Loading...
HomeMy WebLinkAboutCABIN BY THE CREEK LT 3Cabin b y the Creek Lot 3 #015-521-20 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211340 PID Number: 015-521-20 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name Richard & Pamela Lloyd ABSORPTION FIELD ❑ Deep Trench ❑® Wide Trench ❑ Bed ❑ Mound Site Address 10980 Birch Rd, Anchorage, AK 99516 ❑ Other Phone 351-9228 Number of Bedrooms 4 Soil Rating JTotal depth from original grade 0.45 GPD/SF 5.5 / 5.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5/2.5 Ft. Gravel depth beneath pipe 3.0/3.0 Ft. Subdivision Block Lot Cabin by the Creek 3 Fill added above original grade 1.3/0.5 Ft. Gravel length 2 @ 78 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1345 Ft2 2 Well N/A >100" N/A N/A >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Nf�Ttixfa rer Capacity Gal. Surface Water N/A >100' N/A N/A Material umber of compartments Lot Line N/A >10' N/A NIA NA Foundation N/A >10' N/A N/A LIFT STATION Khat turer Capacity Remarks Trench replacement only. Trenches are Gal. Insulated. Alarm location installed by Installer PIPE MATERIAL House to tank EXIStIn g Tank to D1785 drainfield A+ Home Services Drainfield D1785 CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection10/26/21 1s` 10/25/21 Location and description dates: 2nd V Threshold of garage man -door 4`h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �F Conditional Approval: Date Septic SystemB nj chiller 9259•���� Approved Date 122021 CE �� �'slF • 11/10/21 •���� �FaPRO \ ' EESSt(O„ Note: this approval does not include well permit requirements. .�- kr[Cv VJ/VG/ 10) CABIN BY THE CREEK, LOT 3 PERMIT # OSP211340 LOT 2 / FENCE (APX) PID # 015-521-20 I 1 I I 25' CREEKMINT}1 SM ",-EXISTING WELL w/ — "100' RADIUS \ ' z Y ¢ l LOT -3 LOT 3 4-BDRM HOME �r 4_Ig0' SEPTIC SYSTEM ate' CREEK SETBACK MT2 _ � TH®-AMT1 i6MT4 MT3 -- ' �,�---- 10' T EASEMENT w LIMIT'S F;WETLANDS fj TWO REBUILT 78' LONG x 5' WIDE, 3' PER MOA`MAPPING I EFFECTIVE DEPTH ABSORPTION TRENCHES Ji TH Benja i Schiller P '•'��i em.e� 092024-'�Ago PR0F SS 6vP _--- ` 15' SEPARATION j FROM -WETLANDS BENS ti LES ESTATES LOT f,,, t 0 50 100 FEET 1 "=50' A B MT1 58.1 36.7 MT2 36.6 60.1 MT3 66.9 49.8 MT4 49.9 69.4 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE CABIN BY THE CREEK, LOT 3 PERMIT # OSP211340 PID # 015-521-20 NORTH TRENCH 2 108.9 FINISH GRADE 107.6 ORIGINAL GRADE 2" INSULATION 105.1 DRAINFIELD ROCK 102.1 MOA FILTER SAND 101.7 �- 78' rn I— z NO GROUNDWATER 7/1/92 Q 75 92.6 Q SOUTH TRENCH � 109.7 FINISH GRADE 109.2 ORIGINAL GRADE I n 106.6 DRAINFIELD ROCK 103.6 MOA FILTER SAND 103.2 N r- 78' Q NO GROUNDWATER 7/1/92 2 Ca 94.2 Q PROFILE AS -BUILT (NO SCALE) 105.1 102.1 2" INSULATION 106.6 103.6 ®+ It Ar: 49 7H .` .. .......... • ' • • • Benja 'n Schiller ' f��Fc,�j'•NoCmber10 202J•'�O'``�� ��e�F�PROfESS10NP�'�.,� • • kt.\- `-f CD -P • • -� y in • _ --.00 - tea, •�j • • Ti � • N�N s i V'>' • • • • /e p . a s • . '`Pei" e y . . or .40, trim e T r L N UU-U['at5"W Y 1,MM' BIRCH ROAD _j �o u I MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211340 Work Type: Septic Upgrade Tax Code Number: 01552120000 Site Legal Address: CABIN BY THE CREEK LT 3 G:2637 Site Mailing Address: 10980 BIRCH RD, Anchorage Owner: LLOYD PAMELA J & RICHARD E Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: cnt Departinent 9/28/2021 9/28/2022 59673 Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Veronica Pope 2021.09.28 *--4 14:23:54 -08'00' Date: Issued By: G Date: Z Z In "r 17f, :- Community Development Department F a: Y- Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-521-20 Property owner(s) Richard & Pamela Lloyd Day phone 351-9228 Mailing address 10980 Birch Rd, Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Cabin by the Creek Sub, Lot 3 Legal description (Township, Range & Section) Lot Size 59,673 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank ElUpgrade (w/wo ADU) Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: q5 Waiver Fees: Date of Payment: 13 2a Date of Payment: Receipt Number: L17 2 00 Receipt Number: Permit No. 05 PZ 11-3'10 Waiver No. Permit App_'-'-:- "�. c: September 23, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 9/23/21 Subject: Cabin by the Creek Sub, Lot 3 – Birch Road Septic system design Dear On-Site Services Engineer: The owner of the above lot intends to sell their 4-bedroom home on the property and the septic field has reached the end of its useful life, so we are submitting this permit application for the construction of a new septic absorption system. The attached site plan identifies the location of the home as well as the proposed septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. Little Campbell Creek runs through the northeast corner of the property, and the area around the creek on this property has been designated as class C wetlands. The extent of the wetlands is only estimated on the maps and difficult to transfer to the survey. It appears that the wetlands extend throughout the majority of the northeast portion of the property and take up nearly all of the east side. For this reason, the existing septic has been located in the southwest corner. Due to the amount of space available outside of the proposed wetlands boundary, our options have been limited to either advanced treatment, or rebuilding the existing fields in place. After careful consideration, we are proposing rebuilding the existing system. The ground surface on the lot slopes toward the northeast gradually at about 15% or less. There are no slopes greater than 25% within 50 feet downslope of either the proposed site. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211340, Deb Wockenfuss, 09/28/21 Please refer to the attached plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE // // // // // // // // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CABIN BY THE CREEK SUB, LOT 3 FEET 0 50 100 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS.BIRCH ROAD4-BDRM HOME September 23, 2021 100' SEPTIC SYSTEM CREEK SETBACK 25' CREEK MAINT. ESMT LI T T L E C A M P B E L L C R E E K FENCE (APX) 10' T&E EASEMENT 10' T&E EASEMENTTH-A MT MT REBUILD BOTH 78' LONG x 5' WIDE, 3' EFFECTIVE DEPTH ABSORPTION TRENCHES. EXCAVATE CONTAMINATED MATERIAL & DISPOSE OF. MATERIAL EXCAVATED FROM BOTTOM MUST BE REPLACED w/ MOA SAND. MAINTAIN EXISTING MAXIMUM DEPTH EXISTING WELL w/ 100' RADIUS 560 565 555LIMITS OF WETLANDS PER MOA MAPPING MT MT 15' SEPARATION FROM WETLANDS >6' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211340, Deb Wockenfuss, 09/28/21 CABIN BY THE CREEK SUB, LOT 3 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER1 1 4" PERFORATED PVC w/ 30 - 3 16" HOLES SPACED EVENLY (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" ~2' 3' DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 30-60 MIN/IN APPLICATION RATE: 0.45 GPD/SF 3' SHALLOW TRENCH SYSTEM BOTTOM OF TRENCH: MATCH EXITING BOTTOM OF TRENCH ELEVATION FLOW LINE ELEVATION: MATCH EXISTING INVERT ELEVATION TOP OF TRENCH: 6" ABOVE GRADE 600 GPD / 0.45 GPD/SF / 3' DEEP * 0.58 RED FACTOR = 155.6 LF TRENCH REQUIRED (156 LF SPECIFIED) September 23, 2021 2" INSULATION GEOTEXTILE FABRIC Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211340, Deb Wockenfuss, 09/28/21 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE A SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH?- 12 6 4 5 7/30 1 2 3 4 5 6 GM (SILTY SANDY GRAVEL) Professional Engineers Stamp: no NONE 8/6/21 CABIN BY THE CREEK, Lot 3 7/30/21 015-521-20 Pamela Lloyd 9:551 2 3 4 5 6 3 0 16 10:25 10:26 10:56 10:57 11:27 OB / FILL 30 Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEERAugust 11, 2021 SM (FINE SAND) 30 30 6 8 16 3 8 16 3 0 16 5 9 16 2 9 16 3 0 16 5 8 16 2 8 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211340, Deb Wockenfuss, 09/28/21 Municipality of Anchorage Page 1 of 3 Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW000273 PID Number: 015.521.20 Name: Clinton T. Lancaster Wastewater System: New Address: 3213 Ta shee Circle Anch., AK 99504 ABSORPTION FIELD Phone: Number of Bedrooms: 481.1072 Four 4 5' W ide Trench LEGAL DESCRIPTION Soil Rating: Total Depth from onginal grade: .45 GPD/Fe 4 Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 Cabin by the Creek 1 Ft. 3 FL Township: Range: Section: Fit added above original grade: Gravel Length: 2.3 Ft. 154 Ft. • Well: New Gravel mdth: Number of lines: Distance between lines: 5 Ft. 2 >10 Ft. Classnfication (Private. A, B. C): Total Depth: Cased to: I otal absorption area: Pipe Material: Private 123 Ft. 122.5 Ft. 1,334 Ftp ASTM 3034 PVC Driller. Dale Drilled: Static Water Level: nslalier Late sailed: M-W Drilling 812512003 50 Fl. Red Dog Masonry 7130-3112003 Yield: 30+ Pump Set at: Casing l eight Above Ground: >2 TANK GPkf Ft. Ft. SEPARATION DISTANCES STEP To Septic Absorption Lift Holding ublidPnvafe "u acurar. apacuym ons: From Tank Field Station Tank Sewer Line Anchorage Tank 1500 Well >100' >100' >100' NIA >25' Material: Steel Number of Two (2)� Surface Water >100, >100, >100' NIA LIFT STATION LDt L,ne >5' >10' >10' NIA V Ze. 250 Gaf. Anchorage Tankf0renco Foundation >5' >10' >5' NIA unv on eve at: 42 ump level at: 42 igh w2lef alarm at. 44 in. in In. Curtain Drain None Noted Pump Make BModel Orenco Eiecincalinspections PeAme ordoY Municipality ofAnchorage Remarks: BENCH MARK 2- Insulation Placed Over trenches. ocation an scrip ion: Front Deck Southeast Corner. Assumed Elevation: 100.0 Ft. Engineer's Stamp '•••�•aaaaap • ��......., ,+4 ••�P "' 4 .•' QJ � rtDates: �i02 Inspections performed by: MEA 1e` 7130!03 4 "d 7l31103 �.... ............_........ ... �-NAEL E. AND Department of Health and Human Services approval 0 0:MI •. No. tr s CE-43at •���FPF ' Reviewed and approved b . �-•O PP Y' • Date: 2'/,S' 3 �.� ��o'• ...• 'P�,•• (Rev. i099 ( ) 4�,�' ;SS'l �I i Om I*> ru Otr^ 2 _X—x—X—x--X- N 00'02'28'W 213.17' O C 3 O to N a O O Mn /TO' T. & E. ESMT,/ ---------/----- / 333tnV1 / ITLn r%) W — / ITV W . OD u V N / 'i IT N tb / Vel -IVA / SFA1/0 Fk S��SrsrF� o1r i ?S I / / L—--------� —�—,�---------------- / 10 T. & E. ESMT. 38"W 213.48' U1 O BIRCH ROAD — T CD Z L`J O �C0 W 0 N N d co d CD N m z Si -ice m N 0 m 0 <0 m(a m= 3SD<n0 0 Dp0 � o CD rnnX0 N O ��m rn 0 cin =3 I .Z1 A ID W 0 V �o A L s s $ � g 0 n x I N r I OI •I �I R• I ml / cn / 41 I / I / I � _X—x—X—x--X- N 00'02'28'W 213.17' O C 3 O to N a O O Mn /TO' T. & E. ESMT,/ ---------/----- / 333tnV1 / ITLn r%) W — / ITV W . OD u V N / 'i IT N tb / Vel -IVA / SFA1/0 Fk S��SrsrF� o1r i ?S I / / L—--------� —�—,�---------------- / 10 T. & E. ESMT. 38"W 213.48' U1 O BIRCH ROAD — T CD Z L`J O �C0 W 0 N N d co d CD N m z Si -ice m N 0 m 0 <0 m(a m= 3SD<n0 0 Dp0 � o CD rnnX0 N O ��m rn 0 cin =3 I .Z1 A ID W 0 V �o A Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW000273 N / N E 1,500 Gallon STEP Tank PID No. 015-521-20 4 .. S NORTH LEG N S 104.5 Drainfleld Rock 77' (Trench Length) 99.4--/ 3/16'Orlflces @ 4.8' SOUTH LEG PROFILE AS -BUILT Scale: I"= 10' 9 •� 12/09/2003 14:20 3453287 M W DRILLING, INC PAGE 01 ■is M -W trilling, Inc. 'iIzz *P.O. Box 110378#Anchorage, AK 99511• ♦907-345-4000 • 907-345-3287 Fax* Job No.: 03-175 Project No.: NIA Permit No. SW000273 Groundwater Well As -Built do Log ♦ Well Owner: Harding Homes for Lancaster, Clinton ♦ Use of Well: Domestic *Legal Description: Cabin by the Creek, Lot.'--. Construction ♦ Hole Depth: 123' ♦ Casing Size: 6" ♦ Cased To: •Drill Method: Air Rotary 122.5' *Material. A 53 Steel Perf. ♦ ii'ell Completion- Open end - X Screen Perforated _ Method. ♦ScreeNPerforarion description: None ♦Grout Notes: (1) Sack -No. 8 bentonite granules ♦ Nota: ♦ Weli Development. Method. Air surce Notes. 4, Static water level (SWL) 50' (rb~) (below) top of casing (TOC). ♦ Well yield test at 30+ gallons per minute (GPV/gaof_ eherperLeue{6FiI) for i hours with 100% of drawdown (DD) from static level (SWL). ♦Method: Air lift • Date of completion: 25 August 2003 ♦Pump Install: Depth in feet from top of casing. 0' TO 2 Deulls of formatlons penetrated9 size of material color and hardness. - Casing stickup 2 TO 10 Organics 10 TO 50 Sil vel: cobble 50 95 115 TO 95 TO 115 TO 125 Silt: ravell Cla : Wet, veil Water ave]: sand TO TO TO TO TO TO ' TO TO TO . TO 971 csrtifteate xd TO OM HARDING Dec' 30 03 04:47p FAX NO. : 907-333-2828 Dec. 11 2003 04:25)PM P1 Jim li110 .. 1-807-822-7889 'lou`(4pc3P.oPAt- (El Vel 907 943 8Z14 SAM= 06/2T/x062 16:02 TAX SAM= a BPF-CTXW REPORT MUNICIP(/ UTY OF A� �O�H -BUitw SAFETY DMSION Sobi Ass .1 LOT COMMENM or Cobra 4 ::13Y rTl rGcK . X -1.l . 1:tas ATl�Ci C� �p � UM ONLY) Ern Anomvdbd eaan.;.��t+•f ��... . JSQE.L'Ti O N Go t�•-K�-��• IISy�t/dlgmt�r'etiee• il��y¢pfdcKW� [ I whtgooned sptfor es rib • .:.. I i�1 OA= C i /k VISPE=R r0FCr* ISPSCTl0" w Sx.G7lOAt3AR 11aogPLEmr-CAL1 l:i�:::•i.�.,r'`'. :-:i t;;� • ;:ii.>;�:r ..'t �; ,tom•-�-�.i. •' •" .ilw a >_ 4 ,� •� f fi ,,` �•'. .. ''� .... ',il:.V::.. • .'i:Ti 1'n... •.39. {•�.—_t.. }.'.. i:G..: u... .(• .. ......• +A.v�-'•.��. ^:..:. i,•.'L.;;r�n.Jft'.r.:':. ..'S':.��.: ... • MUNICIPALITY OF ANCHORAGE 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 / WATER SUPPLY PERMIT Renewal Permit Number: SW030501 Legal Description: CABIN BY THE CREEK LT 3 Design Engineer: 0014 Anderson Engineering Owner Name: Clinto T. Lancaster Owner Address: 3213 Tayshee Cir. Anchorage , AK 99504 - Date Issued: Dec 10, 2003 Expiration Date: Dec 09, 2004 Parcel ID: 015-521-20 Site Address: Lot Size: 59672 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ 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 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. Received By: Issued By. Date: 17--11-62 Municipality of Anchorage 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.anchorage.ak.us (907) 343-7904 ON-S!TE SEWER./VVELL PERMIT.APPLICAT!ON FOR A SINGLE FAMILY DWELLING a 330 Parcel I.D. I _ ��� Permit Number SW Property owner(s)j Vl l �V1�' t �- Day phone Mailing address (1 Mailing address (2) Zip �Co�de Legal description (Lot, Block & Sub'd.)L��` J\ \ VAX Legal description (Section, Township & Range) 2 Lot Size S_9 V)Acres/Sq.Ft. Number of Bedrooms 7 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ham' 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. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: is Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: L3 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX MEMORANDUM DATE: June 15, 2003 TO: Dan Roth FROM: Mike Anderson, P.E. SUBJECT: Lot 3, Cabin By The Creek Subdivision Revised Septic System Design and Site Plan The owner of Lot 3, Cabin By The Creek Subdivision has requested the septic system originally designed for the lot be revised from a Bottomless Sand Filter to a conventional absorption system. He has also requested the system be designed for a four-bedroom home. We have therefore reviewed the original design and available soils information and revised the design to include a 1,500 -gallon STEP tank with 2 — 72' long by 5' wide by 3' effective depth absorption trenches. The total depth of the trenches will be 4' below existing ground. Soils logs completed near the proposed absorption trench sites indicate percolation rates of 30 to 48 minutes per inch in the accepting soils layer: The soil becomes denser with depth and the percolation rate slows. It appears, however, a minimum of 2' of accepting soil is available below the bottom of the trenches, which percolates at the design rate. The lot is crossed by Little Campbell Creek, which limits the area available for the septic system. The alternate site will be an Advantex Treatment System, which will require a 5' wide by 72' long absorption trench with a 3' effective depth. It is shown on the Site Plan a minimum of 10' from the edge of the primary absorption system. We hereby request the current permit issued for this lot be modified to include the revised design as shown on the attached Site Plan. 213.17 N00 03'00"W 2& I I I I �A> 10• Utility Easement 016! �a�t •''�'''• BIRCH ROAD OW P cn Oo co4 N V bo CD x 10' Utility Easement cn— � o — — — — — — — — — X — — — — — — — —— O O C2 -n o ams Cti m= P W T CD 0- d W 4^ �Q V V1Y� m (iJC y G) N ID < D DXNQ N U) Z I��_ 2 r _ (/) � IX � m O MOB X 1 1 IN m off! 1 v I� �� W II v v z � I 4 Lo I ca I I I I I �A> 10• Utility Easement 016! �a�t •''�'''• BIRCH ROAD OW P cn Oo co4 N V bo CD LOT 3, CABIN BY THE CREEK SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom House 5' Wide Trench System Perc. Rate: 30-60 MinAnch 1,500 Gallon STEP Tank Application Rate: .45 GPDISF 3' Drainfield Rock 4 Bedrooms X 150 GPD/.45 GPD/SF (A plication Rate) = 1.334 SF Absorption Area 1,334 SF/5 LF (Width)' .58 (Red. Factor= 154 LF Trench Length THEREFORE: Construct 2-72' Long x 5' Wide x T Effective Depth Absorption Trenches. Flow Line Elevation in Trench to be 1' Below Original Ground Surface. Total Depth to be 4' Below Existing Ground. Maintain 100' Separation From Well on Lot. Place 2' of Direct Bury Insulation and 2' of Fill Over Absorption Trench or Provide Minimum 3' of Cover to Prevent Freezing. 2' Natural Backfill 2" Insulation eotextile Fabric 6" 3'0" TYPICAL 5' WIDE ,.1, 4" Perforated PVC (Holes Down) Drainfield Rock 5' ------------- TENCH SECTION NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells In the Area. Minimum 100' Separation From Surface Water or Streams. PRESSURE DISTRIBUTION CALCULATION Elevation at Highest Discharge Point Pressure at Highest Discharge Point Liquid Level in Tank (Elevation) Diameter of Holes in Distribution Line Diameter of Distribution Line Hole Spacing in Distribution Line Length of Transport Line Diameter of Transport Line Q = 12.4dii'Fi = 12.4(.1875)(.1875) _ .9748 GPM/Orifice _ .9748 * 30 = 29.24 GPM TDH = (586-570) 16 + .0192(29.24)(29.24) + 16.4 + 37.0' 586' 5' Head 575' .1875" (311611) 1" 4.8' 25' 1.25" + .000995(25)(29.24) 1.el (1.25) -1,z -'r 4.6 Therefore 30 Orifices @ 4.8' Spacing With 37' Total Dynamic Head. Orifice Diameter 3116" c st i+ it Of m, X C' 200 -OC V Y z 150.0c I 016=0 I Me: 311 5.00 10.00 15.00 20-00 25.00 100 35.00 40.00 45.00 50-00 NET DISCHARGE, GPM -Lq, t.%/ FCR�IENC N1ALROAJ"QS_f1_3_O_RG_,OR97470 (503)673-0160 I *FLUENT -1 EFFLUENT PUMPS _A if 1/2 Hp to 11/2 H z it I A SINGL5PHASE, 6M 115/230 VOLT OSI 1SHHF 9 stage. -- PC#2 -20 1::j 1 t. . .. ...... q. 0 5/92 11 ' 14. 4t� 4-+ u. - L +L 2, -�O OSI 30 Hlivstage --T : x}...11. --1}}-. N_ it T.7. -4 4-- .. ... .. 'T" J ... L JJ_ it it L r . ALL i 1 20 IDS IOSHH _LL t J i . - ... . . . . .--}x-_`"i-.. .........I .. .. ....... .. j --rr _j 1 Na 44-Ij . I i j t I L. J ... J. -i.4 . ... ..... .... I.- J. An ncZT nc; T4T4 -.2 stage '..:...::.,..i.. 4--: .. T7 ..... T -JI-1 ...... ....... .. ......... t..t . ... ... .. . . . .. . . .......... ... .. .. ...... . .. .. .. - J ...... V. 20 OSI 05 HHF 5 stage al a ........ . . e if .. 4-1_ .."AA. if W 1/41' flow controller .. . ... 5.00 10.00 15.00 20-00 25.00 100 35.00 40.00 45.00 50-00 NET DISCHARGE, GPM -Lq, t.%/ FCR�IENC N1ALROAJ"QS_f1_3_O_RG_,OR97470 (503)673-0160 I MUNICIPALITY OF ANCHORAGE 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 I WATER SUPPLY PERMIT Renewal Permit Number: SW020284 Legal Description: CABIN BY THE CREEK LT 3 Design Engineer: 0041 AK Water & Wastewater Consultan, Owner Name: Clinto T. Lancaster Owner Address: 3213 Tayshee Cir. Anchorage AK 99504- Date Issued: Aug 12, 2002 Expiration Date: Aug 12, 2003 ParcelID: 015-521-20 Site Address: Lot Size: 59672 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [✓J 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. 3//7%3 t�� F.vGi�E�R�s AKE'.voao v s.G�v o*rA0 r�*flfe� // 2�3 Neu. 47f¢ C YF_ P. SEE't EPC, IA,Z e/e'J AM�'i�oFv pe s16A.- 19n -)"aa Received By: Issued By: /9 r,&2aat� sex Date: C� eta/,Date:r I Municipality of Anchorage 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.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ()K, S Z 1 — Ze__1 Permit Number SWOZOZ94 Property owner(s)i L Ati) L A_/L Day phone 333– e4c �% �Z Z ('� TAY V4 -4a c i– (' Lf �`����RA�rr � T �SC)' Mailing address (1) 3{ Mailing address (2) Zip Code ^ Legal description (Lot, Block & Sub'd.) l AZ,J Y "j, -A- e' EEEK LT 3 Legal description (Section, Township & Range) Lot Size S9 672- Acres q.Ft THIS APPLICATION IS FOR: Number of Bedrooms Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above 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: ��(� 04 �N e t CoQ Waiver Fees: Date of Payment: % 11q p D oQ Date of Payment: Receipt Number: a ( Receipt Number: (Rev. 12100) s ALASKA WATER & WASTEWATER o�i�mmueRa�suwna�noaawmaaen,nta�anmar+maa CONSULTANTS, INC.""""a'mm.a�r�rnawsuvaaai„vuea�+w�m March 11, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 REVISED DESIGN: Permit #SW020284 Ref: Proposed Well and Septic System for Lot 3; Cabin by the Creek Subdivision To whom it may concern: An existing permit (SW020284) was issued on 8/12/2002 for an Intermittent Sand Filter bed type system. We are proposing to use the existing permit and amend it for an Advantex Treatment System. The proposed 3 bedroom house will be served by private well and septic system. Comments regarding the design are summarized as follows: 1. TRENCII DESIGN: a. Percolation Rate: 32, 48, 120 minutes/inch b. Proposed Application Rate: 2.0 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 225 ft2 f. Total Depth: 2.0 feet (max.) g. Sand Filter: 2 feet+ h. Effective Depth: 0.5 i. Width: 5 feet j. Reduction Factor: N/A k. Minimum Length: 45 feet long 1. Effective absorption area = 225 ftZ Note: the distribution line is to be 1.25 inch sch. 40 pvc with 1/4 inch diameter holes spaced 17 inches on center (30 holes total). 2. SURFACE WATERS: A creek runs on the northeast corner of the property and is greater than 100 feet from the proposed septic system upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwNvc.com 3. TOPOGRAPHY: The area for the proposed drainfields is a 5%-10% percent slope running approximately south to north; 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. P.E., M.S. NOTE: A site plan drawing, a design draining, a detail drawing, a soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2Q * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com _ 1 LOT 1, CABIN BY THE CREEK S/D 1 I 1 I \ \ I I \ \ \ I I \ I I 1 I THE CREEK S/D /2 I LOT 2, CABIN BY THE CREEK S/D LOT 2, CABIN BY I I CREEK LOCATION-,Io—TEST� I HOLES BY 1 ALLAN . MURFfTT, P.E. PER ALASKA\ CONSTRUCTION 1(9/30/83 do 10/21/83) (APPROX. LOCATION) SURVEYSy\\ 1 I I C*�� I I o I y\ D I I \\iJ8 7H) I TH13 I F I PROPOSED I y I 4o� 3 BEDROOM HOUSE ofI •Y L LOT 3, CABIN BY THE CREEK S/D /2 I ,1 }TH/2 i LITTLE CAMPBELL -- f------------ STIE I CREEK 1 Y411' I ��— —\ALTERNATE I I PROPOSED SEPTIC SYSTEM. SEE DESICN PACE 2 OF 3. I 1 TEST HOLE BY EARLE V. I I I i I AUSMAN. P.E. (8/15/92) ( I APPROXIMATE LOCATION. ! 1 I 1 I LOT I. BENSLER ESTATES S/D 1 I ���� I 40 4 I c7 4 LOT 1, HICCINS S/D \\ I I I I �I I ryu• \ I LOT 2, BENSLER ESTATES S/D DATE: (REVISED) 3/11/2003 .`'.� DRAWN BY: C.J.G. T .20 _...4._- AI.ASKA «'ATRR & WASTEWATER 4 ««�-•---- •----•----• CONSULTANTS, INC. Ste' _ 1 100 '" ' • • • • • • • • •� 6901 DFRARR ROAD. SUITE 213 • ANCHORAGE. AK 99504 • PHONE (907)337.6179 • FAX (907)338.3246 - j VA i1 ... ,. .... „ .......... PREPARED FOR PHONE NUMBER: PAGE NUMBER: CLINT LANCASTER (907) 333-8752 1 OF 4 S ' eff a A. 14,� -P,� '•. E 7953 " LEGAL DESCRIPTION: BIN THE CREEK SUBDIVISION; LOT 3 +e;e�Prore3g}ono`�cA ����`•�•���•�•��' BY TYPE o SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM -- _ CREEKLOCATION \ I PROPOSED ` CONSTRRU SURVESON Y I � I I NOTE: THE CONTRACTOR SHALL HAVE r o0 THE SOUTH AND WEST LOT LINES w 1\ FLAGGED BY A REGISTERED LAND Ra, �\ SURVEYOR PRIOR TO CONSTRUCTION. I \ \\ INSTALL FOUNDATION CLEANOUT PROPOSED 1500 GALLON FIBERGLASS ADVANTEX TREATMENT �:.. •: SYSTEM w/ PUMP VAULT I� PROPOSED ' 3 BEDROOM•• TEST HOLE BY EARLE V. •� • t\� • ' .• AUSMAN, P.E. (6/15/92) HOUSE •• : • APPROXIMATE LOCATION. •�• �x .'. ,•, y :. THi MH , •' t MT" -711111114 F---------- L ---------- �. ALTERNATE SITE --- L--- --------------------.� 10' UTILITY EASEMENT — — — — — — — — — — — — — — — — — — — — — — — — — PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 2 FEET MAXIMUM BY 5 FEET WIDE BY 45 FEET LONG. ADD 2.0 —DEEP FEET OF APPROVED M.O.A. APPROVED SAND FILTER THEN 0.5 FEET OF SEWER DRAINROCK. THE DISTRIBUTION LINE IS TO BE 1.25 INCH PVC WITH I INCH HOLES SPACED 17 INCHES ON CENTER (30 HOLES TOTAL). DATE: (REVISED) 3/11/2003 oaoo600 DRAWN BY: ALASKA NVATI?R & NVASTEAVATER C.J.G. C-9 T SCALE �,....---e"--•--"--CONSULTANTS, INC.�" = 30+ ........ •• .• •• •• .......... 0 6901 DESARR ROAD. SUITE 28 • ANCHORAGE. AK 9950L • PHONE (907037.6179 • FAX (907)338-3246 '•• 0 PREPARED FOR: PHONE NUMBER: PACE NUMBER: 2 OF 4QO CLINT LANCASTER (907) 333-8752 fry messy13 �4�� 7953 \BOO LEGAL DESCRIPTION: CABIN BY THE CREEK SUBIVISION; LOT 3 •.........• 44wl Dd' rofeesl000�� �:O00000 TYPE OF WORK: DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM NOTE: JIM CROSS, AdvanTex" Treatment System � P.E.HAS THE +� ADVANTEX • • e MANUAL* -Mode 11 O's ° Vis, .. 40x94Pod O al�la� � 1 i•x-TK—x-x-x-Tl—x-x-x->K-x->.• CAI �.�-�.1 III,III,III,III,III,III,III,II) 30 INCH 6- JIM CAP AOVANTTJ( INSULATED FINAL GRADE (TYP.p)� �AxzO POD RISER 6- PVC PUMP—OUT Li I (fYP.2) 6• PVC COUPLING I CLUED TO TANK l _�y�SEWER CrYP.2) 1111111111111 111111111 ® deffa+K9� �eROCK INET I I I IN � I I OPTIONAL SLIDE SECTION OF 6- PIPE OVER THIS CONNECTION ••�-••�••:�••• SHEER PROTECTIOHE 3 BEDROOM EXTEND TO FIBERGLASS TANK BRIDGE EXCAVATION I unc: 3/11/2003 DRAWN BY: ALASKA IVAT.I:R & WASTENVATERSCALE C.J.G. -------------- CONSULTANTS, INC. 6901 OESARR ROAD. SUITE 28 - ANCHORAGE. AK 9950L - PHONE (907)337.6179 - FAX (907)338.321.6 N.T.S. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CLINT LANCASTER (907) 333-8752 3 OF 4 LEGAL DESCRIPTION: CABIN BY THE CREEK SUBDIDIVISION; LOT 3, TYPE OF WORK: DETAIL DRAWING OF ADVANTEX TREATMENT UNIT SIOTUBE SCREENED VAULT PUMP dTillrb"M •.,kflteA.,Ga�ness: -7953 G •• .•oAc d_ro f e s slon�bo FROM PUMP VAULT ---------------1 I OMT � I j MTQ I --------------------------- - 45 FEET LONG --\t Iii INSTALL BRACING AND STAKING AS NEEDED - ORIGINAL GRADE -THE DISTRIBUTION LINE IS TO BE 1.25 INCH PVC WITH 3 INCH HOLES SPACED 17 INCHES ON CENTER (30 HOLES TOTAL). FINAL GRADE. MUST HAVE 2'+ OF COVER. FILTER FABRIC r 2 FEET OF M.O.A. APPROVED SAND FILTER ; FEET WIDE .i7� Tv\Wl _ / w NSTALL BRACING AND STAKING AS NEEDED OF DISTRIBUTION UNE SHALL BE 1.25 INCH PVC WITH 3 INCH HOLES SPACED EVERY 17 INCHES ON CENTER (30 HOLES TOTAL). L'h:g ALASKA NVATER & «'ASTE`VATER 00 ----«�-'m--�-- CONSULTANTS, INC. 6001 DFRARR ROAD. SUITE 20 • ANCHORAGE. AK 99504 • PHONE (907)337-6179 • FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: PACE CLINT LANCASTER (907) 333-8752 LEGAL DESCRIPTION: CABIN BY THE CREEK SUBDIVISION; LOT 3, TYPE OF WORK: DETAIL DRAWING OF PROPOSED TRENCH 11/2003 oSpO BY: C.J.G. •.'T �I N.T.S. ... . ... ............. 4 OF 4 Je r A. o ess: 04p C —7953 �4 4O��p�o f I, ssTotn000 .... I CON'h�"S• LOT 1, CAB] BY THE CREEK S/C CABIN BY TH CREEK S LOT 2, IN 8Y E CRE K S/ T H LES BY ' W. RFTIT. P.E. cif o/ 1021/83 (9/APPR LOCA/TIO r . TT�C� yip I Tr. yo� CREEK LOCATION H 4o QN 1G P NE O.A. GRID MAP �3 AL 700. ryoy4o OT 3, CABIN HE CREEK S/0 CQf� TEST HO EARLE V. MAN, P.E. �4 ti 92) LOCATION) POSSI LE USE LO y I yo - LOT 1, BE SLE ESTA DA. S BY PRNATE WELL AND C 40 4� L 1, HIGGINS S/' PER O.A. RECORDS (FIELD VERIFY I v `O hV (LJOT 2, BENSLER ESTATES /DALA i I SBA A AND WAS WA CONSULTANT ^ 0 A 73 0 E. CHESTER HEIGHTS ROLE. AY HORAGE• AK 89504 '• �� PHONE: (907) 337- 79/FAX: (9 7) 338-3248 iH .GAL CESC 'TICN: CABIN BY THE CREEK BDIVISION, LOT 3 •. ,r��O 0 ...9 ................. YPE CF % RK: ' SlTK PLAN �............. ............... DO s '.•� .' i 'REW ED FCR: PHC E NUMBER: rfNLN 77-7184/250- 892 •., �° �o ••••••••••off rQG7 41 001........... �4pO000�� ATE: 9//4/98 ;RAWN ": J.L.M. SCALE: 1 = 100' PA E: 1 OFJ 1 11 MUNICIPALITY OF ANCHORAGE 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 / WATER SUPPLY PERMIT Renewal Permit Number: SWO10289 Legal Description: CABIN BY THE CREEK LT 3 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Clinto T. Lancaster Owner Address: 4045 E. 20th Ave., A68 Anchorage , AK 99508 - Date Issued: Aug 01, 2001 Expiration Date: Aug 01, 2002 Parcel ID: 015-521-20 Site Address: Lot Size: 59672 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of. EJ Disposal Field Fv'l Septic Tank E] Holding Tank [-] Privy O 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. Received By: Issued By: Date: g Date: 8 — / —0/ Municipality of Anchorage • Development Services Department =•- Building Safety Division _ On -Site Water and Wastewater Program s „ Fr. a 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Q(5V57..] 7_0 Permit Number SWD/0289 Property owner(s) (1,U _M-3 I NC�� -R- Day phone Iii 333 Z Mailing address (1) UCAS E ZO112'- yzt�2 PJ\3 CM 9 ( t !�L Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) C c-bi, h hal 'fV1Q. QrePsi' Legal description (Section, Township & Range) Lot Size 13'%0-Z Acres/q.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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: Date of Payment: Receipt Number: (Rev. 12100) Waiver Fees: Date of Payment: Receipt Number: MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW000273 Legal Description: CABIN BY THE CREEK LT 3 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Clinto T. Lancaster Owner Address: 4045 E. 20th Ave., A68 Anchorage , AK 99508 - Date Issued: Aug 01, 2000 Expiration Date: Aug 01, 2001 Parcel ID: 015-521-20 Site Address: Lot Size: 59673 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field 0✓ Septic Tank ❑ Holding Tank El Privy All construction must be in accordance with: 1. The attached approved design. ❑✓ Private Well Ej Water Storage 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 (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: d ' `� / &'l. ! ' o✓� Date: r�—/-6P-Z�- Date: 9—/— O o ALASKA. WATER F- WASTEWATER ""�'�� •�W»�� CONSULTANTS, INC. �I July 12, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Cabin By the Creek Subdivison; Lot 3 (Bottomless Intermittent Sand Filter - ISF) To whom it may concern: The proposed 3 bedroom house will be served by a private well and septic system. Multiple test holes were excavated on the property. The proposed septic system will be designed around the 30 foot radii of test hole #1 and Earle V. Austrian, P.E. testhole. We are proposing that a 1250 gallon S.T.E.P. tank and and an innovative Bottomless Intermittent Sand Filter (ISF) system be installed. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: Three test holes were excavated on the south half of the property to determine a area suitable for a septic system. Due to the poor soil conditions, the setbacks from the creek, the proposed 100 foot well radius, and the proposed house and garage locations, an innovative Bottomless Intermittent Sand Filter (ISF) system is the most viable option. 2. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and the percolation test results. In both test holes, the soils below the organic layers are a SM/ML material to a depth of 4 feet and then transistions to a ML material to a depth of 16 feet in test hole #1 and 17 feet in test hole#2 (bottom of test holes). No groundwater was encountered during the excavation of the test holes. Two percolation tests were performed for TH#1, one between the depths of 4.0 feet to 4.5 feet which had a percolation rate of 48 minute/inch. The other between the depths of 6.5 feet to 7.0 feet which had a percolation rate of 120 minutes/inch. Two percolation tests were performed for TH#2; one between the depths of 4.0 feet to 4.5 feet which had a percolation rate of 6.7 minutes/inch. A third percolation test was performed by Earle V. Ausman, P.E. between the depths of 3.0 feet to 4.0 feet which had a percolation rate of 32 minutes/inch. It is our opinion that due to the overall appearance of the soils, an application rate of 2.0 gallons/day/ft2 should be used. 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 — akwwc.com 3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 6.7, 32, 48, 60, 120 minutes/inch b. Allowable Application Rate for ISF: 2 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 f. Effective Depth below pressure pipes: 2.5+ inches g. Width: 18 feet h. Length: 20 feet. i. Effective absorption area = 360 ft2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". 1. Sand Material: In accordance with M.O.A. latest standards m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 2 feet (maximum - remove all organics), place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: A creek runs on the northeast corner of the property and is greater than 100 feet from the proposed septic system upgrade. 5. TOPOGRAPIIY: As can be seen on the attached topography site plan, there are no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.). 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact meat 337-6179. Thank ypu for your assistance. S Jeffrey A. Jgamess, P.E., M.S. ent 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 -- Ph: (907)337-6179 -- Far: (907)338-3246 — akwwc.com LOT 1, CABIN BY THE CREEK S/D I ( 1 1 I 1 1 \ \ \ \ I I \ I I I \ \\ \\ \ 1 I I I \ I LOT 2, CABIN BY THE CREEK S/D i2HOLES LOT 2, CABIN BY THE CREEK S/D \ 1 .1�� I �' I ALLAN W. MURFIT�P.E. 1(9/30/83 do 10/21/83) \ I I \ I 1 (APPROX. LOCATION) CREEK LOCATION S ��\ I PER ALASKA 1 O CONSTRUCTIONS 1 SURVEYS I I h\ I Q I �F ,fHi I THi3 I O I 1 4F4 C� PROPOSED THREE I \\ems j GP o:: = p4 BEDROOM HOUSE 1 �� F C.i PROPOSED �' GARAGE � � _ , I I I u• LOT 3, CABIN BY THE CREEK S/D i2 1 I �P' PROPOSED SEPTIC SYSTEM. PROPOSED DRIVEWAY I TMT \ \ SEE DESIGN \ PACE 2 OF 3. r \Y I �I I / SO4, 1-- ---r----=�-_ .- =-- 1------------- ———r----- — — —— — — — — SITE / I I TEST HOLE BY EARLE V. I AUSMAN. P.E. (6/15/92) I I APPROXIMATE LOCATION. 1 LOT 1, HIGGINS S/D ; I 1 LOT 1, BEN LER ESTATES S/O 1 I j I I I 40 Q I �\?O 4 1 Ap \ i I i tiu• LOT 2, BENSLER ESTATES S/D DATE: 7/12/2000 I 4 r'OF '°S^ t �r t, 1 : ' '��,, DRAWN BY: ALASKA NVATER & WASTE NVATER K.D. ;� �. - scALE „ CONSULTANTS. INC. . I ; tr * :��1 6901 DEBARR ROAD. SUTE 28 • ANCHORAGE. AX 99504 • PHONE (907),577-6179 • FAX (907),158.1246 1 1 00• • . .,.... ,...:..Yr i �•��� 6A PREPARED FOR PHONE NUMBER: PACE NUMBER: CLINT LANCASTER (907) 333-8752 1 OF 3 y .� '" ' y�, ' .ffr A. Hess... ylM1 P —7953 -v' 44�hfe LEGAL DESCRIPTION: CABIN BY THE CREEK SUBDIVISION; LOT 3 •••,. ..••� c\�`A? 4��4�d1°���'•' `�v„Ofes— O\ ofea•.•...s\�n�� TYPE OF WORK: SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM �U.1V I I I I NOTES: THE AIR COMPRESSOR SHALL BE LOCATED WITHIN CREEK LOCATION THE BASEMENT OR THE GARAGE. THE CONTRACTOR SHALL PER ALASKA PROVIDE A 0-10 PSI PRESSURE GAUGE AT A LOCATION CONSTRUCTION WHICH IS READILY ACCESSIBLE FROM WITHIN THE HOUSE. SURVEYS NOTE: A 30 PSI GAUGE WILL NOT WORK. THE AIR COMPRESSOR SHALL BE A THOMAS INDUSTRIES MODEL 5070, AS SUPPLIED BY ANCHORAGE TANK. THE AIR LINE SHALL BE 1/2 INCH DIA HDPE (1 PIECE), INSIDE A 2 INCH SCH.40 PVC JACKET. THE LINE SHALL BE BURIED TO A MINIMUM DEPTH OF 3 FEET. SHALL THE PANEL FOR THEBE INSTALLED OUTSLIDE THE RESIDEENCE�WITHTNK AUDIBLE SUAL INDICATOR INSIDE THE HOUSE I AIR COMPRESSOR / /2 (SEE NOTES) PROPOSED THREE BEDROOM HOUSE INSULATED AIR UNE (SEE NOTES) \ � S FCO I PROPOSED 1250 \ PROPOSED DRIVEWAY GALLON S.T.E.P. TANK O I N THI1 I \\\ N '-1 ----T PROPOSED r— r GARAGE Mii o o I ALTERNATE TE • TEST HOLE BY EARLS V. PROPOSED WELL AUSMAN, P.E. (6/15/92) L — — — APPROXIMATE LOCATION. \\ 10' UTILITY EASEMENT I �� — — — — — — — — — — — — — — — — — — — — — — — — PROPOSED BOTTOMLESS INTERMITTENT SAND FILTER. EXCAVATE A BED THAT IS 2 FEET DEEP MAXIMUM BY NOTE: THE CONTRACTOR MUST 18 FEET WIDE BY 20 FEET LANG. SEE ATTACHED HAVE THE WEST AND SOUTH / DETAIL AND PROFILE (PACE 3 OF 3) FOR PROPERTY LINES FLAGGED BY A CONSTRUCTION DETAILS AND REQUIREMENTS. PROFESIONAL LAND SURVEYOR I/ \ PRIOR TO ANY CONSTRUCTION. � I \ DATE: 7/12/20000 ��4 a d 4 v '` "• DRAWN BY: ALASKA WATER 8. WASTE «'ATER K.D.W. �.. •s'���Op�O SCALE CONSULTANTS, INC. 6901 DESARR ROAD, SLATE 29 • ANCHORAGE. AK 99504 • PHONE (907)337.6179 • FAX 907)338-3246 �" _ 30� •••�' •••• """"'Q D ..•••.• .;.. ••• Q PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CLINT LANCASTER (907) 333-8752 2 OF 3 e r QO o '. -7953 bpm �0'°f LEGAL DESCRIPTION: CABIN BY THE CREEK SUBIVISION; LOT 3 •..,•••• ••. ,• �' \�� 4 era �co, LL &o t�D�Y'�ofessionoOO0000�Q TYPE OF WORK: DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM I ORIGINAL It'- -7 MONITORING FLUSHING VALVE AND COVER r -MONITORING TUBE r -FINAL CRADE FABRIC SCH 40 VALVE .OSURE 2x4 & PLYWOOD BOX VI EXCAVATE 2 FEET DEEP (REMOVE ALL ORGANICS) 2 FI D FEET MINIMUM '4E 0 J M.OA APPROVED !3 D INSTALL MR LINE -PEA GRAVEL 2/ORIGINAL GRADE SAND FlLTER_ 6' FROM BOTTOM OF SAND FILTER. DATE: 7- 7/11/2000 0000 DRAWN BY: M ALASKA ANIATER & WASTE ANIATER J.L.M. p Op CONSULTANTS. INC. SCALE. 6901 DESARR ROAD, SUITE 29 - ANCHORAGE. AX 99504 - PHONE (907)337-6179 - FAX (907).336-3246N.T.S. ....•.. . . . . .. ...... ..... PREPARED FOR: P PHONE NUMBER: --- PACE NUMBER: — ... . . .. CLINT LANCASTER (907) 333-8752 3 OF 3 "-.J f ....... ey ...V LEGAL DESCRIPTION: QA o C 953 k CABIN BY THE CREEK SUBDIVISION; LOT 3 TYPE OF WORK: DETAIL OF BOTTOMLESS INTERMITTENT SAND FILTER (ISF) lorofes 510116-:§� XV/ A WASTEWATER CONSULTANTS, INC. SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: CABIN BY THE CREEK, LOT 3 PERFORMED FOR: CUNT LANCASTER DATE PERFORMED: 9/30/98 (feetyORGANICS _ TEST HOLE #1 _ 1 PAGE I OF 2 2 SOIL CLASSIFICATIONS 1 SM/ML '.dr"a: GW - ORG 3 + GP ML 4 GM CL 5 6 7 8 9 10 11 12 13 14 15 16 17 18 ML DENSE l WK ffl�j l lfil l� RRW' �l���1 ilvzzz•�� • ►4l• a4l w DEPTH TO DATE GROUNDWATER DRY 9/30/98 DRY 10/9/98 DATE READING CLOCK TIME I NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 10/2/98 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 4:19 — 6' — 2 4:49 30 5 3/8" 5/8" 3 4:49 — 6" — 4 5:19 30 5 3/8" 5/8' 5 5:19 — 6" — 6 5:49 30 5 3/8' 5/8- 19 PERCOLATION RATE 48 (MIN./INCH) 20 TEST RUN BETWEEN 4.0 FT. AN E COMMENTS: PERCOLATION DATA ON THIS PAGE FOR U CH C. RECOMMEND SHALLOW TRENCH/BED TYP JJ ST BEL PERFOMED BY ALASKA WATER & WASTEWATER I, THIS WAS PERFORNED(IN ACCORDANCE WITH ALL STATEJA�l NI DATE. DATE: -7 113 I W PERC. HOLE DIA. 6 (INCHES) 4.5 FT. )LE ONLY. THE ORGANICS. CERTIFY THAT IN EFFECT ON THIS ALASKA WATER & WASTEWATER CONSULTANTS, INC. 7320 E. CESTER HTS. CIRCLE • ANCHORAGE. AK. 99504 PHONE 907) 337-6179 0 FAX (907) 338-3246 SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: CABIN BY THE CREEK. LOT 3 PERFORMED FOR: CUNT LANCASTER DATE PERFORMED: 9/30/98 DEPTHt) TEST HOLE #1 (fee 1 PAGE 2 OF 2 ,u 10 Ld I I I l w V) SOIL CLASSIFICATION$ 7 0 10/2/98 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING GW .'=::: •- 8 • IIIIIIIIIML 1 14- w 6- CIL 0 4:50 9 Q 1/4" 17- IIIIIIIIIMH•CH Isc 30 is - 1/4" �'.4� • ,u 10 Ld I I I l w V) I NET TIME (MINUTES) 7 0 10/2/98 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 12- 8 1 14- w 6- 15- 0 4:50 9 Q 1/4" ,u 10 Ld I I I l w SEE PAGE 1 OF 2 DATE READING V) I NET TIME (MINUTES) 11- NET DROP (INCHES) 10/2/98 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 12- 13- 1 14- — 6- 15- 2 4:50 16- 5 3/4" 1/4" 17- 5:20 30 is - 1/4" SEE PAGE 1 OF 2 DATE READING CLOCK TIME I NET TIME (MINUTES) I WATER LEVEL I READING NET DROP (INCHES) 10/2/98 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 4:20 — 6- — 2 4:50 30 5 3/4" 1/4" 3 5:20 30 5 1/2" 1/4" 19 PERCOLATION RATE 120 (MIN./INCH) ERC. HOLE DIA. 6 (INCHES) 40 TEST RUN BETWEEN 6.5 FT AND 1 FT. COMMENTS: PERCOLATION DATA ON THIS PAGE FOR LO R BEaCP HO ONLY. PERFOMED BY ALASKA WATER & WASTEWATER I, THIS WAS PERFORME I ACCORDANCE WITH ALL DATE. DATE: , CERTIFY THAT I IN EFFECT ON THIS ALASKA WATER & WASTEWATER CONSULTANTS SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: CABIN BY THE CREEK, LOT 3 PERFORMED FOR: CUNT LANCASTER DATE PERFORMED: 9/30/98 ALASKA WATER & WASTEWATER CONSULTANTS INC. 7320 E. CHESTER HTS. CIRCLE • ANCHORAGE. AK. 99504 PHONE (907) 337-6179 • FAX (907) 338-3248 SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: CABIN BY THE CREEK. LOT 3 PERFORMED FOR: CLINT LANCASTER DATE PERFORMED:_ 9/30/98 ( eet� TEST HOLE #2 1 PAGE 2 OF 2 2 SOIL CLASSIFICATIONS ORG 3 GM CL 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 vi LL - 0 W C� a IL w w V) 111111111 MORD :fl�lf�Ii ��B • NEW DATE SEE PAGE 1 OF 2 DATE READING CLOCK TIME NET TIME I (MINUTES) WATER LEVEL READING NET DROP (INCHES) 10/2/98 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 4:20 — 6" — 2 4:50 30 5 1/2' 1/2- 3 5:20 30 5" 1/2- 3 5:20 30 4 1/2' 1/2' 19 PERCOLATION RATE 60 (MIN./INCH) 20 TEST RUN BETWEEN 6.5 FT. A COMMENTS: PERCOLATION DATA ON THIS PAGE FOR 1,&I CH C. PERFOMED BY ALASKA WATER do WASTEWATER I, THIS WAS PERFORMEF IN ACCORDANCE WITH ALL DATE. DATE: "f 1131 rJ PERC. HOLE DIA. 6 (INCHES) 7.0 FT. )LE ONLY. , CERTIFY THAT I GUIDELINES IN EFFECT ON THIS a v Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: UA N;-!-rr 1175 ITS DATE * ;•4 TH N •'9* i a CE -1393 LEGAL DESCRIPTION: C-AB11-J $YTKt; Cize:c14 •ybTOWnship, Range, Section:'j'1Z 1-4 k3is Is L ZZ ,� OEGTH (.OT SLOPE SITE PLAN '3 ire—i-7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 -)MMENTS C7 1L:0' SILTY SAMA LSM il,sq 0 1'IGo 9g t, WAS GROUND WATER NO ENCOUNTERED) S IF YES, AT WHAT L P DEPTH? E Depth to Water After Monitoring? Dett� PERCOLATION RATE �s7` (minutesnnch) PERC HOLE DIAMETER (10 TEST RUN BETWEEN -3- FT AND 11FT PERFORMED BY: 7)A1110 0 talSwfA &' r 1 7�)& CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-00e (nFv 4185) 3 of 3 4I ra,JTvW -s- LOT 1, CABI BY THE CREEK S/O .00 aTCREEK LOT 2, IN BY THE CR X S/ CABIN BY 5 \T 00, I oT H LES BY W. RFlTT, P.E. (9 83 0/83 . LOCATION I y� TA TH CREEKLOCATION Hr ION 4� 4 PNEE 0.0. GRID MAP .� T¢ �C}J, i C o 4 tiV .DT 3, CABIN HE CREEK S/O cifcl TEST HO �Rq EARLE V. MAN, P. E. 15/92) ( r'ROX. LOCATION) POSSI LE ^ ISE LO C . \O h y� LOT 1, BENSLER ESTA c /D I I BY PRIVATE WELL AND _ C 40 age PER OA RECORDS (FIELD VERIFY p L f 1, HICGINS S I ryGh`o I (L()T i 2, BENSLER ESTATES ,/D SHA A AND WAS WA CONS C. QQ� pp A 7 0 E CHESTER HEIGHTS RCLE, AN HORAGE• AK 89504 �� (907) 337- 79/FAX: (9 7) 338-3248 ••''••• DO •• •• 9 •:O� P-CAL CESCPHONE ECAL OESC 'TION: CABIN BY THE CREEK BDIVISION, LOT 3 ...... .. ........ ..... c/ TYPE OF RK: SIT PLAN ............. ............... oo a �• i •'•. 'RE .RED FOR: PHO E NUMBER: LEE RE REN 77-7184/250- 892 •' F Op �Of°»ipO P9/ Alt: j.)RAw7y:J.L.m. �I:ALt.:100= ' PA �1 OF 1 4/98 1 p040oo M PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated 7 /3 , 2000, is made between the Municipality of Anchorage Department of Health and Human Services (DHHS) and the property owner(s) of Cabin Ru -6(c eree L4 3 . This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owner(s) agree to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be filed annually with the DHHS. Property Owner Name Property Owner Name (Notarize Here) State of AIQS 1(fa - Judicial District 5--,y SS. On this 3 day of C-/ & &Z in the year 76n 0 before me, th6 undersigned notary public, personally ap eared: 6/intn 7' ErtrrAS?Qr known to me to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged that he/she/they executed the same for the purposes therein contained. In wit ess whereof, I hereunto set my hand and fic' 1 seal.^� r No lic (signature) , ' L. (NotaryU printed name) My commission expires: a/aa_i fJ MUNICIPALITY OF ANCHORAGE ) Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-521-20 Legal description Cabin by the Creek lot 3 Site address 10980 Birch road Current property owner(s) Richard Lloyd Expiration Date: 11-24-22 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUHMPA+UT L( OF Development Services Department On -Site Water & Wastewater Section 9 Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-521-20 Complete legal description Cabin by the Creek Lot 3 Location (site address) 10980 Birch Road Current property owner(s) Pamela & Richard Lloyd 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: [N Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community_Septpppp�c_or P 1ic_Sewer 5. SEPTIC TANK: ■❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 19 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ Z 00 x/68 Waiver Fee $ Date of Payment 8r//7/Z2 Date of Payment COSA # a5G 2 2/9 ) Z) Waiver # COSA Application_ June 2022 COSA Checklist Legal Description: Cabin by the Creek Lot 3 Parcel ID: 015-521-20 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA FE -1 Well log is filed with Onsite (or attached) Well production at time of test 6.5 gpm Date drilled 8/25/03 Total depth 123 ft Water storage tank volume N/A gallons Cased to 122.5 ft Well disinfected for coliform test? ❑ Yes ❑■ No ❑E Sanitary seal is functioning correctly ❑■ Coliform bacteria is Negative ❑■ Wires are properly protected Nitrate 2.82 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 24+ in. Arsenic ug/LX Arsenic less than MRL (ND) Date of flow test for COSA 7/27/22 Collected by Forge Engineering Static water level at beginning of test 55 ft. Date 7/27/22 Comments B. TANK DATA Measured operating fluid level in septic tank 38* Date of pumping 6/2/22 A+ ❑ Required maintenance completed, if AWWTS Comments: Fluid checked 7/27/22* D. ABSORPTION FIELD DATA C. LIFT STATION X Required maintenance completed Age of lift station 19 years Lift station material Steel Comments: Which system tested (date installed) 10/26/21 Fit Adequacy test date NEW ass Total measured depth from grade 5.5/5.5 ft (max) Fluid depth prior to test in Measured depth to pipe invert from grade 2.5/2.5 ft (min) Water added gal ❑ N/A — pressurized field. New fluid depth in ❑ Per record drawings, field is insulated. Elapsed time min 0 Monitor tubes go to bottom of effective. Final fluid depth in If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ■❑Yes if No ft❑Yes if No ft Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' FN] Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ❑� Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑E Yes if No ft ❑■ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' DYes if No ft QYes if No ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No _ Tank to Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' g Yes if No ft Private Wells > 100' FE -1 Yes if No Water Main > 10' 0 Yes if No ft Community Wells > 200' E Yes if No _ Water Service Line > 10' El Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft ft G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Naive of Firm Forge Engineering Engineer's Printed Name Benjamin Schiller COSA Checklist—June 2022 Phone (907) 522-7773 Date 8/3/22 .. .. . . . . . : Benjarr>ochiller �+ FFG, •. CE 12592 • c4ki ,11%PROFESS1OWAMV- MUNICIPALITY OF ANCHORAGE Development Service:,, Department Phone: 907-342.7904 On -Site Water & Wasi awater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner 1 VC4 Street Address/0070 Phondqf7 69603Agegal Desc. PID _ Septic Tank: �,� -Sludge level 2Linc ties Pumping: required yg§__4�V -Pumping completed yes ._ po Lift station: -Pump basket cleaner -Effluent filter cleaned � Control floats cleaner *Proper float settings: confirmed / e -Operation satisfactoryFen (--P' -Dedicated electrical a arm -Audible and visual alarm inside dwelling yg;� -Alarm system operatic in _salisfar- jo notsatisfar,,to Manhole Riser -Ground water intrusio at riser to tank connection ' -Manhole lid: Functii -final(� Insulated Properly Secured C'{_.... -.. Other 5� -All manufacturer requi red inspections and maintenance completedok!31_�o Comments: .....:�. ....r' �'.....t .... 0 .................... I .................................................... ....... .... J, Technician LU ' J ice" t Company Signature Date of maintenance�� cess: P. O. Box 196650 `` Anchorage, Alaska 99519-6650 * www.muni.org Rill PA "' z o� o §m� �zp xo�. :Rc U? v �, rn Zc�jO �m ' rrn� i CA rrim z 2— g w o Oo z W D pD n z 0 0) O Uj N ,'0 0-0 r N P� C n OD CA o m cn czi N /� J V w > mxc .. _=� 0V�=�4M'v �o mMZ Mo�— � mo m-o�szzm Co� 0m=rn p aDpZmn z�Ummm� 0 p Zm�rnm�Q c� Z vo�c) �v n g ;u _ v Z Omm�C.) 0 co p M Z N v Z O o m zO -nAoo :e n0cvn o vc o x_ cn Zz�oo'mo-� o zom H NM �zrrvi. 0 m �nS: 4 m m 14.0' o COVERED ENTRY 0 CA 0 N 00002'28"W 213.17' V 10'T.&EESMT./-- (A — — T - - - - - - - -- -- • e N / I � / / 67.0' _ / I � v 67.0' C / cn 0 Z i Aon ( r / OD OD Ul _ I / 0 _- rn 1 / S )"S�, 14 /co C,� I / � I / / I / / I / / L— — — — — — — — — —/- — — — — — — — — — — — 10' T. & E. ESMT. N 00002'38"W 213.48' 0 r%I I r,,F% A r% �� z yn Q i L • •. A IVY tea; � eAff� o7 ° NOO • 110 • e o • o co ° NJDe • • • O eJ • 7 e a . sGrGeeO° • /� AV • • a N"Or i.••°�J rAe m 14.0' o COVERED ENTRY 0 CA 0 N 00002'28"W 213.17' V 10'T.&EESMT./-- (A — — T - - - - - - - -- -- • e N / I � / / 67.0' _ / I � v 67.0' C / cn 0 Z i Aon ( r / OD OD Ul _ I / 0 _- rn 1 / S )"S�, 14 /co C,� I / � I / / I / / I / / L— — — — — — — — — —/- — — — — — — — — — — — 10' T. & E. ESMT. N 00002'38"W 213.48' 0 r%I I r,,F% A r% �� z yn X w z co z �o v N m N xcil m I `° O)p rJi i �� N CEJ m C coM z Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 015-521-20 1. GENERAL INFORMATION Complete legal description Lot 3, Cabin by the Creek subdivision Location (site address) 10960 Bird, Road Anchorage, AK 99516 Current Property owner(s) Clinton and Beth Anne Lancaster Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10980 Birth Road Anchorage, AK 99516 COSA u 10 Oo N S Expiration Date: ( - -..?--/ O Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Individual Well❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of OnSfte 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 OnSfte Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 522-7773 Date =W010 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other BY Original Certificate Date:_ _ 3'��/� pn , _..._ .. ` Municipality of Anchorage Development Services Department J4= Building Safety Division Onsite Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 3. Cabin by the Creek SubdMslon Parcel ID: 015-521-20 A. WELL DATA Well type Pomata If A, B, or C provide PWS 10 # _ Date completed 6/25/4003 Sanitary seal (Y/N) Y Total depth 123 fL Cased to 122.5 f. FROM WELL LOG Date of test 685/2003 Static water level 5o R Well production 30 WATER SAMPLE RESULTS: 1 Coliform 0 colonies/100 mL Arsenic: 5.0� ugA - B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Well Log (YM) Y Wires properly protected (YIN) Y Casing height (above ground) >24 in. AT INSPECTION 6/11/2009 42 LI g.p.m. 3.7 g.p.m. Nitrate 1.41 mg/L Otherbacteria o colonies/100mL Date of sample: KI_M010 Collected by: A. Harala Tank size 1.500 gal. Number of Compartments 3 Foundation cleanout (Y/N) Y Date of pumping 4124=09 C. ABSORPTION FIELD DATA Date installed 7/30/2003 Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Pumper (mars Pumping Service - Date installed 7131=03 Soil rating (g.p.dlft?orf bdnn) ±5 GPDrSF System type 5' Wide Trench Length 154 ft Width 5 ft. Gravel below pipe 3 ft Total depth 6 fL Eff. absorption area 1 -la -ft" Monitoringtube Y Depression over field N Date of adequacy test 6/11M9 Results (Pass/Fail) Page For 4 bedrooms Fluid depth in absorption field before test 9114 in. Water added 627 gal. New depth 12115 in. i! Elapsed Time: 1.320 min. Final fluid depth 9114 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) Absorption rate >= 600 g.p.d. If yes, give date D. LIFT STATION Date installed 7/3/2003 Size in gallons 250 Manhole/Access (YIN) Y 'Pump on' level at 42 In. 'Pump ofr level at 42 in. High water alarm level at 44 In. Datum Bottom of Tank Cycles tested 5 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /Per Ai /I, Septic tanknift station on lot 0 0 b , tr p, On adjacent lots >10a Absorption field on lot >100, On adjacent lots >100• Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line >26 Holding tank N/A Animal containment areas None Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >S Property line >5' Absorption field >5' Watermain N/A Water service line >10' Surface water >100' Wells on adjacent lots >100• SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >1(a Driveway, parldnglvehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: G. ENGINEER'S CERTIFICATION I car* that I have determined through rreld inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name Michael E. Anderson, P.E. Date 2/26/2010 COSA Fee $ % C) Waiver Fee $ _ Date of Payment — - 2 C, - f ri Date of Payment Receipt Number _ 3 �0 S— Receipt Number, (Rev. 11/05) 4! I. V& ANDatWN :v E-4381 : �`v Copyright® 2006.2008 SGS httr)s://Iabview.sgs.com/LabDSILabview/SampleResults-asp MobId=13705&Sampleld=l... 2/26/2010 Page 1 of 1 SGS Data Services - Lab View SGS.COM SGS *round Me woad oNine "Mcee ConMCt SGS Group Terme end Condibone r GROUP BE SURE WHEN YOU NCED TO —SGL$— Settings Logout Anderson Engineering andengr@gci.net LabView ample Results Home>;Sample Client mple Id: Private Well Water 1 Lab Id: 1100553001 Location: NIA Date Sampled: 02/16/2010 Analysis Analyte Name unit Result Reporting Limit EP200.8 Arsenic j 450ONO3-F Total Nitrate/Nitrite-N ug/L mg/L 5 1.21 5 0.1 SM20 9222B Colony Count col/100mt. 0 ISM20 Fecal Coliform cot/100ml- 0 Total Coliform col/100mL 0 Copyright® 2006.2008 SGS httr)s://Iabview.sgs.com/LabDSILabview/SampleResults-asp MobId=13705&Sampleld=l... 2/26/2010 84-59 CABIN BY THE CREEK SUBDIVISION LOT 3 59,673 S.F. i— FENCE (APX) hi 774 77' I e ioCationV the struCture{s}as shown on this record dra�ying (as -built) complies with Title 21, AMC. �y. Date: " AS'--© J P.7 -_?v JV L LJ.Y. IV P"..6Wf BUILDING DETAIL SCALE: 1 "=20' FINAL STRUCTURE AS—BUILT GASTALDI LAND SURVEYING JEFF A. GASTALDI, R.L.S. 4726 WEST 88TH AVENUE ANCHORAGE, ALASKA 99502 PHONE 248-5454 GRID ATE 2637 1 p 1/26/2003 I F.B. JOB NO. 03-16 1 CBTC3 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. R IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE. 0 7 V r 0 50' 7 Y 7 7 Q W M 11�=4D' OF 4�+ S' + r 49TH isJeiiery A. G 1, (di : L r ��P ' L5—b09i iSAW I, map ••.goes.•""• .�yJ+/ of TAILS -�a Municipality of Anchorage • 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.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.521.20 1. GENERAL INFORMATION HAA# 7-2.0(oa") ��LL Expiration Date: 3 - r O T Complete legal description _ Lot 3. Cabin by the Creek Subdivision Location (site address or directions) Bch R ad near O'Malley Road Current Property owner(s) Clinton T. Lancaster Day phone 481.1072 Mailing address Lending agency Mailing address Real Estate Agent `Mailing Address _3213 Tayshee Circle Anchorage, AK 99504 Unless otherwise requested, HAA 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 Four 4 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ 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 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522.7773 Address P 0 Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date � - 12/1012003 5. DSD SIGNATURE ✓ Approved for _ bedrooms. 49th NICNAEI. G ANDERSON No. CC -4391 r Disapproved. Conditional approval for bedrooms, with the following stipulations: `J7: ON-SITE Additional Comments �� Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 102. " ! fo - d 3 (Rev. 12100) Municipality of Anchorage • '"� Development Services Department Building Safety Division On -Site Water & Wastewater Program ° " C " _17- '4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us i (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 3. Cabin by the Creek Subdivision Parcel ID: 015.521.20 A. WELL DATA Well type Private If A. B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 812512003 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 123 ft. Cased to 122.5 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 812512003 Static water level 50 ft. ft. Well production 30 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 1 0 colonies/100 ml. Nitrate .648 mg./l. Other bacteria 0 colonies/100 ml. Date of sampie: 121912003 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 713012003 i Tank size 1.500 gal. Number of Compartments 3 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date Installed 713112003 Soil rating (g.p.d./ft2 or ft2/bdrm) .45 GPD/SF System type 5' Wide Trench -Length 154'! ft. Width 5 ft. Gravel below pipe 3 ft. i Total depth 16 ft. Eff. absorption area 1,334 ft2 Monitoring tube Y Depression over field N i Date of adequacy test Results (Pass/Fail) For _ bedrooms I 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. i Any rejuvenation treatment (past 12 mo.) (Y/N & type) 'N 'If yes, give date i D. LIFT STATION Date installed 713012003 Size in gallons 250 Manhole/Access (YIN) Y "Pump on" level at 42 in. "Pump off' level at 42 in. High water alarm level at 44 in. Datum Bottom of Tank Cycles tested New Const. Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' On adjacent lots >100' On adjacent lots >100' Public sewer main NIA Public sewer manhole/cleanout NIA Sewer• /septic service line >25' Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main NIA Water service line >10' Surface water >100' , Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >250 Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS i G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 1211012003 HAA Fee $ 375 00 Date of Payment 17- " 11, Or Receipt Number SSS a b L� (Rev. 12/00) Waiver Fee $ 49th %F MICHAEL E. ANDERSEN J. jQ i _-No. CE -4381 Date of Payment Receipt Number i i