HomeMy WebLinkAboutSHACKLETON LT 24DMunicipality of Anchorage -
On-Site Water and Wastewater Program • (907) 343-7904 APR ®, 2ft 1
ON-SITE WASTEWATER INSPECTION REPORT uu��
Permit Number: OSP171313 PID Number: 016-141-37
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade
Name:
Campbell Shannon ABSORPTION FIELD
Address
330 N Grant Moscow ID 83843❑ Deep Trench El Shallow Trench El Bed ❑Mound
❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
503-872-4331 3 1.0 GPD/SF 11.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.0 Ft. 8.0 Ft.
Shackleton 24D Fill added above original grade Gravel length
Township Range Section 0.5 Ft. 30 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 3.0 Ft. Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches
From
Tank Field Lift Station Tank Line 480 Ft 1 Ft.
Well >100' >100' N/A N/A >25' ITANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water >100' >100' N/A N/A Anchorage Tank 1000 Gal.
Material Number of compartments
Lot Line >5' >10' N/A N/A Steel 2
NA
Foundation >10' >10' N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain None Noted Gal.
Remarks Pump on level at Pump off level at High water alarm at
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
Installer drainfield
D3034
A+ Home Services Drainfield D3034 CO/MT 3034
Inspector J. Mlllette BENCH MARK (Assumed elevation) 100 ft
Inspeectiontes: 15` 11/10/17 2nd 11/13/17 Location and description
3'" 4th Bottom of siding back of house.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date
71H 4
Be min Schiller
•. C 1 592
Approved fi Q92ux Date q /it I ��� h` 3 } �;�� �� ..'�
�>� >t1t.�547
Inspection Repo rt_9-1-12.doc
SHACKLETON LOT 24D
PERMIT # OSP171313
C,7Y �"� � LOT 14 ! .;: ` f VZVj L01
COMMUNITY WELL > 200' FROM PROPERTY LINE
1 f SHACKLIETON SUB
LOT 24D
LOT 2U p
UNDEVELOPED
i
MT2
CO2 -----
ALTERNATE SITE TH#�''' MT
LOT 243 _
UNDEVELOPED._- — — — —
2C0
--- - _._...--------- SV2
i �svl .
140.0
R \
--- -
LOT 24C
J.
144,0-,
l
EXISTING WELL (SHARED W/ LOT 24') —
KLATT ROAD
0 40 80
FEET
1.=40'
PID # 016-141-37
ABANDONED SEPTIC
CRIB (APPROX)
30' LONG x 3' WIDE, 8'
EFFECTIVE DEPTH
ABSORPTION TRENCH
10002GAL SEPTIC TANK
A B
FCO
9.6
22.5
SV1
48.9
44.1
SV2
53.5
49.8
2CO
55.9
52.7
C01
83.4
87.7
MTI
82.6
86.8
CO2
92.6
87.0
MT2
94.1
88.3
LEGEND
MT - MONITORING TUBE
FCO - FOUNDATION CLEANOUT
TH - TEST HOLE
CO - CLEANOUT
SHACKLETON LOT 24D
PERMIT # OSP171313
90.3
PID # 016-141-37
93.8 FINISH GRADE
OU2 /-93.3 ORIGINAL GRADE
MMMINKOW
82.3 30,
NO GROUNDWATER 10/02/17
76.3
E
90.3
r •n
rrg�P• �'9 �1
j *: 49 TM � ••.*
/ ' Benjamin Schiller
rp,ll�'F�Fo CE 12092•���� w
PROFILE AS -BUILT
(NO SCALE) 1\��PROFESSIONP
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April 3, 2018
Municipality of Anchorage
Development Services Dept- On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shackleton Sub, Lot 24D —151 West Klatt Rd
Waiver request for separation to existing crib
Dear On -Site Services Engineer:
The permit for this property shows an existing septic crib that was being shared with the adjacent
property. The design called for a 20' separation to the new septic trench. During the construction
phase, the measurements taken for the location were somehow incorrect. As -built measurements
have revealed that the trench was placed too close to the crib. The closest separation appears to be
7.8', according to our best estimate of the crib location.
The existing crib is supposed to be 9' deep. The new trench is 8' effective, 11.0' total depth. A
line of influence drawn at a 1:1 slope from the full trench would only barely affect the existing
crib. In addition, the soils had a perk rate of significantly less than 5 min/in. In such quickly -
draining soils, the effluent will not migrate horizontally very much at all. The trench is orientated
perpendicular to the existing crib, so any impact will be limited. The crib is not within the well
radius for this or any adjacent lot, and the test hole is deep enough to show sufficient separation
from groundwater. Even if effluent does migrate into the crib, there will be no contamination of
water or potential for harm to this or the neighboring property.
We request that a waiver be issued for the 7.8' separation to the existing crib.
Sincerely,
Benjamin Schiller, PE
OF • 4--' �l
*; 49 ;*
Beni min Schiller • •'
CE�
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OrE4'W
Municipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
Waiver#: OSVI81013 COSA#:
PID#: 016-141-37
Legal Description: Shackleton Lot 24D
Engineer: Forc,jineering e Eng
Applicant: Shannon Campbell
Permit#: OSP171313
Your request for a waiver of the code required horizontal separation from the new
absorption field to an existing absorption field (crib) has been approved. The approved
separation distance is 7.5 feet. See engineer's waiver request letter for justifications.
This waiver approval applies to the 2017 absorption field only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
a . 0 ... K a ff ... V . 0. 0 M M .. 0 K 0 a .... M ..... a a M K a ...... a M M a .. X .... M 2 8 ... M a a a a ... a .. N 0 a V I
Waiver is Granted: X
Waiver is not Granted:
Date: q1 f
Approved by:
Name of Reviewer
q�
44-oll,
�so"PALI7 ofr MUNICIPALITY OF ANCHORAGE ,„C I'r
On-Site Water&Wastewater Programr.
\ 5.;
PO Box 196650 4700 Elmore Road _
...,_Livik
Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
;
'' http://www.muni.orglonsite
Wail Li
Du irtmt lit
,NCHUA�''E
On-Site Wastewater Disposal System Permit
Permit Number: OSP171313 Effective Date: 10/18/2017
Work Type: Septic Upgrade Expiration Date: 10/18/2018
Tax Code Number: 01614137000
Site Legal Address: SHACKLETON LT 24D G:2630
Site Mailing Address: 151 W KLATT RD, Anchorage
Owner: CAMPBELL SHANNON Lot Size in Sq Ft: 20050
Design Engineer: FORGE ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
1
Received By: /IX:/J1P4 j)/-7)0 Date: 0 ,
Issued By: riT U Date: e5 ..i
MUNICIPALITY OF ANCHORAGE
t •\ ,(,).-<-- -L ' <.),
Community Development Department Rhone: 907-343-7904
Development Services Division OCT�=�icl- 1 0 2 17 ;� Fax: 907-343-7997
On-Site Water & Wastewater Program til
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 016-141-37
Property owner(s) Shannon Campbell Day phone
Mailing address 330 N Grant St, Moscow, ID 83413
Site address 151 W Klatt Rd
Legal description (Sub'd., Block & Lot) Shackleton Sub, Lot 24D
Legal description (Township, Range & Section)
Lot Size 20,050 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field x❑ Initial ❑ Single Family (SF) ❑x
(w/wo ADU)
Septic Tank ❑x Upgrade ❑x Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
( atur f property owner or authorized agent)
Permit/Rush Fees: 4 50 Waiver Fees:
Date of Payment: Ion!!! ( Date of Payment:
Receipt Number: //�� 4/3-3-OC- Receipt Number:
U
Permit No. V PR-13/3 Waiver No,
Permit App_.-:• .:...:c
FORGE ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 9, 2017
Municipality of Anchorage
Development Services Dept- On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shackleton Sub Lot 24D
Septic system design and permit application
Dear On-Site Services Engineer:
The owner of the above lot has a 3-bedroom home on the property, but would like to upgrade the
septic system. Currently they appear to share the system with the property to the east, with lines
from each home leading to a large seepage pit. We are submitting this permit application for the
construction of a new septic system. The attached site plan identifies the location of the home and
existing well,as well as the proposed septic location and alternate site. No conflicts exist between
this proposed system and any wells whether on this lot or adjacent lots. Drainage arrows are shown
on the site plan showing the grade and direction of flow. The drainage pattern in general will not
be changed by the construction.
The test holes placed on the lot indicate silty sand. No groundwater or bedrock was found down
to 17'. The percolation rate was determined to be around 1.5 min/in. An application rate of 1.0
gpd/sf was used in the design of the absorption system. We are proposing to place a new 1000-
gallon septic tank with a deep absorption trench 3' wide x 30' long x 8' effective depth. The
elevation of the distribution line will be 3' below the surface for a total depth of 11'. Soil will be
mounded 0.5' above the trench. A minimum of 3' of fill will be placed over the absorption trench
and 4' over the septic tank.
The ground surface on the lot slopes mildly toward the back,between 1-5%, and there aren't steep
slopes on any portion of the lot. The new trench will be constructed parallel to the slope as much
as possible. It will be a minimum of 100' from all wells and surface water, and more than 5' away
from the septic tank. It will also be a minimum of 18' from the old seepage pit. The alternate site
is located more than 16' away.
If the system is constructed as designed, it will have no adverse impact:
• On the wells in the area or those to be constructed in the future.
• On existing septic systems in the area or those to be constructed in the future.
• On reserve space, either surface or subsurface,on any lots located in the area.
• On drainage patterns in the area. The current drainage pattern will be maintained.
Sincerely, got1.1.4
A..9E.fl i7!4,1,
0. •
: %.7-4/#
Benjamin Schiller, PE • •...:..,1°
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SNOW 011- SNOW CREST VEW LOT 15
COMMUNITY WELL>200'FROM PROPERTY LINE
SHACKLETON SUB
-, LOT 24D LOT 24E
(1-)11 LOT 24A
ALTERNATE
UNDEVELOPED 20 p SITE
4.. EXISTING
lx• SEEPAGE PIT
i (ABANDON)
MIA
16.0 e
LOT 24B 30' LONG x 3' WIDE, 8'
==�' 1 EFFECTIVE DEPTH
UNDEVELOPED_ — • a' __
LJ ABSORPTION TRENCH
tc
,� c0 PRO�?OSED 1000—GAL
v SV SEPTIC TANK
svN l" EXISTING
�� k, �- SEPTIC TANK
140.0 � i � ( ; (DECOMMISSION)
/li i rr\
/ I c0 r \
LOT 21c, 1 \
I
I
100' WELL RADIUS `'
T11f _1
f
EXISTING WELL (SHARED W/ LOT 24E) ---
KLATT ROAD
NOTE:
_,.����\\\ NO SURFACE WATER WITHIN 100'OF THE
i�P..•.°F•`!.4k 4 PROPOSED SEPTIC SYSTEM
TH /� bill NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS ON ADJACENT LOTS LEGEND
r Benda n Schiller ' MT-MONITORING TUBE
76,1'''''''irk , AEL 12592 .•,`�-r 0 40 80
r FCO-FOUNDATION CLEANOUT
1kk\.FSPROFESsiO0•\s FEET TH-TEST HOLE
\AN�"��� 1"=40' CO-CLEANOUT
SHACKLETON SUB LOT 24D
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW 3' WIDE DEEP TRENCH SYSTEM
PERK RATE: 1.5 MIN/IN 1000-GAL SEPTIC TANK
APPLICATION RATE: 1.0 GPD/SF
450 GPD / 1.0 GPD/SF/8.0' DEEP l 2 SIDES = 28.1 LF Trench Length
THEREFORE: CONSTRUCT AN ABSORPTION TRENCH 30' LONG x 3'WIDE x 8' EFFECTIVE
DEPTH. FLOW LINE ELEVATION IN TRENCHES TO BE 3.0' BELOW ORIGINAL GROUND
SURFACE. TOTAL DEPTH TO BE 11' BELOW EXISTING GROUND. PROVIDE 3' COVER OVER
TRENCHES AND 4' COVER OVER SEPTIC TANK, OR INSULATION WITH 2' COVER.
6„ —I 11=11 =11 —_
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6"
===_0-414~441#4141411~ - 4" PERFORATED PVC (HOLES DOWN)
4 1c•tzi.A..4.1N i!ci DRAINFIELD ROCK
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f�f f f�Rf-I •I�I:I�f��.
.'-./-"'-:•-.•-' 4' TO GROUNDWATER
0 6'TO BEDROCK OR IMPERMEABLE LAYER
3' -
TYPICAL DEEP TRENCH SECTION
(NO SCALE) .0t '77OA
f
NOTES: *' TH •'*`�/
GRADE AREA OVER TRENCH TO DRAIN AWAY .00
MIN 6' SEPARATION FROM BEDROCK / • Benja in Schiller '
MIN 4' SEPARATION FROM GROUNDWATER `# AEL 12592ea IT 2017 .•�,���
MIN 100' SEPARATION FROM NEARBY WELLS �'�l�``oeh',„ SS�oNP`��
MIN 100' SEPARATION FROM SURFACE WATER OR STREAMS �\N\� ••""
MUNICIPALITY OF ANCHORAGE _�,��\e\,‘,
DEVELOPMENT SERVICES DEPARTMENT ��P iOF Ac4kk,�
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 �GJ.• k
•-•19 4
*:49.TH *,,
SOILS LOG AND PERCOLATION TEST , •
r B:rmin Schiller : j
LEGAL DESCRIPTION: SHACKLETON SUB, LOT 24D �f�'``�,�1• •• O•E12592 •��.r
PERFORMED FOR: FORGE ENGINEERING 11,�FiPROFESSIO•NP����
DATE: 9-25-2017 PROJECT No.: \\�\����~
PARCEL ID#: 016-141-37 TECHNICIAN: J. MILLETTE Professional Engineers Stamp:
DEPTH TEST HOLE 1
(feet)
SLOPE SITE PLAN
,� .,,.y..,:.7
j.:s ; y�
3
'; :i
4 -;,:11P-C:" .4';!2::
5 ;;7;t t SILTY SAND (SM) SEE SITE PLAN
6 c.;:;_ Fy�W;�
7 , -yz`.
gt
9 >: ';SCR
9
.-C.: i,'w: WAS GROUND WATER ENCOUNTERED? NO
10 arra; '
i'`i' y' ';:.1' IF YES @ WHAT DEPTH? -
{rs,:=1,g•- DEPTH OF WATER AFTER MONITORING: NONE
I I l ..''..70.;','W DATE OF MONITORING: 10/2/17 D
12—
DATE READING GROSS TIME NET TIME WATER NET DROP
13 i.1 . .i (MINUTES) (MINUTES) (INCHES)
"�' (INCHES)
14 "{'`i'},''4. 9/25 TEST HOLE PRESOAKED PRIOR TO TESTING:
w`�rtt.'..>$4 I 3:20 0
15 s }:r
` 2 3:29 8:49 6 6
16 4.01)..,
i'.=+i;T:1;r BOH ...
17 • ::j
9 4:01 0
18 0 4:10 9:17 6 6
19 I I 4:12 0
20 12 4:21 9:16 6 6
PERCOLATION RATE:1.54 (MIN/INCH) PERC.HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: PERK TEST WAS RUN 6 TIMES. INTERMEDIATE RESULTS ARE NOT SHOWN BUT WERE VERY SIMILAR.
GAAB-HD-I G"ATER ANCHORAGE AREA BOROVII�H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME i- D.
LOCATION
j
/1 li
SEPTIC TANK:
MAILING
ADDRESS �L��� PHH''ONEE----
DESCRIPTION " yl _ A� �GllGGGr�2(�UYi��
// 1 e/: I NUMBER OF
DISTANCE FROM WELL Wd /'7%G�_4j�MATERIAL //C�� COMPARTMENTS
LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: % SEEPAGE PIT: /C��/
NUMBER OF. PITS I OUTSIDE DIAMETER 17F` OR WIDTH _12-i
LENGTH -� DEPTH J ,
r
LINING MATERIAL DISTANCE FROM WELL �+ / BUILDING FOUNDATION,
NEAREST LOT LINE ` 1� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) Al SQ. FT.
s `
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM ELL NDA ION , NEAREST LOT LINE , OF LINES ,
NUMBER OF NES. DISTANCE BETWE N LINES TREN WIDTH TOTAL EFFECTIVE
ABSORPTION kkE&_ � - SQ. FT. LEN TH OF LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE: IN. ABOVE TILE
DISTANCE FROM WATER
WELL: TYPES L' DEPTH ,BUILDING FOUNDATION. SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGEOTHER
LOT LINE SEWER LINE ,TANK , SYSTEM- , CESSPOOL , SOURCES_
GAAB-HD-1 GRAATER ANCHORAGE AREA BOROUrH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
VV
/> MAILING f' � �A�d PHONE
NAME us�i�v1 f ///� ` �r� L L ADDRESS r NE
LOCATION y� IL zxc,�, L LEGAL DESCRIPTION -
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL �� MATERIAL COMPARTMENTS /
�LIQUID
LIQUID CAPACITY � GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:` x �;� X %®+/��
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH-, LENGTH,DEPTH ,
LINING MATERIAL DISTANCE FROM WELL �BUILDING FOUNDATION
NEAREST LOT LINE 79 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) QT SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM W
.FOU
LI
TOTAL LENGTH
OF LINES_
NUMBER OF LINES/ DW_NCE BETWEEA LINES lfo:� TR/NCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION ARE 1__� SQ. FT.
LENGACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH
TILE: IN.
ABOVE TILE
WELL: TYPE , DEPTH
�` ./SGL
DISTANCE FROM
BUILDING FOUNDATION. -.SAMPLE
WATER
, NEAREST
NEAREST
SEPTIC SEEPAGE
OTHER
LOT LINE SEWER LINE
, TANK , SYSTEM
, CESSPOOL
, SOURCES_
DIAGRAM OF SYSTEM
DISTANCES:��
(C
9
d
GAAB-HD-2 GREATEr-'-,ANCHORAGE AREA "OROUGH Case No.
HEALTH DEPARTMENT:t
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION S PERMIT
NAME OF APPLICANT ZG. AAD, MAILING ADDRESS ;t PHONE NO.
RESIDENCE ADDRESS A/ 11d,%`Z� /1LOCATION OF INSTALLATION /5 z,# 77, / 167),
LEGAL DESCRIPTION!-dIJ�
APPLICATION TO INSTALL: SEPTIC TANK_, SEEPAGE PIT C� DRAIN
�FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY 3G=l/d'•OfJS— 1L�2)C�t t rf S"(zr.D C-r-�l'� C hE�lZdZl�t�S
FINANCED THROUGHd '5 6PeMZ- TO BE INSTALLED BY
r� /Z_SA j/cW/ ���,rr /
RZaeUtAiJON TEST RESULTS16C-0ZJ ,8512 P•E� TICIPATED DATE OF COMPLETION o� W,
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS,"lKi < :i ;% ,V �L--L 'PERMIT TO INSTALL A iri°"lzti
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED -3%�EIQPC
SEPTIC TANK SIZEee-'O TYPE L-374— SEEPAGE AREA �G' �i2 TYPE
DIAGRAM OF SYSTEM
DISTANCES: (�%�!% /!Id%1,I Jill IMF] 11 1 p:;
Ale o
tau c 4ZPe r�:AJ �e '/
90_nllvZ-�IJ �!p c /r✓Zetag
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III
V\
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am tammar with the requirements or Greater AncnoragC JAmd Dorougn oramance IYo, ZO-00 anu that tine
above described system i in accordance with said code.
DATE s �� APPLICANTS SIGNATURF 4D I AA 49 - 7
•
• 6189 107 4.,,t st,,
•- Municipality of Anchora! 4
On-Site Water and Wastewater Progra (1, ,( .,, .t 9 La I
(907) 343-7904FL JUL 132.018 3N E T Y
Certificate of On-Site Systems Ap v ,val Aw
G>
016-141-37 Ui 6 : L.
Parcel I.D. Expiration Da e. d'
1. GENERAL INFORMATION
Complete legal description Shackleton, Lot 24D
Location (site address) 151 W. Klatt Road Anchorage, AK
Current Property owner(s) Shannon Campbell Day phone
Mailing address 330 N. Grant Moscow ID 83843
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer
WaiverNariance request for: Distance:
I p
Received by: f J tiikfi 1 J`Y11 Date: WM 0
COSA to be released to the engineer,unless otherwise requested by the engineer.
J
COSA Fee $ (o Waiver Fee $
Date of Payment 1! I ! 1�� Date of Payment
Receipt Number Receipt Number
COSA# i J -�\ �C' 1I 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 Forge Engineering Phone (907) 522-1777
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 7/12/18
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e *. 49:w j;\ 4®Li4t,6. DSD SIGNATURE ? o-l� • •
/C System #1 Approved for •� bedrooms 0�,•MICHAEL E. ANDERSON
` ••' CE-4381 .•4`�L
ris
System #2 Approved for bedrooms ®0 e••°0 'Pe.�-7_;y__;. •.•NN�
Disapproved ®`h.41.R0rESS10®®. 9.
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Conditional approval for bedrooms, with the following stipulations:
L.......-/ Original Certificate Date: , SP-(
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_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: Shackleton, Lot 24D Parcel ID: 016-141-37
A. WELL DATA
Well type Private 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 *51 ft. Cased to *51 ft. Casing height (above ground) 28 in.
FROM WELL LOG AT INSPECTION
Date of test 12/04/17
Static water level ft. 35.3 ft.
Well production .7g.p.m. 5'0 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 12.7 mg/L
Arsenic ND ug/L Date of sample: 7/5-10/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 1 1/13/17
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 Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed 11/10/17 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 .° System type Deep Trench
Length 30 ft. Width 3.0 ft. Gravel below pipe 8.0 ft.
Total depth 1 1 .5 ft. Eff. absorption area 480 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New 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/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5' >5'
Building foundation Property line Absorption field
Water main >10Water service line > Surface water >
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10Building foundation >1 Water main >
>10'
>100' >10'
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Well depth determined by inspection done by Arctic Pump & Well 8/01/18.
G. ENGINEER'S CERTIFICATION t�t��A\\
4.OF
I certify that I have determined through field inspections and �,`Q.., • f.i
review of Municipal records that the above systems are in `4 ..-!-".T#�
conformance with MOA COSA guidelines in effect on this date. *;'491 ! ,f\ • *
Engineer's Printed Name Benjamin Schiller, P.E. WV— /
8/02/18
Date /� • • Benja 'n chiller • .
f('•. CE 12592 .••c`Q�
$ d}��..•8/2/18 •.�V��
ikieDPROFESSION'
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COSA brown sheet 10-10-12.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ( • H .� 907-343-7904
On-Site Water and Wastewater Section ` j Fax: 343-7997
www.muni.org/onsite �_/
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181337
Subdivision: Shackleton, Lot: 24D
A water sample revealed a nitrate concentration of 12.7 milligrams per liter (mg/L).
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.
Mailing Address: P.0. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
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NO CORNERS SET THIS DATE
ova s '• SHANE A.HOLT a OHO �
a P . LS-6914 y�00 / 1 HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
VAS..-.....- �oo1OF THE FOLLOWING DESCRIBED PROPERTY
�‘Oppp0000 LOT 24 D, SHACKLETON SUB. ( PLAT 71-27)
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED.
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS _2 ND DAY OF
HEREON ( UNLESS INDICATED) _AUGUST , 2018.
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 LANDER DRIVE
345-55ROVER 99507
\` 13716, FB 184-45,189-49 345-5513