HomeMy WebLinkAboutSHACKLETON LT 24E��I�JUU ifLl f {J "I
Municipality of Anchorage APR ® 4 Zola
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171314 PID Number: 016-141-36
Dwelling: 9 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Eastaugh Linda Family Trust
ABSORPTION FIELD
Al Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
PO Box 112227 Anchorage AK 99511
❑ Other
Phone
Number of Bedrooms
Soil Rating ITotal
depth from original grade
503-872-4331
I 3
1.0 GPD/SF
11.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
8.0 Ft.
Subdivision Block Lot
Shackleton 24E
Fill added above original grade
0.3 Ft.
Gravel length
30 Ft.
Township Range Section
Gravel width
3.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
480 Ft z
1
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1000 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/ASteel
2
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
None
Noted
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer
A+ Home Services
Drainfield D3034 CO/MT 3034
Inspector J. Mlllette
BENCH MARK (Assumed elevation) 100 ft
Inspectiontes: 151 11/10/17 11/13/17
Location and description
2nd
3`d 4th
Bottom of siding back of house.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
#'�v
Conditional Approval: DateAwl
' •,:`i`��}
law
49TH
+ " "
Be aurin Schiller .'
Approved �l!vl,Y Date �(/1 i/13
4
��� `` 3�8•'�4,,,�
Inspection Report_9-1-12.doc
SHACKLETON LOT 24E
PERMIT # OSP171314
PID # 016-141-36
' iT i LILLIAN LN ROW Lar ',a
COMMUNITY WELL > 200' FROM PROPERTY LINE _ _ — ______ WELL > 100' FROM PL
SHACKLETON SUB
.t
LST = LOT "4 Eve NW
LOT 24E ON PUBLICWATER
Lar 24A t`t ` ABANDONED SEEPAGE
PIT (APPROX)
UNDEVELOPED
I .
i i ! TH#1
j I M _ _ C01
I j !
MT1
i i I j CO2
LOT 248
_UNDEVELOPED- zcoz
I SV2
_ 2coi
140.0.'
LOT 240
�r
/J
r
f
144.0
t
KLATT
i
i
.r
----------------
• •1
B nA
EXISTING -WELL -(S
f,.
0 40 80
FEET
1 "=40'
ALTERNATE SITE
30' LONG x 3' WIDE, 8'
EFFECTIVE DEPTH
ABSORPTION TRENCH
1000 -GAL SEPTIC TANK
A B
2C01
43.2
37.4
SV1
45.6
40.3
SV2
50.7
45.9
2CO2
53.2
48.6
C01
84.5
88.4
MT1
83.8
1 88.0
CO2
85.6
79.1
MT2
86.2
1 79.8
J
=D,W/ LOT 24D)
LEGEND
MT - MONITORING TUBE
FCO - FOUNDATION CLEANOUT
TH - TEST HOLE
CO - CLEANOUT
SHACKLETON LOT 24E
PERMIT # OSP171314
90.5
2
I—
P I D # 016-141-36
93.8 FINISH GRADE
OU2 X93.5 ORIGINAL GRADE OU
INSULATION
90.5
--- 82.5 30,
r
NO GROUNDWATER 10/02/17
-76.5
OF •4`�li
Ar. TH •.*
Benja n Schiller
lF. 2092E AS -BUILT 3
(NO SCALE) 1`1\��PROFESSIONP��
April 3, 2018
Municipality of Anchorage
Development Services Dept- On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shackleton Sub, Lot 24E —141 West Klatt Rd
Waiver request for separation to existing crib
Dear On -Site Services Engineer:
05VA�101'4
tS�15
1- -13�: 001 (DA 9 0
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
3.9', according to our best estimate of the crib location.
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 most of the trench will not influence the crib at all. 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 3.9' separation to the existing crib.
Sincerely,
Benjamin Schiller, PE
.�.4`OF Al,:9ls�1
k: 49 :*
...........
.
in Schiller .
1 92
IWOt.►
Munic'
i ipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 96519-6-650 0 (907) 343-7904 0 Fax (907) 343-7997
http:/Iwww.m.uni.org/Onsite
Development Services.- Department
On -Site Water and Wastewater Section
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV181014 COSA#:
PID#: 016-141-36
Legal Description: Shackleton Lot 24E
Engineer: Forge Engineering
Applicant: Linda Eastaugh Family Trust
Permit#: OSPI71314
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 3 ).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 a K K 0 M X K M a M X a K X H a K a U a a K 0 K X 0 2 0. a a a K IN K U R 11 0 M a 0 M K 9 N U K U M 2 M X K IN X K 0 K U M a a 9 U a U M a M K a a k, X U M M ,
Waiver is Granted: X Waiver is not Granted:
Date: L4 i
Approved by: ;U, eF
................................................NHme of Reviewer
K X K K U a M 1X 2 X U a a M a K X K a M a M a a a X K a I
s"PAL/r.Ot MUNICIPALITY OF ANCHORAGE
.ti �,,;,,t
On-Site Water& Wastewater Program . 5.;
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax: (907)343-7997
http a/www.mu ni.org/onsite
III 1151111011/'
1)t•l,.,rtnicnI
4hCHORP('E
On-Site Wastewater Disposal System Permit
Permit Number: OSP171314 Effective Date: 10/18/2017
Work Type: Septic Upgrade Expiration Date: 10/18/2018
Tax Code Number: 01614136000
Site Legal Address: SHACKLETON LT 24E G:2630
Site Mailing Address: 141 W KLATT RD, Anchorage
Owner: EASTAUGH LINDA FAMILY TRUST Lot Size in Sq Ft: 19600
Design Engineer: FORGE ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
0 Disposal Field 0 Septic Tank ❑ Holding Tank 0 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
Received By: 1,4,(Rt%U `i ,(,(l,( l- /7-bille_.) Date: /U -
Issued By: ,;,t k c Date: 0 i 02ol 7
-ui\t.ul
P.O. VALLI
Box 196650 e 4700 Elmore Road
Anchorage, Alaska 99519-6650 S (907) 343-7904 0 Fax (907) 343-7997
http:/lwww.muni.orglOnsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW **
Waiver#: OSV171128 COSA#: Permit#: OSP171314
PID#: 016-141-36
Legal Description: Shackleton Lot 24E
Engineer: Forge Engineering
Applicant: Linda Eastaugh Family Trust
Your request for a waiver to allow insitu to act as filter sand below the absorption field, in lieu of
the required 2.0 feet of filter sand for systems where insitu percolates faster than 1 mpi, has been
approved. See submitted sieve analysis.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all code requirements be met or another approval
from this department.
n The affected adjacent property owner(s) have been given a 7 day notice regarding this
wai ver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
• Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver is not Granted:
Date: /9//e1/20/7 Approved by: Pdle,e,CA Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
h689 70
4 24
MUNICIPALITY OF ANCHORAGE
•L.. OCT 1 0 2017
•
Community Development Department A Phone: 9077' !3-790'
Development Services Division �� Fax: 907-34377997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
61b
Parcel I.D. x-141 -36
Property owner(s) Linda Eastaugh Famiily Trust Day phone
Mailing address PO Box 112227, Anchorage, AK 99511
Site address 141 W Klatt Rd
Legal description (Sub'd., Block & Lot) Shackleton Sub Lot 24E
Legal description (Township, Range & Section)
Lot Size 19,600 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) 17
(w/wo ADU)
Septic Tank ❑x Upgrade Duplex (D) n
Holding Tank ❑ Renewal
Multiple Dwellings
Privy it (SF and/or D)
Private Well
Water Storage I I
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Use of in-situ sand for filter Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Sig ature o •perty owner or authorized agent)
Permit/Rush Fees: 51.0% Waiver Fees: a P
Date of Payment: /0/4/7 1'? nn Date of Payment:
�S �bl�/lI
Receipt Number: �vuo��D Receipt Number: DU,
Permit No. 06/0/413/4 Waiver No. QJ V/?"1/22
Permit App__- ._c.
FORGE ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 18, 2017
Municipality of Anchorage
Development Services Dept- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shackleton Sub Lot 24E
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 west, 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 less than 1 min/in. We took a sample to the lab
for analysis, and the attached result shows a composition of 84% sand. We are requesting that
these in-situ soils be accepted as a sand liner, instead of bringing in 2' of filter sand for the rapid
percolation rate. The existing soils will act as more than 2' of filter sand- there are no additional
threats to health and safety by approving this waiver.
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 moderately toward the back,between 5-15%, 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.
OF
Sincerely, � �:• ......t5 �0
w �•."f"
i �'•
491" 'V Ig*
Benjamin Schiller, PE ; . A;ZJ S
�¢
• :
"'''.V 61E3T VEW LOT 15LILLIAN LN FLOW 1LOT 23A�
COMMUNITY WELL>200'FROM PROPERTY LINE WELL>100'FROM PL
�I
SHACKLETON SUB
i LOT 240 LOT 24 E2 W66'%
U+ LOT 24E ON PUBLIC/WATER
6)LOT 24A C?
UNDEVELOPED 1 v
0.0 `° ALTERNATE
SITE
EXISTING
mon SEEPAGE PIT
CO
• C._ (ABANDON)
LOT 248
UNDEVELOPED L__J ?`' . 30' LONG x 3' WIDE, 8'
rk, O.�% EFFECTIVE DEPTH
,\ CO ABSORPTION TRENCH
— I SV
�
PROPOSED 1000—GAL
\
f — , \,_ sv SEPTIC TANK
EXISTING
140.0
SEPTIC TANK
LOT 24C / (DECOMMISSION)
CO
I
ft
100' WELL RADIUS
1
„1,---- -144.0 __-
EXISTING WELL (SHARED W/ LOT 24D)
KLATT ROAD
NOTE.
...0,1061%..\\v„,, NO SURFACE WATER WITHIN 100'OF THE
.r ....•• 44o PROPOSED SEPTIC SYSTEM
Asi(b• �j '•.9 f�
*::' TH '� •.* j4, NO CONFLICTS WITH WELLS OR SEPTIC
••_— SYSTEMS ON ADJACENT LOTS LEGEND
r • Benjamin Schiller MT-MONITORING TUBE
#lk es••.. AEL 12592 .•�krf� 0 40 80
fik,4 pROFES5l0 4 1"-40- NM FEET FCO-FOUNDATION CLEANOUT
TH-TEST HOLE
N\ - CO-CLEANOUT
SHACKLETON SUB LOT 24E
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW 3'WIDE DEEP TRENCH SYSTEM
PERK RATE: 0.5 MIN/IN 1000-GAL SEPTIC TANK
APPLICATION RATE: 1.0 GPD/SF
450 GPD / 1.0 GPD/SF /8.0' DEEP / 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.
s i-1 I I I-I 1 1 1 1 1 1=1 11=
Ii�ll�ll�ll�ll�llk T
ib I S I�I 11=1 11=1 I I-I
Il�ll�ll�ll�ll�llk
---111- --111-=--111E-11 1=111=1
2,_6,.
i-1I-111-111=111=111=1
II�II�II�II�II�Tk
• -111-111-111-111-1 1 1=I
111=11 LTI=1k
1111-111=111=1 I I_,11 I=I
6
%i_• • �_%:% • �:�. � � 4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
-4444 f 4-P4
8'
.-. s -Pye-
a,f.fr.rlr-fa
la, liattz's
c�: fix:
.I 1 I�I�Ipf�f�j,
Y�f�I�•�I�I�f�f�f�I�f�f�1'
f47
INA;f � 114..fir�/.111,
' A 4' TO GROUNDWATER
f .. . . f .=/4.91, 446' TO BEDROCK OR IMPERMEABLE LAYER
3' -1
TYPICAL DEEP TRENCH SECTION 'oFNMAA
(NO SCALE) ;Xt.' .A�!77 ',
NOTES: �* 49T" �*
GRADE AREA OVER TRENCH TO DRAIN AWAY ,,, 33�
MIN 6' SEPARATION FROM BEDROCK / : Ben-. in Schiller
MIN 4' SEPARATION FROM GROUNDWATER ��Fc�'•, AEL12592 •.•'��r,
MIN 100' SEPARATION FROM NEARBY WELLS ,l�;F•�4gOFESSINP���
MIN 100' SEPARATION FROM SURFACE WATER OR STREAMS
MUNICIPALITY OF ANCHORAGE ��\\\\k/k
DEVELOPMENT SERVICES DEPARTMENT P�G.•••
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 4... �� *lr%l
SOILS LOG AND PERCOLATION TEST ,, • , , , ,,,
IF
Benjami Schiller ..:.11/
LEGAL DESCRIPTION: SHACKLETON SUB, LOT 24E r+go,. ,, CE2592 ..��,�,
PERFORMED FOR: FORGE ENGINEERING �11'i,�`�Ess t=
DATE: 9-25-2017 PROJECT No.:
PARCEL ID#: 016-141-36 TECHNICIAN: J. MILLET TE ProfessionalEn_'neersStam.:
DEPTH TEST HOLE 1
(feet) -
1 SLOPE _ SITE PLAN
.-_,Z!.:.,,,-.0.1-1-----
3 #kli
5 0-14,1741,11 SILTY SAND (SM)
x..k
rk6 ,
T.°i.2mli;i:
k
8 — f h
9 . ..
'a'rI•i fI w?� WAS GROUND WATER ENCOUNTERED? No
I V 4' 4::ra;
glt y�_-1''1 IF YES(d WHAT DEPTH? -
rk..N6j�J;g.� DEPTH OF WATER AFTER MONITORING: NONE
leo: DATE OF MONITORING: 10/?/17
��-" 'yl.v sig
12—= a :,
+ �; DEPTH TO
13� ";{*}'` "` DAZE READING GROSS TIME NET TIME WATER NET DROP
�, `� (MINUTES) (MINUTES) (INCHES (INCHES)
1"5:14V 9/25 TEST HOLE PRESOAKED PRIOR TO TESTING:
3.
15 +44� tf-' I 4:32 0
's•—140 2 4:35 2:28 6 6
16 ,4144,;:a-A,' '
' 't';- BOH
17Yfte.. .._ .
9 4:48 0
18— 10 4:51 3:03 6 6
19 II 4:52 0
20 12 4:55 3:04 6 6
PERCOLATION RATE:0.51 (MIN/INCH) PERC.HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: PERK TEST WAS RUN 6 TIMES. INTERMEDIATE RESULTS ARE NOT SHOWN BUT WERE VERY SIMILAR.
NORTHERN GEOTECHNICAL ENGINEERING, INC./ TERRA FIRMA TESTING
LI
• Laboratory Testing Geotechnical Engineering Instrumentation Construction Monitoring Services Thermal Analysis
PROJECT CLIENT: Forge Engineering %GRAVEL 0.0 USCS SM
PROJECT NAME: 141 W.Klatt %SAND 84.6 USACOE PC N/A
PROJECT NO.: 4841-17 %SILT/CLAY 15.4 %PASS.0.02 mm N/A
SAMPLE LOC.: %MOIST.CONTENT 9.6 %PASS.0.002 mm N/A
NUMBER/DEPTH: 17-S-2 UNIFORMITY COEFFICIENT(Cu) UNKNOWN
DESCRIPTION: Silty sand COEFFICIENT OF GRADATION(Ce) UNKNOWN
DATE RECEIVED: 9/26/2017 ASTM D1557(uncorrected) N/A
TESTED BY: CH ASTM D4718(corrected) N/A
REVIEWED BY: RJPC OPTIMUM MOIST.CONTENT.(corrected) N/A
PARTICLE SIZE ANALYSIS ASTM D422/C136
uS.SIEVE MEMOmRICHES , Hs.SIEVE NUMOERS I HYDROMETER SIEVE ANALYSIS RESULT
100 6 3 is w Inns : r. I tyo IA eryo RIR
♦ SIEVE SIEVE TOTAL% SPECIFICATION
90 - • SIZE(mm) SIZE GIS) PASSING (%PASSING)
• -
80 - 152.40 6"
70 . 76.20 3"
38.10 1.5"
rn 60 - 19.00 3/4"
50 - - ♦ 12.70 1/2"
9.50 3/8"
a --.-_. - 2.00 #10 100
30 0.85 #20 100
20 0.43 #40 98
— • • - ♦ 0.25 #60 86
10 0.15 #100 S1
0 J – 0.075 #200 15.4
100 10 1 0.1 0.01 0.001
GRAIN SIZE(mm) HYDROMETER RESULT
ELAPSED DIAMETER TOTAL%
1COBBLES GRAVEL SAND I SILT or CLAY TIME(MIN) (mm) PASSING
Coarse Fine Cease Medium Fine 0
0.5
1
MOISTURE-DENSITY RELATIONSHIP ASTM D1557 2
4
145 _ 8
— -- 15
140 _ 30 _-60
'135 250
- 1440
Z 130 ,
HYDRAULIC COND. N/A
a
_
125 _ _ {ASTM D2434)
A DEGRADATION N/A
120 (ATM T-313)
— = PLASTICITY INDEX N/A
115 - ASTM 4318
0 2 4 6 8 10 12 14 16
MOISTURE CONTENT(%)
The testing services reported herein have been performed to recognized industry standards,unless otherwise noted, No other warranty is made, Should engineering
interpretation or opinion be required,NGE-TFT will provide upon written request.
11301 Olive Lane • Anchorage,Alaska 99515 • Phone:907-344-5934 • Fax:907-344-5993 . Invwnge-tfi,com
GARB -HD -2 GREATEL ANCHORAGE AREA - OROUGH Case No.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
f; meq/-2iS
NAME OF APPLICANT � L ��� MAILING ADD RESSAk % 642 f `PHONE NO.
RESIDENCE ADDRESS f /P, 10V if LOCATION OF INSTALLATION
LEGAL DESCRIPTION �' �T IZZZ 0f Z4?r S�ZAX-11Z'ZY'N "Yel-bra°
APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PITy DRAIN FIIEELD , OTHER
TO SERVE THE FOLLOWING FACILITY dC��7� %%� �D�C'• ��lS; �)LZ�%�i� " ii/,�/rT�
.T t'172�c+e�srs
FINANCED THROUGH G <k TO BE INSTALLED BYFMNUVP*W/�r� �
C4-
diel/L J ����� P[' !
TEST RESULTS l ��'-- Zr��bc ANTICIPATED DATE OF COMPLETION/
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS�� • ' �� PERMIT TO INSTALL A ���7'�i �y '7
AS DESCRIBED BELOW, eP SIZE OF UNIT TO BE SERVED �914
_.SEPTIC TANK SIZ7157--
E � -PT TYPE c�?��Z SEEPAGE AREA L TYPE
DIAGRAM OF SYSTEM
`3 sc®�E� ���S
ry )CD
DISTANCES
/P'>
HEALTH AUTHORITY
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■
WKNr■■■■■■■■■■■.
■■■■`1■■■■■■■■■■■■■■■■■
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anc rage Area Borough Ordnance 1% zo-08 ana t at thu
above described system is in accordance with said code. �� � L z jn 0. �,tZ7
DATE APPLICANTS SIGNATURE4x
GREATER ANCHORAGE AREA BOROUGH` -'1
HEALTH DEPARTMENT CASE
F 327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Performed PorDate Performed�i - 7 n
Lo
Legal Description: t lock Subdivision
This For.. Reports a: Soi— ]'mss Log gi—Percolation Test
Depth
Feet Soil Characteristics
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Was Ground Water Encountered? AM °d�
If Yes, At What Dept:
Location Sketch
Reading
Date
Gross Time
Net Time Depth To H2O Net Drop
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711- nu a
Proposed Installatio �6Seepage Pit L� Drain Field_
Depth Of Inlet �'si' Depth To Bottom Of Pit Or '?Tench
COMMENTS:
Test Performed Bs;
Data Certified By:
Dater q%OS
C31 8 9 10 ,E •
•- Municipality of Ancho , ; rvt 4'4.4.4'4.4.iv% ic
On-Site Water and Wastewater Pr.g_r•m t, �.0 I i
(907) 343-7904 a JUL j 6 2.Tw v SAFETY
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Certificate of On-Site Systems e •val c;\�z01 66L1;
Parcel I.D. 016-141-36 Expiration Date: 1 J — -1
1. GENERAL INFORMATION
Complete legal description Shackleton, Lot 24E
Location (site address) 141 W Klatt Road Anchorage, AK
Current Property owner(s) Linda Eastaugh Family Trust Day phone
Mailing address PO Box 112227 Anchorage AK 99511
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 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 E Individual LI
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: .&/ I Pt9 Date: 0/l 6
COSA to be released to the engineer,unless otherwise requested by the engineer. •
COSA Fee $ -(O Waiver Fee $
Date of Payment 1 t L(ol/A Date of Payment
Receipt Number t,SO�J6b Receipt Number
COSA# Q5C.-17 133 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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6. DSD SIGNATURE
System #1 Approved for bedrooms �. Michael E.Anderson :•
System #2 Approved for bedrooms �` •.• 4381-E (c-Ave
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AEI
Disapproved `k 'PROFESSk*-�
Conditional approval for bedrooms, with the following stipulations:
;..g ON-SI1 E 4c.
W
WATER
ASTEWATER
GRAM
7-3
:y: Original Certificate Date: L� r (,es?
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...5 • 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 24E Parcel ID: 016-141-36
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 12/04/18
Static water level ft. 35.3 ft.
Well production g.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 11/13/17
Tank size 1 ,000 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 •0 System type Deep Trench
Length 30 ft. Width 3.0 ft. Gravel below pipe 8.0 ft.
Total depth 11 .3 ft. Eff. absorption area 480 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New 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:
Building foundation Property line Absorption field
10' '
Water main Water service line Surface water
Wells on adjacent lots 100'
ABSORPTION FIELD ON LOT TO:
Property line >10Building foundation Water main
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 4,,,tt�\\\
_
OF 44.41‘k,
I certify that I have determined through field inspections and Q ....
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. O*'49 i )\ id,
Engineer's Printed Name Benjamin Schiller, P.E. / � .ti' • : • ' ' ' 6
Date 8/2/18 �� • . •Benjarni,p chiller . j
# .7<*s • CE 12592 .• •`�
fh A.,,...• 8/2/18 ..\,.;(�.i
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1 i`��POFESS14NP -�
COSA brown sheet 10-10-12.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT l • Ff 907-343-7904
On-Site Water and Wastewater Sections i` % Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # osc181338
Subdivision: Shackleton, Lot: 24E
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.O. 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
ARCTIC PUMP&WELL INC.
Jim Sullivan • _ -
PO Box 770197
Eagle River,AK 99577
smuts (907)688-2510 •
(907)243-2282
iim(Iarcticpump.com
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description: Shackleton Property Owner Name& Address:
Lot: 24 D Shannon Campbell
Block: 330 n Grant
AAncrnw ITl R1Rd2
Pump Installation Date: 8-1-18
Pump Intake Depth below Top of Well Casing: 45.6
Pump Manufacturer's Name: Myers
Pump Model:2nfl52-12-p4-01
Pump Size:1/2
Pitless Adapter Burial Depth:10.1
Pitless Adapter Manufacturer's Name: S-50
Pitless Adapter Installer: U/K
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments: well 51' no perforations
35.6 Static
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump& Well, Inc.
Page 1 of I
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NOTE:
NO EASEMENTS APPEAR ON
QpO�O, THIS LOT ON THE RECORD PLAT
g�:qg TH '-900 AS-BUILT SURVEY 1" = 30'
6 v . S ./6 •o
NO CORNERS SET THIS DATE
COQ76' SHANE A.HOLT• OHO
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LS-6914 . p`O HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY \\
�44TY
00rofessional�o� OLOT T24 EHE OLSHACKLETLOWING DONCSUB.
ED(PPLAT R71-27)
040000��
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. DATED AT ANCHORAGE,ALASKA THIS _2 ND DAY OF
EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN _AUGUST , 2616.
HEREON(UNLESS INDICATED)
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 GROVER DRIVE
ANCHORAGE,AK 99507
13717, FB 184-47,189-49 345-5513