HomeMy WebLinkAbout007 TR B007
T act B
#051 - 211 -09
Municipality of Anchorage
Development Services Department
Building Safety Division ~_~_'~ ~'~
On-Site Water and Waatewater Program, 4700 S. Sragaw St. .
P,O, Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW000071 (SePtic) SW070259 (Well) PID Number: 051-211-09
David Malzac Wastewater System: [] New [] Upgrade
PO Box 670651 Chu~iak. AK 99567 ABSORPTION FIELD
LEGAL DESCRIPTION sat, Rating: Tolal Depth from original grade:
1.2 OPD/Ft~ 9 Pt.
Tract B 007 3 Ft. 5.5 Ft
2.76 Ft. 25 FL
Well: [] New [] Upgrade (Eastern Well) Gravelw, dth: 3 Ft. Numberaflil .... I Distano~belweenline,:.. Ft.
Private 64 Ft. 6]. Ft. 278 Et~ PS10 & D3034
Sullivan 9/21/2007 43 Ft David Malzac 05/2000
Yield:3 GPM Pump Se~'~ Ft. Casing Height Ab;e Ground:Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P, [] Other:
Tank Field Station Tank Sewer Lira Anchorage Tank 1000 Gal.
We, 100% 100% NA NA 25%
Steel 2
Su.a~te, 100'+ 100'+ NA NA ~ / LIFT STATION
Lot Un~ 51+ 10% NA NA~ Size: Manu[ac~rer:
Curtain Drain NA * ~0~+ N~. NA Pump Make & Model Electrical Inspections pelformod by:
· none known. System designed/permitted to be 5' above BENCH MARK
bottom of lest hole, PID changed between permits - 051-211- Garage Floor
07 (aw000071) to 0S1-211-~ (Sw070~) ~mo. Elevation:
1O0 pt.
· *See attached letter on sapac system docnmentation
Additional well data inclnded for an exploratory well Engineer's Stamp
located closer_to the hoose~l~:hich was hydro.fraeked,
Inspections performed by: ArcTerra Dates: 1st 05/18/2009
Development ,~arvices [:~art~ent ApproVal ~
Reviewed and approved by~ .~ ~ Date: .~/',~/~ ~
AS-BUILT SYSTEM DETAILS/SITE PLAN Pe. Mi~ suooooT1
007 TRACT B PID# 051-211-07
~ DEEP -~~':..M] '"' .... "
, DECK~-.- .. .~'~
~,c ¢-~. '-.~,,v~ .' ...: ~
SHED
~ SCALE, t' = 50'
~g-C=l~ ~
~ , ~ FINAL GRA~E% ~
o ] ~lOOO G~L ~
T
~ ~. oF ~
. CHUGI~K, ~K 99567
st~ STAKING ~=: KMO ' '~..~ ~ //~ ~
~ ~ m~: FILE ~e .*.: 08-0~5 ' ~ ~s~-~
MUNICIPALITY OF ANCHORAGE
Development Services Depatlment
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Upgrade
Date Issued: Sep 21, 2007
Expiration Date: Sep 20, 2008
Permit Number: SW079259
Legal Description: 007 TR B
Design Engineer: 0000 ZZ - NONE NEEDED
Owner Name: DAVID MALZAC
Owner Address: PO BOX 670651
CHUGIAK, AK 99567-
ParcellD: 051-211-09
Site Address: 018600 JASMINE RD
Lot Size: 864270 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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 ( 'I8AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special previsions.
-THE ORIGINAL WELL NEEDS TO BE PERMANENTLY DECOMMISSIONED PER AMC 15.55.060J,
DOCUMENTATION NEEDS TO BE SUBMITTED WITH NEW WELL LOG.
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM".
Received By:
Issued By: ~'
Date:
Date:
SEP, 17, 2007 IO:05AM INDIAN MOUNTAZN LRRS N0.159 P. 1
Municipality of Anchorage
Development Services Department
Building Safely Division
On~i~e Water and Wastewater Program
4700 Bmgaw Street
P.O. aox 196650
Anohorage, ,Naska gg51g-8650
www.munt.orglonsita
(907) 343-7g04
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I,D, 0512110~.
Properly owner(s) David & Bammie Mslzac
Mailing address P o'Box 670651
Site address 186oo Jasmine Rd,
Legal desoripticn (Sub'd., BIocl( & Lot) 007 sub,d. Tract B
Legal description (Townahip, Range & Section)..
Lot Size 864,270 Sq, Ft.
Day phone r~.5873
Zip Code 9e~6? .
Z~p Code gg567
Number of Bedrooms 3
THIS APPLICATION 18 FOR ([] all that apply): THIS APPLICATION IS AN:
Absorption Field [] Initial []
Septic Tank [] Ul~mde []
Holding Tank [] Renewal []
P~vy []
Private Well []
Water Storage []
t certify that the above information ia correct, I further certify t~lat thin application is being made fOr a
Slngle~ ~_/~/~s i.~.?...~rdance wi,applicable Municipal C°des'
(Signature of property owner or au~rized agent) " '
II
Permit/Rush Fees: , /
Waiver F~s: .¥~* '
Date Of Payment:
Receipt Number:
(Rev. 11~ '
Date of Payment:
Receipt Number;
SN~D NIViNDO~ NVI~NI
~V~O:O[ LOO~'L['dgS
'5
Is welHo~,ated at approved per~it location9 Q.Yes Q No
E4etfi~f D[illing: Q cable tool
Un~ Type:
,Dat_e of Issu~'~'~ _-'~ I- g)~
¢;5~ _ PI! _ oq
.- inches~
feet
.teet
open end ~open'hole
Start feet Stopped
~- /~5
· ' yYes ~ No
10:21 6~82259 SUlLiVAN
Development Services
Building ~e~
~-~1~ W~er &
P.O. g~x g966~
Anchor. A~ 09~19-66~0
Pump Installation Log
, Owaer Name & Add--t,
~ 67~6~-/ ~A~¢"/~/
Adapter Manufacturer'S ~amel
CommentS:
01/Ol
Atteatiea-~ TI~ pump installer shall provide ~ pump In~llatie~ tog to ¢a~ DRD wi~in 30 d~ys of ptxmp iagallatioa.
901 T~qNRINR DI~IV( o ~N(HOfiRG(, RLRSHR 9~/50~ ~ (~07) ~4~0740
August25,2000
Dave Malzac
P.O. Box 670651
Chuigak, AK 99567
RE: Water Well Hydro-Fracing
Dear Mr. Malzac:
Pursuant to your instructions, on August 20, 1999 we mobbed men and
equipment to the site at the end of Jasmine Road. The fracing equipment was
set up and the high pressure jetting unit was lowered in the well. The upper
proportions of Bedrock were jetted under high pressure to remove fines in
crevasses. After the jet operation, we hydro-fraced the well and completed those
operations on September 3rd, 1999. A temporary pump was installed in the well
to help clean it and the well was pumped intermittently from 9-3-99 through 9-17-
99, on 7 separate days. It is our opinion that the well produced at the time, in
excess of 150 gallons per day, There are no warrantees or guarantees
expressed or implied.
Thank you for your business. If you have any questions or concerns please do
not hesitate to call.
Janes A. Ridg~
chorage Wel
~ump Service, Inc.
WATER SYSTEM SERVICES ,, DOMESTIC AND INDUSTRIAL PUMP SALES AND SERVICE
ertifieh [[ ritlinB
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99667 · TELEPHONE 688-2759
OWNER OF LAND ~.~JE A~& :~C BORE HOLE DATA
DEPTH
ADDRESS /.'~0 ~o,~ ~,7~:) -~/-~'J From To
LEGAL DESCRIPTION ~ ~ ~ ~ 0 2
PERMIT NUMBER q~Ot~ Date of ~ssue ~ ~ I~- ~ ~. /~
T~ INDENTIFICATION NUMBER ~1 --~1 / ()~ I~ ~'
Is well located at approved permit'location? ~ Yes ~ No
Method of Drilling: ~f rota~ ~ cable tool
Depth of well: ~ O O
Casing Type [ ~E~ Wall Thickness ~ ~' inches
Diameter ~" inches, depth I~ t feet
Liner Type: ~)~ E .
Casing Stickup Above Ground: ~ feet
Static Water Level (from ground level): ~'
L) feet
Pumping level: feet after__hrs, pumping gpm
Recover Rate: O gpm ~
Method of Testing: ~ t ~
Well Intake Opening Type: ~ Open End ~ Hole
~ Screened; Sta~ feet Stopped feet
~ Pe~omtions.Sta~~'feet~t°pped~ feet
groutType: ~c.~7,~,rE" ~lume /~OZ~9
Depth: from feet, to feet
Pump intake Depth: feet
Pump Size hp Brand Name
Well Disinfected Upon Completion? ~ Yes ~
Method of Disinfection:
Comments:
Drill~ ~ame
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 & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
~,4~T~ CT&E Environmental Services Inc.
CT&E Ref.# 1012819001 Cliest PO~
Client Name C~VflVI General Contractors Printed Date/Time 05/29/2001 16:37
Project Name/# Well Water Malzae Collected Date/Time 05/22/2001 13:40
Client Sample ID Downstairs Bath Received Date/Time 05/22/2001 16:52
Matrix DrLr~c,~g Water Technical Director Stephen C. Ede
Ordered By
PWS1D 0 Released By
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Waters Department
Nitrate-N
0.558 0.500 mg/L EPA 300.0 ~<I0) 05/22/01 SCL
Misrobiolo~y Laboratory
Total Coliform 0
0 col/100mL SMI8 9222B
05/22/01 KAP
JAN-O?-8008 13:11 From:CAPE NEWENHAM 5589570+~3~ To:90T 343 9999
07 Jmmary 2008
1
Ih'rom; David and gammi~ Makzac
Re: Permit 3 SW070259 [
Pared ID: 051-211-09
JefF, '
/
On the above property, ~0 have drilled a now
;till producing water, so i.~ill remain a producing v
Thank you, /.-~)
David Ma lz _.~~
I can be eonlaatnd thror
until Friday.
md is producing water. The old well is
Ii and not be capped.
r37I~ currently at 552-9419, ex~ 21 ]
ArcTerra Consulting, Inc.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
ANCHORAGE OFFICE (907) 868-3792
FAX (907) 868-3793
May 26, 2009
Debbie Wockenfuss
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater PrograJn
P.O. Box 196650
Anchorage, AK 99519-6650
RE: 007 SUBDIVISION TRACT B -- UNDOCUMENTED SEPTIC SYSTEM
Dear Deb,
Per previous discussions and per your instructions, we have investigated and
performed a septic as-built of the subject undocumented property's septic
system. Based on these visual observations, MOA permit record documents,
combined with photos and receipts provided by the owner-it appears that the
above referenced property's on-site wastewater system was installed per the
permitted design (MOA Permit Number: SW000071).
The only change is that a 2-bedroom system was installed and not a 4-
bedroom. This system is to serve an initial garage/residence. As discussed
previously, we are documenting this system because the engineer of record,
Allan W. Murfitt, P.E. is deceased.
Also attached are the well Iogs. The western well was drilled initially and
hydro-fraced with little production, but is still in use. Subsequently, the
eastern well was drilled and produced 3 gallons per minute.
If you have any questions, please contact me at 868-3792 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Kem~eth M. Duffu~
Attachments: MOA On-Site Inspection Report
Septic Construction Photos
As-Built Survey
Well Logs Eastern & Western (hydro-&aced & water sample)
V J_OVUJ_
q ,,9g',gg.69 S
/,
MUNICIPALITY OF ANCHORA GE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(9O7) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 21,2000
Expiration Date: Apr 21, 2001
Permit Number: SW000071
Legal Description: 007, Tract B
Design Engineer: 0009 A.W. Murfitt Company, Inc.
Owner Name: David Malzac
Owner Address: PO Box 670651
Chugiak, AK 99567-
Parcel ID: 051-211-07
Site Address: AK Malzak Property - T15n, Rlw, Section
Lot Size: 864270 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
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:
ate: ¢- - Z/-00
A.W. Murfitt Company_
CONSULTING ENGINEERS & TESTING
13810 Venus Way · Anchorage, Alaska 99515 · Telephone (907) 345-2737 · FAX (907) 345-3264
October 19, 1999
Municipality of Anchorage
Department of Health & Human Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 9951%6650
ATTENTION:
Mr. Jim Cross., P.E.
Well & Septic System Design
Single Family Dwelling
Tract B, 007 Subdivision
T15N, R1W, Sec. 16, S.M., AK.
Malzak Property, Plat 10202
Chugiak, Alaska
Our Job 99-335.01
Dear Mr. Cross:
This septic system design was originally submitted to your office for review and approval in June of
this year. Your office informed us that the sand bed filter for soils which percolate too fast was not
being used any more. Accordingly, the design is now resubmitted as a deep trench system.
The referenced property represents a new 20 acre parcel which was subdivided last year and is
currently undeveloped. The property owner, Mr. David Malzak, is proposing to build an initial
garage/residence at the location shown on the site plan. He has requested we design a septic system
suitable for four (4) bedrooms. The well will be located to the south of the structure with a minimum
separation of 100 feet from the septic system. Our design data is summarized in the following dialog.
1. SOILS:
Attached is a copy of the soillog/percolation test data, Site Plan, and soilparticle size
distribution (sent to your office last year). The log documents the GP-GM soilprofile
from a depth of 1 foot below the ground surface to a depth of 14 feet. This is
classified as a poorly graded gravel with silt and sand. No ground water was
encountered at the bottom of the excavation nor a~er monitoring the stand pipe
installed. The receiving soil had a percolation rate faster than 1 minute per inch.
Page 2.
MOA, DHHS
Tract B, 007 Subdivision
Chugiak, Alaska
99-335.01
October 19, 1999
2. ABSORPTION BED DESIGN:
a. Percolation Rate: 1 minute per inch.
b. Allowable application Rate: 1.2 gallon/day/12.2
c. Number of Bedrooms: 4.
d. Design Flow: 600 gallons per day.
e. Minimum Absorption Area: 500 s.f.
f. Max Total Depth (below original grade): 9.0 ft. ( 3.5 12. cover, 5.5 ft. sewer rock.
g. Width: 2.5 12.
h. Minimum Length: 50 12.
i. Effective Absorption Area = 500 s.f.
3. SURFACE WATERS:
There are no surface waters within 300 feet of the proposed septic system. There are
no streams on the property.
4. TOPOGRAPHY:
The septic site is essentially flat in the north south direction. Slopes on the east and
west of the site are upwards at 10 to 15% and at least 75 feet away f~om the
installation.
5. IMPACTS:
On the basis of our site visits and the ava'flable site information, there are no
developments with in several thousand feet of this new subdivision. Accordingly,
there will be no adverse impacts on adjacent wells or septic systems nor restrictions
to future development of adjacent lots. If you have questions, please contact our
office at 345-2737.
6. WELL and SEPTIC INSTALLATION:
The well installation shall be installed in accordance with the AMC 15.55 (96) by an
Page 3.
MOA, DHHS
Tract B, 007 Subdivision
Chugiak, Alaska
99-335.01
October 19, 1999
approved driller. The septic system designed herein shall be co~structed in accordance with AMC
15.65 (90) by an approved septic system installer. The i~tallations shall be completed in accordance
with the requirements of the On Site Well and Septic Permits. We understand that a well some 400
feet deep was completed at the site this sunmaer.
Sincerely,
A.W. Murfitt. Company
Allan W. Murfitt, P.E. '
Registered Civil Engineer 4977-E
ATTACHMENTS: Site Plan, Septic System Design Drawing, Percolation Test Report and Soil
Paxticle Size Distribution Report.
zd
~ Ol0' ¢
· 010 ,
' 0
Q-O
Municipality ot Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG--PERCOLATION TEST
PERFORMED FOR: DOWI. En~ineem/Malzak Property
LEGAL DESCRIPTION: Tract B, 007 Subd. Chugiak, AK
]
2
3
4
5
6
7
]]
DATE PERFORMED: June26, &Jul;/10, 1998
Township, Range, Section: T15N, RIW, SEC, 16, S,M.,AK.
Foresr litter, Organic SILT (OL), red brown, moist.
to a depth of 1 foot.
GRAVEL (GP) coarse bouldem, with SILT and
SAND, light brown, moist, to 2 ft.
GRAVEL with SILT and SAND (GP-GM), brown,
moist. Finer GRAVEL and less SILT with depth
SLOPE SiTE PLAN
-$
WAS GROUND WATER
ENCOUNTERED? no
L
IF YES, AT WHAT o
DEPTH? P
Depth to Water After
Monitoring/ none [~s: 7/19/98
Bulk Sample 5 to 9 lt. for MA (5.6% SILT)
Perc. test 5.5to6.0 Ft.
more gray with depth.
16
20.
Total Depth 14 feet. Hole
Dr~ after Excavation.
Komatsu PC-120 Backhoe
4" Diameter PVC Installed
for water observations.
Excavated 6/26/98.
Gross Net Depth to Net
Reading Date Time Time Water Drop
resoak 7/10/98 4:25 PM Io fast to measure
~resoak " 4.27 PM _ .~:~-,~ ~, ~ ~
" 4:29 PM ,~';'~ -C~F .~ '~'3~
~ 6**
PERCOLATION RATE '< ] (minul
TEST RUN BETWEEN 5,5 FTAND 6,(~
COMMENTS Generally good site for _~_?!c Recommend a deep trench. SEE PERC. SOIL GRAINSIZE REPORT and A'FrACHED SITE PLAN
by DOW1. Engineers,
PERFORMED BY: Allan W. MunStt, P.E. CE 4977 ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE: July 14, 1998
Particle Size Distribution Report
500 100
10 1
GRAIN SiZE - mm
% SAND
45.3
SIEVE PERCENT SPEC.* PASS?
SIZE FINER PERCENT (X--NO)
1.5 in. 100,0
1 in. 92,9
.75 in. 83,9
,5 in. 72~0
,375 in. 59,3
#4 50.9
#10 23.3
#20 18.1
#40 16.0
#60 13.5
#100 9.9
#200 5.6
(no specification provided)
Sample No.: 1 Source of Sample:
Location: Site Fagged By Home Owner
0.1
% SILT
0.01 0.001
} % CLAY
5.6
Soil Description
Poorly graded gravel with silt and sand
Atte rber,q Limits
PL= NP LL= NV PI=
Coefficients
D85= 19.8 D60= 9.71 D50= 4.52
D30= 2.49 D15= 0.331 DI0= 0.152
Cu= 63.81 Cc= 4.19
Classification
USCS= GP-GM AASHTO=
Remarks
Backhoe Test Pit
Date: 6/26/98
Elev./Depth: 4 to 9 Ft,
A.W. Murfitt
Company
Client: CMM Construction, Mr. Robert Caywood
Project: Soil Percolation Test
Chugiak, Alaska
Project No: 98-294,02
Plate I
2~ ~2
SCALE; 1"~ 400'
TOPOGRAPHIC MAP
TRACTS A, B & C
007 SUBDIVISION
MUNI GRID No. NW]O~9
Municipality of Anchorage
Sru7�fA7 t r:J ?a
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems .Approvai - ---
: =24-
Expiration Date:
Parcel I.D. 051 -211 - 09
1. GENERAL INFORMATION
`7_ 141- 2-c9Zc7
Tract B, 007 Subdivision
18600 Jasmine Road, Chugiak, Alaska 99567
al ing a dress Po Box 670651. Chu
IreS3tf.��. �iliv"S�i?i�A�� err
Vivian Pike
Herrington & Company
NY
2. T^l-FtR� FbW.' LLING:'
®> Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
Day phone ( 907) 688-5873
Alaska 99567
— Day phone ( 907) 440-6392
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
tNaiverNariance request for: Distance:
Received by: I Da#e: oZ �0
COSA to be released to the engineer. unless otherwise requested by the engineer.
COSA Fee $_,,92_6, 0 C7 Waiver Fee
Date of Payments 1..i g.. Date of Payment
Receipt Numbed'.. ��.� Receipt Number
COSA # �S- ! b� 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 Pinard Engineering Phone (907 ) 232-1347
Address PO Box 879347, Wasilla, Alaska 99687
Engineer's Printed Name Paul E. Pinard, PE Date 1248 gift064a -
6. DSD SIGNATURE
f System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
1?(
Conditional approval for bedrooms, with the following supuiatlons: ---
By: �`�"�T���1�' Original Certificate Date:
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 blue sheet r '- .; e
Nitrate Advisory
Arsenic Advisory
Other
Legal Description: r' � Qn7-s.10C1tutS1d^J Parcel ID: OBJ 1 —?w -0y
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)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 2 - `Z 02 0,
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes JK No
[Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic 45 ug/L ❑ Arsenic less than MRL (ND)
Collected by RN
Date of Samples ` j i�� *d��,
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
❑ Code -required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
❑ Yes
Septic Tank/Lift Station on Lot > 100'
ft
Surface Water > 100' ❑ Yes if No ft
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ❑ Yes
if No ft
❑ Yes
if No
ft
_
Community Sewer Main > 75' ❑Yes
if No
ft
Manure/Animal Excreta Storage > 100'
—
❑ Yes
if No ft
From SepticlHolding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
ft
Surface Water > 100' ❑ 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' ❑ Yes if No ft
Water Main > 10'
❑ Yes
if No
ft
Community Wells > 200' [:]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'
❑ 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'
[,1 Yes
if No
ft
Private Wells > 100' ❑ Yes if No ft
Water Service Line > 10'
❑ Yes
if Na
ft
Community Wells > 200' ❑ Yes if No ft
Surface Water > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
�
`7'y7 CG The. 00,5/9 r
J 5 +'/w�ec't-t
"�e- de/VD�" jell/J.,ridPli-) COSH P -;L {Jd.ed 6r� Ga tJ t3W'
9.
wN
G. ENGINEER'S CERTIFICATION OF AX'10
®se®m®neo
I certify that I have determined through field inspections and review 10��
of Municipal records that the above systems are in conformance with gid V�
MOA COSA guidelines in effect on this date. 'deg -80PA-01 agog Vq
m pa ! i s
COSA Checklist yellow sheet
AW
t -Su Test Lab,
1%,
L
Water Quality Testing
9131 E Frontage Rd, Ste 15
Palmer, AK 99645
{907}745-3005
matsutestlab.office@Qmoil.com
Name:
Pinard Engineering
Lab ID#:
M200303
MailingAddress:
P.O. Box 871347
Date Sampled
04/14/2020
Colilert
SM 922313
Wasilla, AK 99687
Time Sampled
1915
Legal Description:
Tract B 007
Sampled By:
PJ Pinard
---
Date Received.
04/15/2020
Sample Site Location:
Kitchen Sink
Time Received.
1030
Health Guard I
Parameter
Method
Result
Unit
MRL
MCI.
Date
Total Coliforms
Colilert
SM 922313
A
___04/16/2020
-"-
---
E. coli
Colilert
SM 9223B
---
---
---
04/16/2020
Total Nitrate - N
TNTplus 835/836
Hach 10206)
2.62
mg/L
0.200
I0.0
04/15/2020
Arsenic
Arsenic by ASV
Metrohm AB 416/3
1.455
[g/L
1.000
I0
04/16/2020
Method Reporting Limit (MRL): the lowest concentration that can be reported reliably
Maximum Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA
mg/L: milligrams per liter, I/1000's of a gram
pg/L: microgramsperiiter; 1/1,000,0001ofagram
Absent (A): none ofthis type of bacteria was detected
Present (P): one or more bacterial cells ofthis type were detected
Results Reported By:
Patience Lynch
Laboratory Analyst
Reviewed By:
Signature: 17ell���
Jen Williams (Apr 23, 2020)
Email: matsutestlab.office@gmai[.com
•
. Municipality of Anchorage r :....„,F.-..s:
h�2 :,_ '
a
On-Site Water and Wastewater Program < V
(907) 343-7904 SA ' ETV
Certificate of On-Site Systems Approval
r CZ
Parcel I.D. 051-211-09 Expiration Date: (�'1,C�.'U^,l� �(.5! , t;)r l'I
1. GENERAL INFORMATION
Coma. : , -ascription Tract B, 007 Subdivision
- .J;yN.
18600 Jasmine Road, Chugiak, Alaska 99567
t. w`" - t .» -•, � "• David Malzac Day phone (907) 688-5873
No tal Ing as0.. ess ;'� PO Box 670651, Chugiak, Alaska 99567
_.,.....:t.,„„:
!..,
'� L"!1 0erl[` +,. Vivian Pike Day phone (907) 440-6392
vs%�..y�u, tipll .,,a .<,.,i Herrington & Company
2. RE"OF DWELLING:
1'
r, •
® -A •
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well X❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: p 0? 6()..4.-41..Z...- Date:3P& 01- 010/e
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ S 26, 00 Waiver Fee $
Date of Payment 121241)2Date of Payment
Receipt Number 0407/9 Receipt Number
COSA# 0-SCIB i 6c✓' 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 Pinard Engineering Phone (907) 232-1347
Address PO Box 871347, Wasilla, Alaska 99687
Engineer's Printed Name Paul E. Pinard, PE Date 12
f• ,
*149 !
6. DSD SIGNATURE ••_`i► fir.•►'
�l System#1 Approved for bedrooms _ PaulSystem#2 Approved for bedrooms S• CE-4 •701
•
Disapproved 11941",••••••
R 4�
t7(2t� t$Z� OFEgS10,�
Conditional approval for bedrooms, with the following stipulations:
CJ\ A`
rG
•ti
C'OjI f
By: 'Idt(1,(1 l,', Original Certificate Date: / >>/='2 ?f/� F
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 r .: 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: Tract B, 007 Subdivision Parcel ID: 051-211-09
A. WELL DATA
Well type Pvt If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 1.0/17/07 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y (well house)
Total depth 64 ft. Cased to 61 ft. Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test. 10/1 /07 12/16/18
Static water level 43 ft. 43.5 ft.
Well production 3 g.p.m. 3.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 2-b mg/L
Arsenic9Q1 ug/L Date of sample: 12/17/18 Collected by: Pinard Engineering
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/2000
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 1 2119118 Ck' Pumper s//artJ. P ir%
1
C. ABSORPTION FIELD DATA
Date installed 5/2000 Soil rating (g.p.d./ft2 ox J 4) 1 .2 System typeDeep Trench
Length 25 ft. Width 3 ft. Gravel below pipe 5.5 ft.
Total dep • -;. ff. absorption area 278 ft2 Monitoring tube Y Depression over field N
,
Dat: .`: :,yt• :- ' '`}; 16/1 8 Results (Pass/Fail) Pass For 2 bedrooms
w
FI +"'•th i • + •re test 6 in. Water added 480 gal. New depth 14. 5 in.
Elapsed Time: I min. . inal fluid depth 8.4 in. Absorption rate >= 300+ g.p.d.
A dvtri� 12 mo.) (Y/N &type) None Known If yes, give date
�., ".s•. X11 3 to .,
,40/fry, ejj
D. LIFT STATION NA
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 100'+ Public sewer manhole/cleanout . 1001+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 501+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 + Property line 10'+ Absorption field 10'
Water main 100'+ Water service line 25'+ Surface water 100 '+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 100'+
Water Service line 25 + Surface water 1 00'+ Driveway, parking/vehicle storage 1 0 +
Curtain drain NA Wells on adjacent lots 100'+
F. COMMENTS
A liquid level measurement of 4. 1 ' was taken from the 2nd compartment
of the septic tank prior to beginning the Adequacy Test. The original
well on this property is still in use and connected to the water system.
G. ENGINEER'S CERTIFICATION (Separation distances provided, apply to both)
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.• .
Engineer's Printed Name Paul E. Pinard, PE w r''-`
Date 12/21/18i./o1� ��
�„ cE.4 21 ��f
COSA yellow sheet_2-6-15.doc (15
PINARD ENGINEERING
d P.O. Box 871347 I iit 1
Wasilla, 1 tIE r
.eco (907) 357-ENGR
° '� (3647)
, ,„
WELL FLOW TEST
LOCATION: Tract B,007 Subdivision JOB NUMBER: 18-305
DRILLER: Sullivan Water Wells DATE OF TEST: 12/16/18
DATE WELL COMPLETED: 10/17/07, per MOA Records FIELD STAFF: PJ Pinard
WELL DEPTH: 64', per MOA Records
STATIC WATER LEVEL(top of casing):43.5'
Elapsed Static Flow Cumulative
Time Time Water Rate Gallons Remarks
(Minutes) Level (gpm) Pumped
1:55 PM - 43.5' 4.0 - Start Test - Meter 554140
2:10 15 4.0 60 554200
2:25 30 4.0 120 554260
2:40 45 4.0 180 554320
2:55 60 4.0 240 554380
3:10 75 4.0 300 554440
3:25 90 4.0 360 554500
3:40 105 4.0 420 554560
3:55 120 4.0 480 554620
4:10 135 56.3' 2.0 540 554680
4:25 150 3.3 570 554710
4:40 165 52.0' 2.0 620 554760
4:55 180 3.3 650 554790
5:10 195 55.3' 2.0 700 554840
5:25 210 2.7 730 554870
5:40 225 54.5' 2.7 770 554920
5:55 240 54.9' - 810 Stop Test - 554950
RECOVERY
11:45 AM 1070 43.5' All well protection features were satisfactory.
A recovery measurement. taken at 11:45 AM the following morning, showed
that this well had fully recovered.
This is the second of two wells on this property. The original well is still in
use, has satisfactory well protection features, and is plumbed into a 250
gallon storage tank that both wells supply for this system.
Average Flow Rate: 3.4 gpm
Comments: DURING THIS TEST,THE WATER SUPPLY WELL WAS CAPABLE OF
PRODUCING 4.0 GPM. THIS TEST DOES NOT CONSTITUTE A Reviewed by: Paul Pinard
WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM
WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Date: 12/18/18
PINARD ENGINEERING
a;ILP.O. Box 871347 d I I
a
Wasilla,AK 99687 itit ,
w (907)357-ENGR(3647)
ADEQUACY TEST
LOCATION: Tract B,007 Subdivision JOB NUMBER: 18-305
APPLICANT: David Malzac DATE OF TEST: 12/16/18
PO Box 670651
Chugiak,Alaska 99567 FIELD STAFF: PJ Pinard
SEPTIC TANK TYPE/SIZE: Stee1/1000 Gallons,per MOA Records NUMBER OF BEDROOMS: 2
ABSORPTION SYSTEM: Deep Trench,per MOA Records SCUM: SLUDGE:
DAILY FLOW: NEEDS TO BE PUMPED: Yes XX No
2 BEDROOMS x 150 GAL/BR= 300 Gallons CURRENTLY IN USE: Yes XX No
TEST DATA
Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments
Rate Volume Tank
pM (GPM) (GALs) (GALS) Liquid Level A Level Monitor A SAS Monitor A SAS
* Tube 1* Level Tube 2* Level
1:55 4.0 - - 4.1' - 0.5' - Start Test- Meter 554140
- 2:10 4.0 60 60 4.2' 0.1' 0.6' 0.1' 554200
2:25 4.0 60 120 4.2' 0.0' 0.7' 0.1' 554260
2:40 4.0 60 180 4.2' 0.0' 0.8' 0.1' 554320
2:55 4.0 60 240 4.2' 0.0' 0.9' 0.1' 554380
3:10 4.0 60 300 4.2' 0.0' 0.9' 0.0' 554440
3:25 4.0 60 360 4.2' 0.0' 1.0' 0.1' 554500
3:40 4.0 60 420 4.2' 0.0' 1.1' 0.1' 554560
3:55 - 60 480 4.2' 0.0' 1.2' 0.1' Stop Flow- 554620
RECOVERY 'ALL MEASUREMENTS IN FT.
Date Time ST MT2 SAS MT1
12/16 4:50 4.1'/-0.1' 0.9'/-0.3'
PM
12/16 6:05 0.7'/0.2'
PM
TEST: PASSED XXX FAILED
COMMENTS: This system found to be operating satisfactorily.There was 0.5'of measurable liquid in the SAS MT
prior to beginning the test.With the addition of 480 gallons to the system(significantly more than the
design daily flow of 300 gallons),the level rose to 1.2',leaving over 5'of ED still available in the SAS.
Recovery measurements,taken 55 and 130 minutes after stopping the test flow,showed satisfactory
absorption.The last recovery measurement,at 6:05 PM,showed that the design daily flow of 300
gallons,had been fully absorbed by the SAS.
Reviewed by:Paul Pinard {top
Date: 12/18/18