HomeMy WebLinkAboutTHE TABLELANDS BLK 4 LT 18The Tablelands
I10"5
y
#051-741-49
Municipality of Anchorage Page 1 of 3
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw, Street
P.O. Box 196850 Anchorage, AK 995196650
www.d.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW040245 PID Number. 051.741.49
N""inell Homes
S
Wastewater System: New
Address:
1900 W. Northern Li hts Ste. 200 Anch., AK 99517
ABSORPTION FIELD
P 4-5676 N Three 3a'"
5' Wide Trench
LEGAL DESCRIPTION
Sou Ralim
Total Depth from erignal pad.:
.45 GPD/Fe
6 Ft.
Blade Lot Subdviaun:
Depth m pipe botlan Rom ari arel Wade:
Drawl depth beneath pipe:
4 18 Tablelands
2 Ft.
4 Ft.
ToeneNp: Reye: Secti":
Ful tltled alme e urigirmi grade:
Gravel Length:
0-2 Ft.
100 Ft.
Well: AWWU Water System
Mtlat
5
Number of Wm:Dlatencebeto
2
uram:
>10
Ft.
Ft
Clanificetim (Pdvele. h a, C}
Teel Depth:
Coad tm
Tatal abeorpWri area:
Pipe tonal:
Ft.
Ft
1,000 Fe
ASTM 9034 PVC
Driller.
Dab Drilled:
Static Water Level:
brawler.
DOW kistalled:
Ft
Paisano's Dirtworks
8/212004
Yusld:
Rmpwat
ceeep AbwearauM:
TANK
GPM
Ft.
Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
I Septic
Tank
Absorption
Field
Lin
Station
Holding
Tank
lublWPIrivide
seiverune
Anchorage Tank
.
1,000
Well
>200'
>200'
NIA
WA
>25'
Steel
Two (2)
sio. Water
>100'
>100'
NIA
NIA
LIFT STATION - NONE ON LOT
w u le
>6
5'
NIA
WA
Gu.
FaaMebn
>5'
>10,
WA
WA
I,
High wider :
In
in
Culein or"
I None
Noted
P"'n ModN
elewiw psrfonnW by: _.
Rome":
BENCH MARK
e Lot Una Waiver.
an:
Finished Floor.
ollamirnea MEW-
100.0 Ft.
Engineer's Stamp
•a�aaaags,
•'(E OF !C ab
.
•�
Inspections performed by: T. Kimbrouah Dates: 10 8!2104
49th
2nd 812104
�.
Department of ealth and Human Services approval
%MICHAEL E. ANDERSON War
. c ar
�.�STo. CE-4381 `
Reviewed and approved by Date:
PROF
110 ESS1��:•:•.
aaa4aaab�
19
Municipality of Anchorage Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 3437904
On -Site Wastewater Disposal System or Well Inspection Report
Permit No. SWO40245
PID No. 051-
\iSPER\BrRCH oRrVE
A 8
sl 4• 4•
82 _NZ 7•
G 48.1' 39.1-
05 78.8' 43.8'
08 32.2 28.8'
C7 89.4' 34.1'
M, 71.1' 387—
W 83R 28.8
BV 139.7' 132.4'
THE TABLELANDS SUBDIVISION
LOT 18, BLOCK 4
42,028 S.F.
G
r
;
Ca
sV
1I® B
2
Three Bedroom
Home
Mt M2
PLAN AS -BUILT
SCALE V = 40'
THH1
0 10temote wile
/
/
/
/
/
/
/
N 8 "E 102.
Permit No. SWO40245
TBM
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Page 3 of 3
PID No. 051-741-49
N
U 2 U
U h- f U
Bralnfleld Rock
90116'—/
.._....
PROFILE AS -BUILT %........................ t�
1� ;MICHAEL E. ANDERSON
Scale: 1" - 10' V.
No
a 1..•'i
)n
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 18, BLOCK 4, TABLELANDS S/D
PERFORMED FOR, SPINELL HOMFS
DATE: 8/2/2004 PROJECT No M0"2
PARCEL ID#• TECHNICIAN: T.L. KIMBROUGH
DEPTH TEST HOLE #2
(feet)
1
2
READING
OB/OG
POORLY GRADED SAND
SLOPE
DEWATER
(INCHES)
NFT DROP
(INCHES
SITE PLAN
TEST HOLE PRESOAKED PRIOR TO TESTING:
8/2
1
10:08
8.5"
SP
2
10:38
30
3
.75"
3
11:08
30
7.12"
.63"
4
4
11:38
30
6.49"
.63"
5
HIO
T
p%
TH2o.
6
,7
SILTY SAND
SOME GRAVEL/COBBLES TO 10"
8
GRAY/MEDIUM DENSE
GM
9
SEE FUTURE ASBUILT
101
O WAS GROUND WATER ENCOUNTEREDT No
IF YES @ WHAT DFPD,1 0%
DEPTH OF WATER AFTER MONTTORWG: NONE
11 DATE OF MONITORING: 8/9/04
m
1
1
1
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEWATER
(INCHES)
NFT DROP
(INCHES
TEST HOLE PRESOAKED PRIOR TO TESTING:
8/2
1
10:08
8.5"
2
10:38
30
7.75"
.75"
3
11:08
30
7.12"
.63"
4
11:38
30
6.49"
.63"
PERCOLATION RATE. 48 (MIN/INCH) PERC. HOLE DIA 8�� (INCHES)
TEST RUN BET�FT. and 4 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. SAME SOIL PROFILE AS THI.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/03/2004
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
December 10, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 18, Block 4, Tablelands Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The extreme south end of the absorption trench for Lot 18, Block 4, Tablelands
Subdivision is located approximately 5' from the west property line. The line was not
flagged during construction and the trench Was constructed within the 10' setback to
provide as much separation as possible from the new home foundation. The lot is very
long and narrow and the width of the house forced the absorption trench to be crowded
close to the lot line.
Placement of the new absorption trench at the location shown will not impact wells or
adjacent septic systems. The subdivision is served by the Municipal water system and
no wells are located within 100'. We therefore recommend a waiver be issued allowing
the new trench to be constructed at 5' from the west property line.
Sincerely,
Michael E. Anderson, P.E.
V 49th
MICHAEL E. ANDERSON
NO. CE -4381 j
Municipality of Anchorage
\\ P.O. Box 196650 • Anchorage, Alaska 99519.6650 • Telephone (907) 34348301 • Fax (907) 343-8200
1Wa 4700 Bragae, Street • Anchorage, Alaska 99507
Mayor Mark Begich am'a'.M=Lorg
Building Safety Division
12/15/2004
Anderson Engineering
P.O. Box 240773
Anchorage, AK 99524
Subject: Waiver Request for The Tablelands, Block 4, Lot 18
Waiver Request #WR040094
Parcel ID #051-741-49
HAA# HAO40664 and Permit # SWO40245
Dear Mr. Anderson:
Your request for a waiver of the required 10 feet h
absorption field to property line has been'gpmvi d., The
5.0 feet. =
This waiver appro
only. Any future
separation distance
If there are any
at 343-7904.
Sincerely,
Julie Makela, P.E.
Civil Engineer
On -Site Water & Wastewater Program
separation from the
separation distance is
property line separation
system will require all
please call our office
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
�< Building Safety Division
On-Site Water and Wastewater Program <
4700 Bragaw Stmt ..
96c r Y
P.O. Box 1650 Anchorage, AK 99519-6650
www.ci.anchorage.alcus
(907)343-7904
Waiver Review Worksheet
WR#: WR040094 PID#: 051-741-49 HAM HA040664 Permit#: SW040245
Date Received: 12/1012004
Legal Description: The Tablelands Block 4 Lot 18
Engineer. Anderson Enaineerina
P.O. Box 240773
Anchorage, AK 99524
Applicant Solnell Homes, Inc.
Waiver Requested: Absorption field to lot line of 5 feet
Criteria: Geology Points:
A. Water Table
B. Soil Sorption �--
C. Permeability
D. Water Table Gradient
E. Horizontal Separation ^
Total:
Waiver is Granted: Waiver is not Granted: _
List Conditions or Reasons for above:
Date: -Ja110 IaZCA By
ame of Reviewer
Rec#: 61605 Amount: $175.00 Date Paid: 121M200
10
s_.
MUNICIPALITY OF ANCHORAGE
Development Servlces Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jul 08, 2004
Expiration Date: Jul 06, 2005
Permit Number. SW040245 Parcel ID: 051-741-49
Legal Description: FSE TA0LELANMSUBDN[SI0U BL= 4 LOT..18.?
Design Engineer: 0014 Anderson Engineering Site Address: 23334 WHISPERING BIRCH DRIVE
Owner Name: SPINELL HOMES, INC Lot Size: 42028 SO.FT.
Owner Address: 23334 WHISPERING BIRCH DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER. AK 99577 -
This permit Is for the construction of:
n Disposal Field E 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 15.85 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
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 dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
SPF.Cthc. PItOVIStON�
A(>0trtoNAt- rzrsr Not.o Nerpt To ISE PEKFOR..,fp �oR �L+6cNttTF
Sr�E DO411vo cvv574,jc-Tiov.
Received By.
Issued By:
Date:
Date: 7-6-04
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6778 FAX
July 3, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: lot 18, Block 4, Tablelands Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
• ♦•Ili I I 1 { 1 -II;i / a• Mrl 1 }A :Jim II ;.LY.1r p: 1 1/11' '�{ 1 �.
.li• r / ri •,"S♦ 1•'1 i11 • .1i11 +, 1- _ _
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Y•I I• '
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9 • Y 1,* i. 1 •" tyV-1. .1 L.•.." 1' 1'r. • -• 1 (• ♦. 11 .t ••.
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/ • J i^..Y' Y b1� `aii.l' aiia•' Ir:'V_ .. el a1. � .-.:}lief }•'. �1�
Lot 2, Block 7, Tablelands
July 3, 2004
Page Two
new septic system will be luded a minimum of 19 from the water service
proposed for ft lot and on adjacent lots. It will also be eructed a n** u m of 100'
from any surface water in the area.
c..I.-
.:�: . I •��- !. t - .. 411 .r i e
2. The system, I constructed as desKpecL will tew no adverse xnpad an edstKV
septic systemsi .set constructedin to liture.
3 The systemconstructed ♦1aas designed.vA 1have no adverse impact on ieseFve
space.e0w surlaceor ".s ac 1.. a. 1 Y. 11 1 t am.
patterns% area.The current li •li .g patternii ismaintained.
Anderson,Michael E.
Attachments
p
MICHAEL E. ANDERSON
No. CE -4381 j
\ �HISp£RING B/R
ocM_ DF?IVc
��s• T,
`.8.28• M R:
530.i
_
THE TABLELANDS s
SUBDIVISION
LOT 18, BLOCK 4
42,028 S.F.
11C
SITE PLAN
SCALE F - 40'
r
=4'
el"Tmlh s
pi
r
r
tr
r
:r
o
%P: r
x
,
r
=4'
el"Tmlh s
pi
LOT 18, BLOCK 4, TABLELANDS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom House V Wde Trench System
Pero. Rate: 48 Min./Inch 1,000 Galton Septic Tank
Application Rate: A5 GPD/SF 4' Drainfield Rods
3 Bedrooms X 150 GPD/..45 GPD/SF (Application Rate) =1,000 SF Absorption Area
1,000 SF/5 SF • .5 (Red. Factor) =100 LF Trench Length
THEREFORE: Construct 2 - 50' Long x 5' Wide x 4' Effective Depth Absorption Trenches.
Flow Line Elevation it Trenches to be 2' Below Original Ground Surface. Total Depth to be
V Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench. Provide 2" of Insulation and 2' of Cover if Necessary.
Natural
Saddill
6"
VON
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rods
TYPICAL 5' WIDE TRENCH SEC I l%J
(NO SCALE)
NOTE:
Grade Area Over Trench to Drain Away.
Minimum B' Separation From Bedrock
Minimum 4" Separation From Groundwater.
Minimum 10' Separation From Water Services in the Area.
Minimum 100' Separation From Surface Water or Streams:
I" ILM41LIVALI I Y OF ANCMUNAlst
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 18, BLOCK 4, TABLELANDS S/D
PERFORMED FOR- SPINELL HOMES
DATE: 6/23/2004 PROJECT No • MO44?
PARCEL IDX- TECHNICIAN: T.L. KIMBROUGH
"I 49th
E
> EP TEST HOLE #1 Type of Test: El Percolation ElVisual
1
2
OB/OG
DRY POORLY GRADED SANDS
NET TIME
(MINUTES)
Dy $TER
(INCHES)
NFT DRQQP
(INCHES)
SP
3
6/23
1
3:13
4
8.12"
2
3:43
6
7.5"
.62"
7
3
MOIST GRAY SILTY -SANDS
30
6.88"
W/GRAVELS SOME COBBLES TO 10'
8
4
MEDIUM COMPACTION
30
6.25"
GM
9
SLOPE
0%
SITE PLAN
THIO k
SEE FUTURE ASBUILT
10—WASORouNDwATEEENooumrmtEw No
IF YES WHA
YDEP[IiC_
DUMOFWAMRAF[E8bY1MfORII1Cr. tbNE y� 0%
11 DATE OF MONNOWN& 6/29/04 teyl
1
1
1
1
1
1
1
pm
DATEREADING
G(�OSS TIME
(MINUTES)
NET TIME
(MINUTES)
Dy $TER
(INCHES)
NFT DRQQP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/23
1
3:13
8.12"
2
3:43
30
7.5"
.62"
3
4:13
30
6.88"
.63"
4
4,43
30
6.25"
.63"
PERCOLATION RATE. �48 (MIN/INCH) PERC. HOLE DIA $_(INCHES)
TEST RUN Bi FT. and—.!—FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. L MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/03/2004
ONSITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 18, BLOCK 4, TABLELANDS SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a new
1,000 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of 2 new 59 long X 5• wide X V effective depth
absorption trenches at the location also shown an the Site Plant The
distribution Cine in the trenches will be placed at 2• below the existing ground
surface. Total depth of the trench w6 be V below the existing ground
surface. A flow splitter valve must be placed to assure even Illow to each
trench. A separation distance of 10' from any water service and 100` between
the septic fordo and absorption bench and any surface water must also be
maintained. A a**mxn of 8• of fill is required over the absorption benches
and 4• over the septic tank. In lieu of the required fill T of insulation and X of
fill may be placed.
f �'fl ►1 • r 1'JR,rh• Ir, ►• II I •'• f i• i li' '•
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•. :{ h4• wv,:'F, ! �ri� .V{} 1 41V.'!tj,.. ri it i• ,'.
: tr• � 0.•+. I .. 1 •I �: 4 • ►:+. If. Ylp. .,v v, lgil. •. t
Mill��v�iil • f,.- viY I CYC 1: f si!'!: •
SEPTIC TANK INSTALLATION
- Ill fall-• orf 1 , • w _.• • :if:r- • cf •1 :. r-
• . 1 ;ri. •. r. I r: 1.- 1' • r 1+: ✓ Vti is 1
, :•�: • ;<.hr.-C�
Lot 18, Block 4, Tablelands
July 3, 2004
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. AN standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 41 of ever shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouls are required between the tank and the drainfield.
9 pill, �11-1 771r-7715=
GRAINFIELD CONSTRLK'TION:
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VARtom_{ '1. y . ...'. 1 I - !K Y}• =17ii • .. I .. L. ..• -
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}
'Lot 18, Block 4, Tablelands
July 3, 2004
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
Jill 11 iiiiiiii 111111111111111111111111111 11 1111111
57
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Parcel I.D. 051-741-49
69
JUL 15 2015
Municipality of Anc
On -Site Water and Wastewater
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: -7-3-17
Complete legal description THE TABLELANDS; LOT 18, BLOCK 4
Location (site address) 23334 WHISPERING BIRCH DRIVE, CHUGIAK, AK 99567
Current Property owner(s) MIKE & DEBBIE LOFTON
Day phone 907-854-9866
Mailing address 23334 WHISPERING BIRCH DRIVE, CHUGIAK, AK 99567
Real Estate Agent DANIELLE GRIGG Day phone 907-312-5001
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
X
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
X
TYPE OF WASTEWATER DISPOSAL:
Individual
X
Holding Tank
❑
Community
❑
Public Sewer
WalverNarianCe request for: N/A Distance: N/A
Received by: Date:
COSA to be released to the engineer, unless othermse requested by the engineer. -
COSA Fee $ X5 ;LaWaiver Fee $ _
Date of Payment V L&j S Date of Payment
Receipt Number ol(420(Q Receipt Number
COSA# 0505-73610 Waiver#
W^'P�:^i ..'
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 Film Garness Engineering Group Ltd. (GEG) Phone (907) 337-6179
Address 3701 E. Tudor Road, Suite 101 Anchorage AK 99507-1259
Engineer's Printed Name Jeffrey A. Garness Date /
In conducting this evaluation, GEG provided E-1 engineering evaluation of the well and/or septic
system in accordance with the guidelines and regulations established by the Municipality of
Anchorage and industry practices. The reported results describe the condition of the system/s on the
dates of the evaluation. Separation distances were measured to readily identifiable features.
Hidden defects or encroachments may exist that were not identified during the evaluation. The
operational life of all wells and septic systems depend on a variety of variables including, but not
limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of
construction (materials and workmanship), and the water usage of the family utilizing the system/s.
These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or
implied) regarding the future performance of the well or septic system. GEG makes no
representation whether an alternative well or septic system can be installed on the property in the
event either of the current systems fail. The content of this report is for the sole benefit of the
person/party who retained GEG. Reliance upon the information provided in this report by any other
person or patty, including but not limited to subsequent property purchasers, is not authorized. In
short, GEG disavows any legal duty to anyone other than the person/party who paid for this report.
6. DSD SIGNATURE
System 41 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
bedrooms, with the following stipulations:
ON-SITE
WATER AND
WASTEWATER
PROGRAM
By Original Certificate Date: 7-12—�✓�
Th ni of orage 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 V Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory. Other
COSA blue sheet 9-1-12.doc
D. LIFT STATION
Date installed Size in gallons Manhole/Access (,YM
"Pump on" level atn. "Pump off" level High water alarm level at
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/11B station on lot On
Absorption Heid on lot On adjacent
Public sewer main
Sewer /septic service
sewer menhole/deanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surrace water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *5'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surrace water 100'+ Driveway, paridng/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
*WR#040094 APPEARS TO BE INADEQUATE SOIL COVER (5" SHY)IN AREA OF MT2. BOTH
TRENCHES ARE INSULATED. a--% N-0 Ct+ U (-r,-'-7 T<49- F 201 'N�
G. ENGINEER'S CQRTIFICATION
l certify that I have determined through freld inspections and
review of Munraipal records that the above systems are in
conformance with MOR COSH guidelines In effect on this
date.
Engineer's Printed
lJNpme JEFFREY A. GARNESS
/
Date ! ei,(s-
(Rev.11ros)
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: THE TABLELANDS; LOT 18, BLOCK 4
A. WELL DATA AWWU
Well type If A, B, or C provide PWSID#
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
Sanitary seal (Y/N)_
Parcel ID: 051-741-49
Well Log
Wires properly
Cased to ft. Casing
FROM WELL LOG
Coliform L colonies/100 mi.
ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate mg./L.
Date of sample:
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Collected by:
ground) in.
g.p.m.
Date installed 8/2/2004
Cleanouts(Y/N)
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 4/30/2015 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD
Date installed 8/2/2004 Soil rating OQl or fftdrm) 0.45 System type SHALLOW TRENCH
Length 100 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth *8.1+ ft. Eff. absorption area 1000 fe Monitoring tube YES Depression over field NO
Date of adequacy test 7/3/2015 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 28 in. Water added1? 20gal. New depth **47in.
Elapsed Time: 120 min. Final fluid depth***44in. Absorption rate >= 450+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date —
INTRODUCED WATER INTO EAST TRENCH; L.L. (25.25 INCHES) IN WEST TRENCH WAS CONSTANT
THROUGHOUT TEST.
**2"ABOVE INVERT
*** 1" BELOW INVERT
08 July 2015
TO: Municipality of Anchorage
FROM: Michael J. Lofton
23334 Whispering Birch Drive
Chugiak, AK 99567
907-854-9866
I am the registered owner of the residence located at 23334 Whispering Birch Drive,.
Chugiak AK. I have lived in the house since 01/01/2004 (over 10 years). Since I have
lived here, the Septic System has functioned normally during all times of the year.
There has never been an issue with the Septic System freezing during the winter
months.
Michael Lofton
Municipality of Anchorage
-� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.gk.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-741.49 HAA # nyn1 Di A
Expiration Date: JAIc�S
1. GENERAL INFORMATION ` - t
Complete legal description Lot 18, Block 4. Tablelands Subdivision
Location (trite address or directions) 23334 Whfsoering Birch Drive
Current Property owner(s) Soineli Homes, Inc. Day phone 344 5678
Mailing address
Lending agency
Mailing address
1900 Northern Lights Blvd. Anchorage, AK 99517
Day phone
Real Estate Agent __ Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD f& pickup.
2. NUMBER OF BEDROOMS:
e�
Boa
3. TYPE OF WATER SUPPLY:
�
g
e
Individual On-sfte ,
Individual Water Storage
❑
Individual Holding tank
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-741.49 HAA # nyn1 Di A
Expiration Date: JAIc�S
1. GENERAL INFORMATION ` - t
Complete legal description Lot 18, Block 4. Tablelands Subdivision
Location (trite address or directions) 23334 Whfsoering Birch Drive
Current Property owner(s) Soineli Homes, Inc. Day phone 344 5678
Mailing address
Lending agency
Mailing address
1900 Northern Lights Blvd. Anchorage, AK 99517
Day phone
Real Estate Agent __ Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD f& pickup.
2. NUMBER OF BEDROOMS:
Three (3)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-sfte ,
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-stle
❑
Pubfic Water System
0
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined In the Health Authority 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 Finn Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchorage. AK 99524
Engineer's Printed Name, Michael E. Anderson, P.E. Date 01012004
5. DSD SIGNATURE
we' Approved for 3 bedrooms.
Disapproved.
Omom- E At
CAI
.,MICHAEL L,'
No. CE-s� 1/ E
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X Maintenance Agreements
Supplemental Engineer's Report
Other
By: / A 1 .0 _ - � �t �Original Certificate Dater
M". 12W)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 18 Block 4 Tablelands Subdivision Parcel ID: 051.741.49
A WELL DATA
Well type If A, B, or C provide PWSID # Well Log (Y/N)
Date completed Sanitary seal (YM) _ Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level fL ft,
Well production g.p.m. 91p•m•
WATER SAMPLE RESULTS:
Coliform coloniest100 mi. Nitrate mg./I. Other bacteria colonies/100 ml.
Date of sample: Collected by--
B.
y:B. SEPTICIHOLDING TANK DATA
Tank Type/Material SdSteet Date installedM004
eoti
Tank size 1.000 gal. Number of Compartments 2 Cieanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water, alarm (YIN) N
Date of pumping Pumper Now Construction
C. ABSORPTION FIELD DATA
Date installed 81212004 Soil rating (g.p.d./fe or felbdrm) .45 GPDISF System type Fwde Shallow Trench
' Length J00 ft. Width ,5 ft Gravel below pipe 4
Total depth 7 R Eff. absorption area 1000 flz Monitoring tube Y Depression over field N
Date of adequacy test Results (PasslFailj 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.) (YIN & type) If yes, give date
Date installed Size in gallons
'Pump on' level at_ in. "Pump ofr level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknift station on lot _ WA
Absorption field on lot NIA
Public sewer main NIA
Sewer /septic service line NIA
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots _NIA
On adjacent lots _NIA
Public sewer manhole/cleanout. NIA
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field >5'
Water main >10' Water service line >10, Surface water >100'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 440' S '*'LA" Building foundation >10, Water main >10,
Water Service line >IV Surface water >700' Driveway, parkingNehicle storage >$I
Curtain drain None Noted Wells on adjacent lots —>200,
F. COMMENTS
G. ENGINEER'S CERTIFICATION 'u
taw w� alocg9 �. , pF "
.•��`p� ..............
i ceriify that I have determined through field inspections and
review of Municipal records that the above systems are in ; ... t � c µ...
conformance with MOA HAA guidelines in effect on this date.%��..0 4
mvzL
Dozsc
Engineer's Printed Name Michael E. Anderson. P.E. �y °� No. cc -4381
Date 1211012004 e4eN.*�.
HAA Fee
C7 -V
Date of Payment _ / z - / D - &5/
Receipt Number )I b5D ARM
(Rev. 12(00)
Waiver Fee $ 175
Date of Payment /Z " /0- O A/
Receipt Number _(���
2004-25
THE TABLELANDS SUBDIVISION
LOT 18, BLOCK 4
42,028 S.F.
Rae 63 DRIVEp
\T `k' E E3M7' Ca 8j •?8' Ra530.Op'
1 "=40'
SEPTIC SYSTEM
m
BUILDINEXISTING G 4
41.5 >
• w
S89 r.i
N 85 102.
FINAL STRUCTURE AS—BUILT
—BUIL
GASTALDI LAND SURVE
JEFF A. GASTALDI, R.
4726 WEST 88TH AVE
ANCHORAGE, ALASKA 9
PHONE 248-545.4
GRID DATE
NW 1559 9/23/2004
F.B. JOB NO.
04-11 TLS184
I HEREBY CERTIFY THAT I HAVE SURVEYEI
PROPERTY DEPICTED ABOVE AND THAT N(
ENCROACHMENTS EXIST EXCEPT AS INDIC)
IT IS THE RESPONSIBILITY OF THE OWNEF
DETERMINE THE EXISTENCE OF ANY EASEI
gpVENANTS OR RESTRICTIONS WHICH DO
APPEAR ON THE RECORDED SUBDIVISION
UNDER NO CIRCUMSTANCES SHOULD ANY
HEREON BE USED FOR CONSTRUCTION 0
ESTABLISHING BOUNDARY OR FENCE LINE
ANCHORAGE RECORDING DISTRICT, ALA:
NOTE: NO CORNERS SET THIS DATE.
THE
'ED.
TO
ENTS,
JOT
'LAT.
DATA
FOR
►lLuxit
OF_. A4
•9IC kv : �r
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