HomeMy WebLinkAboutKASILOF HILLS BLK 2 LT 1Kasl*lof Hills
#015-161-29
Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK W5194650
www.d.anchorage.ek.us (907) 3437904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40052 PID Number. 015.16129
14 "
Michelsohn and Dau hter Construction Inc.
Wastewater System: New
750 W. Dimond Blvd. Anch. AK 99516
70
5
ABSORPTION FIELD
Ph�: Mm to of Sed °
522.3375 Four 4
Deep Trench
LEGAL DESCRIPTION
SOA Rab°
AS
Tebl DWlh koro ariginw Wad•:
10
DFD*e
Ft.
610dc lot subtlml :
DWIh b" bonan from Oda" Wage:
Coeval dWm beneath pip.:
2 1 Kasilof Hills
2 R
8 Ft
Towrekp: Rarypr: sedan:
Fill atldad above original 7• :
2-3
13 v 1lmpm:
86
R.
Ft.
Well: New
wam:
3
NW*W of
1
Disbna baawen linea:
Ft.
- Ft
Claeelfieadon (Pdvale, A, B, C):
Private
TOW Depen: caod W
346 60
aW ebnrpban area;
1,376 Fe
Fqm .
ASTM 3034 PVC
orilbr.
Alpine Drilling
Dab Odkd: sialic Welty L";
612912004 1 30 Ft
Cat's Eye Excavatio
4115.1612004
Yield
3 1
°"masa
c.dna Ab" Glaaa:
>2
TANK
wen
Ft
SEPARATION DISTANCES
® septic ❑ Holding ❑ S.T.E.P, ❑ Other:
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
ublitlprivate
Sewer line
Anchorage Tank,
Ty In'
1 250
wet
>100'
>100,
NIA
NIA
>25'
MIRWr:
Steel
Two (2)
Smboawal.r
>100'
>100'
WA
WA
LIFT STATION - NONE ON LOT
Layne
>5'
>10,
NIA
WA
Fauraran
>5
>10,
WA
NIA
/q,
WOWW.W In.
UMP a
wa �'
curial. Dram
None
Noted
w•o a masa
TIaw PWftMWW br
Rwraft
BENCH MARK
Garage Floor Slab.
-
EXAM
100.0 Ft
Engineer's Stamp
OF qq��
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•••i
•�
Inspections performed by: MEA Dates: 1'r 411512004
49th
•
Zed 411612004--....-.-•µw
� A MICHAEL E. ANDERSON
Department of Health and Human Services approval
.1
•• si N0. CE -4381 Y'
••�F�Fo
Reviewed and approved by: Date:f�-6-O
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15
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO40052
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MICHAEL E ANDERSON
No. CE -4391 _ r'
2
WEST 190.01'
10' UTILITY EASEMENT
-------------------------------------
Ne
•Amate Site
C4 PM2
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LOT 1
C5
Page 2 of 3
PID No. 015-161-29
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S89'58'18"E� 170.00'
SHEBAN F AVENUE
PLAN AS -BUILT
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30'
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SHEBAN F AVENUE
PLAN AS -BUILT
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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. SW040052 PID No. 015-161-29
102,9
L)
N N UV
1,250 Gat on
Septic Tnnk 8.3
98.
98,3
N
U S. H V
PROFILE AS -BUILT
Scale: 1" =10'
�,•• � X9'0
49th
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:• MICHAEL E MIDERS PC C, l
.10 No. CE -4381
. .-
Nov -02-04 14:01
Mayor
from-MICHELSOHN i DAUGHTER CONSTRUCTION 9075223376 T-275 P.01/02 f-563
Municipality of Anchorage
Department of Health and Human Services
825 V Street
P.O. Box 196650 Anchorage, Alaska 99519.6650
Mt V www.d.snrharAW.ak.us
Permit Number. #SW ,040452 Date of Issue: +jL-94 Parcel Identification Number: 011-29
Date Started:28-OA Date Completed: 6-29-04 Is well located at approved permit location? ® Yes Q No
Legal Description: gasikff Hills Blk 2 Lot 1.
Property Owner Name & Address: Sharon & Brett Miller
11130 Glazonof Drive
Borehole Data: Depth (ft)
Soil Type, Thickness s: Water Strata From To
Stick up
0
2
organic & atit
2
3
gravelly silt
3
41
silty gravel
41
48
Bedrock
48
346
M
Method of Drilling ®air rotary [j cable tool
Casing type: steel
Wall Thickness: = inches
Diameter: ¢ inches Depth: 0 feet
Liner Type.
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 10 feet
Pumping level: -14-0 feet atter
2 hours purnpmg 2 gpm
Recovery Rate: P- gpm
Method of Testing: &kg
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped fed
Groot Type: bentonite # 8 Volume: 2
r)enth- Start 0 fed Stowed 2 feet
Pump: f utake-Depth . feet
RTmn site hn Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
Well Driller. Alpine Drilling & Enterprises
PO Box110496
Anchorage Alaska 99511
Attention: The well driller &hall provide a well log to the property owner within 30 days of completion and the property
....:......a.....4, n...1. ,0 .....,t t......1.. T._. .r VT. .11L a ♦Y.. .... p. -.I- .. ..: .L :.. e. A.... .0... .... .I -.o ..
MUNICIPALITY OFANCHORAGE
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: Apr 12, 2004
Expiration Date: Apr 12, 2005
Permit Number: SWO40052 Parcel ID: 015-161-29
Legal Description:St,Lt "LLS SUBDIV)SION BLOCK 2 LOT
Design Engineer: 0014 Anderson Engineering Site Address: 11130 GLAZANOF DRIVE
Owner Name: SHARON & BRETT MILLER Lot Size: 32225 SQ. FT.
Owner Address: 11130 GLAZANOF DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99507 -
This permit is for the construction of:
Q✓ Disposal Field [✓ Septic Tank ❑ Holding Tank ❑ Privy Q✓ Private Well E] 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
Issued
Date:� b t?
Date: %2
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw, St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01
�wsy
Number SWO400 S2
Property owners) Michelsohn & Daughter/TA( AV ! 84F7i ft" !@Oay phone 522-3375
Mailing address (1) 750 W. Dimond Boulevard Anchorage, AK 99516
e g-address(2)4/130GL/ ZAA1OF M.0 04#0496F Zip Code !YM7
Legal description (Lot, Block & Sub'd.) Lot 1, Block 2, Kasilof Hills Subdivision
Legal description (Section, Township & Range)
Lot Size 32,225 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ❑ Well Only ❑
Sewer and Well Q Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub E3 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.
N
(Signature of property owner or authorized agent)
Permit Fees:
Waiver Fees:
Date of Payment: ' ( t ZI 04 Date of Payment:
Receipt Number: D Receipt Number.
(Rev. 12/00)
$173°0 pF$8/o°Q 1S
rOR RKSM
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
622-7773 522-6779 FAX
April12,2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 1, Block 2, Kasilof Hills Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 1, Block 2, Kasilof Hills Subdivision intends to construct a 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 new well
and proposed septic system. No conflicts exist between the well and septic system on
this lot and on adjacent properties. A well is located to the west, which restricts the
area available for a septic system. The system will be constructed outside the 10'
protective radius of this lot. Drainage arrows are shown indicating the current patterns.
The drainage patterns will be maintained after construction.
Test holes were placed on the lot in the area of the new absorption trench by Alaska
Water and Wastewater Consultants, Inc. Their results indicated silty gravel and sand
with varying amounts of silt. The material was apparently looser toward Test Hole No.
1 with a percolation rate of nearly 3 minutes per inch. The recommendation from
AWWC was an application rate of .45 gallons per day per square foot of absorption
area. We will verify this rate during construction of the trench. No groundwater was
found in the monitor tubes for either hole and none was noted during the monitoring
period. We have therefore designed the system for a 1,250 gallon septic tank along
with an 85' long by 3' wide by 8' effective depth absorption trench. The total depth of
the trench will be 10' below the existing ground surface. A minimum of 4' of backfill will
be placed over the septic tank and 3' over the absorption trench.
The ground surface on the lot slopes at shallow grades as shown on the Site Plan.
Spot elevations are also shown on the plan. The trench will be constructed parallel with
Lot 1, Block 2, Kasilof Hills Subdivision
April 12, 2003
Page Two
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
100' from any surface water in the area.
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,
"J'E O."L,
Michael E. Anderson, P.E.
Attachments
4l .— Vii! :*
MICHAEL E. ANDERSON
NO. CE -4381 I
15
E
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0
7A III 3
AREA PLAN
SCALE V =100'
, E.M,pEm
No. cc,33,
1
<
L
g
1 .
^'
num
113.01
189.99
Shebanof
Avenue
,90.00
101UmEm1
t01111PEm{
AREA PLAN
SCALE V =100'
, E.M,pEm
No. cc,33,
Existing
Well
LOT 1, BLOCK 2,
KASILOF HILLS SUBDIVISION
Shebanof
SITE PLAN
SCALE 1" = 40'
v
CD
Proposed
Well
1400.0
1388
WEST 190.01
10' Utility Easement
F---
_
Q THI
TH2® 85
'
xf
Ab
`
\
5'
'
\
1,250 Gallon
Septic Tank
'
139 .7 X
T 14i
=
Four
Bedroo
Z
_ I
Ho e
F.F. 1. 1403.0
Wi
1
170.00
Shebanof
SITE PLAN
SCALE 1" = 40'
v
CD
Proposed
Well
1400.0
LOT 1, BLOCK 2, KASILOF HILLS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House Deep Trench System
Perc. Rate: 30.60 Min./inch 1,250 Gallon Septic Tank
Application Rate: .45 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD/.45 GPD/SF(Application Rate) = 1,334 SF Absorption Area
1,334 SF/16 SF/LF = 83.4 LF Trench Length
THEREFORE: Construct an 85' Long x 3' Wide x 8' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be
10' Below Existing Ground. Maintain 100' Separation From Well on Lot. Provide 3' of
Cover Over Trench and 4' Over Septic Tank or Provide 2" Insulation and 2' of Cover.
Place a Flow Splitter Valve to Insure Even Flow to Each Trench.
3'
f——I
*49
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.
Minimum 10' Separation From Water Service Line.
Natural
Backfill
1'6"
Geotextile
Fabric
6"
4" Perforated
PVC (Holes Down)
8,0"
Drainfield Rock
3'
f——I
*49
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.
Minimum 10' Separation From Water Service Line.
Apr -09-04 15:01 From-MICHELSOHN l DAUGHTER CONSTRUCTION 9075223376
Nar•18- 2004 10s41AM Garness Ensineerin8 Group, Ltd.
Im QESORIPTION: , Keen OE MIA 6UDDwmPj LlYf 1 MM 2
PERFORMED FOR: MR DUAN n12 'ERM BELL 11 JACK wKnE DATF 3/7 03
V"Q [915'^9 ORGANICS EST HOLE 2
SOILS LOGGED
SM- L
41 G) W/
T-848 P.02/05 F-225
Hu -4323 F. 4
PERCOLATION RATE __!L..8? (MIN./INCH) PERC. HOLE DIA. B (INCHES)
TEST RUN OETWFEN 5*0w FT. AND SS_ T.
A FOUR HOUR PRESOAK WAS PERFORMEDr M YES ONO
AUS PERCOLATION TEST_PERFORMEO BY: MATT FISHER
PERFORMED 8SY AKWWC. INC. L JCFFRET A. GARNESS. CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDEUNE9 IN WE= ON THIS DATE:
Received Mar -18-04 9646 From -10T3383246 To-MICHELSOHN i DAUGHTE Page 03
I'
NNE]
VM21:
MONli24
T-848 P.02/05 F-225
Hu -4323 F. 4
PERCOLATION RATE __!L..8? (MIN./INCH) PERC. HOLE DIA. B (INCHES)
TEST RUN OETWFEN 5*0w FT. AND SS_ T.
A FOUR HOUR PRESOAK WAS PERFORMEDr M YES ONO
AUS PERCOLATION TEST_PERFORMEO BY: MATT FISHER
PERFORMED 8SY AKWWC. INC. L JCFFRET A. GARNESS. CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDEUNE9 IN WE= ON THIS DATE:
Received Mar -18-04 9646 From -10T3383246 To-MICHELSOHN i DAUGHTE Page 03
I'
4ar-09-04 15:01 From-MICHELSOHN i DAUGHTER CONSTRUCTION 0075223376
Mar.16.,2004 10:41AM Gernaed Engineering GrouP, Ltd.
JUL ASKA W.
LEGAL DISCRIPTION: KASUF 16LIS EMMM": LOT 1 QOM 2
PERFORMED FOR MR QUAN e/e 7lRE7:A iUl �! Ji1CK r(Ylr[8 DAT1 .3/7^003 _
�p oRGaNlcs trEST HOLE
1 r�
GM/SM
7
e SM -ML
6 MIXGED w/
10
tt
12
13
1ilLo.
N
t8 "
17
ImAsslacoam
cw i—d ORG
�,
c -
Illllilli
II:111�11
I1
9
'•3�
Illtllll!
OZ
10.
T-848 P.03/05 F-225
1,110•4ac4 r. c
PERCOLATION RATE 6120 MIN./INCH) PERC, HOLE DIA. 6 (INCHES)
1!
TE31 RUN BETWEEN 3.0 FT. AND ^ 3.3 _FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES Q NO
SOILS LOGGED BY. JODY MADS PERCOLATION TEST PERFORMED BY: MAr1 FISHER
COMMENTS: OPERLO!AmON TUr BEUEVO 1O BE PFRF71r1YED om uL L£NSF, RECDYYENO USIN4 A 0.49 APPLFdM2 RA7F.
PERFORMED BY AKWWC. INC. I. JEFFRE7 A. GARNESS. CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WMW All- STATE AND MUNICIPAL GWDFUNES IN CPFECT ON THIS DATE: _
Received Mer -18-04 00r48 From -0073383246 To-MICHELSOHN a DAUGHTE Page 02
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 1, BLOCK 2, KASILOF HILLS 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 85' long X 3' wide X 8' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 2' below the existing ground
surface. Total depth of the trench will be 10' below the existing ground
surface. The new absorption trench must be placed a minimum of 100' from
the well on this and adjacent lots. The contractor is required to verify
separation distances from all wells in the area are met prior to construction of
the septic system. The septic system must also be placed a minimum of 100'
from any surface water.
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. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soilsettling. 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
A new 1,250 -gallon septic tank must be procured from an approved source
and installed at the location shown.
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 2, Kasilof Hills Subdivision
April 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 2, Kasilof Hills Subdivision
April 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, Femco, 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
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-161-29
1. GENERAL INFORMATION
Complete legal description KASILOF HILLS B2 Ll
Expiration Date: L
Location (site address) 11130 GLAZANOF DRIVE, ANCHORAGE, AK
Current Property owner(s) BRETT & SHARON MILLER Day phone
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
PO BOK 11320.5 ANCHORAGE, AK 99511
Day phone
Single Family (w/wo ADU)... ...
El Duplex udlylI �.t
0 Multiple Dwellings (Single Family and/or Duplex) FED 24k 2014 L
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
M
Individual Water Storage
❑
Holding Tank
F-1
Community Class _ Well
El
Community
M
Public Water System
El
Public Sewer
F-1
Waiver/Variance request for: Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee
Date of Payment q C
Receipt Number bl'5�t�
COSA # D-)(— 1 A I 05'J -
Waiver Fee $
Date of Payment
Receipt Number
I
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 2/10/14
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen iC OF 4( `
encroachments, deficiencies or discrepancies exist.
4gzi{
-* '1
6. DSDSIGNATURE h `
System #1 Approved for bedrooms. „s10,
System #2 Approved for bedrooms.
�'Rofgs?tcv"�' i
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
The Municipality of Anchorag evelopment 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 engineers work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory C Other
COSA blue sheet 10-10-12. dbc
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: KASILOF HILLS 62 L1 Parcel ID: 015.161.29
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID #
Date completed 612912004 Sanitary seal (Y/N) Y
Total depth 346 ft. Cased to 60 ft.
FROM WELL LOG
Date of test 612912004
Static water level 30 ft.
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG- colonies/100mL Nitrate O.G& mg/L
Arsenic: 14D ug/L Date of sample: 113012014
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTICISTEEL
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 1129114 Pumper A+
C. ABSORPTION FIELD DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
1130114
ft.
g.p.m.
Collected by: ARCTERRA
Date installed 411512004
Cleanouts (YIN) Y
High water alarm (Y/N) N
Date installed 411612004 Soil rating (g.p.d./ftZ or ftz/bdrm) 0.45 System type DEEP TRENCH
Length 86 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth 12' ft. (Measured 1/30114) Eff. absorption area 1376 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 1/30/2014 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 10 in. Water added 630 gal. New depth 15 in.
Elapsed Time: 40 min. Final fluid depth 10 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
Size in gallons
"Pump off' level at _ in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 1001+
Absorption field on lot 1004
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 504
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 100'+
Manure/animal excrete storage areas 1004
Building foundation 54 Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 101+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 104
Water Service fine 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 504(NONE KNOWN) Wells on adjacent lots 100'+
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 KENNETH M. DUFFUS
Date 2110114
COSA brown sheet 10-10-12.doc
Aw OFA -''
�* 4C) T-
X
x *+
P KENNETH M. DVI+' /
¢� 7,
Air
Municipality of Anchorage
Development Services Department x_
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ei.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) 9 OSC141055
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 1 of Kasilof Hills subdivision, the well's
productivity was determined to be .98 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 4 -bedroom
residence is .42 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Development Services Department
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.C85.161.29
HAA# rrJ'' !J:Q G 32Z
Expiration Date: 'P - r� — 0 5
1. GENERAL INFORMATION
Complete legal description Lot 1. Block 2. Kasilof Hills Subdivision
Location (site address or directions)11130 Giazanof Ddve
Current Property owner(s) Micheisohn & Daughter Construction, Inc: Day phone 5223375
Mailing address 750 W. Dimond Blvd., Anchorage, AK 99516
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA wr71 be held by DSD for pickup.
2.- NUMBER OF BEDROOMS:
Four 4
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 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 data of issue for -properties served by a private or Class C well and may be reissued with
new water sampie'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 I 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 investigationand 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 Enalneerina Phone 522.7773
Address .P.O. gox 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 11/22@004
o �
s 49th) �t
... ..." .... ...
5. DSD SIGNATURE i `•.. No CE -43M .Ff
1% Approved for T + bedrooms. � p
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: �,"� a Original Certificate Date: / (p in L•
(Rev. 12MO)
Municipality of Anchorage u ,.
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Sox 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: rot 1 Block 2 Kasilof Hills Subdivision Parcel ID: 015.161.29
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _
Well Log (Y/N) Y
Date completed 612 12004 Sanitary seal (Y/N) Lf
Wires properly protected (Y/N) Y
Total depth ,W4 ft Cased to _0 fL
Casing height (above ground) 2' ' in.
FROM WELL LOG
AT INSPECTION
Date of test 612912004
Static water level 30 ft.
ft
Well production 3 g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
..
Coliform _9—colonies/100 mi. Nitrate 1 mg./l.
Other bacteria �5 oolonies/100 mi. z
Date of sample: 1121/2004 Collected by: MEA
B. SEPTICIHOLDING TANK DATA
'r
Tank Type/Material Spo+icrSteel
Date installed 411512004
Tank size 1,250 gal. Number of Compartments I
Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) 11
High water alarm (Y/N) N
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
i
i
Date Installed 41612004 Soil rating (g.p.d.if or ftz/bdrm) 445 GP_D SSFF System type Deeo Trench
Length 66 ft Width 3
ft Gravel below pipe 8 ft.
Total depth 12 ft Eff. absorption area 11376 ft' Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass(Fail)
For _ bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in.
Absorption rete >= 9•p•d•
Any rejuvenation treatment (past 12 mo.) (YIN & type) N
If yes, give date
"Pump on' level at _ in.
Datum
o�v m yawns
"Pump off" level at _ in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main NIA
Sewer /septic service line >25'
Mannole/Access (Y/N)
High water alarm level at in.
Meets alamr & circuit requirements?
On adjacent lots >100,
On adjacent lots >100,
Public sewer manhole/cleanout NIA
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5' Absorption field W
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' Surfacewater >100' Driveway, parking/vehicle storage >25
Curtain drain None Noted Wells on adjacent lots >100,
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 cernfy that I have determined through field Inspections andi`t 49 h 7*
review of Municipal records that the above systems are in =� Mr...... .
.....
conformance with MOA HAA guidelines in effect on this date. ,,,,,,,,
�.... ;...... �mF'rtsori.f ;
Engineer's Printed Name Michael E. Anderson. P.E.
Date 11123104 iey�D
HAA Fee
Date of Payment
Receipt Number
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
12- 3-04;11:48AM;
SGS Ret#
1047665001
Client Name
Anderson Engineering
Project Name#i
Lot 1, Block 2, Kasilof Hills
Client Sample ID
Lot 1, Block 2, Kasilof Hills
Matrix
Drinking Water
Sample Remarks:
;907 5815301 * 2/ 8
All Dates rimes are Alaska Standard Time
Printed DatalTime 12/02/2004 16:31
Collected Date/Time 11/212004 15:40
Received Datefrime 1!22200 12:30
Technical Director Stephen Ede
Released B ps„�,�/a/
Parameter Results PQL Units Method Container ID Allowable Prep Analysis ]nit
imin to Date
➢Paters Department
Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 B («10) 1122/04 RJA
Microbiology Laboratory
Total Coliform TNTC OB coU300mL SM20 9222B A (<=I) 1122/04 DKC
.J
12— 3-04;14:50 ;CT and E Andersen Engin.
v
SGSICT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform. Bacteria
READ VISTRUCMONS ON REVERSE SIDE ■EFORE COLLECTING SAIA`LE
MUST BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTRIA =
PRIVATE WATER SYSTEM
13 Send RerJb
= e�-1LILoJ caJb
.S
Z•y 0
13 Send NvWes ,may
e�f�r i� alYm ItL
`•5515301
I
0 2/ 2
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tet: 907.562-2343
Fax: 907-61-5301
tab Ref No.
r 1047800
1 X111111111
SAMPLE COLLECTION: SAMPLE TYPE:
wwu_____ �ar. r� .
�, � � P4ulna13 Treated Water
a..+. per I'+•
AM M ianY«rl 13 Repeat Sample DUntreated Water
nmr. D �s .
�+:5( IP I w'" (rater m lab.no I
LOCiaO"` 0 Special Purpose
CONeebr .
a
T=Mpolted
to Lab Sr i^ame as collector Other
To BE COMPLETED BY LABORATORY
Sample ReeeNMa: ❑
Date: / 7-?- o L ❑ S+1+W++� �^ 01tl� RUSH SAMPLE
Rseuld may be wwoftbd
Temp:
Delivery Method:
Received By.
❑ 4e HWVvdrar Phone V. .
�Ppitemple LOOeNom Fax #:.
Commend:
............................................................................................................
Se
............................ M rO ADEI
••• Bac • rloloaleal Water AnaNsisRecord: MM04AUG (PIA) RESULM ANC FSK JUN
Amyed Sgi a ' } I •: t eV TOW ColNoim: Dewrow
aO• r e �
Amlyst �' E. CON:
nPhoned="
to
AmVdml Method:
MEMBRANE PU.TER RESULTS: FdW00ML VeiSatlom
Membrane Fater r
MMO-MUG (PIA) Satisfactory
SGB•
EC� ❑ Unsatisfactory
Reported By:
Daterrhne: ;L �? • e Al /*. oo m •deYrwY4.
SlpvWi.
Fomf a FW o0W 12/17103
15 2
WEST 190.01'
10' UTILITY EASEMENT
i--------------------------- -----------------------
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in
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SHEBANOF AVENUE
• 44.y*,4aOQOQ
PSE �40
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'. Q•p _.'.,FAlchaeLL •JokelO ;� �;��• _
m
LS -7839
owoswso en XCWSION NOTES: It is .the owners': responsibility to determine LEGEND: SET FNO
PAUL MICHELSOHN s existence of my easements. covenants. ar restrictions 5/9'M w/CAPS 5/5' Re 0
which do not appear on the recorded subdlvislon pial. NOTE: yY5• :g..MaN.Q� MONUMENT
with MICHELSOHN &DAUGHTER tinder no cicumstancaa should my data hereon be used for ,� TAa a
construction or for establlshing property Knee.
FENCE- —x— x —
XV T CER7IFlCATION: LANTECH has conducted a �tl1ANG-
physiod survey of this property as shown on this MOOD BECKS-
drawing and that the improvements situated there CONCRETE -
on era wlthim fhs property Ikea and no encroach- ASPHALT- .......^^"�m...^..C.
® ® menta axiat other than noted. GRAVEL-
44STANDIPM
0
k NSTRUCTION SURVEYORS -PLANNERS -ENGINEERS AS—BUILT OF: tEGALDESCRIPnON: wATrt-
AN WEST BENSON BLVD. / 103 (fax) 561-6626 L O T 1, BLOCK 2,
ANCHORAGE, ALASKA 99503 (907) 562-5291
WOK ORENUBRoAw, sae MUMMUs
2004-H-NOV. 24. 2004 1•-40' 66-96
K A S I L O F• HILLS S U B D I VI BO
NRww"MLJ —
64