HomeMy WebLinkAboutTHE TABLELANDS #2 BLK 9 LT 10Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211333 PID Number: 051-741-67
Dwelling: R Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New R Upgrade
Name
TIMOTHY DABNEY & MARTA BUSCAGLIA C/O ARM SEPTIC SRV. ABSORPTION FIELD
Site Address ❑ Deep Trench ❑ Wide Trench X Bed 19 Mound
22604 DEER PARK DRIVE, CHUGIAK, AK ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
907-688-9433 5 *0.5 GPD/SF SEE DWG. Ft,
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot SEE DWG. Ft. 0.51 Ft.
THE TABLELANDS #2 9 10 Fill added above original grade Gravel length
Township Range Section SEE DWG. Ft. 75 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 20 Ft. 4 5 Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches
Tank Field Lift Station Tank Line 1500 Ft' From - -
Ft.
Well PUBLIC PUBLIC PUBLIC — 25'+ T v Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water EXIST. *50+ EXIST. - Gal.
Material NuMbe compartments
Lot Line EXIST. 101+ EXIST. - NA
Foundation EXIST. 10'+ EXIST. - TATION
Manufacturer Capacity
Remarks *THIS IS AWWTS 't�efL Int. SLtS Gal.
l?�__�-:c� Alarm location Electn i ailed by
�ory ti`o2 .Ili tJnr� : + S Int _04 CE�o
PIPE MATERIAL House to tank EXIST. Tank to D1785
Installer drainfield
ARM SEPTIC SERVICES Drainfield D1785 CO/MTD3034
Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 It
Inspection ection 1" 7/7-8/22 2nd 7/11/22 Location and description
3'" 7/12/22 41" 7/12/22 FRONT DOOR THRESHOLD
ONSITE WATER AND WASTEWATER SECTION APPROVAL I Engineers Sfamp
Approval:
Septic System
Approved
Note: this
(Rev
Date
%- Date 6 Z
not include well permit requirements.
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PERMIT NUMBER:RECORD
c p /� ! ! n PARCEL ID NUMBER:
RE
OSP211333 CORD DRAWING 051-741-67
r_
—jI DEER PARK DRIVE
VATER MAINS. LOCATION PER
AWWU RECORD DRAWINGS—
GEG 20
MENS \ TH#1
1,5 UT\U1T �"APPROXIMATE LOCATION OF
S&S ENG. TEST HOLE (2004) .
•. \CONNECT CARD -----
'\ EXISTING 1500 -GALLON BIOCYCLE UNIT—
EXISTING 2000 -GALLON STEEL STEP
TANK. TANK WAS EXPOSED AND
FOUND INTEGRITY TO BE GOOD—
:a
•
-- -_
IFV4--__-'_------ —
t ""
ASSUMED
FV3 _
OCATION OF
f
WATER LINE.
FV2
LOCATION PER
F71
AWWU WATER
100.3
SERVICE
45.8
•. \CONNECT CARD -----
'\ EXISTING 1500 -GALLON BIOCYCLE UNIT—
EXISTING 2000 -GALLON STEEL STEP
TANK. TANK WAS EXPOSED AND
FOUND INTEGRITY TO BE GOOD—
:a
•
,•
• • . i .
88.4
ti :.�
d
MT3
A
51.5
100.8
FV1
d'
51.9
100.3
FV2
45.8
55.8
103.1
FV3
51.1
60.4
106.4
FV4
-4
55.9
64.6
109.4
5-gF ROpM
58.0
67.0
HOUSE
WM WMA
MT1 77.8 1 60.1 58.0
MT2
88.4
73.8
75.8
MT3
39.8
51.5
100.8
FV1
41.2
51.9
100.3
FV2
45.8
55.8
103.1
FV3
51.1
60.4
106.4
FV4
-4
55.9
64.6
109.4
MF
58.0
67.0
111.8
NOTE: PIPE LOCATIONS ARE SHOWN PER GEG
SHOTS TAKEN WITH LEICA DISTO S910 LASER
DISTANCE METER. SWING -TIES TO HOUSE
CORNERS WERE GENERATED IN AUTOCAD.
NOTE: ALL CONTAMINATED MATERIAL
FROM OLD DRAINFIELD WAS REMOVED ;
AND FILLED WITH TYPE IIA MATERIAL /
APPROXIMATE\
\ LOCATION OF `
FRENCH DRAIN \
'2 !O �\
Y , NEW 20 FEET WIDE BY 75
FOOT LONG DRAINFIELD.
'2 a „
FOUND
LOCATION OF
GEG TH#2
2005 DURING
i ) %CONSTRUCTION
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SCALE:
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ENGINEERING- SALES - CONSULTING
3701E TUDOR ROAD SURE 101 • ANCHORAGE, ALASKA • PHONE (907) 337-6179' WEBSITE. w .gamessangineering wm .... ..
®.� ............. �R...... .m
PREPARED FOR: C/O ARM SEPTIC SERVICES PHONE NUMBER: PAGE NUMBER: ®Cn r y A. Games Lv
TIMOTHY DABNEY & MARTA BUSCAGLIA 688-9433 2 OF 3 CE -79 3
/ •'
PROJECT/LEGAL DESCRIPTION: DRAWN BY:®B '•.•• �`.• �ip
®
THE TABLELANDS #2; BLOCK 9, LOT 10 J.L.M. fie® Fp "p•••.L...... „,i�+`•P� ®®
TYPE OF WORK: DATE: 444®E�S®��`®®�
RECORD DRAWING FOR DRAINFIELD UPGRADE 9/7!2022 # LICENSE
4
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PERMIT NUMBER: PARCEL ID NUMBER
OSP211333 RECORD DRAWING 051-741-67 U)
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NOTE: THE ENTIRE MOUND AND ALL DISTURBED; NOTE: BENCHMARK IS THE FRONT 0— 0
AREAS HAS TOPSOIL AND HAS BEEN SEEDED. DOOR JAM (THRESHOLD)= 100.00
INSTALLED FLUSHING VALES AT END OF FINAL GRADES = 101.11-101.93
EACH DISTRIBUTION LINE WITH COVERS
2+ FEET OF COVER OVER TOP OF INSULATION (SEE NOTE)
1.25"SCH. 40 PVC DISTRIBUTION LINES
T3 WITH 3/16" HOLES SPACED 5-FOOT ON MT1 3:1 SLOPES
3:1 SLOPES MT4 FV1
CENTER - HOLES FACED DOWNWARD MT2
'K
FV2 2" OF INSULATION (60 HOLES TOTAL IN DISTRIBUTION LINES)
FV3
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DISTRIBUTION LINES 98.71
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zg LL
ELEVATION OF TOP OF NEW FILTERO
SAND BOTTOM OF DMINROCK 98.20 &Y O0
\,--TOP OF MOA TYPE IIA V w
MATERIAL/ BOTTOM OF NEWy LL
0 0
MOA FILTER SAND = 96.00 C7„
wo0 of
o -J IL
\\-2.2 FEET OF MOA FILTER SAND co u-
91.96-94.00 - EXCAVATION LIMITED TO THE 2-4.04 FEET OF MOA TYPE IIA MATERIAL
0
REMOVAL OF CONTAMINATED MATERIAL AND
OLD SAND/FILL. EXCAVATED TO NATIVE SOIL.
BOTTOM OF EXCAVATION WAS SCARIFIED. 4
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BOTTOM OF OLD FILTER SAND = 95.70 (PER
STEVE PANNONE, P.E. 2011 RECORD DRAWING) 0 W
75 FEET LONG
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DATE SCHEDULED 3 O TIME INSPECTOR._*
SUBDIVISION THE TABLELANDS #2 BLOCK/LOT/TRACT BLK 9 LT 10
INDICATEINORTH
SIZE CONN 1"
CORP. STOP
CURB STOP C TO C
FT. COPPER PIPE
1 1/4" OR 2" KEY BOX
FT. THAW -WIRE
THAW-PLATE/NUT
KEARNY CONNECTOR
OTHER
0�'
�4tcr Per' �a:o7
S\
f�
Kra 43-x S r
i
U(( DOMESTIC ONLY J__ BOTH FIRE & DOMESTIC
FIRE LINE ONLY FIRE HYDRANT ONLY
DATE OF TAPE / / BY
SIZE MAIN i ALLEY I I STREET 11 EASEMENT
TYPE MAIN EXCAVATOR
DISCONNECTS i YES NO SIZE OF DISCONNECT
COMMENTS
KEY BOX LOCATIONam�D%,c
C d F o 7` Dc'v rsaric-ter
INSPECTION REPORT
LINE BLOWN OUT 7 lad / QS— m INSULATED
X K.B. & T.W. - OK AFTER BACK -FILL
OPEN BORE FLUSH i !
200 LB. TEST
MAIN CHLORINATED / 1
CHLORINE FLUSHED
X OK TO TURN -ON DO NOT TURN -ON
INSPECTOR
DATE cf7-" / 3o / OS
COMMENTS
,qe,f
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196050 4700 Elmore Road
Anchorage, Alaska S9s1n0Osu Ph '7904 Fax: (eo7)noa'ryn/
onp://vwnw.muo/urg/vosxo
Permit Number: OSP211333
Work Type: Septic Upgrade
Tax Code Number: 05174167000
Site Legal Address: THE TABLELANDS #2BLK 9 L 18 G:1559
Site Mailing Address: 22S05DEER PARK DR, ChuQiuk
Owner: BUSCAGL|AMARTA &
Design Engineer: GARNESSENGINEERING GROUP LTD
This permit iafor the construction of:
0Disposal Field 171 Septic Tank [] Holding Tank [] Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
8/12/2021
8/12/2022
[] Private Well [] Water Storage
All construction shall beinaccordance 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 (1OAAC80)
3. The wastewater code requires inspections during the installation. The engineer shall '
the Development t
Services Department per AMC 15.G5.Provide notification bycalling (Q07)343'7SO4(24/' 4. From October 150nApril 15. a subsurface soil absorption system under construction during freezing weather
shall beeither: —
o. Opened and Closed onthe same day, or
b. Covered, sealed, and heated Uoprevent freezing
Special Provisions:
Remote monitoring is required to be added to the Biocycle system.
CO#1 Design changed due to tighter soils found.
Receive(
5
, 'MUNICIPALITY OF ANCHORAGE
ci+��zti..'��.eJ_._�-,"'w'�..:..��r>:.e,..7�."F"cE'^ ,:..�.w"qx��'r� 1� � ., ;r mow; .._T'�;-�..��,"°�-'y.`��::=a�s..�xctY�^✓`+��� ;��.�
Development Services ®epanrnent Phone: 907 343-7904
On -Site Mater & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I . D. 061-741-67
Property owner(s) TIMOTHY DABNEY & MARTA BUSCAGLIA Day phone *688-9433
Mailing address *C/O ARM SEPTIC SERVICES - 17933 OLD GLENN HIGHWAY, CHUGIAK, AK 99567
nnr_nc nrr-r� nnov nn N" ^�UGIAK "r\
Site address GLVVU L EEE rr�nr� univ�, r i nn
Legal description (Sub'd., Block & Lot) THE TABLELANDS #2; BLOCK 9, LOT 10
Legal description (Township, Range & Section)
Lot Size
Sq. Ft. Number of Bedrooms
E
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(E all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
F-1Upgrade
Duplex (D) ❑
Holding Tank
F-1Renewal
El
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Pr i'vate vveii
r__1
Water Storage
❑
THIS APPLICATION INCLUDES
A 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: #-5Q _5 Waiver Fees:
Date of Payment:
,rte
Receipt Number: 02398 G
Permit No. 0_'S P-7- ( 1-33-7)
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
III 11111 11111
�.
1
June 14, 2022
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Change Order and Design Revision to Septic System Upgrade for
The Tableland S/D #2; Block 9, Lot 10
Attention: Deborah Wockenfuss
On August 12, 2021, a permit was issued by your department to rebuild the existing drainfield. The
contractor started the rebuild in May of 2022, and during excavation it was noted that there was only minimal
biomat in the drainrock or sand filter. This led us to believe the drainfield may be undersized. A confirmation
test hole was excavated north of the existing drainfield. Several percolation tests were attempted, with each
percolation bench getting further away from the drainfield; however, due to the saturated site conditions
(assumed to be caused by the surcharged drainfield), the percolation tests kept being adversely influenced
by water intrusion. A third perk was attempted near GEG Test Hole #2 that was logged in 2005 but was
unsuccessful due to saturated soil conditions. The GEG percolation test performed in 2005 on TH#2
indicated a 120 minute/inch percolation rate. Based upon this percolation test and our recent observations,
it is reasonable to believe that the existing drainfield is undersized. It is important to note that the soils are
marginal, even for advanced wastewater system; however, instead of installing a holding tank, we are
proposing to install a drainfield sized for a 120 minute/inch receiving soil with the hope that it will perform
adequately.
We have revised the design and detail drawings to show the new proposed configuration of the drainfield
upgrade (see attached). We are proposing to use an application rate of 0.5 gpd/sq.ft. for the drainfield. This
application rate is applicable for a Cat III system. The existing Biocycle AWWTS is rated as a Cat II system;
however, we will be utilizing 2.2 feet of MOA filter sand with this design. We are asserting that after the Cat
II effluent passes through 2.2 feet of MOA filter sand, the effluent will meet Cat III requirements (in terms of
BOD, TSS, & Fecal Coliform) and that the bottom of filter sand square footage requirement will meet the
0.5 gpd/sq.ft. application rate.
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.
S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
N
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211333, Deb Wockenfuss, 08/12/21
NOTE: THE CONTRACTOR SHALL i h GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER
HAVE THE 15' UTILITY EASEMENTS l / \ THAT PERTAINS TO THIS DESIGN. BY PROCEEDING
FORWARD WITH THIS INSTALLATION, THE
FLAGGED/STAKED LAND V A \ �\ ENGINEER, WELL DRILLER, CONTRACTOR AND
REGISTERED LAND SURVEYOR by / PROPERTY OWNER AGREE THAT THEY HAVE
PRIOR TO ANY CONSTRUCTION. / \ READ THESE SPECIFICATIONS AND AGREE TO
ACCEPT THE TERMS AND CONDITIONS OUTLINED.
WATER MAINS. LOCATION PER./��� ` \
AWWU RECORD DRAWINGS \ APPROXIMATE LOCATION `
OF FRENCH DRAIN
APPROXIMATE
MATE
EXTENT OF
— COVER ,,r ;\ .. \\
DEER PARK DRIVES
S �
GEG 2022 -',_'\• : �0fk
.
`` TH#1 PROPOSED 20 FEET WIDE
`. F3sI;MEN� '<:. BY 75 FOOT LONG
DRAINFIELD. SEE DETAIL
�`� DRAWING FOR DESIGN
CRITERIA AND DETAIL
DRAWING, PAGE 3 OF 3.
APPROXIMATE LOCATION
OF WATERLINE. LOCATION
PER MOA RECORDS
APPROXIMATE LOCATION OF
S&S ENG. TEST HOLE (2004)
EXISTING 15 FEET WIDE BY 40 FOOT
LONG DIMNFIELD. NEW DRAINFIELD
>° DETAILDRAWING PAGE 3 OF 3E
` EXISTING 1500 -GALLON BIOCYCLE UNIT—
' EXISTING 2000 -GALLON STEEL STEP F
TANK. TANK TO BE EXPOSED TO LAT./—,
" WATER LINE AND INTEGRITY VERIFIED %
'° '
"`' APPROXIMATE w°r61'
sr1 LOCATION OF/
GEG TH#2 , ��Q'
FCD (2005)/ g
5 gEDR ZOOM / c,VQ CQi
HOUSE
r
OQO
0I
��
1171 '1_19
Ltd
' ENGINEERING , SALES , CONSULTING
=
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, ALASKA' PHONE (907) 337.5179 • WEBSITE: www.gemossengineenng.com
PREPARED FOR: C/O ARM SEPTIC SERVICES
PHONE NUMBER:
PAGE NUMBER:
TIMOTHY DABNEY & MARTA BUSCAGLIA
688-9433
2 OF 3
PROJECTILEGAL DESCRIPTION:
DRAWN BY:
THE TABLELANDS #2; BLOCK 9, LOT 10
J.L.M.
TYPE OF WORK:
DATE: REVISED
DESIGN DRAWING FOR DRAINFIELD UPGRADE
6/16/2022
w`®oaagg4VA
P��. .�'�L,�
Cf -7r3
0
LICENSE ®'P OEESS, ®4 •+
LICENSE
GROUP, Ltd
ENGINEERING, SALES CONSULTING .
3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. ALASKA • PHONE (907)337-6179*MBSrM.www.gamessengineeting.com
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: THE TABLELANDS#2; BLOCK 9, LOT 10
PERFORMED FOR: C/O ARM SEPTIC SERVICES DATE: 5/18/2022
DEPTH Y-6"ORGANICS
(feet) TEST HOLE #1
1
8
9
10
11
12
13
14
15
16
17
18
DEPTH TO
GROUNDWATER
1FILL
y
GM O. SM MIXED
'�
SOIL
CLASSIFICATIONS
5/20/2022
RG
GW
-
IIIIIIIII'ML
N
11111!11GM%//%CL
GCIINN
•
SWIIIIIIIIIMH
y i
%////,CH
����
111,0001
cllll��l
N ���on
CtsOH
8
9
10
11
12
13
14
15
16
17
18
DEPTH TO
GROUNDWATER
DATE
'SEEP @ 4.6'
5/18/2022
8'
5/20/2022
6'
5/23/2022
SITE
DATE READING NET TIME WATER LEVEL NET DROP
READING (INCHES) (INCHES)
ATTEMPTED MULTIPLE PERCOLATION TEST OVER SEVERAL DAYS IN
MULTIPLE BENCHES. BENCHES IN NATIVE MATERIAL WERE BEING
INFLUENCED BY SATURATED SOIL FROM SURCHARGED DRAINFIELD
AROUND PERIMETER OF BED PREVENTING CONFIRMATION
PERCOLATION TEST FROM BEING PERFORMED. SEE GEG 2005 TEST
HOLE #2 FOR PERCOLATION TEST PERFORMED ON NATIVE SOIL.
19 PERCOLATION RATE (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN FT. AND - FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: N/A
COMMENTS:-
PERFORMED
OMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FOR ED IN ACCORDANCE
WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: &/21//2Z
r----------------
---------------------------------------------------------------------------
I
" ® 4" MONITORING TUBE 1.25" SCH. 40 PVC WITH 3/16" HOLES SPACED
FOOT ON CENTER - HOLES FACED DOWNWARD
--INSTALL FLUSHING VALVE WITH COVER
I
I
I
1
i
I
I
I
I
I
INSTALL FLUSHING VALVE WITH COVER
I
I
I
1
I
I
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I �
`INSTALL FLUSHING VALVE WITH COVER
I
I
I
I
I
I
I
1
i
INSTALL FLUSHING VALVE WITH COVER
I 0 0 4" MONITORING TUBE
I
L-------------------------------------------------------
DESIGN CRITERIA:
NUMBER OF BEDROOMS: 5.0
GALLONS PER DAY (GPD): 750
PERCOLATION RATES: 120 MIN/INCH
PROPOSED APP. RATE: •0.5 GPD/SQ.FT.
MINIMUM DRAINFIELD SQ.FT.: 1,500
'USING CAT III APPLICATION RATE
DRAINFIELD DESIGN:
MAX. DEPTH: REMOVAL OF COMTAMINATED
MATERIAUSOIL & INTO NATIVE MATERIAL
WIDTH: 20 FEET
LENGTH: 75 FEET
M.O.A. TYPE IIA MATERIAL: 2 FEET
M.O.A. APPROVED SAND FILTER: 2.2 FEET
EFFECTIVE: 0.5 FEET
ACTUAL SQ.FT.: 1500
3:1 SLOPES (SEE NOTE)
3
1F/
TOP OF SAND/BOTTOM OF EXISTING DRAINFIELD
PER 2011 STEVE PANNONE, P.E. RECORD DRAWING
= 97.70. ON 7/15/2021, GEG CONSULTANT, JODY
MAUS, SHOT IN BOTTOM OF MONITORING TUBES TO
THE BM AND FOUND THEN TO BE AS FOLLOWS: MT1
= 98.03, MT2 = 96.77, MT3 = 97.72, AND MT 4 = 96.69.
LIQUID DEPTHS RANGED FROM 0.04 TO 1.37 FEET.
DRAINFIELD APPEARS TO BE UNLEVEL AND PER
OWNER & ARM SEPTIC SERVICES, THE DRAINFIELD
HAS DAYLIGHTED OUT THE MTS SEVERAL TIMES -
—1.25" SCH. 40 PVC WITH 3/16" HOLES SPACED
5 -FOOT ON CENTER - HOLES FACED DOWNWARD
—1.25" SCH. 40 PVC WITH 3/16" HOLES SPACED
5 -FOOT ON CENTER- HOLES FACED DOWNWARD
—1.25" SCH. 40 PVC WITH 3/16" HOLES SPACED
5 -FOOT ON CENTER - HOLES FACED DOWNWARD
-----------------
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------------------------------------------------------
70'LONG LATERALS
75' LONG
PLAN VIEW OF DRAINFIELD REBUILD
SCALE:
1"=5'
NOTE: THE ENTIRE MOUND AND ALL DISTURBED AREAS ARE
TO BE TOPSOILED AND THE AREA HYDRO—SEEDED
- INSTALL FLUSHING VALES AT END OF
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FEET OF COVER OVER TOP OF INSULATION (SEE NOTE)
OF INSULATION
TER FABRIC
------------------
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---- ---- ----- -.-- ---
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LONG (EXISTING
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--------------
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Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3
www. ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
Permit Number: SW111306 PID Number: 051-741-67
Name:
lan & Karla Dutton Wastewater System: [] New [] Upgrade
Address:
22605 Deer Park Drive, Chugiak 99567 ABSORPTION FIELD
Phone: Number of Bedrooms:
863-44§1 5 [] DeepT~nch [] ~.,o~,~no~ ~ ,~ ~ ~o.,~ ~ O,~.r:
LEGAL DESCRIPTION so~ Rating: Total Depth from original grade:
2 GPD/Ft2 +2 Ft,
Block: Lot: Subdivision: Depth to pipe boEom from original grade: Gravel depth beneath pipe:
g 10 The Tablelands No. 2 +2 Ft. 0.5 Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
2.5 .~. 40 Ft.
Well: ~ New ~ Upgrade G,aw width:
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Class A {E) ~. .~. 600 .~ 3034 PVC
Driller: Date Ddlled: Static Water Level: Installer: Date Installed:
.t. Flintstone Const 10/29/2011
Yield: I Pump Set at: Casing Height Above Ground:
GPMI Ft. Ft. TANK
SEPARATION DISTANCES D Septic D Holding D S.T.E.P. ~ Other: BioCycle
T~To Septic Absorption Lift Holding )ublic/Private Man~acturer: Capacity:
F~om~
Tank Field Station Tank Sewer Line BioCycle 1500 ~[.
Material: Number of Compa~ments:
w., 200+ 200+ 200+~ . 200+ Fiberglass 5
Su,~c~w~,e 100+ 100+ 100+ ~ / LIFT STATION
,o, Une 65 17 35~ S~z~: ~n~u,e,:
Gal.
,o.~,.~,o. 14 50 36 ",.m, on" level at: "Pump o~' level at: J High water alarm at:
in in.l in.
Cu~ain Drain 50+ 50+ 50+ Pump Make & Model Electri~l Inspe~ions pedormed by:
Remarks:
Reused existing 2000g S.T.E.P. Tank. Installed 3' of Engineered fill BENCH MARK
Location and Description:
under new drainfield. Door Jam
Assumed Elevation:
100.0 Ft.
Engineer's Stamp
Inspections pedormed by: PANNONE ENG. SVC, LLC Dates: 1'~ 10/2512011
2"~ 10/2612011
Development Se~ices Depa~ment Approval
Conditional Approval Date:
, .....
.....
Reviewed and approved by? ,.. ~ ~ ~,),,( ~ ? Date: /i/////
(~v o4~o6) ,
REMOVED ISF FIELDtE) & ALL ~ ~ ~ SEPTIC (E).-~
UNDERLYING ORGANICS.
INSTALLED 40LFxlWxO.SED (N)
INSTALLED SAND LINER 2'
~ ,NSTALLED ~oA ~, ;'%
I"CU -/
SEPT C (E) ~ SERVICE ~ ~ ~ ~ ~ - ~ ~ ~ TO FIRST COMPARTMENT
~c ~:~:~ ~ , / / ~¢ /
.1 s4.~ ~.o ~ / / oTM /
M2 64 5 79 1 /
/ / /
NOTES: p~o~ ~G ~C, L~
~ ¢ 0~. AL~'~,~ o/~1/~
,,~, ,~co~o ~.w.,o~.o. ,ox ~oo~z ,,c,o,,~, ,x ,~SlO ~ .... ~¢~, ~,~
,,o,~ (~oz) ~z~-~ ~,x (9cz) ~z~-~ ~'~ ~ '~*'~ ~"=~o'
lAN ~ KARLA DUTTON f¢~.~~q~PERMIT NO.
22605 DEER PARK DRIVE '- .'~
,,,?g... ...¢¢~ o~,~1;o~
PLAN CHUGIAK, AK 99567 '~s~ Sheet
,~~ 1 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BEINSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE NtUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATI'ACHED SPECIFICATIONS.
,3. SCOPE OF WORK: REMOVE EXIST'G ISF FIELD IN FAILURE, INSTALL NEW FIELD, INSTALL NEW MODEL 1500 BIOCYCLE.
REUSE EXISTING 2000 STEP TANK.
F2" R.,. 1 ~" D,A BRA,, P~PE W/
! r--3/16- ¢ HOLES O 24" O.C.
. / 0.5' FILL TOP SOIL
100.5 ~,~ m ~ 5H:lV [;LOPES
PICAL
~7~1~ - FILTER SAND (N)
-3 ML
-4 -- ~'~ ~ ~ MoA~PE II (N)
-11
.Gu gEOTION
~ / /~DRAIN ROCK ~" ABOVE PIPE
== / // ~NV
/ // ~ A" ~ DRArN PiPE
~z ~ / // / ~D~IN ROCK 0.5' BELOW
~ RECIRC LINE TO ~r
/
I
- - 2%00gSTEP ~ BED
TAUK (E) PROFILE
MODEL 1500
BIOCYCLE (N)
DESIGN PARAMETERS ABBREVIATIONS
UPGRADE SEPTIC SYSTEM OU OOPPER
NO. BEDROOM: 4 (600 gpd) DiP DUCTILE IRON PiPE
TANK SIZE: 20009 S.T.E.P.(E) INLINE TH TEST HOLE
BEFORE MODEL 1500 BIOCYCLE (P) FO FOUNDATION CLEAN OUT LEGEND
PERC RATE = 16-30 MPI T~ TANK CLEAN OUT NO.
SOIL RATING: 2 GPD/SF O~ CLEAN OUT NO. ~ W- WATER LINE/
AREA RQD: 300 SF M~ MONITOR TUBE NO. WELL RADIUS
SYS. ~PE: BED 0.5' E.D. IO'W
MIN LENGTH: 30 LF R.I. RIQID INSU~TION
USE: DCO DOUBLE CLEAN OUT SS ~ NEW SEPTIC
40 LF X 10' WIDE, 0.5' E.D., +1' TD DV DIVERTER VALVE
AREA: 400SF FS FLOW SPLICER
O.G. ORIGINAL GRADE
F.G. FINISH GRADE ~,~,
NOTES: .. o,t
RUSH' RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 ~"
PHONE (907) 272-8218 FAX (907)272-8211 ~.~
Scale
~lS
THE TABLELANDS ~2, BLK 9 LT 10
lAN ~ KARLA BUTTONr~'* ~'. CE 8149 ...~_ ~PERU'TNO'
22605 DEER PARK DRIVE~ ~Ji~n;'' .~ 0SP]]~306
DETAILS CHUGIAK, AK 99567 ~i~F~[~¢~~ Sheet
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System
OSPl11306
05174167000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: October 21, 2011 to October 20, 2012
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: THE TABLELANDS #2
Site Legal Address: THE TABLELANDS #2 BLK 9 LT 10 G:1559
Owner/Address: DUTTON lAN M & KARLA M
PO BOX 671007 CHUGIAK AK 995671007
Permit
Depa r tment
Site Mailing Address: 22605 DEER PARK DR, Chugiak
Lot Size in Sq Ft: 40181
Total Bedrooms: 5
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the .Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Date:
Date: [~)/~'~/
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
H Anchorage, Alaska 99519-6650
Rd5!, www. muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-741-67
Property owner(s) Karla & lan Dutton
Mailing address22605 Deer Park Drive, Chugiak Zip Code
Site address 22605 Deer Park Drive Zip Code
Legal description (Sub'd., Block & Lot) The Tablelands S/D No. 2 Block 9 Lot 10
Legal description (Township, Range & Section)
Lot Size 40,181 Sq. Ft. Number of Bedrooms ¢ ~--
Day phone 863-4461
99567
99567
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
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.
Pannone Engineering Services, LLC,..~.,~._.)~ (..~
(Signature of property owner or authorized agent)
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-maih steve@~)anenRak.com
October 19, 2011
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
The Tablelands No. 2 8lock 9, Lot 10
Septic System Permit Upgrade Request - RUSH!
Ladies and Gentlemen:
I am writing to request a permit to construcLan upgraded septic system be issued for this property. The
r ~
p oposed systems will serve an existing ~i~-~edroom house. Currently the lot is developed with an IDSF.
During a recent adequacy investigation discovered that the air pump was not working properly and the
system was in failure. The owner wishes to upgrade the system to a more modern system. I am proposing
to install a Biocycle after the existing 2,000 S.T.E.P. tank, which will be used as a recycle tank for the
biocycle. The existing drain field will be removed and a new drain field installed in the same location. The
biomatted material will be removed. The lot is served by AWWU Public Water. The surrounding lots are
served by AWWU Community water.
1. Soils. A single test hole was excavated by S&S Engineers in July of 2004, and the ground water
monitored in may of 2006 by Steve Eng. The soil logs are on file with your department. Bedrock was not
encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall
soils appearance; an application rate of 2 gallons/day/square feet should be used for a category II upgrade
field.
Soil Absorption System Design.
a. See Sheet 2 of the design package
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the
existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water
and drainage ditches.
4. Topography: The topography in the area generally slopes to the north at 1 to 2%.
M 'i i'~ ~'~ P,O~ BOX ~nrls1~ cB
Physk::~l: 6~..~ E~st 82nd Ave, Cuite
Telephone: (907) 272-8218 FAX: (907} 272-8211
Page 2 of 2
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no wells or septic systems within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
......
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments
Maiti,%: P.O~ Box 100217, Anchorage, AK 995!0-0217
Physical. 6S. 5 East Ave~ Suite B6~ Anchorage, Al< 99503
Tetephoase: (907) 272~82&8 FAX; {907) 272-82ZZ
SEPTIC
(E)~--~
i BIOMAT MATERIAL. INSTALL
~ 40LFxlOWxO.5ED FIELD (f)
-.0_~ ,NSTALL SAND L,,ER ~' M,N--
/ ~U ~' ~ _ , ' % / ~ ~ TO FIRST COMPARTMENT
SEPTIC (E) ~ SERVICE ~ ~
RUSH~ FOR CONSTRUCTION P.O. BOX 100217 ~NCHO~E, ~K 995~0 .. lO/2~/~
~,..'~
THE TABLELANDS ~2, BLK 9 LT 10 ........ 051-741-67
lAN ~ KA~LA DUTTON ~ ~teve~ER~,N~n°~e~ PERMIT NO.
22605 DEER PARK DRIVEf~. u o,~ .~,i~.. .~ OSPll~
PLAN CHUGIAK, AK 99567 ~?~ ....... ,~ Sheet
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BEINSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
.3. SCOPE OF WORK: REMOVE EXIST'G ISF FIELD IN FAILURE, INSTALL NEW FIELD, INSTALL NEW MODEL 1500 BIOCYOLE.
REUSE EXISTING 2000 STEP TANK.
F2" R.I. 1 ~' DIA DRAIN PIPE
/ ~-HOLES o 24" c.c.
/ / 0.5' FILL TOP SOIL
~ ~ 1~ 3H:IV SLOPES
' ~k
B0~ SECTION
~2" ~.~.
~ / /~D~IN ROCK 6" ABOVE PIPE
~ / // ~NV
~ / // ~1 ~" ¢ D~IN PIPE
~ ~ ~ ~-~. //// ~-, .o~Es ~,- 0.~.
~o o o o~ / // / ~D~IN ROCK 0,5' BELOW
~ z ~ ~ ~ ///// ,,,,,,v
~ ~ m REClRC LINETO ~ ~ ~ ~
~ ~ - ~,,,~o.,.,~'~ ~ I ///// ~'.~
- ~oo~- -~ ~~ '~ ..... ...... .~
TANK (E) PROFILE
MODEL 1500
BIOCYCLE (P)
DESIGN PARAMETERS ABBREVIATIONS
UPGRADE SEPTIC SYST~ CU COPPER
NO. BEDROOM~I (~ ~d~ DIP DUCTILE IRON PIPE
TANK SIZE: 2000g S.T.E.P.(E) INLINE TH TEST HOLE
BEFORE MODEL 1500 BIOCYCLE (P) FC FOUNDATION CLEAN OUT LEGEND
PERC RATE = 16-50 MPI T~ TANK CLEAN OUT NO.
SOIL RATING: 2 GPD/SF , C~ CLEAN OUT NO. --W--- WATER LINE/
AR~ RQD: ~SF~~' M~ MONITOR TUBE NO. WELL RADIUS
SYS. ~PE: BED 0.5' E.D. IO'W R.I. ~IGID INSU~TION
MIN LENGTH: ~0 LF -- SS -- NEW SEPTIC
USE: DCO DOUBLE CLaN OUT
40 LF X 10' WIDE. 0.5' E.D., +1' TD DV DIVERTER VALVE
AREA: ~OOSF F$ FLOW $PLI~ER
O.G. ORIGINAL GRADE
F.G. FINISH GRADE
NOTES: P~O~ ~O ~C, ~ ~ __, ?~ Date
RUSH~ FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ~.-'
PHONE (907) 272-8218 FAX (907) 272-8211 .~ NTS
P.I.D.
NO
lAN ~ KARLA DUTTON ~~E~:~-~E~8~'~ o5~-74~-67
22605 DEER PARK DRIVE ?~2.~ CE 8~49...;~ PERMIT NO.
~i,uZ~%·· ..'~ 0SPl1¢~¢¢
DETAILS CHUGIAK, AK 99567 .~.;,4¢~- .... A~ Sheet
, ~~ 3 o F 3
"'~,~*. $'[EVEN R. PANIqONE .",~'
CE - 8149 ' '
Pannone Engineering Service, LLC
P.O. Box 102954
Anchorage Al( 99510
Phone 907-272-8218 · FAX 907-272-8211
JOB TITLE
SUBJECT
1,5"{
Pannone Engineering Service, LLC
RO. Box 102954
Anchorage AK 99510
Phone 907-272-8218 · FAX 907-272-8211
BIOCYCLE INSTALLATION
NTS
ACCES~ ~
EXPOSE
TOP
60 L/MIN ~ J l
ABOVE GRADE
2" INSULATION - ~ BACKFILL AROUND TANK
VE~~ 1~1~ .TH FREE FLOWING1 '2", PVC
0 - " ~ PIPING "~" NFS
4" JO J4 DISCHARGE
SLOPE ~ ,
~ ~ ~ ~ / DIFFUSER
SEPARA ~ON -I' ~K ~T~ME~~ I ~ 4 SHEETS OF
~ 2~8' BLUEBOARD
INSULA ~ON
BIOCYCLE TREATMENT LEGEND ~ 4" SAND/GRAiL
LEVELING COURSE
~ PRIMARY AERA ~ON
~ SECONDARY AERA ~ON
~ CLARIFICATION
~ DISCHARGE
No S:coNs uc o
RUSH~
FOR
...... L ~ ~o/2~/1~
P.O. BOX 100217 ANCHORAGE, AK 99510
P"O~E (~07) 272-~218 F~X (~07) 272-8211 ~.--
BIOCYCLE DETAIL CHUCIAK, AK 99567 '~l~*~L ...... ,:,~ Sheet
Proposed Sa
& U,i;er Si'
r
S&S TF
Proposed PO00
Gatton S,T,E,P, Ta
.mprove
/ /
F,C.D. 69.7 1
S.T. CD1 69.5
STEP C 02 J 24
STEP Riser
FV1 22.5
96.4
FV2 66,7 97
FV3 69.4 98.4
FV4 71,8 99.1
NORTHRIM "~""~'"'""~ THE TAB
907. 694. 7028
2 LDT ~' = 40'
iAS-BUILT
REVISED
CAT III ISF ~
,.+ ~ 0
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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 PERMIT
Initial
Date Issued: May23, 2006
Expiration Date: May 23, 2007
Permit Number: SW060113
Legal Description: The Tablelands i~2 Block 9 Lot 10
Design Engineer: 0838 NORTH RIM ENGINEERING
Owner Name: Mike Thomas
Owner Address: 22605 Deerpark Dr
Anchorage, A 99567-
Parcel ID: 051-741-67
Site Address: 22605 Deerpark Dr
Lot Size: 40181 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] DisposalField [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. A~I 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.
-THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST
BE VEGETATED SUFFICIENTLY TO PREVENT EROSION.
-THE INTERMITTENT DOSING SAND FILTER NEEDS TO MEET ADVANCED WASTEWATER TREATMENT
SYSTEM SPECIFICATIONS APPROVED BY ONSlTE WATER & WASTEWATER PROGRAM.
Received By;,
Issued By:.
Date:
Date:
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
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property owner(s)
Mailing address
Site address
Legal description (Sub'd, Block & Lot) '~"'-.~. ~ ~'/~/~b//~
Day phone .~Z//L ~--~ ~'~'~-~'_
Zip Code ~ 9SCZ
Zip Code ~' ? -~'~ 7
;=f:~_.. /~Zoc/c- I' /_oT'to
Legal description (Township, Section & Range)
Lot Size /' ~ 2_% 7~-~/' Sq. Ft.
Number of Bedrooms
THIS APPLICATION IS FOR ([;~all that apply):
Absorption Field f'~
Septic Tank '~
Holding Tank ~]
Pdvy
Private Well E~]
Water Storage
THIS APPLICATION IS AN:
Initial ~]
Upgrade
Renewal ~
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 o[:~orized agent)
Permit/Rush Fees: ~ ~. O0
Date of payment:
Receipt Number: ~1 ~
(Rev, 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
, .THRIM
E~I~NEERING
MEMO
Steve Eng, PE, PH
17237 Bear Paw Circle, Eagle River AK 99577
(907) 694-7028 tel
(907) 694-7026 fax
NorthRimEng@aol.corn
Date: 5/16/06
Number of Pages: fi'
To: Joe Goodall
MOA On-Site Services
Subject: The Tablelands # 2 S/D, Block 9, Lot I0
Permit Renewal
This follows our telephone conversation this morning. We requested a permit renewal for the
subject property with a design revision. A wetlands permit is not required for the proposed site.
We have altered the design slightly by moving to a Category III system. We are doubling the
required filter size by using a 2 GPD/FT~ design rate instead of the required 4 GPD/FT~. We
monitored the existing MT's, with water @ 3 feet below grade on May 15, 2006. The Pea Gravel
Design Elevation will be moved to 4 feet above this high water monitor. A 2 foot sand liner will
be based at a grade of I foot depth. We will attempt to hardwire the air supply blower into the
alarm system. We will consult Anchorage Tank and the electrical contractor on this point.
Revised design included.
Please issue the permit renewal.
Thanks-Steve
REVISION/RENEWAL Tablelands # 2,Block 9, Lot 10
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is a permit renewal request for a 5-bedroom, single
family home. The design has been revised to a CAT I!I 1SF. Most ofthe neighboring
lots are under development. Groundwater was monitored at 3' on 5/15/06. We are
proposing a 4' separation to pea gravel. This lot is over I acre in size and no adverse
impacts are expected from development. The neighboring lots are similar. A Bottomless
lntermittant Sand Filter (ISF) will be utilized. This will require a S.T.E.P, manufactured
by Anchorage Tank & Welding per Orenco Systems specifications. The easements are
located on the drawing and are not encroached upon. Soil tests revealed silty sand. The
original peat layer has been stripped off. The application rate for an ISF: RATE = 2
GPD/FT2. Required Area -- 750 GPD/2 GPD/FT: = 375 FT~. An ISF with dimensions
10'x 38' will be constructed.
Specification Requirements: All components and work must comply with the Municipality
of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and
Wastewater Regulations.
· Two compartment, 2000 gallon S.T.E.P. tank, conforming to Anchorage Tank &
Welding/Orenco Systems Specifications.
· Watertight couplings on inlet & outlet
· 5' minimum between the tank and ISF. I 0' minimum to property lines.
· 2' ofcover is required for ISF + i inch insulation board.
· Tank & solid pipe must be set on well compacted, stable soil.
· 4 inch diameter cleanouts with airtight caps are required I to 4 feet from foundation wall,
prior to any 90 degree bend in 4 inch line.
· All cleanouts must extend to at least ground level
· ISF to be placed level, minimum of 4' to groundwater, 6' to bedrock
· Allowable application rote for ISF: 2 GPD/FTa
· Air Supply: "Anchorage Tank" Thomas Industries, Model 5070 or equal.
· Air Supply Line: "Anchorage Tank" "Wasteflow" emitter line, ½ inch I.D. HDPE
· Sand Material: In accordance with MOA latest Sand Filter Spec.
· Pea Gravel: 100% passing 3/8 inch sieve, less than 20% passing the ¼ inch sieve, & less than
I% passing the #8 sieve.
· }leader pipe shall be 1.25" Schedule 40 PVC. Lateral pressure lines shall be 0.75"Schedule
40 PVC w/I/8" orifices ~ 27" on center, w/Splash Caps & Flushing Valve Caps per
"Anchorage Tank" specifications.
· Force main shall be 1.25" Schedule 40 PVC, conforming to Anchorage Tank &
Welding/Orenco Systems specifications. Force main burial to be 4' minimum or insulated.
· Silt barrier (filter fabric) to be installed above the pea gravel.
· Smeared trench sides must be raked or scarified before ISF construction.
· Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS
ASTM D266 I, PVC Schedule 40.
· Sewer Service Line is minimum 2% slope
· S.T.E.P. Tank to be pumped every two years or when required
· Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam HI or equal)
Proposed
&--
S&S LO
~0
Proposed E~000
(~a~on S,T.E,P. ~k
Hone
;lOF~
mF ;s,
/
DESIGN
1. Excavate to )th to/l~lace
Bottom of Pea Ivel Elevation
2. Sewer Service
5. Lots Served by
4. Air Compressor is Inc
5. Air Line is 1/2"
6. S.T.E.P. Tank to Meet
7. Upper 6 Inches of Mourn
/ /
tee Ap, Froved Sa/Liner.
e at 1' dbove exi¢ing grade.
)e.
/
em. /
stries Model 5070 ("Anchorage Tank").
Within Insulated Sch. 40 PVC Pipe.
arian Requirements Per "Anchorage Tank".
Consist of Top-Soil & Be Vegetated.
...... !"THE TA]3LELANDS
ENGINEERING " ': ' ]3LBCK 9, LBT 10
907.694.7028 ~%" ....... z I REV[~ED CAT
t LBT ~' = 40'
LAYFIUT
Municipality of Anchorage
Development Services Department
Building Safety Division
O~-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 ~e. AK 99519-6650
(9o?) 343..?eo4
Soils Log - Percolation Test
Perfon'ned Foc MIKE THOMAS
t.egal Desc~pti~: THE TABLELANDS #2 BL9 LT 10
2-
3-
4-
5-
5-
7-
8-
9-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
WAS CRC)UND WATER
ENCCXJN'TERED? YES
$
tF YES. AT WHAT DEPTH?
O
Reading Date Gross'13me Net T~ne Dep~ to Water Net Drop
PERCOLATION RATE (m,n~l~'~) PERC HOLE O La, METER
TEST RUN BETWEEN FT AND FT
PERFORMED BY: STEVE ENG I STEVE ENG CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5/15/06
MUNICIPALITY OF ANCHORAGE
Development Services Deparfmenf
On-Site Water & Wastewafer Program
4700 South Bragaw Street
P.O. Box 196650. Anchorage, AK 99519-6650
(gO7) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 07, 2005
Expiration Date: Apr 07, 2006
Permit Number: SW050069
Legal Description: THE TABLELANDS SUBDIVISION TRACT H
Design Engineer: 0855 Garness Engineering Group, LTD
Owner Name: THE THOMAS COMPANY
Owner Address: NHN DEER PARK DRIVE
PETERS CREEK, AK 99567-
Parcel ID: 051-741-59
Site Address: NHN OBERG ROAD
Lot Size: 132741 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of'
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
A~I construction must be in accordance with:
1. The attached approved design.
2. mi 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 dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
a.) This on-site wastewater disposal permit is for The Tablelands Subdivision Addition #2, Block 9, Lot 10 (final
recorded plat 2005-13).
Received By;.
Issued By:.
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
ON-SITE SEWER/WELL PERHIT APPLICATION
FOR ,A, SINGLE FAHILY DWELLING
05-/- ?el I- ~
Permit Number
Property owner(s)
Mailing address (1)
Mailing address (2)
THE THOMAS COMPANY
HC05 BOX 6929 * PALMER. AK
Day phone
Zip Code
Legal description (Lot, Block& Sub'd.) LOT 10. BLOCK 9: THE TABLELANDS S/D ~2
Legal description (Section, Township & Range)
LotS e Oq!
Number of Bedrooms
441-2664
,H
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
Well Only
Water Storage
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Jacuzzi
Water Softening Unit
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:
Date of Payment:
Receipt Number.
Waiver Fees;
Date of Payment:
Receipt Number:
CONSULTANTS & GENERAL CONTRACTORS ...................
Apfill, 2005
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
Ref: Proposed Septic System for The Tablelands Subdivision//2; Lot 10, Block 9,
The proposed 5 bedroom house will be served by a public water system and private septic system.
Several test holes were excavated on the property. Due to the high groundwater, the lot configuration,
and the poor soils conditions in the area, we are proposing that a MOA approved recirculating trickle
filter system be installed. We are proposing that a 2500 gallon S.T.E.P. tank, a municipal approved
recirculating trickling filter unit (sized for 5 bedrooms), and a bed type drainfield be installed. We are
proposing that the drainfield be installed within the 30 foot radii of out test hole /t2 and S & S
Engineering's Ttl#7. 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 ofthe proposed septic system.
4. TOPOGRAPIIY: The area around the proposed drainfield is relatively fiat. In short, there are no
slope concerns.
We are unawa/¢ of any adverse impacts this installation would have on adjacent wells or septic systems.
u have ~i~ questions, please contact us at 337-6179. Thank you for your assistance.
~I ~awtng, a destgn drawmg, a detatl drmvtng, and three $od logs, whtch are all part
of the de. gn pac 'kage for this septic system. (Contact G. E.G. £td. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.eom
k "-.,. THE TABLEt~DS S/D I I . · ~ t \ /'
~ ~ ~ ~ ~O~S[~S~C~ p ~ X~ X . / //
. ~ ~Z'~ h ~ -' ~ (see DEIGN PAGE 2 ~
~ ~~ _-~-'- ........ ~-j .~% X~. / //
x ~~~-.
~ ~~ ~// /
x ~~ ~/~
,o,,.,,~,, ~.; /I ./- ~ '
' il
/
NOTE: ~L PROPERTIES ~ ~/ /,//
SHOWN ~E SE~D BY ~/ /
Pu~uc WXT[R ~D I / 7 ,'
,m..- r
GAaNEsS E~'iN~]~G ~OUP, Ltd,
THE THOMAS COMPANY I (907) 746-0682 I ~ O~ ~ V~'.~T~.u;.~.."~/
SITE P~N FOR PROPOSED SEPTIC SYSTEMS 4/1/200S
(Rev. 01,~)
{UM~D TO ~E REM~ OF ORate) / ~
THE THOMAS COMPANY (907) 746-0682 I
DESIGN FOR PROPOSED SEPTIC SYSTE~
CO
CO~r
CO.
FROM M.O.A. APPROVED
RECIRCULATING TRtCKI.[
RLTER SYSTEM
75 FEEl'.
NOTE: FINAL GRADING TO INCLUDE
6 i~CH['~ OF TOPSOIL AND SEEDING
(PERFERABLLY HYOROSEFDING).
1.$-2.0 FE~ DEEP
20'
GAI1NESS ~q-GINEEIIING GI1OUP, :Ltd.
~ CONSULTANTS & OENEUL CONTR~,CTOR$
PREPA,~ED FOR: PHONE NUMBER: PAGE NUMBER:
THE THOMAS COMPANY [ (907) 441-2664 3 OF 3
,~ oE~cR,,.~o.: I°'~"~ ~:" -M.~
TIlE TABLELANDS S/D ~2; LOT 10. BLOCK 9.
I '__.___
TYPE OF WORK:
DETAIL OF PROPOSED DRAINPIELD
-I
ISOIL LOG - PERCO~TION TESTI ~'"/"~;:"t ........
LEG~ DES · ~1.~/~.
,,.t) l~ ITEST HOLE ~1 I
~ GP ML
GM CL
GC OL ~s
~lUltlt~ to SU/ML GROUNDWATER
,.,. ,/=/,oo, k / il ./ I,
4.0' 3/25/2005 / / ~ , .
10
11 DATE READING CLOCK NET TINE ~ATER LEVEL NET DROP
TIME (H1NUTES) READING (INCHES)
12 3/18/2005 1 1:30
2 2:00 30 5 3/4' ~/4'
13 3 2:00 - 6"
4 2:30 30 5 3/4" 1/4"
14 5 2:30 --
e 3:00 30 5 314' ~/4'
15
16
17
18
PERCOLATION RATE 120 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 2.5 FT. AND 3.0 FT.
2 A FOUR HOUR PRESOAK WAS PERFORHED: ~ YES ~ NO
SOILS LOGGED BY: JOOY UAUS PERCOLATION TEST PERFORNED BY: ~LEB ~LL
CONHENTS~
PERFORMED BY GEG, Ltd. I, JEFFR~ A. G~NESS. CERTI~ T~T THIS WAS~P~FORMED IN ACCORD~CE
WITH ALL ~ATE ~D MUNIClP~ GUIDELINES IN EFFECT ON THIS DATE:
' S E~;iNEERING GROUP, Ltdl /~.~."~r~'":"..~7~0l
~, CONSULTANTS & GENE~L CO ........... . ......
JSOIL LOG - PERCO~TION TESII
RI~ION' T~LE~DS SUBDMSlON J2; LOT 10, BLOCK 9, ~'~-~[-~
L[~ ~[SC · ~.~ ~f.~.
PERFORMED FOR' ~E lHO~ CO~P~ DA~E:~~
[TEST HOLE ~2~
~OIL C~SSIFICATIONS
CM/SM
to SM/ML
w/CL LENSES
GW
GP
GM
GC
SW
SP
SM
SC
ORG
ML
CL
OL
MH
CH
OH
DEPTH TO DATE
iROUNDWATER
DRY /17/2005
4.5' /22/2005
4.0' 3/25/2005
4.0' 4/1/2005
DATE READING CLOCK NET TIME LEVEL DROP
TIME (MINUTES) READING (INCHES)
1 1:35 - 6' -
2 2:05 30 5 3/4'
3 2:05 6' -
4 2:.35 50
5 2:35 - 6" -
6 3:05 30 5
SOILS LOGGED BY:
COMMENTS:
PERCOLATION RATE 120 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 2.5 FT. AND 3.0 FT.
A FOUR HOUR PRESOAK WAS PERFORMED: M YES r-INO
JODY MAUS PERCOLATION TEST PERFORMED BY: CALEB GALL
PERFORMED BY GE(;, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
IN ACCORDANCE
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
Soils Log - Percolation Test
t%
Performed For: G
�S e
Gross Time
Date. Performed: ! ^
Legal Description: rG�G
Qtj,
r7S 4j)
Township, Range, Section:
Slope
Site Plan
Depth
(Feet)
5-
6-
7-
8-
9-
10F
11=
12-
13-
14-
15-
16-
17-
18-
19-
20 -
COMMENTS
0r"'ctis�rcS
Mz_w;th!
Sp'"<f 6cirt(,1
- ;5l?fei- /"Iz-
W ;16 5-" 11 g rq,;el
WAS GROUND WATER
ENCOUNTERED? %
s
IF YES, AT WHAT DEPTH? L
0
&/'11, Depth to Water After �' / P
V H Monitoring? ,�,1(J E
Date: � 6-0L/
W
If
F1
li
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
7-30-CY
D
O
`f"
5
ID
-3O
_ 'gz
1 VF
PERCOLATION RATE d,,) (minuteunch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN J,5 Fr AND 3. S' FT
PERFORMED BY: S & S ENGINEERING ,
TTHH No -
PERFORMED
—
PERFORMED IN AC Quiver lalat'h AND MUNICIPAL
—CERTIFY THAT THIS TEST WAS
IN EFFECT ON THIS DATE. DATE: $ 6 /0
Parcel I.D.- -~' ~1
1. GENERAL INFORMATION
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastawater 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
- ~q I - ! ~ COSA ~_ ~, ,oq ~'~
Expiration Date: _
'Complete legal description/~/~/, ~/~' ,~/"',-~¢~_./~'-/--4~'/~ "4:f~___. ZS'/.~,.//__ c~
Loca'tion is'~te address) '?Z ,~-5- /~ ~'~--~?-*Zk. ~./V'~
Curren~ Property owner(s) Day phone.
Mailing address
Lending agency
Mailing address
Dayphone
Real Estate Agent
Mailing Address
Day phone
U~essot~i~ mq~st~,COSAv~ll~ ~M~DSDforpick~.
2. NUMBER OF BEDROOMS: .,~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class _
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding Tank ~
Community On-site
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certifr..ates of On-Site Systems
Approval (CO,SA) 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. Certifmates of On-Site Syslems ApProval
are valid for 90 days from the date of issue for Properties served by a Private or Class C wall 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.) Carlifmates are valid for one year for Properties served by Class A or B vmlls or a public water system.
The Municipality o( Anchorage is not responsible for errors or omissions in the professlonal 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 wastawater d~sposal 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 alt applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Phone ~
DSD SIGNATURE
Approved for . bedrooms.
Disapproved.
Conditional approval for
Date ~/d/~O 6"'
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:.
Original Certificate Date:
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
Parcel I.D.
COSA#
Expiration Date: ~ - ,~_ /~ - CO 7
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
4o7'/o
Day phone /-./~ / - ~- ~'~' '*'~
/
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ,~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ,~,
Individual Holding Tank []
[]
Community On-site
Public Sewer []
I
TI~ -Municipality-of 4~nchorage -Development ~Services -Department {DSD) issues -Certif'mates -of -On-Site-Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certif'~-.ates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional 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 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 cedes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ./~ ~"/~ ~'f ~-t ~'~ ~.
Address / 7c),~ .~J~-~,,.- ~ ~[~
Engineer's Printed Name ~/~ ~ ~
5. DSD SIGNATURE
Approved for ~'-
Disapproved.
Conditional approval for
Phone
bedrooms.
~ bedrooms, with the following stipulations:
At the time o£ "it].e trans£er, the r~ew l)roperl:~/' ou'aer shall silva the
attached maintenance aRreement which shall be returned to thiz office
Attachments:
COSA Checklist
Septic-System Advisory
Well Flow Advisory
Nitrate Advisory
By:.
X
A
rsenic Advisory
MaintenanceAgreements %~-~/~/~'~ ..... · '-_~,~'--~
SupplementalEngineer's Report ~~3 .
Other
Original Certificate Date: ~ -- '~' ~ - c/') (~
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/onstte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
COSA#
Expiration Date:
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
/_o7'/o
Day phone
!
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: S
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding Tank []
Community On-site
Public Sewer []
'i'he -Municipality-of-Anchorage -Development -Services -Department{DSD) -issues -Certirmates -of -O n-Sita -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 On-Sita Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C wall 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.
'l'he 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 b~low, 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(aro) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Engineer's Printed Name .~ ,'~._,~C./_~' --K:"..AJ ~'
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for 'i bedrooms, with the following stipulations:
At the time of title transfer, the new property o~ner shall si~n the
attached maintenance aAreement which shall be returned to this office
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance-Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 19O650
Anchorage, AK 99519-8650
www.muni.org/onsite
(9O7) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description.7"'~.. _/~"-
A. WELL DATA
Well type /
Date complete//
Total depth/ ft.
Date of test
Parcel ID:
If A, B, or C provide PWSID #
Sanitary seal (Y/N)7~
Cased to ~'
FROM WELL LOG ~'
/
Static water level
/
Well production /
WATER SAMPLE RESUL~,,~
Coliform colo~ 100 mL
Arsenic: ml~'~
Well Log (Y/Ngro~d~)
Wires properly protected (Y/N
Casing height (above
AT INSPECTION
In.
Water added gal. New depth in.
Date of adequacy test
Fluid depth in absorption field before test in.
Elapsed Time: min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (YiN & type)
In. Absorption rate >=. g.p.d.
If yes, give date
B. SEPTIC/HOLDING TANK DATA
Tan, Type/Material .~ .'T'~. ?
Tank size2Oa O ~[. ~m~r of Com~nmonts
F~a~on ~ean~t '(WN)
Date of pumpi~ ~ Pum~r.
c.
Date instell~ ~//~/0
Len~h ' ~ O,
Total depth ~ fl~
/
~ Results (Pas~Fail)
For
ft. / ft.
g.p.m. / g.p.m.
Nitrate mg/L ~r bacteria ~ mL
Date of sample: C, Collected b~
D. LIFT STATION
Date installed ~
'Pump on' level at/..,// in.
E. SEPARATION DISTANCES
Size in gallons 24:~ GO
"Pump o~ level at .,.~.in.
Cycles tested '~
Manhole/Access (Y/N) 7
High water alarm level at z.~ ~ in.
Meets alarm & circuit requicements? ~
SEPARATION DISTANCES FROM WELL ON LOT TO: /00~/. (C.... ~.,~',,~
Septic tan~ift station on lot On adjacent lots ' ~/
Absorption field on lot / On adjacent lots /
Public sewer main / Public sewer manhole/clea~.
Sewer/septic servi~lfne Holding tank /
;n;~/~I2'i';t(~i~TST;;;;S FROM SEPTIC/HOLDING T;;;uorNe/;n~a;(~;cr~' storage areas
Building foundation
Water main ~/~
Wells on adjacent lots
Propertyline /'el "~-
Water service line //¢~ '~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /43 ~'~'
Water Service line /
Curtain drain ~'
Absorption field ..~ t3 r.~.
Surface water //O ~, ~
Building foundation -~(~ *'-t/" Water main /'0 ~
Surface water /~3 (3 'J" D~ivewey, parking/vehicla storage
Wells on adjacent lots ~- OJG Ij,.
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.
COS Fe $ I1- Waiver
Date of Payment
Receipt Number
(Rev. 11/05)
Date of Paymenl
Receipt Number
