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HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 3 LT 1Chugach Park Estates B10 k 3 Lot 1 #051- 481- 31 t 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) �• .•• r- 0 ° Kullberg Drive 154.16 00 r- 0 o ti � N I 2 -v CA M H I z = I T w c Im CD D O o wcn I cin Cl I CA) C m � , N Co O V w C I (n 0 C C® co �O o S C/)D m y� yyd I m CD to � ZC/)Z a I m O 0� CD vm mM -n � D N Z . O n " > 3 9 ID `n (n S ICn .<o<� CDOnm C I ��c0 r I Amo CDCD coo CD —cn� Nc� m rnm n OZ o c I co •R. v ca \ I o 44 �a I I 0 � n cn to Ln P N _. �o"��� 7 i�y�\ ase I cin m N ♦��r�► �%N ♦ �1� .� .� CO v v — ; D 88 \ 'hegr \ co w o w ♦♦♦ ��'\�� . s��1 O Ln w 0 \ i:• o s :�/. LOU c0 c0 W N Co T : ,N: m g •0 O — 0 cn t0 O�OOD00 A* R. % t �� 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=- � U 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 h 1p h 17 ro w 3 5 3 4 AREA MAP SCALE V =100' 0 8 2 a to • MICHAEL E. ANDERSON �.� NO. CE4381 ssl 0 If 95.00 WEST 1 0.33 81- 51 CD > ... • • 7 Y S90 0.00•E 311.80 � Ss °S�Og • ro w 3 5 3 4 AREA MAP SCALE V =100' 0 8 2 a to • MICHAEL E. ANDERSON �.� NO. CE4381 ssl '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 •3 ZZ , , aa- � �.n. .%•S� f('v�i♦�.,: ...,• .fp. ,y•• . : cif � •l •. i�• :Tli . �♦ 1�� .moi .N' '4`.':1., .<.%?'.: P'•+rS :"`.. ��..,:: $=moi 1t.a•i? }•. �4�,•I':'�:�. 1• - ••4t•�'r. .. '." ,' :: d`. .: V:. � ::'i '. .r•rr'' '. r�..<.' eM1: '.: <.,.:. al i.".r:r,•W..:,. .a `•:a j�•Y'14.r'y:.6 •1'a' J%r. :v. t.t_., tn, t!. •' : 'T:r t. i`"'t' +'• .^� •Fvcd.i .yi'y;3);(I 3c.La.T'/'� '. t : t:. c - -.•, •; 7. 0_:30= Y '�2 '•t' s : t .,'� _ .r 7:. 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"on the pteausee'h5qucnlo and {i,at theta -are no ropdw ' fid,, • 'transtnusan ks+e? or othervisd)le easemenu on.-$&idpsoperty• : a.' H.••<•••!,•! r• ••• *. as jn aced hereon:-, ,< ' , • ... 10 _ .r..H. Mi•. T,r. 44. `,, • _pt as t�� "F2ot;tr4C 7oh(l;an r.•,r j:.. -• ..:.. •. , •'•' �.g".'moo-� day op � lG-�. � '.•t/���� .♦'ice t108�^3•.:. •�'%,o_•'ti ` if ...._. �. - y 'ROSI:BT C.) ;Registerrl Lat+d SltnR orNo.880 CS . R SCALE: • - , y' ' ska 99577' Fj p `•..4.s:H �',� a',. : Box?70456. FzEk River, ilk Y a3 �d�s.nrgtiC���« °: J• Box E9D7)69S7513. m m CL m Ic 0 v m V m c 4 D C R c 3 v U N 0 v 0 m 3� m n �. m c d D 9 `� 0 n .. 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N > D ZID 3 D m S w CO > D �y Zm -4 D�1D R CID 0-4;d OW N Wo a m N O V A A m m 'a m _ y ° 3 a s N N N N to A W❑ S C d 3 AG G 7 El ElF v z CLo x r 0 D #z m m 0 fn 0 O n 3 o_ 3 � r m a -I a � G 7 El v z CLo x r 0 D #z m m 0 fn m m 0 O n Z � r a o Q . If p O 0 0 In m N O m 0 O O 0 �14F� 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 ,.�. 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