HomeMy WebLinkAboutROLLING HILLS VIEW ESTATES BLK 2 LT 5Rolling Hi'611s
View Estates
Block 2
Lot 5
#050-322-05
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Municipality of Anchorage
Development Services Department iijF y'j fi
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw St. 3
/
P.O. Boz 196650 Anchorage. AK 99519-6650 Page of
www.ci.anchorage sk.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:
11 9 3 PID Number: O S O' 3 2 2— 0 yr
Name 9XfA1Y FAY
Wastewater System: W New ❑ Upgrade
AC«aat
I1 -13S AN M
R. v
ABSORPTION FIELD
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DmP Tech O Shall" TrerrlO Bal O MwO o1w
LEGAL DESCRIPTION
5°'R"'rw
ra,lo.wn.«n«w�,•lv.l.
'21
GPDrFIt
FI
Block La
15 bd Vw:
Depth to Ppe baro: rrom ong•ui pax
Waw own b"aal Poe
/
2 E7/
F1.
FI
Twnwp Range
Seamon
Fu a0/s0 above anpnel pals/+
Graw Length
It.
FI.
Well: X New
ElUpgrade
&SVM wan
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1
Dnta«w wr.ean Inas
•-
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Ft
Clwl1.s-^�,on (Penne. A B. C)
terircpto
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3 5 FI=
Pipe Mateno
PVC 303L4
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DO. Dnllal Stalk WON Lew
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1.5
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GPM
FI.
FI
SEPARATION DISTANCES
® Septic ❑ Holding ❑ ST.E.P. ❑ Other.
To
Septic
Absorption
Lift
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ublluPnvate
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Louuon and D•krnp on
X2002 SLA 6
wMl ovation
/ FL
e(2fwt — Dates: 1a 2 % Oc
r11
Engineseg4C ,
�
Inspections performed by:
OF q�
11
2"C 30 06
Development Services Department Approval
.Y '`V a•Mea.•a
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'►9
All, ,.�
Conditional Approval
Date:
!=�
N••.NN......Ho...• •.»•....-
0� c Sr.wn W. Eng r�
d''. PE 6256 ..2go
1 •. .��r
Reviewed and approved by:
Date: -7-10-0
.......... •' =_�
16 Ilk '
2. Sewer Service Line minimum • slope.
3. Trench is Minimum 10' from Lot Line & Old Trench.
4. Lots Served by Private Water Wells.
i
Well
vIV
IS.T. C\0.1 67.5 1 52
C.O. 1 80 1 57.7
C.O. 2 135 _ _ _1 102
M.T. 136 1 104
3 Bdrin House Site
House
Wlb WM Tw*
Test Hole 10
Alternate Trench
Test Hole 2
Absorption
Septic System Construction
1:
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
A` LOT PLAN
NOR THRIM yam" ' I AS—BUILT ROLLING HILLS
ENGINEERING *49. LAY❑UTVIEW ESTATES
17237 Bear Paw Circle 6. * W: :� -- BLOCK 2, L ❑ T 5
Eagle Rimr. Alaska 99377 •.+CC-4=OOOy
Dat 694-7028 PLAN VIEW• --^ —a�•: —. h_«
— - -- — - — - — - - ,-- — - - 6/30/061 SE — -I 1'=50' -- --I 2_
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SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688-2759
OWNER OF LAND: /-3& Nlt^J Elf I
ADDRESS:
LEGAL DESCRIPTION: bulC ' Aji'Ls' J/Eve
FS i'
DATE: _1P
PERMITNUMBER:05-0195Dateoflssuet_-2?.ii-or
TAX IDENTIFICATION NUMBER:asa��-0�
Is well located at approved permit location? 4Wes U No
Method of Drilling: r rotary U cable tool
Depth of well: 3_L U
Casing Type 5rk"Z_Wall Thickness ' dZ!5"3 inches
Diameter inches, depth
q4 feet
Liner Type: rt) r, " F_
Casing Stickup Above Ground: feet
Static Water Level: SS feet
Recover Rate: /' S gpm
Method of Testing: /9//2.
Well Intake Opening Type: U open end bpen hole
U Screened; Startfeet Stopped feet
O Perforations Start feet topped feet
Tc,,..r.7 C#41Djs
Grout Type:/3r-^' volumw
Depth: from 19 feet, to ►� o feet
Well Disinfected Upon Completion? 47�es U No D
Method of Disinfection: S' -,p
Comments:
IZMR ..�
rAl
S�
L? 0- 1 7 I
C S'
7-/
/3caQJt,L
rye ---j
cx_
(moi=rte+
13p:p%xice-
CRk r�J'k-/
�3�,oaacc..
Ea2�c
Driller's Name eOIC SU4L,1J*j
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation.
A W P S
19J"7243W�42 07/10/06 01rMpm P. 002
Development Services Department
Building Safety Division
1 On -Site Water h Wastewater Program
470^ Brox Street
19
P.O. Box 196650
Mart, eoylcn Anchorage. A< 99519-6650 NIQ
A.3yor WAW " M !Iry!%fIYyA
(907)343.7904
Pump Installation Log
Well Drilling Pertnit Number: S11¢_0 /93 Date of Issue:
Parcel IdentiGeatiun Numhcr: 06-322-oS
Ixgal Description --_—� I'r operty Qwncr Name & Addre s:
RO.UNO HILLS VIEW ESTATE. LOT 5 BLOCK 2 BRIAN FAY
1894 UPPER SKYLINE
EAGLE RIVER, AK 99577
Pump Installation Date: 6-8-06
Pump Intake Depth Below Top of Well C3sin;;:3M feet
Pump 1lamtfactarer's Name: RED JACKET
Pump Model: 15OF311CN25VB
Pump Site 1.5 hp
Pitless Adapter Burial Depth. 4'INrITroot
Pitless Adopter blanufactuter's Name:
Pitless Adapter Installer:
Welt Disinfected I'pon Cnmr6 ion? 21 Ve9 ❑ No
AfethodefDi,Ldcelio,r.CALCIUM.iYP'cROHLOkI1tYtLLklU tiff%
Comments:
Palnp iostalkr Naure: MARK VANVJINGERDEN. ANCHORAGE WELL d PUMP SERVICE
Attention: The pump installer s!lall prrnid,: a pump installation lo; to the DSU within 30 days of pump installation.
TH IIM
L7r:-
Date: 8/10/05
FAX
Steve Eng, PE, PH
17237 Bear Paw Circle, Eagle River AK 99577
(907) 694-7028 tel
(907) 694-7026 fax
NorthRimEng@aol.com
To: Julie nlakela, PE
MOA On -Site Program
Number of Pages: 1
Fax: 343-7997
Subject: Rolling Hills View Estates, Block 2, Lot 5
Septic System Relocation
Julie,
Per our conversation we are relocating the septic system installation to the TH 2 location. All
other design standards are the same. As -Built to be submitted with new location.
Thanks -Steve
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 29, 2005
Expiration Date: Jun 29, 2006
Permit Number: SWO60193 Parcel ID: 050-322-05
Legal Description: ROLLING HILLS VIEW ESTATES SUBDIVISION BLOCK 2 LOT 5
Design Engineer: 0838 North Rim Engineering Site Address: 18943 UPPER SKYLINE DRIVE
Owner Name: BRIAN FAY Lot Size: 59677 SO. FT.
Owner Address: 17135 SANTA MARIA DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER. AK 99577 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ 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.
5. The following special provisions.
THE MAXIMUM DEPTH OF THE SEPTIC ROCK FROM ORIGINAL GRADE MAY BE NO DEEPER THAN 2'
Received By:
�i��JL► �' Date:
Issued By: Date: (.1Zt.100—
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
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. f)50- -05 Permit Number SW
Propert.
Meiling
fu"t�-IST
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township &&RRange)
Lot Size Acres7Snft�)
THIS APPLICATION IS FOR:
Number of Bedrooms
phone Kq Uz-K.? 93
,ode
Code 47767q-
z L
Sewer Only ❑ Well Only ❑
Sewer and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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 owrtirr"or authorized agent)
Permit/Rush Fees: 11�P0 46 f/7 -eD Waiver Fees:
Date of Payment: 6a/] 4D5 Date of Payment:
Receipt Number: 1;99 i>7 Receipt Number:
(Rev. 09/04)
,Y.
M
l([c NEERI� 1 NNG—
NorthRim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907.694.7028
June 24, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Septic System Design /Well Location; Rolling hills View Estates, Block 2, Lot 5
A lot is being developed. Suitable soil was discovered in two test holes. This is a new
septic system and water well. Some of the neighboring lots are developed. This site should
not negatively impact any of the other area lots. The drainage slopes from back of lot
towards front of lot toward Skyline Drive.
Please review the wastewater system design for the 3 bedroom single family home. I have
included design plans & specs, design guidelines, & soil tests. If there is need for
additional information or clarification please give me a call.
Sincerely,
Steve nE g E,
Design Enclosures
7
21M
�N ,INEERING ROLLING HILLS ESTATES S/D, Block 2, Lot 5
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is a future single family home projected at 3 bedrooms.
This requires a 1000 gallon septic tank. This lot is about 1.5 acres in size, as are
neighboring lots. Most of the neighborhood lots have been developed. No adverse impacts
are expected from developing this lot. The proposed water well is located on the drawing
as are the neighboring wastewater systems & water wells. The lot slopes from north to
south, toward the Skyline Drive. No conflicts to any neighbor lots is anticipated. Two soil
tests were conducted and demonstrated a well percolating sandy soil. An application rate
of 1.2 GPD/FT' with 0.5 reduction factor for utilizing a 5' wide trench was utilized.
Boulders were encountered at 8 and 9 feet depth. These appeared to be broken bedrock.
A separation of 6 feet was maintained from this apparent broken bedrock. A trench depth
of 2 feet will be used with an effective depth of 1 foot.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Two compartment, 1000 gallon septic tank.
• Watertight couplings on inlet & outlet.
• 5 foot minimum between the tank and bed. 10 foot to property lines.
• 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot
soil cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps arc required 1 to 4 feet from foundation wall, prior
to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing
cleanouts between the tank and the absorption field, not more than 10 feet from the tank
positioned to provide cleanout access towards the tank and towards the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lice of cast iron.
• Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -
rock.
• Drain rock to be V2 inch to 2 %3 inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage over the trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS
ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI or equal)
.N'
1.
Total
De th f Trench is 2'.
NORTHRIM
ENGINEERING w ''
BLOCK 2, LOT 5
LOT PLAN
17237 Bear Pow Cfrcly'.�
E*Vo River. Alas 99377 aeras
2.
Sewer
Service Line mi m 2% slope.
3.
Trench
is Minimum 1 ' from Lo Line &
Old Tench.
4.
Lotis
Served by Priv to Water Wells.
RIO&
0
Hole 1
I/
Absorption Trench //
3 Bclrm Houie Site
1000 Gallon Septic) Tank
Test Hole 2
0
Alternate T
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
OF.k`��
ROLLING HILLS VIEW
STATES
NORTHRIM
ENGINEERING w ''
BLOCK 2, LOT 5
LOT PLAN
17237 Bear Pow Cfrcly'.�
E*Vo River. Alas 99377 aeras
1� - 40�
F
PLARiver.
6/21/05
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X
Y SOILS LOG - PERCOLATION TEST
2THRIM Date Performed: 6/14/05
F� 19INEERING
Performed For: Brian Fay
Legal Description: Rolling Hills View Estates Block 2 Lot 5
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
Organic
.Qr...•
SP
'" • ` Sand w/Gravel
O' *A
Refusal
Location: See Drawing
Groundwater? No
Depth
Water Depth
After Monitorino.None Date: 6/21/05
#
Date
Gross Time
Net Time
Depth
Net Drop
1
6/21
0
--
9.25'
--
2
6/21
2
2 min
10'
0.75'
3
6/21
4
--
6.5'
--
4
6/21
6
2 min
9'
0.75'
5
6/21
7
--
9.25'
--
6
6/21
9
2 min
10'
0.75'
Percolation Rate 2.7 rain./inch Perc Hole Diameter 6'
Test Run Between 1' and 2'
Comments:Presoaked
Performed By NorthRim Eng. CERTIFY THAT THIS TEST WAS
Performed In Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE, DATE: 6/22/05
NOR THRIM*
TESTHOLE L❑G
T. H. 1
ENGINEERING
17237 Boor Pow Circle
Eagle Rlw Alaska 99577 a ,
907.694.7028'•••••••• =
GEOTECHNICAL
WWI Ts
6/22/05 11 of 2
S❑ILS LOG — PERC❑LATI❑N TEST
THRIM Date Performed: 6/14/05
��,9 NEERING
Performed For: Brian Fay
Legal Description: Rolling Hills View Estates Block 2 Lot 5
1 —
2 —
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
Organic
Qr.._.
SP
Sand w/Gravel
Refusal
Location: See Drawing
20 % Slope
Groundwater? No
Depth
Water Depth
After Monitorino.None Date: 6/21/05
#
Date
Gross Time
Net Time
Depth
Net Drop
1
6/21
0
--
5.5'
--
2
6/21
2
2 Min
6.25'
0.75'
3
6/21
5
--
5.5'
--
4
6/21
7
2 minj
6.25'
0.75'
5
6/21
8
--
5'
--
6
6/21
10
2 min
5.75'
0.75'
Percolation Rate 2.7 min./inch Perc Hole Diameter 6'
Test Run Between 1' and 2'
Comments:rresoaKea
Performed By NorthRim Eng, I CERTIFY THAT THIS TEST WAS
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 6/22/05
�E CF A44
NOR THRIM •:,��
TESTH❑LE LOG
ENGINEERING
T. H. 2
17237 Bsar Pow Circle
Eagle River. Alaska99377 4�„+., Uw • p
;
4•P
GE❑TECHNICAL
6/22/05
12 of 2
zG 8
® Municipality of Anchorage °
On -Site Water and Wastewater Program
(907) 343-7904 5 a E T Y
Certificate of On -Site Systems Approval
Parcel I.D. 076-031-18
1. GENERAL INFORMATION:
Expiration Date: 0-7-4_
Complete legal description RAVEN MOUNTAIN ESTATES #1; BLOCK 5
Location (site address) 191 GOLD CLAIM DRIVE GIRDWOOD, AK 99587
Current Property owner(s) DIANE POWERS Day phone 230-2439
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
M Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
M
Individual
M
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment U-1�2/ Date of Payment
Receipt Number 05 '� 17 G Receipt Number
COSA # 0SC� 21 I -� 6 q 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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 3� 1
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system OI
in accordance with the guidelines and regulations established by the Municipality of Anchorage and �G . • / (�
practices. The reported results describe the condition of the system/s on the date/s of the �i �. nn
industry p •.'7— I
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ` g
encroachments may exist that were not identified during the evaluation. The operational life of all wells - (j i, . I f
and septic systems depend upon a variety of variables, including but not limited to, soil conditions ...•.. • .......... "'....
groundwater levels (that may fluctuate during the year), quality of construction (materials and O
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ....................
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the J" ftreess.:
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of QOn (' CE -7953
the well or septic system. GEG makes no representation whether an alternative well or septic system l9 f V .. 3 't, AcG
can be installed on the property in the event either of the current systems fail to perform adequately in Q� er ... • `'
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 0 0, Professtoo aG
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedroomsOF
(�
�
Disapproved�����
Conditional approval for bedrooms, with the following �atiorQN-SITE
WATER AND r"=
''1))))))))W)11'
�� �, ✓ Original Certificate Date: ' Z
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet_10-10-12.doc
Nitrate Advisory
Arsenic Advisory
Other SA-oe�
/I 1c, ddi io
1
COSA Checklist
Legal Description. RAVEN MOUNTAIN ESTATES; BLOCK 5
if rnore than i septic system on lot: COSA Checklist ## of
A. WELL DATA
Well log Is filed with Onsite (or attached)
Date drilled 8118198
Total depth 92 ft
Cased to 92 ft
(1 Sanitary seal is functioning correctly
Wires are properly protected
C2sing height (above ground) 18+ in.
Date of flow test for COSA 6/13/21
Static water level at beginning of test 72.8 ft.
Comments
B. TANK DATA
Age of tank(s) 23 years
Tank type/material SEPTIGSiEE
Measured operating fluid level in septic tank 51
;�] Standpipes/foundation cleanouter record drawing
Date of pumping i `✓e �{2O C7{—
D. ABSORPTION FIELD DATA
Parcel ID: 076-031-18
Structure served by this system
Well production at time of test 7.3+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes L No
Xcoliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by GEG, LTD.
Date of Sample 6113/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Which system tested (date installed) 1998
Adequacy test date 6/13/21
FR ALL standpipes present per record drawing
Results ❑✓ Pass For 4 bedrooms
Total measured depth from grade 7.25 ft (max)
Fluid depth prior to test 2 in
Measured depth to pipe invert from grade 3.33 ft (1 -nil)
Water added 664 gal
❑ NIA – pressurized field
New depth *2 , in
Monitor tubes go to bottom of effective. If not, state
Elapsed time *0 min
depth into effective 10"-11"
t� Code -required soil cover over field
Final fluid depth *2 in
[ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test)
N/A
If yes, enter dare N/A
Gallons introduced gallons
Cornments/Deficiencies: 'LIQUID LEVEL DID NOT CHANGE DURING ADEQUACY TEST
COSA Checklist yellow sheet
E. SEPARATION? DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > '100'
*
Yes
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft
❑✓ Yes
if No ft
Neighboring Tank > 100' M✓ Yes
if No
ft
Private Sewer/Septic Line > 25' 71 Yes
if No ft
Absorption Field on Lot > 100' E] Yes
if No
ft
Holding Tank > 100' M✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' ✓/ Yes
if No ft
✓� `(es
if No
ft
F71 Yes if No ft
Water Service Line > 10'
1771
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' M Yes
if No
ft
r✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enterdistances if less than required)
Building Foundations > 10'
F/
Yes
if No
it
Surface Water> 100'
[✓] Yes if No ft
Property Line > 5'
Fv
Yes
if No
ft
Wells on Adjacent Lots:
✓CI
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
F71 Yes if No ft
Water Service Line > 10'
1771
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓CI
Yes
if No
ft
Private Wells > 100' Q✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
*APPEARS TO BE 100' EXACTLY PER 1998 INSPECTION REPORT
DRAINFIELD HAS DRIVEN STEEL MT INSTALLED BY OWNER 4/16/19. PIPE LABLED C04
ON INSPECTION REPORT IS NOT SHOWN ON AS -BUILT SURVEY; HOWEVER, IT IS PRESENT.
G. ENGINEER'S CERTIFICATION
1 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.
COSA Checklist yellow sheet
#AECC884
Q(3
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC211369
Subdivision: Raven Mountain Estates #1 Blk 5
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 23 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
Mailing Address p O Box 196650 *Anchorage, Alaska 995196650 *www muni org
Chugoch Notional Forest
S 89°34'37" W 288.10'
rr
30
Anch'r Ease";.
3 -Story
73.9'
-use
Ho
Lot 5,
J" D)
0
, .'51'
Block 3 ".p 0 dk, CD
cp
5)
Gen.
G,
0
�F Ay sP.
Shed
88*0'
TH
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��'`g g
r*Hurst
V�F�pROffSSIOKAL`P�
l' �Nl 179
Lot 4,ry
Block 3 G00o
co
\\T
27.5 4.0'
LO
Ln
b Covered
'tied, 'N 3 -Story 7�
QCD
'. House 4.0'
Covered LQ
Carport0
:N 0
:3
:12.0'.;...;. 49"th'*�q /Stair
C'
4.0'
0 4.0'
7 Lot 3
Block 0
cn 'ar (D
C6 7.ua Cl)
0 25 so
House Detail: Y = 30' Li–M—Ma
US SURVEY
NOTES FEET
-All dimensions shown are grid bearings and ground distances, Record boundaries, are per Plat No. 66-161.
-49th Star has conducted a physical survey of the property and all details shown 0a this Asbuilt Survey are correct. Under
no circumstances should any data hereon be used for construction or for establishment of property lines.
-It is the owners, responsibility to determine the e.dstence of any easements, covenants, or restrictions which do not appear
on the recorded subdivision plat.
AS BUILT SURVEY LEGEND
49t-h Star Surveying
Block 5, 0 Found =perty Corner 321 Fireoved DriVe
RaVell MOU11tain EStates, 0 Septic SYS. Pipe/Clean Out Anchorage, AK 99508
Unit 1, Solar Panel (907)891-6111
Girdwood, AK O
Well Jeremy@49thStarSurveying.com
W.O. 19004 DATE Og/10/19
I scma- 1"=50,
MUNICIPALITY.OF ANCHORAGE
Development Services Department - 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050 322 05
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Rolling Hills View Estates Block 2 Lot 5
Location (site address) 18943 Upper Skyline
Current property owner(s) Bloom
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
Z
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request tor: N O N E Distan
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55o Waiver Fee $
Date of Payment Qa 3 io a 1 Date of Payment
Receipt Number 01 60y 5 �3 Receipt Number
COSA 4 0 s C I i 13 5 3 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 C&M ENGINEERING
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI
Phone 8545558
Date 6/15/21
OF Al,
STH
6. DSD SIGNATURE W•• •••• •�•••• I
System #1 Approved for bedrooms
t:HARLES G BALZARIKI �
System #2 Approved for bedrooms r�{�F��s..• CE -13854 �.��
Disapproved tills PROFESSIONI'ti�=�
Conditional approval for bedrooms, with the following stipulations:
Y 0F,
ON-SITE__
Wo
WATER AND
- z-
�` PROGRAM
SER\/
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: ROLLING HILLS VIEW ESTATES BLOCK 2 LOT 5 Parcel ID: 050 322 05
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
OR Well log is filed with Onsite (or attached)
Date drilled 3/27/6
Total depth 360 ft
Cased to 44 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 6/15/21
Static water level at beginning of test 48 ft.
Comments WELL PIT DECOMISSIONED
B. TANK DATA
Age of tank(s) 15 years
Tank type/material SEPTIC STEEL
Measured operating fluid level in septic tank 50
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 7/1/21
D. ABSORPTION FIELD DATA SHALLOW
Well production at time of test 1.6+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑'Coliform bacteria is Negative
Nitrate 0.708 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by C.Balzarini
Date of Sample 6/29/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Which system tested (date installed) 2006
Adequacy test date 6/15/21
❑ ALL standpipes present per record drawing
Results ❑✓ Pass For 3 bedrooms
Total measured depth from grade 4.5 ft (max)
Fluid depth prior to test 2.5 in
Measured depth to pipe invert from grade 3.5 ft (min)
Water added 450 gal
❑ N/A — pre rr-i d-fteel�l—
New depth 6 in
❑ Monitor tubes go to bottom of effective. If not, state
1440
Elapsed time min
depth into effective
❑ Code -required soil cover over field
Final fluid depth 2.5 in
❑ System presoaked
Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced gallons
If yes, enter date NA
Comments/Deficiencies: FAR END OF FIELD REMAINED DRY DURING TESTING
COSA Checklist yellow sheet
WAJ
' E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
P/
Yes
Community Sewer Manhole/Cleanout > 100'
77 Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' [✓ Yes
if No
ft
Private Sewer/Septic Line > 25' F71 Yes
if No ft
Absorption Field on Lot > 100'✓0 Yes
if No
ft
Holding Tank > 100' 7 Yes
if No ft
Neighboring Absorption Fields > 100'
171 Yes if No ft
Water Main > 10'
Animal Containment > 50' 0 Yes
if No ft
F/ Yes
if No
ft
Yes if No ft
Water Service Line > 10'
F71
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' ✓Q Yes
if No
ft
❑✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
P/
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
Yes
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
if No
Yes
if No
ft
Private Wells > 100'
171 Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'✓�
Yes if No ft
Water Service Line > 10'
F71
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
✓Q
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
F✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓Q
Yes
if No
ft
Private Wells > 100' [✓ Yes if No ft
Water Service Line > 10'
F/�
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that l 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. 6/28/21
COSA Checklist yellow sheet
of AL.40
: 49 '•
j C HARLES G BALZARItaf�
Fc . • CE -13854 . • ��
® ROFESSION .
1%junicipality of Anchorage NJ`
Development Services Department
Building Safety Division •"'
On -Site Water and Wastewater Program „ 9 TV
U&I
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. COSA # %ip�5
Expiration Date: O — % C7 — 06
1. GENERAL INFORMATION
Complete legal description t • Weyl
Location(siteaddress) 16945 UPPC--2 SLIL/NC AQIvE
Current Propertyowner(s) BRIAN F -AY Dayphone i
Mailing address t'# -13r 6ANTA MAC -(A '1>2rv6 E-A G1ERtVER,Akg9V4+
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
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 On -Site 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 Onsite 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 engineers 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
Address
Phone 694 --4-6?
Ak 99s}'k
Engineer's Printed Name ATEyE E of 6 Date- 6 X30 / fl to
;: oF
S.;?1
�, .........................:...
5. DSD SIGNATURE �' �� ' Steven VI. EngPE
Approved for (�
Disapproved. 4%.
bedrooms. tId�ip•�aOF �?56
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
... .
_ON.SrrF
WATER AND •Rt --
-WASTEWATER—:
PROGRAM
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ��^� �"' 120-4 Original Certificate Date: 7— 10 — Q &
(Rev. 11/05)
Municipality of Anchorage ••,
• -- Development Services Department
Building Safety Division
On-site water & Wastewater Program :
4710 Bragaw Street
P.O. Box 196850
Anchorage, AK 99519.6650
www.muni.orglcnsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
11:-_ 1.1�.\\L Vietr�f 4ESI&IGS
Parcel ID:
$IOG�2��rr
A WELL DATA
Well
If A, B, or C provide PWSID # e
Well Log (YM) Y
Date completed ALU
lbfo Sanitary seal (Y/N)
wires property protected (Y/N) --
Total depth 3I&Q_ft.
Cased to _ft•
Casing height (above ground) 24 n.
FROM WELL LOG
AT INSPECTION
Date of test
-617-2 1 OLD
Static water level
4�;- S- ft.
ft.
Well production
I • S 9•P•m• I
9 -P.M.
WATER SAMPLE RESULTS:
CdHorm �_colonies/100 mL Nitrate 0.133 fmgL Other bacteria D colonies/100 mL
Arsenic: C�3- mgA Date of sample: AlA1 bLo Collected by: darlhkim
B. SEPTICIHOLDING TANK DATA ! -►/�
Tank Type/Material &VII49AW, TAMt — 57tt�.
EL Date Installed �Z JOU
Tank size / 0b gal. Number of Compartments 2- Geanouts (YM)y
Foundation deanout (YM) Depression over tank (YM) /YL High water alarm (Y/N) d
Date of pumping ffe Pumper
c. ABSORPTION FIELD DATA
Data installed S�bf. Soil rating (g.p.d fe/bdrm) I.2 System type��A 77?�nrG�1
Length GO ft. Width Gravel below pipe
Total depth Eft. absorption area3Wfe Monitoring tube Depression over field „-
Date of adequacy test PiEW Results (Pass/Fail) Ppt6- For -5— bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ In. Absorption rate >= 9•p•d•
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION NIA
Date installed Size in gallons ManholelAccess (YAV)
'Pump on' level at _ in. 'Pump ofr level at _ in. High water alarm level at
In.
Datum Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot /00' w On adjacent lots 106 -VL
Absorption field on lot ,,,I oo � On adjacent lots _ /nn'*-
Public sewer main 3 " //{ Public sewer manhole/cleanout N/A
Sewer /septic service line 2s rr Holding tank N / A
Animal containment areas NSA Manure/animal excrete storage areas YA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation "7' Property line
Absorption
Water main / clN Y Water service line / n r Surfacewater ! l�[Yf
Wells on adjacent lots / a n 1*.* -
SEPARATION
. -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / % r -t Budding foundation 10 v I` Water main / () r >•-
Water Service line / D t r Surface water _ 1 h U r� Driveway, parkingNehide storage 1 d-,4
Curtain drain nCO Arknot Wells on adjacent lots l U t) r r' -
F. COMMENTS
G. ENGINEER'S CERTIFICATION �OF 4Cq1�
I cerfify that I have determined through field /n J y�..e
�g inspections and
review Of Municipal records that the above systems are in % * f4si►1
conformance with MOA COSA guidelines In effect on this date. �" '•' 1 ...........
Engineers Printed Name 5 TE V B {J-yCa p Fst / .�
/v I C Steven W. Eng
Date_ (n%D/liCi If 0'J'.,� PE 6256
COSA Fees t 7 50
Date of Payment
Receipt Number 82587(%
(Rev. I I/DS)
Waiver Fee $
Date of Payment
Receipt Number
ASBUILT SI-VARD h ASSOCIATES LAND SURVEYING 694
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE• "
FOLLOWING DESCRIBED PROPERTY: OF At
GAY!%YG�YillrY/ /err. ll�� Z'g' iq; Z ' DATE. r �� ..... X45 �0
AND THAT NO ENCROACHMENTS EXIT F,CCEPT AS �� 'w h •' ,� '
INDICATED. IT IS THE RESPONSIBILITY OF THE i.'J;' e} TH:q
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: �"' }�"'•'�i' "•i
EASEMENTS, COVENANTS, OR RESTRICTIONS /�'✓�zS/ � f, ... �?......... •
WHICH DO NOT APPEAR ON THE RECORDED SUBDI—
�VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' t+'� tS-6918 fig• s
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.