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HomeMy WebLinkAboutSIEFKER #2 BLK B5 LT 1Onsite File u Municipality of Anchorage On-Site Water and Wastewater Program • (907)343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181242 PID Number: 015-272-59 Dwelling: I0 Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: E New ❑ Upgrade Name: ABSORPTION FIELD Hultquist Homes, Inc. Address ❑ Deep Trench 0 Shallow Trench ❑ Bed ❑ Mound 12580 Old Seward Hwy. Anchorage, AK 99515 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 522-3204 4 0.8 GPD/SF 9.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 5.0 Ft._4.0 Ft. Siefker#2 5 1 Fill added above original grade Gravel length Township Range Section 1.0-1.9 Ft..2 @ 38 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 760 Ft2 2 Ft. Well >100' >100' N/A N/A >25' TANK 9 Septic 9 S.T.E.P. 9 Holding ❑Other Manufacturer Capacity Surface Water >100' >100' N/A N/A Anchorage Tank 1250 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 No insulation was required in the installation of this septic system. in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Hultquist Homes, Inc. Drainfield D3034 CO/MT D3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 1s. 8/24/18 2" 8/27/18 Location and description 3•d 4th Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp =` 9 4.i Conditional Approval: Date ��..• •" , j*'49TH i '• .*#• l r Benja chiller ' �� ,'... CE 12592 .•0?? 1 ' 1/30/19 •.'&� Approve te ' Date ° - ^�a 1i? l F�PROFESSION`' 1 Axx 4 Inspection Report_9-1-12.doc SIEFKER #2 BLOCK B5 LOT 1 PERMIT # OSP181242 PID/# 015-272-59 I B-3 I LOT.4 2 ALTERNATE SITE: CATEGORY 7 III TREATMENT SYSTEM WITH i ,.'.. 12'LONG x 5'WIDE x 4'EFF •' • - •, P2 NEW-1,250 GALLON DEPTH TRENCH.APP RATE 5 .-SEPTIC TANK Z GPDISF. ' /" &�Iz sv1 �� " TH 7•, MT CO3 '�• _. et • / 0 FCO 0 1120 LOT 4 Fs: 01 •.004 114 . Ti 2-38'LONG x 5'WIDE x 4'EFF C0z f• (4) � 0``j`� LOT 2 DEPTH ABSORPTION TRENCHES �Q� \ f 0. P 1 \ s � \ \ 1 I , \ 20'T&E EASEMENT (r! f j \ A B C 1�TJ .- i _- T \ „..- FCO 18.8 11.2 1 _. ti \ __— SV1 44.9 39.7 1 I LOT SV2 38.6 46.0 1 \ I LOT 1 1 2C0 31.3 54.6 CO1 22.6 55.7 11�L\ \ \ \ l EXISTING WELL MT1 18.8 58.7 CO2 28.0 45.5 h \ \ \ ` • - NOTE: MT2 26.3 87.2 \ \ " \.,.. / 1 NO CONFLICTS WITH SEPTIC SYSTEM ON CO3 36.4 61.0 \ \ N \ \ \ THIS LOT. RECORDS INDICATE�A SEPTIC MT3 36.6 65.5 \ \ \ \ SYSTEM MAY BE IN PLACE,BUST MORE C04 38.2 93.6 1 " \ ti \ ' , THAN 176'FROM THE EXISTING WELL. MT4 34.6 89.3 ) \ \\. `\ --- / 10'UTILITY EASEMENT I i \ .---. \ I t I . I 1 E ' AST KLLATT ROAD 11111#ifiwGE NCIN[ERING +~`�..xv LEGEND ��P ,:.4l�' CO-CLEANOUT /g, 9 2C0-DOUBLE CLEANOUT 0* 49 TH ••*/� FCO-FOUNDATION CLEANOUT < � FS-FLOW SPLITTER VALVE Benja in Schiller / 0 50 100 MT-MONITORING TUBE rj*.•• CE 1 592 • �7 FEET SV-SEPTIC VENT 0 r'••, r TH-TEST HOLE Iklt4;ROFESSIONO'r 1"=50' CONTOUR INTERVAL-2' SIEFKER #2 BLOCK 5 LOT 1 PERMIT # OSP181242 PID # 015-272-59 r N 0 O [n (n N — — / 98.1 — — - P - /- 93.5 71 92.9 1250 GAL 92.7 SEPTIC TANK 88.7 J TRENCH # 1 O2 98.9 FINISH GRADE HO U2 f 20 97.0 ORIGINAL GRADE �U 92.0 1 ,DRAINFfELb R©CK 9Z.0 � �— 88.0 88.0 � — 38' TRENCH # 2 O1- 98.0 FINISH GRADE HO U2 97.0 ORIGINAL GRADE �U 92.0 DRRINFIELD RdCK' d . . 9Z.0 ! ".:-:— 88.038' 88.0 if J 79.5 7�� NO GROUNDWATER 7/20/18 ��141•1" ~ 6,k? X4 . 0�1 6 Benja In Schiller / GE PROFILE AS—BUILT fol.'. CE 12592 ��' (NO SCALE) ll ``D�i40FESS100� www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address Siefker #2 Block 5 Lot 1 Nathan & Kimberly Gilmore Pump Installation Date: 12-7-18 Pump Intake Depth Below Top of Well Casing: 230 feet Pump manufacturer’s Name: F&W Pump Model: 4F07P07301S Pump Size: 3/4 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: White Raven Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. I Lot 4 B-3 Found Monument N89'58'31"E 165.14' Found Rebar — e "C.' © 0 E, w • Lot 1 • I 49,010 sf Lot 4 Se :3 �� • Lot 2 l IMP' 5 41 e 62. `L� A Ao°g Q 26.1 — cp ti .� Water $ • 3% d l 1.0ID .E`L.1•. co co c0 ,'') Power Pole rn ( N N 3 uJ in Power Pole o M iV 20' Elec. & Tel. Easement 41I O 0 — 0 Z Z2, Well !n G Existing Shed O 20 I � o' r o w I I isa x: I L - — -- 10' Utiity Easement ® __ Found Rebar 589'57'45"W 165.09' Found Rebar �QOF A°pop M East Klatt Road prc...,..., 49IU " .79 jv 07..., Andre Kae¢%,pVele` l• �e. LS-100298 ...•`o 0^ma,••'•i(. ..'t- it.. e4o 4 A f.... oc ' p���00000�a Gilmore Custom Plan Ordered by. H: As Homes Inc. Legend: Set Rebor with Cap Legal Description: AS Built AL. Monument S4 Found Rebar 0 Lot 1 Block 5 Monument > > Well G ro u p Siefker Subdivision No. 2 Pipe Survey Certificotion: I hereby certify that a Mortgagee's Pavement •.-:..::b;F::.:, Land Surveying Inspection was performed on the described property. Overhang (nE.PQi Land Development Consultants Notes: It is the owner's responsibility to determine the Subdivision Specialists existence of any easements, covenants, or restriction which Wood Deck A are not on the recorded subdivision plat. Construction Surveying Concrete ''1,0M, It is the contractors responsibility to check top of foundation Tom H Dreyer,P.L.S. grade & building setbacks in relation to property lines and 124 E 7th Avenue easements Anchorage,Alaska 99501 Checked by. CB Drawn by. AK Scale 1" — 40' Grid SW2635 (907)306-8104 mail@S4AK.com Job 2018-38 Field Book: 144-54 Plat 82-459 Date: 11/13/2018 H,'"""' MUNICIPALITY OF ANCHORAGE / On-Site Water&Wastewater Program ��' }- 'S.. i 0 \ PO Box 196650 4700 Elmore Road '; Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 w) httpa/www.muni.org/onsite Ir civil' I)(•partillynt 4 N C;;;;;:0' On-Site Wastewater Disposal System Permit Permit Number: OSP181242 Effective Date: 8/7/2018 Work Type: Septic Initial Expiration Date: 8/7/2019 Tax Code Number: 01527259000 Site Legal Address: SIEFKER#2 BLK B5 LT 1 G:2635 Site Mailing Address: 4021 E KLATT RD, Anchorage Owner: GILMORE NATHAN & KIMBERLY Lot Size in Sq Ft: 49008 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: Q Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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 CSpecial Provisions: Existing well on this lot is undocumented. To close out this permit, inspection of well shall b completed to verify it is in compliance with code. Received By: I .,a i /In #O/ Date: • i Issued By: rP.CC9k • • Date: Sli I R MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-272-59 Property owner(s) Hultquist Homes, Inc. Day phone 522-3204 Mailing address 12580 Old Seward Highway Anchorage, AK 99515 Site address 4021 E. Klatt Road Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Siefker#2, Block B5, Lot 1 Legal description (Township, Range & Section) Lot Size 49,008 Sq. Ft. Number of Bedrooms Four APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial X Single Family (SF) X (w/wo ADU) Septic Tank [xj Upgrade [ 1Duplex (D) I I Holding Tank U Renewal [ [ Multiple Dwellings Privy ❑ (SF and/or D) Private Well [X[ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 714t-if E (Signature of property owner or authorized agent) Permit/Rush Fees: T S cro Waiver Fees: Date of Payment: S' 1 ;1 1 8 Date of Payment: Receipt Number: 0"n3-1 \ Receipt Number: Permit No. OSQ 'Vz6 1a a Waiver No. Permit App_ c • Iv) GE E N G I N E E PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) August 7, 2018 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage,AK 99507 Subject: Sietker#2,Block B5, Lot 1 —4021 E. Klatt Road Septic System Design and Permit Application Dear On-Site Services Engineer: The developer of the above lot intends to construct a 4-bedroom home on the property. We are submitting this design and permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home as well as the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any wells, whether on this lot or adjacent lots. Drainage arrows and ground contours 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 sandy gravel. No groundwater or bedrock in the test hole to a depth of 17.5'. The percolation rate was determined to be between 2.3 and 10.9 minutes per inch. An application rate of.8 gpd/sf was used in the design of the absorption system. We are proposing to place a new 1,250-gallon septic tank with 2 absorption trenches each 5' wide x 38' long x 4' effective depth. 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 to the northwest. The new trenches will be constructed parallel to the slope as much as possible. The septic system will be located a minimum of 100' from all wells and surface water. The septic tank will be more than 10' from the house foundation. 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 on any lots located in the area. • On drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments •�6,\S‘ .OF..144S.44 ♦ Ir 49th � * ••• r % MICHAEL E. ANDERSON I W ♦ 7 .• , ,. #�f•. NO. CE-4381 ••+ �� SIEFKER #2 BLOCK B5 LOT 1 1 EXISTING ABSORPTION PIT. PUMP,CRUSH AND BACKFILL. B-3 I LOT 4 _ — EXACT SIZE AND LIMITS ARE '�,- - - J UNKNOWN. I fes,/ \ \ / - • `-1132-, / r /1 mf '•� ^ ` J / EXISTING SEPTIC TANK. 2-38'LONG x 5'WIDE x 4'EFF. /'c; • / .1111 ` / DECOMMISSION IN ACCORDANCE DEPTH ABSORPTION TRENCHES/ 1 F o Y r / '—WITH MOA CODE. / TH111 y �'�'./ / -1420-- / I LOT 4 / MT'' .0, //.• • r 1 I ALTERNATE SITE: CATEGORY r. �' FCO I` N —P�O�'O�ED WATER LINE III TREATMENT SYSTEM WITH (... / 1 \ \ LOT 22 12'LONG x 5'WIDE x 4'EFF. 4-BRM HOME , I / I I DEPTH ABS.TRENCH. APP. I / / ,. i __ -- r , RATE 5 GPD/SF.4LON \ ' • I - / \ ( J / J 1,250 C / 2 /) / • r/ \ _ / \ SEPTIC I ` ` . I \ 1\ \1 `I 1 I \\, ,�I .l'..• • . E)gISTING WATER LI E�1ND VALVE 20'TBE EASEMENT I Ir / f I ... / / l :_ .. I \ NOTE: I 1 17--/ _ I NO CONFLICTS WITH WELL OR SEPTIC 1 J/' 1 SYSTEM ON THIS LOT. I I 1 ll � l - � - I 1 ` I LOT1 .•. I I III 1 `\ \ I /-\ ,� EXISTING WELL I I `\ \ ��\ 1 1 / I st \ \ \ \, I \J ..,. hOTE: // I1 \ \ \ N \_ / 1 0 CONFLICTS WITH SEPTIC SYSTEM ON \ \\ \ \ /THIS LOT. RECORDS INDICATE/A SEPTIC \ \ \ �" y SYSTEM MAY BE IN PLACE,BUT MORE \ `, \ 'THAN 176'FROM THE EXISTING WELL. \ �\ \ I / \ \ � A I / 10'UTILITY EASEMENT I ) \, \ .1 / V/ \ \ \ 1 1 / � • _ i_ � .•L / _ f � t— I r - ,- / J EAST KL�ATT"ROAD // ill I eaGE NGINE E41N4 NOTE: �•�—�x\x\, NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND �` OF N•ei k PROPOSED SEPTIC SYSTEM �kQ.•.• . S �iCO-CLEANOUT • �.� '•.9 I 2C0-DOUBLE CLEANOUT Al*:49 1H i\ .*I4 ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS FCO FOUNDATION CLEANOUT • PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. FS-FLOW SPLITTER VALVE �� •' Anderson•:.•/ MT-MONITORING TUBE #j��F;•.• 4831-E •.���� 0 — 50 _ OFEET SV-SEPTIC VENT sFy'$`y�•����r TH-TEST HOLE lkA\�"`\O' 1"=50' CONTOUR INTERVAL-2' SIEFKER SUBDIVISION #2, BLOCK B5, LOT 1 DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW 5' WIDE DEEP TRENCH SYSTEM PERK RATE: 2.3 - 10.9 MIN/IN 1,250-GAL SEPTIC TANK APPLICATION RATE: .8 GPD/SF 600 GPD / .8 GPD/SF/5' WIDE * .5 RED. FACTOR = 75 LF TRENCH REQUIRED (76 LF SPECIFIED) BOTTOM OF TRENCH: 9' BELOW GRADE FLOW LINE ELEVATION: 5' BELOW GRADE TOP OF TRENCH. .5' ABOVE GRADE 6" — —III—III—III—III—III— 1l i=1 I I—I 11=1 I I—I 11—I I I 1=1 11=1 11=1 11=111=111=1 III—I 11=1 11=1 I I—I 11—I I I 111111111111111111111II I II I II I III1 4'6" I=1 I I=1 1=1 11=1 11=1 11=1 III=III—III=1�I—I�1=1�I 1=III=III=III—I�I—I�I—I III—III—III—I�I—I�I—I�I I=1 I 1=111=111-111—III-1 6 �'='=•'=•=='=•=== '=•'=•'=•' 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5 illOff1 GE TYPICAL WIDE TRENCH SECTION ~oF```�y (NO SCALE) rkiP• 77 / NOTES: %*:4 lTM 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' '. Michael E.Anderson:a j WITH 2" OF INSULATION 4831-E 4831-E ms • b �i �v�r 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER l `pF�PROF>-/7.44e>•' THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY `\Vkvel,"-- MUNICIPALITY OF ANCHORAGE —.D+ A4•4•�)]`� DEVELOPMENT SERVICES DEPARTMENT ,ACkt• 4, '•9 6 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 ,*:4. LTM•.•�A��,�f�* l SOILS LOG AND PERCOLATION TEST // : Michael E.Anderson.:Q I,PF/, 4831-E ���/ #,tl Fx-E�O sir LEGAL DESCRIPTION: SIEFKER #2 B5 LI PERFORMED FOR: HULTQUIST HOMES \�k����+~ Stamp:7/13/18 PROJECT No.: Professional Engineers S PARCEL ID#: 015-272-59 TECHNICIAN: N SHAFER DEPTH TEST HOLE 1 (feet) 0.5'OB SLOPE SITE PLAN 1 '; 2 ",j-c� 3 SAND 'S: '�• 4 :'-; 5 ..,:-.;;;:::::::;.:.:2.,,,,•-..; SEE SITE PLAN 7 1:,.!.‘"1::;::':->*;:-..' SANDY SILTY GRAVEL !;;;;.'..�. SM/GM 8 —" 9 ;!.Vt: •1+..:;....g :'•, •�r• WAS GROUND WATER ENCOUNTERED? NO 10 .: :::r:.::. - S ^: 4"••%•:• IF YES @ WHAT DEPTH? 11 �::•�`.�• •', DEPTH OF WATER AFTER MONITORING: NONE ,,,.• •s^:' DATE OF MONITORING: 7/30/18 12 `.x' GROSS TIME NET TIMf DEPTH TO NET DROP ':i '� '.`: " DATE READING WATER 13 ;:',�;;...y. (MINUTES) (MINUTES (INCHES) ::".•:;f:::/:::"; " }'._':' (INCHES) 14 :::.‘,7;f.: ::::4-f•' 7/13 TEST HOLE PRESOAKED PRIOR TO TESTING: ';15 -7:!•:' ; 1 12:10/12:20 10 4"/9 s" 5a" :1.:; 2 12:23/12:33 10 4"/81-g" 4i-i" - :' 3 12:34/12:44 10 4"/8136" 41s" 17 > " : 4 12:45/12:55 10 4"/8 e" 44" 18 BOH 5 12:57/13:07 10 4"/8i" 416" 19 - 6 13:11/13:21 10 4"/84" 41s" 20 PERCOLATION RATE: 2.3 (MIN/INCH) PERC.HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 5.5 FT. and 6.5 FT. COMMENTS: MUNICIPALITY OF ANCHORAGE of Aq,k �. �• t4 i1 DEVELOPMENT SERVICES DEPARTMENT Ai*: qv �I� '.I A 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 *•49 ')\ �'* r gi4:1:-.1_. a.4-1 SOILS LOG AND PERCOLATION TEST rA '. Michael E.Anderson•: �T$ 1%lF'�.4. 7—/1j•; O LEGAL DESCRIPTION: S I E F K E R #2 B5 L 1 l� PROFESSION PERFORMED FOR: HULTQUIST HOMES `\�X\x,0�~ DATE: 7/13/18 PROJECT No.: Professional Engineers Stamp: PARCEL ID#: 015-272-59 TECHNICIAN: N SHAFER DEPTH PERK TEST 2 (feet) 1 SLOPE SITE PLAN 2 3 4 5 SEE SITE PLAN 6 7 8 9 10 WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH' - 1 I DEPTH OF WATER AFTER MONITORING: NONE L DATE OF MONITORING: 7/20/18 IAC$ 12 GROSS TIME NET TIME DEPTH TO NET DROP 13 DATE READING (MINUTES) (MINUTES) WATER (INCHES) (INCHES) 14 7/13 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 1 11:45 10 4" 16 2 12:15 10 616" 216' 3 12:17 10 4" 17 4 12:47 10 6-6" 2 6" 18 5 12:48 10 4" 19 6 13:18 10 616" 216" 20 PERCOLATION RATE:10.9 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 5.0 FT. and 6.0 FT. COMMENTS: PERCOLATION TEST ONLY. Lot 4 B-3 N89'58'31"E 165.14' — t I E Lot 1 I vl w° I T Lot 4 ;o X:se -4'. Lot 2 o 'o. �� 42.4 Z1QtoQ°Set- 61:6 � �2p 46.0 -- •o. •s. p0 Oc4 I) Wt "v 0 mac'2Z0 o 0o 1'5• in CO co cc; rn rn Cl CV }3W rif1 — — y - (O PO 0 N 20' Elec. & Tel. Easement N_ 0 0 Z (I) 170.0 150.0 0 -o v 0 o_ v v N 0 5- ID' Utility Easement , t 1 589'57'45"W 165.09' 0N..1 in rM M ,0000§1 „\c„... ....qC/„,„ — East Klatt Road 7*: 49-H ...-70 �v m Thomas H. Dreyer: LS-7625 ao,O Ottic,t1 .'••......... ••'ac2tis Drainage osi �'o Z2ssiond Lo� Proposed Finish Grade I PFO 100.0' OOOO�o Gilmore Custom Plon Elevation 1100.0'1 Ordered by.S4Hultquist Homes Inc. Legend: Legal Description: Plot Plan Set Rebor with Cap O AL. Monument Found Rebor O Lot 1, Block 5, Monument 41- Well Group Siefker Subdivision No. 2 Septic ID Survey Certification: I hereby certify that a Mortgagee's Pavement f:^: Land Surveying Inspection was performed on the described property. Overhang Land Development Consultants Notes: It Is the owner's responsibility to determine the Subdivision Specialists existence of any easements, covenants, or restriction which Wood Deck r A Construction Surveying are not on the recorded subdivision plot. y g It is the contractor's responsibility to check top of foundation Concrete Torn H Dreyer,P.L.S. grade & building setbacks In relation to property lines and 124 E 7th Avenue easements Anchorage,Alaska 99501 Checked by: 1110 Drawn by. CB Scale 1- = 40' Grid SW2635 (207)106.8104 mail@S4AK.com Job 2018-38 Field Book: XXX Plat 82-459 Dote: 7/17/2018 EPspj MUNICIPALITY OF ANCHORAGE TP()%c �} Development Services Department i-) Phone: 907-343-7904 On-Site Water & Wastewater Section - ' Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 015-272-59 Expiration Date: ,�� — 1 ? 1. GENERAL INFORMATION Complete legal description Siefker #2 Block 5 Lot 1 Location (site address) 4021 E Klatt Rd. Current property owner(s) Hultquist Homes, Inc. Day phone 522-3204 Mailing address 12580 Old Seward Hwy. Anchorage, AK 99515 Real estate agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) n Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well [ Private Septic Water Storage ❑ Holding Tank Community Well [ Community ❑ Public Water System _ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer COSA Fee $ 1aO Waiver Fee $ Date of Payment 11.315 1144 Date of Payment Receipt Number ag(15b Receipt Number COSA# 65c01021.0 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 907-522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 1/29/19 ... of Acq�i�� F, .1 •••• ,�*4®TM i •*�l 6. DSD SIGNATURE % • •. •• .\( System #1 Approved for bedrooms �/ Benja• filler .' System #2 Approved for bedrooms f;�,sr CE/2592•`e �/ Disapproved IlUtCD OFESSO Conditional approval for bedrooms, with the following stipulations: t y�v Original Certificate Date: Z' G-I! 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 Checklist blue sheet 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: Siefker #2 Block 5 Lot 1 Parcel ID:015-272-59 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) N* Date completed Unknown Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 241 ft. Cased to 241 ft. Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test Unknown 8/28/18 Static water level N/A ft. 172.3 ft. Well production N/A g.p.m. 1 0+ g.p.m. WATER SAMPLE RESULTS: Coliform Neg*colonies/100 mL Nitrate 2.72 mg/L Arsenic ND ug/L Date of sample: 1/29/19 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic / Steel Date installed 8/27/18 Tank size 1250 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 8/24/1 8 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type 5 - Wide Length 2 @ 38 ft. Width 5.0 ft. Gravel below pipe 4.0 ft. Total depth 10-10.9 ft. Eff. absorption area 760 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 100' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: >10'Building foundation Property line >5 Absorption field >j Water main >10 Water service line >10 Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10 Water main >10 Water Service line >10 Surface water >100 Driveway, parking/vehicle storage Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS *Well data obtained from recent inspection by Sullivan Water Wells **Water was retested after chlorination treatment G. ENGINEER'S CERTIFICATION �1���\�I OF A�q llt 1 certify that I have determined through field inspections and A�Q • ,49• k+ review of Municipal records that the above systems are in p> - `4� •-9 +I conformance with MOA COSA guidelines in effect on this date. % *:•49TH i\ •.* // Engineer's Printed Name Benjamin Schiller, PE VP' ' " �i"' ••• 2/5/19 . ..� .. .al . . ...... Date Benja•7 chiller : fri # fie• •.• C25;1129592 •.`4 Sl •.•• ^, `%PROFESSION 4... COSA brown sheet 10-10-12.doc 5. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGELll� PALITY 0P ANCHORAGE I IDEpt. C ; ; , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI _.,1;, QM„Op,;; ., �C4 � �'- N,�1,•aL I �.,_�.�;;C11O N. • 825 L Street - Anchorage, Alaska 99501 - 825 L Street - Anchorage, Alaska 99501 SINGLE FAMILY ❑ One Ea'� Four ❑ Other ENVIRONMENTAL ENGINEERING DIVISION 1` -'AY 1 7 '11 -If -Al Telephone 264-4720 - REQUEST FOR YU 7. WATER SUP LY APPROVAL OF INDIVIDUAL WATER AND SEWER- - DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, 1. PROP YOWNER I 5 '� / - «/ S C� �7 ' S t,u ` ❑ PUBLICUTILITY PHONE f/'�1 MAI LING ADDRESS 5A ��// Lx -t INDIVIDUAL/ON-SITE** **If PROPERTY RESIDENT (If different from above) ❑ PUBLIC UTILITY PHONE.. 2. BUYER - - PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS it 4. REALTOR/AGENT - - - - - PHONE- - - MAILING ADDRESS - - 5. LEGAL DESCRIPTION STREET LO.CA_TION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One Ea'� Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUP LY T L;- INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled pr/o that datel' well ❑ PUBLICUTILITY depth (attach log if available.) / l S. SEWAGE DISPOSAL SYSTEM ��// Lx -t INDIVIDUAL/ON-SITE** **If individual/on-site, give installation dat ❑ PUBLIC UTILITY If system is over two (2) years old an adeq acy/�ired by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 4 a 1 l THIS SIDE FOR OFFICIAL USE ONLY e DAl'E RECEIVED - INSPECTION APPOINTMENTS TIME _ TIME TIME - DATE t� I — INSPECTOR J — -- — --- \ —� W DIRECTIONS: V o ` O ^� ^OLO O�Y� �, cN 1,CN 1. TYPE OF Z svQQ�p +-'�-- bA r o p_ m=air t `� Qn 0.0❑ co SING .E Uj 1— C7 c 2 ~ I Ell MUL a c W E a w a Eooxr w o- 2. WATER SI 4 z rop � a ❑ IND! N o c m ❑ CON r El" o PUB" UTY N CM Connects, a 3. SEWAGE DISPOSAL SYSTEM Ell INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified _ INSTALLER ❑Septic Tank or ❑Holding Tank Size: lc)� If Tank is homemade SOILS RATING T give dimensions: TYPE OFTANK MANUFACTURES TOTAL ABSORPTION AREA MATERIAL - 4. DISTANCES Tank - Absorption Area - Sewer Line Nearest Lot Line - :]Septic/Holding WELL T0: Absorption Area to nearest Lot Line - 5. COMMENTS �- APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) - LEGAL DESCRIPTION - - 72-UlU (Rev. 3/78)