HomeMy WebLinkAboutSKYLINE VIEW BLK 2 LT 6Skyline View
Lot 6
Block 2
#051-192-21
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW000096 PID Number: 051-192-21
Name: MARY KALLENBERG
Wastewater System: ❑ New ■ Upgrade
AddreaP 0. BOX 5035 SANTA FE, NM 87502
ABSORPTION FIELD
Phone:
(505) 425-5685
No. of Bedrooms:
3
■Deep Trench 11 Shallow Trench 11 Bed 11 Mound El Other
LEGAL DESCRIPTION
Soil Rating:
1.0
Total Depth from original grade:
10.5-11.0
GPD/Sq. Ft.
Ft.
Lot: Block: Subdivision:
Depth to pipe bottom Rom original gentle:
Gravel depth beneath pipe:
6 2 SKYLINE VIEW
3.68-4.18 Ft.
6.82 Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
—
—
—
0.5-1.0 FL
37 Ft.
Grovel width:
Number of linea:
Distance between lines:
WELL: ❑ New ❑ Upgrade
2.5 F
1
— a
Claea'rilicotion (Private, AS,C): Total Ds
Cased To:
Total absorption area:
Pipe material:
ASTMD-3034/F810
a
n.
505 so. Ft.
Driller. Data Ddlled:
Static Water Level:
Installer.
GREEN GENERAL
Date installed:
6/29/00
field:Pump
Set At:
Casing Height Above Ground:
TANK
GPM
Ft.
SEPARATION
DISTANCES
0 septic ❑ Holding ❑ S.T.E.P.
TO
Septic
Absorption
Lift
Holding
Public/Private
Manufacturar.
ANCHORAGE TANK
Capacity In gallons:
1000
From
Tank
Field
Station
Tank
sewer uaes
Well
100'+
100'+
—
—
25'+
Material:
STEEL
Number of compartments:
2
Surface
,00'+
,00'+
-
-
-
- LIFT STATION
Water
_wwwwewwe�
LotSize
5 +
*1'
—
—
—
in gallons:
Manufacturer.
Line
'Pump on level at:
'Pump off
High water alarm oL•
Foundation
5'+
10'+
—
—
—
Curtain
Pump Make
Electrical Inepections performed by:
Drain
NO
KNOWN
BENCH MARK
Remarks: * 1' LOT LINE WAIVER GRANTED WITH ISSUANCE
Location and Description:
OF PERMIT.
BOTTOM OF SIDING ® POINT "A"
Aeeumed Elevation:
109-09
Ft.
ENGINEER'S Ill
00 ��� . '• S�4
AWWC INC. s zs
Inspections performed by: Dates: 1st / /00
........... : ...............��
2nd 6/29/00
3rd 6/30/00
'. e fr A. Garness: �D
—7g53
0��4
Department of Health and Human Services approval
f'•,
Reviewed and approved by: d 4-47'_ Date: Oe
0
���° P a`�o�
rofessla� o
0�00`�p00
��
72-013 Rev. 9/91) MOA 25
PERMIT NUMBER: A S —BUILT DRAWING PARCEL I1 NUMBER:
sw0000ss os1—is2-21
I A B
FCO 24.08 23.71
ST1 63.86 81.25
ST2 70.00 86.49
NEW DRAINFlELD i DBL1 72.53 88.66
j I / DBL2 74.00 89.87
/ C01 81.65 103.61
MT1 80.38 101.66
--- --
MT1SEPPTICTIC ,tiTH#� NEW TANK GALLON CO2 80.49 85.25
MT2 78.85 85.62
I
I II I
TEST HOLE BY II DBL7
S&S ENG. II MT2 DBL2
Ll 102 / EXISTING 0
THREE
BEDROOM
FCO HOUSE U
w I' 3)
w O0
Ll
SII V)
b (' WELL Rp01U5
100•
I
-- --- —---'�--'-_
I
_ �SKYVIEW AVENUE _ _ _
DATE:
7/5/00
DRAWN
DRAWN BY:
ALASKA WATLR & WASrrLwATL SCALE: _ H °oo
CONSULTANTS, INC n -•t, „
6901 OEBARR ROAD, SUITE 2B •ANCHORAGE, AJ( 99504 `PHONE (907)337-6179 •FAX (907)338.3246
1 - 30, 0........ Q
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ••••P
MARY KALLENBERG (505) 425-5685 2 OF 3 O e f e A. arness:
LEGAL DESCRIPTION: ° ",p -7953 `c�p
SKYLINE VIEW SUBDIVISION; LOT 6, BLOCK 6, °p�fm' .. • ao
TYPE OF WORK: �Dedf'rOfessiOnO`
AS-BUILT OF SEPTIC SYSTEM UPGRADE 4��Opppp
PERMITNUMBER: AS—BUILT DRAWING PARCEL INUMBER:
SWO
SW000096 051-11 92-21
rim am - 100,16-100,25
511 5ff 2I
Af
fop
OF 95.86 j---� Af OUR. f x,82
/i.. kV: Ate'
FROM HOUSE
TO DRAINF) _
i"ff Of j� I I NSW 1000 6& ON ( I\\\
fNLVf-96 G, 5�C'11C TANK `fahlrf-9..G
Af IN.6f � 9533 Af OlJfl-Ef � 95.04
Mf co
—eiuei r Am , 00 x1.99,78
V- 88.06 (AVG.)
ALASIZA WMEA R & WASThWATER
CONSULTANTS, INC ��-
6901 DESARR ROAD SUITE 28 • ANCHORAGE, AK 99504 • PHONE (907)337-6179 • FAX (907)338-3241
PREPARED FOR: PHONE NUMBER:
MARY KALLENBERG (505)425-5685
LEGAL DESCRIPTION:
SKYLINE VIEW SUBDIVISION; LOT 6, BLOCK 2,
TYPE OF WORK:
PROFILE AS—BUILT OF SEPTIC SYSTEM UPGRADE
7B 5/00
C.J.G. Qf� 4 T BOO
N.T.S. *..... ......... ...... )
NUMBER: Q_ •• .........Q
3 OF 3 QO P f r A. Gayness; Q
Q m C 7953 o Q�
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On -Site Services
Waiver Review Worksheet
WR#: WR000063 PID#: 051-192-21 HAM Permit#: SW000096
Date Received: May 1, 2000
Legal Description: Skyline View, Lot 6, Block 2
Engineer: Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road Suite 2-B, Anchorage, AK 99504
Applicant: Mary Kallenberg
Waiver Requested: 1 foot lot -line waiver from north property line to septic upgrade.
Criteria: 1. Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
2. Special Conditions:
3. Other:
Waiver is Granted:
List Conditions or Reasons for above:
Date: g ";" $ - 0 U
Rec#: 05699 Amount: $115.00
Waiver is not Granted:
By:
N of Reviewer
**********
Date Paid: 511100
AK Water & Wastewater Consultants, Inc.
ATTN: Jeffrey Garness, PE
6901 De Barr Road, Suite 2B
Anchorage, AK 99504 -
August 28, 2000
Subject: Waiver Request for SKYLINE VIEW BLK 2 LT 6
Waiver # WR000063 Lot Line Request for Parcel ID 051-192-21
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 1 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely,
Jeff Poet
Engineering Technician III
On -Site Water Quality Program
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 09, 2000
Expiration Date: May 09, 2001
Permit Number: SW000096 Parcel ID: 051-192-21
Legal Description: SKYLINE VIEW BILK 2 LT 6
Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 019312 STARFLOWER CIR
Owner Name: Mary Kallenbert Lot Size: 15750 SQ. FT.
Owner Address: PO Box 5035 Total Bedrooms: 3 Permit Bedrooms: 3
Santa Fe , NM 87502 -
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. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: 5-10 -(:�o
Date: � ' eco
C>2or�/l
MUNICIPALITY OF ANCHORAGE
/a�/(J�v'30a.-"
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
l
P.O. Box 196650, Anchorage, AK 99519-6650
%�h C ✓rl (l j/
(907) 343-4744
.e
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 09, 2000
Expiration Date: May 09, 2001
Permit Number: SW000096 Parcel ID: 051-192-21
Legal Description: SKYLINE VIEW BILK 2 LT 6
Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 019312 STARFLOWER CIR
Owner Name: Mary Kallenbert Lot Size: 15750 SQ. FT.
Owner Address: PO Box 5035 Total Bedrooms: 3 Permit Bedrooms: 3
Santa Fe , NM 87502 -
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. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: 5-10 -(:�o
Date: � ' eco
ALASKA WATER Ee WASTEWATER
CONSULTANTS, INC.
April 21, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic System Upgrade Design for Skyline View Subdivision; Lot 6, Block 2
To whom it may concern:
The existing 3 bedroom house is being served by a private well and septic system. The existing
drainfield is undocumented and does not meet municipal standards. The homeowner would like
to upgrade her septic system in order to obtain a health authority approval. A test hole was
excavated on the property by Robert C. Cowan, P.E. with S & S Engineering on 6/30/99 and an
additional test hole was done on 4/14/00 by AWWC, Inc. The proposed septic system will be
designed within the 30 foot radii of the two test holes. We are proposing that a new 1000 gallon
septic tank and a deep trench type drainfield be installed. Comments regarding the proposed
design are summarized as follows:
1. SOILS: Attached are two logs which show the soil classifications, groundwater monitoring,
and the percolation test results. The soils below the organic layers are a GW/SW material to a
depth of 13 feet in S & S Engineering's test hole and to a depth of 17 feet in TH#1 (bottom of
test holes). No groundwater was encountered during the excavation of the test holes. A
percolation test for S & S Engineering's test hole was performed between the depth of 4 feet to 5
feet which had a percolation rate of 5.3 minute/inch. A percolation test for TH#1 was performed
between the depth of 7 feet to 7.5 feet which had a percolation rate of 1.67 minute/inch. It is our
opinion that due to the overall appearance of the soils, an application rate of 1.0 gallons/day/ft2
should be used.
2. TRENCH DESIGN:
a. Percolation Rate: 5.3 & 1.67 minutes/inch
b. Allowable Application Rate: 1.0 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 450 ft2
f Total Depth: 11 feet (max.)
g. Effective Depth: 7 feet
6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246
h. Width: 2.5 feet
i. Reduction Factor: N/A
j. Minimum Length: 36 feet long
k. Effective absorption area = 504 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: As can be seen on the design, the area of the septic upgrade slopes
approximately from east to west at a 1 to 5 percent slope.
4. LOT LINE WAIVER REQUEST: We request that a 1 foot lot line waiver be granted from
the north property to the proposed septic upgrade. We are unaware of any adverse effects
concerning the granting of this waiver on neighboring properties.
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
I.S.
U)eo-noVo 'D
NOTE: Attached is a site plan drawing, a design drawing„ 2 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 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246
1
t i I I
i
1 I I
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1 4-
I I i i
LOT 2, BK 2 I I LOT 9, BK 27LOT2, BK 2 LOT 19, VI 2
SKYLINE VIEW I i SKYLINE VIEWNE VIEWSKYLINE VIEW
i I
' i I
O LOT 3, BK 2 j I LOT 8, BK 2 3 LOT 13, BK 2 1 1 LOT 18, SK 2
SKYLINE VIEW
O i - Of SKYLINE VIEW ( t SKYLINE VIEW
( I SKYLINE VIEW J
O0
3Lu
i
LOT 4, BK 2
SKYLINE VIEW �I I I
LOT 7, BK 2
SKYLINE VIEW QI LOT 14, BK 2 I 1 LOT 17, BK 2
SKYLINE VIEW I I SKYLINE VIEW
PROPOSED SEPTIC i i ""Pi —_ ��
UPGRADE. SEE PAGE
2 OFt2 FOR DETAILS
TEST HOLE ( I ♦/TH#1 \\
BY 5&S ENG.
/ LOT 5, BK 2
/ SKYLINE VIEW \ I ' LOT 15, BK 2 i LOT 16, BK 2
/ \ I I I 1 SKYLINE VIEW I I SKYLINE VIEW
psPj nOCProc+ i I I t 1
1 i APPROXIMATE LOCATION \\ i SKYVIEW AVE.
OF EXISTING SEPTIC SYSTEM
LOT 1, BK 2 LOT 2, BK 2
SKYLINE VIEW ADDITION #1 SKYLINE VIEW ADDITION #1
O
O-----------------------------------------
O
�i ----- -- ------------------------
O
O �
D
i
DATE:
4/21/2000 - 'OF ''+v
_ 1 DRAWN BY: G' \� •� �r
ALASKA WATER & WASTEWATER J.L.M.
SCALE:
CONSULTANTS, INC _......
.... . .......
6901 DERARR ROAD. SUITE 28 • ANCHORAGE, AK 99504 • PHONE (907)337-6179' FAX (907)338.1246 1 — 1 Do'
PREPARED FOR PHONE NUMBER: PAGE NUMBER: 7 �7
MARY KALLENBERG (505) 425-5685 1 OF 2 !,7, a fr A. ess, /
LEGAL DESCRIPTION:��1 m —7953
SKYLINE VIEW SUBDIVISION; LOT 6, BLOCK 2 JI'itar cA�>�
TYPE OF WORK:d professioo6��'
SITE PLAN FOR SEPTIC SYSTEM UPGRADE lz , c; --'
i I
II NOTE: THE CONTRACTOR SHALL HAVE THE
of NORTH AND WEST PROPERTY LINES AND 100' 1
WELL RADIUS FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO CONSTRUCTION.
( 31
z I
PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 11 \
p I FEET DEEP MAXIMUM, BY 2.5 FEET WIDE, BY 36 FEET \
I LONG. ADD 7 FEET OF CLEAN, WASHED SEWER DRAINROCK. \
i TiIIMT
O PROPOSED
1 1 1000 GALLON EXISTING SEPTIC SYSTEM TO BE
1 ° ^ SEPTIC TANK COMPLETELY ABANDONED. EXACT
I I LOCATION IS UNKNOWN.
I III /
TEST HOLE BY I I I
S&S ENG. ( 1 1 IMT
0STA
/. OLE W I
r CLEANOUTSTHREE EXISTING
THREE U
M of
SEPTIC
EA c FCO BHOUSE
Of
I I I 31
w
I
Eli
t ,
I I I 1DD' WEA
I I '
� I
SKYVIEW AVENUE _ W
r—
DATE: oop6�0��
111,15 4/21/2000 o OFA Op
.:._._�.,.�.v'DRAWN BY: OO \Ci.••'
K.D.W.
ALASKA WATER & WASTEWATER SCALE: �* SOppO
-= CONSULTANTS, INC --- , 6901 DEBARR ROAD, SUITE 28 •ANCHORAGE, AN 99504 •PHONE (907)337-6179 •FAX (907)338,3246
1 " = 30, .......... ... .............D
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q
MARY KALLENBERG (505) 425-5685 2 OF 2 e r A. ness:'
LEGAL DESCRIPTION: pp y, '•, —7953
SKYLINE VIEW SUBDIVISION; LOT 6, BLOCK 2 4pO a codon
TYPE OF WORK:
40od'Oro f e s sio�
DESIGN OF SEPTIC SYSTEM UPGRADE ��40o; sio(I
ALASKA
READING
WATER & WASTEWATER CONSULTANTS, INC. 00000000
O..
NET TIME
(MINUTES)
�,C�
NET DROP
(INCHES)
4/14/00
6901 DEBARR ROAD, SURE 2B * ANCHORAGE, AK. 99504
PHONE (907) 337-6179 • FAX (907) 338-3246........
••••• •'' V �0
SOIL LOG - PERCOLATION TEST pp y�0
3:21
—
6"
LEGAL
DESCRIPTION:
SKYLINE VIEW SUBDIVISION; LOT 6, BLOCK 2 0 """' .. ' "' ""' ""'*
PERFORMED
331
FOR: MARY KALLENBERG•• •• •• ••• .........
OQ J ff e ess
DATE
PERFORMED:
•
4/14/2000 �Q m C 7953 opt
(t et)
3
TEST HOLE #1�40p4aaP•.......• o\�°d��
� —
6"
—
E-
rofessio� o
1
10
0"
ORGANICS (NORTH HOLE)
5
SOIL CLASSIFICATIONS
2z
6"
—
SITE PLAN LOT 7, BK 2
6
°°°.."'
q°o
W ORG
G " = IDD' SKYLINE VIEW
3
6"
o
aoa
4: c GP ML
7
3:51
tlo°
GM CL
4
000
GC OL C /
4:01
10
Oo 0
SW MH I I a #1 \
5°
o°oo
SM OH � ff
msc
6
6"
o°°°
S&S I
10
ooQ
TEST
7
6"
000DEPTH
TO HOLE I I
DATE
11
4:11
°°0I
qOo
GROUNDWATER
\
6
o
°oa
DRY 4/14/00 _ SKYVIEW� E.
10
0"
o°a
\
9
o°q
o°q°
GW/SW
10
° p
000
°°0
'I.,
oo °o
11
°°D
o-0 Q
1
11
00
a° Q
12
00
°o 0
o°o
13
tlo 0
°°tl
qo°o
00 0
00
14
°°°
O° o
O°tl
000
15
o°O
aoa
16
ao u
°°0
ao °o
17—B.O.H.
tlb q
16
19
PERCOLATION RATE 1.67 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20
TEST RUN BETWEEN 7.0 FT. AND 7.5 FT.
COMMENTS:
PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERF RM D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
DATE: 00
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
4/14/00
PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING
1
3:21
—
6"
—
2
331
10
0"
6"
3
3:31
� —
6"
—
4
341
10
0"
6"
5
3:41
—
6"
—
6
3:51
10
0"
6"
7
3:51
—
6"
—
8
4:01
10
0"
6"
9
4:01.
—
6"
—
10
4:11
10
0"
6"
11
4:11
—
6"
—
1z
4:z1
10
0"
s"
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �AR'N KA L t, k'js 4,/L(,, DATE
SID
LEGAL DESCRIPTION: LO 6 GLK X cSj<Yt+�)E ���`' Township, Range, Section:
�—� SLOPE
14-
15-
16-
17-
18-
191
41516171s19
20
COMMENTS
s
SANA � G•QA•�ti.L
v! r�hc�o
S �r
WAS GROUND WATER N V
ENCOUNTERED?
S
IF YES, AT WHAT L
O
DEPTH? P
E
Depth to Water Atter
Monitoring? Date:
SITE PLAN
L -FEET)
�T
aVe,6-4N�c.<
1
lb
aw'0
w>Ral
2
3
b
4
')
C' .. 1D
Q E
5
v
6
a t
o
SW�GW
.a
I b
_
9
to-
0
12
12
-
13
13
' �- s
CS o, H
14-
15-
16-
17-
18-
191
41516171s19
20
COMMENTS
s
SANA � G•QA•�ti.L
v! r�hc�o
S �r
WAS GROUND WATER N V
ENCOUNTERED?
S
IF YES, AT WHAT L
O
DEPTH? P
E
Depth to Water Atter
Monitoring? Date:
SITE PLAN
PERCOLATION RATE 51 3 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN Z� FT AND r FT
S & S ENGINEERING
PERFORMED BY:17034 e�) tvLoop Road No. Or 1 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE VF4@1Afij %AIA*I0l2®hr'aPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / 1 b q
72-008 (Rev. 4/85)
w>Ral
oQw
PERCOLATION RATE 51 3 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN Z� FT AND r FT
S & S ENGINEERING
PERFORMED BY:17034 e�) tvLoop Road No. Or 1 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE VF4@1Afij %AIA*I0l2®hr'aPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / 1 b q
72-008 (Rev. 4/85)
Municipality of Anchorage .
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR: H,4AY k 4 LI'6NQ-thG DATE PERFORMED: 30 A %
(l LK- 2- ikyLlN Vl.ew
LEGAL DESCRIPTION: �'O I Township, Range, Section:
n�ia—I SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
aliffr(o 0 CoA/
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? Dale:
mmmmmmmmmm
mommommomm
ENEEMENNEW
PERCOLATION RATE (minutes?inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
MUNICIPALITY OF
Development Services Department �\`a
On -Site Water & Wastewater Section
ANCHORAGE
Certificate of On -Site Systems Approval
Parcel I.D. 0511-192-21-000
1. GENERAL INFORMATION
Complete legal description Skyline View L6 B2
Location (site address) 19312 Starflower Cir.
Current property owner(s) Brian & Jennifer Smith
Mailing address
Real estate agent
19312 Starflower Cir.
Rhonda Price
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: Jo -n d of, a 0 o
Day phone (719) 464-1359
Day phone 830-9797
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
Q
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55 0
Date of Payment /0 /q/ I
Receipt Number , 19
COSA # DAG 2 I I r 13
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 Eklutna Engineering, LLC. Phone 406-1058
Address 19162 Mountain Rd. Chugiak AK 99567 w
Engineer's Printed Name Curtis Townsend Date l l Z
6. DSD
SIGNATURE
\! System #1 Approved for 3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
-*4 . f
e e eL..y'7•
..................
•. ( (�:'n "'NEE
Curtis 1. Townsend e EN `N - =f
Dates CE 11z., IG' 4� IJ �� „; ;a
Nl_pROFESS10tt��
bedrooms, with the following stipulations:
OF
-- ^C)N-SITE G)
WATER AND
By: Original Certificate Date: 10 1.26 o?D,
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 X
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other ian is G6 -a acf v;so r- y x
Legal Description: Skyline View L6 B2
Parcel ID: 054-192-21-000
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled unk
Total depth 107+ ft
Cased to 40+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 31 in.
Date of flow test for COSA 10/4/21
Static water level at beginning of test 70.5 ft.
Comments
B. TANK DATA
Age of tank(s) 21 years
Tank type/material steel
Measured operating fluid level in septic tank 49
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 9/22/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/2912000
❑ ALL standpipes present per record drawing
Total measured depth from grade 12.75 ft (max)
Measured depth to pipe invert from grade 5.1 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 5.57
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies: ' MT#2 is filled in by 15".
COSA Checklist yellow sheet
Well production at time of test 0.97 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 4.8 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Brandon L. Jones, Brandon's On -Site Services LLC.
Date of Sample 10/4/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 10/7/21
Results M Pass For 3 bedrooms
Fluid depth prior to test 5 in
Water added 525 gal
New depth 13 in
Elapsed time 30 min
Final fluid depth 5 in
Absorption rate 525 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'
Yes
if No
Community Sewer Manhole/Cleanout > 100'
7✓ Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' F71 Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' M✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
0 Yes
Animal Containment > 50' Q Yes
if No ft
0 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' [Z] Yes
if No
ft
P/1 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5'
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Main > 10'[]✓
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Water Service Line > 10'
M 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'
ED Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' [✓ Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' [✓ Yes if No ft
Surface Water > 100'
0 Yes
if No
ft
F. ENGINEER'S COMMENTS
* See separation distance
waiver from 2000.
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.
+ Vit. 4 I`kIlik
TH
• • • • utUs t.. T �d •
' Date •�" r j-t�
No. CE itAW
•
pROFEl S\\V
COSA Checklist yellow sheet
. kNE ER'S
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Well Water Advisory
Certificate of On‐Site Systems Approval # OSC211613
Subdivision: Skyline View, Block: 2, Lot: 6
This well’s productivity was determined to be 0.97 gallons per minute. The
minimum well productivity required under (AMC 15.55) for a 3‐bedroom residence
is 0.31 gallons per minute or 150 gallons per day per bedroom. Although the
subject well currently exceeds this minimum requirement, the production capacity
can fluctuate and may be insufficient to meet your needs.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC211613
Subdivision: Skyline View Block:2, Lot: 6
The septic tank for this property is 21 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
•
G£ 8G
•
Municipality of Anchorage °r
On-Site Water and Wastewater Program
(907) 343-7904 SA ETY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-192-21 Expiration Date: -1/31/ /
1. GENERAL INFORMATION
Complete legal description SKYLINE VIEW BLOCK 2, LOT 6
Location (site address) 19312 STARFLOWER CIRCLE, CHUGIAK,AK 99567
Current Property owner(s) JAMES A. SCHOL Day phone
Mailing address PO BOX 5155, FORT RICHARDSON,AK 99505
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: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class _Well ❑ Public Sewer ❑
Public Water System. ❑
WaiverNariance request for: Distance:
Received by: Date: /-3 I- /Q
COSA to be released to the_eng neer . -ss otherwise requested by the engineer.
COSA Fee $ 5a(e, Waiver Fee $
Date of Payment la5la Date of Payment
Receipt Number d el OCi a.b Receipt Number
COSA# 65G17I 095 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 ARCTERRA CONSULTING,INC. _ Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 1/24/2018
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. 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 system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen -411:411
encroachments,deficiencies or discrepancies exist.
41/,A OF qL
ter,
* 7 0
6. DSD SIGNATURE • • I �rll
X'
System #1 Approved for 3 bedrooms. ��4. '��
BENNE • �l. r
System #2 Approved for bedrooms. Air
+ <r;.. II ` �`w
k`F%
Disapproved. ''`7Fe,sio �` ��
\'11‘.`+f
Conditional approval for bedrooms, with the following stipulations:
ON-SITE j ..•
WATEK AND \''-
fir. WASTFWATER ''
PROGRAM -
SERA
J
By: ���i� / /moi L G k(fit Original Certificate Date: /3//6.
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 X 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: SKYLINE VIEW BLOCK 2, LOT 6 Parcel ID: 051-192-21
A. WELL DATA—PER MOA RECORD DOCS
Well type PRVT If A, B, or C provide PWSID#_ Well Log (Y/N) N
Date completed UNKNOWN Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 107'+ ft. Cased to 40+ ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test -- 1-10-2018
Static water level -- _ ft. 71 ft.
Well production -• g.p.m. 0.95 g.p.m.
WATER SAMPLE RESULTS:
Coliform Nee- colonies/100 mL Nitrate 5.35 mg/L
Arsenic: ND ug/L Date of sample: 1/10/2018 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 6/29/2000
Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping 8/30/17 Pumper JRs
C. ABSORPTION FIELD DATA
Date installed 6/29/2000 Soil rating 6.d./f't� or ft2/bdrm) 1.0 System type DEEP TRENCH
Length 37 ft. Width 2.5 ft. Gravel below pipe 6.82 ft.
Total depth 12.3 ft. (Measured 1110/18) Eff. absorption area 505 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 1.10.2018 Results(Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 2 in. Water added 685 gal. New depth 7 in.
Elapsed Time: 20 min. Final fluid depth 2 in. Absorption rate >= 450+g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) N 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/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 100'+
Animal containment areas 50'+ _ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 1'(2000 WAIVER) Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+
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 COSA guidelines in effect on this date. �F /-14. .S
\\
Engineer's Printed Name KENNETH M.DUFFUS j�AP"� ���tS1- 1
Date 1/24/2018 #' *214* T_N_ X �� e
COSA canary sheet 2-6-15.doc
/
fir.yi
fir, KENNETH n /
- 7 18t /
kf ?, 2//41,
pT�F'ESSIOa�' �/
r
Municipality of Anchorage �4.'
•, Development Services Department . ,�5,•�A'
z, •• gnY!'E x
Building SafetyuSAFEilding SaA F p r r
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage,AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181025
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 6 of
Skyline View subdivision. This inspection revealed a nitrate concentration
of 5.35 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Municipality of Anchorage
•} "� Development Services Department
Building Safety Division
- rill
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.alc.us
(907) 343-7904
Water Well Advisory
Certificate of On-Site Systems Approval (COSA) # OSC 181025
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 6 of Skyline View subdivision, the well's
productivity was determined to be .95 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3-bedroom
residence is .31 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
_ .. y.
, -iria
nig)
RESIDENTIAL&COMMERCIAL WATER AND WELL SERVICES
24HR EMERGENCY SERVICES AVAILABLE
FREE ESTIMATES
John Netherton
P.O Box 210249
Anchorage,AK
99521 907 30 7&6
A well camera inspection was done at 19312 Starflower Chugiak, AK 99567, Skyline View block 2 lot 6, no breaks cracks
or perforations were found. Pitless depth 7' +/-, cased to 40'+, total depth 108'+. Casing extended to 18"+above grade
with new well cap and conduit. Chlorination was conducted between 1/26/18 and 1/29/18 with new samples pulled
resulting in negative for ecoli/coli.
Thanks
John and Katie Netherton
907 Water Well Services
907-230-1868 or 907-230-7019
I I 1
LOT7 d, N
i
N89'57'29"E 149.67'
(S89'59'00"E 150.00' R) 30' 30'
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La x LOT 6 XI 19.9' Lri W
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S89'59'00"E 149.75' (150.00' R)
BASIS OF BEARING
0
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I
SKYVIEW AVENUE
0
r•7
ANCHORAGE RECORDING DISTRICT,ALASKA
AS-BUILT OF:
SKYLINE VIEW SUBDIVISION
LOT 6 BLOCK 2 PLAT P-508 —_``"``
SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a m O F' 4,�` yp' D LANDSUR,
physical survey of this property as shown on this drawing and that the / �..•''•• •.rtd1 ��. ti0 Si„•�r
improvements situated hereon are within the property lines and no �/c�:' `I ry
enchroachments exist other than noted.Under no circumstance should / Lj:' 49TH , .ch ,---7 o r (1
any information on this drawing be used for construction of fences, * : 9.I ' * l0a 4 r
structures,improvements,or for establishing boundary lines. L~
� 4 v"i *'
EXCLUSION NOTES:It is the owners responsibility to determine 073 e
I J Hx L. SCHULLER: °/ • 0 • .,
the existence of any easements,covenants,or restrictions which , g. �,/ •
do not appear on the recorded subdivision plat. 11s�, • LS-10408 . 1 m� 's •„..,4.,,.,..o
WORK ORDER NUMBER: DA1E: SCALE: E-MAIL: `� 1 S c���/ 1831 Talkeetna Street
k1 a '•/.:14.' a Anchorage, Alaska 99508
JAN 27, 2018 1"=30' ` A
18-002 DRAM BY:CHEacmancaceweot BO PAGE: ���°fession°L 1' � (907) 227-1455 office
JLS NW 1159 180103 \������ (907) 274-4992 fax
Municipality of Anchorage
Development Services Department r �'
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. S I - lq -�- ' 211 cosAa 1' .f OnD82
1. GENERAL INFORMATION Expiration Date: rir — �z O ` 0
Complete legal description SKYLINE VIEW S/D• LOT 6 BLOCK 2
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
19312 STARFLOWER CIRCLE • EAGLE RIVER, AK 99577
JEFF & CINDY CALL Day phone 244-8108
19312 STARFLOWER CIRCLE • EAGLE RIVER AK 99577
Day phone
KATHY w/ GREATLAND REALTY Day phone
694-9125
13135 OLD GLENN HWY. SUITE 100 • EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD /or pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class Weil
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of 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 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.
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 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.Date L1006
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 6 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. GEG, LTD. 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.
5. DSD SIGNATURE
✓ Approved for '3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fltowing stipulations:
""jou" "r""" r Uvl"u'y Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Reort
Nitrate Advisory Other
BY 14 J/, � Original Certificate Date:
Municipality, of Anchorage _..,
Development Services Department
Building Safety Division
OnStle Water & Wastewater Program
4700 Bragaw Street
P.O. Box 1966W
Anchorage, AK 99519-6850
www.muni.orglonsite
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SKYLINE VIEW S/D• LOT 6. BLOCK 2. Parcel 10: 051-192-21
A. WELL DATA
Well type PATE If A, B, or C pride PWSID# N A Well Log (YIN) NO
Date completed UNKNOWN Sanitary seal (YM) YES Wires property protected (YIN) YES
Total depth 107'+ ft. Cased to 40'+ ft. Casing height (above ground) 12"+ in.
FROM WELL LOG - AT INSPECTION
Date of test 10/27/2005
Static water levelF5:p.m.
71 ft.
Well production 0.83 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colontes/100 ml. Nitrate 4.58 mgJL. Other bacteria 0 colonies/100 ml.
Arsenic: <5.0 ugJL. Date of sample: 2/17/2006 Collected by: GEG, LtD.
B. SEPTICfHOLDING TANK DATA
Tank Type/Material ANCHORAGE TANK / STEEL Date installed 6/29/2000
Tank size 1000 gal. Number of Compartments 2 Cieanouts (YM) YES
Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alar (Y/N) N/A
Date of Dumping
11/9/2005 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA IWIOW EXISTING CBM
Data installed 0/29/2000 Soil rating (g.p.d.lft'orqj� 1_O System type DEEP TRENCH
Length 37 ft. Width 2.5 ft. Gravel below pipe 6.82 ft.
Total depth +12 ft. Eff. absorption area 505 fe Monitoring tube YES Depression over field NO
Date of adequacy test 10/27/2005 Results (Pas3tFail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY in. Water added 500 gal. New depth 6 in.
Elapsed Time:13 min. Final fluid depth DRY In. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date
D. LIFT STATION
Data 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/llR station on lot 1 oo'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots
Public sewer main
100'+
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/deanout
100'+
100'+
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ 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 *11 Building foundation 10'+ Water main_ N/A
Water service line 10'+ urfaos water 100'+ Driveway, parking/vehicle storage 10'+
titos k s,iW
Curtain drain _ ells on adjacent lots 100'+
F. COMMENTS
*WR000063
G. ENGINEER'S CERTIFICATION
I certify that I have determined through held inspections and �*
review of Municipal records that the above systems are in """"' " • •Trn
conformance with MOA COSA guidelines in effect on this
date. ......... ..........eas,-
Engineer's Printed Name JEFFREY A. GARNESS' , E-79 3
Date ODlir° 3�ro44r'�.`�
COSA Fee S .0
Date of Payment 115 la,
Receipt Number -3(p ya2
(Rev. 11/05)
Waiver Fee E
Date of Payment
Receipt Number
Municipality of Anchorage N .
Development Services Department
•% Building Safety Division
- ! On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Health Authority Approval # 060082
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 2, Lot 6 of Skyline View subdivision,
the well's productivity was determined to be 0.83 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
3 -bedroom residence is 0.31 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
SGS ReLX
1060800001
Client Name
Garness Engineering Group, Ltd.
Project Name/0
Skyline view Lot 6 D 2
Client Sample ID
Skyline View Lot 6 U 2
hlatris
Drinking Water
Sample Remarks:
353.2 - MS recoveries arc outside QC limits, refer to LCS.
All Dates/rimes are Alaska Standard Time
Printed Date/time
0224/2006 14:07
Collected Date/rime
02/172006 8:40
Received Date/time
02/172006 10:02
Technical Director
Stephen C. Ede
Allowable PreP Analysis
Parameter
Results PQL Units Method Container ID Limits Date Date Init
Nitmic-N 4.58 0.100 mg/L CPA 353.2 D (<=10) 02/17/06 JC
Metals by ZCP/MS
Arsenic ND 5.00
Microbioloay Laboratory
Total Coliform 0
ug/L EP200.8 C (<=10) 02/20/06 0222/06 SCL
coUl00mL SM2092226 A (<-I) 02/17/06 TLF
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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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of thb .validation date shown below, !• verify.that my. r
h'westigation. basod on pro ccdt: res outlined in tfie HoaRh7 Abthority Approval Gufdofines for this application,
shokv3 that the on-site watur st.lpply and/or we'stewater disposal systerr) is(are) safe, functional and adequate
for tho number of bedrooms and type of structure indicated herein. f further verify that based on the
r.;
information obtained from tho Municipality:of Anchorage frlcs and.from myinvostigatioiirind inspection; the
on-site water supply and%r wasicwater disposal system r' re} in compliance with aA pplicable Municipal
and Stato codes, ordinances, 5rid regulations in effect at the time of installation.
Name of Firm ALASKA 1"IATER & INASTEIh'ATER CONSULTANTS, INC. Phone 337-6179
Address 6901 DEBARK ROAD, SUITE-2B * ANCHORAGE, AK 99504
FREY A CARN SS,'a.E
44;�-ng;neer's Primed Narne ut
Eng,ncer's Comments:
in conductinct17iS Eva!ualion, AK".1C. In.- alti:!nptad to pr0✓Ido a tl7UlOUCJl7,
c(7r7sc1ca75o:ls erl;linoeri 7J P4alysls of the sysiene rr7 accord? i„e :iirl: ✓'iDEC alio h-KOA,
l;
DSD Guidolinos & Rogu k7 cons. Tile reported results doscribcd t17c perforn7anco of the
s stern un(lor the conditions en.^o1jn!c'rc'd at the thio Ur the test, and seGaratron
c slanccs measured to readi'y identihab, a f•: a`i:%es. TF,r, clpora;iorat firs of all rv.'is and a [�Cr 1-' • 174G
soptic systolrls dUpond Uri the local scits r'U. n iftlon, Q•'Uundl•✓(tier 1QVcls il7at ll'iF]y or
f u.^.tualc during the year. and the wager usago of lie faintly being solved by the system,. J G
]lies^ CURClitior7.i al'U outsido the control of the ovatualor of the SysrGm.. Saiisfactcry lost .... .....�
results do not guarelntoo future periorr',^sn o of lite system, nor do they guarantor' !hal effr..y Gar .es, G/>
there are r7o lrl(idcn dote is or cncrwichnionls. ✓ k V✓C, Inc. can thr'.r (err, not provl'de' 1, CE 7953
any warranty or f,r71 r(' CstllilaCr of i'7o,. 1Or7 r ti7U sys:Crll v:i:i CUlf.,nuC,• lit /i. i. U; the �` �' 411
operational re then exits of iho AD =C or bCOA DSD. The c onter7t of ibis ruporl is for 1�Pd p
the sole benef t of tiho owncr listed abovo. Any re4anco upon or use of this report by any r0 f ess,�o
other person or party;is no., autiiorixc-d, nor ivi!! it cowlor ally legal right 7-47lsocvor.
DODoo
5. `.DSD SIGNATURE',
Approved for bedrooms. . (t tt f f I,(q'ir
Y Or
: �.y`�' TQC•'.
Disapproved ��'r4• p!
Conditional approval for bedroorhs, with the fllowinn s llu`1 t0 s: Q"' )i
WATER'- � "M _
PROGRAM `
✓ R
Attachments:
HAA Checklist Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: Original Certificate Dater l'ZZ ✓1�3
u
(Rev. 12/01)
_Datum Cycles tested
Meets alarm &circuit requirements?
.E. SEPARATIQN DISTANCES'
SEPARATION DISTANCES FROM WELL ON LOTTO'
Septic. station.on lot 100'+.
p
Ori adjacent lots 100'+
Absorption field on lot 100'+
On adjacent lots 100'+
Public sewer main N/A.
Public sewer manhole/cleanout N/A
Sewer /se tic service line 25'+
p
Holding tank N./A
SEPARATION_ DISTANCES FROM SEPTIC/HOLDING TANK ON LOT. TO: .
Building foundation 5'+ Property line
5.+' 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 *1' Building foundation
10'+ Water main N/A
Water service line 10'+ Surface water 100.'+. Driveway, parking/vehicle storage 10'+
Curtain drain,.. NONE KNOWN Wells on adjacent lots
100'+.
F. COMMENTS.
* 7' LOT LINE WAIVER IN EFFECT
G ENGINEER'S CERTIFICATION
o F b
;01fi c,�n
1 certify that:l have determined through field inspections and
review of Municipal recordsthat the above systems are in
conformance with.MOA HAA guidelines in effect ors this date'