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Home My WebLink AboutTHE TABLELANDS BLK 6 LT 5The Tablelands Block 6 Lot 5 #051-801-28 Municipality of Anchorage Development Services Department Building Safety Division; St. On -Site Water & Wastewater Program, 4700 South Bragaw P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW040087 PID Number: 051-801 �i38 NOTe JOHN THOMSON Wastewater System: ■ New ❑ Upgrade Y Address: 17343 SANTA MARIA DRIVE a EAGLE RIVER, AK. 99577 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 240-2020 3 C7 Deep Trench Cl Shallow Trench Meed DMound Cl other LEGAL DESCRIPTION soo Rotkp: 0.4 Tota Drplh from Crgknl vioe.: 1.75 MAX M/sm. R R Block: Lot: Subdivision: orph to pipe sartam hem erglnol fna Geel drpth bw4olh poo: 6 5 TABLELANDS SEE DWG. R 0.54+ R Township: Range: Section: A aeeN Come «Wino erg: baro/ math' — — — SEE DWG. R 75 R WELL: ❑ New ❑ Upgrade noel wwuc 15 NiwiOer or sn..: 3 Dwtanao be~ "n - 5 rL R CMmilieekon (prhoto, Ae,[} Total Doph: Tart Talal dtwrptko «om: Pp motw,al: D 3034/ F-810 R. R 1125 so.R stotic wa« Lwow; R kNt~ oat. kwt GREEN GENERAL 5%29-6/2/2004 5 TANK W crow: Yrw: sot ALCU*" "htAlwe arrow: cPM R R1514 SEPARATION DISTANCES ■Septic DHolding OS.T.E.P. (3 Other Septic Absorption Uft Holding /Prhabe llanuloc . ANCHORAGE TANK Copachy rt aouon.' 1000 Tank fx,d Station Tank weer un„ Well200'+ 200'+ — — 25'+ llat«ial: STEEL Nunn« r a«np«tmwb: 2 rSurface 100'+ 100'+ — — — LIFT STATIONsitu 10'+ — — — In5'+ anobi al: NWn root« alarm of Foundation 5'+ 10'+ — — — purq Mako I: Fbefrkd kwpocaone W. of. Curtain Drain NONE KNOWN 1 Remarks: REVISED DESIGN TO.BED ON BENCH MARK .lx«ion 5/29/2004 DUE TO RISE IN GROUND WATER «w o.wnptwn: TOP OF FIRST FLOOR CALLED CHANGES INTO MOA ON 6/1/2004 li.9 JEFF POET APPROVED DESIGN CHANGE .USING A...oW E`wvk 100.00R ENGINEERS 8 A 0.4 APPLICATION RATS..:%: .. GEG,Ltd. Inspections Performed by: Daes:1st 5/29/2004 ., " 0 2nd 5/29/20040 3rd 6/2/2004 �� •• j .. ,• •or ess O Development qervices Department Approval Opp E 957 � \&i:l Reviewed and approved by: ate: lei_ ,zro) 4,°professton000 4400000 (N«. PERMITNUMBER: AS -BUILT DRAWING PARCEL ID jE SW08SW040087 051-801- 1-Q / / / / ALTERNATE SITE / WILL REQUIRE THE USE OF AN ADVANTEX TREATMENT SYSTEM / NEW 1000 SEPTIC NEW DRAINFIELD AA- mA� FCO 35.40 31.71 STI 34.75 33.87 ST2 35.70 36.26 DBL1 36.20 37.29 DBL2 36.54 38.07 COI 97.38 136.21 CO2 101.94 139.74 CO3 106.96 143.72 MT 95.53 133.49 MT2 107.87 143.01 C04 103.91 101.36 C05 108.24 106.00 C06 112.98 111.23 MT3 101.83 100.81 MT4 113.18 113.00 DBLI DBL2 " ••: � N / � Ili APPROXIMATE LOCATION OF WATER UNE - APPROXIMATE LOCATION OF XEYBOX - 11/9/2004 . DRAWN BY: R.A.L./C.J.G. �GARNESS ENGINEERING GROUP, Ltd. SALE: � CONSULTANTS 8 GENERAL CONTRACTORS 11" = 4O• 3701 F TUOOR ROAD. SIATF 101 • ANCHORAOF. AK 99501 • FNONF (907)]37*179 • FAX (907)."A-5746 PREPARED FOR: PHONE NUMBER: PACE NUMBER: JOHN THOMSON (907) 240-2020 2 OF 3 LEGAL DESCRIPTION: G TABELANDS SUBDIVISION; LOT 5, BLOCK 6, AS -BUILT DRAWING OF SEPTIC SYSTEM PERMITSW0 NUMBER: A S� B U I LT DRAWING PARCEL NUMBER: SW040087 051-801-A8 rFINAL GRADE � 97.2°-97.73 TH/7 TOP OF TANK AT INLET . 94.21 - TANK AT 94.23 NEW 1000 GALLON MTRT OF BUNG SEPTIC TANK INVERT OF BUNG AT AT INLET 93.59 I OUTLET . 93.50 BOTTOM OF BED • 90.97 (AVG.) - _�-RELATIVE ELEVATION OF GROUNDWATER ON 5/29/04 . 88.72 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE • 78.72 • FINAL GRADE 94.25-94.59 FABRIC ORIGINAL GRADE 92.72 O NICEST POINT VERT OF DISTRIBUTION LINE • 91.51 (AVC.) NOTE: 6-10 INCHES OF LEVELING SAND ADDED TO SOUTH END OF THE BED. A ,,: 11/10/2004 ` DRAWN BY: 0 �•..... . R.A.L./C.J.G. �: g GARNESS ENGINEERING GROUP, Ltd. SALE: CONSULTANTS& GENERAL CONTRACTORS 3701 F T000R ROAD. $IATF 101 • ANCNORAGF, AK 09SO7 • FNONF (9971337.6179 • PAX f907)3S9t3746 N.T.S. PREPARED FOR: PHONE NUMBER: PACE NUMBER: JOHN THOMSON (907) 240-2020 3 OF 3 Q J f LEGAL DESCRIPTION: QA 9i '! TABELANDS SUBDIVISION: LOT 5, BLOCK 6. 0�� 1) TYPE OF WORK:lofes PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM �44po� 1�Iunicipalit3T of Anchorage e. P.O. Na I!NiIKIO • dnchorugc,.\laska !MI519-0(F70 • Tclq,honc 117) 843-9301 •Fuc (!N)7) 3334i^lN) 47(X) nragaw• Strccl • Anclwmgc, Alaska IM.W4)7 m��c.munLorv� D(ttyor Mark Bcgich Building Safety Division 24 Mar 05 John Thomson 17343 Santa Maria Drive Eagle River, AK 99577 Subject: Expired On -Site Water and/or Wastewater Permit. Permit Number: SW040087 Legal Description: The Tablelands Block 6 Lot 5 Dear John Thomson: An On -Site Water/Wastewater Permit, number SW040087, issued by this office for a single-family system, expires on 27 April 05. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincerely, DanWJot Manager On -Site Water and Wastewater Program Enc: Copy of permit - Conunicnity, Security, Prosperity MUNICIPALITY OF ANCHORAGE Development Services Department On -Silo 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 S -'L cf .014' @ / 0: cf, .J- 121,0 Date Issued: Apr 27, 2004 Expiration Date: Apr 27, 2005 Permit Number: SW0400877-dF Parcel ID: 051-801 Legal Description: Design Engineer: 0041 AK Water & Wastewater Consultan+ Site Address: =HISPERING BIRCH DRIVE Owner Name: JOHN THOMSON Lot Size: 40000 SO. FT. Owner Address: 17343 Santa Maria Dr Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River , AK 99577 - 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. brovide 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. THIS PROPERTY IS CURRENTLY CALLED GLENN VIEW ESTATES NORTH TRACT F BUT HAS BEEN OFFICIALLY SUBDIVIDED TO THE TABLELANDS SUBDIVISION BLOCK 6 LOT 5 .i - z A T 44 . #' -7 Ag /,,/-4 ufi 6 - ly; 0. Received By: 144 r- bCtlt %J "X/)' ✓+el /FcG ale sf YrSI«1- fYa-Or( ub-ir'tY�:;i Date: Issued By: Date: �l7 u Municipality of Anchorage Development Services Department Building Safety Division ., On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Bax 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. Permit Number Property owner(s) JOHN THOMSON Day phone 240-2020 Mailing address (1) 17343 nSANTA MARIA DRIVE • EAGLE RIVER, AK. ai ing address (2) �L`� r - NW� dAe 99577 Legal description (Lot, Block & Sub'd.) LOT 5. BLOCK 6: TABLELANDS SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only 0 Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit Fees: g11A) Waiver Fees: Date of Payment: I I �� Date of Payment: Receipt Number. �)SU�f X7 Receipt Number., GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS April 19, 2004 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic System for Lot 5, Block 6; Tablelands Subdivision To whom it may concern: The proposed 3 bedroom house will be served by public water and a private septic system. We are proposing to install a 1000 gallon septic tank and dual 5 -wide trench type drainfields. Two test holes were excavated on the property. The drainfields will be designed around the 30 foot radii of these test holes. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 0.45 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 15 & 60 minuteslinch b. Proposed Application Rate: 0.45 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 100OR2 f. Total Depth: 7 feet (maximum at any point) g. Effective Depth: 3 feet h. Width: 5 feet i. Reduction Factor: 0.58 j. Minimum Length: 120 feet total lenfh (2 @ 60 feet long each) k Effective absorption area = 1035 R 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com 3. SURFACE NVATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: The area around the proposed drainfields is relatively flat. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. JeffreVIAi1 Gbmkss, IYE., M.S. NOTE. A site plan drawing, a design drawing, two soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com LOT 2. BLOCK 6: TABLELANDS S/D r � QQ / LOT S. BLOCK 7; TABLELANDS S/D / / LOT 4. BLOCK 6; TABLELANDS S/D ALTERNATE SITE THIS FR THS. CP O M LOT 3. BLOCK 6: TABLELANDS S/D LOT 6. BLOCK SC / TABLELANDS/D / PROPOSED SEPTIC / SYSTEM (SEE DESIGN PAGE 2 OF 2) / / PROPOSED WATER L PROPERTIES SHOWN SERVED BY PUBLIC LOT 2. BLOCK 6; TABLELANDS S/D LOT 8. BLOCK 4; TABLELANDS S/D BLOCK 4; / TABLELANDS S/D SERVICE LINE LOT 10. BLACK 4; TABLELANDS S/D LOT 7. BLOCK 6; / TABLELANDS S/D Z//— / DATE: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS&GENERAL CONTRACTORS 9111 F T'Dna onnn 41179 IN • Apr..naAfc Ac oo+117 • MOKV faMn O.M10 v FA W7la lN.ajl.A 4/19/2004 , C�1 ••• DRAWN BY: R.A.L. SCALE. 1" = 100, PREPARED FOR PHONE NUMBER: PACE NUMBER: JOHN THOMSON 240-2020 2 OF 2 LEGAL DESCRIPTION: TABLELANDS SUBDIVISION; LOT 5. BLOCK 6. TYPE OF WORK: SITE PLAN FOR PROPOSED SEPTIC SYSTEM T �•.�� 4, r -e A. Dmess: —7953 p�o/esalo�°" f INSTALL FLOW ROPOSED DRAINFEIT EXCAVATE TWO TRENCHES THAT ARE 7 FEET / DEEP MAXIMUM (AT ANY POINT) BY 5 FEET WIDE BY 60 FEET LONG (FEFEET TOTAL LENGTH). ADD 3 FEET T OF CLEAN. WASHED SEWER DRAINROCK. i \ \ \\\ \\ 7\\\ �rUTa/J M21 NOTE: THE CONTRACTOR SHALL HAVE THE NORTH LOT LINE FLAGGED BY A REGISTERED LAN SURVEYOR PRIOR TO CONSTRUCTION. NOTE: DEPENDING OF THE ELEVATION OF THE HOUSE. A GRINDER PUMP OR A LIFT STATION MAY BE REQUIRED. DOUBLE CLEANO OPOSED 1000 )N SEPTIC TANK INSTALL FOUNDATION 1 GARNESS ENGINEERING GROUP, Ltd. R.A.L. SCAL CONSULTANTS& GENERAL CONTRACTORS '. n 4D• 3701 F TUDOR ROAD. $MITE 101 . AWWRAGF. A8 99307 • PNONF (9071331-069 • FAX (901)338-3746 PREPARED FOR: PHONE NUMBER: PACE NUMBER: JOHN THOMSON 240-2020 2 OF 2 LEGAL DESCRIPTION: TABLELANDS SUBDIVISION; LOT 5. BLOCK 6. TYPE OF WORK: DESIGN DRAWING FOR PROPOSED SEPTIC SYSTEM A. Gor ess: C —79 \d< GARNESS ENGINEERING GROUP, Ltd. ^ CONSULTANTSR GENERAL CONTRACTORS LEGAL DESCRIPTION: TABLELANDS SUBDIVISION; LOT 5. BLOCK 6, PERFOR[MMEEDFFOOR: JOHN THOMSON DATE: 1/21/2004 (feet OGANICS TEST HOLE 7 1 ,MHU-LOAM DATE DRY 1/21/04 SOIL CLASSIFICATIONS 1/29/04 iGW 4/8/04 6- — ==zz- •R 30 4- 2- 3 14:52 6- — 4 15:22 30 CIL 2- I 15:22 — IGC • 6 15:52 30 4- SW MH SP CH I i;l�i;t]iSMYN� • Sc 6Iillllllw/ SOM VELE 10 11 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 1/21/04 DRY 1/29/04 DRY 4/8/04 6- — A. r ess: -795 :cq�o1 / T #8 TH#7+ SITE PLAN I"-100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 1/22/2004 1 14:22 — 6- — 2 14:52 30 4- 2- 3 14:52 6- — 4 15:22 30 4- 2- 5 15:22 — 6- — 6 15:52 30 4- 2- 19� PERCOLATION RATE 15 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.5 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS fPERVORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: to GARNESS .ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS V01 [ luoriaw. OR fuf • movwce W f 7 • n ,fro -•f» • F". cw" • ff�e v«. SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: TABLELANDS SUBDMSION; LOT 4, BLOCK 6, PERFORMED FOR: JOHN THOMSON DATE: 1/21/2004 Q et ORGANICS TEST HOLE 8 _OAM SM/ML w/ SOME GRAVEL DEPTH TO GROUNDWATER DATE • • 1 21/2004 012.5' 111111111 v//zi HUM Iilllllll %//% DRY ., 111191 0 i i �Il�ls; �.�e 2 DEPTH TO GROUNDWATER DATE DRY 1 21/2004 012.5' 1/29/2004 DRY 4/8/2004 6' - mul 10-100, DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 1 22 2004 1 14:23 - 6' - 2 14:53 30 5 1/2- 1/2' 3 14:53 - 6' - 4 15:23 30 5 1/2- 1/2' 5 15:23 - 6- 6 15:53 30 5 1/20 1/20 PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.5 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON COMMENTS: 'MAY HAVE BEEN INFLUENCED BY SNOW MELT RUNNING INTO BENCH. PERFORMED BY CEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERF RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC261180 Parcel ID 051 -801-28 Expiration Date: 5/27/2026 Legal description THE TABLELANDS BLK 6 LT 5 Site address 23049 WHISPERING BIRCH DR Current propertyowner(s) SMITH STEPHANIE X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By: ;`!G �'/J �/C�'�� Original Certificate Date: 6/10/2026 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-801-28 Complete legal description THE TABLELANDS BLOCK 6 LOT 5 Location (site address) 23049 WHISPERING BIRCH DRIVE CHUGIAK, AK 99567 Current property owner(s) SMITH STEPHANIE A 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑ Private Well serving # dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 22 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑■ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. BVI COSA Fee $ Waiver Fee $ Date of Payment 1 I Z Date of Payment COSA # SL �� b j �� Waiver # COSA Application_Apr2025.doc COSA Checklist_May2025.docx COSA Checklist Legal Description: THE TABLELANDS BLOCK 6 LOT 5 Parcel ID: 051-801-28 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER 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. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 5/27/2026 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 6/2/2004 ALL standpipes present per record drawing Total measured depth from grade 3.4 ft (max) Measured depth to pipe invert from grade 2.4 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/27/2026 Results Pass Fluid depth prior to test 3 in Water added 500 gal New fluid depth 5 in Elapsed time 1440 min Final fluid depth 3 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 0.54’+ ED) Effective depth used 3 in (Final Fluid Depth) Effective depth remaining 3 in Comments/Deficiencies: Measured depths per existing grade & the northern side of bed has measurable Effective Depth (ED) (0.54’+) whereas southern side is not measurable. COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 06/05/2026 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 06/05/26 Septic Tank Advisory Certificate of On -Site Systems Approval # OSC261180 Subdivision: The Tablelands Block:6, Lot: 5 The septic tank for this property is 22 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. Steel septic tanks utilizing "Coal Tar Pitch" coatings are subject to corrosion as the steel reacts to water and rusts. These tanks have a finite lifespan buried in the ground. These tanks can become structurally compromised and pose a health risk. They could collapse and/or leak untreated wastewater directly into groundwater. In the interest of protecting public health and the environment, the Municipality of Anchorage Development Services Department has issued Policy W.05 Standard of Care Regarding the Inspection of Steel Septic Tanks when Performing COSA Inspection. Please request a copy of this policy from the Department if interested. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. 0. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Municipality of Anchorage On -Site Water &Wastewater Program (907) 343-7904 c .'- APR 2 2 20;5 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. 051-801-28 Expiration Date:_ — �-7 1. GENERAL INFORMATION Complete legal description THE TABLELANDS; BLOCK 6 LOT 5 Location (site address) 23049 WHISPERING BIRCH DRIVE *CHUGIAK AK 99567 Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: GREG & NIKI RAZO Day phone 230-0628 23049 WHISPERING BIRCH DRIVE *CHUGIAK AK 99567 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ ❑ Public Water System Public Sewer WaiwrNadance request for. Distance: COSA Fee $ 52 �O Date of Payment-1VOI*175 Receipt Number 690-6 COSA# 0 5C151168 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can / vary, and are outside the control of GEG. Satisfactory test results do not guarantee future ,,'„`tj� performance of the system/s; therefore, GEG makes no warranty (express orimplied) regarding t future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. Conditior al approval for bedrooms. bedrooms. Phone 337-6179 Date Y) Z! lir •.......... ys�00 9 'H v�0 t Je l r y A. Gar ss.-' G CE -7 $ 3 m�0 ��r`„ '�Zfr'tl�•'' cA�oO Oiled pro f e ssionoo OFAfit�" bedrooms, with the following stipulations: ON-SITE WATER AND WASTEWATER pROGRW Original Certificate Date:�- 3 0 `%.- TheuMuoelpality&Ahchorage Develop,emt Services Division (DSD) issues Certificates ofOn-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engmeerregistered in the State ofAlaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: / COSA Checklisty Nitrate Advisory Septic System Advisory Arsenic Advisory, Well Flow Advisory Other fp— mmm If more than I septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: THE TABLELANDS; BLOCK 6, LOT 5 Parcel ID: 051-801-28 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE PUBLIC WATER If A, B, or C provide PWSID# _ Well Log (YIN) Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG Coliformcolonies/100 ml. Nitrate mg./L. A ic: ug./L Date of sample: _ B. SEPTICIHOLDING TANK DATA Wires properly protected (YIN) Casing height (abo round) in. AT IN TION ft. 9— p.m-Collected by: Tank Type/Material SEPTIC/STEEL Date installed 5/29-6/2/04 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tantk (Y/N) NO High water alarm (Y/N) N/A Date of pumping 23 iS Pumper J'P--s PvmPI(J&- C. ABSORPTION FIELD DATA Date installed 5/29-6/2/04 Soil rating (g.p.d./ft`or /bdrm 0.4 System type BED Length 75 ft. Width 15 ft. Gravel below pipe 0.54 ft. Total depth *eft. Eff. absorption area 1125 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/2/15 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 1_5 in. Water added 1 125 gal. New depth 4 in. Elapsed Time: 165 min. Final fluid depth 2.75 in. Absorption rate >= 450+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date - D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Acoess "Pumpoff" Ill at 1 water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/liit station on lot Absorption field on Public sewer main Sewer /septic service line arms On adjacent On adjacent lots manhole/Geanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 102+ Surface water 100'+ Wells on adjacent lots 100'+ PRIVATE/200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ DriVewag Driveway. parking/vehicle, store a 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE/200'+ PUBLIC F. COMMENTS SEE ATTACHED PHOTOS OF CUT MADE FOR FIRE PIT ON NORTH SIDE OF DRAINFIELD. MOA TO DETERMINE IF CUT NEEDS TO BE FILLED. G. ENGINEER'S CERTIFICATION l 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. Engineers Printed Name JEFFREY A. GARNESS Date 4I Z 1 15 -- (Rev. 111W s 1Rev.111W p.l er`r H O N �1 e h� t ° I/ ngineer: _egal Description: Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650(907)343-7904 Fax(907)343-7997 hftp://www.muni.org/ons!te Planning and Development Services Department On -Site Water and Wastewater Program On -Site Sewer/Well Submittal Comment Sheet GARNESS ENGINEERING GROUP LTD THE TABLELANDS B6 LS 'ermit: OSC151168 Septic Completed By: teport Type: COSA -he attached paperwork has been reviewed and is being returned for the following reasons: 4/28/2015 J. Poet Please provide drawing showing location of fire pit in relation to drainfield. 4TT%C1A6a If R 04 prval4& PF 'rW# A'Pf&*'0ClrAA'rV� 1eC 14(/,PJ pF- INAS FK9 ?Vr 19J It t L&Ij#.1 -IS QRS smrt= ec0. 'tlkE F{0.j Pv4 EIIi^+thin I.'+ IS RPeKwf,IOAA11-I.V r*t S*MP E L0 K1 I..1 Af T14 a Ise"fT6M /P (1te 6E o. tJJ_ lane COr'I 10 r Or MIA LI r, 01InIG GJM1Iri 6 oR A'FTfV LAkXev A M wJN't uC W R7Ea. W Pts hoot s T &E0 Fan- S eforl C p, k GL Jfx c `f --r'4 CT. 16 [*] Municipality of Anchorage •. Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St r n C P.O. Box 196650 Anchorage. AK 99519.6650 SS www.ci.enchorage.ak.us v (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ()51- Qn l " 28 HAA# 0502 3 3 1. GENERAL INFORMATION Expiration Date: _l a1I� o Complete legal description Location (site address or d Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN THOMSON Day phone 240-2020 17343 SANTA MARIA DRIVE • EAGLE RIVER AK 99577 Day phone EVA LOKEN w/ PRUDENTAL VISTA Day phone 16635 CENTERFIELD DRNE • EAGLE RtVER AK 99567 Unless otherwise requested. HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 689-6476 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 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 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation data shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E. 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 all 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 performance 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 right whatsoever. 5. DSD SIGNATURE Approved for S_ bedrooms. Disapproved. Conditional approval for bedrooms, with the Attachments: NAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date D ° 1`((11, 1 t„1lrrr �\�.( OF ANch'O'''� ,�1�TFRAND_ )N Manitenance Agreements Supplemental Engineer's Reort Other By: �� QP Original Certificate Date: (Raw. 12101) Municipality of Anchorage • Development Services Department Buildup Safety Division on -Site water & Wastewater Program 47M South Bragaw St. P.O. Box 196650 AndxMe, AK 99519.6650 www.danchorage.stus (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descrlptb , TABLELANDS SUBDMSION: LOT 5. BLOCK 6 Parcel ID: NFJ A. WELL DATA PUBLIC WATER Well type It A. B, or C provide PWSID# ._. Date completed Sanitary Cased to ft- FROM L FROM WELL LOG Date of test Static water level ft. Well production 0•P-►- WATER SAMPLE RESULTS: coliform colonles1100 ml. Nitrate mgJL. Wen Log protected (YIN) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Date of sample: Collected by: e. SEPTIC/HOLDING TANK DATA Tank TypelMaterlal STEEL/S(PI1C Date metalled 5/29-6/2/2004 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation deanout (YM YES Depression over tank (YIN) .NO High water alarm (YIN) N/A Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Date Lnataned 5/29-6/2/2004 Son rating .p.d ftlbdrm) 0_4 System We BED Length 75 ft. Width 15 ft. Gravel below pipe 0.54 R Total depttMjja—s.s2ft, Eft. absorption area 1125 fe Monitoring tubed Depression over field NO Date of adequacy test NEW SYSTEM Results (PasslFan) For oenrs Fluid depth In absorption field before test _ In. Water ad New depth _in. Elapsed Time: _min. ep _ in. Absorption rate >: g.p.d. treatment (past 12 mo.) (YIN S type) If yes, g� date 0. LIFT STATION Date installed Size in gallons "Pump on" level at __in. E. SEPARATION DISTANCES High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllitt station on lot Absorption field on lot Public sewer main line PUBLIC WATER On adjacent On Public sewer manholeldeanout Holding tank SEPARATION DISTANCES FROM SEPTIC(HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 101+ Water service line 100+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 101+ Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS 0. ENGINEER'S CERTIFICATION I certify that I have detemtined through field inspectlons and review of MunA*ai records that the above systems are in conformance with MOA HAA guidelines in effect on this date. ... ................. e e»r Engineerb Printed N me JEFFREY A. OARNESS • a' o Date tr f l° � •op.. .... HAA Fee $ 5- — Waiver Fee $ Date of Payment WC6 Date of Payment Receipt Number Receipt Number Mn. 1?le1) p.l wq N � Y� • e • A•e [•1 ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY* THE Ti9�' �l/C' AND THAT NO ENCROA HMEt�TS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. [2] SCALE: miaow a OF At DATE • r . + _ GRID: 04-, of FB: LS 15-5918 chi DRAWN: