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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 6 LT 1BSkyway Park Estates Block 6 Lot 1 B #019-151-12 Municipality of Anchorage ' :. Development Services Department -f4i Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SU09O ZO PID Number: 019- 053 - 43 Nems LO415 Kozi,,eAZ Wastewater System: ❑ New Upgrade Address 11210 5!!'.4wi4 Drive ABSORPTION FIELD Plwns Numbar of Bedrooms ffiDdeO TnnC, O $twllow Trento O Bad ❑ Mwrq 0 Ogym LEGAL DESCRIPTION Sal Raurp I•a Total Debt. hom mgmal grade —r Block la SuDdmoon [` (� Sk W Par GPD FT Dope, to pipe bottomhen onpinY kende r Ft. Gre vM depth berwam P.Pe wn 7oalkD Rer,pe c e Sed.m' Ft. Fu added Awve onpnal pada 5.3 Fl GravM lanpth 0-1 Ft. U Ft. I • Well• £ 5T1 x ❑ New ❑ Upgrade Gnw wd m. NumDerad", D..wna WN„a, ",a 1S Ft. I FL ClasNfiuoon (Pnvar A, B. D): ToIA Daps, caked to TMA sbsorpbon area P.P. Material ct. Ft 06.(c Fir Fglo 30311 Driller Date Dnded Slsbc Walar LsvM Installer Dale InNMIed FL 7 11e erv..,�. 8 4 - Isis Oc Y.010ld Pump Set at Count;Count;Naghl Above Grourw GPM FI. FL TANK SEPARATION DISTANCES RSeptic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank lublicrPrivate Sewer Line " •aurer —Greer aDaary Gal I150 we IoOI+ 10o+ — 151Je- MsumA Num of Compannwnw o a sudacewate, N.0, n/.0. — — LIFT STATION Loi U. Lare 5 * IoL+ — — w sower Gal Foundation 5 lo L+ — — 'Pump on, sov n •Pwrp om wvM OL N.ph water Mann at in CuNnDrarn N.o. ^%. 17 — � Pump Make a Mod Elsclnral Inspections perlonhed by R.merka f • •� T.1.,k j a,x;., •all lam BENCH MARK Locebm and Desprnpom. P10 A erdis. i 5.S• •r• Fo4n! ion Cit +124ZA .7 ` Ilan GDAnt(�fA Pt.In1 iC war M Nwmad Nvwpr, o tN UJI $ 0A 100 FL In SFlJILG � I,k,1'�i �Wn � C 1 Inspections performed by: LA(2S SIjr6tclnc Dates: 13' $ i O 9 Engineers Stamp 2 rid A 5 F =�tS.O..AC�rl11 Development Services Department Approval Conditional Approval Date: ' 9 TH. ride N. S.pURKLA!:D, (Reviewed and approved b Date: B L 0 C K 6 firliffE rpe f/C5 Q TIONS TAKEN rWOM ON -SNE WATER AND WASTE WA TEA WMENT DOCUMENTATION. ALL MTAMS SHOWN ARE 25 0 25 50 75 100 LP5 150 SCALD 1' = 50 FL a YUK15 L K/N(i 2 W I I PARK ESTATES BLK 6 LT IBSEPTIC PARK ESTATES 6 LT IB IB SYSTEM AS -BUILT AS -BUILT 103 W 15TH. AVENUE SMAY UE DATE.' AUGUST 21, 2009 ANCH. AK.X99501 11110 SKYWAY DRIVE, ANCHORAGE, AK 99515 (907) 279-3916 SHEET- 21J GRID: 2719 PERMIT H SW 090120 PID / 019-053-43 SKYVAYPARKESTATESB6LIBDLDVG �5 -- - W00 BLVD. SWING 17ES P A B �Q C 41.5'57.5• J ` / LOT 1B D 46.0'57.0' E 46.0' 60.0' f 77.0 61.0 6S3 S&O, 51.5, I 60.0. 31.3' J 1640'1103.5 162.0'199.5' AK 1 1 I AflINDONCD SCPT7C UN /// I / l INSTALLED 4- BEDROOM SEPTIC SYSTEM HOUSC l 1250 GALLON POLY TANK TRENCH LENGTH 1 X 61' / WIDTH ?.S fEET TOTAL DEPTH 9.7 fEET / ROCK DEPTH 15 fEET COVER 4 ffET B L 0 C K 6 firliffE rpe f/C5 Q TIONS TAKEN rWOM ON -SNE WATER AND WASTE WA TEA WMENT DOCUMENTATION. ALL MTAMS SHOWN ARE 25 0 25 50 75 100 LP5 150 SCALD 1' = 50 FL a YUK15 L K/N(i 2 W I I PARK ESTATES BLK 6 LT IBSEPTIC PARK ESTATES 6 LT IB IB SYSTEM AS -BUILT AS -BUILT 103 W 15TH. AVENUE SMAY UE DATE.' AUGUST 21, 2009 ANCH. AK.X99501 11110 SKYWAY DRIVE, ANCHORAGE, AK 99515 (907) 279-3916 SHEET- 21J GRID: 2719 PERMIT H SW 090120 PID / 019-053-43 SKYVAYPARKESTATESB6LIBDLDVG o • c v Standard Trencht A o O O 2.5' Wide 61' Long O Tank Monitor 9.7' Beep 5.3' Sewer rock 1250 gal Septic tank 4' Cover �•S••ri� �!h.. 94.0' Sit t NO SCALE - Monitor — Cleanouts 4' Cover REV.= 98.1' 49th LARS Tank Monitor ELEV.= 99' _. _._. REV.= 88.4' 5.3 Ft of Septic Rock 1250 GAL SEPTIC TANK Effective NO SCALE ELEV= 82.1' BENCH MARK BOTTOM SIDING ® F.C.O. ASSUMED ELEVATION 100 FEET SPURKLAND ENGINEERING SKy AY PARK ESTATES BLK 6 LOT 1B SEPTIC SYSTEM ASBUILT 203 W15th Ave DATE, AUGUST 2L ?009 Anchorage Ak 99501 12230 SKMAY DRAT, AMCHOR16l. AK 9x515 ?7q_z91f, SHEET, 3/3 GRID, P836 PERMIT / SW090120 PIDI 019 -05J -4J 5KYWAYPARKESTA7ES66L18DJ.DWG MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 22, 2009 Expiration Date: Jul 22, 2010 Permit Number: SWO90120 Parcel ID: 019-053-43 Legal Description: Design Engineer: 0007 SPURKLAND ENGINEERING Site Address: Owner Name: LOUIS KOZISEK Lot Size: 0 SO. FT. Owner Address: 12220 SKYWAY DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99515-0000 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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: ` ltd Date: Issued By: h Date: Municipality of Anchorage --�� Development Services Department i\ Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING OKI -093't/ @( )<-- NarjNt aVId 0stows Parcel I.D._ Dia— %SI — )g (N ei11) Propertyowner(s)LOvis K07_15ek Day phone Mailing address Zip Code Site address 1'2Z70 Sk4,oa.o D"Ne Zip Code Legal description (Sub'd., Block & Lot) Skj w•.,, Vti V. £s)ra� e^ SIaV,. C Lot I In Legal description (Township, Range & Section) Lot Size Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 THIS APPLICATION IS AN: Initial ❑ Upgrade B Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. VA (Signature of property owner or authorized agent) Permit/Rush Fees: 53d Waiver Fees: Date of Payment: i 111,10_ 1 Date of Payment: Receipt Number, 0-f- 17 SO Receipt Number: (Rev, 11105) sparMumd EIMU001meerolmg t Environmental Consulting and Design SEPTIC SYSTEM DESIGN Skyway Park Estates Block 6 Lot 1 B Municipality of Anchorage July 10, 2009 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation Permit 12220 Skyway Drive Ladies and Gentlemen: 1 am writing to request a permit to upgrade the septic system for the above referenced property. The proposed system will serve a 3 -bedroom single-family residence. The existing system was installed in 1981 and is at the end of its serviceable life. A soils log, design calculations, site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No Groundwater observed to a depth of 16 feet below ground surface (7/13/09) Soil Rating. From Testhole 7/6/2009 5 min/in = 1.2 gal per sq.fl/day No. of Bedrooms 4 Required Area per Bedroom: I50/ 1.2 =125 sq.R. Total area required: 125 x 4 = 500 sqfl System: We are proposing a 1250 gallon septic tank, and a deep trench absorption field. The absorption field will be 60 feet long and 2 feet wide and contain 5.0 feet (600 sq.ft. effective) of sewer rock. Soils: A test hole was excavated on July 6, 2009. See the attached soil logs. Ground water was monitored for through July 13, 2009. Ground water was not observed. Surface Water: The are no surface waters within several hundred feet of the proposed septic system upgrade. Topography: The lot is generally level. Waivers: None required. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCa)gci.net h. Environmental Consulting and Design The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lou. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, LtpurkI.�nd, P.E. Civil Engineer 203 West 151" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCgci.net l, B L O C K 4 (ell � I LOT 9 S I LOT 2 \ `` P W00 BLVD. S 11 r � Lar 1 '/1 1 P //I r.Or�sx I ell / sar�sr B L!/ C K 6 LOT JA / \\ 1 \ NOTE: ABS IS NOT A SURKWO PLAT. WELL Q SEPAC LOCAMNS TAKEN TROM ON-SITE WATER AND WASTE WATER MOMENT MENT AOCUMENTAWN ALL LOCAAONS SHOWN ARE APPROXMLITE. 50 0 50 100 150 200 250 300 SCAL£t I' = 100 FT. 1� la` LOT 2 I I B L 0 C K 5 LOT 3 .. o LOT 4 [- -4 JYUKKLANU LNOINLLK/NLi I I SKY APARK ESTATES BLK 6 LT 1B I I SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE: JULY 15, 2009 ANCH. AK. 99501 12120 SKYWAY DRIVE, ANCHORAGE, AK 99515 SHEET • 1/3 GRID: 2729 (907) 279-3916 PERMIT Il SV090XXX PID 0 XX -XXX -XX SKYVAYP4RK£ST4TESB6L1BD1.DVG F. --- S WOO BLVD % y LOT IB / ABANDON SEPTIC TANK C) ♦ / >_ V. INSTALL I-8fOROOM SEPTIC STSTCLI 1 / 1150 GALLON STEEL TANK 1 TRENCH LENGTH 1 X 60' / MOTH 2 FEET TOTAL DEPTH 10 fEET / ROCK DEPTH 5 FEET COVER 4 fTfT B L 0 C K 6 LOT IA �....., NOTE: THIS IS NOT A SURVEYED PGI. WELL Q SEPTIC LOrAWNS TAKEN FROM ON -SAC WATER AND WASTE WATER DEPARTMENTOOCWCMA110K ALL LOGIXNJS SHOWN ARC APPROXIYATC. _ 0 25 0 25 50 75 100 125 150 SCALE! I' = 50 FT. I 'LOT 8 49th LARS JT'UMALAnU LNUIN LHInG I I SKYWAY PARK ESTATES BLK 6 LT IB I I SEPTIC SYSTEM D£S/CN 203 W 15TH. AVENUE DATE. JULY 15, 2009 ANCH. AK. 99501 12220 SKYWAY DR/VE, ANCHORAGE, AK 99515 SHUT 21J GRID: 2729 (907) 279-3916 PERMIT # PID # SKYWAYPARKESTATESB6LiBDi.DVG Standard Trench: 2' Wide 60' Long 10' Beep 5.0' Sewer rock 4' Cover Si( t 50 ft of Septic Rock Effective NO SCALE D 1250ga( Septic tank 1250 GAL SEPTIC TANK 1203SPURKLAND ENGINEERING I I SKYWAY PARK ESTATES BLK 6 LOT IB I I SEPTIC SYSTEM SCHEMATIC I 203 WISth Ave DATE JULY 15, 2009 Anchorage Ak 99501 11220 SKYWAY DRA'E, ANCHORAGE, AK 995/S a7o_1a1a SHEETI 3/3 GRID, 2836 PERMIT I SW090XXX SKYWAYPARK£STATES86L180DW0 3 0::: jo----�o 1250ga( Septic tank 1250 GAL SEPTIC TANK 1203SPURKLAND ENGINEERING I I SKYWAY PARK ESTATES BLK 6 LOT IB I I SEPTIC SYSTEM SCHEMATIC I 203 WISth Ave DATE JULY 15, 2009 Anchorage Ak 99501 11220 SKYWAY DRA'E, ANCHORAGE, AK 995/S a7o_1a1a SHEETI 3/3 GRID, 2836 PERMIT I SW090XXX SKYWAYPARK£STATES86L180DW0 Municipality of Anchorage r ��?tcNEEs Development Services Department A, . Building Safety Division h. a„t On -Site Water and Wastewater Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage. AK 995198650 0 4,9 Tii� www.munl.orglonsite (907)343.7904 4 ,• I.ARS E!SPLIRK r(j ^0 11 r. silk (M� Solis S1olis Log - Percolation Test 11 .`�o� Performed For: VQI ISo. M ��t Date Performed: Legal Description: Sk�„y Pill-. £S61e.o 13(o L l b Township. Range. Section:_ Slone Is- 1s16- 17- s- - 17- 18- 19- 20- WAS GROUND WATER Reading Depth Gross Time ENCOUNTERED? (Feet) Net Drop -417/01 oRtaNtc-S 2- 11 r. silk (M� Depth to Water After 3 0 Monitoring?715 „ „ E 4- 9 q;Spln� 2A 6 III LL SIIC./ 7- Silo 90 M;A (I " S at U5;J0 I 50 M., rl ( I 9 - U „ 5: 30 0 M;A ) N 11- 12- 13- Is- 1s16- 17- s- - 17- 18- 19- 20- WAS GROUND WATER Reading Date Gross Time ENCOUNTERED? �/Q Net Drop -417/01 S IF YES. AT WHAT DEPTH? 11 r. L Depth to Water After (( 0 Monitoring?715 „ „ E ate:.j Dale:-294— 9 q;Spln� Site Plan KOa�i Reading Date Gross Time Net Time Depth to Water Net Drop -417/01 4130 P 0 -n; , 11 r. T( (( :n. „ „ art q;Spln� 2A U n Silo 90 M;A (I " Q" at U5;J0 50 M., rl ( I rl U „ 5: 30 0 M;A ) N T� (� 11 PERCOLATION RATE �_Imnw✓.a.lr PERC HOLE DIAMETER CG SO h�tA TEST RUN BETWEEN �_FT AND Co FT COMMENTS P PERFORMED BY: LArS JD wf K'-IQA�� ( �a'rO JD�,Lt,t,M.r� CERTIFY THAT THIS TES WAS PERFORMED IN ACCORDANCE TH ALL STATE AND MUNICIPAUIDELIIIIES IN EFFECT ON THIS DATE. DATE: 1110/0 SPHM�and Enponewong Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: SKYWAY PARK ESTATES BLOCK 6 LOT IB Date: July 15, 2009 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans In accordance with the attached MOA permit. There Is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the project includes the procurement and installation of a 4 -bedroom on- site wastewater disposal system at the location depicted on the attached site plan drawings. The scope of the work also includes the Installation of a new 1250 gallon septic tank, a drain field comprised of 1 trenches,2-feet wide x 60 -feet long, 10 feet deep, with 5 feet of septic rock below the distribution piping. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water or water wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank and a minimum of two feet of cover is required over the drain field. In addition to the required earthen cover, 2 -inch thick, 40 psi, direct bury board foam shall be installed directly over all installed piping. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. S. The property owner shall be responsible for final grading any depressions formed from settlement of backfill material. The property owner is also responsible for vegetation of all areas disturbed by septic system installation activities. 6. Contractors installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used in the Construction of On-site Wastewater Disposal Systems , Dated December 2000, as provided by MOA DSD, On-site Water and Wastewater Program. 203 West 1516 Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagei.net 144 Environmental Consulting and Design Septic Tank Installation: 1. A new septic tank, of the size specified in the design drawings, shall be procured from a qualified manufacture/supplier If the existing septic tank is found to be defective. Construction shall Include two 4" diameter deanouts for pumping access. 2. The burial rating of the tank shall be adequate for the actual burial depth encountered. 3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank. 4. All standpipes on the tank shall extend a minimum of 12inches above the final grade. S. Tanks installed with less than 4 feet of cover shall be insulated. 6. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval is obtained from the engineer. 7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be sufficiently compacted to prevent future settlement of the soil. S. Septic tank inlets, outlets and deanouts shall be fitted with water tight couplings. 9. A deanout shall be installed 1 to 4 feet from the foundation. 10. Post tank deanouts shall be installed per MOA requirements. Does not apply to pressurized lines. 11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. 13. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. 14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and Inspections must be obtained where required by the MOA. 15. The contractor shall verify that the septic tank/lift station is a minimum of 100 feet from any residential water well, 150' from any class `C well and 200 feet from any community water wells. Additional separation distances must also be maintained. 16. The contractor shall remove or abandon the existing tank in compliance with the Uniform Plumbing Code. Drain field Construction: 1. The drain field shall be excavated to the dimensions outlined in the design drawings. If any discrepancies are noted, contact the engineer immediately for clarification. 2. The drain field shall be installed parallel to slope contours. 3. The bottom of the drain field shall be within 2" of level. If the sidewalls or bottom of the excavation become smeared, they must be raked or scarified prior to the placement of filter sand or drain rock. 4. The drain field must be a minimum of 5 feet from the test hole excavation. 203 West 15'" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net Environmental Consulting and Design S. Distribution pipe is to be Installed level with perforations facing downward, atop a level bed of drain field rock. Septic rock shall then be placed atop the distribution piping to provide a minimum of 2" of cover, levet across the entire width and length of the trench, above the piping. 6. A silt barrier must be Installed at between the final drain rock and the native soil ball. The silt barrier shall cover the entire drain rock surface. 7. Monitor tubes must be 4" in diameter, installed In the locations depicted on the design drawings, and extend a minimum of 12" above final grade. The portion of the monitoring tube below the septic rock must be perforated and the portion above the drain rock shall be solid. 8. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be Installed when the backfill depth is less than 3 feet. 9. Drain field back fill shall be mounded to prevent depressions from forming due to subsequent settlement of backfill material. 10. The contractor shall verify that the drain field is a minimum of 100 feet from any residential water well, 150' from any class'C well and 200 feet from any community water wells. Additional separation distances must also be maintained. Inspections: 1. A minimum of two Inspections are required by the Municipality of Anchorage. These Inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The first inspection must be conducted after the excavation of the drain field and before the placement of any gravel. The septic tank may be set in place, but may not be backfilled. 3. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, stand pipes, cleanouts, and Insulation, but before the placement of any backfill. 4. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use In preparing the record drawings. S. The contractor shall coordinate all Inspections with the Engineer. A minimum of 24 hours notice is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurklandl`a`gci.net - MUNICIPALITY OF ANCHORAGE v DEPARTMENT OI' HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION A� 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE: DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ._._. EW 7 CTU GRADE MAI LING ADDR& h—�'— �E LEGAL. DESCRIPTION // '' •-y-- kv LOCATION NO. OF BEDROOMS •II Absorption are Dwelling PERMIT N0X/Q— / ( DISTANCE TO: ©O/ (� 1 — — W ZQ Manufacturer n Materi,/�a� No. of compG,HAents L N Liq. apaci`in gallons Inside length Width HOMEMADE: Liquid depth a Y DISTANCE TO: Well Dwelling T� — PERMIT NO. Z Q Manufacturer Material Liquid capacity in gallons uJj 3: w U Well Foundatio Nearest lot Zinc _ DISTANCE TO: _./O0� .'S �<i 'FronolrJvi PERMIT NO. /'� ��Q� 6-s'— LL No. of lines Len th of each infr Total length o in th J %� "sC Distance betv�Le�t 7, ;;inch y✓ ¢ F. Top of tile to finish grade J Material beneath tile / Total effecj�va absgrption area Ip 63 w Length Width Depth PERMIT NO. QF Type of crib Crib diameter Crib depth Total effcctive absorption area N DISTANCE TO: Wd Building foundation Nearest lot line J s TO� E Depth foundation®DISTANCE Driller Distanceto lot line PERMITNO.Building OTHER _ PIPE MATERIALS ,/I 014-5 % V _ SOIL TEST RATING INSTALLER Y,��grl - REMARKS q ROV P D_ATE L GAL 72-013 (Rev. 3178) V �Jmmn" F 19_N E' --fl g:: A 1" r.. .. 1011.. F.....E- "1" CA F" g_g g" A A. _. F— E' IFA C -i F f..;EPARTMENT _ HEALTH AND ENVIRONMENTAL ��OTE'CiTION c;25 'I...' STREET, FIEp:E:HORAGE, AK. 99501�.`_01 It 61..._,T720 A=::n E°•.9 __. ":_;, ]..-E." E'_E 00 €-_ L4 E:- ,F-" IF- " f f•? 0'1 1 .-A.. PET{MIT ICi. 1.0 ;r 5 :i p' A 0 APPLICANT TRADEMARK HOMES; SRA 1730—Q LOCATION WOO/SKYWHY PARK L...E:CiAL L1..B BLOC:k:6 SKYb.RY PK EST LOT SIZE 22000 SQUARE FEET TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOM'S = " _OIL.. RATING CSG "' THE REQUIRED SIZE: OF THE SOIL ABSORPTION SYSTEM IS: w EE F" -r wi -- =n E_. L �"•� A �. �' F-1 �: R ;121 Ci lzr�!. W A %.-EEL. 1721001'"70–F-1— 15 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIE:LD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN TETE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION &N FEET). TI'HEER:E:, 15 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL. BETWEEN TETE OUTFALL F'IF='E: AND THE: BOTTOM OF THE EXCAVATION (IN FEET). rZ" EE G— 6_.fl I OR FE ID. �5 1E_ L=" 1 I: AT 1- g=9 PA M-': 1 ; E-_ == 11 . &,SLA RRI Cl A:3 FA E__.. g._. C-9 P-4 2L: - PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM 'THIS DEPARTMENT DURING THE. INSTALLATION INSPECTIONS OF ANY WEL.L_:, ADJACENT TO THIS, PROPERTY FIND THE: NUMBER OF RESIDENC:E'S THAT THE: WELL. WIL._L... SERVE. F- E::=: A_-„: T• I A: -A 1,-4,_c3-. F: =9 FE: E ! EE: A -,A LJ :1L E.-° E: E + _.._.....,__.. BAC:R::I=ILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THI'_: DEPARTMENT WIL.L.. BE SUBJECT TO PR?: SE'CUVION, MINIMUM DISTANCE BETWEEN A WELL_. AND ANY ON—',ITE SEWAGE DISPOSAL. SYSTEM IS 1.00 FEET FOR H PRIVATE WEL..L. OR 150 TO E00 FEET FROM A PUBLIC WELL.. DEP'EF+IC:'1:NG UPON THE TYPE OF PUBLIC WELL. MINIMUM UM DI?TANC:E FROM A PRIVATE: WELL TO H PRIVATE SEWER LINE 15 25 FEET APdD TO A COMMUNITY SEWER LINE 15 75 FEET. OTHER: REQUIR:E:MEENTS MAY APPLY. SPECIFIC:ATIOE+S AND COL•.I:=TRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. E 'EE ET'' H'l .E. -1 EE ; E _" 11. g-. FF 11 E_. + F-_ ED En rl ED Ee F " -1.. _. I CERTIFY THAT 1.: I FIM FAMILIAR WITH THE REQUIREMENTS FOR OM --SITE SEWERS WERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WIL...L... INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE RESIDENCE 15 REMODELED TO INC:LUDE MORE: THAN } BEDROOM'_;. L-......................... RPP... CANT TRADEMARK HOMES a ISSUED BY ................ AND WELLS AS SET ENLARGEMENT IF THE: V4. 0 X SOILS LOG MUNICIPALITY Or ANCHORAGE /-- MUNICIPALITY OF ANCHORAH OF HEALTH a J�-OOTC'c TION PEST CATION DEPARTMENT OF HEALTH AND ENVIRONI�1�1��i.�N�f�'I_CTIGN Qt,�a,(y/�9l7� p TEST 825 L. Street, Anchorage, Alaska 99501 261VAi\ q n 1gfJ1 -' SOILS LOG -- PERCOLATION TEST 1 RECEIVED PERFORMED FOR: ' /`F'-� r _ DATE PERFORMED: LEGAL DESCRIPTION: 0� DEPTH e5�'�:i.•ttC (FEET) 1 /�, cr2�r 22 C Mi.) 3 4 S2.nal+- �fa.K-I 6 fi11E�11� 1 9 10 11 12 13 14 15 16 17 18 19 20� I I X1'0` )dle, COMMENTS SLOPE WAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water "� Net /� Drop T/ v 1�3! /u ..3,19 °•�'� (a y Y I 7V J r4 s 0 b PERCOLATION RATE /;Z _��(minutes/inch) TEST RUN BETWEEN ` '� FT AND ._.2' FT PERFORMED BY: a-;14-.,, i _CERTIFIED BY: 72008 (6/79) DA4' ".1 R R R , - p ]:: G.7 jl� r:::,l P_1 q -"7r � C? Tm�'." rl=ll C7 lq� /F?. f I KE:: DEPARTMENT [/P HEALTH AND ENVIROHMENTHL PROTECTION 825 'L' STREET, ANCHORAGE, RK. 99501 264-4720 U��E L.. L.. ��������� PERMIT NO. ( 310377 ) APPLICANT MHYNHRD KELLER 276-8188 LOCATION WOO BOULEVARD LEGHL L 1B B 6 SKYWAY PARK ESTATES LOT SIZE 25000 SQUARE FEET MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM 9 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS"; OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��17�1?: r-1 I - f REE",;-', P' X Es 13 �������F-'! -_11 . . .... I CERTIFY THHT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE, 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED APPLICANT MHYNHRD KFLLER ISSUED BY .............................. DHTE_/� '\'J)-_.__-� Y4.0 MUNICIPALITY OF ANCHORAGE Department Health and Environment:a ?rotection 825 z, Street, Anchorage, AK. 99501 264-4720 # # HANDWRITTEN PERMIT WELL fC-a5' lV 6 3�°'„� PERMIT °lo ol�/r%� � Applicant: --�� --- Mailing Address: �b� U •Se «S II-Gi�,r.� E r� 5 Location: � 1 y m Phone Number: C) % G o i o? Legal Description: /2 �� (3 F)lc < )Ct �, ", Tpu��Lot Size: Type of Soil Absorption System Is: �i Trench: Drainfield: _ _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: �0 _ Soil Rating(sq.ft/br) W The Required Size of the Soil Absorption System Is: LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no 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 SEPTIC(HOLDING) TANK SIZE _ _ GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(1) INSPECTIONS ARE REQUIRED # Backfilling of any 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 system is 100 feet for a private well or 150 to 7.00 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I'.11 install the system in accordance with codes. (3) u derstand that the on-site sewer system may require enlargement if th reside es r odeled to include more that 3 bedroo s. Signed: - C Issued by :7 Abplikakk Date: SWP/024(1/81) '3C RE:! SU TSS RETURN TO: DI, l s loo of Geplog lcal and Geophys lcal Surveys (OGGS) 3001 Porcupine Drive (Telephone: 277-6615) Anchorage, Alaska 99501 W n T E R W E L L R E C D R D Dr l l I Ing Company dame r'. T n 121 LOCATION Of WELL Please complete either la, Ib, of Ic. In. Borough 5 d lvislony lot RloJkl'Frac[lon Sectlpn No. 1,. DISDistance and Olrectlon from Road Intersections Street Address and Area of Well Locatiln WELL LOG --- Material Type CI Feet Below E STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES U.S.G.S. Local go. Drilling Permit No. A.U.L. No. �Township Range ''7II'M�er id lan u",p N/S __� El I _ 3. OWNER OF WELL: Address: f t L DEPTH: (completed) Surface Elevation' Cute iCL umylet ion ❑ Cable tool ❑ Rotary ❑ Driven ❑ Cog ❑Auger ❑ Jetted ❑ Gored ❑ Other. -- E: L_LDomestie❑''II Publie Supply ❑ Industry irrigation ;_IRecharge ❑ Compere ia. ❑ Test Well ❑ Other. SING: ❑ Threaded LJ Welded . to __ft. Depth Weight lbs/Ft . to ft. Depth NISH OF WELL pe: .a. (- Diameterlot/Mesh Sire: Length: Set between ftand ft. Fi t i,,gs: 9, STATIC NATER LEVEL: It fes . Above t_IBeiow land surface Type of Measurements 10. PUMPING _LVCL peiow �•_ t ft. after hrs. dumping ft. after hrs. pumping 9-P II, WELL HEAD COMPLETION: ❑ In Approved Pit Pitless Adapter inches above grade 12. GROUTING: Wall Grouted: ❑ yes 13NO Material ❑ Neat Cement 0 Other: ., ..... 13, PUMP: (if available) HP I.___ / Length of Drop Pipe ft. capacity _( 9r Type: ❑ Submersible ❑ Reciprocating ❑ jet ❑ Other+ _ .. 14. REMARKS: 15, WATER WELL CONTRACTOR'S CERTIFICATION: This r,ell as drilled under my jurisdiction and this report Is true to the best of my Knowledge and belief: Regis[ereU tlus'pess Name i Address: T . Date: Signed: _»av Aul hprrzcd Represcnta till iForm 02-WWR Copy Distribution: WHITE - State DGGS, PINK rrlier, CANARY - Customer y �., VAT \\ 825 k-S1Rt_L7 ANCHORAGE, ALASKA 99501 > tf (907 204 4111 00101. Aw DI PAP I ME NT or HEACEH AND ENVI11OW, I N Ud Pl:OI EC ION September 10, 1981 Maynard Keller % Jess Iio.liday Company 2820 C Street, 45 Anchorage, Alaska 99503 Subject: Lot 1B Block 6 Skyway Park Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: LIQ (1) The water analysis report needs to be submitted to b this office from the Chem Lab, 5633 B Street, for our review. (2) A well log .submitted to this office for our files and review. If there are any further questions, please call this office at 264•-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/ljw cc: Alaska Statebank 310 Last Northern Lights Boulevard 99503 �ff�l'�Owv OD OA 6t� A Us ---------- ---- _ INSPECTION APPOINTMENTS ------ DATE RECEIVED TIME TIME TIME DATE DATE DATE q , I INSPECTOR INSPECTORS- INSPECTO��� ---- C MUNICIPALITY OF ANCHORAGE OF HEALTH & ENVIRONMENTAL PROTECT t6yVICIPAUTY OF ANCHORAGE N ALn I & 825 L Street - Anchorage, Alaska 99501 DEPT. OF HF P:;OTECTION O*NDEPARTMENT ENVIRONMENTAL ENVIRONMENTAL SANITATION DIVISION Sf; n\ Telephone 264-4720 \\ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERKIE110RE/ 1�� D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROP OWNER f� LI G A DR SS S1l t PROPERTY Rry ESI ENT III differerift from above) PHONE 2. BUY E R ---- ---- PITE DS1�iTC-& MAILING ADDnESS 3. L DING INTITUTION - --- 14 E 6 & /_C_ —------J�2z PHONE�C. S AV ADDRESS - ALTOR/ GENT a v PHONE M -L% rC ADDRESS / .LC_SL.C) 0 C2 T ��- 5. L AL DESCRI)TION, - o 1 ./C a — STREET LOCAT O ,1g.� 6. TYPE OFR SIDEN—� /J` NUMBER OF\6EDROOMS SINGLE FAMILY C1 one L7 Four ❑ Other CI Two LJ Five 13 MULTIPLE FAMILY � Three ❑ Six 7. WATERSUP V ----------- INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled 0 COMMUNITY since June 1975. For wells drilled prior to that date, give well _ ❑ BLIC UTILITY depth (attach log if available.) _ 6. SEWAG�E /D� LPOSAL SYSTEM / LTJ INDIVIDUAL/ON-SITE** �/_YEAR ONSITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE: INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) Irl-�r THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE C]/SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑^THREE L1 FIVE 1:1 OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3�. SWAGE DISPOSAL SYSTEM J121fkDIVIDUAL/ON-SITE ED PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER _ ❑Septic Tank or ❑ Holding Tank Size: 1 7—S 9 If Tank is homemade give dimensions: SOILS RATING t' TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA P o a MATERIAL �, /f . 61., 4. DISTANCES WELL TO: Septic/Holding Tank b t� Absorption Area % '•�> Sewer Line Nearest Lot Line %� Absorption Area to nearest Lot Line 5. COMMENTS .g APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE B L/ 72-010 ( Rev. 6/79) C'o • Municipality of AnchoraMe .. On -Site Water and Wastewater Program (907)343-7904 Ate. C� Certificate of On -Site Systems Approval Parcel I.D. 019-151-12 Expiration Date: 1. GENERAL INFORMATION Complete legal description Skyway Park Estates Block 6.Lot 1 B Location (site address) 12220 Skyway Dr. Current Property owner(s) Boblch, Jason Mailing address Real Estate Agent 130 W. Intl Airport Rd. Ste T 2. TYPE OF DWELLING: 7 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 7 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System Public Sewer ❑ Waiver/Variance request for: —Distance: Received by: Date: 1 Z COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 57,tP- Waiver Fee $ Date of Payment 12,17, 1(p Date of Payment Receipt Number 001NG Receipt Number COSA#_03( (, (77(D Waiver# G 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my sealaffixed 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 Slate codes, ordinances, and regulations in effect at the time of installation. In Conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the Control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 'T bedrooms System #2 Approved for bedrooms Disapproved Date 11/30/16 Conditional approval for bedrooms, with the following stipulations: BY: tiu 1^ 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet—E ., . If more than 1 septic system is on the lot: COSA Checklist # 1 of? Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Skyway Park Estates Block 6 Lot 1B Parcel ID: 019-151=12 A. WELL DATA , Well type Public If A, B, or C provide PWSID # AWWU. Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N) I Total depth ft. Cased to ft. Casing height (above ground) . in. ' FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p:m. g p m WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic Steel Date installed 8/5/09 Tank size 1250 gal. Number of Compartments'2 _ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N y High water alarm (Y/N) N Date ofpumpingf'/bIIa0((C Pumper�SC C. ABSORPTION FIELD DATA 7 Date installed 8/4/09 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Deep Trench Length 61 ft. Width 2.5 ft. Gravel below pipe 5.3 ft. Total depth 10.3 ft. Eff. absorption area 646.6 ft2 Monitoring tube Y Depression over field N Date of adequa, cy_test 1'1/18/16 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 48 in. Water added 616 gal. New depth 64 in. Elapsed Time: 1440 min. Final fluid depth 48 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump ori" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES WELL ON LOT TO: " Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOTTO: Building foundation 5+1 Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 200+ ABSORPTION FIELD ON LOT TO: , Property line 10+ Building foundation 10+ Water main 0+ Water Service line 10+. Surface water 100+ Driveway,10+" .parking/vehicle storage Curtain drain 50+,Wells on adjacent lots 200+ F. COMMENTS Survey on file. t G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in " conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name" Steven Pannone Date 11/30/16 COSA canary sheet 2-6-15.doc Municipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 Well Decommissioning Log Legal Address: Subdivision SS�0" PO/_ G sE . Block � Lot T R Section Lot On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: HENRY MARTIN Signature: Company: ANCH.WELL & PUMP SERVICE Well decommissioning date 12/8/2016 Method of decommissioning: AMC 15.55.0601_1 a. ❑ b. ❑ c. El Location: Use the space below to provide a drawing of the property showing the following items; • North arrow • Decommissioned well, • Other water wells on the property, Two separate swing -tie distances for each well shown on the drawing, Note: The swing -tie distances shall be measured from either permanent structures or the property corners. 12220 SKYWAY DR. 23' FROM FRONT DOOR 0 SO' FROM GARAGE CORNER SKYWAY DRIVE G:\Community Development\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning form.doc 4. 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 Sp zkcIa ;n&&QAA, Address Zoo Q. z(st Arc. sF�. ��. AACLO!-4i Ak Ti5o( Engineer's Printed Name LASS 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 7-11-391(o Date _ 5At k�i r �C��F'p�gS'll y' ,g7Ft SA Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report (Rw. 7105) )ther Original Certificate Date: ZS Municipality of Anchorage • y Development Services Department F ,. Building Safety Division - ' On -Site Water & Wastewater Program " 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ws4 ParR £s�Alc,, Slk (, CICS Parcel ID:�rT A. WELL DATA Olq -rs1 - 12 Well type r'v q�E If A. B. or C provide PWSID # Date completed 1981 Sanitaryseal (YIN) y Total depth ( fl Cased to L I ft. FROM WELL LOG Date of test Static water level Well production ft. Well Log (YIN) Wires properly protected (YIN) Y Casing height (above ground) 1'2.+ in. AT INSPECTION g ZO p , 50 fL g.p.m. 5,6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 olonies/100 mL Nitrate ND mg/L Arsenic: 15_b mg Date of sample: 8L7101 B. SEPTIC/HOLDING TANK DATA Tank Type/Material i7rcAlov Tank size 1750 gal. Number of Compartments Other bacteria _colonies/100 mL Collected by: 1. us Sp Uri &,, Date installed g H Cleanouts (YIN) Foundation cleanout (YIN) Depression over tank (YIN) (4' High water alarm (YIN) N Date of pumping New Pumper /%VtZGI C. ABSORPTION FIELD DATA Date installed S 5 Soil ratingp.d./fie or fe/bdrm) 1,2 System type Dc -c-)+ TRx uc k Length G i tL Width 2,5 ft. Gravel below pipe 5,-3 ft. Total depth 5.-J fL `Eff. absorption area 6w„,6ft? Monitoring tube y Depression over field N Date of adequacy test Ney Results (Pass/Fail) — For bedrooms Fluid depth in absorption field before test -- in. Water added gal. New depth ___. in. Elapsed Time: � min. Final fluid depth "— in. Absorption rate >= -- g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) — If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) `Pump on level _ in. 'Pump off" level at in. High water alarm lev in. Datum Cycles tes Meets alarm rCuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ - Absorption field on lot 100 1 - Public sewer main 1001+ - Sewer /septic oo1+Sewer/septic service line 2511 On adjacent lots foo + On adjacent lots 100 t' Public sewer manhole/cleanout 100 t Holding tank -,V ILA Animal containment areas //.0, Manure/animal excrete storage areas N,O, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation 5,+ Property line K I+ Absorption field 5 I+ Water main 104+. Water service line lot + Surface water Wells on adjacent lots 100+ N.0, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation log+ Water main 101+ Water Service tine 10 + Surface water N;O, Driveway, parking/vehicle storage to 1+ Curtain drain N, O , Wells on adjacent lots 100 V F. G. ENGINEER'S CERTIFICATION ��'�A�gS���� I certify that I have determined through field inspections and i .49TH* review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Lxms SR4,yA ti..c` �j� �.LARSFl 00KLA%D`� j Date1�c1�0$ESIC�P�r— a COSA Fee $ S� Date of Payment — Li — O Receipt Number c�S�b Ib (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisor Certificate of On -Site Systems Approval # 090289 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 1B of Skyway Park Estates Subdivision. This inspection revealed an arsenic concentration of 15.6 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS RAN 1094057001 Client Name Spurkland Engineering Project Name/# Sky Way Park Estates B61113 Client Sample ID Sky Way Park Estates B6,1- 113 Matrix Drinking Water Sample RcmAs: Printed Datefrime Collected Dalefrime Received Date/rime Technical Director 08/18/2009 14:00 08/07/2009 13:20 08/072009 13:35 Stephen C. Ede Allowable Prep Analysis Parameter Rcsults PQL Units Mcthod Container II) Limits Datc Datc Init Metals by ICP/MS Arsenic 15.6 • 5.00 ug/L EP200.8 C (<10) 08/13/09 08/17/09 NRB Waters Department Total Nilmtc/Nitritc-N Microbiology Laboratory Colony Count Total Coliform Fecal Coliform ND 0.100 mg1l. SK1204500NO3-1: D (<10) 08/07/09 LCE 0 col/100ml. SM20922213 A (<200) 08/07/09 DLC 0 col/IOOml. SM20922213 A (<I) 08/07/09 DLC 0 col/100ml. 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