HomeMy WebLinkAboutTHE TABLELANDS BLK 6 LT 10The Tablelands
Block 6
Lot 10
#051-741-55
Municipality of Anchorage Page t of 3
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196050 Anchorage, AK 99519-6650
www.cLanchorage.sk.us (907) 543-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW040247
PID Number. 051-741.55
S
Rnell Homes Inc.
7
Wastewater System: New
A eee.
1900 W. Northern Lts. Blvd., Ste. 200 Anch., AK 99517
ABSORPTION FIELD
5678
"334
hee
5' Wide Trench
LEGAL DESCRIPTION
Sit Rarq
Tar DopM fan agrW pee.
,3 CPDTe
.5 Ft.
fila I, Lot $IDrnaal:
DWn b pP bonen fan agnr Vtle.
CGeeel dept, boean pM.
6 10
The Tablelands
+1.5 Ft.
.5 FL
Tow4ty Rove
sawn:
Fa etldad r orgnr p We.
Ceeea Length
4.6 Ft.
100 Ft.
Well: AWWU Water System
Grewl.,an.
15
Nunbr of aee
3
I 0' v bareen we.
Ft.
5 FL
Cwealratwn (venae. A 6. Cl
Tar Depn:
Geed w
ar ebwpan rw
ps astral.
Ft. FL
1,500 Fe
ASTM 3034 PVC
DnW
Dae 0.1w.Stow
war lava
Ie
Fl
Pisano's Dirtworks
6124-2512005
Yell.
Pu,p SM a
LeenaHeghi Above Group.
TANK
CP
Fl.
Ft
SEPARATION DISTANCES
STEP
To
Septic
Absorption
Lilt
Holding
lutgriPovate
GOP&CUty an
Ftom
Tank
Field
Station
Tank
Se%WLim
Anchorage Tank
1,250
Well
>200'
>200'
>200'
N/A
>25'
Steel
Three (3) e
s,e.war
>100'
>100'
>100'
N/A
LIFT STATION
Lave
>5'
>10,
>10,
N/A
250 or
AnchorageTankl0renco
Fandetwn
>5'
>10,
>5'
NIA
wvon 42a
42a
44 60.
ti
ti
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carna.n
None
Noted
Papa atAeda
Orenco
Eleur W.PertwrePrta D'
Allied Alaska Electric
Ronofe
BENCH MARK
nsu a ton Over Absorption System.
Dowoon.
Finished Floor.
Amo ed E Wawa:
100.0 Fl
Engineer's Stamp
••'*gssgssss
I {l
Inspections performed by: TLK
Dates: 1a 612412005
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2nd 6125/2005
: -.`e^m...
fh: V-CIIA(L L. AV9lHSe�N JW
Department of Health
and Human Services approval
•, s* ho. Cl -.3111
Reviewed and approved by:
Date: ®
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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
Permit Number SW040247
TBH -
V
PVC
.06
EPS INSULATION
SEPTIC SAND HORIZON
11 - 3/16' Diameter Holes E 10' Spacing per Lateral
PVC
PID No. 051-741-55
J
1 C2e L
49th 1
PROFILE AS -BUILT �i
Scale: 1' - 20' • 0��,,,'•., No. CE -438! /+
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 10, BLOCK 6, TABLELANDS S/D
PERFORMED FOR-_ SPINFI I HOMES
DATE: 6/24/2005 PROJECT No -10485
PARCEL ID.- TECHNICIAN: T.L. KIMBROUGH
DEPTH TEST HOLE # lA
((m0
I .. ,..
2 ,
3
4 :.,•,
5 .. '.
6
7
8 w
a �
9
10-
11-
12-
13-
14-
15-
16-
17]
011121314151617
18
19
OB/OG
<5%
SILTY SANDY GRAVEL
DENSE
GM
SITE PLAN
THIA
0
WAS GROUND WATER ENCOUNTERED? No
IF YES @ WI IAT DI:11n l?
DEPTH OF WATER AFTER MONITORING: O%
DATE OF MONITORING:
BOTTOM OF HOLE
DATE
READING
G OSS TIME
MINUTES)
NET TIME
(MINUTES)
DEPTH of
WATER
NCHES)
INFT DROP
NCITES
6/24
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
9:14
10.38"
2
9:44
30
9.63"
0.75"
3
9:45
10.5'
4
10:15
30
9.75"
0.75"
5
10:16
9.75"
6
10:46
30
9.0"
0.75"
PERCOLATION RATE 40 (MINANCII) FERC. HOLE DIA. 6 (INCITES)
TEST RUN BETWEEN: FT. and 2 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING TECHNICIANS. . 1, MICHAEL E. ANDERSON CERTIFY THAT
TI IIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 6/24/2005
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION` LOT 10, BLOCK 6, TABLELANDS SID
PERFORMED FOR• SPINELL HOMES
DATE: 8/9/2004 PROJECT No= M0485
PARCEL ID,#- TECHNICIAN: T.L. KIMBROUGH
DC•.rnl TEST I-IOLE # 2
(fiat)
5 .. '.
6
7
8 w
. A
9
11 .
12
13
1
1
1
1
1
OB/OG
SILTY SANDY GRAVEL
DENSE
GM
SITE PLAN
TH2o
THIO
WAS GROUND WATER ENCOUNTERED? No
IF YES @ WI IATDFJ'I'IP+
DEPTI I OF WATER AFTER MONITORING: 0%
DATE 01: MONTIORING:
BOTTOM OF HOLE
49th
E. MDERSW
DATE
READING
G (MINUTES) L
(MINUTES)
WA ERF
(INCHES)
INF DROP
NCHES
8/9/04
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
12:11
10.0"
2
12:41
30
9.25"
0.75"
3
12:42
10.5"
4
1:12
30
9.75"
0.75'
5
1:13
9.75"
6
1:43
30
9.0"
0.75"
PERCOLATION RATE40(MINANCI I) FERC. HOLE DIA• 6 (INCHES)
TEST RUN BETWEEN: 5 FT. and 6 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITf 1 ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE' 3/25/2005
!l�e�
/rlaS
September 6, 2005
Anderson Engineering
Attn: Mike Anderson
P.O. Box 240773
Anchorage, AK 99524
ELECTR/CA L
CONTRA CT//VG
G'7'RI
FAX: (907) 677-7766
Subject: Lift Station Inspections at properties stated below.
This letter is to confum that the lift station(s) at:
• Lot 10, Block 6 —Tablelands
• Lot 8, Block 7 - 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.
Janette L. Brown,
Vice President/CFO
cc: file
P.D. Box 876310, Wasilla, .Vaska 99687 (907) 373-3893 ofc! (907) 232-8687 cell / (907) 373-3894 fax
T'd 468E-ELE (L06) 01azaeT3 eNselU PeTTTH d*2:Z0 SO 90 des
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
MEMORANDUM
DATE:
September 9, 2005
TO:
Julie Makela, P.E.
FROM:
Mike Anderson, P.E.
SUBJECT: Lot 10, Block 6, The Tablelands Subdivision
Septic System As-Built/Certificate of Health Authority Approval
The raised absorption bed on the subject property was covered with 6" of topsoil
yesterday and will be hydroseeded this morning.
The reconstruction of the system was completed between June 24`" and 25th of this
year. Both the inspection dates and installation date on the inspection report have
been modified to reflect these dates.
The revised design called for placement of the new bed directly atop the old absorption
trenches. This area became very wet and unworkable during removal of the existing
piping so the new bed location was moved slightly to the north outside the area of the
trenches. Test Hole No. 2 submitted with the original design was very close to this
area. In addition another percolation test submitted with this memo was completed
near the new location to verify the soils encountered. All soils on the lot were
consistently dense sandy gravel with silt. Percolation rates were consistently between
30 and 60 minutes per inch.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: September 15, 2005
TO: Julie Makela, P.E.
FROM: Mike Anderson, P.E.
SUBJECT: Lot 10, Block 6, The Tablelands
Test Hole No. 2
Certificate of Health Authority Approval
Attached is Test Hole No. 2. The original will be delivered to you this afternoon.
7—'1q -1e iF
To: Anderson Engineer
Legal description: The Tablelands Subdivision. Block 6. 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. _
❑ 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.
grounawater monitoring required in accordance with provisions of permit
Name of reviewer: Julie Makela. P.E.
Date: 9/7/2005
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 DivisionOn-Site
Water and Wastewater Program4700
;.T
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 Engineer
Legal description: The Tablelands Subdivision. Block 6. 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. _
❑ 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.
grounawater monitoring required in accordance with provisions of permit
Name of reviewer: Julie Makela. P.E.
Date: 9/7/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
/� IAhniieipality ofAnchorage
nchorage
Wtte-
-xxOr
It0.IAn 1!Ni16i11 •dnchnrl�;c,.\I:l<a !k).519dp6511 • Tclglhonc (LJ117)Si3K301 • ) 33ab_(NI
47W ISntr tit rcet •:\nchomgc, Alaska !)`Ai117
"'Iv.O111111.0rg
MayorMarkJlc�icA
Building Safct%, Di%islon
June 13,2005
Spinell Homes
1900 W. Northern Lights Blvd 4200
Anchorage, AK 99517-3342
Subject: On -Site Water and/or Wastewater Permit.
Permit Number: SW040247
Legal Description: The Tablelands Block 6 Lot 10
Dear Spinell Homes:
An On -Site Water/Wastewater Permit, number SW040247, issued by this office for a single-family
system, will expire on July 07, 2005. The permit is valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to
this office for review, approval and documentation. This as -built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As -built inspection
reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
15a—al .�
Daniel J. Roth
Program Manager
On -Site Water and Wastewater Program
Enc: Copy of permit
Community, Security, Prosperity
r
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
Permit Number: SW040247
Legal Description -V& YAM -ELANDS BLOM4EXT to
Design Engineer: 0014 Anderson Engineering
Owner Name: SPINELL HOMES, INC
Owner Address: 23301 WHISPERING BIRCH DRIVE
EAGLE RIVER. AK 99577 -
S111°�0/Ibo"D
q%16- 133e)
Date Issued: Jul 07, 2004
Expiration Date: Jul 07, 2005
Parcel ID: 051-741-55
Site Address: 23301 WHISPERING BIRCH DRIVE
Lot Size: 47651 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.
❑✓ 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.
5. The following special provisions.
ADDITIONAL TEST HOLE NEEDS TO BE PERFORMED FOR ALTERNATE SITE DURING CONSTRUCTION
N
Received
Issued BY. L11f— Date:
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
4 ' (907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-'TLI I- 55 Permit Number SW
Property owner(s) Spinell Homes, Inc. Day phone 3445678
Mailing address (1)1900 Northern Lights Blvd., Suite 201 Anchorage AK 99517
M56ng address (2)_.2WOI 1 WIIAr na `Birth Utj Vr► Zip Code
Legal description (Lot, Block & Sub'd.) _ Lot 10, Block 6. Tablelands Subdivision
Legal description (Section, Township & Range)
Lot Size 47.651 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: 480 f .N 175 VuJ v Waiver Fees:
Date of Payment 1 - fo —0 `% Date of Payment
Receipt Number. 5V 75-11 Receipt Number.
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
June 15, 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 6, The Tablelands Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Permit Number SW040247
Dear Onsite Services Engineer:
The groundwater at Lot 10, Block 6, The Tablelands Subdivision has unexpectedly
risen and is currently encroaching into the recently constructed absorption trenches.
We therefore propose to replace the existing 1,000 -gallon septic tank with a 1,250 -
gallon STEP Tank and place a new 15' wide x 100' long raised absorption bed atop the
existing trenches. The attached site plan shows the configuration and location of the
new absorption bed. The distribution piping will be removed from the existing trenches
and replaced with coarse sand. The new absorption bed will be constructed 1' above
the existing ground level atop the coarse sand layer.
The existing septic system construction permit issued for this lot does not expire until
July 7, 2005. We are proposing to complete this work under this permit and will provide
a certified as -built once the work is complete.
Test holes recently placed on the lot indicated silty gravel with minor amounts of sand in
the area of the absorption bed and alternate site. The accepting soils were tested and
found to have a percolation rate of between 30 minutes per inch and 60 minutes per
inch. The system is designed with an application rate of .3 GPD/SF. A minimum of 3'
of cover will be placed atop the bed and a minimum of 4' of cover will be placed atop
the new STEP tank.
The ground surface on the lot has no slope from east to west as shown on the Site
Plan. The absorption bed 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
Lot 10, Block 6, The Tablelands Subdivision
June 15, 2005
Page Two
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.
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
.i 49th
WCNAEL E. ANDERSON W
No. CE -4781
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Existing Ground
LOT 10, BLOCK 6, THE TABLELANDS
SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
3 Bedroom Home
Perc. Rate: 3060 Min./inch
Application Rate: .3 GPD/SF
Raised Bed System
1,250 Gallon STEP Tank
Coarse Sand (As Required)
1,5 0 SF/15 SF (Width) =100 LF Bed 1,500
enggth Absorption Area
THEREFORE: Construct a 100" 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.
/ .5'
.5'
1'
or
As Required
Top 6" of Mound Must Be Topsoiled
and Vegetated to Prevent Erosion.
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' 5' 2.5'
1" PVC
TYPICAL BED SECTION
(NO SCALE)
NOTE: Grade Area Surrounding Bed to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 200' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams. .
Minimum 10' Separation From Water Service Line.
4
71
Existing
n
Michael E. Anderson
6 No. CE4381
PRESSURE DISTRIBUTION
CALCULATION
Elevation at Highest Discharge Point
95'
Pressure at Highest Discharge Point
5' Head
Liquid Level in Tank (Elevation)
93'
Diameter of Holes in Distribution Line
.1875" (3/16")
Diameter of Distribution Line
1.0"
Hole Spacing in Distribution Line
10'
Length of Transport Line
10'
Diameter of Transport Line
1.5"
Q = 12.4d tilfri = 12.4(.1875)(.1875)r
.9748 GPM/Orifice
.9748' 33
= 32.2 GPM
5-
TDH = (100-93) + .0192(32.2)(32.2) + .000995(10) (31.2)
7' + 20' + 1.2'
28.2'
Therefore 33 Orifices @ 10' Spacing With 28.2' of Total Dynamic Head.
11 Holes Per Lateral @ 3/16" Diameter
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522.6779 FAX
July 3, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 10, Block 6, Tablelands Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 10, Block 6, Tablelands Subdivision 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 served
by a community water system and no conflicts exist with adjacent septic systems or
wells. The attached Site Plan and backup documentation identify the location and
configuration of the proposed septic system and alternate site. The water service line is
also shown. The current drainage pattern along with spot elevations are identified on
the Site Plan. The drainage pattern will be maintained after development of this lot is
complete.
A test hole recently placed on the indicated silty sand and gravel in the area of the
absorption trench. The accepting soils were tested and found to have a percolation
rate of 48 minutes per inch. Groundwater was found during excavation at 11' and rose
to 9' during the monitoring period. Our design includes the placement of a new 1,000 -
gallon septic tank along with 2 - 64' long by 5' wide by 2.5' effective depth absorption
trenches to collect and treat the sewage generated in the house. A flow splitter valve
will be placed to assure even flow to each trench. The bottom of the trench will be 4.5'
below the surface. The distribution pipe will be 2' below the surface. A minimum of 3'
of cover will be placed atop the trenches and a minimum of 4' of cover will be placed
atop the new septic tank.
The ground surface on the lot slopes at shallow grades from north to south as 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.
Lot 10, Block 6, Tablelands
July 3, 2004
Page Two
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.
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
49th -x
MICHAEL E. ANDERSON
II,, No. CE -4781 i
LOT 10, BLOCK 6, TABLELANDS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom House 5' Wide Trench System
Perc. Rate: 48 Min.Anch 1,000 Gallon Septic Tank
Application Rate: .45 GPD/SF 2.5' Drainfield Rock
3 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,000 SF Absorption Area
1,000 SF/5 SF • .64 (Red. Factor) =128 LF Trench Length
THEREFORE: Construct 2 - 64' Long x 5' Wide x 2.5' Effective Depth Absorption Trenches.
Flow Line Elevation in Trenches to be 2' Below Original Ground Surface. Total Depth to be
4.5' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench. Provide 2" of Insulation and 2' of Cover if Necessary.
116"
6"
2 5"
Natural
Backfill
/
Geotextile
Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION �..�
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. 9 49th
Minimum 6' Separation From Bedrock. J.
Minimum 4' Separation From Groundwater. 00
Minimum 10' Separation From Water Services in the Area. jo- wa«a
Minimum 100' Separation From Surface Water or Streams: 1. moi, No
El
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 10, BLOCK 6, TABLELANDS S/D
PERFORMED FOR: SPINFLL HOMFS
DATE: 6/23/2004 PROJECT No= M0442
PARCEL ID, #• TECHNICIAN: T.L. KIMBROUGH
NICHNX L ANDCRSM
.. No. CE -+381 .J
Dram TEST HOLE # 1 Type of Test: ❑ Percolation ❑ Visual
OCCO
1
2
READING
OB/OG
DRY POORLY GRADED GRAVELS
NET TIME
(MINUTES)
D WATER F
(INCHES)
INFT DROP
NCHES
GP
3
6/23
1
10:10
4
8.25'
5
2
10:40
6
7.511
.75"
7
3
MOIST GRAY SILTY -SANDS
30
6.87"
W/GRAVELS SOME COBBLES TO 10'
8
4
MEDIUM COMPACTION
30
6.25"
GM
9
SITE PAN
THIO
SFF FUTURE ASRUII T
1 O WAS GROUNDWATER ENCOUNTERED? YES
IF YES@ WHAT DEFTIP W
DEPTH OF WATER AFTER MONITORING: 10.5' 0%
1 I DATE OF MONffO m --K �
BOH /WATER SEEPAGE
l
1
1
1
1
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
D WATER F
(INCHES)
INFT DROP
NCHES
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/23
1
10:10
8.25'
2
10:40
30
7.511
.75"
3
11:10
30
6.87"
.62"
4
11:40
30
6.25"
.62"
PERCOLATION RATE 48 (MINANCH) PERC. HOLE DIA 8�� (RJCHES)
TEST RUN BETWEEN. 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECIINICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE- 7/03/2004
Municipality of Anchorage
Development Services Department
• +.c 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 SEWER/WELL SUBMITTAL COMMENT SHEET
To: Mike Anderson
Legal description: The Tablelands Block 6 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.
® Water monitoring results inadequate. Test hole shows water at 10.5'. letter states water
at 9 feet
❑ 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: Jeff
Date: 7-6-04
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-741-55
Legal description THE TABLELANDS BLK 6 LT 10
Expiration Date:- Z—
Site address 23301 WHISPERING BIRCH DR Chugiak
Current property owner(s)
RYAN & NICOLE GILL
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
By F , Original Certificate Date: 5/9/2023
13 c rz-
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
CertifiCate_af_OnoSite Rysfenas-Approval-Application
1. GENERAL INFORMATION
Parcel I.D. 051-741-55
Complete legal description THE TABLELANDS; BLOCK 6, LOT 10
Location (site address)
23301 WHISPERING BIRCH DRIVE, CHUGIAK, AK
Current property owner(s) RYAN & NICOLE GILL
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone 907-552-4610
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units X Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel ❑Plastic ❑ Concrete ❑ Fiberglass
Age 18 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ S" 5-b Waiver Fee $
Date of Payment 5 Z 2 �Z 3 Date of Payment
COSA # S C_ 23 1( Z ( Waiver #
COSA Applicakn_June 2022
COSA Checklist
Legal Description: THE TABLELANDS; BLOCK 6, LOT 10
Parcel ID: 051-741-55
If more than I well and/or septic system on lot, provide separate checklist. Structure served by this system 1
LL DATA ILL
log
0 with Onsite
F1 Well log i with Onsite (or attached)
Date drilled depth ft
Cased to ft
El Sanitary seal is functioning correctly
R Wires are properly protected
Casing height (above n.
ground)
Date of flow test for CO
Static
Static waterjwMratbeginning of test ft.
43.5
B. TANK DATA
Measured operating fluid level in sepic �tan��
Date of pumping 4/12/2023
R Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/24/2005
WE ALL standpipes present per record drawing
Total measured depth from grade *2.8 ft (max)
Measured depth to pipe invert from grade ft (min)
F-01 N/A — pressurized field.
C9 Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
El Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced _gallons date
Any rejuvenation treatment (past 12 months) NO
If yes, enter date
Well production at time of �test-.-,O'- g pm �!—
Water storage tan] me gallons
Well' ql5'
.1 cted for coliform test? El Yes El No
Coliform bacteria is Negative
ate mg/L n Nitrate less than MRL (ND)
en�ic ug/L n Arsenic less than MRL (ND)
Collected by
Date
C. LIFT STATION
F01 Required maintenance completed
Age of lift station 18 years
Lift station material STEEL
Comments: SEE MAINTENANCE LOG
Adequacy test date 4/17/2023
Results OPass
Fluid depth prior to test
Water added 624 gal
New fluid depth 0 in
Elapsed time 0 min
Final fluid depth 0 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 in
Comments/Deficiencies: *FOR MT1. MT2 HAS DIRT (DRAINROCK) IN AND ONLY EXTEND 2.1' BELOW GRADE.
Zoii—Qr-% HJL A--,— F,�VD,7-7oA 9G-10+
COSA ChecklistJune2022
E. SEPARATION DISTANCES
FMra4Wvate Well on Lot to: (Please enter distances if less than required or if community well on lot)
p■ Yes
Septic Tank/Lift on Lot
> 100'
Surface Water > 100'
Community Sewer Manh anout > 100'
Tank to Property Line > 5'
Yes if No
ft
❑ Yes
if No ft
Neighboring Tank > 100'
❑ Yes i
ft
e Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100'
❑ Yes if N
ft
Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fiel
_
Q Yes if No ft
Animal Containm _ 0' E] Yes
if No ft
if No
M Yes if No
ft
Manure/Animal Excreta Storage >
C l Sewer Main > 75'
❑Yes if No
ft
Yes
if ft
0 N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
p■ Yes
if No
ft
Surface Water > 100'
M Yes if No ft
Tank to Property Line > 5'
[E Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
W Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
Q■ Yes
if No
ft
Community Wells > 200'
Q Yes if No ft
Water Service Line > 10'
Q Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Gayness Engineerinq Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Garness Date 5 i /23
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding!;
the future performance of the well or septic system. GEG makes no representation whether an alternative well
or septic system can be installed on the property in the event either of the current systems fail to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
COSA Checklist June 2022
x4J..... ................
r ........�...a........ .
.J f )Z 6i C7 A'SS.
CE -7953 emG
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E
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20"-25
THE TABLELANDS
i B J
LOT 4
BLOCK 6
47,651 S.F.
4
L-331.16' R-470.00*
•
lSt INN lRCH RlV
,,
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
• WEST 88T+i AVENUE
ANCHORAGE. ALASKA 99502
PHONE
+
i � i is • f
o•'
r1 rtLC All, MoA-
MUNICIPALITY OF ANCHORAGE
Development Services Department \ Phone: 907-343-7904
On -Site Water & Wa'stewater Section Fax. 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-741-55
1. GENERAL INFORMATION
Expiration Date: to ^a Q
Complete legal description Lot 10, Bk 6, The Tablelands Subdivision
Location (site address) 23301 Whispering Birch Drive, Chugiak, AK 99567
Current property owner(s) Doug & Kirsten Fell Day phone
Mailing address 23301 Whispering Birch Drive, Chugiak, AK 99567
Real estate agent Shanna Bloom/Core Real Estate Day phone (907) 231-5656
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3-
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well ❑
Private Septic
Water Storage ❑
Holding Tank
❑
Community Well ❑
Community
❑
Public Water System ®
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $rJ 5 �`
Waiver Fee $
Date of Payment i w 4m
Date of Payment
Receipt Number &e(KA 100
Receipt Number
COSA # O'nC Iq Inn
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Pinard Engineering Phone (907) 232-1347
Address PO Box 871347, Wasiiia, AK 99687
Engineer's Printed Name Paul E. Pinard
DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Date 10/ ®`,�: �
0O�mgYtl
L 6 Ole
® ... ... ..............
. .. ..
N
.........................
y� Paul E. Pinard .°444_7
"as GE 4753 ea®G�ee�1A
Am OOOtln stoto
X1 pROFESa1' .
Conditional approval for bedrooms, with the following stipulations:
By: tom•-- Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
CCSA Checklist blue sheet
X Nitrate Advisory
Arsenic Advisory
Other
COSA Checklist.
Legal Description: Lot 10, Bk 6, The Tablelands Subdiyisioriparcel ID:051—?41-55
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by _
Date of Sample
Static water level at beginning of test ft.
Comments Property is served by a Public Water System
B. TANK DATA
Age of tank(s) 14 years
Tank type/material STEP/Steel
Measured operating fluid level in septic tank _4B n
® Standpipes/foundation cleanout per record drawing
Date of pumping 10/29/19
D. ABSORPTION FIELD DATA
Which system tested (date installed) —fV25/05
® ALL standpipes present per record drawing
Total measured depth from grade 2_,5 ft (max)
Measured depth to pipe invert from grade 2(min)
® N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
® Code -required soil cover over field
® System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2000 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
C. LIFT STATION
® Required maintenance completed
Age.of lift station 1 years
Lift station material Steel
Comments:
Adequacy test date 1 Q LU/ 19
Results IJ Pass For _3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 0 in
Elapsed time 7 min
Final fluid depth 0 in
Absorption rate 4-50+ gpd
Any rejuvenation treatment (past 12 months) No
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well) Public Water System
Septic Tank/Lift Station on Lot > 100'
LA Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
[3 Yes if No ft
❑ Yes
if No
ft
❑ Yes
if No
ft
Neighboring Tank > 100' ❑Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
ft
Neighboring Absorption Fields > 100'
ft
Animal Containment > 50' ❑ Yes
if No
ft
❑ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community. Sewer Main > 75' [:1 Yes
if No
ft
❑ Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Yes if No ft Surface Water > 100' KlYes if No ft
Properly Line > 5
LA Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
[3 Yes if No ft
Private Wells > 100' ® Yes if No ft
Water Main > 10'
[l Yes if No ft
Community Wells > 200' ® Yes if No ft
Water Service Line > 10'
® Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
U Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
[l Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
D Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
E9 Yes
if No
ft
Community Wells > 200' [ Yes if No ft
Surface Water > 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
+ Q � F A�
all ��`G�00CCL6°®Y�t �'JYSs.
-49
® . 0
..........:*Q
Paul E. Pinard
CE - 4793
l1
3 i
MUNICIPALITY OF ANCHORAGE
Development Services Department W Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
I Lift Station/Pump Vault
Ws -4-)0t'zA-kifi Maintenance Log
0 ne:
Owner Street Address !z!xo
Septic Tank:
-Sludge level inches -Pumping: required \ yW no -Pumping complete es no
Lift station:
-Pump basket clean4�sn o -Effluent filter cleaned 2es) no
-Control floats cleaned�Zs no -Proper float settings confirmed Qes no
-Operation satisfactory es no
Alarm System:
-Dedicated electrical � ��en o -Audible and visual alarm inside dwellinQe� no
f: -Alarm system operatidi��atfiisfa ory not satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connection ye '� n
-Ground water intrusion around pipe penetrationsXLS
es,' -Weep hole functionaFyt�) no
7111TS _o I—"-
-Manhole lid: Functiona' ky no Properly Secure' es Insulate S ej ON, no
Other
e -N-
-All manufacturer required inspections and maintenance completed no
Comments:
Qualified Maintenance Provider:
Technician t Date of maintenance �2,cl
Company
Signature t.
Date
•
• _� Municipality of Anchorage
On-Site Water and Wastewater Program in I
(907) 343-7904 a AUG `4`
16 P:
Certificate of On-Site Systems Approval \
051-741-55 6 s L�y
Parcel I.D. Expiration Dater r` f
1. GENERAL INFORMATION
Complete legal description The Tablelands Block 6 Lot 10
Location (site address) 23301 Whispering Birch Dr.
Current Property owner(s) Jennifer Suchan Day phone
Mailing address 23301 Whispering Birch Dr. Chugiak, AK 99567
Real Estate Agent Day phone _
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System Q Public Sewer ❑
WaiverNariance request for: Distance:
Received by. _ a JCCOCUlaQ i / Date: gbh-7
COSA to be released to the engineer, unless otherwise requested by t en ineer.
COSA Fee $ 5 Waiver Fee $
Date of Payment ri 55/r' Date of Payment
Receipt Number 01R 1 c' Receipt Number
COSA# 04DC.11 W?o Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 8/24/2017
6. DSD SIGNATURE 0 •" ' ,• • vv, - • "'
System #1 Approved for bedrooms Seven .•Paririone
O �,•. CE-8149
System #2 Approved for bedrooms ��,i •
4�s•. •• ,r
Disapproved `R.U,' 1OFESS4 4.••-
Conditional approval for bedrooms, with the following stipulations:
.• ON-CITE
WATER AND
WASTEWATER
r,r' ;"rCT. c
Original Certificate Date:,•--
t1 l
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: The Tablelands Block 6 Lot 10 Parcel ID: 051-741-55
A. WELL DATA
Well type Public If A, B, or C provide PWSID# Well Log (YIN)
Date completed Sanitary seal (YIN) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/STEEL Date installed 6/24/2005
Tank size 1250gal. Number of Compartments 3 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) Y
Date of pumping 8/17/2017 Pumper A Full Moon Septic
C. ABSORPTION FIELD DATA
Date installed
6/25/2005 Soil rating (g.p.d./ft2 or ft2lbdrm) 0.3 GPD/SF System type MOUND
Length 100 ft. Width 15 ft. Gravel below pipe 0.5 ft.
Total depth 2.5 ft. Eff. absorption area 1500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/21/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 455 gal. New depth 0 in.
Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed 6/24/2005 Size in gallons 250 Manhole/Access (Y/N) Y
"Pump on" level at 42 in. "Pump off' level at 42 in. High water alarm level at 44 in.
Datum Bottom of Tank Cycles tested 2 Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ 5+line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 200+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 1 00+ Driveway, parking/vehicle storage 1 0+
Curtain drain 50+ Wells on adjacent lots 200+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ~'OF (:.Ot
I certify that I have determined through field inspections and ,`,r
review of Municipal records that the above systems are in ,* •1. \ „ • �'0
conformance with MOA COSA guidelines in effect on this date. =� • ;• - f
Engineer's Printed Name Steven Pannone t••:SI.everi•R•.•*Iriorie:•-
8/24/2017 0 CE-8149
Date �} qs'• /
,W,.\\\5�~-•`-'
COSA canary sheet_2-6-15.doc
Frontier Surveys, LLC Project No: 17-217 Date:August 23rd, 2017
NORTH Ordered By:Maria Doney PIat:2004-25 Grid:N/A
',cale 1"=60'
• ` . / '
/1 /
/
•
TRACT G
LOT 8
/ 4,
/
/
/ 4f- ,
/ / 2.0' 2.8' 1' 2.8'
awvI / s', / 14.1' 11.1' 13.1'
AN\3 l / �p DETAIL"A" '-1
�ac,�' // ��w N SCALE 1'=so' 14.0'
• 12.1'
P / b ho° n '\ 41'� 16.1' 0 N
O 'lto 32.1'
N- crl
1The Tablelands Subdivisio`• ss .
_44.1 ,, •S s Lot 10,Block 6 ��,�e,
�� � 47,651 sq.ft.+1- \9;� LOT 9
23301 Whispering Birch Drive 33s
s 2 Story Wood Framed House •`
'1�• w/Attached 3 Car Garage
A.
/ . 4S •
asf la,,
yai / •
// 1q /
// / r-,, S •
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J SEE DETAIL"A" •
• • •
. wv
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7 II VaMI I
�n IJ ` • • I 69 g9
X93 _ I I � � ��49�
..— •�•. I 3 f r f 590
_ p` -'—:15,---J
r ' i
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` CC
_' G t(ORgI/y L=331.16 I o 15'T&£Easement rte':',
GRA _
_`__ AGE OITGh R 4 31 16 a �- o
WH1SP _ -�'
ERINGBIRCHDR/VE_____-�-�
LOT 18 LOT 17 LOT 16
BLOCK 4
Legend:
i�I Electric Meter/Outside Power — Culvert ti`�o Fire Hydrant
Y
C] Gas Meter to Deck -0- Fence .)f- Light Pole 030 60 120
5) Septic ><1 Water Valve na Tel.Com.
U Mailbox Feet
General Notes:
1.This document is created for the purpose of a single property transaction and is subject to Federal Copyright Law.
2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey.
3.All measurements/setbacks are to the visual/apparent building footprint.
4.Dimensions to property lines are plus/minus 0.1ft.
w' s+d � t This survey complies with ASPLS Mortgage Location Standards.The survey represents visible improvements and
r' ' OF tit ,y conditions at the time of the survey.This document does not constitute a boundary survey and is subject to any
Ar:.04 ..........4`y y inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine
t �). ..• ••4,/� the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no
•'` ; •. I e circumstances should this document be used for construction or for establishing a boundary or fence line.
'' 4 T s' •• * As-Built Survey of:
i -. ...�.2 0 Lot 10 Block 6, The Tablelands Subdivision
� •
�. •FREDERIC W. GNER.• / I,Frederic Wagner,hereby certify that this Mortgage Inspection Survey was performed by me,or
1 •. LS-9946 • t under my direct supervision on August 22nd,2017.
Bo P•lat3t1'7•' C.i
a4, PrO y _, Frontier Surveys, LLC FRONTIER.
'l �`....; � 650 W.58th Ave.Suite E Anchorage,Alaska 99518 41 Sury.
web` 907.460.1686-info@frontiersurveys.com i
PROFESSIONAL SEAL www.frontiersurveys.com 1 •
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 051-741-55 Expiration Date: r�i - -5_-/.5-
v
�°
1. GENERAL INFORMATION 11! 4
Complete legal description THE TABLELANDS BLOCK�6 LOT 10
Location (site address)
23301 WHISPERING BIRCH, CHUGIAK, AK 99567
Current Property owner(s) NICHOLAS PYSZ
Mailing address
Real Estate Agent
MARY STEPHENS
Day phone
Day phone 748-5579
2. TYPE OF DWELLING:
Fxj Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) t
J
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual El
Individual Water Storage
❑
Holding Tank ❑
Community Class Well
❑
Community ❑
Public Water System
Ix J
Public Sewer ❑
WaiverNariance request for: NONE
Distance: ---
Received by:
RR
Date: D J
-
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ �y `t • 4
p
Date of Payment Dlai3113
Receipt Number 096 QO6
COSA # 03(2 /3l y�
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage 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 SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Phone 279-3916
Date _8/20/13
Sti of At lit1)
�p.• 5��110
I'
1 $9T
RS SPURKIAND
t� ��,•. 11500
with the following stipulations:
By:(�li of�� � /,`(/ t /v � Original Certificate Date: — =-) -3 —4
The FAumci orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbWeshe E . ..
If more than 1 septic system is on the lot:
COSA Checklist # Of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: The Tablelands Block 6 Lot 10
A. WELL DATA
Well type AWWU If A, B, orCprovide PWSID#_
Date completed Sanitary seal (Y/N)-
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Parcel ID: 051-741-55
Well Log (Y/N)
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
g.p.m. — 9—
p.m-
Nitrate mg/L
Arsenic ug/L Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/STEEL
Tank size 1250 gal. Number of Compartments 3
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 7/18/13 Pumper JRs Pumping Service
'03W-1:1-101 :12 11 181Z 13f#4T1T_'N 0
Date installed 6/24/2005
Cleanouts(Y/N) Y
High water alarm (YIN) Y
Date installed 6/25/2005 Soil rating (g.p.d.W or ftZlbdrm) 0.3 System type MOUND
Length 100 ft. Width 15 ft. Gravel below pipe 0.5 ft.
Total depth 2'5 ft. Eff. absorption area 1500 fe Monitoring tube Y Depression over field N
Date of adequacy test 8/15/13 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed 6/24/2005
"Pump on" level at 42 in.
Datum BOTTOM OF TANK
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line _
Animal containment areas
Size in gallons 250
"Pump off" level at 42
Cycles tested 2
Manhole/Access (Y/N) Y
in. High water alarm level at 44
Meets alarm 8 circuit requirements? Y
On adjacent lots
On adjacent lots —
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5'+
Water main 10,+ Water service line 10'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water Service line 10,+ Surface water 100'+
Curtain drain 50+ Wells on adjacent lots200+
F. COMMENTS
PROPERTY SERVED BY AWWU
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Lars Spurkland
Date 8122113
COSA brown sheet -1 0-10-1 2-doc
Absorption field 5'+
Surface water 100'+
,
Water main 10+
Driveway, parking/vehicle storage 10,+
gyp.. • .u,� }t
G// j49T
in.
Municipality of Anchorage
• -� Development Services Department
Building Safety Division
i 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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL( .
FOR A SINGLE FAMILY DWELLING',
vkmw
Parcell.D. 051.741-55 HAA#
Expiration Date:
- qhPS/6MLkA_
1. GENERAL INFORMATION
Complete legal description _Lot 10. Block 6, The Tablelands Subdivision
Location (site address or directions) 23301 Whispering Birch Drive
Current Property owner(s) Spinell Homes, Inc. Day phone M4:5678
Mailing address 1900 Northem lights Blvd. Anchorage, AK 99517
Lending agency Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Three 3
Day phone
TYPE OF WASTEWATER DISPOSAL:
❑
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-sfte
❑
®
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (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 Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522.7773
Address _P.O. Box 240773 Anchorage AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date - 3/2512005
4' 49th
5. DSD SIGNATURE
Approved for �_ bedrooms.
Conditional approval for bedrooms, with the following stipulations -
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: ci a , _ n 0, Original Certificate Date:
(R«. IM
i
Municipality of Anchorage
Development Services Department
Building Safety Division
On -She Water 3 Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 9951966M
www.cLanchorage.ak.us.
(907) 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
.:
r-11ion n. li . alu v,
Weil type
Date completed _
Total depth R
If A, B, or C provide PWSID
Sanitary well (YIN) _
Cased to R
FROM WELL LOG
Well Log (YM)
WUas properly pfd (YM)
Casing height (above ground) in.
AT INSPECTION
Date of test
Static water level R
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate mg.A. Other bacteria
Date of sample: Collected by:
B. SEPTICIHOLDING TANK DATA
Tank TypelMaterial 9TEPM90 Data installed 612411005
Tank size 1250 gal. Number of Compartments I Cleanouts (YIN) If
Foundation cleanout (YM) I Depression over tank (YIN) H High water alarm (YIN) Y
Date of pumping Pumper New constructlon
C. ABSORPTION FIELD DATA
Date installed 612511005 Soli rating (g.p.dAe or fe/bdrrn) .3 GEDISE System type Raised Bed
Length 100 R Width 1¢' R Gravel below pipe .5 R
Total depth A R Eff. absorption area 1.6001t' Monitoring tube X Depression over field )Y
Date of adequacy test Results (Pass/Fall) For _ bedrooms
Fluid depth in absorption field before teat _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ In. Absorption rate >e g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
R
9-
p.m-
colonies/100 ml.
D. LIFT STATION
Data installed 6124005 Size In gallons 260 Manhole/Access (YIN) Y
'Pump on' level at 42 in. 'Pump ofr level at 42 in. High water alar level at 44 in.
Datum Bottom of Tank Cycles tested New Construction Mesta alarm & ciradl n quiremenrs? y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAiR station on lot _ WA
Public sewer main NIA
On adjacent lots MIA
On adjacent lots WA
Public sewer manhole/cleanout WA
Sewer /septic service line WA Holding tank WA
SEPARATION DISTANCES FROM SEPTIVHOLDING TANK ON LOT TO:
Building foundation W Property One >�'
Absorption field W
Water main MT Water service line AT Surface water MW
Wells on adjacent lots >20ty
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One >10' Building foundation >to' Water main >10'
Water Service 6ne Mir Surface water MW Driveway, parkingMehfde storage >S
Curtain drain None Noted Wells on adjacent lots 3-2V
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cerdfy that I have determined through field 6tspections end
review of Muntost records that the above systems era in
conformance with MOA HAA guldelines in effect on this date.
Engineers Printed Name Michael E Anderson. RE
Date 411=5
HAA Fee
59 -
Date of Payment 9
Receipt Number �35aS
Mov.12MM /
OV KV -W).) Waiver Fee $
Date of Payment
Receipt Number,
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