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HomeMy WebLinkAboutHILLSIDE PARK PUD LT 9Onsite File 4 }4 ;FO15 am 122mw4Am2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231150 Work Type: Septic Upgrade Tax Code Number: 01512242000 Site Legal Address: HILLSIDE PARK PUD LT 9 G:2539 Site Mailing Address: 7240 TREE TOP CIR, Anchorage Owner: DUNCAN CLAYTON JON & Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 6/30/2023 6/29/2024 21313 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 Received By: l S 5 7D Issued By: �-- Date: Date: W3 e -2cz 3 3 MUIM8 PANLffY OF "HCHORAGi y t-� P 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. 015-122-42 Property owner(s) Clayton Duncan Mailing address 7240 Tree Top Circle, Anchorage, AK 99507 Site address 7240 Tree Top Circle Legal description (Sub'd., Block & Lot) Hillside Park PUD, Lot 9 Day phone Legal description (Township, Range & Section) Lot Size 21,313 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Holding Tank ElRenewal ElDuplex (D) El Multiple Dwellings ❑ Privy ❑ (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: JI Waiver Fees: Date of Payment: l Z 0 Zo 2 3 Date of Payment: Receipt Number: 5-3 b ci Receipt Number: Permit No. 0LP2 -� 11_r3o Waiver No. Permit App_'-'- : • : -.,:c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E‐mail: steve@panengak.com Mailing: P.O.Box 1807, Palmer, AK 99645 Telephone: (907) 745‐8200   FAX: (907) 745‐8201 2 June 2023 Municipality of Anchorage Development Services Department On‐Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject:   Hillside Park PUD, Lot 9          Septic System Upgrade Permit Request Septic System Design Narrative This is a design narrative for a permit to install a septic system upgrade on the subject property. The proposed upgrade will serve an existing three‐bedroom (3) house.  This lot and surrounding lots are served by a community water system. There are no wells within 200’ of the proposed system. 1. Soils: A test hole was performed on this lot by Pannone Engineering Services, LLC on 5/12/2023. Groundwater was not observed during the excavation of the test hole, and bedrock was not encountered. No groundwater was observed in the test hole monitor tube after 7‐days. Based on the results of the percolation test and overall soils appearance an application rate of 0.8 gpd/SF was used for the design of a conventional wastewater treatment system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. 4. Topography: See attached site plan for area topography. There are no slopes exceeding 25% in the area of the drain field. 5. Drawing Markings: The Drawings are marked “For MOA Review Only”. When written notification that the review is complete and no further comments are received from MoA On‐Site Department, the note will be removed and “For Construction” drawings will be issued. 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 (907) 745‐8200. Sincerely, Steven R. Pannone, P.E. F. ASCE Owner/Civil Engineer Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231150, Curtis Townsend, 06/30/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231150, Curtis Townsend, 06/30/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231150, Curtis Townsend, 06/30/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231150, Curtis Townsend, 06/30/23 040.002 Crowther Associates 1632 Bellevue Circle / Anchorage, Alaska 99515 Telephone (907) 349-2198 / E mail: crowther@alaska.net Client: Pannone Engineering Services Project: Hillside Park PU Lot 9 Date: May 17, 2023 Particle Size Distribution Table (percent passing subject sieve size) Sample Source -- Moisture Content 2.6% Sieve Size Percent Finer Percent Finer Percent Finer Percent Finer 3 inch 100 1-1/2 inch 100 ¾ inch 97 #4 66 #10 39 #40 10 #100 5 #200 5 0.02 mm xx Classification Gravelly Sand (SP) Invoice 191 kRCv Uiluel I Of Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191266 PID Number: 015-122-42 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Kenneth Sutherland ABSORPTION FIELD ❑ Deep Trench ❑Q Wide Trench ❑ Bed ❑ Mound Site Address 7240 Tree Top Circle ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 1.2 GPD/SF JTotal 8.7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.7 Ft. Gravel depth beneath pipe 2.0 Ft. Subdivision Block Lot Hillside Park PUD 9 Fill added above original grade 0.0 Ft. Gravel length 60.0 Ft. Township Range Section Gravel width 5.0 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 429 Ft z 1 NIA Ft. Well 200+ 200+ N/A N/A 25+ 9 Septic ElS.T.E.P. E) Holding E] Other Manufacturer Manufacturer Infiltrator Capacity 1060 Gal. Surface Water 100'+ 100'+ N/A N/A Material Number of compartments Lot Line 15'+ 10'+ N/A N/A NA Plastic 2 Foundation 10'+ 10'+ N/A N/A LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 A+ Home Services Drainfield 3034 CO/MT3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100 ft Inspeection ction t51 7/22/19 2�a 7/24/19 Location and description 3`° 7/25/19 4111 7/29/19 Nearest Door Threshold ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date "'D�even E2. anrio�e Septic S stem CE 8149 Approv `- Date Note: this approval does not include well permit requirements. 7/30/2019 kRCv Uiluel I Of ZO CLEAN OUT MONITOR TUBE MONITOR TUBE CLEAN OUT TEST HOLE m \gym i �e o NOTES: RECORD DRAWING DRAWN I SRP SYSTEM ASBUILT O a m li —n FOUNDATION m Z r N Z CLEAN OUT n D i JCC y ^> rm- R, � r co ;u ,a m y 2 O i y m O '} y viz -i R: Shin m A m t x S O RISER/ y B oz CLEAN OUT m�Z a > 2 OCO O Z m rn a v Z CLEAN OUT o. LA a m m < m m= m DOUBLE CLEAN OUT ZO CLEAN OUT MONITOR TUBE MONITOR TUBE CLEAN OUT TEST HOLE m \gym i �e o NOTES: RECORD DRAWING DRAWN I SRP SYSTEM ASBUILT O a m cn m D O C N Z m r N O � y o rm- R, � m co ;u ,a m y 2 O mo '} y o -i R: A m ZD 'o-< 0in O �- vmx o - =0 2 OCO N N cn m D O C N Z g a r N O � y o rm- R, � o_ CSL=- ,a m y 2 O O '} D ova`^m -i R: ao Iz'o ZD 'o-< 0in O �- vmx - =0 2 OCO mz-y{� cn z JT7-i N Z O A O O � y o o m ,a m y 2 O m m 0 D D 3. i A H a -i ZZ A I D O Ta ;uO < z x D z fi I =0 m m rn a OD Z GZ') o. LA m m m < m m= m O� D in 22 Z G) ovi = c=o r -i m ;:o m is O to (n <Z in m N O -I - i n m -i -0, >y N < m>N m Z m m D Z m a Z N D � � C -f D 2 '�• in Z n i = z N In o 0 PANNONE ENG SVC LLC PHONE 907) 745-8200�FAX (907) 745-8201 HILLSIDE PARK PUD LOT 9 KEN & GLORIA SUTHERLAND 7240 TREE TOP CIRCLE ANCHORAGE, AK 99507 m cn n� m Do z n 0 0 o b m y In m N u' o t. 51 w m ym� o Z� n 0 I A ^a N O r r O 0 '6 m vs D 1 REVISIONS "AIL /30/ 2019 �Q ... SCALE P.I.D. NO 015-122-42 ••£iavoiT annone PERMIT N0. CE alas OSP191266 � SHEEi 9 nF v�mmOm^-> '�000�U)00— =0J N xx;u mmm 100) Oo cn y�7 (n DUS 7J -IZU Ti -<>XO mD O-� Z � � 1 M O cn MOM -a p 7 �r o F n zT7 r0' coW D (n -q-�0m-o--jM m _f�J7 <m< m Dx ZJ-c;y�cnm� IJ-{ DN O -<0 D OOrOrx nco ZZ --1-I � D 6 rn Z0 �(P m 00'D = f?l C7Z rMi F7 (n z rmA-0yO�ONO-1 _ O� 4c wW.-.. O -D WW � rC�Z � O m � I mn mN N �N I 0 CA Zm 0 (n -Dco O rn- CJI LJ (n r- (n O .-. N.70 c7 O r• D m mD C�')U) cn V m .� O �-0 -aO CCfl v) C7-OO�� CO -{ Z O * r -r r X m-7 m ND -q : ) Lo mm o Z co z O Q v m (� c m V = N V) O m O �Ao\m m O O' r /� \� Dh n 4 j ----- O t - It S3 ct 090 01. ` _.. ro. 6d 169 18 > v vo X m / Lq v �r >O, En w W 3 i :Qmm A � N m O a n + > U) n'•. m-ro w 0 n = I ®00 O y / L� D D I ..._ oo I zcn O Z nen n� r x r �. N N .— 0 Utfi `Eam o U o — — —=---=-•�--'m ---- O ----- 0 ---------- ----� �v - x I _. N N 0 O � 100 O .cNO v _f�J7 rn D 00 6 c0 Cn co Ut00 - O W N WW � W O W V (P Cn W N V CA NOTES: PANNONE ENG SVC LLC REVISIONS DATE RECORD DRAWING P.O. BOX 1807 PALMER, AK 69645 7/30/2019 PHONE 907 745-8200 FAX 907 745-8201' REV 1: 7/10/2019 SCALE THS R.D.: 7/30/2019 1" = 60' HILLSIDE PARK PUD LOT 9 •• P.I.D. NO -42 DRAWN ACP KEN & GLORIA SUTHERLAND " to 49 4" PERMIT NO. 7240 TREE TOP CIRCLE ` s14s PEOSP191266 SITE PLAN ANCHORAGE, AK 99507 SHEET 1 OF 3 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191266 Work Type: Septic Upgrade Tax Code Number: 01512242000 Site Legal Address: HILLSIDE PARK PUD LT 9 G:2539 Site Mailing Address: 7240 TREE TOP CIR, Anchorage Owner: SUTHERLAND KENNETH J & Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date ,�til�enr f Q-) llet>artmeut Lot Size in Sq Ft Total Bedrooms: 7/11/2019 7/10/2020 21313 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 3 Special Provisions: A test hole shall be provided prior to construction of the drainfield to verify, percolation rate and separation to seasonal high groundwater.; .Construction may proceed at your own :risk prior to 7-d4 ground water monitoring. If results require a design change, construction shall stop pending Onsite review and approval' of a change order. Please submit results of the percolation test and:7-day groundwater monitoring with the inspection report. Received By: Issued By: Date: 7/1// Date MUNICIPALITY 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. 015-122-42 Property owner(s) Ken & Gloria Sutherland Day phone Mailing address 7240 Tree Top Circle Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) Hillside Park PUD Lot 9 Legal description (Township, Range & Section) Lot Size 21,313 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank MUpgrade nX Duplex (D) ❑ Holding Tank E]Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: 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: $ 5 q 5- UD Waiver Fees: Date of Payment: o-9— PLU f I Date of Payment: Receipt Number: 0 3373 (3 Receipt Number: Permit No. LAM P lL7/ Gl' (0�2 Waiver No. Permit App_; :•.�..:c; Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191266, Rebecca Carroll, 07/11/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191266, Rebecca Carroll, 07/11/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191266, Rebecca Carroll, 07/11/19 cv-am zr=D m CD m �mm Om=z sz0� �z0 cn Zm0M zz=O m;u A mmm- Omn0 O 0;0 m o� D z rn C) O r- 0 z 000 o �, Lail m CD a °� (p m O n -ri W N m tV a m O Oi �a n oro O a m ro Q n Om W to z m O m D m m c' 0 n SD •Ja, O �� am: s.. Lot 17B Lakewood Hills Subd. \ 8484A 0 fi cD m \J_ I L/® CD fg l 0 AW 4Z:l + ID m ma n QO m0ro(D'DCD0<0 0) 00 ivy • ° n ° � ' `FYOR ro m �romm�Omm X00 m `\ m � @ c a :01tea°' i r- 0 z 000 o �, Lail m CD a °� (p m O n -ri W N m tV a m O Oi �a n oro O a m ro Q n Om W to z m O m D m m c' 0 n SD •Ja, O �� am: s.. Lot 17B Lakewood Hills Subd. \ 8484A 0 fi cD m \J_ I L/® CD fg l 0 + ID m ma n a m0ro(D'DCD0<0 0) ro m �romm�Omm X00 m � @ c a :01tea°' i 1D ro = m O I t0 i> fti 5` O � ro n m m m n O O -. Z3� C'i (D N+ n n N s cnm CD 03a 7. St ° m = 3 D . ro CDO m A N c�a3mv' c� ZD 0 �m Z 'aa ��mO� �o 0 m m�° �m0 -aa (Do - `�� SDS c(n O C7 co v O a m -• ro ca > CD n c m cn n r 'r � n r- 0 z 000 o �, Lail m CD a °� (p m O n -ri W N m tV a m O Oi �a n oro O a m ro Q n Om W to z m O m D m m c' 0 n SD •Ja, O �� am: s.. Lot 17B Lakewood Hills Subd. \ 8484A 0 fi cD m \J_ I L/® CD fg l 0 , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ,,~ ~_) MAILING ADDRESS p(~ LOCAT, ON ~,~.~ ~f~ ~ NO. OF ~ROOMS Well,~ ~ Absorption area i Dwelling I PERMIT NO DISTANOETO: ~ '~ Mate ~ ~ No o, om '~s~ ~O~artment Manufacturer ~, __ late~. -- I . ~ p Liq ca,achy ir~allons I Inside length Width Liqu d depth DISTANCE ;i~ll ~Dwelling PERMIT NO. ~ ~ ~ t Materia] I Liquid capacity in gallons ~ DISTANCE :O: ~~ Fo~~ [Nearest ot i.%/O I No. of li~es _ .~ I Length of each li~ .- Total length of lines I Trench w dt~ D stance betwe~ lines Top of tile to finish grade ~ ~ ~ Material beneath tile __ . ~ I Total ef~gctive absorption area Length Width Depth PERMIT NO. ] Type~ ~ diameter / ~ dept~ } Total effecti~~ ~ ~ DISTANCE TO: ~ Building foundat~~est lot line ~uildin~ founOat~on Semer line Septic tank ABsorption area(s~ DISTANCE TO: OTHER PIPE MATERIALS - DEPARTMENT ; HEALTH AND ENVIRONMENTAL , ROTECTION 825 "L'" STREET'., ANCHORAGE, AK. 99501 264-4720 C~"-.~--25 I TE S[=--I.-.IE~-~.' F"EF-."Ir-1 ][ T PERMIT NO. (:=:102:E~L:") ) HFFLI..ANT LOCATION I_EGRL [:'& B r'" =ENERFtL 'TREE TUF L, IF..L. LE LOT 9 HILLSIDE PARK PO ~,'1' * ' ~ LOT SIZE TYF'E OF =,YlL HE,_,ORFTIUN =,Y=,TEM tS: TEEN_.H "' ,!1 . ' +' ,': flH~':,Ifl_M N IMBER OF BEE.,RUOM .... 4 '- ' "(Sg! 150 SOIL F..HT I N.~ FT,.."BF.: ) = THE REQUIRE[:, z,I,~E OF THE =,UIL RBSORPTION =,~:=,TEH IS: [:_,.,, E i' TH=-.- :~_ ~:-~ L E i"-.! C:i 'T H--= 5 !,7.'~ .C-i R FI '..,," E IL [') E F' ]- H =: 'THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E).::CA',,,'ATION (IN FEET). THERE IS NO SET WIDTH FOR 'TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REg.~iJ ][ IRE[:. SEF"T' I ~'---.~ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 'TkiC~ (2:) I ~-I_~-.F'EC:TIC~[-~S RRE~:E~;]IJ IRE[:. BRCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE SUBJECT 'TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THR"r Z: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. ;2: I WILL INSTFILL THE SYSTEM IN ACCORDANCE WITH THE CODES. .~: I UNDERSTAND TH8T THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMO[:,ELED TO INCLUDE MORE THAN 4 BEDROOMS. / ~~ D& B GENERAL ~==,.=~. u~~ .... ~-~-==~ ........... ~ ...... ~ ......... ',,,'4, 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: SLOPE 12 13- DATE PERFORMED: ~/~A/ WAS GROUND WATER S L ENCOUNTERED? ~/"~:~ 0 P E IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop 14- 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: ~/C~ PERCOLATION RATE TEST RUN BETWEEN FT AND CERTIFIED BY: E~ Time Time ~e Date Date Date Inspector Inspector Inspector ,/ Comments Conditional Approval (..~) A~prowd ~,.~.~oms Date Sewer Installed ~T~,'~L~,~,.~~ Permit No. Septic Tank Size / .)_ ~--,_,~,/( Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Phone Mailing Address ~~ ,/~ ~Z"~'~'~ Lending Institution Phone Realty Co. & Agent ,,~ Phone Address /.,~?~/~'Z' / ~_. ~-~~ Legal Description Street Location /t9 ~'"--~ ~'~/~//j'"/O~ Type,~f Residence '[3Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply ,,~clndividual ATTACH WELL LOG. A well log is required for all wells drilled since June ommunity 1975. For wells drilled prior to that date, give well depth (attach log if [] Public Utility available.) , Sewa~Q Disposal · ~] Individual Year Individual Installed: [] Public Utility When Connected to Public Utility: E} Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. E rpy � Ag's �,�\ MUNICIPALITY OF ANCHORAGE'' 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. 015-122-42 1. GENERAL INFORMATION Expiration Date: g — / - z oz 6 Complete legal description HIIISIde Park PUD; Lot 9 Location (site address) 7240 Tree Top Circle Current property owner(s) Kenneth Sutherland Day phone Mailing address 7240 Tree Top Circle, Anchorage, AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic FX 1 Water Storage ❑ Holding Tank ❑ Community Well El 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 $ `iq'13 Waiver Fee $ Date of Payment ? 1311 A Receipt Number 636(66( COSA # 05C I q 13(19 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. 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 _4L System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date 07/30/2019 Conditional approval for bedrooms, with the following stipulations: .. U!//i,. �`��1))i11111111�, r By: vim-. 1 Original Certificate Date: I 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 Cheddist blue sheet Legal Description: Hillside Park PUD, Lot 9 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Community Water Supply B. TANK DATA Age of tank(s) 0 years Tank type/material Plastic Measured operating fluid level in septic tank New FE -1 Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA Which system tested (date installed) 7/25/19 01 ALL standpipes present per record drawing Total measured depth from grade 8.7 ft (max) Measured depth to pipe invert from grade 6.7 ft (min) ❑ N/A — pressurized field V 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: COSA Checklist yellow sheet Parcel ID: 015-122-42 Structure served by this system 1 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date New Results ❑ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 0 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 111 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' C] Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No ft 0 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 F✓ Yes if No ft Property Line > 5'✓Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 2✓ Yes if No ft Private Wells > 100' r✓ Yes if No Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' R] 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' ®✓ 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' U Yes if No Water Service Line > 10' Q Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Q 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. 8/1/2019 COSA Checklist yellow sheet ft ft ft ft U C J 'PgnS SIHH POOmGW1 a a c w 8L L 10-1 mRu°' o o d- (V w O 2'4�7 �� N U N 0 i- C8 M,,S '.i7000ON Q C rn Z •2, m a� c c Q a� °' - y._—a �_ ; o o N '� a Z Q p fn p. N ._ p m Y (n T mo> red t- 03 � 3 .c° a) - - oi J Co ?` 5 aj� Ems= mcom�N Qm c` �oCD � vaocUsn -`o 0 oc o n m m W 'o) CL c- y�co -o wa �c �F a v W W �rnO m,aa a'�mco3 n Q /" Cf U -_`Oy cmo a`000 ai U) r m sN N0 `6 mC>' a� cpa o cntu ID ? 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