HomeMy WebLinkAboutBLUE SKIES ESTATES #1 LT 2Municipality of Anchorage Page of "`
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 i Telephone: 343-4744
• On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: <Ie•-)Oa0I q / PID Number Qa I —O(1— t6'
Name: 1' k. P P E R S
S Ce'�r'i
Wastewater System: It New ❑ Upgrade
Address: r O Z. L •` 6� �p •�
`
ABSORPTION FIELD.
Phone:
9 �'� -� q l9 �
No. of Bedrooms:
..A.�'
0 Deep Trench Shallow Trench 0 Bed 0 Mound 0 Other
LEGAL DESCRIPTION
'Soil Rating: I • GPD/SFt.
Q
Depth to pipe bottom from original rade:
1. Ft.
Total Depth from original grader %
Gravel depth beneath pipeJ7
(!,"•5 Ft.
Lot: Block: 1w.Subdivision:
2- --- ,e. SKiiLsi (S'W 't$ ,
e
Township:
Range: Section:
Fill added above original gr..e:
f1 • Ft.
Gravel length: .$ ..� C
r 15 -#'i5 Q Ft.
WELL: New 0 Upgrade
•
Gravel width:
Ft.
Number of lines:
Distance between lines:
1$ Ft.
Classification (Private, A,B,C):
f-V
1LS AN --
4? 11:\\S
Total Depth:
360 Ft.
Cased To:I C ISA,lotai
' Ft
!
absorption area: C
6o SO. Ft.
PipePi�material:
1) 30264( Rio
Driller:
S.44•LA. aas 19%
Date Dr Iled:
7- -Oa
Static Water Level:
)D Ft.
Installer: •
Gutaixe&s .A semcsd,
Date installed:
1-9- az
Yield: Q
I S 1, GPM
P�u/mp et at:
Yl /1 ir'10(,V el Ft.
Casing Height Above Ground:
� p�+ Ft.
TANK
SEPARATION DISTANCES
il4 Septic 0 Holding 0 S.T.E.P.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
(Public/Private
Sewer Lines
Manufacturer:�A►�+�+
Capacity In gallons: ,+
1a 00
Welt
100-}
100' !•
•7 r 4
G+a/ !
Material: ���
Number of Compartments:
A.
Watee
fl
1e+
Lod+
LIFT STATION
Lot
Line
1 h �t +
V V
1601+
Size in gallons:
Manufactu
Foundation
tot*
_a
Z }('r
"Pump on" level at:
'Pump off" level at:
igh water alarm at:
Curtain
Drain
„ los
/y Iv
` �,I
4.�. h
tab
,l
�1
Pump Make & Model
I Elec rice! Inspections performed by:
Remarks: II s-ta l /eat of t nag- /pprave,if
BENCH MARK
$a.•to(.
Location and Description:
'Cep of Fo oitoo. Nott Vkl V.0.P•
Assumed Elevation:
£oo FL
Etezetess SEAL
` <. O ..i1 i lkA.,`fit
.
:
" "`
'
2 .,:.... trrs�-......
T '• ROBERT C. COWAN `�
°+ ')l` c` $a91 'f`„+'�
;y
i �, .,. ; ��`,r
aw Nmou
S & S ENGINEERING
Inspections performed by iates' 1st `1' 6-• Z. e
77vs4 Eagle River Loup Read, No. C Q
Eagle River, Alaska 99577 2nd `~ _`y a
De artment of Health and i-iuman Services approval
pp
Reviewed and approved by:7 ®/ Gam. bate: -7--/- 0 3
72-013 (Rev. 9/91) MOA 25
P~,~flT No. SW020 ~ ~ ~ P~E 2 o~ 3
Municipo~i~c oF' ~h.o~.
DEP~RTMENT OF HE~TH~ND HUMAN SERVICES
ENViRONMENTaL SERVICES D~V~S~ON
. P.O. ~ox 196650 ~nchoroge, A~sko 99519-6650mTe(eohone: ~4~-4744
ON-SITE WASTEWATER OlSPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LOT 2, BLUE SKIES ESTATES #1
P.i.D. NO. 021--011--26
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CENT[RLIN£ OF' 30" DRIVE'WAY.
c~, ACCESS, TELECOM.
z. ELECTRIC EASEMENT
~ORERT C. COWAN
C.~. 8801
PER,~flT NO. SW020191 PAGE 5 OF 3
Municip. oli~c_, yy___oF Ancho~'oae
DEPARTMENT OF HEALTHAND HUMAN SERVICES
ENVlRONHENTAL SERVICES DIVISION
. P.O. Box 196650 eAnchoroge, Alaska 99519-6650~Teleohone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAt LOT 2, BLUE SKIES ESTATES #1
P.I.D. NO. 021--011--26
ST1 ST2 /99.8'
~_, NEW 1500
96'7'/J GALLON J
J S£PTIC TANK J
CO1 CO3
CO2
MTln n nMT2 ICO1 = 98.0'
II II IL/~°~ = ~"'~' ""'fl fl ~;~= = ~,.~'~'"'
__~~INAL G RADE~
' , COB =
MTB = ~4.0~
A B
FCO 49.5' 41.0'
ST1 54.5' 45.0'
ST2 61.5' 46.5'
DBL1 62.5' 47.0'
DBL2 64.0' 48,0'
FS 64.5' 48.5'
C01 46.5' 89.0'
MT1 47.5' 89,0'
CO2 97.0' 38.5'
MT2 96.5' 40.0'
C05 62.5' 92,5'
MT5 61.0' 91.5'
C04 107.5' 55.0'
MT4 107.5' 54.0'
·
WATER FOUND ® 86.9'
86.4' B.O.H.
N. T. $.
ertffie ri[ting
by
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUG;AK, ALASKA 99567 *' TELEPHONE 686-2750
OWNER OFLAND: /~0~//,~] J~J/d~.7//~,lJ'~
ADDR~S: ~ ~ T
LEG~ DESCRIPTION:. ~ ~ ~ ~
DATE: ~ ~
PERMIT NUMBER: ~ Date of Issue
T~ IDE~IFICATION NUMBER: ~l
Is well I~atea at app~v~ peril ICal~n?~ J No
Me~hod of Drilling:~la~ ~ cable Iool
~pth of well:
Oasing Type ~ Wall ~]ckness, ' ~ ~ .... inches
Diamet~ ~ [I ~ches,.Oep~ ~ l _ f~t
Lin~ Type: ~ ~ ~
C~ing Stickup Above Ground: ~' feet
Static Water Level: J ~. , f~t
R~over Rate: ~gpm
Method of Testing:~ ~7
Well Intake Opening Type: ~ open
~ Sc~n~; S~ fee[ S~opp~, . f~t
~a Perforations S~A .fee~ ~p~, f~l
Depth: from ~ feet, to ~ ~ f~t
Well D~inf~t~ Upon Completion? ~ O No
Method af Disinf~tion: ~ ~ · ~ ~ ~~'
Comments:
BORE HOLE DATA
DEPTH
f~m To
ATTENTION: It IS t~e responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation, MatSu Borough:
Department of Environmental Conservation.
Ser) 29 20 ! 2:08p Anohorage ::tell & Pump :gat :,;0712430742 P'l
Cr -.511 -sl Y/riter & W.1s-tawcftV
47C0 Ek-noor-- Zoad
AK
Mayor
Pump Installation Log
'Nell DriffingPernik Nuni her: STNV_.___. Date of lssue:
Parcel Identification Numher:0� -2 t,
Legal Description Property Owner Maine &- Addrm:
23hue S" ��sl L 2- l�d4rria
v"v
Pump lastaHation Mile:
;
Pump Intake Depth Beiow'rop •,if Well Casing;
� 3116 fciP$-
Purnp Manufacturer' - -Name.
PUMPModcf-
Pump Size I Al hp
Pitless Adapter Burja( Depth: d'A'- J;ee4
11 Pitiless Adapter Yfimafacwmr-s Name-, PIAIXTIA),'��
I
Pitless Adapter Insia-fier. /,or
Well Dis0nfected U'Y.jtR Completior.? [j�' Yes "'I No
Method of Disinloxtiovi.-
! conxuleilts:
Pump Insialter Name,
1 4v b
-chcr2ge kVell Service,
1330 E?s'L 76th j'Ave,,jfje
Anchorage, AK 99518
Phone: 907-243-0749
Attention' The pinr.-p "OS10eT Sh;:-'] ---xovidea pump in.stallation log to th.- DSr-, witr ir.-30 da%,,;ot`rz:,rnr.. instaliation.
Municipality of Anchorage
Development Services Department
Budding Safety Division
On-Site Water and Wastevrater Program
4700 South Bcegaw St.
P.O. Box 196650 Anchorage. AK g9519-6650
www.d.anchomqe.ak.us
(9O7) 343-7~04
Soils Log - Percolation Test
2-
3-
4-
5-
6
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18~
19-
20-
WAS G ROUt','D WATER
ENCOUNTERE0? ~
$
IFYES AT ~T DEP~7 ~
O
Dep~ to Water A~er p
COMMENTS
Reading Date Gross Time Net Time Deplh to Water Net Drop
PERCOLATION RATE ~' / (~i-'~les.'~) PERC HOLEDIAUETER ~ '"
'r~sTRUNe~N =. ~ r~ ~,~ /y Fr
PERFORMED IN ~e~t~i~F,EA~IUm~W~fF: ~b%tO~,6,PA-L~UtDELtNES ,. EFFECT ON THIS DATE DATE'
ROB ERT C. COWAN, P.E.
ROBERT^. SHAFER, P.E.
Date:
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-~J21 t
HE~TH AUT FIOrdTY
A.ePROVALS
SEW[R & WATER
M~JN EXTI~NSIOkES
8EWER & WATER
INSPECTION
EN'G~NE ERfl~3 STUOIE$
ANDREPORT$
WTll INSPECTION
& FLOWTEST
ROAD DESIGN
I~RCO~TION
STmJCTL~.&
INSPECTION8
WA~TEWATER
DISPOSAL SYST EM
DESION
Municipality of Anchorage
DEPARTMENT OF NEALTH AND HUMAN SERVICES
825 L Street
P.O, Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: L~'~' ~L .7A. 4-<..7' I ~Lu~ 5~,4J g374r~j
The septic In~p~ctions for the °referenced propert~ were
performed on~/~/0 Q- and .q~/07_ . Prior to submitting
the On-site Wastewa~ Disposal System and/or Well InsPection
Report we are Wa~t~ng for ~he ~$Bu,~ J~,/6~ to be'
comple~ed~
If we may be of further service Please contact us.
Sincerely,
Robert C. CoWan~ P.E.
17034 NORTH EAGLE RIVER LOOP * SUITE 204 - EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 25, 2002
Expiration Date: Jun 25, 2003
Permit Number: SW020191
Legal Description: BLUE SKIES ESTATES #1 LT 2
Design Engineer: 0003 S & S Engineering
Owner Name: Roman Kupczynski
Owner Address: 13001 Back Road
Anchorage, AK 99515-3539
Parcel ID: 021-011-26
Site Address:
Lot Size: 194713 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank ~ Privy
~-~ Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
THE SNAD USED IN THE FILTER LAYER MUST BE A CLEAN COARSE SAND WITH 4% OR LESS PASSING THE
#100 SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE
SAND USED OR OBTAINED FROM AN APPROVED SOURCE.
Received By:
Date: .,~.~_~0 ~..
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. {'~ I- b ~l -c>~-~:~
Permit Number SWOZO! ?1
Properly owner(s) ~,.0 P't f~ lq
Mailing address (1) [ ,'~OO I
Mailing address (2) /¥-[~.~C_ tic3 ~'o.. ~...~ ~([.t,L.
Legal description (Lot, Block & Sub'd.)LoT 7_ I '
Legal description (Section, Township & Range)
LotSize
/'/'/,
THIS APPLICATION iS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Day phone
Code ?'
Number of Bedrooms
Well Only
Water Storage
Jacuzzi
Water Softening Unit
I certify that the above Information ts correct. I fudher cedify that this application is being made for a
Single Family Dwelling and is In accordance with applicable Municipal Codes.
~'/d/~ 2 ~'~ S&SENGINEERING
(Signature of property owner or authorized agent) 17034 Eagle River Loop Road, No. 204
Eagle River, Alaska 99577
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
June 17, 2002
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-12 ! I
FEAJ. TH AUTHORITY
SEWER&WATER
SEWER & WATER
I~SPECTrON
ENGINEERING STt.OIF_S
AND REPORTS
~ELL ~SPECTIO~
& FLOWTEST
SITE PI.N~
RO~ DE$1C.~I
SO~TES!
P~RCOCATI~
TEST
STRUCI'UP, AL.&
MEC~N.
~$~
W~T~ATER
~PC~S~TEM
MUNICIPALITY OFANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 2,~ , Blue Skies Estates S/D #1
It is requested that you issue a permit to install a well & septic system to serve the
proposed five bedroom dwelling on the referenced property.
Two test holes were excavated and percolations tests were performed. The approximate
location of the test holes are located on the attached site plan. At the time of excavation
9/3/99 water was found in test hole #1 at 10 ½ feet and test hole #2 was found to be dry.
After seven days of ground water monitoring water was found at 10 feet in test hole #1 and
test hole #2 was still found to be dry. It was visually dete,lnined that at least 50% passed
the #4 sieve on test hole #1 at this time also.
We do not anticipate any adverse effects .on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
P, CC/jhm
Enclosures
17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577
10-15%
0T
I~l
~ 0.~j 5~,
o
(.3
u~u
O~
~Z ~ ~Z
O~ 0~
10-15%
10-15'/-
/
/
/
/
~l¥3S
,0g = ,,I NDIS,q'Q NVqd 3,LIS
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\
\
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?
,00I = ,,[ NDIS~tCI NV~Id ~£IS
" SITE PLAN DESIGN 1" = 100'
/
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\ \
\ \
\ \
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f /
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~0
SITE PLAN
DESIGN
\
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1" = 50'
mO
O0
0
I
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: d~) ~ ~"
1
2
3
4
5
7
8
9
11
12
13
14-
16-
17-
18-
19-
20-
/'~ ~,~ ~. $~y £t)'.Township. Range. Section:
)
DATE PERFORME~'~
/
.¢ ,,1,,,, a ,~. C.A A v ,f. c,
c., / 7,~,4c,,,f,. $ ~ -j.-
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
S
~F VES.^TWHAT
DEPTH? p
E
DeplhloWater~er I0' Da= ¢1/Io/'1~'
Monitoring?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~. I (minutes/inch} PERC HOLE DIAMETER __
TEST RUN BETWEEN, ~ '/,1-- FTAND Io'f't' FT
COMMENTS
PERFORMED BY: 1__'/_~?a I=..~1. I~Ivas. [eu,,p _D.._.! _ld_~. ~ . . _ CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4/65)
Municlpalily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: e~')O P'I//~J J(' ~ C ZY~ 3 ~' I
LEGAL DESCRIPTION:
."~. ~,L~,,¢..~,y, -~'"'<~' Township. Range. Section:
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9.
10
11
12
13
14-
16
17
18-
19-
20-
WAS GROUND WATER dO
ENCOUNTERED? _
6o/I
I-t','
DEPTH?
Deplh Io Water Aller
Reading Date
PERCOLATION RATE
Gross
Time
Net Depth lo
Time Water
(minules/inch) PERC HOLE DIAMETER __
Net
Drop
~EST.UN.ETWEEN 3 .A.O--~ FT
PERFORMED BY: ~ ~.~ ~,. , , ~ n..4 ~ ~ I
~ '~- _:3- · CERTIFY THAT THiS TEST WAS PERFORMED IN
72-~8 ~Rev.
~..~LTH AUTHO~TY
~'WER & WATER
MA,'N EXTENSK:)N~
~VER & WATER
INSPECTION
WELL INSPECTION
& H. OW TEST
SITE Pt.N~
ROAD DESIGN
TEST
P~ RCOLATIC~I
TEST
STRUCTURAL &
INSPECT~Oq~S
WASTE'WATER
~PO~ALSYSTEM
DE.~GN
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 2 .... :, Blue Skies Estates S/D/ti
June 17, 2002
GENERAL:
The scope of this project includes the installation of a 1500 gallon septic tank'
and new trenches to serve the proposed five bedroom residence located on the
referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
o
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department to do system installations. Owners installing
their oxvn systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be. constructed by a certified septic tank manufacturer,
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577
Page 2
Lot 2, ' Blue 5kle. Estat®s BID #1
June 17, 2002
o
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
Septic tanks installed ~vith less than 4 fl. ofcover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 fi. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shmvn on the design, and extend a minimum of 12 inches above final grade. The portion
ofthe monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot2, ' Blue Skle, Estates $/D #1
June t7,2002
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The folloxving pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 2, ~ ; . Blue Skies Estates
June 17, 2002
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there ~vill be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owners representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the oxvner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project,
CONTRACTOR / INSTALLER
v`') 7891 4
• 1
• Municipality of Anchor. ''`r '� '
On-Site Water and Wastewater Progr.f JUN1 2 2018(907) 343-7904 SAFE /
ti
Certificate of On-Site Systems App + s $ L
Parcel I.D. 021-011-26 Expiration Date: C7-- IF a tv
1. GENERAL INFORMATION:
Complete legal description BLUE SKIES ESTATES#1; LOT 2
Location (site address) 12820 Glen Alps Road *Anchorage 99516
Current Property owner(s) Roman Kupczynski Day phone 240-9032
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
El Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by:( Date: 1..,;j1(91/Z___
COSA to be release: to the en eer,unless otherwise requested by the engineer.
COSA Fee $ Jr' a/.( ' Waiver Fee $
Date of Payment &te!t$ Date of Payment
Receipt Number O512'9'2) Receipt Number
COSA# 0507 Ito Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: .S/l i i( 5
400000w4
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A' 0�4
in accordance with the guidelines and regulations established by the Municipality of Anchorage and �,..•• f. ��\ ,
industry practices. The reported results describe the condition of the system/s on the date/s of the c' .• V
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or I�
encroachments may exist that were not identified during the evaluation. The operational life of all wells �, 4 T •' •..�.t v0
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0 '/ Q
groundwater levels (that may fluctuate during the year), quality of construction (materials and Q� /' VA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q --1 eff Gorn ss. 7
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of VO 0 .!� CE— ' `Q�
the well or septic system. GEG makes no representation whether an alternative well or septic system (9 i j.' .�oeQ
can be installed on the property in the event either of the current systems fail to perform adequately in p fe, .'•S. ....t•' �Ao
the future. The content of this report is for the sole benefit of the person/party that retained GEG to �OP°'ar no\�o
ofessio a
perform the evaluation. Reliance upon the information provided in this report by any other person or \OOOOpdo
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for bedrooms��
System #2 Approved for bedrooms
Disapproved ` ���\ 01:AI
Conditional approval for bedrooms, with the followin?'fipu *.•E �
WATER AND v`
m WASTEWATER o
PROGRAM
fy'�^/'QrRv\GY
�_ /' 1
By: ►� 1 / Original Certificate Date: C9 l 1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist ,Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: BLUE SKIES ESTATES#1; LOT 2 Parcel ID: 021-011-26
A. WELL DATA *TO BEDROCK —. T''C-4- F�^4g. Q. 4.[.1Z.D c 04:10
T --tre.a cid
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 7/22/02 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 360 ft. Cased to *21 ft. Casing height(above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/22/02 5/17/18
Static water level 12 ft. 16 ft.
Well production 1.8 g.p.m. 3.2+ g.p.m
WATER SAMPLE RESULTS:
ill 3
id
0 Coliform NEG colonies/100 ml. Nitrate 0.328 mg./L. Collected by: GEG, Ltd.
Arsenic: <5.0 ug./L. Date of sample:
5/17/18
5 B. SEPTIC/HOLDING TANK DATA
2 Tank Type/Material SEPTIC/STEEL Date installed 9/6/02
j (II Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) YES
o di% Foundation cleanout (Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A
Date of pumping 5/8/18 Pumper AROUND THE CLOCK PUMPING
40
C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MONITORING TUBE NORTH/SOUTH
Date installed 9/6/02 Soil rating(q.p.d./�Zor ft2/bdrm) 1.0 System type DUAL SHALLOW TRENCH
Length 75 x 2 =150 ft. Width 5/5 ft. Gravel below pipe 0.5/0.5 ft.
--3► Total depth *2.6+ _ft. Eff. absorption area M ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 5/17/18 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test 0 in. Water added 768 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate>= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date -
*BOTH TRENCHES HAVE 2 INCHES OF INSULATION PER 2003 INSPECTION REPORT
TESTED NORTH TRENCH ONLY
SOUTH TRENCH WAS DRY UPON ARRIVAL AND REMAINED DRY THROUGHOUT TEST
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at '• wa er alarm level at in.
- _- Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation `5'+ Property line 5'+ Absorption field 5'+ (ASSUMED)
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN_ Wells on adjacent lots 100'+
F. COMMENTS
*MET CODE AT TIME OF INSTALLATION
••"�, cF. .441.
G. ENGINEER'S CERTIFICATION :4P..••• ji• •.
I certify that I have determined through field inspections and • 1.I,i .m ---..).- -•
review of Municipal records that the above systems are in /i •
conformance with MOA COSH guidelines in effect on this •0
date. • J- f e, A Garne s::
♦ Gi ,.'• • 2.
L1 m
Engineer's Printe Nam JEFFREY A.GARNESS •• 5> E— 3 •c. f
Date �Z�I 6 *** PROFESSOr:'
LICENSE 1•Iim"t,•`�
RAECC884
(Rev.10/12/12)
GRAPHIC SCALE: 1 Inch = 80 Feet
i 11 11
LINE CHART
40 0 40 80 160 NO. BEARING LENGTH I l l l L I l l l %//�
L1 S5O°31 '49"E 166.49
o D 4 a ---` - L2 547'05'36"E 41 .18 1r l �/
L3 S40°46'10"E 93.53 0 26.9
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CURVE TABLE B U I L D I N G DETAIL ` BOBBY F. BURNETT /
IS-5484 /
NO. RADIUS DELTA LENGTH N.T.S. 1 5- ,2/ -/e/ Ar 545.00 34°17'27" 326.18 t �htssioNnL`',i
Date Scale Legal Description
T TD�TE l 1 T�7 5/19/2018 1 ' = 80 I hereby certify that the property described hereon has been surveyed
BOBBY F. BV Lel V by me, or at my direction, and that the improvements situated thereon
Grid AS—BUILT LOT 2 are within the property lines and do not overlap or encroach on the
2941 Carriage Drive SW 25842 BLUE SKIES ESTATES, ADDITION 1 property lying adjacent thereto unless otherwise shown. That no
Anchorage, Alaska 99507 improvements on the property lying adjacent thereto encroach on the
(907) 350-5541 Drawn by Field Book premises in question and that there are no roadways, transmission
BFB ASB 2018 PLAT # 98-137 lines or other easements on said property except as shown. //
Municipality of Anchorage
Devetopment-,..qervices-Department
Building Safety Division
On-Site Water and Wastevra~.er Program.
4700 South Bragaw SL
P.O~ Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak, us
(g07) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A ~INGLE FAMILY DWELLING
Parcel I.D. 021-01i-26
GENERAL INFORMATION
Comple.te legal description
Location (site address or directions)
HAA#
Expiration Date: / 0 - / - ["'}_,.~
L'o~ 2; Blue Skies Estates #1
NHN Glen Alps Rd. Anchorage
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Roman Kupqzynski
Day phone 345-0936
Day phone
Scott' Popp~r~ ! p~pp~r Cnn~4Yd'~8~_ ROb-ORS1
1022~ 'W.'Frontage Rd. Anchorage, AK 99577
NUMBER OF BEDROOMS: fi.
TYPE OF WATER SUPPLY: '
Individual Well
Individual Water Storage
Community Class Well
Public Water System
'rYPE OF WASTEWATER DISPOSAL:
Individt~al'On-site
Individual Holding tank
Community On-site
Pub!ic Sewer
The Municipality of A~chom~ Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 .by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 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 pdvate or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a pedod 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 daie shown below, I vedfy that my investigation,
based on procedures outlined in the Health Authority Approval Guidblines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedroomS, and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
HcmcofFirm S.& S Enginee~inK 'Pnone 694':'297(~ ........
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Date (~ / ~-5'-/0 ~. '
Engineer's Pdnted Name
DSD SIGNATURE
b/Approved for
Dis'approved.
Conditional approval for
bedrooms.
',.."
bedrooms, with the following stipulations:
Additional Comments
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(R~.
Municipality of Anchorage
Development Services Department
Building Safety Divtslon
On-Site Water & Wastewater Program
4700 South Bragaw SI
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
Legal Description:
A, WELL DATA
Well type ~
HEALTH AUTHORITY APPROVAL CHECKLIST
IfA, B, or C provide PWSID #
To~I depm ~ ~ Cased
FROM ~ ~O~
Date of test
Static water level
Well production I , ~
WATER SAMPLE RESULTS:
Coliform . Q colonies/100 mi.
Arsenic: , .'-' mg./l.
e.
g.p.m.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
g.p.m.
Nitrate ~! l~ mg./L
Date' of sample:~_/~/~)'~
SEPTICfi-IO~ TANK DATA
Ta,k Type/Mstarial ~'/~"! ~, I ~
I
Tank size ~ gal. Number of Compartments
Foundation cleanout (Y/N) Depression over tank (Y/N)
Date of pumping /J' c~f'/ Pumper
c. ABSORPaO. mELB DATA
) J~ 'f-' in..
I colonies/lO0 mi.
Date inStalled~L~.,~."~' Soil rating (g.p.d./ft~ or e/tx:lrm) I' O System type~
Length J ~ 'ITc,- ft. Width ~ fl. Gravel below pipe ~, ~ fl.
Totaldepth..'~.ff. Eff. absorptionaraa~'St~ft2 Monltoringtube.~_. Depmssionoverfield, /'~
Date of adeguacy test ~.C4~J Results(Pass/Fall) _/?~5 For ~'"bedrooms
Fluid depth in absorption field before test/ in. Water added gal. Ne/depth in.
Elapsed Time: .. min. Final fl~l depth in. Absorption rate >=/ g.p.d.
Any rejuvenation lmatment (past 12 mo.) (Y/N & type) ,/k/ If yes, give date
Date installed
Cleanouts (Y/N)
High water alarm
Other bacteria
Collected by: . ~ ~.'~ ~'~i61eJ(~:~l~G.
D, LIFT STATION
Pump on level at//', in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level at _ . in
Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO.
Septic tank/lift s,~3ff'6n on lot I
Absorption field on lot
Public sewer main /kl
Se~septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~'
Water main ' nj / ~ Water service line I (~) 14--
Wells on adjacent lots ~ ~
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Absorption field
Surface water J ~)
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/
Property line ! (~) ~ ~ I.p ~j /
4-- Building foundation J 0 Water main
Water Service line ~ (~ I.p Surface water ~ ~' ~ Driveway, parking/vehicle storage
Curtain drain ,~0/~ ~J ~ Wells on adjacent lots, ~ ~
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date,
C.
Co,.,,,,.,.,,
Engineer's Printed Name
Date ~'/~-5-/1> '~_
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Data of Payment
Receipt Number
(Rev. 12/01)
.%
5--19,,'03 AS BUILT 58-66
6/12/02 PLOT PLAN 55-28
DATE
-~,~ .........'~ ~w
NOTES: Easements not appearing on record
~1~I ore not shown unless descrlpllon of easemenl Is
~rovlded by client. II Is fha responsibilit~ of the owner
~r builder, prior to conslruclJon, Io verlf~ proposed
building grade rel~live ti finish grade end utilities
connections, end to determine Ihe exislence of
e~sements, covenants, or reslrlclions ~hlch do not
appear on the recorded subdivision
Elevations based on assumed dot~ unless olherwise
indicated, and bearings and distances ore record dot~.
FLD. BK.
SSS Eng neenng
S"~,.Q, -- 17034 [,~L[ RIVE:R LOOP ROAD
(907)694-2979
",,,~. ~., LEGAL DESCRIPTION
X
',, ~. % ~-~7 I ,'.~o' I ~e..
. 18,15'