HomeMy WebLinkAboutCHUGACH PARK VIEW LT 12Chugach
Park Vi w
Lo? 12
#090-042-12
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Municipality of Anchorage MAY 9 2017
Community Development Department Page 1 of 3
On-Site Water and Wastewater Program
4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP161280 PID Number: 090-042-12 ❑✓ New ❑ Upgrade
Name:
James Patrick Geerin ABSORPTION FIELD
Address
❑ Deep Trench 46.45hallow Trench 1:1 Bed ❑ Mound
623 Rand Road El Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 1 GPD/SF 5-0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot
4.5 Ft. 0.5Ft.
Chugach Park View 12 Fill added above original grade Gravel length
Township Range Section 0/1 Ft. 120 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 5.OFt. N/A N/A Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist between trenches
From Tank Field Lift Station Tank Line 600 Ft' 2 10.2 Ft.
Well 135.0 136.1 N/A N/A 25+ TANK p Septic ❑ S.T.E.P. ❑ Holding ❑Other
Manufacturer Capacity
Surface Water 100+ 100+ N/A N/A Anchorage Tank 1250GaI.
Material Number of compartments
Lot Line 110.0 78.0 N/A N/A STEEL 2
NA
Foundation 7.5 21.7 N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ 50+ N/A N/A Gal.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank td 3034
drainfiel
Installer
Pomraning Construction Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100.Oft
Inspection 1,' 11/9/16 �� Location and description
dates: 2 11/10116
3id 11/11/16 a", House FF
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
OFACil>
Conditional Approval: Date .0,651% '4..
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Appro w••1 - .- - Date 5 }1 i F k S -
Inspection Report_1-1-12.doc
/ • 1 • ` • LOT VACANT
`NO WELLS OR SEPTICS
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/ 1
NEW WELL
DR/veil/4 �
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM i. /
NO. BEDROOM: 4(600 gpd)
TANK SIZE: 1250g
PERC RATE: <1 MPI i. \
SOIL RATING: 1 GPD/SF ` / .L
AREA RQD: 600 SF ` \
SYS. TYPE: WIDE TRENCH 0,5'ED I „ /
MIN LENGTH: 120 LF D
USED: , a
(2EA) 60LFx5'Wx0.5' E.D., 5.0' TD M NEW 4 BR y
��
WITH 2.0' OF FILTER SAND HOUSE W�W W
TOTAL AREA: 600 SF ` FC
Tr--,,,,,
` A B 11
IJ
NEW 12509 SEPTIC TANK LOT 12 0 DCO M2
INSTALLED FOUNDATION CLEAN OUT s....--
�— s C2
INSTALLED DOUBLE CLEAN OUT AFTER TANK 10.2�,
C 1 FS ;S • °
¢o C \ M1 _ SSf 10,0 5C4
--i---- 1` M4 5
0 C4 V ✓ 10.0 z
z
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uuj0
0
r7
` TH-12 1 44
NEW PRIMARY/RESERVE(P) DRAIN FIELD
(2EA) 6OLF x 5'W x 0.5'ED x 5'TD(TO BOTTOM OF ROCK)
WITH 2.0' SAND FILTER /
rn
/ +I ..P.<;
. A B 7 . ..,
Ti 25.4 14.9 -
M4 67.5 42.6 4
•
15•x15'
T&E EASEMENT
II
LOT VACANT 1
NO WELLS OR SEPTICS
NOTES: PANNONE ENG SVC, LLC ....„...........00„,,,,,,, Date
L t 5/11/201 7
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 P'� '9cS,��'
DRAWN BY: PHONE (907) 272-8218 FAX (907) 272-8211 &,sprik:.. .r,-,.. . I. Scale 50
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DRM CHUGACH PARK VIEW, LOT 12 f 090-042-12
JAMES PATRICK GEERIN r Steven R `onnorae Ai PER 0.
RAND ROAD 0 4/*cc•, CE 8149 . �O OSP161280
INDIAN, AK 99540
PLAN 11� •
•o�P � Sheet
`'\\\01.4 2 OF 3
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W W
Z CO-D j j D r ? FILTER FABRIC m I-
q0 0 0 WO >
Z z a za m a o 0 4'®PERF PIPE o Z
J Li w FG:98.6(N) z z
o O c? LI n o DRAIN ROCK 6' o Li
- FG:97.6(5) ABOVE PIPE INV FG:98.6(N)
— —98.8— 12
VG:97.6(N/S)
`FG: 97.6(S) ___,OR -1.5
FLOW
---.----.__.—
—L----` SPLITTER
93.t(N/S} '� > 192.6((N/S)
9a.t NEW 1250gGP/
SEPTIC TANK 92.6 (N/S)J SP
DRAIN ROCK
PROFILE FILTER SAND
— i DRY 10/14/13(856)
NOTES: PANNONE ENG SVC, LLC —�_QF AL`�l 5/1/2017
Dote
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 .. . 'qs ki
�'�P' .. , ( Scole
PHONE (907) 272-8218 FAX (907) 272-8211 /g,• ,�� '••y Ta
DRAWN BY: 0 0*.. .
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DRM CHUGACH PARK VIEW, LOT 12
.-I-142-12NO
JAMES PATRICK GEERIN / Steven R. Ponnoiae PERMIT NO.
RAND ROAD I� �• CE 8149 . moi OSP161280
INDIAN, AK 99540 + % •
DESIGN DETAILS ill �o►�s�...* 4.4r
Sheet
3
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On-Site Water & Wastewater System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 EImore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP161280
Tax Code Number: 09004212000
Work Type: WellSeptic Initial
Permit Effective Dates: October 19, 2016
to October 19, 2017
Design Engineer: PANNONE ENGINEERING SERVICES
Subdivision: CHUGACH PARK VIEW
Site Legal Address: CHUGACH PARKVIEW LT 12 G:4456
Owner/Address: GEERIN JAMES PATRICK
12521 HANSA ROSE CIR ANCHORAGE AK 995150000
~ar tmellt
Site Mailing Address: 623 RAND DR, Indian
Lot Size in Sq Ft: 115673
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank 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 B~
Issued By: /~'t~t~4 ~
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Phone:
Fax:
ON-SITE SEWER/WELL pERMIT APPLICATION
SEP ~ a
Parcel I.D. 090-042-12
Property owner(s) James Geerin Day phone
Mailing address 12521 Hansa Rose Cir., Anchorage, AK 99515
Site address Rand Road
Legal description (Sub'd., Block & Lot) Chugach Park View, Lot 12
Legal description (Township, Range & Section)
Lot Size 115,673 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
{[~ all that apply)
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
TYPE OF DWELLING:.
Single Family (SF)
(w/wo ADU)
Duprex (D)
Multiple Dwellings
(SF and/or D)
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 Codes. -:
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
(Signature ~propet~y owner or authorized agent)
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_~- ,-, _.~.c ~
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak:com
September 23, 2016
Subject:
Chugach Park View, i_ot 12
Well and Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install a well and septic system to be issued for this ~roperty. The
proposed systems will serve a proposed four (4) bedroom house. Currently the lot is undeveloped. The
lots to the north, west, and south are undeveloped. The surrounding developed lots to the east are served
by private wells that are over 100' from the proposed development on this lot. There are no wells within
:ZOO' of the proposed septic system.
Soils. One test hole was performed on this lot by Jeffrey Garness in January of 2003, and groundwate~
was monitored for at least seven days. Ground water was observed at a depth of 11.8' below the
surface in the test hole-:Z2 monitor tube in February of 2003. Bedrock was not encountered in the test
hole. Based on the results of the percolation tests and overall soils appearance; an application rate of
:Z gallons/day/square feet was used for a conventional wastewater system with a sand filter in the
area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100' of the proposed septic system. The system
will maintain 100' of separation to all surface water.
4..~oPography: The existing topography generally slopes from the north to the south in the area
surrounding the septic system at approximately 3%. There are no steep slopes within 50' of the proposed
drain field. The proposed drain field will maintain 50' separation all steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only": When w~t,~en,q~tificati0n that
the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of th is or the surrounding tots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-02:Z7
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
PRIMARY/RESERVE SEPTIC SYSTEM ,~ ~ ~
NO. BEDRO'OM: ~ gpd) ~ ~
SOIL RATINO~SF ~
AREA RQD: 600 SF -. ~ ~
SYS. ~PD WIDE TRENCH O~'ED ~ - ~
LIN LENGTH: 120 LF
USE: '~ 4 BR
(2EA) 60LFxS'Wx05' ED 50'TD % ~a~c~ fro/
WITH 2.0' OF FILTER SAND "~
TO~,~LAREA: 600SF
/ INSTALL FOUNDATION CLaN OUT ~ i'
~ · INSTALL DOUBLE CLEAN OUT AFTER TANK I
ck~ our (p)
bIIDWAY BETWEEN TANK AND FIELD ~FLOW SPLITTER (P)
INSTALL CLEAN OUT AND MONITOR TUBE (P) T
AT EACH EN~ (~P) ~ f / ~ X
~ I ~ ,
-1pRIMARY~RESERVE DRAIN FIELD (P) //
(2EA) 60LFx 5'Wx 0.5'ED x 5'TD(/O BOTTOM bF ROCK) ~
WITH 2,0' SAND' FILTER
E~SEMENT
~ LOf VACANT
. NO WELLS OR SEETICS
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211 ~ ..- ~-.~ ~j Scde
DRAWN BY: ~~ 1"=50'
ORM CHUCACH PARK VIEW, LOT 12 oao-o~2-J2
JAMES PATRICK OEERIN ~ ~~ffn'~¢~PERMIT NO.
RAND ROAD ~ ~ OSPl6128Oshoe(
PLAN INDIAN, AK 99540
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTI~UC_TION OF
ON SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND lS.SS.
2. SCOPE OF WORK: INSTALL NEW SEPTIC TANK, SOIL ABSORPTION SYSTEM, AND WELL
3. GROUNDWATER WAS ENCOUNTERED AT A DEPTH OF 11.8 FEET BELOW EXISTING GRADE AS EVIDENCED:BY THE SOIL
TEST HOLE· IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 11.8 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY·
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 50 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK,
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED·
6. THE CONTRACTOR SHALL CALL ~OR LOCATING OF ALL BURIED UTILITIES·
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENOINEER PRIOR TO START OF WORN. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER·
B THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS TO THE
ENGINEER THE RED LINES SHALL INCLUDE PIPE LENOTHS, ORIOINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN-OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(¢)R HIS DESIGNEE) AS REQUIRED BY AMC 15.6b DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS-BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY; TITLE:
DATE:
ABBREVIATIONS
-- W WATER LINE / TH TEST HOLE
WELL RADIUS - (P) PROPOSED
(E) EXISTING
-- SS -- NEW SEPTIC DO CLEAN OUT NO.
MT MONITOR TUBE NO.
TYP TYPICAL
NOTES: PANNON-B TING SVC, I.I.C' o/,8/2o,6
FOR CONSTRUCTION P,0. B0X 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211 ~_,~..' %,.~:%~f~ Scale
DRAWN BY: ,~'1~' ¢~,~1~-,,/'~1.~ ~' NTB
· DRM ~1......(~...~--,.).~]/... ,~ ....... I~l.O. NO
CHUOACH PARK VIEW. LOT 12 ~~t'- 090-042 12
JAMES PATRICK GEERINfl~-s.~", CE 8149 ...~ PERMIT NO.
RAND ROAD ,ii~... ,. ,~x~,~,~ OSPI61280
PLAN INDIAN, AK 99540 i~?~S.sia,~ Sheet
A[:A KA WATER &
CONSULTANTS, INC. .......................................... [?..':~.,1'.7 ~.?[ .~.~.~.., '.
3701 F- ~JDOR ROAg, SUDE 101 * ANGHORN~E, AK, 9950? * PHONE; (507)3~7-5179 * FAX: (907)3~5-3248 * W~SITE: ok~wc,cml 1 ......... '/ ' ' [' ......
ISOIL LOG - PERCOLATION TESTI ~ (~'
LEGAL DESCRIPTION' CHUOACH PARK ~U"D V S ON PROPOSED LOT 12, ~ ~ *'1 0 ' ~; mi; .~ ] ' ~;;;': ' '
..... -- $.." :E-795; "
PERFORMED FOR: BELL & ASSOCIATES DATE: 1/30/2003 ~h~ '), J ."
.... ~ ~,/'i ......... '~q
(feet) .==~=: '~r-¢-'~ ,,~ r- U-~ ~ "~.~
..m~....---~: SOIL CLASSIFICATIONS
~"%"¢ GC OL
'~' .... ~ SP CH
~ :<~,",,'. .SM OH
· SEE ATTACH EC
6 __.:~,~.e ,, SC
'---- * SITE PLAN
:~,~-'°~ w/ LARGE
7--._~-~-%~o COBBLES DEPTH TO DATE
~":.'~,o ;, GROUNDWATER
8 -- .~,~, ,, DRY 1/30/2003
:-q:.:,,~, %, 11.8' 2/7/2003
9 --- ._~..~_:.~ ~, 10/14/200~
,:.~:~,.¢, DRY TO 12'
10
:=o~%, CLOCK NET TIME WATER LEVEL NET DROP
~:%¥',, DATE READING
11 -- -~.<...~., TIHE (MINUTES) READING (INCHES)
~:~'~4 "~" ~'~,.. ~ 1/30/200,3 1 3=56 - 6. _
1
2
B.O,H. 2 5:57 1 O" 6"
I
15 -- `3. 5:57 -- 6- _
4. 5~58 1 O" 6"
14-- 5 5:58 -- 6- _
6 5:59 1 0" 6"
15--
16--
17--
i
18-- I
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19-
TEST RUN BETWEEN ~.0 FT. AND 4..5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORHED: [] YES · NO
SOILS LOGGED BY: MA~ FISHER PERCOLATION TEST PERFORMED BY: MATT FISHER
COMMENTS: SEPTIC SYSTEM MAY REQUIRE THE USE .OFA SAND FILTER
PERFORMED BY AKWWC, INC. J, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS/PE¢ORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
DEPTH TO DATE
GROUNDWATER
DRY 1/30/2003
11.8' 2/7/2003
BRY TO 12' 10/14./200~
? 8 9 707
rV
•
•t _� Municipality of Anchorage MAY oI , ►
On-Site Water and Wastewater Program <
(907) 343-7904 Z: �`
��
Certificate of On-Site Systems Approval �� a
Parcel I.D. 090-042-12 Expiration Date: J ) 1 -17
1. GENERAL INFORMATION
Complete legal description Chugach Park View Lot 12
Location (site address) 623 Rand Road
Current Property owner(s) Geerin, James Day phone
Mailing address 623 Rand Road Indian, AK 99540
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E l Single Family (w/wo ADU)
El Duplex
❑ 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: //,5/1
Date:
COSA to be released to the engineer, unless otherwise requested by the ngineer.
COSA Fee $ -30 Waiver Fee $
Date of Payment 5/6) 1(?- Date of Payment
Receipt Number n 0332q6 Receipt Number
COSA# U )C-14 1' 10" Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by , ffixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certifi ite 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 install 'tea
In conductip� o test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 soil
condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 5/8/2017
Aqkki
.co `�� ••:7
*: Q- /4' *9�
6. DSD SIGNATURE � ..�
System #1 Approved for Li bedrooms - •S l annone
CE-8149
System #2 Approved for bedrooms =.'�
Disapproved �!!� `�PROFESSIONP '"
Conditional approval for bedrooms, with the following stipulations:
OF O %i/�
`��
C
ON-SITE
WATER AND 1.1"'
WASTEWATER o
G PROGRAM
�0,0 (C
r.
•
1
By: , .. Original Certificate Date: 5---11
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 blue sheet_f •
If more than 1 septic system is on the lot:
COSA Checklist# 1 of
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description Chugach Park View Lot 12 Parcel ID: 090-042-12
A. WELL DATA
Well type Private If A. B. or C provide PWSID # Well Log (Y/N) Y
Date completed
11/9/2016 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 124 ft. Cased to 124 ft. Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 11/9/2016 N E W
Static water level 79 ft. NEW ft.
Well production 15 g p.m NEW g p m
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 0.518 mg/L
Arsenic ND ug/L Date of sample: 5/2/2017 Collected by PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 11/9/2016
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 11/9/2016 Soil rating (g.p.d./ft2 or ftz/bdrm) 1 GPD/SF System type Shallow Trench
Length 120 ft Width 5 0 ft. Gravel below pipe 0'5 ft.
Total depth 5.0 ft. Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"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+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ 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 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ..1,13 OF. ALq�ll�
I certify that I have determined through field inspections and ��'<P- ) !�4��
review of Municipal records that the above systems are in0,,,,. .4..
*; I\ ��
conformance with MOA COSA guidelines in effect on this date.
til -Steven Pannone , �.
Engineer's Printed Name /� •.�}everi .•Naririorie .
Date 5/8/2017 0A- t,';;.. CE-8149 r
COSA canary sheet_2-6-15.doc
Certified Drilling Log
p DOC CO dba
61LL & COLE
JULLIVAN WATER WELLS
ler P.O. Box 670269, Chugiak,AK 99567 688-2759
OWNER OF LAND: James Patrick Geerin
ADDRESS: 12521 Hansa Rose Cir. Anchorage, AK 99515 Bore Hole Data
LEGAL DESCRIPTION Chugach Park View Lot 12
DATE: 11-9-16 Depth
From To
PERMIT NUMBER: OSP161280 DATE OF ISSUE: 10-19
0 2 Casing Stickup
16
TAX IDENTIFICATION NUMBER 09004212000 2 4 Overburden
Is well located at approved permit location: Zes❑No 4 18 Boulders & Gravel
Method of Drilling: ®alr rotary ❑cable tool 18 21 Boulders Silt &Sand
Depth of Well: 124' 21 100 Hardpan& Cobbles
Casing Type: Steel Wall thickness 250 Inches
Diameter: ( Inches, depth 124 feet 100 104 Silty Sand & Gravel Water Dirty
Liner type 104 118 Hardpan & Cobbles
Static Water Level: 79 feet 118 124 Sand & Gravel Water
Recovery Rate 15 71 gpm ❑ gph '
Method of Testing Air ,
Well Intake Opening Type:®open end reopen 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: Myes ❑no
Method of Disinfection: Chlorine 50 PPM
Comments:
r r`WATER UA3.l 'TESTING
C'.nINOrr" l °) Co11100m
Nittatim io, y d mg/ . f
Arsenic \') > 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.
MatSu Borough: Department of Environmental Conservation.
L.. oda,
jogBILL a. COLE
� ►4.P.O.ULLIVAN WATER WELLS
Box 670269,Chugiak,AK 99567 6BB-2159
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number:SW 0SP161280 Date of Issue 10-19-16
Parcel Identification Number: 09004212000
Legal Description Property Owner Name&Address
Chugach Park View Lot 12 Spinel!Homes 1900 W. Northern Lights Blvd#200
Anchorage,AK 99517
Pump Installation Date: 11-1546
Pump Intake Depth Below Top of Well Casing: 110 feet
Pump manufacturer's Name: F&W
Pump Model: 4F07P073055
Pump Size: 3/4 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Installer: Pomraning Excavation
Disinfected Upon Completion? yes 0 no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: Martinson
Pump Installers Name: Sullivan Water Wells
Attention:The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
PLAT NO. 2005-202
CHUGACH PARK VIEW SUBDIVISION
LOT 12
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I BUILDING DETAIL
SCALE: l '=20'
1 "= 60' ,
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7.3' X 7.5'
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S 88.20'15"E 291.92' .`
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LAS -BUILT 'I HEREBY CERTIFY THAT I HAVE SURVEYED THE
GASTAUII LAND
'PROPERTY DEPICTED ABOVE AND THAT NO
SURVEYING,L LLC ENCROACHMENTS EXIST EXCEPT AS IKOICA'TED. *oat it#`
IT IS THE RESPONSIBILITY OF THE MIER TO ; OF q ♦40
JEFF& GASFM.BI R.N.s. 4f v. ••,••• L'�S
DETERMINE 1HE EXISTENCE OF ANY EASEMENTS, `• ,
2000 E DOWUNG RD., SUITE 8 COVENANTS OR RESTRICTIONS WWCH DO NOT '� �: *"•.'�
' ANCHORAGE. ALASKA 99507 APPEAR
PEAR ON THE RECORDED SUBDIVISION PLAT i :•491/1
PHONE 246-5454 UNDER ND CIRCUMSTANCES SHOULD ANY DATA 0
CRID GATE !HEREON BE USED FOR CONSTRUCTION OR FOR •• ••• • a
I. ANtI 11. oovitia
SW4355 12/30/2016 ESTABLISHING BOUNDARY OR FENCE LINES. r d.,r•.•. L5-0091 a
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ANCHORAGE RECORDING DISTRICT. ALASKA �"• ••••11, °!•• ' y +
F.B. JOB NO. •# � i f••.+{•� �.
I 16-02 CPyt2 NOTE: NO CORNERS SET THIS DATE 1 aMti1 �'~1