HomeMy WebLinkAboutTHE TABLELANDS #1 BLK 8 LT 18The Tablelands
#1
Block 8
Lot 18
#051-801-63
7
Municipality of Anchorage Page 1 of 3
Development Services Department
on-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519.0650
www ci.anchorage.sk.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO50253
PID Number. r'61—k6I-(o3
R7pi
Wastewater System: New
S inell Homes Inc.
1900 W. Northern Us. Blvd. Ste. 200
Anch., AK 99515
ABSORPTION FIELD
F am'""°era1Ba°°«"'
Raised Bed
344.5678
Three 3
sa Rrw
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LEGAL DESCRIPTION
.5 GPD)F?
.5 Ft.
Block Lot sdxk L
Depth m Pros coil. kW) WVpeas
Grvn c!Wh Dunn;;"
g 16
The Tablelands
+1.5 Ft.
.5 FL
TOwWW R-90
Swmn:
to salla eDws onprW peas
4.5
Garel LwpO.
60
Ft.
Ft.
Dern roan
Nw a thea
DW Down lwse
Well: AWWU
15 Ft.
3
5 FL
CwearWm ItkNw, A B. C)
TOW Depth
Casa b
an ru«pw. rsa
900 Fe
ps "wul
ASTM 3034 PVC
Ft. FL
1
DniW
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e
10119-2012005
FL
YWa
purySilt
"• ev ADor c'
TANK
GP1A
Ft.
FI
SEPARATION DISTANCES
STEP
To
Septic
Absorption
Lift
Holding
Tank
lublrjPrtvate
sewer Lim
AnchorageTank/Orenco
1,250
From
Tank
Field
Slabon
waL
>200'
>200'
>200'
NIA
>25'
tw
Steel
Three (3)
>100,
>100,
>100'
NIA
LIFT STATION
swrecewww
La lir
>5
>10'
>10'
NIA
250 on
Anchorage Tanid0renco
>5'
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>5'
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o
42
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>20'
>20'
Aman
Or
laskapElectric
Allied Alaska
Dvl.et 01—
eMnacheo8
R lurk,
BENCH MARK
2mm
Over Entire Bed A ea.
18* Coarse Sand—
w.
Insula n
Rat]
Finished Floor.
Pl-reellinticirAbsorption
Mrmea EM�
100.0 FL
Engineer's Stamp
000
Inspections performed by: TLK
Dates: 1" 10119105
L 491h
2 10120105
.x.
0 � S y.01,A1 L E. AND( RSON W
Department of Health and Human Services approval
•."/\ CF-4391 , �=
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♦44�z-o r...... 1
Reviewed and approved by.
Date:
ESSI
(Rer Iw99)
7
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
PID No. 051-801.63 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
Permit Number: SWO50253 On -Site Wastewater Disposal System or Well Inspection Report
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Page 2 of 3
THE TABLELANDS SUED.
ADDITION NO. 1
LOT 18, BLOCK 8
PLAN AS -BUILT
SCALE 1' = 50'
53,687 S.F.
�� ,• L
± 49th f^1 ••••i
MICHAEL E. ANDERSON
Municipality of Anchorage
DEVEOPME14T SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 Page 3 of 3
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO50253
PID No. 051-801-63
.39
I / a _ / 2' EPS Insulatlon
:M
50 Gallon
S.T.E.P.
PROFILE AS -BUILT
Scale: NONE
Mar 21 06 01:30p Rllied Rlaska Electric (907) 373-3994 p.l
���P���� OIV RA/t7/NG
�L.�CTR.rC�
March 21, 2006
FAX: (907) 677-7766
Anderson Engineering
Attn: Mike Anderson
P.O. Box 240773
Anchorage, AK 99524
Subject: Lift Station Inspections at properties stated below.
This letter is to confirm that the lift station(s) at:
• Lot 18, Block 8 — The Tablelands
• Lot 19, Block 8 —The Tablelands
were wired by a licensed Journeyman Electrician in accordance with the 2002 National Electric
Code requirements.
If you would like any further information, please feel free to call our office at the numbers listed
below.
Thank you.
Sincerely,
ALLIED ALASKA ELECTRIC, L.L.C.
&tmK �
anette L. Brown,
/ice Presidcnt1CFO
cc: file
P.O. Bos 876310, Wasilla..tlaska 99687 (907) 373-3893 ofc / (907) 232-8687 cell/ (907) 373-3894 fax
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: Jul 26, 2005
Expiration Date: Jul 26, 2006
Permit Number: SWO50253 Parcel ID: 051-801.63
Legal Description: THE TABLELANDS #1 SUBDIVISION BLOCK 8 LOT 18
Design Engineer: 0014 Anderson Engineering Site Address: 22417 BLACKTAIL CIRCLE
Owner Name: SPINELL HOMES, INC Lot Size: 53687 SO. FT.
Owner Address: 1900 W. NORTHERN LIGHTS BLVD #2C Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORGE . AK 99515 -
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 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 catling
(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.
Received By:
Issued By:
Date: 7" J_-7-05 '
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-801.63 Permit Number SW
Property owner(s) Soinell Homes Inc. Day phone 344-5678
Mailing address (1)1900 W Northern Lights Boulevard Suite 200 Anchorage AK 99515
Mailing address (2) 22417 Blacktail Circle Zip Code
Legal description (Lot, Block & Sub'd.) Lot 18 Block 8 The Tablelands Subdivision, Addition No.1
Legal description (Section, Township & Range)
Lot Size 53,687 SF Acres/Sq.Ft.
Number of Bedrooms Three (3)
THIS APPLICATION IS FOR:
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: 0 ` Waiver Fees:
Date of Payment: 7' Ze — or Date of Payment
Receipt Number.711 5L ok_ Receipt Number.
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
July 20, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 18, Block 8, The Tablelands Subdivision, Addn. No. 1
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 18, Block 8, The Tablelands Subdivision, Addition No. 1 intends to
construct a new three-bedroom home on the lot. We are therefore requesting a permit
be issued for the construction of a new septic system to serve the new home. The
subdivision is currently served by a community water system. No conflicts exist with
adjacent septic systems or wells and the proposed septic system on this lot. The
attached Site Plan and backup documentation identify the location and configuration of
the proposed septic system and alternate site. The current drainage pattern is
identified on the Site Plan. The drainage pattern will be maintained after development
of this lot is complete.
Test holes recently placed on the lot indicated silty sands with minor amounts of gravel
in the area of the absorption bed and alternate site. The accepting soils were tested
and found to have a percolation rate of between 6 minutes per inch and 15 minutes per
inch. The system is designed with an application rate of .5 GPD/SF. Groundwater was
found in the test holes during placement at 14' below the surface and was monitored
during the ensuing period at 9' below the surface. Our design includes the placement
of a new 1,250 -gallon septic tank along with a 60' long and by 15' wide absorption bed
to collect and treat the sewage generated in the house. The distribution pipe in the bed
will be 1' above the surface. All organic material beneath the bed will be removed and
replaced with coarse sand. Coarse sand will also be utilized to raise the bed above the
existing ground surface. A minimum of T of cover will be placed atop the beds and a
minimum of 4' of cover will be placed atop the new septic tank.
The ground surface on the lot slopes at varying grades from north to south as shown on
Lot 18, Block 8, The Tablelands, Addn. No. 1
July 20, 2005
Page Two
the Site Plan with steep slopes near the south end of the lot. The absorption beds will
be constructed parallel with the slope of the ground surface as much as possible in
conformance with Municipal requirements. The new septic system will be constructed a
minimum of 10' from the water service proposed for the lot and on adjacent lots. It will
also be constructed a minimum of 100' from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
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STEP Ta
,11•. 1III* THE TABLELANDS SUBD.
ADDITION NO. 1
Throe LOT 18, BLOCK 8
O A° 53,687 S.F.
u.„nt
15' T. k E. /'�
�� I' �wgppvit
, zo' ` ~s�`• � �2+ �2 100' ������ � 444
BLACKTAIL \�
M'
CIRCLE ■,,,,,; ;„,„�
.y
112' i.„.:.'.:----- `:�.�......... ---
SITE PLAN �zMlCINEI f N
SCALE 1' = 50' ••f fitPRa—Ml ••.
Existing Ground
LOT 18, BLOCK 8, THE TABLELANDS
SUBDIVISION, ADDITION NO. 1
DESIGN FACTORS: SYSTEM REQUIREMENTS:
3 Bedroom Home Raised Bed System
Pere. Rate: 6-15 MinJlnch 1,250 Gallon STEP Tank
Application Rate: .5 GPD/SF Coarse Sand (As Required)
3 Bedrooms X 150 GPD/.5 GPD/SF = 900 SF Absorption Area
900 SF115 SF (Width) = 60 LF Bed Length
THEREFORE: Construct a 60' Long x 15' Wide Raised Bed as Shown Below.
Place Distribution Piping at 1' Above Original Ground Surface. Remove Organics and Place
Coarse Sand to Provide 4' Separation From Groundwater (Minimum). Place Insulation
and 2' of Cover Over Bed or Mound Over Bed Minimum of 3'. Place 4' of Fill Over Tank.
Top 6' of Mound Must Be Topsoiled
and Vegetated to Prevent Erosion.
/ 5-
s
1'
or
As Required
Natural Backfill
2' Insulation 8 2' Cover (Min.)
O O O
Drainfield Rock
Coarse Sand (See Specification)
As Required for Levelling
In Situ GM Soil
2.5' 5' S' 2.5'
�4 1
1' PVC
3116' Holes
10 Each Lateral
TYPICAL BED SECTION
(NO SCALE)
NOTE: Grade Area Surrounding Bed to Drain Away.
Minimum 6' Separation From Bedrock. r
Minimum 4' Separation From Groundwater. I
Minimum 200' Separation From Wells In the Area.
Minimum 100' Separation From Surface Water or Streams. .
Minimum 10' Separation From Water Service Line.
Existing
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION- LOT 18, BLOCK 8, TABLELANDS S/D
PERFORMED FOR: SPINELL
DATE: 4/15/2005 PROJECT No - M0522
PARCEL IDR- TECHNICIAN: M. ELDRIDGE
DEPTH TEST HOLE #71
ucct)
1
READING
OB/OG
SILTY SANDS W/GRAVELS
SLOPE
Dy ATER INFT
(INCHES)NCHES)
DRQQP
SITE PAN
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
2
MEDIUM COMPACTION -DAMP
CHARGE
2
1532
30
SM -GM
3.3125'
3
3
11.01
RECHARGE
4
1602
4
7.5'
3.5'
5
THI
11.0'
RECHARGE
6
�
5
7.375'
3.625'
100/1
6
WELL COMPACTED SILTY SAND
7
WITH GRAVEL
8
SM
a
9
I
II
I
15
16
17
I8
19
f Tlm
WAS GROUNDWATER ENCOUNTERED? NO
IF YES ®WIIAT DEPnr r
DEFTD OFWATER AFTER MONITORING.y yyet,(j 0%
DATE OF MONITORING: TO VXAA
DATE
READING
GROSS TIMEJ
(MINUTES)
NET TIME
(MINUTES)
Dy ATER INFT
(INCHES)NCHES)
DRQQP
7/18/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1502
10.0'
CHARGE
2
1532
30
6.6875'
3.3125'
3
1532
11.01
RECHARGE
4
1602
30
7.5'
3.5'
5
1602
11.0'
RECHARGE
6
1632
30
7.375'
3.625'
PERCOLATION RATE: 8.3 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4_5 FT. and 5_5 FT.
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR To TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICIIAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7 - ZS-oY'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 18, BLOCK 8, TABLELANDS S/D
PERFORMED FOR- SPINELL
DATE: 4/15/2005 PROJECT No • M0522
PARCEL IDR- TECHNICIAN: M. ELDRIDGE
DEPTH TEST HOLE # 2
Ocel)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
1
1
I
OB/OG
SILTY SANDS W/GRAVELS
MEDIUM COMPACTION -DAMP
SM -GM
WELL COMPACTED SILTY SAND
WITH GRAVEL
SITE PAN
TH2
O
a
'FF FUTURF ASRllil. T
WAS GROUNDWATER ENCOUNTERED' YFc
IF YES ® WHAT DEPTIII If
DEPTH OF WATER AFTER MONITORING 9 0%
SM DATE OF MONITORING T/11 M5
1191
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH RF
(INCHES)
NET DRQQP
(INCHES)
7/18/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1430
11.5'
CHARGE
2
1500
30
6.9375'
4.5625'
3
1500
11.0'
RECHARGE
4
1530
30
7.0'
4.0'
5
1530
11.0'
RECHARGE
6
1600
30
7.125'
3.875'
PERCOLATION RATE: 7.7 (MINANCH) PERC. HOLE DIA -6 (INCHES)
TEST RUN BETWEEN: 4_5 FT, and 5_5 FT.
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, ]MICHAEL E. ANDERSON CERTIFY TIIAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE-
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 18, BLOCK 8, THE TABLELANDS SUBDIVISION, NO.
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,250- gallon STEP Tank at the location shown on the site plan.
Work also includes the construction of a new 60' long by 15' wide
absorption bed also shown on the Site Plan. The distribution pipe for
the bed will be placed 1' above the surface. Sand will be required to
level the existing ground surface to provide a level plain for the new
bed. All components of the new absorption bed, and STEP Tank must
be constructed a minimum of 200' from wells in the area and 100' from
any surface water. Insulation will be required atop the bed to prevent
freezing. In lieu of insulation a minimum of 3' of cover must be placed
atop the bed. A minimum of 4' of cover is required over the STEP
Tank.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines. Contractor is also responsible to verify the
separation distance from the well on this and adjacent lots.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANKILIFT STATION INSTALLATION
1. The 1,250 -gallon combination septic tank and lift station must be
constructed by a certified tank manufacturer. Construction shall
include an 18" manhole to provide access to the lift station.
2. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
Lot 18, Block 8, The Tablelands, No.1
July 20, 2005
Page 2 of 4
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
4. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
5. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drain field.
6. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAIN FIELD CONSTRUCTION:
1. The drain field shall be constructed to the dimensions shown on the
design. The bottom of the bed shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drain field rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drain field
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drain field are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
less than T of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
8. A minimum 2' of accepting soil is required below the drain field rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
Lot 18, Block 8, The Tablelands, No. 1
July 20, 2005
Page 3 of 4
MATERIAL SPECIFICATIONS:
The lift station must be constructed by a municipally approved septic
tank manufacturer. An Orenco 20 OSI 05 HHF-5 pump is
recommended.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5' to 2.5" in diameter with less than 3% passing
the #200 sieve.
FILTER SAND SPECIFICATION:
1. Material for Filter Sand must be classified as a masonry sand and
meet the following gradation:
50% or More Passing the No. 4 Sieve
2% or Less Passing the No. 100 Sieve
1% or Less Passing the No. 200 Sieve
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Lot 18, Block 8, The Tablelands, No.1
July 20, 2005
Page 4 of 4
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as -built of the completed system.
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
LItQ6wurtez
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. D51-$01-(03 COSA# buotib
Expiration Date: L-- A 6— O z
1. GENERAL INFORMATION
Complete legal description
Location (site address)
'Lot 18, Stock 8. The Tablelands Subdivision No.1
22417 aladda(i circle Chuglak, AK
Current Property owners) sgnan Homes, Inc.
Day phone 344-5678
Mailing address 1900 W. Northam Lights Blvd., Suite 206 Andarage, AK 99517
-
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unloss otherwise requested, COSA will be hold by DSD forpickup.
2. NUMBER OF BEDROOMS: Throe DI
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual On-site
0
Individual Water Storage ❑
Individual Holding Tank
❑
Community Class Welt ❑
Community On-site
❑
Public Water System ❑D
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -She 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 Onsite 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 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 Onsite Systems Approval Guidelines for this application,
shows that the on -she 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 -she 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
Phone 522-m3
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson. P.E.
6. DSD SIGNATURE
_SG Approved for 3 bedrooms.
Disapproved.
Date 414f2000
a
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist _� Arsenic Advisory
Septic System Advisory Maintenance Agreements
well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
0
Na"Sw
By: Original Certificate Date: 4L— 2- - D 6
(Rw IM)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On-Sle Water & Wastewater Program
4700 Bragew Street
P.O. Box 1988
Anchorage, AK 99519-6850
www.muni.orglonake
(907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Descripilm: Lat 1a akar a The TmbWwoda &dx MNan Na 1 Parcel ID:' -$C( -
A. WELL DATA
Wel type—
Date completed _
Total depth R
Date of test
Static water level
Well production
If A, B, or C provide PWSID g
Sanitary seed (YIN)_
Casedto R.
FROM WELL LAO
R.
g.p.m.
WATER SAMPLE RESULTS:
Colifwm colonkaN00 mL Nitrate mglL
Arsenic: _ mgR Date of sample. _
B. SEPIICIHOLDINO TANK DATA
Tank TypelMaterial STEPIffiear
Tank size 1.250 gal. Number of Compartments 3
l Log (YIN)
Wires property protected (YIN)
Casing height (above ground) in.
AT INSPECTION
Foundation deanout (YIN) Y Depression over tank (YIN) N
Date of pumping Now Coed^ Pumper
C. ABSORPTION FIELD DATA
R.
9—
p.m-Wel
Other bacteria colonies/1 00 mL
Collected by:
Date instated 10119r"s
Cleanouts (YIN) Y
High water alar (YM) Y
Date instated MAW Sot rating (g.p.dJe or R=Ibdr) .e GPDW
Length Go R. Width 15 R.
System type Raiaad Bad
Gravel below pipe _5
fl.
Total depth •6 �I. E f. absorption area R' Monitoring tube Y Depression over field N
Date of adequacy test Naw QML Results (Pass/Fall) 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 ttea"ent (past V mo.) (YIN & type) N yes, give date
D. LIFT STATION
Date Installed lona".
'Pump on' level at 42 in.
Datum Bosom of Tank
E. SEPARATION DISTANCES
Size in gallons 250 Manhole/Accm (YIN) v
'PUMP otr level at 42 in. High water alarm level at M
in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankA(R station on lot
Absorption field on lot
Public sewer main
Sewer /septic service one
Animal containment areas
Meeh alarm 6 circuit nqukeabnafl
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manumlanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation W
Property line>s
Absorption fleld
>s
Water main >uy
Water service line >tbr
Surface water
>tar
Wells on adjacent lots >200`
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >ta' Building foundation >to' Water main >te'
Water Service one >ta Surface water >tar Day Pa/sftfthlcle stomp >25,
Curtain drain NMM Need Wells on adjacent lob >toa
F. COMMENTS: Lot los served by Awwu water symmm.
G. ENGINEER'S CERTIFICATION
I certify that I have determined }trough held knspecdons and
review of MunkW records that the above systems are in
conformance WIM MOA COSA guidellnes in effect on this date.
Engineer's Printed Name Aaehaei E. Anderem, P.E.
Date 44rzoos
COSA Fee Z_.T•.o it t.00 lo°ndtl°"°q Waiver Fee $ _
Date of Payment 4r.Y N
Date of Payment
Receipt Number _ �8_�(o Receipt Number
IRM. I il"
1 "= 40'
15' T. & E.
BLACP
CIRC
4-131
THE TABLELANDSDDSUBD.,
LOT 1.8, BLOCK
53,687 S.F.
ADDN.
8
-BUS
4STALDI LAND
/EYING, LLC
A. GASTALDI, R.L.S.
WEST 88TH AVENUE
CAGE, ALASKA 99502
)NE 248-5454
GRID I I DATE
NW 1559 12/28/2005
F.B. JOB NO.
5-16 TLS188
I
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS;
COVENANTS ORESTRICTIONSSUBDIVISIONWHICH
APPEAR ON THE RECORDED PLAT.UNDER i
ATAI
HEREONNBECU USED ORNCONS CCES ONSTRUCTION ORULD ANY FORESTABLISHING BOUNDARY OR FENCE LINES. I
ANCHORAGE RECORDING DISTRICT, ALASKA I
NOTE: NO CORNERS SET THIS DATE I
(Arx)
N0. 1
OF
44�r,�
♦ �00
s . JeHery A. G°et M .■
0
•, LS -6091 : • �a61 j
so
Municipality of Anchorage
Development Services Department
�r Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: Mike Anderson
Legal description: The Tablelands #1 Block 8 Lot 18
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results inadequate.
® Discrepancy in Information submitted. Electrical wires to lift station MUST be buried 18
inches.
❑ Topographic information missing or inadequate.
® Incomplete; missing Cap on MT
❑ Incomplete; missing
❑ Additional adequacy test information needed. .
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils Information submitted.
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
❑ Other.
Name of reviewer: Jeff
Date: 4-6-06
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
