N , Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Electrical Codes(Y/N) Comments Pumping Cycles during Adequacy Test. Meets MOA ** ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Gy,l ► $ Z effect on the date of this inspection. - :44 �. , %1. Signed Q Date 1- I2 ; Company5) KB1/d5/s [Page 2 of 2] ,-t42.(zis%r. c_ MOA No. Si 8q -o 7-3 2-15-84