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HomeMy WebLinkAboutTHE TABLELANDS BLK 8 LT 3The Tablelands Block 8 Lot 3 #051-801-43 Municipality of Anchorage °'° 9"`.< _ Development Services Department '�" ' 1. � ' �� Building Safety Division On-Site Water and Wastewater Program,4700 Bragaw St. P.O. Box 196650 Anchorage,AK 99519-6650 Page / of 3 www.ci.anchorage.ak.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: O SO a !q PID Number: (157- 8O(-4/3 Name:-7-1Q0-/ ,A'(c MvIres Wastewater System: ,New ❑ Upgrade Address: S 41seAre hod ABSORPTION FIELD Phone: Number of Bedrooms: 3S.7 ? ? 0 Deep Trench 0 Shallow Trench 0 Bed 0 Mound ?Other: l J/ Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION TS2 GPD/Ft2 5 Ft. Block: Lot: L Su bdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 77/6 774& rdhtlid.c 2,5. Ft. a'S Ft. Township: Range: Section: Fill added above original grade: Gravel Length: es? "r Ft. 3 Ft. Gravel width: Number of lines: Distance between Jines: Well: P4LiC. ew ❑ pgrade /2 Ft. 3 T Ft. Classification.:Private,A,B, Total Depth: Cased to: Total absorption area: Pipe�fMatenal: � Ft. Ft. 4// SC y? FI eet 4(U a `/ c- Driller Date Ohne . Static Water vel: Installer: Date Installed' Ft. 7 tf6 S/3cio 5 Yield: / Pump Set at: Casing Height A ve Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 0 Septic 0 Holding F.T.E.P. 0 Other: To Septic Absorption Lift Holding •ublic/Private Manufacturer. Capacity: From Tank Field Station Tank Sewer Line �f(�,J�/ze(�f/f(�iK— /SGQ Gal. Mater' II: Number of Compartments: ^ Well i / t-'1anc— 2' Surface Water pa cs. /00(4- X00 <r- LIFT STATION Siizze: Manufacturer �/� Lot Line /014- /'(�'t ! O (� / 5 lir Is-co Gal. -Cfli L _ "Pump on level at: "Pump off Level at: High water alarm at: z Foundation #.t d i t �O in. 3 in. Q p in. Pump ke& delEledn nspections performed by: Curtain Drain .-- .---- ISI etc Z0e6i5 J 1S/AlC &),c/ Remarks: , BENCH MARK Location and Description: ?—DP J F FoJ,06,4-r c.'-.1 Assumed Elevation. /Od Ft. ,� / 2/2Cri Y ' Stark Inspections performed by: NEiiil`t e(r�r• eN _ Dates: 1st 3/i/oS .edmr Ak,4'ttr q 3/2 fair �k 0. s�f �J 2nd ?(?alas • .` s:".÷.;41# ' . 41# Development Services Department Approva *l 491M ='� * Pi A Conditional Approval Date: 01.1 }.r'�4 Steven W.Eng Q 0^`e PE 6256 ,y t�G' '`•°......•,x`07, afI Reviewed and approved by: J a44.� Date: /2/31//e �Qy.�t,.�`��'`� (Rev.04/06) f /, ' F / AS—BUILT MEASUREMENTS A B X MT/Tank CO's 17 64 Field MT1 77 75 Field MT2 55 38.5 li/- & Manhole 23.5 65 CO 1 74.3 72 CO 2 75.6 71 .5 v_� CO3 78 71 33' Section Line Easement Reserve Site 1500 Gallon STEP Tank Premier AKTH2 AKTH1 10 •o o 5% -1p'O 10 F.C.O. O \ A House B Water Valve :ottomless ISF —\—. ____ 3� 2 cfc Septic System Construction F EoSe nt— Dotss Foes �omt Preclude Sanitationdjoining SgMBAR Improvements. 1" = 40' ,•\0.1-.' �c°'+ THE TABLELANDS S/D NORTHRIM "�P..., , N IN RING * :49111 *+ T CK 8 SEPTIC ENGINEERING eoXE77o724 ...;. � bb �L� 3, BLOCK O Eagle River, Alaska 99577 # a-ene .• � I SYSTEM + . • RECORD DRAWING _ isrOf 3 1, Depth of ISF is 5'. Mound soil cover material to maintain 2 foot cover. 2. S.T.E.P. Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free From Boulders. 3. Sewer Service Line is Minimum 27. Slope & 3' Cover, Force Main 4' Cover 4. Water-Tight Couplings. 1' Insulation over trench. 5. The S.T.E.P. -tank will be manufactured by Anchorage Tank 6. See Specification Sheet. Foundation Cleanout Elevation = 100.5' MAINTAIN 4' MINIMUM SEPARATION TO GROUNDWATER / Tank Cleanout MAINTAIN 6' MINIMUM SEPARATION TO BEDROCK Riser AT TRENCH. MOUND COVER MATERIAL. 4 Foot Cover 1.25' PVC Force Main Elevation = 95.5' or Equal r— To End-Point of ISF 1500 Gallon S.T.E.P. 'Premier' Mounded Cover To Match Slope Elevation = 107.5' + Monitor Tube levation = 96' Slope 1 ation = 105.5' - • 2,0' 1" Insulation 3/8' PEA GRAVEL - M❑A SPEC SAND � .: . . . } Elevation = 102. ' iiiii 12' 1/2' HDPE AIR LINE TH1 Water Elevation = 90' k� u ISF END VIEW TABLELANDS S/D l`'JORTHRIV *.49m LOT 3, BLOCK 8 ENGINEERING "' S,TE,P, TANK PR❑FILE Po Box 770724 RECORD DRAWING Eagle River, Alaska 99577 1 CE-12511 _...___._ -- — — — — iDate: --- r ° Irown By BOTTOMLESS ISF 17/17 • - s 3 of 3 , Jul 20 2007 12: 24PM Rising Son Electric, Inc. 622 -3777 p. 1 it Iisin .5an �.Lecfric. Inc. ,• ` I 1496 Voo Lard Drive r_agle I2.JVer. 99577 -, `ice 1/4.1.:. .\, r: t (907) 622-6/// July 26, 2007 Northrim EnOrAecring Attn: Steve FAX #694-7026 Re: Lot 3 Plock 8 The Tableland Subdh.►sioii Dear Steve: The ljft station at.the above refer.?nced prar e:ty has been ,wed in accordance with NEC and State/Local codes. Thank you. Sincercty, ,�✓. y `ten-1/..-i stet. Lc 6 , Kevin.urnbuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 cc: file sY., PO BOX 240773 a, '' ? ... ANCHORAGE, AK 99524 522.7773 677.7766 (FAX) Vn) GE r;:i. ENGINEERING FORGECIVIL.COM December 26, 2018 �~ OF Ai,q�<<1 %�P•• 'f 1 MOA Development Services. On-Site Water & Wastewater Program .4-'03•49 ii ) *�/, 47 Elmo AnOcOhoragere Rd AK 99507 ...�� .7 A� /6 . Benja chiller •••• Al, ���•, CE 12592 �t/ t sl •.)2/26/I 8 ,• �C�,� Subject: The Tablelands, Block 8 Lot 3 1kk�14�\F``0�.. Septic permit closeout Dear On-Site Services Engineer: Per our recent discussion, and with permission from Steve Eng, PE, we .ft would like to provide the needed information to close out this permit. �� ��u"E ees�E�T There were only two comments that really needed to be addressed- the r � I Compressor 40,006 location of the compressor, and verification that it was operational by - =JJIPROPosED n providing the current pressure. -�, ''pNE STORY I 61 DWEWNG tri < PLA( ?Co -87' \` 85 The compressor is located in the crawlspace at approximately at the �3 �4. ,, , 2- marked location in the attached image. _,'t F.F.=97' 4N lJ'CO3 • ^BS!• N �y )i.:,- m 42..'..y9 ,�', o,-,-0., J At the time of our inspection, the compressor gage read 3.8 psi. >N x'92' +250-C. ROPOSE1. 15 SEPTIC ` DRIVEWAY _?5 �A110N� L'96' • w�4P-5-' . °S q Sincerely, , �_, a, �sF� < ,r ,4,4-- --.., Benjamin Schiller, PE �� " MUNICIPALITY OFANCHORAGE 1 n Development Services Department I� ' b u v Onsite Water d 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: Feb 02, 2005 Expiration Date: Feb 02, 2006 Permit Number: SWO50019 Parcel ID: 051-801-43 Legal Description: THE TABLELANDS SUBSIVISION BLOCK 8 LOT 3' Design Engineer: 0032 Alaska Rim Engineering Site Address: NHN SAMBAR LOOP Owner Name: TROY DAVIS HOMES Lot Size: 40006 SO. FT. Owner Address: NHN SAMBAR LOOP Total Bedrooms: 4 Permit Bedrooms: 4 PETERS CREEK. AK 99564 - This permit Is for the construction of: E Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage Ali construction must be in accordance with: 1. The attached approved design. 2. All requirements specked In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated,. and heated to prevent freezing. 5. The following special provisions. Maximum depth of absorption field shall not exceed 3.3 feet below original grade for any portion of the bed. Rw;:!ska Atz-%T ck s4A Qo. aa,a«os ma d to -olk," d**� C� iPU0 . gcoQval r E�cw,�l cvy-k Wtr..s>id3.3 �eAs�r �ouJ cx'�.vroa g� �., ._Sgcn Received By. Date: a - 3 - d S FROM :NORTHRIM FAX NO. :9076947026 Feb. 24 2005 11:48M PS K�T xT !y NEERING FAX Steve Eng, PE, PH 17237 Bear Paw Circle, Eagle River AK 99577 (907) 694-7028 tel (907)694-7026 fax NorthRimEng@aol.com Date: 2/24/05 To: Bob Subject: Lot 3 Block S, Tablelands SID Number of Pages: 6 Fax: 694.1250 Julie Makela, PE, @ MOA On -Site Services approved the included redesign, utilizing the Bottomless ISF. The original design condition of 3.3 fcct depth will be met by this revised design, because of the 2 foot sand liner. Please call if I can be of further assistance. CC: Julie Makela, PE; MOA On -Site Services Troy Davis Homes, Inc. \ 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 SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05/ -WI -145 Permit Number SW Prop Maili Site ie 357-939N 99(0 ssc! Legal description (Lot, Block & Sub'd•) b 4- 151OGJ_1 u,�1�/. N 5 Legal description (/Section, Township & Range) Lot Size (/ Ac s/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only QI 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. of properly owner or authorized Permit/Rush Fees: Date of Payment: Date of Payment: Receipt Number. Receipt Number. (Rev. 09104) Y X SIM 1N(iINEERING NorthRim Engineering 17237 Bear Paw Circle Eagle River, AK 99577 907.694.7028 February 22, 2005 MOA On -Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: REVISED DESIGN; Tablelands S/D Lot 3, Block 8, Chugiak A wastewater permit was issued for the referenced property. During construction it was discovered that the design would not match the contours of the lot. After conferring with the owner and excavator it appeared that a Bottomless Intermittent Sand Filter (ISF) would work best. The following revised design is being submitted: 1. Soils: Previous soil logs will be used for the revised design. AKTH 1 provides the greatest separation to groundwater and this site will be used for the ISF. 2. ISF Drainfield Design: Allowable application rate for ISF: 2 GPD/M Number of Bedrooms: 3 bedrooms + Den; Size for 4 bedrooms Design Flow: 600 GPD Minimum Absorption Area: 300 FT= Effective Depth Below Pressure Distribution: 0.5' Width: 10' Length: 30' Effective Absorption Area: 300 FT= Air Supply: "Anchorage Tank" Thomas Industries, Model 5070 or equal. Air Supply Line: "Anchorage Tank" "Wasteflow" emitter line, %z inch I.D. HDPE Sand Material: In accordance with MOA latest Sand Filter Spec. Pea Gravel: 100% passing 3/8 inch sieve, less than 20% passing the '% inch sieve, & less than 1% passing the #8 sieve. 3. Excavation: Excavation will be a maximum of 5' depth. 0.5' sand will be placed, the air supply line will then be installed, and 1.5' of sand will be placed over this. Above the sand layer will be 0.5' of pea gravel, the pressure distribution pipe will then be installed, followed by 0.25' pea gravel covering the pipe. A 1500 gallon S.T.E.P. tank Y 4 HW �1INEERiNG ("Anchorage Tank" will be used with programmable timer for intermittent dosing. 4. Materials & Construction Practice: S.T.E.P. Tank to Meet "Anchorage Tank" material specifications. Sand Filter to comply with MOA "Intermittent Sand Filter Design, Installation & Maintenance Manual". The Tablelands Subdivision is being developed. Public water is provided resulting in no water well conflicts. The lot slopes toward the northwest. Please review the revised wastewater system design for the planned 4 bedroom (3 bedroom + den) single family home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Sincere Steve Eng, PE, Design Enclosures DESIGN NOTES: 1. Total Depth of Trench is 5'. Terrain Slopes Toward NW. 2. Sewer Service Line minimum 2% slope. 3. Trench is Minimum 10' from Lot Line. 4. Lots Served by Public Water System. 5. Air" Compressor is Thomas Industries Model 5070 ("Anchorage Tank` !j J 6. Air Line is 1/2" Diameter HDPE, Within Insulated Sch. 40 PVC Pipe. 7. S.T.E.P. Tank to Meet Installation Requirements Per "Anchorage TanP 33' Section Line Easement 1500 Gallon Site Tank AK H2 TH1 57.-1 d House \� F.C.O _ qn , Water Valve is ec Eose�eni SgMBgR Bottomless ISF 9 Septic System Construction Does Not Preclude Adjoining Lots From Sanitation Improvements. t• = An' CF, tE °F. k'a NORTHRIy ENGINEERINGG '..g,4em • THE TABLELANDS S/D LOT . .. 17237 Bear Pow C4rlo a w.. Eove Rf~. Alo0a 99577 a-uWw ,.• % LAYOUT LOT 3, BLOCK 8 )04W N"Mr 2/22/05 11 of 3 � 0 CQ0 3 u U . 00 §}k �2U + L \ Q, ©tee 2 fuQ)zL &0C Eu(uu )3�t& p§�L>, 22 EO (/k)3 OCL* .:P -P /±�]} o E:©, tno,5r- _I o C a)! . :3 CL 4)_ 2�22� aaS:t Zi :5-Y o OC— L) L. :>fizz ©L&L- 01-- "I QP •E cl¥L� ® ��§d±■ -4 ew¥wiZ G . � | o ) _E Cki a tr) /emu .:g.. 0 •• \ : \ } } 0 in QOD � � o too ..0 m \\� 0 u LSAN EM § 7 qLi ��n CL' ¢ m 22§ $ 2 222 ±3 ,@ 2 j\L I 7 0 cu �<) n \ \ 53 I << ® § /d § w 2 P/ 0 -1 .tbX h > k< a 2 k c > LnZ < U LLI -i � 7:�� a Lq w k . > c� e u_ a0 } 8/ §r- | : \k §/ %�J 0 * 0 \ \}( % La 222. \ /�{ ! C6 x Ol N N d CL V v \ rn N N d CL 0 N v OD M O1 N N d CL .N CD U C3 N ^L w� o as l7 Y C as H CL -a a a, Li C H W N ar O U y d +1 �sCQ N _ �. 3 O N "' N t� as 0. W L > 3 A ai (b4. >J N N L) S VJ to .a O ++ Z E U £ O O Z4f y2 V/ROI N FL - Li Q -• fU (`') v 0 M 4 W 2 U N V a N � Z n O N F ml Q W W a LY N O N � f H .. N 3 0 O Ce W 2 O U O N Z U > J d W 3 � N O 2 C Q 3 H N W U C3 r. S U Z Qy Q � O d F L LO F d K d O L Oy LC A CC) N Y o U mo Z —i Q pq J w M J ¢o F- J 0 LLW C:) J X F— C) O W N N N \ (U o � o„ Q IOWzi o� Q. lb Q. 44 w �y OFA.... Municipality of Anchorage .1ENGIp1 "EA J, Development Services Department Building Safety Division ..... ..—...... a.i On -Sao Water and Wastewater Program 4700 South Bragaw St. ..••• .. ...• '• .• P.O. Box 196650 Andwrage, AK 99519-6650 j 9,.. •• -Mary . Shrevea t r? www.m7)NI.� e ��j�J'•. CE 9351 Soils Log - Percolation Test 71t1U904 111111 Performed For. Troy Davis Homes Date Performed: 12/13/04 Legal Description: Lot 3, Block 8. The Tablelands Township. Range Section: Depth r . Sa1A w1gvautl,-ir0ec 4 v e7 t+) wlxt•Awrlt) 5 r ocz. cotobl,* 6- 7- t) 7-p 8- Date •• WAS GROUND WATER Depth to Water Net Drop 1 ENCOUNTERED? Yes 10- 30 min. 6.7/8 In. IF YES. AT WHAT DEPTH? 1 O• E 11-• 12/13/04 V Depth to Water After 0 McntkorYq? 4.3' 7 in. : 12/13/04 12- ••0 7 in. Dale: 12/20/04 H 1 1 1 Reading Date Gross Time Net Time Depth to Water Net Drop 1 12/13/04 1518 30 min. 6.7/8 In. 2 12/13/04 1549 30 min. 7 in. 3 12/13/04 1620 30 min. 7 in. 1 In. r......w..Nnranic krr-•a• l MKC HOLE DNk1ETER ekrlw TEST RUN BETWEEN 4.e FT AND 5.0 Fr COMMENTS Presoak 4 Man. PERFORMED BY: Kent Streets, AK Rim Engineering, Ina. t Mary L Shreyes, P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 12/20/04 ,re,q�- Municipality of Anchorage Development Services Department Building Safety DMsion a.t OnSta Water and Wastewater Program 4700 South Brag" SL P.O. Boz 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343.7904 Soils Log - Percolation Test *:..,,.. FWA .* Mary V Shreves .,• CE 9351 ......... . Perforated For. Troy Davis Homes Date Performed: 1127 11\I\\\1�— Legal Description: Lot 3, Block 8, The Tablelands Township, Range, Section: Depth 1111 15i 1� Sit. pt.. a- �oID ya1/� W�gY0.vf.I � .0.• 51�ti}� vhDiSF• 9- 1 1 1 WAS GROUND WATER ENCOUNTERED? No S IF YES. AT WHAT DEPTH? L Depth to Water After G Monhodng? p E Date: Reading Date Gross Time Net Time Depth to Water Net Drop 1 1/27/05 1434 30 min. 8 in. 2 1/27/05 1507 30 min. 7-3/4 In. 3 1/27/05 1538 30 min. 7-5/8 in. 1-10/16 in. MKU HOLE DIAMETER aw-e TEST RUN BETWEEN 4.0 FT AND 5.0 FT COMMENTS I>resoe1,41hours. PERFORMED BY: Kant Sheets. AK Rim Engineering, Inc. I Mary L Shreyes, P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1/31/05 MUNICIPALITY OF ANCHORAGE Development Services Department " Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-801-43 Certificate of On -Site Systems Approval Expiration Date: l7' 30 -2622 1. GENERAL INFORMATION Complete legal description The Tablelands, Block 8, Lot 3 Location (site address) 22726 Sambar Loop Chugiak, AK Current property owner(s) Samuel & Christine Fedak Day phone (907) 390-7292 Mailing address 22726 Sambar Loop Chugiak, AK 99567 Real estate agent 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ y l a, 5 I Date of Payment Receipt Number 7 7 2020 o51r7sQ Waiver Fee $ Date of Payment Receipt Number COSA # 0 S C 20 13 0 1 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson Date 7/6/2020 Original Certificate Date: 7,2-0-2-6 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet OF q �qS ®®�P�E,.. . IV ''.®+s 6. DSD SIGNATURE ` 49th ®' ;,�J �3�T. System #1 Approved for bedrooms ®........................................ ; 7AI t.4ICHAEL E. ANDERSON fAlry System #2 Approved for bedrooms No. CE -4381 ��• _® ����F;••.,•,7i6i20 ,•.,.••���® Disapproved �® ®®"ROFES50' 41®® Conditional approval for bedrooms, with the following stipulations: N OF g WATER AND Original Certificate Date: 7,2-0-2-6 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: The Tablelands, B8, L3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Public Water System B. TANK DATA Age of tank(s) 15 years Tank type/material STEP/Plastic Measured operating fluid level in septic tank *21 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/20/20 - JRs Septic Pumping D. ABSORPTION FIELD DATA IDSF Bed Which system tested (date installed) 3/30/05 ❑ ALL standpipes present per record drawing Total measured depth from grade 3.2 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-801-43 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station 15 years Lift station material Plastic Comments: *Tank was pumped prior to measurement. Adequacy test date 6/30/20 Results [DPass For 4 bedrooms Fluid depth prior to test 0 in Water added 771 gal New depth 0 in Elapsed time 20 min Final fluid depth 0 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) None If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) - Public Water System Septic Tank/Lift Station on Lot > 100' ❑7 NA if No Community Sewer Manhole/Cleanout > 100' NA ❑ Yes if No ❑✓ ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No NA ft Private Sewer/Septic Line > 25' ❑ Yes if No NA ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ❑ Yes if No NA ft Neighboring Absorption Fields > 100' Water Service Line > 10' NA Yes Animal Containment > 50' ❑ Yes if No NA ft ❑ Yes if No Lot is served by a Public ft Water System. NA Manure/Animal Excreta Storage > 100' NA Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑7 Yes if No ft Surface Water > 100' ❑✓ Yes if No _ Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: ✓❑ Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No Water Main > 10' Q Yes if No ft Community Wells > 200' ❑✓ Yes if No _ Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' [D Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS Lot is served by a Public Water System. G. ENGINEER'S CERTIFICATION OF ..4���� �E ....: _<J �® ��••••.S 1 certify that I have determined through field inspections and review ��P.'•'!'... 0 C._��` of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. =� 49th c • .............f;........ a....................� MICHAEL E. ANDERSON •� %'• No CE -4381 TCS �`••,p 7/6/2020 F��� COSA Checklist yellow sheet ,.•'� 44� p14 ROFESSO� lig ft ft ft ft tf') cc Lot 4 H O Z 12.2'x9.9' SHED iN WOOD M MANHOLE-� PATIO °i 2 I 16.7' �.3' n CANT 19, 6 14.7' H 1 STORY RESIDENCE w/ WALKOUT BSMT. 6.7' o 2.7- 1.0'x8.0' CANT �A CONCRETE PORCH 1� ASPHALT •. RETAINING WALL L� 134 07 57'09"E 252.60' 33' SECTION LINE EASEMENT Lot 3 40,006 s.f. N� Lot 2 NOTE: THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 15' T&17 EASEMENT SA app �o PLOT PLAN ___ AS BUILT _X_ SCALE _ 1 _==40__ GRID _ NW 1560Project No. 20= 30�A1__—__ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang Associates, inc. (907) 522-6476 Phone a�o00��0 (907) 522-4625 Fax C) F A Professional Land S u rve ors ken0langsurvey.com c� �' Yjonathan01angsurvey.com ©OP�''S �O 1 hereby certify that i have surveyed the following described property: �' LOT 3, BLOCK 8, THE TABLELANDS SUBDIVISION (Plat No. 2004-25) 4 gTH Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed 5 • • - premises and that there are no roadways, transmission lines or other visible �0���, KENNET NG easements on said property except as indicated hereon. V s� '• -1A &I _, at Anchorage, Alaska 4dQ�F�A -..LS-5202..- Dated LS-5202.• Dated this the __ �___ Day of � �?i-�'___ 404ROFFSSIONA\- It is the responsibility of the owner to determine the existence of any easements, DOOOOo�c covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 BILL TO Scott Fedak 22726 Sambar Loop Chugiak, AK 99567 USA NaSKa Sewer & urain LLC. P.O. Box 221914 Anchorage, Alaska 99592 (907) 248-9557 www.aksewer.com Scott Fedak 22726 Sambar Loop Chugiak, AK 99567 USA s No power to Liftstations control panel, referred to frontier electric TASK DESCRIPTION QTY PRICE TOTAL Service Service Call: 1.00 $140.00 $140.00 Call Service Call -frontier electric installed a new controls panel which restored power to Liftstations, inspected Liftstation pump, floats and alarm, all operating properly, no liquid in tank to test hydraulic flow pressure, co is clear and flowing to the tank. PAID ON TYPE MEMO AMOUNT 5/22/2020 Visa $140.00 POTENTIAL SAVINGS $0.00 S U B -TOTAL $140.00 TAX $0.00 TOTAL DUE $140.00 PAYMENT $140.00 BALANCE DUE $0.00 Thank you for choosing Alaska Sewer & Drain LLC CUSTOMER AUTHORIZATION Page 1 of 2 MUNICIPALITY oi,- ANCHORAGE 0 Community Development Department 0 On -Site Water & Wastewater Program P: 907-343-7904 ® F: 9011-343-7997 - P.O. Box 196650 Anchorage, AK 99519-6650 - 11ttp:,//www.n1uni.org Intermittent Dosing Sand Filter Owner Street Address lf1_716 5 c-,,, CY---)N­) C,� N 0 C) ip Phone Legal Desc. M Septic Tank: -Sludge level winches -Pumping: required��s I no -Pumping f mpleted­t�ij no Absorption Field: cl A �. W -Liquid level inches -Flushing valves per approved design es no -All flushing valves opened, distribution lines flushed, and flushing valves closed es no Lift station: -Pump basket cleanedQ�no -Biotube effluent filter cleaned <'yes) no -Timer float settinginches -High level float setting 6�, inches -Reference point -Pump on N'114 seconds -Pump off___bJ19.. minutes -Cumulative lifetime cycles__. 'Cumulative run timeJ\q//1/) hours -Operation satisfactory (ves ) no Air5ytem. -Air pump filter cleaned es no -Air pressure psi -Date of latest install or rebuild Ck -Air system operation satisfactoi_rL not satisfactory Alarm System: P_Q -Dedicated electrical circuit ( es, no -Audible and visual alarm inside dwelling esno -Float setting inches -Alarm system operationc-_s�afisfa�ctory not sa�tisfactory Comments: ........... M�.......... ....... ................ P ...... ...... UN .......... ................... Maintenance Provider: Technician � Ck�X-v Company �—As (;a, V I i s=s Signature IMIZE: AA_;_f - - r. nr. i n f) A n.) It 'D Ar. Date of maintenance sU,4o Date 4 A Mi`NIC"ti';- u'ry OF ANC1,10RAGE r'#i?'1'A.' C-EI)ITNT' ysTr,, VI ,MAINTENANCE AND RFPAIR AGREEMENT THIS+ 1%,ti- l v t l \AN E At D REPAIR AGREEMENT. herein the -AGRI.;I:MEN "' made and entered into as of this Ni _ Day of t (.t%of 10 2e) , by :arid beiNveen �> ,/�' C11 �erc in the "{)IiR," atad the \huaicip:ality of Anchorage. herein ti e `AIL. NUClI,r11,I r'"' inaccordance � ith Anchorage vlunicipill Cade. (A,Ny C) 15.65.365. In consideration of the mutual covenants contained herein, the: parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment. Systems The 11Iunicipality grrnzts permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (A\t'1trl'S). described as IntermittentD©sing Sand Filter (IDSF) located at (legal description) The Tablelands, Block 8 Lot 3 ?. ?Maintenance, Repairs and Alterations. (Ovmer is required to toad, understand and initial each section) Throu�.thout the term of this Agreement) the Owner shall enter into a service agree►nent with an NNINV- `S service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactoiy condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibilityof the Omer during the term of this Agreement to payfor all repair(s); maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Ow=ner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance. repairs or permitted alterations to the system. , Omer -acknowledges that regular maintenance of an AW'k`TS reduces the potential 1 OWNER* Bv:h re) Date: STATE Or ALASKA ) } ss. THIRD RMICIAL DISTRICT ) The foregoing instrument was acknowledgedbefore me thisU " day of I'Llq 202 , by Chv: c,( 4 3e4-5�4 NOTARY PUBLI OR ALASKA LCOrmi � �S My Commission expires: 7 II3/ZCys e afglaske irea July i3, 2023 MUIITICIPALI By t� (signature) Date: —Z d 'Z V (print name) Title: