HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 3 LT 1Chugach Park
Estates
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Lot 1
#051- 481- 31
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Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and Wastewater Program �r
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www,ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030342 PID Number: 051.481.31
Name:
MM&M Contracting, Inc. Wastewater System: New
Address:
P.O. Box 670495 Chu iak AK 99567 ABSORPTION FIELD
Phone: Number of Bedrooms:
688.1236 Four 4 5' Wide Trench
LEGAL DESCRIPTION - Soil Rating: Total Depth fro moriginalgrade:
Block:
1,2 GPD/Ftp 6 Ft.
Lot: Subdivision:Depth to pipe bottom from original grade: Gravel depth beneath pipe:
3 1 Chugach Park Estates 2 Ft. 4
Township: Range: Section: Fill added above original FL
gratle: Gravel Length:
2 Ft. 50 Ft.
Well Gravel width:
New C Number of hoes: Distance between lines:
Classification (Private, A B, C): Total Depth: Cased to: Total absorption area: Ft. t Ft
Private Pipe Material:
121 Ft. 121 Ft. 500 Ft= ASTM 3034 PVC
Driller: Date Drilled: Static Water Level: nstaller:
Sullivan Water Wells 9123/03 69 Ft. MM&M Contracting, Inc, ate nstall9/18-19103
Yield: Pump Set at: Casing eight Above Ground:
7 GPM Ft. >2 FL TANK
SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P.
❑ Other.
To Septic AbsorptionFUftHolding ubiic/Private nu ac urer:From Tank Field Tank Sewer Line Anchorage Tank �' y'nons:1250Well >100, >100,N/A >25' Steel u ero ompartmenls:
Two (2)
Surface Water >100, >100, NIA LIFT STATION — NONE ON LOT
Lot Line >5'
>10, NIA N/A
u ur
Gat.
Foundation >5'
>10, N/A N/A
ump on eve a :
Furnp o eve at: ig water a arm a
Curtain Drain None
Noted
In.
Pump Make a Model
in. In.
Electncal Inspections peAom>ed by:
Remarks:
BENCH MARK
ow ion an scop ion:
Garage Slab
100.0 Ft.
Engineer's Stamp
Inspections performed by: T.L. KimbroughAr
Dates: 1st 9/18/03 % 49th
,................ .
2"d 9/19/03 ;.....;.. '
Department of Health and Human Services approval 4 : AtICFIAELE' ...
ANDERSON �4'
'#F ..No. CE -4381 'Reviewed and approved by: 0��
Date: 6 -0 ♦ tp ' •••� '.
(Rev. 10/99) �• .••
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Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030342
-81.5
N 0 UU
1,250 Gat
Septic Tc
76.7
PID No. 0151-481-31
N
U F=-
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EROFILE AS -BUILT -
Scale: 1"= 10'
4.5
ROM COUNTRY RERLTY
PHONE NO. : 9076881238
Mar. 25 2004 12:11PM Pi
r'tt'ng 30a
by
aoceo. e=
SULLIVAN �WATER WELLS
P.O. MoX b7W2, CHUGIAK, ALf1ffKA tI W •
ADDRESS:
LEGAL DESCMIRTM.: h(1) 6,i r -Ar PAC i< --T
naTE:-
FFRAhIT NUMBM; CL3o Jr JA Date of Issm_L-a
TAX IDENTIRCA ICIN NUMBER: -05 _ j F1
Is we 1oczb--d at awrovw nem it bwr=p WA51 i:1 NO
Meft od of DrOung: Gz rmtary 0 cabta tool
Dth of wa11:• - /A
Ca-ingTypo-4'Wa217hickoees� �"�, Inches
Diameter- L I / rhes, deptt, �! feet
IinerType: �,Jo..tjg-
Casing SUckup,Above Ground.,--
static
round.,-_Static W2ttor t zVeL:-- aJ fs�
Rec4vvx' Rate: ._SIM
fuS�tttdd of'T�ting: _ �' iL
Weg Cr eke Opening Type- tD open end 13 open hors
.r S�ned; , StaR feat Sfs�Atl — fest
W%etforstlans Stam,..M2_..f at Stopped ---'U feet
Grout Type: !S•a... 1 w .' ne L dF
Deptf>: from - D tom, to A% feet
Well Disinfeckd tlpan CampLs ort? CPA= C1 go
Method of DisinfCction: - C h4 6 A �.�.! cz' rd A/," -
Ms m7
—f�r¢R r01'�i�4,J
_e"., 4
_ tn r�
Drfllsr's Name ,
XT37ENt70N: It is thO respanslbtIIty of the property owner tO sutwnit a Copy or the "11109 to the proper authon'ty, Municipality
.A Armhaage: Dapariment of Hoalth & Human SerAces and/or DsPe tment of F wkonmorlw Conmrveflon. MatSu Borough:
)gpartment of Environmental Conservation.
Q'I IC��a'3— 10 3v�
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Aug 28, 2003
Expiration Date: Aug 27, 2004
Permit Number: SW030342 Parcel ID: 051-481-31
Legal Description: (Chugach Park Estates Block' 3 L'ot 1
Design Engineer: 0014 Anderson Engineering Site Address: Unknown
Owner Name: MM & M Contracting, Inc. Lot Size: 54477 SQ. FT.
Owner Address: P.O. Box 670495 Total Bedrooms: 4 Permit Bedrooms: 4
Chugiak , AK 99567 -
This permit is for the construction of.
Q✓ Disposal Field 0✓ Septic Tank Holding Tank ❑ Privy Private Well ❑ Water Storage
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 (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (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:
Issued By: _
Date: '� i
Date: 8J-2 8 03
• Municipality of Anchorage
Development Services Department
Building Safety Division.. . .
0* On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. C) 1� L, ���� Permit Number SWO 36342
Property owner(s) M M&M -Contracting, lqc _Day phone 688-12,36
Mailing address (1) PA- Box 670495 Chugiak, AK 99567
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot .131ack 3. Chugach Park Estatco Subdivision
Legal description (Section, Township & Range)
Lot Size �r�1-i Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ❑ Well Only ❑
Sewer and Well ® Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ I Jacuzzi ❑
.Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: �' Waiver Fees:
Date of Payment: 8 13IU3 Date of Payment:
Receipt Number 00 Receipt Number.
(Rev. 12100)
ANDERSON: ENGINEERING
P OBOX 240773 4 "
ANCHORAGE ,'AK 99524
22.7 73-- _522-67,79 FAX
August 12, 2003
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 1, Block 3, Chugach Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 1, Block 3, Chugach Estates Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to serve the new home. The attached Site
Plan and backup documentation identify the location and configuration of the proposed
well and septic system. Also identified on the plans are the locations of the alternate
site, proposed well location and the well and septic.system locations on the adjacent
properties. Drainage arrows are shown indicating the current patterns. The drainage
patterns will be maintained after construction.
Test holes placed on the lot in September of 2002 indicate well graded gravel with
varying amounts of sand and some silt in the area of the new absorption trench and
alternate site. No groundwater was found during placement of the test holes and none
was noted during the ensuing monitoring period. We are therefore proposing to place
a new 1,250 -gallon septic tank along with a 50' long by 5' wide absorption trench with
an effective depth of 4' on the property. The distribution line in the trench will be
placed 3' below the existing surface. Sufficient fill will be placed over the trench to
provide:a' minimum of 3' of cover.
The ground surface on the lot is virtually flat with only minor grades from the northeast
to the southwest. The new absorption trench will be constructed parallel with the slope
as much as possible in conformance with Municipal requirements. The new septic
system will be constructed a minimum of 100' from the proposed well on the lot and the
existing wells on the adjacent lots. It will also be constructed a minimum of 200' from
LQt 1, Block 3, Chugach Park Estates Subdivision
August 12, 2003
Page Two
the proposed Class A Well on the property to the north.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
,in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
1 23
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17
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AREA MAP
SCALE V =100'
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• MICHAEL E. ANDERSON
�.� NO. CE4381
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WEST 1 0.33 81- 51
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AREA MAP
SCALE V =100'
0
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• MICHAEL E. ANDERSON
�.� NO. CE4381
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'LOT 1, BLOCK 3, CHUGACH PARK SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area
500SF/5 LF (Width)' .5 (Red. Factor) = 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be
T Below Existing Ground. Maintain 100' Separation From Well on the Lot. Place 2' of Direct
Bury Insulation and 2' of Fill Over Absorption Trench or Provide Minimum 3' of Cover to
Prevent Freezing. Place 4' of Cover Over Septic Tank. Maintain 200' Separation From
the Class A Well on the Adjacent Lot.
Natural
Backfill
2'6"
Geotextile
Fabric
6" 4" Perforated
PVC (Holes Down)
4'0" 1 1 ,-� Drainfield Rock
5'
TYPICAL & WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
2
3
4
5
6
12
17
U.
- ~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT DFHEALTH & HUMAN SERVICES
825 LSTREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TFI,;T
PROJECT #:- M0248
PERFORMED FOR: PAUL MYERS/MM&MCONSTRUCTION
LOT BLOCK [*UG�KP PARK A K [ T T
-_TE�THOLF# 1 ��SLOPE-____
---- '
PERFORMED:
4
i
2
UHE. ADRO
SITE PLAN
READING DATE
GROSS
TIME
NET
TIME
WELL GRADED SANDY GRAVELS
NET
DROP
Start 9/6/02
10:20
12 -
Recharge
10:30
WAS GROUNDWATER
12 -
ENCOUNTERED)
|pYES, WHAT DEPTH?
DEPTH orWATER
^�
AFTER MONITORING:
MEDIUM DENSE '
12"
POORLYGRADED SILTY DATE:
5ANOSW/GRAV[LS
SOME COBBLES TO 12
PERFORMED:
4
i
2
UHE. ADRO
SITE PLAN
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 9/6/02
10:20
12 -
Recharge
10:30
12 -
Recharge
10:40
12"
BOH PEncRATs _1___ Mm./|wca Psnc HOLE D|wnsTsn_6"--
TEST RUN BETWEEN FT' AND --5-5_-_FT.
ComnswTo N0|MpEQMEABL[SENCOUNTERED. HOLE PRESOAKED PRIOR TOTEST
TEST PERFORMED BY: |. MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PsnronmEo')wACCORDANCE
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16.
17.
18.
19-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PROJECT #: M0248
PERFORMED FOR: PAUL MYERS / MM&M CONSTRUCTION DATE PERFORMED:
LEGAL DESCRIPTION: LOT 1, BLOCK 3, CHUGIAK PARK ESTATES SUBO.
TEST HOLE # 2 SLOPE SITE PLAN
I / // 1 OG/OG
r WELL GRADED SANDY GRAVELS
Perc.
Zone
``' "':
WAS GROUNDWATER
NET
TIME
DEPTH OF
WATER
ENCOUNTERED?
NO S
10:19
12"
1
L
'
IF YES, WHAT DEPTH?
0
t
DEPTH OF WATER
P
NONE
12-
MEDIUM DENSE AFTER MONITORING:
E
10:39
POORLY GRADED SILTY DATE:
6/11/2003
.;...
SANDS W/GRAVELS
10:39
:'...::
SOME COBBLES TO 12"
" .. � .>',' .� p'��• A4 q 181
av .• /� • .�s���
"..� ?: fie....' ... ..... .... ... d
1p�MICHAEL E. ANDERX94 : cj� OF
jkw
CE -4381 AV
BOH
9/6/02
O
200' WELL RADIUS
4
N
O TH1`
O TH2 \
100' WELL RADIUS
O
NO SCALE
0/
No
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 9/6/02
10:19
12"
1
10:29
10
2.5"
9.5"
Recharge
10:29
12-
2
10:39
10
Recharge
10:39
12"
3
10:49
10
2.5"
9.5"
i I PERC RATE: 11 MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN 4.5 FT. AND 5 5 FT.
COMMENTS: NO IMPERMEABLES ENCOUNTERED, HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.L.-KIMBROUGH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 8/12/2003
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 1, BLOCK 3, CHUGACH PARK ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,250 -gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new absorption trench 50'
long by 5' wide by 4' effective depth also at the location shown on the
Site Plan. The total depth of the trench will be '7' below existing
ground and the distribution pipe will be placed at 3' below the surface.
All components of the new absorption trench and septic tank must be
constructed a minimum of 100' from any surface water and 100' from
the well on this and adjacent lots. A minimum of 4' of cover is required
over the septic tank and 3' over the absorption trench. In lieu of cover
2" of direct bury insulation and 2' of cover may be placed.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground
utility locates and for the layout of the septic system and verification of
the location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must
receive prior approval from D.H.H.S. before beginning system
installation.
SEPTIC TANK INSTALLATION
1. A new 1,250 -gallon septic tank must be procured from a certified
septic tank manufacturer if the existing tank is found to be defective.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
.Lot 1, Block 3, Chugach Estates Subdivision
August 12, 2003
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
less than 3' of backfill .depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade. area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
Lot 1, Block 3, Chugach Estates Subdivision
August 12, 2003
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as -built of the completed system.
Municipality of Anchorage
Development Services Department
\\ /% Building Safety Division ^'
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050.481-31 COSA # CXI Q off ) y
Expiration Date: I
1. GENERAL INFORMATION
Complete legal description Lot 1, Block 3, Chugach Park Estates Subdivision
Location (site address) 19543 Kuliberg CircJe Chuglak AK 9956
Current Property owner(S) Doug 8 Jennifer Koenig Day phone 688.2858
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
19543 Kullberg Drive Chugiak AK 99567
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, F.E.
Phone 522.7773
Date 715rz009
4•P�F;.OF•A�git)�
*:• 49TH Jy F 4;�o.
�NJO AEI E ANDERSONv
5. DSD SIGNATURE I�, f�f •• CE -4381
Approved for _ bedrooms. �I�...... a` �•
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: 7-0—o9
(R. 1IMS)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/ons@e
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 1. Block 3. Chugach Park Estates Parcel ID: 051481-31
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _ Well Log (YM) Y
Date completed 9123/03 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 121 ft. Cased to -121 ft. Casing height (above ground) i24 in.
FROM WELL LOG AT INSPECTION
Date of test 9123103 6125/06
Static water level.- - 69 ft. 74.3 ft.
Well production 7 g.p.m.' 6.3 g,p.m,
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 2.49 mg/L Other bacteria 0 colonies/100 mL
Arsenic: N/0 mgll Date of sample: 6/10/09 Collected by: T. Kimbrough
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/16/03
Tank size 1.250 gal Number of Compartments Two Cleanouts (YM) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YM) N
Date of pumping M12009 Pumper JRs Pumping
C. ABSORPTION FIELD DATA
Date installed 9/19103 Soil rating (g.p.dJft' orft2/bdrm)1.2 GPD/SF System type 5' Wide Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth —L—ft. Eff. absorption area 500 ft" Monitoring tube Y Depression over field N
Date of adequacy test 6125109 Results (Pass/Fail) Pass For 4 'bedrooms
Fluid depth in absorption field before test 0 in. Water added 636 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 4 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on' level at _ In. 'Pump off" level at _ in.
Datum Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
ILS
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100'
Public sewer main NIA
Public sewer manhole/cleanout NIA
Sewer/septic service line >25'
Holding tank NIA
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line>5_
Absorption field >5'
Water main N/A Water service line
>10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >t(r Water main >10'
Water Service line >10' Surface water >100'
Driveway, parkinglvehicle storage >5'
Curtain drain None Noted Wells on adjacent lots
1100'
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson. P.E.
Date 7/512009
COSA Fee $_ 7 %c)
Date of Payment��/Dy
Receipt Number_
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
* 491H
ICNArL-E ANDERSON :v i
CE
4381
1, VorESSWA 4b'
FROM : COL.ffRY REALTY PHONE N0. : 9076881238 Oct. 13 2003 11:04AM P3
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Municipality of Anchorage
Development Services Department *A.
Building Safety Division
On -Site Water and Wastewater Program °
4700 South Bragaw'St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051.481.31 HAA
Expiration Date: 7 D LL
1. GENERAL INFORMATION
Complete legal description Lot 1, Block 3. Chugach Park Estates Subdivision
Location (site address or directions) Kullberg Drive
Current Property owner(s) MM&M Contracting Day phone 688-1236
Mailing address
Lending agency
Mailing address
Real Estate Agent
:,
Mailing Address
P.O. Box 670495 Chugiak, AK 99567
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department' (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an. independent. professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD -also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority 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 Anderson Enc
ineerinq Phone 522.7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 4/12/2004
5. DSD SIGNATURE
Approved for_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
OFAN„r�,
ON : G�
Additional Comments o ^ —R AND m"
WASTEWATER
A
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: �. Original Certificate Date: % `- d
(Rev. 12/00)
i •
Municipality: of Anchorage E
Development Services Department;
Building Safety"
Division i t
` SAOr cTY'
i On=Site Water & Wastewater PrograOrm
m
li I I a 9
I � I't � I � 1
l 14760'South Bragaw St. I I.
l_
j { i P..O.I Box 196650 IAnctiorage' AK 99519 6650 ; I €
l 1+ I II Illi +] II cli+ I,
S � I II h iwww.c! i.anchorage.ak tis
II(907) 343-7904
.',, = III•
I I 11 r II
I t •
I 7111 HEALTH AUTHORITYr APPROVAL ,CHECKLIStT I
-{ ill I+, lilt I I I '. III�. I I .1 1 I• . I ,t +;, gg ,.
I Legal Description• Lot 1,18lock 3 Chugach Park Estates Subdivision I I i Parcel ID: 051-481-31 -
I1
IA. 14
WELL DATA('(
1 `.i I I ypi I a +I III � I I •� ,r, ; '+
;' i `{�
Well,type Private I j a �If A, 13'6r C provide P,WSID # a E Well Log'{Y/N) Y ' l
':Ills,
Date completed 9123/2003 f ? Sanitary seal (Y/N) Y ; Wires properly protected (VN) Y
It'..�
Total de th ,121 IIft Cased to 1121 Ift ` u { I l I
l ; Casin hei ht (above ground 24 .
p,�Casing i I g l I .) in
II 1. S ,.II .I,II II l I I l li 't' s f 11, I�I 1 it III,
:FROM WELLILOG '! AT INSPECTION l
:I I • ,i jj ' I' y I -i yyI ' I I'..li I I'.i' II , I '. � r �i it I ;�,� I I�I I!: �
'''604
,:
i Date of test 11i'I III 9123/2003 e i ` , ; 313112004
I�,� f ', I �'.II(j
l Static water level ! i' 121 ' I ft
169.0
ff ; -
I a7I I11 ') II I iIWell roduction 7 ,;I i t 4 l
l p g p:m + 8 4 I I I a g.p.m:
t
;; 1 All I I- I
.k. i
WATER SAMPLE'. RESULTS � l
j
i Coliform 0 i olo n ios%100 ml it j I Nitrate 1.19 mgal k " I 1, I R IIOtFier bacteria 0 colonies/100 mL
a i
.Illi I �ilE�lll'II��Ii IFl•�lb ;,�; IiIlI II11 I�� III•"'ll ' ;II
t II f
Dateofsample:{ 313112004 Collected by + TLK 13
i'I,'IiII
I i B SEPTIC/HO (DING TANK DATA 7 a I, + l I {
I--
Tank?Type/Material Septic/Steel 'I �I I i ' I I j!'' i III l IDate installed 9!1812003 '
I,
11250 I, .,1111 111 Ili i ,jj� I Illi a l,, ,IIII � l�•. t i + 'Il I+I'I 'itj�l 1 I. II!i' � I: Il
l f Tank size ,1.250 al III I j 4
g l (Number of Compartmen s 2 Cleanouts (Y/N) Y{;
,j I I i,'I ,�,�! I�II•II'i II11 IIII ��;I'll,l�,�ll I;I� �! ,; '•I'I'I; III;II�;I II
I Foundation'bleanout (Y/N) Y ll; Depression over tank (YM) jN I :Ij I High water alarml(Y/N) IIN
Il I i it- III ll lel +I,�:II II I.II�°I�i
Date of pumping 11 a :'III I'' J I Pumper NewConstructionl iI ill�f 'l;l ;j l Is I
II it I!1tI t,I 'I,ji 11 l;; �'lll + lll" 1 II I � I II IIII'��I: IIS II �II '• �I I I �� P
!' I '1C ABSORPTION FIELD DATA
ISI I j 111 .I i III' E-IIII Li ill I i! I � 61 � Iy,. I II I ll I1 I II I i
.'I l Date installed 911912003 I Soil rating (g p d /ft or, ft /bdrm)1 2 GF ISF System type 15 Wide Trench
Ill I i'l l 1111 IL. I'IlI 1i1116;.;11llilcll'I ill illilj!.L o Ii i i 1411 91Glllll',II I l,lllsl,l , l l,ijl,
Length 50 +' Ill ,ft:l i Width 5 II'tit�•� li�I ft' ,II Gravel below pipe 4
ft.
�;I ;II SII III I''I �Li1ll slll,j II41 Ilili:l ( I! a llIIII ► II'; '� l
Total de t 8
h t
f Eff. absor tion area 500 f
t
P Monitorin tube. YI'
_ � � ,11 P, � , g Depression over field N
Iti
' li l I l � I ll l I, IIS` I +l II I I 11 '
l oto I Ie 4
I a e f adequacy test I; Results (Pass/Fail) I I 1 i:: For ` bedrooms
l - , ., i 1. +; ; I I : iii • i I I {, l.' . I � I I � I I " � I I
I Fluidde th it abs or tion feld e r l lIn'I ;11,� I ,. a
{ p b fo a !test Water, added gal. I ,; New depth in.
pj�.,` I�` l•
Elapsed Time E�`—I II min. I l: Final fluid depth ' in �, i :Absorption rate I > I
g.p.d.
,I I+'s,
r { ;I
I Any �ejuvenafion treatment (past 12 m0.YY/N &type) N I ! If yes, give date
ji M I I I I Lr l l :ill l; II1..I 1
III IIII , l iif'`•L I i �l I � � �II c � � I � Id' i I 1 I 1,� ;I''' I II'1 ' III �' ,I
I
i
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
Size in gallons Manhole/Access (Y/N)
"Pump off' level at in. High water alarm level at in.
Cycles tested, Meets alarm & circuit requirements?
E. SEPARATION DISTANCES.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
On adjacent lots >100'
On adjacent lots >100'
Public sewer main NIA Public sewer manhole/cleanout NIA
Sewer /septic service line >25' Holding tank. NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field >5'
Water main NIA Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots >100' r
F. COMMENTS
OF
kit
G. ENGINEER'S CERTIFICATION •� #
6
P
i that I have determined through rield inspections and
Ar
I certify a 49th .....�.�
review of Municipal records that the above systems are in 0 .....: ...................
conformance with MOA HAA guidelines in effect on this date. 0 ,•,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,
MICHAEL E. ANDERSON•]
Engineer's Printed Name Michael E. Anderson, P.E. �i� No. CE -4381 ,.�.
Date 411212004 •� ss1�P:•
HAA Fee $—Ifka Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
(Rev. 12/00)
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