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HomeMy WebLinkAboutHIGGINS ESTATES LT 1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page I of_,.~__ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: "~__~ ~l~ ~ ~A~I ~ Wastewater System: ~New ~ Upgrade ~~. ABSORPTION FIELD Phone: No. of Bedrooms: ~ ~q~-~ 1~ ~ ' ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: To[a[/~ / Z .~Depth from original grade: Lot: ~ Block: SubdivBion: ,~ I Depth to pipe botto, from original grade: Gravel ~epth beneat~ pipe. Township: Range: Section: Fill added above original grade: Gravel length: Gravel width: Number of lines: Distance between lines: WELL: ~New ~ Upgrade 2~ ~'c~ Ft. ~ Z~)Z ZO ~> Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump Set at: Casing H~ Above Ground: ~O~0~, K ~O GPM / ~[ ~ Ft. Ft. SEPARATION DISTANCES ~s~pti~ u Holding U S.T,E.P. TO Septic Absorption Lift Holding ~ublig/Privote Manufacturer: Capacity in gallons: From Tank ~ Field ~ Station Tank Sewer Lines ~ ~ tq~ Material: Number of Compa~ments: Sudace W,t~r '¢=~ ~ LIFT STATION CudainDrain ~¢¢~ , ¢¢* i ~~1 Electrical Inspections performed by: BENCH MARK Location and Description: Assumed Elevation: Inspections performed by: ~.V~m~/~,~ Dates: 1st ?J~le~ -,,- ........................ Department of Heal~ and H, uman ~s a I %~¢¢..¢/~ AS-]}UILT WASTEWATER ABSORPTION SYSTEM LOT 1, HIGGINS ESTATES C~\Work\I-HIGNS,DWG ! ! / DC4 New Well e~.~2 ..... ', New 1250 Qaltom septic ~WING TIES T1 75,8 i 47,1 Ta 80,0' il 54,6' ,DV 81,7' il 7a,O' DC3 111,0' i 88,8' 'R'O0~ ........... ~J~i~~ ....... i 'g~'~- '~'T} ....... ~9;S~ ....... '" '"'ii~'~' ~b~ ~'~','~ .... ~ ~'~L'~~' t'o'o ?'. 5(~T) 151,9' i 135,3' ~C4 ~ la0,0' i 9'~" ' ..... i'a'S a~ .... ' 'i'~'a ~'~ ~(aT~...~. 144 a.f ........ !.~! 0'. ~(Ca) ~ ~57S' . !.~O'.. lO(CO) :: 148,0' ~[ 15.4,3' ll.{Mll.~ .....16~,E ...... :..~..16ai..~ m(cm mas' 775' NDTES~ WIE,~T l) Systems were construe,ted SY3TEH around actual Location oFf,est 1% pits, f:TA~T 8) Test Pit 5 w~s moml~er~ dry SYgTEM on M~y 3, 1997, .................................................................................................. 3) Test PI~ 3'~ mcml~op ~be ~ L~t ~, ~.~g~,~ E~.~, 4) Primary ~nd Reserve S~s~ems Valve (DY) was Installed ~etween the two ~ys~ems, Exist, WeLl Salt Rating = 250 s?/br 4 Bedroom House 1000 s? Rqd As-Built, 5' E?Pectlve 10,1' Total Depth 2' Wide, 100' L_onQ Total absorption =lOOO s? PREPARED FUR, Debble :Draglch 11019 Baronlk Street Anchorage, AK 99516 (907) 346-4013 PANNBNE ENG, SVC P, O, 3OX 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-8218 Fax OATE~ 5-3-97 I AS-BUILT I 20,1M]n ~oo C'\Work\!-HIGNg,DWG 38~1 ~Ol)ND~ 1~0N¥390 IODNV3q3 NOIiV~NnO~ ] I $ u ~d -~ ld ~q PREPARED FBR~ Debb~e Dr~glch 11019 Bcromik ~treet Aochop~ge, AK 99516 (907) 346-4013 PANNDNE ENG, SVC, , O, ~OX 1420~b ANCHORAGE, ALA~;KA 99514 277'~0308, 872~8218 FAX NOT TO ~ AS-3UILT ] 18:21 LOCATION OF WELL laORou~iH LOCATION/SKETCH: DEBBIE DRA~ICH aEO~IQN WELL OWNER: SrA?E O; ALA$~ DEPAI~TMENT OF NATURAL RESOURCEs DIVISION OF MINING & WATER MGMT WATER WELL, RECORD 8EOTI(~N TOW~ RANt31 3N C~ £}s ~w DE'PTH$ MEASURED FROM:'~ca$ing top ~ground .~uflace 80REHOLE DATA: Material Type anti Color Depth From To CONTRACTOR INFORMATION: WELL DEPTH:  DATE OF COMIq. ETION Depth of hole; ft DEPTH TO STATIiCc WATER LEVEL; ~ft be ow ~,~_~op of casing ~, groun(~ aurtace METHOD OF DRILLING: ~ a,r rotary '-- cable tOOl ~ other ~ UaE OF WELL: '~domes:ic ~ irngation L.~ monitor [] public supply ~ Other CA~ING STICK.I It)lam: ~' in. ~0 Casing WELL INTAKE OPENING TYPE: ~open end "~ screened [] per/orated ~ Open hole Depths of openings: ~to ft SCREF,,N TYPE: _._~____~. Diam; ~ , _ in, $1oUMesh Size: _~ Long:h: ~ GRAVEL PACK TYPE~ Volume used: __ De~th ~o top:.-- GROUT TYPE: DeDth: fFom ..... Volume: ft to DEVELOPMENT METHOD: Oure':ion: PUMPING LEVEL AND YIELD: after hr~' puol PUMP INTAKE DEPTH: ft HoriepOwer: WELL DISINFECTED UPON~LEI'ION? ~, YES REMARKS: I~ NO I © Z ~rl LO'- 89'58'1'" W 10' TELE. C0fV V. 299 49' ~EC. ¢AS2VE\7 LOT N 89'ST5Y' W 329,36' o, .z r-~ T 440 W~ST BENSON BLVD. ~ 'S'J ~ -- " ' ANCMO*AGE, A.ASKA g95C5 (907, 562-~291 LOT 1, ESTATES SUBD TDT~L P. 0~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED EOR:--~:b~-~tC;--b~ ¢* t c Fl- LEGAL DESCRIPTION: L.. (. [:-I~t~l,~t.(/tJx, ~P--'~"-(7 Township, Range, Section: 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16 17 18 19 20 SLOPE WASGROUND WATER ENCOUNTERED? S L IF YES, AT WHAT ¢ pO DEPTH? ~ E Depth to Waler After Monitoring? ~ rr....t' Dote: SITE PLAN PERCOLATION RATE ~.~L (m~nutes/~nch) PERC HOLE DIAMETER 'lEST RUN BETWEEN ~ '~__ FT AND COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop /~,'~ ~ ~ t ~/~ PERFORMED BY:~,~ .~.~ I -4.~"('~.-&~ ~'~"~.A..,U.,,O.~'~L, CERTiFY THAT/THIS/TEST WAS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~/(¢'~' 72-008 {Rev, 4/85) PERFORMED IN PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ?'17' ?~ I,'oc~/, ,~, ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960285 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:STEELE KAY H OWNER ADDRESS:501 ST. LASARIA CIRCLE ANCHORAGE, ALASKA 99508 PARCEL ID:01552124 LEGAL DESCRIPTION: T12N R3W SEC 22 LT 31 LOT SIZE: 97501 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 DATE ISSUED: 9/06/96 EXPIRATION DATE: 9/06/97 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 (iSAACS0) . 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: ~ i~..~y ISSUED BY: A_.//~/4,~// Steven R. Pannone, P.E. Consulting Engineer (907) 272-8218 August 20, 1996 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subj eot: Lot 1 Higgins Estates Well and Septic Permit Request. P.O. Box 142025 Anchorage, Alaska, 99514 (9_~07)272-8218 Fax Gentlemen: I was contacted by tile Owner of the lot described above to investigate installing a septic systetn and well on this lot. I conducted a soils investigation on August 6, 1996. The soils log and percolation data is attached. Soft silts with trace gravels were discovered under a foot of organic mat. The soil perced at twenty four minutes per inch, This rate is consistent with surrounding perc data. A primary and secondary system can be installed within the two test pits radius. The proposed system would have five feet of effective absorption area, with a total depth often feet. The system will be a double trench fifty feet long and two feet wide with three feet of cover. The trenches will be separated by ten feet. A new 1250 gallon septic tank will be installed to serve this system. The proposed well will be drilled ou the northern portion of the lot, while the septic system will be installed along the south-western portion of the lot. See attached site plm~. The lot is approximately two and a half acres in size. It slopes to the northwest at a rate of approximately one to two percent. The proposed installation will be located greater than 100 feet away from the proposed and existing wells and 25 feet fi:om the water service lines. The surrounding septic systems are located greater than 200 feet from the proposed installation. All neighboring wells are located greater than 100 feet from the proposed system. Installing this:system will not effect any surrounding systems or wells. :. If you have any questions about the proposed installation, please contact me at 272-8218 C:\WORK\I -HIONS.001 Unc~eveloped ReplaceMent ~ 1× TF FLow Splltte~ ~'~- 17, TP No well or septic within 200' o? proposed system, DESIGN WASTE~/ATER ABSORPTION SYSTEN L. DT 1, HIGGINS ESTATES No well or' septic within 200' o£ proposec~ systeM, Exist, We[L. P~oposec~ Wetl 1250 g~llon sep%Jc 'tank twin ~_. deeR-~Pench system ' .... ' No septic sys~m within 800' o¢ propose~ syste~, Exist, No welt or septic within 200' DP proposec~ sys-t;er~. No well or septic within 800' of' proposed system, C,\Work\l-HIGNS,dwg Soil Ro.'t;Ing = 250 s?/br 4 ]~edroon House 1000 s? Rq0l Design, 5' E??ect;Ive 8' Tol;o.[ Oep-th 2' Wiole, tOO' Long Tot;(~l ~bsorptlon = 1000 sP PREPARED FDR, Debble Dragich 50t S~, Laz~rla Circle Anchorage, AK 99508 (907) 338-8896 PANNONE ENG, SVC P, B, 30X 142025 ANCHORAGE, ALASKA 99514 274-0308, 272-8218 Fc~x DATE, 8-19-9G I DESIGN DESIGN DETAILS WASTEWATER ABSDRPTI[]N SYSTEM LOT 1, HIGGINS FSTATEg Z C~\Work\i-HIGNR,dWQ IHDN¥39D NDIZ¥~NDDJ u u d ~w n._l m PREPARED FURl Deblole Dragich 501 S~, Lc~z~rJa CircLe Anchor,:lge, AK 99508 (907) 338-8896 PANNONE ENd, SVC, P, 0, BBX 142025 ANCHORAGE, ALASKA 99514 27,4-0308~ 272-8218 FAX ;NBT TO SCALEI ~J~-miuIN Municipality of Anchorage DEPARTMENT OF HEALTH 8, HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFOR LEGAL DESCRIPTION: .Z,¢' q' ( /L/'{~i(I I,.4/_g ~~~'." 5 6 7 8 9 10 11 12 13- 14- 15- 16 17, 18- 19- 2O Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTER ED? ~- ~ S L IF YES, AT WHAT 0 DEPTH? ~ p E Depth Io Water Alter SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop q:qt :3 ~" PERCOLATION RATE r2r tt (m~nutes/mch) PERC HOLE DIAMETER ~_ If TEST RUN BETWEEN ~ FTAND -~ FT COMMENTS '-T--z~%'7'"t~t.(?-Lt2,~..~ '-'~t~L;.~&cPA ~ C~ , PERFORMED BY: ~.%Jt.,4P t..',Jll-l'm-4~ 1~2~.'I~_'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, ALaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 2 4 5 6 7 8 'h'LL 9 10- 11 12 13- 14- 15 16 ~ ~8 20 COMMENTS DATE Township, Range, Section: EAL) SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L iF YES, AT WHAT O DEPTH? ..... P E I]epth lo Water Alter Monitoring? '~O.."-d Dale: ~-i.~ Reading Date Gross Net Dept h,*¢ oF Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN tmmutes/mchl PERC HOLE DIAMETER __ ~ FT AND c~ . FT PERFORMED BY: ~,~-.~-~,.-/L,',.) t,J~(~'('"i"'~¢,~.,.,.,.,.,.,.~- *-~" ~- N, .~:~-~.~'~' '* ........ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; ~¢~[~;;/c~'A 72-008 (Rev. 4/85) M10 W I - N owl 'q'% ' OF ki, I IRALITY P J Development Services Department On -Site Water & Wastewater Section Parcel I.D. 015-521-45 ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Higgins Estates Lot 1 Location (site address) 11019 Baronik St. Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: - q - 21 - V Current property owner(s) Edward Goldmann & Debbie Dragich Day phone Mailing address same Real estate agent 2. TYPE OF DWELLING: Rx Single Family (w/wo ADU) R Duplex R Multiple Dwellings (Single Family and/or Duplex) 3. -NUMBER •-•• I'd I Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FiEl Private Septic RX Water Storage El Holding Tank R Community Well R Community R Public Water System R Public Sewer 1-1 Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. 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 Phone (907) 745-8200 Date 720 2� -p" OF.Al- 4�S', ACTH �r System #1 Approved for bedrooms 'Steven �. Pannone �t F• . CE 8140 ti F System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: ll By: 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. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet CSA Checklist Legal Description: Higgins Estates Lot 1 Parcel ID: 015-521-45 If more than 1 septic system on lot: COSA Checklist # 1 'of 1 Structure served by this system 1 A. WELL DATA FM� Well log is filed with Onsite (or attached) Date drilled 9/23/96 Total depth 148 ft Cased to 148 ft Fil Sanitary seal is functioning correctly PC Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9!1712020 Static water level at beginning of test 68.8 ft. Comments B. TANK DATA Age of tank(s) 24 years Tank type/material ""' Measured operating fluid level in septic tank 0_1 Standpipes/foundation cleanout per record drawing Date of pumping 9/18/20 D. ABSORPTION FIELD DATA D eQch Which system tested (date installe �o-u-Qra FR ALL standpipes present per record drawin�S Total measured depth from grade 12.0 ft (max) Measured depth to pipe invert from grade 7.0 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective ®❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Tested the East system COSA Checklist yellow sheet Well production at time of test 4.0+ gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes R No 0 Coliform bacteria is Negative Nitrate J// mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Z Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample —-V-2 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/7/2020 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0/0 in Water added 600 gal New depth 0/3 in Elapsed time 150 min Final fluid depth 0/0 in Absorption rate >600 gpd Any rejuvenation treatment (past 12 months) no 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' Fv� Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft / Yes if No Neighboring Tank > 100' F✓ Yes if No ft Private Sewer/Septic Line > 25' [Z] Yes if No Absorption Field on Lot > 100' F71 Yes if No ft Holding Tank > 100' 21 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Fv� Yes if No 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main ? 75' Yes if No ft F,/� Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [✓ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑✓ Yes if No _ _ ft Property Line > 5' Fv� Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F/ Yes if No ft Private Wells > 100' ❑✓ Yes if No. Water Main > 10' 0✓ Yes if No ft Community Wells > 200'✓0 Yes if No Water Service Line > 10' F/ 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' ✓l Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION �-ssa,�� OF. A� I certify that l have determined through field inspections and review 15e -- 9 of Municipal records that the above systems are in conformance with r� MOA COSA guidelines in effect on this date. . . . . . . . . . . . . 2t®t2C ...... Steven f1 Fannone COSA Checklist yellow sheet ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201546 Subdivision: Higgins Estates Lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. t"° --ir.^X,011140G"`.`'S"`� �:as ,. ''• , -'".. "`?rr. sip ' A w ��� � ,�, Mailing ddress�P. O $ox�196650 Ar�choragelaska�99519 6650 vuvw'�mun, i org �`��� �� Y�.,_x .�+ ..:s.+..n`�"z- �....�_.,�st�+s,.....m�ms'S'a....a � i�,"'�,�,�. �*,:• ��ti`t . ,x,-�z�' '� ,� :cam Development Services Department \ Phone: 907-343-7904 On -Site Water & Wastewater Section Far: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-521-45 1. GENERAL INFORMATION Complete legal description Higgins Estates Lot 1 Location (site address) 11019 Baronik St. Expiration Date: I- ?-d 021 Current property owner(s) Edward Goldmann & Debbie Dragich Day phone Mailing address same Real estate agent 2. TYPE OF DWELLING: Day phone 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: Private Well ED Private Septic 17 1 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 $ 150 I oy I Date of Payment Receipt Number 08 7 33 G, COSA# 06C20115y� 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Date _Z9 /0(f9 2 ---- OFA System #1 Approved for bedroom's o 'Steven R. Penl,ane System #2 Approved for bedrooms�� ;� CE 81,19 A �;.,•, Disapproved Conditional approval for bedrooms, with the following stipulations: By: ) �`—� _A , Original Certificate Date:../ - Z 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 cv-,A� COSA Checklist blue sheet COSA Checklist ,gal Description: Higgins Estates Lot 1pat.cel ID; 015-521-45 1f more than 9 septic system on lot: COSA Checklist # 1 Of 1 Structure served by this system 1 Total measured depth from grade 12.0 ft (max) Fluid depth prior to test 0/0 in Measured depth to pipe invert from grade 7.0 ft (min) Ml�.....0 A. WELL DATA New depth 0/3 in X Well log is filed with Onsite (or attached) Well production at time of test 4.0+ gpm Date drilled 9123/96 Water storage tank volume n/a gallons Total depth 148 ft Well disinfected for coliform test? ❑ Yes ❑✓ No Cased to 148 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 1.65 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic 2.005 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by Pannone Engineering Date of flow test for COSA 9/1712070 Date of Sample 9",7,2020 Static water level at beginning of test 68.8 ft. Comments B. TANK DATA Age of tank(s) 24 years Tank type/material s'""'s` m Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 9/18/20 D. ABSORPTION FIELD DATA Deep Trench C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) t o 1?4 Adequacy test date 9"72020 X ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 12.0 ft (max) Fluid depth prior to test 0/0 in Measured depth to pipe invert from grade 7.0 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 0/3 in © Monitor tubes go to bottom of effective. If not, state Elapsed time 150 min depth into effective Code -required soil cover over field Final fluid depth 0/0 in ❑ System presoaked Absorption rate '600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 rnonths) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Tested the East system COSA Checklist yellow sheet 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' 0 Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft (✓ Yes if No ft Neighboring Tank > 100' 71 Yes if No ft Private Sewer/Septic Line > 25' F,-/� Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Yes if No Water Main > 10' Animal Containment > 50' [71 Yes if No ft F,/� Yes if No ft Q Yes if No Water Service Line > 10' F,-/] Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' F/-1 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' 0 Yes if No ft Surface Water > 100' ®✓ Yes if No. Property Line > 5'✓� Yes Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' ✓D Yes if No ft Private Wells > 100' Yes if No Water Main > 10' ✓C] Yes if No ft Community Wells > 200' Q Yes if No Water Service Line > 10' F,-/] 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' 0✓ Yes if No Water Service Line > 10' F7✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' F/I Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF A���� 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with l� MOA COSA guidelines in effect on this date. C7 StevenR. PC7Ytfi0(1?. r CE 81.79 COSA Checklist yellow sheet ft ft ft ft ft DEVELOPMENT SERVICES DEPARTMENT � On -Site Water and Wastewater Section www.muni.org/onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 201546 Subdivision: Higgins Estates Lot 1 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. �' � Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org