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Home My WebLink AboutTHE TABLELANDS BLK 8 LT 13The Tablelands Block Lot 13 #051-801-53 Municipality of Anchorage Page 1 of 3 Development Services Department Onsite Water and Wastewater Program 4700 South Bragaw Street P.O. Boz 196650 Anchorage. AK 99519-6650 www cl.anchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO40244 PID Number. 051-801.53 rpinell Homes S i Wastewater System: New 11900W. Northern Lights, Ste. 200 Anch. AK 99517 ABSORPTION FIELD r ' h 5' Wide Trench 345678 �B' 3 sw Rerc Tar D.M kwn aw.tr gr•e• LEGAL DESCRIPTION .6 GPD/F? 7 Ft. B10dt, ld. S.00 Deph to PP Orbe krn aper greee GnvM dph t r pve 8 13 The Tablelands 3 Ft. 4 Ft Te.ratvp n•rw• see F• eod.d a r.prel gree. D.e.r Lrpn. 1.3 Ft. 77 Ft. evl wan. !M•nb.r a Yn...O•ov.•n knee Well: AWWu water system 5 Ft. 1 - FL CWkhuian (Ptwr•. A S. C). Tar DephCe.Wp eW eworpwnrw 4r rW Ft. Ft 770 Fl ASTM 3034 PVC Onllef. D.t•Da Statc Wrr Lsv wataw Pisano's Dirtworks 812412004 FL F " set r c~V H.QN asst. Dtand TANK DPM Ft. Ft SEPARATION DISTANCES Septic To From Septic Tank Absorption Field Ldt Station Holding Tank hawpavate SewIff une Anchorage Tank 1,000 We$ >200' >200' WA NIA >25' Steel T. Three (2) sarrawatr >100' >100' WA WA LIFT STATION — NONE ON LOT La Lew >5' >10' WA WA Get FoLmlie n >5' >10' WA WA in in r alem ax „ None Noted P1 Gke M Eleck” kw,, d prlrtn.d by D w on. Ft" BENCH MARK =a Rear Deck NE Comer. 100.0 FL Engineer's Stamp *,tiwwwwaps 4440 Inspections performed by: T. Kimbrough Dates: 1r 8124104 ; 49th '� ••� 2nd 8124104 - -... DeDepartment of Health and Human Services approval P PP �• C� MICHAEL E ANDER" r No. CE -4381 = Reviewed and approved by: Date: •� �•• /p ;5;: Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit No.: SWO40244 PID No. 051-801-53 THE TABLELANDS SUBDIVISION LOT 13, BLOCK 8 40,001 S.F. S 81.03'42"E 256.21 A e St 33.5 50.2 52 38.7 54.7 , Ca 54.9 55.8 C5 74.8 84,1 ` M2 75.9 57.1 M, I N Ali ioli � I w I it I n Allemate Sita Sq i I F A I o st I O- to 00 m ® I i. O TH Throe Bedroom Noms I J 1 30, Q z GRAVEL DRIVE I ;., CD cs I b < o Mz I I I I z N I 80.1' I 1 N 89'56'06"E 252.84' PLAN AS -BUILT == 49th `_'• SCALE 1' - 40' i•_..._ _.._ ... ��;MICNKI E A"af:RSON � ��'; No. lxraet �� Permit No.: SWO40244 TBM Rear NE G 91.9 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Di—c-s'jl System or Well Inspection Report x r - X87.9 81.0' Dralnfleld Rock PROFILE AS -BUILT Scale: 1' . 20' 67.9'J ti N x U Page 3 of 3 PID No.: 051-801-53 X91.9 r r 49th NEL L ANDERSON No. EE�JBI g 11/17/04 _.•' C MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & 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 06, 2004 Expiration Date: Jul 06, 2005 Permit Number: SW040244 Parcel ID: 051-801-53 Legal Description: fTHE TABLELANDS BLOCK 8 LOT -13.1 Design Engineer: 0014 Anderson Engineering Site Address: 22502 SAMBAR LOOP Owner Name: SPINELL HOMES, INC Lot Size: 40001 SQ. FT. Owner Address: 22502 SAMBAR LOOP Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER, AK 99577 - This permit is for the construction of. ❑d 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 specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AACBO ). 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. Received By: Issued By: Date: Date: -7-6 - - 0 4 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.sk.us t" f (907) 343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING R& 4V� Parcel I.D. ()51— Fb I - 53 Permit Number SW n L O 2 q Ll Property owner(s) Soine0 Homes, Inc. Day phone 3445678 MMsa-iling address (1)1900 Northern Lights Blvd., Suite 201 Anchorage, AK 99517 Maifrng address (2) 2?,sbr� S&ry COY Lzw Zip Code Legal description (Lot, Block & Sub'd.) Lot 13, Block B. Tablelands Subdivision Legal description (Section, Township & Range) Lot Size 40,001 SF Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Three (3) Sewer Only ® 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. ry�< (Signature of property owner or authorized agent) Permit Fees: f �� w Waiver Fees: Date of Payment: :7- 6-0V Date of Payment Receipt Number. s 17 Sb Receipt Number. (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522.6779 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 13, Block 8, Tablelands Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer. The owner of Lot 13, Block 8, Tablelands Subdivision intends to construct a new three- bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic system to serve the new home. The subdivision is served by a community water system and no conflicts exist with adjacent septic systems or wells. The attached Site Plan and backup documentation identify the location and configuration of the proposed septic system and alternate site. The water service line is also shown. The current drainage pattern along with spot elevations are identified on the Site Plan. The drainage pattern will be maintained after development of this lot is complete. A test hole recently placed on the indicated silty sand and gravel in the area of the absorption trench. The accepting soils were tested and found to have a percolation rate of 30 minutes per inch. No groundwater was found during excavation and none was noted during the monitoring period. Our design includes the placement of a new 1,000 -gallon septic tank along with a 75' long by 5' wide by 4' effective depth absorption trench to collect and treat the sewage generated in the house. The bottom of the trench will be 7' below the surface. The distribution pipe will be 3' below the surface. A minimum of 3' of cover will be placed atop the trenches and a minimum of 4' of cover will be placed atop the new septic tank. The ground surface on the lot slopes at shallow grades from east to west as shown on the Site Plan. The absorption trench will be constructed parallel with the slope of the ground surface as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 10' from the water service Lot 13, Block 8, Tablelands July 3, 2004 Page Two proposed for the lot and on adjacent lots. It will also be constructed a minimum of 100' from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, wwt"L c Michael E. Anderson, P.E. Attachments U MICHAEL E. ANDERSON 'ty No CE -4381 / .. 90 2004-25 THE TABLELANDS SUBDIVISION LOT 13, BLOCK 8 40,001 S.F. Nlemete Ste Tx 4% S 21 I in ILj I � tar x 'I o r.v. I L 1,000 Gorton EL . 703.5 q r1 Septic Tank o' X 102' I Thrss Bedroom Horne SLOPE. �R +/_ I 101' x 75' Lang x 5' Wide x 4• Effective Depth Absorption Trench 4% W 252.84 SITE PLAN SCALE 1' - 40' 6 a2� A.C. DRNE I 10 I o X 102' 1 = I I I I I . I ee F SO'j 2004-25 THE TABLELANDS SUBDIVISION LOT 132 BLOCK 8 40,001 S.F. Alternate Ste TH 4z t�42 "E' 101' 1.000 Canon EL Septic Tank tot* x 7S' lag s S' Wide s 4' Effective Depth Absorption Trench 4% I � I 47 I � I O O X 102' I J Three Bedroom $ Home SLOPE - 2% +/— I j 30, Q EL SLAB 2I I h m �L A•C. CR!VE I o U) U Lj X 102' I z N 80'56'06"E 252.84 - SITE PLAN SCALE V - 40' ED NEL E AMOERSM No. CE-gEl j LOT 13, BLOCK 8, TABLELANDS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom House 5' Wide Trench System Perc. Rate: 30 Min./Inch 1,000 Gallon Septic Tank Application Rate: .6 GPD/SF 4' Drainfield Rock 3 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 750 SF Absorption Area 750 SF/5 SF • .5 (Red. Factor) = 75 LF Trench Length THEREFORE: Construct a 75" Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation In Trench to be 3' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Provide 2" of Insulation and T of Cover if Necessary. 5' Geotextile Fabric 4" Perforated PVC (Holes Down) TYPICAL 5' WIDE TRENCH NOTE: Drainfield Rock ECT1kiKI Grade Area Over Trench to Drain Away. Minimum 6' 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. Natural 2'5" Backfill 6" A / 5' Geotextile Fabric 4" Perforated PVC (Holes Down) TYPICAL 5' WIDE TRENCH NOTE: Drainfield Rock ECT1kiKI Grade Area Over Trench to Drain Away. Minimum 6' 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. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION' LOT 13, BLOCK 8, TABLELANDS S/D PERFORMED FOR- SPINFLL HOMES DATE: 6/23/2004 PROJECT No PARCEL ID#' TECHNICIAN: T.L. KIMBROUGH DEPTH TEST HOLE # 1 Ir«o 1 2 READING OB/OG DRY POORLY GRADED SANDS NET TIME (MINUTES) DEPTH OF (INCHES) NET DROP (INCHES) SP 3 6/23 1 4 8" 2 2:15 6 6.75"" 1.25" 7 3 MOIST GRAY SILTY -SANDS 30 5.75" W/GRAVELS SOME COBBLES TO 10' 8 4 MEDIUM COMPACTION 30 4.75" GM 9 10- 11- 12- 13- - 0111213 BOH 14- 15- 16- 17- I 4151617 1 SLOPE 0% 49th NEL E ANDERSON No. CE -4301 SITE PAN THIO g WAS GROUNDWATER ENCOUNTERED? NO ff YES O WILAT DTP741+ 4% DEPTH OF WATER AFTER MONITORING: NON[ DATE OF MONRORING: 6291Z DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH OF (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 6/23 1 1:45 8" 2 2:15 30 6.75"" 1.25" 3 2:45 30 5.75" 1N' 4 3:15 30 4.75" IN PERCOLATION RATE; 30 (MIN/INCII) PERC. HOLE DIA.8�INCHES) TEST RUN BETWEEN ._FT. and__L_FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT TIIIS WAS PERFORMED IN ACCORDANCE WITII ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 7/3/2004 ONSITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 13, BLOCK 8, 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 a new 75' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 7' below the existing ground surface. A separation distance of 10' from any water service and 100' between the septic tank and absorption trench and any surface water must also be maintained. A minimum of 3' of fill is required over the absorption trenches and 4' over the septic tank. In lieu of the required fill 2" of insulation and 2' of fill may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,000 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 13, Block 8, 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. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover 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 cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. Lot 13, Block 8, Tablelands July 3, 2004 Page 3 of 3 MATERIAL SPECIFICATIONS: Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Municipality of Anchorage • : On-Site Water and Wastewater Program • (907) 343-7904 t _ ' ..aI0 S A t C CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-801-53 Expiration Date: (0-- -N-g7---/9 1. GENERAL INFORMATION Complete legal description The Tablelands Block 8 Lot 13 Location (site address) 22502 Sambar Loop,Chugiak, AK Current Property owner(s) Heieren Day phone 854-0310 Mailing address same Real Estate Agent Anneliese Cooper Da � ”=;:»,-0310�� 3u /i 2. TYPE OF DWELLING: QMQR 2019 ® Single Family (w/wo ADU) ❑ Duplex c ti ❑ Multiple Dwellings (Single Family and/or Duplex) //as 8 9 `' 4J 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Received by: ,r--- ): Date: 313(( COSA to be released to the engineer,unless oth rwise requested by the engineer. COSA Fee $ -24 Date: Date of Payment 31221a Date of Payment Receipt Number 0571740 Receipt Number COSA# OOo D 1«O 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 3/22/2018 6. DSD SIGNATURE . `` z f, System #1 Approved for 3 bedrooms. 9 a System #2 Approved for bedrooms. rE". •`� L,:.,•:... .,. �" r. Disapproved. r: �� 3122%/ Conditional approval for bedrooms, with the followingsti ulaflons;� �'<' 1�� \AY OF* .•.- ON-SITE WATtK AND Vti WASTFWATER fi PROGRAM >� / By 1 "A.,v`-(-1 — Original Certificate Date: 3 z �R The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: ' COSA Checklist X Nitrate Adviso:ry•.' " Septic System Advisory Arsenic Advisory.. Well Flow Advisory Other COSA blue sheet 9-1-12.00c 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: 79 7 LE i-4416 S 88 a Parcel I D:Q S1 CPQ l S3 A. WELL DATA rI'4 Well type If A, B, or C provide PWSID# . Well Log (YIN) Date completed Sanitaryseal (YIN) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA yp 5 /' Tank F / Type/Material � 7�/C- 5TL�- Date installed o 2y/�9 Tank size /GID� gal. Number of Compartments Cleanouts YIN /` J (YIN) I / Foundation cleanout(Y/N) "f Depression over tank(YIN) High water alarm (Y/N) N Date of pumping -2-1 1 Pumper SO"`' 6tAA/ C. ABSORPTION FIELD DATA Date installed r721/01( Soil rating (g p 2 or ft2/bdrm) C. System type 7?�� Length 7 7 ft. Width .5 ft. Gravel below pipe X ft. Total depth f ft. Eff. absorption area 77161 ft2 Monitoring tube Depression over field N Results /) For -? bedrooms Date of adequacy test ...re///� Pass/Fail)(Pass/Fail) depth in absorption field before test /6- in. Water added /45".. gal. New depth?6 in. Elapsed Time: 30 min. Final fluid depth /' in. Absorption rate >= 1450 'f g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date • D. LIFT STATION AIA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off'level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: /\J A Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout . Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: OtBuildin foundation � Property line /D 71-- Absorption field 5 '-rL Water main /a '4.- Water service line / a l� Surface water /4 G ft Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line /o ' Building foundation /c `4- Water main /Q ( f .1 Water Service line /GP ri4 Surface water / OO (f Driveway, parking/vehicle storage .30 r^' Curtain drain Vi(/ Wells on adjacent lots ZOO ,74- . F. COMMENTS G. ENGINEER'S CERTIFICATION ....®�`t�,tl I certify that / have determined through field inspections and O, review of Municipal records that the above systems k4_!// "•" 9 4 y msarem r� � « . .� 5� conformance with MOA COSA guidelines in effect on this date. o*,tt€'MI;:;{:'r °i * Pa Engineer's Printed..?(ZN me c� jr•OF ' :r ."��1t Date . �z (ip u. ; I�, Steven \eV. g 14.(441 'o P 62 .' ��%6�� ''" • COSA yellow sheet_2-6-15.doc ( • • II 2004-25 THE TABLELANDS SUBDIVISION LOT 13, BLOCK 8 40,001 S.F. 5 8/ 3'42"E 258.21' ul Ti 0 ti 0 tM `F. i 8 iie utLaNc I--r n 30'IAT r GRAVEL DRIVE 1 .-------i I z b " I 7 L 50.1' I _. 111'=40' N 81:1•51Y0/3"E252.54' p.0•� nod 1 e,g a E/ e f/ 2.0.0 S.0' •^p 2.0'CNIT 0 w.CANT 7.0: 60• 6.i g, b 6.0' n 11:4 22.0' BUILDING DETAIL SCALE: 1"...20' A S-B U I L T I HERESY CERTIFY THAT I HAVE SURVEYED THE h— PROPEITTY DEPICTED ABOVE AND THAT NO *6 *rtl!!� GASTALDI LAND SURVEYING ENCROACHMENTS EXIST EXCEPT AS INDICATED. • PLG•05..4(6. JEFF A. GASTALDI, R.L.S. IT IS NE RESPONSIBILITY OF THE OWNER TO . . 4725 WEST 85TH AVENUE DETERMINE THE EXISTENCE OF ANY EASEMENTS, ,� :49Th ••%7-„ ANCHORAGE,ALASKA 99502 CovENA14T5 OR RESTRICTIONS WHICH DO NOT r APPEAR ON THE RECORDED SUBDIVISION PUTT. s PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA • .r vORID DATE HEREON BE USED FOR CONSTRUCTION OR FOR a• ••'10 •6"/°'41•. ESTABLISHING BOUNDARY OR FENCE LINES. •6•s• LS-6091 ‘;'ql NW1559 11/29/2004 ANCHORAGE RECORDING DISTRICT.ALASKA •/,p�......at�0��4'• F.B. JOB NO. "%11Rr** 04-14 TLSt38 NOTE; NO CORNERS SET THIS DATE. Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 051-801-53 Expiration Date: 1. GENERAL INFORMATION Complete legal description The Tablelands Block 8 Lot 13 Location (site address) 22502 Sambar Loon, Chugiak, AK G£ �4 'C APR 2 4 2015 a3 -Y71 Current Property owner(s) Russo Day phone 301-0701 Mailing address Real Estate Agent Hope Russo Day phone 301-0701 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: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Received by:� Date: COSA to be released to the engineer, unless otherwise requested by the engineer COSA Fee $ JrrZ(,o Date of Payment t4 12Ll105 Date of Receipt Number 66—b63A) COSA # Q '' !Sl1 ?q Receipt Number 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724 Eagle River Engineer's Printed Name Steve Eng Date 6. DSD SIGNATURE _\Z System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following ,a: 'Steven w ng•• PE By: S /0 t Original Certificate Date:✓ The Municipality of Anchorage Devlopment 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 Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12.tl c X Nitrate Advisory Arsenic Advisory Other 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: MqF 7,-4&Gm-4 adid S Z13 Parcel ID:d51—�'Q/_33 A. WELL DATA ?081- (C Well type If A, B, or C provide PWS ID # Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Collected by: ft. g. p. m. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed PIZ q Tank size IdOO gal. Number of Compartments Z Cleanouts (Y/N) V Foundation cleanout (Y/N) Depression over tank (Y/N) -A4 High water alarm (Y/N) _Al Date of pumping JV2?S Pumper C. ABSORPTION FIELD DATA Date installed_ zw-/0ySoil rating (g.p.d./ft2 or ft2/bdrm) 6 System types /7 Enreiy Length 77 ft. Width 5 ft. Gravel below pipe Total depth ft:: Eff. absorption area ]7a fe Monitoring tube Depression over field Date of adequacy test 41Z3113 -.Results (Pass/Fail) _ For- bedrooms Fluid depth in absorption field before test _4 in. Water added 1V50 gal; New depth_ in. Elapsed Time: 3D min. Final fluid depth 0 in. Absorption rate > !4 JI Cl g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) ti 0 If yes, give date D. LIFT STATION Date installed "Pump on" level at in Datum Size in gallons "Pump off" levet at in. Cycles tested E. SEPARATION DISTANCES WELLONLOTTO: /Pd$LIC, wiJrE12 Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 r-� Property line AQ 1 Absorption field S +` Water main 14 17c. Water service line / d `t Surface water �� ? Wells on adjacent lots 20Q 'f- fABSORPTION ABSORPTIONFIELD ON LOT TO: Property line /d v'r` Building foundation /O ''` Water main /4 10. Water Service line /d `� Surface water ZOQ Driveway, parking/vehiclestorage Curtain drain 4 A Wells on adjacent lots Z oa �t F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are -in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date`��S COSA yellow sheet_2-6-15.doo I Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program s, , t 4700 South Bragaw SL Q, P.O. Box 196650 Anchorage, AK 99519-6650 `I� 0 www.ci.anchorage.ak.us Ey � (907) 343-7904 �� ► CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-801.53 HAA# n5 p i07�- Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 13 Block 8. The Tablelands Subdivision Location (site address or direZ ions 50 m r 000y19�JCe Current Property owner(s) Soineli Homes, Inc. Day phone 3445678 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 1900 Northern Llahts Blvd. Anchoraae, AK 99517 Unless otherwise requested, HAA w0l be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Three Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ 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 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 Firm Anderson Engineerina Phone 522.7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E Anderson, P.E. Date 3/2312005 5. DSD SIGNATURE —Z Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Well Flow Advisory Supplemental Engineer's Report Other 'By: .'� -LAM, ;Iti,,CL Q4 Original Certificate Date: (n«.Imm Municipality of Anchorage ••, • Development Services Department ` Building Sa" Division s. .,. On -Site Water 3 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6850 www.ci.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 11 BWA R_ The Tablelands Subdivision Parcel ID: 051.801.M A. WELL DATA Well type _ If A, B, or C provide PWSID # _ Well Log (YIN) Data completed _ Sanitary seal (YIN) _ Wires property protected (YIN) Total depth R Cased to tL Casing height (above ground) In. FROM WELL LOG AT INSPECTION Data of test Static water level it It Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform coloniesl100 mi. Nitrate mg.A. Other bacteria colonies/100 ml. Date of sampie: Collected by: B. SEPTICIHOLD.ING TANK DATA Tank TypelMatedal SeoflelMW Data installed 812412004 Tank size 1.000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) I Depression over tank (YIN) H High water alar (Y/N) i;N Date of pumping Pumper New Constmction C. ABSORPTION FIELD DATA Data installed 812412004 Soil rating (g.p.dltt2 or felbdnn) .6 OPDISF System type S Wide Shanow Trench Length 71 it Width 5 R Gravel below pipe 4 R Total depth 8 R Eff. absorption area jMfe Monitoring tube y Depression over field jy Date of adequacy test Results (Pass/Fad) 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. fury rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. UFT STATION Date installed 'Pump on' level at _ in. Datum Size in gallons 'Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot WA Absorption field on lot WA Public sewer main WA Sewer /septIc service fine _NIA Manhole/Access (Y/N) High water alarm level Meets alarm & circuit requirements? On adjacent kits WA On adjacent kits WA Public sewer manhole/cleanout _WA Holding tank _WA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property line >' Absorption field >S Water main >17 Water service fine >10, Surface water >IW Wells on adjacent lots >2W SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Mir Building foundation >10' Water main >10' Water Service line MW Surface water >100' Driveway, par(drglvehide storage >S Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION I ceRty that I have determined through fled inspecdons and 4th review of Municipal records that the above systems are in Conformance With MOA HAA guidelines In etfed on this date. r¢aw> c ANDEM r Engineer's Printed Name Michael E Anderson. RE �.: No, a-aar Date 9123/2005 HAA Fee s Si S 'f' /%S�D- PLA uSj+ Date of Payment 3— f-61— O S Receipt Number L $ZL9 (Rev. 121011) Waiver Fee s Date of Payment Receipt Number in. c a ri 0 if r• c It c 2004-25 THE TABLELANDS SUBDIVISION LOT 13, BLOCK 8 .40,001 S.F. AS -BUIL GASTALDI LAND SURVE JEFF A. GASTALDI, R. 4726 WEST 88TH AVE ANCHORAGE, ALASKA 9 PHONE 248-5454 GRID I DATE NW1559 11/29/2004 F.B. JOB NO. 04-14 TLS138 I HEREBY CERTIFY THAT I HAVE SURVEYE THE PROPERTY DEPICTED ABOVE AND THAT N ENCROACHMENTS EXIST EXCEPT AS INDICPTED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, 5PVENANTS OR RESTRICTIONS WHICH DO OT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION 0FOR ESTABLISHING BOUNDARY OR FENCE LINE ANCHORAGE RECORDING DISTRICT, ALAS. A NOTE: NO CORNERS SET THIS DATE. 30' a m a V) I 1 "= 40' OF A i k49TE :9 .0 ....................... .. 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