HomeMy WebLinkAboutGOLDEN VIEW HEIGHTS LT 4BM0 [44T T
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#020-042-37
Municipality of Anchorage
Pane t of 3
Development Services Department
Onsite Water and Wastewater Program
4700 South Bragaw Street
P.O. Bot 196650 Anchorage, AK 90519-6650
www.d.anrchorage.ak.us MM 343.7904
ON-SrTE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW040033 PID Number. 020-042-37
JerNems
e Kukowski Wastewater System: New
15735 Amberwood Cir.,Anchoracre AK
ABSORPTION FIELD
Fh"ts: NunW oraedepae:
569.2911 Four 4
5' Wide Trench
LEGAL DESCRIPTION
&A`�e
1.2
Tatn Dept ftmo Wyme:
No* Lot
4B a G
Golden View Heights
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1
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3.4 Fl.
56.5 Fl.
Welt: Exlsting
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nen FUM e".ccraw Abwaamwm
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TANK
Fc
SEPARATION DISTANCES
® Septic [3 Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
LM
Holding
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250
War
>100,
>100,
WA
NIA
>25'
WNW
Steel
�0fCWVWMWvW—
Two (2)
aeerWrer
>100'
>100'
WA
WA
LIFT STATION - NONE ON LOT
Lau*
>S
>10,
WA
WA
Fa.n.ean
>5'
>10'
WA
WA
p.bdn D we
None
Noted I
.f- I/V f L ,L
BENCH MARK
ori L s,� s
First Floor Slab
4� Gr c
100.0 Fie
Engineer's Stamp
♦pgap
♦♦♦♦��E OF q� q a♦♦
Inspections performed by: AH Dates: 1" 5112/2004
asih ♦♦�
2nd 511312004
•�•r
Department of Health and Human Services approval
p MICHAEL E. ANDERSON'
'• 4�:
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Reviewed and approved by: Data: �S
♦ iS No. CE-4381 1=r
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519.8855 - 343-7804
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number. SW040033
10' um- ea f.
[a
M
rA
Four
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W*
49th ..
A=SE No, a-4=PLAN AS -BUILT
SrAE 1'
Page 2 of 3
PID No. 020-042-37
A 1 8
51 11.3 .0
S2 17.0 2.8
sl
C4 47A 5
C5 32.1 1.2
Mt 30.1 39.5
rc
U
Q 25' ;
10' um- ea f.
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A=SE No, a-4=PLAN AS -BUILT
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Page 2 of 3
PID No. 020-042-37
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-79D4
On -Site Wastewater Disposal System or Well Inspection Report
Parm4 No.: SW040033
PID No.b20-042-37
PROFILE AS -BUILT
Smile- r - 20•
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: Jeremy Kukowski DATE PERFORMED: 5/12/2004
LEGAL DESCRIPTION: Lot 4B, Golden View Heights Subdivision
TEST HOLE # 2
PT/OG/OL
Poorly Graded Sand
with Gravel 1%
SP
Well Graded
Sandy Gravel
GW
WAS GROUNDWATER
DATE GROSS
TIME
NET
TIME
ENCOUNTERED?
Yes
S
5/12104 10:09
L
IF YES, WHAT DEPTH?
8.5'
10:19
DEPTH OF WATER
8 5'
P
BOH - 11' AFTER MONITORING:
10:20
E
DATE:
6/20/04
2
49th
SEE SITE PLAN
FOR TEST HOLE LOCATION
READING
DATE GROSS
TIME
NET
TIME
DEPTH TO
WATER
NET
DROP
Start
5/12104 10:09
7.76'
1
10:19
10
Dry
7.75"
Recharge
10:20
8.0"
2
10:30
10
Dry
8.0"
Recharge
10:31
8"
3
10:41
10
Dry
8"
PERC RATE: 1_25 MIN./INCH PERC. HOLE DIAMETER: 8„
TEST RUN BETWEEN 2.5 FT. AND 3.5 T.
COMMENTS: Test Hole Pre Soaked Prior to Test.
TEST PERFORMED BY: ALAN HARALA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 12/28/04
MUNICIPALITY OF ANCHOR4GE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW040033
Legal DescriptionttGyP (ia},;m
Design Engineer: 0014 Anderson Engineering
Owner Name: JEREMY KUKOWSKI
s� iz{al- ll;3p
Date Issued: Mar 18, 2004
Expiration Date: Mar 18, 2005
Parcel ID: 020-042-37
Site Address: 015735 AMBERWOOD CIR
Lot Size: 20800 SQ. FT.
Owner Address: 15735 AMBERWOOD CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99510-4929
This permit is for the construction of:
❑✓ Disposal Field Z 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 ( 18MC80 ).
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:
Issued By:
Date: S— ZZ—DSO
Date: 3118104
Municipality of Anchorage
•
l�4C 94 �
Development Services Department
Building Safety Division r=�,
On -Site Water and Wastewater Program `
4700 South Bragaw, St. s ""
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020.042.37 Permit Number SWO400 33
Property owner(s) Jeremy Kukowski Day phone 569.2911
Mailing address (1) 9801 Main Tree Drive Anchoraae AK 99516
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 46 , Golden View Heights Subdivision
Legal description (Section, Township & Range)
Lot Size -,des=Z� WQDAcre Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade N
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
(Signature of property owner or authorized agent)
Permit Fees: Ir
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING .
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6i79(FAX)
March 17, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 4B, Block F, Golden View Heights Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing septic system on the subject lot has failed and must be upgraded prior to
the construction of a new house on the property. We are therefore requesting a permit
be issued for the construction of a new septic system to serve the four-bedroom home
to be placed on the lot. The attached Site Plan and backup documentation identify the
location and configuration of the existing and proposed septic system. Also identified
on the plans are the locations of the existing well and the well on the adjacent lot. No
conflicts exist between the proposed septic system and existing well and those on
adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The
drainage patterns will be maintained after construction. The existing septic tank and
absorption pit will be pumped, crushed, backfilled and abandoned in place.
The test hole placed on the lot indicated poorly graded sands with gravel with varying
amounts of silt in the area of the new absorption trench. The percolation rate for this
material is between 1 and 5 minutes per inch. Groundwater was found during
placement of the test hole at 14' and remained at that level during the monitoring
period. We are therefore proposing to place a new 1,250 -gallon septic tank and a 50'
long by 5' wide by 4' effective depth absorption trench to treat the effluent generated in
the house. The elevation of the distribution line in the absorption trench will be 4' below
the surface and the total depth will be 8'. Sufficient fill will be placed over the trench
and septic tank to prevent frost penetration and possible freezing.
The ground surface on the lot slopes at shallow grades from east to west and north to
south. The trench will be constructed parallel with the slope as much as possible in
conformance with Municipal requirements. The new septic system will be constructed a
Lot 413, Block F, Golden View Heights
March 17, 2004
Page Two
minimum of 100' from the existing well and any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverseimpact 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 reserve
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,
Michael E. Anderson, P.E.
Attachments
GOLDEN VIEW HEIGHTS
LOT 4B
SEPTIC SYSTEM
i
N 89'S9'05E 130.00'
x I lo' unt- ESMT.
max` I
t_ _____.______ ___________________
T— Albmale She
I
1 x�x` 127G -
x�x
myI.�y�T50' Lenq
1� tl' orM�ay {' E/1. ppM Tnneh
UhMng
p8pa
x x _
piv
i ,y/ 38
250 V11T
ptic S.
I '
Pwlq �,a°aek811 X � i
U Fahll n° SU.n t Tmk j w
O 0Absorption Pit
0 25 1� g
m z �--FENCE (AFX)
/ z
I I I
I ( t
1 � j
I ® 1
i I WELL j
1
' CA" 1
I
L -R i +F F •-i-x x-R-R-Y-�i-i-i-x-x-x-R�-R F-F�
N 8353'321 130.06'
49th =. L
.... ............ .....:
SITE PLAN 0iCME� E. RSUN
SCALE Is - JO' ,•• No. CE -4381 • j �,t
•1j�r
LOT 4B, BLOCK F, GOLDEN VIEW
HEIGHTS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5' Wide Trench System
Perc. Rate: 1.2 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPD/SF (Appplication Rate) = 500 SF Absorption Area
500 SF/5 LF (Width)- .5 (Red. Factor) = 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be
8' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
3'6"
6"
4'0"
Natural
Backfill
5'
I�
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION 0OF
o••'ap
(NO SCALE) r ( .................
NOTE: Grade Area Over Trench to Drain Away. yc
Minimum 6' Separation From Bedrock. 4 t.h—.. ...
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area. aatt'` "Mic ...... E MDERs
Minimum 100' Separation From Surface Water or Streams. jZ%:, No. CE4MI
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH a HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PROJECT #: M0368
PERFORMED FOR: JEREMY KAILOWSKI DATE PERFORMED: 10/24/2003
LEGAL DESCRIPTION: LOT 4B GOLDEN VIEW HEIGHTS
TEST HOLE #
OG - OB
DAMP POORLY GRADED SANDS
SOME ORGANICS W/ LITTLE FINES / SP
2%
DAMP WELL GRADED
SANDY -GRAVEL MIXTURE
SOME FINES / SW
WAS GROUNDWATER.
ENCOUNTERED? YES
IF YES, WHAT DEPTH? 14 FT
DEPTH OF WATER
AFTER MONITORING:
DATE:
POORLY GRADED SILTY -SANDS
WET SOME GRAVESL / SP -SM
AEL e. ANDERSON
CE•4381
14'
S
L
0
P
E
SITE PLAN
0%
as
READING
DATE GROSS
TIME
NET
TIME
THP
NET
DROP
FOUNDATION
10/24/03 10:40
�j
N
1
10:50
10
4.0"
8.0"
Recharge
NO SCALE / SEE ASBUILT
0%
as
READING
DATE GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start
10/24/03 10:40
12.0"
1
10:50
10
4.0"
8.0"
Recharge
10:50
12.0"
2
11:00
10
3.875"
8.125'
Recharge
11:10
12.0"
3
11:20
10
3.875"
PERC RATE: 1.2 MIN./INCH PERC. HOLE DIAMETER: 6„
TEST RUN BETWEEN._ -5 FT. AND 6.5 T.
COMMENTS: NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.L. KIMBROUGH (,.MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE:
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 4B, BLOCK F, GOLDEN VIEW HEIGHTS SUBDIVISION
GENERAL:
The scope of this project includes the work to pump, crush and backfill
the existing septic tank and absorption crib on the lot. Work will then
include the procurement and placement of a new 1,250 -gallon septic
tank at the location shown on the site plan. Work also includes the
construction of a new absorption trench 50' long by 5' wide by 4'
effective depth also at the location shown on the Site Plan. The total
depth of the trench will be 8' below existing ground and the distribution
pipe will be placed at 4' below the surface. All components of the new
absorption trench and septic tank must be constructed a minimum of
100' from any surface water and 100' from the well on this and
adjacent lots. A minimum of 4' of cover is required over the septic tank
and 3' over the absorption trench. In lieu of cover 2" of direct bury
insulation and 2' of cover may be placed.
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. The Contractor is also responsible to assure
the separation distance from wells and surface water in the area is
maintained. The engineer will accept no responsibility for Contractor
errors.
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.
Lot 4, Block F, Golden View Heights
March 17, 2004
Page 2 of 4
SEPTIC TANK INSTALLATION
1. A new 1,250 -gallon septic tank must be procured from a certified
septic tank manufacturer.
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.
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. The Contractor is solely
responsible to assure these separation distances are met.
Lot 4, Block F, Golden View Heights
March 17, 2004
Page 3 of 4
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 trench 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 be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
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:
Municipal Ordinance requires a minimum of two inspections must be
completed during the construction of the septic system. 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 Contractor must notify the engineer 4 hours prior to the
inspection to prevent delays.
Lot 4, Block F, Golden View Heights
March 17, 2004
Page 4 of 4
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.
His measurements must include verification that the proper separation
distances have been met. A certified surveyed as -built may also be
required to assure the proper separation distances are met from wells in
the area. The as -built will also include separation distances from streams
or surface water in the area.
M -W DRILLING, Inc. 7-i74
P.O. Box 110378 • 10330 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner Janes 1:.usseli Useof Well 11011-a3tic
Location (address of: Township, Range, Section, if known; or distance main road_
L4B Coluenvie:; ` ,3 .nts SU'L11ViSion
4 1/?" PVC Liter 5 - 25 PVC Liner
Size of casing 611 Depth of Hole -2-50 feet Cased to ---b 1+ � —feet
Static water level ft. (al qav) (below) land surface. Finish of well (check one) open end ( )
Screen ( ) ; Perforated
Describe screen or perforation 4 1/2" PVC Liner rerfd _ JG, - 2.50'
Well pumping test at- 3—gallons per (Yqur (minute) for_ 1 hours with—i'JC� -Jt.
of drawdown from static level.
Date of completion 27 Jul -,r 1 ;:
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
TO
—To 3
3
_TO 30
3J
TO 35
]LTO
60
--a
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TO 52
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TO L)Q
—L):)—TO
12
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TO
TO
TO
_
TO V1
OTO____TO
-TO-
--TO-
-- —T
Stick
nits
Ian silty t=ravel. ,17et
Tan silty water lbearirE orayel
(,ray silty .,rave
ay Al ty ;craw -"L—
Cray be it ''r; - _go
7 :yedr-ocIL - %larder than aboup
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3 — CONTRACTOR
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CERTIFICATE OF PROFESSIOtJAL LAND SUR 566, -
I hereby certify that an as -built survey of �„� TA�j
J
, I�f. •../•i 6jj—i e'_.+_� �/-- l i 1 r. .iii. --f.!
Ca62LP(5r1 V I r�:vK/ H T5. 5(j ems.
Anchoraoe Recording_ District,. Alaska, has',�,I°„�i 1
been made by me or under my direct supervision;
that improvements are situated as shown hereon
and that no visible easel1ents exist except` �• Qi AZ�"'b
as shown hereon. Easements of record not �r ��;,.••••..,�Q 4
indicated on the official survey plat are ;.•''•.;��f^�6Q
not ne"cessari ly shown. • [}CTM ••P�
Encroachments: Q0r115, 00..' ......... ....t....
Dated at Anchorage, Alaska this 10�lay of
.Jo'tJ _, I98-f�.
(1010 _I QR�I Or I 5Ci(If � I GRID
$"RON 940
t 4F
JAMES B. 01AY*%—, R L 5
360 W. 13ENSON DLVO, SUITE 207
ANCHORAGE , ALASKA 99503
563-1063 --
M
GRE �ER ANCHORAGE AREA Bor 'UGH
Department of Environmental Quality
M 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM _
NAME G��y CjU✓GG�i/ MAILING ADDRESS<�Gl'�l�i�-v.G��?
LOCATIONLEGAL DESCRIPTION /_-OJ CUA+/i✓ G'/LGA/ /Td
SEPTIC TANK:
DISTANCE �'2Uiv�s _ NUMBER OF
FROM WELL MANUFACTURER �%ii5//G _ MATERIAL COMPARTMENTS 41Vf_
LCG /�,���voG�� �7✓i'
INSIDE LENGTH _ INSIDE WIDTH _LIQUID DEPTH LIQUID CA PAC ITYz!,L,2�ZJ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER-? / OR WIDTH _, LENGTH__ DEPTH
LINING MATERIAL CRIB SIZE: DIAMETER-I� DEPTH Z' DISTANCE FROM: WELL ✓%��C��
/ TOTAL EFFECTIVE
BUILDING FOUNDATION/L' ✓f NEAREST LOT LINE ABSORPTION AREA (WALL_ AREA) _SQ. FT.
ADDITIONAL ABSORPTION/
WELL:
TYPE _CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY:����✓f✓yitir
i
0
PIPE MATERIAL: ��'✓'��/rte / M
LOT SLOPE:
REMARKS: «rT/r!ov`ii�ta�ez>
G>.t� C!✓�/ter l� Tij>✓iC �.✓r_� c .T
Form No. EQ -031
NEAREST
SEWER LINE
REMARKS
DEPTH
DISTANCE_ FROM:
SEPTIC SEEPAGE
TANK SYSTEM_
DIAGRAM OF SYSTEM
40 4
a`
0T3�
DATE APPROVED
G.A.A.B.
`.
GREATER ANCHORAGE AREA BOROJC3H ( I
M R1TNO. '
•� 0 �9h # r r AE
6 DEPARTMENT OF ENVIRONMENTAL QUALITY fI_!. ,� �
3330 "C" STREET ANCHORAGE, ALASKA 99503,�-'-
�` TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
NAME OF APPLICANT 'LL e,�,, a /� f (j ',, 2 /�
(/�'' ,,_'C '"'^ `�E'.. y„ MAILING ADDRESS �`�`�' I�:,Y2�i�P%Y.. I'PHONE
INSTALLATION LOCATION \N sLi-OC'�-v �.�/� 1 -
LEGAL DESCRIPTION C.. r q R --J� uAo ,
INSTALLATION OF: SEPTIC TANK V SEEPAGE PIT �Y DRAIN FIELD _, OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTSO NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED _
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE _J-ooc, TYPE./4"m SEEPAGE AREA SIZE r I_4
TYPE
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK - -
FOUNDATION TO SEEPAGE PIT C71 1 DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
1
SEPTIC TANK SEEPAGE PIT 1;�Ln DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT J AAf
DRAIN FIELD / ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK ` SEEPAGE PIT_
DRAIN FIELD
SEPTIC TANK, �(�C11 SEEPAGE PIT -- j ���
L�_, DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING I 7
ALLATION.
G,A.A.B. ,
OR
LICENSED DESIGNER
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER F, CHI
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
r /
��`
DATE APPLICANT'S SIGNATURE
RAGE. ARJA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
.va . e Le Do -y -
f• $TV
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 02D -N2-37 COSA# n
Expiration Date: %— 03 O , 0-7
1. GENERAL INFORMATION
Complete legal description Lot 4B, Laden view Heights Subdivision
Location (site address) 15715 Amberwood Ckde Anchorage. AK 99516
Current Propertyowner(s) Jeremy and Jennifer Kukowsid
Mailing address
15735 Amberwood CJrde Anchorage, AK 99516
Day phone 301-2911
Lending agency Day phone
Mailing address
-- Real Estate Agent - - - -- . _.. ___..Dayphone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
- --- 2. - NUMBER OF BEDROOMS: - - Four (4)
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site❑
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 OnSfte 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 OnSRe 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-sfte 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineees Printed Name Michael E. Anderson, P.E.
b. DSD SIIGGJJATURE
_= Approved for bedrooms.
Disapproved.
Date 426=7
onditional approval for--bedrooms,-WWthe following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date: 3 0-07
(R... 11M
Municipality of Anchorage
C Development Services Department ,
r Building Safety Division '
On -Site Water b Wastewater Program '
47W Bragaw, Street
P.O. Bon 196650
Anchorage, AK 99519450
www.muni.orgbrnite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Deception: Lot 4B, Golden View Helptw firbtihmon
Parcel ID: 02D042-97
A. WELL DATA
Wed type Prelone If A, B, or C provide PWSID S _
Web Log (YM) Y
Date completed12 W Sanitary seal (Y" Y
Wires properly protected (YM)
Y
Total depth 250 fL Cased to 64 ft.
Casing height (above ground) >24
in.
FROM WELL LOG
AT INSPECTION
Date of test 7R711967
V22f2007
Static water level LM fL
44.5 fL
Well production 3 g.p.m.
4.75 O.P.M.
WATER SAMPLE RESULTS:
Coliform 0 colomesN W mL Nitrate NO rtgA_
Other baGeria 0 colonies/1
W mL
Arsenic: NO mgA Date of sample: 41507
Collected by: F. U Dom
B. SEPTIWHOLDING TANK DATA
Tank Typauaterlel sytic3bd
Date installed 5112%2004
Tank sae 1,250 gel, Number of Compartments Two
Cieanouts (YM) Y
Foundation cleanout (YAC Y Depression over tank (YM)
N High water alarm (YIN) H
Date of pumping 30007 Pumper awgach ftlq*y
C. ABSORPTION FIELD DATA
Date installed 5M=004 Sod rating (g.p.dJe or 1trAdnn) t.2 G VW System type S Wide Trench
Length 55.5 R Width 5
ft. Gravel below pipe 3
It.
Total depth 7.5 ft. Eff. absorptions area So4.5 ft's Monitoring tube Y Depression over, field
N
Date of adequacy last 4Q?=? Results (PasslFaiq Pave For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 794 gel, New depth 7.5
in,
Elapsed Time: 1,140 min. Final fluid depth _2in.
Absorption rate >= e00
g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N
If yes, give date
D. LIFT STATION
Date installed Size in gallons
ManholaiAecess (YIN)
'Pump Orr level at _ in. 'Pump or level at _
in. High water alarm level at in
Dnthsn Cydea tested
Meets slamh b ccadt heghdrertierhbT
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic WnkAdt station on lot >10V
On adjacent lots »ea
Absorption field on len >10V
On adjacent kXs >1W
Public sewer main WA
Public sewer menhoWcleanout WA
Sewer haptic service line >25'
Holding tank WA
Animal containment areas None
Manurelanimal excrete storage areas Nom
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >s Property one>S
Absoriftn field >^
Water main WA Water service line
»a Surface water >1W
Wells on adjacent kits >tar
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >70' Building foundation »v Water main »Q
Water Service one »o Surface water >10V
DriveM. petepNstade storage >W
Curtain drain Now Noted Wells on scUscom lots
»on
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I cot* that I have deterrolned through held irtspecLions and
review Of MunB OW records fhet the above systems are in
conformance with MOA COSH guldellnes in eflad cn this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date IR5*W
COSA Fee S_
Date of Payment
Receipt Number.
Rev. t treat
Waiver Fee i
Date of Payment
Receipt Number,
SCS RLLN
1071406001
Client Name
Anderson Engineering
Project Nsme/a
Lot 4D Golden View Ileights
Client Sample ID
Lot Q Golden View Heights
Matris
Drinking Water
PWSID
0
Sample R�nnarks
An Dates/rimes an Alaska Standard Time
Printed DateMme
04/1812007 15:25
Collected Date rime
04/052007 14:15
Received Datdrime
04/052007 15:25
Technical Director
Stephen C. Ede
Allowable Pmp Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 04/06/07 04/12/07 TK
Waters Department
Total Nitratc/Nitrite-N ND 0.100
mg/l. EPA 3532 D (<10)
04/06/07 AZS
Microbiology Laboratory
Total Coliform 0 coU100ml. SM20 9222D A (<I) 04105107 DPT
I
i
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Municipality of Anchorage j
• Development Services Department i
Building Safety Division ,
On Site Water and, WastewatecRrogram,
.,4700 South B
P.O. Box l ragaw -6
9¢650 Anchorage. AK 99519650
www.ci.anchora9e.ak,us
(907j 3437904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY -DWELLING
Pamle11.D.
Expiration Date: -- /-� 7 — d ,5�
1. GENERAL INFORMATION
codmplete rugal description _Lot 46. Golden View Heights
Location (site address ordirections) 15735 Amberwood Cir,
Anchorage, AR
,.:.,;.
Current Property owners) �leremv Kukowski Day Phone 669-2911::
M�niGit�-address .'15735 Amberwood Cir. , Anchorage AK 445'16 4429
sr
Lending agency
i Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD lorpkkup.
2. NUMBER OF BEDROOMS: Four
3. TYPE.OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL,
Individual Well ® Individual On-site
Individual Water Storage ❑ Individual Holding tank ❑
Community Class . Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development'Services Department (DSD) Issues CerBlice6s of Health Authority
Approval (HAA) based only upon then presentations given In paragraph 5 by an Independent professional civil
titl (r registeredb the State of Alaska. Certificates of Health Authority Approval arerequired for the transfer of
spouses)except between for Parties served by a .single family on-site wastewater disposal and/or water
suPPhr system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority 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
newwatersande results less than 30 days.old. (Certificates may be reissued for a period of up to one year with
slid water samples.) Certificates are valid for one year for properties served by Class A or B wells or aublic
water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional
engineer's work.
e sl
4. STATEMENT OF INSPECTION 61-140MER f
is,!
Asce ifi by my seal affixed hereto and as of,the validation date shown below, l verity that myt)baied'ai`procedures outlined M ft,Hejjj Autl'i * Approval Guldet`ines for tlds applicatitine
on-ske water supply and/or wastewater disposal systeM is(ere) safe. fimWonal and adequate for the number
of bedrooms and type of structure indlcated'herein. I futther verify'that based on the Information obtained from
the Municipality of Anchorage flies and from,my i nvestigadon`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 Anderson EnaMeedna - .Phone 522.7773
Address P.O. Box 240773 Anchorage AK 99524
Engineers Printed Name Michael E: Anderson P.E. Date 1?!27l2004 , c
PSE �
* 49th
�i�- c wmcnsa .
ti .DSD SIGNATURE
Approved for bedrooms.
Orsappnrred.
Conditional approval for bedrooms, with the following stipulations
OF:
StTF,�
n
Additional Comments rE
• �� TER
(RW.
oV�IAETE�N
Y Yl
(RW. 7ZM
Municipality of Anchorage
E ' Development Services Department
4
Building Safety Division
On-site Water 6 Wastewater Program
4700 South Bragaw St.
P.O. Box 196950 Anchorage, AK'99510*50
(07) 343-7904akus, .
r
HEALTH AUTHORITY APPROVAL CHECKLIST u
Legal Description: lot 48 0oldemlew Heights Subdivision Parcel'ID
A WELL DATA
Well type Pte:. If A, 8, Or C provide PWSID # Well Loy (YM) Y
Date
completed j/g y
Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 0 R Cased to , Casing height (above grog) s24 In. .
_... _ FROM WELL LOG ATdNSPECTION
Data of teat –f_ 10/2812003.
Static water level fJMk (L n
r
iWell production 3' g.p.m. 5 g.p.m.
WATER SAMPLE RESULTS:
ColNonn–9—colonies/10o mi. Nitrate 4„ 10 m9A. Other bacteria 1: oolonies/100 ml.
Date of sample: 12 / 20 / 2004 Collected by: AH
�. B. SEPTICIHOLDING TANK DATA
q Tank Type/Material seotk a"I Date Installed 3112004
Tank Size 120 gal.Number of Compartments j Cleanouts (Y/N).X
Foundation cleanout (Y/N) X Depression over tank (Y/N), fi ,,High water alarm (Y/N) N .
e
Date ofum i
P P n9 , Pumper }few coratmc"on `
C. ABSORPTION FIELD DATA
Dete installed 6132M Soil rating (g.p.dAe or ft2/bdrm)1.2 OPOISF System typa S Wide Trench
kLem be.5 fL - Width 6. ft . Gravel below pipe 3
N Total depth Z& ft. Eff. absorption area 904•!i ftp Monitoring tube Y Depression over field jy
Date of adequacy test Results (Pass/Feil) For _ bedrooms
s Fluid depth In absorption field before test; in ' Water added gal. New depth_in.'
Elapsed Time: ,_,_, min. Final fluid depth _ kr. Absorption rate >= g,p,d,
' Any rejuvenation treatment (past 12 mo.) (Y/N & type) - N 9 yes, give data
i
r
Dd IT ATATION"
Date installed
'Pump on" level at _ In.
Size in gallons Manhole/Access (YM)
'Pump Q1P level at in. C High water alarm level at in.
1.Cycles tasted`'''),jeets storm 3 circuit requirements?
E. SEPARATION DISTANCES a
SEPARATION DISTANCES FROM WELL ON LOT T&
Septic tank1 ift siation,on lot ,'0700 On adjacent lots '0100!
Absorption field on lot '0100' On adjacent lots '0100' '
Public sewer main NIA Public sewer manhole/deanout WA
Sewer Isepft service Ride" *2T Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 305 Property fine >V Abswption'field�j> '
Watar male >i0 Water Service line 3010' ' Surface water >100'
Wells on adjacent kits >100 _
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: -
Property fine 3010' Building foundation MW Water main >10' '
wete'service fine '010' "- i "'Surfacewater 30/00 - 6riveway, Parkirgnronlde s►oraQe 305
.Curtain drain None Noted Wells on adjacent kits >10�
F. COMMENTS
Q..ENGINEER'S CERTlFICATNSN '
I certify that I havi detemrined through!field inspections end
review of Munidipal records that the above systems are M
conformance wfih MOA HAA guidelines In effect on this date.
Engineer's Printed Name fifirho0l E Anderson. RE '
SGS Ref.#
1048161001
Client Name
Anderson Engineering
Project Name/#
Lot 4B Goldenview Heights S/D
Client Sample ID
Lot 4B Goldenview Heights S/D
Matrix
Drinking Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 12/27/2004 12:13
Collected Date/Time 12/20/2004 11:40
Received Date/Time 12/20/2004 12:11
Technical Director Step C. Ede
Released
Parameter Results PQL Units Method Container ID Allowable Prep Analysis
Limits Date Date Inst
Waters Department
Nitrate -N 0.100 U 0.100
Microbiology Laboratory
Total Coliform 1 OB, No Coli
mg/L. EPA 300.0 B (<=10) 12/20/04 BJA
cot/100mL SM209222B A (r--1) 12/20/04 DPT
LL
L
70-308
GOLDEN VIEW HEIGHTS
LOT 4B
21,397 S.F.
N 89'59'05"E 130.00'
I
1 "=20'
AS -BUIL
GASTALDI LAND SURVEYING
JEFF A. GASTALDI, R.L.S.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 99502
PHONE 248-5454
GRID DATE
3238 11/16/2004
F.B. JOB NO.
04-14 GVHS4B
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.