HomeMy WebLinkAboutTHE TABLELANDS BLK 6 LT 8The Tablelands
Block 6
Lot 8
#051-801-31
Municipality of Anchorage y
• Development Services Department
Building Safety Division
Onsite Water 8 Wastewater
\ Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.enchorage.ek.us (907) 343-7904 page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW040085 PID Number: 051-801—oS ZI
Name: JOHN THOMSON
Wastewater System: ■ New ❑ Upgrade
Address:
17343 SANTA MARIA DRIVE a EAGLE RIVER, AK 99577
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 689-6476 4
0Deep Trench C3 Shallow Trench ■Bed 0Mound 0Other
LEGAL DESCRIPTION
so fl t w
0.4
Tota Depth fon, odpea pack
*SEE DWG
GM/sq.
R n.
Block: Lot: Subdivision:
Depth to pbe Wt.n cant w 4in0l prove:
Co,* depth beneath pipe:
6 8 TABLELANDS
*SEE DWG
R 0.5 R
Township: Range: Section:
T• peal aeoee ar4gra
Go.el length:
— — —
SEE DWG.
R 75 n.
WELL: ❑ New ❑ Upgrade
nava .km
20
Number of Mnee
4
Dkt. W.e.r sn.e:
5
R
R
cbeeilca4.n prime. A.e.c): Tobi
Coeed To:
Tay ebsopaan Gree:
Pp enate :
R
R
1500 so. rL
D 3034/ F-810/ SCH 40 PVC
onp . Dote DrYW:
statk voter Level:
IM1000n
GREEN GENERAL
Dole Mbl
1 616-17/2004
R
vele:
Pump set Al: I
Ceeiro Nelpht Aaew around:
TANK
GPY
R
R
SEPARATION
DISTANCES
aseptic 0Holding ■S.T.E.P. 0Other
To
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
/Prleote
sever once
MO1411vCt""n
ANCHORAGE TANK
Cepepiq b pope"''
1500
Prom
Well
200'+
200'+
200'+
—
—
Material: STEEL
N nO" a eanpo Ment•
2
Surface Water
1Do'+
100'+
100'+
—
—
LIFT STATION
Lot one
5'+
10'+
5'+
—
—
5fe M pwpme:
1500
Yonufaetwer.
ANCHORAGE TANK ORENCO SYSTEMS
Foundation
5'+
10'+
5'+
—
—
an Mrel ol:
eilevel et:
H water alarm au
42"
42"
46"
Curtain Drain
NO KNOWN
P""'p Yaee • YoOi°
%20 OSI 05 HHF
Ea of Mpee00n& Perla t7 .
RISING SON ELECTRIC
Remarks: 'EXCAVATION LIMITED TO REMOVAL OF
BENCH MARK
Laxation and Deeadpt
ORGANICS LOAM. 2' MAX DEPTH AT ANY POINT
BOTTOM OF SIDING
Ae.Nned &Nvwti.l:
l 0-00 ,,.
ENOINEER3 s
,006040
��• �F
' •• .SAO
�P •:`r00
Inspections performed by: GEG. Ltd. Dates: 1st 6/16/2004
g ��
..........................�
2nd _6/16/2004
D
3rd 6/17/2004
0 .............:....D
DO �.J fre own ss:
� �
00 E-795
Development ervices Department Approval
`cl F`op
Reviewed and approved by: Daterdp
o0
0� pro f esslonaoo
r Rev. 1 x/01)
�40006��
PERMrrNUMBER: AS-BUILT D RAW I N G PARCEL ID NUMBER:
SW0
SW040085 051-801-W
FA
TH/11+
TH/12+
DRA NFIELD
0 S�
ALTERNATE SITE
WILL REQUIRE THE
USE OF AN
ADVANTEX SYSTEM
1500 GALLON
S.T.E.P. TANK
1 / /
WATER UNE/
/ KEY
/ Box
/
/
i
i
i
11/10/2004
$� DRAWN BY:
GARNESS ENGINEERING GROUP, Ltd. A.J.G.
CONSULTANTS &GENERAL CONTRACTORS SCALE:
370, F TUM FOM. SU -TF 101 • ANNORAGF. AK 00507 • Fw F (001)337. 170 • FAX (001)333dT6l, 1 b — 50,
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOHN THOMSON (907) 240-2020 1 2 OF 3
LEGAL DESCRIPTION:
TABLELANDS SUBDIVISION; LOT 8, BLOCK 6,
AS -BUILT DRAWING OF SEPTIC SYSTEM
.A.. X1 I....`1....:.".
PERMIT NUMBER: AS -BUILT DRAWING PARCEL 6) NUMBER:
SW040085051-8015
TOP OF TANK
AT INLET - 94.70
INVERT OF BUNG
AT INLET - 94.16
EXCAVATION LIMITED TO REMOVAL OF ORGANICS/LOAM
2' MAX TOTAL DEPTH.
3:1 SLOPE
I TH/BA
TOP OF SAND
- 95.79 (AVG.)
GRADE - 99.40
P OF MANHOLE
- 99.36
ST2
TOP OF TANK
OUTLET - 94.70
NEW 1500 GALLON
S.T.E.P. TANK
TO BE TOPSOILED
AND RE—SEEDED
SPRING 2005.
JAL GRADE INSULATION
- 101'1 rFILTER FABRIC
—20' WIDE
*BOTTOM OF BED / INVERT OF DISTRIBUTION UNE - 96.29 (AVG.)
92.50-94.98 J THE DISTRIBUTION LINE IS 1.25 INCH PVC WITH
1/8 INCH HOLES SPACED 48 INCHES ON
RELATIVE GROUNDWATER LEVEL CENTER. (18 HOLES PER LATERAL/72 HOLES
ON 6/16/2004 - 89.70 TOTAL)
RELATIVE ELEVATION OF
BOTTOM OF TESTHOLE - 84.88
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS& GENERAL CONTRACTORS
370, F. TLOOR ROAD. SUITE 101 • ANCNORAOF. AK 00507 - MON* (00))33]-0AO - FAX (007)338.3766
PREPARED FOR: PHONE NUMBER:
TURNER CONSTRUCTION (907) 689-6476
LEGAL DESCRIPTION:
TABLELANDS S/D; LOT 8. BLOCK 6
TYPE OF WORK:
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
DATE:
11/10/20
DRAWN BY:
A.J.G.
SCALE:
i"=40'
PAGE NUMBER:
3 OF 3
SLOPE
BARRIER
._( r. •r_,..., tee. •
XRIZIng Son EleCTric Inc.
:
men
907 622 0777
02/29/05 03942P P.001
��\ Rising Son Electric. Inc.
0916 Woodland Drive
i l Eagle River. AIC 99577
` (907) 622-6777
February 28, 2005
Gamess Engineering Group, Ltd.
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Re: Lot 8 Block 6 Table Lands
Dear Chris:
The lift station at the above referenced property has been wired in accordance with NEC
and StatoLocal codes.
Thank you.
Sincerely, �l 7A/
�
Kevin S. Hombuckle, Owner
Administrator License Number 1284
Specialty Contractor License Number 27285
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Wafer & 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: Apr 27, 2004
Expiration Date: Apr 27, 2005
Permit Number: SW040085-i4t-7-&&& w."vps _rL6 4;j, Parcel ID: 051-801-08
Legal Description: '1-3f51
Design Engineer: 0041 AK Water & Wastewater Consuitani Site Address: 23210 WHISPERING BIRCH DRIVE
Owner Name: John Thomson Lot Size: 40000 SO. FT.
Owner Address: 17343 Santa Maria Drive Total Bedrooms:�3y Permit Bedrooms: �y
Eagle River , AK 99577-
This permit is for the construction of:
❑✓ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, 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 8
S -1510q- DES17A/G(741e1 Tf-fr- (n,rivESr LE7rE.i RNID n1iW517E PIA,✓
A+TED APA; l ?I.,
2Jp t,
S,Ilz_loq— r%FSlfA/ e,"'Isvjf, Il(rASf SEF Pep,r7A/ LaTTEM, 11^10 A/EL' S174r
pjA4 OATEO /"A-) 17 , 7-00q,
Received By.
Issued By.
Date: /ew
Date: *710q
Municipality of Anchorage
Development Services Department '
Building Safety Division '
On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property owner(s) JOHN THOMSON
Ma'an-g
g address (1)
Me address (2)
17343 SANTA MARIA DRIVE • EAGLE RIVER, AK.
Permit Number
Day phone 940-9020
orilSVIr Zip Code
Legal description (Lot, Block & Sub`d.) LOT 8, BLOCK 6: TABLELANDS SUBDIVISION
Legal description (Section, Township & Range) _N/A
Lot Size Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Sewer Only
_ _ _.... Sewer and Well
Sewer Upgrade
THIS PROPERTY -COI
Hot Tub
Swimming Pool
Therapy Pool
El
99577
Number of Bedrooms 3
Well Only ❑
Water Storage ❑
Jacuzzi - - '❑
Water Softening Unit ❑
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.
ar+
Permit Fees:u(117
Date of Payment: i jb)1UH
Receipt Number n QU77
Waiver Fees -
Date of Payment:
Receipt Number.
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
May 12, 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: Revisions to Septic System Permit# SW040085 for Lot 8, Block 6; Tablelands
Subdivision
To whom it may concern:
A permit was issued on April 27, 2004, by your department (SW040085). The permit was issued
for a 3 bedroom residence. The contractor/owner, requested that the design be changed to
accommodate a 4 bedroom residence. Since then, the groundwater has risen to 5'. We are
proposing to install a 1500 gallon S.T.E.P. tank and a pressurized bed type drainfield. Two test
holes were excavated on the property. The drainfield will be designed around the 30 foot radii of
test holes #8A & 8B. Comments regarding the revisions to the design are summarized as
follows:
TRENCH DESIGN:
a.
Percolation Rate: 7.5 & 60 minutes/inch
b.
Combined Application Rate: 0.4 gallons/day/R2
c.
Number of Bedrooms: 4
d.
Design Flow: 600 gallons per day
e.
Minimum Absorption Area: 1500 R2
f.
Total Depth: 2.0 feet (maximum at any point)
g.
Sand Filter: 2.0+ feet
h.
Effective Depth: 0.5 feet
i.
Width: 20 feet
j.
Minimum Length: 75 feet
k.
Effective absorption area = 1500 R2
3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507
Ph: (907) 337-6179 0 Fax: (907) 338-3246 • Website: gamessengineering.com
SURFACE NVATERS: There are no surface waters within 100 feet of the proposed septic
System.
TOPOGRAPHY: The area around the proposed drainfield 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. A
P.E., M.S.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com
No
wm
PROPOSED DRAINFIELD. EXCAVATE A BED
THAT IS 2.5 FEET DEEP MAXIMUM BY 20
FEET WIDE BY 75 FEET LONG. ADD 2+
FEET OF M.OA SAND FILTER AND THEN
ADD 0.5 FEET OF CLEAN, WASHED SEWER
DRAINROCK. THE DISTRIBUTION UNE IS
TO BE 1.25 INCH PVC w/ 1/8 INCH
HOLES SPACED 4 FEET ON CENTER. (18
HOLES PER LATERAL / 72 HOLES TOTAL)
NOTE: THE CONTRACTOR SHALL HAVE THE NORTH
AND SOUTH LOT LINE FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO CONTRUCTION.
C�ID
q�!D
1LTERNATE SITE (WILL
1EOUIRE THE USE OF
AN ADVANTEX
TREATMENT SYSTEM)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS& GENERAL CONTRACTORS
5701 F T1AnR ROAD SURF 101 . ANCN ACF AK 9OK07 • PHMNP (007)357-6170 • FAX (Rn7)755-5746
PREPARED FOR: PHONE NUMBER:
JOHN THOMSON (907) 240-2020
LEGAL DESCRIPTION:
TABLELANDS SUBDIVISION: LOT 8, BLOCK 6,
TYPE OF WORK:
REVISED DESIGN OF PROPOSED SEPTIC SYSTEM (REVIS
PROPOSED 1500 GALLON
S.T.E.P. TANK
-INSTALL FOUNDATION
CLEANOUT
PROPOSED
WATER UNE
/ EXISTING KEY
BOX LOCATION
�•�: 7-..:i .
/
"'L' REVISED
0060
5/12/2004
_o`er
OF
p�
S��O
DRAWN
C.J.G.
0���......,
�y /:�
i
••�
SCALE:
1. = 50'
.. ..
. . . .....
........
PACE NUMBER:
2 OF 2
QQ ff
Q0� J •,
A. ....
-7953
SS;-
`a
_
...
c(.qo
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS d GENERAL CONTRACTORS
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: TABLELANDS SUBDMSION; LOT 8, BLOCK 6,
PERFORMED FOR: JOHN THOMSON DATE: 5/4/2004
(feet)_=
_=
ORGANICS
TEST HOLE 8A
00000���
1
----
SOIL CLASSI]FlCATION
2
GW ORG
3
a �` GP ML
GM CL
TH18A
4
GCOL
♦ ��
°. •°• a SW MH
5
•• •�• S SP CH
ABB
GM
SM OH
;
%
6
o
to
Sc
�
ML
THg9
%
7
TH TO
DATE
♦
GROUNDWATER ER
/
8
SEEPS O 10' 5/4/2004
5.5' 5/11/2004
9
SITE PLAN
�'
1'100'
10
-/-
11
DATE READING CLOCK
NET TIME
WATER LEVEL NET DROP
TIME
(MINUTES)
READING (INCHES)
12
5/5/2004 1 3:03
—
6• —
B.O.t1.
2 3:33
30
5 1/2- 1/2-
13
3 3:33
—
6• —
4 4:03
30 1
5 1/2o 1/2*
14
5 4:03
—
6• —
6 4:33
30
5 1/2- 1/2-
15
16
17
18
19
PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.0 FT. AND 4.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS
COMMENTS:
PERFORMED BY GEC, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF9RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE: 5113 11),1,
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS d GENERAL CONTRACTORS
LEGAL DESCRIPTION: TABLELANDS SUBDMSION; LOT 8, BLOCK 6,
PERFORMED FOR: JOHN THOMSON DATE: 5/4/2004
(f et = _ ORGANICS
GM/SM
to
ML
9
10
11
12
13
14
15
16
17
18
19
DEPTH TO
GROUNDWATER
i
SEEPS O 8'
5/4/2004
5.0'
5/11/2004
iSOIL
—
6'
CLASSIFICATIONS
2
3:34
30
2-
4-
3
I
—
6'
ZGW1::zzz: •.
4
'GPIillllillML
30
1 2-
4-
5
'
—
6'
I1i111!11 CIL
6
4:34
30
2-
GcHHH •
'00
0111111111
'
- %//%CH
i!tl121� 4.�� •
'
�j?SC
GM/SM
to
ML
9
10
11
12
13
14
15
16
17
18
19
DEPTH TO
GROUNDWATER
DATE
SEEPS O 8'
5/4/2004
5.0'
5/11/2004
3:04
—
6'
—
THIBA
lee
THJ9
-''- -/- SITE PLAN
-/ 1'=100'
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
5/5/2004 1
3:04
—
6'
—
2
3:34
30
2-
4-
3
3:34
—
6'
—
4
4:04
30
1 2-
4-
5
4:04
—
6'
—
6
4:34
30
2-
4 -
PERCOLATION RATE 7.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 3.0 FT. AND 3.5 FT.
20� A FOUR HOUR PRESOAK WAS PERFORMED: N YES • ONO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS
COMMENTS:
PERFORMED BY GEC. Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
GARNESS ENGINEERING GROUP, Ltd. ppm
CONSULTANTS 6 GENERAL CONTRACTORS ;
.. ......:.*.
3m, LIWN NWA +si 0 MUCK L • -sin w • , ymw 0 *.... .. ...
SOIL LOG - PERCOLATION TEST ..•.. „••„
LEGAL DESCRIPTION: TABLELANDS SUBDIVISION; LOT 8, BLOCK 6, OO '•.J f e A. rness.-
a
PERFORMED FOR: JOHN THOMSON DATE: 1/22/2004 QO4� —7953
DE __-- �44sdp,ofesslov% lc*l
(feet yyyy ORGANICS EST HOLE 11 �040000��
1
B
DATE
DRY
1/22/2004
SOIL CLASSIFICATIONS
1/29/2004
12.5'
i
—12:20 —
GW zzzz:•.
2
12:50
30
" 111111111ML
1/2'
3
12:50
—
11:111!11
4
13:20
30
���� H/NH•CL
•
5
13:20
—
'. IIIIIIIIIMH
—
6
13:50
30
5 1/2-
1/2.
s
7111111111
IIII �RAVELE
9
10
11
®�-itflllll®
13
14
15
16
17
18
DEPTH TO
GROUNDWATER
DATE
DRY
1/22/2004
+10'
1/29/2004
12.5'
4/8/2004
—12:20 —
Q . SITE PLAN
If
OQ�1 10-1009
LOT 8, TABLELANDS S D
7H/11+
LOT 9, BLOCK 6:
TABLEIANDSS/D
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
1/26/2004-
—1—
—12:20 —
6'
2
12:50
30
5 1/2-
1/2'
3
12:50
—
6'
4
13:20
30
5 1/2-
1/2'
5
13:20
—
6'
—
6
13:50
30
5 1/2-
1/2.
79 I I PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
—_j1I—III 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 GEG. Ltd. I, JEFFREY A. GARNESS. CERTIFY THAT THIS WAS qERFqRMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 4,1ZI o
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
Parcel I.D. 051-801-31
Legal description THE TABLELANDS BLK 6 LT 8
Site address 23151 WHISPERING BIRCH DR
Expiration Date: 8/1/24
Current property owner(s) WAUSON DEAN A &BAKER DIANE K
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: Original Certificate Date. 8/1/2023
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 Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
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. 051-8
Complete legal description THE TABLELANDS BLOCK 6 LOT 8
Location (site address) 23151 WHISPERING BIRCH DRIVE CHUGIAK, ALASKA 99567
Current property owner(s) Dean Wauson & Diane Baker Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ® Community Well or Public
❑ Water Storage
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 19 - See advisory if steel 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.
COSA Fee $ �� d
Date of Payment -?42 1,
Waiver Fee $
Date of Payment
COSA # \ Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: THE TABLELANDS BLOCK 6 LOT 8 Parcel ID: 051-801-31
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 NA 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 *NA
Date of pumping 6/13/23
Required maintenance completed, if AWWTS
Comments: *NA – STEP FLOATS
C. LIFT STATION
Required maintenance completed
Age of lift station 19 years
Lift station material STEEL
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/17/2004
ALL standpipes present per record drawing
Total measured depth from grade 2.8 ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes 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 7/6/2023
Results Pass
Fluid depth prior to test 0 in
Water added 600 gal
New fluid depth 0.5 in
Elapsed time <15 min
Final fluid depth 0 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 in
Comments/Deficiencies: Approximate total measured depths from existing grade. *ED per visual observations, MOA
records & elevation measured shots & appears approximate.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/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 Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 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 > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private 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 7/10/23
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 &
7/10/23
MUNICIPALITY OF ANCHORAGE
Devok*wrant 5-e� 0@0&wwA PhCWW. 907-343-7
Ori WaWK & Wmftwpr Fic: 9V -U3 -M7
Lm bw,13,r-j-P VAA
Maintenance Log
&Sl �Purgp rr.: ra��4 .� �P4rrr er
�`�+ed �n�.#�es
Lift sUdlon-
-C"M fli 81S cMarad tea: semrr--gs mfflm1$d
Alwm Sy Item:
.deo, �ateo 6*criod clam am Yr 5ual al&m ins4e dAmll"519�
-arm system operation nity�+e
MEr1wip fuser
.Gnwflid wa(w elfuson a1 riw Z Welk
' fOUnd Talar J arold pipe per*df2SOME-Weep i� �rticbial
+h�9f1fIQ� fid: Fr,�171. Wmi p P Se"red
.Aj rnamdacwreir reqvkM h5pe%*9ns ard maiinUrmm vgmp�ftO CY";m
Cm*ntm;
Qu a rifled Ma I r tq none# PwA
I Tezhilscl$n rf- L4
ny
5igr tjre
oat$ of "intenanee
Date!
Municipality of Anchorage
Development Services Department IL Building Safety Division '�
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orgtonsil/onslte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 05 v 151 COSA#0QQ
0135
1. GENERAL INFORMATION Expiration Date: 5- 123
Complete legal description THE TABLELANDS, BLOCK 6. LOT 8
Location (site address) 23151 WHISPERING BIRCH DRIVE • CHUGIAK. AK 99567
Current Property owner(s)
KELLY
BRANSCOM
Day phone 688-3093
❑
Individual On-site
Mailing address
23151
WHISPERING BIRCH
DRIVE ' CHUGIAK, AK 99567
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone
DONNA ALDERMAN w/PRUDENTIAL VISTA Day phone 360-0158
16635 CENTERFIELD DRIVE " EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
N
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 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 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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of 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 (les 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, 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 lost, 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
_Z Approved for + bedrooms.
Disapproved.
Phone 337-6179
Date
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
13-48
By: � Original Certificate Date: —
i
A. G ness:
3
Ol I OFf4r��i,p
C'S%
ON-SITE •:�G�
WATER AND ; r^=
WASTEWATER
PROGRAM '
i„ilJlt))
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: THE TABLELANDS, BLOCK 6, LOT 8 Parcel ID: 057 - 801'3/
A. WELL DATA PUBLIC WATER
Well type if A, B, or C provide PWSID#
Date'completed Sa ' Wires properly protected (Y/N)
ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft,
Well production g.p.m, g.p.m.
WATER SAMPLE RESULTS:
j
Coliform colonies/100 ml. Nitrate mg./L. co 0nies/100 mi.
Date of sample: Collected by:
S. StPTIC/HOLDING TANK DATA
Tank (Type/Material STEEL/S.T.E.P. Date installed __ 6/16/2004
Tank size 1500 gal. Number of Compartments 2 Cleanouts (YM) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping 8/9/2007 - Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA rOELOW EXISTiNG GRADE
Date installed 6/16-17/04 Soil rating (g.p.cldft2orqjH0.4 System type BED
LengtlIh 75 ft. Width 20 ft. Gravel below pipe 0.5 ft.
Total depth •2.91 ft. Eff. absorption area 1500 ft' Monitoring tube YES Depression over field NO
Date of adequacy lest 3/18/2008 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth In absorption field before test DRY in. Water added 610 gat. New depth DRY in.
Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >=600+ d,
g.p.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) `NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed 6/16-17/04
"Pump on" level at 42 in.
Datum BOTTOM OF TANK
E. SEPARATION DISTANCES
Size in gallons 1500 Manhole/Access (Y/N) YES
"Pump off' level at 42 in. High water alarm level at 46 in.
Cycles tested 3 Meets alarm & circuit requirements? YES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on tot
Absorption field on
Public sewer main
Sewer /septic service
areas
PUBLIC WATER
On adjacent
On adjacent
sewer manhole/cleanout
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 10'+ Surface water 100'+
Welts on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
t0'+
Water main 10'+
Water service line
10'+
Surface water
100'+
Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS �-atLJt
y{?j_ .
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in p
conformance with MOA COSA guidelines in effect on this,
.. .... ......
date. Q J f A Gar ss.-.
Engineer's Printed Name JEFFREY A. GARNESS QO 7 `A
9'J3 / O $ Op�,.V $�31 . 1,
Date �DOr ofass,
COSA Fee T
41'�v �-
Date of Payment qJ a
Receipt Number 3y 559
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage ••,
Development Services Department
Building Safety Division .. ...
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 00461- 31 HAA# 175031 5
1. GENERAL INFORMATION Expiration Date: Z
Complete legal description
Location (site address or directions)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
BIRCH DR.
JOHN THOMPSON Day phone 240-2020
17343 SANTA MARIA DRIVE • EAGLE RIVER, AK 99577
Day phone
Real Estate Agent_ EVA LOKEN W/ PRUDENTIAL VISTA _Day phone 689-6476
Mailing address 16635 CENTERFlELD DRIVE ' EAGLE RIVER, AK 99567
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well _
❑
Public Water System
0
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
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 engineers work.
4. 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 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 Firm GARNESS ENGINEERING GROUP, Ltd. Phone
337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 7/3 05-
Engineers
S
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
ooh p�0
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD
o ' ' " `!9�i00
Guidelines B 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 identifiable features. The
readily operational life of all wells and
septic systems depend on the local soils condition, groundwaterlevels that may
.... ..................
fluctuate during the year, and the water usage of the lamily 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
OO A. arness,
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
Q CE— 9
any warranty or future estimate ofhow long the system will continue to meet the
00 Ndv
''vy 7'' 111
operational requirements of the ADEC or MOA DSD. The content of this report Is for
C
00 PrOfes$%O
the sole benefit of the ownertisted above.-Anyreliance upon or use of report b an
PY Y --
o�--
-' OpO�ppoo
otherperson or partyis not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for L4 bedrooms.
Disapproved.
Conditional approval for
`ltttttl(GHO pfrr���ir
bedrooms, with the folloat+ongR9(;
1
Attachments:
����JJJJJIIII)111N��
HAA Checklist _vl�
Maintenance Agreements
Septic System Advisory
Supplemental Engineer's Report
Well Flow Advisory
Other
By:L t • U 1 )1 1�. �d sslg� Original Certificate Date:
(Rw.11A1)
Municipality of Anchorage ,
Development Services Department '
J Building Safety Olvision
On -Site Water& Wastewater Program
4700 South Bmgaw St.
P.O. Box 198650 Anchorage, AK 995196650
www.ci.anchorage.ok.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:�Qla TABLELANDS SUBDIVISION: LOT S. BLOCK 6 Parcel ID: 051- SOV —,5t
A. WELL DATA PUBLIC WATER
Welt type If A. B, or C provide PWSID# _
Date completed Sanitary seal (Y�
Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production —
9 -p.m -WATER SAMPLE RESULTS:
Conform colonies/100 ml. Nitrate nvjL.
Date of sample:
S. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL/S.T.E.P.
Tank size 1500 gal. Number of Compartments 2
Foundation cleanout ('YIN) YES Depression over tank (YIN) NO
Data of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date instaned6116-17/20oa
77-7.5177;. n,-4
�...A
Well Log
protected (YIN)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
Date installed 6/16/2004
Cleanout, (YM) YES
High water storm (YIN) YES
System We BED
Length 75 R Width 20 ft. Gravel below pipe 0.5 ft.
Total depth 24.81 fL EN. absorption area 1500 fe Monitoring tube YES Depression over field NO
Date of adequacy test NEW SYSTEM Resutts (Pass/Fail) For?b%d:oo s
Fluid depth in absorption field before Lest , In. Water ad New depth _in.
Elapsed Time: _ minJ!'11:1:11111,111 1111:11epth _ In. Absorption rate sa g.p•d.
Anytreatment (past 12 mo.) (YIN & type) M yea, give date
D. LIFT STATION
Date installed 8/18-17/2004 Size in gallons 1500 Manhole/Access (YIN) YES
•Pump on• level at 4Y in. •Pump ofP level at42• in. High water alarm level at 46
Datum BOTTOM OF TANK Cycles tested NEW Meets alarm S circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAln station on lot
Absorption field on lot
Public sewer main
line
On adjacent
167
Public sewer manhole/deencut
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 101+ Surface water t 00'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One 10'+ Building foundation 10'+ Water main 10'+
Water service One 101+ Surface water 100'+ Driveway, parkinglvehide storage _10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
0. ENGINEER'S CERTIFICATION
I cut* that I have determined through Held bspecOons and t 9 `�*:
review of Munlolpa/ records that the above systems are in
coniamence with MOW HAA guidelines in effect on this date.
. ..............
Y ess'
Engineer's Printed Name JEFFREY A. GARNESS
Date ^Ili 3hor •'•op_L r3 �a
HAA Fee S J / Waiver Fee $
Date ct Payment 7tH 05 Date of Payment
Receipt Number Recelpt Number
IRev. 17/01)
P.2
ASBUILT
121
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE=
�v
FOLLOWING DESCRIBED PROPERTY.
-
p OF At N%
TyE—TII��GSiYOS�Jli.9 GAB. !'tom:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
DATEr/`t�
S 4f
w
y
q
INDICATED. .IT IS THE RESPONSIBILITY OF THE
��v
%• : 4 H
GRID
OWNER TO DETERMINE THE EXISTENCE OF ANY
.10
EASEMENTS, COVENANTS, OR RESTRICTIONS
ywi��
4Lf �4ry�
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB`
/off-7f/�
f'� LS-6918Ar
1
ANY DATA HEREON BE USED FOR CONSTRUCTION
���4r ••...• `jM„
OFFENCE LINES, OR FOR ESTABLISHING BOUND-
DRAWN
ARY LINES.
!�