HomeMy WebLinkAboutSHACKLETON LT 23A-4Shackleton
Lot 23A-4
#016-141-48
\ Municipality of Anchorage
.� Development Services Department
4-�O
Building Safety DivisionOn-Site 4. M -
Water 8 Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 2
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW020127 PID Number: 016-141-48
Name: JAMES &TRACY STEELING
Wastewater System: ❑ New ■ Upgrade
Address:
110 JOAN COURT, ANCH, AK 99515
ABSORPTION FIELD
Phone: No. of Bedro m
(907) 349-8729
ODeep Trench ■$hallow Trench Oeed OHound OOther
LEGAL DESCRIPTION
Sail Rating:
1.2
ram, Depth horn Original prod.:
GPD/Sq.
n 14.0 n.
Block: Lot: Subdivision:
Depth m FM beton from "inel prod-:
Gravel depth beneath 0":
23A-4 SHACKLETON
10.9
3.1
rL
R
Township: Range: Section:
Fill added above orlg." grade:
Gravel length:
_ _ —
N/A rL
46 n.
WELL ❑ New rade
❑ Upgrade
Gravel nam 5
Number of'nee'
1
pelawe ween Ywt.
FL
n.
aoes•I.oalgn (Prnale, A.B.c): Tata
caeed To:
Tota absorption area:
P.pe material:
n.
n.
397 sal. FL
D 3034/ F-810
paler. Date palled:
stotia wall« Leval:
Instal«:
CAT'S EYE
Dote Installed:
5/24/2002
In.
Ywa:
Pump set Al:
Cal""ght Above GravM:
TANK
CPN
n.
rt
SEPARATION
DISTANCES
0Septic 0Holding OS.T.E.P. Cl Other
To
Septic
Absorption
lift
HoldingPublic/Private
Nanvraet..
Capaaty In polbnc
Tank
Feld
Station
Tank
wear Linea
Well
—
—
—
—
25'+
Yaleripl:
Nurre.. a earrporMrenm:
Surface water
100'+
100*+
—
—
—
LIFT STATION
Lot Line
5'+
*5'+
—
—
—
Site In "lens:
Y.wlaclurer
Foundation
5'+
10'+
—
_
_
""n an /'vel a:
Pomp orf as
Nph .a. alarm Der.
Curtain Drain
NO KNOWN
Pump YOYe
EMcuka Inspection. p.famed br.
Remarks: *LOT LINE WAIVER REQUESTED.
BENCH MARK
lAcation one Description:
BACKDOOR THRESHOLD
NsumW aevation:
103.83
n_
ENGINEER'S SEAL
oopd�00
o �• .stip
Inspections performed by: AWWC, INC. Dates: 1st 5/24/02
:.4 ��00
2nd 5/24/02
°.:...... -.. .......:.°. Q
3rd 5/24/02
0
'ness.r
4th 5/24/02QQ
of ey O
Development Servic s Department Approval
�'
Des '•• c 785.3 '• `
Reviewed and approved by: l� - Date: S 30 -0.2,
`FvpO
0 Orel. •' • ..... • •' 6°Q�
�p� Prof.:,;o^0%
O0000��
PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
-
SW020127 016-141-48
1 \
I I
I
SHON 5/D
LOT :23 I I
Lor s3A-s I
A�
F /
/ (OC9
/ �/Oti
EXISTING
TRENCH
FINAL GRADE
100.0+
JOAN COURT
I I
I; APPROXIMATE
LOCATION OF
WATER LINE
j
EXISTING 2
BEDROOM
HOUSE I
EXISTING 1000
GALLON TANK
ORIGINAL GRADE
100.7 AT
HIGHEST POINT FILTER FABRIC
DRAWN BY:
ALASRA NVATLR & AVASIT'l iVrER' SCALE: M.E.W
- ^. ----
CONSULTANTS. INC. - -^^-^---^ 1F - 30F
A0Al RCRARR OCAS SOITF PR • ANCNC0A4F AK 00506 • PNONF (907)N%7.6170 • FAX (007)314.3746
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
TRACY & JAMES STELLING (907) 349-8729 2 OF 2
LEGAL DESCRIPTION:
SHACKLETON S/D; LOT 23A-4
TYPE OF WORK:
AS -BUILT OF SEPTIC SYSTEM UPGRADE
MT
J
t--
GRAINFIELD
[SEPTIC
ARS
i
o
0
0_
NEW
lCO2
N
ti tpoi
D
Z
•i
2
0
DRAWN BY:
ALASRA NVATLR & AVASIT'l iVrER' SCALE: M.E.W
- ^. ----
CONSULTANTS. INC. - -^^-^---^ 1F - 30F
A0Al RCRARR OCAS SOITF PR • ANCNC0A4F AK 00506 • PNONF (907)N%7.6170 • FAX (007)314.3746
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
TRACY & JAMES STELLING (907) 349-8729 2 OF 2
LEGAL DESCRIPTION:
SHACKLETON S/D; LOT 23A-4
TYPE OF WORK:
AS -BUILT OF SEPTIC SYSTEM UPGRADE
MT
J
t--
GRAINFIELD
[SEPTIC
ARS
i
o
0
0_
NEW
lCO2
N
Z
2
0
ess..
7953 .."
Ap
�Q o
'Municipality of Anchorage
Development Services Department
� Building Safety Division
On-Sitc Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WR020020 PID#: 018-14148 HAM HA020226 Permit#:
Date Received: 0=9=2
Legal Description: Shackleton Lot 23A-4
Engineer. Jeffrey Oamess, PE
Applicant: James & Tracy Stelling
Waiver Requested: 8 feet from dfsoosal system to lot 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 - -30- 0 2 By:
f R
........................................
a .............eviewer.......................�
Rec#: 20489 Amount: $M Date Paid: 813012002
1Vlunicipality of Anchorage
'dt;? George P. 117uerch, Mayor
Bttilding Safctc� Division
P.O. Bos 1196650 • 4700 S. Bragata Strcct
Anchorage, xUaska W519-670750 • (9(r) 343-8.401
h ttp: //e�t��•.ci.anchoru�c.ulc.us
AK Water & Wastewater Consultants, Inc.
ATTN: Jeffrey Gamess, PE
6901 De Barr Road, Suite 2B
Anchorage, AK 99504 -
May 29, 2002
Subject: Waiver Request forSHACKLETON LT 23A-4
Waiver # WR020020 Lot Line Request for Parcel ID 016-141-48
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 5 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely,
G/
Jeff Poet
Engineering Technician III
On -Site Water Quality Program
ALASKA WATER shy WASTEWATER
""""" CONSULTANTS, INC.-•...^..»•-,.^»».�.....,..,�.�..a...„.,•.w--
May 29, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Lot Line Waiver for Lot 23A4, Shackleton Subdivision
To whom it may concern:
We request that your department issue a 5 foot lot line waiver from the east property line to the
new drainfield. I am unaware of any adverse impacts this waiver would have on adjacent wells
or septic systems. I•ou have any questions, please contact us at 337-6179. Thank you for your
assistance. •
M.S.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
MUNICIPALITY OF ANCHORAGE
Development Services Department 3oq K
On -Site Water & Wastewater Program i
4700 South Bragaw Street � �
P.O. Box 196650, Anchorage, AK 99519-6650 !i t (�
(907) 343-7904 P• M
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 23, 2002
Expiration Date: May 23, 2003
Permit Number: SW020127 Parcel ID: 016-141-48
Legal Description: SHACKLETON LT 23A-4
Design Engineer: 0041 AK Water & Wastewater Consultarc Site Address: 000110 JOAN CT
Owner Name: Tracy & James Stetting Lot Size: 12615 SQ. FT.
Owner Address: 110 JOAN COURT Total Bedrooms: 2 Permit Bedrooms: 2
ANCHORAGE. AK 99515-2924
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)343-79D4 (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, seated, and heated to prevent freezing.
Received By:
Issued By:
Date: 1 - ?3-(b?
Date: 2 O 2
Municipality of Anchorage
• �.1 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.enchorage.ak.us
(( (907) 343-7904
flu t ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. n1 to — /'-/ / - lib Permit Number SW 0201 Z 7
Property
Mailing a
Mailing address (2) K- Zip Code9 e/S/S-.-_>V�
Legal description (Lot, Block & Sub'd.) hC1 ,Cj,,1e }C n SJO
Legal description (Section, Township & Range)
Lot Size / 2 & / S_ Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms IQ
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade V.
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: I �/G2� " / cp ����cSII Waiver Fees:
Date of Payment: 5-02-09—Date of Payment:
Receipt Number: C o o l y% Receipt Number:
(Rev. 12100)
ALASKA WATER & WASTEWATER
CONSULTANTS. INC.
May 22, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water &: Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed Septic System Design Upgrade for Lot34A4, Shackleton S/D.
To whom it may concern:
Public water and a private septic system serve the existing 2 -bedroom house. The drainfield is in
a state of failure and needs to be replaced before the sale of the house. The drainfield upgrade
will be within the 30 foot radius of the test hole performed by Robert C. Cowan, P.E. We are
proposing that a five foot wide drainfield be installed. Comments regarding the design are
summarized as follows:
SOILS: See the attached logs, which show the soil classifications, groundwater monitoring,
and the percolation test results.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minute/inch
b. Allowable Application Rate: 1.2 gallons/day/ft2
c. Number of Bedrooms: 2
d. Design Flow: 300 gallons per day
e. Minimum Absorption Area: 250 f12
f. Total Depth: 14 feet (max.)
g. Effective Depth: 3 feet
It. Width: 5 feet
i. Reduction Factor: 0.58
j. Minimum Length: 46 feet long
k. Effective absorption area = 397 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade.
6901 Debarr Road, Suite 2B • Anchorage, AK 99504
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwtvc.com
4. TOPOGRAPHY: The area for the proposed septic system is mostly flat; in short, there are
no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
Sincerely,
JefkeyATqah<sssV.V.. M.S.
NOTE: Attached is a site plan drmving, a design drmving, a soil log, and a 7 page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2t3 • Anchorage, AK 99504
Ph: (907) 337-6179' Fax: (907) 338-3246 • Website: akwwc.cona
72
• 1
SNACKLETON S/D `
LOT 22A I
i 1SHACKLETON S/D
I LOT 22A-1 �
— — ----1_L-------- 1 0
OAN COU
r-----
--------�--------
DRAWN M.E.W
If�%IyATE
I
III\ 15HACKLETON S/D!SHACKLETON S/D
lJ
I
/I
/ I
II
Ie5E �PTIC
1
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gI
c
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li
.z
dp
I
2
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I ,
�I GA
SRACKLETON S/D;
I
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jl x F
LOT 23A-2
I!
'SHACKLETON S/DI:
l Vs
_
LOST 23A-3 I
I w --
STPT,
i
i
i
_='-;5
I WACAN I
/
or
ANCHORAGE SAND
AND GRAVEL
Two
J \ \ 1 I I O
/ —_______T_T___—_J I HOUSE HOUSE
\1 \ II! I I
` of " I ----r' --------- /
1 s"
IAPP
LOGON
DRAWN M.E.W
If�%IyATE
I
III\ 15HACKLETON S/D!SHACKLETON S/D
1
I
I \ 11\LOTI 23A-6 - LOT 23A-5/'
/I
/ I
Ie5E �PTIC
I
AREA a_te-
I L -___.c
----J
CSEPTIC
PROPOSED SEPTIC ARS
.ID�D.nc
T12N, REW, SEC. 19
LOT 24
II I
_APPROXIMATE
I LOCATION OF
I I WATER LINE
ijl I
I I
it I
I I
I I SYSTEM
I I
I
I I
I I
I I
I I
I
I I
I I
I I
I
I I
I I
I I
I I
SHACKLETON S/D
LOT 108
I i
I
I j
I I
_ _ _ _
I -
1
I
L__________—'_____ ----------
ALASKA «'APER & WASTER'ATER
CONSULTANTS, INC.
001' OF0A00 GOAD SIIITF TG • ANFMOGAOF AK OOSOG • GeONF (00)1111.0110 - FAX f00)1}]q.1T/.A
5/22/2002
; o•,, 4 �,
'
':; Iff rnes�
DRAWN M.E.W
SCALE:
10 = 100
>REPARED FOR PHONE NUMBER:
TRACY & JAMES STELLING 349-8729
PACE NUMBER:
1 OF 2
SHACKLETON S/D; LOT 23A-4
PUN FOR SEPTIC SYSTEM UPGRADE
SITE PLAN FOR SEPTIC SYSTEM UPGRADE
-4.....••-
F)oIesslo^
NN PI I
SHACKLETON S/D I
LOT 23A-5 '
THE CONTRACTOR IS RES
FOR ALL SURVEY C0�
`SEPTIC
AREA,
i
I
—JOAN COURT
EXtSTINC 2 BEDROOM I I I
HOUSE
I I�
APPROXIMATE
��' I LOCATION OF
'r
WATER LINE
•
:j•., I
EXISTING 1000
4 II
GALLON TANK
/ 7'+/ I ALTERNATOR
VALVE.
i�
)NSIBLEEXISTINC
ROL. 4. o I TRENCH
� � I
i
------- -- C.01
M.T
I
PROPOSED TRENCH
UPGRADE.
46' LONC. 11' DEEP.
5' WIDE 3' EFFECTIVE
(-SEPTIC
ARE
i
5/22/2002
DRAWN BY:
M.E.W
-. k -,
°goo
.ALASKA NATER & «'ASTENNATER
ooh
0 ° 4
SCALE.
CONSULTANTS, INC.
99 4 n OTF 4 • AV w 4A F AR 90504' faOVF 0017}}1d�)0 •FAY (O0gy3
ego DF4n n o s. F c o c t +-v4e
Q............
Q
PREPARED FOR: PHONE NUMBER:
PACE NUMBER:
TRACY & JAMES STELLING (907) 349-8729
2 OF 2
y C roes , D
.ECAL DESCRIPTION:
E 795 e�O
SHACKLETON S/D; LOT 23A-4
Pr .....��}��
��0 ressodo
TYPE OF WORK:0�
DESIGN OF SEPTIC SYSTEM UPGRADE
DDoo
PERFC
LEGAI
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TEST RUN BETWEEN _1 FT AND 11 FT
COMMENTS
S R S ENGINEERING
PERFORMED BY::X�lCERTIFY THAT
j/ HIS TE/5T WAS PERFORMED IN
ACCORDANCE WITWIl 94M AIR/WRISM GUIDELINES IN EFFECT ON THIS DATE. DATE • / 8 � / %
72-M (RW. 4/83)
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION .
P.O. Box 196650 Is, Anchorage, Alaska 99519-6650 Is, Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: Stj %c0o70 PID Number: Old -111%-41X'
Name:
rti15
Wastewater System: New ❑ Upgrade
)
-7ma
ABSORPTION FIELD
oLtpi
Phone:
No. of B rms:
p Deep Trench Q('Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
spll Rating: 1.a
Total Depth froI�i?inal grade:
GPD/Sq Ft.
Lot: Block: Subdivision:
Depth to pipe Donauoriginal grade:
ho�
Gravel depth beneath pipe
A - Su LiO.v
I Ft
► Ft
Township:
Range:
Section:
Fill added above ongirgal grade:
Gravel length: /
�
0' I Ft.
Ft.
WELL: [I New ❑ e
Gravel width: 51
5
Numberollines:
I
Distance Denwenlines:
Ft
Ft
Classification (Private. A.B.C):
Total Depth:
Cased To:
Total absorpti�^1n arg9
Pipe materiel:
A.
to L. $Ia l C_
FL
Ft
Ft
J vo
Driller:
Date Dulled:
Static Water Level:
Installer.
C't�
Date in balled:
�''-3o-TL
Ft.
E rJATfeAI
Yield:
Pump Set at:
Casing Haight Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
Xseptic ❑ Holding ❑ S.T.E.P.
To
Septic
ADaorption
LlM1
11°Idnp
DlklPrwala
Man lecturer. �7—'
Capacity In gallons:
From
Tank
Fiord
Station
Tank
Sewer Linea
4Aj
(7Q�
WBIt
D01
I t
)
Iov t
—
�—
Material:
57-F6t_
Number of mpartments:
Waters
100,E
100114
—
--
-,
LIFT STATION
Lot101{
lO 1
^
^
�-
Size In gallons:
Manufacturer
Line
Foundation
Jp 1 t
/o 1�
"pump on" level ar. um off' level at:
High water alarm at:
Curtain
i 1
-
Ok.v IJ
Pump Model
I Electrical Inspections performed by:
Drain
OvIJ
Remarks:
BENCH MARK
Location and Description:
"
Ct.OcAp 7a Por.vT "A"
Assumed Elevation: L o
F.
T( , �*
Inspections performed by$ a S ENGINEERING Dates: I
17034 Eagle River Loop Road, NO1 ,2 3 2nd 5 2"9
ar , aOMT C COWAN
Eagle River, Alaska 99572 3 ~ G _ 16- 97
'
��, C E - 8801 r?
Department of Heal and" uman Services -approval
Iwrw. 7- -17
yy-�1se.10��F�
Reviewed and approved by: Date: 8-7- 97
~
72-013 (Ain, . diel) MOA 25
PERMIT go.SW960070 PACE 2 OF 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 • Anchorage, Ataska 99519-6650 • Telephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 23A-4, SHACKLETON SUBDIVISION P.I.D. No. 016-141-48
JOAN COURT- -
45.5' 24.5' \ II
46.0' 26.0' APPROX. LOCATION OF WATER LINE
47.0' 27.5'
61.5' 41.0' } I I
61.0' 41.0' 3 1
37.0' 42.0' > j
p I
WELL 1pO' WELL i+V i '
Rqp/US2 6DRM
HOUSE I Q
NEW 1000 GAL.)LOT
A FCO e j Od l
SEPTIC TANK 1 0
3A-4 2 1 fW�
LOT 23A-5 ,''� 'Z I co
II
w, x
r -ATF! 1.
ALT.
NEW TRENCH ----------'
I
ALT. SITE -----------------
I
10' UTIL ESMT.
I
STI ST2
96.9* FINAL GRADE
MAT Rn
COl - 96.9' SCALE V 40'
I L I I Z—CO2 = 96.1' -..,�
SEPTIC AL rn•S
MTI
NO WATER FOUND
75.9' NO BEDROCK
Cot - 83.0'
CO2 = 82.9'
1-
4
ROBERT C. COWAN
CE -8801
11G
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER PE.
CML ENGINEERS
(907)694.2979
Date: zr u L y a C,/ 9 '1C FAX(907)694-1211
EEALTHAUTHONTY
APPROVALS
RECEIVED
Municipality of Anchorage
SEWERSWATER
DEPARTMENT OF HEALTH AND HUMAN SERVICES JUL 29 1996
MkINDGENSIOAS
825 L Street
P.O. Box 196650 MunlclpalityofAnchorage
Anchorage, Alaska 99519-6650 Dept. Health$ Human Serv,ces
SEWERS WATER
NSPEcnON
REFERENCE: ° T a3 A _ y S/44ct-1f, 70r-' S/p
ENGINEERINGSTT101ES
ANDREPORTS
The septic insppections for t�,hhe referenced property were
performed on S /70 /9G and - 10/9 Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the r+w�o4riory to be
MLLINSPECTION
S PLOW TEST
completed.
If we may be of further service please contact us.
SITEPLANS
Sincerely,
WYZ 4a.,
ROAD DESIGN
Robert C. Cowan, P.E.
SOIL TEST
PERCOLATION
TEST
STRUCTURALS
WO A CAL
14PECTIONS
ONSITE
WASTEWATER
OSPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE 9Lo'M
DEPARTMENT OF HEALTH AND HUMAN SERVICES S pm
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650 -OtIO
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT u n lKc
PERMIT NUMBER:SW960070 DATE ISSUED: 5/07/96
DESIGN ENGINEER:S S S ENGINEERING EXPIRATION DATE: 5/07/97
OWNER NAME:THOMAS JOAN E
OWNER ADDRESS:7010 OLD SEWARD HIGHWAY
ANCHORAGE, ALASKA 99518
PARCEL ID:01614148
LEGAL DESCRIPTION:
SHACKLETON LT 23A-4
LOT SIZE: 12615 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: "'"'to -
ISSUED BY
DATE •
DATE • 5-- 7- /!e-
S&
April 23, 1996
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
LEALTHAUTHOMY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AR. 99519
SEWER 8 WATER
MaNOMNSIONS
REFERENCE: Lot 23A-4, Shackleton Subdivision
Request you issue a permit to install a septic system to
SEWERBWATER
serve the proposed two bedroom house on the referenced
INSPECTION
property.
A test hole was excavated and percolation test performed.
The approximate location of the test hole is located on the
ENGWERiNGSTUDiES
attached site plan.
ANDREPORTS
At the time of excavation no water was encountered in the
test hole. The monitoring tube within the test hole has
been checked and found to be dry(A<r4A S(V(M DAYS).
WELLINSKCTION
8 FLAW TEST
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
SITE PLANS
This property will be served by public water.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
ROAD DESIGN
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
Son. TEST
Robert C. Cowan, P.E.
PERCOLATION
TEST
RCC/gk
Enclosure
STRUCTURALS
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSISTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577
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ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
ON—SITE WASTEWATER DISPOSAL SYSTEM CMLE4-2979 RS
CONSTRUCTION PRACTICES FAX(994-294-
FAX(907)694-1211
and
MATERIAL SPECIFICATIONS
A�Ls"a°TM (REFERENCE: Lot 23A-4, Shackleton Subdivision
April 23, 1996
SEWERBWATER
.......v....
MNNE%TENSIO'S
1. The scope of this project includes the installation of
a 1000 gallon septic tank and leachfield trench to
serve the proposed two bedroom residence located on
SEWERBWATER
INSPECTION
the referenced property.
2. Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
ENGNEERINGSTLOES
applicable State and Municipal Wastewater Disposal
ANOREPORTS
Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
WELLINSPECTION
8 RAW TEST
4. Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
SITE PLANS
5. Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
PaADDESIG.,
systems must also receive prior approval from the
Municipal Health Department.
SOIL TEST
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
PERCOLATION
two 4" cleanouts for pumping access.
TEST
2. The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
STR=LVM&
3. All standpipes on the septic tank shall extend a
ICAL
��
minimum of 12 inches above final grade.
ONS
ONSITE
WASTEWATER
OISPaiALSYSTEM
DESIGN
17034 NORTH EAGLE RNER LOOP • SUTTE204 • EAGLE RIVER. ALASKA 99577
Page Two
Lot 23A-41 Shackleton Subdivision
April 23, 1996
4. Septic tanks installed with less than 4 ft. of cover shall
be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before
gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 23A-41 Shackleton Subdivision
April 23, 1996
5. Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1.
2.
3.
4.
5.
6.
7.
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Perforated
Solid
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Use of a type of pipe other than listed above must be.
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 38 passing the $200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 23A-yShackleton Subdivision
April 23, 1996
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 23A-41 Shackleton Subdivision
April 23, 1996
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: To N [ y N4 NN'# Al DATE PERFORM
LEGAL DESCRIPTION: LOT a 34 - y 5//4C 4'[L>a.. i'pTownship, Range; Section:
DEPTH SLOPE SITE
(FEET)
Ir
3 FILL
4 rA 8 S1L>
M L �-1 ocBR•s
5
6
7
8
12
V 4 x y
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13
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15-
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.7
16
16
17-
7
.n
18-
18
3r:00L.,
19-
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED? N U
IF YES. AT WHAT
DEPTH?
Depth to Water After
Ry
Mp
onitoring] Date:
1i
r,
ROBERT C. COWAN
Reading Date Gross Net
Time Time
Depth to
Water
Net
Drop
I.
b
TEST RUN BETWEEN
11
3 !I IN
3 T
3:16
17
Y -.x
3: rg
.7
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER
I.
b
TEST RUN BETWEEN
11
FTAND 11 FT
S & S ENGINEERING
PERFORMED BY:ye9dtwP Mondno.CERTIFY THLA,TIHIS TE T WAS PERFORMED IN
ACCORDANCE WIT�1 a BIYPR Nvk(U9Ji1il7AL GUIDELINES IN EFFECT ON THIS DATE. DATE �9
72-008 (Rev. 4/85)
MUNICIPALITY -OF ANCHORAGE
oz, ,sem
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 016-141-48
1. GENERAL INFORMATION
Complete legal description SI ACKLETON LOT 23A-4
Expiration Date:
Location (site address) 110 JOAN COURT, ANCHORAGE, AK 99515
Current property owner(s) KEO FUJIMOTO Day phone
Mailing address
Real estate agent
110 JOAN COURT, ANCHORAGE. AK 99515
Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2.. �� oy o Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
COSA # (25C-2_0 l q 26 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/10/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the _z�\\\\�l
system and maintenance. The operational life of all well and septic systems are subject to rCIF
��,il
these various and dynamic characteristics and are outside the control of the evaluator of the • .
well and septic system. Therefore, any estimate of how long a system will function satisfactory ���g�Q: • • �,9 ���
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
49
discrepancies exist can be given by First Water Consulting & FWrs * . ili .....•:*
..
� . .... ... V �.~.'. .
6. DSD SIGNATURE Curtis Huffman
System #1 Approved for or bedrooms r����Fc��T . • •CE 128991 .��,��,•�
PROFESS NAO��'~"
System #2 Approved for bedrooms �l
Disapproved
Conditional approval for bedrooms, with the following stipulations:
.���OOF ((AN('(r���ii.
pN PNp
o�
SSLv�:AT ��
�JJlIipMENT SER�� �
JJ)))))11
By: Original Certificate Date: 02 d2 U
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other T0_M\k cuadw; l SDY-
J
COSA Checklist
Legal Description: SHACKLETON LOT 23A-4 Parcel ID: 016-141-48
If more than 1 septic system on lot: COSA Checklist #
of
Structure served by this system
A. WELL DATA – PUBLIC WATER
Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) 24 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 50”
Standpipes/foundation cleanout per record drawing
Date of pumping 8/5/2020
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/24/2002
ALL standpipes present per record drawing
Total measured depth from grade 13.8 ft (max)
Measured depth to pipe invert from grade 10.7 ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2000 gallons
Adequacy test date 8/6/2020
Results Pass For 2 bedrooms
Fluid depth prior to test 0 in
Water added 500 gal
New depth 0 in
Elapsed time <1 min
Final fluid depth 0 in
Absorption rate 300+ gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies:
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well) NA PUBLIC WATER
Septic Tank/Lift Station on Lot > 100’
Yes if No
ft
Neighboring Tank > 100’ Yes if No
ft
Absorption Field on Lot > 100’ Yes if No
ft
Neighboring Absorption Fields > 100’
Yes if No
ft
Community Sewer Main > 75’ Yes if No
ft
Community Sewer Manhole/Cleanout > 100’
Yes if No
ft
Private Sewer/Septic Line > 25’ Yes if No
ft
Holding Tank > 100’ Yes if No
ft
Animal Containment > 50’ Yes if No
ft
Manure/Animal Excreta Storage > 100’
Yes if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ Yes if No
ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No
ft
Community Wells > 200’ Yes if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10’ Yes if No
ft
Property Line > 10’ Yes if No *5 ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
*WAIVER – WR020020
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.
8/11/2020
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC201426
Subdivision: Shackleton Lot: 23A‐4
The septic tank for this property is 24 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & 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
FOR A SINGLE FAMILY DWELLING
Parcel I.D. I')I(o-I4j_% COSA# N11b)(4
1. GENERAL INFORMATION Expiration Date: 9 - j - 0 Co
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
SHACKLETON SUBDIVISION: LOT 23A-4
110 JOAN COURT • ANCHORAGE. AK 99515
JEFFERY SEMAK Day phone 952-2718
110 JOAN COURT • ANCHORAGE. AK 99515
Day phone
Real Estate Agent DAWN STORM w/ REMAX PROPERTIES Day phone 227-9306
Mailing address 110 WEST 38TH AVENUE + ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class—Well
❑
Community On-site
❑
Public Water System
0
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 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 samples. (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. 1 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 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
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results dosaibed the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do riot guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or parry Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the Illowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
ON-SITE
WASTEWATER
By: 14- 4 / G(J. Original Certificate Date: I
IF.,, I'M%
Municipality of Anchorage ,
• Development Services Department
Building Safety Division F
On -Site Water 6 Wastewater Program
4700 6ragew Street
P.O. Box 196650
Andwrage, AK 995196650
www.muni.orglorgke
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SHACKLETON SUBDIVISION: LOT 23A-4 Parcel ID: D 14 - / yl -
A. WELL DATA PUBLIC WATER
Wen type If A, B, or C provide PWSIDN _ Well Log (YIN)
Date completed Sanitary seal (YIN s property protected (YIN)
Total d Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate-mg./11, on es/100 ml.
Ar Date of sample: Collected by:
S. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 5/30/1996
Tank size 1000 gal. Number of Compartments 2 Cleanout (YM) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 4/17/2006 Pumper MCDONALDS PUMPING
C. ABSORPTION FIELD DATA I -BELOW EXISTING MM
5/30/1996
Date installed 5/74/2002 Soil raling .p.d. ft%bdrm) 1_2 System We TRENCH
Length 46/46 ft. Width 264 5/5 ft. Gravel below pipe 1/3 ft.
Total depth *14/14 R. Eft. absorption area 391 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 4/12/2006 Result (Pass/Fail) PASS For 2 bedrooms
Fluid depth in absorption field before test DRY In. Water added 462 gal. New depth DRY in.
Elapsed Time: 6 min. Final fluid depth DRY in. Absorption rate >- 300+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
aooa -►42Mj'j("
D. LIFT STATION
Date installed
"Pump on" level at _in.
Datum
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
areas
PUBLIC WATER
On adjacent lots
On adjacent
sewer manhole/cleanout
Holding tank
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'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '5. Building foundation 10'+ Water
:e
Water service line 10'+ Surface water 100'+ Driveway. partdnglvehide storage 10'+
Curtain drain 50'+ Wells on adjacent lots 100'+
F. COMMENTS
*WR020020
G. ENGINEER'S CERTIFICATION
I car* that I have detemdned through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 417-6/06
COSA Fee S L i O
Date of Payment 51510b
Receipt Number
(Rev. tI=)
Waiver Fee E
Date of Payment
Receipt Number
-------=c-Qua------------I
o"w 90.001
rRAWL
CONCR(
001V AV
Fd unLm rrNY.
N H9952130"E 90.00
LrOrND
F4
THE NFDRWTN'YT HEAEON IS FOR THE USE OF LENDING K4TIMION4 SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
IMSTMG STRUCTURES AND PLATXO LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL H
STRLCTLMESORFEHCEUNES.
EASEMENTS OF RECORD. OTHER TH 4 THOSE SHOWN ON THE RECORDED PLAT. ME NOT SHOWN HEREON .MUSS WpCATEDI
NOTE. ANY FENCEUNE5 SHOYM ME LOCATED APPROXIMATELY MD ME NOT TO BE USED TO DETERMINE PROPERTY LYES
OR LOCATE STRUCTURES.
ANY PAVING MOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
II
AS -BUILT SURVEY (NO CQRI
SCALE: 1'"20 I
SET THIS DATE)
I HERESY CERTIFY THAT I HAVE PERFORMED A
MORTGAGEES INSPECTION OF THE FOLLOW"NO
DESCRIBED PROPERTY.
LOT 2Y 1. SHACXLETON SLB.
AHCHOMGE RECORDING INSTRICT. ALASXAANO TWAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ME
"ROTNMIILIPROSEXI LYESA!NOTEDIND NO NlIBLE
EMROIDEM! EXIST EXCEPT N NOTED,
DATED AT RCHIORAGE ALASKA TMS�DTH�
DAY OF fPRll_ 2ao5_
HOLT LAHD SURVEYING LSSS. F89LIl,1L47
TEL NSSSI]
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 South Bragaw Sl.
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 M
Parcel I.D. 016-141-48 HAA# dA
1. GENERAL INFORMATION Expiration Date: S' 3 O ' O 3
Complete legal description SHACKLETON SUBDIVISION; LOT 23A-4
Location (site address or directions) 110 JOAN CT, ANCHORAGE, AK 99515
Current Property owner(s)
JAMES &
TRACY STELLING
Day phone 349-8729
❑
Individual On-site
Mailing address
110 JOAN
CT. ANCH, AK 99515
Individual Holding tank
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone
PEGGY GONZALEZ w/ DYNAMIC PROPERTIES Day phone 242-3825
3111 C STREET, ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
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
E
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 samples. (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 welts or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ 2,400.00 at, or prior
to closing forthe engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DESARR ROAD, SUITE 28 • ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
S. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
337-6179
Date OZ.
Conditional approval for bedrooms, with the tllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
L 7
8Y� l� " �� Original Certificate Date: -y ' O
lRev 12.911
Municipality of Anchorage
• Development Services Department
BU&" Safety bivalon .. "
O"b Water 8 Wastewater Program
47W South Bragaw SL
P.O. Boz IMWAndwage,AKta95iSON
www.d.arrdrorage.ak.us
(907)$43.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SHACKLETON SUBDIVISION: LOT 23A-4 Parcel 10: 016-141-48
A. WELL OATA PUBLIC WATER
Well type
Date completed —
Total depth ft.
Date of test
Staticwater �
production
If A. B, or C provide PWSIDN —
Sanitary seal (Y/N)—
Cased to ft.
FROM WELL LOO
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate
B. SEPTICIHOLDING TANK DATA
Well Log (YIN)
Wires PropeJr y4wi ected (YIN)
height (above ground) in.
AT INSPECTION
ft. ft.
g.p.m. g.p.m.
of sample: Collected by:
Tank Type/Material STEEL Date installed 5/30/96
Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alar (Y/N) N/A
Date of pumping 5/20/02 Pumper ANCHORAGE CESSPOOL
C. ABSORPTION FIELD DATA
Date Installed 5/24102 Soil rating .p.d ft%dr) 1_2 System type TRENCH
ml.
Length 46 ft. Width 5 A. Gravel below pipe 3 ft.
Total depth 14+/- ft. EN. absorption area 397 ft' Monitoring tube YES Depression over held NO
Date of adequacy test NEW Results (Pass/Fall) -
Fluid depth in absorption field before test _ in. Water added _
Elapsed Time: —min. Final
(past 12 mo.) (Y/N & type)
UM,., ..,.
For E bedrooms
If yes, give date
_in.
MI
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent kits
5
Public sewer manhole/deanout
S ervice line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Adsorption field 5'+
Water main
10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line `5'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkingtvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS *LOT LINE WAIVER REQUESTED WITH HAA SUBMITTAL.
G. ENGINEER'S CERTIFICATION lsff6 _, Y..,...
I certify that I have determined through field inspections and s :: �+
review of Municipal records that the above systems are in ......' .. . ........
conformance with MOA HAA guidelines in effect on this date.
Engineer's Prin Nartle JEFFREY A. GARNESS °�e� `•u —7953 .•
Date _ 7 �" eyp�oreeia
HAA Fee 3 3 p 1 �o Waiver Fee $
Date of Payment -a 9 oe�a Date of Payment
Receipt Number QC?D 4116 Receipt Number
(Rev. 12/01)
OF q
LEGEND
S SEVER
TO BE USED FOR POSITIONING
NEA. H
.S-6914
.... s
SURVEY t NJ CORNERS SET THIS DATE )
a 20
I HAVE PERFDRMED A
OF THE FOLLOWING
23A-4, SHACXLETEN SUB.
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON.(UNLESS I DAY ' - ANCHORAGE,
ilAT _ MAY ----__
NOTE: ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO OCTERNINC PROPERTY S LAND •SURVEYINI
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH 8 HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska
343-4744
99519-665()v 1RN1CTF.gUTyof
ONMEMAC SER l "OkAs ON
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.ti 0I6 —I 'i/—K`6 HAA#
1. GENERAL INFORMATION
Complete legal description
Lot 23-4; Shackleton Subdivision
Location (site address or directions) NHN Joan Court
Anchorage, AK
Property.owner Toney Hannah Day phone 349-2014
:. Mailing address 7010 old Seward Hr ,•_ Anchorage, AK 99518
Lending agency Day phone
Mailing address'
Agent. Day phone
'*+...t..r.
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-M (R.,. 1/91) front MOA 821
S. 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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S 8 5 ENGINEERINGq _ �9
Phone .717034 Eagle Rim L6or ROW 010 204
Address - Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for Z bedrooms.
Disapproved.
Conditional approval for
Additional Comments
M
It lTi r]
Date *7 / Z ;L/R 7
ROBERT C. COWAN
CE -8601
�� �'A,OfFiSaN�
bedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and theirlending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
nau m. vvo owk MOA N21
MUNKIPALITY Of ANCHORAGE
ENvitONAAEWALSERVICES DIVISION
Municipality of Anchorage JUL 23 19"
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division -
G - vEtO
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3=j�
Health Authority Approval Checklist
Legal Description: LsT -ISA -ti 51{ACkl ETOU Parcel l.D.: o)6 - l y/-yB
A. WELL DATA
Well type ` P U JILLA —C-' If A, B, or C. attach ADEC letter. ADEC water system number d
Log present (Y/N) .
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE I
Coliform
of sample: _
Date completed
Cased to
FROM WELL LOG
S. SEPTIC/HOLDING TANK DATA
Nitrate
Casing height (above
Wires property pfd (YJN)
g.p.m.
Collected by:
Other bacteria
Elm
Date installed rj-30 - 9(0 Tank size 1600 Number of Compartments �Cleanouts&) YES
Foundation cleanout �J) ES Depression (�&A O High water alarm (YM)
Datagf•Pumping E Lj Pumper Z
C. A$SORPTION FIELD DATA
j)72AT.ur-
�S
qate-Installed - 3 0 - 9G Soil rating (g.p dJW or ftMArm) � System type-rRe-.JCN
Langtb ��� Width ` 5 Gravel thickness below pipe Total depth /z/ �' /f s '
Effk*m absorption area ,� / i/-`` Monitoring Tube preseni�l) TSS Depression over field (YAD a
Date of ad`egaeey test E L✓ Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.); --Tm-mediately atter-=gal. water added (in.):
Fluid depth pyre) Minutes later: Absorption rate = g.p d.
Pero;dds treatment (past 12 months) (YM) /'� If yes, give date
72026 (Rev. 3M6r
D. LIFT STATION
Date installed
Manhole/Ac teas (YM)
High water alarm level at"
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM
Septic/holding tank on lot
L
ption field on lot
sewer n '
septic service line
Size In gallons
>Datum
"P off" level at'
On adjacent lots
On adjacent lots
Public sewer manhde/deanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
, c r
Foundation 104- Property line /y � Absorption field /O f
Water maintservice line /0f Surface water/drainage /00'+t
Wells on adjacent lots / OO r/ -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ) y c Building foundation / o /f" Water main/service line �O
Surface water /fi/b c) �i Driveway, paridng/vehicle storage area
11,0
Curtain drain Awe o.J A Wells on adjacent Ift /00 f
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field Mspectfons and review of Municipal records Ma
in conformance M qui Imes in effect on Mis date.
Signature
Engineer's Name Qd d 4'c T �. �✓A�g7
X /p) Ro![rr C. COWAN
Date % Pi„", CE - 8801
HAA Fee $ g�_f.7
Date of Payment ��7'—�4ef" 3.�— l
Receipt Number d �y 3 Owl /
72-028 (Rev. 3/98)"
Waiver Fee $
Date of Payment
Receipt Number
are