HomeMy WebLinkAboutCAMPBELL POINT BLK 1 LT 2Campbell
Point
Block 1
Lot 2
#011-262-16
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage Page 1 of 3
Development Services Department
Onsite Water and Wastewater Program
4700 South Bragaw Street
P.O. Bax 196650 Anchorage, AK 99SIMSO
www.ci.anchorage.sk.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW050136
PID Number. 011-262-16
Nrne
Northern Home Builders
wastewater System: New
AAOeee
8000 Kin Street Anchorage,
AK 99518
ABSORPTION FIELD
PIW,.
830-2052
Fr Wll.avIcttrv,
Four 4
Deep Trench
LEGAL DESCRIPTION
SaIR."q
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1 2
Campbell Point
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7
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sbg ,:
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7 FL
Q.wl L&Vn
1-3 Fl.
56 Fr.
Well: New Class
fr. Mandtt
Moro. al"w
aHe aaLwwsen Lrrs
3 Ft.
1
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CL .ftnt n EPmele. A 6. Cl:
Class C
Te DeM
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1
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P" A/elan.l
321
784 Fr
ASTM 3034 PVC
Dner Bob DnIW
AI ine Drilling 5/7 05
BULK W" Level
235 FL
kWaear
Sanders & Sanders
Dn. YwW"O
7/27/2005
Yr limp seta
Cewq ALo.e Grw
20 cm F..
>2 Fl
TANK
SEPARATION DISTANCES
® Septic O Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
LM
Holding
biictateIt-'w
n
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250
wa
>100'
>100'
N/A
N/A
>25'
'bi
Steel
Two (2)
Suhm W."r>100'
>100'
N/A
N/A
LIFT STATION—NONE ON LOT
La Lin.
>51
>10'
N/A
N/A
a
of
cr
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> 5'
>10'
N/A
N/A
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ww
rah walw"m el
in
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k
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Pump Maks e"oEel
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BENCH MARK
Class C Well Separai[OfFuisiance-wa
.aw L
Bottom Flnlshed Floor.
E"...
100.0 FL
Engineer's Stamp
�P�� �...� sq!se4•
� t9 ••
Inspections performed by: AH
Dates: 1" 7/27/20051
49th' •;
•
2^e
7/27/2005
Department of Health and Human Services approval
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MICHAEL E. ANDERSON i. •,
s No_.DE_e381
Reviewed and approvedby:
Lcl. Date: 3' ' 06
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519.6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO50136
TBM 100.00'
Lower Leve
Flnlsh Floor
Page 3 of 3
PID No. 011-262-16
N
U h= f U
PROFILE AS -BUILT
Seale: 1' _ 20'
49th
E. ANDERSON
FROM.: RYINE DRILLING
FAX No. : 907 345 0202 Feb. 06 2006 11:36PM P1
ALPINE DRILLING & ENTERPRISES
Penult Number. #S W Date of Looe: Parcel Identification Number:
�= a Dtla Completed•
Legal 1+ is well located at approved permit locW�? ® Yes ❑ No
DauswWC:arnobep2,1
PrOPsr ty Oweer Mame do Addrow Norttrem Homes
WW King Street
Borehole Data:
Sail Typo. Thidmen a: water Stmt&
Depth (n)
From To
Method of Drlllin R air rotary Q cable tool
atbk-ap
0
Casing type: AfSSI
sandy slit
2
Wall 'i'hielmess:;Z inches
swygravel
2
15.
Diameter B inches Depth: 12, feet
15
31
WnerType;
sandy slit
31
so
Diameter inches Depth: feet
aNYBand
50
120
Cnhng stickup above ground: 2 feet
M* gravel
126
147
static water level (from ground leve)): Meet
0
147
163
Pumping level;.a&mt after
silty send
163
241
2 how pmp►ug 20 gpm
Recovery Rate: a gpm
sandy gravegy sftt
241
312
Method of Tesdng: gj�llf�
Ay walersand d gravel
312
331
Well Intake Opening Type;
® Open Edd ❑ Open Hole
Q Screened` - Start feet Stopped fact
Q Perforations
Start Deet 'Stopped rW
Grout Type: AMfttjftZMM& vohnae: j
lkPtb-- Start 0 feet Stopped? feet
Pump: Intake Depth feet
?Mp eme . bpBmndName
Well Disinfected Upon Completion? R Yet Q No
Method of Disinfection: chlorine teWets
Comments•
Well Driller.. Alpine Dolling 6 Enterprises
PO Box 110488
! Anchorage AK 99511
Atteadow The well driller shall provide a well log to the property owner within 30 days of completion and the property
.... .. d �..\/ .I U/.. .1 O .u..}J. »..b /.... M.. T..e\. ..•a A.. • ..:�. -.... ...»6L t- //1 J.. P.. -.-/.d..
02-06-2006 09:00 fYDERSpN ENGINEERING BM -ax -aux !
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
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: May 23, 2005
Expiration Date: May 23, 2006
Permit Number: SWO50136 Parcel ID: 011-262-16
Legal Description: CAMPBELL POINT BLK 1 LT 2
Design Engineer: 0014 Anderson Engineering Site Address: 008430 HEATHER CIR
Owner Name: NORTHERN HOME BUILDERS Lot Size: 16957 SO. FT.
Owner Address: 8500 HEATHER CIR Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99502-3907
This permit is for the construction of:
0 Disposal Field Q 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 ( 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.
Received By.
Date: I
Issued By Date: o
Municipality of Ainchorage
-• Development Services Department _'
Building Safety Division
On -Site Water and Wastewater Program : r
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011 — AL191 - 1 �7 Permit Number SW
Property owner(s) Northern Home Builders Day phone 830.2052
Mailing address (1) 8000 King Street Anchorage, AK 99518
Mailing address (2) 8436 Heather Circle I Zip Code
Legal description (Lot, Block & Sub'd.) Lot 2, Block 1, Campbell Point Subdivision
Legal description (Section, Township & Range)
Lot Size__ .. 1 tP0154 Acr s Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
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.
(Signature of property owner or authorized agent)
Date of Payment:
Receipt Number:
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
May.17, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 2; Block 1; Campbell Point Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The owner of Lot 2, Block 1, Campbell Point Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to accommodate the home. The attached Site
Plan and backup documentation identify the location and configuration of the proposed
septic system along with the alternate site. Also identified on the plans are the
locations of the adjacent wells in the subdivision. No conflicts exist between the
proposed septic system and the proposed well and those on adjacent lots. Drainage
arrows are shown indicating the current drainage patterns. The drainage patterns will
be maintained after construction..
Test holes placed in the area of the absorption trench and alternate site indicated
organic fill to a depth of 7' underlain by silty sand with minor amounts of gravel. The
percolation rate at this depth was determined to be 8 to 12 minutes per inch. We are
proposing to place a new 1,250 -gallon -septic tank and a 55' long by 3' wide by 7'
effective depth absorption trench to treat and dispose the effluent generated in the
house. The elevation of the distribution line in the absorption trench will be 7' below the
surface and the total depth will be 14'. A minimum of 3' of fill will be placed over the
absorption trenches and 4' over the septic tank.
The ground surface on the lot slopes at varying grades from east to west and north to
south. The new trench will be constructed parallel with the slope as much as possible
in conformance with Municipal requirements.. The new septic system will be
constructed a minimum of 100' from the existing wells and any surface water in the
area.
Lot 2, Block 1, Campbell Point Subdivision
May 17, 2005
Page Two
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,
ly'�JL-tlz
Michael E. Anderson, P.E.
Attachments
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LOT 2, BLOCK 1, CAMPBELL POINT SUBDIVISION
DESIGN FACTORS:
Five Bedroom Home
Perc. Rate: 8 to 12 Min./Inch
Application Rate: .8 GPD/SF (Average)
SYSTEM REQUIREMENTS:
Deep Trench System
1,250 Gallon Septic Tank
T Drainfield Rock
4 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 750 SF Absorption Area
750 SF/14 SF/LF = 53.6 LF Trench Length
THEREFORE: Construct a 55' Long x 3' Wide x T Effective Depth Aborption Trench at the
Flow Line Elevation in Trench to be T Below Original Ground Surface. Total Depth to be
14' Below Existing Ground. Provide 3' of Cover Over Trench and 4' Over Tank or Provide
2" of Insulation and 2' of Cover. Maintain 100' Separation Between Existing Wells in the Area
and the Absorption Trench and Septic Tank.
Natural
Backfill
6'6"
Geotextile
Fabric
6" 4" Perforated
PVC (Holes Down)
7'0"
3'
F�
Drainfield Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE) ���P�..••
NOTE: Grade Area Over Trench to Drain Away. 49th
Minimum 6' Separation From Bedrock. :..„.'..„ ...„,
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area. 00 ; Michas
Minimum 100' Separation From Surface Water or Streams.. ':
Minimum 10' Separation From Water Service Line. �,Ni�;•., NO
*s
Ali
Municipality of Anchorage t
Development Services Department 100
�,
Building Safety Division V ••
y� On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 195550 Anchorage, AK 99519.5550 I
www. Ci. anchors- ak.us
(907) 343.7904 Q)
Soils Log - Percolation Test q
Performed For. Date Perk
Legal Description: Lot 2, Blk 1, Campbell Point Subd. Township, Range, Section:
Depth
(Feet)
1-
2-
3- �L
4-
5-
6-
G'•
1 8
e- M
10
11- Or Kq��rw
12- ��/ eJnfFrvt _
13- c9ra-✓.�
15
17-
15-
19-
20 -",5 -L,)
7-
18 -
20 -UC -Cd H
COMMENTS 7 sl egt/
WAS GROUND WATER
t I
A
ENCOUNTERED?
tp
Depth to Water
S
IF YES. AT WHAT DEPTH?
L
Depth to Water After--
tt D
Monhoring?
NC rJ LS— E
Date: 5.1!r-05'
1CHAEL [. ANCERSON
CE -4381
V r
3/7 /oS
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
3 of
ll: Lt
2•V
3�
(r•rl�
2,S(,
PERCOLATION RATE L_(�@shn�) PERC HOLE DIAMETER /0'
TEST RUN BETWEEN FT AND _25 FT
-PERFORMED BY: 77& I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
•
fr,�
Gross Time
®.',�\\\\tib'
OF -Ate
Municipality of Anchorage
,`p.•c- GINEE
••'
Development Services Department
Building Safely Division
C7.491)J e y�I�
i� On -Site Water and Wastewater Program
\F/r 4700 South Bragow St.
` "•' '•"• ::: w•/f••- ••j•/
C.tZ,a.-ff��"
'P.O. Box 195550 Anchorage, AK 99519-5550
/•. ...........
0 r•: AUCNaEI, I.ANDEaSON•: �.00
••e
w+ w el onshomoe at. us
(907) 343-7904
c 4361�
���✓p ••?)�j '0 S..'i4'�i
Soils Log - Percolation,Test
��° 000rEssiov
"'� �0'
Performed For.
• Date Performed: 3 o S
Legal Description' Lot 2, Blk 1, Campbell Point SUM. Township, Range, Section:
01
Depth
11-
12-
13-
14-
15-
16-
17-
s-
19-
COMMENTS
NWr/i�=
yr,grc,I, r/ ••
one rian
T
Reading
Date
Gross Time
Net Time
461, It"� P✓Ci!'I v
Net Drop
3 7 nj
WAS GROUND WA TER
/
5M
ENCOUNTERED?
S
IF YES, AT WHAT DEPTH?
L
rN4 fin,./r.•'��
Depth to Wator After
P
Monitoring?
��(.'rU �.' E
Y
Date-
&�
yr,grc,I, r/ ••
one rian
T
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
3 7 nj
�Lt oG
/
y. 7S•
/1-: 3 to.
'eiv
P-• ► -
4.OiG
Y
:PS_JO
C,.%;-
PERCOLATION RATE FC Imnm•.Fr,eq PERC HOLE DIAMETER /O Q
TEST RUN BETWEEN � b FT 'AND FT
PERFORMED BY: i7` I CERTIFY THATTHIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DAT-. DATE:
ONSITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2, BLOCK 1, CAMPBELL POINT SUBDIVISION
GENERAL:
The scope of this. project includes the procurement and placement of a new
1,250 -gallon septic tank at the location shown on the Site Pian. Work also
includes the construction of a new 55' long X 3' wide X 7' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 7' below the existing ground
surface. Total depth of the trench will be 14' below the existing ground
surface. The new absorption trench and septic tank must be placed a
minimum of 100' from the wells in the area. A minimum of 100' must
separate any surface water in the area and the septic tank and absorption
trench. The trench must be a minimum of 10' from the lot line and both the
well and septic tank must beat least 10' from the water service line.
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
1. A new 1,250 -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 2, Block 1, Campbell Point Subdivision
May 17, 2005
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 2, Block 1, Campbell Point Subdivision
May 17, 2005
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. 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, cieanouts 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.
ri 1 EOF
L ► (11 SK
FRANKH. MURKOWSKI, GOVERNOR
w w 555 CORDOVA
DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE, AK 99501
Phone: (907)269-7696
Fax: (907) 269-7650
DIVISION OF ENVIRONMENTAL HEALTH mailio:Vanessa Blevinsnadec.state.ak.us
DRINKING NATER PROGRAM
b_q://NN,Nvw.state.ak.us/dec/deh/
April 5, 2005
File: Campbell Point Subdivision
PWSID: Pending
Michael Anderson
Anderson Engineering
PO Box 240773
Anchorage, AK 99524
Re: Waiver Approval (well to septic of 100) and Class C Well Location Approval
Lot 2 Block 1 Campbell Point Subdivision, Anchorage, AK
Dear Mr. Anderson:
On April 4, 2005 this office received your submittal requesting a waiver approving a minimum
separation distance between a proposed Class C well, which will serve 2 single family homes, and
surrounding onsite septic systems. This subdivision has small lots which make meeting the required
150 separation distance impossible between the Class C well and septic systems located on Lot I
Block 1, Lot 2 Block 1 and Lot 2 Block 2.
Based on the following, this waiver is approved:
1. The newly constructed well will meet minimum construction standards.
2. The other wells in the area are a minimum of 267 feet deep and extend through a clay
confining layer.
3. The anticipated well flow and associated drawdown is comparatively low, meeting the water
demand of 2 single family homes.
4. The onsite septic systems involved will be approved by the Municipality of Anchorage Onsite
Program.
This approval is for a waiver of required separation distances and the placement of the proposed well
only. In order to obtain final operational approval you must complete a "Class C Well Inventory
Form". This form may be obtained online at: http://www.state.ak.us/dec/eh/docs/dw/classc.pdf.
Finally, due to the high development densities in this subdivision, it is recommended that this
proposed system complete annual nitrate and total coliform bacteria testing.
If you have any questions regarding this plan review, please contact me at the above number.
Thank you,
Vanessa Blevins, P.E.
Environmental Engineer
cc: Jamie Stain , ADEC/EH/DW Program
C9 Prinled on Recycled Paper
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.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: MIKE ANDERSON
Legal description: CAMPBELL POINT BLOCK 1 LOT 2
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ 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 loo deep for soils information submitted.
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
® Other.-ABSORBTION FIELD AND TANK NEED TO MAINTAIN 150 FEET FROM CLASS "C" WELL
-TEST HOLE DOES NOT ESTABLISH 4 FEET TO GROUNDWATER AND 6 FEET TO IMPERMEABLE LAYER.
Name of reviewer: JOE GOODALL
Date: 5/23/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
I �wf kw iuldez,
Municipality of Anchorage
• Development Services Department Y
Building Safety Division
On -Site Water and Wastewater Program `
4700 Bragaw Sueet
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-262-16 COSA #_ C t o O O C D
1. GENERAL INFORMATION Expiration Date:_( 2 - O (o
Complete legal description Lot Z• Block 1, Campbell Point Subdivision
Location (site address) SM Heather Circle Anchorage. AK
Current Property owners) Northern Home Builders
Mailing address 1100010ngStreet Andiorage.AK9951e
Lending agency
Day phone - 830.2052
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address .
Unless otherwise requested, COSA will be hold by DSD for pickup.
2. NUMBER OF BEDROOMS:
Four (4)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
21
Individual Water Storage .
❑
Individual Holding Tank
❑
Community Class c Well
0
Community On-site
❑
Public Water System
❑
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 On -Site 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 Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private itClass 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 engineers 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 Onsite 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 Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 98524
Engineer's Printed Name Michael E. Anderson. P.E. Date 2/24C1005
A -,
J 49th
6. DSD SIGNATURE i `WQQ' " `UN
Approved for bedrooms. •� No cc-43ai /
Disapproved.
Conditional approval for bedrooms, with the following stipulations:. .
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: . Original Certificate Date:
(RW 11.05)
Municipality of Anchorage
_ Devetopme n�tSeervvicess DOPartment
Building
y (•
On -Site Water a Wastewater Program .. ...
4700 eregaw Street
P.O. Box 198850
Anchorage, AK 99519-fl85o
www.munLorg/onaRe
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: La 2, Brock t, an Pane Srremvwon Parcel ID 011-262-1e
A. WELL DATA
Welt type ctau c If A B, or C provide PWSID 9 _ Well Log (Y" Y
Date completed afros Sanitary seal (YIN) I Wires properly protected (YAC v
Total depth 321 fl Cased 11Dft. Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of teat anaoo5
Static water level 235 fl.
Well production 2D g.p.m.
9 -
p.m -WATER SAMPLE RESULTS:
Coliform o oolonk1a1100 mL Nitrate •1 mglL Other bacteria e
colonies/100 mL
Arsenic: e mgA Date of sample: tr mm Collected by: LH
B. SEPTIWHOLDING TANK DATA
Tank Typ&Ugbriel esptlrJ3msel
Tank size 1.250 gal,
Dew inatww 7=2005
Number of Compartments 2 Cbanouls (YIN)
Foundation cleanout (Y" r Depression over tank (YIN) N
Date of pumping New Consauccon Pumper
C. ABSORPTION FIELD DATA
Y
High water alarm (YIN) N
Date installed MrAN Soil rating (g.p.dA a or fe/bdrm) •a aPoeF System type 08@P Trarrdr
Length 5e fL Width 3 R. Gravel below pipe 7 ft
Total depth t4 fL Eff. absorption area ler fl' MOmftw ft tube Y Depression over field N
Date of adequacy test New conoL Results (Pasa/Faiq For _ bedrooms
Fluid depth h absorption fleld before test in. Water added gal. New deptin in.
Elapsed Time: min. Final fluid depth M. Absorption rate >_
g.p.d.
Any rejuvenation treabmeM (past 12 mo.) (YIN &type) H yea, give date
D. UFT STATION
Date installed Size In gallons Manhole/Access (YM)
'Pum on' level at _ in. 'Pump dr level at _ In. High water alar level at in.
Datum Cycles tested Meat atr b dreud rsMAement9
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtlt station on lot >1W On adjacent lots >1W
Absorption field on lot >iw
Public sewer main WA
Sewer /septic service dna >V
On adjacent let >iw
Public sewer manhole/cleanout wA
Holding tank WA
Animal containment areas WA Manure/animal excrete storage areas WA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >9 Property dna >55_
Water main WA
Wads on adjacent Iota >1W
Water service line
Absorption field >s'
>19 Surface water >iae'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >1w Building foundation >ta Water main NIA
Water Service line >10P Surface water >1W Driveway, paftVAishide ataage >25'
Curtain drain Nara Noted Welt on adjacent let >1W
F. COMMENTS:
0. ENGINEER'S CERTIFICATION
I car* that I have determined through field iispecli ns and
review49th
of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.RM
Engineer's Printed Name UkhW E. Andmal, P.E.
` MWIL c
Na C
�4♦•e.
Date ?/21/to0o
Aa,,
COSA Fee $-K.50
Date of Payment 2/24=05
Receipt Number G,7
tneV. 1 il"
Waiver Fee $
Date of Payment
Receipt Number
02-02-06;15:44
;907 561 5301 # 2/
SCentNa
1060317001ULA�Is
Prep
Client Nam
And on Engineering
AllDetesMmesareAlaskaStandardTime
Printed DatelTimaProje02/02/2006
Naule/u
Lot, 1 Campbell Pt Sub D
� p Q�lr PO'OC Colkcted Date/Tlmo
14:40
OU30/2006
Bent
Chenix mete IU
Olk
LOInkBIk 1 Campbell Pt Sub D
16:33
ttatris
Drinklnl;Wntcr
Received DateMme
O1/3=006 16:58
Technic&[ Director
Stephen QLde
Sample Remarks:
P0f01"e1f' ResultsPQL
Allowable
UnitsMcthod
Prep
Analysis
Container ID Limits
Data
Dew ["it
Waters Deoartttwnt
Nitrate•N 0.100 U 0.100
Microbiology Laboratory
Total Coliform 6 OB, No Coll
mA EPA 300.0 B (o-10) 02/01/06 DSH
COVIOOmL SM20922213 A (o-1) 01/30106 DPT
SCS ReLa
1060427001
aeut Name
Anderson Engineering
All DatcaMma am Aloka Standard Time
Project Name/#
Lo9Alk 1 Campbell Point SD z
a /
Printed Date/rlme
02/022006 15:04
Client Sample 1D
LotAlk 1 Campbell Point SD 1
Received Date/Ilme
0125/2006 15:55
Metric
Drinking Water /�„1•j
sw
/.�
G
Received
0125200616:09
Technlcal Director
Stephen C. Ede
Sample Rettrirks:
Perimeter
Results PQL
Units Method Container m
Allowable Prep Analy,u
Limits Date Date
Init
Metals ICp/mg
.
Arsenic
6.69 3.00
agti EP200.6 A
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