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Home My WebLink AboutTHE TABLELANDS BLK 4 LT 22Th Tabl lands Block 4 Lot 22 #051-741-53 Municipali ty of Anchorage Development Services Department :"" ,'-' · Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: .~ I.~J 0500 r..~3 PID Number:. [~3~-~ '~ '7-~'OV' /"~/~V'/'J' ///O/t,f~'o". /,,'V'(~, WastewaterSystem: ,~New I--IUpgrade ~-~.P_2~ [ O,'~,'~ C ~ ABSORPTION FIELD LEGAL DESCRIPTION so...,,,,o Z.,2 G,.o,~e /,,. 5'0 ,,. We,'. ?U&~C.,. ~'~"~ [] ~ [] U,~r~,¢ / ..5' .. / ,..w.. ,. -.- o....,, s/do ,u ~ .. TANK SEPARATION DISTANCES , ~,, [~septic r-IHolding F'IS.T.E.P. r'lothet: s..~w.. /dO', ttO0't' - " ~/X "'''''/~'''''''''~''''' LIFT STATION/ BENCH MARK ,.-,.r/,//o~ [ ~..- .~...-..2~L...... ~ Development Sorvice~ Dopartment Approval" Key Box M,T DESIGN NOTES: 1. Total Depth of Trench is 7.5'. Terrain relatively flat. 2. Sewer Service Line minimum 2% slope. .3. Trench is Minimum 10' from Lot Line. 4. Lots Served by Public Water System. Absorption Trench Reserve C.O, 1 Top oF BtuF¢ S.T. 1 S.T. 2 D.C. 0 C.O. 1 C.O. 2 M.T. A 39 47 50 51 8~ 66 7o / Gallon 'Sept' 7 12 18 20 25 Septic System Construction Does Not Preclude Adjoining Lots From S~nlt~tlon Improvements. NOR THRIM (~ "' ..~'...~\ . /'."'.4~'~'"._".'~ THE TABLELANDS ENGINEERINGj ~. ~.,~_.'. -J ............ ,o,.~,,.,o~ LDT ~, 3LDCK 4 1' = 40' S/D AS-BUILT !LAYOUT .,,,,., ....... 9/29/05 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ulq ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Mar 10, 2005 Expiration Date: Mar 10, 2006 Permit Number: SW050043 Parcel ID: 051-741-53 Legal Description: THE TABLELANDS SUBDIVISION BLOCK 4 LOT 22 Design Engineer:. 0838 North Rim Engineering Site Address: 22201 OBERG ROAD Owner Name: TROY DAVIS HOMES, INC. Lot Size: 41169 SQ. FT. Owner Address: 22201 OBERG ROAD Total Bedrooms: 4 Permit Bedrooms: 4 PETERS CREEK, AK 99567- This permit Is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements 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 dosed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Maximum depth of absorption field shall be 7.5 feet below original grade. Received By:, Date: 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.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ~51-ci~11- 55 Permit Number .SW Propertyowner(s) "7'-,~0'./ /'),4Wd" ./-.-.-~6t.~,1~'.-.9 ,. ~--A/~_ Dayphone ~,.~S7- / Mailingaddre_ss//-?~-/ ~' ~),4-~'~',[' ~-~0 7. _t,~J'l/-Z~ ZipCode ~'~'~'~P'~ ~'~:~! -- ' ! ~/l~-/~z't''/('' Zip Code ~ 5'~' 7 Site address- /)~ ~__~' ~0~.,~ Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size /"/~//~ Acr~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub [] Swimming Pool [] Therapy Pool [] Number of Bedrooms Well Only Water Storage Jacuzzi [] Water Softening Unit [] 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 o~thorized agent) Permit/Rush Fees: Date of Payment: Receipt Number. (Rev. 09104) Waiver Fees: Date of Payment: Receipt Number: NorthRlm Englneeflng 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 March 10, 2005 MOA On-Site Water & Wastewater Program ATT: Julie Makela, PE 4700 Bragaw St Anchorage, AK 99519 RE: The Tablelands S/D, Lots 22 & 23, Block 4, Chugiak Dear M..s.4~kela: The referenced lots are unique for the Tablelands subdivision. They are high in elevation and very well drained. This is made possible by a fortunate geologic formation. The two lots lie along the crest ora ridge with topography dropping offto either side. This is a drumlin glacial feature or has similar characteristics to a drumlin. Because of this, the soil is dry at depth and no groundwater was present after monitoring. The soil also exhibited superior percolation during testing. For these reasons, conventional septic systems should function well for wastewater treatment. Please review the new septic system designs for the planned 4-bedroom single family homes. I have included design plans & specs, design guidelines, & soil tests. Ifthere is need for additional information or clarification please give me a call. Sincerely, Design Enclosures The Tablelands S/D, Lot 22, Block 4 ~$PECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is a single family home projected at 4 bedrooms. This requires a 1250 gallon septic tank. The lot is about an acre in size. A greenbelt is situated to the west and Oberg Road to the east. This lot sits along a ridge- see sheet 2 for drainage features. For this reason the lot is well drained and no groundwater is present. No adverse impacts are expected from developing this lot. The lots are served by a public water system. No conflicts to any neighbor lot is anticipated. This lot exhibited superior soil with an good percolation rate; a silty sandy gravel. An application rate of 1.2 GPD/FT: with 0.5 reduction factor for utilizing a $' wide trench is utilized. Monitoring revealed no groundwater on this well drained lot. Sp~ifieation Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. · Two compartment septic tank · Watertight couplings on inlet & outlet · $ foot minimum between the tank and bed. 10 foot to property lines. · 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot soil cover. · Tank & solid pipe must be set on well compacted, stable soil · 4 inch diameter cleanouts with airtight caps are required I to 4 feet from foundation wail, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing clcanouts between the tank and the absorption field, not more than 10 feet from the tank positioned to provide cleanout access towards the tank and towards the absorption field. · All clcanouts must emend to at least ground level · In solid pipe runs, ASTM D-3034 may be used in lieu ofcast iron · Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain-rock · Drain rock to be ½ inch to 2 ½ inch screened. Drain rock to be distributed uniformly throughout the trench. · Perforated pipe to be installed level with perforations down · Silt barrier (filter fabric) to be installed above the drain rock · Smeared trench sides must be raked or scarified before drain rock placement · Backfill over drain rock must not be less than 36" · The finish grade must be mounded to promote drainage over the bed · Insulation must be placed over any pipe installed under driveways or parking areas · Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, · Sewer Service Line is minimum 2% slope · Septic Tank to be pumped every two years or when required · Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI or equal) ~ter Key ~ox DESIGN NOTES: 1. Total Depth of Trench is 7.5'. Terroin relotively fiat. 2. Sewer Service Line minimum 2% slope. ;5. Trench is Minimum 10' from Lot Line. 4. Lots Served by Public Water System. Absorption Trench Reserve Sl~e Top o? Dtu?? Gallon Se ' Sep'clc Sys'cem Cons~ruc~clon Does No~c Preclude AdJolnlng Lo%s From Sanl~ca'clon Improvemen'cs, 1' = 40' N OR THRIM ENGINEERING 172~7 Beor Pow C~rcle £o~le Rlvm'. ,4~asko 99577 907.694.7028 THE TABLELANDS LOT 22, BLOCK 4 S/D LOT LAYOUT 3/7/05 -Drainage: Lots ;:>;:> & ;:>3 are situated on a ridge which may be a drumtin or simitar to a drumlin. The drainage ?al, l,s away to either side as indicated betow. For this reason, no groundwater was present in any o? the test bores. The terrain drops o?? to the drainage greenbelt on the western side. Lots served by Public ~/ater Lot 80 Proposed Deve[o Lo~ 21 Lo~ 22~ Trac~ Troc~ ~// Tr~c% ;' = ;BO' NOR THRIM '>"~'" '" THE TABLELANDS S/D S/D ENGINEERING .- ,7,,7 ,.o~ ~,.,, c~,. · , "~'" .."'~; LAYOUT ~o,.6,,.,~ '%~'-, ....... ~- LDT 22, BLDCK 4 ~ 3/10/05 Wi-- ~'u °~ ~ ,:5,, o o ~$~ ~x~ SDILS I M EERINC- LOG - PERCOLATION TEST Date PerForMed= 3/8/05 Per?arMed For: Troy Davis HoMes, Inc, Legal Description: The Tablelands S/D, Lot 88, Block 4 DEPTH (FEET) ,..o.;:.~ a - ':.'~: 3 - 5 - ~ ".,;' ,,~ 7 9 - .--~'z Il - .,'.;... ', 13 - '.',?. '. , 14 - ~'. 15- 16- 17 - 18- 19 - 80- 81 - Organic Location: See Drawing Slope < 10% SM Silty S~nd ~// Gr~vet Groundwater? No Depth none Water Depth AFter Monltortnc Date: 3/9/05 i D~e Gross TIMe Ne~ TIMe Depth Ne~ Drop 3/2 0 -- 9- -- 3/2 3 3 Mln 10' 1' 3/~ 5 -- 10.5' -- 3/~ 8 3 nih 11.5' 1' 3/8 10 -- 9, -- 3/2 13 3 rain 10' 1' Percolation Rate ~ Min./Inch Perc Hate Diameter 6' Test Run Between 4' and 5' Comments, Presoaked Test Hole Per£ormed Dy Nor'tlq~iM Eng. ~-...~--~ CE.RTIFY THAT THIS TEST WAS PerFormed In Accordance with All S~cai~/Hun]clpal, Guidelines In EFFect ON THIS DATE, DATE, 3/2/05 ~.J ~x~ SDILS I', CRTHRIM I E,!~.~(~J_.N E ERI N G LOG - PERCOLATION TEST Date PerFormed. 3/8/05 PerFormed For. Troy Davis Homes, Inc. Legai Descrlp.tlon, The Talolet:nds S/D, Lo.t 82, B~ock 4 DEPTH (FEET) 1 - ',,;..? -:- 3 - .:.,' ;..: 4 "-" ' :.S.2 ', 6- 7 - 8- 9- 10- 12- 13- 14 - 15- 17- 18- 19- 20- 21- Oroanlr SM Sit.fy S:nd VI/ Or:vet Location, See Drawin9 Slope < 10% Oroundwuter? No Depth none Water Depth AFter Monltorin¢ D:te, 3/9/05 # Da~e Gross TIMe Ne~ TIME Depth Ne~ Drop 1 3/2 0 -- 8.5, -- 2 3/2 3 3 Mln. 9.5' 1' 3 3/2 5 --- 8.5' -- 4 3/2 B 3 Min, 9.5' 1' 5 ,3/2 10 -- 8, -- 6 3/2 13 3 MIn 9' 1' Percol:tlon Rate 3 Mln,/lnch Perc Hole Diameter Test Run Between 4' and 5' CommentS, Presoaked Test Hole PerFormed By Nor±bRIM Fng, I~ CERTIFY THAT THIS TEST ~/AS PerFormed In Accord:nee wl'th"-A'[t S.tc~Fe/Munldp:l. Guidetlnes In EFFec.t ON THIS DATE. DATE, 3/2/05 I',IORTHRIM ~.:.:~_;"..~ TESTHDLE LOG ~o~.~.~o~ .,,~, ......... .- GEDTECHNICAL ~ 31;.0105 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.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D..051-741-53 GENERAL INFORMATION Complete legal description TABLELANDS BLOCK 4, LOT 22 Location (site address) 22201 OBERG ROAD, CHUGIAK, AK 99567 Expiration Date: Current Property owner(s) MIKE GEIGER & MEGHAN FRIDLEY Day phone Mailing address PO BOX 670251, CHUGIAK, AK 99567 Lending agency Mailing address Day phone Real Estate Agent Mailing Address KATHI OLMSTEAD - REMAX Day phone 694-5050 Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 T~,PE oF WATER ~S.U.PPLY: ?Individual Well _ ~: [] Individual wa.rer Storage [] CommunitY Class Well [] Public Water System [] 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 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 On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in .the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified bY my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 06/01/2011 Engineer's Comments: This inyestigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE ~ Approved for .~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TABLELANDS BLOCK 4, LOT 22 Parcel ID: 051-741-53 A. WELL DATA Well type PUBLIC Date completed Total depth f. IfA, B, or C provide PWSID # Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100mL Nitrate Arsenic: __.mg/I Date of sample: B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) . Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION rng/L Collected by: Tank Type/Material Septic/Steel Date installed 5/4/2005 Tank size 1250 gal. Number of Compartments _2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/31/11 Pumper IRs C. ABSORPTION FIELD DATA Date installed 5/¢/2005 Soil rating (g.p.d./ff2 or ft2/bdrm) 1.2 System type TRENCH Length 50 lt. Width --5 ft. Gravel below pipe 4__ft. Total depth &l ft. (Measured 5/31/11) Eft. absorption area 500 ~ Monitoring tube Y Date of adequacy test 5/31/11 Fluid depth in absorption field before test 24 in. Elapsed Time: 1140 min. Final fluid depth 25.2 Depression over field N Results (Pass/Fail) Pass For 3 bedrooms Water added $70 gal. New depth 36 in. __ in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N__lf yes, give date __ D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas in. Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requ rements? On adjacent tots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation $'+ Property line $'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ (None Known) Absorption field $'+ Surface water 100'+ Water main 10'+ COSA Fee $490.00 Date of Payment (~0 Receipt Number \~. (Rev. 11/05) 10'+ Waiver Fee $ Date of Payment Receipt Number F. COMMENTS System operatinq in upl3er half of effective depth. 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 !'~~ En ineers Printed Name ' g KENNETH M. DU'FFUS Date 6/112011 ' _ · Driveway, parking/vehicle storage Wells on adjacent lots 200'+ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 051- I- 1. GENERAL INFORMATION cos^. Expiration Date: - //4..- O$ Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TABLELANDS SUBDMSION; BLOCK 4, LOT 22 22201 OBERO RD. * CHUCIAK, AK 99567 DAN &: CAROL FISHER Day phone 22201 OBERO RD. * CHUCIAK~ AK 99587 Day phone 317-7134 BROOKE STILTNER w/ REMAX PROPERTIES Dayphone 694-4804 16600 CENTERFIELD DR. * EAGLE RIVER~ AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates 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 On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water samples. (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. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy that based on lhe 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SUITE: 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date' Engineer's Comments: In conducting this evaluation, GEG, ltD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of ali wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future perfon'nance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal ~fght whatsoever. 5. DSD SIGNATURE V'"' Approved for .~ bedrooms. Disapproved. Conditional approval for __ bedrooms, with the fllowing stipulations: Attachments: · COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Odglnal Certificate Date: (Re~. 11/05) Municipality of Anchorage Development Services Departmenton-s,.~"~'~ w,. & 4700 amgaw Street · P.O, Box 196850 Anchorage. AK 99519-6650 (907) 34379O4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TABLELANDS SUBONISION; BLOCK 4, LOT 22 Parcel ID: O..~'/- '7/-//°,.v'~--~ WEU,. DATA PUBLIC WATER Well type If A, B, or C provide PVVSID~ Total d . Cased to ft. Casing height (above ground) in, FROM WELL LOG AT INSPECTION Date of test Static water level Well production ~ J g.p.m, WATER SAMPLE RESULTS: PUBLIC WATER '. ' - colonlas/100 mi NJ. tra~ ' mg./L. ' colonies/100 mi:..: Coliform ~ _ . Date of sample: Colle~,~--'by: Co SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Comparlments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 7/31/2007 Pumper Date installed 5/4./2005 C~eanouts (Y/N) YES High water alarm (Y/N) N/A JR'B PUMPING ABSORPTION FIELD DATA ~,~ELOW EXISTING GRADE O Mil Date installed 5/4/2oo5 Soil rating ~r fl;rodrm) 1.2 Length 50 ft. Width 5 fl. Total depth 8.1 ff. Eft. absorption ama 500 ff~ Monitoring tube YES Date of adequacy test 7/30/2007 Results (Pass/Fail) PASS Fluid depth in absorption field before test 3, in. Water added*"~734gat, Elapsed Time: 180 min. Final fluid depth 14.,.5. in. ~rptton rate >= Any rejuvenation treatment (past 12 mo.) (YiN & type) NONE KNOWN e%AST 200 GALLONS CAUSED 2.5" RISE System type FIVE WIDE Gravel below pipe. 4.0 .ft .... Depression over field NO For 3 bedrooms Now depth 17.5 in. 450+ g.p.d:- If yes, give date D. LIFT STATION Pump on" level at ~Hlgh water alarm level at in.' Datu....__~m ~ Cycles tested. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line__ On adjacent lots On adjacent lots hole/cleenout Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field Water main 10'+ Water service line * 10'+ Surface water. 5'+ 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10"+ Water service line * 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Water main 10'+ Driveway. pan~ing/vehicle storage 5'+ *ASSUMED BASEPON KEY BOX LOCATION NOTES BY STEVE ENG~ P.E. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this data. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/0~) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewaler Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPRO /AL FOR A SINGLE FAMILY DWELLING · i~' ~f' '~. Expiration Date: ~. GENE~'IN[ORMATi~ Lo[ation (site address ~r'Oi~tions) Curr, ept property ~owne,r.(.'s) ~"',~ · .'~ ,,.. ...'..~$' I - Lending agency Mailing address Real Estate Agent Mailing Address Unless othe~ise mquested, H~ will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: /~C. Day phone Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank [] Community On-site .l-I Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or {Nastewater disposal system is(are) in compliance with all applicable Municipal and State codes,.ord[nances, and regulations in effect at the time of installation. Name of Firm /[/6~"~h'~ Address / Engineer's Printed Name DSD SIGNATURE Approved for Disapproved. Conditional approval for S 7'"'r~'.,,t,/.~ ~ ~ Date ~ . bedrooms. bedrooms, with the following stipulations: Additional Comments By: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water 8, Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST ' Legal Description: 7'?,~¢,~ A. WELL DATA /O~{~O-,. Well type ~f A, B, or C provide PWSIDy Datecomplet~ / Sanita~seal (Y/N)~ / WATER ~MPLE RESULTS: Colifo~ ~1~100 mi. ~ Nitrate rog.& Ars~c: mgJI. ~ Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Malerial.~)~ ~ ~¢~ Tank size/~ gal. Numar of Compadments Foundation cleanout (Y/N) ~ Depression over tank (Y/N) . Date of pumping ~ ' Pumper Well Log (Y/N) / Wires properly prote.cted (Yp . Casing height (above gr~fnd) . AT INSPECTION / g.p.m. in. / llected by: . colonies/100 mi. Date installed ~~,5' Cleanouts (Y/N) y ,/LC' High water alarm (Y/N) ~ C. ABSORPTION FIELD DATA Date installed .~,,/¢~./0,,~ Soil rating (g.p.dmlft= or~.Cbdm~ ~ ~. System type Length ,50 ft, Width _~ ft. Gravel below pipe q ft, Total depth 7~ 5 ft. Elf. absorption area,~'O0 ft2 Monitoring tube ._~ Depression over field Date of adequacy test ~S y,..~'~'"~'~:~ass/Fail) . For r~ bedrooms Fluid depth in absorptio/ld befo're test in./ Water added gal/ New depth/in. Elapsed Time: min. Final fluid depth/ in. Absorp~on rate >= //' g~.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) ./~ If yes, give date D. LIFT STATION Date installed / on" levela/t// in. 'Pump Datum t~~' E. SEPARATION DISTANCES Size in gallons f Manhole/Access (Y/N) ,. 'Pump off" level at/ High water alarm level~ / Cycles tested Meets alarm & cir~lj~requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift sta/n lot Absorption ~,~n lot __ Public ~r main..~_.... Sewf/sep it c service line adjacent lots adjacent lots Public sewer manhole/cl~/ .// Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ..~ ~' Property line /O ¢'f" Water main Wells on adjacent lots ~ ~,~'r'~.~. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line Water Service line Curtain drain Absorption field · ~/'~' Surface water /O ~ "~' Building foundation /~/'f" Water main ,~- Surface water / ~¢:~/'~' Driveway. parking/vehicle storage Wells on adjacent lots /O'~JZ~., 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 HAA guidelines in effect on this date. Engineer's Printed Name '~,'7'"'~'.~Jz~.. ~(J ~ Date / ~/.~/0 $ HAA Fee $ Date of Payment Receipt Number (Rev. ~2/01) Waiver Fee $ Date of Payment Receipt Number Lo? ~1 Lot ~-.2, 16: / BUlL ,-"~'"." ~ · .... :.~..~~...,, MORTCAG£ SURVPf CERTIFICATF: I HEREBY CERTIFY THAT I, OR SOMEONE UNDER MY DIRECT SUPERVISION, HAVE PERFORMED A MORTGACEE'S INSPECTION ON THE FOLLOWING DESCRIBED PROPERTY, AND THAT NO ENCROACHMENTS EXIST EXCEPT .AS INDICATED. MORTGAGE SURVEY LoT' ~.~.~ ~ ~. ~, ~..1,:. ,~N~dI'~gA,~.RECORDING DISTRICT, ALASKA BULL MOOSE SURVEYING ROBERT S. HOFFMAN 200 HYGRADE lANE, WASILLA. ALASKA 99654 (907) 357-6957 FAX (907) 357-6977 I DRAWN BY: ! DATE OF SURVEY: CHECKED BY: SEC. TWP. NOT[.. ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS OTHERWISE NOTED. IT IS THE RESPONSIBlUTY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECOROED SUBDMSION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA SHOWN BE USED FOR CONSTRUCTION OR FOR ESTABUSHIN¢ BOUNDARY OR FENCE UNES. IPLAT I~ OR SERIAL IiII IBYI ~/-~1' '~'2'° ~ ~' "~ I I RE'VISION OAT[ /~G. J SCALE: /",To' I PREPARED FOR: "lT~o,f