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Home My WebLink AboutTHE TABLELANDS #2 BLK 9 LT 9The Tablelands #2 Block 9 Lot 9 #051-741-66 Municipality of Anchorage ,,6','• i�~�,••e'' Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. /Of P.O. Box 196650 Anchorage, AK 99519-6650 Page ,3 wvlw.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 0 ;� Q P mp PID Number: Q,5 -J — _l" to Nan" Wastewater System: /E;7New ❑ Upgrade Atlas'• ABSORPTION FIELD Phone Nw aBe&w,hs _ D Deep TIMCh O SMllwv TranM 0 Bed >n.binE 0 OIMr LEGAL DESCRIPTION Sod Rawtg S Cporr? Taal Depth eon apatal grace: fa -'7N. Bio% La elLemewn' N* Depth W ppe Doean can orlg a p °�" Gravel depth D°neam pipe S. FI. .+ FI Tons 1p Range. seam FA atltlea scow anginal gretle. 3 GravM Length. 36 Ft. FI. Well:,4Wil ❑ N ❑ Upgra G'" "Oh: ZS NuTWr a IMs DlManoe OelweBn late, s v Ft. FI ctasi,e am IPmMe. A B. C) Tar Depthe>aC m Taal Wsolpran rea. i� O Pipe Mmenal J� ' I VC 30314 F FI .J FT O i Dnllr Dale Done,. Slaw: water Lavr Invalw r Date InsINbO (� O-..± FI rw Pw setat. Camp HeightMoveGrano TANK GPM I. FI SEPARATION DISTANCES [I Septic ❑Holding ❑ S.T.E.P. AA/%F/IR Other: To Septic Absorption Lift Holding ubl.C[Plivate w✓w •Par tT. From Tank FieldStation Tank Sewer Line QfQ Matrue NurMer a Carrprptbre,. Well sur,aawater ��/r 60/,f GQ% _ LIFT STATION La L. �.r. 3 `,f- se. aO Gal xhanw. tt �j /f 'Pune W. level at 'Poop Of level Mph ralr Yarm al Sin. Pump Malo b Male) El,xtrtcal et,peapn, penanlsa by Cvtrn Dram ^ — r PTQ 6SQ BENCH MARK c T Louuon rq Daaalpuon. vLAth /L bwnea wvaum IQQ FL r/ E Caeom ovAr, C 7_ ! o (-"C-1Ed E"��n�oa, OF `bp��.•A�•Qs��i •• -Vr� 15'6o 0,41ZOW 4 V 6/`TE}c /4 TRRo✓EQ 8 11 T e Inspections performed by: Inspections rFr, nr� %� �, /� * 149 •...L �� ;��:'�• Development Services Department APPo�a, W. F tM5-,2 ;L -Ob by: Date: •,v'ary6256 ••••Reviewed and approved f••RR ...•••'��;�- OFESSIO'A IRev4�7 a F.C.O. A B 45 29 1000 Tank CO 60 38 1500 Tank CO 47 28.5 Advantex Riser 52 26 L.S. Riser 50 23 MTl 70.5 55.5 MT2 84 61 MT/CO3 93 80 C04 94.5 79 C05 96.5 80 •IT inns 4R, 0^ Alternate ADVANTEX C1 RF NORTHRIM y�P ' ., ! THE TABLELANDS #2 AS -BUILT ENGINEERING 17237 Bear Pow Clrale •, "" '••� —'--- LAY❑UT Cagle River. Aloska 99577 •� I — ^' ` J --__-- 907.694.7028 �'''•••••''•: VV BL❑CK 9, LOT 9•� 5/19/06 2 of -3 - - --- -- --- - - - - ---- - - 612C ! x•� NOTA FH INCHES OFCRAONC MILTO NZOE AND (PERFER�OLLY �M9ROSECORIG)EOING Elevation = 104.7' Elevation = 101.4 .-Fi5 S - i?crrb et-- Q-0— S-7' oundation Cleanout jElevatlon = 97 n 1 F(avn{Inn = 9A.ii�� r 1000 Gallon Single Compartmerr Septic Tank Elevatlon -'! Elevation - ! rr Elevatlon = 101' 1500 Gallon ADVANTEX Elevation = 101' 1.25' PVC Force MalnJ THE TABLELANDS #2 SAS -BUILT BLOCK 9, LOT 9 ELEVATI❑NS 3/8/06 13 of 3 ,�ATLU :PtE GF R NOR THRIM :~em ENGINEERING 1 ' 17257 Bear Paw Circle Eagle River. Aloska 99377 •. air. 907.694.7028 rr Elevatlon = 101' 1500 Gallon ADVANTEX Elevation = 101' 1.25' PVC Force MalnJ THE TABLELANDS #2 SAS -BUILT BLOCK 9, LOT 9 ELEVATI❑NS 3/8/06 13 of 3 Oct 20 2005 4:10PH HP LnSERJET Fnx 622-0777 p.4 \,`` 1 1", Rising bon electric. Inc. \ ' � 0916 \Vva&aM Drive rr y Lagle River, AIC 99577 t ` (9o7) 622-6777 w October 28, 2005 Dean Construction Development 22222 Elkhorn Circle Eagie River, AK 99577 Re.. Lot 9 Block 9 Tableland #2 Dear Mr. Dean: The lift station at the above referenced property has been wired In accordance with NEC and State/Local codes. Thank you. Slncerett, Kevin . Hombuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 a� MUNICIPALITY OF ANCHORAGE � b ro Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Apr 07, 2005 Expiration Date: Apr 07, 2006 Permit Number. SWO50070 Parcel ID: 051-741-59 Legal Description: THE TABLELANDS SUBDIVISION TRACT H Design Engineer: 0855 Gamess Engineering Group, LTD Site Address: NHN OBERG ROAD Owner Name: THE THOMAS COMPANY Lot Size: 132741 SO. FT. Owner Address: NHN DEER PARK DRIVE Total Bedrooms: 5 Permit Bedrooms: 5 PETERS CREEK. AK 99567 - This permit is for the construction of: 0 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. a.) This on-site wastewater disposal system permit Is for The Tablelands Subdivision Addition #2, Block 9, Lot 9 (final recorded plat 2005-13). Received By. Issued By Date: lL 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.sk.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051 -ti -L ( 1" 5`)' Permit Number Property owners) THE THOMAS COMPANY Day phone 441-2664 Mailing address (1) HC05 BOX 6929 • PALMER.AK Mailing address (2) Zip Code 99645 Legal description (Lot, Block & Sub'd.) LOT 9 BLOCK 9• THE TABLELANDS S/D #2 Legal description (Section, Township & Range) th<6'14tG ii<T L VAC TR Ar -r t 1 Lot Size �3a Aa q.F Number of Bedrooms 5 THIS APPLICATION IS FOR: Sewer Only 0 Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. Permit Fees: y l`Y� Date of Payment: Receipt Number: C� n5 74O Waiver Fees: /7s Icrf. LLL,_, Date of Payment: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS April 5, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 Ref: Proposed Septic System for The Tablelands Subdivision #2; Lot 9, Block 9, The proposed 5 bedroom house will be served by a public water system and private septic system. Several test holes were excavated on the property. Due to the high groundwater, the lot configuration, and the poor soils conditions in the area, we are proposing that a MOA approved recirculating trickle filter system be installed. We are proposing that a 2500 gallon S.T.E.P. tank, a municipal approved recirculating trickling filter unit (sized for 5 bedrooms), and a bed type drainfield be installed. We are proposing that the drainfield be installed within the 30 foot radius of Steve Eng's test hole (T.FI. 5). Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for dminfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: The area around the proposed drainfield is relatively flat. In short, there are no slope concerns. 5. LOT LINE WAIVER REQUEST: We request that a 1 foot lot line waiver be granted from the west property line to the proposed dminfteld. The owner of the adjacent lot is the same owner as the referenced property. The owner has no objection to this waiver. We are unawa a any adverse impacts this installation would have on adjacent wells or septic systems. If you have ar scions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. N07i: V itached is a site plan drawing, a design drawing, a detail drawing, and three soil logs, which are all part ofthe design pachagefor this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com LOT 17, BLOCK 8: \ 1 \ C THE TABLELANDS S/D /1 / \ L \ LOT 11, BLOCK 7; / LOT 16. BLOCK 8; \ \ THE TABLELANDS S/D /2 / O`F \ THE TABLELANDS SID do \ \ \ PROPOSED SEPTIC SYSTEM\ (SEE DESIGN PACE 2 OF 30 ` TEST HOLE STEVE ENC P.E. TEST HOLE I LOT 4.BLOCK 9: THE TABLELANDS S/D /1 I .; 'S .� ` .�•� T I ? _ 412 I I i?1f / LOT 10. BLOCK 9; TERNATE SITE I tr'..• / THE TABLELANDS S/0 /1 TH/2 1 •'iii.. // // / / PROPOSED 5 BEDROOM HOUSE /LOT BLOCK 4; ®r � THE TABLELANDS S/D LOT 5. BLOCK 9; THE TABLELANDS S/D /1 LOT 9. BLOCK 9; THE TABLELANDS S/D /1 / /LOT 20. BLOCK 4; /THE TABLELANDS S/D THE OTABLELANDS S/D / BLOCK 9:/ / / 1 t• .too' NOTE: ALL PROPERTIES / / LOT 21, BLOCK 4; SHOWN ARE SERVED BY / THE TABLELANDS S/D PUBLIC WATER AND ON—SITE SEPTIC SYSTEMS. / oaoo� 4�� GARNESS ENGINEERING GROUP, Ltd. p;'�.,OQ CONSULTANTS& GENERAL CONTRACTORS .••••• •••••• A. [ (eafJ]. lm a IM (001})] "" • eiesn -. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: "' f GOf G5.. . THE THOMAS COMPANY (907) 746-0682 1 OF 3 Qy Y p LEGAL DESCRIPTION: DRAWN BY: Op° CE- .•' �Fv� OWORK:TS9,BLOCK 9; THE TABLEANDS S/D. ADDN #2 DC.EJ•.G./J. TYPE rofess}000 O�ooP SITE PLAN FOR PROPOSED SEPTIC SYSTEMS 4/1/2005 DO��o�o (Rev. OtA5) NUMBER OF BEDROOMS: 5 GALLONS PER DAY (CPD): 750 PERCOLATION RATES: B MINANCH PROPOSED APPLICATION RATE: 1.5 MINIMUM DRANFIELD SO.Ff.: 500 DRAINFIELD DESIGN: MAXIMUM DEPTH: 1.5 FOOT (REMOVE ALL ORGANICS) WIDTH: 20 FEET LENGTH: 25 FEET M.O.A. APPROVED SAND FILTER: 2t FEET EFFECTIVE: 0.50 REDUCTION FACTOR: N/A LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT CEO. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPEOFlCATIONS AND AGREE TO ACCEPT THE TERMS AND STEVE ENC. P.E. TEST HOLE— ALTERNATE PROPOSED 2'. GALLON S.T.E.P DEER PARK DRIVE 15' UTILITY EASEMENT LOT LINE WAVER/ III I I- MUNICIPAL APPROV RECIRCULATINGFILTER PACKAGE PROPOSED 5 BEDROOM HOUSE Ile GARNESS ENGINEERING GROUP, Ltd. ; CONSULTANTS & GENERAL CONTRACTORS SAI G TIOOo IIO10. Mn[ 101 • WOdIML NI 0 ? • F151[ • fM w40v� PREPARED FOR: PHONE NUMBER: PACE NUMBER: THE THOMAS COMPANY (907) 746-0682 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: LOT 9, BLOCK 9; THE TABLELANDS SUBDIVISION #2 C.J.G./J.L.M. TYPE OF WORK: DATE: DESIGN FOR PROPOSED SEPTIC SYSTEM 1 4/1/2005 (Rn. 01J05) SAS ENC. TEST HOLE -PROPOSED WATER UNE 1- 40 ED DRAJNF SETA (SEE DRAW PACE 3 OF 3) \i�� \\ I +TH12 III I I- MUNICIPAL APPROV RECIRCULATINGFILTER PACKAGE PROPOSED 5 BEDROOM HOUSE Ile GARNESS ENGINEERING GROUP, Ltd. ; CONSULTANTS & GENERAL CONTRACTORS SAI G TIOOo IIO10. Mn[ 101 • WOdIML NI 0 ? • F151[ • fM w40v� PREPARED FOR: PHONE NUMBER: PACE NUMBER: THE THOMAS COMPANY (907) 746-0682 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: LOT 9, BLOCK 9; THE TABLELANDS SUBDIVISION #2 C.J.G./J.L.M. TYPE OF WORK: DATE: DESIGN FOR PROPOSED SEPTIC SYSTEM 1 4/1/2005 (Rn. 01J05) SAS ENC. TEST HOLE -PROPOSED WATER UNE 1- 40 FROM M.O.A. APPROVED RECIRCULATING TRICKLE FILTER SYSTEM - r— — — — — — — — — — — — — — — — — — — I OWT WTO I I I I I OMT WTO I L------------------- F2' ------------------2' 21' I 2' 25 FEET NOTE: FINAL GRADING TO INCLUDE B INCHES OF TOPSOIL AND SEEDING (PERFERABLLY NYDROSEEDING). 20 i 20' YAOE I -� OF GARNESS ENGINEERING GROUP, Ltd. • 4 ;v; CONSULTANTS 6 GENERAL CONTRACTORS ••••• •••• •• '•••••• ......... SAI E t110M11101A. 11SIE IOt • moov0E w 901507 F (907)"7-0I140 • F" (M1}u! o • �91C• w � PREPARED FOR: PHONE NUMBER: I PAGE NUMBER:••••• ......•• THE THOMAS COMPANY (907) 441-2664 3 OF 3 OQ m A. Gar ess: LEGAL DESCRIPTION: DRAWN BY: OD•P, •, 795 THE TABLELANDS S/D #2; LOT 9, BLOCK 9, C.J.G./J.L.M. e ••�}'.� d�6�°o ITYPE OF WORK: DETAIL OF PROPOSED DRAINFIELD (It". 01105) 1111111,111,10 jim o F, of q" pop GARNESS ENGINEERING GROUP, Ltd. - CONSULTANTS 6 GENERAL CONTRACTORS >? 9 y 701 )UDJ11 ado. FMR 101 . AWAQKLL M. 1010,01 • P.,aL 100) )-11110 • Fw (1007).3311-12" . MC85tIL p,rwwp�rYp. SOIL LOG - PERCOLATION TEST ..... .. .......... LEGAL DESCRIPTION: TABLELANDS SUBDMSION 2; LOT 9, BLOCK 9, 9 re Garn ss.• s C — 53 PERFORMED FOR: THE THOMAS COMPANY DATE: 3117/2005 DEPTH—___ ORGANICS �pO41P`Ofe 1, � (feet) TEST HOLE 1 �O000�% E 4 5 7 �I I I I%/iI Smix OME WG 8 9 10 11 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE tlSSu� 3/17/2005 2.0' � IIIIIIIII 31191 N vzzzyl rM% t TH#2 NNE IIIIIIIII .I.I'Y.-i•7 lII�111 LOT 10 Y/f/� � LOT 8 LOT 9 DEPTH TO GROUNDWATER DATE SEEP O 4.5' 3/17/2005 2.0' 3/28/2005 DATE READING CLOCK I NET TIMEI WATER LEVELI NET DROP TIME (MINUTES) READING (INCHES) 19� PERCOLATION RATE _ (MIN./INCH) PERC. HOLE DIA. — (INCHES) TEST RUN BETWEEN FT. AND FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: — COMMENTS: PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RF RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: V10 �r -'-'•' ITNA ----- ---------------':a --.•'A N t TH#2 .I.I'Y.-i•7 LOT 10 THJ1 LOT 8 LOT 9 ' SCALE:® 1• � 10 ' DATE READING CLOCK I NET TIMEI WATER LEVELI NET DROP TIME (MINUTES) READING (INCHES) 19� PERCOLATION RATE _ (MIN./INCH) PERC. HOLE DIA. — (INCHES) TEST RUN BETWEEN FT. AND FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: — COMMENTS: PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RF RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: V10 �r SOILS LOG - PERCOLATION TEST Date Performed, 9/17/04 Performed For, Rex Turner/ Rick Besse Legal Description. Lot 9 1- 2 - 3 - 4 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - 21 - DEPTH (FEET) Organic SM w/Gravel o� d ' GP ....Sandy Gravel q. w/Slit Tom.` •I... Slope < 5% Groundwater? ,N.4_ Depth -- Water Depth After Monitorino. 6' LeT I, f.�v 111 -VLea�Aps *Z Dater 9/23/04 # Date Gross Time Net Time Depth INet Drop 1 9/19 0 -- 6' -- 2 9/19 10 10 min. 7.25' 1.25' 3 9/19 40 -- 6' -- 4 9/19 50 10 min. 7.25' 1.25' 5 9/19 1 80 -- 1 5.5' -- 6 9/19 90 10 min. 6.75' 1.25' Percolation Rate 8 m1n./Inch Perc Hole Diameter 6_ Test Run Between 4' and 5' Commentst Pro—Snalrad. Ganundwntpr Performed By No ting• Ijl�' Performed In Accordance with F ON THIS DATE. DATEe 9/23/04 CERTIFY THAT THIS TEST WAS lunicloal Guidelines In Effect CF KN NOR THRIM TESTHOLE LOG T. H. 5 ENClNEERlNG ••• 17237 Hear Pow Chole "•'••• rev* Rn., AV1006 9"2577•' ...... •�' - GEOTECHNICAL 07-694-7028 9/23/04 F5 -of 5 Ne -re; 1""%S V4 IG Loc rbc 5140144118.j, 041610/4L Or' Dice AT M.o.,A, Municipality of Anchorage o� M. llox I!X;(ii() • Anchoragc, Alaska 1x.1,51!) GAGS() • Telephone 0)7) U101 • Pax ('.l1)7) 313-f0X) \ / 47IX11Srugux• Strccl 0.1:x•hamge, Alaska 111ti507 xlmnlunl.org Jlayor 3lark Begich Iluildl,lg Safety Division 4/7/2005 Gamess Engineering Group 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for The Tablelands Tract II( The Tablelands Subdivision Addition #2, Block 9, Lot 9 Waiver Request #WR050018 Parcel ID 4051-741-59 Permit # SW050070 Dear Mr. Gamess: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 1.0 foot. 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, ZtXXDLUrr� Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity 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.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: WR050018 PID#: 051-741-59 HAM _ Permit#: SW050070 Date Received: 4//12005 Criteria: • :,IFiRit'ilrli - . - .•1 •d. •a- . I Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: ..............................................................................• Waiver is Granted: �� Waiver is not Granted., Ust Conditions or Reasons for above: Date: LI/72 S By: / li (S-, _�_ML, Q�s— bA-Name of Reviewer ....•................••......sees......V..................•........ aseess... as Rec#: 65742 Amount: $175.00 Date Paid: 4/7/2005 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.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 65 -1 -:7 -ill -626 COSA # IUoDl q Expiration Date: _ �' 2 2 O % 1. GENERAL INFORMATION Complete legal description Slj�6 TAL ANd S Z SL GCkt el L d 7 - Location (site address- Location(siteaddress- rt/F Current Propertyowner(s) Tff_6 7260.51RS 001"84Ky Day phone [__/.�/1- 24CK!V Mailing address AA -,4f4 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: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ 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 Onsite 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 seat affixed hereto and as of the validation date shown below, 1 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. Nameo Address f Finn 4�pPhone �91,l-7cZ� J7o237 ,�e�� y�—P••.e. �. Engineer's Printed Name .,STEc/F j5W(, Date Z106 - OF Ak t 1OrOFA`t 7tt 5. DSD SIGNATURE c''; Steven w. Eng ? W Approved for bedrooms. �pC rFa: aPE 6256 Disapproved. % Conditional approval for 5 bedrooms, with the following stipulations: At the time of title transfer the new property owner shall sign the a a h d Maintenance Agreement which shall be returned to this office before a unconditional approval is issued. Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By � Original Certificate Date: S-- O G (Rev. 1105) Municipality of Anchorage •., • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519-6850 www.muni.orglonsite . (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 7 O r, 4&GC,,46&X B//Ac 10— T L ? Parcel ID: A. WELL DATA iPV9Uc WArAU7 Well type _ If A, B, or C e PWSID # _ Well Log (YM) Data completed _ San seal (YIN) _ Wires ProP�Y (YAV) Total depth ft./adto ft. Casing height ( ground) In. FROG AT INSPECTI Date of test Static water level ft. ft. Well production 9•P•m• 9 -P.M. WATER SAM RESULTS: Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: mgA Date of sample: Collected by: B. SEPTICIHOLDINGTANK DATA/sod GA((� + /Ooo dt'rf..' Tank TypWaterial An V,¢,l/TF �ST-EL �� Date installed /�4 S Tank size Z ao gal. Number of Compartments Z Clearouts (YIN) Foundation cleanout (Y/N) --Y— Depression over tank (YM) AL— High water alarm (YM) _ Date of pumping ---&JQ'4J— Pumper C. ABSORPTION FIELD DATA Date installed 16S Soil rating (9.p.dJfe 2 ) Z's System type ettd U41 A Length 30 ft. Width ZS ft. Gravel below pipe d. s ft. Total depth —3 ft. Eff. absorption area —7-5Oft Monitoring tube * Depression over field Date of adequacy test A1641 Results (Pass/Fail) For S bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, 9^re date D. LIFT STATION Data installed &Z6— I Size in gallons AIRML S OQiManhole/Acoess (Y/N) 'Pump on' level at -�(L in. 'Pump ofP level at 32 in. High water alarm level at 4/S in. Datum T_N`di 7b/'% Cycles tested L Meets alarm a circuit requirements? �L E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /'IV 5 f C Septic tank/lift station on lot% On adjacent lots Absorption field on lot Public sewer Sewer /septicp6rvice line Animal colamment areas On adjacent lots Public sewer Holding excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Jr Property line /Q / Absorption field Water main' O 'r Water service line / O t Surface water / O a '-e- Wells on adjacent lots 200 r l - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line 3 'a1' Building foundation q6 f4" Water main /D 14L Water Service line /D /4/ Surface water /01 r-0- Driveway. Perkin9/vehide storage 4 t' Curtain drain — Wells on adjacent lots SZA20 r* F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through Aeld inspections and �' y : � ••'�' �l review of Municipal records that the above systems are in % 9IH •• '• ♦..... ............. cOnfmn8nc& with MOA COSH guidelines in effect on this date. ' d ... Engineers Printed Name $oven W. Eng DateT,Z210e PE ansa ,il �PA/irro�rtl�1� r. COSA Fees Date of Payment Receipt Number O 3 (Rev. I IM) Waiver Fees � on d; Date of Payment Receipt Number _ t� O D 3S 14 1MNH UFr SEPTIC µOT PLOT Lan & ASSOCIGt6$ Inc11500 Daryl Avsnus, Anchorage, Alaska 99515-3049 9 s 907) 522-6476\Phone Registered Land Surveyors _. _ (907)'522-4625 Fax ' Of A www.langsurvoyare.com / Infoolangsurveyors.com .`v,.•• '" •.,�' 1 hereby certify that I have surveyed the following described property. LOT 9, BLOCK 9, THE TABLELANDS SUBDMSION. ADDN No 2 (PLAT No 05-013) 491d Anchorage Recording District. Alaska, and that the Improvements situated thereon an within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premise and that there are no roadways, transmission tines or other visible easements KENNETH LA11 on said property except as Indicated hereon. � LS -5 02 Dated this the 10`t�) Day of WAAt .. . at Anchorage. Alaska Y11�0b 4� a4•• H Is the responsibility of the owner to determine the existence of any easements. covenants. or restrictions which do not anneor an the manrded ■uhdM.inn ni rt.