HomeMy WebLinkAboutAUTUMN RIDGE LT 5May 05 22 09:38p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
Development Services Department ® Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 015_05408
Legal Description Block I Lot
AUTUMN RIDGE 1 1 5
Pump Installation Date: os - 02 - 2022
Pump Intake Depth Below Top of Well Casing: 245
Pump Manufacturer's Name: RED JACKET
Pump Model:
8S21
Pump Size: 1'0 hp
Pitless Adapter Burial Depth: 14 feet
Date of Issue: -
Property Owner Name & Address:
HARRIS TRAVIS LEE & ANN SMAKA
9362 AUTUMN RIDGE CIRCLE
ANCHORAGE, AK 99507
Pitless Adapter Manufacturer's Name: MARTINSON
Pitless Adapter Installer:
Well Disinfected Upon Completion? $] Yes ❑ No
Method of Disinfection: PELLETS '
Comments:
Pump Installer Name: _
Company:
Mailing Address:
feet
ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
ANCHORAGE, AK 99518
907-243-0740
State:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
www.d.anchorage.ek.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO10480 PID Number: 015-051.04
wme Wastewater System: New
Crown Pointe Inc.
"°"°°a° ABSORPTION FIELD
5400 Abbott Road Anch., AK 99507
P,,, : MAnoeraeeaoon:: Deep Trench
345-6277 Five 5
Sd Ratap. TOUT oePm hom orgvW yreoe:
LEGAL DESCRIPTION 5 DPGF' 12.5 Ft.
Dean W PCW oatom hum agmM 2A :
Ga;M teem oaneam PW
Block: Ea: sueGrvUiM:
5 Autumn Ride
2 Ft.
10 Ft.
itvmanp: Range: sac :
to aotea Mt We onYnM Vete:
1
Gavel Largm:
76 Ft.
12N 3W 15
Ft.
Gaw++tm:
"W 01 knee: QManW eMreen Ines:
Well: New
3 Ft.
1 Ft
owufteeon (Pnvate. A, S. Cl:
TOW Dapm:
Gael10:
ia4 Wnplipn area:
1,520 Fe
Para Mater W:
ASTM D3034 PVC
Private
262 FI.
262 Ft
Dnnw.
Dale dAb:
SUIK water L":
"Law.to
Sanders & Sanders
eUlMlad.
12112.13101
Alpine Drilling
tntro2
215 Ft.
YwW:
Pump set at:
Cmog MAoove Gant:
TANK
50 GPM
Ft.
2 FI.
SEPARATION
DISTANCES
o Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To Septic Absorption
Lift
Holding uW„JPrtYate
Line
w wa:
Anchorage Tank 1,500
From Tank Field
Station
Tank sawer
w WNnenU.
>100' >100'
NIA
NIA >25'
lotIx W.
Steel Two (2)
waa
>100'
>100'
NIA
NIA
LIFT STATION — NONE ON LOT
sulfaWwster
Ease
>5'
>10'
NIA
NIA
bad.
GM.
w�laczwer.
X
pM SL
P at. nnMw•arm 11.
FaaafMan
>5'
>10'
NIA
NIA
„.
„. in.
Pump Moxa 8 Motel
EIeCe.Cal YUpeao^e Ped—' by.cwM„DM+1
None
Noted
Renanu:
BENCH MARK
ltewqWn.
Top of Foundation Cleanout
100.0 FE
Engineer's Stamp
.'6S\U\aa44
�i
`P���.
`7P ay #1
Inspections performed by: Mike Anderson Dates: 11' 12/12/01
..--. -.t... ,
a
'
2nd 12113101
....... ....- ... .._... ...0
r^� M'CHAEI'E. AVDE 4504 ! =
Department of Health and Human Services approval
No. CE -4,391 tr
�_
Reviewed and approved by: Date:
��Essla'P••
kahae�..••�
(tea.. 'oust
Municipality of Anchorage Page 2 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 -343-7904
On -Site Wastewater Disposal System or Well inspection Report
Permit Number SWO10480 PID No. 015-051-04
N 00°06'29' W 220.22'
--------- 10_T.dcE-----____--
o /0
)SJS2�N C4
M T
Ziemlak
Circle
,,-JM%5 ®„ w'
ve amu,
room C 4
PLAN AS -BUILT
SCALE 1" = 40'
MICHAEL E. ANDERSON
. No. CE -4381 r
A
B C
S1
9.2
21.1
S2
19.4
21.5
C4
44.5
55.2
M1
41.7
50.5
C5
28.8 14.7
M2
25.0 13.8
PLAN AS -BUILT
SCALE 1" = 40'
MICHAEL E. ANDERSON
. No. CE -4381 r
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW010480
PID No.: 015-051.04
Q N in
s f U
rmur ILC f-\J-uvll_
Scale: 1- - 10'
Municipality of Anchorage
Development Services Department/On-Site Water & Wastewater Program
4700 South Bragaw Street Anchorage, AK 99519
SOILS LOG - PERCOLATION TEST
Performed For. Crown Pointe, Inc.
Legal Description: Lot F Block 1 Autumn Ridge
11
18
OG/PT
Silty Gravel
w/Sand
[CUT
Medium
Dense
Bottom of
Hole -19'
Was Groundwater
Encountered? No
If Yes, What Depth?
Depth to Water
After Monitoring
Date:
Date Performed:
snt
See Site Plan
a �F' �•..:AA�LgSQa9
••% �f
t •. GF -S 1
t� psi , •_.`° . .
` rTF'•.....••
PRO
Reading
Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
0 h4e71 4:08
1.75'
2
/s L 4:38
30
3.25'
1-5-
3
4:39
1.75-
4
5:09
30
3.13'
1.38•
5
5:10
1.75'
6
5:40
30
3.13•
1.38•
Perc. Rate: 13 MinAnch Pem. Hole Diameter. 8•
Test Run Between 5 Ft. and 6 Fl.
Comments: Soils Encountered are Similar to Those in Testholes 11 and 12.
Test Hole Pre Soaked Prior to Testing.
Performed By: Mike Anderson. I, Michael 17 Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 6118/02
Municipality of Anchorage
Department of Health and Human Services
825'L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Pod: Mystrom hltPjMWW.d.anchcrage.akus
Mayor
Permit Number. tISW 010480 Date of Issue: 12 601
Parcel Identification Number. 015-051-04
Date Started: 1-9-02 Date Completed: 1-11-02 Is well located at approved permit location? ® Yes ❑ No
1egid Description: Autumn Ridge tot 5
Property Owner Name & Address: dr—own
po Box 112313 c.
Anchoraae. Ak 99511
Borehole Data: Depth (f3)
Soil Type, Thickness & Water Strata From To
stick-up
organic & silt
gravelly silt
silty sandy gravel H2O 2 gpm
silt
gravelly silt
silty gravel
silty sandy grave- wet
silt
silty cobbly gravel
Water sand & gravel
0
2
3
79
83
90
115
164
171
178
246
2
3
79
83
90
115
164
171
178
246
262
Method of Drilling ® air rotary ❑ cable tool
Casing type: steel
Wall Thickness: .025 inches
Diameter. 6 inches Depot 262 feet
Liner Type:
Diameter: inches Depth feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 265 feet
Pumping level: 262 feet after
2 hours pumping 50 gpm
Reeovery Rate: 50 gpm
Method of Testing: airlift
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Start fed Stopped fed
❑ Perforations Start fed Stopped feet
Grout Type: O.entonite # 8 Volume: L±i
Dept Start 0 feet Stopped ± fed
Pump: Intake Depth feet
Pump size hp Brand Natne
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection:
Comments:
Well Driller. Alpine Drilling & Enterprises
P O Box 110496
Anchorage AK 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
eh.11 ..m.,;A^ a a 11 Inn fn thn rlvnt of rrvolfh .0 M,,man CnrvNPa .4h:n 6n AOV nf,y.n.nldinn
111=40'
2001-143
AUTUMN RIDGE SUBDIVISION
I nT r
FlNAL STRUCTURE AS -BUILT
AS -BU I LT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
GASTALDI LAND SURVEYING
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
JEFF A. GASTAIDI, R.L.S.
IT THE RESPONSIBILITY OF THE OWNER TO
4726 WEST 68TH AVENUE
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
ANCHORAGE, ALASKA 99502
COVENANTS OR RESTRICTIONS WHICH DO NOT
PHONE 248-5454
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
GMD
DATE
HEREON BE USED FOR CONSTRUCTION OR FOR
2437
6/17/2002
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
F.B.
JOB NO.
02-07
ARSS
NOTE: NO CORNERS SET THIS DATE.
OF -•*1
49TH • •?
......................
Jeffer astaldi I o`
j- AV• LS -6091 �`
604, •••.....•••••a5J�4�
'��ono
itFA aa%**•�
0
ZIEMLAK
CIRCLE
z�
BUILDING DETAIL
SCALE: 1"=20'
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Dec 06, 2001
Expiration Date: Dec 06, 2002
Permit Number: SWO10480 Parcel ID: 015-051-04
Legal Description: T12N R3W SEC 15 NE4 PTN
Design Engineer: 0014 Anderson Engineering Site Address: 005400 ABBOTT RD
Owner Name: Crown Pointe, Inc. Lot Size: 40272 SQ. FT.
Owner Address: 5400 Abbott Road Total Bedrooms: 5 Permit Bedrooms: 5
Anchorage , AK 99507-0000
This permit is for the construction of:
❑✓ Disposal Field r;� 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 ( 1BAAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL SOILS TEST TO
COVER THE PORTION OF THE ORIGINAL AND UPGRADE ABSORPTION FIELDS WITH A 30 FEET RADIUS
AROUND THE PERCOLATION TEST HOLE.
r` NOTE: THIS PERMIT ISSUED FOR AUTUMN RIDGE SUBDIVISION LOT 5
Received By:
Issued By:
v ¢
Date:
Date: 1? -16
3:�s�M
MUNICIPALITY OF ANCHORAGE
Development Services Department
m. i<.-
5 D
On -Site Water 8 Wastewater Program
t
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Dec 06, 2001
Expiration Date: Dec 06, 2002
Permit Number: SWO10480 Parcel ID: 015-051-04
Legal Description: T12N R3W SEC 15 NE4 PTN
Design Engineer: 0014 Anderson Engineering Site Address: 005400 ABBOTT RD
Owner Name: Crown Pointe, Inc. Lot Size: 40272 SQ. FT.
Owner Address: 5400 Abbott Road Total Bedrooms: 5 Permit Bedrooms: 5
Anchorage , AK 99507-0000
This permit is for the construction of:
❑✓ Disposal Field r;� 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 ( 1BAAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL SOILS TEST TO
COVER THE PORTION OF THE ORIGINAL AND UPGRADE ABSORPTION FIELDS WITH A 30 FEET RADIUS
AROUND THE PERCOLATION TEST HOLE.
r` NOTE: THIS PERMIT ISSUED FOR AUTUMN RIDGE SUBDIVISION LOT 5
Received By:
Issued By:
v ¢
Date:
Date: 1? -16
Parcel I.D. Ill
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 SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Number SW 010400
Property owners) Crown Pointe Inc.
Day phone 345.6277
Mailing address (1) P 0 Box 112313 Anchorage
AK 99511
Mailing address (2)
Zip Code
Legal description (Lot, Block & Sub'd.) Lot 5 Autumn Ridge
Subdivision
Legal description (Section, Township & Range)
Lot Size 40.272 S.F. Acres/Sq.Ft.
Number of Bedrooms Five
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
❑
Sewer and Well
®
Water Storage
❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: 302 � � Waiver Fees:
Date of Payment: Date of Payment: h
Receipt Number: / i5 7 Receipt Number:?
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE; AK 99524
522-7773 522-6779 (FAX)
November 26, 2001
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 5, Autumn Ridge Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The owner of Lot 5, Autumn Ridge 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 serve the proposed home. The attached Site Plan and
backup documentation identify the location and configuration of the new septic system
and the parameters used in the design. Also identified on the plans are the location of
the new well on the lot and the test hole locations. Existing drainage patterns are
shown and will not be altered by the development of the lot.
Two test holes were placed near the location of the proposed absorption trench. These
test holes indicate gravel with varying amounts of silt near the location of the new
absorption trench. Percolation tests In the material resulted in rates of between 24 and
34 minutes per Inch. No groundwater was found during the placement of the test holes
and none was noted during the monitoring period. We are therefore proposing to place
a deep absorption trench system with 10' of gravel beneath the distribution pipe. The
total depth of the trench will be 10'. The distribution pipe will be placed at 2' below the
ground surface to provide sufficient drop from the septic tank to the absorption trench.
The total length of the new absorption trench will be 75'. The majority of the trench will
be constructed near the material with the lower percolation rate. We are, however,
using an average application rate of .5 gallons per day per square foot as a small
portion of the trench is covered by Test Hole No. 12 which has soils with a slower
percolation rate.
The ground surface on the lot slopes as shown on the attached Site Plan with very little
to no slope near the proposed septic system site. The new absorption trench will be
constructed on a fairly flat surface in conformance with Municipal requirements and
parallel to ground contours where possible. All components of the new septic system
will be constructed 100' from the well to be constructed on the lot.
If the system is constructed in accordance with our design the following statements
apply:
Lot 5, Autumn Ridge Subdivision
November 26, 2001
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.
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,
Michael E. Anderson, P.E.
Attachments
�Y 49th
MICHAEL E. ANDERSON
No. CE -4381
Qwb
999 .2
Trz
T.3
Am
P,
40 404.9
474.
t5
4 474 ft.
11 ft
m -10 IH -27
a lq!,e +3 2
U) Tr
Drjl,
U2. J saaµ is
-
w
lb
THIS PROJECT
Z + ! P97
40,38 q.ft
�4B 0
TH-12
Deck
f -k +
39S.4
4C
i q4l
+ IN
/4 1 k,7,' , .1 1 40,196 s ft.
TH-1
7
X,
21.
s.
40.516 Allt.
4 +729 C -.-t
32-11 9
M�ek
1H-
390—
A7
-AR
.4 EA MAP'�..'
T7=100,1
_----_-_ N01.&".ESWT.22
1 _--___-_
.0Tdo ---
Cron /
THI�
75' 3slide
X 10 �f ctive.De
Absor ti Trend
y N _
co ao
V
o
, i, 1, 00 Gallo
N Septic Tan
rri { _ r
Home
I }
b
G4
i A s:
ternate
Site
IF"
49th `vh•
w
MICHAEL E. ANDERSON
Jij�4y
No. CE -436+ Fr21
L -61.41V , Qf
R=50.00. p
W
0
56 "K SITE PLAN
m
SCALE 1" = 40'
LOT 5, AUTUMN RIDGE SUBDIVISION
DESIGN FACTORS:
Five Bedroom Home
Perc. Rate: 24 to 34 MinAnch
Avg. Application Rate: .53 GPD/SF
SYSTEM REQUIREMENTS:
Deep Trench System
1,500 Gallon Septic Tank
10' Drain Field Rock
5 Bedrooms X 150 GPD 1.5 GPDISF = 1,500 SF of Absorption Area
1,500 SFI20 SFILF = 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 Be 12' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
Natural
116^ "T" . Backfill
6"
10'
3'
_Geotextile .
Fabric
4" Perforated
PVC (Slots Down)
Drainfield
Rock
TYPICAL DEEP TRENCH SECTION
NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
y
0
49th qi
MICHAEL E. ANDERSON
Ly No. CE -4381 A
r
491h
Municipality of Anchorage L/G •mob
Department of Health 8 Human Services 4LHAEI E. ANDERSON
epa - �� s,S, NoNo.CE-4361 4i
825 L Street. Anchorage, AK 99502-0650 • r
SOILS LOG - PERCOLATION TEST 040 PRT E55N�:�'rr
Performed For " h '^^ Date Performed: 1211199
Legal Description: I of 5� Autumn Ridge St 1w!ivieion SITE PLAN '
SLOPE
1 OGIPT. �s .
2
3 gSTHOL�Q �1 0
4 540.381.340t -
5
t -5 Gravel
Some Silt
GM .
7 .
•
8
Net
Time
Depth To
Water .'
Net
Drop
Was Groundwater '
4 -Dec 14:37
9
Some, Encountered? No
Glazing If Yes, What Depth?
'
10,
Depth to Water.
•'
After Monitoring .. None'
11
Date: 129J00
Hole .
19 Perc. Rate: 24 MinAnch . Perc. Hole Diameter. 6''
Test Run Between 4 FL and 5 FL
Comments:.Percolation Cavity Presoaked Prior to Testing.
Performed By' AA H� t. M15 hiel F Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date120!00
:
4
W1 14.
ate Gross
Time -
Net
Time
Depth To
Water .'
Net
Drop
4 -Dec 14:37
4-
� 1507
30
54"
125'
15:10
4.
15:40
30
525'.
1.25'
I
16:10
30 .
6.5-,
125'
Hole .
19 Perc. Rate: 24 MinAnch . Perc. Hole Diameter. 6''
Test Run Between 4 FL and 5 FL
Comments:.Percolation Cavity Presoaked Prior to Testing.
Performed By' AA H� t. M15 hiel F Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date120!00
:
4
W1 14.
Or Ak
Municipality of Anchorage �• f;:'J"
Department of Health & Human Services w <�•�•etf�•`f �,-�"`^��
6'tF+• WCHAEL E ANERXN � <�
825 L Street, Anchorage, AK 99502-0650 0`` f� CE -4331 .•�
SOILS LOG- PERCOLATION TEST 6�/9D''•••••••
Date Per���•��"
formers l F 0 f0
Performed For. Bob Klein 1. -ml59 6
Legal Description: Lot 5 Autii n Ridge Subdivision
SLOPE SITE PLAN
1 OG/PT 4
2
3 TESTHOLE NO.'12
4 40.385 sq -n-'
5 Gravel - '•� ..0 f '
Varying Silt
6
GM1MLLji
7
g
Was Groundwater
9 Some Encountered? No S
Glazing . If Yes, What Depth? L
10 Depth to Water O
After Monitoring None P
11 Date: 1/22/00 E
12 Reading Date Gross Net Depth To Net
Time Time Water Drop
13 1 4 -Dec 14:42 2.88"
2 15:12 30 3.81" .93"
14 3 15:13 2.88" .
4 15:43 30 3.76' .88"
15 5 1 15:44 2.88'
6 16:14 30 3.76" 88'
.16
17
18L Bottom of .
Hole
19 Pere. Rate: 34 MinAnch Perc. Hole Diameter. 6"
Test Run Between 4 Ft. and 5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing. .
Performed By: A I, Michael Ande Mai ' Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 1120100
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 5, AUTUMN RIDGE SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,500 gallon septic tank at the location shown on the Site Plan.
Work also includes the construction of a new 75' long X 3' wide X 10'
effective depth absorption trench at the location also shown on the
Site Plan. The distribution line in the trench will be placed at 2' below
the existing ground surface. Total depth of the trench will be 12' below
the existing ground surface. The new absorption trench must be
placed outside the 100' protective radii of wells in the area.
2. 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.
3. 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.
4. 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.
5. 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. A new 1,500 -gallon septic tank must be procured from an approved
source and installed at the location shown.
2. 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.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 5, Autumn Ridge Subdivision
November 26, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. 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.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. 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.
6. 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.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify 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.
2. 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).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank Inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 5, Autumn Ridge Subdivision
November 26, 2001
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 -built of the completed system.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: December 5, 2001
TO: Dan Roth
FROM: Mike Anderson, P.E.
SUBJECT: Lot 5, Autumn Ridge Subdivision
Septic System Construction Permit
The test holes shown on the Site Plan for the septic system on the subject lot are
located at each end of the proposed absorption trench. We assumed based on this
information that the subsurface material between the test holes would be similar. We
will, however, furnish a new test hole log and percolation test for materials encountered
near the middle of the new absorption trench. This log will be submitted with the as -
built for the new system. If the subsurface materials are found to be substantially
different than the existing test holes indicate, you will be consulted and a new design
prepared for the absorption system.
Please let me know if further information is required before the septic system
construction permit can be issued.
•
GC
• Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 S,i E T Y
Certificate of On-Site Systems Approval
015-054-08-000f 2 5�`t�
Parcel I.D. Expiration Date:
1. GENERAL INFORMATION
Complete legal description Autumn Ridge, Lot 5
Location (site address) 9362 Autumn Ridge Circle Anchorage, AK
Current Property owner(s) Sharon Tobias Day phone
Mailing address 177754 Shasta Circle, Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
tl Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Five
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: ti,tim Led p1 Date: of z /p
6q
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ C Ltb Waiver Fee $
Date of Payment POO Date of Payment
Receipt Number Oa� D Receipt Number
COSA# 0 5C1g15 6 1 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, P.E. Date 9/18/18
TM �\ 9*�l
6. DSD SIGNATURE
System #1 Approved for bedrooms
pp i Benja n Schiller
System #2 Approved for bedrooms � csl. .CE 12592
Disapproved llSSS +��
Conditional approval for bedrooms, with the following stipulations:
Y UI y`
�G
ON-St►t ;r6
W
;,1-2) WASTEWATAND
ER
0,4�
PROGRAATERM
le
417-sERvo-s
By� _ 4 / Original Certificate Date: 9-a
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 blue sheet c
n ;t i an 1 septic system is on the lot:
6 >>, OSA Checklist# of
11 ct e> erved by this system
ti
n
Certificate of On-Site Syst - tPAtO, o - Checklist
A
Legal Description: Autumn Ridge, Lot 5 �! `�� s s 9�
Parcel ID: 015-054-08
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed
1/11/02 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 262 ft. Cased to 262 ft. Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 1/11/02 4/20/17
Static water level 215 ft 207.6 ft.
Well production 50 g.p.m. 6.13 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate •372 mg/L
Arsenic ND ug/L Date of sample: 8/16/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 12/12/01
Tank size 1 ,500 gal. Number of Compartments TWO Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping 4/25/17 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Date installed 12/13/01 Soil rating (g.p.d./ft2 or ft2/bdrm) .5 GPD/SF System type Deep Trench
Length 76 � ft. Width 3 ft. Gravel below pipe 10 ft.
Total depth 13.5 ft. Eff. absorption area 1,520 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4/20/17 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 9 in. Water added 756 gal. New depth 21 in.
Elapsed Time: 1 ,440 min. Final fluid depth 9 in. Absorption rate >= 750 g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100' On adjacent lots 100'
Absorption field on lot 100' On adjacent lots 100'
Public sewer main >75' Public sewer manhole/cleanout 100'
Sewer/septic service line >25' Holding tank >100'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5 Absorption field
5'
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
>10'Property line Building foundation 10 Water main >10
Water Service line 0>1Surface water 100 Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION ��t\\\\‘
I certify that I have determined through field inspections and .• 1,
review of Municipal records that the above systems are in Aete•
conformance with MOA COSA guidelines in effect on this date. *.• 49 /\ 1-17•*
Benjamin Schiller, P.E. •• •• r,
Engineer's Printed Name 'Ai • ��
Date 9/18/18 �r -. Ben n Schiller
l� f( '. C 1592 ..**1/4(4r�
49
l °PROFE SIGN' . ..
COSA brown sheet 10-10-12.doc
0
• Municipality of Anchor •• �� '' =a>°` $L `o
V. 2
On-Site Water and Wastewater Progr•.rp °fir z h:
(907)343-7904 5 a`E.
APR 262017
Certificate of On-Site Systems At'a oval w
Parcel I.D. 015-054-0$-000 Expirationl10. -6 g a 011
1. GENERAL INFORMATION
Complete legal description Autumn Ridge, Lot 5
Location (site address) 9362 Autumn Ridge Circle Anchorage, AK
Current Property owner(s) Stanley & Joan Lewis Day phone
Mailing address 9362 Autumn Ridge Circle Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
0 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Five
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well 0 Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: 1/ 1C4U1Z /2] (f Date: �r7/
9
COSA to be released to the engineer,unless othervnse requested by the engineer.
COSA Fee $ J,�, (i Waiver Fee $
Date of Payment -// 57/9 Date of Payment
Receipt Number CA 5P, i? Receipt Number
COSA# Cd/W/6-7) Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seatieffivaiklereto 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 522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 4/25/2017
J4 ,,
Cf)
49�i VA
-
6. DSD SIGNATURE �• " •���• "_
System #1 Approved for 5 bedrooms E.
System #2 Approved for bedrooms � • :4381e ��./41CL 'ANDERSON v<;
Disapproved .zeh� PROFESS\W�, ,"
K�y ,�`3`ny'".
Conditional approval for bedrooms, with the following stipulations.
J� ON-SITE `7
6 .
WATER AND r"
m WASTEWATER o
PROGRAM ,?
re,�
7-q+r0\Int
By: 1� rpI�� 0,(2.fut-Crel
C�.A1-66 a Original Certificate Date: 5///.20 1 7
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 blue sheet r .. c
If more than 1 septicsystem is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Autumn Ridge, Lot 5 Parcel ID: 015-054-08
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 1/11/02 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 262 ft. Cased to 262 ft. Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 1/11/02 4/20/17
Static water level 215 ft. 207.6 ft.
Well production 50 gpm 6.13 g p m
WATER SAMPLE RESULTS:
Coliform 0 colonies/l OOmL Nitrate .20 mg/L
Arsenic ND ug/L Date of sample: 4/14/17 Collected by: Anderson Engrg.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 12/12/01
Tank size 1 ,500 gal. Number of Compartments Two Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 4/25/17 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Date installed 12/13/01 Soil ratingd./ft2 or ft2/bdrm 5 GPD/SF System type
Deep Trench
(9 P ) Y YP
Length 76 ft. Width 3 ft. Gravel below pipe 10 ft.
Total depth 13.5 ft. Eff. absorption area 1,520 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4/20/17 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 9 in. Water added 756 gal. New depth 21 in.
Elapsed Time: 1 ,440 min. Final fluid depth 9 in Absorption rate >= 750 g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main '75' Public sewer manhole/cleanout 100'
Sewer/septic service line >25� Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas 100'
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5' >5'
Building foundation Property line Absorption field
Water main >10 Water service line >10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
10'
Property line > Building foundation > Water main >
Water Service line > Surface water > Driveway, parking/vehicle storage >
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION w"`a"a�' �;" t:y
I certify that I have determined through field inspections and b'a,, �' _.'- -,C=F-9.,
review of Municipal records that the above systems are in .; ' �¢
conformance with MOA COSA guidelines in effect on this date.
es:0204470.:47...
" j>r, i'
Benjamin Schiller, P.E. �,,... — !� ...,,, si
Engineer's Printed Name d !! 4
5/1/2017 kt anm `�� 19erd
Date , 12597 �+•,+gip
•COSA brown sheet 10-10-12.doc
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program *A4 4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-051-04 COSA#_ t tOO)
Expiration Date: _ 3 — / % — d�
1. GENERAL INFORMATION
Complete legal description W 5. Autumn Ridge subdivision
Location (site address) 9362 Auham Ridge Circle
Current Property owners) Joel and Laurie Toren Day phone 522-0663
Mailing address 9362 Autumn Ridge Circle Anchorage, AK 99507
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA wd1 be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Five (5)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
(]
Individual On-site
R1
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of OnSke Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -She Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by rry seal affixed hereto and as of the validation date shown below, I verify that rry investigation,
based on procedures outlined in the Certificate of Onsite 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 Finn Anderson Engineering Phone 522-7773
Address P-0• Box 240773 Anchorage, AFC 99524
Engineers Printed Name Michael E. Anderson, P.E.
b. DSD SJGNATURE
Approved for r bedrooms.
Disapproved.
Date IZWOoe
Conditional approval for bedrooms, with the following stipulations:
Attachments: '191))m 091
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineers Report
Nitrate Advisory Other
Original Certificate Date:_
QW 1IM5)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Stte Water & Wastewater Program
4700 SregaW Street
P.O. Box 196650
Anchorage, AK 99519-6650
wwwxmi.org/onsdo
MM 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: La 5. Aub im Ridge Subs Wm Parcel ID: 015451-04
A. WELL DATA
Well type Prlvere U A, B, or C provide PWSID S _
Date completed 1n1=02 Sanitary seal (YIN) v
Total depth —M --ft Cased to Tet R.
FROM WELL LOG
Date of teat 11112004
Static water level 215 fl.
Well production so g.p.m.
WATER SAMPLE RESULTS:
Conform D cotaniWIDO mL Nitrate -ue mg&
Arsenic: NID mg/I Date of sample: 10242008
B. SEPTIC HOLDING TANK DATA
Tank Type/Material SywSt"
Tank sae 1 -WO gal. • Number of Compartments Two
Wen Log (YM) Y
Wires property protected (Y/N) Y
Casing height (above ground) a24 in.
AT INSPECTION
14/52006
206 R
4.61 9 -
p.m -
Other bacteria 0 colonies/100 mL
Collected by: F. Leo=
Date installed 14/142001
Cleanouts (YM)
Y
Foundation cleanout (YM) Y Depression over tank (YM) N High wader alemr (YM) N
Dateofpumping 10-95"C6 PumperJ)efYll'i Ale-- Ml)(CQUI'Linn
C. ABSORPTION FIELD DATA
Date installed 14012001 Son rating (g.p.dJflz or felbdnn) •5 GPDISF System type Deep Hench
Length 78 t Witt 3 tt Gravel below pipe 10 It.
Total depth 1Sa fL Eflabsorption area _jzF0 R' Monitoring tube Y Depresaw aver field N
Date of adequacy test 125th Raub (PaaslFen) Pse• For 5 bedrooms
Fluid depth in absorption field before test in. Water added 1,7 gal. New depth -5 in.
Elapsed Time: 1M0 min. Final fluid depth 4s in. Absorption rate :.- 750 g.p.d.
Any rejuvenation tmatrnent (pest 12 mo.) (YM & type) " N yes, give date
D. UFT STATION
Date installed Size in gallons ManhoWAccm (Y/N)
'Pump on' level at _ in. 'Pump ofr level at _ in. High water alarm level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot >1W
Absorption field on lot >100
Public sewer main VA
Sewer /septic service fine >2F
Animal containment areas None
Meets alarm t: coradt ratImementa9
On adjacent Iota >1aa
On adjacent Iota >1W
Public sewer manhole%leano d WA
Holding tank N/A
Manure/animal excrete storage areas Norm
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >s Property lines Absorption field >s
Water main NrA Water service fine >1c' Surface water
Wells on adjacent lots >1W
>100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >tV Building foundation >10' Water main NIA
Water Service fine >10' Surface water >1an Drivearay, parldnUNshicle I ni >25'
Curtain drain Nam Ned Wells on adjacent klts >1W
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance wlth MOA COSA guidelines in effect on this date.
Engineers Printed Name Michael E. Anderson, P.E.
Date 1218x1008
COSA Fee S qW Waiver Fee $
Date of Payment /4Z1015 Date of Payment
Receipt Number 97 Q - Receipt Number
(nev. I Imm Ye
z
m
L
WF
2.
w
M
Q
J
0
ON
ZO
E3N
J_
S
m
Y W
� tr
W
N U
'On.A- ..
wv vvv nmvc suet 1V N
w
O
-------------
I)
•
iE lzzo
g�
g�g 4
3 SVS Z . N
I. ON O p h
�z
a
wo
Uzi
w
no: V O��j�C9
Izo
z
ZVf Ws N n
g
m C.4
too
a
••.,mss �1
♦ 5 •.••':
•
i
.
•
4G
•
AV 1/• •
'
• 2-%
: C
' •
�� i �:
• •tie /
: •• Quo /
•
iE lzzo
g�
g�g 4
3 SVS Z . N
I. ON O p h
�z
a
wo
Uzi
w
no: V O��j�C9
Izo
z
ZVf Ws N n
g
m C.4
too
a
Municipality of Anchorage a_
Development Services Department
Building Safety Division
i' On -Site Water and Wastewater Program e . r
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
R� QSH (907) 343-7904 /
•�vH CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
o�
Parcel I.D. 015.051-04 HAA # 'A!An_20_e? �
Expiration Date: Cl - .Z-0 - 0.2-
1.
11. GENERAL INFORMATION
Complete legal description Lot 5 Autumn Ridge Subdivision
Location (site address or directions) Ziemlak Circle
Current Property owner(s) Crown Pointe, Inc. Day phone 727-8167
Mailing address 5400 Abbott Road Anchorage AK 99507
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
Five 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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. Certificates 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. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the 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,! upply 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 522.7773
Address P.O.Box _240773 Anchorage AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Date 6/19/02
�C �F•q���j�
V••••�A •••
_d`
O'\� .��AY
/* 4�7X�+�ItfE 'S •`•�
•••
5. DSD SIGNATURE
i r : WQ(AEL E 94=2SC::r ,`f ,
°) : CE - 4C 81
Approved for S bedrooms.
a4'`o p•••• •' '
_�.
Disapproved.
•ti3�ta ''
Conditional approval for bedrooms, with the following stipulations:
O
Additional Comments4F
moi; WATERAND
PROGRAM
����llJl)Jl1))11j1>
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
III
BY: / �r J �t� Original Certificate Date: 0 — C
(Rev. 121001
Municipality of Anchorage
y Development Services Department
Budding Safety Division
On -Site Water & Wastewater Program
4700 South BragaW St.
P.O. Box 196650 Anchorage, AK 995196650
www.ci.anehorage.ak.us
(9D7) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 5 Autumn Ridge Parcel ID: 015-051-04
A. WELL DATA
Well type Private It A, B, or C provide PWSID #
Date completed IM112002
Sanitary seal (YIN)!
Total depth 282 ft.
Cased to 262 ft.
FROM WELL LOG
Date of test
11112002
Static water level
215 ft.
Well production
so 9 -P.m.
WATER SAMPLE RESULTS:
Cddorrn —9—colonies/100 ml. Nitrate .378 mgA.
Date of sample: 61188002 Collected by: MEA
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SOV–UC teal
Tank size 1,5D0 gal.
Foundation cleanout (YM) Y
Date of pumping
C. ABSORPTION FIELD DATA
Number of Compartments 2
Depression over tank (YM) N
Pumper New Construction
Well Log (YIN) Y
Wars properly protected (YIN) y
Casing height (above ground) >24 in.
AT INSPECTION
ft.
g.p.m.
Other bacteria _.L cdonies1100 mi.
Date installed 12n28001
Cleanouts (YM)
High water alarm (YIN) N
Date installed 121138001 Soil rating (g.p.d.lff or ft'Ibdrm) .5 GPDISF System type Deep Trench
Length 76 ft. Width 3 ft. Gravel below pipe 10 ft.
Total depth 15.5 ft. Eft. absorption area t5 ft' Monitoring lube Y Depression over field N
Data of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test _ in. Water added_ gal.
Elapsed Time: —min. Final fluid depth _ in. Absorption rate >=
New depth_ in.
Arty rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
g.p.d.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
'Pump on' level at _ in. `Pump ofr level at _ in. High water alarm level at in.
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic lonkAift station on lot >100'
Absorption field on lot >IW
Public sewer main WA
Meets alarm b circuit requirements?
On adjacent lots >i00'
On adjacent lots >100'
Public sewer manhole/cleanout WA
Sewer /septic service line >25' Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S Property line >5' Absorption field >S
Water main WA Water service line >Ir Surface water >100
Wells on adjacent lots >IW
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >70' Building foundation >10' Water main >10'
Water Service fine >10' Surface water >100' Driveway, parkinglvehk9e storage >2S
Curtain drain None Noted Wells on adjacent lots >IW
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined Buough field inspections and„-�r '• ' A
review of Municipal records that the above systems are in �'�: '49TH fl` % � • 'l�
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E Anderson. P.E.
d J : CE -4301
Ci •.
Data 6119/02 C6Q4, PPpEESSIO :�V” V
Ism I
HAA Fee $_f -t- d'
Date of Payment 4o / 9 CD 02
Receipt Numberp2 ( S Z
(Rev. wool
Waiver Fee $
Date of Payment
Receipt Number