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HomeMy WebLinkAboutEMERALD GROVE LT 4Onsite File Emerald Grove Lot 4 #015-521-50 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191519 PID Number: 015-521-50 Dwelling: n Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: N New ❑ Upgrade Name Hultquist Homes Inc ABSORPTION FIELD Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10990 Baronik Street ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.45 GPD/SF 11.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 Ft. Gravel depth beneath pipe 7.0 Ft. Subdivision Block Lot Emerald Grove 4 Fill added above original grade 0.0 Ft Gravel length 2@ 50 Ft Township Range Section Gravel width 2@ 2.5 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1,400 FF 2 14+ Ft. Well 1001+ 1001+ 25'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 51+ 10'+ NA HDPE 2 Foundation 101+ 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 White Raven Drainfield 3034 CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 549.5 ft 1s' 4/21/2020 4/23/2020 Inspect Location and description es: 2nd 3'0 4/23/2020 41" 9/17/2020 NW Bottom House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional A Approval: ���®��k A�qs�� DateOF .� TH Steven R. Pannone Wk � �F•....�c�164��� Septic Systeme Approvey!! 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Sol uoilelleisul dwnd a apino.id llegs aalleisul dwnd aq 1 :uoi}ua:gV OS-TZS-STO 61-LI-Zl anssl }o 94ea 6TST6TdSO Sol uopelle1sul dwnd i 03's'jamaajemueniijns•mmm :aagwnN uol;e39IIuapl la:)aed MS:jagwnN I!wJad su! nia (lam SM -8$9 L9966 NV ,Nei6n4O '69ZOL9 xo0 'Od STIRM H31VM NVA1110:40-o-, 0003103 lite 9P 03 �0� t'11 1`'' MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program �S�'� PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 p http://www.muni.orglonsite •��-�' L?epartmc:ut '"Clio RAA On -Site Water & Wastewater System Permit Permit Number: OSP191519 Effective Date: 12/17/2019 Work Type: WellSeptic Initial Expiration Date: 12/16/2020 Tax Code Number: dJ,�5-521-50 Site Legal Address: - G9 -WE -&T -TR -4v -G:2637 loco 5mero.IA Cove - Ly Site Mailing Address: 10990 BARONIK ST, Anchorage Owner: HULTQUIST HOMES INC Lot Size in Sq Ft: 175301 Design Engineer: PANNONE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Z Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: / r The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The OK aq Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit h stamped and signed results with the As -built Inspection- Report. If the results require a design change, bec,n wr+p�c��Ol construction of the system will stop pending On -Site review and approval. Received By: Date: Issued By:�it� Date: 2 T MUNICIPALITY OF ANCHORAGE All! 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. 015-521-16 Property owner(s) Hultquist Homes Inc Day phone Mailing address 12570 Old Seward Hwy, Ste. 204, Anchorage, AK 99515 Site address 10990 Baronik Street Legal description (Sub'd., Block & Lot) Bob West, Tract A (�I�q �ree�tD �,eova Loz Legal description (Township, Range & Section) Lot Size 175,301 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial FX -1 Single Family (SF) ❑X Septic Tank FX]Upgrade ❑ (w/wo ADU) Duplex (D) ElHolding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X 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:PZO Date of Payment: Receipt Number: b02�t Permit No. 05 P l q 151 Permit App_-'- :- :-..:c Waiver Fees: Date of Payment: Receipt Number: Waiver No CC) <I� S k "t tit $ _( . �• �; Q.. �, E 1" a• t Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com 12 February 2020 Subject: Emerald Grove, Lot 4 (Bob West Tract A) Septic System Permit Request Design Narrative This is a design narrative for a permit to install an initial septic system to be issued for this property. The proposed systems will serve a proposed four-bedroom (4br) house. The subdivision has been approve and was recorded (512505). Currently the lot is undeveloped. This lot and surrounding lots are served by private wells, with the exception of a non -community transient well serving the church to the northwest. Currently there are no wells within 100 feet of the proposed system and no public water systems within 200'. 1. Soils. Two test holes were performed on this lot by PES in June of 2019 and January of 2020, and groundwater was monitored for at least seven days and through the October high groundwater period. Ground water was not observed to a depth of 17.0' below the surface in the test hole monitor tubes. Bedrock was not encountered in the test hole. Based on the results of the percolation tests, overall soils appearance and the selection of the proposed drain field; an application rate of 0.45 gallons/day/square feet was used for a conventional wastewater system in the area of the test hole. With a reserve field using an application rate of 2 gallons/day/square feet in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water. 4. Topography: The existing topography generally slopes from the east to the west across the lot in the area surrounding the septic system at approximately 5%-10%. There are no steep slopes within 50' of the proposed drain field. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at 745-8200. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O.Box 1807; Pah-ner, nl< 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201. WELL (P) -' I W z w (� � z w w Cn Qw UJ Cn Q w J w RESERVE DRAINFIELD (P) 3OLF x 2.5'W x 7.0'ED x 11'TD INSTALL CLEAN OUT AND MONITOR TUBE ' AT EACH END \N/ _ �o W 0 I r SS 'FUTURE SHOP ss o • lb K it vJ 2 TH-4 TH - 3 N PRIMARY DRAINFIELD (P) (2EA) 50LF x 25W x 7.0'ED x 11'TDM ti INSTALL CLEAN OUT AND MONITOR TUBE,,---' AT EACH END ` AA LOT 4 \• INSTALL 1250g SEPTIC TANK P) -WITH FOUNDATION CLEAN OUT, DOUBLE CLEAN OUT, AND FLOW SPLITTER. ........... w 4BR HOUSE '- (P) x z; Cr Q WELL (P)..,TI m WELL (P) J . DESIGN PARAMETERS DESIGN PARAMETERS LEGEND PRIMARY/ RESERVE SEPTIC SYSTEM RESERVE SEPTIC SYSTEM W WATERLINE/ NO. BEDROOM: 4 (600 gpd) NO. BEDROOM: 4 (600 gpd) WELL RADIUS TANK SIZE: 1250g TANK SIZE: ADVANCED TREATMENT PERC RATE: 54 MPI CAT III SS NEW SEPTIC SOIL RATING: 0.45 GPD/SF PERC RATE: 54 MPI AREA ROD: 1,334 SF SOIL RATING: 2 GPD/SF SYS. TYPE: DEEP TRENCH 7.0'ED AREA RQD: 300 SF ABBREVIATIONS MIN LENGTH: 95.2 LF SYS. TYPE: DEEP TRENCH 7.0'ED TH TEST HOLE MIN LENGTH: 22 LF (P) PROPOSED USE: 100 LF X 2.5' WIDE, 7.0' E.D., 11.0' TD USE: (E) EXISTING TOTAL AREA: 1,400 SF 30LF X 2.5' WIDE, 7.0' E.D., 11.0' TD CO CLEAN OUT NO. TOTAL AREA: 420 SF MT MONITOR TUBE NO. TYP TYPICAL ES: p AST PAMONE P.O. AST T LLC ENG S d C� LLC. BOX 100217 ANCHORAGE, AK 99510 � ��OF A �0N 'C� "' Lqs��� Date 20 CHANGE ORDER PHONE (907) 272-8218 FAX (907) 272-8211 Co -- 49 Di 'Steven R: 'Ponnorie ® Scale Scale 50 EMERALD GROVE, LOT 4 (BOB WEST, TR A) P.I.D. NO 015-521-50 PERMIT NO. HULTOUIST HOMES INC. BARONIK STREET �� �F� . CE 8149 ����F�Fo •......P�-``��� OSP191519 PLAN Sheet ANCHORAGE, AK ����� So����- 1 OF 4 TEST HOLE 4 1 2 3 4 5 6 7 SMI GM 8 9 10 11 12 13 14 15 16 17 BOH 18 ORGANICS SILTY SAND WITH TRACES OF GRAVEL DATE PERFORMED: 6/28/19 Co -;;Z, SOILS LOG - PERCOLATION TEST SLOPE WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER MONITORING? -DRY DATE: 10/1/19 .�i' . � • q�`3 TE PLAN � j • .h TH-4 TH-3 I w-�L' -- w� iS1 i�• TH-4 �` ��M •d LOT 4 SLOPE TH X READING DATE CLOCK NETTIME WATERTIME LEVEL READING NETDROP 1 6/28/19 12:45 --- 6.54 --- 2 1:15 30 MIN 8.60 2.06 3 1:15 --- 6.54 --- 4 1:45 30 MIN 7.11 0.57 5 1:45 -- 6.54 — 6 2:15 30 MIN 7.10 0.56 PEROLATION RATE 54 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS: Test hole excavated by WHITE RAVEN DEVELOPMENT. PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: y�at PANNONE ENG SVC LLC ��� Dote CHANGE ORDER P.O. BOX 102954 ANCHORAGE, AK 99510 ,� �� OF A�gs�l0 2/12/2020 PHONE (907) 272-8218 FAX (907) 272-8211 Boj�P fiyt� Scale ,4.99-1 NTS 0 % 1' ' 0 P.I.D. NO EMERALD GROVE, LOT 4 D15-521-50 (BOB WEST, TR A) Steven 'R. Pannone' � 0. N HULTOUIST HOMES INC. ��� �� . CE 8149 �,� OS PERMIT MIT N9 SOILS LOG A NIK NCOHORAGEREET AK �t��OFE5510N--� Sh�eOF 3 �O ate• 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 TEST HOLE 4A I OR I ORGANICS SILTY SAND WITH TRACES OF GRAVEL SOILS LOG - PERCOLATION TEST s' aja3TE PLAN \/ r SLOPE WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER BOHI MONITORING? -DRY DATE: 2/12/2020 DATE PERFORMED: 1/21/2020 C, v -e- TH-4 JH -3 I /, .N� -..: s I% 4 / j�.... SLOPE TH X READING DATE CLOCK NET TIME WATERTIME LEVEL READING NETDROP 1 1/21/2020 10:55 --- 6.97 --- 2 11:25 30 MIN 8.04 1.07 3 11:25 —_ 6.97 --- 4 11:55 30 MIN 7.90 0.93 5 11:55 -- 6.97 --- 6 12:25 30 MIN 7.89 0.92 PEROLATION RATE 32.7 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS: Test hole excavated by WHITE RAVEN DEVELOPMENT. PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: 7� AAAA�TTnA�77��•. �7 JCtilVl�Vl`IL'. ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 .���a � OF A�,\t� ®. '(� qs �� �rOj�P y�p 0 �•: g � '.fit' �A ". \' " "" ®ot5-521-50 / Steven 'R. Pannom' I d+��'• CE 8149 ��� 'PFa•.....•. 11���ROFES`okl- Date 2/12/2020 CHANGE ORDER Scale NTS EMERALD GROVE, LOT 4 (BOB WEST, . TR A) HULTQUIST HOMES INC. BARONIK STREET ANCHORAGE, AK P.I.D. NO PERMIT NO. OSP191519 SOILS LOG Sheet 3 OF 4 Co .2t 1 NOTES & SPECIAL PROVISIONS: 1. SCOPE AND SPECIFICATIONS: 1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MOA COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 1.2. CONTRACTED WORK WILL BE IN COMPLIANCE WITH MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) DIVISION 10 & DIVISION 20 AS APPROPRIATE. 1.3. SCOPE OF WORK: PERFORM ADDITIONAL PERCOLATION TEST. INSTALL NEW 1250g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM. INSTALL WELL 1.4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 1.5. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING: CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER; A PLOT PLAN DEVELOPED BY RLS; OR A SURVEY AS—BUILT. 2. CONSTRUCTION SPECIFICATIONS: 2.1. ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN 2.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. 2.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO t1" PRIOR TO INSTALLING THE PERFORATED PIPE. 2.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. 2.5. ALL INSULATION SHALL BE 2" THICK DOW HI -40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER SEPTIC TANK OR LINES. 2.6. GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. 2.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. 2.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 2.9. SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MOA CODE. 2.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM. 2.1 1, MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. 2.12. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON IAW WITH MOA CODE IF NEEDED. 3. CONTRACTOR RESPONSIBILITIES: 3.1. THE CONTRACTOR SHALL FAMILIARIZE THEMSELVES WITH THE SITE CONDITIONS AND LOCATIONS OF ALL LOT LINES, EASEMENTS, WELLS (E & P), SEPTIC SYSTEMS (E & P) AND SHALL MEET MINIMUM SEPARATION DISTANCES OR AS NOTED. 3.2. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 3.3. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 3.4. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 3.5. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 3.6. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 3.7. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 3.8. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 4. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WILL BE PERFORMED IN ACCORDANCE WITH THE APPROVED PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: DATE: NOTES: PAMONE ENG SIC LLC ���'�n k. Date CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 '(� of k., kkk� 2/12/2020 PHONE (907) 272-8218 FAX (907) 272-8211�Q . Scale�y*��� Nrs EMERALD GROVE, LOT 4 "' "' P.I.D. NO 015-521-50 (BOB WEST,. TR A) Steven R, onnone PERIT NO. HULTQUIST HOMES INC. �d¢�Fc� CE 8149 -o-, OSPM91519 ARONIK STREET DESIGN DETAILS ANCHORAGE, AK ��kkR6 O ss - SheetOF 4 MUNMPAUTY OF INCH ORA(23E Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-521-50 1. GENERAL INFORMATION Complete legal description Emerald Grove L4 Location (site address) 10990 Baronik St — Expiration Date: 12 - 2z, - z O2 -c.) Current property . owner(s) Hultquist Homes Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well F-1 Private Septic F1 Water Storage 1:1 Holding Tank 171 Community Well El Community 171 Public Water System El Public Sewer 171 Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $—go CAVI 0 Waiver Fee $ Date of Payment �1dq1oto p-0 Date of Payment Receipt Number 0 S -?" 0 -) 6 Receipt Number COSA# 05 523 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. 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 System #1 Approved for _V_ bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date 2®0`r _Z— OF A�,j .G t. e P.. �Ponnane .'. CE o0"149 • oL Conditional approval for bedrooms, with the following stipulations: o WASTEv''ATER Z JjJJ J��M, SEOCj, lN`�,, B `^' Original Certificate Date: q,2 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 Legal Description: Emerald Grove L4 Parcel ID: 015-521-50 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4-2-20 Total depth 184 ft Cased to 184 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/2/20 Static water level at beginning of test 86 ft. Comments B. TANK DATA Age of tank(s) 4/21120 years Tank type/material 50{""' Measured operating fluid level in septic tank n/a ❑ Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 423'2020 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.0 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 60 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑✓ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 1.428 ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 9/17/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date n/a Results [D Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate '600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 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' M✓ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' Cj✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' [✓/ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft ❑✓ Yes if No ft 0 Yes if No ft Water Service Line > 10' M Yes if No Manure/Animal Excreta Storage > 100'M If septic tank is under driveway Community Sewer Main > 75' Q Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M✓ Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ✓� Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' P1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' n Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' ✓1 Yes if No ft F. ENGINEER'S 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. ?� Q2 s COSA Checklist yellow sheet OF A4-4'1 �. As Steven •R ' Pannone• CE 8149 c.s Lot 29 1 1 Lot 30 N8959'39"W 299.26 0 F .. ....... .. . .............. Ben Jamin G Hairristra S89 -58'26"E 65.00' Lot 1 Set Rebar with LS –1i 7 10,; Utility Easement fu Found Rebor 0 Monument Well G Lot 1 E Pavement EI Q Wood Deck WI 0 Cn U.1 LU: 01 30.3, M to 51.0'— ci Lot 3 50' Temportary Turnaround I C3 to be automatically vacated 0) a o'. N89'59'39"W 100.00' I CF) . ......... LO 4 Manhole 0 1 z Qr .0 5o.7'- 30, I? Existing House -00o (:y Lot 2 – – – – – – – – – to 10' Utility Easement Lot 29 1 1 Lot 30 N8959'39"W 299.26 0 F .. ....... .. . .............. Ben Jamin G Hairristra Set Rebar with LS –1i 7 AL. Monument fu Found Rebor 0 Monument Well G Septic Pavement Overhang 4 Wood Deck Cn 01 M ho 0 50' Temportary Turnaround I C3 to be automatically vacated when road is extended N89'59'39"W 100.00' I C14 Legal Description: As -built Lot 4 Emerald Grove Subdivision Survey Certification: I hereby certify thot a Mortgagee's Inspection was performed an the described property. Notes: It Is the owner's responsibility to determine the existence of any easements, covenants, or restriction which are not on the recorded subdivision plot. 30*1 Legend: Set Rebar with Cap 0 AL. Monument fu Found Rebor 0 Monument Well G Septic Pavement Overhang Wood Deck Concrete Checked by. CB Drawn by. AR I Scale: 1" = 50' Grid: SW2637 Job: 2019-69 Field Book: 148-78 1 Plot: 2019-112 Date- 9/7/2020