HomeMy WebLinkAboutTHE TABLELANDS BLK 4 LT 9AThe Tablelands
Block 4
Lot 9A
#051-801-73
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. SW050360 PID Number. 051-801-17
7pinell Homes
Wastewater System: New
Aaaaaa
1900 W. Northern Lights Anch. AK 99518
ABSORPTION FIELD
344-5678 our
5' Wide Trench
LEGAL DESCRIPTION
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SEPARATION DISTANCES
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Inspections performed by: TLK dates:1M 11/9/06
, ���-4�9�t�h �'�
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Department of Health and Human Services approval
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage. AX 99519.6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW050360
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Page 3 of 3
PID No. 051.801-17
98.46
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May 15, 2006
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 9 Block 4 —The Tablelands
were wired by a licensed Journeyman Electrician in accordance with the 2002 National Electric
Code requirements.
If you would like any further information, please feel free to call our office at the numbers listed
below.
Thank you.
Sincerely,
Allied Alaska Electric, L.L.C.
Nu'v' �(• 31'e"
tc L. Brown
PresidcntlCFO
cc: File
P.0. Bar 8 763 10, Wasilla, Alaska 99687 (90 7) 3 73-3893 ph / (90 7) 232-8687 cell / (90 7) 3 73-3894jar
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MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite 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: Sep 21, 2005
Expiration Date: Sep 21, 2006
Permit Number: SWO50360 Parcel ID: 051-801-17
Legal Description: THE TABLELANDS SUBDIVISION BLOCK 4 LOT 9
Design Engineer: 0014 Anderson Engineering Site Address: NHN WHISPERING BIRCH DRIVE
Owner Name: SPINELL HOMES, INC Lot Size: 40000 SO. FT.
Owner Address: 1900 W. NORTHERN LIGHTS BLVD #2( Total Bedrooms: 4 Permit Bedrooms: 4
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 (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
Issued
Date: �� D�
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. 651- W)I- 1- Permit Number SW
Property owner(s)_Spinell Homes. Inc. Day phone 344.5678
Mailing address (1)1900 W. Northern Lights Boulevard, Suite 200 Anchorage, AK 99517
address (2) MAK) Whispering Birch Drive Zip Code
Legal description (Lot, Block & Sub'd.) Lot 9, Block 4. The Tablelands Subdivision
Legal description (Section, Township & Range)
Lot Size 40.000 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms _Four (4)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: J460 = 5.-»r1e. Waiver Fees: X f7S t-- ler 4'je
Date of Payment 9 -/S—D S Date of Payment
Receipt Number. O 7 3 q 89 Receipt Number.
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
September 15, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 9, Block 4, The Tablelands Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 9, Block 4, The Tablelands Subdivision intends to construct a four
bedroom home on the lot. The soil conditions, groundwater elevation and house
location make the construction of a conventional septic system nearly impossible. We
have therefore decided to place an Advantex Treatment System on the lot to provide
the most effective treatment of the septic effluent prior to discharge into the surrounding
soil strata. The location of the absorption trenches is shown on the attached Site Plan.
Additional documentation is furnished which identifies the absorption trenches in
relation to the proposed water service on the lot and on adjacent lots.
The test holes placed on this lot revealed silty sand and gravel. The percolation rate in
the materials encountered was 8 minutes per inch. Groundwater was found during the
excavation 13' below the surface. We are therefore proposing to place a four-bedroom
Advantex Treatment System. The absorption trenches will each be 20' long x 5' wide
with a 2' effective depth. The distribution line in the trench will be placed 1' below the
existing ground level. The total depth of the trench will be 3' below the ground. 3' of fill
will be placed above the trenches and 4' over the septic tank to meet Municipal Code
and prevent freezing.
The ground surface of the lot is basically flat with only minor grades sloping to the
southeast. The absorption trenches will be constructed parallel with the slope as much
as possible in conformance with Municipal requirements. All components of the new
septic system will be constructed a minimum of 100' from any surface water and 10'
from the water service proposed for this lot.
If the system is constructed in accordance with our design the following statements
apply:
Lot 9, Block 4, The Tablelands
September 15, 2005
Page Two
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
'�1f 49th
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LOT 9, BLOCK 4, THE TABLELANDS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: 8 Min./inch 4 Bedroom Advantex Treatment System
Application Rate: 3 GPD/SF 2' Drainfield Rock
4 Bedrooms " 150 GPD/Bedroom = 600 SF Absorption Area
600 SF/3 GPD/SF/5 SF (Width)' .7 (Red. Factor) = 28 LF Trench Length
THEREFORE: Construct 2-20' Long x 5' Wide x 2' Effective Depth Absorption Trenches.
Flow Line Elevation in Trenches to be 1' Below Original Ground Surface. Total Depth to be
3' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank.
14
6-
2-0"
Natural
Backfill
5'
2" Insulation and
Geotextile Fabric
1" Perforated
PVC (Holes Down)
3/16" Holes @ 1.5' Spacing
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTIO"'
(NO SCALE)
NOTE:
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Water Service Line.
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 9. BLOCK 4, TABLELANDS S/D
PERFORMED FOR, SPINELL HOMES, INC.
DATE: 6/6/2005 PROJECT No- M0548
PARCEL ID#- TECHNICIAN: M- FI DRIDGE
DGPTI I TEST HOLE K2::]
(red)
1 OB/OG SLOPE SITE PLAN
2 TH2
3 O
4
5 5%
6 SLIGHT COMPACTION
SILTY GRAVELLY -SANDS
7 SP -GP
8
9
10
I I
READING
WAS GROUND WATER ENCOUNTERED/ YES
IF YES ®WHAT DEFnI? 13'
DEFT11 OF WATER AFTER MONITORING: Nano
DATE OF MONITORING: yy�ppT
NET TIME
(MINUTES)
0%
N(PDROP
IN
(INCHES
13
14
15
16
17
18
19
COMMENTS:
BOH
WATER WEEPING
DATE
READING
G OSS TIME
MINUTES)
NET TIME
(MINUTES)
DEPTH of
WATER
(INCHES)
N(PDROP
IN
(INCHES
8/8/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1410
10.0"
CHARGE
2
1440
30
6.0"
4.0"
3
1440
10.0"
RECHARGE
4
1510
30
6.25"
3.75"
5
1510
10.0"
RECHARGE
6
1 1540
1 30
1 6.25111
3.75"
PERCOLATION RATE: 8_0 (MIN/INCII) PERC. HOLE DIA.6(INCHES)
TEST RUN BETWEEN: 5 FT. and 6 FI'.
NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY TFIAT
TI IIS 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
DEPTI I
(req
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION. LOT 9, BLOCK 4, TABLELANDS S/D
PERFORMED FOR, SPINELL HOMES, INC.
DATE: 6/6/2005 PROJECT No • M0548
PARCEL IDX TECHNICIAN: M- FI DRIDGE
TEST HOLE �
OB/OG
LOOSE COMPACTION
WELL GRADED GRAVELLY -
SANDS GW -GP
MEDIUM COMPACTION
SILTY GRAVELLY -SANDS
SP -GM
SLOPE
WAS GROUND WATER ENCOITNTERED? YFS
SITE PLAN
THI
O
IF YES ®WHAT DEPTIIT i36
DEPTH OF WATER AFTER MONfTORING: Nm 0%
DATE OF MONITORING. an/ s
BOH
WATER WEEPING
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
D yATER F
(INCHES)
INET DROP
(INCHES)
8/8/05
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1400
10.0°
CHARGE
2
1430
30
7.37501
2.62511
3
1430
10.0"
RECHARGE
4
1500
30
7.1875'
2.5625'
5
1500
11.0"
RECHARGE
6
1530
30
8.511
2.511
PERCOLATION RATE I� 2_0(MIN/INCI I) FERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN.5FT. and 6 FT.
COMMENTS: NO IMPERMEABLE LAYERS ENCOUNTERED. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITII ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 9, BLOCK 4, THE TABLELANDS SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a
new Four Bedroom Advantex Treatment System, which includes a
septic tank sized for four bedrooms with an AX -20 Pod to serve the
proposed home on the lot. The new system will be placed at the
location shown on the Site Plan. The new septic system also includes
the construction of 2 new 20' long X 5' wide X 2' effective depth
absorption trenches at the location also shown on the Site Plan and at
the configuration shown. The distribution line in the trench will be
placed at V below the existing ground surface. Total depth of the
trench will be 3' below the ground surface. The new system must be
placed a minimum of 10' from the water service on the lot and those
currently in place on adjacent lots and 100' from any surface water
located on or near the lot The new trench must be covered with a
minimum of 3' of cover. In lieu of cover 2" of direct bury insulation and
2' of cover is acceptable.
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.
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.
Lot 9, Block 4, The Tablelands
September 15, 2005
Page 2 of 4
SEPTIC TANK INSTALLATION
1. The Advantex Treatment System must be installed in conformance
with specifications and regulations furnished by the manufacturer,
Anchorage Tank and Orenco Systems Incorporated. No variances
from the manufacturer's specifications will be allowed without
permission from the manufacturer and Municipal representatives.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
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:
The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the bed shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of 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.
Lot 9, Block 4, The Tablelands
September 15, 2005
Page 3 of 4
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 trenches 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.
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.
SAND GRADATION:
1. Sand used to level the new absorption bed must have the following
gradation:
50% Passed the No. 4 Sieve
2% Passed the No. 100 Sieve
1% Passed the No. 200 Sieve
2. The sand source must be approved prior to use.
Lot 9, Block 4, The Tablelands
September 15, 2005
Page 4of4
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.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
September 15, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 9, Block 4, The Tablelands Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The soil conditions, groundwater elevation, house location limit the area available for a
septic system. We are proposing to place an Advantex Treatment System to minimize
the required absorption area. Unfortunately only a small area remains and much of it is
closer than 10' to the southwest property line. We are therefore requesting a waiver to
allow the construction of the new absorption trench at 3' from the west property line.
The placement of the absorption trench within 3' of the southwest property line will have
no impact on the surrounding lots and will not encroach into areas reserved for septic
systems. The subdivision is served by a community water system and no conflict will
exist with this system. We therefore request a waiver be issued allowing the trench to
be 3' from the southwest property line.
Sincerely,
7V4tA,.,L C �,e _,
Michael E. Anderson, P.E.
�ttf 49th
WCAAIL E. ♦40EMSCh
0
Mayor Mark Begich
Municipality of Anchorage
CO. Ikm l'.11A.,t1 • Anchnrnge, Ahislut lk6519faCi(1 •Telephone ('.>f171333Ri(11 •1'aa ('.1117) a}:f•R:.YM)
4M) Brupw Strcet • Anchoruge, Alaska (X!507
uxiv.munl.org
Building S. -defy Dii.9slon
9/21/2005
Anderson Engineering
P.O. Box 240773
Anchorage, Alaska 99524
Subject: Waiver Request for The Tablelands Subdivision, Block 4, Lot 9
Waiver Request #WR050077
Parcel ID #051-801-17
Permit # SW050360
Dear Mr. Anderson:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to the property line has been approved. The approved separation distance
is 3.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely, 1
� 1 1
`Julie Makela, P.E.
Civil Engineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
Dodding Safety Division
J On -Birt Water and Wastewater Program
4700 Dragaw Street
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WRO50077 PID#: 051-801-77 HA#: _ Permit#: SW050360
Date Received: 9/1512005
Legal Description: The Tablelands Subdivision, Block 4. Lot 9
Engineer. Anderson Engineering
P.O. Box 240773
Anchorage, Alaska 99524
Applicant: Spinell Homes. Inc.
Waiver Requested: 3 feet from absorption field to lot line
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
..sesses.......................................................................
Waiver is Granted: Waiver is not Granted:
List Conditions or Reasons for above:
Date: —TT By:
Name of Reviewer
..... .... a .......................... a....aasses...............................
Rec#: 73989 Amount: $175.00 Date Paid: 9/2112005
�� Municipality of Anchorage � °`- ,o
a On-Site Water&Wastewater Program _
(907)343-7904
$A E T Y
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CERTIFICATE OF ON-SITE SYSTEMS A-tcl:OyAL4. 0
2018
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Parcel I.D. 051-801-73 Expiration 3- :• /
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6 9 L
1. GENERAL INFORMATION
Complete legal description THE TABLELANDS SID;BLOCK 4, LOT 9A
Location (site address) 23028 WHISPERING BIRCH DRIVE, CHUGIAK,AK 99567
Current Property owner(s) MARK&DARCI ORNELLAS Day phone 301-3336
Mailing address 23028 WHISPERING BIRCH DRIVE, CHUGIAK,AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
▪ Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual On-site U
Individual Water Storage ❑ Individual Holding tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System U Public Sewer ❑
WaiverNariance request for N/A • Distance: -
Received by: %V\ Date: 76 1
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee$ ✓Z('COWaiver Fee$
Date of Payment lir"( (J o Date of Payment
Receipt Number 01114 I�l Receipt Number
COSA# W CGL Q ( ?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.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E.TUDOR ROAD,SUITE 101 'ANCHORAGE,AK,99507
Engineer's Printed Name JEFFREY A.GARNESS,P.E. Date 47)4/
Engineer's Comments:
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 resorts describe the X44 OF t 41♦
•condition of the systems on the date/s of the evaluation.Separation distances were measured to readily identifiable features. 44u P\.••.•••"' ... (1.•♦
Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic =(�\.� •.••Y�•
systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during .. 4,, v.
the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system/s.These iii
conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the 9 •
systems;therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. I 0
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.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the °; f TQ, , Gam s i w-
information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not 1.0� J/ -7. -
authorized.In short,GEG disavows any legal duty to anyone other than the person/partywho paid for this report. • it ... (/ , Var
6. DSD SIGNATURE �'/4i;ROFESS\ s4
LICENSE 1%„ `*
System#1 Approved for �`( bedrooms. #AEccaea
System#2 Approved for bedrooms.
G
-. Or AIVCn
Disapproved. ��,
Conditional approval for bedrooms,with the following stipule ns: 0‘4--. ‘ .
D
M Wg SPA ER 0
o� WFS GRW S.
PRO r
By: T:\^^ ( � • Original Certificate Date:
The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist > - Nitrate Advisory
/
Septic System Advisory y Arsenic Advisory
Well Flow Advisory Other •
(Rev.10/12/12)
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 TABLELAND S/D; BLOCK 4, LOT 9A Parcel ID: 051-801-73
A. WELL DATA PUBLIC WATER SYSTEM
- pe If A, B, or C provide PWSID# Well Log (Y/N)
Date compie - , Sanitary seal (Y/N) Wires properly protected
Total depth ft. Cased to ft. Casing height .•ove ground) in.
FROM W OG A i PECTION
Date of test
Static water level ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RES :
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
A . lc: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 1/9-11/2006
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout(Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) YES
Date of pumping - Pumper SEE CERTIFIED SERVICE PROVIDER'S REPORT
C. ABSORPTION FIELD DATA `BELOW EXISTING GRADE-DRAINFIELD MAY NOT HAVE ENOUGH COVER.
**EAST TRENCH/WEST TRENCH
Date installed 1/9-11/2006 Soil rating •.p.d.Poor ft2/bdrm)**3.0 System type 5-WIDE
Length 44 (2@229 ft. Width 5 ft. Gravel below pipe 2.0 ft.
Total depth *4.1 -4.4 ft. Eff. absorption area 314 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/19/2018 Results (Pass/Fail) PASS For 4 bedrooms
**560/ **13/
Fluid depth in absorption field before test-0/0 in. Water added 564 gal. New depth 15.5 in.
**220/ **3/
Elapsed Time: 130 min. Final fluid depth 6.5 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date -
`SEE CERTIFIED SERVICE PROVIDER MAINTENANCE REPORT.THERE IS ALSO A SECONDARY PUMP VAULT
LOCATED AFTER THE ADVANTEX UNIT. APPEARS TO BE A STANDARD ANCHORAGE TANK PUMP VAULT.
D. LIFT STATION **PER ELECTRICIAN REPORT AND CERTIFIED SERVICE PROVIDER REPORT.
1/9/2006 Size in gallons `500 Manhole/Access (Y/N) YES
Date installed
"Pump on" level at * in. "Pump off' level at * in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: PUBLIC WATER
Sep I • .ft station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main -• • is sewer manhole/cleanout
Sewer/septic service lin- Holding tank
A6.••- .ntainment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation `5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line —10'+ Surface water 100'+
100'+ PVT./
Wells on adjacent lots 200'+COMM.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line "1' Building foundation 10'+ Water main 10'+
Water service line .,,10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
100'+PVT./
Curtain drain NONE KNOWN Wells on adjacent lots 200'+COMM.
F. COMMENTS
*MET SEPARATION DISTANCE AT TIME OF INSTALLATION. **LOT LINE WAIVER ISSUED. SEE 2016 COSA
***PER MIKE ANDERSON, P.E. RECORD DRAWINGS
G. ENGINEER'S CERTIFICATION : P,.••''"'...... ••.. 1.
t
�` 49fi
111. - • :;*•�0.
I certify that I have determined through field inspections and �. . ..
review of Municipal records that the above systems are in : i
conformance with MOA COSA guidelines in effect on this
s......f ".. . •
date. •�.c :fly A. Ggmess.r'�
•
JEFFREY A. GARNESS ••%j, ... CEJ-73 3 ' �
Engineer's Printed Name ••14.
�Fp•''•3•( � P�-• •
Date 71 211 LICENSE',tf,\"S`\0%••
#AECC884
(Rev. 10/12/12)
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
AND GL (I e. ! Ekoss
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of tins
2b Day of ,1 a of 20 ,by and between G r t e. I Ek.SS
herein the"OWNER,"and the Municipality of Anchorage,herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein,the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS),described as
Z .; 07 1311i 4e.c
Ch ikk 1k 99 Sb7
located at(legal description).
i a6(e 1a Ii LSA !�y
:. Definitions.
teration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts,components or pieces not
included in the original construction permit and design
Certificate of On-Site Systems Approval(COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code(hereinafter,"AMC") 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On-Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA,and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations,Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS,the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement,the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement,and any renewals thereof,at the owner's sole expense,to pay
for any and all: (1)repair(s), (2)maintenance,(3)adjustment(s),(4)replacement
costs,and(5)inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws,regulations,rules
and orders for the AWWTS
C. Upon request by the Municipality,the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained b'
the system vendor,the owner agrees to allow the Municipality access to thi'
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance,repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On-Site Systems Approval.
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction,maintenance and repair of the
Owner's AWWTS.
I. Owner agrees to provide and maintain a telephone connection to the AWWTS as
required by the AWWTS approval.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions,nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof,or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended,modified or
changed by a writing,executed by authorized representatives of the parties,with
the same formality that this Maintenance and Repair Agreement was executed
with,and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement,the only authorized representatives of the parties
are:
a. Owner: Go(_,r, ( E1<;SS
b. Municipality: Director.Community Development or designated authority
C. Any attempt to amend, modify,or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
B : _. / . /
y (signature) Date: 7, 8 „Jo. Za 113
I �<< s 5 (print name)
STATE OF ALASKA )
}ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this, day of 6-
20/V.
20/V.by G 2Lf.L 7 i±S
. . .. .
N ►Public
NaTARY PUBLIC FOR ALASKA CYNTHIA K. DIXON
My Commission expires:,.t'(.h'te,1C,Jt);)-.). r Ste of Alaska
My Cor wn eebn Expires June 16,2022
MUNICIPALITY:
• (signature) Date: 7 q
(print name) Title:
Municipality of Anchorage g4\
-2 development Services Department oto`
Building Safety Division a
On -Site Water and Wastewater Program SA E t r
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING ek'
Parcel I.D. 051-801-73 COSA #
Expiration Date: _% — -
1. GENERAL INFQRM"PN, - 1
Complete legai'deal
Location (site addrQ
>n 'stat, 9A, Bk 4, The
23024 Whispering
,). Erik.,Forland
9567
Dayphone (9071 727-2502
MailingAddfess 23,028 Whispering Birch Drive Chuciiak,_ AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent David Aquino @ Prudential Day phone J907) 947-8755
Mailing Address 3801 Centerpoint Dr. , Suite 200 Anchorage: .AK
Unless otherwise requested, COSA will behold by DSD forpickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class Well ❑
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
IN
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
. Approval (COSA) based only upon the representations given in paragraph 4 by an independent, professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal andfor water
supply system. DSD also issues C.OSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and.may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
99503
a
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, f verify that my.investigation,
based on procedures outlined in the Cerfificate 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 Pinard Engineering Phone (907) 232-1347
Address PO Box 871347 Wasilla, AK "99687
Engineer's Printed Name Paul E. Pinard, P.E. Date 10111 /1� 2
6. DSD SIGNATURE
Approved for � bedrooms.
Disapproved,
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other .
By: 1 Original Certificate Date:�—
Bev.11M51
Municipality of Anchorage
• "� Development Services Department '-
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 9A, Bk 4, The Tablelands Subd. Parcel ID: 051-801-73
A. WELL DATA
Well type _ If A, B, or C provide PWSID # _ Well Log (Y/N)
Date completed _ Sanitary seal (Y/N) _ 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 Collected by:
Arsenic: _ ug/L - date of sample:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel Dateinstalled 1/9/06
Tank size 1500 gal Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping Pumper 5 e e AL,47ix I �e.pal,4
C. ABSORPTION FIELD DATA
Date installed 1 / 11 / 06 Soil rating (g.p.d.tlf or fin) 3.0 System type 5 Wide Trench
Length 40 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 3 ft. Eff. absorption area65tZ Monitoring tube Y Depression over field N
mom OG
Date of adequacy test 10/9/12 Results (Pass/Fail) Pass For _4 bedrooms
Fluid depth in absorption field before test _0 in. Water added 600gal. New depth 2 in.
Elapsed Time: —min. 485 Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Known - None If yes, give date
D. LIFT STATION
Date installed 1/9/06 Size in gallons 500 Manhole/Access (YM) Y
"Pump on" level at 28 in. "Pump off' level at 26 in. High water alarm level at 34
Datum Bottom of Tank Cycles tested 2 Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM 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/deanout
Sewer /septic service line Holding tank
Animal containment areas Manurelanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 + Property line 5 + Absorption field 5' + .
Water main 10'+ Water service line 10'+ Surface water 100' +
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 3'* Building foundation 10'+ Water main 10''+
Water Service line 10'+ Surface water 1001+ Driveway, parldng/vehide storage V+
Curtain drain None Known Wells on adjacent lots 200' +
F. COMMENTS
Y
* Lot line waiver
G. ENGINEER'S CERTIFICATION
I 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 Paul E. Pinard, P.E.
Date 10/11/12
COSA Fee $_
Date of Payment
Receipt Number.
(Rev. 4110)
Waiver Fee $
Date of Payment
Receipt Number
in.
absorption
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNIyC'IPALITY OF ANCHORAGE
AND
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
f Day of of 20t by and between
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AW WTS), described as
located
at�.7 �; t� 4" � 1`'�0 +�7 i rtd�� K7 t ly--, Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AWWTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations. Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
Owner: 11 k 4— .k- \)Ne_ ;.n U ,A(l 04-�
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNEId
---
By:�'1r
v
Date: t- lau
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
MUNICIPALITY:
By:
Title:
Date:
ss.
The foregoing instrument was. acknowledged before me thisc)ftiy of 6dtw--%--,
20I1-, by�1Ti C99k"AiVI,i <1 , the
NOTAAY'PMIACFO t LASKA
anFOk
ALASKA
com
My Commission expires: L ILIC
Tennie Kt;a
4,2u'14
05/28/2012 17:25 8686770 APLUS PAGE 13
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bftalee lisle
Napeaf Clean
Ffoate
Punp
kupeat/aer+dce Otlfer syatmrf Components
Inspow, clean desan"
OiefMectkm Equip N Dmmeraal LataMWOMM
Observations
Addltlesnal Sawices Rendered
❑ Cleaned textile shw in? ❑ UVJlemst
❑ ftp acaftxed adew kerne?
Parts used: w = Wanard„, 9 e 6gable V app"Nale .electial)
Fl et"Rnsvatlr Wspsdtion
;j VM teW mmn on
�{a�aeffsld mronnected; Nueh valves dosed Cantrel pond rema:tivated
Su immy/Recummerrda0ma
❑ Oystem pulmmingi m nmm�ar sauon neaded ❑ Tmmk neads pumping
❑ Cd1 iw narvice ❑ Dserr
Dasa
Pax completed Torre to 1.866-384.7404
9pks Box ....................
Float Cattle ....................
.......................
Pump .......... ............': I[J
ek &*MO F1ter...............
elatubv PumPvmdt ............
I[J
nacafesls&MSPlkrer Yalra.......�
.
Comments
RrF T
Measure SludgdScum
sludge - scum
lutcavvOunem Oumnt Pmvloes GLaent Peevloue
a!
2nd canpanment cunaet L/ Previous Conard Previous
Inspeat/c 1man AdwanTex Fiher
Odw. Zkwmal ❑ Pungent
aiamat },,���,,/NNw mal ❑E=aasw
Midping/PwMr .21NMa/Mkwr C)Exosasfm
Inspeot/clean Discharge Pump system
ld
Spam
Box
float cads
rde/Odfbas � cl
ea
Late^�J
Pod "ant
bftalee lisle
Napeaf Clean
Ffoate
Punp
kupeat/aer+dce Otlfer syatmrf Components
Inspow, clean desan"
OiefMectkm Equip N Dmmeraal LataMWOMM
Observations
Addltlesnal Sawices Rendered
❑ Cleaned textile shw in? ❑ UVJlemst
❑ ftp acaftxed adew kerne?
Parts used: w = Wanard„, 9 e 6gable V app"Nale .electial)
Fl et"Rnsvatlr Wspsdtion
;j VM teW mmn on
�{a�aeffsld mronnected; Nueh valves dosed Cantrel pond rema:tivated
Su immy/Recummerrda0ma
❑ Oystem pulmmingi m nmm�ar sauon neaded ❑ Tmmk neads pumping
❑ Cd1 iw narvice ❑ Dserr
Dasa
Pax completed Torre to 1.866-384.7404
PINARD ENGINEERING
o, P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST
LOCATION: Lot 9A, Block 4, The Tablelands Subdivision
APPLICANT: Erik Forland
23028 Whispering Birch Drive
Chugiak, Alaska 99567
SEPTIC TANK TYPE/SIZE: SteeIN 500 Gallons, per MOA Records
ABSORPTION SYSTEM: 5 Wide Shallow Trenches, per MOA Records
DAILY FLOW:
4 BEDROOMS x 150 GAL/BR = 600 Gallons
TEST DATA
1�
JOB NUMBER: 12343
DATE OF TEST: 10/9/11
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 4
SCUM: 0.0' SLUDGE: 0.0'
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes XX No
Time
Flow
Rate
Volume
Cumulative
Volume
Septic Tank
Septic
Tank
Soil Absorption System
Comments
AM
(GPM)
(GALS)
(GALS)
Liquid Level
*
A Level
Monitor
Tube 1*
A SAS
Level
Monitor
Tube 2*
A SAS
Level
9:10
6.7
-
-
4.0'
-
0.0'
-
0.0'
-
Start Flow - Meter 482600
9:25
6.7
100
100
4.1'
0.11
0.0'
0.0'
0.0'
0.0'
482700
9:40
6.7
100
200
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
482800
9:55
6.7
100
300
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
482900
10:10
6.7
100
400
4.1'
0.0'
0.0'
0.0'
0.1'
0.1'
483000
10:25
6.7
100
500
4.1'
0.0'
0.1'
0.1'
0.2'
0.1'
483100
10:40
-
100
600
4.1'
0.0'
0.2'
0.1'
0.2'
0.0'
Stop Test - 483200
RECOVERY
Date
Time
SAS MT1
SAS MT2
10/9
5:15
PM
0.0'/-0.2'
0.0'/-0.2'
*ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: System appears to be operating satisfactorily. There was no measurable liquid in the SAS MTs
prior to beginning the test. With the addition of 600 gallons to the system (the design daily flow),
the levels rose to 0.2' in each trench. Recovery measurements, taken about 6.5 hours after stopping
the test flow, showed satisfactory absorption with a return to the starting level.
Reviewed by: Paul Pinard 'PVii
Date: 10/10/12
�lrula
Municipality of Anchorage �/
•,� l • 4,r
• � Development Services Department
Building Safety Division
On -Site Water and Wastewater Program $ A 9 r r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. COSA# No OIRtp
Expiration Date: 3 — O 7
1. GENERAL INFORMATION
Complete legal description
4, The Tablelands Subdivision
Location (site address) o098 Whispering Birch Drive
Current Property owner(s) Sdnelt Homes, Inc.
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone 344-6678
1900 W. Northern Ughts Blvd., Suite 200 Anchorage, AK 99517
Unless otherwise requested, COSA will be held by DSD for pickup.
Day phone
Day phone
2. NUMBER OF BEDROOMS:
Four (4)
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
IZI
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
fitle (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, 1 verify that my Investigation,
based on procedures outlined in the Certificate of Onsite 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. 1 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
Address P.O. Bax 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
S. DSD SIGNATURE
✓ Approved for L� bedrooms.
Disapproved.
Phone 522-7773
Date 5/1512006
Conditional approval for bedrooms, with the following stipulations: V
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: �' �� Original Certificate Date:
(a.,,./1M)
Municipality of Anchorage .°
' Development Services Department `•;
Building Safety Division •
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 198850
Anchorage, AK 99519.8850
www.murd.org/onstte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Let e. Block 4, The raaelands Wb&Mon Parcel ID: 051.801-17
A. WELL DATA
Well type _ If A, B, or C provide PWSID # _ Well Log (YM)
Date completed _ Sanitary seal (YIN)_ Wires property protected (YM)
Total depth R Cased to ft. Casing height (above ground) in.
FROM WELL LOO AT INSPECTION
Date of test
State water level
R
II
Weil production g.p.m. 9 -
p.m -WATER SAMPLE RESULTS:
Conform colanies1100 mL Nitrate mglL Other bacteria cctonILW100 mL
Arsenic: _ mg4 Date of sample: _ Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material AdvardexlSteel Date installed 1=05
Tank size 1.500 gal. Number of Compartments Two Cleanouts (YIN) Y
Foundation deanout (YM) Y Depression over tank (YIN) N High water alarm (YM) Y
Dein of bumping New Q0O6WCOcn Pumper
C. ABSORPTION FIELD DATA
Date installed U11=05 SOU rating (g.p.ddle or felbdrm) 3 GPO1SF System type S wide Tnmch
Length 4e R Width 5 ft. Gravel below pipe 2 R
TOW depth -M--R Eff, absorption area e5� tlx Monitoring tube Y Depression over field N
Date of adequacy test New craft Results (Pass/Fall) For _ bedrooms
Fluid depth In absorption field before test in. Water added_ gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yea, give date
D. LIFT STATION
Date installed 1MA05 Size in gallons 500 Manhole/Accesa (YIN) Y
'Pump on' level at 28 in. 'Pump ofr level at 28 in. High water alarm level at 34 in.
Datum Bottom of Tank Cycles tested New Canssucaon Meets alarm R Bradt
regtdramarss9 Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot On adjacent lots
Public sewer main
Sewer /septic service line
Animal containment areas
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >s Property line >s Absorption field >a'
Water main >ta Water service line >ta Surface water >tco'
Wells on adjacent lots >2W
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t' Building foundation >IV Water main NIA
Water Service line >1W Surface water >1W Driveway, padmg/vehicle age >g
Curtain drain Now Noted Wells on adjacent lots >2W
F. COMMENTS: Lot Is Served by AW WU water system. Lor lyre waken blued.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and e
review of Munlctpal records that the above systems are in (W
49th
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Udwal E• Andernen. P.E. naaNa�
Date snaRoos 0.
COSA Fee $ 100 s q - -so
Date of Payment
Receipt Number 3
(Rev. I 11
Waiver Fee $
Date of Payment
Receipt Number
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