HomeMy WebLinkAboutTHE TABLELANDS BLK 8 LT 11The Tablelands
Block 8
Lot I I
#051-801-51
Municipality of Anchorage
•,
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St
P.O. Box 196650 Anchorage, AK 9951 M650 Page /of 3
www.ci.anchorage.ak.us (907) 3417904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number..-510060 03? PID Number:
Name
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Inspections performed by: AGr R,m GTg • Dates: 1" el'old
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Services Department Approve:
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Conditional Approval Date:
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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
Permit Number: SWO60039
Legal Description: Tlhe Tablelands Block 8 Lot 11
Design Engineer: 0838 NORTH RIM ENGINEERING
Owner Name: Spinell Homes
Owner Address: 1900 W. Northern Lights
Anchorage , A 99567 -
Date Issued: Mar 21, 2006
Expiration Date: Mar 21, 2007
Parcel ID: 051.801-51
Site Address: 22546 Sanbar Loop
Lot Size: 400004 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
Q Disposal Field M 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 catling
(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.
-THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST
BE VEGETATED SUFFICIENTLY TO PREVENT EROSION.
Received By.
�rJ
Date: 3/210(,
Date: ? L1 o
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 07 s01 r S 1
Property owner(s)_Z7jTtAlir L Day phone 3f�z- SL' i op
Mailing
Site address S
0
Code
Zip Code 5 p s/ %
q ps6_ r)
Legal description (Sub'd, Block & Lot) 7a •0 , 1, 'Re' L//
Legal description (Township, Section & Range)
Lot Size dOi00ui Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
Septic Tank
[-
Holding Tank
(�
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
Upgrade
❑
Renewal
❑
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.
c5;TZ1
(Signature of property owner or autj)drized agent)
Permit/Rush Fees: L/ to 0 Waiver Fees:
Date of Payment: Z ' Z - 0 G Date of Payment:
Receipt Number: Q 3 Receipt Number:
(Rev. 11/05)
[\C2TINEERHER N
ENGING
Northitim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907.694-7028
March 10, 2006
MOA On -Site Water & Wastewater Program
ATT: Joe Goodall
4700 Bragaw St
Anchorage, AK 99519
RE: The Tablelands, Block 8, Lot 11, 2 o REDESIGN
Dear Joe:
After conversations with your office, we have redesigned to a bed system & moved the
system upslope to the front of the lot. The bed system is elevated.
We believe that this will address the groundwater issue. We will continue monitoring the
site and change the design if necessary.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
Steve Eng, PE, PH
Design Enclosures
�G2Th�IM
ENGINEERING
NorthRim Engineering
17237 Bear Pow Circle
Eagle River, AK 99577
907-694.7028
March 6, 2006
MOA On -Site Water & Wastewater Program
ATT: Joe Goodall
4700 Bragaw St
Anchorage, AK 99519
RE: The Tablelands, Block 8, Lot 11, REDESIGN
Dear Joe:
We are submitting this redesign for the proposed wastewater system. We have included a
TH2 by Mike Anderson that was monitored for groundwater during the fall high water
period. This T112 is about 50' from the proposed trench. The proposed disposal field has
also been elevated to grade. We believe that this will address the groundwater issue. We
will continue monitoring the site and change the design if necessary.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Si I
Steve Eng, PE, PH
Design Enclosures
CNN
ER
ENGINEERING
NorthRim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
February 23, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: The Tablelands, Block 8, Lot 11
A 4 bedroom home is planned for the subject property. The soil tests were favorable.
Groundwater was monitored in existing tubes and was absent. A conservative design has
been completed, with a large separation to groundwater.
The neighboring lots are mostly developed. This site should not negatively impact any of
the other area lots. The lot slope is relatively flat.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
i�
Steve Eng, PE, P7
Design Enclosures
2TF��IM
ENGINEERiNG Tablelands S/D, Lot 11, Block 8
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is a new 4 -bedroom, single family home. Some of the
neighboring lots are not yet developed. Groundwater was monitored during the high time
of the year in existing subdivision test holes and was not present. This redesign moves
the wastewater leach field upslope on the lot. We have redesigned to a bed system to be
at grade to ensure separation to groundwater. Due to seasonal groundwater fluctuation, a
S.T.E.P system will be installed, manufactured by Anchorage Tank & Welding per
Orenco Systems specifications. This lot is over 1 acre in size and no adverse impacts are
expected from development. The neighboring lots are similar. A I' lot line waiver is
being requested. The lots are served by a public water system. No conflicts to the other
lots will take place by this septic system construction. The easements are located on the
drawing and are not encroached upon. Soil tests revealed sandy soil with low silt. An
application rate of 1.2 GPD/FP for a V effective depth bed. Bed Dimensions = 500
FP/30' = 16.66', say 17'. 3 lines @ 25'. No bedrock was encountered.
Specification Requirements: All components and work must comply with the Municipality
of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and
Wastewater Regulations.
• Two compartment, 1500 gallon S.T.E.P. tank, conforming to Anchorage Tank &
Welding/Orenco Systems Specifications, allowing gravity -flow from outlet.
• Watertight couplings on inlet & outlet
• 5' minimum between the tank and bed. 10' to property lines.
• 2' of cover is required for trench + 1 inch insulation board.
• Tank & solid pipe must be set on well compacted, stable soil
• 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall,
prior to any 90 degree bend in 4 inch line.
• All cleanouts must extend to at least ground level
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -rock
• Drain rock to be %2 inch to 2 %2 inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Distribution pipe shall be 1.25" Schedule 40 PVC w/ 1/8" orifices n 27" on center.
• Force main shall be 1.25" Schedule 40 PVC, conforming to Anchorage Tank &
Welding/Orenco Systems specifications. Force main burial to be 4' minimum.
• Silt barrier (filter fabric) to be installed above the drain rock
• Smeared trench sides must be raked or scarified before drain rock placement
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS
ASTM D2661, PVC Schedule 40.
• Sewer Service Line is minimum 2% slope
• Septic Tank to be pumped every two years or when required
• Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam III or equal)
• Maintain minimum 10' separation between water line & wastewater system.
• Topsoil & seed the elevated trench
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Lots Served By Public Waterl yste`m
r —__ --- V 60'__
NORTHRIM y�".•' TABLELANDS S/D
ENGINEERING *'4 • .....'... S/D
117237 Bear Paw Circle :..... o....... LAYOUT
Eagle River. Alaska 99577 a-•w ,yam
907.694.7028 r LOT 11, BLOCK 8 ---
1 2/22/06 12 of 4
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGALDESCRIPTION: LOT 11, BLOCK 8, TABLELANDS S/D
PERFORMED FOR: _ PISANO'S
DATE: 10/11/2005 PROJECT No..,
PARCEL IDX: TECHMCIAN: M FI DRIDC.F
DF.PT11 TEST HOLE # 2
0m)
1
2
3
5
6
7
8
9
10
11
I
11
9 . •
SILTY SANDY -GRAVELS
SM -GM
CI.m
SITE PAN
TH2
O
6.PUE
SEE FUTURE ASWILT
0% >25%
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
D(INCHES) EPTH OF
WATER
INET DRQP
(INCHES)
I0/11/05
TEST HOLE PRESOAKED FOUR HOURS PRIOR TO TESTING:
1
1410
11,0"
CHARGE
2
1440
30
10.375"
0.625"
3
1440
11.0"
RECHARGE
4
1510
30
10.25"
0.75"
5
1510
11.0"
RECHARGE
6
1540
30
10.25"
.75"
PERCOLATION RATE• 40 (MTN/INCII) PERC. IIOLE DIA 6 (INCIIES)
TEST RUN BETWEEN: 4.5 FT. ancL 5.5 FT.
WAS GROUND WATER ENCOUNTERED? NO IF YES @ WIIAT DE•PTII?
DEPTII OF WATER AFTER MONITORING: NONE DATE OF MONITORING: 10/19/05
TEST HOLE PRE SOAKED PRIOR TO TEST.
I, MICHAEL E. ANDERSON CERTIFY THAT TI ITS TEST WAS PERFORMED IN ACCORDANCE WITII ALL
M
STATE AND MUCIPLE GUIDELINES IN EFFECT ON THIS - d u/ bt
1 \
\ S❑ILS LOG - PERC❑LATI❑N TEST
T1 IM Date Performed: 2/17/06
Lr7lll
Performed For: Spinell Homes
Legal Description: Lot 11, Block 8
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
Slope @ 10%
Groundwater? No
Depth
Water Depth
After Monitoring. None Date: 2/23/06
Percolation Rate
Test Run Between
Perc Hole Diameter 6'
Comments:
Performed By NorthRim Eng. I �' 7— CERTIFY THAT THIS TEST WAS
Performed In Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 2/23/06
j
NORTH RIM
Organic
'
17237 Boor Pow Clrel
Cagle River. Alaska 99577
ate.
SP
Sand
w/Gravel
Slope @ 10%
Groundwater? No
Depth
Water Depth
After Monitoring. None Date: 2/23/06
Percolation Rate
Test Run Between
Perc Hole Diameter 6'
Comments:
Performed By NorthRim Eng. I �' 7— CERTIFY THAT THIS TEST WAS
Performed In Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 2/23/06
j
NORTH RIM
ENGINEERING
17237 Boor Pow Clrel
Cagle River. Alaska 99577
ate.
�
07-694-7028
TABLELANDS S/D
GE❑TECHNICAL T,H, 1
LOT 11
BLOCK 8
?3/06 1 of 3
y S❑ILS LOG - PERC❑LATI❑N TEST
T �
Date Performed: 2/17/06
Pr\l
gINEERING
Performed For; SpineR Homes
Legal Description: Lot 11, Block 8
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
Organic
SP
Sand
r.:: >:• •:; w/Gravel
Slope 2 10%
Groundwater? No
Depth
Water Depth
After Monitorino. Date,
#
Date
Gross Time
Net Time
Depth
Net Drop
1
2/17
0
--
4'
--
2
2/17
4
4 Min.
5'
1'
3
2/17
8
--
3'
--
4
2/17
12
4 min.
4'
1'
5
2/17
14
--
3'
--
6
2/17
18
4 min.
4'
1'
Percolation Rate 4 min./Inch Perc Hole Diameter 6'
Test Run Between 3' and 4'
Comments, PrP-SnnkPd
Performed By NorthRim Fng, I —
Performed in Accordance with All
ON THIS DATE. DATES 2/23/06
'Z- CERTIFY THAT THIS TEST WAS
State/Municipal Guidelines in Effect
TABLELANDS S/D
GE❑TECHNICAL T.H. 2
LOT 11
BLOCK 8
2/23/06 12 of 3
NORTHRIM
yP��.....
i ENGINEERING
' '49
17237 Bear Pow Circle
Eagle River. Alaska 99577
.""
a w
907-694-7028
'Z- CERTIFY THAT THIS TEST WAS
State/Municipal Guidelines in Effect
TABLELANDS S/D
GE❑TECHNICAL T.H. 2
LOT 11
BLOCK 8
2/23/06 12 of 3
L \ S❑ILS LOG - PERC❑LATI❑N TEST
hI
TDate Performed: 2/17/06
ENGINEERING
Performed For: Spinell Hones
Legal Description: Lot 11, Block 8
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
DEPTH
(FEET)
Organic
'•• SP
Sand
r.:'. ;;• •: w/Gravel
Slope 2 10%
Groundwater? No
Depth
Water Depth
After Monitoring, Date:
#
Date
Gross Time
Net Time
Depth
Net Dro
1
2/17
0
--
6'
--
2
2/17
4
4 Min.
7'
1'
3
2/17
8
--
6'
--
4
2/17
12
4 Min.
7'
1'
5
2/17
14
--
6'
--
6
2/17
18
4 rain.
7'
1'
Percolation Rate 4 min./inch Perc Hole Diameter 6'
Test Run Between 3' and 4'
Comments: PrP-Snnked
Performed By NnrthRim Fng, I
Performed in Accordance with All
❑N THIS DATE. DATES 2/23/06
NOR THRI M
ENGINEERING
177237 Bear Paw Circle
Eagle River. Alaska 99577
907-694-7028
N.w p
2- CERTIFY THAT THIS TEST WAS
State/Municipal Guidelines in Effect
TABLELANDS S/D
GE❑TECHNICAL T.H. 3
LOT 11 j
BLOCK 8
2/23/06 33 0f 3';
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.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: NORTH RIM ENG
Legal description: TABLELANDS BLOCK S LOT 11
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. -
0 Other. -SITE PLAN SCALE INCORRECT. A TEST TO DETERMINE THE DEPTH OF THE GROUNDWATER SHALL
BE NO MORE THAN 30 FEET FROM THE PROPOSED SUBSURFACE DISPOSAL FIELD. AVAILABLE HISTORIC DATA
INDICATES THE HIGHEST SEASONAL GROUNDWATER LEVEL MAY BE WITHIN 4 FEET OR LESS BELOW THE
BOTTOM OF THE PROPOSED SUBSURFACE DISPOSAL SYSTEM. 'NEED TO DO'GROUNDWATER MONITORING
THROUGH MAY 15TH: THE RESULTS OF GROUNDWATER TESTING MUST BEAR ORIGINAL SIGNATURE AND STAMP
OF ENGINEER.
7y(b-7 rc�:�rcl �� ?•H C"e ►j/ /-�"'colA)11 nv Fn TF or yo •,.v�v
Name of reviewer: JOE GOODALL
Date: 3/1/2006
Please supply the necessary information and re -submit your request.
Parcel I.D. 051-801-51
Municipality of Anchorage a .
On -Site Water and Wastewater Program�' w
(907)343-7904 sxrcrr
Certificate of On -Site Systems Approval
Expiration Date: /0 3 " 15-
1. GENERAL INFORMATION
Complete legal description The Tablelands, Block 8, Lot 11
Location (site address) 22546 Sambar Lp.
Current Property owner(s) William Claar Day phone
Mailing address
Real Estate Agent
22546 Sambar Lp.
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
0
Public Sewer
❑
Waiver/Variance
1 ,
Received by: t t', � 6/ � Date:
COSA to be released to the 4
eer, unless otherwise requested by the engineer.
COSA Fee $ Lig 6
Date of Payment Id �q nI3
Receipt Number 67
COSA# r3SC/3JS2,S'
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
If more than 7 septic system is on the lot:
COSA Checklist # of
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: The Tablelands, Block 8, Lot 11
A. WELL DATA
Well type Public If A, B, or C provide PWSID # AWWU
Date completed Sanitary seal (Y/N)
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate
Arsenic ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
mg/L
Parcel ID: 051-801-51
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Collected by:
ft.
g.p.m.
Tank Type/Material Septic/Steel Date installed 4/10/06
Tank size 1,250 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) N
Date of pumping V3>/.lo t 3 Pumper P _rrt1-S
C. ABSORPTION FIELD DATA
Date installed 4/10/06 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/BR System type Bed
Length 30 ft. Width 18 ft. Gravel below pipe 1 ft.
Total depth 4.3 ft. Eff. absorption area 540 112 Monitoring tube Y Depression over field N
Date of adequacy test 10/3/13 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 622 gal. New depth 0 in.
Elapsed Time: 130 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date
Municipality of Anchorage
Development Services Department
Building Safety Division c
On -Site Water and Wastewater Program S. t"
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
051-801-51
Parcell.D.
1. GENERAL INFORMATION
COSA # 10003: )
Expiration Date: 3 - a (o -
LL -
Complete legal description The Tablelands Block 8, Lot 11
Location (site address) 22546 Sanbar Loop
Current Property owner(s) Brandon Thompson Day phone 688-4288
Mailing address 22546 Sanbar Loop
Lending agency Day phone
Mailing address
Real Estate Agent Eric Bushnell Day phone 360-7471
Mailing Address Prudential
Unless otherwise requested, COSA 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
Q
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 0
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 and/or water
supply system. DSD also issues COSAs 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 engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-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 NorthRirn Engineering
Address P.❑. Box 770724
Phone 694-7028
Engineer's Printed Name Steve Eng Date
0
r ,` Steven . W. Eng
'
RE
PE 75
5. DSD SIGNA proved for bedrooms. gee%80ce pFEs;q, .
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: v" • Original Certificate Date:
(Rev 11J05)
Municipality of Anchorage
•7q Development Services Department °
Building Safety Division
On -Site Water & Wastewater Program y "�
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: The Tablelands, Block 8 Lot 11 Parcel ID: 051-801-51
A. WELL DATA
Well type _ If A, B. or C provide PWSID # _ Well Log (YIN)
Date completed_ Sanitary seal (Y/N) _ Wires property protected (YIN)
Total depth ft. Cased to ft. � Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level off% ft. P� ft•
Well production g.p.m. 9 P•m•
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
Arsenic: ug/L date of sample: _ Collected by:
B. SEPTICIHOLDING TANK DATA
TankType/Material Anrhnrnnp Tonk/Steel Date installed 4/10/06
Tank size --4gOgal. Number of Compartments _P Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping x/15/10 Pumper 1131s
C. ABSORPTION FIELD DATA
Date installed 4/10/06Soil rating (g.p.d./fO or ft�/bdrm) 1.2 System type Bed
Length 30 ft. Width 18 ft. Gravel below pipe 1 ft.
Total depth 4 ft. Eff. absorption area �40ft Monitoring tube Y Depression over field N
Date of adequacy test 3/15/10 Results(Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test _L in. Water added 60gal. New depthN In.
Elapsed Time: L5nin. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) unk If yes, give date
D. LIFT STATION
Date installed no
'Pump on' level at no in.
Datum no
E. SEPARATION DISTANCES
Size In gallons no Manhole/Access (Y/N) no
'Pump off level at no in. High water alarm level at na in.
Cycles tested no Meets alarm d circuit requirements? no
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot no
Absorption field on lot
Public sewer main
no
no
On adjacent lots
On adjacent lots
no
no
Public sewer manhole/cleanout NA
Sewer /septic service line no Holding tank NA
Animal containment areas no Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' + Property line 1n, + Absorption field g• +
Water main Ig.. Water service lines Surface water
Wells on adjacent lots 2D0• +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line a, x Building foundation r n•+ Water main 30.+
Water Service line 10' + Surface water 100' + Driveway, parking/vehicle storage 10' +
Curtain drain NA Wells on adjacent lots 200' +
F. COMMENTS
117 %J rVC
G. ENGINEER'S CERTIFICATION
I 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.
Engineer's Printed Name Steve Eng
Date
COSA Fee
Date of Payment
3/22/10
d
Receipt Number % C
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number_
.. ;. .......
.rc�...................
�- Sloven W. Eng .W
C 6256 `.
\ Municipality of Anchorage
• -� Development Services Department
Building Safety Division "
Onsite Water and Wastewater Program `
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. t%l M - 6-1 COSA # 044{0
Expiration Date: q—
1. GENERAL INFORMATION
Complete legal description %�C 72131 6(.AZA J 940 V_ A- P 407—
Location (site address) 225'q6' SAN8.42 40af
Current Property owner(s) S 2&6aC A -JC NFA Day phone _3UU- Xe7gF
Mailing address zeloo 4VFST- Na/ZrA4W UC6Ft
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA 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 iz
Individual Water Storage ❑ Individual Holding Tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System Public Sewer ❑
- #�-&UIuuNainy-ueveiopmenwervices-uepartment{05D)Jssues-Certificates-of-Onsite 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 and/or water
supply system. DSD also issues COSAs 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-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 riles 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 Firrn
Address / 7.13 7 �_ 0_a(t %
Engineers Printed Name 757"Ek/E E.VK'
S. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone 70 Z ?
Date /
k.4
tp
.'C4�C ••........, qS, 1t
=.;Iz_.�,r+ '•.910
r... ..��`,_ ,
=:4
st,.,.,, W. ens / ; '4;.4
Pf 6756
l $1.: ..
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: v''=� — Original Certificate Date:�L�
(R". I IMS)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program '
4700 Bragaw Street
P.O. Box 19885o
Anchorage, AK 99519.6850
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
-e So1-5/
Legal Description: 2WC T.4({(,E AdAt iff4ock 8 L a 7- /1 Parcel ID:
A. WELL DATA PuBLlC.
Wen :ple
Date ted
Total depth ft.
If A, B, or C proFft.
to #
Sanitary seCased to
FROM WELL LOG
Date of test _
Static water level
Well production
WATER SAMPLE RE LTS:
Coliform oniesH
Arsenic: mgA
00 mL Nitrate
B. SEPTICIHOLDING TANK DATA
ft.
g.p.m.
Data of sample:
Well Log (Y/N)
Wires properly protected I
Casing height (abov nd) in.
AT INSPECTION
ft.
g.p.m.
mg/L / Other bacteria colonies/100 mL
Collected by:
Tank TypefMaterial A/ 041 AC re&X / /S %E0 -f—
Tank size 4Z 50 gal. Number of Compartments 2
Foundation cleanout (YM) Depression over tank (YM) A( -
Date of pumping IyEGaI Pumper
C. ABSORPTION FIELD DATA
Date installed "./in
Clearouts (Y/N)
High water alarm (YIN) IV
Date metalled 40�/[QVo 4�, Soil rating (g.p.dR or ftrlbdrm) _�
System type a
Length SO ft. Width /8 ft. Gravel below pipe _L ft.
Total depth —* ft. Eft. absorption area `SQfe Monitoring tube —1— Depression over field 6
Date of adequacy test A(lr$l % Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test _ in.
Elapsed Time: _ min. Final fluid depth
Water added_ gal.
in. Absorption rate >=
New depth_ in.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date
...
D. LIFT STATION
Date installed Size in gallons Manhole/Aocess (YIN)
'Pump on level Zin- 'Pump off" level at in. High water alarm ei at in.
DatumCycles tested Meets alarm requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic t/station lot
AbsorpPublic sSewer /lineAnimalreas
Po&/c ire
On adjacent lots
On adjacent
Public sewldr manhole/cleanout
excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S t Property line /Q /4- Absorption field S +
Water main O �t Water service line / 4 Surface water / O G r�
Wells on adjacent lots Z6 Ort
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line � Building foundation � Water main /Q /f
If
Water Service line Al T Surface water /OQ /,4 Driveway, parlcirg/vehide storage AQrs
Curtain drain
F. COMMENTS
-r
G. ENGINEER'S CERTIFICATION
Wells on adjacent lots 0-6 c -0'-
Al 0 7-
"
Al07- 11"Ao4C7-
i cenVy that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines /n effect on this date.
Engineer's Printed Name E'Af k
Date
L CTS n r
OF
Srwsa W. E
�ti• PE 6456 j
COSA Fee $ 59- 15Z Waiver Fee $ lqy
Date of Payment /// a& Date of Payment (i o b
Receipt Number q qp B Receipt Number E&o27✓'
(Rev. 11/05)
Municipality of Anchorage
Development Services Department .�
r Building Sallcty Division
On-Sitc Watcr and Wastcwatcr Program <
4700 Bragaw Strcct
P.O. Box 196650 Anchoragc, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: 060056 PID#:051.801-51 HAM 060446 Permit#: 060039
Date Received: 9/16106
Legal Description: The Tablelands Block 8 Lot 11
Engineer. Steve Eng
Waiver Requested:_2 feet separation distance absorption field to property line.
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
...............................................................................
Waiver Is Granted: ✓ Waiver is not Granted.
List Conditions or Reasons for above:
Date: `7 I g ' O G By: �J--�e
(-I Nar6e& Reviewer
........................................................................6606...
Rec#: 9-18-06 Amount: $175.00 Date Paid: 9-18-06
Mayor Mark Begich
Municipality Of Anchorage
CO. Ibx 1!MMKO • Ancimnige, Aht lui!X69M.W4) • lcicphonc (107),'43 -SU) I • rnx (!0)7) 333-RLIM)
47(X) ling nc Swet • Anvh(.mgc,.Vnslur!Y.i )7
uAm.munLnq;
9/18/2006
Steve Eng
North Rim Engineering
I3uiltling Safety M%Islon
Subject: Waiver Request for The Tablelands Block 8 Lot 11
Waiver Request #WR060056
Parcel ID #051-801-51
IIAA# 060446 Permit # 060039
Dear Engineer,
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 2.0 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,
Jeffrey W. Poet
Engineering Technician
On -Site Water & Wastewater Program
Communhy, Security, Prosperity
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