HomeMy WebLinkAboutSHAWN LT 1Shawn
Lot 1
#051-092-61
Municipality of Anchorage ;•'" '"
Development Services Department 5
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650 Page 1 of 2
www.cl.anchorage.ek.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40493 PID Number. 051.092.61
Nam.PETE HALVERSON
Wastewater System: ® New ❑ Upgrade
Adman P.O. BOX 670813 CHUGIAK. AK 99567-0813
ABSORPTION FIELD
Ph" Nu *W M llad n .
0 DNP Twxh O alreftr Trend! ® Bed l] Mound Cl Omer
Sod RaWV
TMM DNA, eom OW W 7mle.
LEGAL DESCRIPTION
0.8 cPDIFe
0.8 Ft.
111 A LM: Sue wcn
DOPdt IP PNO oatae can MgnM Veda
GmW depth bvmO PTe
1 SHAWN
0.2 Ft.
0.6 Ft
TowWN: RMpe sect d
FA added oxm, orgmal Vade
lYM L*rVh:
15N 1W 10
3 Ft.
50 Ft.
Well: ® New ❑ Upgrade
DrM wget
15
Numtw a Irw Dntrce Uetrwen IMO:
3 6
FI.
FI
Clr.ewan (P"9 A B, CL
Total DNdr
Card to
TPIM ebm"M MM
Ppa MManM.
PRIVATE
200 Ft.
184 Ft
750 Fr
PVC
Dr
DMO D"WI'.
BWKWMMLM.
"NM
Date IWOW
SULLIVAN WATER WELL
112012005
55 Ft
CCC CONSTRUCTION
8124005
YWdI
Pune sat M'.
Gerq tlMple Move roam.
TAN
K
10 CPM
190 Ft.
2 Ft
SEPARATION DISTANCES
® septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
ubwPovine
Sevier line
WrKAWw.
ANCHORAGETANK
,peaty
1250 ON.
w.n
+100'
+100'
—
—
a25
MMMw.
STEEL
tlureMdcampMl W 5
2
sulacowMer
+100'
+100'
—
—
LIFT STATION
LM line
45
+10'
—
—
�e NO LIFT CM
+5'
+10'
—
—
'Pump ar IMM
'Pump w wO M.
Hqn MMM MMm M.
Fon"M
_ In
— „
.. im
+50'
thy'
—
PWV M O a Mo
EWmicO1 MPOcbone PMlanud W
Cu1am Oran
Contractor raised the elevation of the house eliminating the need
BENCH MARK
Ldcnan Mid o.eaereon.
for a lift station.
CORNER OF SLAB BY BACK DOOR
MVMwn.
100 Ft
E '
�•F '4v
Ois
A. PSS,..
Q ' f
Inspections performed by: CHARLES BALZARINI Dates: 1' 811112005
Jr
2ed 8/2412005
CHRISTOPHER
X MOW
4'
W.. t, Z
Development Services Department Approval
Reviewed and approved by: Date: "
(Rin. 11W)
V. �•'.r� _
^'CSSIDNF�'O�
Permit No. SW040493 Page 2 of 2
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
ON—SITE WATER & WASTEWATER PROGRAM
4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: SHAWN LOT 1
051-092-61
SWING
TIES
10' SEC LINE ESMT.
R
A
---------4--------------------------------------
C 9.3'
I
"
1 26.6'
D 45.4'
43.6'
LOT 1
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° �-1250 GAL.
EPTIC TANK
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-� -
WELL
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rONITOR
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'
^ 3 '
—02-05
GIN
ELEVATIONS ORIGINAL GROUND
RNR r A LEVEL AT, 96.8
o000044p0
o OF A�' p�
ASSIA/ED ELEVATION 100• (NOT TO SCALE)
MT -1 MT -2 \ TH-1
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INSULAT ON 3' FILL
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0.2' YPA 96.6
0 .. .. .............. Q
,1250 GAL. 0.6 GRAVE ' 8 ::. 96.0
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97.6 692
96.0
93 93. 96. BOTTOM OF T.H.
00444�Ooo
EAGLE RIVER SENGINEERING
10421 VFW RD, 201
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: PETE HALVERSON DATE PERFORMED 12/30/05
LEGAL DESCRIPTION: SHAWN LOT 1
TEST HOLE #_3 SLOPE
1
6
7
6
9
10
11
12
13
14
15
16
21
WE
AND ORGANICS
WAS GROUND WATER
ENCOUNTERED? NO
IF YES AT WHAT DEPTH NONE
DEPTH TO WATER AFTER
MONITORING?
DATE: _LVi/L
TOWNSHIP RANGE SECTION T15N,R1W,SEC8
SITE PLAN(NOT TO SCALE)
PERC TEST RESULTS
FLAT
READING DATE GROSS TIME NETTIME DEPTH TO WATER NET DROP
1
2
3
4
5 PERCOLATION RATE WAS FASTER THAN 1 MINUTE PER INCH
6
7
6
PERCOLATION RATE- FASTER THAN 1 MINUTE PER NCH
SOILS LO E��ERTIFY
ARLES BALZARINI PERCOLATION TEST BY: CHARLES BALZARINI
I��THAT THIS TEST WAS PE'RF% MED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
BIRCHWOOD LP. ROAD
149.9'
LOT 1
4
r3
QuY}j
llh
US
K
1
0
PERC TEST RESULTS
FLAT
READING DATE GROSS TIME NETTIME DEPTH TO WATER NET DROP
1
2
3
4
5 PERCOLATION RATE WAS FASTER THAN 1 MINUTE PER INCH
6
7
6
PERCOLATION RATE- FASTER THAN 1 MINUTE PER NCH
SOILS LO E��ERTIFY
ARLES BALZARINI PERCOLATION TEST BY: CHARLES BALZARINI
I��THAT THIS TEST WAS PE'RF% MED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
(Certttteb 33rillim 109
by
coC CO. dw
S
ULLIVAN WATER WELLS
p.0. BOX 670272 CHUGU K. ALASKA 99567 • ��• '
OWNERQFUWO t'✓i�T� WL J�rcSc�
ADDRESS:
LEGILDESM Thr:- SNi4
DATE: �������"?
Pt3tMfT SUSt Date d Is��
TAX IDENTFICATION NLWBM 01TL-
Is well Ionated at apJpioved/hermit bCatim? QAtls v No
Method of Drilling: ise rotary U Cade tool
Depth of welt d )'o
Casing Type—WalThickress ' r� _inches
Diameter12_frhdres.depth jL6 few
UnerType: Aza-dz
CYrsing Stickup Above Gram a' Leet
Static Water Level:
Recover gate: 10 �^SIM
Method of Testing !7! /-
WellIntake Operrrg Type: D open end Qvj5i;�ihoie
;j Screenect Start feet Stopped feet
U Perforations Start feet Stopped feet
-i�oa/ t 6 K- ! a S <63
Grout Types �ka�
Depth Imm feet. to
& a � teat
Well Disk4ected Upas Completion? n No
Method of Dlsirdecti0rc C H� ti'C •-�" ���
acy
I qD hldc,o%� .
S', r Y S;4.Jo q
cc -,Pty All , x
�,C.•9..rn�ra..�� _ uJw; tic
iITENTTOm It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
hf Anchorage: Department of Health & Human Services and/or Department Of Env'umune ntat Conservation. Matsu Borough
)apartment of Erwiromental COnservation.
' MUNICIPALITY OF ANCHORAGE �J�
Development Services Department1�{ \�D'D
On -Site Water d Wastewater Program
4700 South Bragaw Street A
P.O. Box 196650, Anchorage, AK 99519-6650 ✓1i
(907) 343-7904 \\
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SWO40493
Date Issued: Dec 14, 2004
Expiration Date: Dec 14, 2005
Parcel ID: 051-092-61
Legal Description: SHAWN LT 1'
Design Engineer: 0024 Eagle River Engineering Services Site Address: 020907 BIRCHWOOD LOOP RD
Owner Name: PETE HALVERSON Lot Size: 43036 SO. FT.
Owner Address: PO BOX 670813 Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567-0813
This permit Is for the construction of:
❑,/ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage
All construction must be in accordance with:
1: •The attached approved design.
2. All requirements specked In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By.
Date:
Issued By. / Y'f✓' ` Date: t2 I e
09/03/03 11:27 FAX 9073438437 ROA LAND,USE
Municipality of Anchorage
�. Development Services Department
Building Safety DMeion
On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anchoragwak.us
(907) 343-79G4
ON-SITE SEWERIWELL PERMrr APPLICATION
FOR A SINGLE FAMILY DWELLING
0001
Parcel I.D. 05.1 -012 -&1 Permit Number SW
Property owner(s)_ PLrE • 14, i t_o/vP5vnJ Day phone G �v h ^ 2 /l �
Mailing address (1) Z1)2 /N 49CA t f ->u6
Mailing address (2) L' f{tA4,r�C / _< Zip Code 9 15-X7
Legal description (Lot, Block & Sub'd.) 5 tf 1A) SK R -0 % /
Legal description (Section, Township & Range) , Z: / 5_AJ 2 11,1 Sfe �
Lot Size `(3 o3GAcres/t�L Number of Bedrooms y
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only, ❑
Sewer and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑, Water Softening Unit ❑
Therapy Pool ❑
I certify that the above informatio is correct. I further certify that this application is being made for a
Single Family_ Dwellin and Is in7c!rda%e with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: % 3 Li Waiver Fees:
Date of Payment: 1 2,— •-7 — O LI Date of Payment:
Receipt Number: O Receipt Number
(Rw. MOO)
Eagle River Engineering ,Services
Christopher R. Wood, P.1~.
10421 VFW RD. Suite 201 (907) 694-5195 tel
Eagle River, AK 99577 (907) 694-3297 fax
December 7, 2004
Dan Roth
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Shawn Subdivision Lot 1
Narrative & Permit Application
Dear Mr. Roth:
Eagle River Engineering Services (ERES) has been contracted to design a new septic system and
well at the above referenced property. The proposed new 4 bedroom septic system and
replacement site will have very limited impact on adjacent properties for the following reasons:
1. The surrounding lots are all large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +20' distance from the proposed new
septic system, and no private wells are within 100' of the new system. Class C
wells are +150'.
3. This permit is for a new septic system and well.
4. Drainage will not be affected and is not a major consideration in our design.
Two test holes indicated that the underlying soil in the area for the septic system is generally
comprised of 4-5 feet of gravelly sand GW -SW underlain by brown clay CL material. Water was
present slightly above the clay layers, at 5.6 feet on Test Hole 2, and 4.8 feet at Test Hole 1. A
lift station and sand filter will be required for this system, due to shallow water table and
sand/gravel gradation. The water table was monitored for a week in November for water table
information. This work will not affect the reserve septic areas on adjacent lots. If you have any
questions please call our office at 694-5195.
Sincerely,
EAGLE RIVER ENG EERIN SERVICES
Christopher R. Wood, P.E.
Principal
\2003\04-122SEMCNARRATI VE.DOC
SCALE: 1"= 60'
LEGEND:
0 —
0 —
o —
UNDEVELOPED
BIRCHWOOD LP. ROAD
S 89' 16'08" E 149.89'
50' SEC LINE ESMT. ,
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SCALE: 1"= 60'
LEGEND:
0 —
0 —
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UNDEVELOPED
BIRCHWOOD LP. ROAD
S 89' 16'08" E 149.89'
50' SEC LINE ESMT. ,
zLOT 1
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1� 1HDPE
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1,500
TANK
4"
AEPTICl
REA
150.0'
LOT 2
a \ \ O
00 \ 000
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� DRIVE / v
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PROPOS>cu 4 RR CV
ROUSE / O
rn
/ PROPOSED
I/ WELL LOCATION•
100' MIELL ADIUSzoTEST HOLE '
MONITOR TUBE IN 89'49\11' W 147.73'
SEWER CLEAN 0 T
WELL HEISLER
EASEMENT
PROPOSED LEAC FIEL&\
DRIVEWAY \
� 3
\ � o
�pM
EXISTING CLASS \
"C" WELL
tt
I
N 89-49-11 " W 150.00'
LOT 1 EXISTING/CLASS
C' WELL
vt /
NOTES: EPTiC
1. NO KNOWN CURTAIN DRAIN ''�EA� \ /
2. NO KNOWN SURFACE H2O \ - _
WELL/SEPTIC SITE PLAN
LEGAL: SHAWN SUBDIVISION LOT 1
OWNER: PETE HALVORSON
CONTRACTOR: N/A
JOB# 04-122 DATE: 12/03/04 1 SCALE 1 "= 60'
EAGLE RIVER ENGINEERING SERVICES
10421 VFW RD. SUITE 201
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX. • (907) 694-3297
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Eagle River Engineering ,Services
Christopher R. Wood, P.E.
10421 VFW RD Suite 201 (907) 694-5195 tel
Eagle River, AK 995773294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM — MOA CERTIFIED INSTALLER
LEGAL: Shawn Subdivision, Lot 1
December 7, 2004
A. GENERAL
1. The replacement septic plan is for a 4 bedroom single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Ilealth and State Department
of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi -family wells. A licensed surveyor should locate any utility easements and exact 100'
radius from the existing and neighboring on-site wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. Any remaining open test holt excavations shall be filled and monitor tube removed.
B. SEPTIC TANK WITH LIFT STATION
1. The septic tank shall be an Anchorage Tank 1,500 gallon septic tank with integral OSI lift station
pump model OSI -05-20-I11-117, or other engineer approved configuration (example: 1250 gal septic
tank with auxillary lift basin of 250 gal min.)
2. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all
applicable codes.
C. BED
1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom.
2. The bottom of the bed shall be level, plus or minus 1.5".
3. The "depth above grade" of the gravel layer is not to be 0.5' as measured at the monitor tube.
4. Two (2) feet of MOA/DEC spec. bedding sand shall be utilized beneath the sewer rock, and shall
begin at 1.5 feet below the ground surface as measured at the monitor tube, or deeper if required to
remove all organic material.
5. The effluent lines (3) are to be 1" PVC lines with 1/8" holes drilled 36" OC within the Ieachfield,
placed face down, or up with orifice shields placed over holes. Line from tank to field is to be 1-1/4"
HDPE.
6. The bed gravel is to be covered with typar fabric material.
7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed
over the bed. Mounded side slopes not to exceed 3:1.
8. The septic tank and Ieachfield must not be closer than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
BOTTOM OF GRAVEL LAYER = 0.5' Above Grade at monitor tube
BOTTOM OF FILTER SAND LAYER= 1.5' Below Grade at monitor tube
GRAVEL THICKNESS = 6" under pipe, 2" over pipe
BED LENGTH= 50' BED WIDTII = 15'
SOIL RATING = 0.8 GPD/115 BEDROOM CAPACITY = 4
SEPTIC TANK = 1,500 Gal S.T.E.P or Engineer approved equal
0003\04-122Bed-lift- spee.doc
EFFLUENT PIPE =1" PVC with 118" holes oriented down, or up with orifice shields spaced at 36" OC.
Twenty-four (24) hours notice required for all inspections.
Additional Charges will be incurred for the 3 required inspections and preparation of septic
system as-builts.
\2003\04-1220cd-lift- spmdoc
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 6945195
ERES Project No.: 04-122
Calculated By: CW
Date: 12/07/2004
Legal: Shawn Lot 1
Single Family 4 Bedroom Dwelling
Bed Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom =
Percolation rate =
Wastewater application rate =
Required absorption area =
Bed width (W) =
Gravel depth (D) =
TEST HOLE 1 & 2
600 gallons
1.5 minutes per inch
0.6 gallons per day per square foot
750 square feel
15 feet
0.5 feet
Required length = Required absorption area / Bed width
Required length = 750 / 15
Required length = 50 feet
Total Excavation Depth = 1.0 feet
04-122 drainrieldCalc.xls 3:10 PM12/07/2004
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Municipality of Anchorage
Development Services Department
Building Safety Division
• yt On -Site Water and Wastewater Program
4700 South Bragaw, SL
P.O. Box 196850 Anchorage, AK 995198650
r www.d.snchoraae.ak.Us
(907) 3413-7904
Soils Log - Percolation Test.
Performed For. _PF -16 HALUOlUo/2 Date Perk
Legal Description: S tis At, 1/J SIAM 4-O r Township, Range, Section:
Depth
7 19P50T1. f 0 i^AoIrL,
a � ln1`SvJ
6' SAAvOy CAMJ61-
o wl totL'L6!j
- VOWOV ct-Ay
11�0110M Or T. H
11
COMMENTS
CE]Q387
L
WAS GROUND WATER, ,
ENCOUNTERED? .--LV.It 5
IF l'ES. AT WONT DEPTH7 ;f 'C7 / O
Depth to Rer
IeoneorIng? oringT 5 � r[ �
i
Reading Date Gross Time Net Tine Depth to Water Net Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
PERC HOLE DIAMETER
PERFORMED BY: GOk S y4m N I CERTIFY THAT THIS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT 0 THIS DATE. DATE:
Municipality of Anchorage
Development Services Department
Building Safety Division
>r.. On -Site Water and Wastewater Program
1700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cI.anchoraae. ak.us
(907) 343-7904
Soils Log - Percolation Test.
Performed For.. _i7ElE {-i�LliO�.'.SD/'�� Date Performed: 11116�0L.l
Legal Description: S H A t„) j j S%Af , !r0 r Township, Range, Section: j I S AJ1? / i,_3 _S I—
.1,^ 1
Depth
-YZ= 701>5;rL•+oRoVo
�/ coeaCt3
n= G, Vj- SW
1
17-
18-
19-
20-
COMMENTS
Gt 4-(
Y1V'To M O r T 1A -
WAS GROUND WATER
ENCOUNTERED? �ES
a e
IFVES,ATWINTDEPTH7y•�i L
Depth to WaterAner D
Monhortng7 E
Date: // lz gl A
PERCOLATION RATE 4� (.W.A akd) PERC HOLE DIAMETER
ourrccn n ANo
L
PERFORMED BY: C-li J S CERTIFY THAT THIS TEST VVAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT O THIS DATE. DATE: //l/o /
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel 1. D. Expiration Date:
1. GENERAL INFORMATION
Conntpletialegal-deslcrjoon
Location (site address),' � 6%,)?
.Current Property owner(s)Day phone
Mailing addrgss.'
Real or, Estate Agent q KF� S Day phone
2. TYPE OF DWELLING.
'a Single Family (w1wo ADU)
Ej Duplex . SURAWITTAL
El Multiple Dwellings (Single Family and/or Duplex) Lir0
?014
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY: TYPE OF wASTEWATER.61SPQqA
Individual Well Individual L:
Individual Water Storage Holding Tank ❑
Community Class Well El Community ❑
Public Water System ❑
Public Sewer ❑
Waiver/Variance request
Received Date:
COSA to b ed to the eng er, unless otherwise requested by the engineer.
COSA Fee
Date of Payment
Receipt Number
COS , A'# c),5 cjq N 2-9
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 C -f1'1 ,` 'OrM= 9R:V(6 Phone 102-"'�4 5559'
Address 3�P4 q-1 POGO` (S > ✓
Engineer's Printed Name C Est 13a"/n 1
6. DSD SIGNATURE p
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Date�waiai a�
0+s'49 iH
o'•� �
.... ���
,I;m. C 1.4
with the following stipulations:
I e/ / f
By: �A Original Certificate Date: -,2 �P, -ILI
ThenicipaU A orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSH) 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet r : c
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: Parcel ID: Ob —6 j
A. WELL DATA
Well type If A, B, or C provide PWSID # /U/
Well Log jSGiN) SFS
Date completed 14* /05 Sanitary seal O/N) _)B Wires properly protected i)N) YF.5
Total depthv?o0 ft: Cased to ft. Casing height (above ground) a y_in.
FROM WELL LOG AT INSPECTION
Date oftest _ I/aD/0' 5 7/J(/1V
Static water level ft. 132—
ft.
Well production to g.p.m. f 5
g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 mL Nitrate 0 _ mg/L
Arsenic U ug/L Date of sample: 7/6011 Collected by: 24k1 -Vi
B. SEPTICIHOLDING TANK DATA
Tank Type/Material. Date installed 51d wi7og, S
Tank size I �b . gal. Number of Compartments -2:,, Cleanouts (®'N) YC 5
Foundation cleanout ON.)) Depression over tank (Yl(§) >� A10High water alarm (Y/W /V
Date of pumping 7/* //� Pumper 2ANS TA -1?, s
od
C. ABSORPTION FIELD DATA
Date installed ��� f% ' :.SQiI rating (g.p.d./ft2 or ft2lbdraa) O. SJ System type
Length _ Jc z ft. dth 1 ft. Gravel below pipe 06 ft.
Total depth' ft.� ., Eff. absorption'area Z 52 ftZ Monitoring tube �C5 Depression over field X/0.
Date of adequacy test.7/1 V 1�1 ' Results /Fail S
a (� ) For bedrooms
Fluid depth in absorptionfield'before test_0 in. Water added 4 6c gal. New depth --C— in.
Elapsed Time.: �.� min. Final' fluid depth 0 in. Absorption rate >= 0c:;' g,p,d,
Any rejuvenation (6atmenQpas62 mo.) (Y/®& type) N6 NoNr li NOt/n/ If yes, give date_
D. LIFT STATION NO (-.l P7—
Date stalled Size\test
"Pump o " level at in. "Puel at in.
Datum Cycl
E. SEPARATION DISTANCES
WELL ON LOTTO:
Septic tank/lift station on lot 414V
Absorption field on lot ^E I&P /
Public sewer main 4.1W i
Sewer /septic service line f SD
i
Animal containment areas -F(mD
nholelAccess (Y%N)
High Iter alarm level at in.
Meets ala & circuit requirements?
On adjacent lots
On adjacent lots
4 [c9 D
�Ov
Public sewer manhole/cleanout (Q�
r
Holding tank
Manure/animal excrete storage areas rF OU
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation -L 5 Property line 'E S Absorption field--tS
Water main �
Water service line 4(& r Surface water -f Wog
i
Wells on adjacent lots t SD
ABSORPTION FIELD ON LOTTO:
r
Property line l,,9 Building foundation (o
� r
Water Service line Surface water (067
Curtain drain f 5 D Wells on adjacent lots 6aD
F. COMMENTS
l
Water main -E fc2 /
Driveway, parking/vehicle storage rt2 5-
G.
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 CO/SA guidelines in effect on this date.
Engineer's Printed Name! ,ti —re! tl�rn/Ml
Date
COSA brown sheet_10-10-12.doc
*;
CE•13854
Municipality of Anchorage e
Pr
Community Development Department
Development Services Division s,
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval 4 141424
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
1 of Shawn Subdivision. This inspection revealed an arsenic concentration
of 11.8 micrograms per liter (ug/L) for the property's well water sample.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems.
While private wells are not subject to this regulation, EPA standards are
based on existing health information and can therefore be used to gauge the
relative quality of water from private wells. Information on arsenic is
available from the On -Site Water and Wastewater Program website
(www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Cygtemc Aprnro . al.
vmcrL6
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
Parcel I.D. 051- 09a- - to 1 HAA # 0 Er D 6 5-1
. t, Expiration Date: .14 — 3 - Co
1. GENERAL INFORMATION
Complete legal descriptio0 f#"—v y LOT /
:Location (site address or directions) 144enywoob LOOP . A4b
Current Property owner(s) 'PETE Nf+LLVE: /e tON Day phone
91 Mailing address ,.. O• Rn>c�oS
I3 Chygia/,Rn>c�0813 Chygia/� AP, 'nSTo-7-
0/83
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
9
Individual Water Storage
❑
Individual Holding tank
.❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 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. (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.
Eagle River Engineering Services
Name of Firm 19421VRA9 A-1,iMa _ Phone 69N-5/95
Address Eagle River, AK 99577
Engineer's Printed Name rt7i!2§t ell -Cr- Pe. M)Wef Date 0/2i�O�7_
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
TEE
CHRISTOPHER R
CEL
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: �• �"" ` Original Certificate Date: 3 ' Cv
(Rev. 01002)
Municipality of Anchorage
• �' Development Services Department
Building Safety Division .
On -Site Water & Wastewater Program '" "`
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: E I `c6Lu11'i dZ 1 Parcel ID: o5(- 6141 - A I
A. WELL DATA
Well type a�l04 t-. If A, B, or C provide PWSID # _
Date completed !/.1-0/0 S. Sanitary seal ON) (. „-1.
Total depth eft. Cased to 174 ft.
FROM WELL LOG
Date of test I ./,P0/O5
Static water level 55 ft.
Well production In 9 P.M.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate 0.17 mg./l.
Arsenic: mg./I. Date of sample: It /Z 'VW*
rsTZ0W7
B. SEPTIC/HOLDING TANK DATA
Tank TypelMaterial [402ACI 5,144,1
Tank size ,154 gal. Number of Compartments 2 -
Foundation cleanout &N) Depression over tank (Y&
Date of pumping `Atw) Cons -L. Pumper
C. ABSORPTION FIELD DATA
Well Log (9N)
Wires properly pr6tectedON)
Casing height (above ground) -24 in.
AT INSPECTION
ft.
Other bacteria colonies/100 ml.
Collected by: Ciy4kas 94t2fr i.uE
Date installed X�3ooS
Cleanouts&N) d
High water alarm (Y& �-ru
Date installed Soil rating (g.p.d./ftZ or ft2/bdrm)D� System type Bcc[
Length SD ft. Width 15' ft. Gravel below pipe 0 . to ft.
Total depth Q ft. Eff. absorption area _f11= Monitoring lube � Depression over field �2
Date of adequacy test !21Results (�Fail) ¢
For LP_ bedrooms
Fluid depth in absorption field before test __ in. Water added_ gal.New depths in.
Elapsed Time: _r min. Final fluid depth _,QL in. Absorption rate >= 0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/O& type) 1-f'� k rt LJ*i If yes, give date ki la.
D. LIFT STATION
Date installed
"Pump on" level at _ in.
E. SEPARATION DISTANCES
Size in gallons
'Pump off"
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift-station on lot t/00
Absorption field on lot -r 1W '
Public sewer main +76,
Sewer/septic service line *'.xS ,
Manhole/Access
water alarm level at
Meets alarm & circuit requirements?
On adjacent lots +/00 f
On adjacent lots _ -r /00 '
Public sewer manhole/cleanout t/00 '
Holding tank +'7 5' '
SEPARATION DISTANCES FROM SEPTIC/1 16E94116 TANK ON LOT TO:
Building foundation +'S' Property line +19 ' Absorption field t-5
Water main f'f O ' Water service line 'Y r O ' Surface water 4-1 OU'
Wells on adjacent lots +100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line +10 ' Building foundation 1,10 ' Water main -r to 1
Water Service line + /0 ' Surface water ++
Curtain drain t50 ' Wells on adjacent lots +100
F. COMMENTS
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 HAA guidelines in effect on this date.
Engineer's Printed Name i!�hrr 490d2bti' A bU00d
Date /2/L4 /44
HAA Fee $ " �� 0
Date of Payment _ ` a -T
Receipt Number ?To 9 2
(Rev. 12/01)
Driveway. parking/vehicle storage .2T
Waiver Fee $
Date of Payment
Receipt Number
:
in.
12-27-05;15:32 ;
;907 561 5301 # 2/ 2
200 W. POTTER DRIVE
W$— SGS/CT&G ENVIRONMENTAL SERVICES ANCHORAOEt ALASKA 99519
TO. 907 -S@2 -n43
Fax: 907-581-5301
Drinking Water Analysis Report for Total Coliform Bacteria 1058312'-
RE" WITRUC71c RE ON "VMS eros BEFORE COLLEGM tufts
MUST RE COMPLETED BY WATER SUPPUGR I II INNIMHO
13#0= WATER sysu 1 ma _
❑ PRIVATE WATER sTETDA ` —• —_ ~ __
0 a.mr R..ewt mr a«d I n. -
Q' and Rauh 135-d!
SAMPLE COLLECTION:
COWnR
Tnn.perW
b Lab Br: ❑ Same as tanwar
TO Be COMPLETED BY LABORATORY
�Lliate..RKelVina•
Dal.: i2.22.
Deay.ry Mau
Received
Cen.e.ng
SAMPLErMi
0 Reran.
❑ Repast Semple
(rehrto Inkno.
❑ spatial punme
13 Treated Water
13 Unmated Witter
eeroee"'7ehm"ew 13 RUSH SAMPLE
ROWAN sop M unr.e.Me
Phone E;
Fax R•
.................................................................................................................................... e........
.. MMO-WO P VAt R2SMTa:
A.ayeloWEont /2�ZL�RS�/7?O ToWCoeramc
AfWpL — r� LGh,
A vuoM MNirodt
fi.mbreno Filler
MMO•MUG (NA)
a.pan.d ey: ,.
NOORARe ALM RUUL�T�et(+
ok"C..nt Col.nlwl00ml
vs awsee,t
tra+..r —CLTa:
writ+.. tC'
e.nl.rAoet:
ANO FSK JUN
aeglTYtr�
seri in CMnt
75--Sethractory
0 Unsatisfactory
Cd M -dw.ra..i.n.
Foml a FW OOa7 12n7N3
12-28-05;17:00-&a%-
;
;907 561 6301 # 2/ 4
SGS Ret l
1057826001
All Datcsrrlmca arc Alaska Standard Time
Client Name
Eagle River Engineering
Piloted DateMma
12/07/2005 16:53
Project Namem
Shawn LOT 1
Collected Date/time
11/29/2005 10:50
Client Sampk ID
Shawn Lot I
Received Dateltlme
11/29/2005 12:20
Malls
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable Ptcp Analysts
P.nmerer Results POL Units Momod ConminerID Llmiu Date Date Ink
Nitrate -N 0.137 0.100 mg/L EPA3532 a (410) I1r29105 JC
Microbiology Laboratory
coV100mL SM2092228 A (o-1)
IIIM,L4f fA0
ASBUILT
�O/.fCiylGCY7d trop ewe
n
_ iyB�%6 p6 W iY9• /9
HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE:
-OLLOWING DESCRIBED PROPERTY=
S.s/.ali.cvs 1GB DoT/ [DRAWNs
TE
ND THAT NO ENCROACHMENTS EXIST EXCEPT AS
NDICATED. IT IS THE RESPONSIBILITY OF THE
WNER TO DETERMINE THZ EXISTENCE OF ANY ID,
ASEMENTS, COVENANTS, OR RESTRICTIONS �✓wi�J7
'HICH DO NOT APPEAR ON THE RECORDED SUBDI—
ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD,
VY DATA HEREON BE USED FOR CONSTRUCTION /o6•�z o
F FENCE LINES, OR FOR ESTABLISHING BOUND -
4Y LINES.
�.•►1
OF At
'...i3 ..... d�
..... M..t 6.-..-e
LS -6918 •` `Aj
•.
Municipality of Anchorage
Development Services Department
+� Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: hris Wood
Legal description: Shawn Lot 1
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. Does bed have 6 insches topsoil and seeded.
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted. _
❑ Topographic information missing or inadequate. _
® Incomplete; missing Class' C' well must be located on Inspection Report
® Incomplete; missing Need New test hole North of primary and reserve sites Primary and
reserve sites moved from permit.
❑ 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. Te
Date: 12-29-05
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK