HomeMy WebLinkAboutTHE TABLELANDS BLK 7 LT 6The Tablelands
Block 7
Lot 6
#051-801-38
Municipality of Anchorage
Development Services Department
Building Safety Division ,
/ On -Site Water 8 Wastewater Program, 4700 South Bragaw St. ,. ...
- P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.sk.us (907) 343-7904 Page i of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
SW050215 PID Number. 051-801-38
Permit Number.
Name: Wastewater System: ■ New ❑ Upgrade
JOHN THOMSON
17343 SANTA MARIA DRIVE * EAGLE RIVER, AK 99577
ABSORPTION FIELD
Phone: No. of Bedrooms:
4
Ct Deep Trench C I Shallow Trench O Bed O Mound ■ Other
(907) 240-2020
LEGAL DESCRIPTION
Sa Raba: Total Depth horn ertpinat Fade:
2.0 Gran,. R SEE DWG. R
Block: tot•. Subdivision:
Depth to p" bad" nam adgu grads:
G,ew depth b«wath pipe: 0.5+
7 6 TABLELAND S/D
SEE DWG. R
R
Township:Range: — Section: —
M added ate- 060hal grade`
Grave wwh:
64 R
G. mat aiath:
l*~ Of iMe:
awtanos t st~ Ines:
WELL: ❑ New ❑ Upgrade
5 R
1
—
R
Gberlcaban (p„wb. Ae.G): T" Depth Talatavot)
Taal awarptw, 0010:
320
ft" nwtaw:
D 3034/ F-810
G R R
so.
Ntlpler
GREEN GENERAL
Data ":
10/18/2005
ayw. V b bread: Stabs Nater tawl:
R
Gro',:
rww:
TANK
CPY R R
SEPARATION
DISTANCES
aSeptic 0Holding 0S.T.E.P. ■Other*
To
Septic
Nnkg
wteddWw
unes
GREER/ZABEL TECH
g0x
1500
From
Fmld
Station
Ta
sda'Or
Na"�
Numbr at aampartmenb:
Well
N/A
N/A
N/A
—
—
STEEL
2
Surface Water
100'+
100'+
too'+
—
—
LIFT STATION
Lot Une
5'+
10'+
5'+
—
—
Sae N gadahe:
1500
Nanulaclunr:
GREER ZABEL TECH
en lewd at
NI lav al:
Ngh a0t. alarm at:
Foundation
5'+
10'+
5'+
—
—
TIMER
TIMER
45-
" Naa • Medd:
Decbk,, Nepcbahe prtdrmad or
Curtain Drain
NONE
KNOWNP—TE-30
1
PLUS
RISING SON
—1Remarks:
BENCH MARK
MOUND TOP SOILED AND SEEDED
teaatwn dad oeeariptidn:
TOP OF CMU NEAR POINT B
'THIS IS A SCAT AEROCELL SYSTEM
A.wrwd Elewtw,: 100.00 ,,.
ENGINEER'S EAL
°
o=SOF °O p
Ltd. 10/17/2005
Inspections performed by: GEG, Dates: 1st
.................
2nd 10/17/2005
Q
3rd 10/18/2005
Q , j r. y .... G ness
Development Services Department Approval
�0� CE -7 03 .ca
erg �•1 � �
� �'''����J
approved by: `
0 �o
4�0° professloo°o
Reviewed and
(R«. 12/01)12/01)Date
AS -BUILT DRAWING PARCEL 10 NUMBER:
PERMIT NUMBER: 015-192-26
SW050099
rFINAL GRADE - 98.90++
/ STOP OF MANHOLE - 100.39
TOP OF TANK
AT INLET - 94.'
INVERT OF BUNG
AT INLET - 94.43
FINAL CRADE -
103.79-104.31
INVERT OF DISTRIBUTION
UNE - 101.01 (AVG.)
NEW 1500 GALLON
S.T.E.P. TANK
BOTTOM OF TRENCH
- 97.92-98.42 —
TOP OF TANK
OUTLET - 94.90
INSULATION
BRIC FILTER
iiW STOP OF SAND
100.42 (AVG.)
M20 0 4' BELOW
ORIGINAL GRADE
RELATIVE ELEVATION OF BOTTOM A
OF TESTHOLE . 85.47 ---------
GAR - NESS
GARNESS ENGINEERING GROUP, Ltd. p,
-- CONSULTANTS b GENERAL CONTRACTORS
�......
3T1 L T4M bU. AIIC 101 . MKMNL(. IR II30f /1101[ (I0f)31)-IIT IM (Ip1)].N•JON w.M�M'M'm^
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOHN THOMSON 240-2020 3 OF 3 OQ e
LEGAL DESCRIPTION: ORAWN BY: IQ$
TABLELANDS SUBDIVISION; LOT 6. BLOCK 7, DATE: C.J.G. 0 `
TYPE OF WORK: 12/6/2006
AS -BUILT FOR PROFILE DRAWING
(Rev. OU05)
...
A. arness:
—�53 �• :<
08 2006 10:33RM Risin6 Son Electric, Inc. 622-6777
Rising Son Electric. Inc.
14916 \Voodland Drive
:? Eagle River. AIC 99577
(907) 622-6777
June 8, 2006
Gamess Engineering Group
3701 E. Tudor Road, Ste. #101
Anchorage, AK 99507
Re: Lot 6 Block 7 Tableland
To Whom It May Concern:
P. 1_. _
The lift station at the above referenced property has been wired in accordance with NEC
and State/Local codes.
Thank you.
Sincerely,
7va� v9- J �
aA"'Lm
Kevin S. Hornbuckle, Owner
Administrator License Number 1284
Specialty Contractor License Number 27285
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Date Issued: Jul 08, 2005
Expiration Date: Jul 08, 2006
Permit Number: SWO50215 Parcel ID: 051-801-38
Legal Description: THE TABLELANDS SUBDIVISION BLOCK 7 LOT 6
Design Engineer: 0855 Garness Engineering Group, LTD Site Address: NHN FALLOW CIRCLE
Owner Name: JOHN THOMSON Lot Size: 40031 SO. FT.
Owner Address: NHN FALLOW CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567 -
This permit is for the construction of:
0 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.
Received By:
Date: 7-//'0-577
t��
Municipality of Anchorage
C Development Services Department ,
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. �">> "' >Q1 – ZZ , Permit Number
Property owner(s) JOHN THOMSON
Day phone
4 0-9090
Mailing address (1) 17343 SANTA MARIA DRIVE •
EAGLE RIVER, AK.
Mailing address (2)
Zip Code 99577
6
TABI
Legal description (Lot, Block & Sub'd.) LOT 6 BLOCK
7s FLANDS cJ 1 11.1 3JnN
J%
Legal description (Section, Township & Range) N/A
�,,�M_.1� Acre
Lot Size��,ss Aq.Ft.
Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only 0
Well Only
Sewer and Well ❑
Water Storage
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
HotTub ❑
Jacuzzi
❑
Swimming Pool ❑
Water Softening Unit
Therapy Pool 0
certify that the above information is correct. I further certify that this application is being made fora
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP Ltd.
Permit Fees: `ttlo
Date of Payment:a I D5
Receipt Number.u� r—
Waiver Fees*
Date of Payment:
Receipt Number:
GARNESS ENGINEERIN U URu u r, JAG.
CONSULTANTS & GENERAL CONTRACTORS
July 6, 2005
Municipality of Anchorage
Development Service Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Septic System for Tableland Subdivision; Lot 6, Block 7,
To whom it may concern:
Your department issued a permit for a 3 bedroom septic system on the referenced property (SW040086). The
owner requested that we re -design his septic system to accommodate 4 bedrooms. We are proposing that a
new 1500 gallon S.T.E.P. tank, a M.O.A. approved recirculating trickling filter (sized for 4 bedrooms), and a 5
wide type drainfield be installed. One test hole was excavated on the property. The drainfield will be designed
around the 30 foot radius of the test hole. Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system
4. TOPOGRAPHY: As can be seen on the attached design drawing the average area around the proposed
drainfields is relatively flat. In short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If
you have any questions, please contact us at 337-6179. Thank you for your assistance.
Games .E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com
LOT 4, BLOCK 8;
LAT 8. BLOCK 8: TABLELANDS
LOT 6. BLOCK 8: TABLELANDS S/D / —
TABLELANDS S/D
LOT 7, BLOCK 6: (VACANT)
TABLELANDS
LOT e. BLocK e: NC
AHO -
TABLELANDS S/O '
Q 9, BLOCK 8;
SLELANDS S/D • , �'
(VACANT) N
LOT 3. BLOCK 7; LOT 2. BLOCK 7;
TABLELANDS
NC/D TAB S/D
(NO�i
E BLOCK 7
TABLELANDS S/D LOT 8. BLOCK 7; TABLELANDS
/\ (VACANT) TABLELANDS S/D NAMM
\ (VACANT) /
PROPOSED TERNA /
4 HOUSE 6MROOM SITE /
�< \\ (APPROXIMATE &TH03 /
r\\ 4.0�, \\ LOCATION) TH 2 /
�,S/D TH
�
TH%T
I �
I
LOT 6. BLOCK 7;
TABLELANDS S/D \\--
(NO CONCERN)
I NOTE: ALL PROPERTIES SHOWN
WILL BE SERVED BY PUBLIC
WATER.
Box
ROPOSED SEPTIC /
SYSTEM (SEE DESIGN. /
PACE 2 OF 2) /
LOT 7. BLACK 7. /
TABLELANDS S/DS
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS "•
E noce )low. •oc 10i • nnwi m iw • "aw �,w • w • �oalc .w 0
2EPARED FOR: PHONE NUMBER: PAGE NUMBER: QQ••' f
JOHN THOMSON (907) 240-2020 1 OF 3 P
:GAL DESCRIPTION: DRAWN B7:
TABLELANDS SUBDIVISION: LOT 6. BLOCK 7, R.A.L �0�•��v
7E of WORK:
DATEREVISED ape
SITE PLAN FOR PROPOSED SEPTIC SYSTEM 71612005
IRM.OIA15)
P,o
1E99,' •
NUMBER OF BEDROOMS:4
GALLONS PER DAY (GPD): 500
PERCOLATION RATES: <1 MIN./INCH
PROPOSED APPLICATION RATE: 2.0
MINIMUM DRNNFIELD SO.Fi.: 300
DRAINFIELD DESIGN:
MA)OMUM DEPrH:1.5 FEET
WIDTH:5 FEET
LENCTH;54 FEET
M.OA APPROVED SAND FILTER:2 FEET
EFFECTNE:0.5 FEET
REDUCTION FACTOR: N/A
ACTUAL SO.FT.: 320
-CEC
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
CONTACT CEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER. CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
CONDITIONS OVTUNED.
�`. Lr{.5. i•L�i.�.S
Box
LOT 3. BLOCK 7;
TABLELANDS S/0
(NO CONCERN)
LOT 5. BLOCK 7;
TABLELANDS s/D
LOT 2. BLOCK 7;
TABLELANDS
PROPOSED M.OA+3
APPROVED RECIRCULATING
TRICKLING FILTER (SIZED ALTERNATE
FOR 4 BEDROOMSTH+2 SITE
\MT
�II II
I II
II II
C� Z SII II
II II
II II
INSTALL ROPOSED u
FOUNDATION 1500 GALLON 7H�1
CLEANOUT S.T.E.P. TANK
WITH TRICKLING PROPOSED
FILTER CONTROL DRAINFIELD
SYSTEM
LOT 7. BLOCK 7: /
TABLELANDS S/D /
(VACANT)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS R GENERAL CONTRACTORS
rftr a Boor ruw rune rei . AMOOMrr. IR Mn1 • w dm)m-rift • rug (W"V-42" • 41C .•. +""
PREPARED FOR: PHONE NUMBER:PAGE NUMBER:
JOHN THOMSON (907) 240-2020 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
TABLELANDS SUBDIVISON; LOT 6, BLOCK 7, R.A.L
TYPE OF WORK: VAIUREVISE
DESIGN FOR PROPOSED SEPTIC SYSTEM 1 7/6/20(
(R".01005)
.Q0
FROM MCA APPROVED
RECIRCULATING TRICKLE
FILTER SYSTEM -
OMT J
FINAL GRADE MT CO
I -R
2' INSULATION
PLYWOOD BRACING ABRG FILTER
r/ VISOUEEN BARRIER PLYWOOD BRACING
•/ VISOUEEN BARRIER
T.9
.� S
GRADE
GARNESS ENGINEERING GROUP, Ltd. * :;
CONSULTANTS & GENERAL CONTRACTORS
MI L TDa MIM4 YR 101 • MOEMOL M< Mm1 • NO[ Rbns»-�1T • W Wn3 =" •
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: . • ........ .......•••
JOHN THOMSON (907 240-2020 3 OF 3 �Q e f CE— 53neos. •ai
LEGAL DESCRIPTION: DRAWN BY: O ,�
TABLELAND SUBDIVISION; LOT 6, BLOCK 7, R•A•L �Q •.� +y( !• 0.50• Fo°vO
TYPE OF WORK: DATE: REVISED �OQOd4Op'>>�A�''p
DETAIL FOR PROPOSED DRAINFIELD 7/6/2005 0�
ol".O1m)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 6 GENERAL CONTRACTORS.
1 WR 101 • / . -,1T • t ' N • � p�M�^
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: TABLELANDS SUBDMSION• LOT 6 BLOCK 7,
PERFORMED FOR: JOHN THOMSON DATE: 1/21/2004
(feet ORGANICS TFS� T H01 F�
1
scoe'+ • .. SOIL CLASSIFICATIONS
GW•.
II1111111ML
I�:1110GMp/pN� CIL
•
IIIIIIIIIMH
;1 1!SP CH
SM4'.68. •
.!sc
elllll GRAVELS
9
10
11
12
13
16
17
18
DEPTH TO
GROUNDWATER
DATE
SEEP O 12.0'
1/21/04
010'
1/29
2:40
4804
4-
5/10/05
+STH#3
+TH/2
Kv.
+TH;1
SITE PLAN
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
7/6/2005 1
2:40
—
6"
—
2
2:50
10
2 3/4-
4"3
3 1/4-
.3
2:50
—
6"
—
4
3:00
10
2"
4-
5
3:00
—
6-
6
3:10
10
1"
5-
7
3:10
—
6"
—
8
3:20
10
1"
5-
9
3:20
—
6"
—
103:30
10
11
3:30
—
6"
—
12
3:40
1 10
1"
5 *E]
19—{ I PERCOLATION RATE 2 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
I�JI TEST RUN BETWEEN 1.5 FT. AND 2.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL CUIDEUNES IN EFFECT ON THIS DATE: 7 O
GARNESS ENGINEERING GROUP, Ltd. p? 9 yZ
CONSLTANT& GENERAL CONTRACTORS
US tt
Mi ADA I, . M10URNLM. -11T • At: • WOWL p P••^t
SOIL LOG • — PERCOLATION TEST
LEGAL DESCRIPTION: TABLELANDS SUBDIVISION; LOT 6. BLOCK 7. �O�p•� '•.J' rr mess.-
PERFORMED FOR: JOHN THOMSON DATE: 7/21/2004 p4p. �T'S�cgoo
DEe^�_�EST HOLE 2 �0��ofeesio
e
2
3
5
0
8 lillllll �RSOM
A ELE
9•
10
11
12
13
14
15
16
17
18
DEPTH TO
GROUNDWATER
DATE
DRY
1/2104
•10•
111111111
12.5
III'�I
4'
S/10/OS
2
f,1UIR
10
•
5-
IIIlillll
2:49
—
N1:b�qy��//�O/,
—
4
fS7fL)i
10
Y/f/i�
•
5
2:59
DEPTH TO
GROUNDWATER
DATE
DRY
1/2104
•10•
1 29'04
12.5
4/8/04
4'
S/10/OS
+TH13
$ THJ2
t'1
r +THJI
SITE PLAN
W;771 =011i
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
7/6/2005 1
2:39
—
6•
—
2
2:49
10
1•
5-
3
2:49
—
6•
—
4
2:59
10
1•
5•
5
2:59
—
6•
—
6
3:09
10
1•
5-
7
3:09
6•
—
8
3:19
10
1•
5-
9
3:19
—
66
—
10
3:29
1 10
1•11
5•
11 1
6•
—
12 1
3:39
10
1•1
5•
PERCOLATION RATE 2 IN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 1.5 FT. AND 2.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: D
0J.Ii1
Mayor Hark Beyich
24 Mar 05
Ah nicipality of Anchorage
ICO. bis 14Xi VA • .Vrchorugc, :tlaskn V.ki19-G(Zo • Telephone 0)7) 313-M1 • Fix (1)1)7) 343.KNX)
4700 nragaw Street • .Vrchoruge, Musku 91..):A)7
John Thomson
17343 Santa Maria Drive
Eagle River, AK 99577
uAmmuni.org
Btiilding Safety Division
Subject: Expired On -Site Nater and/or Wastewater Permit.
Permit Number: SW040086
Legal Description: The Tablelands Block 7 Lot 6
Dear John Thomson:
oF,. 3v
P �!
� O
t•
• r) t t .tee
An On -Site Water/Wastewater Permit, number S W040086, issued by this office for a single-family
system, expires on 27 April 05. This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as -built inspection report must be
sent to this office for review, approval and documentation. This as -built inspection report must be
signed by the licensed Professional Engineer who inspected the installation of the system. As -built
inspection reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. When applying for a new permit,
the fees are: $460.00 for a wastewater permit and $175.00 for a well permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
BGSaa
J. Roth
Manager
On -Site Water and Wastewater Program
Enc: Copy of permit
Community, Security, Prosperity
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 27, 2004
Expiration Date: Apr 27, 2005
ITHE )"R6LEL1i�sOJ Su BA' n�
Permit Number: SW040086) "ik . 7 -tom (,,- Parcel ID: 051.8018
Legal Description b !� aL� t�LL
Design Engineer: 0041 AK Water & Wastewater Consultan+ Site Address: PER+N@'91RCH-DRWE
Owner Name: JOHN THOMSON Lot Size: 40000 SQ. FT.
Owner Address: NHN FALLOW CIRCLE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK . AK 99577 -
This permit Is for the construction of:
RV Disposal Field ESeptic Tank ❑ Holding Tank Pr ivy ❑ 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.
'.THIS PROPERTY RECENTLY SUBDIVIDED TO THE TABLELANDS SUBDIVISION BLOCK 7 LOT 6
Received By.
Issued By.
f7iY ! Date:
Z
CZN Lt 0��. Date: 4-127 L04
Municipality of Anchorage
\
1 Development Services Department
Building Safety Division ,
Onsite Water & 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. L9S/ — RC/ -0 a Permit Number 5'W10400 86
Property owner(s) JOHN THOMSON Day phone 240-2020
Mailing address (1) 17343 SANTA MARIA DRIVE * EAGLE RIVER, AK.
Mailing address (2) JVL!U CALLOW r'IRGLE Zip Code 99577
Legal description (Lot, Block & Sub'd.) LOT 6 BLOCK 7- TABL ci ANDS SUBDIVISION
Legal description (Section, Township & Range) N/A
Lot Size 4!9006) Acres q.F Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
0
Well Only
❑
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
11Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP Ltd.
Permit Fees: v
Date of Payment: yl.?o%N
Receipt Number: 0
1.50
Waiver Fees*
—
Date of Payment:
Receipt Number.
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
April 19, 2004
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic System for Lot 6, Block 7; Tablelands Subdivision
To whom it may concern:
The proposed 3 bedroom house will be served by public water and private septic system. We are
proposing to install a 1000 gallon septic tank and dual 5 -wide trench type drainfields. Three test
holes were excavated on the property. The drainfield will be designed around the 30 foot radii of
these test holes. Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that an application rate of 0.45 gallons/day/fl2
should be used.
2. TRENCH DESIGN:
a. Percolation Rate: 30 minutes/inch
b. Proposed Application Rate: 0.45 gallons/day/fl?
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 1000 62
f. Total Depth: 5 feet (maximum at any point)
g. Effective Depth: 1 foot
h. Width: 5 feet
i. Reduction Factor: 0.87
j. Minimum Length: 174 feet total lenfh (2 @ 87 feet long each)
k Effective absorption area = 1000 ft
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPIIY: The area around the proposed drainfields is relatively flat. In short, there
are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you_ have any questions, please contact us at 337-6179. Thank you for your
13
NOTE: A site plan drawing, a design drawing, two soils logs, and a 7 page construction
specification letter which are all part of the design package for this septic system.
3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507
Ph: (907) 337-6179' Fax: (907) 338-3246Website: gamessengineering.com
/ LOT 3. BLOCK 7; LOT 2, BLOCK 7: /
TABLELANDS SID TABLELANDS S/D t, BLOCK 7;
/
/ TABLELANDS S/D
LOT 4, BLOCK 7: %
TABLELANDS 5/D
LOT 6. BLOCK 7:
•� TABLELANDS S/D
ALTERNATE S
PROPOSED 3 BEDROOM HOUSE TH 3 LOT 6, BLOCK 7;
(APPROXIMATE LOCATION) S/D TH TABLELANDS S/D/
•. \•SCF -� -• ; TH/2
```� C \ Fr+Tj+T','`• TH/1 / / / LOT 4. BLOCK 6:
{�:pS TABLELANDS S/D
1 /
ol
♦\ �/
TRACT C:
TABLELANDS S/D `- SEPTIC
yea EE DESIGN I / / LOT S. BLOCK 6:
PACE 2 OF 2) / p TABLELANDS S/D
LOT 7, BLOCK 7:
TABLELANDS S/D
LOT 6. BLOCK 6:
/ TABLELANDS S/O
TRACT G;
TABLELANDS S/D // LOT 7, BLACK 6;
J / / TABLELANDS S/D
NOTE: ALL PROPLRTILS bHU)
WILL BE SERVED BY PUBLIC
LOT 6. BLOCK 6:
TABLELANDS S/D
11:1 jjjlj��1111111
% e.>. 1^ f
GARNESS ENGINEERING GROUP Ltd.
CONSULTANTS & GENERAL CONTRACTORS
POs 0 r�NOAO $MTF 10i • ANCw6QAG4 A4 00801 • VuMv (9011}O.6t70 • FAX 1001)1.4—}11.A
PREPARED FOR PHONE NUMBER:
JOHN THOMSON 140-2020
4/19/2004
�;ry
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of A. a ess.•
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DRAWN BY:
RAL
SCALE:
I" - loo'
PAGE NUMBER:
1 OF 2
LEGAL DESCRIPTION:
TABLELANDS SUBDIVISION: LOT 6, BLOCK 7,
TYPE OF WORK:
SITE PLAN FOR PROPOSED SEPTIC SYSTEM
ELEVATION OF THE HOUSE, A
INDER PUMP OR A LIFT STATI
NOTE: THE CONTRACTOR SHALL
HAVE THE SOUTH LOT LINE
FLAGGED BY A REGISTERED LAN
SURVEYOR PRIOR TO
CONSTRUCTION.
APPROXIMATE LOCATION
OF KEY BOX
PR o�SFD�y 1JNE ��^,. v
/ {lVUEANouOu
ct1s ��•T+/'�
TM�,S TH)2 ALTERNATE SITE WILL
INSTALL FOUNDATION REQUIRE USE OF
CLEANOUT Fl M
AWApt SYSTEM.
�i
s/D TH I ?R 1 itT I I
I I I I I I INSALI. FLOW
II I
'•' I I I I I
ER
11 I II
LJ
1a•/�'•' I I I I )1 ///
MTI. I MTL I /
/
/
/DRMAJNFEILD. EXCAVATE
TWO TRENCHES THAT ARE S FEET
DEEP MAXIMUM AT ANY POINT By 5
FEET WIDE BY B7 FEET LONG (174 ti <
FEET TOTAL LENGTH). ADD i FOOT ^
OF CLEAN. WASHED SEWER
DRAINROCK.
DATF-
4/19/2004 OF
DRAWN BY: Od'�-•'•••.• .
_ e d'�•
GA NESS ENGINEERING GROUP, Ltd. SCALE: RAL
CONSULTANTS& GENERAL CONTRACTORS -� I" = 40'
1701 F T'nOQ PpAfl 5!IITF 101 • ANLw0..... A6 00501 • FNONF (007)517-6119 • FAX (007)558.5746 PACE NUMBER:
PREPARED FOR: PHONE NUMBER:
JOHN THOMSON 240-2020 1 2 OF 2
LEGAL DESCRIPTION:
TABLELANDS SUBDIVISION; LOT 6, BLOCK 7•
TYPE OF WORK:
DESIGN DRAWING OF PROPOSED SEPTIC SYSTEM
�o
Je fr ess.
E 795 F`d�
40�eQy/'ro f esslo�°oo
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 6 GENERAL CONTRACTORS
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: TABLELANDS SUBDUISION; LOT 6, BLOCK 7
PERFORMED FOR: JOHN THOMSON DATE: 1/21/2004
(f et) MORGANICS EST HOLE 1
1
2
3
4
'71111 SM/ML
w/ SOME
8 GRAVEL
9-
10-
11-
12-
13-
14
2•13•14
15
16
17
18
19
IGROUNDWATERI DATE I
PF,. Qho(
........
Jeffrey A. Gamess.,
to yi ''• CE -7953 FG
+TH13
+TH12
$TH#1 /
f
f� SITE PLAN
DATE
READING
• -
I111�111�11
1/22/2004.
1
14:05 —
2
111111111
3
14:35 —
6.
4
15:05 30
5- 1.
IGROUNDWATERI DATE I
PF,. Qho(
........
Jeffrey A. Gamess.,
to yi ''• CE -7953 FG
+TH13
+TH12
$TH#1 /
f
f� SITE PLAN
DATE
READING
CLOCK NET TIME
TIME (MINUTES)
WATER READING EL NET DROP
(INCHES)
1/22/2004.
1
14:05 —
2
14:35 30
3
14:35 —
6.
4
15:05 30
5- 1.
5
15:05 —
6-
6
15:35 30
5- 1.
PERCOLATION RATE 30 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.5 FT. AND 5.5 FT.
201 A FOUR HOUR PRESOAK WAS PERFORMED: N YES NO
SOILS LOGGED BY:
JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS: 'MAY HAVE BEEN INFLUENCED BY SNOW MELT RUNNING INTO BENCH.
PERFORMED BY GEG, Ltd. 1, JEFFREY A. CARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
GARNESS ENGINEERING ONTRA�TORS GROUP_
ANTS a fm L 11002 Pil 101 • AIL yp0p1 ' mac. W --"- ' IAII: YO M' I�SIfO P^ 90m
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: TABLELANDS SUBDIVISION: LOT 6. BLOCK 7.
PERFORMED FOR: JOHN TH)MSON DATE: 1/21/2004
Meet ORGANICS TEST HOLE 2
8 VIII �RA ELE
9-
13-
14-
15
-
13•14-15
16
17
18
19
DEPTH TO
GROUNDWATER
CLOCK
DRY
•10'
j4/8/04
12.5'
LOAM SOIL CLASSIFICATION
e '•.
re mess.,
E-7953
ii ' .
CHES)
Pre f SS, o�
111111111
–
6.
GPM
2
14:38
GCN,HH� •
5-
1.
Sw �1111111�MH
14:38
–
' CH
4
�1t1i11� •
30
5-
Sc
8 VIII �RA ELE
9-
13-
14-
15
-
13•14-15
16
17
18
19
DEPTH TO
GROUNDWATER
CLOCK
DRY
•10'
j4/8/04
12.5'
e '•.
re mess.,
E-7953
$ #3
$TH#2
STN#1
i
SITE PIAN
I"-100'
CLOCK
NET TIME
WATER EL
/...
.. .. .... ...........
e '•.
re mess.,
E-7953
F`G
CHES)
Pre f SS, o�
$ #3
$TH#2
STN#1
i
SITE PIAN
I"-100'
20— 1 1 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ONO
SOILS LOGGED BY:
JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS: 'MAY HAVE BEEN INFLUENCED BY SNOW MELT RUNNING INTO BENCH.
FORT JEFFREY SNNEITHIS WAS PE A0RMED IN ACCORDANCE
WIHALLLSTEA D MUNICIPAL ELINEEFFECT ON THIS DATE:
CLOCK
NET TIME
WATER EL
(E
DATE READING
TIME
(MINUTES)
RE DING
CHES)
1/22/2004 1
14:08
–
6.
2
14:38
30
5-
1.
3
14:38
–
6.
4
15:08
30
5-
1.
5
15:08
–
6.
6
15:38
30
5-
1.
PERCOLATION RATE 30 MIN./INCH) PERC. HOLE DIA.
6 (INCHES)
TEST RUN BETWEEN
4.5 FT. AND 5.5
FT.
20— 1 1 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ONO
SOILS LOGGED BY:
JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS: 'MAY HAVE BEEN INFLUENCED BY SNOW MELT RUNNING INTO BENCH.
FORT JEFFREY SNNEITHIS WAS PE A0RMED IN ACCORDANCE
WIHALLLSTEA D MUNICIPAL ELINEEFFECT ON THIS DATE:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS �-
-���
3ni KNO. IUM 101 NK1QK.r. NL 11low • POR: W -11]• • IJL' YO N • ROinG P�+�"' 'Op11
SOIL LOG —PERCOLATION TEST
LEGAL DESCRIPTION: TABLELANDS SUBDMSION; LOT 6, BLOCK 7
PERFORMED FOR: JOHN THOMSON DATE: 1/21/2004
(i eORGANICS TEST HOLE 3
� 1
2
3
4
6
7 SM/ML
w/ SOME
8 GRAVEL
10-
11-
12-
13-
14-
15
0-
11-
12-
13•14•15
16
17
18
4 I ...,y�
...:....... ................
of r A G mess.
lo°oi '• C -7953
On e� .... '' 1:4
CLOCK
NET TIMENET
►►i
DROP
I
• -
(MINUTES)
-
plllllll
1 22 2004 1
Ililllal
—
oz=0i
2
14:40
30
•
1'
3
IIIIIIIII
—
6-
4
15:10
�illlill;
5'
1
5
15:10
—
6-
4 I ...,y�
...:....... ................
of r A G mess.
lo°oi '• C -7953
On e� .... '' 1:4
PERCOLATION RATE 30 LMIN./INI.n) "i,'.
19
TEST RUN BETWEEN 4.5 FT. AND 5.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ONO
SOILS LOGGED BY:
JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS: 'MAY HAVE BEEN INFLUENCED BY SNOW MELT RUNNING INTO BENCH.
PERFORMED � TREYA.NN TI THAT
SWAS PE ORMED IN ACCORDANCE
WITH
ALL pMUNICIPAL GUIDELINES EFFECT THIS DATE:
CLOCK
NET TIMENET
W ATER EL
DROP
DATE READING
IME
(MINUTES)
READING
(INCHES)
1 22 2004 1
14:10
—
6-
2
14:40
30
5'
1'
3
14:40
—
6-
4
15:10
30
5'
1
5
15:10
—
6-
6
15:40
30
5-
1.
e hni!`uCC1
PERCOLATION RATE 30 LMIN./INI.n) "i,'.
19
TEST RUN BETWEEN 4.5 FT. AND 5.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ONO
SOILS LOGGED BY:
JODY MAUS PERCOLATION TEST PERFORMED BY: RICK LYON
COMMENTS: 'MAY HAVE BEEN INFLUENCED BY SNOW MELT RUNNING INTO BENCH.
PERFORMED � TREYA.NN TI THAT
SWAS PE ORMED IN ACCORDANCE
WITH
ALL pMUNICIPAL GUIDELINES EFFECT THIS DATE:
MUNICIPALITY
Development Services Department P P Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-801-38 Expiration Date: J 20 Z y
1. GENERAL INFORMATION
Complete legal description THE TABLELANDS BLOCK 7, LOT 6
Location (site address) 23633 FALLOW CIRCLE, CHUGIAK, AK 99567
Current property owner(s) RICHARD & ANGELA LAUDERBACK Day phone
Mailing address
Real estate agent
23633 FALLOW CIRCLE, CHUGIAK AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment��
Receipt Number 00q0
Date:
Waiver Fee $
Date of Payment
Receipt Number
COSA # 0,,'5C-7 -711 q 6 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE AK 99516
Engineer's Printed Name _CURTIS HUFFMAN, PE Date 5/5/2022
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to • �i
11
these various and dynamic characteristics and are outside the control of the evaluator of the •�(i i`
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: •' • . :1
for current or future occupants or guarantee that no unseen encroachments, deficiencies or /fig•' 9 �r
discrepancies exist can be given by First Water Consulting & FKS ' *' ili •..• .......
6. DSD SIGNATURE ..." WlWl
/ Curtis Huffman
System #1 Approved for L( bedrooms � c�'•• CE 128991
System #2 Approved for bedrooms �1`Fop ROFES ONP��`� `r
Disapproved
Conditional approval for bedrooms, with the following stipulations:
`��okkOF c((((((i
A
AST`-� SATE1, A o:z-
J
P?
O�
r_c,_
Original Certificate Date
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: THE TABLELANDS BLOCK 7 LOT 6 Parcel ID: 051-801-38
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system
A. WELL DATA - PUBLIC WATER
❑ Well log is filed with Onsite (or attached)
- - Date drilled ---
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) — in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
Well production at time of test _gpm
Water -storage -tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by_
Date of Sample
B. TANK DATA
C. LIFT STATION
Age of tank(s) 17 years
® Required maintenance completed*
Tank type/material STEP / STEEL
Age of lift station 17 years
Measured operating fluid level in septic tank*
Lift station material STEEL
® Standpipes/foundation cleanout per record drawing
Comments::*SEE AEROCELL MAINTENANCE
Date of pumping 513/22
REPORT BY ARM SERVICES & SANITARY
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/18/2005
Adequacy test date 5/5/2022
® ALL standpipes present per record drawing
Results Pass For 4 bedrooms
Total measured depth from grade **2.7 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade **3.2 ft (min)
Water added 630 gal
❑ N/A - pressurized field
New depth 4 in
® Monitor tubes go to bottom of effective. If not, state
depth into effective IR SHOWS 0.5' ED
Elapsed time <60 min
®Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies: **AT CO/MT GRADE. SHOTS SHOW 0.5' ED. 2005 MOUNDED AEROCELL SCAT FIELD, WITH
INSULATION & NO KNOWN FROST ISSUES REPORTED.
FWiS
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot
> 100'
Community Sewer Manhole/Cleanout >
100'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100'
❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100'
❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields
> 100'
Animal Containment > 50' ❑ Yes
if No ft,_
❑ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
_
❑Yes
if No
ft
El Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water >' 100
_ ®Yes
if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells >' 100
_ ®Yes
if No ft
......Water Main >.10'
® Yes.
if No_. _..
ft_ .
_,:.... Community.Wells > 200' ® Yes
if No __ ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot
to: (Please enter distances
if less than required)
Building Foundation > 10' ,
® Yes
if No
ft
If absorption field. is under driveway comment below
Property. Line -> 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells >' 100
_ ®Yes
if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes
if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l 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.
low
Aw
TH
�.. • Curtis Huffman •: 4
acs . CE 128991
��A,�'
�� lE,9' • 519/22.. • ' � �
1klk'0pROFESSIOW
ARM Septic Services, LLC
«- x .. (Gfn .e'':�-waY+' '.,'" .. �•;v,. .�.-M,�k r_,s^,.k4ru"F)._n`'� fi:ffi#;£Atit:i" ":'�
Media Advisory
23633 Fallow Circle
Chugiak, AK 99567
5/9/2022
ARM Services recently completed maintenance and upgrades on the Quanics Aerocell
located at the subject property. During the maintenance visit, it was noticed that the
media was showing its age and in need of remediation or replacement. At the direction
of the sellers, ARM completed remediation on the media to bring the media back to
health. ARM installed a retrofit kit in the aerocell and treated the media twice. During
the second site visit to treat the system media, the condition of the media was observed
to be acceptable and the system passes inspection. However, given the age of the media
(17+ years), the treatment media may need additional remediation or replacement in
the future. The system appears to be processing effluent properly and the upgrades
completed appear to have prolonged the lifespan of the media.
Please don't hesitate to contact ARM Services with any questions,
n _
l A � � f�
Nathaniel Swanberg
ARM Services
Ph: (907) 688-9433
Cell: (907) 854-1684
Email:
Pers: S°w c<n berfz.t« aI ms i 4J11icEv Is
> a nt:. C i,"sl!
17933 Old Glenn Highway *Chugiak, AK 99567
office: (907) 688-9433 Email: ARMServicesAK@outtook. corn
Maintenance Checklist- Advanced Treatment System
Operational Checklist: Advanced Treatment System
Legal Description:
Street Address: 2
Service provided on: Date: lin�iaTime'.
Service provided by: Company-t1t iii Technician:
_5j�'j, Vic
Date of last service: By: "You "1. Other. IV*1
1. Type of Aerocell Treatment System:
Cat If -AeroCell Treatment System
E7
I I Cat III -AeroCell Treatment System
2. Conditions at media filter: DAcceptable 0 Unacceptable
a. Evaluate presence of odorwithin 10 ft of perimeter of system:
f None 11 Mid OStrong F Chemical F—I Sour
b. Source of odor, if present:
3. Manhole Risers and Pipe Caps: lAcceptable F Unacceptable
a. Cover/s intact: Yes No
b. Method of securing cover: 11e;lir7
c Insulation present on all lids? FO' Yes D No
d. Any plumbing leaks or water intrusion- F-1 Yes 2/N o
e. Surface water/infiltration into components: El Yes No
4. Venting/Air supply: 'ElAcceptable C Unacceptable
a. Air supply unit operating properly. 7''
7 ',Yes 17 No
b. Venting appears operable,
_1 Yes No
5. Media surface: LJAcceptable
Li Unacceptable
;V/ I
a,
Biomat on surface-
121yes
Ll No
f
b
Uniform spray pattern,
Yes
El No
li'k''Q"� "C"_
d.
Ponding inlon media,
12Yes
� 'No
11)
A—!
e.
Plugging/clogging of nozzles.
F-1 Yes
El No
f
Media appears to be settling,
MV Yes
171 No
g.
Appropriate maintenance performed.
Yes
7— No
ZZ
h.
Pest activity at Surface.
01 Yes
D N o
6. Effluent quality
a. Effluent odor after passing through media filter:
None Mid Strong
b. Effluent color after passing through media filter: Clear Brown rL_❑I Black 7
17933 Old Glenn Highway *Chugiak, AK 99567
office/fax: (907) 688-9433 Email: ARMServicesAK@outLook.com (PAGE 1 of 3)
lTasks for recirculating/discharge flows: '71 Acceptable E-1 Unacceptable
10. Drainfield:
a
Type of D="eld (circle mxe):Be
D�pT�n�
lbb. Design Effective depth: _ (--- che lfee(::���Me
u Checked Liquid Levels inDmiohald: LJ Yes []No
MT#1Liquid LeveInches
M##2Liquid Level: Inches
K8|#3 Liquid Level: Inches
M7#4Liquid Level: Inches
d |sthere any surfacing affluent?, El Yes ��No
170]]Old Gien Highway
a |fapplicable, Jandyvalve functioning: FYes
EJ No
F0 N/A
b. |fapplicable, JandyValve basin dry: El Yes
11 No
N/A
cCleaned collection system inAamoo||unit. FYey
ZNo
Not Necessary
U. Design recirculation ratio 80 20
? �",�
/T
e Actual recirculation ratio (Estimeted):
8.Pump System: 12Accoptable ElUnacoeptab|e
- - --
a-
Control panel inAuto: FLAYes 17No
b.
Timer settings IFS Panel (No Override timer): r"Yes
ON: OFF:
Override ON, Override OFF: [lN/A
c
Floats incorrect p|ocement� [Q
��No
^
d
Floats working propedy,L��es
2 N
o.
High water alarm operational:li�Yes
7 -,Nn
f.
High wa��
ranncount
g�
Pump Run Counts:
h,
-�
Pump
.not Error Cn /ntn:__________ './4
j
Total Override Counts: ________ ION/4 /
k.
Effluent Filter sewioad� Yes
F7 No
i
Tank lids secured after inspection, EV:
�No
m.
Weep hole hunotionaL 112, Yes
No
8. Primary Tank: Acceptable ��Unocmeptab|e
a-
Sludge and scum level checked: El Yes
lv�Nu
b.
0udge/Snum|eve|s: 1st:______2nd�______3rd:
|enknoodstnbepumped: ��Yes
N/Ac.
EJ No
g
Water softener backwash discharging onsystem? F-1Yes
F-1 No
e,
How many people live onthe oystem?�
t
Tank lids/caps secured after inspection: Yes
Ll No
g.
Last Date Tank pumpe, ' Zc/��
10. Drainfield:
a
Type of D="eld (circle mxe):Be
D�pT�n�
lbb. Design Effective depth: _ (--- che lfee(::���Me
u Checked Liquid Levels inDmiohald: LJ Yes []No
MT#1Liquid LeveInches
M##2Liquid Level: Inches
K8|#3 Liquid Level: Inches
M7#4Liquid Level: Inches
d |sthere any surfacing affluent?, El Yes ��No
170]]Old Gien Highway
I '_,____
'
11.|sthe remote monitoring system functioning? (if no, describe incomments) Yeo rlNo
a. Type of Monitoring
b.Phone line working? I] Yes Fl No N/A
12. Does this system receive on advisory notice/warning? (if so, describe in comments) r��^s
13. Is the system in saUafuotory000dition/pano inspection? (if no, describe in comments) '
Other Comments:
_
Service Provider:;,,//
17V]]Old Glenn
/
j vi
_
Service Provider:;,,//
17V]]Old Glenn
/
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this 12th
Sean Foley
Day of May of 20 22 , by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as AN SYSTEM
located at (legal description) 0 05U:
THE TABLELANDSL6 B7
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
`��%Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
� it shall be the responsibility of the Owner during the term of this Agreement to pay for all
v
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
(/---"includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or pennitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
1<2
„x Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Fes..
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
f 3 Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begun on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the ANNTWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of
OWNER: _,
By: ''�'' (signature)
(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
Date: -5-- / (--- Z 2
The foregoing instrumen was acknowledged before me this day of Wat:� ,
20�, by ,'� 'Wr`
NOTARY PUBLIC OR ALAS
My Commission expires: It 14 3 _ NOV. m;
23
MUNICIPALITY:
By:'==---�AM ( (signature)
• 2022
0 OF
Date:
(print name) Title:
(rev. 05/18/2018) Page 3 of 3
Parcel I.D. 051-801-38
C4-1sow
Municipality of AnchorOn-Site Water and Wastewater Progra(907) 343-7904
Certificate of On -Site Systems Approval
Expiration Date: (�, 29 1 O
1. GENERAL INFORMATION
Complete legal description The Tablelands. Block 7, Lot 6.
Location (site address) 23633 Fallow Circle
Current Property owner(s) Martin Neil Walters Day phone
Mailing address 23633 Fallow Circle Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El 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
❑
Individual
M
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
E]
Public Sewer
❑
WaiverNariance request
Received by:Date: 71
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5'26 - to 0 Waiver Fee $
Date of Payment
/6 Date of Payment
Receipt Number V V061 0 Receipt Number
COSA # Waiver #
5. STATEMENT O,NSPECTION 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Date 6/29/16
6. DSD SIGNATURE
System #1 Approved for bedrooms t,SVeven R.'Fianr
CE -8145
System #2 Approved for bedrooms}fig
Disapproved �eZ��OFE5510�p
1I mik-0
Conditional approval for bedrooms, with the following stipulations:
By:77�a_ irw. iZdL Original Certificate Date::z 2S —Ifo
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet r '. c
It more than 1 septic system is on the lot
COSA Checklist # + of
Structure served. by this system +
Certificate of On-Site Systems Approval Checklist
Legal Description: The Tablelands. Block 7; Lot 6. Parcel dpi 051-801-38
A. WELL DATA
Well type Public If A. B, or C provide PWSID # AW W U Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depthft. Cased to ft. Casing height (above ground) in. .
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft: ft
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
- Coliform colonies/100`mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/ Steel Date installed 10/18/2005
Tank size 1500 gal. Y Number of Compartments Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depressionover tank (Y/N) N High water alarm (Y/N)
Date of pumping 6/28/1-6 Pumper Denali Pumping &`Waterworks LLC
C: ABSORPTION FIELD DAfiA
5 2.0g.p.d./sf see TmncWAO cen
Date installed Soil rating (g.p:d./ftp or ffa/bdrm) System type
Length 64 ft: Width 5 ft. Gravel below pipe 0:5 ft.
Total depth*�� fit. _ Eff. absorption area 320 ff Monitoring tube Y Depression over field -
/28/�6 pass 4
Date of adeq a est � -� Res For -bedrooms
Fluid depth in absorption aid before test - in. Water added 6$8 gal. New depth 0- in:
Elapsed Time: `100 mIln.. -Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 rho.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed 10/18/2016 Size in gallons 1500 Manhole/Access (YIN) Yes
"Pump on" level at Tinier Timer "Pump off' level at Tlmer in. High water alarm level at 45 in.
Datum Bottom Of Tank Cycles tested 4 Meets alarm &circuit requirements Yes
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent Iola '
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 200+
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 10+
Curtain drain 50+ Wells on adjacent lots 200+
F. COMMENTS
* 2"" of insulation over field }
A4vc,te-yt CVSlPM f 4? oL:ei,
G. ENGINEER'S CERTIFICATION
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 Steven Pannone
Date 6/29/16
COSA canary sheet 2-6-15.doc
1
D. LIFT STATION
Date installed 10/18/2016 Size in gallons 1500 Manhole/Access (YIN) Yes
"Pump on" level at Tinier Timer "Pump off' level at Tlmer in. High water alarm level at 45 in.
Datum Bottom Of Tank Cycles tested 4 Meets alarm &circuit requirements Yes
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent Iola '
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 200+
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 10+
Curtain drain 50+ Wells on adjacent lots 200+
F. COMMENTS
* 2"" of insulation over field }
A4vc,te-yt CVSlPM f 4? oL:ei,
G. ENGINEER'S CERTIFICATION
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 Steven Pannone
Date 6/29/16
COSA canary sheet 2-6-15.doc
•
•
O .e
Qeeee Mark Sewed, • /
LS
ASBUILT
5I F]A[tD h
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE:
FOLLOWING DESCRIBED PROPERTY:
��yo
T//E" 7�1EG�ipO/'tUB cor 68�:
AND THAT NO ENCROACHME ITS EXIST EXCEPT AS
DATE.
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID.
EASEMENTS, COVENANTS+ OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FS,
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BDUND-
- -
ARY LINES.
DRAWN
O .e
Qeeee Mark Sewed, • /
LS
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
e. y4 M1..
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
0 Day of 7o ( of 20[_� by and between LtK, cS
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS), described as
located at (legal description).
-Fke tielcwds 8t,,L -7 Lof
2. Definitions.
Alteration. Any change to the design or function of an AW WTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC') 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AW WTS that were included
in the original design which would allow the AW WTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AW WTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AW WTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations. Installation and Removal of Additional Eauinment. Prior to
performing any alterations to an AW WTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Renairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AW WTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AW WTS
service and maintenance provider approved by the Municipality and the
manufacturer of the AW WTS for the entire term of the AW WTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AW WTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AWWTS.
I. Owner agrees to provide and maintain a telephone connection to the AWWTS as
required by the AWWTS approval.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such parry thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner:
b. Municipality: Director Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By: �/9 (signature) Date: v LV2d
(printname)
STATE OFA W6fHlf067ot� )
) ss.
eacLNTY (oFf(M- cC )
The foregoin instrument was acknowledged before me this St -day ofd,
��
NOTARY PUBLIC FOR ALASKA NCTgRy`,�
My Commission expires: JAN y 7 701R`vZ pig' z
P� ., 69
27,
MUNICIPALITY:
By: (signature) Date:
name) Title:
Municipality of Anchorage,
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-801-38 Expiration Date: ` l�
1. GENERAL INFORMATION
Complete legal description THE TABLELANDS; BLOCK 7 LOT 6
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
23633 FALLOW CIRCLE *CHUGIAK AK 99567
DAVID HORN Day phone 360-4741
23633 FALLOW CIRCLE *CHUGIAK AK 99567
N Single Family (w/wc ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
0
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
E'
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
Received by: i L -o• � t -- � Date
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number-
COSA #
umberCOSA# dscl31L1 /
Waiver Fee $
Date of Payment
Receipt Number
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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
in conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole ance upon or use
other person o/r party is not at of the owner uthorized, ed, sted nor will it confer any legal right whatsoever.s report any
6. DSD SIGNATURE
_AZ System #1 Approved for -- bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 337-6179
Date c 1
bedrooms, with the following stipulations:
OF
ON-SITE
WATER AND
WASTEWATER
Original Certificate Date:
Lj-30-I3
ertificates of On -Site Systems Approval (COSA) based only
The M icipal� Anchd a Develop,emt Services Division (DSD) issues C
upon the represenatations 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. ATTCHMENTS: /
COSA Checklist v Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
1pr isms
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: THE TABLELANDS; BLOCK 7, LOT 6 Parcel ID: 051-801-38
A. WELL DATA PUBLIC WATER
Well type If A, B, or C provide PWSID#
Date completed Sanitary seal (YIN)_
Total depth ft. Cased to ft.
Date of test
Static water level
Well production
WATER SAMPLE
Coliform
FROM WELL LOG
ft.
W
colonies/100 ml. Nitrate mg./L.
A ic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/STEEL
Tank size 1500 gal. Number of Compartments ?
Well Log (Y/N)-
Wires properly protected
Casing height (abo rc
AT
ft.
9-p M.
Collected by:
Date installed 10/17-18/05
Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) YES
Date of pumping Pumper
C. ABSORPTION FIELD DATA BELOW EXISTING GRAC
in.
QUANICS AEROCELL SYSTEM
Date installed 10/17-18/05 Soil rating (g.p.d./ftor j drm 2.0 System type SHALLOW TRENCH
Length 64 ft. Width 5 ft. Gravel below pipe O.5 ft.
Total depth *3.00+ ft. Eff. absorption area 320 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 9/10/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 676 gal. New depth E in.
Elapsed Time: 0 min. Final fluid depth E in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date
Y
D. LIFT STATION *PER AROUND THE CLOCK PUMPING MAINTENANCE REPORT
Date installedl 0/17-18/05 Size in gallons 1500 Manhole/Access (Y/N) YES
"Pump on" level at TIMER in. "Pump off level at TIMER in. High water alarm level at 46 in.
Datum BOTTOM OF TANK Cycles tested * Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on
Public sewer main
Sewer /septic service line
Animal con areal
On adjacent
On adjacent lots
Holding tank
Manure/animal excrete storage areas
DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
53+
Property line 5'+
Absorption field
5'+
Water main
10'+
Water service line 100+
Surface water
100'+
9
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ . ' Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date _q .1 Z' /13
(Rev. 11105)
. T_
9
.
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Municipality of Anchorage Z I?'l zec7; •• •;.,
Development Services Department '
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ��' — �Q COSA# d p .rte 3 ,Z
03-
1. GENERAL INFORMATION Expiration Date: — —
Complete legal description
Location (site address)
Current Property owners)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TABLELANDS SUBOMSION• LOT 6 BLOCK 7
NHN FALLOW CIRCLE • CHUGIAK AK 99567
JOHN THOMSON Day phone 240-2020
17343 SANTA MARIA DRNE • EAGLE RIVER AK 99577
Day phone
EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476
16635 CENTERRELD DRIVE • EAGLE RIVER AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSO) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality ofAnchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lest, and separation
distances measured to readily fdentirable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lest
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate ofhow long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benerit of the owner listed above. Any reliance upon or use of this report by any
otherperson orpartyis not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Date !/2s'! a-"
. .. . ..............
.JV f r v A. ess:
Conditional approval for bedrooms, with the Blowing stipulations:
Attachments:
COSA Checklist L/
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
Pro to Belo^°QuP
'4000Y OFrrq,tk
• ON-SITE • c
WATER AND
WASTEWATER
PROGRAM
By: ! �"� r� Original Certificate Date: <�2 — 7— 6`7
Municipality of Anchorage
Development Services Department
Building Safety Division :. ...
Onsite Water 6 Wastewater Program
4700 Bragaw Street
P.O. Box 195650
Anchorage, AK 995196650
www.muni.orglonske
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: TABLELANDS SUBDIVISION• LOT 6. BLOCK 7, Parcel ID:
A. WELL DATA
Welt type PUM If A, B, or C provide PWSID# _ Well Log (YIN
Date completed Sanitary seal res properly protected (YIN)
Tota Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Col form colonies/100 ml. Nitrate mg.IL. ba0Ie1l&===coIoniesI100 ml.
Arse Date of sample: Collected by:
B. SEPTICIHOLDING TANK DATA THIS IS SCAT AEROCELL SYSTEM
Tank Type/Material GREER / STEEL Date Installed 10/17-18/2005
Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation deanout (YM) YES Depression over tank (YIN) NO High water alarm (YIN) YES
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date installed to117-11a22 Soil rating OE�oDr ft%dnn) 2_0 System type TRENCH
Length 64 ft. Width 5 ft. Gravel below pipe 0.5 ft.
Total depth •3.37-3.8911. Eff. absorption area 320 fe Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fall) - For 4 bedrooms
Fluid depth in absorption field before test = in. Water added = gal. New depth =in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed I Q/17-18/05 Size in gallons 1500 Manhole/Access (Y/N) YES
"Pump on" level at TIMER in. •pump ofP level atRMERtn. High water alarm level at 46 in.
Datum BOTTOM OF TANK Cycles tested 3 Meets alarm 8 circuit
requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
areas
PUBLIC WATER
On adjacent
On adjacent
sewer manhole/deanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Suiface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main _ N/A
Water service line 10'+ Surface water 100'+ Driveway, pafldnglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTWICATION
I car* that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance wftil MOA COSH guidelines in effect on Nus
date.
Engineer's Printed Name JEFFREY A GARNESS
Date ( I'Z S& 4
COSA Fee & 5-7,1`c)
Date of Payment 6l
Receipt Number - q % 0
(Rev. 1 troy)
Waiver Fee $
Date of Payment
Receipt Number