HomeMy WebLinkAboutTHE TABLELANDS BLK 4 LT 3The Tablelands
Block
Lot 3
2
#051-801-11
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 99519-6650
www.ci.anchorage.ok.us (907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO50311 PID Number. 051-801-11
S inell Homes Inc.
Wastewater System: New I
AOb...
1900 W. N. Lights Blvd. Anch., AK 99517
ABSORPTION FIELD
PIS,. r«.m.ra.�
344-5678
5' Wide Trenches I
LEGAL DESCRIPTION
s°'Rr"°
Tar Opr oan argw
.8 cvaFr
31 F,.
ll a Lale
4 3 The Table
Tablelands
o � lwlr
raW-
er..m
cr.r.l aagn pp.
1 FI.
2 I Ft
TO-UNP ROW Sr]m
FA mam.ew.onpnr aom
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2-4 FI.
80, FI.
Well: AWWU
"" °A
1 a 011�
o.aao. err..arw
5 Ft.
2
>10 FL
cwsvk n (F . e. A S. Ci
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Tar tl.apom rx
pp. L.q.ar
FI. Ft
571 FP
ASTM 3034 PVC
Dr
Drs Dmm SW Wrr Lrnl
Ft
kola4r
Pisano's Dirtworks 1
ors.rWl.o
3/2-6/2006
Y1
PwtWsrr:
c...V H.91,1 Ae Ca
GPM
FI.
FI
TANK I
SEPARATION DISTANCES
STEP
To
Septic
Absorption
1ffi
Holding
3UUWPnVate
'a
nA
From
Tank
Field
Station
Tank
sewerune
Anchorage Tank
1;250
vim
>200'
>200'
>200'
N/A
>25'
"w""
Steel
r«..wacarymmr..
Three
s,o.a.wrr>100'
>100'
>100'
N/A
LIFT STATION
La t..
>5'
>10'
>5'
N/A
250 cr
Anchorage Tank/Orenco
FourKL n
>5'
>10'
>5'
N/A
•""°°"•""°"
•Pl.ap ar i..rr
Rpn wlr rrmr
42 h
42 in
44 in.
cw+lDr..l
None
Noted
FvapLl...&L
Ercar�Ilr-p aroprlaa+oor i
Orenco
Municipality of Anchorage
Ramrk.
Lift Station um s Effluent to Splitter Valv .
BENCH MARK
Gravity Flow From Splitter Valve
to
Finished Floor.
A.r.lro EMnoan
100.0 Ft
i
Engineer's Stamp
a
Inspections performed by: TLK Dates: 1° 3/2/2006
r `g'h•
r.....A .. .....».... 1.....00
:;`y »
Iq
2 3/6/2006
...„`...............
°;uc-tAU E. ANDERSON i v:
Department of Health and Human Services approval
'.` \ h� cE I.M.�,�:
ate: - I 7-OG
Reviewed and approved by:G7�G%�v
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Permit Number SVM50311
M1 Iwo
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage. AK 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
THE TABLELANDS SUBDIVISION
LOT 3, BLOCK 4
40.000 S.F.
31
BIRCH
A 1 6
MH
276
92.2
C2
32,7
197
sV
M6
21.7
C9
646
57.S
C4
45.2
17.9
CS
72.9
5sr
M1
64.7
552
M2
73e
55.r
PLAN AS -BUILT
SCALE 1' = 50'
Y
A
Page 2 of 4
PID No. 051-801-11
i
i
I
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit No. SW050311
193.6 —�
193.45—""�
U �
1,250 Gallon
STEP Tank
1.25- PVC U
u
4.3
N
U
91.4 J
PROFILE AS -BUILT
Scale: 1' - 10'
i
I Page 3 of 4
PID No. 051-801-11
I
X93.7
i
\
93.43'
k104A L E M DERSCH
97.1
eotextile F brie
91.7
Droinfield Rock
60.2 U
96.65
Geotextile ric
Drainfield Rock
91.4 J
PROFILE AS -BUILT
Scale: 1' - 10'
i
I Page 3 of 4
PID No. 051-801-11
I
X93.7
i
\
93.43'
k104A L E M DERSCH
0 08/15/2006 12:53 .9073733894 ALLIED AK ELECTRIC PAGE 01/01
it A���i� ELET
C"/CAL
�LiCS.%Lt CON774ACT/NGMOO
August 14, 2006 FAX: (907) 677-7766
Anderson Engineering
Attn: Mike Anderson
P.O. Box 240773
Anchorage, AK 99524
Subject: Lift Station Inspections at property stated below.
This letter is to confirm that the lift station(s) at:
Lot 3� Block 4 — The Tablelands
was 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.
cc:
: L. x-
L
,
resident/CFO
file
P,018763fP.#�asillu,�4lsukaflSt6&t(SKt7,13733843e,11'r/(AOT,l2i?�B87utti(9Q7,�3t3-
3894fras
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 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 23, 2005
Expiration Date: Aug 23, 2006
Permit Number: SW050311 Parcel ID: 051-801-11
Legal Description: THE TABLELANDS SUBDIVISION BLOCK 4 LOT 3
Design Engineer: 0014 Anderson Engineering Site Address: 22832 WHISPERING BIRCH DRIVE
Owner Name: SPINELL HOMES, INC. Lot Size: 40000 SQ. FT.
Owner Address: 1900 W. NORTHERN LIGHTS BLVD #2C Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99517 -
This permit is for the construction of:
❑v' Disposal Field Q 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.
Received By:
Issued By:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05-1' 901-11 Permit Number SW
Property owner(s) Spinell Homes, Inc. Day phone 3445678
Mailing address (1)1900 W. Northern Lights Blvd., Suite 200 Anchorage, AK 99517
Mailing address (2) o?A 8 3P- Whispering Birch Drive Zip Code
Legal description (Lot, Block & Sub'd.) Lot 3. Block 4, The Tablelands Subdivision,
Legal description (Section, Township & Range)
Lot Size 40.000 SF Acres/0
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.
G' (
(Signature of property owner or authorized agent)
Permit Fees: 410 !' Waiver Fees:
Date of Payment f - i$ • 0 S Date of Payment
Receipt Number.-7��iAlj Receipt Number.
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
August 17, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 3, Block 4, The Tablelands Subdivision, Addn. No. 1
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 3, Block 4, 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 sand with minor amounts of gravel in
the area of the absorption trench and alternate site. The accepting soils were tested
and found to have a percolation rate of 13-17 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 2 - 40' long by 5'
wide by 2' effective depth absorption trenches 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. A flow splitter valve will be placed to assure even flow to
each trench.
The ground surface on the lot slopes at varying grades from northwest to southeast as
Lot 3, Block 4, The Tablelands Subdivision, No.
August 17, 2005
Page Two
shown on the Site Plan. The absorption trenches 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,
*VkEav--O -
Michael E. Anderson, P.E.
Attachments
r "9
0)_ 49th
V CHAU E. ANOLRSON
No. CE -4581 e
too'
THE
- HISP BIRCH DRIVE
/ (d
0
N 94'30•38-E 108.17'
8.170.00'
TABLELANDS SUBDIVISION
LOT 3, BLOCK 4
40.000 S.F.
F=7
SITE PLAN
SCALE 1' = 40'
Bo'
LOT 3, BLOCK 4, THE TABLELANDS, ADDN. NO. 1
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom House 5' Wide Trench System
Perc. Rate: 13.3 Min./inch 1,000 Galton Septic Tank
Application Rate: .8 GPD/SF 2' Drainfield Rock
3 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 562.5 SF Absorption Area
562.5 SF/5 LF (Width)' .7(Red. Factor) = 78.75 LF Trench Length
THEREFORE: Construct 2 - 40' Long x 5' Wide x 2' Effective Depth Absorption Trenches.
Flow Line Elevation in Trenches 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
Trenches. Provide Flow Splitter Valve to Assure Even Flow to Trenches.
14
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 SECTION
(NO SCALE)
JI
NOTE: Grade Area Over Trench to Drain Away. Cu
Minimum 6' Separation From Bedrock. �...+
Minimum 4' Separation From Groundwater. i*yl'
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams: •AA
MICHAEL E. ANDERSON
No. CE4381 j
E-11
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION. LOT 3, BLOCK 4. TABLELANDS S/D
PERFORMED FOR- SPINELL HOMES, INC.
DATE: 6/6/2005 PROJECT No - M0564
PARCEL ID,-{• TECHNICIAN: T.L. KIMBROUGH
DEPTH TEST HOLE # 1
(raq
1
2
READING
OB/OG SLOPE
NET TIME
(MINUTES)
3
N�T DROP
(INCHES)
<5%
4
5
14:30
6
CHARGE
7
2
POORLY GRADED GRAVELLY -
30
8.7511
SANDS SOME FINES
8
SP -SM
15:00
25
9
10
15:30
WAS GROUNDWATER ENCOUNTERED? IJn
8.75"2.25"
IF YES® WHAT DFPn I?
11
5
DEPIII OF WATER AFTER MONITORING: N-
11.0,1
DATE OF MONITORING: llaWS
13
14 BOH
15-
16-
17-
181
5161718
19
COMMENTS:
<5%
DATE
READING
G OSS TIME
MINUTES)
NET TIME
(MINUTES)
DEPTH OF
WATER
(INCHES)
N�T DROP
(INCHES)
6/6/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
14:30
11.011
CHARGE
2
15:00
30
8.7511
2.2511
3
15:00
11.0"
RECHARGE
4
15:30
30
8.75"2.25"
5
15:30
11.0,1
RECHARGE
6
16:00
30
8.7511
2.25"
PERCOLATION RATE: 1_3_ MINANCII) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4_5 FT. and 5_5 FT.
NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY TI IAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION. LOT 3, BLOCK 4, TABLELANDS S/D
PERFORMED FOR- SPINELL HOMES, INC.
DATE: 6/6/2005 PROJECT No - M0561-
PARCEL
0564PARCEL ID,#• TECHNICIAN: T.L. KIMBROUGH
DI:I>nl TEST HOLE # 2
(fat)
OB/OG
1
2
3
4
5
POORLY GRADED GRAVELLY -
6 SANDS SOME FINES
7 SP -SM
0
C
SLOPE
1 O WAS GROUND WATER ENCOUNTERED? Nn
IF YES ® WUAT DEPnD
DEPTTI OF WATER AFTER MONITORING: Nano <5%
11
BOH DATE OF MONITORING: InIM5
14
15
16
17
18
19
COMMENTS:
TH2
O
DATE
READING
OSS TIME
G MINUTES)
NET TIME
(MINUTES)
DEPTH RF
(INCHES)
NFT DROP
(INCHES
6/6/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
14:45
12.0"
CHARGE
2
15:15
30
10.0"
2.0"
3
15:15
12.0"
RECHARGE
4
15:45
30
10.25'
1.75"
5
15:45
12.0"
RECHARGE
6
1 16:15
1 30
1 10.25-i
1.75"
PERCOLATION RATE• I. 7. I (MIN/INCI I) FERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN -.,L--5 FT. and 5_5 Fr.
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 ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE;
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 4, TABLELANDS SUBDIVISION, NO.
GENERAL:
1. 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 2 new 40' long X 5' wide X 2' effective depth
absorption trenches at the location also shown on the Site Plan. The
distribution line in the trenches will be placed at 1' below the existing ground
surface. Total depth of the trenches 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. A flow splitter valve must be placed to assure even flow to
the trenches.
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 3, Block 4, Tablelands No. 1
August 17, 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 3, Block 4, Tablelands No. 1
August 17, 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, 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.
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.
�je >_a�jy-
Municipality of Anchorage
Development Services Department
Building Safety Division
/ On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Parcel I.D.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051-801.11
1. GENERAL INFORMATION
Complete legal description
22832 Whispering Birch Drive Chugiak, AK 99567
Current Property owner(s) Spinell Homes, Inc. Day phone 344-5678
Mailing address 1900 W. Northern Lights Blvd., Suite 200 Anchorage, AK 99517
Lending agency Day phone
Mailing address
I
Real Estate Agent Day phone
Location (site address)
_ COSA# orpfl�J�t-`
Expiration Date: B 171-07
Lot 3, Block 4, The Tablelands Subdivision
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: T'mo DI
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
V
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑D
Public Sewer
j❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (CO SA) based only upon the representations iven in paragreph 4 by an independent professional civil
engineer regis er in e StaEe o�/� aT sloe iptes of bnSite Systems Approval are required for the transfer of
We (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-Sfte Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-sRe 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 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date B/I W0o6
6. DSD SIGNATURE
✓ Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
t
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate -Advisory e
By Original Certificate Date: — — QG
(R. 11M)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water 3 Wastewater Program
47W Bregaw Street
P.O. Box 196650
Anchorage, AK 995196650
www.muni.org/omfte
(907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 3 Blade 4, The Tablelands Subdivision Parcel ID: 051-801-11
A. WELL DATA
Wen type
Date completed —
Total depth fL
Date of test
Static water level
Well production
If A. B. or C provide PWSID #—
Sanitary seal (Y/N) —
Cased to fl.
FROM WELL LOG
WATER SAMPLE RESULTS:
fL
9—
p.m-Wel
l Log (YM)
Wires properly protected (Y/N)
Casing height (above ground) ' in.
AT INSPECTION
Coliform colonies/100 mL Nitrate mg/L Other bacteria
Arsenic: _ mgA
B. SEPTICIHOLDING TANK DATA
Date of sample: _ Collected by:
Tank Type/Material STEP/Steel
Tank size 1,250 gal. Number of Compartments 3
Foundation cleanout (YM) Y Depression over tank (yM) N
Data of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Date installed 3/2-6=
Length 80 fL
Cteanouts (YM)
fl.
g.p.m.
I
i
_coloniesllo0 mL
i
i
i
i
3/2/2008
High water alarm (YM)
Soil rating (g.p.dJe or fe/bdrn).8 GPD/SF
Width 5 ft
y
i
i
gystern type 5- Was Tranch
Gravel below pipe 2 i R
Total depth 8 8 R Eff. absorption area 571 ftp Monitoring tube Y Depression over field N
Date of adequacy teat New Const. Results (Pass/Faip For — bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth _,in.
Elapsed Time: min. Final fluid depth in.
Any niuvenation bomb, end (past 12 mo.) (YM a type)
Absorption rate >= g.p.d.
i
If yea, give date
0. LIFT STATION
Data inafened =200e
Pump od level at 42 in,
Size in gaGona 250
'Pump ofr level at 42 in.
Datum Bosomof Tank Cycles tested New CansL
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
ManhoWAccess (Y/N)
High water alarm level at 44 in.
Meets alarm d drers re0uiroma ts? Y
Septic t !"M station an lot
On adjacent lata
Absorption field an lot
On adjeceM Iota
Public sewer main
Public sewer manholekkanout
Sewer hreptic service line
Holding tank
Animal containment areas None
Manure/arar rima) excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S piny line
Absorption field >10
Water main >IV
Waterservicaune >10
Wells ons Surface water' >1W
djecant lots >201f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One >10 Building foundation >10
Water main >tly
Water Service fine >10' Surface water >iw
—� Driveway, parktrphehitle storage >25'
Curtain drain Nana Noted_ Wells on adjacent lots >Z00
F.
G. ENGINEERS CERTIFICATION
/ CGMY that / have detemdned through field k1spectionsand 41 49 h
review Of MuniaPal raoorys that the above systems are in
conformance wylr MOA COSA 9UA*ffnes in effect an this date. � rsaaa c
Engineer's Printed Name Mkhael E. Anderson. P.E. NO, C
Date sH8/2c01oa, ♦♦4♦♦,e
COSA Fee E
Waiver Fee $
Date of PeymeM _opI SID I- Date of Payment
Receipt Number _Oyj
(Rev. lvrc) Receipt Number
m
2004-25
THE TABLELANDS SUBDIVISION
LOT 31 BLOCK 4
40,000 S.F.
WHISP BIRCH DRIVE
w
0
-BUILT
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 9950.'
PHONE 248-5454
GRID DATE
NW1559 6/26/2006
F.B. JOB NO.
06-08 TLS34
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 OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE
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