HomeMy WebLinkAboutAUTUMN RIDGE LT 12Autumn Ridg
#015- 054-15
Municipality of Anchorage Page
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343,7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020263 PID Number: 01].5-054--1 5
Name:
Crown Pointe, Inc. WastewaterSystem: New
5400 Abbott Road Anch., AK 99507 ABSORPTION FIELD
345-6277 Six (6) Deep Trench
LEGAL DESCRIPTION .6 c.~,, 13
12 Autumn Ridge 3 F,. 10
1 r,. 77
Well: New ~ r~.
Private 62 r,. 62 r,. 1,540 re ASTM D3034 PVC
Alpine Drilling 9/11/2002 46 Ft. Sanders & Sanders 8/8-9/2002
Y""~: 15 G.. I~''"" ~'':F,. lc,..,, .~.,,~,. ~.o..d:2 F,. TANK
SEPARATION DISTANCES [] Septic I-I Holding r"l S.T.E.P. D Other:.
Fmm~ Septic Absorptior Lift Holding ~ublic/Pfivate Manulaclurer; ~apac~l¥ m ~al~on$:
Tank Field Station Tank S~,,~rUr,, Anchorage Tank 2,000
We,, >100' >100' N/A N/A >25' Steel Two (2)
s~.:.w.,~, >100' >100' N/A N/A ~~./~ ~,~o. LIFT STATION. a~..~,~,.,: - NONE ON LOT
~,~ >5' 4' N/A N/A
Fo,.d.,o, >5' >'10' N/A N/A 'Pump on' level at: 'Pump O/r level al: [ H~gh wale, alarm al:
c,,,~,o,,~ None Noted Pump Make & Model Electr~callnspecluonsperformeclby:
See Lot Line Waiver. BENCH MARK
Lower Level Floor.
100.0
Engineer's Stamp
e -\ ........ :...v..
~, c..-:.." . ";~r:_.'~.
.- 49th . ·
Inspections performed by: MEA Dates: 1't 8/8/02
2"~ 8/9/02
Department of Health and Human Services approval
%~4. '.. --..." _~.~ ~
Reviewed and approved by: &/z~ ../' /4fid /c::::)/'c/'-~Date: ¢- q' ~ ~
Permit Number. SW020263
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
PID
Page 2 of 3
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TH 49
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N 90'00'00#E
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S2 I 71.4
C4 11 12.9
C5 J 74.7
M1 ~106.6
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WELL ~ ~'~
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Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-79~4
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW020263 PID No.: 015-054-15
~-86.3
2000, ~*ttOn~<
80.5
69.9 /
/ 64.0
IL~eo~c e x 1;lie
84,0
.Fo__bric .............
Orninf'ietd Rock 80.5
77' /
69.9 /
PROFILE AS-BUILT
Scale: 1" = 10'
FRgl~ ALPINE DRILLING FAX NO. : 907 345 0202 $~n. 0@ 2003 Og:44P, H P1
Borehole Data:
Soll Type, Thickne~ & Wa~cr Stm~
Municipality of Anchor. age
Department of Health and Human Services
825 'L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
R/ck Mysttorl/ http:l/www.cLa nchomge.ak.us
Mayor
Permit l~umber:. #SW 020263 Date of Issue: 6-31.02 Parcel Identification Number:_016~64~16
Date Started: 9-71.02 Date Completed: 9-1'/-02, Is well located al approved p~mlt location? [] Yes []
Legal Description: Autumn Ridge Lot,,!2,
Property Owner Name & Address: Ctowo Pointe Inc.
PO Box 112313
Anchorage, Alaska 99511 ., ,,,
Depth (ft) Method of Drilling [] air rotary [] cable tool
From To
t:tiek-.uo 0 ~
silt 2 3
silty gravel 3 52
gravelly silt 52 58
water sand & gravel 58 62
Casing type: Steel
~nmeter: _Umches ~epm: u.~ zeet
Liaer Type:_ .
Diameter: inches Depth: feet
Casing sfickup above ground: _.2 feet
Static water level (from ground level): 46 feet
Pumping level: 62 feet after
_2 hours pumping ~ gpm
Recovery Rate: 15 gpm
Method of Tcsting: glr.
Well Intake Opening Type:
[] Open End r-I Open Hole
I-] Screened Sta~ feet Stopped feet
[] Perforations Start feet Stopped feet
Grout Type: bentgnite # 8 Volume: 1
Depth: Start O feet Stopped feet
Pump: Intake Depth feet
l~rmp size hp Brand Name __
Well Disinfected Upon Completion? [] Yes [] No
Method ofDisinfectlon: chlodne tablets
Comments:
Well Driller:. Alpk~e Drilling 8. Eoterprisss
Anchorage Alaska 99511
Attention: The well ddllex $hall provide a well log to the property' owner within 30 days of completion and the property
MUNICIPALITY OF ANcHORA GE
Development Services Deparfment
On.Site Water & Wastewater Program
4700 South Bragaw Street
P,O, Box 196650, Anchorage, AK 99519-6650
(907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jul 31,2002
Expiration Date: Jul 31, 2003
Permit Number: SW020263
Legal Description: AUTUMN RIDGE LT 12
Design Engineer: 0014 Anderson Engineering
Owner Name: Crown Pointe, Inc.
Owner Address: PO Box 112313
Anchorage, AK 99511-
Parcel ID: 015-054-15
Site Address: 009410 ZIEMLAK ClR
Lot Size: 43925 SQ. FT.
Total Bedrooms: 6 Permit Bedrooms: 6
This permit is for the construction of:
[] D sposa Fie d [] SepfioTank [] Ho dingTank [] 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.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.Ol '"
Permit Number swOZ, OZ~'=J
Property owner(s) Crown Pointe, Inc.
Mailing address (1) P.O. Box 112313 Anchorage, AK 99511
Mailing address (2).
Legal description (Lot, Block & Sub'd.). Lot 12, Autumn Ridqe Subdivision
Legal description (Section, Township & Range)
Lot Size 43~ 925 s~' Acres/Sq.Ft.
Day phone 345.6277
.Zip Code
Number of Bedrooms Six (6)
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
I cedify that the above information is correct. I fudher cedify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: ,.~
Date of Payment:,
Receipt Number:
(Rev. 12/00)
Waiver Fees: L
Date of Payment:
Receipt Number:
:'i:.:.:;:-:! i;':~ :P.O.' BOX 240773 ~,": :::
:::!ANCHORAGE,: AK 9D524
~:522'7773';.:!~!:?::: i.522-6779 (FAX)
July 23, 2002
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 12, Autumn Ridge Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:.
The owner of Lot 12, Autumn Ridge Subdivision intends to construct a six-bedroom
home on the lot. We are therefore requesting a permit be issued for the construction of
a new well and septic system to serve the proposed home. The attached Site Plan
and backup documentation identify the location and configuration of the new well and
septic system and the parameters used in the design. Also identified on the plans are
the test hole locations and the locations of the wells and septic systems on the adjacent
lots. Drainage arrows are also shown and current drainage patterns will be
maintained after construction. Spot elevations are also shown on the Site Pian.
The test holes placed near the location of the proposed absorption trench and alternate
site indicated silty sand and gravel with varying amounts of silt and a percolation rate
varying from 15 to 35 minutes per inch. We are using an average application rate of .6
gallons per minute per square foot to design the new absorption trench. No
groundwater was found dudng the placement of the test holes and none has been
noted since. We are therefore proposing to construct a 3' wide deep absorption trench
with 10' of drain field rock beneath the distribution pipe. The total depth of the trench
will be 12' with the distribution line at 2' below the surface. The total length of the
trench will be 75'.
The ground surface on the lot slopes as shown on the attached Site Plan with fairly
steep slopes in the area of the new trench. The new absorption trench will be
constructed in conformance with Municipal requirements and parallel to ground
contours where possible. All components of the new trench will be constructed a
minimum of 100' from the well on the lot. The system will also be constructed a
minimum of 100' from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
Lot 12, Autumn Ridge
July'23, 2002
Page Two
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.
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.
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.
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,
Michael E. Anderson, P.E.
Attachments
3,'7 2
'"N:'o~.. / DEDICATE TO F
.+.~¢~' ..... i .....
4O. lO8 ft. V~.x ' x. 2
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'/'"' ~ 31 "" "'
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.~ THIS PROJECT -. -. -.' ..~..
' ' ",. ", '" 49th
3
AREA SYSTEM PLAN "' "' '"' -~"""..
SCALE 1" = 100' I '- '-
110'
2O%
50!
I
.,.~0' X
2,000 Gallon
Septic Tank
Lonq X 3' Wide Six
0' Effective De Bedroom
Absorption Trench Home
Z
' ;
SITE P=L6N "'~ I I '11
:~E~---~ ~o J
LOT 12, AUTUMN RIDGE SUBDIVISION
DESIGN FACTORS:
Six Bedroom Home
Perc. Rate: 15 to 35 MinJInch
Avg. Application Rate: .6 GPDISF
SYSTEM REQUIREMENTS:
Deep Trench System
2,000 Gallon Septic Tank
10' Drain Field Rock
6 Bedrooms X 150 GPD 1.6 GPDISF = 1,500 SF of Absorption Area
1,500 SF/20 SF/LF = 75 LF Trench Length
Therefore: Construct an Absorption Trench 75' in Length by 3' Wide With 10' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 2' Below Existing
Ground. Total Depth of Trench to Re 12' Below Existing Surface. Cover Over Septic Tank
a Minimum of 4' or 2" of Insulation and 2' of Cover
NOTE:
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 10' Separation From Water Service Line.
Municipality of Anchorage ~,.~...~ ..... ./~....~.--/.].,.
. Depa~ment 0f Health & Human Se~ices ~~.~
' 825 L S~t, Anchorage, AK 99502-0650 ~
SOILS LOG - PERCO~TION TEST
. . . ~ ~,~... ..- ~,~
Pe~orm~ For: Dob Klein Date Pe~orm~
Legal D~c~ption: Lot. 12. Autumn Ridge Su~ivision
SLOPE SITE P~N
5
~ .-. ~~ · .'.. . '
'7
g .
Was Gmun~ater
9 E~unter~? No S
If Yes, ~t Depth? . '. L ·
10 Depth to Water O
Afl~ Monitoring None P
11 ~ 'SM · Date: · 1~00 " "E
Reading Date Gross Net Depth To Net
13me 'i~me Water ' .IDrop · '
-1 - 9-Dec 1:04 2.5"
2 1:34 .30 5" · 2.5"
3 . 1:34. ~.5"
4 2:04 30 4.5" 2" ·
5 2:04 2.63'
6 2:34 30 4.63" I. · ".2" '
.12
14 ."
15
18
Bottom of Perc. 15 Min./Inch Perc.'Hole Diameter:: 6"
.. Hole Test Run Between" 4 FL and 5 FL ..
Comments: Percolation Cavity Presoaked Pri(~r tO Testing. '
Performed By: 'A. Harala. I, ' ' Cedify' That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 1/20/00
~'~' ".. '-.'-,..' 'L-~ -' '.'v
Municipali~ of ~chorage · ..... ~.
Depa~ment of Health & Human Se~ices ~~,~
825 L Street, ~omge, AK 99502~650 . ¢. ~ ~ ~,ICH~L E. ~lg~aSC:l
j SOILS LOG - PERCO~TION TEST ~ ~". CE - 4381
'~, ~;-. . ..'~>-;- .
edo~ For: B,ob Klein '; Date Pedo~e~ ~
L~al Description: Lot 12~ Autumn Ridae_ Subdivision
j SLOPE S~E P~N
"5 :
9
' 10
¸.SM
I
i
'Was Groundwater
· Encountered?
If Yes, What Depth.
Depth. to Water
Aftbr Monitoring
· Date:
No
None
1/22/00
's!
'L
O
P
E
13
14
16
17
18
19
Fine
Graded'
Dense
· B~ttom of
Hole
Reading Date Gross Net : Depth.To Net'
Time Time Water · Drop ·
1 -9-Dec 1:07 3,12".
2 1:37 30 4,12' ' 1'
3 1:38 3.06"
4 2:08 30 3.94' ,88'.
5 2:38 3.06"
6 ' 3:08 30 '4' · .94' '
Perc. 35 MJn~/Inch · · Perc. HoI(~ DiameterJ 6"'
Test Run Between 4 Ft. and 5 Fl. '"
comments: Percolation Cavity Presoaked Prior to Testing· -. ' '.
Performe~l By: A._lJAca[~ I, }Z~ Cedify That'This Test Was Performed
In Accordance With Ail State and Municipal Guidelines In Effect On This Date: 1/20/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 12, AUTUMN RIDGE SUBDIVISION
GENERAL:
The scope of this project includes the the procurement and placement
of a new 2,000 gallon septic tank at the location shown on the site plan
and the construction of a 75' long by 3' wide by 10' effective depth
absorption trench also shown on the Site Plan. The total depth of the
trench will be 12' below existing ground and the distribution pipe will be
placed at 2' below the surface. All components of the absorption
trensh must be constructed a minimum of 100' from the well on this
and all adjacent lots. A minimum of 4' of fill must be placed atop the
septic tank and 3' of fill atop the absorption trench. In lieu of fill 2" of
direct bury insulation may be placed with 2' of fill atop the insulation.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
o
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. The 2,000 gallon septic tank must be procured from an approved
septic tank manufacturer and installed at the location shown.
o
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
Lot 12, Autumn Ridge
July 23, 2002
Page 2 of 2
o
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
A silt barrier or geotextile fabdc must be placed between the drainfield
rock and the natural soil backfill.
Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The podion below ground must be perforated.
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield reck for
a 5' wide trench. Contractor shall vedfy this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 12, Autumn Ridge
July 23, 2002
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve,
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-bdilt of the completed system.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
July 30, 2002
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject:
Lot 12, Autumn Ridge Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
We hereby apply for a lot line waiver to allow the alternate absorption trench on Lot 10,
Autumn Ridge Subdivision to be constructed within 5' of the existing lot lines. The
owner of the property intends to construct a six-bedroom home on the lot which will
require a 75' long absorption trench. The lot is only 90' wide in the area of the
proposed alternate absorption site. Soils encountered in the area are silty sands and
gravel with percolation rates between 15 and 30 minutes per inch. This material is
effective in the treatment of septic effluent and migration should be contained in a fairly
limited area. Since the area to the south will never be developed no conflict will ever
exist. We therefore recommend the lot line waiver be approved.
Michael E. Anderson, P.E.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. l~ox 196650 Anchorage, AK 99519-6650
wv~v.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WRg: WR030024
Date Received: 4/7/03
Legal Description: Auf~umq Ridoe Lot 12
Engineer: Michael E, Andemoq, PE
Anderson Enalneerlna
Applicant: Crown Pointe. Inc.
PID#: 015,.o -15 HA~: HA030t21 Permitg:
Waiver Requested: 4 feet from ab$omtlon field to nrooertv line
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
Total:
List Conditions or Reasons for above:
Date: L~ .. ~-- 0 ~' By:~
Rec~: :~3417 Amount: $150.00 Date Paid: 4/7103
-'ANDERSON ENGINEERING
P.O. BOx'240773 :
ANCHORAGE, AK 99524'
522,7773 522'6779 (FAX)
April 4, 2003
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject:
Lot 12, Autumn Ridge Subdivision
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The absorption trench recently constructed on Lot 12, Autumn Ridge Subdivision was
inadvertently placed within 4' of the west lot line. The line was not clearly marked
dudng construction making accurate placement of the absorption trench difficult.
Sufficient area exists on the property to the west for placement of an original and
replacement absorption system. In addition, soils in the area consist of silty sand and
gravel and absorb water at rates considered good for absorption of septic effluent. No
conflicts will exist with the well to be placed on the well to the west.
All required separation distances can be met between the new trench and all wells in
the area. We therefore recommend a waiver be issued allowing the new trench to be
located 4' from the south property line.
Sincerely,
Michael E. Anderson, P.E.
Municipality of Anchorage..
Development SerVices Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
~wvw.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-054-15
GENERAL INFORMATION
Complete legal description Lot 12, Autumn Ridq~ Subdivision
LocatiOn (site address or directions) ZiemlakCircle
Expiration Date: T/l!
Current Properly owner(s) Crown P, ointe, lnc.
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Six {6)
Day phone 727.8167
5400 Abbott Road Anchoracje. AK 99507
Day phone
Day phone
,'FYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site [--I
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Cedificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for propedies served by Class A or B wells or a public
water system, The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
o
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 Health Authority 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 Engineerin.q
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 522.7773
Date 4~4~2003
,..
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(R=v. 12~0)
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
'Development Services Department
· ' Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A, WELL OATA
Well type Pdvate
Date completed 9/1 !/2002
Total de)th ..6~ ;ft.
Parcel ID: 015-054-15
Lot 12, Autumn Ridge Subdivision
ff A, B, or C provide PWSID #
Sanitary seal (Y/N)~_
Cased to ,~i% q.
FROM WELL LOG
Date of test 9/11/2002
Static water level 46
Well production t5
WATER SAMPLE RESULTS:
Coliform 0 coloniesJl00 mi.
Date of sample: 4/2/2003
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size .2~000 gal.
Foundation deanout (Y/N).Y_
Date of pumping
C. ABSORPTION FIELD DATA
Date installed 8/912002
Length ~
Total depth 1~4 ff.
Date of adequacy test
Well Log (Y/N) Y
Wires pmpady protected (Y/N) y
Casing height (above ground) >24
AT INSPECTION
ft.
g.p.m.
in.
g.p.m.
Nitrate~.~mg.A.
Collected by: UFA
Number of Compartments _2
Depression over tank (Y/N) N_
Pumper New Construction
Date installed 8~U2002
Cleanouts (Y/N) Y
High water alarm (Y/N) N
0 colonies/100 mi.
Soil rating (g.p.d./ft~ or ~/bdrm) .6 GPD/SF System type Deep Trench
It. Width 3 fl. Gravel below pipe 10
Eft. absorption area 1,54.0 ~ Monitoring tube Y_. Depression over field N_
Results (Pass/Fail) __
Fluid depth in absorption field before test in. Water added gal.
Elapsed Time: ~ mtn. Final fluid depth in. Absorption rate >=
Any rejuvenation, treatment (past 12 mo.) (Y/N & type) N
For bedrooms
New depth in.
If yes, give date
g.p.d.
D. LIFT STATION
Date installed
"Pump on" level at ~ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump ofT' level at ~
Cycles tested
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements? ~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main NIA
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water service line >10'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout N/A
Holding tank N/A
Absorption field >5'
Surface water >100'
Water main >10'
Driveway, pa~Jng~ehicle storage >25'
Properly line 4~
Water Service line >t0'
Curtain drain None Noted
F. COMMENTS
"See Lol line Waiver
Building foundation >l~
Surface water >I01)'
Wells on adjacent lots >100'
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 HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson~ P.E.
Date 4/,I/2003
HAA Fee $.
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number