HomeMy WebLinkAboutCHANDELLE ACRES LT 28Onsite File
Chandelle
Acres
Lot 28
#051-822-07
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Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211488
PID Number: 051-822-07
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade
Name
David & Gayle White
ABSORPTION FIELD
❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
23915 Chandelle Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
0.45 GPD/SF
6.5 / 9.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.0/4.1 Ft.
Gravel depth beneath pipe
5.5/5.5 Ft.
Subdivision Block Lot
Chandelle Acres
28
Fill added above original grade
3.6/0.5 Ft.
Gravel length
61 / 61 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
1342 Ft2
2
14 Ft.
Well
>100'
>100'
N/A
N/A
NIA
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
>1 00'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
NA
Plastic
2
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Little Dipper Excavating
Drainfield D3034 cO/MTD3034
Inspector L. Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspdection 15` 8/3/22 8/4/22
Location and description
2nd
3'° 8/10/22 4`h
Bottom of siding
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF ! q kk�
Conditional Approval:
Date
.�,�
���Q�.•'
49 •*
��� imUr
Septi S stem
� ;• Benja Schiller
Approved \ �-�—�;;d
Date q_ 1�P -2Z
+Ok��sjF9�, sii5z? • .�����
lily PROFESSI0�
Note: this approval does not include well permit requirements.
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CHANDELLE ACRES. LOT 28
MT4
C04 .c\
1250 -GAL SEPTIC
TANK W/ 20"
MANWAY
PID # 051-822-07
',LONG x T WIDE, 5.5'
ECTIVE DEPTH ABSO
t
I
l
t
NEIGHBORING
ON SEPTIC i
LOT 29
NEW WELL
!--- M D-- LLE D -RIS -
`�
r J /
LOT 14
\ , NEIGHBORING SEPTICS NOT I,NiVIEW AND > 100' FROM WELL
LOT 15
A B C
ENGINEERING'
® v• f
.49 TH '•.9
` Benja i Schiller
CE 2592
29�
PLAN AS -BUILT
0 50 100
FEET
111=50'
FCO
1.7
27.4
-
MH1
33.2
15.0
66.0
SV1
38.2
17.5
66.5
2CO
41.0
19.2
66.6
FS
55.7
30.8
69.3
MT1
1 71.1
50.8
1 91.0
C01
70.7
51.0
92.4
MT2
-
30.8
35.8
CO2
-
32.1
34.9
MT3
-
53.6
47.0
CO3
-
5 .
1 45.6
MT4
87.4
65.0
98.8
C04
86.3
63.9
98.1
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
CHANDELLE ACRES, LOT 28
PID # 051-822-07
U 89.8 FINISH GRADE 86.2 ORIGINAL GRADE
85.2
DRAINFIELD ROCK 85.2
79.9 79.7 80.3
61'
TRENCH1
NO GROUNDWATER 11/30/21
69.2
~ Ol- I- O
U� 83.5 FINISH GRADE 83.0 ORIGINAL GRADE 2� U
79.0 79.0
DRAINFIELD ROCK
4
73.3 73.5 73.1
61'
TRENCH 2
NO GROUNDWATER 11/30/21 1.9&. ��i1'
66.0
LN6INLERIHG
PROFILE AS -BUILT
(NO SCALE)
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enja' Schiller
,•'••
'®�Fc CE 12592
VJhaz L'0n Wear AVYee �g'j54CC.
1190 N. Wasilla-Fish hook Road
Wasilla, AK 99654
(907)376-2041
Name:
Hultquist Homes, Inc
Address:
12570 Old Seward Hwy #204
City:
Anchorage State: AK Zip Code: 99515
Well Site:
Chandelle Acres
Lot/Block: L28
Additional:
23915 Chandelle Dr, Chugiak
Well Depth:
208 ft.
From:
To: Formation:
0
55 silt/gravel/cobble
Below Ground:
206 ft.
55
106 sand/gravel w/clay streaks
Above Ground:
2 ft.
106
117 clay
Gal/Min:
7117
121 gravel/silt
121
148 pea gravel
Static Level:
172 ft.
148
155 sand
155
164 silt/gravel
Casing:
208ft. of 6 in. x .25 in. steel
164
177 wet gravel/silt
177
199 clay/silt/sand
Liner Pipe:
N/A
199
203 gravel/sand/water
203
205 sand/water/gravel
Screened:
N/A
205
208 gravel/water/sand
Perforated:
N/A
Grouted:
Yes
Depth:
20'+
WATER T'ES'1'9N0
Develop. Method:
Air
VITY
ColsfOrm 4 C01/100ML
Nitrates (V L
Use of Well:
Residential
A'rseNc —ug/'
Drilling Method:
Rotary
Misc:
Other:
Chlorinated to 50ppm
The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 7gpm .
Date Drilled:
2/9/2022 Driller: Brandon Moore
Development Services Department
Building Safety Division
7 tin -Site Water & Wastewater Program
ggun 4700 Elmore Road
P.O. Box 196650 d ��
Mark Begich Anchorage, AK 99507 S A F E T Y
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW OSP211488 Date of Issue: 12/14/2021
Parcel Identification Number: 051-822-07
Legal Description Property Owner Name & Address:
Chandelle Acres Lt28 Hultquist Homes
23915 Chandell Dr 12570 Old Seward Hwy #204
Chugiak, AK Anchorage, AK 99515
Pump Installation Date: 8/25/22
Pump Intake Depth Below Top of Well Casing: 180' feet
Pump Manufacturer's Name: Meyers
Pump Model: 3NFL102-8-P4
Pump Size 1 hp
Pitless Adapter Burial Depth: 13 feet
Pitless Adapter Manufacturer's Name: Cambpell
Pitless Adapter Installer: Unknown
Well Disinfected Upon Completion? ✓❑ Yes ❑ No
Method of Disinfection: Sterilene
Comments:
Pump Installer Name: Wheaton Water well, Inc.
1190 N. Wasilla-Fishhook Road
Wasilla, AK 99654
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP211488
Work Type: WellSeptic Initial
Tax Code Number: 05182207000
Site Legal Address: CHANDELLE ACRES LT 28 GA 560
Site Mailing Address: 23915 CHANDELLE DR, Chugiak
Owner: WHITE DAVID L & GAYLE L
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
i»en�
O
U ♦h
t�epartrne�lt
Lot Size in Sq Ft:
Total Bedrooms:
12/14/2021
12/14/2022
49312
Q Disposal Field Cif Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ 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
Com 1 c 1_Q . — - 1/31ZZ
Received By: Date: _
Issued By:Date: 1:2
0
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-822-07
Property owner(s) Eklutna Inc. Day phone 907-310-2501
Mailing address 16515 Centerfield Drive #100, Eagle River, AK 99577
Site address NHN Chandelle Dr.
Legal description (Sub'd., Block & Lot) Chandelle Acres Lot 28
Legal description (Township, Range & Section)
Lot Size 49,312 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(N all that apply)
Absorption Field
❑X
Septic Tank
Q
Holding Tank
❑
Privy
❑
Private Well
❑X
Water Storage
❑
APPLICATION IS AN:
Initial 0
Upgrade ❑
Renewal ❑
TYPE OF DWELLING:
Single Family (SF) Q
(w/wo ADU)
Duplex (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.
k
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 a 2 0 Waiver Fees:
Date of Payment: I )-o� I Date of Payment:
Receipt Number: 05; 1 014b Receipt Number:
Permit No. 03 R2 11 ya3' Waiver No.
Permit App_'-'- :-
December 2, 2021
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
12/2/21
Subject: Chandelle Acres Lot 28 – NHN Chandelle Drive
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 4-bedroom home on the property, so we are
submitting this permit application for the construction of a new well and septic system. The
attached site plan identifies the location of the home as well as the proposed well, septic location
and alternate site. No conflicts exist between this proposed system and any other well or septic
system, whether on this lot or adjacent lots.
The ground surface on the lot slopes toward the north. The slopes on the property within 100’
downgrade of the proposed absorption trenches do not exceed 46% and comply with the steep
slope provision. The absorption trenches have been designed with steep slope guidelines in mind.
Drainage arrows on the site plan show the grade and direction of flow. Stormwater drainage will
not impact this septic system. The new trenches will be constructed parallel to the slope as much
as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. The alternate site is located
more than 12’ away.
Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211488, Rebecca Carroll, 12/14/21
CHANDELLE ACRES, LOT 28 W-41
ALTERNATE SITE:
20' LONG x 5' WIDE, 4'
EFFECTIVE DEPTH
CATIIIADVANCED
TREATMENT ABSORPTION
TRENCH
1250 -GAL SEPTIC L-,,�'
TANKW/20"
MANWAYQTR
TRACT A
I
28 I
s NEIGHBORING
2-61LONG x -T WIDE, 5.5' SEPTIC
\MT EFFECTIVE DEPTH ABSORPTION 3 5
CO TRENCHES
Co
\. �J 3'0
FS
LOT 29
N#2�
y litw i
�. X10\
FCOFCO
NEJG HBORING ( 4 BDRM HOME
SEPTIC \, \
EXIS� ING WELL ` ;\
10' UTILITY EA ES MEN -
PROPOSED WELL
/ HANDI
_ ----
i
N GHBORING SEPTIC dT IN VIEW AND > 100' FROM WELL
\ — _ LOT 15 \ //
1pGEIN[l RING NOTE:
LOT 14
NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC LEGEND
SYSTEM
��P••' �9,+ CO - CLEANOUT
491N •.'•,* �� ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO - DOUBLE CLEANOUT
"' • • • • • • PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO -FOUNDATION CLEAN(
• SYSTEMS. FS - FLOW SPLITTER VALVE
Benja i Schiller / MH - MANHOLE
' ��� •.• CE 2592 0 50 100 MT -MONITORING TUBE
�sl marslao:, . •''� r FEET
�I�F�F�pROFESSION•' SV - SEPTIC VENT
1 —50 TH -TEST HOLE
46
%
ANG
L
E
OF EF
F
L
U
E
N
T
INFLU
E
N
CE
EXI
STI
NG
GRAD
E
PROPOSED TRENCH 1
PROPOSED TRENCH 2
1"=10'
2010 0
FEET
SLOPE CROSS SECTION
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER12/9/21
>12'
2'
CHANDELLE ACRES, LOT 28
355
350
345
340
335
330
325
320
5 10 15 20 25 30 35 40 45 50 55 60 65 7570
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211488, Rebecca Carroll, 12/14/21
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
3'
5'-6"
DESIGN FACTORS:SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 24 MIN/IN
APPLICATION RATE: 0.45 GPD/SF
5.5' DEEP TRENCH SYSTEM
1250-GAL SEPTIC TANK
BOTTOM OF TRENCH: 10.5' BELOW GRADE
FLOW LINE ELEVATION: 4.5' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
600 GPD / 0.45 GPD/SF / 5.5' DEEP / 2 SIDES = 121.2 LF TRENCH REQUIRED (122 LF SPECIFIED)
12/9/21
GEOTEXTILE FABRIC
4'6"
6"
CHANDELLE ACRES, LOT 28
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211488, Rebecca Carroll, 12/14/21
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
L.TIDWELL
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?-
24 6
4 5
11/23/21
1
2
3
GM (SILTY SANDY GRAVEL)
Professional Engineers Stamp:
N/A
DRY
11/30/21
CHANDELLE ACRES L28
11/23/21
051-822-07
HULTQUIST HOMES
11:481
2
3
0-1 6 16
12:33
12:34
1' OB
30
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER12/2/21
30
30
0-1 416
0-1 416
1 6 16
1 416
1 416
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211488, Rebecca Carroll, 12/14/21
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 2
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
L.TIDWELL
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?-
24 6
4 5
11/23/21
1
2
3
GM (SILTY SANDY GRAVEL)
Professional Engineers Stamp:
N/A
DRY
11/30/21
CHANDELLE ACRES L28
11/23/21
051-822-07
HULTQUIST HOMES
12:181
2
3
0-1 6 16
12:49
1:20
1' OB
30
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER12/2/21
30
30
0-1 416
0-1 416
1 6 16
1 416
1 416
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211488, Rebecca Carroll, 12/14/21
- ~ [~ SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
DATE PERFORMED: '2- / ~;,/q- ~ ~/
SITE PLAN
lO
11
12
13
14
15
16
17
18
19
2o
COMMENTS
PERFORMED BY:
/~O~.7~i~4 ~ 1L~d~_ WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading Date
~-/~
~-/¢
CE ~
2-/¢
0
P
E
7-/'~
Gross Net Net
Time Time Drop
Depth to
Water
PERCOLATION RATE
~ ~ ,.~..~/~,~TEST RUN BETWEEN
'~O (minutes/inch)
~ FT AND ~' FT
DATE:
?-/¢.
72-008 (6/79)
700 "H" STREET, SUITE I
ANCHORAGE, ALASKA 9950I
TELEPHONE (907) 272-9151
PAN
A
MERICAN
CONSULTING
ENGINEERS
ARCHITECTURAL, CIVIL,
ELECTRICAL, MECHANICAL
STRUCTURAL ENGINEERING
December 28, 1978
The Blue Max Corporation
411 E. 36th Avenue
Anchorage, Alaska 99503
Attention: Mr. Robert Ohrt
Subject: Soil Investigation for '!'Chandelle A~re$'I Subdivision, Peters Creek,
Alaska.
Dear Mr. Ohrt:
On December ll, 12, and 13, 1978, we conducted a subsurface soils investigation
to determine the suitability of this proposed subdivision for on site sewage dis-
posal systems, for satisfactory road and runway subgrades, and for supporting
the foundations of residential structures. The investigation complied with the
requirements of the Department of Health and Environmental Protection, Municipal-
ity of Anchorage.
A backhoe was utilized to excavate five (5) test holes. Soil samples were taken
at depths as indicated on the Test Hole Logs for sieve analysis and two samples
located in planned roadways were taken for hydrometer analysis for an accurate
determination of frost susceptibility. The test samples show the soils to be SM,
silty gravelly sand or GM, silty sandy gravel generally and tend to become more
impervious with depth. This indicates that the preferred leaching system on most
of the lots will probably be trenches rather than leaching pits. Probably, as
indicated by T.H. #1, there will be some pockets of sand and gravel but it is
not predicted that these will be extensive nor frequent. Also, there will prob-
ably be some silt pockets which are more impervious than that indicated by the
percolation tests which were made at each of the test holes. Again, it is not
felt that these silt pockets will be large nor widespread and can be compensated
for by the engineer making the soils inspection at the location of the particular
leaching field.
Percolation tests were performed on ledges located within the test holes at the
depths indicated on the Test Hole Logs, see Figures 3, 5, 7, 10, & 13 for the logs
and the results of the percolation tests. Holes approximately 10" in diameter and
with a depth of 18 inches were dug into undisturbed soils. Procedures described
in Public Health Service Publication No. 526, "Manual of Septic Tank Practice",
were followed in making the percolation tests.
No ground water was encountered in any of the test holes and is not expected to
pose any problems for on site sewage disposal systems nor for subgrades in road,
runway, or residential construction.
Soil In
~tigation, Chandelle Acre~
Page 2.
Frost had penetrated approximately one foot below the ground surface at the
time of 'the investigation but no permafrost was encountered in any of the testl.
holes. The majority of the soils which will be serving as subgrades for the
roads, runway, and residential construction will be either F1 or F2 for frost
susceptibility. Commonly accepted design and construction techniques should
limit.frost movements to tolerable levels with the types of soils which were
2~-~'~'found during this investigation. Since the soils analyses show that the soils
become more frost susceptible with depth except for the thin layer of hUmus
soil at the surface which will be stripped for all construction over excava-
tion is not expected to improve the quality of the soils as subgrades for the
roads, runway, or house foundations.
Although it is felt that this soil investigation has shown the general nature
of the soils and conditions for this proposed subdivision, soil conditions can
vary between the test holes without any surface indication. Therefore, tech-
.~.~~:.~nical assistance should be. utilized to evaluate the soi,.l~conditions during the
~ 'development construction of this subdivision.
Sincerely yours,
L. 0. Mathis, . .
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MUNICIPALITY OF ANCHORAGE
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Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-822-07
Legal description Chandelle Acres Lot 28
Site address 23915
Current property owner(s) Chandelle Dr. Anchorage
Expiration Date: 12-16-22
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Bye Original Certificate Date: q —1 C —2:2>
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovWjune 2022
PV1UH0C� F A L0 u Y OO F A H CCH0R%„
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Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-822-07
Complete legal description Chandelle Acres, Lot 28
Location (site address) 23915 Chandelle Drive, Anchorage, AK 99567
Current property owner(s) Hultquist Homes, Inc
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone (907) 522-3204
3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑® Plastic ❑ Concrete ❑ Fiberglass
Age 1 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ®❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee 12-0 Waiver Fee $
Date of Payment S 03Z -Wo -0 Date of Payment
COSA # (D S L 2 7,( Waiver #
COSA Application_ June 2022
COSA Checklist
Legal Description: Chandelle Acres, Lot 28 Parcel ID: 051-822-07
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 2/9/22 Total depth 208 ft
Cased to 208 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 2/9/22
Static water level at beginning of test 172 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping New Installation
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/3/22
❑ 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.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced N/A gallons N/A date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Comments/Deficienci
COSA Checklist June 2022
Well production at time of test 7 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L On Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Wheaton Water Wells
Date 9/1/22
C. LIFT STATION
L uired maintenance completed
Age of lift sta i _ years
Lift station material
Comments:
Adequacy test date NEW
Results on Pass
N
d depth prior to test in
Wat added gal
New flui epth in
Elapsed time min
Final fluiddepth in
Absorption rate gpd
FIELD STATUS — POST ECOVERY
Effective depth (per recordwings) in
Effective depth used in
Effective depth remaining iri
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
O Yes
if No
Community Sewer Manhole/Cleanout > 100'
DYes
if No
ft
EYes
if No ft
Neighboring Tank > 100' ❑® Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' Fu_1 Yes
if No
ft
Holding Tank > 100' QYes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' R Yes
if No ft
Q Yes
if No
ft
ft
If tank or field is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q Yes
if No
ft
Q Yes
if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) 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 _
Tank to Property Line > 5'
❑® Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
0 Yes
if No
ft
Private Wells > 100'
FE -1 Yes if No
Water Main > 10'
E Yes
if No
ft
Community Wells > 200'
0 Yes if No _
Water Service Line > 10'
M Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
ft
ft
ft
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Forge Engineering
Engineer's Printed Name Benjamin Schiller, P.E.
COSA Checklist—June 2022
Phone (907) 522-7773
Date 9/13/22
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