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HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 15 LT 1North Woods
Unit 4
Block 15
Lot 1
#051-064-12
Municipality of Anchorage
On -Site Water and Wastewater Section o (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201265
PID Number: 051-064-12
Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
Robert Wilkins
ABSORPTION FIELD
❑ D Trench El Wide Trench El Bed El Mound
Site Address
21910 Sheltering Spruce Chugiak
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
P D/S F
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from origin rade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Northwoods Unit 4 15 1
Fill added above original grade
Ft.
ravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number
of Lines
istance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of
trenches
Dist. be en trenches
From
Tank
Field
Tank
Line
Ftz
Ft.
Well
p
V A
t
1v A
IV A
NA
!
TANK ❑® Septic ❑ S.T.E.P. [IHolding ElOther
Manufacturer
Greer
Capacity
1000 Gal.
i
Surface Water
> 100
NA
NA
I NA
Material
plastic
Number of compartments
2
Lot Line
>10'
RIA
NA
NA �
NA
Foundation
4'
NA
NA
NA
LI STATION
Manufacture
Capacity
Gal.
Remarks 2" INSULATION OVER TANK
Alarm location
Elert4GaLinstalled by
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer
ARM Services
Drainfield
CO/MT D3034
Inspector Curtis Townsend
BENCH MARK (Assumed elevation) 100 ft
Inspection15 9/17/2020 9/18/20
Location and description
es: 2 n
bottom of siding
3d 10/26/26 411
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Enginer(n�p
0 A( �
Conditional Approval:
Date
-
o-C-'�
. 4 �-�
'..• Si.'r . ......
b�rtiaA-Date
�1ii . No. CE 11904 . •ti
Septicstem���b�t
Approved
Date U 32.00
Note: this approval does not include well permit requirements.
(Kev Ub/U2/1 b)
111 Cll(
l unicipaUty ®f Anchorage
u°parn»°nt
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 o Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV201076 COSA#: Permit#:OSP201265
PID#: 051-064-12
Legal Description: North Woods Unit 4 Block 15 Lot 1
Engineer: Eklutna Engineering
Applicant: Robert Wilkins
Your request for a waiver of the required 5.0 feet horizontal separation from the septic tank to
the absorption field has been approved. The approved separation distance is 3.5 feet. See
engineer's justifications on profile record drawing.
This waiver approval applies to the existing septic tank and absorption field only. Any future
upgrade to the on-site wastewater disposal system will require all separation distances be met or
another approval from this department.
...............................ww.....................................w..w......
Waiver is Granted: X Waiver is not Granted:
f ku"Date: ! 1 oZD D Approved by: 09-JUX
Name of Reviewer
■ w w w w w w w w w w■ ............ ■■ ............................... ■ w w w w w w w w w w w w■■■■ w w w w 1
**** VARIAN C E/WAIVER REVIEW ****
THERE ARE NO STEEP SLOPES
TANKN 50' OF THE PROPOSED SHELTERING SPRUCE LOOP
THIS LOT AND ALL NEIGHBORING
LOTS ARE SERVED BY A PUBLIC
WATER SYSTEM AND THERE ARE NO
WELLS WITHIN 200' OF THE SYS EM.
NEW DECK SUPPORTS ARE 5' AWAY
FROM SEPTIC TANK
NEIGHBORING SEPTIC
IS > 10' FROM
PROPERTY LINE
2" PRESSURIZED LINE
DELIVERS WASTEWATER
TO THE SEPTIC TANK.
Lot 5 1
NEIGHBORING SEPTIC I
IS > 10' FROM
PROPERTY LINE
N
O
J
15'1 TELEPHONE XND ELECTRIC EASEMENT
3 BR
HOME
1000 GAL SEPTIC TANK —
B M T1
X
CORNER OF BED LOCATED
CLEAN OUT AND MONITOR
TUBE PROVIDED X
I
A
B M� X X
DCO
SS
SS I
SS f�T2 I
SS II
7% SLOPE
EXISTING 43' x 21' x 6'L-11
EFFECTIVE DEPTH BED WATER LINE '
L—x--x--x--
WATER KEY
Lot 6 NEIGHBORING SEPTIC
IS > 10' FROM
PROPERTY LINE
Septic Record Drawing Prepared for
LLJ
U
-W-
I �
SCOPE OF WORK
1. EXISTING SEPTIC TANK REMOVED.
2. PLACED NEW 1,000 GALLON SEPTIC TANK
AND TIED INTO EXISTING ABSORPTION
SYSTEM. THE TANK WAS PROVIDED WITH A
MINIMUM 20" 0 MANWAY RISER SERVING
THE FIRST COMPARTMENT.
3. ALL CONSTRUCTION WAS IN ACCORDANCE
WITH ALL REQUIREMENTS SPECIFIED IN
ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65.
ROBERT WILKINS
21910 Sheltering Spruce Loop Chugiak, Alaska 99567
NORTHWOODS UNIT 4 BLOCK 15 LOT 1
OSP201265
EKLUTNA ENGINEERING, LLC
19162 MOUNTAIN ROAD
CHUGIAK, ALASKA 99567
(907) 406-1058
DATE:
DRAWN:
12/21/2020
CLT
SCALE: 1" = 30'
PID: 051-064-12 SHEET 2 OF 3
DF
14
•T4H
.............,.�.s....�.�..�.i
...�.
0 : C TIS TOWNSEND
���i % No. CE 1 1 04
S �
2i
E
fifilt � ► �: �7��:7��1
FG 101 .5
TOP OF TANK 98.8
1,000 G
PLASTIC TANK
2" INSUL OVER TANK
THE NEW TANK IS 4' AWAY FROM THE HOUSE FOUNDATION. THE
HOUSE FOUNDATION IN THIS AREA IS AT LEAST 4' DEEP. THE
FOUNDATION SOIL PRISM IS SHOWN TO EXTEND BELOW THE
BOTTOM OF THE PROPOSED TANK.
2" INSULATION WAS PROVIDED OVER TOP OF NEW TANK PLUS
2.7' OF COVER.
NEW TANK IS APPROXIMATELY 3.5' AWAY FROM EDGE OF
EXISTING FIELD. THE EDGE OF THE EXISTING FIELD WAS NOT
DISTURBED DURING INSTALLATION OF THE NEW TANK. THE SEPTIC
ROCK REMAINED INTACT.
MARK
A
B
SV1
23'-10"
28'-10"
SV2
24'-10"
28'-7"
MT1
41'-4"
12'-5"
MT2
38'-6"
55'-2"
MT3
2J'-11"
52'-8"
Septic Record Drawing Prepared for ,
ROBERT WILKINS .••�� OF ��
21910 Sheltering Spruce Loop Chugiak, Alaska 99567CD,/ •''��
NORTHWOODS UNIT 4 BLOCK 15 LOT 1 49TH
0 �
OSP201265 0.....:.................................:.....No
oo
. ..... :cn.....................;
EKLUTNA ENGINEERING, LLC DATE: 12/21/2020 .8 . CURTIS TOWNSENDc�.
19162 MOUNTAIN ROAD DRAWN: CLT ���� ° No. CE 11904
�` •••. i
CHUGIAK, ALASKA 99567
SCALE: 1 1/2" = 1' 1 ..... •1�.�.
(907) 406 1058
PID: 051-064-12 SHEET 3 OF 3 4144 N TA;
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONS!SI LI TY OF THE
OWNER TO DETERMINE THE E'.0STENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING 694-0829
SCALE:
OF Al
DATE. Ar �� -���: •;�' ��•
/ 7 T H ^ !r y
GRID
Duana erx Seward
FB' • q CS - 5
��'� f���kFT�•'L°oma
DRAWN;
��1
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 . 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http:iiwww.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201265
Work Type: SepticTank Upgrade
Tax Code Number: D5106412000
Site Legal Address: NORTH WOODS UNIT 4 BLK 15 LT 1 G:1460
Site Mailing Address: 21910 SHELTERING SPRUCE LOOP, Chugiak
Owner: WILKINS ROBERT J
Design Engineer: EKLUTNA ENGINEERING, LLC*
This permit is for the construction of:
Effective Date:
Expiration Date:
t„cnt s
Q.
n
C_ ro-
* J :i
Department
Lot Size in Sq Ft:
Total Bedrooms:
8/13/2020
8/13/2021
24315
❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Northwest corner of existing bed shall be located at time of construction to confirm
separation between septic tank and bed.
Received B)
Issued By:
Date: 20v
bate: V /S /_20,6
3
MUNICIPALITY OF ANCHORAGE
Development Services Department_ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-064-12
Property owner(s) WILKINS ROBERT Day phone
Mailing address 21910 Sheltering Spruce Loop Chugiak AK 99567
Site address 21910 Sheltering Spruce Loop Chugiak AK 99567
Legal description (Sub'd., Block & Lot) NORTH WOODS UNIT 4 BLK 15 LT 1
Legal description (Township, Range & Section)
Lot Size 24,315 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
0
Upgrade 0
(D) El
Holding Tank
F-1
Renewal
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
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 Codps.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: "?
Receipt Number: L9 7Q? 3.D
Permit No. OSP201 2 -LS
. f / / 5/ Z-0 -Z-_0
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201265, Rebecca Carroll, 08/13/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201265, Rebecca Carroll, 08/13/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201265, Rebecca Carroll, 08/13/20
-e-eaz7
I
ASSUILT
SEWARD
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE -
FOLLOWING DESCRIBED PROPERTY-
DATE.
AND THAT NO ENCROACHMENTS EXIST P_XCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE MCISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
rim/yGo
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
DRAWN;
LINES.
;gavvchA�
()F A( p�
r_.
Deana Mark"Seward it A
LSg- s A,
y �Sk%'ici?� Loo
Municipality of Anchorage Page I of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 i Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5"' 93 PID Number: 651 06glln
Name: M AA t M C10eJ-i`-A-!n1",3�
Wastewater System: JR'New ❑ Upgrade
Address: p00995 C
b T
ABSORPTION FIELD
Phone:
GSS 1 ZZ34
No. of Bedrooms:
3
El Trench ❑Shallow Trench Bed EJ Mound ❑Other
�+
LEG AL DESCRIPTION
Soil Rating: O,5
Total Depth from or c�ipal grade:
3 � h0 S 1
GPD/S . Ft.
Lot: Block:Subdivision:
1
l �
Depth to pipe bottom from original grade:
6 -5
Gravel depth beneath pipe S
0 Ft.
I �+L�Y+kWbbQL 1
1/i1 IL5 7 - It
TownshipT�
Range: 1
Sections
Fill added above original grade:
S 18
Gravel length:
'�3, Ft.
.5
1 Ft.
WELL: ❑ New ❑ Upgrad
Gravel width:
Z►t
Number gf lines:
`i
Distances between lines:
` Pt.
Ft.
Classification (Private, A,B,C):
Total D
Cased To:
Total absorption area:
So✓
Pipe material:
-PVG ArTm Z) 3o34
Ft.
Ft.
SC. Ft.
Driller:
Date Drilled:
Static Water Level:
Installer: 1
AA �. r► rdcdit
Date install d: 93
Ft.
Yield:
jjjGPM
Pump Set at:
Casing Height Above Ground:
TANK
Ft.
FL
SEPARATION DISTANCES
OdSeptic ❑ Holding o S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/ mate
Manufacturer:
�^ p ,`
Capacity in gallons:
1006
From
Tank
Field
Station
Tank
Sewe
!'�{11�.PW'ZPf(TG
Material:
Number of Co�Zartments:
WellSurfac
S
LIFT STATION
Water er
+tva'
-if-I
-4-1 DD
LotSize
14-7t
in gallons:
Manufacturer:
Line
1
"�
"Pump on" level at:
"P off' level at:
High water alarm at:
Foundation
�'
(n
'Y
Curtain
+
Pump Ma odel
I Electrical Inspections performed by:
Drain
BENCH MARK
Remarks:
Location and Description:
A<4 0V_Pti KE iN 1T9
GAZA &C Pt16
Assumed Elevation:
od'
qi,� Puy b�9.�I�4 Pgy�V
Yii�Yu�� �I's a �'611,
13
�vL�"—�-- Dates: 1st
� lT }
Inspections performed by: -A-11 —1-93)
k '' tl@Ai.fa'SasA @wa'axn.TlA4i4&�L ¢'=,q
NO. 1732-E
qy'" 1mns22119 e° ,E
Department of Healt Hum n j ices approval
'z
G Date: Ad
Reviewed and approved by:
72-013 (Rev. 9/91) MOA 25
Permit No. 93 0Z'1' Page Z of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LC;,T I By 4 i'�' Noy+kwoad5 PID No.: os 1 0641 17 -
(most �ti`�•
%te r'V6
�1
8+61
t Fve—
A (1193) `
vu"�
t�fartM x4e�a.M ee f:tlb Yt44:r �c
WO.
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE °a(Pol
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930247 DATE ISSUED: 7/23/93
DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. EXPIRATION DATE: 7/23/94
OWNER NAME:NORTHWOODS INC
OWNER ADDRESS:709 W. INTERNATIONAL AIRPORT ROAD
ANCHORAGE, AK 99518
PARCEL ID:05106412
LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 15 LT
1 l
LOT SIZE: 24316 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /S9PTIC TANK SYSTEM
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS: Z•(q�
t(r Y1.� ; `qtr So
R��zMAII.UM
O'T,�
RECEIVED BY: DATE:_ h73
ISSUED BY: DATE: Z
SITE
PLAN -- WASTEWATER ABSORPTION SYSTEM
ND1 bE��C1.0�>=1�
--
—
�
13zcPr5rb 3
j7
opb'S�n
�dPUCCw\ siTe
JO
Nos 'DTyt1..00W
pKdP0S6�J 2o'x45' 36X9
w rm I Oo o G"Al I*1evK
�^
-T _..I
INS'rrg•tt�.ry
2
/
I�o�Se Vc-+bt'�C I
(JoT mvmov"
�
�
Lcr .�cta►�1 24316 s�'
— —
— — --
LESS f\ouSF Fc�o-S-PR1(N'^t�
I
�
I
3 �/2 �Mrn1�� �•et✓ r,-r�JJ .
0
t�rz avFN YN'91.ta; 7-ove
S�PTe s`1S�Ern
r
15,�Oo s�
SITE PLAN --PROPOSED ABSORPTION SYSTEM
RETAILS OF 13ED ABSORPTION SYSTEM
OF °Al.�h LOT 1f BLOCK 15° NORTHWOODS SUB
*� PREPARED FOR: PAUL MEYERS 688-1236
PO BOX 670485
CHUGIAK, AK, 99567
a aa® .. a...o.aayewes°a e
SCALE: 1" = 100'
June 22, iSliO J ,p`
CONSTRUCTING ENGINEERS 346-2000
'* 9601 BUDDY WERNER IDR 694-9095
;, ANCHORAGE AKI 99526
DRAWN Bf CAL
7-1-9_i
DRAWING # 93-S1-01 3
0
N
ABSORPTION SYSTEM DESIGN DETAILS
F20M TAN�c
4s, ----d
ABSORPTION AREA CALCULATIONS: 3 Bedrooms x 150gpd/bedroom = 450 gpd
(soils rating : 0.5 gpd/sf) 450 gpd : 0.5 gpd/sf = 900 sf area
Bed design: use 201W x 451L bed (minimum) w/ 4 ea 4" perf pipes @ 5' centers,
each 40' in length.
IMPACT ON ADJACENT LOTS: This lot is served by a public water system. The
proposed absorption system is located such that there is no adverse impact
to any adjacent lot. There are no wells, private or public, within 200, of
the proposed system.
"''" � .,�.�•s g DESIGN DETAILS --PROPOSED ABSORPTION SYSTV14
BED ABSORPTION SYSTEM
• w4, LOT 1, BLOCK 15, NORTHWOODS SUB,
0PREPARED FOR: PAUL MEYERS 688-1236
�• • •«+•••••�� PO BOX 670485
CHUGIAK, AK, 99567
NC7. 1732
oR• June 22, j968� NOT TO SCALE DRAWN BY CAL
���� «, • ldA4 •� .�" CONSTRUCTING ENGINEERS 346-2000
ENG 9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516 7-1-93
DRAWING N 93-S2-07-3
A`
CO
9"
n 40' pBQF (-Vyo
C.0
M r •
N
co
4s, ----d
ABSORPTION AREA CALCULATIONS: 3 Bedrooms x 150gpd/bedroom = 450 gpd
(soils rating : 0.5 gpd/sf) 450 gpd : 0.5 gpd/sf = 900 sf area
Bed design: use 201W x 451L bed (minimum) w/ 4 ea 4" perf pipes @ 5' centers,
each 40' in length.
IMPACT ON ADJACENT LOTS: This lot is served by a public water system. The
proposed absorption system is located such that there is no adverse impact
to any adjacent lot. There are no wells, private or public, within 200, of
the proposed system.
"''" � .,�.�•s g DESIGN DETAILS --PROPOSED ABSORPTION SYSTV14
BED ABSORPTION SYSTEM
• w4, LOT 1, BLOCK 15, NORTHWOODS SUB,
0PREPARED FOR: PAUL MEYERS 688-1236
�• • •«+•••••�� PO BOX 670485
CHUGIAK, AK, 99567
NC7. 1732
oR• June 22, j968� NOT TO SCALE DRAWN BY CAL
���� «, • ldA4 •� .�" CONSTRUCTING ENGINEERS 346-2000
ENG 9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516 7-1-93
DRAWING N 93-S2-07-3
a +.� Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: DATE PERFORMF'W'°w^-'°•+�
LEGAL DESCRIPTION: Lt�'.lS Nv r?°N,S Township, Range, Section: 5w)/4 53 -1'1 5-tJ Q I U)
SLOPE SITE PLAN C-,L_I I_ . _ _ C.•.,.,..
DEPTH _
(FEET) O"7•rwr"'
2 - `�.wt� t/J j t r 2 tlt. 0 RIk1
3
4
5
L}�v� vi
lvtih'i17 —•
8
9
10 -
11
12
13-
14-
15-
16-
17
314151617
81920 is-
19 -
20 -4
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
S
L
0
E
Dale: 7-t`q3
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? No^'a
Reading
Date
Gross Net Depth to Net
Time Time Water Drop
1
4arr„a rn r g„ i B
Z.
q"
"LS n, V:
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER _S. / it
—
TEST RUN BETWEEN FT AND FT —7
4eO �)C. �'7 sem. .�''V ,_,�Q� W --� l ^T Yyc) i/�.%�c/7'C
ry\lb t � "Z ns ,
/' --0 n —
PERFORMED BY: — h�,;vn+c vn� ""J {J� ��t'^ p"
I CF-_RTIFY THAT TH.I$TESTZWAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _� 7 t 193 9 ✓
72-008 (Rev. 4/85)
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
Parcell.D, 051-064-12
1. GENERAL INFORMATION
Complete legal description
+fit€�ltr�i-.
Expiration Date: q — a -1 I
Lot 1, Block 15, North Wood-:
Unit 4
Location (site address) 21910 Sheltering Spruce Loop Chugiak, AK 99567
Current Property owners) William &Sharon Keller Day phone (907) 688-4879
Mailing address 21910 Sheltering Spruce Loop Chugiak, AK 99567
Real Estate Agent
Fitzy O'Hare @ Re/Max Dynamic
2. TYPE OF DWELLING:
Ej Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone (907) 232-6368
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
F-1
Public Sewer
❑
WaiverNariance request for: Distance:
Received by: �f�c r i Date: > %lj%'kf ;.�;;f ,?
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ t196 Waiver Fee $
Date of Payment �X113 Date of Payment
Receipt Number jla. 'gzfo Receipt Number
COSA# 0512,13WI-1 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 Pinard Engineering Phone (907) 357-3647
Address PO Box 871347 Wasilla, Alaska 99687
Engineer's Printed Name Paul E. Pinard, P.E.
6. DSD SIGNATURE
L System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By , ,2 Original Certificate Date: ' f
Thenicipali` of chorage D elopment 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 engineers work.
ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheets . c
Nitrate Advisory
Arsenic Advisory
Other
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: Lot 1, Block 15, North Woods -S , Unit 4 Parcel ID: 051-064-12
A. WELL DATA N/1
pe If A, B, or C provide PWSID # Well Log (Y/N)
Date comple Sanitary seal (Y/N) _ Wires properly protected (YIN)
Total depth t Cased to ft. Casing height (above ground) in.
FROM WE OG AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate
Arsenic ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
ft.
mg/L
Collected by:
ft.
Tank Type/Material Septic/Steel Date installed 8/11/93
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) N Depression over tank (YIN) N High water alarm (Y/N) NA
Dateofpumping 3/27/13 Pumper JRs Pumping
C. ABSORPTION FIELD DATA
Date installed 8/12/93 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.5 gpd/sf System type Seepage Bed
Length 43 ft. Width 21 ft. Gravel below pipe 0.5 ft.
Total depth 4 - 5 ft.Eff. absorption area 903 ft Monitoring tube Y Depression over field N
Date of adequacy test 4/24/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0.0 in. Water added 480 gal. New depth 0.0 in.
Elapsed Time: 90 min. Final fluid depth 0.0 in. Absorption rate >= 450+ g.p,d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) None Known If yes, give date
D. LIFT STATION
"Pump on" level at
Datum
NA
Size in gallons
in. "Pump off' lei
Cycles tested
E. SEPARATION DISTANCES fSWF; P
VEt
NLOTTo NA
Septic tank/lift statio n t t
Absorption field on lot
Public sewer main
Sewer /septic service line
Animal containment areas
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm &
On adjacent lots
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Building foundation 5'+ Property line 5'+
Water main 10'+ Water service line 10'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water Service line 10'+ Surface water 100'+
Curtain drain None Known Wells on adjacent lots 200'+
Absorption field 5'+
Surface water 100'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
F. COMMENTS
* There is o foundation cleanout; a 2" pressurized line delivers wastewater to
the septic tank.
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 Paul E. Pinard, P.E.
Date 5/2/13
COSA brown sheet 10-10-12.doc
in.
PINARD ENGINEERING
P.O. Box 871347
` Wasilla, AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST
LOCATION: Lot 1, Block 15, North Woods Subdivision, Phase 4
APPLICANT: William & Sharon Keller
21910 Sheltering Spruce
Chugiak, Alaska 99567
SEPTIC TANK TYPE/SIZE: Steel/1000 Gallons, per MOA Records
ABSORPTION SYSTEM: Seepage Bed, per MOA Records
DAILY FLOW:
3 BEDROOMS x 150 GAL/BR = 450 Gallons
TEST DATA
JOB NUMBER: 13-115
DATE OF TEST: 4/24113
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 3
SCUM: 0.0' SLUDGE: Minimal
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes XX No
Time
Flow
Rate
Volume
Cumulative
Volume
Septic Tank
Septic
Tank
Soil Absorption System
Comments
PM
(GPM)
(GALS)
(GALS)
Liquid Level
*
A Level
Monitor
Tube 1*
A SAS
Level
Monitor
Tube 2*
A SAS
Level
3:25
5.3
-
4.0'
-
0.0'
-
Start Flow - Meter 36760
3:40
5.3
80
80
4.1'
0.1'
0.0'
0.0'
36840
3:55
5.3
80
160
4.1'
0.0'
0.0'
0.0'
36920
4:10
5.3
80
240
4.1'
0.0'
0.0'
0.0'
37000
4:25
5.3
80
320
4.1'
0.0'
0.0'
0.0'
37080
4:40
5.3
80
400
4.1'
0.0'
0.0'
0.0'
37160
4:55
-
80
480
4.1'
0.0'
0.0'
0.0'
StopTest- 37240
RECOVERY
MT2
*ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: Testing on this W WDS found it to be operating satisfactorily. There was no measurable liquid in the
SAS MT prior to or at any time during the test.
Reviewed by: Paul Pinard1'>
Date: 5/2113
C -36
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
t Division of Environmental Services M
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # C-131 OC 4t L HAA # iAP)0i 1 ('`I^ zA
1. GENERAL INFORMATION
Complete legal description L 1 66 Nd`-i�W000iS It �A
Location (site address or directions) 5y\QJ4` Nr\3 Vy"c.Q LADOP
Property owner
N- t"\4
Day phone 6:9 j Z 36
Mailing address
po goy
60495 Chugiak,K1
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
NOTE: If community well system, ,provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
t
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOA#21
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lou sl a6saoyouy to Al!led!o!unW @14_L'Panssl sl aleolpliao a aaolaq elep azAleue ao suolloadsul lonpuoo
lou op SHHo do saa�(oldw3 •sluawa.unbei alels pus leaapal ulel�ao A4slles oliepio ul suo!1n1!lsul bulpual alayl pue
sawoy to saasuyoand of �Csolinoo a se slyl saop SHHQ ay1 "e>iselbio a1e1S ayl u! pa)alsibei iaaul6ua leuolsseloid
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aalem alis-uo all 'uolloadsul pue uolle6l;sanul Aw woal pue salll a6eaolouy to Al!led!o!bnW ayl
woal paulelgo uollewaolul all uo paseq jell �tluanaallanl i •ulaaal paleolpul ainlonils to edAl pue
swooapaq to aagwnu all aol alenbape pue leuollounl 'ales sl welsAs lesodslp aalenr(alsum ao/pue
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Municipality of Anchorage
.. Department of Health and Human Services 44
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: t aT t gt.oc' 15 Nori-hw"d Js Parcel I.D. 05 f O6 4-1 z
A. Well Data
Well type If A, B, or C, attach ADEC letter. ADEC water system number.
Log present (Y/N) Date completed Driller _
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION /
Date of test _
Static water level
Well'flow
Pump levell
SEPARATION DISTANCES FROM WELL TO: v L
Se tic/holdin tank on lot
P g
Absorption field on lot _
Public sewer main
Sewer service line
WATER SAMPLE R
Coliform
Date of
TS:
B. SEPTIC/HOLDING TANK DATA
rr
c
O
m y
m �
n
N y
00
®�
Z
_; On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Date installed A)6-- 1993 Tank size / 0eo e Compartments Z
�v)gtito LtNF Feo*NFko�)';V
NJ 1rftN+r
Cleanouts (Y/N) i� Foundation cleanout (Y/N) 'Depression (Y/N)
High water alarm (Y/N) NJ/k Alarm tested (Y/N) tv
Date of pumping tJ fl _ NOLO Pumper v
N
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot N P� On adjacent lots (y Foundation
To property line 47' Absorption field Water main/service line
Surface water/drainage +100
72-026(3/93)• Front CONTINUED ON BACK PAGE
J
.p.m. g.p.m.
rT 1
�+
.If
rr
c
O
m y
m �
n
N y
00
®�
Z
_; On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Date installed A)6-- 1993 Tank size / 0eo e Compartments Z
�v)gtito LtNF Feo*NFko�)';V
NJ 1rftN+r
Cleanouts (Y/N) i� Foundation cleanout (Y/N) 'Depression (Y/N)
High water alarm (Y/N) NJ/k Alarm tested (Y/N) tv
Date of pumping tJ fl _ NOLO Pumper v
N
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot N P� On adjacent lots (y Foundation
To property line 47' Absorption field Water main/service line
Surface water/drainage +100
72-026(3/93)• Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FR STATION TO:
Manufacturer
Manhole/Access (Y/N)
Level at
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed IAvU 199-5 Soil rating (GPD/Ft) ©. S System type
O b
Length `43 Width Z1 Gravel thickness G,' Total depth
Total absorption area 905 S� Cleanout present (Y/N) Depression over field (Y/N)
Date of adequacy test N 8�'^ SY5 Results (pass/fail) — for "" Bedrooms
Water level in absorption field before test After test
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
if yes, give date
Well on lot N P- On adjacent lots N ('� Property line
To building foundation 141 To existing or abandoned system on lot _
On adjacent lots 4--3o Cutbank -+50' Water main/service line
Surface water +1 Driveway, parking/vehicle storage area �
Curtain drain + So
E. ENGINEER'S CERTIFICATION
Zt'
NP)
410'
I certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature 414
6�"
Y,s c. S r rears
Engineer's Name 94,C)k 3Q a,1 D,-
r�� K 99 6
Date
HAA Fee $ L�db `ejo
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
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Waiver Fee $
Date of Payment
Receipt Number