HomeMy WebLinkAboutKASILOF HILLS BLK 4 LT 6Kasilof Hills
Block 4
Lot 6
#015.-131-26
PIn7 T A VHIM
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 M P 1 0
ON-SITE WASTEWATER INSPECTION REPORT rj.j.f9r
Permit Number: OS0121266 PID Number: 015-131-26
Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade
Name:
DAVID KENNEDY
ABSORPTION FIELD
❑ Deep Trench Shallow Trench ❑ Bed ❑ Mound
Address
10700 KASILOF BLVD.
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
3.0 GPD/SF
3.5 FL
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2 Ft
Gravel depth beneath pipe
1.5 Ft
Subdivision Block Lot
KASILOF HILLS 4 6
Fill added above original grade
1-2 FL
Gravel length
50 Ft.
Township Range Section
Gravel width p✓
+p.S. Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
320 Fel
1
NA Ft.
Well
>100'
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
>100'
Gal.
Material
Number of compartments
Lot Line
6'
NA
Foundation
>10'
LIFT STATION
Manufacturer
Capacity
Curtain Drain
>20'
Gal.
Remarks EXISTING DRAIN FIELD CONNECTED
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
VIA VALVE IN BIOCYCLE UNIT
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank Tank to
drainfield SCH40
Installer
A+ HOME SERVICES
Drainfield SCH40 CO/MT F810
Inspector LARS SPURKLAND
BENCH MARK (Assumed elevation) 100 ft
Inspeection
i� 9/14/12 9/14/12
Location and description
ction 2"
30 4m
GARAGE SLAB
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Enn�€���P,a
of.A<
Conditional Approval: Date
x•49 I 9`
00
�� n • RS E. SPURKLAND;� /
1500 k
CL
Approved Date /( /
�1\`Z.�\��
Inspection Report_9-1-12.doc
BLIOCK
17 ' I
1
0
0
19 I
0
SLC/P�" < PO%
C 17'
28'
D 64'
75'
SLOPE <?OZ
lWell
SL IJPE l 207
4�
R
A
s —
SLCIPF ( P07
INSTALLED RESERVE TRENCH
TRENCH LENGTH 50 FEET
7R£NCH WIDTH 5 FEET
MAX EXCAVATION DEPTH 3.5 FEET
SEWER ROCK 1.5 FEET
INSULATION 2 INCHES
COVER 2 FEET MIN.
1 \
5
NOT£.• SLOPES £ CE£DING 25% WERE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED
ABSORPTION FIELD LOCATION.
NO THIS IS NOT A SURVEYED PLAT. WELL & SEP77C
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
25 0 25 50 75 100 125 150
SCALE: I' = 50 FT
QRS SPURKLAND
No. CE -11500
E7
SPURKLAND ENGINEERING I I KASILOF HILLS BLK 4 LOT 6 I (SEPTIC SYSTEM ASBUILT
203 V 15TH. AVENUE KIM KENNEDY DATE, SEPT 17, 2012
ANCN. AK, 99501
(907) 279-3916 10600 KASILDF BL VD„ ANCHORAGE, AK 99516 SHEET• 1/4 GRID. 2541
PERMIT # LISPI21OXX PID # 015-131-26 K4SILOFHILL9B4L6SC50-ASB.BV&
Existing BioCycle Wastewater Treatment
5' X 50' Shallow Trench:
Exca va tion Depth 3.5' (max)
1.5' Sewer Rock
2' Insulation
2+' Cover
3/16' holes LV 30 inches ac.
4—BEDR00M RESIDENCE I
NOT TD SCALE
&NUH MAKK MKAUL JLiH. ADSUMLU LUVAHUN !UU PW.
SPURKLAND ENGINEERING KASILOF HILLS BLK 4 LOT 6 SEPTIC SYSTEM DESIGN
203 W15th Ave KIM KENNEDY DATE, AUG. 21, 2012
Anchorage Ak 99501 10600 KASILOF BLVD., ANCHORAGE, AK 99516 SHEET: 3/4 GRID: 2541
279-391611
PERMIT # DSPIIIOXXX PARCEL ID # 015-131-26 KASIL0FHILLSB4L6D3DWG
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http:11www. muni.ora1Ons ite
Development Services Division
On -Site Water and Wastewater Program
n.eni
LN° S,
Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP131025 COSA#: Permit#:OSP121266
P1 D#: 015-131-26
Legal Description: Kasilof Hills Block 4 Lot 6
Engineer: Spurkland Engineering
Applicant: David Kennedy
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 6.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
............................................................ aaan...............
Waiver is Granted: X Waiver is not Granted:
Date:// Approved by: Li` �.
Name of Revi er
......................................................... ..............anon...
Rec#: 09025G Amount: $200.00 Date Paid: 311113
**** VARIANCEIWAIVER REVIEW ****
SPLITMalmd Eim onsefing
Environmental Consulting and Design
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
Subject:
Ladies and Gentlemen:
Lot Line Waiver
10700 Kasilof Blvd.
October 17, 2012
I am writing to request a lot line waiver for the septic system absorption field at Lot 6 Block 4
Kasilof Hills Subdivisions. A new absorption field was installed on September 14, 2012. A
surveyed property as -built located the end of the trench 6 feet from the south property line. The
property to the south is developed with the existing septic system approximately 30 feet from the
new absorption field. The current configuration of this septic system will not prevent wells and
septic systems from being installed on the adjacent lots and no adverse impacts are anticipated.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
Lars Sp kland, P.E.
Civil Engineer
®SPi3p�e�5
C)q o2SG
203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
Lot 17 I
IA
Lot 19
Lot 7
N81°34'3�E
I
1
111
Cal
cl
II Wood fence
{1
�U71
ml
ml
�I
0 1
1
1
11
I
1
SCALE: V= 40'
LpT 6
3.0
R ��
z.0 o zs. 7
{
5. { {
764 { {
0
orch {
8o Conc. block {
septic Tank ret. wal
{ ,rave\ diNeWay /
Septic vent f //
�NpQ1I f
• L
h
S ry Frame House o
3 38.3 2%3.
N81°34'39„E
Lot 5
f
� 4ff//9 th 9
00
,�� srF • 3255 - SAw
,� I O �dFESSIONA�•�a�
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. Fib 12-6, pg 7-8
200.00
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: LOT 6, BLOCK 4
KASILOF HILLS SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 10th day of October ,2012
FRED WALATKA & ASSOCIATES
(907-248-1666)
BE Engineers and Surveyors
8375E
30
I
�
I �
N
Ln
r
<
�
1
O
O
O
I
30
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: LOT 6, BLOCK 4
KASILOF HILLS SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 10th day of October ,2012
FRED WALATKA & ASSOCIATES
(907-248-1666)
BE Engineers and Surveyors
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP121266
Tax Code Number: 01513126000
Work Type: Septic Upgrade
Permit Effective Dates: August 31, 2012 to August 31, 2013
Design Engineer: SPURKLAND ENGINEERING
Subdivision: KASILOF HILLS
Site Legal Address: KASILOF HILLS BILK 4 LT 6 G:2541
Owner/Address: KENNEDY DAVID & KIMBERLY
LIVING TRUST 10700 KASILOF BLVD ANCHORAGE AK 995076429
Site Mailing Address: 10700 KASILOF BLVD, Anchorage
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank
Lot Size in Sq Ft: 34000
Total Bedrooms: 4
N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Receive
Issued
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel 1.D. 0(5-131- 2.(o
Property owner(s) J<yA XenoEDy Day phone lbl-01)
Mailing address
Site address 'JAME—
Legal description (Sub'd., Block & Lot) KaswLo H 1 IIs CALK W L} 6
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms ti
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(® all that apply)
Initial ❑
Absorption Field
Septic Tank
El
�
Tank
❑
Renewal
Renewal ElHolding
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
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.
property owner or
Permit/Rush Fees: $30.
Date of Payment: 4 Ia 3I12 c (^6.
Receipt Number: QVIDT0%
Permit No. OStPt a ta�O(o
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GAl3ui1ding\0n SiteTorms\Client Forms\Peonh App_010411.doc (Rev. 1 /11)
SparM and Enuffieeflimp
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
Municipality of Anchorage August 21, 2012
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Rd.
Anchorage, Alaska 99519
Subject: Septic System Upgrade Permit
Kasilof Hills Block 4 Lot 6
Ladies and Gentlemen:
I am writing to request a permit to upgrade the septic system for the above referenced property. The
proposed system will serve a 4 -bedroom single-family residence. The existing system was installed in
2003 and the drain field was surcharged when it was inspected prior to conducting an adequacy test. The
existing Biocycle AW WTS and drain field will be left in place and the reserve trench will be installed.
Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for
your review.
Design Cates: Groundwater observed at a depth of 9.5feet below ground surface (8/21/12)
Soil Rating. From Test hole (8/10/12)
12.9 min./in = Max Application rate 3.0 gpd/fC
No. of Bedrooms 4
Required Area per Bedroom: 15013 = 50 sq.ft.
Minimum area required: 50 x 4 = 200 sq.ft.
System: A Biocycle AW WTS with a shallow trench 50 feet long with 1.5 feet of sewer rock (320 sq.ft.)
Soils: A test hole was excavated on august 10, 2012. See attached soils log. Ground water was
observed at 9.5 feet below the ground surface on August 21, 2012. Ground water monitoring will
continue through construction of the proposed drain field.
Surface Water: No surface waters were observed within 100 feet of the proposed septic system.
Topography: No slopes greater than 25% were observed with 50 feet of the proposed drain field. The
ground surface slopes down towards the west at approximately 20% in the vicinity of the proposed drain
field.
Waivers: None required.
The installation of this septic system will not prevent wells and septic systems from being installed on the
203 West 150i Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
ArW& SpUMand EngomIng
Environmental Consulting and Design
adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or
concentration of surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
el
Lars Spurkland, P.E.
Civil Engineer
203 West 15a` Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
b
5
I , I
1
Well 1
II 1 1
1
4 1
NOTE., TIRS IS NOT A SURVEYED PUT. WELL k SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
50 0 50 100 150 200 250 3W
SCALE, 1' = 100 FT.
21 `.
VACANT /
0
SPURKLAND ENGINEERING
(907) 279-33916916 I I KASILOF HILLS BLit 4 LOT 6 I (SEPTIC SYSTEM DESIGN
203 V 15TH, AVENUE KIM KENNEDY DATE: AUG. 21, 2012
(NCH AK. 10600 KASILIF BLVD., ANCHORAGE, AK 99516 SHEET, 1/4 MID Z541
PERMIT # 07121OXX PID # 015-131-26 KASILOFHILLSB4L6SC100,BVG
BL igCK
1.
L!
0
6
SLOPE < 207
Well 1
c SLOPE < 207 -C� ��•
I yI i
r
y
I I EX! 1 YC A
I
a
r
• '
�o
SLOPE < 207
I ' I TH
I ALL RESERVE TRENCH
TRENCH LENGTH 50 FEET
<
18
TRENCH WIDTH 5 FEET
C+
SLOPE < 207
MAX EXCAVATION DEPTH 3.5 FEET
I
SEWER ROCK 1.5 FEET
INSULATION 2 INCHES
I
I
COVER 2 FEET MRN.
19 SLOPE
�
j
1
I I 5
I I SLOPE < 202,
I I
O
50 ffET RADI o�nE
�..................... ,.
THIN DOWN T PROPOSED
ABSORPTION FIELD LOCATKIN.
��� ���i
P••1�..
NOT£.• TN1S IS NOT A SURVEYED PUT. Wal.& SEP77C
LOCATIONS TAKEN FROM ON -SIT£ WATER AND WASTE WATER
4
•••••• ....••..... •....... ••••••�
DEPARTMENT DOCUMMENTATIOlL ALL LOCATIONS SHOWN ARE
�•••••:•
APPROXIMATE.
..
,......,•J
L• S• PURKLAND•
No.�j E- 1500 'ti,=
25 0 25 50 75 100 125 150
.
SCALE., 1' = 50 FT
SPURKLAND ENGINEERING
KASILOF HILLS BW 4 LOT 6
SEPTIC SYSTEM DESIGN
VENUE
I
KIM KENNEDY
I
1
DATE+ AUC 21, 2012
g2/0�13'(JWg1(!5T{M9$4
C907J c�7993916
MW KA3YLdr NL t -R, ANbHMA&t AIF YYW&
3Ntttr 114 w1fo EU4r
PERMIT # LISP121OXX PIB # 015-131-26
KASILOFHILLSB4L6SC100.BV6
Existing BloCyde Wastewater Treatment
5' X 50' Shallow Trench:
Excavation Depth 35' (max.)
1.5' Sewer Rock
2' Insulation
2' Cover (max)
3/16' holes R 30 Inches o.c.
Cfl'I4�I;Z�I47;7�91�Z�.7�'f
NOT TO SCALE
Existing BloCyde Wastewater Treatment
I SPURKLANO ENGINEERINGKASILOF HILLS BLK 4 LOT 6 I I srvnc srsrcu ucslcN
UG. I
203 W15th Ave KIM KENNEDY DATE: A 21, 2012
AnchoragI ( e Ak 99501 10600 KASILOF BL VA, ANCHORAGE; AK 99516 SHEET, 3/4 GRIB 2541
279-3916
PERMIT # XPI11OXXX
PARCEL ID k 015-131-26
KASILOFMILLSB4L6D3DWG
Municipality of Anchorage
Date
Development Services Department
Net Time
Building Safety Division
OrrSite Water Wastewater Program
00,
8/10/12
and
4700 Elmore Road
10
12.625"
P.O. Boz 196650 Anchorage, AK 99507
8/10/12
www.ci.anchoraae.ak.us
/ J�
/
(907) 343-7904
,�11
Soils Log - Percolation Test
8/10/12
Performed For: KIM KENNEDY Date Performed:
Legal Description: KASILOF HILLS BLK 4 LOT 6 Township, Range, Section:
12.875"
Depth
1-
2-
3-
10
11
12
12
15
16
17
18
olkag1G5
ML- CvM
WAS GROUND WATER
ENCOUNTERED? YES
Y S
'y
IF YES, AT WHAT DEPTH? 9.5' L
0
Depth to water After p
Monitoring? 9.5' E
Date: 8/21/12
Bo•$
PRE-SOAKED.
4 TH p
• s.
R5 E. SPURKLAND:'A-
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
8/10/12
10:55 AM
0 MIN
12.625"
10.000"
8/10/12
11:25 AM
30 MIN
12..250"
2.625"
10.188"
8/10/12
11:55 AM
30 MIN
12.875"
2.250"
10.563"
8/10/12
12:25 PM
30 MIN
2.313"
PERCOLATION RATE 12.9 (mint sfinch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 3 FT AND 3.5 FT
PERFORMED BY: ANSON MOXNESS I / 40 " CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNIciPALGuEELINES IN EFFECT ON THIS DATE. DATE: 8/21/12
S:a•n:
`'
h
r�
Inspections performed by: 1 r S Dates: 1" V-17/07 49IM Ent
2"< G t 7 o z.Development Services Department Approval alm
Retnewed and approved by: Date: Z 11 0
1,,`R�ENiV
Municipality of Anchorage :••' 1•
Development Services Department
Building Safety Dwis,On
On.Sde Water and Waslewaler Program. 4700 S. Bragaw SL
P.O. Bax 196650 Ancborage.AK 09519.6850 Page of
I
wwwtLan&orage.ek.vs (907)310.790<
1 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number.
SL6,`0104f5'7 PIDNumber. 015— ! 1—r26
I1.4
C 'eI!e ki
WastewaterSystdm: QrNew [3 Upgrade j
r•..
t 33
ABSORPTION FIELD
b
o 42
I
00"07.0 a"•eor Tnw, COW O uo.M C C^w �
LEGAL DESCRIPTION
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tar o.rr ►a"ap.r,r .
a '
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a%. la
a.ae�..r,
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tLA51 Lp F 1
n.
O. r. i
• ':.h•t
arv,• irvM
ri ree.e raa. rqw feet•
f/M 1•"p'n
4 D .•
well:
New [3 Upgrade
5
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1
r,.
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to pr•.
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lar n.ar.e r•.
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-I
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wrrw
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rrf�ire�
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TANK
i
t11
3aa
r,.
n
SEPARATION DISTANCES
0 Septic 0 Holding 0 S T.E P. �COlne I
Ta
SeObC
Absorcllon
Litt
Hoklog
rYbkMMat
rrd.wr
wKq
1
e.—
Tank
Field
Station
Tank
Simmer
i f�
J Or2r
�•
/30
ItrD
13e
N�1.
>uv
er.w
r;hjIt 4 ass
Mrcr r Crr•—•-.
44i
s.%,r,r.
N
LIFT STATION i
SOD
10+
LD
N�J✓
tl•
/4oU ar
YWI[✓M t
7F�;.0C C
icurt e-
ip
2 Jo
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'Pwrw.wr
'►,wr.'r ,r.ww
r,.•1 rM.a Y.rr
tra•.er .•,M[M.. r.•,r.,'•.N
me-"$
BENCH MARK 1
l«..a, ti o.ww•a,
•ot^ /.c
S:a•n:
`'
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r�
Inspections performed by: 1 r S Dates: 1" V-17/07 49IM Ent
2"< G t 7 o z.Development Services Department Approval alm
Retnewed and approved by: Date: Z 11 0
1,,`R�ENiV
4—INCH INSULA7708
6' MIN
O \OI�
;01
STANDARD 5—WIDE DRAIN fl£LD
4 FT TOTAL DEPTH
2.0 iT fff£CTIV£ ROCK
3 FT COVER
AIRCOMPR SSOR 100.00
AN INES
• 9S y
SlNO &ICXT7LL •• :• 90n0;0,;Onwnvnv "n—n—n a t! ..
.9 =4'
v v .' $4.5 94.5
'O sO •• S11T R1RR/CR ! R
5'-2* MIN '. D .
$'-0* MAY • • ASSUMED GROUNDWATER
• ND SCALE
BIOCYCLE 6000
49th
No. cc-tzts
LEGEND:
1-1/4 PVC WRH 1/Q' NOUS AT 30 M70
r1 _
PRIMARY TREATMENT, SEPTIC TANK
2.
;01
STANDARD 5—WIDE DRAIN fl£LD
4 FT TOTAL DEPTH
2.0 iT fff£CTIV£ ROCK
3 FT COVER
AIRCOMPR SSOR 100.00
AN INES
• 9S y
SlNO &ICXT7LL •• :• 90n0;0,;Onwnvnv "n—n—n a t! ..
.9 =4'
v v .' $4.5 94.5
'O sO •• S11T R1RR/CR ! R
5'-2* MIN '. D .
$'-0* MAY • • ASSUMED GROUNDWATER
• ND SCALE
BIOCYCLE 6000
49th
No. cc-tzts
LEGEND:
1.
PRIMARY TREATMENT, SEPTIC TANK
2.
AERATION TANK
J.
CLAMCAT/0N TANK
4.
DISCHARGE TANK
5.
SOIL ABSORPRON
AS BUILT
BENCH MARK.• TDP BMCI'C!!
ASSUMED WARON 100.00 !T
It/5OLIf+n✓ �.�. I SIL HILLS SID LOT 6 BK 4I I wASlEWATER STSTEY scNIMADO
203 W151h Ave Ave DATE:
Ag a Ale 99501 B117CYCLE PASTE VAT£R SYSTEN JULY 13, 2003
119-�1�6 SHEET 3/3 CR/0.2541
PERMIT # SV0I0457 PID # 015131-26 KAH04063DV6
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 *V Street
P.O. Box 196650 Anchorage, Alaska 99519.6650
httpt1Mww.d.8 ncho".sk.us
Permit Number. {/SW 000386 Date of Issue: 9-21-00 Parcel Identification Number.
Date Started: 6-19-01 Date Completed: 6-20-01 Is well located at approved permit location? ® Yes ❑ No
Legal Description: Kasftof Hills 131k 4 Lt 6
Property O mer Name & Address: Thaddeus CA16tewskI
PO Box 113342
Anchorage, Ak 99511
Borehole Data:
Soil Type, Thickness & Water Strata
Depth (ft)
From To
Method of Drilling ® air rotary ❑ cable tool
Casing type: steel
stick-up
0 2
Wall Thiclaess:.025 inches
gravelly silt
2 19
Diameter: 6 inches Depth: 23 feet
bedrock
19 307
Liner Type:
Diameter. inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): i8 feet
Pumping level: 307 feet after
N20 260 307
2 hours plumping 5 gpm
Recovery Rate: 5 gpm
Method of Testing:Ip ri ft
Well Intake Opening Type:
® Open End ® Open Hole
❑ Screened Start feet Stopped feet
.❑ Perforations Start feet Stopped feet
Grout Type: Penronite #,Y Volume: J -ft
Depth: Start 0 feet Stopped + fw..
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ N
Method of Disinfection: Clorine Tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
P O Box 110496
Anchorage AK 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
^%% ' nr t6,. %, .It ,bill..' oholl • %wAl Inn to tk. rtt n# nr N..Irf. k N„men Cr.MIPM w:tl,:n sn rlavm of nnrr.n4tinn
nightFAX 6/17/2002 12:10 PACE 1/1 nightFAX
Inspection Report
Municipality of Anchorage, Building Safety Division
4700 South Bragaw
INSPECTION: VOICE 343.8300 INSPECTION: FAX (907)249-7777 INFO: 343-8211
Name Brick's Electric: Bill Permit 02.7995
Address 1C700 KASILO;' DLVD P,__ 440-9351
440-9351
345-29"23
Legal BK 4 LT 6 Inspection Date 6/17/2002 PM
Subdivision KASILOF HILLS
Comments or Directions
Septic System - Rough -In underground only
Inspection Underground Electrical Relnspection N
NO NONCOMPLIANCE OBSERVED
CORRECTIONS ESSENTIAL AS EXPLAINED BELOW
WILL RE-EXAMINE AT NEXT
INSPECTION DO NOT CONCEAL UNTIL REINSPECTION
COMMENTS: (far Inspector use only)
�f � n.�� s I� �` use 11�5a�-�5�-•— `
•7--
Inspector vrT / ✓ C%i' •a'->TJ>� Date:/,- 17- L' Z_
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water b Wastewater Program
4700 South Bmgaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Permit Number. SWO10457
(Legal Description: KASILOF HILLS BLK 4 LT 6
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Thaddeus Chmlelewski
/0/716
G/7 /aa is
Date Issued: Oct 31, 2001
Expiration Date: Oct 31, 2002
Parcel ID: 015-131-26
Site Address: 010700 KASILOF BLVD
Lot Size: 34000 SO. FT.
Owner Address: PO Box 113342 Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage , AK 99511 -
This permit is for the construction of.
0 Disposal Field E] Septic Tank E3 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:
`110TIO
Municipality of Anchorage
• -� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program «•
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 15-1 .51 26-1 Permit Number SW
Property
Mailing address (1) Pn bo)` 11159 q 2 -
Day phone _ R ZZ —; C -
Mailing
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size L10 DOAcresl q.Fl. .
THiS APPLICATION IS FOR:
Number of Bedrooms _ 4
Sewer Only 9 Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Not Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
1 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.
�0'
of property owne73r authorized agent)
Permit Fees: Waiver Fees:
Date of Payment: RE'VrtP11uu_Lmber�_) a:
Receipt Number: :
(Rev. 112f00)
MUNICIPALITY OFANCHORAGE
Department o1 Health and Human Services
OnSito Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 3434744
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number. SW000386
Legal Description: KASILOF HILLS BLK 4 LT 6
Design Engineer. 0007 Tobben Spurkland, PE
Owner Name: Thaddeus Chmielewski
OwnerAddress: PO Box 113342
Anchorage . AK 99511 -
Date Issued: Sep 21, 2000
Expiration Date: Sep 21, 2001
Parcel ID: 015-131-26
Site Address: 010700 KASILOF BLVD
Lot Size: 34000 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
M Disposal Field Q Septic Tank Holding Tank ❑ Privy Q 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 DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface sol 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 j — tr-V
Date:F-2- '2
T.SPUR KLAND PX.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 6 BLOCK 4 KASILOF HILLS SID
THADDEUS CHMIELEWSKI
Municipality of Anchorage
Department of Health and Social Services
820 I Street
Anchorage, Alaska 99501
August 27, 2000
We are submitting an application for the installation of a well and waste water disposal system for
Us lot. The submittal consists of three (3) drawings showing the present improvements on the lot
and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the
well and waste disposal systems arc subject to this permit application, (sheet 2/3), and a schematic
of the waste disposal system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are
also enclosed. The septic system design is based on the following :
Ground Water at 8 Ft.
Use Standard 5 -Wide Trench with BloCycle
Soil Rating. From Testhole 06/15/99
1 min/in — 3.0 gal per sq.lt/day
No. of Bedrooms 4
Required Area per Bedroom: 150/3.0 - 50.00 sq.tt.
Total area required: 50 x4-200 sgtt
Bottom Rock At 4 feet
Top Rock At 2 feet
Rock Depth 24 inches
Total Trench Length 200/5-40 [R]
SYSTEM CONFIGURATION
BIOCYCLE
STANDARD 5 -WIDE TRENCH
TOTAL LENGTH
40
FT
TOTAL WIDTH
5
FT
TOTAL DEPTII
4
FT
ROCK DEPTH
2
FT
COVER
3
FT
The Installation of this well and waste water disposal system system will not prevent wells from being installed on
the adjacent lots.
There are no developed or natural surface /sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
49th �..
w
/0 - 70 wl s'y KLAN 7 ••,
50 0 SD IA7 PA7 3Q0 //` ��1""" •• »» ��i /
SCALES 1' = 100 FT.
16
/
/I
I 03 W o TH.:AV u r c. I I KASIL0F HILLS BLOCK 4 LOT 6 I I SUM SYSTEM DESIGN I
?03 W 15TH :AVENUE 10700 KASILOF BLVD. DATE.' AUC. 24,2000
ANCH. AK. 99501 THADDEUS CHMIELEMY SHUT. 113 CRID. 2541
907 ?79-3916
PERHIT R SVOOOXX PID # XX KAH04061.BVG
17 I .p
1
1
�— t1rel
. 1
l
e Cu
Fr -1 ,
1 sr, s->,tac
P C18
0
1
0
P coMc ( �
7zef Dur .I esthole I
na or R= J 1
gX4C V f 7ROKH
— I
SCALEr P = 50 FT.
03 W arurtnc VrM [.c. AASILUF MCLS" BLUCK 4 LU7' 6 SEPTIC SYSTEM DESIGN
ANC W 15TH AVENUE 10700 KASILOr BLVD. DAM AUG. 24,2000
ANCH. AK. 99501 THADDEUS CHAIIELEWSKY SHEET• 213 GRID. 2541
_(907) 279-3916
rums i a SV000XX PID # XX KAH0408ZBVG
r
��.••OF
I 1 •
1 y 1 ��,` �...
I.
�l'
I 4t49
�th '�•�s
TDB .NNo. awms
SPURKLAND J
1
50 0 SO 100200 0 300 / �IItiSCALD B 100 rT.
��"
16 I 8 1 /
1 -�--7
1-- ne
— - - Will 22 /
7 o I ¢ raL Q
w 6
— �..,
Imo.
/21 a
V -r 1
19 5 '
' I 1 VACANT /
I 1
:,,
- - 4
I
i6Y V/ 15TH. AVENUE I I IIAJILUI' HJLL) JfLUUK 4 LUT b SEPTIC SYSTEM DESIGN
ANCH. AK. 99501 10700 KASILOf BLVD. DATE. AUG. 24,2000
_(907) 279-3916 THADD£US CHMIELEWSKY SHEET.• 1/3 GRID. 2541
PERMIT # SVOOOXK PID X XX KAH0406LDV6
i
�18 ,{cvucrucNr 1atNCH
19
i a9til
I. :L T139 EN�SGURKLAND
No. EE -2223
► ..rte.
25 50 75 100 '125
SCALD I' = 50 FT.
I
i6Y Y/ 15TH. AVENUE AAOILUP IIILLJ ULUGA 4 LUT 6 SEPTIC SYSTELI DESIGN
ANCH. AK. 99501 10700 KASILOF BLVD. DATE: AUG. 24,2000
(907) ?79-3916 THADD£US CRUIELEWSKY SHE£T.• 2/3 GRID: 2541
PERMIT # SVOOOXX PID # XX KAH04082.DVG
14—INCH INSULATION
1-1/4 PVC 07TH 1/6' HOLES AT JO' Wo
OO - I STANDARD 5—WIDE DRAIN FIELD
- 4 f7 TOTAL DEPTH
2.0 f7 EFFECTIVE ROCK
3 FT COVER
_} r— ANCOMORESSOR
J.
AIR [1Nf5 • 11 9T
—1 n
6" dIIN lll—Lu
SAND OACKfXL =. — — —
.9'-4'
5'-2' IRN . O J O O �• SILI BARRICR
6'-0' I/AX ' • IHPERWOOS SOIL
• I ND SCALE
BIOCYCLE 6000
LEGEND.
1.
PRIMARY TREATMENT, SEPTIC TANK
2.
AERATION TANK
J.
CLARIFICATION TANK
4.
DISCHARGE TANK
5.
SOIL ABSORPTION
}:+ L
! 49th
I8E1' SPURKLAND
No. tE-2225 I
4 TT
two 3 aWISfhrtv Arve
20int r.c. KASILOF HILLS SIT LOT 6 BK 4 WASTEWATER SYSTEM SCHWATIC
lh Ave
Anohoro a Ak 99501 BIOCYCLf WASTE WATER SYSTEM DATE: AUG. 26. 2000
27-39 6 11 SHEET. • 3/3 CRID.2541
PERMIT M SWOOOXX PID # YY KAH04063.DWG
Ali
(ENGINEER'S 6EALj 1
.. - Munlelpailly of Anchorage
DEPARTMENT OF •IEALTH d HUMAN SERVICES t:: "C3r1s✓
825 •L• Street. Ale:horage, Alaska 89502-0650 ` T L -' L'r d % %• '%
SOILS LOG — PERCOLATION TEST . , : , •., %�
M
PERFORMED FOR: 16%cleleLL6 C(,F j�/%.t �•e Lt,«g�(, DATE PERFORMED:_
LEGAL DESCRIPTION: L..CT & DV -4 Township. Range. Section:
1
2
3
4
5
6
7
8
i']
it
12
13
14
15
16
17
18
19
20
1LAs1.1.o-F
OeGANfcS
P�
s:1. ,1 Sati
sM
WAS GROUND WATER
ENCOUNTERED?
�eTTv wL 0 IF YES. AT WHAT
F DEPTH?
+ Dt;nb to Water Ater e
Maniering? — tje%i_
ItC rLAN
■■■■■■■■■■
■■■■■■■■■■
LJ PERCOLATION RATE 11(minatevmch) PERC HOLE DIAMETER Ell
TEST RUN BETWEEN 4q FT AND YX FT
DISCLAIMER• rrnnndwatar rnnditinne indirat•od Ann fnr the dates shown only.
Past and future presence and/or depth of groundwater can not be predicted
romese or .sea n .
PERFORMED BY: - l - I — l- S CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIE ELINES IN EFFECT ON THIS DATE. DATE:
77-008 (Rev. 4/85)
KMM
MOM.
LJ PERCOLATION RATE 11(minatevmch) PERC HOLE DIAMETER Ell
TEST RUN BETWEEN 4q FT AND YX FT
DISCLAIMER• rrnnndwatar rnnditinne indirat•od Ann fnr the dates shown only.
Past and future presence and/or depth of groundwater can not be predicted
romese or .sea n .
PERFORMED BY: - l - I — l- S CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIE ELINES IN EFFECT ON THIS DATE. DATE:
77-008 (Rev. 4/85)
+4 +s
i, MunlelFollty of Anchorage ..
DEPARTMENT OF •IEALTH & HUMAN SERVICES r�
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST '•:T'
PERFORMED FOR: TIn Rdell lL 5-!J 1f.7%GIl w -a 1s.c DATE PERFORMED:
LEGAL DESCRIPTION: L -C L $Y, Township. Flange. Section:
DEPT" "s Uw4 14 4%11.4
D E
0"-jRt1icb P4
2
3
4
5
6
7
a
I']
10
11
12
13
14
15
16
17
18
19
45K
OINEER'S SEAL) r�
.�I '3 rl:a,�t• ��i
...t.
.r, v
('vim<i1 r
WAS GROUND WATER - 1
ENCOUNTERED? 0
S
IF YES. AT WHAT L
O
DEPTH?
P
E
Depth b Wlter Atter
Mpnitcring? Drlc
®=mm®
20 -{ I
U_ .I
PERCOLATION RATE � (minutesnncn) PERC HOLE DIAMETER
TEST RUN BETWEEN b FT ANO A /L FT
DISCLAIMER• rrnundwatrr rnnditinne indira Pd arr fnr the datpe chnwn only
Past and future presence and/or depth of groundwater can not be predicted
romese �G
PERFORMED BY. -- f - CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIE ELINES IN EFFECT ON THIS DATE. DATE
72-0Ca (Rev. ue5)
■EE■
■EEONENEE■
NONENONENNEr�NE
■EEE
EEEEEEEEEE
EEN■
ENEEEEEEEE
■EE■■E
EEEEEEE
E
AMEN
■EEEENEEEE
NOON
■EEEEEEEEE
MONO
■ONNNNEE
E■
■EN■
■EEEEEEEE■
■EE■
EEEENEEENE
NONE
■EEEEEEEEE
EEEE
■ENEEOEENN
WAS GROUND WATER - 1
ENCOUNTERED? 0
S
IF YES. AT WHAT L
O
DEPTH?
P
E
Depth b Wlter Atter
Mpnitcring? Drlc
®=mm®
20 -{ I
U_ .I
PERCOLATION RATE � (minutesnncn) PERC HOLE DIAMETER
TEST RUN BETWEEN b FT ANO A /L FT
DISCLAIMER• rrnundwatrr rnnditinne indira Pd arr fnr the datpe chnwn only
Past and future presence and/or depth of groundwater can not be predicted
romese �G
PERFORMED BY. -- f - CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIE ELINES IN EFFECT ON THIS DATE. DATE
72-0Ca (Rev. ue5)
20 -{ I
U_ .I
PERCOLATION RATE � (minutesnncn) PERC HOLE DIAMETER
TEST RUN BETWEEN b FT ANO A /L FT
DISCLAIMER• rrnundwatrr rnnditinne indira Pd arr fnr the datpe chnwn only
Past and future presence and/or depth of groundwater can not be predicted
romese �G
PERFORMED BY. -- f - CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIE ELINES IN EFFECT ON THIS DATE. DATE
72-0Ca (Rev. ue5)
PROPERTY OWNER AGREEMENT
• FOR TEE MAINTENANCE OF AN
ON-SITE WASTEWATER DISPOSAL
SYSTEM
agreement. dated `I O ��
This a
gr i99_, is made between the Municipality of
Anchorage Department of Health and Human Services (DHHS) and the property
owner(s) of.
L-.OiL� 1�kti V, AC, nC NI
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject pr`opeity.
The property owners agree to the following;
Submit to the Municipality of Anchorage, on an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and
operation statement shall verify that the engineer has inspected all effluent and air
pumps, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
(Printed Name)
(Signature)
(Printed Name)
--------------------------------N, --
tarize Here —— -- ----- �—----------_-----------
State of I On th. s �$� day of
T adde.tts JAmitLilcpe-sonally appeared before me,
Whois personally known to me
X who•se identity I proved on the basis of,f)t,f'
whose identity I provdd on the bath/affirmation of
, a credible witness
to be the signer of the a�e��VdddC"njp.Ett„ and he/she acknowledged that he/she signed it.
:NOTARY''<1
N ar Public
0Z U� my commission expires Wras
,03
Municipality:of Anchorage ;
:Development Services.Departinent •.:
Building Safety Division'
On-Site Water; and Wastewater Program
4700 South Bregaw St.. ' ' .
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorege.ek.us
(9 7) 343-7904
'ON-SITE SEWER/WELU SUBMITTAL COMMENT SHEET
To: TODDEN SPURKLAND
Legal descriptionmASILOFHILLS SUDDIVISION'DLOCK4 LOT6
The attached paperwork has been reviewed and is being returned for the following reasons: v
❑ • Original signature &stamp missing on
' ❑ .Calculation error in deslgri..... ,
:. ❑ Additional soils information needed. ; ' �. y/
' ❑ • Water�monitoring results inadequate.V10Y
,• • . , .��•
Q
❑ .Discrepancy in information submitted: ✓ Q
® Topographic information missing 'or inadequaf
❑ ' ,Incomplete; missing
❑ 'Incomplete; missing , ' „`.
❑ ,Additional adequacy test information needed.
[3 Walecsarnple unacceptable.
❑ . Measured/proposed distances/dimensions missing.; �' Q•
❑ ;Locations of all soils, percolation:and water monitoring tests not shown.';
❑ ;Proposed system too deep for sofis information submitted. •�
❑ Weil lgg required; ��(
F;
' „ ❑
:Omission in narrative. .• , :'•• .. .• .
❑ ; Insufficient fill over tank or field. ;
®' :Other: YY}iERE IS WATER WELL LOCATED'
Name'of reviewerData: 9/24/01
Please _supply.the necessary information and re-submit your. request. '
:LEAVE THIS FORM ATTACHED TO THE PAPERWORK ;
MUNICIPALITY OF ANCHORAGE
A
Ar
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-131-26
Expiration Date: l� - 30 ^ 2
J_
1. GENERAL INFORMATION
Complete legal description Kasilof Hills Sub, Block 4, Lot 6
Location (site address) 10700 Kasilof Blvd
Current property owner(s)
Travis
& Courtney Bond Day phone
(907) 782-8832
Mailing address
10700
Kasilof Blvd, Anchorage,
AK 99507
Real estate agent Cody Keim
2. TYPE OF DWELLING:
❑■ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or. Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone (907) 250-9558
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well IC Private Septic Q
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment 3- g — 21
Receipt Number (73 q -12
COSA# OSC211094
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 3/3/21
6. DSD SIGNATURE
System #1 Approved for qbedrooms
B
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
.=' OF
49TM /
.. ........
Benjanj r�chiller /
CE 12592
,illi PROFESSl0�a4.��
with the following stipulations:
VV/A I Crx r%114LJ
Original Certificate Date: 3 —S — 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description:
•
Kasilof Hills Sub, Block 4, Lot 6
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 6/19/01
Total depth 307 ft
Cased to 33 ft
❑® Sanitary seal is functioning correctly
❑® Wires are properly protected
Casing height (above ground) 20 in.
Date of flow test for COSA 2/24/21
Static water level at beginning of test 92
Comments
B. TANK DATA
Age of tank(s) 19 years
Tank type/material OTHER/BIOCYCLE
li
Measured operating fluid level in septic tank N/A
❑o Standpipes/foundation cleanout per record drawing
Date of pumping N/A
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) 6/17/02
❑® ALL standpipes present per record drawing
Total measured depth from grade *4.3 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
limil Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 015-131-26
Structure served by_this system
Well production at time of test 5 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 3/2/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 19 years
Lift station material Fiberglass
Comments:
Adequacy test date 3/2/21
Results m Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 623 gal
New depth 3 in
Elapsed time 1440 min
lJm_1 Code -required soil cover over field Final fluid deipth 0 in
R-1 System presoaked
Absorption rate '600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 225** gallons If yes, enter date
Comments/Deficiencies: * Grade sloped at monitor tube
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
if No
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' Q Yes
if No ft
Absorption Field on Lot > 100' ❑✓ Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
✓0 Yes
Animal Containment > 50' M Yes
if No ft
❑✓ Yes
if No
ft
*Waiver #: OSP131025
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑✓ Yes
if No
ft
F71 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Q Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5'
Yes
if No
ft
Wells on Adjacent Lots:
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' 0 Yes if No ft
Water Service Line > 10'
[D 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
*6'0 ft
Wells on Adjacent Lots:
Water Main > 10'
✓❑ Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
✓❑ Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No
Surface Water > 100'
✓0 Yes
if No
ft
F. ENGINEER'S COMMENTS
*Waiver #: OSP131025
G. ENGINEER'S CERTIFICATION Ad
O�Q�t�
I certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with 49 T H
MOA COSA guidelines in effect on this date. f ''
. BenjaiSchiller
�F• CE 12592 ••`��
�FD PR 4 f E S S 1 ONa� �®�?
COSA Checklist yellow sheet
ft
ft
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of a ' of 202-i , by and between
I 1�_ c5 A k C" - , herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
Biocycle
located at (legal description)
Kasilof Hills Block 4 Lot 6
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
{ Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
,-B (signatureDate: 7-3- x _ ( )
r ..
STATE OF ALASKA }
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this;S day of AAAAU /I-
20,21_,
t20,x, by -"Wje- &Fir -1 -Orr
NOTAR PUBL C FOR ALASKA
My Commission expires:�LI
MUNICIPALITY:
�- (signature)
(rev. 05/18/2018)
?; NoraR Y , .o N.
� cpm 'OIJg �
•sSjO ��a��. a•
n �'xpires''��er
Date: 3 3 Z
(print name) Title:
Page 3 of 3
1---, CC Anchorage AK 99503
Email: crbioak@gmail.com
(907)274-0314
Ist Quarter •' Report
Homeowner Info
Customer Name: Travis Bond Tank#: 130 Install Date: June 2002
Address: 10700 Kasilof Area Upper O'Malley
Initial Inspection:
Alarms Tested: Air 0 High Water Battery Tested: Yes R1 No ❑ N/A ❑
(Please make sure alarm is on "normal", not "mute")
Does system have a septic tank ? No YJ Yes ❑ (Recommend pumping tank every 2 years)
Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor?
Yes 171 Repaired ❑ Yes 0 Repaired ❑ Strong Rj Mild F None 0
System Inspection
pH Reading:
(pH of 6-8 is ideal)
7.4
Pump float operating?
Yes FV1 Replaced F
Filter cleaned?
Yes F71 N/A ❑
Dissolved Oxygen PPM
(2-5 is ideal)
3.7
Alarm float functioning?
Yes YJ Replaced ❑
Turbidity of discharge (in FTU)
(Under 35 FTU is considered compliant.)
5.83
Any buildup of solids?
Yes ❑ NoFVJ
Discharge line condition:
Good Z Replaced ❑
Comments:
Has emailing or mailing of form been requested?
Inspected By: Chris Date: 02/12/21 (contact office to request...) Yes1:1 No G
Lot 7
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Lot � 7
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SCALE: 1 "= 40'
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septic Tank ret. wal
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Septic vent �� }
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30
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200.00 I
Lot 5
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0* k_ . Fred Walatka : ff 00
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A��'SSIONA�
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. Fb 12-6, pg 7-8
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described property:_ LOT 6. BLOCK 4
KASILOF HILLS SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this '10th day of October 2012
FRED WALATKA & ASSOCIATES
BE(907-248-1666) Engineers and Surveyors
Municipality of Anchorage or
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-131-26 Expiration Date: 6-11-1-13
1. GENERAL INFORMATION
Complete legal description KASILOF HILLS; BLOCK 4, LOT 6
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
10700 KASILOF BLVD. *ANCHORAGE, AK
DAVID KENNEDY Day phone C/O AGENT
10700 KASILOF BLVD. *ANCHORAGE, AK
KATHLEEN POULIN W/ KELLER WILLIAMS Day phone
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
865-6560
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
❑
Received by: Z�� Dater/ s
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ ':a6 1 rA/6- Waiver Fee $
Date of Payment 15 1 �J v "d^ Date of Payment
Receipt Number ", Receipt Number
COSA # 05C.1310 85 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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. /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.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
in conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test -
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
__Z System #1 Approved for —4—_ bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
Phone 337-6179
Date 3/ 3/13
OF
ti
ON-SITE
WATER AND
fl WASTEWATER
PROGRAM
H
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
By: I 11f a
(Rev. 11105)
Nitrate Advisory
Arsenic Advisory
Other
Original Certificate'Date: `
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: BLOCK 4, LOT 6 ParcellD: 015-131-26
A. WELL DATA
*TO BEDROCK
Well type PRIVATE If A, B. or C provide PWSID# N/A
Date completed 6/01 Sanitary seal (Y/N) YES
Total depth 307 ft.
Date of test
Static water level
Well production
Cased to *33 ft.
FROM WELL LOG
6/01
18
5
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenic: ND ug./L.
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)
YES
Wires properly protected (Y/N) YES
Casing height (above ground) 24+ in.
AT INSPECTION
**9/18/12
46 ft.
g.p.m. 3.0+ —9-p M.
**WELL FLOW CONDUCTED BY LARS SPURKLAND, P.E.
Nitrate 0.397 mg./L. Collected by: GFO. Ltd.
Date of sample: i a rd
Tank Type/Material BIOCYCLE/FIBERGLASS Date installed 6/17/02
Tank size 1600 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES
Date of pumping
Depression over tank (Y/N) NO High water alarm (Y/N) _
PumperJerCf e. /�44c- b ed /14c4."4e,?a,-2C
C. ABSORPTION FIELD DATA *BELOW FINAL GRADE
Date installed 9/14/12 Soil rating (.p.d./ft r ft'/bdrm) 3_0
Length 50 ft. Width
11
System type SHALLOW TRENCH
ft. Gravel below pipe 1.5 ft.
Total depth *4.40 ft. Eff. absorption area 320 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test — in. Water added =gal. New depth =in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date —
D. LIFT STATION *PER MAINTENANCE REPORT
Date installed 6/17/02 Size in gallons 1600 Manhole/Access (Y/N) YES
"Pump on" level at 22 in. "Pump ofr level at 15 in. High water alarm level at 45 in.
Datum BOTTOM OF TANK Cycles tested * Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING 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 **6' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
**OSP131025
G. ENGINEER'S
I certify that i have determined through freld inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
(Rev. 11/05)
Environmental Consulting and Design
,°L
September 20, 2012
Kim Kennedy
10700 Kasilof Blvd.
Anchorage, AK 99516
Subject: Well Flow Test
10700 Kasilof Blvd.
Dear Kim,
The following report describes the performance of the well and septic system under the
conditions encountered at the time of the test.
Well Flow Test
According to the well log, the well was drilled in June of 2001, has a total depth of 307 feet, a
static water level of 18 feet below the top of the casing, and a yield of 5 gallons per minute. The
well was pumped at a constant rate of 6.3 GPM while the draw down was monitored with a
water level indicator. At the beginning of the test water level was found at 46 feet below the top
of the casing. The water level stabilized 240 feet, while 630 gallons was drawn from the well.
After the water was shut off, the water level in the casing rose 34 feet in 15 minutes. A water
sample was collected on September 18", 2012 and is being analyzed for arsenic, bacteria, and
nitrate. Pending acceptable water quality results, the well appears to meet the minimum
Municipal standards for approval of a 4 -bedroom residence.
If you have any questions please call me at 279-3916.
Sincerely,
Laws 6,66, a ral
Lars Spurkland, P.E.
Spurkland Engineering
203 West 15`h Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
MoCycle Alaska
4971 Thompson Drive
Homer, Ali 99603
226-2476 office 399-0331 cell
Email: biocyclealaska(rfgcimet
10700 KaWof
Anchorage, AK 99516
AI0.rrr1
fie. (bio���(�.
1 st Quarter 2013
1 Date:
M.
P)0µse,
son1C�
70/T0 39Vd
SNI VNSV-lV 3-10AOOIE
3 `. HzD
9LN',KFL06 67:9T £T0d/7T/£0
MAINTENANCE DESCRIPTION____.___
_ COMMENTS_
PRIMARYCHAM13ER SCUMLEVEL
HIGH
AERATION CLAMBER & AERATION SYSTFN
f
BE SURE YOUR ALARM IS
BLOWER SIZE 60
L/MIN
ALWAYS ON "NORMAL' NOT ON
AERATION PRESSURE
r�t-I�,�120
'HIGH LOW
"MUTE"
NOISE LEVEL
HIGH
GENERAL CONDITION
POOR
SYSTEM: AIR LEAKS
LEAKS
AIR DIFFUSER/AIR SUPPLY
POOR
MIXED LIQUOR CONDTTI014 ODOR
YES
CLARIFICATION CHAMBER �-
SLUDGE ACCUM IN HOPPER
HIGH
CLARITY OF EFFLUENT CL
PAIR CLOUDY
DISCHARGE CHAMBER
DISCHARGE PUMP OPERATING S
NO
ALARMS CHECKED AND OnRA I7NG
AIR/POWER S
NO
HIGH WATER YES
NO
1st Quarter 2013 Maintenance was performed
BY: LARRY BETTS (862-7434) DATE:
70/T0 39Vd
SNI VNSV-lV 3-10AOOIE
3 `. HzD
9LN',KFL06 67:9T £T0d/7T/£0
BioCycle Alaska
4971 Thompson Drive
Homer, Alt 99603
226-2476 office 399-0331 cell
Email: biocyclealaska@gci.net
10700 Kasilof
Anchorage, AK 99516
337-8518
4th Quarter 2092 u e
0.5e --
IBIOCycle Location
40/Z0 39vd SNI VASV IV 3-10AOOIS 9LVZ9i7L06 67:ST ETK/PT/E0
MAINTENANCE DESCRIPTION
COMMENTS
PRIMARY CHAMBER SCUM LEVEL
K HIGH
AERATION CHAMBER & AERATION SYST�
BE SURE YOUR ALARM IS
BLOWER SIZE
8 120 L/MIN
ALWAYS ON "NORMAL" NOT ON
AERATION PRESSURE 0
�
HIGH LOW
"MUTE"
NOISE LEVEL
HIGH
GENERAL CONDITION
POOR
( U e rj VS-�eYI l
SYSTEM: AIR LEAKS
LEAKS
I
AIR ELI
NRXD LIQUOR CONDITION ODOR
POOR
5 �j
N
YES
V •U
-
CLARIFICATION CHAMBER
This chamberwas cleaned as part
SLUDGE ACCUM IN HOPPER LO
HIGH
of quarterly maintenance during
CLARITY OF EFFLUENT CLE
FAIR CLOUDY
October and April
DISCI -LARGE CHAMBER
This chamber was cleaned as part
DISCHARGE PUMP OPERATING (. YESj
NO
of quarterly maintenance during
October and April
ALARMS CHECKED AND OPERATING .._
AWPOWER S
NO
HIGH WATER YES
NO
4th Quarter 2012 Maintenance was performe
BY: LARRY BETTS (862-74x4) DATE:
40/Z0 39vd SNI VASV IV 3-10AOOIS 9LVZ9i7L06 67:ST ETK/PT/E0
BioCycle Alaska
4971 Thompson Drive
Horner, AK 99603
226-2476 office 399-0331 cell
Email: biocyclealaska@gci.net
(Customer I
10700 Kasilof
Anchorage, AK 99516
337-8518
3rd Qtr Maintenance 2012
Install
V0/C0 3sdd
Fol. SASE
K*vh1a l Pao A
qo 7 z47� y�,Z3 CK�II{i 41�11;;M
ONI VASV-ld 3-10ADOIS 9LVZW,ZL06 6V.9T CTOZ/VT/C0
-----MAINTENANCE DESCRIPTION
__ ____—
COMMENTS
PRIMARY CHAMBER SCUM LEVELK
HIGH
BE SURE YOUR ALARM IS
AERATION CHAMBER & AERATION SYS TE
BLOWER SIZE
I20 LuIN
ALWAYS ON "NORMAL" NOT ON
AERATION PRESSURE
HIGH LOW
"MUTE"
NOISE LEVEL
HIGH
GENERAL CONDITION
POOR
SYSTEM: AIR LEAKS
LEAKS
AIR DIFFUSER/AIR. SUPPLY
POOR
MIXED LIQUOR CONDTTJON ODOR
YES
CLARIFICATION CHAMBER
SLUDGE ACCUM IN HOPPERI.OW
HIGH
CLARITY OF FFFLUENT CLE
FAIR CLOUDY
DISCHARGE CHAMBER _
DISCHARGE PUMP OPERATING ES
NO
ALARMS CHECKED AND OPE'RA'TING
ATR/POWER
NO
HIGH WATER YES
NO
3rd Qtr 201.2 Maintenance was performed today
BY: LARRY BETTS DATE:
`-
V0/C0 3sdd
Fol. SASE
K*vh1a l Pao A
qo 7 z47� y�,Z3 CK�II{i 41�11;;M
ONI VASV-ld 3-10ADOIS 9LVZW,ZL06 6V.9T CTOZ/VT/C0
BioCycle Alaska
4971 Thompson hive
Homer, AK 99603
226-2476 office 399-0331 cell
Email: biocyclealaska@gci.net
10700 Kasilof
Anchorage, AK 89516
337-8518
2nd Quarter 2012
Date:
70/40 39VJ ONI VASti"ld 3-10AOOIS 9L7Z9ZZL06 67:9T £TOZ/7I/E0
MAINTENANCE DESCRIPTION
COMMENTS
PRIMARY CHAMBER SCUM LEVEL
K HIGH
BE SURE YOUR ALARM IS
AERATION CHAMBER & AERATION SYSPOYES
BLOWER SI7,E
120 L/MIN
ALWAYS ON "NORMAL" NOT ON
AERATION PRESSURE
GH LOW
"MUTE"
NOISE LEVEL
GH
GENERAL CONDITION
R
SYSTEM: AIR LEAKS
AKS
AIR DIFFUSER/AI R SUPPLY
OR
MIXED LIQUOR CONDITION ODOR
CLARIFICATION CHAMBER
SLUDGE ACCUM IN HOPPER LOW
HIGH
CLARITY' OF EFFLUENT CLE
AM CLOUDY
DISCHARGE CLAMBER
DISCHARGE PUMP OPERATING YES
-NO
ALARMS CHECKED AND OPERATING
AIR/POWER YES
NO
HIGH WATER YES
NO
2nd Quarter 2012 Maintenance Was performed
BY: LARRY BETTS (862-7434 DATE: IQ
('
70/40 39VJ ONI VASti"ld 3-10AOOIS 9L7Z9ZZL06 67:9T £TOZ/7I/E0
Municipality of Anchorage
Ca . °
•' �- Development Services Department <<
Building Safety Division
Onsite Water and Wastewater Program `
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.orglonsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.r7 ! ,r- I3 I - COSA* Oro 000 7
Expiration Date: 4 -to- O6
GENERAL INFORMATION
Complete legal description _tell G Blk 9 k4ti lot 115
Location (site address) 10100 kas; t BI VA
Current Property owners) 1 h a,dAeks ON rtii c l etj5ki Day phone
Mailing address
Lending agency
Day phone
Mailing address
Real Estate AgentAa. rry
J to
✓tr.s Day phone _ 2-13 - -4 0(0
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
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 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, 1 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.
NameofFirm SDurwlfsa EE5tneer'tnu Phone 219-311to
Address ?D3 W. ISt� Aug-. SwAe' 203 AAS 4Kk`fsol
Engineers Printed Name T ter -S r klanci Date 14 05
i
5. DSD SIGNATURE
_jG Approved for HL bedrooms.
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:_% — / 0 — O C
(R«, IM)
Municipality of Anchorage
Development Services Department
Butklnp safety Dmalon -
OnSRe Water 6 NrA1leweter Prapram ' • • .
1700 BrspBW b'traet
P.O. Baur 180050
Aod>ww, AK 08314-050
www.o Obulte
MM 343-TW4
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Laaw Descv wm LA b Block 1 Kes;l.T Vk As pemet to: b 15-131- 2-G
A. WELL DATA
Wall type-2dwakc H A, B, a C pnuvlde PWMD S = V6W LOU (YM) V
Date mnpleted A -4d I Sanitary seal (YM) l VNres preperly protected (YM)y
Total depth jol & Cased to -13—ft. C@sN heWd (above proud) I B * in.*
FROM WELL LOO AT WSPECTION
DOW ofteu A1010-1 of IZ nS
Stade waterlevel IA ft 41 1L
Was pr ubm S p.p.m. q p.p.m.
WATER SAMPLE RESULT&
Cabrm _jd--4
Ars00 mL Nitrate 1.61 mpA. 00W baetww �colonieall0o mL t
enic .< � �Date of ample: tt IT 05 C acted by: _ -M6b .. SAA.'"o nx
B. 13MCMOLDINO TANK DATA
Ter+r TypefRAate w Flu oate hstaded (01,710Z
Tank size IWD paL Number of Compartrtt i Cteanouls (YIN) _ Y
Fmr%Wcn dean! MM ! oeMstion owr tank (Y" -�IL High water wrm (YIN) )'
Dateorpumpinp'"� PtsrW_�rx41,L%A DNMMN4 St(I/ ceo) Tac,
C. ABSORPTION FIELD DATA
Data krtalled d1110Z- Sea raft (p.p.d.Alr or ft'lbdrm) To system type 5616.0 Trt r� k
Lenpm 40 IL VNdth 5 R. Gravel beim pipe 0.5 IL
Total depth 115 4. ER. absarptbn area 1LD R' Moth WVV tube I Depression war pea N
Dale of adequacy test.l�j0,S PA= is (Passft* 2a0— For 'q bedtans
FUd depth lnabec"m Held before test --j.in. Water added_(&pal. New depth I2 in.
Elaaeed Tine: _IIb0 min. Feu! ftukf dept! --J in. v Abeorptbn rate :1-6 OO q.p.d.
Any re)uvanadon treatment (pest 12 mo.) (YM 6 type) I" known M yes ptve date
D. UFT STATION
Date hOMod fi 17 40
-pump on' Iad at 1.7- K
Datum bAg1 ,T..•k
E• SEPARATION DISTANCES
Size in pftm 1 600 Menhd@tA=m (Y" Y
•Pima otT levet at IL irt. No water aimm kvd at -45 In.
tyles ta>tad 3} Maass awm R dart mamma *? y
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se:*c Wma eta" , an W 410D t
Absorption Raid an lot 4001
Public sewer n do Hoof
Saver hustle Service Wre +25 I
Anand cn tahw#m areas ► S01
Floo I
100,
MamaeJalrmat excrete awrape areas + UO r
SEPARATION DISTANCES FROM SEPTICMOLDINO TANK ON LOT TO:
BWWV bundtlon a 100 property Um; 10' Absorption Reid + S r
Water mdn N A Water wilce I m +2 5 I Sut m weer N. O.
Web on adJacent bb 4CO$
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
property line 410' Bulk ft bw4ld n 4 ID' Water main NI A
Water Service We JVIA
&Mce water . 0 • D' v - pendWwnide Smrem + 10 t
Curtain Ittihi N, 0 • Web on agawrt bus
F. comimENT8: f SEE KAWW(r
O. ENOINEER'SCERTIFICATWN
I owffly Met I have detem~ Vuowh ffald Inapectl" andis .. ••.:j
revbw of Alnnlr�al eacomb Mat Me &bow syatart� are In �; j
o0r!/amee we wft MOA COSH prided w In shed an Mia data. ••", •: •: ; • • �• '' �r' •L �•rj
ErVh&Wa Name Te6600 $� *'� f
COSA Fee i q 3 o Waiver Fee S
Date of Paymert G 1 LAO 6 Date of P&ym&M
Recdpt Nw bar "�� 2 / % k A 1 Receipt Number
WELL DETAI L LOT D .6LOU4 j _..kASILDF... H1 LLS
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