HomeMy WebLinkAboutT15N R1W SEC 19 LT 41T15NI
RIWI
Section 19
Lot 41
#051-241-25
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water System Permit
Permit Number: OSP211462 Effective Date:
Work Type: Well Upgrade Expiration Date:
Tax Code Number: 05124125000
Site Legal Address: T1 5N R1 W SEC 19 LT 41 G:0954
Site Mailing Address: 18914 KLONDIKE ST, Chugiak
Owner: FELLMAN JACOB M Lot Size in Sq Ft:
Design Engineer: Total Bedrooms:
This permit is for the construction of:
11/1/2021
11/1/2022
1:•11
Disposal Field Septic Tank Holding Tank Privy Q Private Well Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: To close this permit please submit:
1. Well Log
2. Pump Install Log
3. Water sample results
4. Well Decommissioning Log or indicate that the old well is being used in conjunction with the new well to
serve the house.
Received By:
Issued By:
Date:
Date:
3
MUNICIPALITY OF ANCHORAGE
Development Services Department Z Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-241-25
Property owner(s) Feliman, Jacob M and Jillian M
Mailing address 18914 Klondike Street
Site address 18914 Klondike Street
Day phone 907-240-8772
Legal description (Sub'd., Block & Lot) TI 5N R1 W Sec 19; LT 41
Legal description (Township, Range & Section) TI 5N R1 W Sec 19; LT 41
Lot Size 108,900 Sq. Ft. Number of Bedrooms 3
.APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial 0
Single Family (SF) 0
Septic Tank
1:1
Upgrade
Upgrade ❑
ADU)
Holding Tank
El
Renewal❑
(D) ElRenewal
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
n
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
NA Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
nature of property owner or authorized agent)
Permit/Rush Fees: X22 S
Date of Payment:
Receipt Number:
Permit No. OSP 21 [ q 6 Z
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment ServicestBuilding Safety\On Site Water and WastewaterTo rms\Cl lent FormsTermit Application.doc
11
PROPO$W vdaSHM FLOOR
ELEV. (ASSLUM)
- — - — - — - — - — - — - — - — - — - — - — - — - --- - — - — ---
'c0 KLONDIKE STREET
m
PROPOSED O«aNER
2eHWG DISTRICT
FRONT BUILDING SETBACK
N89e 55' 10"W 329.80'
sIDE BUILDING SETBACK
C.N x 2
i�
w
REAR SUILDiNO SE RACK
C•0.5 x 2`
W
2
C.Os x 2
C.Os x
is
o.oz2
42A'
v 0
tom.
. 't APPROX. GRAVEL DRIVE
p
O
F.itl
3U3ESE ti
! N
O
C>
C;O.
2
Ti-
t41r
�
I I
/ EXISTING i Z 40
/ G HOUSE `
00
4
/ a �v
t•)
T c D
! WELL
t � i l ao
rJJ
t Proposed NevVVeli Location.
i No septic,, within 1 00of proposed well site.
� f
i 1
1
' I
-------------------- ------------------
_________________42B
42B
t f
` i t
1 i t
� I t
' .. , , , , , , , , , .. • • " I j I attest that the well will be sited, drilled and completed
/ in accordance with standards and provisions in
chapters 15.55 and 15.65
Digitallysig ed by Jacob
Jacob Fellman p to 2021.1 .291124:20
I
` -08'00'
Print .5 x 1 i ;nr'i" = 60ft
89"..55' 1O.W ! 329_80 Lot 44' Jrce's 051- 4'11-41
_ tp"
UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTA13USHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SURVEY SURVEY TYPE
SYMBOLS
❑ FOUNDATION AS-BUILT
1wa PRop rdv
' SET ASPHALT
❑ FINAL STRUCTURE AS-BUILT
DRE DRAINAGE
O FOUND REBAR
❑ PLOT PLAN ... AS-BUILT ...LOT SURVEY ...TOPOGRAPHY
g__9 B WOOD FENCE " CONCRETE
ER AS-BUILT ... NO CORNERS SET RE T)RCATION AS-BUILT ... NO CORNERS SET
00II ASSUMED ELEV. 'X—X—XMETAL FENCE ® WOOD DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND MS18LE WALL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION�,�,�
Prepared by
PLOT PLAN
,� of A4 ���
Robert E. Johns, Jr. 8c Assoc.
'hereby ca.t'ty"°t"°wwy"y.n°,.d
the tot dra.n and described hereon, and that
I ,`P;.••• ••95��
Professional Land Surveyors
hav fouad found « "tobil•hed of the tot corner:
ae .1o.n an the plan and to the beet of my
�s:'
�q
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
lato.ted4. and obis Im an dkno alwa have been
measured tn. Ona`aL
r
•:�
Scale: „ y(d^}�,
1 6V
Rec. Lot S.F.
Rec. Plot File No.
4�ii1• r;.
FOUNDATION AS-BUILT
g ...............•�
—
Dote Surve d:
'� 10/01/15
Drown la
Y R EJ
Checked byn A
J'Vf
t. Robert E 3ahttA Ur., hereBull Drury that t
have prfan, ed an As-Batt .rwy of the
fetrsdotlan an this tot and itw4 otl We
., •.
.., •
® ••, ..e..•...• tr ... ..
d iraws1ane and tnformntwn at ehavn hr6orr'!._
AN
P' ROBERx E. JOHNS, JR. • V
� ••
Date Drown: 10/02/15
Grid: NW954
W.O. 15-420
are true and no etaoaohnnents Bidet t,A—
otner��
I •' :» o
FINAL STRUCTURE AS-BUILT9s
�' 41 21 — S
�••'..
Legal Description:
41
t. Robert I- ,ohne, a:, hereby oenify that t
haw pertomrod an Ae-Buutt w y of the
eUvatrxe on We lot and that ed rhe
�® •.'' oc ems'
••••.. ,.` '
••••••Lot
and och ae richt here
ondrd
0
aro true and no ancroachmenle Brief lade::
eh— oe es
no onav
ri iofessiono
��>���
T1 5N R1 W SEC 19
Jan.19.2010 04:08 PM PAGE. 1/ 1
Municipality of Anchorage
Development Services Department
�J
evaug Safety Dania, ,.
OtsSAe Water and Waete"ter Program. 4700 E4rnre Road
P 0. Box 196650 Anchorage, AK 99507 Page , of 3
WV1 anc)grege.akue (907)343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW09021S PID Number. 051-241-25
VERN S. 8 ALICE M. FOSTER
Wastewater System: Q New ❑ Upgrade
A"o
Po Box 671881 CHUGIAK, AK 99567
ABSORPTION FIELD
REo... r•.e.ra.a.w
s
oo»i Tnwa yawn.. rroem Ce.a Orwwa Ooiw:
LEGAL DESCRIPTION
ea R.we
Tar o.aR saRorywr prM
/.a oRryFr
6 n
ear a.41 eww.rr.
as W.eaoaa awe .ew
aprw
awwr •.rn e.ro.m w.:
5 F
1 q
15N ""�•1W erww 19
er......ee..riwr e'�•^:
Omrlw+an
0 n.
37 q.
Well: ®New [I Upgrade
51
5' q.
2
Tar Cw+n r
Crr.r r
T.r."eybwe.:
.p rrwr.
.7G>7 n
n.
165 i�
ASTM 30341AB97610
Oa.
Q 10
iww VMM Lw+e
2W
WY,
EVERETT CAULKINS
d.Yr.l...
1171!2009
n,
kSEPARATION
eaWm.TANK
ATION DISTANCES
m SepOC ❑ Holding ❑ S T E P ❑ oum
bsorption
UR
Hok7mg
r.rx
From
Tank
FIek1
6tatron
Tank
s. LM
I GREER
1000 y
vio
IDO'.
10e.
25'.
wr
HDPE
.,.row a Carwrrw+r
2
S. Wrr
too•
IDD'•
LIFT STATION
61
faxr.i..
T,
IV+
4aro On'MILL
...q a'r.rr
wyn rrr wor
r
M
►,
erE.. o..
NONE
KNOWN
R""R'"""�"100"
a�.cxxr eiwr.An.iMw.w.q
RMwY
Kir) 7701 DUeILT F
BENCH MARK
xA 6tinNm
DOORFRAME $1Lt.
E r
100 q
r
S&S Englneedng
Inspections performed by:IARA7 ! R1rhw�nr4I R*S: 10 10/31/2009
i�
ChugiDk, Alaska 99567 2e° 11/7 0e
,..*.
; �%.•• '%
Development Services Department Approval
9
Conditional Approval Date:
r..•.. '•e
Reviewed and approved by: e; �_� O
Y 14374
4 • `7/ 1�
—��yr���Fr"
PERMIT NO. SWO90215
PAGE 3 of 3
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-7904 • www.ci.anchorage.ak.u<_
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL T15N; R1 W; SEC. 19; LOT 41 P.I.D. NO. 051-241-25
FINAL GRADE
TOP OF
TANK = 92.0'
INLET = 91.4'
Col
1.1T1 _ CO2_IIT2
I
ST2
NEW 1000
GALLON GREER
HDPE
SEPTIC TANK
GRADE = 96.0'
2" INSULATION
OUTLET = 91.2'
C01= 96.6'
CO2=96.5'
2" INSULATION
COI =91.5
q(a1�J 1 111
SRWCO2=91.5
MT1=90.5' `MT2=91.1'
MT3=88.8
MT3 CO3
A
WATER FOUND AT
83.8'
B.O.H. = 81.8'
SR
CO3=95.8'
C04=94.6'
'�__�ORIGINAL
GRADE = 94.8'
CO3=89.8' awVE
C04=89.8' ?LrA
�
MT4 =88.8' N. T. S.
ibn A. 1a+ckp
He. 14074
AMP
A
B
FCO
---
7.5'
ST1
27.7'
9.4'
ST2
31.8'
13.3'
DBL1
33.5'
15.0'
DBL2
35.1'
1 16.8'
C01
48.7'
38.5'
MT1
49.0'
39.3'
1 CO2
60.0'
32.9'
MT2
60.3'
33.3'
CO3
72.6'
47.9'
MT3
71.7'
47.0'
C04
64.7'
52.6'
MT4
64.9'
52.9'
TMT
33.5'
14.5'
CO3=95.8'
C04=94.6'
'�__�ORIGINAL
GRADE = 94.8'
CO3=89.8' awVE
C04=89.8' ?LrA
�
MT4 =88.8' N. T. S.
ibn A. 1a+ckp
He. 14074
AMP
PERMIT NO. SWXXXXXX
PACE 2 OF 3
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone; (907) 343-7904 • www.b.anchorage.ak.u-
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL T15N; R1W; SEC 19; LOT 41 P.I.D. NO. XXX—XXX—XX
KLONDIKE STREET
ABANDONED '"33'BLM ROW Esnt
I—
CESSPOOL ARE
u
Wt
NEW SHALLOW
"
FIELD 3Nr TRENCHES
W
CO 0.
U
NT INIA�TI '.
t'
2••'
CO 01
2L0 1 IS NEW 1000------
W
TNT �T1RCT'DRLI GALLON GREER ♦THR2
$T HDPE TANK
....
u
ST co ALT SITE,
ter,
F`
EXISTING 1 BEDROOM
U
HOUSE
Li
W
in
�ABANDONEDM
i
PIT WELL
NEW 100'
I
IWELL
RADIUS
°o.
2
k
I/ - 60'
ENCI STAMP
`nR`'
9MObw
ti
14pJ f
r
t�9
PROpES�
SGS Reta
1100108001
LOO Units
htctlwd
Client Name
S R S Engineering
Printed Datefrime
01/192010 12:11
Project Name/N
L41;SEC 19;Tl5N;R1 W
Collected Datefrime
01/112010 15:15
Client Sample ID
L41;SEC19;T15N;RIN'
ReceivedDatefrime
01/112010 15.55
platri=
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
Pammeley
Results
LOO Units
htctlwd
Commer ID
Allo%ahlc
Limits
Pmp Analysis
Date Date
[nit
Microbiology Laboratory
Colony Count
0
col/IOOmL
SM209222O
A
(<200)
01/11/10
KAR
Total Coliform
0
col/IOOmL
Sk1209222O
A
(<I)
01/11/10
KAR
Fecal Coliform
0
col/IOOmL
SN1209222B
A
(<I)
01/11'10
KAR
SCS ReEN
1100046001
Client Name
S aC S Engineering
Project Name/N
Lot 41,SEC 19,TISN.RI W
Client Sample ID
Lot 41,SEC 19,TISN.RI W
Matrix
Drinking Water
Sample Remarks:
Printed Daleffime
Collected Date?ime
Received Date/Time
Technical Director
01/19/2010 10:14
01 /06!2010 11:00
01/06/2010 13:05
Stephen C. Ede
Allowable Prep Analysis
Parameter Results Ltl(J Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 5.00 U 5.00
Waters Department
Total Nitratc/Nitrite-N 0.100 U 0.100
Microbiology Laboratory
Colony C TNTC '
Total Coliform alid
Fecal Colifunn � QSQ�.J �alid
ug/L
EP200.8
C
(<IO)
01/12/10 01/15/10
NRB
mg/L
SM204500NO3-F
B
(<IO)
01/08/10
RJT
col/IOOmL Sh1209222B
col/IOOmL Sh1209222B
col/IOOmL SM209222B
A (<200)
A (<I)
A (<1)
01/06/10 KAR
01/06/10 KAR
01/06/10 KAR
r r
�11�� n21f�
mata�o
Arctic Pump & Well Inc.
Jim Sullivan
PO M)x770197
Eagle River, AK 99577
(907)688-2510
(907)258-2510
(907)745-2510
arm y�,_rr ei.nct
Pump Installation Log
Well Drilling Permit Number: SW090215
Parcel Identification Number: 051-241-25
Date of Issue: 10-16-09
Legal Description: TISNRI WS19 Property Owner Name & Address:
LotA l Vem Foster
Block: PO BX 671861
Chusiak, AK 99567
Pump Installation Date: 10/28/2009
Pump Intake Depth below Top of Well Casing: 136 Feet
Pump Manufacturer's Name: Dempster
Pump Model: MBF3-75-S2
Pump Size:3/4 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: Baker
Pitless Adapter Installer: Arctic Pump & Well, Inc.
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & Well, Inc.
Page I of
Jan 28 10 11:27a Sullivan Water Wells
907 688 2759 p.1
O
SULLIVAN WATER WELLS
Mer 9a746947 a
rww.ewlire.wweroee�.re
Well Log
Permit Number: #SW o9621s Date of Issue tat6noo Parcel Identification Number: os1-241-2s
Date Started: 10/20x1009 Date Completed: 10129!2009 Is well located at approved permit location? Yes I INo
Property Description 18914 M.OND(KE STREET Lot Block 4C-1 '+i Section: Ic) Town: f-j'iJ Range: 1W
Property Owner Name & Address: VERN FOSTER
PO BOX 671861 CHUGIAK, AK 99567
Borehole Data:
ur&7
Depth
Method of Drilling X I air rotary I 1 cable tool
Soil Type, Thickness & Water Strata
From
To
Casing type:
Casing Stickup
0
2
Wall thickness 0.25 inches
Overburden
2
4
Diameter 6 inches Total:'_ e4 feet
Uner type:
Send Gravel Sift
4
65
Diameter 4.s inches Depth: 200 feet
Sandstone
55
61
Casing stick-up above ground: 2 foci
Coal
61
63
Static Water Level(from top of casing) 126 feet
Shale
63
70
Pumping lsvel: feet alter
Bedrock
70
73
1 hours pumping gpm
Recovery Rate 1 gpnl
Shale
73
117
__
Method of Testing: Air
Sandstone
117
156
Well Intake Opening Type
Sandstone W1Gravel
156
168
I I Open End IX I Open I lole
Sandstone
168
200
17 Screened Start feet Stopped feet
I Perforations Start feet Stopped feet
CroutTree: Sentonkedrygranular Volume•. log Pounds
Depth 44 SEMI o feet Stopped 44 feet
Pump Intake Depth: feet
Pump size: I IP brand name
Well disinfected upon Completion? Ix Yes l_; No
Method ordisinfeetion CHLORINE SOPPM
Comments:
Watts Sample Results:
Arsenic:
ur&7
Well Driller.
Cob Sullivan
Nitrates
mZ4
Sullivan Water Wells
Total Coliform Bacteria
—
.. colonics/100mi.
P.O. Boa 670272
Chuglak, AK 99567
Other bacteria:
coV100ml.
(gan688-2759
Attention: The property owner shall provide this log to DSD (onsite) and DNR within 30 days ofcomptetion.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water B Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM f WATER SUPPLY PERMIT
Initial
Permit Number: SWO90215
Legal Description: T15N R1 W SEC 19 LT 41
Date Issued: Oct 16, 2009
Expiration Date: Oct 16, 2010
Parcel ID: 051-241-25
Design Engineer: 0003 S & S ENGINEERING Site Address: 018914 KLONDIKE ST
Owner Name: VERN S. & ALICE m. FOSTER Lot Size: 108900 SO. FT.
Owner Address: PO BOX 671861 Total Bedrooms: 0 Permit Bedrooms: 3
CHUGIAK , AK 99567 -
This permit is for the construction of:
❑✓ 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.
Receive
d
Issue
By:
Date:
d Date: O
Municipality of Anchorage
Development Services Department
Building Safety Division
_ On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, Alaska 99507
www.muni.org/onsite
(907)343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. (?,61 — Z9 1— Z S
Property owner(s) VERN FOSTER Day phone 688-0432
Mailing address PO BOX 671861, CHUGIAK AK. Zip Code 99567
Site address 18914 KLONDIKE RD., CHUGIAK AK. Zip Code 99567
Legal description (Sub'd., Block & Lot) LOT 41
Legal description (Township, Range & Section) SECTION 19; T15N; R1W
Lot Size / 69 �%9Q0Sq. Ft.
Number of Bedrooms 3
THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN:
Absorption Field 0 Initial 0
Septic Tank 0 Upgrade ❑
Holding Tank ❑ Renewal ❑
Privy❑ �e111Ca� cvt Sw6w��
Water Storage E]�d jalbloq bg Owner
Private Well 0�$� 0 RQce?pi No. 03'3& C
1 (%
certify that the above' ormation is correct. I further certify that this application is being made for a
Single Family
lWeltin , n jis in accordance with applicable Municipal Codes.
authorized agent)
Permit/Rush Fees:
Date of Payment:
Waiver Fees:
Date of Payment:
Receipt Number. Q7 5 77 Receipt Number:
(Rev. 11105)
WALTHAUTHMTY
APPROVALS
SEWERS WATER
M NE%TE1SNDNS
SEWERS WATER
PSPECTION
ENG:NEERINGSTLEMES
ANOREPORTS
WELLSSPECrIoN
SfLOWTEST
SITE PLANS
m
SOILTEST
PERCOLATION
TEST
STRLCrLPA A
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
OSPOSALSYSTEM
OESIGN
S&S\
;InevzlnG
ROBERT C. COWAN .
CIVIL ENGINEERING
FH: 907.694-2979
October 13, 2009 FAX: 907.694-1211
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 41; Section 19; T15N; RI W
It is requested that you issue a permit to install a new 3 bedroom septic system to
sen -e the existing one bedroom dwelling, on the referenced property.
Two test holes were excavated and percolation tests performed by S & S Engineering. The
approximate locations of the test holes are located on the attached site plan. At the time of
excavation (9-30-99 T1191, T1142) water was found at 11 feet on test hole #1 and 10 feet
on test hole #2. After seven days of monitoring, ground water was found at 10.5 feet on
test hole #1 and 9.5 feet at test hole #2.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
15861 S. Birchwood Loop Road - Chugiak, Alaska 99567
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72 088 (Rev. 4,851
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Municipality of Anchorage
etlf DEPARTMENT OF I IEALTH & HUMAN SERVICES
i 825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: DATE
LEGAL DESCRII
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PERFORMED BY: 1 CEn7lFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle RiverLoep Raed No. 404
ACCORDANCE WINdl6tRIieYY7�EAIV&V et Al GUIULLINLS IN EFFECT ON THIS DATE. DATE: It) 3 h
72-008 (Rev 4185)
i
ROBERT C. COWAN .
CIVIL ENGINEERING
PH: 907.694.2979
FAX: 907.694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
NEALTHAVfNDIPTY
CONSTRUCTION PRACTICES
APPROVALS
and
MATERIAL SPECIFICATIONS
SEWER& WATER
N NDUENSONS
REFERENCE: Lot 41; Section 19; T15N; Rl W
October 13, 2009
SEWEA&WAiER
GENERAL:
WECTION
1. The scope of this project includes the installation of a new 1000 gallon IIDPE
septic tank and new 3 bedroom shallow trenches to serve the existing one
ENG(NEERWGSTUPES
bedroom residence located on the referenced property.
ATDREPORTS
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
i OWNSTL'TON
applicable State and Municipal Wastewater Disposal Regulations.
�
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
SITE PWB
4. Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
ROADOESGN
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department or ADEC if required, for
system installations. Owners installing their own systems must also receive
SOL TEST
prior approval from the respective agency.
PERDOLXO+
SEPTIC TANK INSTALLATION:
TEST
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access. All IIDPE
septic tanks are required to have a 4" monitoring pipe installed next to the
NEo Nix°
PSPECRONS
tank extending to the bottom of the tank.
2.
The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
ONSITE
WASTEWATER
DISPCS&SISTEAI
DESIGN
15861 S. Birchwood Loop Road - Chugiak, Alaska 99567
Page 2
Lot 41; Section 19; T1 SN; R1 W
October 19, 2009
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated. All FIDPE septic
tanks are required to be covered with a minimum of 2" direct burial insulation, and a
maximum of 4 feet of cover.
5. A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 f4. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCIUDRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
Page 3
Lot 41; Section 19; T1SN; R1W
October 13, 2009
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pine Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the 4200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Page 4
Lot 41; Section 19; T15N; R1 W
October 130 2009
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted afier the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted atter the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage
Department of Health and Human Services
825 " L" Street
Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
htlp://www.ci. anchorage. ak. us
August 11, 2000
Judith Ann Glaugus
PO Box 771971
Eagle River, AK 99577
Subject: T15N, R1W, Section 19, Lot 41
Permit # SW990397 PID # 051-241-25
The subject permit #SW990397 issued by this office for a single family well and/or on-
site wastewater system, is due to expire 365 days after it's issuance on October 22, 1999.
If this is a well permit and you have drilled the well, a well log must be sent to this office
for documentation of the installation and to close the permit.
If this is an on-site wastewater system and a licensed Professional Engineer has inspected
the installation, the original as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports must be submitted within 30
days of construction completion.
A new permit must be obtained from this office for a well and/or on-site wastewater
system NOT installed by the expiration date. However a new permit can be issued free of
charge for a second year if the application for the renewal is received on or before the
date of expiration of the original permit for which a fee was paid.
When applying for a new permit after the original permit has expired or for more than a
second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
Jes Cross, PE
Program Manager
On-site Services
enc: Copy of Permit
Permit application
ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT
Initial
Permit Number: SW990397
Legal Description: T1 5N R1 W SEC 19 LT 41
Date Issued: Oct 22, 1999
Expiration Date: Oct 21, 2000
Parcel ID: 051-241-25
Design Engineer: 0003 S & S Engineering Site Address: 018914 KLONDIKE ST
Owner Name: Dan Clagus Lot Size: 108900 SQ. FT.
Owner Address: PO Box 771971 Total Bedrooms: 4 Permit Bedrooms: 4
Eagle River , AK 99577 -
This permit is for the construction of:
❑✓ 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: 16 — 2 2" /
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
/
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT
Initial
Permit Number: SW990397
Legal Description: T1 5N R1 W SEC 19 LT 41
Date Issued: Oct 22, 1999
Expiration Date: Oct 21, 2000
Parcel ID: 051-241-25
Design Engineer: 0003 S & S Engineering Site Address: 018914 KLONDIKE ST
Owner Name: Dan Clagus Lot Size: 108900 SQ. FT.
Owner Address: PO Box 771971 Total Bedrooms: 4 Permit Bedrooms: 4
Eagle River , AK 99577 -
This permit is for the construction of:
❑✓ 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: 16 — 2 2" /
ROBERT C.
CIVIL ENGINEERS
(907)694-2979
FAX(907)694-1211
P.E.
October 12, 1999
HEALTHAUTHORITV
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
SEWER&WATER
Anchorage, AK. 99519
MAIN EXTENSIONS
REFERENCE: Lot 41, Section 19, T15N, Rl W
SEWER& WATER
INSPECTION
It is requested that you issue a permit to install a well and a septic system to serve the
proposed four bedroom dwelling on the referenced property.
ENGINEERINGSTUDIES
Two test holes were excavated and percolation tests were performed. The approximate
ANDREPORTS
locations of the test holes are located on the attached site plan. At the time of excavation,
9-30-99, water was found at 11 feet. After seven days of ground water monitoring, water
was found at 10.5 feet.
WELLINSPECTION
& FLOW TEST
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
SITEPLANS
properties.
If you require additional information, please contact us.
ROAD DESIGN
S,inncerelly//,
SOILTEST
Ary
Robert C. Cowan, P.E.
RCC/bjj
PERCOLATION
TEST
Enclosure
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577
P.E.
1 " =
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LEGAL DESCRIPTION
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1
2
3
4
5
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7
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9
10
11
12
13
14
15
16
17
18
19
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COMMENTS
ofe/sm
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WAS GROUND WATER
ENCOUNTERED?
S TTI
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Date:
Reading
IF YES, A
/?
�j—
DEPTH?
Net
Drop
Depth to VON
13 , Q • E+
Monitoring?
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
l
3, 2- H,
-
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PERCOLATION RATE !>s (minutes/inch)) PERC HOLE DIAMETER
TEST RUN BETWEEN � FT AND V FT
PERFORMED BY:
S & S ENGINEERING I
CERTIFY THAT T IS
TE T WAS PERFORMED IN
ACCORDANCE WITH
17034 Eagle River Lao �oa��
&fe jTver EE aD9 577 L SECINES IN EFFECT ON THIS DATE, DATE: /0 113
�0gt K( AI SK
/019
72-008 (Bev. 4/85)
PERFORMED FOR
LEGAL
DESCRII
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
0
smloe
GW I C --M
DATEPERFORM
p, Range, Section:
SLOPE
WAS GROUND WATER / <1
ENCOUNTERED?
s
IF VES, AT WHAT D ( 0
61P. DEPTH?
Pea yea.,`e(Depth to Waler 1111erMonit / `//v �71
!
Monitoring? v Date:
(LI JlOI41 L I i bLSLAL)
Or /aL
SITE PLAN
Reading Date
Gross
Time
Net Depth to
Time Water
Net
Drop
30 99
g 1--
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30 �..-„ � �
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20 f ' PERCOLATION RATE —5� (minutes/inch) PERC HOLE DIAMETER v K
L—J TEST RUN BETWEEN FTAND 4—FT
Ole_ l NrY�G7.vcr
PERFORMED BY: S & S ENGINEERING I wv, CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No. 204 /{
ACCORDANCE WIMgj6LRgJ TEAy"1WWy1- GUIDELINES IN EFFECT ON THIS DATE. DATE:/o /� 3 / G: q
72-008 (Rev. 4/85)
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX (907) 694-1211
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
ON-SITE WASTEWATER DISPOSAL SYSTEM
HEALTHAUTHORITY
CONSTRUCTION PRACTICES
APPROVALS
and
MATERIAL SPECIFICATIONS
SEWER& WATER
MAINSCIENSIONS
REFERENCE: Lot 41, Section 19, T15N, Rl W
October 12, 1999
SEWER&WATER
GENERAL:
INSPECTION
1.
The scope of this project includes the installation of a 1300 gallon
polyethylene septic tank and leachfield trench for the proposed four bedroom
ENGINEERINGSTUDIES
house located on the referenced property.
ANDREPORTS
2.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
WELLINSPECTION
&FLOWTEST
applicable State and Municipal Wastewater Disposal Regulations.
3.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
SITE PLANS
4.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
ROADDESIGN
5.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
SOILTEST
their own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
PERCOLATION
TEST
1.
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
STRUCTURAL&
MECHANICAL
INSPECTIONS
2.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
ONSITE
WASTEWATER
DISPOSALSYSTEM
-
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page 2
Lot 41, Section 19, T15N, R1 W
October 12, 1999
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
tot 41, Section 19, T1 SN, R1 W
October 12, 1999
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe
Perforated
olid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam III or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current MOA or ADEC requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 41, Section 19, T15N, R1 W
October 12, 1999
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct
or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached MOA permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
• Municipality of Anchorage `
On -Site Water and Wastewater Program
(907) 343-7904 =T,
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcell.D. 051-241-25
1. GENERAL INFORMATION
Complete legal description T15N R1W SEC 19 LOT 41
Expiration Date:
Location (site address) 18914 KLONDIKE ST., CHUGIAK, AK 99567
Current Property owner(s) FOSTER VERN & ALICE MAE 2013 TRUST... Day
Mailing address PO BOX 671861 CHUGIAK, AK 99567
Real Estate Agent
Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
��yy����yy®®^�
UBMI
❑ Duplex
6
F-1Multiple Dwellings (Single Family
and/or Duplex)
JUN 3 "v 2011t
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank ❑
r ,� r -i IAO -11
VV.......'"'y VIaJJ G
f1
LJ
Co ..,�nir\\���
-0111111-R L I
Public Water System
❑
Public Sewer ❑
WaiverNariance request for:
Distance:
"
f:
I
Received by°i't` +7. . /, r' ,;.:
,: ,_
Date:
COSA to be released to the engineer, unless othedisE r6t(uested by the engineer.
I
COSA Fee $ rj2(o
Date of Payment
Receipt Number
COSA# 0%'1q12 -q5'
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 ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 6/12/14
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen OF`. 44 \
encroachments, deficiencies or discrepancies exist. ,p- . v L4 ilt
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms.
System #2 Approved for bedrooms.
Disapproved.
P KE,NNEI'N1. m /
it,l6 .F'.`/
� FESS IO`Sb''
Conditional approval for bedrooms, with the following stipulations:
rv� tiV(SEKv'' �7�'
By: Al J Original Certificate Date:
The Mumcality f chorage 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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10.10.12.dw
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: T15N R1W SEC 19 LOT 41 Parcel ID: 051.241.25
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID #
Date completed 1012012009 Sanitary seal (YIN) Y
Total depth 200 ft. Cased to 200 ft.
FROM WELL LOG
Date of test 1012012009
Static water level 126 ft.
Well production 1 9 -
p.m -
WATER SAMPLE RESULTS:
Coliform It/t & colonies/100 mL Nitrate/D�mg/L
Arsenic: AID ug/L Date of sample: 611112014
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC l HDPE
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping Pumper JRs
C. ABSORPTION FIELD DATA
Well Log (YIN)
Wires properly protected (YIN) Y
Casing height (above ground) 24+ in.
AT INSPECTION
6110114
ft.
g.p.m.
Collected by: ARCTERRA
Date installed 111712009
Cleanouts (YIN) Y
High water alarm (YIN) N
Date installed 111712009 Soil rating (g.p.d./112 or fC/bdrm) 1.2 System type SHALLOW TRENCH
Length 66 (2X33) ft. Width 5 ft. Gravel below pipe 1 ft.
Total depth 6.3'17 ft. (Measured 6n vm) Eff. absorption area 375 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 6111/2014 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 010 in. Water added 600 gal. New depth 110 in.
Elapsed Time: 10 min. Final fluid depth 010 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
"Pump ofr level at _ in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 1004
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 54
Water main 104 Water service line 101+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 1004
F. COMMENTS
VACANT SYSTEM PRESOAKED PRIOR TO TEST.
G. ENGINEER'S CERTIFICATION
1 certify that t 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. i OF AL\ ',
Engineer's Printed Name KENNETH M. DUFFUS / �F� f� ,
Date 6112114 49TH**
9 TH* �*
/ r
COSA brown sheet 10-10-12.doc
— 49e; KEtNE'1' Dl; /
P F'E5 lOtr'�
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ei.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) 4 141295
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot 41 of T15N R1W Section 19 subdivision,
the well's productivity was determined to be 0.70 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
3 -bedroom residence is 0.31 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
rgao�n neslm nnm
--- -----__'---- ----------------- ----
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SURVEY SURVEY TYPE
SYMBOLS
❑ FWNOATION AS -BUILT
SET REBARDRAINAGE ASPHALT
❑ RNAL STRUMUK AS-WLT
El PLOT PLAN... A5 -BUILT TOPOGRAPHY
LOT SCU
0 FOUND REBAR ..: CONCRETE
WOOD FENCE
... ...
OO Il ASSUMED ELEV. r -- )T METAL FENCE ® WOOD DECD(
AS -BUILT ... NO COMIERS SET WRECFRrI1FlCAl10N AS -BUILT ... NO CORNERS SFT
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WALL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN- FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVIS,CN PLAT.
I ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICA110N�,
Prepared by
�..�E of gC,04 i Robert E. Johns, Jr. & Assoc.
PLOT PLAN
1h• ymVfytwit iham alp yv»yM
.•,•• ..•S,��e Professional Land Surveyors
t'• wt °a" " °iieifi° h•f°'' s°°Tot I
redlw.tl a m n» KK ••rnw.
♦ ® 1700 Brink Drim
Gj •: •'.,"y�. ANCHORAGE, ALASKA 99504
.» � r te• na.. e...
n»w.t er.. .» wmec
♦ '� ' Ree. Lot S.F. Rae. Plat File No,
r t :• Scale: r, r
r _
'T 1 — 60
FOUNDATION AS -BUILT
}••• ,• +••• ••••^�
' Checked b
L Aa L xMA r.. h.. y e.By e.A 1
.P.�... A IMR .»y.le»
/ Date Surveyed: ., Drown by. REJ V
F• 07/16/14 K
sn.,.lons .w hMmu,bn a m•.n n.•.f fr'
J
ROB,-
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Grid: W.O.
aet_.na.se.o«e..n•t ww
.,. pe I i Dote Drawn:
07/16/14 NW954 14-320
•�°�/
FINAL STRUCTURE AS -BUILT
lM I
V yf •'•.••• , L J •., • Description:
4 RNf.I F. Je,nA Y. Indy ..MY
N»mob. BWt. wA�.
wmhv a. nt ah mat a w
. i .. ,• iLe9n1
o�<,A•..............oaav Lot 41
ame d ew»akh a ra.n ++.�
,,,,� �,,;-���^ � �— I
jt Ao1<ssionot V
OVA%,...�,� T15N R1 W SEC 19
_L__
