HomeMy WebLinkAboutSKYLINE VIEW #1 BLK 5 LT 4BOnsite File
Skyline View
#1
Block 5
Lot 4B
#051-191-37
Municipality of Anchorage Page of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: _! t>W l °joo f2 PID Number: 0S;1 -•• l9 L-
Name:
#c. Ae� GAgT Qv
Wastewater System: EI New Upgrade
Address:
P. �,yZoZ� CNuGlA1c IL L'�
ABSORPTION FIELD
Phone: ' �
(' Y
No. of Bed come:
o Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
1 0
Total Depth from original grade:
• GPD/Sq. Ft.
-5.
Lot: Block: Subdivision:
4.B 5 S
Depth to pipe bottom from original grade:
l t
Gravel depth beneath pipe
\116 vJ
-9.0 - . S Ft.
2.0 + Ft.
Township:
Range:
Section: a_
Fill added above original grade:
Gravel length:
-3. • o Ft.
90' -. .S EAGq. Ft.
WELL:t ❑ New ❑ Upgrade
Gravel width:
Q
Number of lines:
ro
Distancebetweenme
.5. Ft.
Classification (Private, A,B,C):
Total Depth:
sed To:
Total absorption area:
Pipe material:
vkIV
Ft.
Ft.
b - s13 SQ. Ft.
Asan 0-3C1 F 010
Driller:
Date Drilled:
Static Water Level:
Installer: /'
GREENZ✓ �rS(WitTrNC
Date ins ailed:
Ft.
.37
3 11 " M/99
Yield:
Pump Setat:
I
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
KSeptic ❑ Holding ❑ S.T.E.P.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Private
Sewer Lines
Me ufacturer:
rIGyID�ArG� IAev� (_
Capacity in gallons:
z.,O
Well,__.
1101+
l?oi-
^,
#
ZS t
Material:
S -rc-f=�Z
o
Numberf Compartments:
SurfaceLIFT
Water
I oo +
100
STATION
Lot
1
1
_
Size in gallons:
Manufacturer: /
Line
to 4'
10
Foundation
ra 14
1+
.,Pump on" level at:
"Pump off" le
High water alarm at:
Curtain--
11
I'
m
Pump Make 8
Electrical Inspections performed by:
Drain
NO/�
1 -No
/
Remarks:
BENCH MARK
Location and Description:
'i I P of Cott R Te Snag
Iri GArtA,C C -
Assumed Elevation:
)00 Ft
ENG#NEF�
A ® o
°CIO
' 6 —yq
0 6 Y
Inspections performed by: Dates: 18 11 9�
6cn'•'.6 VV d •• 016.0• 9.s
2nd 3/1?
....... ,;..
"` -�. J r . Gornee'n rw
o� G' 7953
Department of Health and Human Services app oval
° °
Y( "'I,
�� 3-Z5- 99
y• o,n
'sc t f'n C4r$IO��P oB
kuk��.����
Reviewed and approved by: Date:
72.013 (Rev. 9/91) MOA 25
NUMBER:
SW99001Z
ILTDRAWING
PARCEL IU NUMBER:
PARCEL
051--191-37
SUMAC DRIVE
ST1 58.8
10.3 \, EXISTING TRENCH TO BE
ST2 63.1
18.0 \ \ USED AS A RESERVE SITE.
DBL1 615.0
21.2
DBL2 65.8
22.5 \ ` _\
FD e 66.8
24.1
FS 57.2
33.7
C01 60.4
36.1 NfW DRAINFIELDS
w
CO2 105.0
77.5 C04
CO3 54.0
47.3
02
C04 102.0
83.1 a / ! /
MP
MT'I 83.2
\, /!
MT2 78.1
64.8
v nn2! /
/Tfi#1
LLJ
INSTALLED FLOP! � J ! %
> '
SPUTTER (FS)-"--,_ Go
INSTALLED FLOW
DI,ERTER (FD)-----`
CO
ST2
NEW 1250 GALLON---t----
���sT1
DBL2
LTJ
SEPTIC TANK oBL1
��
FCO
=
,
EYIAY`I
cn
H
�
<
4ANsE
KGs
`I
Ulu
li
(rte
WELL
{
I
j
I
I
I
I
J
� i
ALASKA WATEE. AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD SUITE 20, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FA%: (907) 338-3246 10' UTILITY EASEMENT
Qosy'�'`� ,S4400
' • .•��-n-*
LEGAL DESCRIPTION:
(�. �O
SKYLINE VIEW
SUBDIVISION; LOT 49, BLOCK 50
„ „ ..... •,,,,0
0
TWE OF WORK:
AS—BUILT
OF SEPTIC SYSTEM
•••...
frC 7953
OQ
PREPARED FOR: PHONE NUMBER:
9S, u`�Q
.e
MICHAEL AND MARGARET QUINN 688-1145
09
PAGE:
DATE:
3/16/99
DRAWN BY:
J.L.M.
SCALE:
1 = 40
2 OF 3
00pp,00Q�"
PERMIT NUMBER: _% PARCEL ID NUMBER:
SW990012 ppS-BT LT DRAWING
051-191-37
.-FINAL6WM a 10I,90t
tP Of ua AT-
imr ay ftm.
AT IMXT a 97.12
WEST TRENCH
CO3
MT2_ CO4
PI5fkIDIkf1ON I IN,
INMRT - 920 (AVO
m
5r2
NSW IM GALLON
VIC �A K
'I" 6Rn
-,99,90+
-OpIGINAL 6pWr
e 95,50
ray Or LIP AT
\_IN)&9 r R Fln
AT ouur ` 96,90
PINK GSE
- 100,30+ -
ORIGINAL Gt?f r
96,81 --I
P15VIDIMN LM -
INWkr - 93,81(AVGJ
EAST TRENCH
CO1
CO2 MT1
MNGH DOfTOM--J 19NIGH DOfTOM-i
90,10 (AMM) - 91,69 (AVEC 60
ALASKA WATER. AND WASTEWATER CONSULTANTS, INC.
6901 OEBARR ROAD SUITE 2B, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FAX: (907) 336-3246
LEGAL DESCRIPTION:
SKYLINE VIEW SUBDIVISION; LOT 4B, BLOCK 5,
TYPE OF WORK:
PROFILE AS -BUILT OF SEPTIC SYSTEM
PREPARED FOR: PHONE NUMBER:
MICHAEL AND MARGARET QUINN 688-1145
DATE: DRAWN BY: SCALE: PAGE:
3/16/99 J.L.M. N.T.S. 3 OF 3
OF
MIN
s C ...7953
��Qncdp� o f es slon0c.,c"��
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services kv'OA. 0V 2
On -Site Services Program 3 ,' () . 9 9 t �Vvl LI. P yvl
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650 Z^� -4 tQp,u <, ' q,_I n
' YVI � � M
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Feb 11. 1999
Expiration Date: Feb 11, 2000
Permit Number: SW990012 Parcel ID: 051-191-37
Legal Description: SKYLINE VIEW BLK 5 LT 4B
Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 023140 SUMAC DR
Owner Name: MICHAEL & MARGARET QUINN Lot Size: 49486 SQ. FT.
Owner Address: PO BOX 672023 Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567-2023
This permit is for the construction of:
�] Disposal Field[V] Septic Tank [7 Holding Tank [] Privy Private Well Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: -42"10 -
Date:
10
Date: 2"-//`/%
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 211 — Anchorage — Alaska 99504
(907) 337-6179 — Fax (907) 338-3246 I e ` ED . `.
Consulting Engineers f f �/ h ld
r --pp a" 1999
February 4, 1999 MONK,-WA\u i r ur ANCHORAGE
ENVIRONMENTAL. SERWCES DIVISIp14
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Upgrade Design for Lot 413, Block 5, Skyline View Subdivision Addition #1.
To whom it may concern:
The existing 4 bedroom house is served by a private septic system and by a private well. The
existing drainfield is surcharged and must be upgraded prior to the sale of the house. A test hole
was excavated to the west of the existing septic system. Comments regarding the proposed
upgrade design are summarized as follows:
1. SOILS: Attached is the log which shows the soil profile, and the percolation test result.
Below the organics, the soil is a GW/SW material to a depth of 10 feet and then transitions to a
GP/SP material to a depth of 12.5 feet (bottom of test hale). A groundwater seep was
encountered during the excavation at a depth of 12 feet. After seven days, the monitoring tube
was checked and was found to be dry. A soil percolation test was performed between the depth
5.5 feet to 6.0 feet and was determined to be less than 1 minute/inch. Given the high percentage
of sand, the insitu soils should act as a sand filter. A grab sample can be provided if deemed
necessary.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.0 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 600 ft2
f. Effective Depth: 2 feet
g. Reduction Factor = 0.70
h. Width: 5 feet (minimum)
i. Minimum Length: 90 feet total len th (2 @ 45 feet long each)
j. Effective absorption area = 643 ft (>600 ft2 OK)
k. Maximum depth = 6.0 feet (on uphill side)
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The general topography in the area of the proposed upgrade is a 1 to 5
percent slope running from approximately southeast to northwest, in short, there are no slope
concerns (see design).
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
Sincerely,
JeITro ,�. g*ness, P-F� M.S.
NOTE: Attached is a site plan drawing, a design drawing, a soils log and a 4 page construction
specification letter which are all part of the design package for the upgrade of this septic system.
ALASKA WATER, AND WASTEWATER CONSULTANTS, INC,
6901 DEBARR ROAD SURE 213, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
LEGAL DESCRIPTION:
SKYLINE VIEW SUBDIVISION ADDITION #1; LOT 4B; BLOCK 5;
TYPE OF WORK:
SITE PLAN FOR SEPTIC UPGRADE DESIGN
MICHAEL AND PEGGY QUINN 688-1145
2/4/99
J.L.M. I 1= 100' 1 1 OF 2
LOT 7, BLOCK 1,
SUE TAWN ESTATES ADDN #1
OF
y ..
�F� lm
,P. ,
fre A. ness-
C —7953 oG
I
LOT 4, BLOCK 4,
r
i
SKYLINE VIEW S/D AODN #1
SERVED BY PRIVATE WELL AND
SEPTIC PER M.O.A RECORDS
LOT 4, BLOCK 1,
SUE TAWN ESTATES ADDN #1
i
SERVED BY PRIVATE WELL AND
SEPTIC; PER M.O.A RECORDS
C
ff
SUMAC DRIVE
------- - - --- ----
W
,
r
z•
-I
PROPOSED SEPTIC UPGRADE
(n
(SEE DESIGN, PAGE 2 OF 2)
<
i
�r
5. BLOCI�AD�N
in
L \ i��
xa'�a. ��
�I
SUE TAWN ESTATEST #1
0�
SERVED BY PRIVATE WELL AND
SEPTIC PER M.O.A RECORDS
[vim
S cn
m
h�5
ow
mss)-l.l
p 4 E1n1S0roa
a'EXISTING
Qp
!
SEPTIC
YMEM
I WELL
�
------------
LOT 6, BLOCK 1,
SUE TAWN ESTATES ADDN #1
SERVED BY PRIVATE WELL AND
SEPTIC PER M.O.A RECORDS
ALASKA WATER, AND WASTEWATER CONSULTANTS, INC,
6901 DEBARR ROAD SURE 213, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
LEGAL DESCRIPTION:
SKYLINE VIEW SUBDIVISION ADDITION #1; LOT 4B; BLOCK 5;
TYPE OF WORK:
SITE PLAN FOR SEPTIC UPGRADE DESIGN
MICHAEL AND PEGGY QUINN 688-1145
2/4/99
J.L.M. I 1= 100' 1 1 OF 2
LOT 7, BLOCK 1,
SUE TAWN ESTATES ADDN #1
OF
y ..
�F� lm
,P. ,
fre A. ness-
C —7953 oG
NOTE: THE CONTRACTOR SHALL VERIFY THAT ALL
SEPARATION DISTANCE WILL BE MET PRIOR TO
CONSTRUCTION.
PROPOSED DRAINFIELD UPGRADE
EXCAVATE TWO TRENCHES THAT
ARE 6 FEET DEEP (MAXIMUM)
BY 5 FEET WIDE (MINIMUM)
BY 45 FEET LONG EACH
(90 FEET TOTAL LENGTH)
SUMAC DRIVE
s �n7 I
®.r.
/ 0
MT(rF
!/ /
/ !r
�.1 Cco
INSTALL FLAW SPLITTER
INSTALL FLOW DIVERTER--a-- t --'J
0
PROPOSED 1250 GALLON
SEPTIC
ASPHALT DR1VG�4'( FCO
VA S EM
CO
-EXIST
TO BE AB
/
1 t�-
I �-
WELL
I
I
1
10' UTILITY EASEMENT
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD SUITE 20, ANCHORAGE, AX 99504
PHONE: (907) 337-6179/FAX: (907) 336-3246
LEGAL DESCRIPTION:
SKYLINE VIEW SUBDIVISION ADDITION #1; LOT 48; BLOCK 5; G
TYPE OF WORK: p
DESIGN OF SEPTIC SYSTEM UPGRADE Q
PREPARED FOR: PHONE NUMBER:
MICHAEL AND PEGGY QUINN 688-1145
2/4/99 J.L.M. I 1= 40' I 2 OF 2
ING TRENCH TO BE
AS A RESERVE SITE:.
�L GO
G SEPTIC TANK
JDONED COMiPLFTEI_Y
l '
1
1
I
I
I '
I
I I
I
1
I
WAS
V ire A. G\ agss
Cf�-7953 `�oG
ession0\
AI„ASKA WATER & WASTEWATER CONSULTANTS, INC.
7320 E. CHESTER HTS. CIRCLE " ANCHORAGE, AK. 99504
PHONE (907) 337-6179 • FAX (907) 338-3246
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: SKYLINE VIEW SUBDIVISION ADDN. #1; LOT48, BLOCK 5,
PERFORMED FOR: MICHAEL AND PEGGY QUINN
DATE PERFORMED: 1/28/98
DEPTH_ _.: TEST HOLE #1
(feet) _.-� -�-� ORGANICS
1
c °
7 ` ^
00 0
V°v
ALJ°.
r
oU°
10
nno
GP/SP
HARD DIGGING
12 �He
A " B.O.H.
13
14
15
16
17
18
DEPTH TO
J 1
o
GROUNDWATER
SOIL
CLASSIFICATIONS
1/28/99
DRY
2
oc4•
l � I
SITE 5
PLAN
IOD �;_-----"�`'
i
--EXISTING
GW
SEPTIC
SYSTEM
ORG
s
' aV
��G
!� `R
GP
ML
�, _
111 ;
I
o°
`.
I
GM
CL
'6,I
GC
OL
o c(_
sw
MH
po op�p
I 5
°t
GW/SW
SP
CH
"
>°
°
WITH SOME LARGE
SM
,'.
OH
6
poor
BOULDERS/COBBLES
,
SC
p°
WITH SOME SILT
c °
7 ` ^
00 0
V°v
ALJ°.
r
oU°
10
nno
GP/SP
HARD DIGGING
12 �He
A " B.O.H.
13
14
15
16
17
18
DEPTH TO
DATE
GROUNDWATER
PROPOSED SEPTIC UPGWE
(SEE DESIGN, PAGE 2 OF 2)
SEEP ® 10'
1/28/99
DRY
2/4/99
SUMAC DRIVE
j
Lr
CLOCK
TIME
PROPOSED SEPTIC UPGWE
(SEE DESIGN, PAGE 2 OF 2)
WATER LEVEL
READING
NET DROP
(INCHES)
l � I
SITE 5
PLAN
IOD �;_-----"�`'
i
--EXISTING
�
NE
SEPTIC
SYSTEM
NOUS
��G
!� `R
1
I Y �rVlELL
I i
I
I
I
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
�
NE
\M
191 PERCOLATION RATE <1 (MIN./INCH)
20 TEST RUN BETWEEN 5.5 FT. AND_
COMMENTS: THE INSITU SOILS SHOULD ACT AS A SAND 1LTE
PERFOMED BY ALASKA WATER & WASTEWATER I, - 1
THIS WAS PERFOR E IN ACCORDANCE WITH ALL STATE NICI
DATE. DATE: -Z 4e
rERC. HOLE DIA. 6" (INCHES)
.0 FT.
, CERTIFY THAT
ES IN EFFECT ON THIS
% MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & E=NVIRONMENTAL PRO-rECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AME06001111I INSPECTION REPORT
NAME rPmHONE NEW
a� J
J& Iry MC CV—I->1etl ') ❑UPGRADE
MAILING ADDIRESS
14,—
I
.■�■I
72-013 (Rev_ 3!721
P. d. Sox
C'h��;,mak
LEGAL DESCRIPTIIQNen>'T
LOCATION 11
J"e T4Wt
// 1
l� ��u `Ar-
NO. OF BEDROOMS
®
U Y
DISTANCE TO:
WeII
f I' -
Absorption area
/`��
` �L--
Dwelling
//�
PERMIT NO.
90067
-_2
0.
�
Manufacturer
ri
Material
No. of compartments
N
S t�
Liq. capacity gallons
6-0/
IF HOMEMADE:
Inside length
Width
Liquid depth
DIST L;E TO:
Well
welling
PERMIT NO.
Z2
0x Z a
facturer
aterial
capacity in gallons
w
DISTANCE TO:
Well
Fou�a ion
�.?�
Nearest l�ne
%
PERMIT NO. / L/�
LL
No. of lines I
Length of ,CP line
Total length of lines
Trench width
Distance between lines
Q
Top of tile to finish grade
nV
Material ben th the �
n2
Total effectiveabsorption aria
LengthWidth
W
(7
N Type rib Crib diameter
a.
Lu
Uj
rn DISTANCE TO: -wed
eII
Class Depth
J
W
DISTANCE TO: Building foundation
OTHER
PIPE MATERIALS
f
1'�yc 1-) �U -ski
SOIL TEST R[ATI NGn
INSTALLER
LA) % c)n ) GG C h C
REMARKS
Depth
Crib depth
Building foundati
Sewer line
Nearest lot line
Distance to lot
Septic tank
on area
PERMIT NO.
Absorption areals)
■ow—
1110111MI
l���l
NONNI
IMENI
DATE LEGAL
I
.■�■I
72-013 (Rev_ 3!721
IINW
-.'ll
APPROVED
DATE LEGAL
72-013 (Rev_ 3!721
' M 1.1141 10: 12 1: doll I_I -T- W 0:1 Fo." ��9!, _.I F--,� F -'A C.i KEO,
DEPHRTM�NT OF HEHLTH HND PROTECTION /1c,W1
STREEET/ HNCHORHGE, HK, 995�1
///��^ /���
264-4720 ^ �7��. Or c) �
��!s-. 1 "IF' IE-'., --..O _7 7:". "U��Fe. �F III - e I -, E F �
PERMIT NO. ( S10745 )
HPPLICANT JERY 0 ' P.D BOX ]61 CHIGIHK / 688�2
LOCFIT ION SUET N DRIYE �
LEGHL LO BLK 5 SKYLINEVIEW HDD.# LOT SI -:.E 4]2560 SQUHRE F�� ���—
TYPE OF SOIL HBS0RPTION SYSTEM IS: DRHINFIELD
MAXIMUM NUMBER OF BEDROOMS -- 4 IL RATING (SQ FT/BR)� 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
�E-EE:����� ��Y U -r Ii- o = �1:1 FA If"ll "WEE U Q EEO Fil W 1-1 - �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DIS"FAN CE BETWEEN THE SURFHCE OF THE
G�OUND HND THE BOTTOM OF THE FEET).
r H.- El �PA 11-A I! Q 1 T- V-1 1 "-H.5; ! -r-.,---,.C-Eil �IIEE.' ''IF'.
TFiE (3RHVEL DEPTH IS THE MINIMUM DEE.PTH OF CiRHVEL BETNEEN THE PIPE
HND THE BOTTOM OF THE EXCAVHTION (IN FEET).
�����r].EE:: EE IF'"" "Y" :1 u-'.-:: '"ll 0:1:11 1 Ci F:_9 Er- 9 Cfl��
PEIT!MIT HPPLACHIT KIA!�:-, THE To lNFORM THIS 1:,EPFIRTME�-4T DURING THE
INSTHLLHTION INSPECTIONS OF H@Y WELLS HDJRCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THHT THE WELL WILL SERVE
Y8AA Co Q 02". 1 1E CUOMO 10] fit EVE Fol Q Q U I W K EV
IBA CKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM c)ISTHNCE BETWEEN H WELL HID AhlY ON-SJT[`.E SEWAGE DI!-'_';POSHL SYSTEM I�
100 FEET FOF�: H PRIVRTE WELL OF: 150 TO FEET FROM H PUBLAC HELL DEPENDING
�PON THE T�PE OF PUBLIC W��L
MINIMUM DISTHNCE FF:011 H PRIVRTE Wf.�,LL TO H PRIVHTE SEWER LINE IS 25 FIEEET FIND
TO A NITkr, :`5EWER LINE IS 75 FEET.
OTIAEF! MHY FIPPL.Y. SPECIF ICFIT' III, NS HND CONSTRUCTION C-IHGRHMS ARE:
HVHILHBLE TO INSURE PROPER INSTHLLHTION
�P=n IN: r"l it: M K 1-2 If" 1 IFT: W Al EDT Q III`= 11".1 E-." E_F�! ���.,: IL.
I CERTIFY T�HT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON--SITE SEWERS HND WELLS AS SET
FORTH BY THE MUNICIPHLITY OF RNCHORHGE.
I WILL INSTALL, THE SYSTEM IN WITH THE COC,ES,
�� I UNDER�THND
THAT THE SEI-.I(.'_'F! SYSTEM MAY REQUIF.!E IF THE
FREES! III)ENCE IS'; REMODELM TO INCLUDE MORE THAN 4 GEDROOM�.
�..... ~.. ..-~�~~�~-�
HPPLI MCNERRNEY
O & E ENUiNEERING & DEVELOHMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Fussell Oyster ,L} q Earl Ellis
694-2774 / SOIL LOG � IT �" 688-2280
Performed for: Name: _ J_ i /1/c �/�= 1 a -f Tel. No.
Mailing Address: �e'/
t. -
Legal Description: Z_ C'� � `�./ «c. e
Depth (feet) Soil Characteristics
0—
,✓ c
2
3
4
5
6_
7
10
11
12
13
14
15
16
105 .i�1`t 1 } 1094
Qr� 7 1 PLOT PLAN
N 0, A/C-,
PERC. TEST
Ground Water Encountered: Yes No If yes, what depth—
Proposed
epth Nroposed installation: Seepage Pit Drain Field—
Comments:
ield Comments: a
Performed by:
Date:
F" is: Hot M X - 1 ISE �1 M.���� R-.1�����
I CERTIFY THRT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR QN~SITE SEWERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2� I WILL INST��L THE SYSTEM IN HCCDRDHNCE NITH THE CODES
SIGNED�..... ..... ..... .... ... .... .... .... .... .... ... ... .... ....... ..... ...
~�^_
HPPLICJE
ISSUED BY
.... ..... ... ..... ........ ....
H
... ..... . ..... . . .... A.
11 Who
C T F" 121 chi
n I 4�����E
DEPHRTMENT
OF H�HLTH HND
ENVIRONMENTHL
PROTECTION
825 �L'
STREET/ HNCHORHGE,
HK
99501
261-4720
/ PERMIT NO ( 820042 )
HPPLICHNT JERRY MC NEFRN1W
BX
361 CHUGIHK
688�2�8�
LCOR TION CHUGIHK
�
LEGHL LT4^B Bl.-.!,:::. 5, SKYLINE
VI�W S/D
LOT SIZE 4]560 SQUHRE FEET
MINIMUM DISTHNCE BETWEEN H
|RELL AND HNY
010-03111ESENHGE
DISPOSHL SYSTEM IS
100 FEET FOR H PRIVHTE WELL
OR 150 TO 200
FEET FROM
H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
. MINIMUM DISTANCE FROM H PTIYHTE
WELL TO
H P�IYHTE
SEWER LINE IS 25 FEET HND
TO A COMMUt%!ITY SEWER LINE
IS 75 FEET
NELL LOGS HRE REQUIRED
BE RETURNED TO THE:
DEPHRTMENT WITHIN ]0 DAYS
C.C. THE WELL COMPLETION.
OTHER R�8UIREMENTS MHY
HND
CONSTRUCTION DIHGRHMS HRE
HVHILHBLE Al INSURE PROPER
INSTHLLATIMN.
F" is: Hot M X - 1 ISE �1 M.���� R-.1�����
I CERTIFY THRT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR QN~SITE SEWERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2� I WILL INST��L THE SYSTEM IN HCCDRDHNCE NITH THE CODES
SIGNED�..... ..... ..... .... ... .... .... .... .... .... ... ... .... ....... ..... ...
~�^_
HPPLICJE
ISSUED BY
.... ..... ... ..... ........ ....
H
... ..... . ..... . . .... A.
�v E-+
O
O
_0
O
O
O
•a'f
O
0
0
S
44
C?
C'J'
�
e
�
e
64
r
�v E-+
t
O
O
_0
O
O
O
0
O
0
0
t
MUNICIPALITY OF ANCHORAGE
ti
Development Services Department R i` Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-191-37 Expiration Date: aLA4
01
1. GENERAL INFORMATION
Complete legal description SKYLINE VIEW #1 BLK 5 LT 4B
Location (site address) 23140 SUMAC DR, CHUGIAK AK
Current property owner(s) BOBBY & BARBARA SPERLING Day phone
Mailing address SAME
Real estate agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU) _-
❑ Duplex If
❑ Multiple Dwellings (Single Family and/or Duplex) G �,
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
FX -1
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 $ O SID Waiver Fee $
Date of Payment 5,12.L1 2- 1 Date of Payment
Receipt Number L aL4 p 1 N Receipt Number
COSA # 0 S C a l 1�2 L a 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. 1 acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E.
6. DSD SIGNATURE
System #1 Approved for 4 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Date 6-24-21
Owl
�.*.-*49TH
. ...........��
t'
a
iri1CHA'cl N. AnDERSCiJ
CE - 9Z
Aw
�k<'D pRGFiSS13.,^�
with the following stipulaat�,���a•�~
By: lul yt \ g
&U—Usj Original Certificate Date: �xsldo� 9
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
Septic System Advisory
Well Flow Advisory
COSA CneGaist blue sneet
Nitrate Advisory
Arsenic Advisory
Otherv\,,h. a �% x
Legal Description: SKYLINE VIEW #1 BLK 5 LT 46
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached) Well production at time of test 1.2+ gpm
Date drilled 612/$0 Water storage tank volume 0 gallons
Total depth 285 ft Well disinfected for coliform test? ❑ Yes ❑ No
Cased to *40'+ ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate 0.66 mg/L ❑ Nitrate less than MRL (ND)
NO Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 16"+ in. Collected by MNA
Date of flow test for COSA 5/4/21 Date of Sample
Static water level at beginning of test 58 ft.
Comments *MOA RECORDS, SURROUNDING WELL LOGS.
Parcel ID: 051-191-37
Structure served by this system
B. TANK DATA
Age of tank(s) 22 years
Tank type/material SEPMWEE
Measured operating fluid level in septic tank 48"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 5/4/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) Y1116199
❑ ALL standpipes present per record drawing
Total measured depth from grade 6/6.3 ft (max)
Measured depth to pipe invert from grade 4/4.3 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
5/4/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/4/21
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 3/0 in
Water added --gal — (60(D 4 —
New depth 3/0 in
Elapsed time 1440 min
FEW Code -required soil cover over field
Final fluid depth 3/0 in
❑ System presoaked Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _
date of test)
Gallons introduced 0 gallons If yes, enter date
Comments/Deficiencies: WEST TRENCH TESTED.
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'
171
Yes
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft✓�
Yes
if No ft
Neighboring Tank > 100' Q Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' Q Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' 7 Yes
if No ft
Yes
if No
ft
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0Yes
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' ❑ Yes if No *5 ft Surface Water > 100'[]✓ Yes if No ft
Property Line > 5'
171
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
F71
Yes
if No
ft
Private Wells > 100' 1771 Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Water Service Line > 10'
MQ
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'
❑Q
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
[]✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓Q
Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' ❑Q Yes if No
Surface Water > 100'
®
Yes
if No
ft
F. ENGINEER'S COMMENTS
*tank installed prior to MOA code change.
ft
ft
G. ENGINEER'S CERTIFICATION
1 certify that 1 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.Ir
,�� f ,• t �t _ f
rs►`...vy
COSA Checklist yellow sheet
ft
ft
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC211268
Subdivision: Skyline View #1 Block:5, Lot: 4B
The septic tank for this property is 22 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Parcel I.D. 051-191-37
30
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 s s e r
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: 7-2, 3 "I
Complete legal description SKYLINE VIEW #1; BLOCK 5, LOT 413
Location (site address) 23140 SUMAC DRIVE *CHUGIAK, AK 99567
Current Property owner(s) JON SCHROEDER
Mailing address
Real Estate Agent
Day phone 854-3539
23140 SUMAC DRIVE *CHUGIAK, AK 99567
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:
Individual Well
lid
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
WaiverNariance request
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by:
COSA to be released to he engineer, unless of ervvi�requested by the engineer.
COSA Fee $ 6;L<0 �-
Date of Payment q1"116
Receipt Numbery C( ZC4
COSA # / 51
Date:
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 Garness Engineering Group, Ltd. Phone (907) 337-6179
Address 3701 E. Tudor Rd., Suite 101, Anchorage AK. 99507-3246
Engineer's Printed Name Jeffrey A. Garness Date /' Ini
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic
system in accordance with the guidelines and regulations established by the Municipality of
Anchorage and industry practices. The reported results describe the condition of the systerr✓s
on the date/s, of the evaluation. Separation distances were measured to readily identifiable
features. Hidden defects or encroachments may exist that were not identified during the
evaluation. The operational life of all wells and septic systems depend on a variety of variables
including, but not limited to, soil conditions, groundwater /aveis (that may fluctuate during the
year), quality of construction (materials and workmanshio), and the water usage of the family
utilizing the system/s. These conditions can vary, and are outside the control of GEG.
Satisfactory test results do not guaranteo future performance of the systems; therefore, GEG
makes no warranty (express or implied) regarding the future performance of the welt or septic
system. GEG makes no representation whether an alternative well or septic system can be
installed on the oronerty in the event either of the current systems fail. The content of this report
is for the sole benefit of the person/party who retained GEG. Reliance uoon the information
provided in this report by any other person orparty, including but not limited to subsequent
orooerty purchasers, isnot authorized. In short, GEG disavows any legal duty to anyone other
than the person/oarty who paid for this report
y *tfilli ssss,s '
.Vi OF AIV6
6. DSD SIGNATURE Z7
JZ ON-SITE
System #1 Approved for bedrooms = WATER AND
System #2 Approved for bedrooms ; o WASTEWATER o
Disapproved � PROGRAM
,'.< p:
Conditional approval for bedrooms, with the following stipulation's°,N/VT SER'l\(:F
...........
By: 49Original Certificate Date:
Theicip it A cb age 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
Septic System Advisory
Well Flow Advisory
COSA blue sheel9-1-12 doc
Nitrate Advisory
Arsenic Advisory
Other
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: SKYLINE VIEW #1; BLOCK 5, LOT 48 Parcel ID: 051-191-37
A. WELL DATA *BASED UPON SURROUNDING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Lo Y/N) YES
Date completed 6/2/80 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES
Total depth 285 ft, Cased to *40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 6/2/80 3/31/2015
Static water level 85 ft, 63
ft.
Well production 3.83 g,p.m, 1.43
g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. NitrateQ.�Nng./L. Collected by: GF( I td
Arsenic: Aloug./L. Date of sample: _W245
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 3/11-15/1999
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping Pumper J & ' 5
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installedJ11-15/tss9 a EAST TRENCH/WEST TRENCH
Soil rating (.d./ft r ft /bdrm) 1.0 System type SHALLOW TRENCH
Length 2 ® 45' = 90 ft, Width 5
ft• Gravel below pipe 2'+ ft•
Total depth *5.89+/*6 31 ft. Eff. absorption area 643 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 3/31/2015 Results (Pass/Fail) PASS For 4
bedrooms
Fluid depth in absorption field before test 0/0 in. Water added 329/308 gal, New depth 0/0 in.
Elapsed Time: 0/0 min. Final fluid de th 0 0
p Lin. Absorption rate >= 600+ g•p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE - If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access
"Pump ofr level high water alarm level
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot
100'+
On adjacent lots
100'+
Absorption field on lot
100'+
On adjacent lots
100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout N/A
Holding tank
Manurelanimal excr 7te storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Pre •oierty line 5'+ Absorption field 5'+
Water main— N/A Wa+erservice line 10'+ Surfs(* water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line 10'+ Building foundation 10'+ Water mail N/A
Water service line 10'+ Surrace water 100'+ Driveway, pt lcingivehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. 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 COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Data ZD j/ -s7 --
(Rev. 11/05)
/S
(Rev.11/05)
O CORNERS SET THIS DATE.
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY: 111=301 OF A4aa�
Skyline View Subd.,IST.Addn.,Lot 413,111k. 5 DATE; w ( .••••.. Qs,��
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 6-6-91 «� 0
INDICATED. IT IS THE RESPONSIBILITY OF THE ,; r rH 9 0
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: y ... ..,
EASEMENTS, COVENANTS, OR RESTRICTIONS NW
WHICH DO NOT APPEAR ON THE RECORDED S,UBDI- 1159 .. r....a
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB 4 < ; Dvene mk Seward ; C
ANY DATA HEREON BE USED FOR CONSTRUCTION- 21-2544°'••, r5�
OF FENCE LINES, OR FOR ESTABLISHING BOUND- ORAWNs
ARY LINES. �'` 41x ;:rte ¢
DMS
`V)
rl
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY: 111=301 OF A4aa�
Skyline View Subd.,IST.Addn.,Lot 413,111k. 5 DATE; w ( .••••.. Qs,��
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 6-6-91 «� 0
INDICATED. IT IS THE RESPONSIBILITY OF THE ,; r rH 9 0
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: y ... ..,
EASEMENTS, COVENANTS, OR RESTRICTIONS NW
WHICH DO NOT APPEAR ON THE RECORDED S,UBDI- 1159 .. r....a
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB 4 < ; Dvene mk Seward ; C
ANY DATA HEREON BE USED FOR CONSTRUCTION- 21-2544°'••, r5�
OF FENCE LINES, OR FOR ESTABLISHING BOUND- ORAWNs
ARY LINES. �'` 41x ;:rte ¢
DMS
I
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY: 111=301 OF A4aa�
Skyline View Subd.,IST.Addn.,Lot 413,111k. 5 DATE; w ( .••••.. Qs,��
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 6-6-91 «� 0
INDICATED. IT IS THE RESPONSIBILITY OF THE ,; r rH 9 0
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: y ... ..,
EASEMENTS, COVENANTS, OR RESTRICTIONS NW
WHICH DO NOT APPEAR ON THE RECORDED S,UBDI- 1159 .. r....a
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB 4 < ; Dvene mk Seward ; C
ANY DATA HEREON BE USED FOR CONSTRUCTION- 21-2544°'••, r5�
OF FENCE LINES, OR FOR ESTABLISHING BOUND- ORAWNs
ARY LINES. �'` 41x ;:rte ¢
DMS
�I.IIRM
2025
i
� z
I _ �
i 1
qr
y
4.4/231
r� I*
t
U�
OJ
, e13el
0
,'t,�o� o
NE 1/4 SEC. 16, , 4 SEC
RETURN TO: Division of Ged1o91oal and Geophysical Surveys (OGGS)
3001 Porcupine Drive (T � w 277-6615)
i
• Anchorage, Alaska 99501 S
' - H A T E R W E L L R E C 0 R
Drilling Company Nave Ma%M11100a D iJli-Tlg--------
/ Please complete either la, Ib, ar lc.
ti LOCATION Of WELL _ _
STATE OF ALASIU
-. DEPARTMENT Of NATURAL RESOURCE$
r
0
U.S.G.S. Local No.
Drllllnq Permit No.
A.D.L. No.
Merid len
I.. Borough Subdivision Lot Block Ib. Fraction Section No.
Anoh uetawn 5 �^ /
'
la• Distance and Direction from Road Intarset[ions
Street Address and Area of Well Location
Feet Below
2. WELL LOG Surface
TOP Bo [tom
Material Type...
' TOp BOiI v 0 _
i Dr jpravel dad bouldors �•
and
r vel water int. _ 4 lol_�
Tewns hit Rx age
5 E/M
3. OWNER OF WELL:. Mra Paul Myers
Address: P.O. Box 351
Chugiak3 Aka 99567
4. WELL DEPTH: (completed) Surface Elevation Oate of
Copiol atE0 _nQi
120 fL iV V
5. Qtable tool ,�"potnry []Or wen [,]Dug
[]Auger []Jetted []Bond . 00th.,:—
yt
6. USE:Ddaesere []tubi le Supply Qlndu3tty
Qlrr lgat'on QRee harge uCommarcial
Test Well []Other:
Brown c1 101 110_
+ Ydet ravel water incl. 110 lLO
7. CASING: []Threaded XZpelded
6 in. to 120 ft. Depth Weight 171bs/ft.
in, to ft. Depth
-^_
---
B. FINISH OF WELL:
Type: GP011 x010 Diameter: 611
- -
Slot/Mesh Size: _ Length:
Set betseeo .-. ft. and -, ft.
fittings: - -_—
i s n,?ArE
)CfPAf
. E)F.J
I'
-'-'
9. STATIC WATER LEVEL:-•�`i_--'• ft•
E] Above []Below land surface
Type of Measurement:
-� r
}'V1i
V
10. PUMPING LEVEL below land surfnce
ft. after hrs. Pumping -_,.,r 9.p•m.
ft, after his. Pumping T- 9.p.m.
il. WELL NERD COMPLETION: []In Approved Pit^�
E] Pi ti ess Adapter Inc Nes above grade
Id. GROUTING: Well Grouted: []7 Yea Q Ho
Material- 11M.41: Cement [] Other:
,•�-
13. PUMP: (If .,.liable) HP
Length of Drop Plpe ft. eaPeclty 9,•P•
Type: i❑1 Submer a l b le [�]1 Ree i proca It l ng - -
QJet 1..J Othe r:
�-
•
14. REMARKS: Bail tested at 20 GPM
Water Temperature:
5, WATER WELL CONTRACTOR'S CERTIFICATION: '
This Weil was drilled under my jurisdlction and this report Is true to the beat of my knourledge and belief:
Magnuson DrilliisrL__ AA 53$5 T
Reyiste red Business Namn - Can tract �censa Nutn er
Address: P',�_OBox 04 la R�/lnvgr //Ap��ka t1�
Signed:--/i=*+e- Oat,: .r.f„Tr.a-=3-xe�'adf
Authorized Repre entail /%-`
Farr; 02-WwR Coup Dlstrib,`Inn: WHITE - State OGGS, PINK - Driller, CANARY - Customer
li
(D
m
JAY WILLIAMS DRILLING
3768447
p.01
A54/5
E�
rn
cn
m
m
m
r
r -
Pt
0
0
�l
tv
Iml
q
tv
p.01
A54/5
E�
rn
cn
m
m
m
r
r -
Pt
0
0
p.01
A54/5
E�
rn
cn
m
m
m
r
r -
Pt
r'n R1 M `+1 "n " 'n ' % 'n h1 M "n
0 0 O O O O 0 0 4 0 0 4
;r
:Vi 10
0 O 0 0 0 0 O 0 O 0 0 O
x1 �r1 bhyy :N :�
Ei EIC E I E
I MAY 7 M2; ;
f urVi iPAI!fyof Ahchdrage
Dent. Health & Human Services q
a
PR -
zr
0
o
>t++
4
b
tv
a
>
H
n
r
ran
a
a
:fYJ
D
r
_
D
C
C
�
D
V N
t
wr
D
D
o
�
t
•
tt
t0
iT
%)
in;d
�
ko
11005
'tn
ft
zr
0
o
>t++
4
b
tv
a
>
H
n
r
ran
:fYJ
D
r
_
D
C
C
�
D
V N
D
r
_
D
C
C
�
D
V N
t
wr
D
D
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH 8L HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1G
051-191-37 HAA# 1e-]fLgS
1. GENERAL INFORMATION
Complete legal description Lot 4B; Block 5; Skyline View Subdivision
Location (site address or directions) —
23140 Sumac Drive
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Chugiak, AK
Michael & Peggy Quinn Day phone
P.O. Box 672023 Chugiak, AK 99567
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
Day lihone
Day phone
688-1145
NOTE: if community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025)Rsv.1/91) Front MOA#21
Engineer's signature
Alaska Water &
Wastewater Consultants, Inc.
Shall be PAID $ 180 -0 ilt,
or prior to, closing for the
Engineering Services Provided,
6. DHHS SIGNATURE
Approved for
Disapproved.
7_ _ ` Date
2 bedrooms.
Conditional approval for
/9/59
�l�f��'�QFE 5 SNP v
bedrooms, with the following stipulations:
Additional Comments
By: I/` Date J 2 J
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.,
72-5(Rev.1/81) sack MOAi21
RECEMU
Municipality of Anchorage MAR 19 199
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNICIPALITY OF ANC
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907 t44+LSERVIC
Health Authority Approval Checklist
Legal Description: �K`(LltJE vltvJ _<UgOIYi51o✓' Parcel 1.D.:_ 7
�Goctc S�
A. WELL DATA I
Well type PA)vATE If A, B, or C, attach ADEC letter. ADEC water system number tj /N
Log present ON) �c S Date completed A6Az_ 8o
Total depth Z8� Cased to y o / -�
p _Casing height (above ground) 1 f
Sanitary seal ON) YES Wires properly protectedN.)
FROM WELL LOG AT INSPECTION
Date of test L -z /$ c ) Za 9
Static water level
Well production Z3o &Pt+ cesr -� z 4' g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate e ✓Vlr L- Other bacteria'
Date of sample: S/R°1 Collected by: - r� • Uj • W • L . , 1 N 6-.
B. SEPTIC/y0XWW TANK DATA
Date installed 3 i z q Tank size )260 Number of Compartments L Cleanouts (DN) YF -S
Foundation cleanout (SYN) �YES
Date of Pumping d EUJ
C. ABSORPTION FIELD DATA
Depression (YQ No High water alarm (Y, ILQ} d\la _
Pumper
5 NNLLOO
Date installed Z q Soil rating g.p.d./ off) 1.0 Systemtype bKAi0Fi4E�S
Length iol Cz 60 YS' Width 51 Gravel thickness below pipe 2 ` —Total depth
Effective absorption area (OHS 96 Monitoring Tube present/N) YR5 Depression over field (Y,@ No
Date of adequacy test N L w Results (Pass/Fail) For 4 - bedroo
Fluid depth in absorption field before test (in.); Immediately after== gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
ms
D. LIFT STATION AS
Date installed
Manho
High water alarm level at*
Cycles
E. SEPARATION DISTANCES
"Pump
*D
Size in gallons
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot Ito 1 4- On adjacent lots
"Pump off" level at*
1 0 0 1 -f -
Absorption field on lot j 30 On adjacent lots loot
f
Public sewer main /� Public sewer manhole/cleanout ti
Sewer /septic service line
z.S 1-F
Lift station � /P,
Pc
SEPARATION DISTANCES FROM SEPTIC/TANK ON LOTTO:
Foundation 6 tt Property line I 0 1 "f Absorption field �� r
Water main/service line 10 1 + Surface water/drainage 1001-i' Wells on adjacent lots 1001
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 1 + Building foundation 35 I fi Water main/service line 101 -
Surface
01 -
Surface water 1001+
1
Driveway, parking/vehicle storage area 15
Curtain drain 1�04E kw oW W Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
l certify that f
in conforman
inspections and review of Municipal
?s in effect on this date.
Signature I v
Engineer's Na e ����`% A"
Date /7?/C� 9
HAA Fee $ n , -)( )
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Fs , •. ") V - NP,,."
'���p�ES51��„"�
MUNICIPALITY OF ANCHORAGE I�>
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
/APPROVAL FOR A SINGLE FAMILY DWELLING
/�1
Parcel I.D. # �w--1Qj-3� HAA #
1. GENERAL INFORMATION
Complete legal description L4 6 61ock 5')'5kg I%re- Vk evi 5„)o
Location (site address or directions) Z5 ( 4<:) S.., ��) Ch u gi al<
Property owner
^`tJe2yN_��
Day phone
Mailing address
('ot3ox
361
Ck')gi-�k
99 SG -;-
Lending agency
Day phone
5G -z Z -77S
Mailing address
Agent S 11a�o� AA Day phone 69g 9z00
Address 166ob Csi ,-ler a Dy { a le Tiye v
Unless otherwise requested, 1 -IAA will be held for pickup.
4
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
La° vow aO°e (l8R'A9d) 9Zo-ZL
•>laom sdaeui6ua leuolsseloid eyl w suoissiwo ao saoaaa aol alglsuodsai
lou sl a6eaoyouy to /4!IudlolunjN ayl •panssl sl aleollpi90 a aaolaq elep azAlLue io suolloadsui lonpuoo
lou op SHHIJ to s,39Aoldw3 •sluewaainbai eleis pue lsaapal uiepao A4slles of iepio ul suollnl!lsul bulpue aiayl pus
sewoy to saaseyoind olAsalinoo a se slyl saop SHHQ ayi •e�sely to alelS eyl ul paaalsl6aa joeui6ue leuolsseload
luapuadepui ue Aq enogs,g gdeifted ul uan16 suopaluesaidaa ayl uodn Aluo paseq soleoilpeC) lenoiddy
Allaoylny yllsaH sanss! (SH
Ha) soouueS uewnH pus OB91-1 to luaw>asdeci a6eaoyouy to AlllediolunVW ayl
NOIlI1VJ
_ / —/ algia
r
:AS
sluawwoO leuo!l!pPy
:suolelndlls bu!nnollol ayl Ul!M 'swooapaq aol lenoidde leuoll!puo0
•panoaddeslp
•swooapaq aol panoaddy
rc www W
alunI1N01S SHHa '9
�
��' l9i61 �Z • ON
b!..-
i 6 z algid J�� aanjeu6ls s,ioeul6u3
C! S6 >\ o�j Z) Ara\.k'"a(y\ PP>S� )O9 _ssaaPPV
g6Q6-469 000z- auoyd xaau%u`tan�f-s�toJ wa!� to aweN
-uolloadsui s!yl to alep ayl uo loalle ui suolleln6ai pue 'saoueulpao
'sapoo alelS pue ledlolunW Ile yl!M aoue!ldwoo ui si wals/\s lesods!p aaleMalsenn ao/pue Alddns
aalem al!s-uo eql 'uolloadsu) pue u0lle6i1s9nul Aw woal pue salq a6eaoyouy to Al!ledlolunW ayl
woal poulelgo uo!lewaolul ayl uo paseq leylAluanaaylanl ! •ulaaay paleolpui ainlonals to adAl pue
swooapaq to aagwnu ayl aol alenbape pue leuo!lounl'ales sl walsAs lesodslp jejumalsem ao/pue
Alddns ielem alls-uo ayl leyl sMoys uolleolldde lenoiddy Ltl!aoylny ylleaH slyl to uollebllsanul
Aw leyl Allaan ! ,moloq uMoys alep uo!lepllen ayl to se pus olaaay paxllle leas /\ua /\q pall ljao syr
U33NION3 A9 N01103dSNl d0 1N3W31d.LS 'S
e
Municipality of AnchorageNnENTAL HVIUs civiSION
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLISTAJ U L - 3 1991
RLegal Description: L `f�,'�k �1cy1'n�V�ei,� 5��� arcel I.D. _ l_ I VE D
A. WELL DATA
Well type WIvA_rt;
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Y
Z.�05
If A, B, or C, attach ADEC letter. ADEC water system number _
Date completed 6 -2. - Driller
Cased to
Casing height 20 ASOJE orKpurvo
Wires properly protected (Y/N) Y
Public sewer main
Public sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample: (,- Z_ 1- 91
AT INSPECTION
(9-91
_ ; On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
_P.m. sdo�age�
Nitrate - o,'S w,a 1 L Other bacteria
Collected by: Gvv s-4''ezv>
B. SEPTIC/HOLDING TANK DATA
Date installed 19 $ I Tank size
Y
1ZSd — Compartments
Cleanouts (Y/N) Foundation cleanout (Y/N) Y
High water alarm (Y/N)
Date of pumping
/1) Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I'z.o On adjacent lots -I- 19�0
-}ZS 1
To property line
Surface water/drainage
.Absorption field
—
4-ZC 61
5'
Z
Depression (Y/N) N
NA
Foundation
Water main/service line
a
-i. SC3
72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE
FROM WELL LOG
Date of test
19 80
Static water level
a51'c'
Well flow
50g%?� �.
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
1,7-0
Absorption field on lot
1-50,
Public sewer main
Public sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample: (,- Z_ 1- 91
AT INSPECTION
(9-91
_ ; On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
_P.m. sdo�age�
Nitrate - o,'S w,a 1 L Other bacteria
Collected by: Gvv s-4''ezv>
B. SEPTIC/HOLDING TANK DATA
Date installed 19 $ I Tank size
Y
1ZSd — Compartments
Cleanouts (Y/N) Foundation cleanout (Y/N) Y
High water alarm (Y/N)
Date of pumping
/1) Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I'z.o On adjacent lots -I- 19�0
-}ZS 1
To property line
Surface water/drainage
.Absorption field
—
4-ZC 61
5'
Z
Depression (Y/N) N
NA
Foundation
Water main/service line
a
-i. SC3
72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) T
SEPARATION DI/STA
Well on later
D. ABSORPTION FIELD DATA
— Manufacturer —
Manhole/Access (Y/N)
LIFT STATION TO:
On adjacent lots
level at
tested
Surface water
Date installed A"-9uc.1 1981 Soil ratingBS sp /1011 Wrd - ren
! System type C
Length 49 WidthGravel thickness e Total depth 140
1_ b0'�"'ti
7 q,a,., P-5.' bQ, I+
Total absorption area l S� ealcvlaled Cleanouts present (Y/N) V
Depression over field (Y/N) Date of adequacy test G Z 1- 91
Results (pass/fail) Pt1J55 for _
bedrooms
Peroxide treatment (past 12 months) (Y/N) N If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 13 On adjacent lots 145, Property line j t 57
To building foundation Z'S1 To existing or abandoned system on lot N A
On adjacent lots *) 00 Cutbank 4 7_') Water main/service line
Surface water + )0 Driveway, parking/vehicle storage area + ( b
Curtain drain N 1:)
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect onn�this inspection.
Kyr
44
Signature �" ` �" �' gg4 E y Al
Engineer's Name �-� VA VVI I,> ^ 61A CIO k
QatePS?! 9 4f,r u`
yi [�sjh. 9 `tea 1 : �.{.r
•� 0*040;y °
AW
Volk
HAA Fee $ Z 9(1• �V
Date of Payment :2_ -7/ p>
Receipt Number 122
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $ —
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456-3116 • FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645
Constructing Engineers
9601 Buddy Werner Drive
Anchorage AK 99516
Attn: Jerry McNermy
Our Lab #: A111436
Location/Project: -
Your Sample ID: L4 BLK 9 Skyline View
Sample Matrix: Water
Comments:
Method Parameter
----------------------
NO3/IC Nitrate -N
Reported By: William E. Buchan
Anchorage Operations Manager
Report Date: 06/26/91
Date Arrived: 06/21/91
Date Sampled: 06/21/91
Time Sampled: 0900
Collected By: CAL
Flag Definitions
U = Below Detection Limit
DI, Stated in Result
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Units Result Flag Analyzed
-----------------------------------------
mg/l 0.3 06/25/91
4 .
0 c --)Lf 9 ( /,YLF
Time e Time
l�sq-f Lo-�C
Date
Date
Date OL1 rn ne L
Inspector
Inspector
7
Inspector
Comments 7
/ (
Conditional Approval
Date Sewer Installed
Permit No.
Septic Tank Size 0
6 -cal
--ca(
Holding Tank Size
Soils Rating
Well To Absorption Area ) i
Well Log Received
Well to Tank
.v
Y._&—
APPLICANT FILLS
OUT LOWER HALF ONLY
Property Owner A -f `'
� �� Phone
Mailing Address60A c %f ��7tJ J /<t k ��, y� ��- & 8
Buyer !�
Address 5a ; -n e A.5 # bo t/ e- -
-q
Lending Institution e-,eo/� ,S u fT `+ '
Phone
Address G- -5 / /� y a bra rr4t c 41 5 kit
Realty Co. & Agent
Phone
Address
Legal Description
'�7 z �^
Street Location J0 e
Type qi Residence
RR Single Family
�-
❑ Multiple Family No. of Bedrooms
❑ Other
Water Supply
Individual i ''
ATTACH WELL LOG. A well log is required for all wells drilled since June
❑ Community i.
1975. For wells drilled prior to that date, give well depth (attach log if
❑ Public Utility
available.)
Sewa�gge Disposal
Im Individual
Year Individual Installed:
Cl Public Utility
When Connected to Public Utility:
❑ Holding Tank
w„ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED-