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Home My WebLink AboutLAKE HILL ACRES LT 2Lake Hill Acres Lot 2 #051-053-25 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 121252 PID Number: 051-053-25 Dwelling: X Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑t New ❑ Upgrade Name: Robert Kasuboski ABSORPTION FIELD ❑t Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.8 GPD/SF 10.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 7.5 Ft. Subdivision Block Lot LAKE HILL ACRES 2 Fill added above original grade 1-2' Ft. Gravel length 38 Ft. Township Range Section Gravel widthBeds: 2.0 Ft. 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 1 From Tank Field Tank Line 570 Fiz 1 Ft. " Well 100'+ 100'+ 50'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 1000 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 10'+ STEEL 2 NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Curtain Drain I UN I UN Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 drainfielTank to d 3034 ROBERTKASUBOSKI Drainfield3034 COIMT 3034 Inspector MIKE N. ANDERSON. P.E. BENCH MARK (Assumed elevation) 108.5 n Inspection 1" 7-21-13 7-21-13 Location and description dates, - 2H are 41n WELL CASING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL "I'M OF A(,q 99 Conditional Approval: Date .• �p�'••�6r P� h: y * 49TH* •,* re J ............. ... ••... .....•...•./ • MICHAEL N. ANDERSON ,0 �• C 94 9 �`•j l l 2 pp W" `-E "v Date2 If V�Z� :5`fl ispecuon Keport_a-1-l2.doc Permit No. OSP121252 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99 51 9-66 50 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 2, LAKE HILL ACRES S/D PID No.: 051-053-25 MARK A B c01 25 12 TC01 90 75 MT 99 83 i \\ / / NEW WELL \\ f \ I A \ 1 I I I I I I I HOUSE I I I T 1 / C0403 \\ / C05\ / +CO \\ BENCH, TOP OF WELL ELEV. 108.5 / (-SEPTIC SEPTIC (--. (---� SEPTIC- ` ' \ UIL `\ SC LE: � 50' lC�nls�t gra e rcm rroz 1 1 `Tcm / c.3 C04 cos rcaz Mr ('cos / .♦♦♦"(� ��OF q/ 41, RR FaM 49 TH : ♦�/ 99.9 1,[f0 MI. SRR 1PNK snw aa. GM .....:......... .� .. • ... ............ ........... 0 / • ..... • .......................90 0, ':MICHAEL N. ANDERSON;.* i ss° r y� S� �I��s•'• No. 469 CE •,,r•:: SEPTIN.T.S CIION ez Li f � 4 - S U N N Y S I D E D R I V E- — - — - — - - - - - - - - - - r PROPERTY UNE --\ r r r r � r I r M 7 I 1.000 GALLON SEPTIC TANK I DRIVEWAY I Vitus �s 1 , , FCO i 1 y PROPOSED HOUSE DOUBLE CORAINFlE JOCA�`♦ot SI�AII !?Q i \ IM % co " Ver!-A- V� ltia{1 •S ico 'CO l00' rotnl ---- kc --- •wr}.1�a well• t , LEO'S LOT 5 LEO'S LOT 4 LEO'S LOT 5 .--'-SE- - -'------., � CPS ' l — ------ -------------- Septic Design Prepared for Septic .\\1\\ilii\ G op- et a ROBERT KASUBOSKI . ......... q @♦♦i LOT Z LAKE HILLS ACRES SID .+`� 9 ♦♦ Anch, Alaska Ar 491" ..................................:..... • r ,.....;................................., ♦♦ ';N HAIL N. ANDERS014' r� Michael N. on, P.E. DATE: 8/15/2012 4661 NATR ANCHO �E, ALASKA99516 G DRAWN: DJR ♦♦ No. CE 9469 ;•-� ♦ "'.' 34 -3377 / FAX: 345-1391 SCALE: i" 1"=30' r " ♦♦of,"" �� ' DESIGN CRITERIA: MO OVER E (11) o 3 BDRM X 150 = 450 GPD 05 ORG SOILS = 450/0.8 = 563 GPD FILTER FABRIC 563 GA/14 = 40' —4'0 PIPE —3.O (1) TRENCH GM SEWER ROCK 10.0' DEEP G 7.0' EFFECTIVE -10.0 20' WIDE 12_° f 40' LONG 18 SEPTIC FIELD SECTION I FAKE HILL ACRES `i 7 LAKE HILL ACRES 1 LOT 2 t lAKF HILL ACRES I LOT 1 I { fj 1 j / LOT 3 \ \ • 1 1 --� ' I • �LPRNP05ED HOUSE 1 ' 1 €i40 WELL 100' RADIUS \ i SEP J7¢\ "'� ��— - ---- P ��n�. exVACANT J LEa'SyOT 9 EEO'S IyY`0 LEO'S LOT 11 LEpS-IDT 12 (SEJIG' (I-Tl� PROPERTY LINE ! ` I //l _-•-, d y \� ! J..- • •� :[ / -/ LE�'S LOT 44 LEO'S LOT 15 LE} SdOT 16 LED•S LOT 17 \\\ — LEGS /,ROAD I \ �r��l may•-%- A� ! \� � t \ /1 LEO'S LOT 6 LEGS LOT 7 / LEO.51OT 6 LEO'S LOT 5 LEO'S LOT 4 LEO'S LOT 3 LEO'S L01 2 LEO'S LOT ) / Septic Design Prepared for 1 / ROBERT KASUBOSKI ..1,*1G1L1k1L%%jI4 OF /IC r v� LOT 2 LAKE HILLS ACRES SID 0�' Anch, Alaska 0............49T........... ..... Michael N. An rson, P.E. DATE: 8/15/2012DERSON,+� 4661 NATRONA ANCHORAG LAI Q516 DRAWN: `j ( DJR �� ., N' E 9469 ♦�` 1 SC 1"=150' +O°y N�� 34527 /FAX. 345-1391 all �� a Certified Drilling Log ,�OC CO dba BtLL 8, COLE O&LIVANWATER WELLS g OWNER OF LAND: Robert Kasuboski ADDRESS: PO BOX 672441 Chugiak, AK 99567 Bore Hole Dat Depth From To LEGAL DESCRIPTION Lake Hill Acres Lot 2 DATE: 7-14-16 0 2 PERMIT NUMBER: OSP161181 DATE OF ISSUE: 7-1-16 TAX IDENTIFICATION NUMBER 05105325000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 197' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 194 feet Liner type Static Water Level: 164 feet Recovery Rate 10 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: SO lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes no Method of Disinfection: Chlorine 50 PPM Comments: 2 4 4 85 85 121 121 162 162 164 164 197 Casing Stickup Overburden Silty Sand & Gravel w/ Cobbles Tight Sand & Gravel Silty Sand & Gravel Silt & Sand Sand & Gravel Drillers Name: Cole Sullivan 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. • r A• a ,BILL g, COLE CC dba �ULLIVANWATER WELLS P.O. Box 670269, g,ak, AK 99567 688-2759 www.suilivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW OSP161181 Date of Issue 7.1-16 Parcel Identification Number: 05105325000 Legal Description Lake Hill Acres Lot 2 Pump Installation Date: 7-21-16 Pump Intake Depth Below Top of Well Casing: 180 Pump manufacturer's Name: Flint & Walling Pump Model: 4FOSP05301S Pump Size: 1/2 Pitless Adapter Burial Depth: 10 Pitless Adapter Installer: Sullivan Water Wells Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson B10 XLF Pump Installers Name: Sullivan Water Wells Property Owner Name & Address Robert Kasuboski PO BOX 672441 Chugiak7AK 9567 feet hp feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. September 21, 2016 Mike, In regards to the septic system located at 24300 Sunnyside Dr in Chugiak, AK; as the home owner I installed the septic system per the drawings you provided. The tank was purchased from Greer Tank in Anchorage. Equipment was rented from a local Chugiak business to do the excavation and backfill. I have over 10 years' experience in the construction industry working for general contractors in all phases of construction including plumbing and drain systems. I was assisted by a friend with many years of construction experience as well. Thank you, Robert Kasuboski On -Site Water 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: OSP161181 Tax Code Number: 05105325000 Work Type: Well Initial Permit Effective Dates: July 01, 2016 to July 01, 2017 Design Engineer: Subdivision: LAKE HILL ACRES Site Legal Address: LAKE HILL ACRES LT 2 G:1561 Owner/Address: KASUBOSKI ROBERT W PO BOX 672441 CHUGIAK AK 995672441 Site Mailing Address: 24300 SUNNYSIDE DR, Chugiak This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 31500 Total Bedrooms: 2 N Privy Y 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. Received Issued By '4rz-1c6Y MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907x43-7-®.97 ON-SITE SEWER/WELL PERMIT APPLICATION (if,?J'/WEj AUL 0 12016 Parcel I.D. OS/ O 53 2 s on o Property owner(s) /"—/ j!, f z< -4o f/e Day phone Mailing address 6,)Z Al Gni% it _z el sr/�°1 � a X e Site address �igIoe fvnir S We Ds �L?y;,,(� �l� ?Ff67 Legal description (Sub'd., Block & Lot) 4 -et Legal description (Township, Range & Section) Lot Size 3 / S 0 0 Sq. Ft. Number of Bedrooms Z APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial Single Family (SF) [j (w/wo ADU) Septic Tank ElUpgrade E]Duplex (D) E]Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal C de . (Signature of property owner or authorized agent) Permit/Rush Fees: a1 -5 t I'M – 3V'/ Date of Payment: 7/1-11 t' ck Receipt Number: 2o2gb? Permit No. 051112 d 1x11 a 0 Permit App__- :- : L.:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. / -SUNNYSIDE DRIVE - a---— - - — - -- --- --- ---- i PROPERTY UNE / i r � r r I II r EX%SY:In r 1.000 GALLON* SEPTIC TANK DRNEWAY Ica FCO i 1 1 DOUBLE CO � - ----- PROPOSED HOUSE y �X' . 13RAINFlEL ' loca�;ov� skall b� M / CO AVer, ed ttia t 1 ;S 1CD---- --- 0 a�� Qe�s} l0a' ro►M _---_— ff-----_—____0 , • } lea well• LEO'S LOT 5 LEO'S LOT a LEVS LOT 1 ------ '- 1 —_----- / 11G 1 / EXl smllG l Septic Design Prepored for OF � ROBERT KASUBOSKI � .•'��E �4♦ LOT 2 LAKE HILLS ACRES S!D � �.:• � + Anch, Alaska mr " ' �............I...................::.... • f.,..., ............................... ♦♦ ': HAEL N. AN'DERSON."0 ♦1�� ••. Michael N. ion P.E. DATE: 4661 NATR ANCHC E, ALASK 99516 DRAWN: DJR /1�,�/ No. CE 9469 ► ♦j •'•.. ♦ SCALE:P 1"=30' �.� +1W�'`,.0� �• 3 —3377 / FAX: 345-1391 _",Zr� DESIGN CRITERIA I '.l mo OVER DE (TH#t) o 3 BDRM X 150 = 450 GPO oRc 1 SOILS = 450/0.8 = 563 GPD 0.5 FILTER FABRIC 563 GA/14 = 40' —4.0 PIPE -30 (1) TRENCH I Cm SEWER ROCK 10.0' DEEP L 7.0' EFFECTIVE -10 ° 2.0' WIDE (zsD 40' LONG 18 SEPTIC FIELD SECTION — — SUN W T SIDE U K IVE—\ LAKE HILL ACRES \\ LOT 3 + LAKE HILL ACRES ! Lot 2 \ 1-Mi/HILL ACRES 1 LOT i I 1 / \ i i i ' 1 • i I i 1 I 1 i I I • li I 1 1 1 ! �— —.i �L PROPOSED HOUSE it 57 f _IL / 6,r,'r><•' \ Jj > / €xSRW WELL 100• RADIUS LLb's,Lor 9 LEGS QDT40 LEO'S LOT 11 LEO.'S-LOT 12 VACANT PROPERTY LINE i ��'' { ! / -- 'I ti I \\ I' � • n .' / LETS LOT 44 LEO'S LOT 55 LEgSl OT 15 LEO'S LOT 17 I \\ — —LEGS /ROAD i r %• v. / I I I I v l v v v 1 ly/ , i LED'S LOT & LE0:5 LOT 7 LEO$4OT 5 LEO'S LOT 5 LEOs LOT 4 LEO'S LOT 3 LED'S LOT 2 LEO'S LOT 1 I / Septic Design Prepored for / ROBERT KASUBOSKI �F. �L '�� .+•+�E • LOT 2 LAKE HILLS ACRES SID •, �� O Anch, Alaska Th 49 ;; (�. •.••••••.- i............... ;.�;.: '�;Mt aAE' D RSOIN Michael N. An r/s�on, P. E. DATE: 8115!2012 4661 NATRONA Ci ANCHORAO LA�i J; 516 C DRAWN: DJR [/ �1 'N' E 9469 �t i • Al 345-- 7 / FAX!. 345-1391 SC �+ �� 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: OSP121252 Tax Code Number: 05105325000 Work Type: Septic Initial Permit Effective Dates: August 27, 2012 to August 27, 2013 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: LAKE HILL ACRES Site Legal Address: LAKE HILL ACRES LT 2 G:1561 Owner/Address: LORI G & M 1101 CORDOVA ST APT 433 ANCHORAGE AK 995014590 Site Mailing Address: 24300 SUNNYSIDE DR, Chugiak This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 31500 Total Bedrooms: 3 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. Received Issued By MUNICIPALITY OF Community Development Department`_) Development Services Division - On -Site Water & Wastewater Program Parcel I.D. Property owner(s) Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 1�lDTJ'F kaSu_ S�e Mailing address V. (P• (3o tc & a- 2 Phone: 907-343-7904 Fax: 907-343-7997 Day phone Site address Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size `7j, tl 4;'00 Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial Absorption Field Septic Tank Upgrade ❑ Holding Tank ❑ Renewal ❑ 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. of property owner or Permit/Rush Fees:5 0 Waiver Fees: Date of Payment: 2r/ 'L-- Date of Payment: Receipt Number:1559Z�k Receipt Number: Permit No. ose jalal5a Waiver No. G:\Building\On Site\Forms\Client Forrns\Permit App_010411.doc (Rev. 1/11) Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 Aug. 15, 2012 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Lake Hills Acres Subd. Lot 2 To Whom it may concern: This is a request for a septic system on the above referenced lot. A test hole was excavated and found silty gravel for the full 18 foot depth. The perc was 12 minutes per inch with no water observed during excavation or after the 7 day monitoring period. The lot slopes uphill (south) toward the back at about 3 to5 percent. None of the neighboring lots will be impacted by this installation. No slopes greater than 25 percent existing within 200 feet of the proposed system. Please call me if you have any questions. Sincerely Michael N. Anderson, P.E. DESIGN CRITERIA: MOUND OVER (TH#1) o GRADE 3 BDRM X 150 = 450 GPD ORO SOILS = 450/0.8 = 563 GPD 0s 563 GA/14 = 40' 4� ®�PIPEABRIC -3.0 (1) TRENCH GM SEWER ROCK 10.0' DEEP 7.0' EFFECTIVE —10.0 2.0' WIDE 2.0' 40' LONG 18 SEPTIC FIELD SECTION - SUN Y SID L LAKE HILL ACRES`\ / LAKE HILL ACRES LOT 3 \ ! LOT 2 DRIV -\ \ 1 LAKE' HILL ACRES 1 l LOT 1 II / / / \ I I I I • I I • I I / PROPOSED HOUSE W I ' IXISTING WELL 100' RADIUS SEPJB• �_____— LE)'S QT 9 LEO'S WT -6 LEO'S LOT 11 LEAS -LOT 12 --1 VACANT J �� --� CSEPIIG' C'SE PROPERTY UNE J I / I, -, I \\ I • i\ 44i' �\ __— N I / LE�'S LOT 4 LEO'S LOT 15 LkS/LOT 16 LEO'S LOT 17 L E 0 S /\R 0 A D- \\ / \ I / \\ /�/ I II / / • I j • II T_ )1114— / LLEOS 6 ILg0:5 LOT 7 LEOS'LST 6 LEO'S LOT 5 LEO'S LOT 4 LEO'S LOT 3 LEO'S LOT 2 LEO'S Septic Design Prepared for O� t,t, ROBERT KASUBOSKI ..', �.'�E .......:AGqb�.♦ LOT 2 LAKE HILLS ACRES SID Anch, Alaska ;` 49 . . .... ......... * ... ............. 10 %��11 ""'"N. ANDERSON"' •l'� ;MICHAEL N. ANDERSON;�� Michael N. Anderson P.E. � DATE: 8/15/2012 4661 NATRONA DRAWN: DJR •�� P''•. No. C 949 ANCHORAGE, ALASKA 99516 ��' •?�l..• '' :.• 345-3377 / FAX: 345-1391 SCALE: 1"=150' — S U N N Y S I D E D R I V E— PROPERTY UNE —\ / / / r r / r i r PROPOSED 1,000 GALLON SEPTIC TANK DRNEWAY i Rpp1115 itpG 100' WEU DOUBLE CO \\ FCO CO \ PROPOSED HOUSE _ PROPOSED DRAINRELD i / M � - CO MID MT \ REPLACEMENT \ DRAINnEL.D LEO'S LOT 5 LEO'5 LOT 4 LEO'S LOT 3 --- �1 """-----'-\ Septic Design Prepared for ROBERT KASUBOSKI OF ................. LOT 2 LAKE HILLS ACRES S/D ♦i�� Anch, Alaska 49 ■,,,, 10........... 0............ .......................... ■ ��i.MICHAEL N. ANDERSON2�i Michael N. Anderson, P.E. DATE: 8/15/2012 •�� .... 6s I 4661 NATRONA ANCHORAGE, ALASKA 99516 ANCHORAGE, DRAWN: DJR ��,, �� % Lwm ' J0 SCALE: 1"=30' X1411," 345-3377 / FAX: 345-1391 ;.U�� Performed For: Legal Description: 5 - Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. ci.anchoraae.ak. us (907) 343-7904 .yam..• �Pl Date �.••�� *' 49TH Depth to Water S 10- •...... •.......•.... MICHAEL N. ANDERSON :C�c q0,0' �'. C€-9469 11- n Soils Log - Percolation Test �� l ` a 6s r( 1005 & , Date Performed: L„ 4- Z Lw 4-e //S rK )' . Township, Range, Section: 6 C�ah GwSG. 9- Date WAS GROUND WATER ENCOUNTERED? Net Time Depth to Water S 10- IF YES, AT WHAT DEPTH? L 11- & rf Depth to Water After D Monitoring? plelf P P� E 12- Date: 4 13- 19 - COMMENTS 3o f{a�rr r Are, Site Plan k. A-/'l>.L.a. Reading Date Gross Time Net Time Depth to Water Net Drop & rf VA, Iv r 2 %i bF re VAS PERCOLATION RATE J /'Z,i (rnmutesilnch) PERC HOLE DIAMETER TEST RUN BETWEEN 7j FT AND d4 FT PERFORMED BY: me k'e X.4harwri I - CERTIFY THAT THIS TES AS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4$' / Page 1 of 1 Crewdson, James A. From: Cole Sullivan [colesullivan_21@hotmail.com] Sent: Thursday, January 31, 2013 5:15 PM To: robjas@mtaonline.net; Wockenfuss, Deborah M.; Crewdson, James A. Subject: Lake Hill Acres Deb and ]ay, I have been onsite at 24300 Sunny Side street (Lake Hill Acres Lot 2) and can find no evidence of a water well. I looked at an original clearing that may have accommodated a drilling operation, but found no casing or depressions of any kind. The owner also had a metal detector and we surveyed the approximate area where the well was supposedly drilled. If there was a well there at one time, it has been removed or destroyed in a way that it cannot be found. Thanks! Cole Sullivan X PO BOX 670269 Chugiak AK 99567 907-688-2759 mm.Sullivan WaterWells.rom 2/1/2013 MUNICIPALITY OF Development Services Department --� On -Site Water & Wastewater Section 051 Parcel ►.D. 053 25 ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 0117z-'-'7 Complete legal description LAKE HILL ACRES LOT 2 Location (site address) 24300 SUN NYS I D E Current property owner(s) Mailing address Real estate agent VINCENT ENGLISH 2. TYPE OF DWELLING: (] Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 Day phone �253�3q�(-266y Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5—W Waiver Fee $ Date of Payment -��3� I .r11y/tit Date of Payment Receipt Number. O31700 ON oqz. j_ Receipt Number COSA # (/5Ci2 12?,5 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 6. DSD SIGNATURE CHARLES BALZARINI . 4 System #1 Approved for '- bedrooms System #2 Approved for bedrooms Disapproved Phone 8545558 Date 5/9/21 ,dftl'OF Al, C:-- �• r .. . .... �JJ • CHARLES G BALZARII CE -13854 lROfE5S10� -�- �\ate»>-�� Conditional approval for bedrooms, with the following stipulations: OF�(�i WATER AND J� VATER a "N Ppnrk ARA f- /JJ0�iN� COy ,-j " VT SERV5U'r;1,,`, By: &04 Original Certificate Date: .1171Z 1 The Municipality of Anch ge 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 COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test 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 Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: STEEL TANK LEVEL MEASURED PRIOR TO PUMPING Lines pumped downstream of tank for repairs. There was no monitor tube in the drainfield at time of pumping, so it was not able to be pumped below distribution pipe. Pumping did not impact level in field. 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 ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft F.ENGINEER’S COMMENTS G.ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. DRAINFIELD WAS NOT IN USE DURING TESTING • Municipality of Anchorage aj a s On -Site Water and Wastewater Program (907)343-7904 s <<,. n CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcell.D. 051-053-25 Expiration Date: "� 2 r 1. GENERAL INFORMATION f, Complete legal description LAKE HILL ACRES S/D, LOT 2 a Location (site address) 24300 SUNNYSIDE DR, CHUGIAK, AK 99567 Current Property owner(s) ROBERT KASUBOK[ Day phone Mailing address Real Estate Agent P.O, BOX 672441, CHUGIAK, AK 99567 n 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone ro b� 4. TYPE OF WATER SUPPLY: TYPE OF WAST Individual Well. . ® Individual Individual Water Storage ❑ Holding Tank Community Class Well ❑ Community Public Water System ❑ Public Sewer WaiverNariance request for: Received by:f'M J��_ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ U1, �-o � 1 /' LO Date of Payment 21 i (P Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA# rjocgo1j31 Waiver# 2 I 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 09/21/15 AW .• - ;*.• /• ...• • ...........P,. �..• ,.• PPr 6. DSD SIGNATURE ifs a MICHAEL N•ANDERSON �'. C f-9 9 System #1 Approved for bedrooms. System #2 Approved for bedrooms. ��>> �tsilZO z- Disapproved. By:_(cnnri�C�. f� Original Certificate Date: 2Z' The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 blue sheet 10-10-12.doc 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: LAKE HILL ACRES SID, LOT 2 Parcel ID: 051-053-25 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed 711 412 01 6 Sanitary seal (Y/N) Y Total depth 197 ft. Cased to 19V ft. FROM WELL LOG Date of test 711 412 01 6 Static water level Well production WATER SAMPLE RESULTS: 164 ft. g. p. m. Wires properly protected (Y/N) Y Casing height (above ground) 24" Coliform NEG colonies/100 mL Nitrate 1.1 mg/L AT INSPECTION ft. Arsenic: NQ ug/L Date of sample: 712212016 Collected by: Sullivan Water Wells B. SEPTIC/HOLDING TANK DATA Tank Type/ Material SEPTIC I STEEL Date installed 712112013 Tank size 100.Q. -gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 'NEW PumperNEW C. ABSORPTION FIELD DATA —1985 SYSTEM TESTED Date installed 7121 12 01 3 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type DEEP TRENCH Length 38 ft. Width 2 ft. Gravel below pipe 7.5 ft. Total depth 11 ft. Eff. absorption area 570+ ft2 Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) NEW For 3 bedrooms Fluid depth in absorption field before test NEW in. Water added NEW gal. New depth NEW in. Elapsed Time: NEW min. Final fluid depth NEW in. Absorption rate >= NEW g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in.High water alarm level at _ in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1004 Public sewer main 75'+ Sewer /septic service line 504 Animal containment areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 100'+ On adjacent lots 1001+ 1 Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 1001+ Building foundation 5'+ Property line 51+ Absorption field 54 Water main 100'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water main Water Service line 101+ Surface water 1001+ Driveway. parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 1001+ F. COMMENTS FG o aua (o6fe, ih i1^e. r yam)� Ail -510AV ntof'f r-Cawl ,® G. ENGINEER'S CERTIFICATION F "g8 Q Al� kl 1 certify that !have determined Through field inspections and ,.� ••"'• ,s• � review of Municipal records that the above systems are in y~P'•�• �9�p conformance with MOA COSA guidelines in effect on this date. * , 49TH , ••••, yt' .. .. ............. Engineer's Printed Name MIKE N. ANDERSON. PE �. r . ............ Date 0912012016 c .NIGH CE NN9A69ERSON , COSA canary sheet_2-6-15.doc P"O`C PWS b ILKq [Ai5ru ' • a Pfl�aYO SU�IfS.NC SHN(,t ncv. (.ss;lao) ZpNiG'S.4WGT Pamr .'Al %mi,4N 9CE CV'.i.'JSIIC $EflAb. IIGR BVILGING S"-.R9AG1' SUNNYSIDE DRIVE — 210.00' N89° 55' 10"E w 3 O IN UJ a O t O C.C1s 8L.0. �2' WELL O ZI � a - U' 1 ZD l LI o � oU5 ' O1 O O I U) � SE39° T5' 10"W 290,00' 11 12 13 14 15 UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. 1 THE SJRVEYDi TAKES RESPONSIBNTY FOR THE INITIAL TRANSACOON ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY, LISTED DISTANC'E'S PREVAIL OVER SCALING, REPRODUCTION _17-to s R'rY SURVEY TYPE MAY CAUSE ERRORS IN SCALE. SYMBOLS E' E' FO rDATION AS DUII.T NNE T N1O " SET REBARYPOS DRAINAGE ❑ FOUND REBAR WOOD FENCE CONCRETE -LAN AS-BUI0... un suaEY . TaCCRnPnV ns auu.1' . xeo caRN€as SEi [� r,FCExnflfnnory as_pull,T_,,;�. r14 COw R=, se 004 ASSUMED ELEV. *--*"-X' METAL FENCE W000 DECK I PLOT PLANS & LOT SURVEYS _ NOTE; IT :S�THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO I ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CCNSTRUCTION, TO VERIFYPROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOVTS. SIDEWALKS, DRIVEWAYS, I TO FINISHED GRADE AND UTILITY CONNECTIONS AND 1'0 DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXIS'ENCE OP ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED, SURVEY CE-PnFICAHON ------ Prepared by p� PLOT PLAN sPSE. OF .q�,��.� Robert E. Johns, Jr, & Assoc. 1•+re+r°�`�'°=^4nflfl„�°r�°mro° ��` ;;”' S �� o-l..: m i u 01 r Professional Land Surveyors ll- d IM `y. Io- N A o At m my 777 qq j'MOM C9 Wal .new oeM ; �vA S]00 Brink Drive. I ANCHORAGE, ALASKA 99504 __ _ I „40, I" Rec. Lot S.F. Rec. Plat File No. AV 49th FO)NJtIION AS-BUIL '� 3 / t rs [. w a n wy ty uae N = Date Serve ed: Y 07/25/16 Crown b Y REJ Chocked by, -K A4 ffi� l '§e 2ge M m ', ......0 tN nen >:m,.,, IM ffi o.. w tew..e �<.eosR.x. •arz „xe.a RORER. E. JOHJ JR., Data DrowreGrid; 07/26/16 1561 W.O. 16-271 8�P 4121--S flrvAi STRU^.P4E AS-BUILT ®'gN �'• fif Le9a; Description: I. PCLaI c .an.o-, � n.Wr� Ily lool I �� n ".. : "• S� �'fl` nc�. <-. A.-ani r er m. usno-.nw .., .• 69 I .w., I,n loc .r.. ebl <r m. ®� a•••••, p .q. LOT 2 oci o-lmmsia `. c-.o bnaoc no- .n �.v.m � "c fe "®®,��mmmm�®� LAKE HILL ACRES E