HomeMy WebLinkAboutCAMPBELL POINT BLK 1 LT 6Campbell Point
Block 1
Lot 6
#011-262-20
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 3 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131127 PID Number. 011-262-20
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ® New ❑ Upgrade
Name:
S inell Homes Inc.
ASSORP71ON FIELD
❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound
Address
1900 W. North. Lts. Blvd., #200 Anch., AK 99517
Cl Other
Phone Number of Bedrooms
Soil Rating
Total depth from original grade
344-5678 Five (5)
.8 GPD/SF
10.2-11.3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert tom original gradeGravel
6.2-7.3 t
Ft.
depth beneath pipe
O Ft.
Subdivision Block Lot
Campbell Point 1 6
Fill added above original grade
0-1 Ft
Gravellength
94 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
I Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trench"
-between trenches
From
Tank
Field
Tank
Line
_ 940 Fe
2
>10 Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1,500 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
Steel
TWO
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
In.
Pump make and model
Electrical Inspections performed by
Installer
Ink ld D3034
PIPE MATERIAL Horse to tank D3034
Pomraning Excavation
Drain9eld F810 Co/Mr
Inspector MEA
BENCHMARK (Assumed elevation) 100.0 It
Ins tlea 8/4/13 $/5/13
Location and description
es:t` 2�
3m $/7/13 4"'
Garage Slab.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's stamp
Conditional
��a�aap
e�.
Approval: Date
.•�P; -^""""
49th f
, E. ANDERSON •' j
}MICHAEL
No. CE -4381a=-
Approved Z,/ Date pa 'Noe
VaaksESS.k�
Inspection Report -9-1-1246c
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
Permit Number: OSPI31127 4700 Elmore Road Anchorage, AK. 99519-6655 -343-7904
PLAT NO. 66-78 y�Ty
CAMPBELL POINT SUBDIVISION
LOT 6 BLOCK 1 43
1275 S.F.
4
MICHAEL E. ANDERSON
No. CE -4361 -
Five Bedroom
Home
O ALTERNATE SITE
Advantex Treatment
System w/21' Long x 3'
Wide by 6' Effective
Depth Absorption Trench.
Application Rate 3
GPD/SF.
0
m
PLAN AS -BUILT
SCALE V = 30'
J
b
z
Page 2 of 3
PID NO.: 011-262-20
Im
LEGEND
Mt - Monitor Tuba
FCO - Foundation Clean Out
TH - Test Hole
Cl - Clean Out
FSV - Flow Splitter VaNe
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP131127
03.0
y y UU ti
Exlstlre Finsh
Grouts G au
1,500 Gallon
Septic Tank
7.9 9 .75
Page 3 of 3
PID No. 011-262-20
6-20-2013
EAST TRENCH
U
6-20-2013
WEST TRENCH
PROFILE AS -BUILT C:NICHAEL E. ANDERSON
•' i. No, cE-�.ael
No Scale'{
ssia'�s�
EM.
96.7
Certified Drilling Log
VULLIVANDOC
cWATER WELLS
"P.O. Box 670269, Chugiak, AK 99567 BOB -2759
OWNER OF LAND: Spinell Homes —Jeff & Kathie Hoehne
ADDRESS:
LEGAL DESCRIPTION Campbell Point BILK 1 Lot 6
DATE: 7/11/13
PERMIT NUMBER: 131127 DATE OF ISSUE: 6/14/13
TAX IDENTIFICATION NUMBER 01126220000
Is well located at approved permit location: 0 Yes ❑ No
Method of Drilling: ®air rotary ❑ cable tool
Depth of Well: 315
Casing Type: steel Wall thickness ,250 inches
Diameter: 6 inches, depth 315
Static Water Level 220 feet
Recovery Rate 15 ® gpm ❑ gph
Method of Testing air
Well Intake Opening Type: ® open end ❑ open hole
❑screened Start feet Stopped feet
Grout Type: Volume: Bentonite chips
Depth: from 0 feet, to 20 feet
Well Disinfected Upon Completion: ® yes ❑ no
Method of Disinfection: Chlorine 50 ppm
Comments:
Click here to enter text.
Bore Hole Data
Depth
From To
0 2
2 4
4 12
12 65
65 111
111 280
280 310
310 315
Casing Stickup
Overburden
Sand
Sand w/ Gravel
Silt & Sand
Silt Sand & Gravel
Silt w/ Sand
Sand Gravel & Water
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
Matsu Borough: Department of Environmental Conservation.
Development Services Department
N-61ding Sefeiy Division
E
On—Site Water A Wastewater Prr14r, am r°epe a4�`a
4700 Elmore Road
P.Q. Box 196650 <Mill
MarkBegieh Anchorage, AK 99507
Mayor wm.munwralorsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SWj—?L I A Date of Issue: ��13
Parcel Identification Number:` a i/ a GAA &00 0
Legal Description
Property Owner Name & Address
Pump Installation Date:
Pump Intake Depth Below Top of wen Casing: 0 70feet
Pump Manufacturer's Name:6ou )dam
Pump Model: -755l04Q C t_
Pump Size 1 hp
Pitless Adapter Burial Depth: `L feet
Pidess Adapter Manufacturer's Name: ( ark i V1Y\t
Pitless Adapter Installer � ( an r<� EX Ca trd v l0-07
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name: ' j�VriViL
— h�
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation,
On -Site Water & Wastewater System Permit
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
Permit Number:
OSP131127
Tax Code Number:
01126220000
Work Type:
WellSeptic
Permit Effective Dates: June 14, 2013 to June 14, 2014
Design Engineer:
ANDERSON ENGINEERING
Subdivision:
CAMPBELL POINT
Site Legal Address: CAMPBELL POINT BLK 1 LT 6 G:2322
Owner/Address: HOEHNE JEFFREY P & KATHIE A
8207 STORMY PL ANCHORAGE AK 995183010
Site Mailing Address: 8510 HEATHER CIR, Anchorage
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank
All construction must be in accordance with:
Lot Size in Sq Ft: 17275
Total Bedrooms: 5
N Privy Y Private Well N Water Storage
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 By
Issued By:
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 011-262-20
Property owner(s) Jeffrey & Kathie Hoehne Day phone
Mailing address 8207 Stormy Place Anchorage, AK 99518
Site address 8510 Heather Circle Anchorage, AK
Legal description (Sub'd., Block & Lot) Campbell Point, Block 1, Lot 6
Legal description (Township, Range & Section)
Lot Size 17,275 Sq. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
0
Septic Tank
0
Holding Tank
❑
Privy
❑
Private Well
Multiple Dwellings ❑
Water Storage
❑
Number of Bedrooms Five (5)
APPLICATION IS AN:
TYPE OF DWELLING:
Initial 0
Single Family (SF)
(w/wo ADU)
Upgrade F-1Duplex
(D) ❑
Renewal ❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Dis tance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
property owner or authorized agent)
Permit/Rush Fees: 1 ��
Date of Payment: (o �1b l I Ch
Receipt Number: OSSt-Igi'1G
Permit No. os? 1�)lNa-1
Permit App_9-1-12.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
June 9, 2013
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 6, Block 1, Campbell Point Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 6, Block 1, Campbell Point Subdivision intends to construct a new
five -bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to accommodate the home. The attached
Site Plan and backup documentation identify the location and configuration of the
proposed well and septic system along with the alternate site. Also identified on the
plans are the existing wells in the area and septic systems on surrounding lots. No
conflicts exist between the proposed septic system and well or septic systems and wells
on adjacent lots. Drainage arrows are shown on the site plan showing the grade and
direction of flow on the lot. The drainage pattern will not be changed as a result of this
project.
The test hole placed on the lot in the area of the absorption trenches and alternate site
indicate silty sand (SM/SW). The percolation rate of the soil was determined to be 10-
11 minutes per inch. No groundwater was found during the placement of the test holes
and none was noted during the monitoring period. An application rate of .8 gallons per
day per square foot was used in the design of the absorption system. We are
proposing to place a new 1,500 -gallon septic tank and 2-30' long by 3' wide by 8'
effective depth absorption trenches to treat and dispose of the effluent generated in the
house. The elevation of the distribution line in the absorption trench will be 2' below the
surface and the total depth will be 10'. A flow splitter valve will be placed to insure even
flow to each trench. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed
over the absorption trench and 4' over the septic tank.
The ground surface on the lot in the area of the septic system slopes to the southwest
at a shallow grade with some cross sloping from the east. The new trenches will be
Lot 6, Block 1, Campbell Point Subdivision
June 9, 2013
Page Two
constructed parallel with the contours of the slope as much as possible in conformance
with Municipal requirements. The new septic system will be constructed a minimum of
100' from all wells and any surface water and 10' the proposed and existing water
services in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
W E auj'.'
Michael E. Anderson, P.E.
Attachments
MICHAEL E. ANDERSON
No. CE -4381
PLAT NO. 66-78
CAMPBELL POINT SUBDIVISION
LOT 6, BLOCK 1
17,275 S.F.
h
1Ds �TNFR cin,CL�
N
<a
s?$T Rego. 100'
3
^< ac
A I
Five Bedroom
ALTERNATE SITE r"6 \*� Home�
Advantez Treatment co 1,500 Gallon FCO
System w/2I Long z 3' / Septic Tank /
Wide by 6' Effective / \
Depth Absorption Trench. / @ / ,a
Application Rate 3 / / Fsv SV /
GPD/SF.
/ w
OTH1/
/ / o
2-47' Lo Be epth
x 5' Wide �/ I c
/ x 4' Eff iD+
co* / Absorptt''pn Trenches / me I a
Mi• / �/ I
10co T-122
3' /
/ I
NOTE: I
No Areas of Excessive
Slope or Surface Water
are Within 100' of Any Existing
Part of the New Septic Proposed Well
System. S 83'20'00-E 82.84' Well
RELATIVE ELEVATION FROM ASSUMED DATUM 98'
� o
LEGEND
MT - Monitor Tube
•OFQF ,Al \ THO- Test Hole'on Clean Out
�� •••••'•••••, CO - Clean Out
/••��P•"♦j♦ DIMOND BODLEygRD FSV - Flow Splitter Valve
i e 49th s .
z} ♦ _
.........
......:....
�................................... .
�? MICHAEL E. ANDERSON t
♦♦�'�j+'., NO. CE -4381 •.• •. SITE PLAN
. •
♦♦♦�� �j ESS SCALE 1" = 30'
Go F
LOT 6, BLOCK 1, CAMPBELL POINT SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS
Five Bedroom Home 5' Wide Trench System
Perc. Rate: 10 Min./Inch 1,500 Gallon Septic Tank
Application Rate: .8 GPD/SF 4' Drainfield Rock
5 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 937.5 SF Absorption Area
937.5 SF/5 SF/LF'.5 (Red. Factor) = 93.75 LF Trench Length
THEREFORE: Construct 2-47' Long x 5' Wide x 4' Effective Depth Absorption Trenches at the Location
Shown. Flow Line Elevation in Trenches to be 7' Below Original Ground Surface. Total Depth to be
11' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area.
M
50111
5'
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE) �OP�E. ••qC q�.4
00 �. t
NOTE: Grade Area Over Trench to Drain Away. ;'
Minimum 6' Separation From Bedrock. Q, .....asm
Minimum 4' Separation From Groundwater. i
Minimum 100' Separation From Wells in the Area. MICHAEL E. ANDERSON
Minimum 100' Separation From Surface Water or Streams: ��%, a, No. CE -036, :'�,
Natural
Backfill
Geotextile
Fabric
6"
4" Perforated
O
PVC (Holes Down)
50111
5'
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE) �OP�E. ••qC q�.4
00 �. t
NOTE: Grade Area Over Trench to Drain Away. ;'
Minimum 6' Separation From Bedrock. Q, .....asm
Minimum 4' Separation From Groundwater. i
Minimum 100' Separation From Wells in the Area. MICHAEL E. ANDERSON
Minimum 100' Separation From Surface Water or Streams: ��%, a, No. CE -036, :'�,
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Lot 6 Block 1 Campbell Point Subd.
PERFORMED FOR: Spinell Homes
DATE: 6/1/13 PROJECT No.:
PARCEL ID#: TECHNICIAN: JB
DEPTH TEST HOLE 1
(feet)
1 OB/OG
2
3
4
5
6 SM/Sw
7
8
9
10
11
13-
14-
15-
16--
3141516 B.O.H.
17-
18-
19—
I
71819
WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH? L
DEPTH OF WATER AFTER MONITORING: None O
DATE OF MONITORING: 6/10/13 tC
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
1TH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/3/13
1
9:18
5.75"
2
9:48
30
8.75"
3"
3
9:50
5.5"
4
10:20
30
8.375"
2.875"
5
10:22
5.5"
6
10:52
30
8.375"
2.875"
PERCOLATION RATE:10.4 (MIN/INCH) PERC. HOLE DIA. g (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 6/3/13
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Lot 6 Block 1 Campbell Point SUbd.
PERFORMED FOR: Spinell Homes
DATE: 6/1/13 PROJECT No.:
PARCEL ID#: TECHNICIAN: JB
DEPTH TEST HOLE 2
(feet)
1 OB/OG
2
3
4
5
6 SM/Sw
7
8
9
10
11
12-
13-
15—
213
15 B.O.H.
16-
17-
18—
I
61718
WAS GROUND WATER ENCOUNTERED?
IN
IF YES LD WHAT DEPTH'
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
DEPTH OF WATER AFTER MONITORING:None
6/I O/13
TEST HOLE PRESOAKED PRIOR TO TESTING:
DATE OF MONITORING
1
9:13
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/3/13
1
9:13
8.511
2
9:43
30
11.25"
2.75'
3
9:45
811
4
10:15
30
10.75'
2.75"
5
10:17
8,2511
6
10:47
30
1111
2.75"
PERCOLATION RATE: 10.9 (MIN/INCH) PERC. HOLE DIA.-7—(INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 6/3/13
O
NITORING: 6/1 �/I3 LC
C, c) -=I
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
MUNICIPALITY OF ANCHORAGE
Na
DEVELOPMENT SERVICES DEPARTMENT
-0i OF
���"CE OF a♦♦
�p ...................
1
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
�:'• ♦1
g,g ��
i:' i}♦1
' 49th
2
SOILS LOG - PERCOLATION TEST
',
11.25"
2.75"
/................................................ r
',MICHAEL E. ANDERSON jAt
3
LEGAL DESCRIPTION: Lot 6 Block 1 Campbell Point SUbd.
♦♦�rj'•., No. CE -4381
g��
-6/1/13 R: Spinell Homes
♦aI �r
4
DATE:PERFO
PROJECT No.:
�S�� �•••
10.75"
PARCEL ID#: TECHNICIAN: 113
P oCeasional Engineers Stamp:
DEPTH
TEST HOLE 2
(feet)
1-TmmOB/OG
SLOPE
SITE PLAN
2
2.75"
3
4
5
6
SM/Sw
7
8
9
O
10—
WAS GROUND WATER ENCOUNTERED4 NO
IF YES @ WH AT DEPTH
11
DEPTH OF WATER AFTER MO
MONITORING None
DATE, OF MO
12
13
14
15
16
17
18
19
20
B.O.H. C@! 21' PERCOLATION RATE:10.9 (MIN/INCH)
PERC. HOLE DIA. 7 (INCHES)
TEST RUN BETWEEN: 3 FT, and 4
FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR To TEST. TEST HOLE DEEPENED FOR CHANGE
ORDER.
TEST
PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:
8/21/13
O
NITORING: 6/1 �/I3 LC
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/3/13
1
9:13
g,g ��
2
9:43
30
11.25"
2.75"
3
9:45
g��
4
10:15
30
10.75"
2.75"
5
10:17
8.25"
6
10:47
30
11"
2.75"
Development Services Department
On -Site Water &Wastewater Section
Certificate of On -Site Systems Approval
Parcel I.D. 011-262-20
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax. 907-343-7997
Expiration Date: (,, — 2 2 Z -Q V
Complete legal description Campbell Point Sub, Block 1, Lot 6
Location (site address) 8510 Heather Circle
Current property owner(s) Paul & Amanda McGrath Day phone (907) 312-0787
Mailing address 8510 Heather Circle, Anchorage, AK 99502
Real estate agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
IC
Private Septic
❑■
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ $550 Waiver Fee $
Date of Payment IO 11. Date of Payment
Receipt Number. 3 Receipt Number
COSA# OSC211090 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller Date 3/4/21
'�c oF'4�q�11
TH
6. DSD SIGNATURE
System #1 Approved for • • • • • ' • ' /
bedrooms • Benj chiller •Schiller i
System #2 Approved for bedrooms�� ��`c�s••• CE 12592���
Disapproved �,,kF�
ipROfESS10�P���
'N*4& s`
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date:_ -Z2 -2 C�Z�
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Campbell Point Sub, Block 1, Lot 6 Parcel ID: 011-262-20
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/11/13
Total depth 315 ft
Cased to 315 ft
9 Sanitary seal is functioning correctly
limil Wires are properly protected
Casing height (above ground) 20 in.
Date of flow test for COSA 3/3/21
Static water level at beginning of test 233.9 ft
••,C�Z7"1010- M,
I�irel�li7��e1
Age of tank(s) 8 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 50
Fmil Standpipes/foundation cleanout per record drawing
Date of pumping 3/4/21 Around the Clock Pumping
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) $/5/13
D ALL standpipes present per record drawing
Total measured depth from grade 12.2/9.4 ft (max)
Measured depth to pipe invert from grade 8.4/52 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 3.8/4.2
0 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Structure served by this system
Well production at time of test 4.8 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic 7.43 ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 3/2/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 3/3/21
Results R]Pass For 5 - bedrooms
Fluid depth prior to test 0/0 in
Water added 872 gal
New depth 0/10 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate X750 gpd
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0
Yes
Community Sewer Manhole/Cleanout > 100'
0✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' F71 Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' r-71 Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
0✓ Yes if No ft
Water Main > 10'
Animal Containment > 50' 0✓ Yes
if No ft
F/ Yes
if No
ft
Yes if No ft
Water Service Line > 10'
0✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' F/ Yes
if No
ft
0✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
0✓ Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Q
Absorption Field > 5'
0✓
Yes
if No
ft
Private Wells > 100'
0✓ Yes if No ft
Water Main > 10'
[Z]
Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
0✓
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S 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.
COSA Checklist yellow sheet
low'.
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¢���'F��• . CE 12592 . •,``4 7,
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MUNICIPALITY OF ANCHORAGE
l
Development Services Department \ `-= " � Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 011-262-20 Expiration Date: �/!-,
1. GENERAL INFORMATION
Complete legal description Campbell Point, Block 1 , Lot 6
Location (site address) 8510 Heather Circle Anchorage, AK
Current property owner(s) Adam & Fritha Breidinger Day phone (907) 529-9050
Mailing address 8510 Heather Circle Anchorage AK 99502
Real estate agent Day phone
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
n Duplex
H Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic
Water Storage H Holding Tank
Community Well n Community
Public Water System Public Sewer n
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ S Waiver Fee $
Date of Payment 2//21/ f Date of Payment
Receipt Number Oil (965-D Receipt Number
COSA# CSC 1R i 0-3 �l Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 2/11/19
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6. DSD SIGNATURE •
11 fit
System #1 Approved for bedrooms f• }MICHAEL E. ANDERSON N/.41
• ff
•C%;a No. CE-4381 {�=
System #2 Approved for bedrooms ••,�FQ�..ti•2/25/19�.e' r
Disapproved ,+h�vtRs ..:.4•
Conditional approval for bedrooms, with the following stipulations:
ON-SITE m
WASTEWWATER ANDATER
PROGRAM
M1 A.
SEROC'
By: , - Original Certificate Date: 3 _J/•
`1
The Municipality of Anchorage Development Services Division (DSD)issues Certificates of On-Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Campbell Point B1 L6 Parcel ID: 011-262-20
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
0 Well log is filed with Onsite (or attached) Well production at time of test 4.1 gpm
Date drilled 6/14/13 Water storage tank volume N/A gallons
Total depth 315 ft Well disinfected for coliform test? ❑ Yes ❑■ No
Cased to 315 ft ❑■ Coliform bacteria is Negative
■❑ Sanitary seal is functioning correctly Nitrate mg/L It Nitrate less than MRL(ND)
['Wires are properly protected Arsenic 9.51 ug/L ❑Arsenic less than MRL (ND)
Casing height(above ground) 24 in. Collected by Forge Engineering
Date.of flow test for COSA 2/5/19 Date of Sample 2/6/19
Static water level at beginning of test 233 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 5 years ❑ Required maintenance completed
Tank type/material "`' Age of lift station years
Measured operating fluid level in septic tank 50 Lift station material
■❑ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 2/5/19
D. ABSORPTION FIELD DATA 5-Wide Shallow Trench
Which system tested (date installed) 8/5/13 Adequacy test date 2/5/19
■❑ ALL standpipes present per record drawing Results ['Pass For 5 bedrooms
Total measured depth from grade 10/12 ft(max) Fluid depth prior to test 13/0 in
Measured depth to pipe invert from grade 6/8 ft(min) Water added 1171 gal
❑ N/A—pressurized field New depth 38/0 in
O Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min
depth into effective
Final fluid depth 20/0 in
El Code-required soil cover over field
Absorption rate >750 gpd
❑ System presoaked No
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test) gallons Gallons introduced N/A If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100'
0 Yes if No ft 0 Yes if No ft
Neighboring Tank> 100' 0 Yes if No ft Private Sewer/Septic Line > 25' El Yes if No ft
Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft
0 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft
Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft
Water Main > 10' El Yes if No ft Community Wells > 200' 0 Yes if No ft
Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0. Yes if No ft If absorption field is under driveway comment below
Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' El Yes if No ft
Water Service Line > 10' 0 Yes if No ft Community Wells>200' El Yes if No ft
Surface Water> 100' El Yes if No ft
F. ENGINEER'S COMMENTS
4744
G. ENGINEER'S CERTIFICATION .44���, .IR,,,,..... ..
AP(79\•••• S. t
I certify that l have determined through field inspections and review s `4 '•.•• ..
of Municipal records that the above systems are in conformance with i 4 49th 1\ ,
MOA COSA guidelines in effect on this date. S11iraH1111f11 11t1111 111111K111 1111„ 11,E„111111!
im reams, ..a ......w....
MICHAEL E. ANDERSON I j
♦��'� ''•. No. CE-4381 �•'��-
` < ••NI 2/18/19 ••6411•'`t11
COSA Checklist yellow sheet ;T.a el) •1111.11■11.11111111••'' x, \4••m
• '� Municipality of Anchorage
On -Site Water and Wastewater ProgW
(907)343-7904 x,.
Certificate of On-Siite systems- proval
Parcel I.D. 011-262-20 I !� Expiration Date: -� 7
1. GENERAL INFORMATION ) Li
Complete legal description Campbell Point, Block 1, Lot G
Location (site address) 8510 Heather Circle Anchorage, AK
Current Property owner(s) Spinell Homes, Inc. Day phone
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
344-5678
1900 W. Northern Lights Blvd., #200 Achorage, AK 99517
Day phone
F� Single Family (w/wo ADU)
❑Duplex SUBMITTAI
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Five JAN 2 4 2014
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
71
Public Sewer
❑
Waiver/Variance request for:
Disi
Received by:
COSA to be released�fo the engineer, unless otherwise requested by the engineer.
COSA Fee $ (,9 ?u I A )�(Ar, 1
Date of Payment I label
Receipt Number 0015D_ G
COSA# o,)C114Io1�"
}
Date:
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 Anderson Engineering Phone
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE _
_System #1 Approved for J bedrooms
System #2 Approved for bedrooms
Disapproved
522-7773
Date 1/20/2014
Conditional approval for bedrooms, with the following stipulations:
By: ��� ir� Tit% . Original Certificate Date: 1-2 i - %
The m.. lity o Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
CASA f . sheet E - c
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: Campbell Point, Block 1, Lot 6 Parcel ID: 011-262-20
A. WELL DATA
Well type Private
Date completed 7/11/13
Total depth 315 ft
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
_ Sanitary seal (Y/N) Y
Cased to 315 ft
FROM WELL LOG
7/11/13
WATER SAMPLE RESULTS
220
ft.
15 g.p.m.
Coliform 0 colonies/100 mL Nitrate 4 1) mg/L
Arsenic S 13 ug/L Date of sample: 1/14/14
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,500 gal. Number of Compartments 2
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) >18 in.
AT INSPECTION
ft.
g.p.m.
Collected by: Anderson Engineering
Date installed 8/4/13
Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN)
Date of pumping New Const. Pumper
C. ABSORPTION FIELD DATA
Date installed 8/5/13
Length 94 ft
Total depth 10-12 ft. Eff. absorption area 940 ft?
N C t
Y
Soil rating (g.p.d./ft? or fe/bdrm) .8 GPD System type 5' Wide
Width 5 ft. Gravel below pipe 4.0 ft.
Monitoring tube Y Depression over field N
Date of adequacy test ew OnS . Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons_
"Pump on" level at in. "Pump off" level at
Datum Cycles tested _
E. SEPARATION DISTANCES
Septic tank/lift station on lot
>100'
Absorption field on lot
>100,
Public sewer main
NIA
Sewer ]septic service line
>25'
Animal containment areas
>50'
SEPTIC/HOLDING TANK ON LOT TO:
>5'
— Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
>100'
>100,
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas >100'
>5'
Building foundation Property line
1
Water main > Water service line >10,
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOTTO:
Property line >10' Building foundation >10'
Water Service line >10' Surfacewater >100'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
Engineers Printed Name Michael E. Anderson, P.E.
Date 1/20/14
COSA brown sheet -1 0-10-1 z.doc
Absorption field >5'
Surface water >100,
Watermain >10'
Driveway, parking/vehide storage >10'