HomeMy WebLinkAboutSKYLINE VIEW #1 BLK 2 LT 1ASkyline View
#1
Block 2
Lot 1 A
#051-191-54
~� Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650 Page of
www.d.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030028 PID Number. 051-191-54
Nan"
an & Shelly Gray
Wastewater System: ® New ❑ Upgrade
"POR 773182 Eaofe River. AK 99577
ABSORPTION FIELD
ph":
7Sod
0 Deep Trench® ShalNhe Tracer, O Bea D 1110114 o Dow.
LEGAL DESCRIPTION
�
1.2 GPD/FI•
Total Depth hamo phW paOe.
8.0 Ft.
Bkck Lex: Subehbion:
Depth m Pipe bollwn from ON" qr«e:
Gr «Pith beneath ppe:
2 1A S ine View #1
3.87 Ft.
4.13 FL
Twmehq: Ranps: Swtwl:
F. aeose sNme a•tp"•si Antis:
Grav Length:
0.42-0,77 Ft.
SS Ft.
Well: ® New ❑ Upgrade
Grant vnath:
Number d hies' Dnlanca behaean Yrlss:
1
5.0 Ft.
FL
classification (Private, A S. C):
TOW Depth:eeeed
to:
TOW abewpean wee:
550 Fe
Pipe Mate"
D3034 & F810
Priva
Ft
pilar:
Dive Detae:
Stack Waw Level:
hata e":
Strata
Dale Nnlauea:
4/24/03
Sullivan14/21/Q
88 Ff
Inow:
Pump s.t at:
D«lnp HNpht Atwvs cmlwa:
TANK
0.33 GPM
nkn wn FI.
2 Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Litt
station
Holding
Tank
Publk-jPrtvat
sewerune
•n° •r'
Anchorage Tank
1250 GM.
wea
100'+
100'+
NA
NA
25'+
1'Steel
Ste
NMnbw 2 pwN « .:
2
Surlacewelw
100'+
100'+
NA
NA
LIFT STATION
WLaw
5'+
10'+
NA
NA
GeL
5'+
10'+
NA
NA
amp Pin la at.
camp is a w.
Hgh waw *Wm al.
Faunaetkn
�
,,.
�,.
NA
*50'+
NA
NA
Pwnp Malta a Mp«I
EM lnepscOons pvd m by:
canals peen
BENCH MARK
*none known
Bottom of siding
Assumee Elavatkn:
100 FL
Engineers Stamp
E OF A�q�!
..
Gj �/
r • 9
7t 1,494 %%
Inspections performed by: KND Engineering Inc.Dates:lst4/24/2003
e.. e.Z«...... .... ...�,
/,
na 4/25
S f s�oy
. ..e. ...... . . ....
«
KannCE s''• W�
Developm nt Services Department Approval
194:.17116
Reviewed and approved by: Date:'7/ af���'
F.''*.%j••4*'•p����r
(Rev. 13/00) •
T
�'`,"`
O�
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW030028
SKYLINE VIEW S/D, 1ST ADDN.,BLOCK 2, LOT 1A PID# 051-191-54
12.0' x 14.0' DECK
W/ CONC. PAD BENEATH WELL
LOT 1A
172.2'
B
KN D EXISTING
A
0 0 FC
EXI NG 1251'
Q�OQOSeO �GQ�1MP�y G T GAL 6PTI xT N 0' DECK
Cp MT iv
TH03-1 Lo
4' CHAIN-LINK FENCE
--------------------------------------------------------------------------------------------
SCALE: 1' - 30'
A -C=45.4'
B -C=59.6'
A -D=54.7' 2w-;1
98.7 97.5
FINAL GRADEB-D=66.6' A-E=70'B-E=81.5A F=121'�PTIC250 L 93.00 92.95B -F=134.5' NK SEWER ROCKA-G=70.8'
B -G=83.3' 93•$4 ea.so 69.62
A -H=116.8' ss
B -H=130.5 SCALE: NTS
AZ A
...
OF \
<�,•.••••.. "�?�sL1 PREPARED FOR:
/`y,%• `�l ,1 - BARI&SHELLY GRAY
P.O. BOX 77382
49 TIi `* * 1/ EAGLE RNER1AK 99577
................................
�KENN Y' U "s ;•/ naD BOOKS Cawtm:
END ENGINEERING
C/E_-/7116 / "OuNDA DRAM: WAC
��'.•`1 0tf j1 }STAKNt . CKOIM-KMD 20441 PTARMIGAN BLVD.
`
," .• ..............`AV AwmT AN DA 4 EAGLE RIVER, AK 99577 8738
J�*bFEss1001 , AV 0110. ME: GM
NW1159
\``� 0 004ASB.DWG 03004 (907)696-6111/FAX (907)696-8111
OWNER OF LAND: dfti
ADDRESS: yj
LEGAL DESCRIPTION:!
QLv, .off DoT 1 /Q
DATE:/ b3
PERMITNU BER:MQ22� Date ofIssued-L+?A-.63
TAX IDENTIFICATION NUMBER: iTV -- _L1L I
Is well located at approved permit location? UN 10�a No
Method of Drilling: pair rotary, U cable tool
Depth of well: .'
Casing Type ST L Wall Thickness ' inches
Diameter d'0 inches, depth feet.
Liner Type: /►� a n1 c
Casing Stickup Above Groun�d::�'!Q' feet
Static Water Level:. do feet
Recover Rate: 90 am 6 P H
Method of Testing: y�
Well Intake Opening Type: 0 open end 111 open hole,
U Screened; •. Start feet Stopped feet
U Perforations Start �H��Stopped feet
Grout Type•-� 1'� �' t ' Volume % S" 0
Depth: from feet. -to a O 1- feet
Well Disinfected Upon Completion?�es' 0 No. .e
Method of Disinfection: CtRnvt= S0 �i�/✓l'
BORE HOLE DATA
o Jr2 /?o�e�Jr�
�• C OG�/.3C G S'
sto Y 5,4�� ; 6•��-arc.
,SA, -J10 ! e,,tRJf ` .
C.,�
• Rr Qly� 6Cc r.�J -
i� ryrr3 lo�-�G rt/
v-
,
Driller's Name
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.
.
2 STORY
SINGLE FAMILY RESIDENCE
0
4 36.2'
HOUSE DETAIL
t• 30'
CA
SKYVIEW AVENUE
S 89'58'00-E 327.34'
30.00' 30.00'
WELL -
12.0* z 14.0' DECK
v I W/ CONIC. PAD BENEATH
Q 172.2' 1
C DD
•G � SEPTIC
Q CLEANOUTS
w
v
cu
p6. a 12.0' DECK •'
= Lot 1A
0 45,792 s.f.
n 4' CHAIN—LINK FENCE
10' TELECOM do ELECTRIC EASEMENT
LOT 1B
�•4.6' : 7.6'
> I
GRAVEL DRIVE.'. .
S 0'. ■ 6.0' 'DECK 3
77 Do
74.3'
N
lO
J
PLOT PLAN AS BUILT _ SCALE 1•-50• GRID NW 1159 Project No. 03-040
Lan 8C A$SOCIatBS inc.11500 Daryl Avenue, Anchorage, Alaska 99515-3049
9 s (907) 522-6476 Phone 4
Registered Land Surveyors (907) 522-4625 Fax
P—a�OF A
www.langsurveyors.com / InfoOlongsurveyors.com (�..••• •••.�.9s�o0
I hereby codify that I have surveyed the following described property: pA\
Lot 1A, Block 2, SKYVIEW /1 SUBD. (Plat No. 2001-84) 4931J
Anchorage R,cording District, Alaska, and that the Improvements stivatod thereon on Q....:.....•. ..... ....
within the property line and do not encroach onto the property adjacent thereto, that t7
no Improvements on the property lying adjacent thereto encroach on the surveyed
premises and that then are no roadways, transmission lines or other visible easements KENNLZ}i c
on said property except as Indicated hereon. Q
LS -5202c
Datod this the 1 Day of hIOVGMJ'.rR 7,004., of Anchorage. Alaska '•...
M Is the responsibility of the owner to determine the existence of any easements, osw _
covenants, or restrictions which do not appear on the recorded subdivision plat.
Municipality of Anchorage
Development Services Department
• +-� Building Safety Division
Onsite Water and Wastewater Program
a
4700 South Bragaw St. e A T
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: KNO Engineering
Legal description: Skyline View #1. Block 2. Lot 1A
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate. _
❑ Incomplete; missing _
❑ Incomplete; missing _
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field.—
ED Other. Well does not meet the minimum flow requirements for a 4 -bedroom house.
Name of reviewer: Julie Mokelo. P.E.
Date: 5/9/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW030028
Legal Description:`Skyline View #1 Block 2 Lot 1A
. Design Engineer: 0070 KND Engineering
Owner Name: Bari & Shelly Gray
Owner Address: PO Box 773182
Eagle River , AK 99577 -
@ // : o o
Date Issued: Feb 24, 2003
Expiration Date: Feb 24, 2004
Parcel ID: 051-191-54
Site Address: PO Box 773182
Lot Size: 45791 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[,�_ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued
Date: Z� 7
Date: 2¢ 03
Municipality of Anchorage
Development Services Department
Building Safety Division r�
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 LD 051-191-54 Permit NumberSW03002$
Property owners) Bari A Shelly Gray
Dayphone 263-2449
Mailing address (1) PO Box 773JR2
Mailing address (2)
Zip Code
Legal description (Lot, Block & Sub'd-)
Skyline
View #1 Rlock 2 Lot 1A
Legal description (Section, Township & Range)
Lot Size 45791 Acres/Sq.Ft.
Number of Bedrooms 4
THIS APPLICATION IS FOR:
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.
of property owner or authorized agent)
Permit Fees:
Date of Payment: O 2,11 S'
Receipt Number: 631520
(Rev. 12100)
Waiver Fees:
Date of Payment:
Receipt Number:
MD ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111 /FAX (907)696-8111
February 18, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer/well permit — Skyline View #1, Block 2, Lot 1A
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. One testhole was performed on April 18, 2001 for the proposed system. The results
of this test are attached. The general slope of this lot is from southeast to northwest at a
grade of approximately 2-8%.
We have designed our system utilizing the existing testhole that was excavated for the
4 -bedroom house, which is proposed for this lot. The lot will be served by an individual
well, located on the northern portion of the lot. We propose to install one 5' wide
shallow trench. Insitu material sufficient to act as filter. Water was not encountered
during excavation or monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
MID D Engineering, Inc.
Kenneth M. Duffus, P.
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
Construction Practices
WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLA
SKYLINE VIEW S/D, 1ST ADDN., BLOCK 2, LOT 1A
24 I IOL.
5 ��� IWELL
PROPOSED 43DRM
HOUSE
KND ! I�iB „Eu.
.WELL
W POSLTC VELLS VRHDI !00' 6
PROPOSED STSTEK
NO PRIV4TE VELLS VTTTDI 200' 6
PROPOSED SYSTEM EXCEPT AS IQTEa
W SEPTIC SYSTEMS VITOH E00' OF
PROPOSED VELL EXCEPT AS NOTED.
rqH*
OF At_�
I KDOWII M. DUFTJ ;4
7cz-
�4
711SS1011, AMP
venue
6
2
W
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/1.2 GPD PER SQ. FT. (<1 MIN/IN.)= 500 SQ. FT
500/5'(W) X 0.5(RF) (4.0' GRAVEL) = 50 FT. TRENCH
USE I TRENCH 50'(L) X 5'(W) X 4'(D)
Total depth of system Is 8.0' from original grade.
Total depth of gravel below dlstrlbutlon plpe Is 4.0' .
NOTES,
1. USE 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM..
3. CONTRACTOR WILL ENSURE MAXIMUM 27 SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
PREPARED FOR,
BARI 6 SHELLY GRAY
P.O. BOX 773182
EAGLE RIVER, AK 99577
nELD BOOKS
sruuTa --
ASOMr.
cm rLL
AmrLS" 03004
CO PVRR
DRAW VBG
aw00"I KMD
DATE: 2/16
CM NW115'
'°B "" 03004
Scale, 1'= 100'
PAGE 1 OF 2
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8738
WASTEWATER DISP❑SAL SYSTEM DETAILS
SKYLINE VIEW S/D, 1ST ADDN., BLOCK 2, LOT IA
soup
37.1'
_.4-ft��0k
OFA�Z�X1�
�* 1�C)
ui�a.aan a. u�,rr
TH
41.2'
V 0
0
ilm°
al
PREPARED FOR,
BARI 6 SHELLY GRAY
P.O. BOX 773182
EAGLE RIVER, AK 99577
FIELD BOOKS compu7m
saAOAar. MAW
STA101a -- Of0m KMD
A90UlT. _ DAM 2/16
Dm rte am NW115
Am FLL' 03004.OWG '108 w- 03004
WELLI
68.1'-1
0
50
GALPSEETIC2TANK
Scalel 1'= 20'
�y PAGE 2 OF 2
JK M) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
1
111
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for: Tim Rosin Date Performed: 04/18/01
Project, Skyline View SID #1, B2, UA TESL' BOLE p 2001-01
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
Depth
ORG — black rootmat, red -
Brown overburden
GP/GW —brown, sandy gravel
w/ cobbles to 3'
moisture increasing w/
depth
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? NA Date? 04/25/01
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
4/18/01
1:00
-
8"
2
1:05
5 min
dry
8"
3
'
1:06
8"
-
4
1:11
5 min
dry
8"
5
1:12
8"
6
1:17
5 mind
8"
7
"
1:18
8"
-
8
1:23
5 min
d
8"
9
1:24
-
8"
-
10
1:29
5 min
dry
8"
11
1:30
8"
-
12
1:35
5 min
dry
8"
"
Water
Added
Percolation Rate < (min/ in) Perc Ilole Diameter 6"
Test Run Between 3 feet and 4 feet
I, Kenneth ht. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
JCerttf teb 'r'11' tug 'Log
by
:._.,.._ Docco.uo.,
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALAS" 99561 TELEPHONE 666-2750
OWNER OF LAND: i rJA / t S NC LL t 64 `r --
ADDRESS:
LEGAL DESCRIPTION:
DATE:
PERMIT NU BER: 3 008 Date of lssuea?— +7
TAX IDENTIFICATION NUMBER:
Is well located at approved permit location? G><s 'J No
Method of Drilling:4�1`air rotary J cable tool
a
Depth of well: �O 1
Casing Type STC`LL Wail Thickness • y inches
Diameter 0 inches, depth ( feet
Liner Type: Ij a ^f o
Casing Stickup Above Ground: y12 • feet
Static Water Level: dtJ feet
Recover Rate: ;0 6,0H
Method of Testing: A IA
Well Intake Opening Type: U open end ' open hole
J Screened; Start feet Stopped feet
J Perforations Start feet Stopped feet
'
CH r
Grout Type* n. J, c Volume L
Depth: from 0 feet, to J O t feet
Well Disinfected Upon Completion?—? es ❑ No
Method of Disinfection:N/-ti d?,r V 6 -?A 0
BORE HOLE DATA
e sr-uh S7'14.4jo,9
Otic% 43,t9,060 -J
Si<rY :SAI -A Gye.R,je
s C o[�dc c S•
s,�..f+0 �a•�Jc iff C'o/3e4 -S
=r
6 -!
/3cd.C,1c 64qE,.J
Driller's Name a,:J Q
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.
• Municipality of Anchorage
On -Site Water and Wastewater Program 4
(907) 343-7904 s s
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcell.D. 051-191-54 Expiration Date:
1. GENERAL INFORMATION
Complete legal description SKYLINE VIEW #1 BLOCK 2 LOT 1A
Location (site address) 22950 SKYVIEW AVENUE CHUGIAK AK 99567
Current Property owner(s) BARI & SHELLY GRAY Day phone
Mailing address PO BOX 773182, EAGLE RIVER, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING: SUBMiTTAI
® Single Family (w/wo ADU)
❑ Duplex NOV 10 ?014
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class _ Well ❑ Community ❑
Public Water System, ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: _ LA &_-_. Date: //-2
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ J" —
Date of Payment lil hook/ C --nn :�,
Receipt Number 01511
COSA#
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 11
Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen it; OF AL\ NA
encroachments, deficiencies or discrepancies exist. / �v �� ,
AP rlI �,.
6. DSD SIGNATURE
x System #1 Approved for L bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the
+" l KEanrrr��11. DIV, /
Air
rE,SSIO^ ti .ir
rnTFR ANI
By: Original Certificate Date: ( 2 f
The Municipality of ArichorO a 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory X Other
COSA blue sheet (1-10-12Ax
If more than 1 septic system is on the lot:
COSAChecklist# of
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: SKYLINE VIEW #1 BLOCK 2 LOT 1A Parcel ID: 051.191.54
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 412112003 Sanitary seal (YIN)Y Wires properly protected (Y/N) Y
Total depth 400 ft. Cased to 118 ft. Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 4121103 10130114
Static water level 88 ft.
Well production 0.33 g.p.m.
ft.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2.27 mg/L
Arsenic: ND ug/L Date of sample: 1013012014 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping 10130114 Pumper SANITARY
C. ABSORPTION FIELD DATA
Date installed 4124/2003
Cleanouts (YIN) Y
High water alarm (YIN) N
Date installed 412412003 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH
Length 55 _ ft. Width 5 ft. Gravel below pipe 4.13 ft.
Total depth 8.6' ft. (Measured 10130/14) Eff. absorption area 550 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 1013012014 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 1 in.
Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
"Pump off' level at _ in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 1001+
Public sewer main 754
Sewer /septic service line 25'+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank 1004
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 54 Absorption field 54
Water main 104 Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 104
Water Service line 10'+ Surface water 1004 Driveway, parking/vehicle storage 104
Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1004
F. COMMENTS
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Water storage system in crawl space -
G. ENGINEER'S CERTIFICATION
I certify that t 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. i �� OF AL'
Engineer's Printed Name KENNETH M. DUFFUS / �Q .,
Date 1117114 * G� TH* +�
COSA brown sheet_10-10-12.doc 7� xr:ns2u
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Municipality of Anchorage s ,
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # OSC141588
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot IA of Skyline View #1 subdivision, the well's
productivity was determined to be .36 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 4 -bedroom
residence is .42 gallons per minute. All parties concerned are advised that
the production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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