HomeMy WebLinkAboutT15N R1W SEC 8 LT 202T15N RIW
Sec 8
Lot 202
#051-153-40
Municipality of Anchorage �F
Development Services Department
Building Safety Division
OnSlte Water and Wastewater Program, 4700 Elmore Road 1 r
of
P.O. Box 196650 Anchorage, AK 99507 Page
wwwci.anchorage.ok.us (907)343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
Permit Number:
SWO70257 PID Number: 051.15340
R•'"• Elaina Shawback Wastewater System: 21 New E]Upgrade
Ae m P.O. Box 670810 Chugiak,AK 99567 ABSORPTION FIELD
Prions N~ a B• 11 4 B D,Trsltat 13 Slulw. Trench D Bea O Mara O Onw,
230.3447
Sd Raxq Tda Depn horn nr,prol V•as
LEGAL DESCRIPTION 0.6 GPM' 9 Ft.
SaMmsun Dealt m Pp lxxlan ttax aq+ 9'" Gwrw"11 wren pas
Buri LN 202 2 Ft. 7 FI
S•apl f+i •aria soo.• aq+w vae crMl L•r10n1
TO iAQ 15N RB1Q° 1W 8 1.3-1.5 Ft. 76 Ft.
� ,•,an N,mw to Yre Dmwue Eettvert Yre
Well: 0 New ❑ Upgrade 3 Ft. 1 Fl
cwm*14Ft.
Cassa to Taa eD.aqun was Pp mwI
Private
nm (Prmd. A e. CI 1064 Fe ASTM D30341F810
Private R. 158 Fl
$rw. Ww•r L•'A1 RIRYnOr Do. srtalra
SulkTweed Excavating 9/212007
Sullivan Water Wells 101 Ft
y„u Pu v SM Mco•a rrax now. DraxrTANK
4 DPM 2 Fl
SEPARATION DISTANCES 0 Septic O Holding ❑ S.T.E.P. 0Other.
Mdmal.clow •P.uIY
Mptic Absorption Lift Holding ubllUFnvate Premier Plastics
1300 ow
ank Field Station Tank Sewer Llne Nuaw CO canes -tMls
M.Iwrl
' 13T 25'+ HDPE 2
•+ 100'+EE
LIFT STATION
46' GY 31'PuneMMe6 EMcvuM N.pKI,msPerrrr^nWWNone Known BENCH MARK
loulun sra pssdpm
Top of foundation near poinl'A•
rvalun
tt 100' Fl
.I' _ •:-1 .Iti,��� lfl^• '', i:. t. 'tel i.l
S&S Engineering
'=.A :.Engin amp
amp
Inspections performed by:
16961 S Birchwood LD Rd
Dates: 1" 921/2007
�.+
Chugiok, Alaska 99567
2nd 9212007
; • Lfi1-
^ •••""' " b�
Development Services Department Approval
a f �T; a ? �'
Date: !r
i.. ..... ,t...
Conditional Approval
.. .......,M»!
,. .�.,.»..,•�...,
�� A1C
Reviewed and approved by
1 �
Date:
.�.t,..l+
(R.. Hans)
/� 0
PERMIT NO. SW070257
PAGE 2 OF 4
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak,us
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 202, SECTION 8, T15N, R1W, S.M. P.I.D. No, 051-153-40
I
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TRENCH
M C01
ATH
DBL1 & DBL2
1300 GALLON
E SEPTIC TANK ..--
33' SECTION LINE EASEMENT
UNDEVELOPED
Z
1" - 49'
A. zlll €dw
143"7-'n
F
PERMIT No. SWO70257
PAGE 3 OP 4
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 *Anchorage, Alaska 99519-6650 Telephones; (907) 343-7904 • wwwci.onchorage.ak.us
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 202, SECTION 8, T15N, R1W, S.M. P.I.D. NO. 051-153—
LOT
199
LOT 200
LOT A
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CO2 i2 T-#2 ...,,.1 E-
NEW TRENCH `-
TMTST
LOT B
ST1 . M COt
STH
5
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pP
BM DBLt k DBL2
N
NEW 1GALLON W
SEPTIC
AREA
y
SEP
ECO HOPE SEPTIC TANK
y
�o
NEW
A HOUSE
g 1° q 60'
— — — — — —
— — — — — — — — — — — — —
. /� °°••••a eeyyA
•1 _ — — _ — — — —
_ • i��y���N
�. %
DOTTIES°
r! T
:.•i••T•P
33' SECTION L
DRIVE
... ....°.�.'
tob A. Shaft
o. 1457-E va
y.•
do
�NOEVELOPED�
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S A °°°cw° M••a••t` Aw
Ap
�@ `� OFESS 6'N
PERMIT No. SW070257
PACE 4 of 4
DEVELOPMENT SERV CESCDEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P0. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www ci.anchorage.ok.us
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 202 SECTION 8 T15N R1W S.M. P.I.D. No. 051-153-40
TOP OF TANK = 94.4'
ST1 ST2 96,9'
ORIGINAL & FINAL GRADE 2" INSULATION
NEW
93.3' 1300 GALLON
POLYETHYLENE 93.0'
SEPTIC TANK
FINAL GRADE
ORIGINAL GRADE=94.6'
D1T1=85.6'
NIT2=85.5'
'HOUSE OFFSET
(USES POINT A)
C01= 95.8'
CO2=96.0'
2" INSULATION
C01=92.6'
CO2=92.6'
NO WATER FOUND
78.5' B.O.H.
P.
A. Vxe
get
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw, SL
P.O. Box 196650 Anchorage, AK 99519-6650
www d anchorage a_k tis
(907) 343.7904
Fla $011'5 Lo
Performed For: a I n a
Legal Description: 4-7
_ eGz�
�Pth
(Feet) Al L/p /�
1
8-a/�
9.
10- fr
11- e
12- - 1Y
13-1.1
14 ',
15- Ir
. e
17-
19-
tsp law
SILzt j t h
WAS GROUNDWATER -.�
ENCOUNTERED?
s
IF YES, AT WHAT DEPTH! L
Depth to Water After U
Monitoring? P
E
Dote:
Reading aI Date
6.0.14
COMMENTS __FH –}/e
�ationnTest
2aC_ (_ Date Perfo�
�L Township, Range, Section:
PERCOLATION RATE
TEST RUN BETWEEN
Gross Time
3(D
O
6V
0
Net Time I Depth to Water
t—meahgh) PERC HOLE DIAMETER
Fr AND —,JL FT
Net Drop
v
PERFORMED BY:CERTIFY )
PERFORMED IN ACCORDANCE WITH ALL STATE AND 6fUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.? DATE:IS TEST WAS
Sullivan
19076882259 p.?
�C�rtiiieD� 4Dritting Rog
by
DOC o^. daa
SULLIVAN WATER WELLS
P.O. BOX 070272, CHUGIAK, ALASKA 99567 TELEPHONE 658.2759
OWNER OF LAND:t-}�/�%_�_Ac dSORE HOLE DATA
ADDRESS: c^DEPTH
LEGAL DESCRIPTION:.�"l�i� PILL) S�4_L Ff
DATE: -----
PERMIT NUMBER: Q t7 +_rt'ate 04Issue Cr -f�o-
TAX IDENTIFICATION NUMBERQS/ -- /f3__�O_
Is well located at approved permit focatan? <d'P6s ::No
Melhod of Drilling: (af ctary :I cable tool
Depth of %e!f: _ 15-e
w _�
Casing Type rJ9LWab-rhi^kness, + _inches
Diameter -_.-_b inches, depth � feet
Liner Type:.
Casing Stickup Above Ground: --feet
Static Water Level: --LQ f feet
Recover Rate: — -gpm
Method of Testing: �f
VVetl Intake Opening Type: Sf-1pen end * open hole
* Screened; Start ___--feet Stopped feet
O Perforations Start `— feet gapped Leet
Grout Type ...sT�.� —
Depth: from _ feet, to O --_feet
WiRll Disinfected Upon Completion? 'j� o No
Method of Disinfection: Ga_.�ao,�, _ _S"wy"
Comments:
c5+/L F t -�J �.•%t9 c_.,/��(a /C rilt�r?C
L34tJ C cel J,
644J44. k/
71
Driller's Name -.-�eJ cJ-Ij
ATTENT,DN: It is the rssponsibilty of the property ovrner to submit a Copy of the well Iog to the proper authority, Municipality
of Anchorage: Department at Health & Human Services aiwor Department of Ew;ronnnenat Conservation, Matsu Borough:
Department of Environmental Conservation.
11/20/2008 10:16 FAS 907 Jag 7997
0\ SITE
ARCTIC PUMP & WELL INC.
Jim Sullivan, CPI
PO Box 770197
rieia Eagle River. AK 99577
(907) 688.2510
(907)258.2510
(907)745-2510
pnt^n-eaI nn
Pump Installation Log
Well Drilling Permit Number: S W070257
Parcel Identification Number: 051-15340
MEH
Date of Issue: 9-20-08
PrOPerty Owner Name & Address:
Elaina Shawback
PO BX670810
rh..n;.4 A1C oaG77
Pump Installation Date: 8-14-08
Rump Intake Depth Below Top of well Casing: 146 Feet
Pump Manufacturer's Name:
Dempster
Pump MOdel:MBF3-75-S2
Pump Size:3/4
hp
Pitless Adapter Burial Depth:10
feet
Pitless Adapter Manufacturer's Tame:Martinson
Pitless Adapter Installer.
Tweed.
Well Disinfected Upon Completion? Yes
Method of Disinfection:
Chlorine
Comments:
Pump Installer Name:
Arctic Pump & Well, Inc.
Arufc Pump & Well, !mc
Page / of I
SCS Ra La
1086697001
Client Name
S & S Engineering
Project Name/a
Lot 202 Sec 8 TI 5N R I W
Client Sample ID
Lot 202 Sec 8 T15N R I W
Matrix
Drinking Water
P1i:SID
0
Sample Remarks:
Printed Date/rime
01/052009 23
Collected Date/time
12/162008 10025 :25
Received Daterrime
12/16/2008 14:40
Technical Director
Stephen C. Fade
Pamm`t`r ResultsAllowable
IYJL Units
hletMal
Pre Analysis
Container
ID Limits
Date 6mc
Init
Metals_ by I
Arsenic ND
5.00
ug/L
EP200.8
C
(<to)
12/18/08 1224/08
NRB
Waters Department
Total Nivatc/Nitritc-N ND
0.100 mg/L
SM204500NO3-F B
(<I0)
1229/08
JD7.
Microbiology Laboratory
Colony Count 0
Total Coliform 0
col/100mL
SN120922211
A
(<200)
12/16/08
Fecal Coliform
col/100mL
SM209222B
A
(<I)
DLC
0
col/100ml.
SM209222B
A
12/16/08
DLC
(<I)
12/16/08
DLC
.v�9'Y9'w Jz9.J
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4SBUILT SEWARD h ASSOCIATES LAND SURVEYING 694-08
I H=P.EBY CERTIFY THAT I HAVE SURVEYED THE SCALE,!yv
FOLLOWING DESCRIBED PROPERTY: _ Z OF Al
LoT Zb2 ftl, DATE. r Q ' • • • •. S,�,_b�
AND THATrNO FNC 64CHMENSS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONS131LITY OF THE i +
OWNER TO DETERMINE TH'•. EXISTENCE OF ANY GRID •"•" 6
EASEMENTS, COVENANTS, OR RESTRICTIONS wwizs6 j ...
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 4 ", . M..: s..•e : �S •
VISION PLAT. UNDER NO CIRCUMSTANCES SHOUD FB`sy �j �' , L5'� 3 < <s'i
ANY DATA HEREON BE USED FOR CONUrRUCTION L?
OF FENCE LINES, OR FOR ESTABLISHING BDUND- DRAWN
ARY LINES.
MUNICIPALITY OFANCHORAGE II0't u
Development Services Department
On -Site Water 8 Wastewater Program p
4700 South Bragaw Street r1
P.O. Box 196650, Anchorage, AK 99519.6650 �� 0
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT
Initial
Permit Number: SW070257
Legal Description: T1 5N R1 W SEC 8 LOT 202
Date Issued: Sep 20, 2007
Expiration Date: Sep 19, 2008
Parcel ID: 051-153-40
Design Engineer: 0003 S & S ENGINEERING Site Address: 19605 S. BIRCHWOOD LOOP ROAD
Owner Name: ELAINA SHAWBACK Lot Size: 108900 SQ. FT.
Owner Address: PO BOX 670810 Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567 -
This permit is for the construction of.
Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
Engineer needs to do an additional percolation test during construction of septic field. A new soil log needs to be
submitted with the Inspection report. If the results require a design change, construction of the system will stop
pending On -Site review and approval.
Received By:
Date:
Issued By: I I A Date: ?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/onsile
(907)343-7904
ON-SITE SEPTICMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o 5 i — (e-)-3 - y0
Property owner(s) G I(?, I ri G( -/i
Mailing address Po QO X 67075
Site address lgLcOJ, 'S 1
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size It)?- QbD Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
V
Septic Tank
❑
Holding Tank
❑
Privy
11
Private Well
Water Storage
❑
IV
ZD
phone 230-387
Code of S-
Se�f��� 2T15PJ P I W
Number of Bedrooms Ll
THIS APPLICATION IS AN:
Initial
V
Upgrade
❑
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwellincg andi"cc rid `ce-with-applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/RushFees: 1160^ 17S"
Date of Payment: hi/013
Receipt Number:
(Rev. 1 V05)
Vdaia-r Fees: 11457
Date of Payment: gi-7-d07
Receipt Number: OV5,004
September 19, 2007
ROBERT C. COWAN PE
CML ENGINEERS
(907)694-2979
FAX (907) 694-1211
IEALTNAIJTNGRTV MUNICIPALITY OF ANCHORAGE
AP°RMALS . Development Services Department
P.O. Box 196650
Anchorage, AK 99519
SEWER 6 WATER
"NEXTENSIONS REFERENCE: Lot 202; Section 8; T15N; RI W; S.M.
SEWER&WATER It Is requested that you issue a permit to install a new well and septic system to serve
'SPECTION the proposed four bedroom dwelling on the referenced property. An additional test
hole and percolation test will be performed during excavation to confirm soil
consistency.
EMiNEERINGSTUDIES
""°REPORTS We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
wELL*rPECnoN properties.
&FLOWTEST
If you require additional information, please contact us.
SITE BANS Since y,
PAW DESIGN ;t?obe hafer, P.E.
SOCTEST
Psc=nON
TEST
STRUCTURAL&
MECHANICAL
PSPEcnaNS
ONSITE
WASTEWATER
CMPOSALS'STEM
DESIGN
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CYRUS STREET
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Performed rot: �oq �•s
Legal Desalplion: LG�G
Municipalily of Anchorage
Development Services beparimeni
Building Safety Division
On-Slle Water and Wastewater Program
41DO South eragaw SI.
P.O. Box 196650 Anchorage, AK 99519"6650
Y,ww,cL4nfhoml-A&I
(907) 043.7904
Solis g - Percolation Test
��in R �j g// w Bac bate
Tovms 1 P. Flange. Section:
S oe
14• ` F
15 8-0. H alte
18-
17-
iB-1
COMMENTS
l4trUmn
Reading
Depth
Gross TMne
Net Tone
(reel)
`Lt L — — —
-- z-
e.•
-
�yP��,
4;
j•
S/9 n7D
bO
3Y�"_�
±40
D
60
Z,,
WAS GROUND WATEn
ENCOUNTERED?
10-L
(.
IF YES. AT WIIAT OEPIII7
11•
y
bsprhlo Wa(sr Allsr b
Mon110r11,97 p A le
��
12-
�t
O
1J-
14• ` F
15 8-0. H alte
18-
17-
iB-1
COMMENTS
l4trUmn
Reading
bale
Gross TMne
Net Tone
Deplh to Water
Nel Drop
'�
bO
3Y�"_�
±40
D
60
Z,,
30 '
70
3Y"
/'Jg"
170
:z it
O
ruwvanrr.n rwt 7V (.d w.eindl
TEST RUII BETWEEN 5 rT AND
PERC IIOLE DIAMEJER b •.
rT
PERrORMED DY: Ss �' ��' I \1-1.1
CERTIFY i11Ar 1ESi WAS
PERFORMGU IN ACCORDANCE Willi ALL ATE —AND MUNICIP UIDE l E fECT ON 11IIS UAIE. VAIE:
E:
ROBERT C. COWAN, P.E.
CMLENOINEERS
(907) 6942979
FAX(907)694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
'F'1TMN11ON V
APPRDJAu
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
SEWER& WATER
MAIN E MNSIOfS
REFERENCE: Lot 202; Section 8; T15N; RIW; S.M.
September 19, 2007
SEWER&WATER
NSPECTION
GENERAL:
1. The scope of this project includes the installation of a new 1300 gallon HDPE
septic tank and a septic trench to serve the proposed four bedroom residence
AE oWPORTS aEs
located on 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
;TTINSPECTION
applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
SITEPIANS
4. Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
&DAO DESIGN
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department or ADEC if required, for
system installations. Owners installing their own systems must also receive
�L'aT
prior approval from the respective agency.
PERCOLATION
SEPTIC TANK INSTALLATION:
TEST
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access. All HDPE
&TRLCTURAL&
septic tanks are required to have a 4" monitoring pipe installed next to the
INSPECTIONS
tank extending to the bottom of the tank.
ONSITE
WASTEWATER
DISPOSALSKTEM
DESIGN
Page 2
Lot 202; Section E; T1 SN; R1 W; E.M.
September 19, 2007
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated. All HDPE septic
tanks are required to be covered with a minimum of 2" direct burial insulation, and a
maximum of 4 feet of cover.
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 TRENCII/DR.AINFIELD INSTALLATION:
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.
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.
Page 3
Lot 202; aaction S; T1 SN; R1 W; a.M.
September 19, 2007
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Tyne of Pine Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or
equal).
5. 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.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
Lot 202; Section S; T1 SN; Rt W; E.M.
September 19,200T
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.
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
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval I
Parcel I.D. 051-153-40 Expiration Date:
1. GENERAL INFORMATION
Complete legal description TI 5N R1 W SEC 8 LOT 202
Location (site address) 19605 SOUTH BIRCHWOOD LOOP RD., CHUGIAK, AK 99567
Current Property owner(s) LOIS SHAWBACK Day phone 230-3446
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Fx�
Individual
E
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: NONE
Distance: ---
Received by: Date: S I 11S11,3
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $�0 l Waiver Fee $
Date of Payment gB�ad�3 (+� Date of Payment
Receipt Number Oqq q aQ Receipt Number
COSA # 01�c Q ?) i1R 1 A Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 279-3916
Date 8/9/13
i..:.. .T". ..
.. ...........
LA, E. SPUR'KLAND; J` %
Popo
Conditional approval for bedrooms, with the following
By: 11 p Original Certificate Date: 7) J!7 1
Th ume'ipali 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
COSAblveeheet v . c
If more than 7 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: T1 5N R1 W SEC 8 LOT 202
A. WELL DATA
Well type PRI If A, B, or C provide PWSID #
Date completed 9/25/2007 Sanitary seal (YIN) Y
Total depth 158 ft. Cased to 158 ft.
Date of test
Static water level
Well production
FROM WELL LOG
9/25/2007
101
4
WATER SAMPLE RESULTS
ft.
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: ANSON
7Ja'I t3
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/HDPE
Tank size 1300 gal. Number of Compartments
Foundation cleanout (YIN) Y
Date of pumping 7/30/2013
C. ABSORPTION FIELD DATA
Depression over tank (YIN) N
Pumper Sanitary Pumpers
Parcel ID: 051-153-40
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) 2 in.
AT INSPECTION
8/8/13
M
ft.
t!1!ud
An5oA
Collected by: MOXNESS
Date installed 9/21/2007
Cleanouts (YIN) Y
High water alarm (YIN) N
Date installed 9/21/2007 Soil rating (g.p.d.e or ftz/bdrm) 0.6 System type TRENCH
Length 76 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth 12.3 ft. Eff. absorption area 1064 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/9/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 36/31 in. Water added 1000 gal. New depth 52/49 in.
Elapsed Time: 1440 min. Final fluid depth 42/39 in. Absorption rate >= 600 9 p d
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum M
Size in gallons _
in. "Pump off" level at -
E.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested --
Septic tank/lift station on lot '100'
Absorption field on lot '100'
Public sewer main NA
Sewer /septic service line 25
Animal containment areas '50'
Manhole/Access (YIN) -
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots '100'
On adjacent lots '100'
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas '100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5
Water main NA Water service line '10'
Wells on adjacent lots '100
ABSORPTION FIELD ON LOT TO:
Property line '10 Building foundation >10,
Water Service line '10'
Curtain drain '50' (N.O.)
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water '100'
Wells on adjacent lots '100'
I certify that i have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKLAND
Date 8/9/13
COSA brown sheet 10-10-12.doc
Absorption field >5
Surface water >100'(N.O.)
Water main NA
Driveway, parkingtvehicle storage 10
.Z71 o. F. A (,,q 1k1I
A,.
`'' g T
00 s.
na puRKLAND
(I�F�PR FE S\OhP�_