HomeMy WebLinkAboutTERI #2 LT 1Teri #2
Lot 1
#050-751-26
(Kev Ub/U2/18)
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP221191
PID Number: 050-751-26
Dwelling: ❑■ Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
Eric &Shannon Jensen
ABSORPTION FIELD
El Deep Trench El Wide Trench El Bed ❑Mound
Site Address
31445 Prudhoe Bay Ave
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Teri #2
1
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
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 trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
100'+
n/a
n/a
n/a
25'+
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface water
100'+
n/a
n/a
n/a
Material
Number of compartments
Lot Line
5'+
n/a
n/a
n/a
NA
HDPE
2
Foundation
10'+
n/a
n/a
n/a
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
CMM
Drainfield CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) ft
Inspdection X51 7/22/2022
7/23/2022
Location and description
3'd
2nd
4,h
See Site Plan, Bottom of house trim @ A
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
•••.•
��P�G.
*•4ATM :*
.... .. .......
••$�eVen aririoRe
Septic System
CE 8149
Approved
pp Lf%
Date /Z 2 Z
'•
'••�,
Note: this approvp
oes not include well permit requirements.
(Kev Ub/U2/18)
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NOTES: PANNONE ENG SVC LLC (C.1. 1088) REVISIONS DATE
RECORD DRAWING P.O. BOX 1807 PALMER, AK 99645 OF 2023.12.12
PHONE (907) 745-8200 FAX (907) 745-8201 p{ SCALE
DRAWN MMM TERI # 2 LOT 1 ... .. `_1"=so'
'•'. * P.I.D. NO
CHECKED ACP ERIC & SHANNON JENSEN "!elevei, ooriope 050-751-26
C1= 8149 PERMIT NO.
SITE: 31445 PRUDHOE BAY AVENUE z023.121z. OSP221191
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PUBox 1S00oO – 470OElmore Road —
Anchorage, Alaska 8951e8650 Phone: 904 Fax: (907)o43-7997
Permit Number: [)SP221181
Work Type: SephcTankUpgnad*
Tax Code Number: 05075126000
Site Legal Address: TER|#2LT 1 G:0704
Site Mailing Address: 31445pRUDHOEBAY AVE, Eagle River
Owner: JENSENERIC &SHANNON
Design Engineer: PANNONEENGINEERING SERVICES
This permit {efor the construction of:
Effective Date: 6/23/2032
Expiration Date: 6/23/2023
Lot Size in Sq Ft: 66385
[]
Disposal Field 10 Septic Tank [] Holding Tank [] Privy 171 Private Well Water Storage
.. .
All construction shall beinaccordance 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
VVaetevvetar Disposal Regulations (1 8AAC72) and Drinking Water Regulations (1 8AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify -the Development
Services Department per AMC 15.85.Provide notification bycalling (0O7)343-7984(24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall beeither:
e.`Opened and Closed onthe same day, or
b. Covered, sealed, and heated to prevent freezing
Received B)
Issued By:
URNAIUMCIPAUITY 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
Parcel I.D. 050-751-26
Property owner(s) Eric & Shannon Jensen
Mailing address
Day phone
Site address 31445 Prudhoe Bay Avenue Eagle River, AK
Legal description (Sub'd., Block & Lot) Teri #2 Lot 1
Legal description (Township, Range & Section)
Lot Size 66,385 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) X❑
Septic Tank
ElUpgrade
X❑
(w/wo AD U)
Holding Tank
El
Renewal❑
(D) ElRenewal
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 22 _ Waiver_Fees:
Date of Payment: Date of Payment:
Receipt Number: 17 y 06 Receipt Number:
Permit No. % 2 I j Waiver No.
Permit App_.:- :• :-..:c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221191, Deb Wockenfuss, 06/23/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221191, Deb Wockenfuss, 06/23/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221191, Deb Wockenfuss, 06/23/22
Municipality of Anchorage Page 1 of 2
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
Permit Number: SW990218 PID Number: 050-751-26
Name: JOHN THOMSON
wastewater System: ■ New ❑ Upgrade
Address:
PRUDHOE BAY ROAD
ABSORPTION FIELD
Phone:
(907) 540-2020
No. of Bedrooms:
4
El Deep Trench IN Shallow Trench EI Bed ❑Mound 11 Other
LEGAL DESCRIPTION
Boll Rating:
1.2
Total Depth from original grade:
3.5 — 54Q.
GPD/Sq. Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
1 TERI #2
1.5 — 3.0 Ft.
2.0 Ft,
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
—
—
—
0.5 — 2.0 Ft.
75 Ft.
WELL: ■New ❑Upgrade
Gravel width:
5.0
Number of Una
1
Distance between lines:
—
Fl
PL
ClaeelDcallon (Private, A,B,C):
I Total Depth:
Cased To:
Total absorption area:
Pipe material:
PRIVATE
115 FL
111 Ft.
536 so. Fl.
ASTM D -3034/F-810
Driller.
SULLIVAN WATER WELLS
Date Drilled:
7/28/99
Static Water Level:
70
Installer.
GREENE CONTRACTING
Date Installed:
8/12-13/99
Ft
Yield:Pump
20
Set AC
Casing Height Above Ground:
TANK
oPM
UNKNOWN
2 Ft.
SEPARATION
DISTANCES
■septic ❑Holding ❑S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public /Private
Manufacturer.
ANCHORAGE TANK
capacity in gollons:
1250
From
Tank
Field
Station
Tank
sewer Una.
Well
100'+
100'+
—
—
25'+
Material:
STEEL
Number of compartments:
2
Surface
100'+
100'+
-
-
-
LIFT STATION
Water
LotSize
5'+
10'+
—
—
—
in gallons:
Manufacturer.
Line
'Pump on' level at:
'Pump a al:
High water alarm at:
Foundation
5'+
10'+
—
—
—
CurtainPump
Make el: Electrical Inspections performed by:
Drain
NONE KNOWN
1
Remarks: TANK AND DRAINFIELD WERE INSULATED.
BENCH MARK
Location and Description:
BOTTOM OF WINDOW SILL AT NORTH
EAST CORNER OF HOUSE.
Assumed Elevation: 107.94
pt,
ENGINEER188EAL
go�Opp
ooP� ............. 0
400
Inspections performed by: AWWC, INC. Dates: 1st 8/12/99
.4. ......••••• D
2nd 8/13/99
O
3rd 2/17/2000
Jetfr A. rness: Q
Department of Health and Human Services approval•.
-7953 ; \coops
���p°"/'r•
Reviewed and approved by �� `� Date: A--
no �oA�
d
afesslo 0
oO0�000�6
72-013 Rev. 0/01) MOA 25
PERMIT NUMBER; AS—BUILT DRAWING PARCEL ID NUMBER:
SW990218 050-751-26
Af IM.Ef e 102.91 __�l
fOP OF fANK
1 NSW 1250 GALLON ATaw, IO2.41
IM/ERFdr P 16 %FflC TANK INVERT of PING
Af IM.Ef - IOL83 Af atti"Ef - IOI.63 INVERT a PIPE
--I0I35(AVG)
POITOM OFTWu
- 9935(AV&)
ALASKA WATER AND WASTEWATER CONSULTANTS, INC. oo�oo
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 336-3246 �0�,�\\.,••��••
TERI SUBDIVISION #2; LOT 1 0 * ;• N
WORK:OF
DESIGNOF SEPTIC SYSTEM UPGRADE AND WELL LOCATION � .!••• Ga
PARED FOR: PHONE NUMBER: A m e r A. GOrn ss,
JOHN THOMSON (907) 240-2020 0 79 a�
E: DRAWN BY: SCALE: PAGE: �4�ar '• •••••••••''• cA�O
2/21/2000 K.D.W. 1 = 40' 2 OF 2 Prof es
plus
100
C
\c
:
N� SE
\
. n ..
N00M FC B
DBL1
GRAVEL.
RAV
gEDA
DBL2
DRIVEWAY
/ C01 M\1
TH#2 ���NEW
BRRMNFIELD
NEW 1250
GALLON SEPTIC n�
TANK
��� ��\ TH#1
MT2
� CO2
A B C
ST1
53.5 28.7 49.3
_
ST2
61.3 36.7 55.7
ALTERNATE
' DBL1
63.0 38.3 57.3
SITE
DBL2
64.0 39.3 58.0
C01
52.6 36.5 60.3
MT1
54.7 37.4 61.0
d
CO2
1 126.8 107.7 125.3
MT2
T124.5 104.9 122.0
-- 10' UTILITY EASEMENT--- --- _ _—
— ------------
PRUDHOE BAY AVENUE
14f
C49 FINN-GRADE-109.8(AVGJ
/'FINN. C2ZAnE - 105.76
5n / 5f2
0061" QM 102,85
I
Ll
OIZIGINN- C�PDi
0935
Af IM.Ef e 102.91 __�l
fOP OF fANK
1 NSW 1250 GALLON ATaw, IO2.41
IM/ERFdr P 16 %FflC TANK INVERT of PING
Af IM.Ef - IOL83 Af atti"Ef - IOI.63 INVERT a PIPE
--I0I35(AVG)
POITOM OFTWu
- 9935(AV&)
ALASKA WATER AND WASTEWATER CONSULTANTS, INC. oo�oo
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 336-3246 �0�,�\\.,••��••
TERI SUBDIVISION #2; LOT 1 0 * ;• N
WORK:OF
DESIGNOF SEPTIC SYSTEM UPGRADE AND WELL LOCATION � .!••• Ga
PARED FOR: PHONE NUMBER: A m e r A. GOrn ss,
JOHN THOMSON (907) 240-2020 0 79 a�
E: DRAWN BY: SCALE: PAGE: �4�ar '• •••••••••''• cA�O
2/21/2000 K.D.W. 1 = 40' 2 OF 2 Prof es
OCT -25-99 MON 10:55 AM SULLIVAN WATER WELLS 688 2759444444444444 P.01
Qjxrtiffejh
by Priffling
DOC Co, dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99687 a TELEPHONE 688.2759
OWNER OF LAND /ciW.J WOMSt` tJ GORE HOLFDATA
DEPTH
ADDRESS 7 13 f4-ji #t
LEGAL DESCRIPTION o I °Z
PERMIT NUMBER"pAld"�" Date of Issue-7�-Q�
TAX INDENTIFICATION NUMBER-465t-
Is
651-Is well located at approved permit location? 6 -Ws ❑ No
Method of Drilling: r rotary O cable tool
Depth of well:
Casing Type s 7V4 L Wall Thickness , a s� inches
Diameter_ inches, depth— L --feet
Liner Type: /L)DH1>^
Casing Stickup Above Ground: OZ' feet
Stant Water Level (from ground level): -70 feel
Pumping level:—feet after hrs, pumping gpm
Recover Rate: dL% gpm
Method of Testing: 414
Well Intake Opening Type: 49-Cpen End ❑ Open Hole
0 Screened; Start feet Stopped feet
C] Perforations Start fept Stanped feet
AT
Grout Type:8&re-Jd7i' Volume Isv4AV
Depth: from a) feet, to !77 feet
,P
Cyr
Pump Intake Depth:
Pump Size hp Brand Name
Well Disinfected Upon Completion? ji-Ws' 0 No
Method of Disinfection: Cv7e� e.dG $ f i�/►'i
Comments: /
'O r i;, % �� 3`l `t a
,Je' S'71C-K Ljr
r4.4 o 1 L
khn
s, ^JIO l�R.9u,�� cavy
/i' i x eel
J',4. -Jo 6944 � �JE%—
Sq,J� GSA✓�� . c«r
1n 1 x.O
S/�1..lrQ GQR✓ �__��.9�
/1%1 yea WEi
'ro+Jo 6'C4jL>4.
R 't!4 c —
t
RECEIVED
f =R 4. 911Arot _r
do�i-p1<a ' t � -luman Services
Driller's Name 1241a.l 'w� =�—
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
'Oeowdill 00%60000 /.grazier
4
IN
MUNICIPALITY OF ANCHORAGE �31L �% ✓Ic^.C'I/1
Department of Health and Human Services rd_ t . 99 klce)o , 1 3n vv1
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650XCCx�ICti'�/�
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW990218
Legal Description: TERI #2 LT 1
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: John Thomson
Owner Address: 17343 Santa Maria
Eagle River , AK 99577 -
Date Issued: Jul 27, 1999
Expiration Date: Jul 26, 2000
Parcel ID: 050-751-26
Site Address:
Lot Size: 66385 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑✓ Private Well ❑ Water Storage
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
(907) 343-4744 ( 24 hours). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date:
Issued By: �/ / `_� I LSZW Date:��79L
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B — Anchorage — Alaska 99504
(907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
July 22, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Z
Ref: Proposed Well and Septic Design for Lot 1, Teri Subdivision
To whom it may concern:
The proposed 4 bedroom house will be served by a private septic system and a private well. Two
test holes were excavated on the property. Comments regarding the proposed upgrade design are
summarized as follows:
1. SOILS: Attached are logs which shows the soil profile, and the percolation test results. In
both test holes, the soils below the organic layers are a GM material (with some roots) to a depth
of 4 feet in both test holes and then transitions to a GM/SM material to a depth of 15 feet
(bottom of both test holes). The soils at the bottom of both test hole (at 15 feet) were visually
rated to be impermeable. Groundwater was encountered at 14.5 feet in both test holes during the
excavation. Seven days later, groundwater was found to be at 9.5 feet in TH#1 and at 12.2 feet in
TH#2. A percolation test for TH#1 was performed between the depth of 4.5 feet to 5.0 feet which
had a percolation rate of <1 minute/inch.. A percolation test for TH#2 was performed between
the depth of 5.0 feet to 5.5 feet which had a percolation rate of <1 minute/inch. It is our opinion
that due to the high percentage of sand, the insitu soils will serve as a sand filter. A grab sample
can be provided if deemed necessary.
2. TRENCH DESIGN:
a. Percolation Rate: <l minutes/inch
b. Allowable Application Rate: 1.2 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 500 ft2
f Total Depth: 5 feet (maximum on uphill side.)
g. Effective Depth: 2 feet
h. Width: 5 feet minimum
i. Reduction Factor: 0.70
j. Minimum Length: 75 feet long
k Effective absorption area = 536 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: As can be seen on the design drawing, the proposed drainfield is to be
installed parallel to a 15 to 20 percent slope running from northeast to southwest. In shorts, there
are no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
fnr vnnr as.ci.ctnnre
, M.S.
NOTE: fltlaehed is a site plan drawing, a design drawing, two soils logs and a 4 page
construction specification letter which are all part of the design package for this septic system.
LOT C-1
TERI S/D #2
PROPERTY DEVELOPED. WELL AND SEPTIC
ARE UNKNOWN. PRIOR TO DRILLING WELL,
THE DRILLER SHALL FIELD VERIFY THAT ALL
SEPARATION DISTANCES WILL BE MEr.
cum
M AY
m
TRACT1A1A
SIERRA VISTA S/D
SERVED BY PRIVATE WELL AND
SEPTIC. (NO ENCROACHMENT)
PROPOSED FOUR
\ BEDROOM HOUSE
� I
\ TERLOT 3
I S/D #2 '
/LOT >&\ TERI S/
Ag
FA.
T #1
F
PRUDHOE BAY AVENUE
1v/b7d1
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 28. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
_EGAL DESCRIPTION: ;t 2-
TERI SUBDIVISION; LOT 1
TYPE OF WORK:
SITE PLAN FOR SEPTIC SYSTEM DESIGN AND WELL LOCATION
PREPARED FOR: PHONE NUMBER:
JOHN THOMSON (907) 240-2020
DATE: DRAWN BY: SCALE: PAGE:
7/22/99 K.D.W. 1 = 100' 1 OF 2
F
1.....::* .
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A. Gayness; o
—7953 �
Profes&(o &o
f i
cum
M AY
m
TRACT1A1A
SIERRA VISTA S/D
SERVED BY PRIVATE WELL AND
SEPTIC. (NO ENCROACHMENT)
PROPOSED FOUR
\ BEDROOM HOUSE
� I
\ TERLOT 3
I S/D #2 '
/LOT >&\ TERI S/
Ag
FA.
T #1
F
PRUDHOE BAY AVENUE
1v/b7d1
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 28. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
_EGAL DESCRIPTION: ;t 2-
TERI SUBDIVISION; LOT 1
TYPE OF WORK:
SITE PLAN FOR SEPTIC SYSTEM DESIGN AND WELL LOCATION
PREPARED FOR: PHONE NUMBER:
JOHN THOMSON (907) 240-2020
DATE: DRAWN BY: SCALE: PAGE:
7/22/99 K.D.W. 1 = 100' 1 OF 2
F
1.....::* .
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A. Gayness; o
—7953 �
Profes&(o &o
GRAVEL
DRIVEWAY
NOTE:
THE CONTRACTOR SHALL FIELD VERIFY THAT A GRAVITY FLOW SYSTEM
IS FEASIBLE PRIOR TO CONSTRUCTION. IF A LIFT STATION IS REQUIRED,
THE CONTRACTOR SHALL NOTIFY THE HOMEOWNER/BUILDER PRIOR TO
CONSTRUCTION.
` BOG
i
^yqe INSTALL FCO `
INSTALL DOUBLE `
CLEANOUTS \
v0 0 TH#2 \
`\ \ ALTERNATE SITE. WILL \
COQ o \ ` \ REQUIRE LIFT STATION.
MT \\\ \
/PROPOSED 1250 GALLON �q° \�\� TH#I
SEPTIC TANK MT CO
PROPOSED DRAINFIELD. EXCAVATE A TRENCH
THAT IS 75 FEET LONG BY 5 FEET WIDE
THAT IS 5 FEET DEEP (MAX). ADD 2 FEET
OF CLEAN, WASHED, SEWER DRAINROCK.
1- _ _ _ i _ _ _ 10' UTILITY EASEMENT --
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 !. Q�, °
PHONE: (907) 337-6179/FAX: (907) 338-3246
TER] SUBDIVISION #2; LOT 7
DESIGN OF SEPTIC SYSTEM UPGRADE AND WELL LOCATION �..:::/�...�.
PARED FOR: PHONE NUMBER:000 m ff A795a3rnes cGQ
JOHN THOMSON (907) 240-2020
DRAWN BY: SCALE: PAGE: 4440^ad P�ofessi00O&
7/22/99 K.D.W. 1 = 40 2 OF 2 ��\"Qsfx oma'
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: TERI SUBDIVISION #2; LOT i
PERFORMED FOR: JOHN THOMSON
DATE PERFORMED: 7/1/99
(feet ORGANIC TEST HOLE #1
1
2 GM WITH SOIL CLASSIFICATIONS
SOME ROOTS GW ORG
GP ML
GM CL
4
GC � OL
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS:
GM/SM
BOTTOM
IMPERMEABLE
°o SW J MH
foe>, SP CH
SM / OH
SC
DEPTH TO
GROUNDWATER
DATE
14.5'
7/1/99
9.5'
7/8/99
7/8/99
FT. AND
5.0 FT.
URMYNY
PROPOSED FOUR
BEDROOM HOUSE
\AGC
� �Fti
c,
STH#2 �c�F
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
7/8/99
FT. AND
5.0 FT.
_
MSN•
— Z—
NS
_
PERCOLATION RATE
<1
(MIN./INCH)
PERC. HOLE DIA.
6 (INCHES)
TEST RUN BETWEEN
4.5
FT. AND
5.0 FT.
PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERFQRMFD IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
690PHONEARR ( 07) 337 SUITE
T79 26 FAX (9070) 338 9504
3246
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: TER] SUBDIVISION #2; LOT 1
PERFORMED FOR: JOHN THOMSON
DATE PERFORMED: 7/1/99
(fe t) ORGANIC TEST HOLE #2
1-
2—
DATE
14.5'
12.2'
7/1/99
—7/1/99
GM WITH
SOIL
CLASSIFICATIONS
FT. AND
5.5 FT.
3
SOME ROOTS
GW
GPML
ORG
a a"
V�P(E
�t LL
GM
-
GP�val
CL
4
--
----
/
GC
OL
o°o o
SW
_ _
MH
5
°> ouo �,
SP
SM
CH
OH
6
SC
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS:
GM/SM
BOTTOM
IMPERMEABLE
DEPTH TO
GROUNDWATER
DATE
14.5'
12.2'
7/1/99
—7/1/99
WATER LEVEL
READING
NET DROP
(INCHES)
7/8/99
FT. AND
auw
MNFMAY
PROPOSED FOUR
BEDROOM HOUSE
A
� \ G��Fti
c,
� STH 22 \�C"
--------------------
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
7/8/99
FT. AND
5.5 FT.
V�P(E
-
GP�val
-
--
-
--
----
PERCOLATION RATE
<1
(MIN./INCH)
PERC. HOLE DIA.
6 (INCHES)
TEST RUN BETWEEN
5.0
FT. AND
5.5 FT.
PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERFOIRMEb IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
• '� Municipality of Anchorage
On -Site Water and Wastewater Program fl
(907) 343-7904 5 n F s r v
Parcel I.D. 050-751-26
Certificate of On -Site Systems Approvalu Y
Expiration Date: 1�j
1(-C.i-l'�
1. GENERAL INFORMATION
Complete legal description Teri #2,L of 1
Location (site address) 31445 Prudhoe Bay Ave.
Current Property owner(s) Kenneth et all TakakuWa
Mailing address
Real Estate Agent
31445 Prudhoe Bay Ave.
2. TYPE OF DWELLING:
Fx1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
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 reauest for:
Received by ,l, t Date'
`COSA to be released to the e,igineer, unless otherwise requested by the engineer.
COSA Fee $ JF0�/
Date of Payment g ! �/C j
Receipt Number 67 1246
COSA # d5dLV3X
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.
Name of Firm Pannone Engineering. Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE pp�
L✓SISystem #1 Approved for '7 bedrooms
System #2 Approved for bedrooms
Disapproved
Date 10/31/13
Conditional approval for bedrooms, with the following stipulations:
By Original Certificate Date:_ O 0
Thenicl iry of A rage 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 blue sheet E 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: Teri #2, Lot 1 Parcel ID: 050-751-26
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 7/28/99 Sanitary seal (YIN) Y
Total depth 115 ft. Cased to 111 ft
FROM WELL LOG
Date of test 7/28/99
Static water level 70
Well production
20
ft.
g. p. m.
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) 24 in.
AT INSPECTION
10/30/13
55 ft
3.2+
g.p.m.
WATER SAMPLE RESULTS:
Coliform ' e1# colonies/100 mL NitrateQ•r15 5 mg/L
Arsenic N ug/L Date of sample: ���`d��<' )�i Collected by: J >>
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8113/99
Tank size 1,250 gal. Number of Compartments 2— Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) /N High water alarm (YIN) N
Date of pumping i
')/I c� i 3 Pumper ;V2 s Pt,,
C. ABSORPTION FIELD DATA
Date installed 8/13/99 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/BR System type Shallow Trench
Length 75 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 6.1 ft. Eff. absorption area 536 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 10/30/13 Results (Pass/Fail) PBSS For 4 bedrooms
Fluid depth in absorption field before test 17 in. Water added 614 gal. New depth 19 in.
Elapsed Time: 210 min. Final fluid depth 17 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 Size in gallons
"Pump on" level at in. "Pump off' level at
Datum Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
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+
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+
SEPTIC/HOLDING TANK ON LOT TO:
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
l 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 10IZT1 13
COSA brown sheet -1 0-10-1 2.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
in.
I HEREBY CERTIFY THAT i HAVE
+EYED THE
SCALE.
�-y
DATE.
XCEPT AS
Y OF THE
rd�
OF ANY
GRID=
MONS
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services i
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. # 050-751-26 HAA # r ICIM(0 J
1. GENERAL INFORMATION
Complete legal description TFRI SUBDIVISION #7• LOT 1
Location (site address or directions) PRUDHOE BAY AVENUE
MailingL-roperly owner JOHN THOMSON Day phone 240-2020
address 17,343 SANTA MAGA DRRIVER, '• 99577
Lending agency
Mailing address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xxx
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 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 #21 Computer Version
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 Municipd State codes, ordinances, and regulations in effect
on the date of this inspection.
Name of Firm
Address
Engineer's Signature
6. DHHS SIGNATURE
Approved fors—bedrooms
Disapproved
Conditional approval for
Additional Comments
A
Phone (907) 337-6179
;Nlfe Z
bedrooms, with the following stipulations:
Date a' .'). S D O
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 SERAL
VIVED
!�Environmental Services Division
825 t
"L" Street, Rm 502 Anchorage, Alaska 99501 (907) 34f-�42 4 2000
MVIWIJPALI IV UI' ANLIIUMGE
,
Health Authority Approval Checklist nnnIMLNTA. SHVICFS 01VI�-
Legal Description: TERI SUBDIVISION #2: LOT 1 Parcel I.D.: 050-751-26
A. WELL DATA
Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) YES Date completed 7/28/99
Total depth 115' Cased to 111 Casing height (above ground) 2'
Sanitary seal
FROM WELL LOG
Date of test 7/28/99
Static water level
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Wires properly protected (Y/N) YES
AT INAPFCTIM]
g.p.m.
Coliform Nitrate ' 170 ✓nQ 4- Other bacteria QCT
Date of sample: 2/17/2000 Collected by: A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
Date Installed 8/13/99 Tank size 1250 Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N)
Date of Pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date installed 8/13/99 Soil rating (g.p.d./ft2 orft2/bdrm) 1.2 System type TRENCH
Length 75' Width 5' Gravel thickness below pipe 2' Total depth 5.5'
Effective absorption area 536 SQ.FT. Monitoring Tube present (Y/N) YES Depression over field (YIN) NO
Date of adequacy test NEW Results (Pass/Fail) - For 4 Bedrooms
Fluid depth in absorption field before test (in.); - Immediately after - gal. water added (in.): -
Fluid depth - (ins) Minutes later: - Absorption rate =
Peroxide treatment (past 12 months) (Y/N) - If yes, give
72-026 (Rev. 3/96)' Computer Version
D. LIFT STATION
Date installed
Manhole/Access (Y/N) Win" level at* "Pump off' level at*
High water alarm level *Datum
High
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septictholding 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 5'+
Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
F. ENGINEER'S
t certify that I i
of Municipal 0
with MOA H.A,
Signature
Engineer's
JEFFREY
Building foundation 10'+ Water main/service line 10'+
Driveway, parking/vehicle storage area 10'+
Id inspections and review
stems are in conformance
this date.
Gn
HAA Fee $ � /
Date of Payment �,(��/ (7
Receipt Number ` 7 h
72.026 (Rev. 3/86)' Computer Version
Wells on adjacent
Waiver Fee $
Date of Payment
Receipt Number
100'+
�6F o0
0 ,� p00o
................
........
y A. Garness;'
E-7953 .}�
02-23-00 16:21 FROM -CTE ENVIRONMENTAL
ALCT&E (Environmental Services Inc.
vvw o. rR�'rr. vrmrrr rrra
5615301 T-046 P.02/03 F-772
CUE Ref.# W00651001 Client PO#
Client Name AK Water & Wastewater Consultants Inc. Printed Date/time 02/232000 10:07
Project Name/ft Tert S/D #2 Lt 1 Outside WB Collected Date/time 02/172000 16:35
Client Sample ID Terl S/D #2 Lt 1 Outside H/B Received Dateirime 02/18/2000 12:00
Matrix Dunking Water Technical Directs Stephen C. Ede�/� Q Q
Ordered By Released «��F�'�
PWSID 0
Sample Remarks
Al law0te Prep Anatyeis
oarnmecer Results PDL units Met1101 Limits Date Date Imt
WATERS DEPT
Nitrate -N 0.707 0.500 m0/L EPA 300.0
MICRO LAS
Total Coliform 0 col/100m4 SM18 92228
(00) 02/18/00 SCL
02/18/00 JDT