HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 2 LT 13Chugach Park
Estates
Block 2
Lot 13
#051-481-08
Municipality of Anchorage
.� Development Services Department_='r,
Building Safety Division
On -Site Water 8 Wastewater Program, 4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ei.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SWO20456 PIO Number: 051-481-08
Name: HEARTLAND HOMES
Wastewater System: ■ New ❑ Upgrade
Address:
5043 NORTH SANDLWOOD LANE a PALMER. AK
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 746-6266 4
ODeep Trench ■shollo. Trench Deed 011ound Dalher
LEGAL DESCRIPTION
Sae Rolvq:
1.2
Taal Depth Nam oipnol pout:
9 MAX
cpo/sq. rt.
rL
elack: Lot: subdivision:
Doth to pipe saltwe Iran w'e"al pad.:
Wont depth booth pqe:
2 13 CHUGACH PARK ESTATES
4.97 MAX rt.
4.03 n.
To.nship: Range: Section:
ra ode.d stow W" peer.
Dra.N bngth:
- - -
SEE DWG. rt.
50 rI
WELL: ■ New ❑ Upgrade
fwa.al .elh:
5
Nwnew of dn..:
1
O.lonc. W. lines:
—
rt.
n
cme:t<aen (prHel., we.c):
Taal 0.0h:
1
Cosa To:
Total ob. 9tion ww:
Pio ~~PRIVATE
D 3034/ F-810
400 n.
237 rt.
500 so. rt.
oirsr:
0.1. onsee:
Stout wotw L~'
ent~
BAILEY'S BACKHOE
Date Ynlas.d:
11/18/2002
SULLIVAN WATER WELLS
ll 15 02
201 n.
.«e
Pwnp set .t:
N.:
c." ghl ,sew www:
TANK
1.1 GPu
UNKNOWN n
2 n
SEPARATION
DISTANCES
■septic 0Holding 0S.T.E.P. 0Other
To
Septic
Absorption
Lift
Holdingtc/Pruol.
VOApt«lw«:
ANCHORAGE TANK
Copootr in pibn.:
12550
From
Tonk
field
Station
Tank
Se.w Lnee
Well
too'+
100'+
-
-
25'+
.Iatwial:
STEEL
one« of swnpwlmenl.:2
Surface water
too•+
100'+
—
—
—
LIFT STATION
Lot Line
5'+
10'+
—
—
—
y.e N tiMens;
.IeM«lures:
Foundation
5'+
10'+
—
—
—
en tonal ol: p alt .1:
High .oto ear. at:
curtain Drain
NONE KNOWN
}-regal.
LNc4cw ln.p.clions pwfwmW W.
BENCH MARK
Remarks:
Locoten and 0..rvlW
TOP OF CMU FOUNDATION
r.,.n.d ENwton: 100.00
n,
ENGINE!W3ll
�p
p�OFo 4
Inspections performed by: AKWWC, INC. Dates: 1st 11/18/2002
0 ... T ."° 0�
2nd 11/18/2002
l�
000 'e "
3rd 11/18/2002
e
; orne s:DeveloG
al-
Service DepartmentApproval
o4�pOdP -795
r a
d bit
ovv
a�oFh
0
Reviewed and approe
IZ/01)
ofes O
4p0000��.
(An.
PERMIT N°HOER AS -BUILT D RAW I N G PARCEL ID NUMBER.
SW020456 05I-481-08
NEW /
WELL ,
W
RA �
/ / I D0L2 /
/ /p{
/ 1 NEW GALLON
/ rTEST PIT SEPTIC
TANK
CUTBANK
10' UTILITY EASMENT
l
♦ H/1 \ ♦ EXISTING
♦♦ ♦♦ 4 BEDROOM
♦♦♦ 7� H IISE
♦ ♦♦
DRAINFIELO ♦\♦ ♦!; KNHENC.
II
♦
TERNATE SITE
— _ — —
C01
25.28
13.96
STI
26.39
16.49
ST2
30.87
24.19
CO2
48.23
65.04
CO3
69.30
82.72
MTI
67.62
80.99
EN'
A'.j ffr A. Cor e55;'
Qa —79
''
52.14
C04
25.68
50.78
5/29/2003
o OF �pf�1
JRAWN BT:
vP \�!•'••.. ... .V 40
ALASKA WATER & WASTEWATER
c• 1•c.
Q ;. • `fy��
SCALE
1" — 40�
CONSULTANTS, INC.
""'•• ..... • "' """"'
6001 DFRARR ROAD. SOITF 7R • AWHORAGF. AK 995M. • MONF I9071557EA9 • FAX (90A55A.5tAM1
Q
QO
'REPAREO FOR: PHONE NUMBER:
"AGE NUMBER:
HEARTLAND HOMES (907) 746-6266
2 OF 3
A'.j ffr A. Cor e55;'
Qa —79
''
_EGAL DESCRIPTION
CHUGACH PARK ESTATES SUBDIVISION; LOT 13, BLOCK 2,
r
loo�QoG
�4 �P�ofeesOX C
4040000
TYPE OF WORK.
AS -BUILT DRAWING OF NEW WELL AND SEPTIC SYSTEM
PERMIT NUMBER. PARCEL ID NUMBER.
SW020456AS-BUILT DRAWING 051-4811-08
r FINAL GRACE . 98.73+
TOP OF TANK A
INLET . 94.73
INVERT OF BUNG J
AT INLET . 94.35
ORIGINAL GRACE
97.71 O
NEST PONT
RELEME ELEVATION OF BOTTOM OF
TESTHOLE • 81 71 (TESTHOLE DRY)
NEW 1250 GALLON
SEPTIC TANK
TOP OF TANK AT
OUTLET . 94.65
`INVERT OF BUNG AT
OUTLET . 94.06
nNAL GRACE .
97.99 (AVC.j
FABRIC
INVERT OF PIPE
. 92.74 (AVG I
iTTOM OF TRENCH
. 88.71 (AVG.)
5/30/2003
AWN BY.
ALASKA WATER & WASTEWATER C.J.G.
WASTE, i
CONSULTANTS, INC. SGLE
6001 OFAARR ROAD. SUITF ?A • ANEHMAGF AI 99SO1. • PHONF (907)]}7.6179' FAX (907)310.3?16 1 — 40'
'REPARED FOR. PHONE NUMBER: PAGE NUMBER
HEARTLAND HOMES (907) 746-6266 2 OF 3
EGAL DESCRIPTION:
CHUGACH PARK ESTATES SUBDIVISION. LOT 13, BLOCK 2.
TYPE OF WORK
PROFILE AS—BUILT DRAWING OF NEW SEPTIC SYSTEM
re fW7
neSS:
C9 ...
Certifieb tri ting Log
by
Doc co. db,
SULLIVAN WATER WELLS
D.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2750
OWNER OF LAND: &-A<TAt4w)A A0-*; t" -P BORE HOLE DATA
DEPTH
ADDRESS: I o.., t
LEGAL DESCRIPTION: CGM-16 j9ief #V
R4 /,O
DATE /1 /S DCrZ•
PERMIT NUMBER: 012245_6 Date of Issue -L3-
TAX IDENTIFICAMON NUMBER: OS� _ _-� F
Is well located at approved permit location? No
Method of Drilling:it rotary :.I cable tool
Depth of well: 401D
Casing Type -�1.. 4' Wall Thickness inches
Diameter 12 // inches, depth e2 R -7- feet
Liner Type: —A) aOJ a
Casing Stickup Above Ground:—d- feet
Static Water Level: two/ feet
Recover Rate: /, 1 gpm
Method of Testing: _OQ 4
Well Intake Opening Type: u open end &open hole
U Screened; Start feet Stopped feet
U Perforations Start feet )lopped feet
Grout Type: Tod"i'l! Volume d5-C,/_!g
Depth: from feet. to feet &
Well Disinfected Upon Completion? &- re;' J No
Method of Disinfection4li/e 04?i .Ji- .5-0
Comments:
ATTENTION: It is the responsibility of the property owner to Submit a Copy of the well log to the proper authority. Municipality
Of Anchorage: Department of Health t£ Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
10/10 39Vd NVAIITIS 6SZZ889 10:00 6661/10/10
d,4S foJG
pati/c 06dCOcn/
S 4 LSI Q �,f0q J L
Higapt�,9r.1
s
,
J 44,tw t 64 4irc
Hwgoo oO,4^j
iaz
x(4 ry 6e1>lLdL9r
8
S4 -J4 s jgR,lJec.
tilb
dir T
16 M r .Sr:- 7-
/?4no,c
S cJI _rFyr / 6 eH
Lc?L=AQ_(7G� /[.✓}GIC
2.
N"I
_
Y
s3
39
_QFattiC,L 11,,e4Y
4IOa
14 7
Drillers
Name
j .eM��ir
ATTENTION: It is the responsibility of the property owner to Submit a Copy of the well log to the proper authority. Municipality
Of Anchorage: Department of Health t£ Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
10/10 39Vd NVAIITIS 6SZZ889 10:00 6661/10/10
MUNICIPALITY OF ANCHORAGE
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 I WATER SUPPLY PERMIT
Initial
Permit Number: SW020456
Date Issued: Nov 13, 2002
Expiration Date: Nov 13, 2003
Parcel ID: 051481-08
Legal Description: CHUGACH PARK ESTATES BLK 2 LT 13
Design Engineer. 0041 AK Water & Wastewater Consultarr Site Address:
Owner Name: HEARTLAND HOMES Lot Size: 58525 SO. FT.
Owner Address: 19210 KULLBERG DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK . AK 99567 -
This permit is for the construction of:
❑; Disposal Field R✓ Septic Tank Holding Tank El Privy Private Well Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: z -
Date: /3 02
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
V P.O. Box 196650 Anchorage, AK 99519-6650
t www.ci.anchorage.ak.us
(907) 343-7904 �'►
ON-SITE SEWER/WELL PERMIT APPLICATION<'
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-481-08 Permit Number 5tv02045'6
Property owner(s) HEARTLAND HOMES
Day phone (907)
746-6266
Mailing address (1) 5043 NORTH SANDLWOOD LANE
* PALMER. AK
SlT¢
44ertingaddress(2)I92/0 ICULLBERG DRryti
C11t,61.48, 4 Zip Code 99745
Legal description (Lot, Block & Sub'd.) CHUGACH
PARK ESTATES SUBDIVISION, LOT 13,
BLOCK 2.
Legal description (Section, Township & Range) N/A
5B. 2 S Acres/Sq.Ft.
Lot SizeS
Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer only ❑
Well Only
❑
Sewer and Well 0
Water Storage
❑
Sewer Upgrade ❑
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.
ALASKA WATER do WASTEWATER CONSULTANTS. INC.
$900 .11,150f 150170p
Permit Fees:
Date of Payment: It - M-62.
Receipt Number: 28 043
Waiver Fees:
Date of Payment:
Receipt Number:
ALASKA WATER F& WASTEWATER
CONSULTANTS. INC.
November 5, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed Well and Septic for Lot 13, Block 2; Chugach Park Estates Subdivision
To whom it may concern:
The proposed 4 bedroom house will be served by a private well and septic system. Two test
holes were excavated on the property by KND Engineering and one testhole by AKWWC Inc,.
The drainfield will be designed around the 30 foot radii of these test holes. We are proposing that
a 1250 gallon septic tank and a 5 -wide type drainfield be installed. Comments regarding the
design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/R2
should be used. The insitu SP soil layer @ 14' of depth should act as a sand filter.
2. TRENCII DESIGN:
a. Percolation Rate: <l, <1 & <1 minutes/inch
b. Proposed Application Rate: 1.2 gallons/day/RZ
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 500 R2
f. Total Depth: 9 feet (max.)
g. Effective Depth: 4
h. Width: 5 feet
i. Reduction Factor: 0.5
j. Minimum Length: 50 feet long
k. Effective absorption area = 500 R2
6901 Debarr Road, Suite 2B' Anchorage, AK 99504
Ph: (907) 337-6179' Fax: (907) 338.3246' Website: akwwe.com
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed design.
4. TOPOGRAPHY: The area for the proposed septic system is fairly flat. There is an cutbank
to the southwest of the proposed drainfield that is approximately 35 feet away. We request that
you grant the 50 foot separation waiver from the drainfield to the cutbank to 35 feet. The
porosity of the soils should create a downward movement of the effluent and minimal lateral
movement. The cutbank is heavily vegetated which will keep the effluent from daylighting from
the cutbank.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
NOTE: A site plan, design drawing, three soils logs, and a 7 page construction specification
letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 213 • Anchorage, AK 99504
Ph: (907) 337-6179' Fax: (907) 338-3246 • Website: akwwc.com
V /
CHUGACH PARK ESTATES
LOT 10, BLOCK 2 _•
I ._.. WE1l-o'♦O'l1L
i
C ACANT-
CHUGACH PARK ESTATES \
LOT 9, BLOCK 2 \ \
-_--_\ \
KND ENG. TH/1
CHUGACH PARK ESTATES
LOT 12, BLOCK 2
'CZACANTD
iCACH PARK ESTATES
AT 11. BLOCK 2
rr
WACANTD
\ PROPOSED SEPTIC SYSTEM
\(SEE DESIGN PACE 2 OF 2) /
/
lee
/
L. ..i
ALTERNATE STfE
11/5/2002
P'1-1. _...._ .. ..T-• _ / i Y.( " ♦ DRAWN BY:
ALASKA NVATRR & WASTENVATRR C.J.G.
CONSULTANTS, INC. SCALE:
6001 DFRARR ROAD. 51RTF tR • ANCHMAGF. AK 995M • PHONF (00)1357-0170 • FAX (007153p-0)GE 1 w C 100'
PREPARED FOR PHONE NUMBER: PAGE NUMBER:
HEARTLAND HOMES (907) 746-6266 1 OF 2
LEGAL DESCRIPTION:
CHUGACH PARK ESTATES SUBDIVISION. LOT 13, BLOCK 2,
TYPE OF WORK:
SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM
I
�\I
CHUGACH PARK ESTATES
\ LOT 14A, BLOCK 2
ENG. TH/1
-PROPOSED
4 BEDROOM
HOUSE
mi//Aiam
f
a CGmess:
C 7953 A,
\F
0
10' UTILITY EASMENT
PROPOSED /
�ND ENG.
TH01
4 BEDROOM
HOUSE /
`\ KND ENG. /
♦\ �\ THII /
PROPOSED DRAINnmp. EXCAVATE A
TRENCH THAT IS 9 FEET DEEP
MAXIMUM BY S FEET WIDE BY 50
FEET LONG. ADD 4 FEET OF CLEW.
WASHED SEWER DRAINRDCK.
ALASKA NVA
c
600, OFRARP POEO. SIPTF ]R • ANCi
PREPARED FOR:
HEARTLAND HOMES
3TEWATER
PHONE NUMBER:
(907) 746-6266
11/5/2002
AWN BY:
C.J.G.
ALE:
1"=40'
;E NUMBER:
2OF2
CHUGACH PARK ESTATES SUBDIVISION, LOT 13, BLOCK 2.-
E OF WORK:
DESIGN OF PROPOSED WELL AND SEPTIC SYSTEM LOCATION
.; .:
/.'
PROPOSED ::.
•:•
WELL
���:
r:�
J •
INSTALL DOUBLE
CLEALNOUTS
�.�^�. �•;'r• /
\
ROPOSED 1250 CALLLON,.��
SEPTIC TANK
< ALTERNATE SITE WILL
\
.: '',:.•�",.% /
/ REQUIRE THE USE OF
y�
��
INSTALL FOUNDATION
/,
ENT UNIT
TREATMENT
� , ; . •�•.••`
/ �
10' UTILITY EASMENT
PROPOSED /
�ND ENG.
TH01
4 BEDROOM
HOUSE /
`\ KND ENG. /
♦\ �\ THII /
PROPOSED DRAINnmp. EXCAVATE A
TRENCH THAT IS 9 FEET DEEP
MAXIMUM BY S FEET WIDE BY 50
FEET LONG. ADD 4 FEET OF CLEW.
WASHED SEWER DRAINRDCK.
ALASKA NVA
c
600, OFRARP POEO. SIPTF ]R • ANCi
PREPARED FOR:
HEARTLAND HOMES
3TEWATER
PHONE NUMBER:
(907) 746-6266
11/5/2002
AWN BY:
C.J.G.
ALE:
1"=40'
;E NUMBER:
2OF2
CHUGACH PARK ESTATES SUBDIVISION, LOT 13, BLOCK 2.-
E OF WORK:
DESIGN OF PROPOSED WELL AND SEPTIC SYSTEM LOCATION
'a9pF o
. � r� .a.. c .. � � .........• .SAO
ALASKA WATER &. WASTEWATER y
CONSULTANTS, INC. A * * Q
90 •k4CHDPA04 AK 92504 • 90 _ •k•..,opn
SOIL LOG - PERCOLATION TEST 0.. ,.. ,. „ ..... ...
CHUGACH PARK ESTATES SUBDIVISION; LOT 13• BLOCK 2, of a A. am ss:
LEGAL DESCRIPTION: C 795 .pp
AA9 •
PERFORMED FOR: HEARTLAND HOMES DATE: 11/4/2002 VOD �dO
DEPT 000�
zzz==-- ORGANICS •^p0o t+++loaa�
(feet
t
TEST HOLE71:1
0000
SM/ML SOIL CLASSIFICATIONS t //
2
Gw
GM CL y: i
•'s.•:
'•' GC OL
SW MH
5 �, -••: •• •••: SP CH
SM : OH ��' AKWWC INCsc.
7 `-_. '0
GP/SP
•?"-••• \ ND ENG.
8'^�'• THi1
.� .
g R-'••:
KND ENC. %'`., SITE PLAN
•?"^•.• • THI1 1 •a1 DDS
10 •'•
13 '-'•':
14 •
15 •... SP
is '••'
615 �oi
B.o.u.
17
18
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 6.0 FT. AND 6.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ENO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS
COMMENTS: THE NATURAL SANDY INSITU SOILS SHOULD ACT AS A SAND FILTER
PERFORMED BY AKWWC, INC. I, JEFFREY A. CARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
DEPTH TO
GROUNDWATER
DATE
DRY
11/4 2002
`f
� I Icoi
DATE
READING CLOCK NET TIME
WATER LEVEL NET DROP
TIME (MINUTES)
READING (INCHES)
GP
�1
ENGINEERING J
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for. Sean 8r Chris Stevhensen Date Performed: 08/21/02
project Chugach Park Estates Block 2,Lot 13 TEST HOLE a 2002,01
15-
16
17-
18-
19-
20-
ORG — red/brown overburden
w/ organics
SW — gray sand w/ !race of silt
GPlSP—brown/gray, sandy
gravel w/ cobbles to 2'
mane sand & moisture
increasing w/ depth
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? NA Date? 08/28/02
Reading
Date
Gross
Time
Net
Time
Net
Drop
1
8/28/02
1:00
2
1.0.5
5 min6"
P6'
3
1:06
4
1:11
5 min
dry I
6"
5
1•
1:12
6"
-
6
1:17
5 grin
dry
6"
7
1.18
6"
8
1:23
5 min
6"
9
124
6"
10
129
5 min
6"
it
•
1:30
6"
12
135
S min
dry
6"
•
Water
Added
Percolation Rate s1(min/in) Perc Hole Diameter_¢=
Test Run Between 4 feet and 5 feet
I, Kenneth M Duffus, certify.that this test was performed in accordance with all State and Mtutidpal guidelines in
effect on this date.
600E YYd ZVOT ZOOVOWOT
K D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
Performed
15-
16-
17-
18-
19-
20-
SOILS PERCOLATION TEST
ORG - red/brown overburden
w/ organo
GP/SP -brown/gray, sandy
gravel w/ cobbles to 3'
coarse sand & moisture
increasing w/ depth
trace of silt
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
CF 7116
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? NA Date? 08/28/02
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
8/28/02
1:00
6"
2
SAS
5 min
dry
6"
3
•
1A6
6"
-
4
1:11 1
5 min
dry
1 6"
5
•
1:12
6"
6
1:17
5 min
dry
6"
7
•
1:18
6"
8
1:23
5 min
dry
6"
9
•
124
6"
10
129
5 min
drV
6"
11
•
1:30
V
-
12
135
5 min
12a
6"
•
Water
Added
Percolation Rate ,S1(min/in) Pere Hole Diameter—Al.-
Test
iameterTest Run Between_ 3 feet and 4 feet
I, Kenneth M. Duffus, certify that this best was performed in accordance with all State and Municipal guidelines in
effect on this date.
Coo® YY3 ZO:OT ZOOVSVOT
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-481-08 COSA# 107o�10R
Expiration Date: /0-30-07
1. GENERAL INFORMATION
le§Q G
Municipality of Anchorage
713
Complete legal description Chugach
Development Services Department
Lot 13
Building Safety Division
Dr Chugiak
On -Site Water and Wastewater Program
4700 Bragaw Street
l" hristine Stephenson
P.O. Box 196650
Anchorage, AK 99519-6650
670202 Chugiak
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-481-08 COSA# 107o�10R
Expiration Date: /0-30-07
1. GENERAL INFORMATION
Complete legal description Chugach
Park Estates,Bim,
Lot 13
Location (site address) 19210 Kullberg
Dr Chugiak
Current Property owner(s) Shawn and
l" hristine Stephenson
Day phone
Mailing address PO Box
670202 Chugiak
AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent Iles Rail
Py
Day phone _689-6451
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community Onsite
❑
Public Water System
❑
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 On -Site
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 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.
Engineer's Printed Name KENNETH M. DUFFUS Date 07/20/07
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.
The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from
the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the
year and the water usage of the family being served by the system. The operational life of all well and
septic systems are subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
��
.: OF `\ %It1�
system will function satisfactory for current or future pL.••••••A;•45,
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist. W* iwoTu •'•. •t ry
K-777.
S. DSD SIGNATUREdo
I s'•. <%% _ : �'
Approved for bedrooms.
it Fe •�7•••• .••���.r
Disapproved. 1������
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA ChecMist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: �/ !�✓, �� Original Certificate Date: 7— �� ` "f7 %
Jr� nAs�
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water b Wastewater Program •�
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID #
Date completed 11/15/02 Sanitary seal (Y/N)Y
Total depth 400 ft. Cased to 237 ft.
FROM WELL LOG
Date of test 11115/02
Static water level 201 ft.
Well production 1.1 g, p. m.
WATER SAMPLE RESULTS:
_ Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 2-4 in.
AT INSPECTION
7!12/07
209 ft.
/. g.p.m.
Coliform _Q colonies/100ml- Nitrate 0 mg/L Other bacteria —aoolonies/100 mL
Arsenic: Q mgA Date of sample: 7/13/07 Collected by: ArcTerra
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 11/18/02 Tank size 1250 gal.
Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) JN
High water alarm,(KJN) N_Date of pumping 7/13/07 Pumper A Pumping
C. ABSORPTION FIELD DATA
Date installed 11/18/02 Soil rating (g.p.d./le orfefbdrm) 1.2 gpd System type Trench
Length 50' ft. Width -1 ft. Gravel below pipe A -ft. Total depth.1 ft.
Eff. absorption area-Ji1Li-fe Monitoring tube Y Depression over field )Y
Date of adequacy test 7/13/07 Results (Pass/Fail) Pass For A— bedrooms
Fluid depth in absorption field before test _Q_ in. Water added Innn gal. New depth.0_in.
Elapsed Time: -BD— min. Final fluid depth 0 in. Absorption rate >= 600+ 9.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) N If yes, give date .....
D. LIFT STATION
Date installed NA
`Pump on' level at --in.
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at—in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 7S'+
Sewer /septic service line 25'+
Animal containment areas 50'+
Manhole/Access (Y/N)
High water alarm level at—in.
Mae% alarm & circuit requirements7Y
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 10 0'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5 '+ Absorption field S' +
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 101+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ Wells on adjacent lots 10 0'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and rix'
review of Municipal records that the above systems are in ✓ &Cnmt
conformance with MOA COSA guidelines in effect Is
date.. s .....,..;
Engineer's Printed Name KENNETH M. DUFFUS
COSA Fee
Date of Payment 14 - /,�6 0,4
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
C*6;
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 SouthS
` P.O. Box 196650 Anchorage,
L
AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
stiCERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING 6--
h
Parcel I.D. 051-481-08 HAA#
O
1. GENERAL INFORMATION Expiration Date: — S ' Q 3 \ j
Complete legal description CHUGACH PARK ESTATES SUBDIVISION; LOT 13, BLOCK 2.
Location (site address or directions) 19210 KULLBERG DRIVE • CHUGIAK, AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
HEARTLAND HOMES Day phone (907) 746-6266
5043 NORTH SANDLWOOD LANE ' PALMER, AK
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
0
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 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 private or Class C well and may
be reissued with new water samples. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, orprior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified jiff y seal affixed hereto and as of the validation date shown below, I verify ths(my
Invest' Ad?IvO`a&ed on procedures outlined in the Health Authority Approval Guidelines for this application,
sl t liPen-site water supply and/or wastewater disposal system Is(are) safe, functional aAb equate
*for thej�yyumber of bedrooms and type of structure indicated herein. I further verify that based on the
y Infon�ation obtained from the Municipality of Anchorage riles 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 ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SURE 28 • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
S. DSD SIGNATURE
Approved for L� bedrooms.
Disapproved.
337-6179
Date o3
o�oF
d
e
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Car ess:
By: ag,� l� /� Original Certificate Date:
(Rw. 1901)
Municipality of Anchorage
• Development Services Department
Sulidheg Safety Division
OnSke Water d Wastewater Program
4700 South Bragaw, St.
P.O. Boa 196650 Anchorage, AK 99519-6650
www.ci.anctwrage.sk.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
4
Legal Description: CHUGACH PARK EST. S/D: LOT 13, BLOCK 2. Parcel ID: 051-481-08
A. WELL DATA
Well type SATE If A, B, or C provide PWSID# N/A Well Log (YM) YES
Date completed 11/15/02 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth 400 ft. Cased to 237 ft. Casing height (above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 11/15/2002
Static water level 201 ft. ft.
Well production 1.1 g.p.m. g.p.m.
WATER SAMPLE RESULTS: 11
Coliform � colonies/100 ml. Nitrate N• JP mg./L. Other bacteria _{(Lcolonies/100 ml.
Arsenic: N/A mg./L. Date of sample: Collected by: AKWWC. INC.
S. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL Date Installed 11/18/2002
Tank size 1250 gal, Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) N/A
Date of pumping NEW Pumper —
C. ABSORPTION FIELD DATA
Date installed 11/13/2002
Sob rating .p.d.
ft'/bdrm)
1.22
Length 50 ft.
Width
5
ft.
System type TRENCH
Gravel below pipe 4.03 ft.
Total depth 9.3 ft. Eff. absorption area 500 fe Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fall) —
Fluid depth in absorption field before test = in. Water added =gal.
Elapsed Time: = min. Final fluid depth — in.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type)
Absorption rete >=
For 4 bedrooms
New depth =in.
If yes, give date —
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 59+ Property line 51+ Absorption field 5'+
Water main N/A 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 N/A
Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cer* 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.
Engineer's Prirr arae JEFFREY A. GARNESS
Date 3
HAA Fee S 3a 4'150 s0625,*10 n
Waiver Fee $
Date of Payment
Receipt Number. 396462
(rt.v.12101)
Date of
Receipt Number
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