HomeMy WebLinkAboutTHE TABLELANDS #1 BLK 8 LT 20The Tablelands
Block 8
Lot 20
#051-801-65
Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196850 Anchorage. AK 99519-6650
www4anchorage.sk.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO50295 PID Number. 051 -BOM
S inell Homes Wastewater System: New
Art
1900 W. Northern LI hts Ste. 200 Anch., AK 99517
ABSORPTION FIELD
ptxM 344-5676 " h eea 3°°"
5' Wide Trench
LEGAL DESCRIPTION
Sod lt�'aTaW
Depth Yomrp.WWeft
.7 wwr
3 Ft.
11 tl La B.edlM.bc
S
Dpm b P" basin kr. MiVW VW.
G.vr E.pm CrwWr pp
20 The Tablelands
1 Fr.
2 FL
Taw, Rrpr. s.tdwT
FA add.d.bo rqa grade
D....i LrpUi
1.3 Ft.
90 Ft.
Well: AWWU Water System
NunOia1i"
D"'rpDMi'°n""
5 Ft.
1
cxr.d (Pm . A a. C}.
Tarr D"ftCuM
xr
abswpl r.a
pa rW.
Ft.
FL
643 Ft'
ASTM 3034 PVC
pa.r.
Dr. Mort
ams WOW L.vr.
Ft
Pisano's Dirlworks
919/2005
YrNd
Prep sr r.
Cana H.VN Aaw. crud:
TANK
DPL.
Fr.
FL
SEPARATION DISTANCES
Septic
To
Septic
Absorption
1M
Holding
WwPrtata
.
From
Tank
Field
Station
Tank
sewerune
Anchorage Tank
1,000
WN
>200'
>200'
N/A
WA
>25'
Steel
Two (2)
s.ra.wrr
>100'
>100'
WA
NIA
LIFT STATION — NONE ON LOT
Lnr l}r
>5'
>10,
WA
WA
cr
FauMrbn
>5'
>10'
WA
WA
„
„
Dr.t .
None
Noted71
Pmrwkw
BENCH MARK
2 of Insulation Over Entire System.
r
Finished Floor.
100.0 FL
Engineer's Stamp
'.*gyp F silt
a•4•�a0
Inspections performed by: T. Kimbrough Dates: 1d 91912005
�` 49th L� `� 00
2nd 91912005
Department of Health and Human Services approval
V♦ C14 CHAEL E. ANDERSON
/ —}—
Reviewed and approved by: lJ A Date:3 zR-fl6
♦ if No. CE -4391
•sss�pfp
(M 1(10))4e�ea"�
SSIO' ��•
Municipality of Anchorage
N e9'52'01'E DEVEOPMENT SERVICES DEPARTMENT
Permit No.: SW050295 23 4700 South Bragaw Street Anchorage, AK 9951M55 -343.7904
PID No. 051-8015 1 \ Onsite Wastewater Disposal System or Well Inspection Report Page 2 of 3
49th 6V
MICHAEL L ANDERSON
s}
NIL
su ali 41.r
THE TABLELANDS, ADDITION NO. 1
LOT 20, BLOCK 8
54,088 S.F.
S
PLAN
AS -BUILT
SCALE 1' = 50'
T. h E. ESWr.
BLACKTAIL
CIRCLE
Permit No. SWO50295
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
PID No. 051-801.65
abrlc
� i •J49t �k��
PROFILE AS -BUILT
Scale: t' - 20' OXV;T UEL c ANDERSaN I N
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 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: Aug 17, 2005
Expiration Date: Aug 17, 2006
Permit Number: SWO50295 Parcel ID: 051-801.65
Legal Description: THE TABLELANDS #1 SUBDIVISION BLOCK 8 LOT 20
Design Engineer: 0014 Anderson Engineering Site Address: 22416 BLACKTAIL CIRCLE
Owner Name: SPINELL HOMES, INC Lot Size: 54088 SO. FT.
Owner Address: 1900 W. NORTHERN LIGHTS BLVD #2( Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99515 -
This permit is for the construction of:
❑7 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.
a.) The total depth of the absorption field shall not exceed 3 feet below original grade.
Received By:
Issued By:
Date: 6-49-'01-
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. D _"�l- 96 I- /n 5 Permit Number SW
Property owner(s) Sainell Homes, Inc. Day phone 3445678
Mailing address (1)1900 W. Northern Lights Boulevard, Suite 200 Anchorage, AK 99515
Mailing address (2)'"411,* 9lacktail Circle Zip Code
Legal description (Lot, Block & Sub'd.) Lot 20 Block B The Tablelands Subdivision, Addition No. t
Legal description (Section, Township & Range)
Lot Size 54.088 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Three (3)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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: ``L 0 W Waiver Fees:
Date of Payment:PJ[) — CSS'" Or _ Date of Payment
Receipt Number.7ZOli� Receipt Number.
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: August 16, 2005
TO: Julie Makela, P.E.
FROM: Mike Anderson, P.E.
SUBJECT: Lot 20, Block 8, The Tablelands Subdivision
Septic System Design
We have revised the site plan to include the location of the subdivision test hole. We
have also modified the length of the trench to 90' compensate for the slower percolation
rate. We have used an average absorption rate of .7 gallons per day per square foot
and increased the length of the trench to 90'. We are confident the trench will be
effective in the absorption of the septic effluent generated in the house.
Please review the attached documentation and call with any questions.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766_(F
August 6, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 20, 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 20, 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 gravel with minor amounts of sand in
the area of the absorption trench 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 .8 GPD/SF. No groundwater
was found in the test holes during placement and none was monitored during the
ensuing period. Our design, however, is based on the bottom of the trench at 3' below
the surface and includes the placement of a new 1,000 -gallon septic tank along with an
80' long by 5' wide by 2' effective depth absorption trench to collect and treat the
sewage generated in the house. The distribution pipe will be 1' below the surface. A
minimum of 3' of cover will be placed atop the trench 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 southeast to northwest as
shown on the Site Plan. The absorption trench will be constructed parallel with the
Lot 20, Block 8, The Tablelands Subdivision, No.1
August6,2005
Page Two
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 1 00'from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. 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,
rn"J" Eale-,
Michael E. Anderson, P.E.
Attachments
49th 1
MICHAEL E ANDERSON
i No. CE -4381 .
N89'S2'Ol'E
Q0. 23.83' 5/8' MM (TYP PER PLAT)
2004-131
THE TABLELANDS, ADDITION NO. 1
LOT 20, BLOCK 8
54,088 S.F.
i`
A J,
O
10
n
0 11
2
e{
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•
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100• At.
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SLACKTAIL
+••••������, CIRCLE
• •�� pF �..•Q
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zt 49tl�%,5.�•dd
�y i
NICNNEL E ANDERSON r' .` -i i
•, f: N0. cE-4791 frytiZ: SITE PLAN
••�4•1ESSii•••` SCALE 1' = 50'
LOT 20, BLOCK 8, THE TABLELANDS, ADDN. NO. 1
DESIGN FACTORS:
Three Bedroom House
Perc. Rate: 6-17.2 Min.Anch
Application Rate: .7 GPD/SF (AVG. Rate)
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,000 Gallon Septic Tank
2' Drainfield Rock
3 Bedrooms X 150 GPD/.7 GPD/SF(Application Rate) = 642.86 SF Absorption Area
642.86 SF/5 LF (;Width)" .7(Red. Factor) = 90 LF Trench Length
THEREFORE: Construct a 90' Long x 5' Wide x 2' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be V Below Original Ground Surface. Total Depth to be
3' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
6"
6"
2'0"
Natural
Backfill
5'
3' Cover or 2" Insulation
and 2' Cover
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SE
NOTE: Grade Area Over Trench to Drain Away.
Minimum V Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION. LOT 20. BLOCK 8. TABLELANDS S/D
PERFORMED FOR- SPINELL HOMES, INC.
DATE: 7/29/2005 PROJECT No- M0562
PARCEL ID,y TECHNICIAN: M FI DRIDGF
DErn1 TEST HOLE # 1
(rcn)
1
READING
OB/OG
NET TIME
(MINUTES)
2
=
7/29/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1U
3
11:01
11.0"
CHARGE
2
11:31
30
5.25++
12-
2
3
6}..
11.0"
RECHARGE
13--
13
7
BOH
POORLY GRADED GRAVELLY -
14-
415161719
5.5++
SANDS SOME FINES
8
5
SP -GP
9
READING
OSS TIME
G MINUTES)
NET TIME
(MINUTES)
DNATER
(INCHES)
NFT DROP
( INCHES)
7/29/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1U
•.i: '7.
11:01
11.0"
CHARGE
2
11:31
30
5.25++
12-
2
3
11:31
11.0"
RECHARGE
13--
13
4
BOH
30
14-
415161719
5.5++
15-
5
12:01
16-
11.0"
RECHARGE
17-
6
12:3130
5.63"
19
COMMENTS:
WAS GROUNDWATER ENCOUNTERED' NO
SITE PAN
THI
O
SFF FUTURF ASRUR.T
IF YES ® WIIAT DFPRI'"'°I <5%
DEPTH OF WATER AFTER MONITORING O%
DATE OF MONITORING 8141NM
DATE
READING
OSS TIME
G MINUTES)
NET TIME
(MINUTES)
DNATER
(INCHES)
NFT DROP
( INCHES)
7/29/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
I
11:01
11.0"
CHARGE
2
11:31
30
5.25++
5.75"
3
11:31
11.0"
RECHARGE
4
12:01
30
5.5++
5.5++
5
12:01
11.0"
RECHARGE
6
12:3130
5.63"
5.37'
PERCOLATION RATE: 5.8 (MINANCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 5 Fr.and 6 Fr.
TEST HOLE PRESOAKED PRIOR TO TESTING.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE*
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ����Q'^••..••.'��j
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 7*49th r
� _49th
SOILS LOG - PERCOLATION TEST-
�NtcNAEt E. ANRERSW
LEGAL DESCRIPTION LOT 20, BLOCK 8. TABLELANDS S/D ,i� � No. cr.-4 {
PERFORMED FOR- SPINELL HOMES INC. — ��h�� n •'�
DATE: 7/29/2005 PROJECT No' M0562
Professional Engin Slam
PARCEL ID -j• TECHNICIAN: M FI MIDGE
DrPTII TEST HOLE # 2
(fcct)
OB/OG SLOPE SITE PAN — 'y.�
2 e� �r
3
4
0
5' ` .�: o O
v TH2
6 •:a'. iy
4yI y .•
7 ';:.;•' MOIST SITLY SANDS
•�' :' SOME GRAVELS W/FINES
8 ': �•; ' SM -SP
9 '• �: i. SFF FUTU RF ASNIIILT
10 WAS GROUNDWATER ENCOUNTERED' Nn
. , IF YES ®WIIAT DEFIAT 500
r�=•'�'•+ DEFT11 OF WA7ER AFTER MONITORING N^e 0%
11 : i•. DATE OF MONITORING: <l0%
12 �. ....
13 '; ";� BOH
14
15
16
17
18
19
20
PERCOLATION RATE: IO.0(MIN/INCFt) PERC. IIOLE DIA. 6 (MCFIES)
TEST RUN BETWEEN.5 FT. and 6 FT.
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON TFIIS
DATE-
G OSS TIME NET TIME �rygTERF INFT
DATE
READINGMINUTES)(MINUTESNCHES
(INCHES)
DRP
7/29/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
11:35
11.0"
CHARGE
2
12:05
30
8.19"
2.8125"
3
12:05
11.0"
RECHARGE
4
12:35
30
8.19"
2.8125"
$
12:35
11.0"
RECHARGE
6
13:05
30
8.0"
3.0"
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BESSE ENGINEERING TEST BORING MCMANUS PARCEL
1690 w. ja6mc unite tlrde GEED LOT (BOOK 469, PACES 155 3 156), ANCFIORACE
WASLLA. AK. 99651 LOCATION .MAP RECORDING DISTRICT. LOCATED WITHIN THE NE 1/4
907-357-4257 -SECTION 4,;T15N, R1W, SEW'ARD. MERIDIAN, ALASKA.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 20, BLOCK 8, TABLELANDS SUBDIVISION, NO. 1
GENERAL:
The scope of this project includes the procurement and placement of a new
1,000 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 80' long X 5' wide X 2' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 1' below the existing ground
surface. Total depth of the trench will be 3' below the existing ground
surface. A separation distance of 200' from any well and 100' between the
septic tank and absorption trench and any surface water must also be
maintained. A minimum of 3' of fill is required over the absorption trench and
4' over the septic tank. In lieu of the required fill 2" of insulation and 2' of fill
may be placed.
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. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
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 TANK INSTALLATION
A new 1,000 -gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 20, Block 8, Tablelands No. 1
August 6, 2005
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield 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 drainfield 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 drainfield 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
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield 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 20, Block 8, Tablelands No. 1
August 6, 2005
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
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, Femco, 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.
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.
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
+1 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: Anderson Enaineerina
Legal description: The Tablelands #1. Block 8. Lot 20
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.
❑ Topographic information missing or inadequate.
❑ incomplete; missing _
❑ 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. 1) Two different test holes designated os '"THl." Please is
Name of reviewer: Julie Mokelo. P.E.
Date: 8/11/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
4ndkilemodu.
Municipality of Anchorage
Development Services Department
' Building Safety Division
On -Site Water and Wastewater Program '
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-665o
www.muni.org/onske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051.801-65 COSA #
Expiration Date: 3 - o-7,9 -0'-2
1. GENERAL INFORMATION
Complete legal description Lot 20. Brock S. The Tablelands Subdivision No.1
Location (site address) 22418 Biaddall Circle Chuglak, AK
Current Property owner(s) Spinae Hanes, Inc.
Day phone 3445678
Mailing address 1900W. Nathem Lights Blvd.,
Suite 200 Andwrage, AK 99517
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pi kup.
2. NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual On-site
R1
Individual Water Storage ❑
Individual Holding Tank
❑
Community Class Well ❑
Community On-site
❑
Public Water System
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 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 mors 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 Onsite Systems Approval Guidelines for this application,
shows that the on-ske water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of Installation.
Name of Finn Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
✓ Approved for 3 bedrooms.
Disapproved.
Date 3/2120013
49th
Conditional approval for bedrooms, with the following stipulations:
COSA Checklist _X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By:c "I Original Certificate Date: 3 ' R ' O 6
CA -
(11". 1 W)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water 6 Wastewater Program
47W Bragaw Street
P.O. Bax 196050
Anchorage, AK 995198650
www.munLorglonake
Mn 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Let 24, Block a, The Tsbr www sub& i aan No. t Parcel IQ 0 1-001.85
A. WELL DATA
Web type _ If A, S. or C provide PWSID 0 _ Wen Log (YIN)
Date completed _ Sanitary seal (YIN) _ Wires pmp&V protected (Y/N)
Total depth fL Cased to ft. Casing height (above ground) in.
FROM WELL LOO AT INSPECTION
Date of teat
Stats water level ft. ft.
Well production g.p.m. p.p.m.
WATER SAMPLE RESULTS:
Coliform cokxlleahW mL Nitrate mg& Other bacteria colontes/100 mL
Arsenio. _ mgn Date of sample: _ Collected by:
B. SEPTICIHOLDINO TANK DATA
Tank Type/Material _ aepadsw Date installed 92AM
Tank sae 1.000 gal. Number of Compartmerds s Cleanouts (YIN) v
Foundation cleanout (Y" Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping New ConsrnuM n Pumper
C. ABSORPTION FIELD DATA
Date Installed 9=2005 Son rating (g.p.dJf? or felbdrm) LG -POW System type s vane Trench
Length =o R Width a ft. (travel below pipe 2 ft.
Total depth _1±__A Elf. absorption area fflfe Monitoring tube Y Depression over field N
Date of adequacy test Now Canes Results (Pass/Fall) For _ bedrooms
Fluid depth in absorption flew before test in. Water added_ gal. New depth in.
Elapsed Time: min. FMW fiukl depth in. Absorption rate a- g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 6 type) N If yea, give date
D. LIFT STATION
Data installed Size in ga0ons
'Pump on' level at _ In. 'Pump off" level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot
Public sewer mein
Sewer /septic service line
Animal containment areas
Manhole/Access (Y/N)
High water slam level at in.
Meets alarm & dreu t requhmerds9
On adjacent iota
On adjacent iob
Public sewer manhoWdeanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTICMOLDINO TANK ON LOT TO:
Building foundation >s' Property line >& Absorption field >s
Water main »a Water service line >ia Surface water :-JW
Wells on adjacent kits >2ea
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One »a Building foundation >V Water main >+a
Water Service One »a Surface water »ar Ddveeay Psi W"hide smrepe >25'
Curtain drain None Ned Wells on adjecent bts >1W
F. COMMENTS: Ld y rived by AWwu weer sy.rem.
G. ENGINEER'S CERTIFICATION
I cerw that l defand
review 4 }
ai M records
that the above � systems are in ..9th-,
cordormance wllh MOA COSA guidelines io effect on this date.
Engineer's Printed Name Michael E. Andm%M P.E. raoaa L ANOM
a a-ast
Date 9127r2008 il
S' -r L
COSA Fee S Waiver Fee $ _
Date of Payment Jr- 2 fr--O 6 Date of Payment
Receipt Number Receipt Number,
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