HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 1 LT 22 Onsite File
Chugach Park Estates
Block 1
Lot 22
PID# 051 - 481 - 33
The 1978 3 -bedroom field may not be tested for
future COSAs .
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 191218 PID Number: 058 481 33
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New❑ Upgrade
Name
Moore
ABSORPTION FIELD
❑� Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
19512 Kullberg
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
10 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft.
Gravel depth beneath pipe
6 Ft.
Subdivision Block Lot
Chugach Park Estates Block 1 Lot 22
Fill added above original grade
2.1 Ft.
Gravel length
42 Ft.
Township Range Section
Gravel width
3 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
504 Ft2
1
Ft.
Well
+100
+100
-
-
+25
TANK A Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1250 Gal.
Surface Water
+ 100
+100
_
_
Material
Number of compartments
Lot Line
+10
+10
-
-
NA
EPDXY COATED STEEL
2
Foundation
+10
+10
-
-
LIFT STATION
Manufacturer
Capacity
Remarks old tank demolished per code
Gal.
diverter valve not installed due to insufficient drop
Alarm location
Electrical installed by
PIPE MATERIAL House to tank pvc drainfield Tank to
3034
Installer
Martin Construction
Drainfield 3034 CO/MT3034
Inspector CHARLES BALZARINI
BENCH MARK (Assumed elevation) 100 ft
Inspection
�s' 6/27/19 nd 7/1/19
dates:2
Location and description
corner of deck
3'd 41h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF A�gtll
Conditional Approval: Date
dW' •• •s,�.
/rGJ.-.�
49— '.
.......
t
CHARLES G 13ALZARI91
�� �F�is CE-13854 ���
Septic System
ApproDate Z-� - (�
•
AMW-
`ll���PROFESSIONP�
Note: this approval does not include well permit requirements.
(Kev u5iuu16) 7/7/19
NEW 3x42x6' EFFECTIVE
DEEPTRENCH
i
MONITOR TUBE TH-1
0 REMOVED
C AFTER 7 DAYS,
r NO GWT
-<
m
� MONITOR TUBE
IT!
IT!
z
of At,qs���
i CHARLES G BALZAR11- 1
�� ��c •. CE -13854 .••�`��
F�PROFESSI0
A B
H / T4BR
C 55.8 40.4
F G / D 56.6 41.8
E 56.1 44.5
HOME F 51.0 43.4
1 G 50.0 44.0
D ' - C a H 50.4 45.4
/ 1 54.0 53.9
J 78.0 61.1
j BM, DECK K 74.3 58.0
CORNER
NEW 1250 GALLON
i STEEL TANK W/ '
EPDXY COATING /
AND MANHOLE
\/ DRIVEWAY
LEGEND
O CLEANOUT
0 MONITORTUBE CHUGACH PARK ESTATES
TEST HOLE
BLOCK 1 LOT 22
® \
PLAN - SCALE: - = 30'
- DECK CORNER:+100
FILTER FABRIC x97.8
5.6'
COVER
16
85.7_A
4"0 DISTRIBUTION PIPE
6' EFFECTIVE SEWER ROCK
SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED
ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY,
INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA
REQUIREMENTS ONLY.
SCHEMATIC ELEVATION - SCALE: NTS
TUBE
_( GRADE TESTHOLEAWWC
-95.7'
ORIG. GRADE
91.7 INVERT
X85.7
NO GWT 713/19
79.2 BOH
LEGAL DESCRIPTION: CHUGACH PARK ESTATES BLOCK 1 LOT 22
C&M ENGINEERING SERVICES OWNER: MOORE DATE:07/07/19 I REV: 11 DRAWN: CB REF:
907-854-5558
SEPTIC RECORD DRAWING
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Section
4700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Soils Log - Percolation fest
Performed For: MOORE
Legal Description: CHUGACH PARK ESTATES BLOCK 1 LOT 22
Depth
(Feet)
i
2-1
1
3
4-
5-
6-
7-
8-
9-
10-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
TOPSOIL
-67-
89-
10-
12-
13-
14 -15 -16-
17-
18-
19-
20 -
TOPSOIL
SW/SP, SAND WITH
GRAVEL AND COBBLES
BOH (INITIAL)
BOH,DEEPENED
6/26
O�
• GINEER'S E
CHARLES G BA ARIIi(
CE -13854
pROFE SSIONP� �®
Date Performed: 05/29/19
Township, Range, Section:
Site Plan
WAS GROUND WATER
Date
ENCOUNTERED? NO
Net Time
Depth to Water
S
IF YES, AT WHAT DEPTH? NA
L
Depth to Water After
P
P
Monitoring? None
E
Date: 7/3/19
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1
5/29/19
3:24
0
2-0/16"
0"
2
3:34
10
5-5/16"
3-5/16"
3
3:35
0
2-0/16"
0"
4
3:45
10
5-4/16"
3-4/16"
5
3:46
0
2-0/16"
0"
6
3:56
10
5-4/16"
3-4/16"
PERCOLATION RATE 3 (minuteslinch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN 3 FT AND 4 FT
COMMENTS LAST 3 READINGS SHOWN, PERFORMED FOR 1 HOUR.
PERFORMED BY: CHARLES BALZARINI I CHARLES BALZARINI CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 06/05/19
•
PA LI
os)toCIAL.0p MUNICIPALITY OF ANCHORAGE lent
7,., 'IP On-Site Water&Wastewater Program
.. PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
httpa/www.muni.org/onsite • MI •
Department
NcHOAp6� On-Site Wastewater Disposal System Permit 7///or
Permit Number: OSP191218 Effective Date: 6/19/2019
Work Type: Septic Upgrade Expiration Date: 6/18/2020
Tax Code Number: 05148133000
Site Legal Address: CHUGACH PARK ESTATES BLK 1 LT 22 G:1161
Site Mailing Address: 19512 KULLBERG CIR, Chugiak
Owner: MOORE OLIVER &VENITA FAM TRST Lot Size in Sq Ft: 54632
Design Engineer: C & M Engineering Total Bedrooms: 3-y
This permit is for the construction of:
El Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
The Engineer needs to do an additional test hole prior to the construction of the septic field. Construction may
proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed
results with the As-built Inspection Report. If the results require a design change, construction of the system will
stop pending On-Site review and approval.
•
Received By: Date: 6/19/19
Issued By: )I/*CSV Date: 6A/9'
Municipality ®f Anchorage °`n,`,', :`�-
,. .• ,. .- t
\y I r.rartmt
P.O. Box 196650 • 4700 Elmore Road
Anchorage. Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV191042 COSA#: • Permit#: OSP191218
PID#: 051-481-33
Legal Description: Chugach Park Estates Blk 1 Lt 22
Engineer: CM Engineering •
Your request for a waiver of the required 50 feet horizontal separation from the absorption field to
the excessive slope has been approved. The approved separation distance is 12.0 feet.
This waiver approval applies to the proposed 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.
•
Waiver is Granted: X Waiver is not Granted:
Date: 6/q/7 Approved by: 6 al
Name of Revi er
***'k VARIANCE/WAIVER REVIEW ****
EPLAP4S
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section — Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Oft
Parcel I.D. 481 33
Property owner(s) VENITA MOORE Day phone ,6SS-32.9S
Mailing address
Site address 19512 KULLBERG
Legal description (Sub'd., Block & Lot) CHUGACH PARK ESTATES BLOCK 1 LOT 22
Legal description (Township, Range & Section)
Lot Size 54,632 Sq. Ft. Number of Bedrooms I
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) H
(w/wo ADU)
Septic Tank 0 Upgrade ❑
Duplex (D)
Holding Tank ❑ Renewal ❑ Multiple Dwellings
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
C&M ENGINEERING
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5q5 Waiver Fees: 142-7-16-
Date
42-2.1Date of Payment: to I tot i9 Date of Payment: XyViq
Receipt Number: 60o7cg3O Receipt Number: 6049_00
Permit No. 6S pIc fZl?3 Waiver No. DSV 11/O `{ 2-
G: Development
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System replacement for Chugach Park Estates Block 1 Lot 22
Dear Reviewer,
The above referenced property is currently served by an older, 3 bedroom septic system. The owner
would like to replace it with a new septic system and upgrade the to a 4 bedroom system.
We are proposing to install a new septic tank, and a new drain field. The old tank will be demolished per
moa requirements.
Our review of available documentation and field investigation show that this project will not adversely
impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing
onto and off of the subject property.
The existing drain field is sized for 3 bedrooms and may be used as a 4 bedroom reserve site with the
installation of an AWWTS system. There is also sufficient space for a new AWWTS drain field elsewhere
on the lot.
The existing trench should not be used for the 4 bedroom system and shouldn’t be tested for any
COSAS. It does however serve as a good temporary backup should the new system fail, and as a
suitable reserve site if an AWWTS system is used, or if it is extended.
A waiver request for a drainfield to steep slope waiver has been provided as a separate document.
Included with this letter is a permit application and design package, including plans, and calculations. A
test hole was excavated, however a deeper test hole will be excavated to 16’ deep during construction to
verify soil conditions and the groundwater table.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
6/18/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191218, Deb Wockenfuss, 06/19/19
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System replacement for Chugach Park Estates Block 1 Lot 22
Dear Reviewer,
We would like to request a slope separation distance wavier for the above referenced property. The
proposed drain field will be a minimum distance of 12.7’ from the top of the steep slope. W e believe the
following points mitigate the drainfield’s proximity to the slope and greatly reduce chances for effluent to
travel horizontally and break the ground surface:
• The soils are free draining which will help effluent to disperse vertically downward with less
chance for horizontal migration. A copy of the soils log has been attached.
• The existing slope is stabilized by vegetation reducing risk for erosion.
• The attached cross sections show the existing slopes relative to the drain field. In most cases, a
theoretical 25% placed 2.5’ above the invert of the distribution pipe would daylight over 35’ from
the edge of the system. At worst, the 25% line daylights 26.5’ from the edge of the system. At no
point, does a 46% slope line placed at the same location, daylight below the system.
• Since the 46% slope line does not daylight, that means the system should behave similar to a
system installed on a slope less than 46%. A relatively minimal amount of fill could be placed
downslope of the system to prevent the 25% line from daylighting within 35’ of the slope. It’s likely
that placement of fill could ultimately damage the existing native vegetation which adversely
impact the slope.
For these reasons, we believe the drainfield to steep slope waiver is justified.
Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558
or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
6/14/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191218, Deb Wockenfuss, 06/19/19
Residence:
number of bedrooms 4 br
Water usage/bedroom 150 gpd/br
Water Usage 600 gpd
system type: CONVENTIONAL
type: DEEP
Application Rate 1.2 gpd/sqft
required absorption area 500 sqft
trench width (W) 3 ft
gravel depth (D) 6 ft below distribution pipe
Min Required Length: 41.6666667 ft
Total Excavation Depth: 10 ft BASED ON ORIGINAL TESTHOLE DEPTH TO
Cover: 3 ft 16 FEET
Insulation: 2" blueboard
Effluent Pipe:
Calc By: CGB Date: 5/30/2018
C&M ENGINEERING SERVICES
907-854-5558
Septic Design Calculations
Chugach Park Estates Block 1 Lot 22
RESIDENCE/LOT INFO
DRAINFIELD
4" ASTM 3034
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191218, Deb Wockenfuss, 06/19/19
4 BR HOMETH-1 10' UTILITY EASEMENTDRIVEWAY
NEW 3x42x6' EFFECTIVE
DEEP TRENCH
NEW 1250 GALLON
POLY TANK INSTALL
MONITOR TUBE AS
REQUIRED.
DEMOLISH OLD TANK PER
MOA REQUIREMENTS
1 00' WEL L R A D IUS
BULL RUN
DIVERTER
CHUGACH PARK ESTATES
BLOCK 1 LOT 22
CHUGACH PARK
ESTATES
BLOCK 1 LOT 21
CHUGACH PARK ESTATES
BLOCK 1 LOT 23
APPROX. 100'
NEIGHBORING WELL
RADIUS
APPROX. 100'
NEIGHBORING
WELL RADIUS
CHUGACH PARK
ESTATES
BLOCK 1 LOT 15
KULLBERG DRIVEAFTER TANK
CO'S
MONITOR TUBE
CHUGACH PARK
ESTATES
BLOCK 1 LOT 14
SEC
TION
ADO
W
N
S
L
O
PE
8.5
12.7
CONFIGURATION
OF LINES
UPSTREAM OF
TANK MAY VARY
FROM SHOWN
INSTALL CO FACING
TOWARDS HOME
EXISTING DRAINFIELD
TO REMAIN, SERVE AS
RESERVE SITE WITH
INSTALLATION OF CAT
III AWWTS.
1' CONTOUR
INTERVAL
SEC
T
I
ON
B
DEEPEN TH TO 16'
DURING CONSTRUCTION
GWT MONITOR TO REMAIN
C&M ENGINEERING SERVICES
907-854-5558
AREA PLAN
LEGAL DESCRIPTION: CHUGACH PARK ESTATES BLOCK 1 LOT 22
OWNER: MOORE DATE: 06/05/19 REV: 0 DRAWN: CB REF:
SCALE: 1" = 60'
CHARLES G BALZARINI
CE-13854R
EGISTEREDPROFESSIONALE NGINEER
06/15/19
SEE SITEPLAN FOR DETAILS
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191218, Deb Wockenfuss, 06/19/19
4 BR HOMETH-1 10' UTILITY EASEMENTDRIVEWAY
NEW 3x42x6' EFFECTIVE
DEEP TRENCH
NEW 1250 GALLON
POLY TANK INSTALL
MONITOR TUBE AS
REQUIRED.
DEMOLISH OLD TANK PER
MOA REQUIREMENTS
100'
WELL
RADI
U
S
BULL RUN
DIVERTER
CHUGACH PARK ESTATES
BLOCK 1 LOT 22
CHUGACH PARK
ESTATES
BLOCK 1 LOT 21
CHUGACH PARK ESTATES
BLOCK 1 LOT 23
APPROX. 100'
NEIGHBORING WELL
RADIUS
APPROX. 100'
NEIGHBORING
WELL RADIUS
CHUGACH PARK
ESTATES
BLOCK 1 LOT 15
AFTER TANK
CO'S
MONITOR TUBE
CHUGACH PARK
ESTATES
BLOCK 1 LOT 14
SEC
T
I
ON
ADO
W
N
S
L
O
P
E
8.5
12.7
CONFIGURATION
OF LINES
UPSTREAM OF
TANK MAY VARY
FROM SHOWN
INSTALL CO FACING
TOWARDS HOME
EXISTING DRAINFIELD
TO REMAIN, SERVE AS
RESERVE SITE WITH
INSTALLATION OF CAT
III AWWTS.
1' CONTOUR
INTERVAL
SEC
T
I
ON
B
DEEPEN TH TO 16'
DURING CONSTRUCTION
GWT MONITOR TO REMAIN
C&M ENGINEERING SERVICES
907-854-5558
AREA PLAN
LEGAL DESCRIPTION: CUGACH PARK ESTATES BLOCK 1 LOT 22
OWNER: MOORE DATE: 6/05/19 REV: 0 DRAWN: CB REF:
SCALE: 1" = 40'
CHARLES G BALZARINI
CE-13854R
EGISTEREDPROFESSIONALE NGINEER
LEGEND
CLEANOUT
MONITOR TUBE
TEST HOLE
SLOPE INDICATOR
NOTE:
1. THE PROPOSED SEPTIC SYSTEM IS
GREATER THAN:
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
100' FROM ANY SURFACE WATER
10' TO ANY PROPERTY LINE OR FOUNDATION
5' TO ANY TEST HOLES
EXCEPT WHERE SHOWN
0.5%
06/15/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191218, Deb Wockenfuss, 06/19/19
CURRENT TESTHOLE DEPTH, 14'
3.5'
6.5'
4.0'
16.0'
2.0'
10.0'
BOTTOM
OF ROCK
TOP OF ROCK
GROUND
SURFACE
25%
SLOP
E
LINE
46
%
SL
O
P
E
LINE
CLEANOUT
MONITOR TUBE
FILTER FABRIC
INSULATION
DEEPEN TESTHOLE TO DEPTH, 16'
12.7'
50.0'
TOP OF STEEP SLOPE
43.8'
2.5'
CURRENT TESTHOLE DEPTH, 14'
3.5'
6.5'
4.0'
16.0'
2.0'
10.0'
BOTTOM
OF ROCK
TOP OF ROCK
GROUND
SURFACE
25%
SLOP
E
LINE
46%
SL
OP
E
LINE
CLEANOUT
MONITOR TUBE
FILTER FABRIC
INSULATION
DEEPEN TESTHOLE TO DEPTH, 16'
15.5'
50.0'
TOP OF STEEP SLOPE
26.5'
2.5'
C&M ENGINEERING SERVICES
907-854-5558
SECTION
LEGAL DESCRIPTION: CUGACH PARK ESTATES BLOCK 1 LOT 22
OWNER: MOORE DATE: 6/05/19 REV: 0 DRAWN: CB REF:
SECTION A, SCALE: 1" = 10'
CHARLES G BALZARINI
CE-13854R
EGISTEREDPROFE S S I O N ALENGINEER
06/15/19
0 105
SECTION B, SCALE: 1" = 10'
0 105
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191218, Deb Wockenfuss, 06/19/19
CHARLES G BALZARINI
CE-13854R
EGISTEREDPROFESSIONALE NGINEER
6/5/19
MOORE
CHUGACH PARK ESTATES BLOCK 1 LOT 22
05/29/19
NO
6/5/19
NA
5/29/19 1 3:24 0 2-0/16"
2 3:34 10 5-5/16"
3 3:35 0 2-0/16"
4 3:45 10 5-4/16"
5 3:46 0 2-0/16"
6 3:56 10 5-4/16"
TOPSOIL
SW/SP, SAND WITH
GRAVEL AND COBBLES
0"
3-5/16"
0"
3-4/16"
0"
3-4/16"
LAST 3 READINGS SHOWN, PERFORMED FOR 1 HOUR.
3 4
3
CHARLES BALZARINI CHARLES BALZARINI
06/05/19
BOH
6"
None
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191218, Deb Wockenfuss, 06/19/19
~_ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I' ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
IP'ONE [l~EW
~AILING ADD~ESS
LEGAL DESCRIPTION
~ ~ DISTANCE TO: Il Well /~O fII Absorption area~g f' Dwelling ~ O / PERMIT NO.
~ Manufacturer ~ Mat~~ ~o. of ~artments
~}q. 9apacitg in ~allons Inside length ~idth kiquid depth
~ OO O
IF
HOME.DE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
OZ ~ Manufacturer Material Liquid capacity in gallons
Q Well FounO~ Nearest I~e~ PER~ ~O ~ 9 ~
~: ~ t ~~__ inches Distance between lines
~ No. of lines Length h/ine Total le~t~lines Trench wi~/7
Q~ ~ Top of tile to finish grade~ ~ Material beneath tile ~ / inches Zotal~f~ti~ev~ absorption area
Length Width Depth PERMIT NO.
< h Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS ~ ~' ~
~ ~ 3o3q I
SOIL TEST RATING f ~-
INSTALLER~ ~~
R EMAR KS
APPROV~A ~ DATE 7~/~-- 78 LEGAL
72-013 (Rev. 3/78)
~MIT NO.
~ICANT SPECIAL SERVICES SRS BOX 1042
.CATION SULLINS DRIVE
£GRL L22 Bi CHUGACH PARK ESTATES
CYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
~XIMUM ~MBER OF BEDROOMS = ~ SOIL RATING (SQ FT?BR)=
THE REQUIRED SIZE OF THE SOIL. ABSORPTION SYSTEM IS'
DEPTH=
264-4720 ~'
I TE 5ENER PERM · T
ON~
LOT SIZE 54458 5GURRE FEET
85
12 LENS'tH= 22 GRAVEL [)EPTH= 6
TM LENGTH DIME~ION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH ~ A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS ~ SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REQUIRED SEPTIm; TANK SIZE= 1000 GALLO~4S
PERMIT APPLICANT HAS TM RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATI~ INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER ~ RES IDE~ES THAT THE WELL WILL SERVE.
------ TWO ( 2 ) I N'SPECT IONS ARE REL--qLI I REg.
BACKFILLING OF ANV SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL S~STEM IS
100 FEET ~ A ~IVGTE WELL~ OR
150 TO 2~ FEET FR~ A PUBLIC WELL DEPENDING ~ON THE TYPE OF PUBLIC WELL.
OTHER REQUIRE~NTS MAY AP~Y SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXP I RES DECEMBER ~l. 1978
I CERTIFY THaT
i' I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICI~LIT¥ OF ANCHORA~.
2' I WILL INSTALL THE SYSTEM IN ACC~DANCE WITH THE C~ES.
3' I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
SIGNED' ~~-~--
I AL SERV ICES
ISSUED
V3:. 2
i
MUNICIPALITY OF ANCHORAGE
Development Services Department c`' �'-� Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051 481 33
1. GENERAL INFORMATION
Expiration Date: 10 " 2.l�__t
Complete legal description CHUGACH PARK EST BLOCK 1 LOT 22
Location (site address) 19512 KULLBERG
Current property owners) MOORE Day phone
Mailing address
Real estate agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
0
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 $ !�a
Date of Payment
Receipt Number
COSA# ®5C 01,31 4/
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.
Name of Firm C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 7/7/2019
,.�' OF "
' '�.�Zl
j g149 P• TM
6. DSD SIGNATURE
OF
System #1 Approved for bedrooms �r G BALZARINI
System #2 Approved for bedrooms 4_600CHARLES
?60, • CE -13854 ••. zg� a
Disapproved ok et, AW --
Conditional
--
Conditional approval for bedrooms, with the following stipulations:
VVMI Cr< r11-VLI
/1111RRR1111�
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: CHUGACH PARK ESTATES BLOCK 1 LOT 22 Parcel ID: 051 481 33
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
❑® Well log is filed with Onsite (or attached)
Date drilled 3121/77
Total depth 290 ft
Cased to 206 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) +12 in.
Date of flow test for COSA 6127/19
Well production at time of test 0.83 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 9.77 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by C&M Engineering
Date of Sample 7/1/19
Static water level at beginning of test 127 ft.
Comments PUMP SET AT APPROX 180'. The well is capable of providing 1.11 gallons per minute of water in a 4 hour period due to storage in the casing
B. TANK DATA
Age of tank(s) 0 years
Tank type/material SETPIC
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NA -NEW
D. ABSORPTION FIELD DATA 2019 TRENCH
Which system tested (date installed) 7/19
❑ ALL standpipes present per record drawing
Total measured depth from grade 12.1 ft (max)
Measured depth to pipe invert from grade 6.1 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of drainfield. If not, state
depth into effective
❑ Code -required soil cover over Feld
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies: NEW SYSTEM, TESTING NOT REQUIRED
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station NA years
Lift station material NA
Comments: NEW TANK
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
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'
O✓ Yes
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' QYes
if No
ft
Private Sewer/Septic Line > 25' QYes
if No ft
Absorption Field on Lot > 100' QYes
if No
ft
Holding Tank > 100' QYes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Q Yes
if No ft
Q Yes
if No
ft
ft
Community Wells > 200'
2 Yes if No ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' O✓ Yes
if No
ft
0✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
O✓ Yes
if No
ft
Surface Water > 100'
Q✓ Yes if No ft
Property Line > 5'
F✓ Yes
if No
ft
Driveway/Parking > 0'
Q•/ Yes if No, comment
Absorption Field > 5'
Q✓ Yes
if No
ft
Wells on Adjacent Lots:
Q Yes if No ft
Water Main > 10'
❑✓ Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Service Line > 10'
F/ Yes
if No
ft
Community Wells > 200'
2 Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q✓ Yes
if No
ft
Driveway/Parking > 0'
Yes if No, comment
Property Line > 10'
0 Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
❑✓ Yes
if No
ft
Private Wells > 100'
Q Yes if No ft
Water Service Line > 10'
F✓ Yes
if No
ft
Community Wells > 200'
QYes if No ft
Surface Water > 100'
F✓ Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION �"N
A
c gsiN
OF
Aw
I certify that / have determined through field inspections and review lop,
, P' •'�.4 O�
of Municipal records that the above systems are in conformance with d
MOA COSA guidelines in effect on this date -7/7/2019
% • • •�/ff/,
CHARLES G BALZARINI
CE -13854
PR0FE5 QW --1-.-
COSA Checklist yellow sheet
I MW %W iffl
DEVELOPMENT SERVICES DEPARTMENT
On -Site water and wastewater Section 1.
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC191314
Subdivision: Chugach Park Estates, Block: 1, Lot: 22
A water sample revealed a nitrate concentration of 9.77 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
�1VIrMyng��c�es�s�ox* �An�c or�ge� ask nCr
1 60
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Well Water Advisory
Certificate of On -Site Systems Approval #OSC191314
Subdivision: Chugach Park Est., Block: 1, Lot: 22
This well's productivity was determined to be .83 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 4 -bedroom residence is .41
gallons per minute or 150 gallons per day per bedroom. Although the subject well
currently exceeds this minimum requirement, the production capacity can
fluctuate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
�ri�lrn�ds 65 cit as ! 9 unt
A & L DRILLING COMPANY
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION Z o1~
DATE-Started 3//7/7 7
PERMIT NUMBER '7 7 0 (~ ~"
4 '-/~/ I
DEPTH OF WELL C~
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
Ended '~/c~//7 '7 GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From ,/.,' '?Ft. to [ Ft.
From / Ft. to ~ Ft.
From Ft. to Ft.
From '~O Ft. to 37 Ft.
From '_~i ~1' Ft. to--Ft.
From _~-73_~ Ft. to
From_(!c~- Ft. to .
From ]~ ~ Ft. to__
From ..)Ot Ft. to
From '> c -
_~.,~ ; Ft. to
From .-)' '7(2 Ft. to
From
From
From__.Ft. to.__Ft
From Ft. to__Ft
From__Ft. to Ft.
From Ft. to Ft
From
Fron~
From Ft. to Ft.
From
From Ft. to Ft
From
Ft. to Ft.
Ft. to.__.Ft
Ft. to__Ft,
Ft. to.__Ft,
__Ft. to Ft,
Ft. to Ft,
Ft. to.__Ft,
Ft. to Ft.
__Ft. to.__Ft,
Ft. to Ft._
Ft. to Ft.
Ft. to Ft
Ft. to Ft
Ft. to Ft.
__Ft. to.__Ft.
Ft. to Ft.
Ft. to.__Ft
MISCL. INFORMATION:
DRILLER'S NAME
1
AYEi VENTUF S
CONSULTING GEOLOGIST
BOX 476-M, STAR ROUTE A ' ANCHORAGE, ALASKA 99507 · PHONE 344-7071
SOILS LOG
Soil Type Water Level
Remarks
2
~ .~0
-ri
~ ~2
16
18
2O
Total Depth of Excavation
Groundwater
~ot Reached
Depth, if Reached
Classification Method
~isual
( ) Sieve Analysis
()
Material at Total Depth
Bedrock
~ Reached
Depth, if Reached
Gary F. Player, Consultin~g Geologist
Municipality of Anchorage
DATE:
TO:
FROM:
SUBJECT:
MEMORANDUM
91-010 (4/76)
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