HomeMy WebLinkAboutTHE TABLELANDS BLK 4 LT 16The Tablelands
Block
Lot 16
#051-801-08
Municipality of Anchorage Development Services Department
U141?V
Building Safety Division '=
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650 Page of
wwwc.anchorage.ak.us (907)343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
Permit Number. SW040109
_
PID Number:
Addmaw Troy Davis Homes Wastewater System: Q New ❑ Upgrade
1451 E. Parks Hwy, Suite 207, Wasilla, AK 99654
ABSORPTION FIELD
• 357-9394 Nuneer or 6eM1eoine
4
Dt1e.a TmM ❑swwTnea ❑' BM
❑Lb,m ❑�
LEGAL DESCRIPTION
Sm' R.ey: 0.40
T'a"D "'""""00"N"�•^•
swe. . The Tablelands
4 16
opomt.
t>.F" ""a wweeomwv"WaI
4.0
Cn (10amh. od,III Ft.
TO""'^"' R•^Y•' Seam:
3.5 Ft.
Fe eafW eooe enp,W ie"e:
0.5 Ft.
Gn v« Lergin.
Well: ❑ New ❑ Upgrade
0.0 Ft.
w. """"` 18
64 Ft.
Ruro«olrre Detmaeeteeene"ee
CbFtrMaw" (Fm«e, A 8, Ck TM Depn; u..a b:
community water
Ft.
Tai care vase �•'
3 6 r
NO McNI
Ft. FL
DrNr
1,512 Fe
PVC
Dam aew: stnnw««LM:
6441116,'DeM
nmra:
FL
v.a:
Roya—Cm Ajfta.omak.
5/27/04812/13/04
Fmp 5« at;C•uq Neplit Aoo.e clow:
GPM FL
TANK
SEPARATION DISTANCES
OSeptic []Holding ❑S.T.E.P. ❑ottef
To Septic AbsorptionMub"IPdvate
From Tank Field r Line
•�« r
Greer
1,250 Gy,
w«
na
na
WI
Steel
"'"°"ay.:
2
Swf•"•w•w
na
na
LIFT STATION
L«tN.
>10'
3'
>5�
>10,
'Pump m' Iw« eLFpegelgn
Pnarr.ei«nana
PoriaMYeeMmel
Eycbry."p."torep«I«mgpt.;
Ra~m:
2" Insulation over all sewerline and tank.
BENCH MARK
Avg pert rate is 24.1 minrnch.
L°��"e a0iap�
Bottom of MT (NW MT) (temp BM)
Waiver approved for lot line setback. (yA*A 'P
t
•w"
100 FL
�E�,��K�arrpP
E OF At.j
Inspections performed by: Kent sheets, AK trim Engineering, tnG Dates: 1' 5/27/04
2ne 12/20/04
t
Developmnt Seryices Department Approval
�; Mary Shreves
Reviewed and approved by Date: ®
'Vsr'••
�c•ftoe CE 935:
tR... rzml
I F ,
''''/l
````
l l
11111\\\\�',
0
1,2 0 -GAL
SEPTI TANK
Ln
b,
CO3 IV
10 2.0 �8• `V X30
i� C01 .8.4 8"v�
20 10
•
N U6'
W
51
-I�EPLACEM
SEPTIC SYSTEM[ PLOT PLAN
0
TION • M
'\A�KT113
TH2
NT BED
FIXED
unk ft, FINAL GRADE FINAL GRADE 105.0+ft. 104.0+(t,
n n nn Rn
01.8
100.5
100.0 ft.
DATUM (TEMP.)
SEPTIC SYSTEM PROFILE
aDDODpp ASx P.O. BOX 2749
SEPTIC ENC &RIM INC.PALMER, ALASKA 99645
d PHONE: (907)745-0222
9 �0 FAX: (907)746-0222
TH••.�t: DD W.O. 0400123 1 DATE: 1/1 2 04 SCALE: 1" = 20' 1 FILE: 0400123_1
D
. L.•Shreves . -� LOT 16, BLOCK 4, THE TABLELANDS SUBDIVISION,
CE 9351 v�d PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE,
ROFESS10N�oop RECORD OTHER H
AN RECORDED PLAT ARE NOTSHOWNHEREON. SHOWN ON THE
-WxTER
VALVE
' — —UTILITY ��
PEDESTALS
LOT 17
1 "=40'
CO2
CO3
0
N
30.
o
LOT 16
40,000 S.F.
EDGE Or BlUrr
25>+
� %25%+
TYPICAL \
Col CO2 CO3 C04 MT1 MT2
A 10.96 16.43 25.31 76.68 20.31 79.21
B 26.57 28.72 30.89 61.70 26.99 64.59
C -- 57.13 55.13 N2.1 . 52.61 45,. S
SITE PLAN
AS BUILT _
49TH
_ �, 0 W.O. 5740ot23
S85'20' 42" W
257.+
BLOCK
LOT 15
LEGEND:
(C)=CALCULATE
(M)= MEASURED
(R)=RECORD Di
U.G.=UNDERGR(
'NER OR BUILDER, PRIOR TO CONSTRUCTION TO VERIFY PROPOSED
(TIES CONNECTIONS AND TO DETERMINE THS EXISTENCE OF ANY
OT APPEAR ON THE` RECORDED SUBDIVISION PLAT.
as P.O. BOX 2749
PALMER. ALASKA 99645
E Y JNC. PHONE: (907)745-0222
FAX: (907)746-0222
NTE: i/=o os SCALE: 1" = 40' 1 FILE: 0400123_WW-1J1S
L. Shreves 9 LOT 16, BLOCK 4, THE TABLELANDS SUBDIVISION,
9351PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE,
EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
FEssiol od RECORDED PLAT ARE NOT SHOWN HEREON.
y.em..nf.
2w4. W.
BED DETAIL
Not.: No ln. lauon
�y
SSP•
tl 49TH
I .ul.uo.. Y u..d
... not. 2
ABSORPTION BED
PLAN VIEW
BED SECTION
n
v
y.flOrotd rvC
nal. Mml.u..
(nolo Oo..)
SECTION X -X
.uoo...nl.
••v
2rouod .urf.p
///
PVC y..ter.t.d
MONITOR TUBE
DETAIL
AS BUILT AASK4 P.O. BOX 2749
DETAILS ENC ' Rim INC. PALMER, ALASKA 99645
d , PHONE: (907)745-0222
*din FAX: (907)746-0222
W.O. 04001231DATE: 1/1
FILE: 0400
L. Shreves
C 9351 . �p LOT 16 BLOCK 4, THE TABLELANDS SUBDIVISION,
E �'d
PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK
°ROFESSI�pdd" EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
SOO000� RECORDED PLAT ARE NOT SHOWN HEREON.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 9951M650
www.muni.orgtonsite
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: Alaska Rim Engineering Inc
Legal description: The Tablelands Subdivision Block 4 Lot 16
The attached paperwork has been reviewed and is being returned for the following reasons:
® Original signature or stamp missing on _last pane of Inspection Report
❑ Calculation error In design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate. —
❑ Discrepancy in information submitted. _
❑ Topographic information missing or inadequate.
® Incomplete; missing Need to provide septic system profile with elevations
❑ Incomplete; missing
❑ Additional adequacy test information needed. _
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils Information submitted. _
❑ Well log required.
❑ Omission in narrative. _
® Insufficient fill over tank or field. The finished nmelo nv......„a
Name of reviewer. Julie Makela. P. E. Date: 1/12/2005
Please supply the necessary information and re -submit your request.
Of.
P.O. Box 190650 . Anchomge, Alaska 99519.6050 • Telephone (907) 313-8, , • FaX (9(17) ai 8200
4700 ilmguw• S(net • Anchom9c, Alaska 99.507
Mayor Mark BeyicIt
Alaska Rim Engineering
P.O. Box 2749
Palmer, Alaska 99645
%MV.mnnl.org
Building Safcty Division
Subject: Waiver Request for The Tablelands, Block 4, Lot 16
Waiver Request #WR040099
Parcel ID #051-801-08 (051-741-47)
Permit # SW040109
Dear Mr. Charles Leet:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to the property line has been approved. -The approved separation distance
is 6.0 feet. The redesign of the'abs&ption field is also approved. The redesign of the
absorption field includes the additioli of 9 feet on the eastern portion of the existing bed
in order to meet the minimum size requirements for the single family dwelling.
This waiver approval applies,to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this"department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
1
Julie Makela, P.E.
Civil Engineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
• �' Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WR040099 PID#: 05180108 HAM _ Permitg: SW040109
Date Received: 12/30/2004 Mt- Hyl' &i1
Legal Description: The Tablelands. Block 4 Lot 16
Engineer. Alaska Rim Enaineerina
Palmer. Alaska 99645
Applicant Trov Davis Home
Waiver Requested: 6 feet from absorption field to lot line
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
01711
...............................................................................
Waiver is Granted: —ll� Waiver is not Granted -
List Conditions or Reasons for above:
Date:Ja?/'�/ By:
•u.fffuf u.f u.uuuu•uf•uf ufffffff faM or Reviewer
Reck _ Amount: $175.00 Date Paid: 12/30/2004
I8cW611
A• .
t�iQQS�'Q
engine/�/ting; enc.
Phone (907) 745-0222
Fax (907) 746.0222
akdm@rogorshsa.com
December 29, 2004
Ms. Julie Makla
Municipality of Anchorage
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
RE: Lot 16, Block 4, Tablelands Subdivision
Request for Lot Line Waiver and Redesign
Dear Ms. Makla:
P.O. Box 2749
Palmer, Alaska 99645
We are writing to request a waiver of the 10' distance of the soil absorption system from the
lot line and have included a check in the amount of $175.00 for the lot line waiver fee. This
waiver is required, as the initially designed 18' x 75' absorption bed was undersized and to
met MOA requirements the size of the absorption bed must be increased to an 18' x 84'
absorption bed. Due to the increase in absorption bed length the cast end of the absorption
bed will be within 6' of the east lot line. We have included a drawing showing the
relationship of the redesigned absorption bed to the lot line.
Design Summary
The original 18' x 75' absorption bed was designed using an incorrect application rate of 0.45
gpd/sgft. The correct application rate is 0.4 gpd/sqft for the percolation rate of 24.1 minutes
per inch. This application rate was derived by averaging three perk tests.
AK2 52.6 min/inch
AK 3 9.6 min/inch
TSL15B4 10.0 min/inch
Average 24.1 min/inch
Using this application rate the required size of absorption bed is 18' x 84 feet. The other
design factors remain the same and are contained in our original submittal.
Engineers • Planners • Surveyors
Lot 16, Block 4, Tablelands Subdivision
12/29/2004
Page 2 of 2
Surrounding Properties
This property and the parent subdivision will be served by a community water system. We
are unaware of any adverse affect this waiver would have on any adjacent wells or septic
systems. Development on this lot will not preclude the development of septic systems on the
adjacent lots. There should be no other adverse effects to the development of any adjacent
lots.
If you have any questions regarding the above please contact me.
Sincerely,
ASKA R[M E�RING, INC.
arles A. Leet, P.E.
Professional Engineer
CC: Troy Davis Homes
AK Rim File No. 04-00123
Municipality of Anchorage
Development Services Department
Building Safety Division
.a.t
On -She Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 995196650
www.muni.orglonsfte
(907) 343-7904
y L. Shreves
CE 9351 ,
Soils Log - Percolation TestPaorEssto;�����
Perfomred For. Troy Davis Homes Date Perlomred: 8/31/04
Legal Description: Lot 16, Block 4, The Tablelands Township, Range, Section:
JKtrt3
Dejet
F
2- o
3-
.a
4'
5-
6-
7-
8-
9-
10-
1 t-
17-
5aws{ygrsved w� �rgCc
' WAS dROUND WATER
ENCOUNTERED? No
IF YES• AT WHAT DEPTM
Depth to WaterARer
MonxorNg?
Date:
S
L
O
P
E
rran
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1
8/31/04
1418
30 min.
9.1/2 riches
2
—
1449
30
9-1/81n.
3
—
1520
30
9-1/8 In.
3-1/8 in.
PERCOLATION RATE 9.6 PERC HOLE DIAMETER amd
TESTRUNBETWEEN 4.0 Fr AND 5.0 Fr
COMMENTS Presoak 4 hours. Percolation teat oNy.
PERFORMED BY: Kant Sheets. AK Rlm Engineering, Im I Mary L Shreves, P.E. CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1219/04
WI S p E �p °rA
05
1RCH�
g8'C / 5/8" RENDB
WvL,w/YPC 4094—
S
0B 30'
\
TYPICAL
UTILITY
PEDESTALS
1 "=40'
LOT 17
IT
�,—WATER
VALVE
LEGEND:
` (j N.`�• N (C)=CALCULATED DATA
(M)=MEASURED DATA
(R)=RECORD DATA
U.G.=UNDERGROUND
50 -GAL
IC TANK
CO2 T1 \8X84
`�O
B0
W
241 BEi
LOT 16
40,000 S.F. \`
DF BLUFF 25
EDGE 257+
\\ 25%+ \
�Y
BLOCK
LOT 15
N�AbILIIY Ur ]HE OWNER OR BUILDER. PRIOR TO CONSTRUCTION. TO VERIFY PROPOSED
HED GRADE AND UTILITIES CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY
ICTIONS WHICH DO NOT APPEAR ON THt RECORDED SUBDIVISION PLAT.
SITE PLAN ALASK P.O. BOX 2749
ALMER, ALASKA 9645
ENC/�EE,M INC. PHONE: (907)74590222
FAX: (907)746-0222
W.O. 0400123DATE: 12/27/04 SCALE: 1 " = 40' 1 FILE: 0400123_WW-I-AS
LOT 16, BLOCK 4, THE TABLELANDS SUBDIVISION,
PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE,
EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.
MUNICIPALITYOFANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW040109 ��- rr►aPuMos Ky trrt;
Legal Description: OLE -NN VIEW-E6TATE-9-NQPTf4=F
Design Engineer: 0032 Alaska Rim Engineering
Owner Name: Troy Davis Homes
Owner Address: 1451 E. Parks Hwy, Ste 207
Eagle River. AK 99577 -
Date Issued: May 07, 2004
Expiration Date: May 07, 2005
Parcel ID: 051-801-08
Site Address: 23210 WHISPERING BIRCH DRIVE
Lot Size: 40000 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Private Well
❑ E] 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 15.65 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.
5. The following special provisions.
THIS PROPERTY IS CURRENTLY CALLED GLENN VIEW ESTATES NORTH TRACT F BUT HAS BEEN ,
'OFFICIALLY SUBDIVIDED TO THE TABLELANDS S/D BLOCK 4 LOT 16 ;
Received By:
Date:
Issued By�
Date: V17-/014
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.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
ZD
O 1 - 8of — oB (6lemv ✓JEW Fs 4. NodA 7-a x)
Parcell.D. Osf — 77-N1 —.r/7 (TNF ZftE EL!! 8y t/6i Permit Number SWoc/olo9
Property owner(s) Troy Davis Homes Day phone 357-9394
Mailing address (1) 1451 E. Parks Highway Suite 207
Mailing address (2) Wasilia, AK Zip Code 99654
Legal description (Lot, Block & Sub'd.) Lot 16, Block 4, The Tablelands Subdivision
Legal description (Section, Township & Range)
Lot Size 40,000 sqft Acres/Sq.Ft. Number of Bedrooms 4
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 ❑
I 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.
(Signature of property owner or authorized agent)
Permit Fees: % 0 Waiver Fees:
Date of Payment: -6-- 7 0 T Date of Payment:
Receipt Number: J Receipt Number.
(Rev. 12/00)
(AVaagh
T1111
2119illeehing, 911c.
Phone (907) 745.0222
Fax (907) 746.0222
akHmOrogershsa.com
May 5, 2004
Mr. Dan Roth
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water and Wastewater Program
PO Box 196650
Anchorage, AK 99519-6650
RE: Lot 17, Block 4, The Tablelands Subdivision
On -Site Sewer Permit Application
AK. Rim Engineering Ref. No. 04-00123
Dear Mr. Roth:
P.O. Box 2749
Palmer. Alaska 99645
The owner of the above referenced lot is proposing to construct a 4 -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 letter we are requesting
plan review and a permit to install an onsite septic system to serve the proposed
development.
DESIGN SUMMARY
Soils
A test hole was excavated on February 25, 2004, and a monitor tube installed. A
percolation test was conducted in the same location on the property on February 26,
2004. The proposed drainfield will be designed around the 30 -feet radius of the test
hole. The attached Soils Log — Percolation Test form shows the approximate location of
the test hole, labeled TH #2. The soils were rated in the field as SM, silty sand. The
percolation test indicates a soil percolation rate of 52.6 minutes per inch which translates
to a wastewater application rate of 0.45 gpd/sgft.
Groundwater was encountered at 11.5 feet below ground surface during the initial
excavation of the test hole. On 3/3/04 and on 4/2/04, the monitor tube was probed and
groundwater was detected at 11.5 feet below ground surface on both occasions.
Trench Design
The following is a summary of the proposed design of the trench SAS:
Percolation rate: 52.6 minutes/inch
Soil application rate: 0.45 gpd/sqft
Engineers • Planners • Surveyors
Mr. Dan Roth, MOA
Page 2
May 5, 2004
Number of bedrooms:
Daily wastewater flow:
Drainfield:
Septic tank:
Minimum absorption area:
Total depth (max):
Effective depth:
Width:
Reduction factor.
Minimum length:
Effective absorption area:
Topography
600 gpd
5 -wide type drainfield
1,250 gallons
1,334 sqft
6.5 ft
4 f
5 f
0.50
134 ft (2 — 67 ft trenches)
1,340 sgft
The attached topographic map shows this lot to be relatively flat throughout the north half
of the lot, then sloping down steeply with slopes exceeding 25% on the south half. There
is adequate usable area for an onsite septic system and replacement system.
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,
ALASKA RIM ENGINEERING, INC.
Ar
Mary L. Shreves
Professional Engineer
CC: Troy Davis Homes
AK Rim Engineering File No. 04-00123
Attachments:
• MOA On -Site Sewer/ Well Permit Application Form
• MOA Soils Log — Percolation Test Form (2)
• Septic System Plot Plan (3 pages)
OF
fL. Shreve*
CE 9351 -
Municipality of Anchorage
Development Services Department
Building Safety Division
+.1 Onsite Water and Wastewater Program
1 4700 South Bragaw SL
P.O. Boz 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Solis Log - Percolation Test
Performed For. Troy Davis Homes Date Performed:
Legal Description: Lot 16, Block 4, The Tablelands Subdivision Township, Range, Section:
ffKTlt�j
Depth
(Feet)
1- 5111`
fcvlr— s -
T `l' 7-
Q 11
12-
.V0.d'LY
5l LP5 13-
14-
15-
16-
17-
is-
19-
20 -
COMMENTS
hi►>�yyarldwf IVAVd,
5ca crcd covm►rs, gY><y,
�Od •da4thf/�ili9h+Ly
w1�i�iF tyM)
1�10y ��dwIttakt�ASGROUNDWATER
'X-10 rfA C01,4 It* ENCOUNTERED? Yes
oilwepIrtt d" SL
If 7 IF YES, AT WHAT DEPTH? 11.5ft
�•+Y 'jr Depth to Water After e
Monitoring? 11.5 R E
``✓✓ J E
Date: 3/3/04
Df
III
'y(L. Shreves
CE 9351
J.
Reading
Dale
Gross Time
Net Time
Depth to Water
Net Drop
1
2/26/04
1449
10 min
6 8116 in.
8/16 in.
2
—
1500
10
64/16
4/16
3
—
1511
10
164/16
4/16
4
—
1527
10
64116
4/16
5
—
1533
10
63/16
3116
6
—
1544
10
631
3/16
• �••""`^•. .1 ^^, l MHU MULE DIAMETER 6h
TESTRUNBETWEEN e3 FT AND 6.5 FT
PERFORMED BY: Kent Sheets, AK Rim Engineering, Inc. I Mary L. Shreves, P.E. CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3/11/04
I'.eI• L.a U7 VJi aJea Iroy uavas nn
au roJ iaaaa p, 2
- 112r 25 04 O0:43a Rick 307-357-SG41
Municipality of Anchorage
Development Services Deparlmenl
W1,11,9 Safety Dw on
O A -e on.Sto water ww Waste.ralerplop.s.n
' e7003a+th Brapavr Sl
P.O. Boa 196650 Anchorage. AN 995195635
.....v. 62nehvan. sky,
1907) aa119N
Soils Log - Percolation Test
:*rrneaFu- AIZC 11C 0EVCD
e 100SU'DIen: Ot E Nlax
V 1 t=yL f�lo(Z�tl T DRi
LD Ti 14 SK 7 r --r— r-7--1
09DIN
o'
/ va-
I
5--L-3C- iL4
ur11'T"4J K
17•w ct
t'1 L
lborvo" or
4{o l -a
Date Perfonneo: 3�X•r'o yl ::
WAS GROUND WATER 1
ENCOLae:EREDF Nt>
S
iTES.ATWNATDEPTMT G i
WPAaeW Ah.r r I I
ItwlM...27 [
Daw
Hea,%N
Date
Gm's Time
Nel Time
Depth q Water
Ne: Droa
FtLL-
RE 40AV
1
I:la
1
I
.inLLiA. V..N.e lu PERCNOLE01"EIEP _ b R
IESTPLWeETWEE.+ 1, Fr A --L rt
-ILCTORLIED BT 1. S, I 1 . S. CERTIFY TlY-. Twc TEST 1'I:.L
Pr -101,040:00 ACCORDANCE WITH ALL STATE AND MUNICIPAL GU1DELIKES W EFFECT ON TN:S DATE. DATE 3 -.27-oz-
i
PtRMIT NUMBER
PID NUMBER
D3.ZZ �1 w 1NGS
PROPOSED
TWO STORY
PROPOSED
DRIVEWAY 1�5,� 16. _ 6' w DWELLING
v IZN 10
V7 U C
� r0 0.
N CIN
w X11 40
� 03
y1
ZABLE FLOW
SPLITTERN �21c
OR EQUAL Ln 1
CD
O
1
LOT 17 1
1"=40'
C.2
gL9�9DD�
49TH
1 /.........
:,, Mar L Shreves
�QO�fD CE 9351.
BLOCK 411
V50 0.
EDGE OF gWFF 257{
257.+ \
257•+
LOT 16
1 40,000 S.F.
1 \
1 �
1 _
_ 10' BUILDING SETBACK _
585'20'42' W
LOT 15
TO VERIFY PROPOSED
EXISTENCE OF ANY
PLAT.
SITE PLAN AAS P.O. BOX 2749
juy I PALMER, ALASKA 99645
ENC EE INC. PHONE: (907)745-0222
FAX: (907)746—
W.O. 0400123 1 DATE: 5/5/04 1 SCALE: 1" = 40 FILE: 0400123
LOT 16, BLOCK 4, THE TABLELANDS SUBDIVISION,
PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE,
EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.
1 OF 3
PERMIT NUMBER
1 "=30'
PID NUMBER
w. �
O 3�
0015 w. 4' 4' g 0` \O.
O Ys 0 8 2.0° '(9• C1.
8'4.8'0 X584 \
�1) \ Z
�1W CEMENT �
IJ � to REP1-A p\
rn 40 R30't 2 x 9' 50.63
FLOWN 25 0
LIT�.
TER
QUAL cP 1 50' \�
)
ry 1 �
r 1 EDGE OF BWFF 25%t
25%+ \
SEPTIC SYSTEM PLOT PLAN
a f = .t
..a
.e..mu..
(... D.t�-&-t 8)
SEPTIC SYSTEM PROFILE
44�ooDDDD�q SEPTIC A9645
S P.O. BOX 2749
P� •OF• A419 pDo ENC EE INC. PALMER, Rulm HONE:(907)7459 02 2
S;• 9 d0 FAX: (907)746-0222
fir; 49TH ..••:*D0 W.O. 0400123 DATE: 5/5/04 SCALE: 1" = 30' FILE: 0400123
A 1000600".
v%: Mor L•Shreves•••LOT 16, BLOCK 4, TABLELANDS SUBDIVISION,
>�lf.• CE 9351_� PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, At
��QlZd�PROFESSI�?�d� RECORDED PLATEASEMENTS OF RARE NOT SHOWN HEREON.ECORD OTHER THAN THOSE
SHOWN ON THE
2OF3
PERMIT NUMBER
pad ..t.d a• r7e
w NW I
e/4' a r
w.ar ..ek
a.wl mwlt.r as .
at a a twee
la.all alwwat at
won aad of drain rtro
yGN'/` V<i /`Y/lI I
wuda• M. ow.
.r r2 &m 40 2 0 67'
NMa 1: b w mae m Iml
1attaa "i..! o.olr erre w.nu.n)
TRENCH DETAIL
N.a ! Ml/W
n... mlvlm® .f "aad .f ea
M ..Wuwt" t. w. tad of aarW .)
tq a • m.>lmnm M tar aoaw a b m.
Moa i meal.® aM v. m
emtb &a orda 7 fa
Note 4: Nd ..d
WIDE DRAINFIELD
PLAN VIEW
Alf.c. EM. 40.0'
// / / /
uwd faR t aW
..uan'
p
EM. 37.0'
TRENCH SECTION
PID NUMBER
5' t
r..r...t.e red
beta anwat•m
SECTION X -X
11111
I�Ilhv
MONITOR TUBE
DETAIL
a
SITE PLAN AASO P.O. BOX 2749
222
S�P�E a�F • A�q �aOd ENC EE y •INC. PHONE: (907)7459 645
*; 49TH *�0 FAX: (907)746-0222
��;;��;•••� •••�.••.•• W.O. 0400128 DATE: 5/5/04 SCALE: ntsI FILE: 0400
y L Shreves 0o
CE 9351• • `d LOT 6, BLOCK 8, THE TABLELANDS SUBDIVISION.
• �, PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK
ROFESS15'cz!�' EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
�OO000� RECORDED PLAT ARE NOT SHOWN HEREON.
OF 3
.rfwu.a dapl!
L M. 33.0'
.nel.lmnad
Y
..rtn
i
q
dour 2e.s�
Y""°aai nyn
{
awod..t�
•6
v wWa L
8UMV ra
TRENCH SECTION
PID NUMBER
5' t
r..r...t.e red
beta anwat•m
SECTION X -X
11111
I�Ilhv
MONITOR TUBE
DETAIL
a
SITE PLAN AASO P.O. BOX 2749
222
S�P�E a�F • A�q �aOd ENC EE y •INC. PHONE: (907)7459 645
*; 49TH *�0 FAX: (907)746-0222
��;;��;•••� •••�.••.•• W.O. 0400128 DATE: 5/5/04 SCALE: ntsI FILE: 0400
y L Shreves 0o
CE 9351• • `d LOT 6, BLOCK 8, THE TABLELANDS SUBDIVISION.
• �, PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK
ROFESS15'cz!�' EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
�OO000� RECORDED PLAT ARE NOT SHOWN HEREON.
OF 3
Municipality of Anchorage
Development Services Department
• �.r 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
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Alaska Rim Engineering, Inc.
Legal description: The Tablelands Subdivision, Block 4. Lot 16
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
® Calculation error In design. The drainfield
�q irement for a bed design. t\0aa %1&
❑ Additional soils information needed. _
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate. _
❑ Incomplete; missing _
❑ Incomplete; missing
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils information submitted.
❑ Well log required.
❑ Omission in narrative.
t0tZ)W (ibrK,5,r) w/ a
C, ® Insufficient fill over tank or field.
ana approvea prior to construction: and 69 -On-site wastewater disposal system must be
Installed by an approved installer.
Name of reviewer: Julie Makela. P. E.
Date: 8/18/2004
Please supply the necessary information and re -submit your request.
Municipality of Anchorage
Development Services Department
Building Safety DMsion
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page Of
www.ci.anchorage.ak.us (907) 3417904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40109 PID Number. 051-801-08
Troy Davis Homes
Wastewater System: ❑ New ❑ Upgrade
Baa«•:
1451 E. Parks Hwy, Suite 207, Wasilla, AK 99654
ABSORPTION FIELD
PPw,.: 357.9394 NwrttwpBi°� 4
13D•.FTwchC3ston"TmchEla.a 0m.4
LEGAL DESCRIPTION
s..RaM,°.0.45
T. D.ane°'""gWV° :
Gvaclr
4.0 FI,
ebtl� 4 tat 16
swewd The Tablelands
Ii.pTbpp.edbmepnpgn.Q•e.:
G.ra.w R•."moo"`
3.5 R.
0.5 FI.
7.wrrr•y: R+"P: S.c•al:
Fa •aC.a •Ee,. a�V'w V•a•:
Gma L•rgV,:
0.0 FI.
75 FI.
Well: ❑New ❑Upgrade
G""w
18
B, raww
owwwK•Mnw. MK
FI.
3
e FL
Cl (P W. A B. C);TdY
community water
Gwn Cn.a b:
Tpa.ewpeon •r.•;
p� Lyy„r.
FI. F,
1350 Fir
PVC
pe.r.
0.4pt.1b: Bl.I,c WMx LIMI;
YI.1•Il.r.
Roy Brown Constr.
ayy,�ya;
FL
5127104
Yra:
Pmp sa •1:
C"" PryM w+.•. GmuM:
GPM
FI.
FL
TANK
SEPARATION DISTANCES
ElSeptic [I Holding ❑S.T.E.P. ❑Other.
To
Septic
Absorption
Lift
Holding
ubfir/PMate
Inom
Tank
Field
Station
Tank
Sewer lens
Greer
1,250 Ga.
wa
na
na
na
na
na
wl.,,r:
Steel
N. a Caro.ro�w %.
2
swf• w.w
na
na
LIFT STATION
lam»
>70'
>10'
Y WM.
Nnana
W,
Fa.M.lbn
>5'
>10'
'PmF W. I .L
•Pnp•Irl..a.t
�•y, w•Iw •Irm •L
cwlnab.
na
na
P.q MW a Mall
EMcbCa vtsp w •.rl.,mq •1'
R« ;
2" insulation over all sewedine and tank.
BENCH MARK
Louw".,,a o..a,ywn.
Bottom of MT (NW MT) (temp BM)
.L.,.
00 FL
.t;a�usq�y
�.N`�OF Atq Ill.*,
• ••...
Mr
••
Inspections performed b , Kent Sheets, AK Rim Engineedng, Inc. M 5/27/04 *%• TH !*,, i
P Pe Y' Dates: 1
/ �..........._...
2n° _
Development Services Department Approval 'P ., Mar L. Shreves
c
Reviewed and approved by: Date: CE 9351 : •�a�`
-B
00.
UTILITY_
PEDESTALS
PROPOSED
DRIVEWAY
1 "=40'
'ter 49TH
_SET PK
TYP.
P POSED
TW
DWE LING
25'� ''•�e'
w
8. CO
3
w W p 4 9 0;
1o•
a w.o'O ?e• v
1.2 0 -GAL
%,*4.e.
TSLI 4
PTI TANK
co.
B
L O C
N 20'
18•X75' ABSOR N
10 o
W
0 BED
Fr
r
LA
�?0.
aM2
51
R EPLACEMENT BED
—
� LOT
51
O.
50
LO
u,
LOT 17OF B1 OF
EDGE,
25%+
25R+
LOT 16
40,000 S.F
.......... .
is' Ma�•Shreves
�n s: •. CE 9351
257.+
RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION TO VERIFY PROPOSED
IRESTRICTIONSAWHICH DOT NOTEAPPOEAREONOTH� RECORDED SUBDIVISION EXISTENCE OF ANY
SITE PLAN P.O. BOX 2749
AS BUILT wy PALMER, ALASKA 99645
ENCvk�
C. PHONE: (907)745-0222
Did FAX: (907)746-0222
W.O. 0400123 DATE:_8/10/04 SCALE: 1" = 40' ELLE: 0400123_WW_1JlS
LOT 16, BLOCK 4, THE TABLELANDS SUBDIVISION,
PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE,
EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.
OF 3 I
-GAL
TANK
FIXED
unk ft.
'S
V0. Ma • L Shreves
CE 9351 "
10'
N
I
W
,I 4 3,
W W 4' $ 0'
a' CA cb
20 +�8• ti'
A (9,4
20' CO• 18'X75' ABSOR
6' 0 BED
-, 'AKfH2
SEPTIC SYSTEM PLOT PLAN
FINAL GRADE
105.0+ft.
1
TSL1
CO•I\�
MT• O
FINAL GRADE
104.0+ ft,
100.5
\1 00.0 ft.
DATUM (TEMP.)
SEPTIC SYSTEM PROFILE
AS BUILTs P.O. BOX 2749
SEPTIC Juy PALMER, ALASKA 99645
ENC EE INC. PHONE: (907)745-0222
Odd FAX: (907)746-0222
,AW.O. 0400123 DATE: 8/10/04 SCALE: 1" = —2 O' Fli
LOT 16, BLOCK 4, THE TABLELANDS SUBDIVISION.
PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE,
EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
RECORDED PLAT ARE NOT SHOWN HEREON.
OF 3
�n�
BED DETAIL
ABSORPTION BED
PLAN VIEW
BED SECTION
..m..w rrc
SECTION X -X
Mo.r td
MONITOR TUBE
DETAIL
,�•�4gUpF A �D� AS BUILT S P.O. BOX 2749
a ��••••••••<q �a DETAILS luy PALMER. ALASKA 99645
SSP.••' J`I dD ENC EE INC. PHONE: (907)745-0222
• 9 d FAX: (907)746-0222
49TH �
n •••.�•:•••• D W.O. 0400123 DATE• 8/10/04 1 SCALE: nts I FILE. 04001
L Shreves f LOT 16, BLOCK 4, THE TABLELANDS SUBDIVISION,9351 •:ted PLAT No. 2004-25, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK
_d
FESSI�Pod" EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE
o....od RECORDED PLAT ARE NOT SHOWN HEREON.
161 8 9 7 •
!;t{ Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 APR A TIT:.
?AA\iCertificate of On-Site Systems Approval �<< s o� •Acv
b6 8 c 9
Parcel I.D. 0.51-8w-08 Expiration Date: Z. L
1. GENERAL INFORMATION:
Complete legal description The Tablelands; Block 4, Lot 16
Location (site address) 23254 Whispering Birch Drive*Chugiak,AK 99567
Current Property owner(s) Tracy&Michael Smith Day phone (405)664-0466
Mailing address
Real Estate Agent Janine Babusch Day phone 302-1035
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual
Individual Water Storage 0 Holding Tank 0
Community Class Well 0 Community ❑
Public Water System ® Public Sewer 0
WaiverNariance request pry Distance:
Received by:` Date: G4-elf'g
COSA to be released to the ineer, unless otherwise requested by the engineer.
COSA Fee $ 5:2(oWaiverWaiver Fee $
Date of Payment 111.2 J/i 3 Date of Payment
Receipt Number Q 2C-(C[6, Receipt Number
COSA# 66C.1 11(05 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: L+1 Z�f l( 9
00000� 0
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o QF / N
in accordance with the guidelines and regulations established by the Municipality of Anchorage ando� •. ..A7 •
industry practices. The reported results describe the condition of the system/s on the date/s of the Q •
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or Q • �►,�
encroachments may exist that were not identified during the evaluation. The operational life of all wells ,i * ; A r T •' V0
*
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q
groundwater levels (that may fluctuate during the year), quality of construction (materials and 0
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 A '•• e f A. .-.r�ess,
system/s;therefore, GEG makes no warranty(express or implied) regarding the future performance of VQ'�9 CE 795
the well or septic system. GEG makes no representation whether an alternative well or septic system V s • �•' •�c Q
can be installed on the property in the event either of the current systems fail to perform adequately in ()���,e •'� z 1.1:2 o
the future. The content of this report is for the sole benefit of the person/party that retained GEG to OQ aprofesslo(1°oa
perform the evaluation. Reliance upon the information provided in this report by any other person or 4��000000
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE /
), System #1 Approved for `7 bedrooms
/ t
System #2 Approved for bedroomsP\- \('OFg4yc,
Disapproved ,Q
Conditional approval for bedrooms, with the foil \in N-StTE c .
•
WASTEWATER
PROGRAM ,c9
Original Certificate Date:
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 Nitrate Advisory •
Septic System Advisory / Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10.12.doc
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; Block 4, Lot 16 Parcel ID: 051-801-08
A. WELL DATA AWWU
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (YIN) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (abo - •round) in.
FROM WELL LOG AT I CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESU :
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
enic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA *Pre—tank double cleanouts
Tank Type/Material Septic/Steel Date installed 5/27/2004-12/20/2004
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) *No Depression over tank (Y/N) No High water alarm (YIN) N/A
Date of pumping 2/1/2018 Pumper One Stop Pumping
C. ABSORPTION FIELD DATA *Below Existing Grade West MT/East MT
Date installed 5/27/2004-12/20/2004 Soil rating gg`.p.d./)2or ft2/bdrm)0.40 System type Bed
Length 84 ft. Width 18 ft. Gravel below pipe **0.5 ft.
Total depth*3.6/3.7+ft. Eff. absorption area 1512 ft2 Monitoring tube**Yes Depression over field No
Date of adequacy test 4/19/2018 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 1/Dry in. Water added 764 gal. New depth 3/5 in.
Elapsed Time: 1140 min. Final fluid depth0.5/0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date —
**West MT (MT1) extends approximatley 5.28" below invert of distribution line
**East MT (MT2) extends approximatley 11.28" below invert of distribution line
West cleanout (002) is approximaley 5.16" lower in elevation than the east cleanout (001)
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 & circui -.uirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: AWWU
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/se. ervice line Holding tank
• mal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation * Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line **6'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'4-
Curtain
0'+Curtain drain None Known Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC
F. COMMENTS
*ST1=9.5' from edge of pipe to foundation wall, ST2=10' from edge of pipe to foundation wall
*Wood fence over septic tank (see attached) **WR#040099
•
G. ENGINEER'S CERTIFICATION OF
0
certify that I have determined through field inspections and A ! THt *�0
review of Municipal records that the above systems are in • f
conformance with MOA COSA guidelines in effect on this
date. //)—.73J:f r: • •. Garnes:
Engineer's Printed Name JEFFREY A. GARNESS v01)%. E-79 vp
Date Li 1211//V •04eap o�=o
�o essio�a
#AECC884
(Rev. 11/05)
Municipality of Anchorage
O,•' •4.t
Development Services Department e
Building Safety Division )
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
4✓� w onsite
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel 1p.:. ° 51 _ L) HAA # 050010
Expiration Date:
1. ;GENERAL -INFORMATION
Complete legal description Lot 16, Block 4. The Tablelands
Location (site address or directions) 23254 Whispering Birch Drive, Peters Creek
Current Property owner(s) Troy Davis Homes Day phone 357-9394
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
1451 E. Parks Hwy, Ste 207, Wasilla, AK 99654
USAA Federal Savings Day phone 1-800-531-2265
10750 McDermott Freeway, San Antonio, TX 78288
REMax of Eagle River (Audrey Mason) Day phone 696.3887
16600 Centerfield Dr., Ste 201, Eagle River, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: •4
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class A Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ❑r
Individual Holding tank ❑
Community On-site . ❑
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.)
Certificatesare 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. l 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 AK Rim Engineering, Inc.
Address PO Box 2749, Palmer, AK 99645
Phone 745-0222
Engineer's Printed Name Mary L. Shreves Date
P
7 9
0% MaryW. Shreve$
5. DSD SIGNATURE /ZVsrF� CE 9351
JC Approved for L4_ bedrooms. �V7,Z�o 11„"`
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
r `HAA cnecldist:..::. x
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
gy; ��� , �i�ic ,o V e �i. Original Certificate Date:
I RA FEE J
57-56 fi Il -s-' a PSI`-
Fn 0102) ' //
,P�
ro
t'{ s p.E /o , �/
1'1 1 f1 Q .5510 hS O�� ti / FOUND \
1—' Q (; �JCl \ i 5/6' REBAR \
'131 1 v" e 1 •w9'�' i ' "'�C rrP1ICAL
LOT 14
WATER
_ — — — GnuTY ' VALVE \ y� 10 NAIL \
PEDESTALS VEREDGAS \
CO DECK 1.6 •' ��
�e
a
v
'-
U.G. o b CANT. BLOCK
' ELECTRIC TYPICAL
nA
r; Os
W ® DECK
'PIS TWO STORY
7
SEPTIC DWELLING
RISERS
iJD
TYPICAL
LOT 17
LOT 16
40,000 S.F.
BASIS OF BEARING DERIVED FROM
THE PT LOT 16 TO THE NE CORNER
LOT 14. S6146'15"W. 217.69'(R)
217.74'(M)
1
LOT 15
LEGEND:
(C) -CALCULATED DATA
(M) -MEASURED DATA
(R) -RECORD DATA
U.G.-UNDERGROUND
PT;POINT OF TANGENCY
TRACT B-2
OF SURVEY.
ANY
1r 50o
M
OR�R£B�RICTINOTE: IT WHICH 00 NOT RESPONSIBILITY APP
ONON E RECO DED ER SUBDMSMON PUT. FUNDER CNO CIR STANANy ECESMSHOULD�
ANY DATA HEREON 8E USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE ONES.
P.O. BOX 2749 PAGE 1 of
AS -BUILT RIM PALMER, ALASKA 99645
ENC EE INC PHONE:
FAX E (907)746 50222 -0222 F.B. 04-19
5;' 9s '50' FILE: 04�00123A5
;49TH*•.•.�*, W.O. 0400123 DATE: 12 13 04 SCALE: 1
I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGE"
INSPECTION ON THE FOLLOWING SUBDIVISION
ESCRIBED PROPERTY:
lIkRob J. Former LOT LOT 16,. BLOCK 4, THE TABLELANDSANCHORAGE' ALASKA.
10615-S 8 PLAT N0. 2004-25, ANCHORAGE RECORDING DISTRICT
*aciiiowA1` 1
EASEMENTS
CORDEDS OF RARERNECOR OTSHOWN HEREON. EON HER THAN THOSEDATED ATSHOWN OPALMER, .
ALASKA, THIS 14th DAY OF DECEMBER, 2004.