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DENALI VUE LT 3
Denali Vue Lot 3 #051-134-09 FROM : COUTW REALTY PHONE NO. : 9076181238 Dec. 29 2005 02:27PM P4 STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION INVENTORY AND SOURCE REGISTRATION FORIii FOR CLASS "C" PUBLIC WATER SYSTEM 2yatemNarne: Legal Description of property: Number of People Served Daily. W Number of Service Connections: Owner's Name: " .ff Address' /0-d t3or Phone: 6,811—/z.l� Fax: y� fj—/ 3� Email ITEMS REQUIRED FOR APPROVAL: Ch box if complete. Provide written explanation If not complete. ff!S registration fee as required by 18 AAC 80.1910(c)(3). Make checks payable to "State of Alaska". Results of nitrate and coliform water samples, indicating those contaminants do not exceed the MCL set in 1S AAC 80.300. Attach reports from certified laboratory. All source water protection requirements of 18 AAC 80.015 listed on page 4 have been meet 9All minimum separation distance requirements of ISAAC 80.020 listed on page 411&M -..ARt ✓ All cross -connection requirements of 18 AAC 80.025 listed on page 4 hale bee [MVIRONMEHIOE He i-1 1 I VGt 6 PUBLIC WATER SYSTEI►I SOURCE' Circle Yes or No. Yes Well depth Is less than 30 feet to the first opening foimt4x Yes o Well Is located less than 50 horizontal feet to a surface water source. Yes Source uses an infiltration gallery, spring, rain catchment, or surface water. Yes Source requires treatment to meet required MCL's set in 18 AAC 80.300. If answer Is "Yes" to any of the above, then water treatment must be provided and the items on page 5 under PUBLIC WATER SYSTEM SOURCE TREATMENT mast be addressed. Uall answers are "No" continu to page C ADEC APPROVAL: This water system Is hereby granted Department approval to operate. The following public water system identtftcation number (PWSID) Is assigned to this public water system`eVa* 7V --S DOC Co. dn. SULLIVAN WATER WELLS P.0.BOX 67p272 CHUMAK,ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND !jt /j / ! DEPTH OF WELL l G� ADDRESS _ STATIC LEVELOF WATER FT. LEGAL DESCRIPTIO BR�kw DOWN FT, DATE -Started Ended SAT' GALS. PER HR PER -"IT NUMBER Y.'.IND OF FORNN1ATION: f KIND OF CASING From—�D—Ft. to-,'—�Ft. �'�t-S i 7 GK J"O From Ft. to. Ft. From Ft. to Ft. From— Ft. to Fr. From <,Fr. to�Ft. � �(� `J (24411 7 From Ft. to Ft, From--� - Fr. to a1 Ft. C�+'~ r' 6e41 L _ From Ft. to Ft, �' From-� --Ft. to�Ft.—_S1'^JQ 6-5' 694,C -<-'- t - />7t X �� From Ft. to Ft From Ft. to Ft. C 0%r`!L C `oS From . �/- Ft. to 6C-, Ft, Ft, to Ft. Ft. to— Ft. t7 From 411 Ft. to 2 Fc C'< ? �+�, ✓� t From om Ft, From Ft. to �D ? Fr r .. !� ! l ^ L 4 �7 to Ft, From lb Ft. to f /!T Ft. From t.= z FL to Ft. From Ft, to Ft. From Ft, to Ft_ From Ft_ to Ft. From — Ft. to Ft. From Ft, to Ft. From Ft. to Ft. From From. ------ Ft, to Fr. Froth Ft. to FG From Ft. to Ft_ From FL to—Ft- oFt.FrontFt. From—Ft.to Ft. From Ft. to Ft, Frotrt Ft_ to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME Inspection Report1-1-1 .do Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:l/www.muni.org/onsite • (907) 343-7904 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSPI21058 PID Number: 051-134-09 ❑✓ New ❑ Upgrade Name: Skyline View Corporation ABSORPTION FIELD []Deep Trench E] Shallow Trench ❑✓ Bed ❑Mound Address P.O. Box 670351 Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 688-1236 4 .7 GPD/SF 9.4 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 7.1 Ft. Gravel depth beneath pipe .5 Ft. Subdivision Block Lot Denali Vue 3 Fill added above original grade 2 Ft Gravel length 66 Ft Township Range Section Gravel width 15Ft. Beds: Number of Lines 3 Distance between lines 5Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 990 Ft2 Ft. Well >150' >150' NIA NIA >25, TANK O Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1,250Gal. Surface water >100' >100' NIA N/A Material Steel Number of compartments Two Lot Line >5' >10' N/A N/A NA Foundation >5' >10' NIA N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to drainfeld D3034 Installer MM&M Contracting Drainfeld HDPE COIMT D3034 Inspector MEA BENCH MARK (Assumed elevation) 100.OH Inspection 1$r 5123!12 - 5/24/12 Location and description Zw Garage Slab. 3" 5125112 a"' COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL vOWN � o Conditional Approval: Date 4918 ... .... .... .. ........0 s p : eMlefna. a u�sO %'9 0" 4381 jW -� 1o♦i�FO ddo Approved DateCE. �h'� pg..uf...0. tOrESS10H*��► Inspection Report1-1-1 .do =KoN F- M ilii O SOV Z wooer oo'0 Og " C -m m ITl V D z r'�'Cfb: 1 :'•�. Z S 70' LL� 10 'rC 15' r g E �� EASEMENT R� �2 O oO o �c �Z D r� M M Z . a - i m oa m m W D � � C) Z 00 G� co D 0) n � Z N V W o $ TD N jj� D CIO S 70' LL� 10 'rC 15' r g E �� EASEMENT R� �2 O oO NINEIA IN 1N V O] O] V O) U A N N J A 4 y W O W� N N mN W Oi N m o m V m Ol O W N C% Li m N N M M Z . a - i m oa n � O � � NINEIA IN 1N V O] O] V O) U A N N J A 4 y W O W� N N mN W Oi N m o m V m Ol O W N C% Li m N N Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. OSP121058 98.1 N �N UU 1,250 Gallon Septic Tank PID No. 051-13409 89.9 88.4 —/ 81.0 No Groundwater No Scale Drainfield Rock T Coarse Sand 89.9 88.41 ! 49th .4 PROFILE AS -BUILT - p MICHAEL EE -4381 SON ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) MEMORANDUM DATE: January 13, 2013 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Lot 3, Denali Vue Subdivision Septic System Permit No. OSP121058 Septic System As Built/COSA We have reviewed your comments concerning the subject permit and have made the following revisions: 1. Water Sample Results are attached. 2. The test hole completed on 5/23/12 mistakenly indicated water at 11' even though it also states no water was encountered. The test hole log has been modified to show no groundwater was encountered and none developed during the monitoring period. Test Hole No. 1 similarly shows no presence of groundwater. 3. A joint inspection was held with you on site after the excavation to the bottom of the bed was completed. A percolation test was also accomplished. The percolation rate was slower than 1 minute per inch indicating a sand liner was not required. Sand was already available on site and ready for placement in the bed. You agreed at the time to a sand liner depth of 1' over the entire bed as a compromise in lieu of the design depth of 2'. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 ELMORE STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 3, DENALI VUE S/D PERFORMED FOR: MM8,M CONSTRUCTION DATE: 5/23/2012 PROJECT No.: PARCEL ID#: TECHNICIAN: M. ANDERSON TEMP: 48° DEPTH 1 11 TEST HOLE # 2 1 2 3 4 5 6 7 8 9 10 15 16 17 18 OB/OG GRAVEL WITH SAND GM/GW COBBLES To 3" BOH SLOPE WAS GROUND WATER ENCOUNTERED? No N <P 00 0 F 49th IAEL E. ANDERSON NO. CE -4381 Professional SITE PLAN 0O IF YES Q WHAT DEPTH? - 0%DEPTH OF WATER AFTER MONITORING: NONE ' Zc50/' DATE OF MONITORING: 5/31/2012 P 2-5% E DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH OF WATER (INCHES) NET DROP (INCHES) 5/23 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 9:40/9:50 10 1.25"/10.00" 8.75" 2 9:51/10:01 10 .13"/10.13" 9.00" 3 10:02/10:12 10 .25°/10.25^ 9.001, 4 10:13/10:23 10 .13"/10.13" 9.00" 5 10:24/10:34 10 .25"/10.25" 9.00" 6 10:35/10:45 10 1.13"/10.13" 9.00" PERCOLATION RATE:: 1.1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: I I_0 FT. and 12.0 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. PERCOLATION TEST TO VERIFY APPLICATION RATE. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 9120112 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 ELMORE STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 3, DENALI VUE S/D PERFORMED FOR: MM&M CONSTRUCTION DATE: 5/23/2012 PROJECT No.: PARCEL ID#: TECHNICIAN: M. ANDERSON TEMP: 48° DEPTH TEST HOLE # 2 (feet) I OB/OG SLOPE C91 14 15 16 17 I SITE PLAN O2 OI WAS GROUND WATER ENCOUNTERED? No fF YES @ WHAT DEPTH? II' DEPTH OF WATER AFTER MON TOR]NG ' 25% 0% DATE OF MONITORING: 2-5% DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) MATETH R F (INCHES) NET DROP (INCHES) 5/23 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 9:40/9:50 1 Q 25"/10.00" 8.75" 2 9:51/10:01 10 1.13"/10.13" 9.00" 3 10:02/10:12 10 .25°/10.25" 9.00" 4 10:13/10:23 10 .13"/10.13" 9.00" 5 10:24/10:34 10 .25"/10.25" 9.00" 6 10:35/10:45 1.13"/10.13" 9.00" PERCOLATION RATE: I_I (MIN/INCH) PERC. HOLE DIA.-6—(INCHES) TEST RUN BETWEEN: I I_0 FT. and 12.0 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. PERCOLATION TEST TO VERIFY APPLICATION RATE TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 9/20/12 MUNICIPALITY OF ANCHORAGE Development Services Department. d Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-134-09 Certificate of On -Site Systems Approval Expiration Date: 0/ 1. GENERAL INFORMATION --- Complete legal description Denali Vue, Lot 3 Location (site address) 19635 Kullberg Circle Chugiak, AK Current property owner(s) Charles & Kathryn Francks Day phone (325) 733-2825 Mailing address 576 Tierra Bella Drive, Alamogordo, NM 88310 Real estate agent Day phone 2. TYPE OF DWELLING: ❑° Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑■ ❑ Holding Tank ❑ ❑� Community ❑ ❑ Public Sewer., Ir ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee 6a Date of Payment/0= J~ /0= D Receipt Number o50 6) / b COSA# OSC 2-012.Sy Date: Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 522-7773 Address 1399 W. 34th Avnenue, Ste. 100 Anch„ AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/23/2020 6. DSD SIGNATURE _4 System #1 Approved for _1L_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: ll((((((. ON-SITE w� WATER ANDMAP L ,, I R Z^ JJ PROGfAM JJJ 5< iSERVSN By: w Original Certificate Date:—7 (� 2020 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: l' COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet X-i161T�T�i Legal Description: Denali Vue, Lot 3 Parcel ID: 051-134-09 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.2 qpm Date drilled 5197 Water storage tank volume N/A gallons Total depth 111.5 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 111.5 ft ❑Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 2.66 mg/L ❑ Nitrate less than MRL (ND) Al Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 56 in. Collected by FORGE ENGINEERING Date of flow test for COSA 6/16/20 Date of Sample 6/8/20 Static water level at beginning of test 75.3 ft. Comments This is a Class C Well registered with ADEC. PWSID No. 218745. B. TANK DATA Age of tank(s) 8 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/26/19 JRs - Septic Pumping D. ABSORPTION FIELD DATA Shallow Bed Which system tested (date installed) 5/23/12 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.9 ft (max) Measured depth to pipe invert from grade 6.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 1456 gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/16/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 620 gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date M E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q✓ Yes Community Sewer Manhole/Cleanout > 100' ✓vJ Yes if No ft M Yes if No ft Neighboring Tank > 100' F✓ Yes if No ft Private Sewer/Septic Line > 25' E✓ Yes if No ft Absorption Field on Lot > 100'✓❑ Yes if No ft Holding Tank > 100' M✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' P Yes if No ft R Yes if No ft Fv Yes if No ft Water Service Line > 10'✓❑ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ✓Q Yes if No ft [Z] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'✓0 Yes Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' Q✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ✓V Yes if No ft Community Wells > 200' Fv Yes if No ft Water Service Line > 10'✓❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ✓v Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF 49th ............. ... ..................n......�. .� 4 MICHAEL E. ANDERSON to No. CE -4381 Z Ttn/�•°'•. 7/2/20'4, .••°�tc� Parcel I.D. 051-134-09 AG4 R4. Municipality of Anchorage =� Cn-Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Denali Vue, Lot 3 Expiration Date: /I " C� o -'1. Location (site address) 19635 Kullberg Circle Chugiak, AK 99567 Current Property owner(s) Mindy L. Firth Day phone 727-0735 Mailing address P.O. Box 771505 Eagle River, AK 99577 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System I] Public Sewer ❑ WaiverNariance request for: Distance: Received by: 11"1"4'1-y— L (-4-� Date: 8� ZO-1S COSA-to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment - y� �, Date of Payment Receipt Number b © 9/�i Receipt Number COSA# l.�'U _�31 t 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 Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE _� System #1 Approved for 4 bedrooms 522-7773 Date 8/113/2015 �� 49 rH * • ®� • MIC4i'/PE^L1'PT ANDERSON e a System #2 Approved for bedrooms �0 s� •,• CE • 4381 Disapproved �tQ9Fo.8,19• apX®d off%% orr sl ®®;0 Conditional approval for bedrooms, with the following stipulations. By: 4 Original Certificate Date:_ The M Icl II f orage Development Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the represent ions 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r .x c 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: Denali Vue, Lot 3 A. WELL DATA Parcel ID: 051-134-09 Well type C If A, B, or C provide PWSID # 218745 Well Log (Y/N) Date completed Sanitary seal (YIN) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2.06 mg/L Arsenic N/D ug/L Date of sample: 7/31/2015 Collected by: And. Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/23/2012 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 11-f7-141 Pumper -z-ZZz f amrilNJ4 C. ABSORPTION FIELD DATA Date installed 5/24/12. Soil rating (g.p.d./ft2 orft2/bdrm) .7 GPD Length 66 ft. Width 15 ft. Total depth 1 1.4 ft. Eff. absorption area 990 ft2 Monitoring tube Date of adequacy test 8-19-15 Results (Pass/Fail) Pass Fluid depth in absorption field before test 0 in. Elapsed Time: 0 min. Final fluid depth 0 System type Shallow Bed Gravel below pipe •5 ft. Y Depression over field N 4 Water added 604 gal in. Absorption rate > For _ bedrooms New depth 0 in. 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed _ "Pump on" level at Datum Size in gallons in. "Pump off' level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >150' Absorption field on lot >150' Public sewer main >75' Sewer /septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots >150' On adjacent lots >150' Public sewer manhole/cleanout >100' Holding tank >75' Manuretanimal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >51 Water main >10 Water service line >10 Wells on adjacent lots >150' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line 10 Surface water >100 Curtain drain None Noted Wells on adjacent lots >150' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 8/13/2015 COSA brown sheet -1 0-10-1 2.doc Absorption field >5v Surface water >100' Water main >10' Driveway, parking/vehicle storage >10, 1 cA^ MICHAEL E. ANDERSON : ,�T 0 c • CE -4381 ie .S " in. }U£ B • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-134-09 Expiration Date: 1. GENERAL INFORMATION Complete legal description Denali Vue, Lot 3 Location (site address) 19625 Kullberg Road Chugiak, AK 99567 Current Property owner(s) Skyline View Corporation Day phone 688-1236 Mailing address P.O. Box 670351 Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class O Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: uiscanc . Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ f j Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # 1 2— 3 -6— 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. f 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By. ZILtoriginal Certificate Date:_ The unicip y An age 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f - ', c 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: Denali Vue, Lot 3 A. WELL DATA Parcel ID: 051-134-09 Well type C If A, B, or C provide PWSID # 218745 Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production 9-p m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2.00 mg/L Arsenic N/D ug/L Date of sample: 1/2/2013 Collected by: B. Schiller B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/23/2012 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Date of pumping New Pumper Construction C. ABSORPTION FIELD DATA IF Date installed 5/24/12 Soil rating (g.p.d./ft2 or ft2/bdrm) .7 GPD System type Shallow Bed Length 66 ft. Width 15 ft. Gravel below pipe •5 ft. Total depth 1 1.4 ft. Eff. absorption area 990 ft' Monitoring tube Y Depression over field N Date of adequacy test N2W Const. Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/liftstation on lot >150' Absorption field on lot >150' N/A Public sewer main Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots >150' On adjacent lots >1 50' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >100' Building foundation >5' Property line >5r Water main >10' Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 1/12/2013 COSA brawn sheet_10-10-12.doc Absorption field >51 Surface water >100' Water main >10, Driveway, parking/vehicle storage >10' --L �j— =59.87' 0 R=50.00 - L=49.85' R=50.00'- / / 0 2 / LOT 3 I O• / 41,615 S.F. -4--15'T& E EASEMENT W I 33' SECTION LINE 20' T & E `d. EASEMENT EASEMENT M 0 D Z LOT 2 EXISTING 6.2•x6.2' WELL WELL HOUSE--�n X10' UTIL & 12' TRAIL : Dr — LOT 1 CHUGACH PARK ESTATES FOUNDATION ONLY PLOT PLAN AS BUILT X SCALE 1" = 50' GRID NW 1261 Project No. 12-037/82 Lan & Associates inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang (907) 522-6476 Phone Registered Land Surveyors (907) 522-4625 Fax o-:� OF A �0 ken®langsurvey.com / jonathan®langsurvey.com o I hereby certify that I have surveyed the following described property: OD�Q •'S�4OI LOT 3, DENALI VUE SUBDIVISION (Plat 2005-152) �GJ TH Anchorage Recording District, Alaska, and that the improvements situated thereon are o.. 4'g—� within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed a premises and that there are no roadways, transmission lines or other visible AO . ..L N.. . to KENNETH G. LANG easements on said property except as indicated hereon. Dated this the Day of , at Anchorage, Alaska 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. 1o4u40pROFfSSIONAL't O On -Site Water & Wastewater System Permit Permit Number: OSP121058 Tay Cnda_ NIImhPre 05113409000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 S_-223-/2 �' /d &o' Work Type: WellSeptic Initial Permit Effective Dates: April 27, 2012 to April 27, 2013 Design Engineer: ANDERSON ENGINEERING Subdivision: DENALI VUE Site Legal Address: DENALI VUE LT 3 G:1261 Owner/Address: SKYLINE VIEW CORP PO BOX 670351 CHUGIAK AK 995670351 Site Mailing Address: 19625 KULLBERG CIR, Chugiak Lot Size in Sq Ft: 41615 Total Bedrooms: 1314 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. AMC 15.65.060. B.3 -5/s 3/j New p"C >/ A "e' `corp Received Bv: 1 ( 04 � Issued By: I Sane ii4r reLceA'b I' Date: Z Z MUNICIPALITY OF ANCHORAGE i 1 .%Community Development Department Development Services Division On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-134-09 Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s): Skyline View Corp. Day phone: 688-1236 Mailing address : P.O. Box 670351 Chugiak, AK 99567 Site address: Legal description (Sub'd., Block & Lot): Denali Vue, Lot 3 Legal description (Township, Range & Section) Lot Size: 41,615 Sq. Ft. Number of Bedrooms: Four (4) THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial X Absorption Field X Upgrade ❑ Septic Tank X Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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/Rush Fees: a Waiver Fees: Date of Payment: / Date of Payment: Receipt Number: Receipt Number: Permit No. af,,2l,j / e �N k� Waiver No. i C:VUsersV\ndEngSDesktoplMikelDenali VuelPermit Application Lot 3.docC:\UserslAndEng\Desktop\Mike\Denali VuelPermit Application Lot 3.doc April 19, 2012 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 3, Denali Vue Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The owner of Lot 3, Denali Vue Subdivision intends to construct a new four-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic system to accommodate the home. The lot will be served by a community Class C Well and Water System. The attached Site Plan and backup documentation identify the location and configuration of the proposed septic system along with the alternate site. No existing wells or septic systems are closer than 150' from the proposed septic system. Drainage arrows are shown on the site plan showing the grade and direction of flow on the lot. The drainage pattern will not be changed as a result of this project. The test holes placed on the lot in the area of the absorption trench and alternate site indicated silty sandy gravel (GP). The percolation rate of the soil was determined to be less than 1 minute per inch. We are therefore proposing to construct a bed with a 2' sand liner to slow the percolation rate of the septic effluent. Verification percolation tests will be performed prior to construction of the new absorption trench to verify field conditions. No groundwater was found and none was noted during the monitoring period. The monitor tube remains dry to this date. An application rate of .7 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,250 -gallon septic tank and a 58' long by 15' wide absorption bed to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption bed will be 3.5' below the surface and the total depth will be 6' including the depth of the sand liner. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot in the area of the absorption bed slopes to the northwest Lot 3, Denali Vue Subdivision April 19, 2012 Page Two at a grade approximating 5%. The new bed will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 150' from the Class C well on the lot and 100' from any surface water and 10' from the proposed and existing water services in the area. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on 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, Yy F�-�-�� Michael E. Anderson, P.E. Attachments .�W.n..pIII 04 �.... ..... th.. .. ...s... �..... ��t MICHAEL E. ANDERSON =g�' •* f 19 No. CE-4381 _pr'�� l LOT 1 0 >r -r ID, x,51 C9 / - goads ------ - �Ci� n ;class C -___ _______ _____________________ ,._ Water Service Well I £8=. 1✓'. fAYMM M' l i C 1 •. 30' 2r, v� GSF14M ------------------ I LOT 1, BLOCK 3 �**���������� CHUGACH PARK -S .• RTES r •�E..gCq!1. :C�,;' • ' 49th ° ••/ ®ExZ .mg ell ;.....:... ... �`.�" AREA MAP It. MICHAEL E. ANDERSON ;y�� j •• f°•., N0. CE -4381 '•�J ♦ l•. •O�Eo �r�7„�.• SCALE r = so• •••,RpF�S��0��0 M M ,09'1 � M„l �v. ;o m•��•j1 �- 2: ' a N u< 05 0. o i u lb Vj. O Q t� . �i 6 •. w ,.q. ,,...' (A N L% Lo ado J O z i'z .oaey _jw L oaf + Q y z w Q � yM/ s z -0 O OJ CL w W ¢ ------------- V o ¢ O /I •� _N x u� I Z 0) 00 O N \\ o h/ %m > �/ it z z U J Y r \.0 o n HZ W H W f1 m M U Jh y� NW W 1 v 00 0� �`\� U d 1N3rGSV3 Z a a v w 3V1.91 -03° 0 �,09'ZL 3„bL,£'2. N a° 00, ^� O ar rn a �/ M X0`6 W N O T V OO OS U 0. O O U Q a v o w u 0 0 w WtiiUE� v c co 0¢s t; ” ” LJ J o v >O�m Zz33z wUsti LOT 3, DENALI VUE SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: 4 Bedroom Home Shallow Bed System Perc. Rate: .2 Min./Inch 1,250 Gallon Septic Tank Application Rate: .7 GPD/SF 1' Total Depth Drainfield Rock 4 Bedrooms X150 SF/Bedroom/.7 GPD/SF(Application Rate) = 857.1 SF Absorption Area 857.1 SF/15 LF (Width) = 57.1 LF Bed Length THEREFORE: Construct a 58' Long x 15' Wide Shallow Bed as Shown Below. Place Distribution Piping at 3.5' Below Original Ground Surface. Provide T of Cover Over Bed and 4' of Cover Over Septic Tank. In Lieu of Fill Provide 2' of Insulation and 2' of Fill. Place 2' of Coarse Sand Prior to Placement of Drainfield Rock. FviOinn ('rni inri 2.5' 5' 5' 2.5' TYPICAL BED SECTION (NO SCALE) NOTE: Grade Area Surrounding Bed to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 150' Separation From Wells in the Area. Minimum 100' Separation From Surface Water or Streams. Minimum 10' Separation From Water Service Line. Existing Ground Natural Backfill 3.0' Geotextile Fabric S Drainfield Rock 4" PVC 2.0' Coarse Sand (See Specification) 2.5' 5' 5' 2.5' TYPICAL BED SECTION (NO SCALE) NOTE: Grade Area Surrounding Bed to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 150' Separation From Wells in the Area. Minimum 100' Separation From Surface Water or Streams. Minimum 10' Separation From Water Service Line. PERFORMED FOR LEGAL TH9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19. 0 W.0.96298 Municipality of Anchorage DEPARTMENT OF IIEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 9 `il� J Lot )Y Dena1 i Vi c'+ Organic Overburden Frozen to 1' Organic Silt with Sand with Roots to 2' Township, S1. Silty Sandy Gravel Rock to 6" occasional Boulders to 24 Hit 60" Boulder Dry _ DATE PER Section: WAS GROUND WATER ENCOUNTERED? No S1. Silty Gravelly Sand IF 1`1117 WHAT D Drrnr Rock to 3" E ueplll In Warrr Aller 4/30/ 9 7 Mnnilnnno? None Oat.: Bottom \ v.a..oaeeee poo eo I DEE H H JI I t I'LAN 2 I� PERCOLATION RATE 0,2 (mmulesnnch) PERC HOLE DIAMETER 611 T E51 RUN BETWEEN 5.5 FT AND 6 F1 COMMENTS Soils presoaked Arior_to runnin4 percolation test PERFORMED BY: Dee High -- , CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH M L STATF AND MUNICIPAL GUIDFI iNr-S IN EFFECT ON THIS DATE. DATE: