HomeMy WebLinkAboutT12N R3W SEC 24 SE4SW4SE4NW4 PTN PARCEL 67T12N R3W
SEC 24
SE45W45E4N
W4 PTN
PARCEL 67
#015-163-22
Municipality of Anchorage m,,,r•,
Development Services Department •'H:, I'I`�'it''
' Building Safety • �V■
- Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of 3
,i
www.cl anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM
AND/OR WELL INSPECTION REPORT
Permit Number: SAN O A 0.410 3 PID Number: 4315 -•j U 3 — ZZ
Ift .SV1f&ro n SOnr A,YrA Wastewater System: ❑ New t$ Upgrade
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ABSORPTION FIELD
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LEGAL DESCRIPTION
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SEPARATION DISTANCES
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�pb RIvy, Alaska 99577 2nd t0 Z3 O
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Services Department Approval
ROBERTC COWAN
Reviewed and approved by: Date: �i 3, I,t,
LRN IL,M11
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PERMIT NO. SW040403
PACE 2 OF 3
DEVELOPMENT SEYRVICES DEPARTMENT
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
LEGAL T12N, R3W, SEC24, PARCEL 67 P.I.D. NO. 015-163-22
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T' ROBERT C COWAN
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PERMIT NO. SW040403
PACE 3 of 3
DEVELOPMENY SEYRVICES DEPARTMENT
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
LEGAL T12N, R3W, SEC24, PARCEL 67 P.I.O. NO. 015-163-22
ST1 ST2 95.0
FINAL GRADE
90.6 NEW 2000 90.4
GALLON
SEPTIC TANK
COI =93.1'
CO2=94.7' CO2 152.5 115.0
FINAL GRADE
C01=88.5'
SR CO2=88.8'
MTI =82.1'
MT2=82.2'
P T f ROBERT C. COWAN %NMS
A +�1��: a, 0`77-8801 J,
NO WATER FOUND C`7 00
� r.w• 75.2' B.O.H.
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FCO
20.0
42.0
ST1
47.5
62.0
ST2
62.0
67.0
DBL1
65.5
68.0
OBL2
67.0
68.0
CO 1
139.5
127.0
MT 1
138.5
127.0
MT2
153.0
1 13.0
Permit Number: SW040403
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
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Sep 23, 2004
Expiration Date: Sep 23, 2005
Parcel ID: 015-163-22
Legal Description: "T12N R3W SEC 24 SE4SW4SE4NW4 PTN PARCEL 67
Design Engineer: 0003 S & S Engineering Site Address: 011500 SNOWLINE DR
Owner Name: SHARON SCHRAM Lot Size: 128375 SQ. FT.
Owner Address: 11500 SNOWLINE DR Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE. AK 99516-1154
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 closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
ORIGINAL EXISTING TRENCH NEED TO BE PERMENANTLY ABANDONED
/0/rr(o7. 7-N€ EcrerrrvE r>r�--r.r PoA. 7HE 744FivcH Wfte- I-vf err. r'tSTrA0
D' oq'f?f-r4G 3.5 -FT PT�IoeS/tc, 440 7-AH1Cy cEovhry Wicc dE
%? F7 4cws To '0MptNS4re Fo-t EFFfcr.U1 OFvey. rsI
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Received By.
Issued By.
Date: 9 AY/a y
Date: "Z e
Municipality of Anchorage
--1 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.ek.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-163-P,2- Permit Number SW
Property
m
phone
Mailing address (1) 11 503 b„
5rrowe /bl':Vc/-
Mailing address (2)11 "4G 4 4e , 1/�, ZipCode_ gg507
Legal description (Lot, Block & Sub'd.) :56;14 -, .5tcJyq, 5E& / )IJIVv I
Legal description (Section, Township & Range) 5e�/O� ,
D Y1, TIQAr l� n
3 Q
Lot Size_ Acre/Sq.FL Number of Bedrooms S
THIS APPLICATION IS FOR:
Sewer Onlj ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade P3
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.
S8ENGINEERING
17033 4 Eagle Ricer Loop Road No. 404
C—I.D1...' •6.1,.00477
(Signature of property owner or authorized agent)
Permit Fees:
0, ”
Date of Payment: �� 40 /0 y
Receipt Number: C s Syr 5( /
(Rev. 12100)
Waiver Fees:
Date of Payment:
Receipt Number:
September 15, 2004
ROBERT C. COWAN PE
CMLENGINEERS
(907) 8942979
FAX (907) 894121 t
'EXTHAUTH tlN
MUNICIPALITY OF ANCHORAGE
APT'ROJIL9
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
SEWER 6 WATER
M N E (TEM*W
REFERENCE: SE%4, SW'/., SE'/4, NW'/4, Section 24, T12N, R3 W, S.M.
SEWER{WATER
It is requested that you issue a permit to install a septic system upgrade to serve the
MPECTION
existing five bedroom dwelling on the referenced property.
Two test holes were excavated and percolation tests performed. The approximate locations
ENGAWKPMSRr sTwEs
of the test holes are located on the attached site plan. At the time of excavation (9/7/04)
water was not found. After seven days of monitoring, no ground water was found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
EIOW ECTION
I
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
WYE PL"
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
souTTsr
RCC/bjj
Enclosure
MACO(ATION
TEST
i
STRUCTNVLA
MECNANR'IL
wsncnONS
ON WE
WASTEWATER
DGPOSALMTDA
DESIGN
'
17034 NORTH EAGLE RNER LOOP SUITE 204 • EAGLE RIVER ALASKA 99577
DESIGN I SITE -PLAN
30' ROAD
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To
Municipality of Anchorage
Development Services Department
euitCmg Safety Division
t♦ �i
On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci anchcrace.ak.us
(907) 343.79D4
Percrmed For:
Legal Description:
Soils Log - Percolation Test L
SOA -pop, _S�F}t2N— _DaleFarormed:
5EV SU_-)qtJy' '
s.- Se.,rM .(v Township,
COMMENTS
wF4 cwbg:�
Ce -"T,1.. w/
501 -7 -
ROBERT C. COWAN
CE -8801 '
WAS GROUND WATER
Depth
ENCOUNTERED?
Net Tune
(Feet)
-&ebnIu1e.S
1-
'� L
O
Depth to Water After
2-
Monitoring?
— m�
3-
,qb�
30
4644M
4-
�
5-
:;."
WL
6-
3o
7.
7
O o0
1o'ge
30-
6i✓vt
9
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9D
ID "
i Yoft
10-
O
11-
COMMENTS
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Ce -"T,1.. w/
501 -7 -
ROBERT C. COWAN
CE -8801 '
WAS GROUND WATER
Date
ENCOUNTERED?
Net Tune
Depth to Water
s
IF YES. ATY/PAT DEPTH?
'� L
O
Depth to Water After
p
Monitoring?
E
Date:
,qb�
SEcv{; -T721J
V-3 U-:').
Reading
Date
Gross Time
Net Tune
Depth to Water
Net Drop
9 0
0-
30
�
30
Err
-
3o
30-
30
9D
ID "
i Yoft
PERCOtATIOV RATE J, FERC P.CLE DIAMETER f7 "
TEST RUN 6c1.vEEri --.I- FT AVD P-1)
/� \ FT
S & S ENGINEERING
PERFORNIED BY17034 Ejab RiYjr Reid No ?04 I,.✓ice C'ERTIF'Y THAT THIS TEST `!AS
PERFORMED IN 6fafjWWgWVkWjjd AAO�.TE AND 6IUMCIPAL GUIDELINES LNEFFECT ON THIS DATE. DATE: r, �0
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)884.2979
FAX(907)894-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
A"sNO"'Y
N
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
SEWERSWATER
REFERENCE: SE%4, SW'/4, SE'/4, NW'/., Section 24, T12N, R3W, S.M.
September 15, 2004
SEWERtio;TE"
GENERAL:
1. The scope of this project includes the installation of a new 2000 gallon septic
tank and a new trench to serve the existing five bedroom residence located on
AANNnRERTPo�'6aaT�Ea
the referenced property.
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
a�TEST
applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
SME PLAW
4. Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
ROADEESIGN
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Flealth Department for system installations. Owners installing their
SMtEST
own systems must also receive prior approval from the Municipal Health
Department.
rafO1AT10N
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
arTlucTURAL t
11CC/ q*M
Banc m
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
CNSITE
WASTEWATER
EISPOSALMTEM
[ESIGN
17034 NORTH EAGLE RIVEn LOOP � SUITE 20A • EAGLE RIVER ALASKA 99577
Page 2
SE%, SW%, SE%, NW%, Section 24, T12N, R3W, S.M.
September 14, 2004
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCII/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement..
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier coven the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
SE -A, SWY., SE%, NW%., Section 24, T12N, R3W, S.M.
September 15, 2004
MINIAIUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (IIDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam III or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
SE%, SWY., SE%, NW%, Section 24, T12N, R3W, S.M.
September 15, 2004
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S &: S Engineering. S &: S Engineering shall be
the owners representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S R S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S R S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
September 21, 2004
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Waste Water Program
4700 Bragaw Street
Anchorage, Ak.
RE. Application for septic system upgrade at 11500 Snowline Drive, Anchorage, Ak.
Legal Description; SE 1/4, SW 1/4, SEI/4, NWI/4, Section 24, T12N, R3W,
Seward Meridian.
To Whom It May Concern,
An application to upgrade the septic system at 11500 Snowline Drive has been submitted
on my behalf by S& S Engineering, 17034 Eagle River Loop Road No. 204, Eagle River,
Alaska.
It is my desire to act as' Owner—Builder" for the actual installation of the proposed
system. My co -occupant, Pat Patterson, will be assisting me with the co-ordination and
actual installation of the system designed by my engineering firm. Mr. Patterson is not
involved for any financial gain.
Your staff is authorized to discuss this project with Mr. Patterson, and Pat Patterson is
authorized to make decisions for this project, on my behalf, as though I were physically
present.
We have thoroughly reviewed all of the specifications pertaining to such work in the
MOA and understand the requirements for this work.
All work on this project will conform to all applicable codes and ordinances for the MOA
and the State of Alaska and be performed in a manner consistent with the best standards
of the industry with due regard for all adjacent property.
I thank you for your review and co-operation as I complete the task ahead.
Sincerely,
—Ngvlz i1 o-
Sharon L. Schram — Owner
11500 Snowline Drive
Anchorage, Alaska 99507 — Ph. 346-2205 / Ex. 346-1948
MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ~ NEW
LEGAL DESCRIPTION
¢ NO. OF BEDROOMS
/ /
Well [ Absorption area Dwelling PERMIT NO.
DISTANCE TO:
I
~.~' Manuf.cturer~ ~ ~,~ Material No, ofcomp~rtments
~ Lq.c~cty nga ohs [~ HOME.DE: Insidelength Width Eiquiddepth
~ ~ DISTANCE TO: Well Dwelling PERMIT NQ,
O z ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
~ ~ ~o. of lin0s kon~th of each llne Total length of lines Tranch ~idth Distanco between lines
~ -- Too o~ tile to finish
~ inches
,Depth ~~ ~ PERMIT NO.
Length Width
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ C~ass Depth DriJJer Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO;
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
72-013 (Rev. 3/78)
PERMIT NO,
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 "L" STREET~ ANCHORAGE., RE. 9950t
2~4-4720
01'-4--S I TE SENEFJ II_Ip~3RR~':.E F'ERr-1 I T
RPPLICRNT
LOCATION
LEGRL
R. 8. SCHRRM
SNOWLINE TRAIL
S24 Tl2N R3W SM
SR BOX ~067C
LOT SIZE
~44 5287
SQUARE FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: DRRINFIELD
MRXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT/BR)= 0
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEF"TH= O LEi'tGTH= 0 GRR'v'EL [>EPTH= 0
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET),
THE TRE~:H ~iI[)TH IS ~3. (~00 FEET
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
RE~]~J I RE[) SEPT I C~ TF4;'-~-~'. S I ZE= 500
F'ERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTRLLFITION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TL..iO ( ~ ) I ~'-JSPEC2:T I mi_Il%IS FIRE REQLi I F~.: ElD
BACKFILLING OF ANY SYSTEM WITHOLIT FINAL INSPECTION AND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN 8 HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE
~VAILHBLE TO INSURE PROPER INSTALLATION.
I CERTIFY THRT
l: I AM FRMILIRR WITH THE RE~!UIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL IWSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
S I GNED: ~~C~-~- R. A,. - . __2 -- ....... ' .... St: ~' 2~-~-~J' HR AM ................
I_._.LIED BY 'v'2:. '?
OAAB-HD- I
GR!'~,~ER ANCHORAGE AREA BOROU"~,I
DI:r'AFITI~IEBIT OF EBIVIBOBIMEBITAL QUALI'I ~'
3§00 TUDOFI ROAD ANCHORAGE, ALASKA 99§07 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION .~"/~/~c¢.',,~:~'...~/_.,r~ ..~,,,~/~'c..~--~
SEPTIC TANK:
DISTANCE FROM WELL Y.~" /
LIQUID CAPACITY ,~'"~ GALLONS.
,~ -'"~.~-'"'~..~/ .~'~'"~--. / /~' ADDRESS c., J-~' PHONE
NUMBER OF
MATERIAL _c"~'~ ~./¢/'C~,~''~/~- COMPARTMENTS
INSIDE LENGTH / INSIDE WIDTH / DEPTH~
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE_ '-~ ~ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SEEPAGE PIT: '~7'~'~-) ~'~'/' ~'~"'~/'~x'~:~ ~ ~/~/~ ~ ~~/~
OUTSIDE DIAMETER / OR WIDTH / ~ / /
, LENGTH /~ , DEPTH
~(~~.~/~/~ DISTANCE FROM WELl ./~.~' , BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD: ./~/,-"/~
DISTANCE FROM WELL /..~'~NDATION '-~/,~EST LO, EAREST LOT LINE
NUMBER OF LINES ./ DISTANCE BETWEEN LINES tRENCH WIDTH
ABSORPTION AR~''/' SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
_ /
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
· OF LINES
WELL:
IN, TOTAL EFFECTIVE
IN. ABOVE TILE
DISTANCE FROM ~' WATER /~
TYPE,,~'~'/~-~:=~z' DEPTH ~:~ J~" BU LD NG FOUNDATION.__/~z'J SAMPLE ..,'~)//.~ , NEAREST
LOT LINE /~ ~ NEAREST / SEPTIC SEEPAGE ~- / 2 ~OTHER
, SEWER LINE '"'~'~' ~ TANK ~/" , SYSTEM_ ...~"'~.~ . CESSPOOP'''''f~')'~'~' , SOURCES'K~X"~/~/j
DISTANCES:
DIAGRAM OF SYSTEM
GREAi'ER ANCHORAGE AREA BORUUGH
3~00 TUDOR ROAD POUCH 6-650
ANCHORAGE. ALASKA
TELEPHONE 279-~686
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
i~s~a~TIoN o~: ~p~lc T~Nk ,,~ s~p~ge ~t .~
COMPLETION DATE ANT[C]PATED
FINAL INSPECTION~ 2~4 HOUR NOTICE REQUIRI~I~. BAGI~FILLING OF ANY SYBTI~M WITHOUT FINAL INSFE~TION B~ THb
HEALTH DI~FARTME:NT AUTHORITY WILL BE: SUBJI~:T TO FRO$I~(~UTION.
SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE / / ¢ / '
DRAIN FIELD
~) / DRAIN FIELD
.. SEEPA~E ~"~ /00/
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK _. SEEPAGE PIT
DRAIN FIELD
' /00 ~
TO RIVER, LAKE. STREAM.
CAST IRON _INT(~ S~TIC TANK AND INTO CR[~ CROSSING GAP OF
EXCAVATION 5 FEET iNTO UNDISTURBED SOil.
4 INCH DIAMETER CAST IRON S]PHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
F~ITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGe AREA bOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
Parcel I.D.
Municipality of Anchorage
Development Services Department e4 a
Building Safety Division =
On -Site Water and Wastewater Program g,
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
015.163-22
1. GENERAL INFORMATION
COSA# 05C 1a I A3a
Expiration Date. '; 6 -- %
Complete legal description
T12N, RM, Section 24, SE4, SW4, SE4, NW4, PTN Parcel 67
Location (site address)
11500 Snowline Drive Anchorage, AK 99516
Current Property owner(s)
Sharon Schram Day phone
Mailing address
11500 Snowline Drive Anchorage, AK 99516
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup
2. NUMBER OF.BEDROOMS: Five (5)
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual Oh -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
auith_new_watersamplesults—.(Certificates may-bereissued for a penod 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
5. DSD SIGNATURE
_LeL__� Approved for bedrooms.
Disapproved.
Phone 522-7773
Date 6/19/2012
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: /✓ r / �S
(Rev. 11105)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
— ✓ !n
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: T12N, R3W, PTN Parcel 67
Parcel ID: 015-163-22
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _
Well Log (YIN) Y (Well Survey)
Date completed 1971 Sanitary seal (YIN) Y
Wires properly protected (YIN) Y
Total depth 155 ft. Cased to 93.33 ft.
Casing height (above ground) >18 in.
FROM WELL LOG
AT INSPECTION
Date of test 11/15/05
6/12/2012
Static water.level 62.3 ft.
56 ft.
Well production 1.0 g.p.m.
1.04 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 1.99 mg/L
Arsenic: N/D mgA Date of sample: 6/6/2012
Collected by: J. Berkram
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/steel
Date installed 10/4/04
Tank size 2,000 gal. Number of Compartments 9
Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N
High water alarm (YIN) N
Date of pumping 9/20/2012 Pumper Around the Clock Pumping
C. ABSORPTION FIELD DATA
Date installed 10/23104 Soil rating (g.p.d.W or ftZ/bdrm) .6 GPD/sF System type Deep Trench
Length 72 ft. Width 3 ft. Gravel below pipe 6.5 ft.
Total depth 10 ft. Eff. absorption area 936 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 6/1612012 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 0 in. Water added 750 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 750 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N)
"Pump on' level at _ in. "Pump off level at —in.
High water alarm level at in.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >1W
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100'
Public sewer main N/A
Public sewer manholelcleanout N/A
Sewer /septic service line >25'
Holding tank >75'
Animal containment areas >50'
Manurelanimal excrete storage areas >100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5_
Absorption field >5'
Water main N/A Water service line
>10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line >79 Building foundation >19 Water main NIA
Water Service line >10' Surface water >1W
Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots
>100'
F. COMMENTS:
10P L
G. ENGINEER'S CERTIFICATION 4 hP•' fi '•
I certify that t have determined through field inspections and * 49BW
review of Municipal records that the above systems are in s" • •.4
conformance with MOA COSA guidelines in effect on this date. 0...... .....«••/
� vo% i4 �
Engineer's Printed Name Michael E. Anderson, P.E.
I1p 4
Ar
/CE:ig81 .�
Ar
Date 6/2012012 ,1 •••I' ••
��a a tit:: •''. ..�„
COSA Fee $ s Qqo - /�/I
Date of Payment 612o t ^ den!
Receipt Number. C� d �f! Z 4
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
• Development Services Department
Building Safety Division
�.- On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 615-1 1n3 -�2.:L COSA#_
Expiration Date: 09
1. GENERAL INFORMATION
Complete legal description SE 4; SW 4; NW 4; PTN Parcel 67; Section 24; T12N; R3W
Location (site address) 11500 Snowline Dr. Anchorage, AK 99516
Current Property owner(s) Sharon Schram Day phone 346.2205
Mailing address same
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
0
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 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 s a s engineering Phone
Address 15861 S. Birchwood Loop Chugiak, AK 99567
Engineer's Printed Name Robert A. Shafer Date L= L
694-2979
NIP
f:
5. DSD SIGNATURE
Approved for bedrooms.
......
A. TAa`w
1357•S
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Nitrate Advisory Other
By: b Original Certificate Date:
JR" 1105)
Municipality of Anchorage
Development Services Department
Building Safety Division
�- On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
ZD
Legal Description: JCy"Jk)ti; 3c"t�jR kN; PW -PARCEL x•71 Parcel ID: Of -1/,3-P?,2
A. WELL DATA
S6c ick) Z q; T12R%) ' rt tw
Well type �6M If A, B, or C provide PWSID # — Well Log(ON) 'OVu�+s/oa
Date completed Sanitary seal Jfs Wires properly protected &N) iES 1
Total depth �ft. Cased to�13'33 ft. Casing height (above ground) /S++ in.
Date of test
Static water level
Well production
FROM WELL LOG
n 5
�2•sft.
WATER SAMPLE RESULTS:
/./5 g.p.m.
Coliform ! colonies/100 mL Nitrate D i mg/L
Arsenic: `k_ ug/L date of sample: /1 0
B. SEPTICIHOLDING TANK DATA
Tank Type/Material cSWnC_ /d3TE15(.
Tank size „�L00 gal. Number of Compartments
Foundation cleanout4:0J) � Depression over tank
Date of pumping Pumper
AT INSPECTION
tl Otics
6a
ft.
MCCOWe-
9 p•
+:t- 31>.-- c,Aucwu WgTpe 41,10"kF_ T►iCrr - / J
Othei r bacteria.0 colonies/100 mL
I
Collected by: S4 s 6AXWF1FRJA &
i
i'
Date installed /o a
Cleanouts�/ 1) Yf;�
is
High water alarm (Y® /JO
C. ABSORPTION FIELD DATA
Date
Date installed '/C/)5 rrt Soil rating g.p.d./ft r ftZ/bdrm) b. $ System type
Length W, ft. Width 3 + ft. ,Gravel below1 e / c r
PP �ft.
+
Total depth ft. Eff. absorption area 9158fe Monitoring tube Depression over field
Date of adequacy test 1113 0$ ResultsPas Fail) C/7�3� For 5 bedrooms
A to
Fluid depth in absorption field before test Q In. Water addediOgal. New depth, in.
Elapsed Time: 0 min. Final fluid depthZi in. Absorption rate >= tTS0 t" g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y a 10 '—
type) f If yes, give date
D. LIFT STATION A3{A
Date installed Size in gallons
'Pump on" level at _ in. p�otf`1ev�
Datum Cycles tested ,
E. SEPARATION DISTANCES
at High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1004
Absorption field on lot ler '1'
Public sewer main 64"
r
Sewer /septic service line o2Gf
Animal containment areas
cb ,1
On adjacent lots /CO f
r
On adjacent lots 160-1
Public sewer manhole/cleanout LiA
Holding tank 6�
f
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
f
Building foundation 6 '4- Property line �' f Absorption field 154
r r
Water main A Water service line /O a Surface water 1 co
r
Wells on adjacent lots f� f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I r
Property line LD + Building foundation LO � Water main N
r r/O
Water Service line it) 4" Surface water Driveway, parkinglvehicle storage
(
Curtain drain ArIQKK YxcYQ Wells on adjacent tots /� {
F. COMMENTS
'7X- 9, rt) +ca-tt .i: c(' w vn"r:rA• c� u _ t .mob er.�, vrw Tr VRRI A!T7CRrS CA&') C.,c't-t'Jl?
,or
G. ENGINEER'S CERTIFICATION
I certify that 1 have determine rough field
review of Municipal records that he above
conformance with MOA CO elin il�A
Engineer's Printed Name D
Date %Z— Z, 0f3
COSA Fee
Date of Payment
Receipt Number
(Rev. 11105) ,
is and
ire in
date.
Waiver Fee $
Date of Payment
Receipt Number
Iii
A s: >
1w73
�� •'.').TOC '� Y.
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 080410
During a recent COSA on-site inspection and test of the potable water
supply well on T12N; R3W; Section 24; SEI/4; SWIA; SEI/4; NWI/4
PTN; Parcel 67, the well's productivity was determined to be 0.8 gallons per
minute. The minimum well productivity required by this Department (AMC
15.55) for a 5 -bedroom residence is 0.52 gallons per minute. Although the
subject well currently exceeds this minimum requirement, all parties
concerned are advised that the production capacity of the well may fluctuate.
Restriction of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
ENI
SGS Ret.N
Client Name
Project Name/a
Client Sample IU
P
Matrix
PNSID
1086195001
S R S Engineering
SE4;SW4;SE4;N%%'4;PmParcel64•
•Sec king W N;R3N'
Drinking Water
0
Printed Uate/Time
Collected Date/Time
Received Date/Time
Technical Director
11262008 11:47
11/072008 14:00
11/072008 14:40
Stephen C. Ede
Sample Remarks -
Remarks -
parameter
Results Ppl-
Units
Allowable Prep
Method Contain" 11) Limits Date
Analysis
Date
Inn
Metals by ICP/MS
Arsenic
ND 5.00
ug/L
EP200.8 C (<10)
11/18108 1124,'08
NRB
Waters Department
Total Nitrate/Nitritc-N 0.491 0.100
mg/L
S%1204500NO3-F U (<10)
11/12/08
1DT
bticrobiolLM
Laboratory
Colony Count
0
col/IOOmL
S%1209222D A (<200)
11/07/08
DLC
Total Coliform
0
col/IOOmL
SM2092220 A (<I)
11/07/08
DLC
Fecal Coliform
0
col/IOOmL
S%1209222D A (<I)
11/07/08
DLC
ryOIIo nmxn ncx
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PLOT PLANS & LOT SURVEYS
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR. TO
CONSTRUCTION, TO VERIFY PROPOSED BUILD!NO GRACE RELATIVE
TO FINISHED GRACE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
ONLY MHOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
S4CriN. FENCES. WELLS, SEPTIC CLEANO'UTS. SIDEWALKS, DRIVEWAYS.
ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
MAY PREVENT SOME IMPROVEIAENTS FROM BEING SEEN AND LOCATED.
UNOCR NO CRCUI/.STAILES SHOUIL: AN AS -BUILT BE USED FOR CONSTItUCT!ON OP FOR ESTASLISHLNG LOIXICA.RY OR FENCE LINES.
THE SURVEY;; TARES RESPONSE)LITY FOR THE IMI -.AL TRANSACT.ON ONLY AND ASSUMES FINANCIAL UAS!L.1— OY_Y FOR THE COST OF THE SURLY.
LISTED DISTANCES PREVAIL OVER SCALING. REVRCOUCTION WAY CAUSE ERRORS IN SCALE.
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 19665o
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
C LIZ 1KOO
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-163-22 COSA#
Expiration Date: �- a —05
1. GENERAL INFORMATION
Complete legal description _ T12N; R3W;
Sec
24; SE4 •
S144:
SE4 • NW4 • PTN Parcel 67
Location (site address) 11500 Snowline
Dr.
Anchorage
AK
99516
Current Propertyowner(s) Sharon Schram Dayphone 346-2205
Mailing address same
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY. TYPE OF WASTEWATER DISPOSAL:
Individual Well 13 Individual On-site U
Individual Water Storage ❑ Individual Holding Tank ❑
Communes Class Weld ❑ _Community On-site. _. ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite 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 seat 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 S 5 S Engineering, Phone 694-2979
Address 17034 N. Eagle River Lp Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan, P.E. Date y147/o
5. DSD SIGNATURE i n ROBERT C. COWAN ;
!!l�clF ``C8-8801 /J
t/ Approved for bedrooms. _
t`
Disapproved. '`i�Zt__z:
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By. Original Certificate Date: L/r' "� & O�
(Rev 77A3)
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/onske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: TO 1 IZ q.. Sw 2,;5-' J��_ 1 Parcel ID:Q l5 - l b 3 -,2 P
A. WELL DATA
Well type 211/ArE If A, B, or C provide PWSID # = Well Log (?IN) 03kL/��Lry (l/i5�o5
Date completed � property P Protected)
Sanitary seal(ITM Wires ro fbg
Total depth I� - ft. Cased to 3 •eft. Casing height (above ground) I S"+ in.
FROM WELL LOG
Date of test It 1 151D5
Static water level E59 � 3 r ft.
Well production _JC'o g.p,m,
WATER SAMPLE RESULTS:
Coliform--2—colonies/100 mL Nitrate ;2.4S mgg/L
Arsenic: U mgA Date of sample: T 5 0(,
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material epic /SQL
Tank size ;X0 gal. Number of Compartments 2
AT INSPECTION
SS' ft.
g.p.m.
Other bacteria 0 colonies 100 mL
Collected by: �S K)6
Date installed 101464
Cleanouts(DN) 7ES
Foundation cleanout(&) ,)Ye_'-. Depression over tank (Ya Rn High water alarm (Y/ 1� AL0
Date of pumping 1 d ll i. Pumper 014S `Z f ;IlHC1� S
C. ABSORPTION FIELD DATA
Date installed IC -5 O Soil rating (g.p.d.lft2 or ft2/bdrm) Dr�!) System type -DEr-t' -n2C--A-Cl'i
Length ft. Width 3 ft. Gravel below pipe ft.
Total depth Q ft. Eff. absorption area �ft2 Monitoring tube *r- Depression over field Ivo
Date of adequacy test ti^sw s .\ Results (PassiFail) — For $ bedrooms
Fluid depth In absorption field before test — In. Water added —gal. New depth— in.
Elapsed Time: — min. Final fluid depth = in.
Absorption rate >= — g.p.d.
Any rejuvenation treatment (past 12 mo.) (YAT& type) NC> If yes, give date -"
D. UFT STATION u(R
Date installed Size in gallons
"Pump on' level at _ in. 'Pump off" lev _
DatumCycies tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/Gft station on lot
I CC7 +-
Absorption field on lot
/CXR 14 -
Public sewer main
0 A
Sewer /septic service line
+
as "t
Animal containment areas S+O 4
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 1 bG 14 -
On adjacent lots 100 14 -
Public sewer manholeiclearout ) A
Holding tank 1J I+
Manure/animal excrete storage areas 1004
in.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 i� Property line6 r't Absorption field S
Water main NA Water service line !01 Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I1n i+ Water main A) A
Property line ID 4 Building foundation
1
Water Service line 104 Surface water /OO r+ Driveway, parking/vehicle storage to 4
1
Curtain drain 6 KAx xC" Wells on adjacent lots 1620 !
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
�QIt g., :� rG7.%
Engineer's Printed Name ' `0 e ms: t!- Co 4/4,0 =lot
Date li 17 A0
COSA Fee S (430 -OD
Date of Payment /4 q t L,06
Receipt Number4�
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
IrRmT rwnea anAa
v roma rne.m
Rw arena rn.a
w
2.
Imt
S 89'54'42" W
329.15'
ZI S65'NE1/4SW1/4SE1/4NW1/4
SE1/4SW1/4SE1/4NW1/4
•¢L
329.03'
S 89'54'53' W
NOTE: RRG. & DIS. INFO. FROM MOA GRID SW2640
P
N
O
P
M
I�
W
Z
0
Z
IV)
SURVEY CERTIFICATION yr��at,t;
Prepared by
PLOT PLAN .�P�E °000
Robert E. Johns, Jr. & Assoc.
.
"•'"""" 1"""'"""°"'""° ' •e
M q per. « wp•,. n„rq « M, 1 ♦ i
..w rNIM �1.OY.M ✓f I —J
Professional Land Surveyors
M M M A„w •:
BRINK
«.� � � �Vs•,..r•. NUI w.. I {t ,• '; %} .
'
ANCHORAGE, ALASKA
RAG 99504
stele: Ir _
�' - 7D r
R ec Lot S.F.
Rat Plot Fie No.
9th = `
-'
FOUNDATION AS -BUILT %"'• .... "' "' '• .. 0
L s a al.,. a. re+r wuy Y 1 M �
w p.Mna w 4rpl Y...r p M 10 SI
'••• �y.• "::.I
Dnte Surveyed:
Drown by.
Checked by.
a 4Y a « n a r»
OBERT . ., S, �
19'1%—GJ
RFJ
iM « w •yOM„wY YI I.iA
o. pn.+•. 0, -P '; f u w
Dab Drorn:
riACLC
W.O.
y.:, 4 1—S .Aa
FINAL STRUCTURE AS -BUILT s '., !
•0
10-13-055
2640
v
5'S4
Mw• i�a••.w" . M M 1 a •••'•'••.,•,,.•..•'•'� • �,4 ft
d a
Legal Oaccripli00:
..,.a«Yager
«p�^^e^-a^•�-- +11 fessiond`Os+�
SE 1/4 SK 1/4 St 1/4 NW 1/4 and S65 feet
a
+m.�•+��"""'�"""" �,�lq{p19��
NE 1/4 SW 1/4 SE1/4 NW 1/4 SEC 24
T12N R3W SM
❑ LAT waver SURVEY TYPE
---
❑ FOUNDATION AS-BUILT��f`�
SYMBOLS
13 MAL STRUCTURE AS -BUILT
• SET RESAR � DRAINAGE 0 ASPHALT
11 RAT RAN ... AS-BMIi. .. LOT SURVEY... TG,00;;I y
p
o FOUND RFRAR WOOD FENCE'
CONCRETE
9- t T NO FPS IIFCRT ATd! _ e!T, . NO b 1r SFT
OD ASSUMED ELEV. ..n., �•,,., rn3
- a Inc NLCI'VNW1 ;UTT OF THE BUILDER OR OWNER, PRIOR TO ONLY INOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SNOWN. FENCES, WELLS. SEPTIC 11EANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED CRAP AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LCCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH 00 NOT APPEAR ON THE RECORDED SUP.DIVISION PLAT. ALL DISTANCES ARF RFC111 IN ce
NnTrn
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UAB!UTY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
Municipality of Anchorage
• :.!,.r -y,� ,
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Strcct
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
Water Well Well Advisor
Health Authority Approval # 060139
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot 67 of T12N R3W Section 24
SE4 SW4 SE4 NW4 PTN subdivision, the well's productivity was
determined to be 0.75 gallons per minute. The minimum well productivity
required by this Department (AMC 15.55) for a 5 -bedroom residence is 0.52
gallons per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the production
capacity of the well may fluctuate. Restriction of non-critical water uses
such as washing cars and watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
0
SCS ReEM
Client Name
Project Name/#
Client Sample ID
Matrix
PWSID
Sample Remarks:
1061649001
S & S Engineering
Parcel 67 See 24 TI 2N R3N'
Parcel 67 Sec 24 TI 2N R3 W
Drinking %Pater
All Dales/rimes are Alaska Standard Time
Printed Date/time
04/132006 16:17
Collected Date rime
04/052006 13:30
Received Date/time
04/052006 14:00
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date [nit
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<-10) 04/07/06 04/12/06 SCL
Waters Department
Nitrate -N 2.45 0.100
Microbiology Laboratory
Total Coliform 0
mg/l. EPA 353.2 D (<-I0) 04/05/06 ALR
col/IOOmL. SN1209222D A (<-I) 04/05/06 TLF
M- W Drilling, Inc. .
1
sus►.
Video Narrative y /h S/ d
Well CD/Video Format. ! �•
Date: 5h5-� Time:���� a Job No
��.
WenthPr: " Ua� JAA
Contractor (If different thon
Site Address: 500
Ll
City: /" G�1 9/ State: Alaska
Well Depth: 5s Pump Set: Screen: Yes / No
Other Notes and Information: Why are we'd oing the video?
s ,m'�����ia�.
RAF
l
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF IIEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P2OTECTION
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
JAN 1 2 1979
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWF-~ E/~L~-.~'I'~ED
;)IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
2. BUYER
~PHONE
PHONE
MAILING ADDRESS
3. LEND__lNG INSTITUTIO~N
MAI LING ADDR ESS
PHONE
4. REALTOR/AGENT PHONE
MAILING ADDRESS
E, LEGAL DESCRIPTION
T12N, R3W, S24, SE?/4, SWI/4, SE 114, NW 1/4, & So. 55.'00, NE 1/~, SW 1/4, Sel/4, IN I 1/4
STREET LOCATION $M~'2 91AC
E. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
~[~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ' ~' Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTI LITY
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) ~/I-
C)
SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE~
[] PUBLIC UTI LITY
**If individual/on-site, give installation date f' ~,.~4:/
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72~910(3/781 ~'~ ~, , /~t ~ (~-'- .~-'~
· ~ THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY,
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
•PUBLIC UTILITY
Connection Verified __ INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
PROVED FOR .EDROO S
~ CONDITIONAL APPROVAL (letter must e~pen¥ certificate),
DATE ~ ~_p ~-Q ~ BY(Title)
LEGAL DESCRIPTION
72-010 (Rev, 3/78J
January 29, 1979
R.A./Sharo~ L. Schra~
Star .Route A Box 67C
~choraga~ Alaska 99507
W~ have ree~ived the results of you~- p~rcotation test,
i~rfozz~ed by Alaska D~v~lo~,~nt Consultants. ~he ~eepage'
pit is adequate for a three(3) bedroom ~in~31e fm~lly
dwelling.
The ~ize of the ~eptie tank is not adequate, a 1,000 gallon
tank is re,~ired for a three(3) bedroo~ single family
dwelling.
Th~refor~ before approval may be granted, a five-hundred
(500) gallon septic tank m~st be installed i~ tandem with
your existing 750 gallon tank.
Conditional Al~roval ~y b~ granted ~f monies are ~erowed
to complete the upgrade by June 1, 1979.
A p~r~it must b~ issued by thi~ d~partment prior to
upgra%]eo
If there ar~ a~y further questions, please ~ontact this
offtea at 264-~720o
Assoolate Specialist
RCP/lJw
First National Bank of ~ehorage
Post Office Box 4-2090 99509
J~uary !5~ 1979
Star Rout~ A Box 67C
S~j~t~ ~12N P~ Section 24 ME~ S~ SE% ~ AND
()
( ) A w~lI loq is submitte~.l to this d~partmene.
( ) ~he ~P of the ~tl ca~ing i~ ~ai~l with a sanitary
seal so that i~ is water tight.
groun~ l~v~l.
(X) A four(4) inoh ~st iron ol~anou~ be ~stalled ~o th~
( ) Connect to the ~blic sewer which is avail~l~ to yo~
~otify this dep~t for a r~-in~ection wh~ descrepancies
Rc /ljw
First National Bank of Anchorage
Post Offic~ ~ox 4~2090 99509
~90S OlD' S'EWARD h GNWAY
ANCHORAGe' ALASKA
979 ADC
79005
Mr. Roger Schram
Snowline Trail
Anchorage, Alaska
Re: Adequacy Test for Existing Septic System on:
SE ~/4 NW 1/4 & South 50.00' of NE 1/4 SW 1/4 SE
T12N, R3W, S.M., Alaska.
SE 1/4 SW 1/4
1/4 NW 1/4;: Sec.
24,
Dear Mr. Schram:
At your request our office conducted a percolation adequacy test
on your existing septic system at the above-referenced location
during the period January 23-24, t979. You reported that your
septic system consists of a 750-gallon concrete septic tank and
a seepage pit.
The septic tank had not been pumped prior to the percolation test.
Since the 3-bedroom house had been occupied up to the time of the
test, a normal degree of saturation within the leach field is
assumed.
In accordance with the Anchorage Municipal Code, Chapter 15.65,
Waste Water Disposal Regulations, any on-site sewage disposal
system "shall have adequate capacity to properly dispose of the
maximum daily sewage flow~" The maximum daily flow is computed
at 75 gallons per capita-day (gcpd). Since "the population of
dwellings shall be estimated at two persons per sleeping room,"
the maxiimum daily sewage flow for your 3-bedroom house is 450
gallons per day (gpd).
To test the soil absorption capacity of your system, the maximum
daily flow or 450 gallons of clear water was added in 50-gallon
increments to the septic tank. The water was obtained from your
on-site private well. The liquid levels were monitored closely
to detect any backup in the septic system.
During the course of this test, the water well on the subject site
could not maintain a constant flow rate. Considerable well recovery
time during the test was necessary in order to obtain the required
amount of water (Table of Test Data, Page 3~. ·
Mr .~. Roge r Schram
· J~nuary 24, 1979
Page -2-
The attached Table of Test Data represents the depths of liquid in
the septic tank and seepage pit, and the quantities of water added.
The septic tank was determined to be 11.5 feet deep (bottom of tank
to ground surface) with an initial depth of 4.7 feet in the tank.
The seepage pit was measured to be 9.7 feet deep with an initial
depth of 3.~ feet. Ground elevation at the septic tank standpipe is
approximately 6.0 feet higher than at the seepage pit standpipe.
The attached Summary of Test Results indicates that the liquid level
in the seepage pit on Day 2 fell to 0.3 feet below its initial static
level on Day 1, during a recovery period of 22 hours. The level in the
seepage pit at its highest level during the test (3.8 feet) was
approximately 5.1 feet below the liquid level in the septic tank.
Based on the above described procedure, a percolation rate for your
existing septic system of approximately 452 + gpd is indicated.
Since an on-site sewage disposal system for a 3-bedroom dwelling
must be capable of disposing of 450 gallons of sewage per day, your
septic system appears to be functioning satisfactorily at this time.
Many factors affect the operation of a soil absorption type of
sewage disposal system. Soil type, groundwater depth, age and
history of maintenance of the system, and types of waste are a few.
This test has been performed in an attempt to model actual soil
absorption capabilities of your septic system under normal useage
by considering the degree of saturation of the leach field and surge
loads that might be imposed on the system. This test can only evaluate
apparent performance at a given point in time, and cannot determine
either the condition of the leach field, seepage pit or other components
of the septic system, or the depth of the water table.
We appreciate the opportunity given to perform this adequacy test.
If you have any questions regarding this test, please contact this
office.
Very Truly Your,
ALASKA DEVELOPMENT CONSULTANTS
Stephen D. Shrad , · ·
Project Manager
JkNU~RY' 24,
Pa~e -3-
1979Adequacy Test for Existing Septic System
Owner: Roger ~rhrmm
Address: Snowline Trail
Project No. 79005
Legal Description:
Components of Septic System:
Number of Bedrooms: 3
Ho~Along vacant: NA
Test performed by: Jeff Ayres
Initial Static Levels:
SE ¼ SW ~ SE ¼ NW ¼ & S.50.00' of NE ~ SW 4 SE ~ NW ~,
Sec. 24, T12N, R3W, SM AK.
750-gal concrete tank & seepage pit
Occupied prior to test: Yes X No
· Last pumped: October 1978
Water meter/S.N. Neptune/22812186
; Seepage Pit 3.1
Septic Tank 4.7
TEST DATA
~ ~. ~' ~ ~ '~:Liquid ~Depth,- ft~ '~ ~': Water Meter
Time Septic Tank Seepage Pit Added, gal Reading, gal ·Remarks
START TEST
9:12a.T 4.7 ~.1 75DN 1/23/79
9:20 4.7 3.2 50 2550
9:30 4.7 3.7 70 2620
9:40 4.7 3.8 65 2685
STOP
9:42 4.7 3.8 17 2702 (WELL DRY)
9:56 4.7 3.5 2702 RESTART
STOP
10:05 4.7 3.7 40 2742 (WELL DRY)
10:18 4.7 3.6 2745 RESTART
STOP
10:22 4.7 3.5 17 2810 (WELL DRY)
11:30 4.7 3.2 2762 RESTART
11:39 4.7 3.5 48 2810
STOP
11:55 4.7 3.7 60 2870 (WELLDRY)
12:42pm 4.7 3.3 2870 RESTART
STOP
1:02 4.7 3.5 64 2934 (WELLDRY)
1:30 4.7 3.3 2934 RESTART
1-23-78
1:40 4.7 3.4 21 2955 END TEST
452 gal.
1:30am 4.7 2.8 - - 1/24/79
Rr-[ Roger Schram
JANUARY 24 , 1979
Page -4-
ADC Ne.79005
Wtr Added, Seepage Pit
Rise in Seepage Pit
Rise in Septic Tank
Gallons Wtr Added per
Ft of Rise (gal/Ft)
SUMMARY OF TEST RESULTS
Day I Day 2
455 gal
0.7
0.0
Recovery Time beEween Test (Hours)
Drop in Pit during
Recovery
Average Rate of Fall (fE/hr)
Average Absorption Rate
(gal/day)
22hr.
I ,0'
455 +