HomeMy WebLinkAboutSCIMITAR #1 BLK 1 LT 2Scimitar #1
Block 1
Lot 2
#051-132-07
Municipality of Anchorage Page 1 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: SW980473 PID Number: 051-132-07
Name:
MM&M Contractingr---
Wastewater S stern: ® New 0 Upgrade
Systern:
Address: P O. Box 670495 Chugiak, AK 995 (7
FIELD
Phone:
688-1236
No. of Bedrooms:
Three
_ABSORPTION
DTh ❑Shallow Trench Bed ❑Mound ❑Other
❑eeprenc
LEGAL_ DESCRIPTION
SoiLRating: .8
Total Depth from original grade:
GPD Sq. Ft.
Lot: Block: Subdivision:
1
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
2 1 Scimitar No.
3.5' Ft
.5' Ft.
Township:Range:
Section:
Fill added above original grade:
Gravel length:
0 Ft.
40' Ft.
���__��_—��_
WELL: New ❑Upgrade
Gravel width: 15'
Number of lines:
Dis ante be ween lines:
Ft.
3
5_ Ft.
_
Classification (Private.A.B.C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Private
200'Ft.
141' Ft,
600 So.Ft.
ASTM D3034 PVC
Driller: —
Sullivan Water
D t D' a
�� �/ 9
StaY{c e(Level:
I
Installer:
Date installed:
FL
��n-,�Ll
—
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
2 GPM
Ft.
2 Ft.
SEPARATION
DISTANCES
—
--_
❑Septic ❑Holding %kS.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Privale
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Aneli marb /rl.-eR
5 F,
STP—
WeIF
>100'
>100
N/A
N/A
N/A
Material:-
Number of Compartments:
Surface
_
>100
>100
N/A
N/A
N/A
LIFT STATION
Water
Lot
>10
5'
N/A
N/A
N/A
Sizeingauons:
_
Manufacturer:
Liffe
250
Orenco
Foundation
10
>10
N/A
N/A
N/A
"Pump on" level at:
4211
Pump off' level at: High water alarm at:
= 42" 44"
Curtain
None
Noted
On Lot.
Pump Make&Model
200SI05HH
Electrical Inspections performed by:
Eagle Electric
Drain
___
Remarks: Well Deepened on 9/9/99—
MARK --
See Lot Line Waiver.
_BENCH
Location and Description:
Threshhold at West
Entrance to House.
—
--
Assumed Elevation
1 n rl f
ENPkW. ,Rs\§ L
A
Inspections performed by: _ A. Harala Dates: 1st 7 21 99
V
D IL
2nd 8 24 99a"
p
�/ ^fg `�}irilPF�46f ��+'�,t3'JIt�
Department of Health and Haman Services approval
% fe 4�11t° V,yy
7—
by: Date:
Reviewed and approved _�'
ZZ
72-013 (Rev. 9/91) MOA 25
SP1
SP2
MH
MT
Municipality of Anchorage Page 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW980473 PID No. 051-132-07
A
0.6
4.9
6.0
5.5
26.3
32.3
33.9
53.9
3 BR
House
PLAN AS -BUILT
SCALE: 1" = 2.0'
Alternto �(N�
Site
15' X 40'
Ab orption
Be
�} MT
SP1 SP2 °
Co
1,250 MH
I Gal.
S.T.E.P.
i
Cd
l
i
W �
Cd 3 1 \
5
&v,, _ .A
'TH:std
I � . �q���ry La�q�-��y;�tV=�
FA Qr:L�iRiV1'c�
pp ey
Park Drive
r
�ho'7ac
>n
�e
Municipality of Anchorage Page 3 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW980473 PID No. 051-132-07
SP2 100.0
MH
CO SP1 Y
—" 97o eotex i'abr i.c
- " insulation
[" PVC 303[, 1 , 250 gal L± __ 960 15' x [,0'
S.T.E.P. absorption bed
95 1z" PVC, SCH 40
9072'd-
elivery & distribut;ion
q51 piping
MT
septic rock
96
Lateral Orifice Diameter 3/16"
Total Number of Holes -
Ho1e Spacing - 3.5'
ROFILE AB-BIJ
HORIZONTAL SCALE 1" = 10'
NO VERTICAL SCALE
_91 s
Municipality of Anchorage .
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:__�L—.`"� DATE PE
1 4
A,//Al/ Township, Range,Section:
LEGAL DESCRI
I-
�—
FN � l�—
2
Net
Time
3
Net
Drop
4-
5
s-�,
�IVI
;
./j
10
12
13
14
15
16
n
18
19
20
COMMENTS
SLOPE
WAS GROUND WATER �D
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? P
E
Depth to Water AIIe
Menitarina? 'D"LF—Date — 29
SITE PLAN
Reading Date
PERCOLATION
Gross
Time
Net
Time
Depth to
Water
Net
Drop
14 YL 11
n3
/0 Y1
orY7
a07 -
oz
r �„
PERCOLATION RATE J' (mmuteSrmchl)/PERG HOLE DIAMETER
TEST RUN BETWEEN FT AND Y FT
Tv Ir l s; 14vu,� 4009� �n,� Geef.rez
�fEST G/svrr� R.0 Soy++r.•rra r wv�� ^•„ �., _—
PERFORMED BY: �' -- I • Y'/-�.aN J--�RTIFY 7T)HA7T �T IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:—'—
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
E25 "L- Street, Anchorage. Alzskz 990502-0E50
SOILS LOG — PERGOLA T ION TEST
MM&M Contracting DATE
pERFORMED
7f•2,2 `.
LEGAL DESCRIPTION:_ Lot 2, Block I_ Sci.mi tar NO OI l __ SITE PLAN
F
IN
I
1II111111
I S4e kite klaln I I I
� I l 1 l L lI1
L1 1_1 I l l 1 I l
{ I I 1 I I l 1 1 1
IIIIIIIII
i I 1
=cV I pT L
t
-Mom
4-
&0 -Im AA
&DAA OF
6
I �5'rrFO! E
7
WAS GROUNDWATER No
10 I ENCOUNTERED? - -
112 I S
L
IF YES. AT WHAT O
DEPTH? - t'
E
13-
14-
115.
3-
14.,5.
16
17
is
19
DEldh ID W= Attu
Mun=mg,l D= -
20J
L_-- PERCOLATION RAT: Immo ,ncn) PZ -RC HOLE DIAMETER _
TEST RUN BE7WE_EN _! � 11 AND _ s FT
COMMENTS_ Perc. Cavity presoaked prior to testing.
_ Percolation Test in Area of New
BB'eeddd./—
PERFORMED BY: _ A. Harala _—_ I _S'� �-`.s�fIFY TF i T $TST AS
-- Michael E. Anderson �C19
ACCORDANCE WITH ALL S7A7E AND MUNICIPAL GUID3)NES IN EFFECT ON THIS DATL DATE
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
Alaska Hydrologic Survey
WATER WELL LOG Revised 08/18/2016
Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______
City/Borough Subdivision Block Lot Property Owner Name & Address
Well location: Latitude Longitude
Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4
BOREHOLE DATA: (from ground surface)
Suggest T.M. Hanna’s hydrogeologic classification system*
https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD
Depth
From To
Drilling method: Air rotary, Cable tool, Other
Well use: Public supply, Domestic, Reinjection, Hydrofracking
Commercial, Observation/Monitoring, Test/Exploratory, Cooling,
Irrigation/Agriculture, Grounding, Recharge/Aquifer Storage,
Heating, Geothermal Exploration, Other
Fluids used:
Depth of hole: __________ ft Casing stickup: ___________ft
Casing type: __________ Casing thickness: _________ inches
Casing diameter: _________ inches Casing depth: __________ ft
Liner type: _________ Depth: _____ ft Diameter: _____inches
Note:
Well intake opening type: Open end, Open hole, Other
Screen type: _________, Screen mesh size: ____________
Screen start: ________ ft, Screen stop:________ ft, Perforated Yes No
Perforation description: Perf from: ________ ft, Perf
to: _______ft, Perf from: ________ ft, Perf to: ________ ft
Gravel packed Yes No Gravel start: ______ ft , Gravel stop:______ ft
Note:
Static water (from top of casing): _______ ft on____/____/_____ Artesian well
Pumping level & yield: ______ feet after _____ hours at _____ gpm
Method of testing:__________________________________________
Development method:______________ Duration: ____________
Recovery rate: _________ gpm
Grout type: _________________ Volume __________________
Depth: From ___________________ft, To ___________________ft
Final pump intake depth: __________ ft Model: _______________
Pump size: _____________ hp Brand name: __________________
Include description or sketch of well location (include road names,
buildings, etc.):
Was well disinfected upon completion? Yes No
Method of disinfection:
Was water quality tested? Yes No
Water quality parameters tested:
Well driller name: ..................................................................................
Company name: ...................................................................................
Mailing address: ....................................................................................
City: __________________________ State: AK Zip: ___________
Phone number: (________) ________- ______
Driller’s signature:
Date: ______/______/_________
Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require
that a copy of this well log be submitted to the Development Services Department/City
within 30 days of well completion.
City Permit Number: _____________________________
Date of Issue: _____/____/_________
Parcel Identification Number: ______-_______-________
*Guide for Using the Hydrogeologic Classification System for Logging
Water Well Boreholes by Thomas M. Hanna NGWA Press
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a
copy of the well log be submitted to the Department of Natural
Resources within 45 days of well completion. Well logs may
be submitted using the online well log reporting system
available at:
https://dnr.alaska.gov/welts/
OR email electronic well logs to
dnr.water.reports@alaska.gov
North
S
SULLIVAN WATER WELLS
B1
NW
Municipality of Anchorage MYERS & MYERS CONSTRUCTION ,
24936
SCIMITAR 1
SW
19999
141
PO BOX 670272
n
SW001W015N
n
2
CASED 141FT, PERFS 50-55, 80-100 & 130-140 FT
BILL SULLIVAN
L02
n
9
136
SE10
n
CHUGIAK
200
n
open hole
99567
FROM : MMM CONTRFICTING PHONE NO. : 6881238 May. 05 1999 08:28AM P2
O LAND j'YJ /%� s �'! 8ORVIH04EiUk ,
ATTENTION: It Is the responsibility of the property owner to E
of Anchorage: Department of Health & Human Services andl
r)enwrtmAnt of 1-nvironmental Conservation. .
ADDRESS — - — —e
j
LEGALDESCRIPTION,,GJ,.1_
a C r __--
-- r
PkRMIT NL)MBEF2gp'-4�7JDate of Issue
TAX INDENTIFICATION NUMBER .,,•,.;.f��
Is well located at approved permit location? 0 Yes
p No
Method of Drilling: - air rotary ll cable
tool
Depth of well:., a.
Casing Typo (,._ Thickness w2S �
'Nall
Diem@ter Inches, depth
_inches,
Liner TYpe � h?
CAsing S41ckup Above Ground a' _
fee%t
Stade Water Level (from ground level) ;( �d
_feet',
F umping level _ fAet efter firs pumping
gp j
Reaaver Rafe al �gpm
s
^" k
Method of %sting
Well Intake OpeninType: .C3 Open End 01-96'pen
Hold .'^
[� Screened; .' Start feat Stopped " „
feed
C Pertoration's Start feet StMed i6�1
r,CtC.rli
CyroutType
Depth:iremQ
Pump Inthka`Depth:
Pump Size'hp Brand
- - —
ly'
--
Well Dlslnfacted Upon Completion! &%s l` i No
Method of,b"wectlon: o r !^
v
Comments
c ;
11
v
'�;.
ATTENTION: It Is the responsibility of the property owner to E
of Anchorage: Department of Health & Human Services andl
r)enwrtmAnt of 1-nvironmental Conservation. .
j
;,
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650 u 7 �7
(907) 343-4744 U
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW980473
Legal Description:
SCIMITAR #1 BLK 1 LT 2
Design Engineer:
0014 Anderson Engineering
Owner Name:
MM&M CONTRACTING
Owner Address:
1521 W 12TH AVE
ANCHORAGE AK 99501-4207
Date Issued: Dec 21, 1998
Expiration Date: Dec 21, 1999
Parcel ID: 051-132-07
Site Address: 020128 CHUGACH PARK DR
Lot Size: 53765 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
Z Disposal Field [✓] 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 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.
9-2.3—yf SEE Povolwee,?'S 42MCH5,9 .gMeN✓1 tJ Vr--.Ti6N eilel�06E 0,07 -,EO
Received By:
Issued By:
Date: (2 ZZI�Is
s • Date: �2- / 6'
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522.6779 (FAX)
MEMORANDUM
DATE: August 23, 1999
TO: Dan Roth
FROM: Mike Anderson, P.E.
SUBJECT: Lot 2, Block 1, Scimitar Subdivision
Permit No. SW980473
Septic System Design Revision
RECEIVED
AUG 23 1999
Municipality of Anchorage
Dept. Health & Human Servicea
The recent heavy rains in the area have temporarily raised the water table on Lot 2,
Block 1, Scimitar Subdivision so that the originally designed trench type system cannot
be constructed without encroaching into the 4' separation from groundwater. We have
therefore redesigned the system for a 15' X 40' bed and a pressure distribution system
with a 1,250 gallon STEP tank. The bottom of the bed will be a minimum of 5' above
the highest observed water table. The attached drawings show the location of the tank
and absorption bed. We hereby request the permit be modified to allow placernent of
the bed in lieu of the originally designed deep trench system.
Attachments
Three jj�250TG
Gallon `
BedroomEP an --_House 1.5" PVC
N I'I eliver Line
cw Alt. / / /
TO/H1
si e �/ 15' W' e X40' Long
Ln I I Absor tion Bed
cr
Pa J
l
ti I ®:r
rt
n
(D VACANT
LOT
i
® Well
Location
UGACH PARK DRIVE
SITE PLAN
SCALE 1" = 40'
�}ti,fv41
m d
x
y s�Ef
,� Cw,Ea7'�I i R✓ i, '�' 4p
8
IV71tt nAF� 41U�VJ(
3
1
LOT 2, BLOCK 1, SCIMITAR SUBDIVISION
DESIGN FACTORS:
3 Bedroom Home
Perc. Rate: 5 Min./Inch
Application Rate: .8 GPD/SF
SYSTEM REQUIRE=MENTS:
Shallow Bed System
1,21,50 Gallon Septic Tank
Pressure Distribution
3 Bedrooms X 150 GPD / .8 App. Factor = 562.5 Gallons Per Day
562.5 SF/15 LF (Width of Bed) = 38 LF Length of Bed
Therefore: Construct a Shallow Bed System 15' Wide X 40' Long.
Distribution Piping to be Placed at 3' Below Original Ground Surface or
Higher. Remove all Organics and Place Bed Atop GP/GM Soil Layer. 2 "
High Density Direct Bury Insulation and 2' Protective Cover Over Filter.
Natural Backfill
(3' Minimum)
Geotextile Fabric or 2" Insulati
Drainfield Rock
1" PVC
Lateral Orifice
Tota]. Number of
Diameter:
Holes:
3/16"
29
Hole Spacing:
3.5
A,
SHALLOW
BED SECTION
pais
( NO
SCALE )
�44s
NOTE:
Grade Area
to Drain Away.
°
)' 'w A
w����„gin,
Maintain 6'
Se P aration
From Bedrock.
�`1z'�`�� a,
Provide 4'
of Cover or
2” Insulation and 2'
Cover.
Maintain 4'
Separation
From Groundwater.
ANDERSON ENGINEERING
P.O. Box 240773 SHEET No. OF
ANCHORAGE, AK 99524 CALCULATED By DA
(907) 563.7155
(907) 337.8855 CHECKED BY DA
l S r fi S, h� _ 4- 7 `{
//� �q d t
27 ontFICxS_ 3r'`u V /.`7_ Ji�V) J_L
rj�'�4gg � rytfli��U�L � �R tJ��ii
PRODUCT KI Ir* SWA M I (W&]).
December 8, 1998
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 2, Block 1, Scimitar Subdivision No. 1
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 2, Block 1, Scimitar Subdivision No. 1 intends to
construct a three bedroom home on the lot. We are therefore applying for
a permit to construct a well and septic system to serve the new house.
The attached Site Plan and backup documentation show the location of the
systems and those on the surrounding lots.
Testholes placed on the lot revealed silty to poorly graded gravel with
percolation rates ranging from 17 to 45 minutes per inch. No groundwater
was encountered during testhole placement nor was any noted during the
monitoring period. We have therefore designed a deep trench system sized
for the slower percolation rate. The trench will be 63' in length and 3'
wide. It will have an effective depth of 8' and the total depth will be 12'
from the existing ground surface.
The surface of the lot slopes from north to south at a rate of
approximately 2%. It also slopes from west to east toward Chugach Park
Drive at rates between 2% and 5%. The trench will be placed across the
2% slope near the north property line.
We do not anticipate any conflicts with wells or septic systems in the
area. The septic system on the lot to the south falls just outside the
protective radius of the new well. The lot to the north is vacant and i t
appears sufficient room is available to place a well and septic system on
this lot without conflict.
Lot 2, Block 1, Scimitar No. 1
December 8, 1998
Page Two
If the system is constructed as designed the following statements apply:
1. The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
2. 'The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
3. 'The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
4. 'The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
F— Q,u-eL-,N
Michael E. Anderson, P.E.
Attachments
p��6400
MON
/y�
t MICHAkI,pp����pS(dC1M.
1 \ W -E a
b
N00.00103"W 2028 19 (74-186)
F
1
iaaco .
�
120.00
o
527'E -IR2gg
� Y \
This \ \\
Pro j ec tic VACANT" \ \ \
b \
N
v I Well & Septic-
100' Eatt
Well
r \-
p \
AJC°�O. a
\e\
?14
AREA MAF � \ ��
SCALE 1" _ 100'
yti� ass°� C'N
I�so°
MI
8809-E i
°
Three
Bedroom
House
N
aW
I
Alternate
2% Site
S&pticOTanKn
TH1
x f? x 3' Wide
x S' Effective Depth
H�bs ption Trench
VACANT
LOT
SITE PLAN
SCALE 1" = 40'
�••(.N`i ei o.e owl/, �;
M HP8, E, AI+ )ERSOM
LOT 2, 13LOCK 1, SCIMITAR NO. 1
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home Deep Trench System
Perc. Rate: 31 - 60 Min./inch Verify Existing Septic Tank
Application Rate: .45 GPD/SF 8' Drainfield Rock
3 Bedrooms X 150 GPD / .45 GPD/SF = 1,000 SF of Absorption Area
1,000 SF/16 SF/LF = 63 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral
with 8' of Drainfield Rock Beneath the Lateral. Distribution Pipe i n
Trench Placed at 4' Below Original Ground Surface. Mound Over Trench
to Provide Positive Drainage Away From Area.
3' 6"
611
91
Natural
Backfill
Geotextile
Fabric
4" Perforate;
PVC (Slots Down)
infield
1--- 3 1 —f
TYPICAL. DEEP TRENCH SECTION_
(NO SCALE:)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
MI�IfAE4 E. AN�ER"a4M .
PERFORMED FOR:
LEGAL DESCRIPTION/–•
DC -r
Municipality of Anchorage .
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 " L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
c-//?// NO, /
1
2L—
/V
3
5 O 1
�.0,'
V
o
'J
0
8 �o Vtr/
00 6
9
DATE
Township, Range, Section:
- - /A[/ "IN
d
I
°49 obi
JIIL FLAN
10
(
Net
Drop
WAS GROUND WATER
ENCOUNTERED?_
T—
GI
3V .2
11
-�
'
s
IF YES, AT WHAT LO
12
DEPTH? P
13
_
E
ILP m waer
M6nitmi"? Oats
o
o,
14
15
16
17
18 l r
19
Reading Date Gross
'rime
Net I Depth to
Time Water
Net
Drop
T—
f2_4D
3V .2
1.15
1,15_
— 2'•41
4-3
/
zo /
PERCOLATION RATE/ (mmutes mCh) IFE�RC HOLE DIAMETER 12.—
TEST RUN BETWdEEN _ FT AND FT
COMMENTS `KL'ZW_ Q S ,�2 3 oerCl�/oj/'� _/J/�,_�_`�_— —_
PERFORMED /— _ I • - y I k-CMrrtFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WI1"HALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:I-
r€EY7
1
2
3
4
5
�r>
8
9
10
11
12
13
14
15
16
n
18
19
20
Municipality of Anchorage .
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
DATE PERFO
Section:
WAS GROUND WATER
ENCOUNTERED? A
S
IF YES, AT WHAT L
DEPTH? D
P
E
Depth to W71G
Monitoring? LYS /(Ittc 11 -���Jr
Readin 8
II Date Gross
L Time
NetDepth to
Time Water
N
IQ
Cv 19
'+rte - 3 C
W
h r
i" 95
o
I
e
I
� 1
�2_
I �
I
I
Readin 8
II Date Gross
L Time
NetDepth to
Time Water
Net
Drop
�gZ
Cv 19
'+rte - 3 C
'I
2•.sg
s� L
�2_
PERCOLATION RATE k-- (minutevinch) PERC HOLE DIAMETER
TEST RUN BETWEEN- FT AND _GFT
PERFORMED BY' ___._ Za(A-'4eTHAT THI TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:64q U
72-008 (Rev. 4/115)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2, BLOCK 1, SCIMITAR NO. 1
GENERAL:
1. The scope of this project includes the procurement and
placement of a new 1,000 gallon septic tank. It also
includes the construction of a new 63' long x 3' wide x 8'
effective depth absorption trench at the location shown on
the attached Site Plan. The total depth of the trench will be
12' below existing ground. The protective radius for the
well is shown on the plan. Note the proximity of the
absorption system to the south and verify the well is placed
more than 100' from this system.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be
responsible
for
obtaining all
underground utility locates
and for the
layout
of the septic
system and verification of
the location
of all
lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
1. The 1,000 gallon septic tank must be procured from an
approved source.
Lot 2, Block 1, Scimitar No. 1
December 8, 1998
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5. Tanks installed without 4' of cover shall have a minimum of
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trench shall be within 2"
of level.
2. Distribution piping
must
be placed
level with perforations
down atop a level
bed of
drainfield
rock. Rock should then
be placed over the
pipe
to provide
a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Lot 2, Block 1, Scimitar No. 1
December 8, 1998
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trenches to drain
away.
8. A minimum 2' of accepting soil is required below the
drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL. SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated,
but not solid) and ASTM D2662 or A.B.S. (perforated and
solid).
3. Insulation shall beat least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam I-II or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Lot 2, Block 1, Scimitar No. 1
December 8, 1998
Page Four
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as -built
of the completed system.
MUMCPAUTY OF HCHOR„GE
Lt
Development Services Department �; Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-132-07-000
Expiration Date:
Legal description SCIMITAR #1 BLK 1 LT 2
Site address 20128 CHUGACH PARK DR Chugiak AK 99567
Current property owner(s) BURIK DONALD A II & STACIE A
11/22/2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 8/22/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory X Arsenic Advisory
Other
COSA ApprovaLJune 2022
Development Services Department '' Phone: 907-343-7904
_ 7
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-132-07
Complete legal description Scimitar #1 Block 1 Lot 2
Location (site address) 20128 Chugach Park Drive, Chugiak, AK 99567
Current property owner(s) Stacie Burlk Day phone (907) 688-8259
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 23yrs _ See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ S 50 Waiver Fee $
Date of Payment Ohl2-5 Date of Payment
COSA # 05C.2_2'1 2`65 Waiver #
COSA Application—June 2022
Scimitar #1 Block 1 Lot 2 051-132-07
1.8
11/21/98*200 N/A
141
6.23
18+
6/26/23 Forge Engineering
59.8 7/27/23
Well deepened 9/9/99*
47"
2/8/23 Sanitary Pumpers
7/21/99
4.1
N/A
N/A N/A
N/A
23
Steel
6/26/23
0
502
3
15
0
> 450
6
0
6
Benjamin Schiller, P.E.8/4/23
5*
Waiver #WR990074
(907) 522-7773
MUHCPAUTV00FANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section -`' j—
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC231285
Subdivision: Scimitar Block:1, Lot: 2
907-343-7904
Fax: 343-7997
The septic tank for this property is 23 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more,
not including engineering, surveying or MOA permitting fees.
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.
lNTitrate Advisory
Certificate of On -Site Systems Approval # OSC231285
Subdivision: Scimitar, Block: 1, Lot: 2
A water sample revealed a nitrate concentration of 6.23 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address =P O Box 196650 *Anchorage, Alaska 99519 6650 � www muni org x,
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
y pss P O Box�.96650 *Anchorage, Alaska 9959 6650 *www muni org t' ��
Mailing Addr
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Lift Station/Pump Vault
Maintenance Log
Owner Street Address
Septic Tank:
•Sludge level inches •Pumping: required yes no •Pumping completed yes no
Lift station:
•Pump basket cleaned yes no •Effluent filter cleaned yes no
•Control floats cleaned yes no •Proper float settings confirmed yes no
•Operation satisfactory yes no
Alarm System:
•Dedicated electrical alarm circuit yes no •Audible and visual alarm inside dwelling yes no
•Alarm system operation satisfactory not satisfactory
Manhole Riser
•Ground water intrusion at riser to tank connection yes no
•Ground water intrusion around pipe penetrations yes no •Weep hole functional yes no
•Manhole lid: Functional yes no Insulated yes no Properly Secured yes no
Other
•All manufacturer required inspections and maintenance completed yes no
Comments:
Qualified Maintenance Provider:
Technician Date of maintenance
Company
Signature Date
Don & Stacy Burik 20128 Chugach Park
Pumpng Completed 2/8/23
SEAN DOLAN 6/27/23
Sanitary Pumpers
6/28/23
Municipality of Anchorage
• -� Development Services Department *A.
Building Safety Division
On -Site Water and Wastewater Program4700 Bragaw Street .J .
VIP" r P.O. Box 196650 .' .!,' ._
1 Anchorage, AK 99519-6650 �-
www.munl.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. COSA# 0`4041 -4
Expiration Date:—/ _ �– g
1. GENERAL INFORMATION / r
Complete legal description So rw r ><s. 8�p �k L oTt 2
Location (site address) _ ZOfZB C4,jjaa4 Park
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Day phone
Day phone
Day phone 0167^ Gy<4
TYPE OF WASTEWATER DISPOSAL:
Individual On-site Jam'
❑ Individual Holding Tank ❑
❑ Community On-site ❑
❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
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 Onsite 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. l 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
Address
Engineer's Printed Name
E
5. DSD SIGNATURE
✓ Approved for �: bedrooms.
Disapproved.
Phone % 70z
Date19Z a
.•�Q�� of aCgs�l
� •1
ry. •.
iR tot ... ...-n
,
eau . 1.1.1.11....
� . ...'.• • •T" "
yt
Steven W. Eng
�, f�•. PE 6255
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By. Original Certificate Date: d — 5 — O-]
(Rev., IM)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program : • ...
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SC/M rr0ffL / CT (s a (L �{ L_ 7LZ Parcel ID _D.5-/ -1 3 2 - O 7
A. WELL DATA
Well type! 1I/2 114,P If A, B, or C provide PWSID #
—
Date completed 2 / 7/ft Sanitary seal (YIN)
Total depth 14610. Cased to "(ft.
FROM WELL LOG
Date of test 1112
Static water level / 3� ft.
Well production Z g.p.m.
WATER SAMPLE RESULTS:
Coliform _c5—colonies/100 mL
Arsenic: Q�
�`j
B. SEPTIC/HOLDING TANK DATA
Nitrate .!/Zmg/L
Well Log (Y/N)
Wires properly protected (Y/N)_
Casing height (above ground) z lin.
AT INSPECTION
06
6 it.
Date of sample: ZOV10 7
Other bacteria 00 colonies/100 mL
Collected by. o.2•
Tank Type/Material S 1Q Date installed 41-2y, 9 f
Tank size 1066 gal. ',.Number of Compartments Z Cleanouts (YM) Y
Foundation cleanout (Y/N) Depression over tank (Y/N) L!� High water alarm (Y/N)
Date of pumping 7 Pumper cl,g A i rear
C. ABSORPTION FIELD DATA
Dale installed d 9i Soil rating (g.p.d./ft2 or ft2/bdrm) d• 0' System ys type Bim(
Length�Li o ft. Width /5 ft. Gravel below pipe 0, s ft.
Total depth 4 ft. Eff. absorption area 4(96 -ft' Monitoring tube _ �/ Depression over field A/
Date of adequacy test --� Results (Pass/Fail) /i s T For -?- bedrooms
Fluid depth in absorption field before test ® in. Water addedsO4gal. New depth -L- in.
Elapsed Time6 G min. Final fluid depth tl_ in. Absorption rate >= $-/J O g.p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) __ bwke- If yes, give date
D. LIFT STATION
Dale installed �a
'Pump on' level at i 2
Datum
E. SEPARATION DISTANCES
Size in galions2Jr ZSO
'Pump off" level at rZin.
Cycles tested Z
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot r to O �
Public sewer main
Sewer /septic service line
Animal containment areas
Manhole/Access (Y/N) Y
High water alarm level at n•
Meets alarm & circuit requirements? _
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank I e0a,
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation % S r Property line >S Absorption field S
r
Water main �� Water service line �' /O O r Surface water to o
Wells on adjacent lots >"10,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line S r Building foundation >16 Water main T / d
I /v
Water Service line > /D Surface water >16(3w Driveway, parkinglvehicle storage
Curtain drain VALL_Wells on adjacent lots r
/t]
a
F. COMMENTS .; �� Of At Ah
G. ENGINEER'S CERTIFICATION a 149764 pq '- *'
--------------------
I certify that I have determined through field inspections and•,
review of Municipal records that the above systems are in ♦ %-%— ,
. > sw� W. rNo ; w
conformance with MOA COSA guidelines in effect on this date. tJ��r P 6256 •••.- 0
Engineer's Printed Name S % �t/�� �j9F•• •••''• ��
l'R0FEb�-�4"
Date
COSA Fee $ US Waiver Fee $ _
Date of paymentj l a �l Dale of Payment
Receipt Number 1 U 1 q03 Receipt Number
(Rev. 11/05)
Northrim Eng
Attn: Steve Eng
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
Fax: 907-694-7026
Client Sample ID:
Sampling Location: 20128 Chugach Pk Dr
Client Project: Northrim Eng
Sample Matrix: Aqueous
COC #: 59494
PWS#:
Residual Chlorine:
Comments:
Lab#: A0709313-OIA
Parameter Result Units Flags AIRL
92226 (Aqueous) - Membrane Filtration MF
Bacteria, Other <MRL CFU/IOOmL
Total Coliform 1.0
<MRL CFU/IOOmL 1,0
Lab#: A0709313-OIB
Parameter Result Units Flags AIRL
4500 -NOSE (Aqueous) - Nitrate
Nitrate as N 1.42 mg/1
0.50
Lab#: A0709313 -OIC
Parameter Result Units Flags MRL
200.8200.8 (Aqueous) - Family Well Water 1
Arsenic 0.292 ug/L
0.15
\6
Reported by: Steve Gaither,
Laboratory Project Manager Page I of 1
Analytica International, Inc.
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date:
10/8/2007
Receipt Date:
924/2007
Sample Date:
9242007
Sample Time:
11:30:OOAM
Collected By:
SA
Flag Definitions•
MRL = Method Reporting Limit
MCL - Maximum Contaminant Limit
B = Present also in Method Blank
11= Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
"= RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF= Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Prep Prep Analysis
MCL Method Date Date Analyst
fest was conducted by: Analytica -Anchorage
9242007 9242007 PL
1 9242007 9242007 PL
Prep
MCL Method
Test was conducted 1
/0
Prep Analysis
Date Date
9282007 9282007 AJ
Prep Prep �Analysis
MCL Prep
Date Date Anal
Test was conducted by: Analytica - Thornton
10 200.8 10/32007 10/42007 KS
\ Municipality of Anchorage
• -- Development Services Department
Building Safety Division f
On -Site Water and 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
FOR A SINGLE FAMILY DWELLING
Parcel I.D.10-9f'-132- 07 COSA # NP 02L41
Expiration Date: —0
1. GENERAL INFORMATION
Complete legal description Scimitar Subd. #1 Block 1, Lot 2
Location (site address) . 20128 Chugach Park Drive
Current Property owner(s) A1466 -C I Day phone
Mailing address 2olp- U4cCA P 1<� Q�rdL
Lending agency Day phone
Mailing address
Real Estate Agent Laura Hamilton Day phone 696-0357
Mailing Address 16600 Centerfield Dr. Eagle River, Ak 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
El
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Q
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family ons a wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a pudic water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work
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 OnS to Systems Approval Guidelines for this application,
shows that the onsite 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 onsite 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 NorthRim Engineering Phone 694-7026
Address 17297 Bear Paw Circle
Engineer's Printed Name Steve Eng Date 6/13106
c 0`
S. DSD SIGNATURE
JC
Approved for bedrooms.Q h''• � � '
Disapproved. ZZ �tiiocawti`�
Conditional approval for bedrooms, with the following stipulations:
Attacnmems:
COSA Checklist x
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By: 0, Original Certificate Dater— O—
(A. 11ft)
,•
FZt6ven
W. En
� �
�+,•._ PE 6256
.. 1 ,4
JC
Approved for bedrooms.Q h''• � � '
Disapproved. ZZ �tiiocawti`�
Conditional approval for bedrooms, with the following stipulations:
Attacnmems:
COSA Checklist x
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By: 0, Original Certificate Dater— O—
(A. 11ft)
Municipality of Anchorage
• Development Services Department
Building Safety Division '
On -Site Water & Wastewater Program ' • "
4700 Bragaw Street
P.O. Box 190050
Anchorage, AK 99519 -OM
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: " ram;+O'r */ BI nC_ac I Lan Parcel ID: 0-5'1 -13 a - 0 7
A. WELL DATA
Well type,If A, B C provide PWSID # _ Well Log (YIN) �v
Date completed 1( 121 %91 ZI1
Zi
seal (YM) Wires properly protected (YM) I
Total depth jL*J0t. Cased to 14 I , ft. Casing height (above ground) J-14 a in.
FROM WELL LOG AT INSPECTION
Date of test 112 b b1610 0
Static water level I -64 r ft. 7 (/ or ft.
Well production Q? g.p.m.
WATER SAMPLE RESULTS:
9 -13 -m -
Coliform Shcoloniesl100 mL Nitrate 1. 4 Z mg/L Other bacteria _0 colonies/100 mL
Arsenico•u3 rl 11 Date of sample// 6(p CoOected by: FAa
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 4 .T T. E �) Date installed 1121 — 812-4
Tank size 1. D� gal. .. Number of Compartments eZ Clearwuts (YM)
Foundation cleanout (Y/Ni L Depression overtank(YIN) High water alarm (Y/N)
Date of pumping �2 L/ A S Pumper ' ice. rS u p 'i n a
C. ABSORPTION FIELD DATA
Date Installed K 14M Sol rating (g.p.d./R= or fe/bdrm) .19 System type
Length 4d ft. Width I q y ft. Gravel below pipe -1:7 ft.
Total depth 4 ft. Eff. absorption area &0(Q_fe Monitoring tube Y Depression over field Al
Date of adequacy test /p (c Results (Pass/Fah) S S For _� bedrooms
Fluid depth in absorption field before test _t) . in. Water added_C0_6 gal. New depth In.
Elapsed Time: _Jb - min. Final fluid depth _a in.
Absorption rate >= 5'00 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date
D. LIFT STATION
Date installed SLU111 Size in gallons CO ( I ZSO) Manhole/Access (Y/N) Y -
'Pump on' level at 40� in. 'Pump ofr level at A in. High water alarm level at A q „ in.
Datum 6atthnm est Twntk! Cycles tested Masts alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
r
Septic tankAift station on lot 16(L_
Absorption field on lot '> 1 X01
Public sewer main 9A
Sewer /septic service line � q c� f
Animal containment areas _ a 1 A
On adjacent lots �, I bbr
On adjacent tots IUD" /
Public sewer manhole/cleanout A A
Holding tank > 1 6n r
Manurelanimal excrete storage areas AD
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation > S I Property line �, 4�11 Absorption field %
Water main i I Ur Water service line i OU' Surface water i 16U
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line _ � Building foundation > I D Water main
r
Water Service line % Surface water. i I hff Driveway, parkingNehide storage
Curtain drain boric 4n Let Wells on adjacent lots %
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AS -BUILT
1 hereby certify that 1 have turvYed the following described
gyp_ cor z Nl.�k 1
1017-1.0- yPIw 5M.
Anchorage Recording Precinct, Alaska, and that the improve -
ad thereon are withip the Property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no hnprovements on property lying ad scent thereto encroach
on the pnmiaes In question and that ere are no roadways,
transrniaabn lines or other visible easements on said property
except a htdicaW hereon.
Dated at Eagle River. Alaska
this yd rills, 19P_
kODERT C. JOHNSON t .f�
SCALE: Registered Land Surveyor No. t160 -LS
Dox 77.0456. Eagle River, Alaska 99577
furore (907) 694.2547
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AS -BUILT
1 hereby certify that 1 have turvYed the following described
gyp_ cor z Nl.�k 1
1017-1.0- yPIw 5M.
Anchorage Recording Precinct, Alaska, and that the improve -
ad thereon are withip the Property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no hnprovements on property lying ad scent thereto encroach
on the pnmiaes In question and that ere are no roadways,
transrniaabn lines or other visible easements on said property
except a htdicaW hereon.
Dated at Eagle River. Alaska
this yd rills, 19P_
kODERT C. JOHNSON t .f�
SCALE: Registered Land Surveyor No. t160 -LS
Dox 77.0456. Eagle River, Alaska 99577
furore (907) 694.2547
Analytica International, Inc.
5761 Silverado Way, Unit N
Anchorage, AK 99518
Phone: 907-258-2155
Fax: 907-258-6634
ANALYTICA
GROI:P
North Rim Eng
Report Date: 51&R006
Attn: Mr. Steve Eng
Receipt Date: 4/25/2006
17237 Bear Paw Circle
Sample Date: 425/2006
Eagle River, AK 99577
Sample Time: 11:30:OOAM
907-694-7028
Collected By: S
Fax: 907.694-7026
Flag Definitions:
MRL - Method Reporting Limit
MCL - Maximum Contaminant Limit
Client Sample ID: AX 2376
B - Present also in Method Blank
Client Project: North Rim Eng
H - Exceeds Regulatory Limit
Location: Scimitar 41 B I L2
M - Matrix Interference
Sample Matrix: Aqueous
I - Estimated Value
COC #:
D - Lost to Dilution
PWS#:
•• RL higher than MCL; target not detected
Residual Chlorine:
Comments:
Lab#: A0604198 -02A
Analysis Method Prep prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
500-NO3E (Aqueous) - Nitrate Test was conducted by. Analytica - Anchorage
Nitrate asN 1.72 mg/L 0.50 10 5/12006 5/12006 AJ
Lab#: A0604198 -02B
Analysis Method Prep Prep Analysis
Parameter Result units Flags MRL MCI. Method Date Date Analyst
92228 (Aqueous) - Membrane Filtration MF Test was conducted by: Analytica -Anchorage
Bacteria, Other <MRL CFU/IOOmL 1.0 4252006 4252006 EK
Total Coliform <MRL CFU/100mL 1.0 1 4252006 4/252006 EK
Lab#: A0604198 -02C
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
00.8200.8 (Aqueous) - Family Well Water I Test was conducted by: Analytfca - Thornton
Arsenic 0.283 ug/L 0.15 10 200.8 522006 522006 MCG
Reported by: Rob Gustafson, Page 2 of 2
Laboratory Project Manager
MIMMMPIPMPVI�
r'A1
The. Municipality,,of Anchorage Department of. Health an
Approval Certificates based only upon the representatic
professional engineer registered in the State of Alaska. The
and their lending institutions in order to satisfy certain feder
conduct inspections or analyze, data before a certificat
responsible for errorsor omissions in the professional enc
72-025(BBM,II91) Beck MOAM21
,� Municipality of Anchorage I v ®
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division SEP 21 1999
8215 L Street, Room 502 • Anchorage, Alaska 99501 • (90&J�4,3�7y46 Kr,cnorage
Dept. Health & I-tuman Services
Health Authority Approval Checklist
Legal Description I,ot 2, Block 1, Scimitar No. 1, Parcel I.D.:-051--1 32-07_ _
A. WELL DATA
Well type _Pi-ivate _ If A, 13, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Total depth _
Y
Date completed 11 /21 /98 Deepened 2/17/99
Cased to
Sanitary seal (Y{N) ---Y —
FROM WELL LOG
Date of test — 11/21/98
_
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
136'
2
Casing height (above ground) 2' __
Wires properly protected (Y/N) Y
AT INSPECTION
Nitrate _ 5.97 mg/LOther bacteria 0
Date of sample: --Pj 13 / 9 9 9/17/99 Collected by: _ A. Harala
B. SEPTIC/HOLDING TANK DATA
Date installed I 8 24 99_ Tank size .1000_ Number of Compartments 2 _ Cleanouts (Y/N)_ Y _
Foundation cleanout (Y/N) _ Y __ Depression (YIN) N _ High water alarm (Y/N) Y__.
Date of Pumping _ New___ Pumper__ Construction _
C. ABSORPTION FIELD DATA
Date installed 8 / 24 / 9 9 `_ Soil rating (g.p.d./ft2 or ft2/bdrm) __8 _ System type _ Bed___
Length _40'__Width --L52— 5'— Gravel thickness below pipe _ . 5' Total depth ___L
Effective absorption area _60 0 SF Monitoring Tube present (Y/N) Y _ Depression over field (Y/N) _ N
Date of adequacy test _New cnp c t- _ Results (Pass/Fail) Pas s — For _ Three __bedrooms
Fluid depth in absorption field before test (in.); _
Fluid depth ._-- (Ins) Minutes
Immediately after__ gal. water added (in.):
__ Absorption rate =
.p.d.
Peroxide treatment (past 12 months) (Y/N) __ If yes, give date _ ri,.A
72-026 (Rev. 3/96)''
D. LIFT STATION
Date installed 8/24/99 Size in gallons 250 ( 1 , 250 STEP)
Manhole/Access (Y/N) Y "Pump on" level at* 42" "Pump off" level at* 42"
High water alarm level at* 44" *Datum Bottom of Tank
Cycles tested New Construction
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
>100'
N/A
On adjacent lots
>100'
On adjacent lots > 1 0 0 '
Public sewer manhole/cleanout N/A
Lift station >1001
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation >51 Property line >5' Absorption field >51
Water main/service line > 1 0 ' Surface water/drainage > 10 0 ' Wells on adjacent lots > 10 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 5' **
Surface water>
Building foundation > 1 0' Water main/service line
Driveway, parking/vehicle storage area
Curtain drain None Noted on Lot Wells on adjacent lots
** See Lot Line Waiver
F. ENGINEER'S CERTIFICATION
>100'
>10'
I certify that I have determined thru field inspections and review of Municipal recofleiFf fh`b..VP ve systems are
in conformance with MOA HAA Cui,411nes in effect on this date.
Signature Wt�- ' !)
Engineer's Name Michael E. Anderson, P.E. FsalrIl y��
Date
9/21/99
%, OFFSS1_(m
HAA Fee $ ��Cli�� Waiver Fee $ \ \ 11 C -"U
Date of Payment
�� O�G�
Date of Payment
� - �.1—��1 _
Receipt Number
���3t2� I �/ "� �/
Receipt
72-026 (Rev. 3/96)*
Municipality of Anchorage ,
Department of Health and Human Services Cf
825 "L' Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor http://www.ei.anchorage.ak. us
Anderson Engineering
ATTN: Michael E. Anderson, PE
PO Box 240773
Anchorage, AK 99524-0000
September 21, 1999
Subject: Waiver Request for SCMTAR #1 BLK 1 LT 2
Waiver # WR990074 Lot Line Request for Parcel 11) 051-132-07
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 5 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely,
o� t
Jeff Poet
Engineering Technician III
On -Site Water Quality Program
September 17, 1999 RCC F I VE 1)
S(P 2 1 1999
Municipality of Anchorage Municipality of !',nchorago
Department of Heath & Human Services Dept. Plealth & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 2, Block 1, Scimitar Subdivision No. 1
Separation Distance Waiver
Absorption Bed to Lot Line
Dear On Site Services Engineer:
The absorption bed on Lot 2, Block 1, Scimitar Subdivision No. 1 was constructed
within 5' of the west lot line to provide sufficient area for the alternate site on the lot. A
high water table noticed after heavy rains in August of this year required the redesign of
the system from a trench to a bed. Additional surface area was required for the bed
and alternate site and the house, driveway and other amenities were already in place.
It was therefore necessary to encroach into the lot line setback to provide sufficient
area for the two beds.
Soils in this area were found to be the most effective on the lot for the absorption of
septic effluent. We also noted percolation rates were much better at shallower levels.
The location of the absorption bed should provide effective treatment of the septic
effluent.
The new bed is more than 100' from wells on this and adjacent lots. It is also
acceptable distances from the septic system to the west and does not conflict with any
easements. We therefore recommend that a waiver be issued allowing the bed to be
located 5' from the west property line.
Sincerely,
fi� (f 0,U4,'n
Michael E. Anderson, P.E.
MUNICIPALITY OF ANCHORAGE
Department of Iieal.th and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR990074 _ PID# _051-132-07 _ HA# HA990470 — Permit #
Date Received: Sept 21, 1999
Legal Description: Lot 2 Block 1 Scimitar #1--- _—_—_
Engineer: Michael E. Anderson, PE, AndersonENgineeri.n�_
PO Box 240773 Anchorage, Alaska 99524 --- _
Applicant: MM & M Contracting--
Waiver
ontracting—Waiver Requested: Lot line waiver of 5' from wef_L2r2erty line to the ait rrnzrfe
site on lot.
Criteria: 1. Geology: Points:
A. Water Table _
B. Soil Sorption
C. Permeability
D. Wager Table Gradient
E. Horizontal Separation
TOTAh:
2. Special Conditions: —_ ----_
3. Other:
M
Waiver is Granted: _ Waiver is NOT Granted:
List Conditions or Reasons for above: _-----_
Date: _�z --- By: _ �. /�,o _
N 0 hYeviewer
Rec #: 06303/9741 Amount: $_115.00 — Date Paid: 9-21-99
SEP -20-99 15:33
A&
FROM -CTE ENVIRONMENTAL
5615301
T-080 P.01/02 F-483
ME Environmental Services Inc.
Laboratory Division r�ro�►su!« ►+ter„merit/io�r,►'o'sr'r'I►ri"°,ri'wir�'vn�oi�
200 w. Potter Drive
Drinking Water Analysis Report for Total Coliform Bacteria Tev (907)5.2- aas,a•,eoy
Tel. (907! 562-23 9
CTIONS ON REVER-vE SIDE BEFORE COLLECTING SAMPLE Fax (9071561-5301 J�
REM INS CRU ��� _�,_�_���� TO BE COMPLETED BY LAESORA fORY
-.�--��••-- . -. 77;1 ' �.,..or r•rRn av WaTER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D. It LE_L_.1=
❑
PRIVATE WATER SYSTEM
❑ Send Reaulrs J ❑ Send Invoice
VMW NmW
L• .�� a --r-_
M1
❑ Send Results CC❑ Send Jnvorce
.JDGTrso
arI amt
-
,(�—
SAMPLE DATE: CIS Hca,
Month Day
SAMPLE TYPE:
Routine
❑ Repeat Sample (for rouline sample
with lab ref. no.
❑ Special Purpose
SAMPLE LOCATION
�� L �bU6/ SCJ rK 1 -r -aa
Comments:
❑ Treated Water
Untreated Water
Time
Collected
Collected
By
Ancn Fbls
Jun
Pm.0 YrwJ_
An lysis shows this Water SAMPLE to be.
Sansl'actory
❑ Unsatisfactory
❑ Sample over 30 hours aid, results may
be unreliable
❑ Sample er tae long in transit; sample should
not ba ov4S hours old at examination
to indicate reliable results. Please send
new sample wa Special delivery mail.
Date Received /
Time Received—
Analysis Began= -=---
Analytical Method; -9 41embMMOrane Hier
994SE32
]Cnr ro A.V.C•l.
Result* Analyst
1 V JI
Ancn Fbls
Jun
Fazca
Dale Tmie: --
Client notified of unsatisfactory results:
Phonro Spoke with Faa.A
Date - fime.
AAC'i ERIOLOGICAL. WA'T'ER ANALYSTS RECORD
MMo-MUG Result: Total Coliform F. con
0Colonles/100 ml
.Membrane Filter; Direct Count �-�,.•r— �— T,Yl'C•'TuoNuumro.aTacu.nl
Verification: LTB .. _ SGB COLIFIRM— -
OB -Om.r Bvnena
Fecal Coliform Confirmation ���� —•-
Filial�� —moo Colifornv100 Mi
Membrane Filter ^ery�Results - 6yt �'-J v
RepoiKed By `I- c' Aa[c Time , a3U ht's
(*jjM-~ Morntwr of The SOS Group (Somete Genetaio 4e Surveillance) -
0 C 0•I V 0 d � � Pi 0116 0 pe Z ,I -IF Z ur F oRiDA, iLUNDIS, MARYLAND. MICRiGAN, MISSOURI, NEW JERSEY, OMID, WEST vIRGINI
ENVIRONMEN R
I
SEP -17-99 0806 FROM -CTE ENVIRONMENTAL 5615301
CT&E Environmental Services Inc.
vim'+r�V�rrr. �r rrs� rryos. �
CUE Ref.N
Client Name
ProJect Name/N
Client Sample 11)
matrix
Ordered By
PWSID
994902001
Anderson F_nginenring
Lel 2, Blk 1 Scimitar Subd
Lot 2, Blk 1 Sclmitar Subd
Drinking Water
C
T-008 P.01/02 F-387
Client PO#
Printed Date/Time 09/17/99 07:59
Collected Date/Time 09/13/99 17:40
Received Date/Tywe 09/14/99 15:00
Technical Director; Stephen C. Ede
Released By
PgrgmeYer Ra- culxs Allowable Prep Ana Lysis
POI�_� Uni_�u �� NMethod �i^ itt. Dare Dote
Lnir
Torel CoLlform ?.2 00/100 NL, No Coli
Nitrate•N BN18 9222B 09/14/99 KAP
— — - 5.97 0.500 mg/L EPA 300.0 10 mru 09/14/99 09/14/99 SCS
Received Time Sev,11, 7;08AM