HomeMy WebLinkAboutTHE TABLELANDS BLK 4 LT 10AThe Tablelands
Block 4
Lot 10A
#051-801-74
Municipality of Anchorage I Page 1 o1 3
Development Services Department
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us (907) 3437904 j
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO50335
PID Number. 051-801.18
S nell Homes
Wastewater System: New i
1900 W. Northern Lights, Ste. 200 Anch., AK 99517
ABSORPTION FIELD
344-5678
Foura 4
5' Wide Trench
LEGAL DESCRIPTION
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SEPARATION DISTANCES
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Absorption
Lift
Holding
umorpowate
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Station
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Sewer Line
Anchorage Tank
1000
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>200'
>200'
N/A
WA
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>100'
>100'
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Engineer's Stamp
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Inspections performed by: T. Kimbrough
Dates: 1" 2/14/2006,
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Department of Health
and Human Services approval
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and approved by:
Date: 0 tt u
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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 Number. SW050335
92.
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Page 3 of 3
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Sep 07, 2005
Expiration Date: Sep 07, 2006
Permit Number: SWO50335 Parcel ID: 051-801-18
Legal Description: THE TABLELANDS SUBDIVISION BLOCK 4 LOT 10
Design Engineer: 0014 Anderson Engineering Site Address: 23050 WHISPERING BIRCH DRIVE
Owner Name: SPINNEL HOMES, INC. Lot Size: 40000 SO. 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:
❑✓ 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 (18AACBO ).
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 B
Issued E
Date: i —1—nS
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.ak.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0sl - 4>b1 - lis Permit Number SW
Property owner(s) Spinell Homes Inc
Day phone 344.5678
Mailing address (1)1900 W Northern Lights Blvd Suite 200
Anchorage AK 99517
Mailing address (2).365440 Whispering
Birch Drive
Zip Code
Legal description (Lot, Block & Sub'd.)
Lot 10 Block 4. The Tablelands Subdivision,. --
-Legal
Legal description (Section, Township & Range)
Lot Size 40.000 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
❑
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)
Date of Payment:
Receipt Number. dr Receipt Number.
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX
August 16, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 10, 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 10, 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 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 5 minutes per inch. The system is designed
with an application rate of .8 GPD/SF which is conservative considering the percolation
rate. 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 10, Block 4, The Tablelands Subdivision, No.
August 16, 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 100' 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.
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, N �
Michael E. Anderson, P.E.
Attachments
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LOT 10, BLOCK 4, THE TABLELANDS, ADDN. NO. 1
DESIGN FACTORS:
Three Bedroom House
Perc. Rate: 5 MinAnch
Application Rate: .8 GPDISF (AVG. Rate)
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,000 Gallon Septic Tank
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 a 80' 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"
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:
SCALE)
L-1
Grade Area Over Trench to Drain Away.
Minimum 6' 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 10, BLOCK 4, TABLELANDS S/D
PERFORMED FOR- SPINELL
DATE: 6/6/ 005 PROJECT No - M0543
PARCEL IDn• TECHNICIAN: M FI DRIDGE
Drrnl I TEST I IOLE # 1
(r�l>
F777 OB/OG
2
3
4
i
7 WELL GRADED SANDY -
GRAVELS SOME FINES
8 GW -SW
9
SLOPE
SITE PLAN
THI
WAS GROUND WATER ENCOUNTERED? N"
101 IF YES ®WIIAT DEFnit
DEIMI OF WATER AFTER MONnORING N— <5%
11 DATE OF MONn ORINO. gni2 S
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH OF
WATER
(INCHES)
NET DROP
(INCHES)
6/6/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1435
11.0"
CHARGE
2
1505
30
5.0"
6.0"
3
1505
11.0"
RECHARGE
4
1535
30
5.0"
6.0"
5
1535
11.0"
RECHARGE
6
1605
30
5.0"
6.0"
PERCOLATION RATE• 5�O (MIN/INCI I) FERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: L_5 FT. and 5_5 FP,
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 WITI I ALL STATE 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 10, BLOCK 4, TABLELANDS S/D
PERFORMED FOR- SPINELL
DATE: 6/6/2005 PROJECT No - M0543
PARCEL IDn• TECHNICIAN: M FI DRIDGE
DI:1'7'1l
(fixQ
COMMENTS:
TEST HOLE #7 2
OB/OG
MOIST SILTY SANDS
WITH FINES
SP -SM
WELL GRADED SANDY -
GRAVELS SOME FINES
GW -SW
TH2
O
WAS GROUND WATER ENCOUNTERED? Nn
IF YES ®WIIAT DFPI1n <5%
DEPTH OF WATER AFTER MONITORING: N^
DATE OF MONITORING: !///MOS
PERCOLATION RATEL5.0 (MIN/INCII) PERC. HOLE DIA. 6 (INCITES)
TEST RUN BETWEEN: 4_5 FT. and 5_5 FI'.
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 THIS
DATE*
READING
G OSS TIME
MINUTES)
NET TIME
(MINUTES)
Dy ATERF INFT
(INCHES)
DRDATE
NChIES
6/6/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1455
11.01,
1 CHARGE
2
1525
30
4.5"
6.5"
3
1525
11.0"
RECHARGE
4
1555
30
5.011
6.0"
5
1555
11.0°
RECHARGE
6
1625
30
5.0"
6.011
PERCOLATION RATEL5.0 (MIN/INCII) PERC. HOLE DIA. 6 (INCITES)
TEST RUN BETWEEN: 4_5 FT. and 5_5 FI'.
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 THIS
DATE*
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION. LOT 10, BLOCK 4, TABLELANDS S/D
PERFORMED FOR- SPINELL
DATE: 8/25/2005 PROJECT No - M0543
PARCEL IDX TECHNICIAN: T I KIMRROtIGH
DEPTH
(4x0
2
n
G
7
n_
8 w
0
N
9 (ll
J
10
I1 ~
w
12 F-
13
COMMENTS:
TEST HOLE #73:]
OB/OG
MOIST SILTY SANDS
WITH FINES
99i
WAS GROUNDWATER ENCOUNTERED?
IF YES® WIIAT DEFnl?
DEPTH OF WATER AFTER MONITORING: N.
DATE OF MONITORING: swami
<5%
DATE
READING
G OSS TIME
MINUTES)
NET TIME
(MINUTES)
DEPTH OF INET
(IN
DROP
(INCHES)
8/25/051
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1220
11.0"
CHARGE
2
1235
15
4.25"
6.75"
3
1235
11.0"
RECHARGE
4
1250
15
4.25"
6.75"
5
1250
11.0"
RECHARGE
6
1305
15
4.375"
1 6.625"
PERCOLATION RATE`(MIN/INCII) FERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 1_5 FT. and 2_5 FT.
WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH?
DEPTII OF WATER No IMPERMEABLELAYTER EIRSNENCCOUN E -
RD. ST IOLE PRE SOAKED PRIOITORING: DATE OF R To TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
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 10, 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 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 10, Block 4, Tablelands No.1
August 16, 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 10, Block 4, Tablelands No. 1
August 16, 2005
Page 3 of 3
MATERIAL SPECIFICATIONS:
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.
Municipality of Anchorage
Development Services Department
ae 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 SEWER/WELL SUBMITTAL COMMENT SHEET
To: Anderson Engineering
Legal description: The Tablelands. block 4. Lot 10
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. Need to perc SP -SM soil in TH#2
❑ 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. _
Name of reviewer. Julie Mokela. P.E.
Date: 8/23/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage
Development Services Department
Building Safety Division
On -She Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-901- 714
1. GENERAL INFORMATION
COSA # D&[ b3 -
Expiration Date: 8fill 4.7
Complete legal description Lot 10A, Block 4, The Tablelands Subdivision
Location (site address) 23050 Whispering Birch Drive Chugiak, AK
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 II
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS: Tree (3)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual On-site (]
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 OnSRe Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineerucgistemdjr.1he_6tat€9LAlaska,Cedifrcates-ofQtbSite-SySterms APpr9val_prgsequirVdforrJhe_jransfgLgf
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 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,
shares that the on-sfte water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineers Printed Name Michael E. Anderson, P.E. Date 8/9/2006
5. DSD,SIGNATURE
7 Approved for --3_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checidist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By. &r Original Certificate Date: 'b I 04
(Rm. I IMS)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995196550
www.muni.ory/onske
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legai Description: Lot 10, Block 4, The Tabblards Subdivision Parcel ID: 051-01 !18
A. WELL 12ATA
Wen type —
Date completed —
Total depth fL
Date of test
Static water level
Well production
IfA, S, or C provide PWSID i/—
Sanitary seal (YIN) —
Cased to fl
FROM WELL LOO
WATER SAMPLE RESULTS:
Col form colonies/100 mL Nitrate
Arsenio _ mgfi
B. SEPTICIHOLDINO TANK DATA
ll
9—
p.m-
Wen Log (Y/N)
W Ms Property protected (Y/M
Casing height (above ground) in.
AT INSPECTION
mg/L Other
Date of sample: _ Collected by:
ft.
g.P.m.
Tank TypeAMatedal SeptlrlSteel Date installed 2H4/2008 `
Tank aim 1,000 gal. Number of Compartments 2 Cleanout, (YIN) Y
i
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High wader alarm (YIN) !N
Data of pumping Now Construction Pumper
I
C. ABSORPTION FIELD DATA
Date installed 2/15/2008 Sail rating (g.p.d.A? or tt=Ibdnn).8 GPD/SF system type 5' Wide Trench
Length 80 R Width 5 A. Gravel below pipe 2 R
Total depth 67 fL Eftabsorption area 571 fe Monitoring tube V Depression over field N
Date of adequacy test New Const. Results (Pass/Fan) For— bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Firm fluid depth in.
Any rejuvenation treatment (past 12 mo.) (YIN S type)
Absorption rate >= g.p.d.
N yes, give date
Q LIFT STATION
Date installed Size in gallons
'Pump on' level at _ in. 'Pump or level at _ in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanUilt station an let
Absorption field on krt
Public sewer main
Sewer /septic service line
Manhole/Access (Y/N)
High water alarm level at in.
Meet slam a circuit ?
On adjacent kits
On adjacent kits
Public sewer manhokr/deanout
Holding tank
Animal r 1 Inment area Nam Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >S Property One W Absorption field >5
Water main
>10'
Wefts on adjacent lots >2W
Water service One >11Y Surface water >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One >10' Building foundation >10' Water main >10'
Water Service One >1(r Surface water >1W Driveway. parkingNMide steerage >26
Curtain drain Nana Noted Wells on adjacent lots >
F. COMMENTS: Lot Is Served by AW WU Water System.
G. ENGINEER'S CERTIFICATION e�i
I cedtify that I have determined fhrough field Inspections and
review of UunA#W records that the above systems are in
corAmmance with MOA COSH guidelines m eBed an this date. y
Engineer's Printed Name Michael E. Anderson. P.E.
Date
9/9/2008 'Vtiap�
COSA Fee $
fV".6-0 Waiver Fee $
il 9
Date of Payment
to yo Date at Payment
Receipt Number
o OLM Receipt Number
RM. I MM