HomeMy WebLinkAboutTHE TABLELANDS BLK 4 LT 4The Tableland4
#051-801-12
Municipality of Anchorage ;.
Development Services Department •
Building Safety Division a
Onsite Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 995195650 Page of
www.d.anchorsge.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO40079 PID Number. 051-801808"
Nem.:
The Thomas Company
Wastewater System: 1] New ❑ Upgrade
Add�a HC 05 Box 6929, Palmer, AK 99645
ABSORPTION FIELD
Prime: 746-0682 11umbaror9admorne:
3
ODap rl.nd,Osnailew Tr«k;n C3 Bad QMouM ❑✓otMn
LEGAL DESCRIPTION
0.45
ToMlDepth fiomorpinalWade;
GPD/FP
7.77 Ft.
Block: Wt: aubdlitim:
4 4 The Tablelands
Depth to pipe boaan hom original pada:
Gravel depth beneath Pip,:
3.81 Ft.
4 �.
Toaenhip: ','. Range: Seotlm:
FYI added above odanel pada;
GnvN Length:
2tl' Ft.
100 Ft.
Well: ❑ New [3 Upgrade
Grael vndlh.
Number or am,:
DZe ones:
5 Ft.
2
;between
14 Po.
Clara fiwtbn (PrNele, A, S. C):
Told Depth: Cased to:
Told abw,pYon arta:
Pope Material:
Community Water
Ft. FL
1000 Fla I
PVC
Dreer:
Data DrYled: Salic Water Levai:
hateller.
Data In Welled:
FL
Baileys Backhoe
8/26/04
Ylele:
Pump set eb
Daing Haight Above Ground:
OPM
FL
FL
TANK
SEPARATION DISTANCES
Elseptic ❑Holding ❑S.T.ER [3 Other.
To
Septic
Absorption
Lift
Holding
ubIIGlPnvate
Mmr.
parry:
From
Tank
Field
Station
Tank
Sewer Una
Anchorage Tank
1000 Gel.
Wefi
na
na
na
na
na
Maw al:
Steel
Number a CmgraMlmte:
2
Bad.cewate,
na
na
na
na
LIFT STATION
Wt LYro
40'
20'
na
na
Gal.
Mawa=mn '..
FouMedm
5'
16'
ria
ria
Pomp ori level eC
'Pump Wlewd a
High water Wenn at
„
in
CorMln Drainria
na
na
na
Pomp Make 6 Model
Elec&A kepewom performed by.
Ramarlu:
-
BENCH MARK
Wagon aoripdm:
Garage Slab'
mad velem:
100 FL
OF�S���','
Inspections performed by: 'Ae"ah" ee' ""eaNe" "k"a°`"""°'" Dates: 1" 8/26/04
* TM *'
�...... .... .......,.
f......
2ntl 8/26/04.
,
Developm nt Services Department Approval
Mar . Shreves
iAm
' CE 9351"RO
Reviewed and approved by: Date: I i /' /[XI _
gF �
',/tillilFESS�� �
i
/ Lol
ol. 5'WX4'ED 'KTRENCH Lp S
/ MT2
/ C04 %
/ �' 'EDX33'
9-7ABEL FLOW SPUTTERS
1 "=40'
LOT 5
R,M
V568
56811
REPLACEMENT
SITE
1,000 -GAL
SEPTIC TANK
COI
CO2
CO3
C04
MT1
MT2
A 27.30
27.34
67.21
84.85
54.24
84.45
B 37.66
30.83
40.85
47.77
38.03
46.90
C 59.40
52.64
41.54
32.20
39.21
30.12
40,000 S.F.
LOT 4 ZN,.
•Og
PROPOSED
OF ANY
g400ppD4p� SITE PLANS P.O. BOX 2749
4OFAS BUILT ` atm PALMER, ALASKA 99645
�P\V. •••••••• ..9'p, ENC BB INC. PHONE: (907)745-0222
> C7 ' '•.,9 dd FAX: (907)746-0222
*.,'*49TH**
�� ¢9TH ADD W.O. 0400225 DATE: 10 28 04 SCALE: 1" 40' FlLE:
,.:Ww ..............4....:...D.
Shreves d Lot 4, BLOCK 4, THE TABLELANDS SUBDIVISION,
9351 , 'tid PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE,
'C7 EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
ESSIDN?dc�' RECORDED PLAT ARE NOT SHOWN HEREON.
5'WX4'EDD6�TRENCH ....
/ MT2 / C
/
CO �(
MT1 B .
/ F';AX4'EDX33' TR C CO3
AK 1
C 2
V.
2-ZABEL FLOW SPLITTERS
N s\
SEPTIC SYSTEM PLOT PLAN
FIXED FINAL GRADE
-00.00ft / 99.72 ft'
1,000 -GAL
SEPTIC TANK
DATUM = GARAGE SLAB = 100 ft.
GWMT DRY, 8/17/04 (DEPTH AT 83.72').
.w.
Shreves
9351 .
SEPTIC SYSTEM PROFILE
SEPTIC P.O. BOX
AS BUILT RIY PALMER, ALAS
R1=4 E INC. PHONE: (907)
77 FAX: (907)7•
I
1,000 -GAL
SEPTIC TANK
FINAL GRADE
99.72 ft.
99645
97.72 ft.
ORIG. GRADE
°0 W.O. 0400225 DATE: 10 28 04 SCALE: 1 " 30' 1 FILE: 0400225_WW
LOT 4, BLOCK 4, THE TABLELANDS SUBDIVISION,
d PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK
EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.'
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
0
t'i`p �to
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 26, 2004
Expiration Date: Apr 26, 2005
Permit Number: SWO4007 °` 'r 44 _r OFT --, Parcel ID: 051-8012,,
Legal Description:
Design Engineer: 0032 Alaska Rim Engineering Site Address: 23210 WHISPERING BIRCH DRIVE
Owner Name: THE THOMAS COMPANY Lot Size: 40000 SO. FT.
Owner Address: NHN WHISPERING BIRCH DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK , AK 99567 -
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3_ The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
IS. The following special provisiohs:
JHIS PROPERTY RECENTLY SUBDIVIDED AND THE LEGAL DESCRIPTION IS THE TABLELANDS '
'SUBDIVISION BLOCK 4 LOT 4
/VorE.• chuck
A/M4*ri0-
i+5o5
4o
s IoPE
. THE IrR&'Vcr1
PRoPoSdD DESrSM
#V1 It gE RlfiG2ER
7/joM
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iS�
c%ip f✓tH fo
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e/aeI/o4
Received By:
Issued By:/ /G(iWt
Date: A1 g D
Date: :4124 l>
Municipality of Anchorage
t'O�X m•�•4•
• -.r Development Services Department
Building Safety Division
On -Site Water and Wastewater Program a „
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 3437904
ON-SITE SEWER/WELL PERMIT APPLICATION
Q FOR ASINGLE FAMILY DWELLING
Parcel I.D. 05-1-801— OeT Permit Number SW 04 007y
Property owner(s) The Thomas Company Day phone 746-0682
Mailing address (1) HC05 Box 6929
Mailing address (2) Palmer AK Zip Code 99645
YI[E
Legal description (Lot, Block & Sub'd.) Lot 4, Block 4"I'ablelands Subdivision
Legal description (Section, Township & Range)
Lot Size 40,000 Acres/Sq.Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only 0 Well Only
❑
Sewer and Well ❑ Water Storage
❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi
❑
Swimming Pool ❑ Water Softening Unit
❑
Therapy Pool ❑
1 certify that the above Information is correct. I further certify that this application is being
made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
q-a0j
. T.> e. owr<er !ty i% Vmr-
(Signature of property owner or authorized agent)
Permit Fees: 7 Waiver Fees:
Date of Payment: 4 — 3 D 14 Date of Payment:
Receipt Number. Q 5' B Aa� A- d Receipt Number:
(Rev. 12100)
i
Page I of 1
Goodall, Joe P.
From: Chuck [chuck@alaskarim.com]
Sent: Thursday, April 29, 200411:21 AM
To: Goodall, Joe P.
Subject: Lot 4 Block 4 Tablelands
Joe,
We will be altering our proposed design from a 7' x 75' deep trench to 4' x 82.5' 5 wide
Respectfully
chuck
4/29/2004
�_Afftka
Tint
pflguleeking, On.
Phone (907) 745-0222 P.O. Box 2749
Fax (907) 746.0222 Palmer, Alaska 99645
akdm®rogershsa.com
April 17 2004
Mc DarrRoth
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water and Wastewater Program
PO Box 196650
Anchorage, AK 99519-6650
RE: Lot 4, Block 4, The Tablelands Subdivision
AK. Rim Engineering Ref. No. 04-00129
Subject: On -Site Sewer Permit Application
Dear Mr. Roth:
The owner of the above referenced lot is proposing to construct a 3 -bedroom single family
dwelling (see attached Plot Plan). The proposed dwelling is to be served by a community water
system and a private septic system. With this lefterwe are requesting plan review and a permit
to install an onsite septic system to serve the proposed development.
DESIGN SUMMARY
Soils
A test hole for ground water and percolation test was excavated on April 1, 2004, and the soils
logged by our firm. A monitor tube installed at that time. A percolation test was conducted on
April 2, 2004. The proposed drainfield will be designed within the 30 -feet radius of the test hole.
The attached Soils Log — Percolation Test form shows the approximate location of the test hole,
labeled AK TH #1. The soils were rated in the field as GM, gravel with silt. The percolation test
indicates a soil percolation rate of 60 minutes per inch which translates to a wastewater
application rate of 0.45 gpd/sgft.
Groundwater was not encountered during the initial excavation of the test hole. On 4/2/04 and
4/12/04, the monitor tube was probed and no groundwater was detected.
Engineers • Planners 9 Surveyors
Lot 4, Block 4, The Tablelands Subdivision
April 12, 2004
Trench: Design
The following is a summary of the proposed design of the trench SAS:
Percolation rate: 60 minutes/inch
Soil application rate: 0.45 gpd/sgft
Number of bedrooms: 3
Daily wastewater flow: 450 gpd
Drainfieid: 7 -foot deep trench
Septic tank: 1,000 gallons
b tin area 1000 sgft
Page 2
Total depth (max): 8 ft
Effective depth: 7 ft
Width: 2 ft
Reduction factor. NA
Minimum length: 72 ft (2-36ft trenches)
Effective absorption area: 1,008 sqft
Minimum a sore o
Topography
The topography of this lot is that it slopes evenly from the southeast to the northwest, with the
contours perpendicular to the long lot lines. The slope is approximately 2%$% throughout the
lot. The back third of the property is a steep buff with slopes 25% or greater.
Surface Water
There are no surface waters within 100 feet of the proposed septic system.
Surrounding Properties
This property and the parent subdivision will be served by community water system. We are
unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
Development on this lot will not preclude development of wells and septic systems on
neighboring lots in the future.
If you have any questions regarding this report or its recommendations, please feel free to
contact me.
Sincerely, ��w�.����
ALASKA RIM ENGINEERING, INC. .. r�' �E ALAS •r,ll
Iy . �.•
Charles A. Leet •'••
Professional Engineer ••5 0 `"
CC: AKeThomas Rim Engineering File No. 04-00225 +ikl�\�E9 lit��5����~~
Attachments:
• MOA On -Site Sewer! Well Permit Application Form
• MOA Soils Log — Percolation Test Form
• Septic System Plot Plan (3 pages)
PERMIT NUMBER
PID NUMBER
/
i I1J (c
/ / R PROP ED
WATER ERVICE
ALTERNATE
REPLACEMENT
/ L01 SITE
f CEO s
`
PROPOSED
/ TWO STORY
DWEWNG Jai LOT 3
/
OEC`` INSTALL 1000 GAL�� �
SEPTIC TANK
/ REPLACEMENT C^
/ SEPTIC SYSTEM
v x,
5�
1-72' X 7'
DEEP TRENCHES LOT 4
40,000 S.F. / /
s
LOT 5
\\ BLOCK 4
1 "=50'
EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED
BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON TH� RECORDED SUBDIVISION PLAT.
�ppDDDpp�
SITE PLAN AS K P.O. BOX 2749
pF q4��Q RIM PALMER, ALASKA 99645
o P ;9f Q ENC EE INC. PHONE: (907)745-0222
FAX: (907)746-0222
¢91H W.O. 0400225 DATE: 4/12/04 SCALE: 1" = 50' FILE: 0400225
• D
Charles A. Leet p Lot 4, BLOCK 4, THE TABLELANDS SUBDIVISION,
CE 10480 PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA
QQ f�FFp'
........���o EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
�4n��04FESSIV e RECORDED PLAT ARE NOT SHOWN HEREON.
SHEET 1 OF 3
PERMIT NUMBER
O/ Uv / WATER
z P ,
/ a PROPOSED 1ti
TWO STORY
DWELLING
P f.
REPLACEMENT
SEPTIC SYSTEM
1-72' X 7'
DEEP TRENCHES
J. %i........p ..
...............t.
Charles A. Leet
CE 10480
PID NUMBER
ALTERNATE
REPLACEMENT
SITE
4C, / vO V'
r
0 INSTALL 1000. GAL
SEPTIC TANK V
SEPTIC SYSTEM PLOT PLAN
LOT 4'
40,000SY
capp.d
dbl .L.v ut
..0
.bwrpUvv '.
ry.tam
(.ea �oN 9 of 9))
1 "=40'
SEPTIC SYSTEM PROFILE
SEPTIC X P.O. BOX 2749
kIlvc-
PALMER, ALASKA 99645
ENC EE PHONE: (907)745-0222 -
FAX: (907)746-0222
W—.004002251 DATE: 4/12/04 SCALE: 1 = 30' 1 FILE: 0400225
Lot 4, BLOCK 4, THE TABLELANDS SUBDIVISION,
PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AI
EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.
SHEET 21
PERMIT NUMBER PID NUMBER
p.rloreted 4' PVC
M. Not. 1
8/4' to 9'
.ewer rock
.bd 4' M. DIP.
or PVC {ch. 0
Not. 1: wsteD W grtor.t.a Pvc tweet
(wlthiv 0.0 toot o/ ...hrvetiort)
permeable m Note 39 need
{wtaslib �
1v
TRENCH DETAIL
Not. 8: Me.. minimum o1 4-1.t o1 earth cover
(or equivalent) over .beorption trench. one
inch o1 western M.ulf. D' (or pJ may
be wu . tut.d for one tool of s cover
V to . m tl nvm of two tvch.. of hund.tion.
Not• o: N.atmum a.Un .hell M vo mon 9 feet.
Not. {: Not used
end of drei. pl"
II
hx
a
�� -� °��-�• +�-• ���• a ���
2®36' ±
DEEP TRENCH
PLAN VIEW
hot.
orit.d PVC
bola ..down)
(holo down)
SECTION X -X
round .urtsce ELEV. 100.0'
re emov.ebls
P
e.r ut
.tneetion.
{round .urtwe
ELEV. 98.0'
n-p.rtoretea
PVC above
ewer rack
9 7. coupling
=E?» mak'?'•?i? o
•_•_•_ _ . • _ ... Montle. depth �pV 0
1.;2°.;:;:;°.•a::iggg1=^:1;1; '0 0`6
{' PVC prtoretea
i 6' Ivtenek
in sews rook
?11?1112:g ELEV. 91.0' 000
Oq�ot �r
9 g $ 8
uvd et d Y 9 �jo0 0 0
0
n 0
�k{re,maJw.hyh � a n� a�CC��
DO CH6
Im rmsebl. to or ELEV. 86.0 0�,y
00 Mb
EOTTON TH
TRENCH SECTION MONITOR TUBE
DETAIL
g4�pO040p� SITE PLANASKIM P.O. BOX 2749
RPALMER, ALASKA 99645
•OF A4,1 �Da�
ENG;EEJ INC. PHONE: (907)745-0222
S; y df FAX: (907)746-0222
49TH W.O. 0400225 DATE: 4/12/04-] SCALE: nts FILE: 0400225
(fit`
::.:::.:..: o
Q� , Charles A. Leet • �d Lot 4, BLOCK 4, THE TABLELANDS SUBDIVISION,
Q s°•, CE 10480 PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA
RECORD
Q%%PRDQSSIVO' � RECORDED PLATAREE NOT O THOSE SHOWN ON THE
SHOWN HEREON.
SHEET 3 OF 3
Municipality of Anchorage(NGI s s -A,1* r
Development Services Department 'fir'e••'�
Building Safety Division H� 9�j ' • ,.
.►,� On-She
Water and Wastewer470 South Brag �StP�mm *•4•Ieee•''e•e••'w
P.O. Box 196650 Anchorage, AK 99519-6650 ' •' 16 •"
www.muni.org/onsite . pn••-
(9 07) 34&7904 'it •• ('f, .
Soils Log - Percolation Test +������Fo ►AoiES����-lw'
Performed For: The Thomas Company Date Performed: 4/2/04
Legal Description: Lot 4, Block 4 Tablelands Subd. Township, Range, Section:
Depth
i I14 tz w 1E1-
�tnsc
Gu
16-
17-
18-
19 -
Reading
Date
Gross Time
WAS GROUND WATER
9-
Net Drop
Az:ESo
ENCOUNTEREO? K�
e
10-
z�cY
ti IS
IF YES, AT WHAT DEPTH? L
Depth to Water After 0
11-
30
u 1v
Monitoring? E
12-
/s/5'
Date: D 41/1
16-
17-
18-
19 -
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
Az:ESo
K- i i
ii
z�cY
ti IS
14 'IS
30
u 1v
tr It,
/s/5'
:�D
rENc;t I IUN NATE (,Do (Mmutwafth) PERC HOLE DIAMETER _ b
TEST RUN BETWEEN r FT AND_7FT
I 'ter— A
-ir r�r�r ra. awn�cra
PERFORMED BY: Kent Sheets I Charles Leet, P.E. CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4/12/04
Municipality of Anchorage
Development Servkes Department
9ulding Safety OMsion
• +.e On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.d. endwraoe.ek.us
(907) 343.79G4
Soils Log - Percolation Test
Performed For: ASG { It Date Perk
Leczi Description: (9 ni V! i V✓1\101G1 17 Township, Range, Section:
7-
a-
9-
10-
11-
12•
13-
14-
15-
16-
17-
1_-
20-
LO-rq ZV B
nDepth ;Q3LE1-ANDSI
dT y BK 4
5; 't 14y Sa. , "t
r
0.v •t -L
�2M4P
SH
WAS GROUND WATER
lD
Gross Time
ENCOUNTERED?
Depth to Water
Net Droo
FILL
3'i�6r—
s
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
G
EP
'BoT T o t► -t O F
HOLE
Date:
r:.
.a:
. ,. •r: i.la,d
C. sY23
Reading
Dale
Gross Time
Net Time
Depth to Water
Net Droo
FILL
3'i�6r—
PRE
3
2:30
0
:O O
li-t IN
a
3P i
70
:tro
3J
C1 Ir VII
I
PERCOLATION RATE on W-~) FERC HOLE DIAMETER
TEST RLN BETWEEN FT AND 14 FT
CCM%,IENTS rt- un Uq t I" t
f
PERFORMED BY: CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ?✓ t0 02
Municipality of Anchorage 9_I t-0.7
-�
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. /�5I — �'oI- / `ot COSA #
Expiration Date: 1 — i—O
1. GENERAL INFORMATION
Complete legal description %f/E %ABL tc L e±&16X r6L�/ /07—q
Location (site address)
Current Property owner(s) RC,. f `Ip44tS Day phone _glgl^ tz
Mailing address
Lending agency
Mailing -address
Day phone
Real Estate Agent 0rrt4
/ timo -1
Day phone
2340—?49?
Mailing Address
"t fo
-AL
Unless otherwise requested, COSA will
be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
. 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
0
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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. (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 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 _X044)Fi,*1 ,e�ng .
Address A) 96X 7>07o2c./
Engineer's Printed Name
5. DSD SIGNATURE
V-00, Approved for 3 bedrooms.
Disapproved.
Phone
�3a-cflb�l
Date 7/J.�C0
ry..tyrAll
10 AN
0. qt
�} V.
�. .^ Steven
PE 6256
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: 1J � � zt l/ ra- . Original Certificate Date: _2_' Qi — 0 7
)Rev. 11105)
Municipality of Anchorage
• Development Services Department
Building Safety Division '
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 198850
Anchorage, AK 09519-6850
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ��/,ozAAeb r ff, � Parcel ID:05/- gKI—/2
A. WELL DATA WOter
Weil type _ If A. B. or C provide PWSI # _ Well Log (YM)
Date de:: Sanitary seal (Y/ Wires properly protect /N)
Total de ft. Cased to ft. Casing height (abov ground) in.
FROM WELL LOG AT INSPECTI
Date of test
Static water level
Well production
WATER SAMPLE
ft.
g.p.m.
RESULTS:
Coliformcol ies/100 mL Nitrate g/L
Arsenic:::; mgli Date of s ple:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material,4
Tank size /000 gal. Number of Compartments 2
Foundation ciesnout (Y/N) _y- Depression over tank (YIN) _d[
ft. ft.
Other baste
Coll by.
colonies/100 mL
Date installed e/a/a_�_
Cleanouts (Y/N)
High water alarm (Y/N) IV
Date of pumping -y7��2 Pumper lu f
C. ABSORPTION FIELD DATA
r
Date installed a oy Soil rating (g.p.d.m' or ft2rodrm) j2Lt�/S System type S w/OE
Length l�Q ft. Width s ft. Gravel below pipe _ ft.
Total depth 140 ft. Eft. absorption area/d9O6 ftp Monitoring tube __Y_ Depression over field
Date of adequacy test Yhz-167 Results (Pass/Fail) 214 S For =3L bedrooms
Fluid depth in absorption field before test L in. Water added_46,Mgal. New depth /.T in.
Elapsed Time: i min. Final fluid depth In. Absorption rate >= 4/ SO g.p.d. -.I-
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Vit//G If yes, give date
D. LIFT STATION
Date installed Size in gallons I Manhole/Access (YIN)
`Pump on' level a 1n. 'Pump off" level at in. High water alarm el at in.
Datum Cycles test Meets alarm circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: RJBUC' &J o
Septic tank/lift station on k
Absorp/serviceline,
Public SewerAnimal
On adjacent lots
On adjacent lots
Public sewer me
Holding tank/
excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
/ � r
Building foundation S Property line Absorption field S '`
Water main /O rf Water service line /d f Surface water
Wells on adjacent lots ZOo ff
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ��% /� Building foundation /a 'r Water main /Q
Water Service line Al '7" Surface water _ /� rf Driveway, parking/vehicle storage le '70 -
Curtain drain VAJk- Wells on adjacent lots _Lr*'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and j *; Q
review of Municipal records that the above systems are in j••
conformance with MOA COSA guidelines in effect on this date. ,
;dw"
Engineer's Printed NameLI� e,
pE 6256
Date/%L�IJ % +t1�FOFti : ���-��,•!
COSA Fee $ `Y � .i
Date of Payment� 0 T
Receipt Number 35D:5a
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
/C'o.� TLion2a-S
s
K
st�trr
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-801-
1.
GENERACINFORMATION
Complete legal 41e6CHp60rt �i1x
Location (site address. or directions)
HAA#N hln'+q
Expiration Date:
Current Property owner(sj The Thomas Company Day phone 746-0682
Mailing address' HC 05 Box 6929, Palmer, AK 99645
Lending agency
Mailing address
Real Estate Agent
Mailing Address
1st National Bank
Day phone 777-3563
101 W. 36th Ave., Suite 333, Anchorage, AK 99503
Prudential Jack White Real Estate Day phone 230-9699
3201 C Street, Suite 200, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
❑✓
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
❑✓
Community On-site
❑
Public Water System
❑
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 4 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. (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 Firm Alaska Rim Engineering, Inc. Phone 745-0222
Address PO Box 2749, Palmer, AK 99645
Engineer's Printed Name Mary L. Shreves, P.E.
5. DSD SIGNATURE .100"
Approved for bedrooms.
.,:,
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
�J tCppiierr
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
WATER
rVLV. Rl
"Vi^ FOUND
►I1-'s1�R� 1L � � 5/8" REBAR
TYP.
R1 i L
kill
" y g P UTILITY 56�
1\
LEGEND.
(C)=CALCULATED DATA
(M)=MEASURED DATA -
(R)=RECORD DATA
U.G.=UNDERGROUND -�
TYP.=TYPICAL�O\
YPC=YELLOW PLASTIC CAP
J
LOT 5
BLOCK
BASIS OF BEARING DERIVED FROM THE NW
CORNER LOT 4 T THE PC LOT 3. N56'17'2YE
277.98'(R) 277.,97'(M).
5
LOT 4
40,000 S.F.
LOT 3
TRACT B-2
TE
'. THIS LOT `,FRVI,-ED BY A CCMMUNIC% WATER SY,TEM
THC; SUPVEY FEPRFSENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY,
S
ThDi,(VENT DOE' NOT CGN'_DTUTF_ A ROUN)ARY `IJR Y & IS SUBJECT TO ANv
INA CIIRAI iE. THAT A SUBSCOUENT 60UNDART SURVEY MAY DI-0EOSE
/I
1"=50'
EX It)SInN NOTE IT IS THE RESPONSIBILITY Oh THE C)WNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS
OR RESTRICTION, WHOCH DO NOT APPEAR ON THE RECORUFU SUBDIVISION PIAT. UNDER NO CIRCUMSTANCES SHOULD
AN, DATA HEREON PE USED FOR C `NSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE I.MES.
AS -BUILT 4kASK P.O. BOX 2749
OF A�gJ F9645
M'� TA(9- PHONE: (907)745Rtm PALMER, ALASKA 9 0222
ENC r EE /NC.
`.1 9 � FAX: (907)746-0222 F.B. 04-14
.tr49TH ..•'
. ,,,,,,,,,,,,;,,, W.O. 0400225 DATE: 9/1/04 SCALE: 1 " 50' 1 FILE: 04-00225AS
I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGE
INSPECTION ON THE FOLLOWING DESCRIBED PROPERTY:
.Rob rt J. Former : o LOT 4, BLOCK 4, THE TABLELANDS SUBDIVISION
Nif4f•• 10615-5 PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK
O pROrCis IOM�L �'+0 EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.''_ DATED AT ANCHORAGE,
ALASKA, THIS 13th DAY OF SEPTEMBER, 2004.
FLs9 0 6 M
i ?(SPHALT PEDESTA
D/W TYP..
M
COVERED
DECK CANT.
U.G.
w
JZS�� ir'i
/ NAT'L
UTIL.
L,Jm
\5
q63
GAS
c
ONE STORY yi
(
DWELLING
SEPTIC
FOUND RISER
�
5/8•
TYP.
REBAR TYp.—�
ai 5t'1
s DECK
C)�
l
1 \
1\
LEGEND.
(C)=CALCULATED DATA
(M)=MEASURED DATA -
(R)=RECORD DATA
U.G.=UNDERGROUND -�
TYP.=TYPICAL�O\
YPC=YELLOW PLASTIC CAP
J
LOT 5
BLOCK
BASIS OF BEARING DERIVED FROM THE NW
CORNER LOT 4 T THE PC LOT 3. N56'17'2YE
277.98'(R) 277.,97'(M).
5
LOT 4
40,000 S.F.
LOT 3
TRACT B-2
TE
'. THIS LOT `,FRVI,-ED BY A CCMMUNIC% WATER SY,TEM
THC; SUPVEY FEPRFSENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY,
S
ThDi,(VENT DOE' NOT CGN'_DTUTF_ A ROUN)ARY `IJR Y & IS SUBJECT TO ANv
INA CIIRAI iE. THAT A SUBSCOUENT 60UNDART SURVEY MAY DI-0EOSE
/I
1"=50'
EX It)SInN NOTE IT IS THE RESPONSIBILITY Oh THE C)WNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS
OR RESTRICTION, WHOCH DO NOT APPEAR ON THE RECORUFU SUBDIVISION PIAT. UNDER NO CIRCUMSTANCES SHOULD
AN, DATA HEREON PE USED FOR C `NSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE I.MES.
AS -BUILT 4kASK P.O. BOX 2749
OF A�gJ F9645
M'� TA(9- PHONE: (907)745Rtm PALMER, ALASKA 9 0222
ENC r EE /NC.
`.1 9 � FAX: (907)746-0222 F.B. 04-14
.tr49TH ..•'
. ,,,,,,,,,,,,;,,, W.O. 0400225 DATE: 9/1/04 SCALE: 1 " 50' 1 FILE: 04-00225AS
I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGE
INSPECTION ON THE FOLLOWING DESCRIBED PROPERTY:
.Rob rt J. Former : o LOT 4, BLOCK 4, THE TABLELANDS SUBDIVISION
Nif4f•• 10615-5 PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK
O pROrCis IOM�L �'+0 EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.''_ DATED AT ANCHORAGE,
ALASKA, THIS 13th DAY OF SEPTEMBER, 2004.