HomeMy WebLinkAboutAUTUMN RIDGE LT 18Autumn
idg
Lot 18
§- 054
-21
Municipality of Anchorage Page I of 3
" 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: SW020165 PID Number: 015-054-21
Name:
Wood Built Homes Wastewater System: New
Address:
8524 Pluto Drive Anch., AK 99507 ABSORPTION FIELD
Phone: Number of Bedrooms: 5' Wide Trench
346-2985 Six (6)
Soil Rating:. Total Depth from original grade:
LEGAL DESCRIPTION .8 ~.D~e 12 ~t.
Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
18 Autumn Ridge 4
Township: Range: Section: Fdl added above original grade: Gravel Length:
4-6
Gravel vadth: Number of lines: I D~stance between lines:
Well: 'New 3 Ft. 1J Ft.
Classification (Private, A, B. C): Total Depth: Cased to: Total aJ~sorpt~on area: P~pe Material:
Private 320. 320 1,136 Fe ASTM3034PVC
Ddtien Date Drilled: Static Water Level: Installer;. Date Installed:
M-W Drilling 4/27/2001 147.8 Ft. Glacier Masonry 8/3-5/2002
~,e,d: 30 G,M I"u"~se'a':Ft. j Ca,,ng~f.i~ht~oveG.ound:>2 F,. TANK
SEPARATION .DISTANCES [] Septic [] Holding [-1 S.T.E.P. [] Other:
T~mm"~,~o Septic Absorption Lift Holding ~ublic/Private Manulacturer; ~.,apat"ly in ~a;ions;
Tank Field Station Tank Se,~erLine Anchorage Tank 2,000
Material: Number of Compart~nents:
>100' >100' N/A N/A />25'
Wen
Steel
Two
(2)
Su,a~Water >100' >100' N/A N/A LIFT STATION - NONE ON LOT
LotUne >5' >10' NIA NIA .
Foundation >5' >10' NIA NIA //x'*um~°"'levelat:~X 'Pu.~o,,',e..I.t;
In. in.J In.
Curtain Drain None Noted ...~ Make & Model Electhcal Inspections performed by:
Rare,k,: BENCH MARK
Locabon and I.,)escripbon:
Garage Slab
'~ 00,0 Ft.
Engineer's Stamp
Inspections performed by: MEA Dates: 1't 8~3~2002
81512002
~'.. . ..'.%,
Department of Health and Human Services approval
Reviewed and approved by: //)~/' ~ ,/~~Date: /0-..2,2---0~¢
I
I
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
Permit Number: SW020165
Page 3 of 3
PID No. 015-054-21
86,35
88,1
7~.6
70'
66.0
~ 80.8
PROFILE AS-BUILT
Scale: 1" = 10'
0CT'-14-~00~ 01:P4P FROM:
Sent By: }. Iq CONSTI~UGTION;
~,~. I
I
5223~g2;
T0:5886779
M-W .Drilling, l:nc.
Box l10378,AncheraSe, AI~ 99511*
e907-345-4000 · g07-345-3287 FaKe
0
Groundwate'r We_ti As-_Built & Log
Job No.;
?crm{t lqo,;
;
01-141D
L & H Conll~a~tioa · Ust oflfZell:
,
.Cgns, .t;rucilgn
320' · ¢~ing St, e: 6'~' , C~x,d ~'~:
^'tr Ro~ary ~_
320'
. I
·Wctl C'omp~. tion. Open end. X Screen . ' Perforate~t · Sc~eMPerJ'otatlon description: None
~, M'aterlal:. A $3 Steel
Method:
* Crbut Not~: (I) Sack- No. 11 be~mnit, granubs
· Well DeveloPment: Method: Air surge l~ate.~.. .
, ~aac w~' 6~W~) 147.8, 0~) ~w) ~p o/~g ff~). --
,Method: Air lift
· Date ofcut~
~letlon: 27 April 2001 · Pump ffnxtall:
-- - .. Well Lok
D~nails of garmatlons peneteattnL site of'material~ color and hardn~.
....
~.Sil~ cla~
Silt: brown
Grawlly
j.~ilW ~vel ....
Silty, ~dy~yel~" dam~
Gravelly_~t: damp .... :__
~dy gravel:
Sil~, ~apdy gr~91: 'brown ..
S~J.~, ~andy grovel: damp.
..Sil~, sandy ~v912_ bro~ :~ ~ .
_~S~dy gravel: damp
.~X?~. water bea~n$, qEa~e, sli~.sandy ..
~ clay
I houri
240 TO 262
222 TO 229
234 TO 240
205 TO 212
212 TO 222
45 TO 142
142 TO 180
':~180 TO ' 195
l~pth in f~t from
0 TO 2
2 TO 6
6 TO 18
18 TO 35
35 TO 40
40 TO 45
0CT-14-8003 01:84P FROM:
./cONStRUCTION|
5223892;
TO:S88G?T9
Nov. 16-01 12:03PW;
P:3~3
Page
Job 'NoZ. O1.141D
ProJect 1~o.~ .~/^
Well Log Continucd
Depclt in feet ¢rom i .... ' .........
top of. cnqn£. Detnlls orfo~llons ~nefrnled, si~ ~r~te~ntt eo~r and b~rdn~t. '. _
26~ TO 265 Gravel: water b~ing ....
265 TO 2681' Clay
268 TO 2801~ Gravel: water bering_ ' .....
TO
.TO ~.
TO
TO
TO :
TO ·
TO
TO
TO
TO
TO
TO
TO '::
TO
TO ....
TO
TO
TO
TO
TO ,-
TO
TO
TO I ..
To
TO
TO I :
TO ~ ...... : :
MUNICIPALITY OF ANCHORAGE
Development Services Department
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: Jun 12, 2002
Expiration Date: Jun 12, 2003
Permit Number; SW020165
Legal Description: AUTUMN RIDGE LT 18
Design Engineer: 0014 Anderson Engineering
Owner Name: Wood Built Homes
Owner Address: 8524 Pluto Dr.
Anchorage, AK 99507-
Parcel ID: 015-054-21
Total Bedrooms: 6
Site Address: 009487 ZIEMLAK CIR
Lot Size: 73823 SQ. FT.
Permit Bedrooms: 6
This permit is for the construction of:
[~ Disposal Field [~ Septic Tank [-~ Holding Tank [~] Privy
[] Private Well
Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
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 SEWERNVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-054-21
Permit Number
Property owner(s). WoodBuilt Homes
Mailing address (1) 8524 Pluto Drive Anchoraqe, AK 99507
Mailing address (2).
Legal description (Lot, Block & Sub'd.) Lot 18~ Autumn Ridge Subdivision
Legal description (Section, Township & Range)
Lot Size 73.823 SF Acres/Sq. Ft.
Day phone 346-2985
.Zip Code
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Number of Bedrooms Six (6)
Well Only []
Water Storage []
I--I Jacuzzi []
I--I Water Softening Unit []
I certify that the above information is correct. I fudher 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: ~"~'~. ~ '
Date of Payment: OJ/~//~'~
Receipt Number: ,.~-t%/-~ ~
(Rev, 1~00)
Waiver Fees:
Date of Payment:
Receipt Number:
· ANDERSON :ENGINEERING
P,O. BOx 240773 ~ :
ANCHORAGE, AK99524 1
522"7773 ~ 522-6779 (FAX)
May 29,2002
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 18, Autumn Ridge Subdivision
Well and Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 18, 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 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 location of
the well on the lot, test hole locations and the locations of existing wells and septic
systems in the area. Drainage contours are also shown and current drainage patterns
will be maintained after construction.
The test holes placed near the location of the proposed absorption trench and alternate
site vary from silty sand to silty to poorly graded gravel with percolation rates of less
than 1 minute per inch to a high of 44 minutes per inch. The majority of the absorption
trench will be constructed in the faster percolating material. We have chosen, however,
to use an application rate of .8 gallons per day per square foot in the design of the new
trench. No groundwater was found during the placement of the test holes and none
was noted during the high water pedod. We are therefore proposing to place a 3' wide
by 71' long by 8' effective depth absorption trench on the property. The total depth of
the trench will be 12'. The distribution pipe will be placed at 4' below the ground
surface to provide sufficient separation from groundwater.
The ground surface on the lot slopes as shown on the attached Site Plan with moderate
slopes from west to east. The new absorption trench will be constructed in
conformance with Municipal requirements and parallel to ground contours where
possible. All components of the new septic system will be constructed a minimum of
100' from the well on the lot and those in the area and 10' from the service line from the
well to the house.
If the system is constructed in accordance with 'our design the following statements
apply:
L'o.t 18, Autumn Ridge
May 29, 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
.)
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..":'19
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\
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IJECT
MICHAIrL ir. ANDERSON
No. Cir-4581
AREA SYSTEM PLAN
SCALE 1" = 100'
:mation: ,
Z
~o
.~x
LOT 18, AUTUMN RIDGE
SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Six Bedroom Home
Perc. Rate: LT 1 to 44 Min./Inch
Avg. Application Rate: .8 GPDISF
Deep Trench System
2,000 Gallon Septic Tank
8' Drain Field Rock
6 Bedrooms X 150 GPD 1.8 GPDISF = 1,125 SF of Absorption Area
1,125 SFI16 SFILF = 70.3 LF Trench Length
Therefore: Construct An Absorption Trench 71' in Length by 3' Wide With 8' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 4' Below Existing
Ground. Total Depth of Trench to Be 12' Below Existing Surface. Cover Over Septic Tank
a Minimum of 4' or 2" of Insulation and 2' of Cover
3 ' 6"
8' 0I!
Natural
Backfill
3!
Geotextile
Fabric
4" Perforated PVC
Schedule 40
Drainfield Rock
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
Depadment of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For:. Bob Klein
Legal Description: · Lot 18. ·Autumn Ridge Subdivision
Date Performed:
1
· 2
3
4
· ' 7
'1:1
Dry to '
~ottom of
SLOPE SITE PLAN.
iReading :'Date 'IGross Net Depth To Net
Time Time Water Drop
1 10-Dec 4:12 2.75" ..
· 3 - · 4:13- 2.5" '
.5 4:16 2.5"
6 ·4:18 · 2 · 10" 7.5" '1
· : Perc, Rate: LT :i MinJIncH Perc..Hole Diameter:' 6"'
·... - '. : Test Run Between 5 Ft. arid'6 Ft. '-' ...' ' .-
Commen{s: i Percolation Cavity Presoaked' Pri~/' to Testing. "
Perf,ormed By: A. Harata. I, Michael E. Ande'rson Cedify That This Test Was Performed
in Accordance WiU5 Ail siate' and'Municipal Guidelines In Effect On This Date: ,. . 1/20100 - -
· PTIOL '
GP
TEsTHoLE NO. 62 ".
GIVI/GP . .:
EnCOUntered? .' No . S ,.' ' '.' .'.
If Yes; Wh~t Depth? . '" · L '.' '... ' '" :-
" Depth to Water .' :' .' " .
· ' After Monitoring ' ' ' Nohe' ".
· Date: '" ' .. '1122/00 .....
Municipality of Anchorage
Depadment of Health & Human Services
825 L'Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For:. ~,ob Klein
Legal Descripti0n: ' Lot 18. Autumn Ridge Subdivision
.1
2
3
4
7
10
13
14
i5
Date Performed:
PTIOL
TESTHOLE NO. 61
'Golden '
to'
light Br.own
SLOPE SITE .PLAN
None'
1127_/00
No
Was Groundwater . '
' Encountered?
If yes, What D~lSth?
Depth to Water ..
After Monitoring
Date: · ..
O
P
E
18
Reading. Date Gross. Net' DepthTo Net "'
Time Time Water Drop -
.. I 12-Dec -4:12 2.75"
2 4:42 30 .3.5" , .75" '
..3 '4:43 2.5" ' '
-' 4' . 5:13" 30 3.19" .69"
· 5 5:14 2.5". ..
· 6 5:44 -' '30' 3.19" .69"
Bottom of
· Holi~ -, · .
m ' Perc. Rate ~,4: MinJIr~ch' Perc..Hole Diameter: 6"
Test Run Betweer~ 6 Ft~ and 7 Ft. ·' :
' Comments: Pe~'colati0n Cavity Presoaked Prior to Testing..' ,. · '.
Performed...BY: A- Harala. · I, Michael E. Anderson . Cedify Tha..t This Test Was Performed
· In Accordance With/Nil State and Municipal Guidelines In Effect On This Date: 1120100
MUNICIPALITY OF ANCHORAGE
Deve/opment Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SW010140
"~ ~Legal Description: T12N R3W SEC 15.NE4 pTN'
Design Engineer: 0014 Anderson Engineering
Owner Name: LH CONSTRUCTION
Owner Address: 5400 ABBOTT ROAD
ANCHORAGE, AK 99507-4364
Date Issued: May 30, 2001
Expiration Date: May 30, 2002
Parcel ID: 015-051-04
Site Address: 005400 ABBOTT RD
Lot Size: 2214155 SQ. FT.
Total Bedrooms: 0 Permit Bedrooms: 0
This permit is for the construction of:
[~] Disposal Field [--'J Septic Tank J--J Holding Tank [--'J Privy
Private Well [] Water Storage
o
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.
The following special provisions.
THIS PERMIT ISSUED FOR AN EXPLORATORY WATER WELL ONLY. UPON COMPLETION OF THE WELL
AND SATISFACTORY WATER IS ENCOUNTERED, THE WELL DRILLER SHALL PLACE AN APPROVED
SANITARY SEAL ON THE WELL CASING AND NO PITLESS ADAPTOR OR PUMP SHALL BE PLACED IN THE
WELL UNTIL A WASTEWATER DISPOSAL SYSTEM HAS BEEN CONSTRUCTED.
~HIS PERMIT ISSUED FoR PROp'~)SEDLoT 18 AUTUMN RIDGE S'UBD.~.
Received By: ~
Issued By: ~ ~
Date: ,~-- ~0 -" O/
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 SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O !.,~ '-- 0-~-! -- Oi~-
_Permit Number.SW O/O
ProPerty owner(s) LH Construction
Mailing address (1) 12130 Regency Drive, Suite 201 Eagle River~ AK 99654
~ IT'E ' ·
I~address (2~J"400 ~¢¢oT'i' /~o,~z7
Legal description (Lot, Block & Sub'd.) P._~.gp_osed Lot 18_._~.~Autumn Ridq. e Subdivision
Legal description (Section, Township & Range) ]'1~.~ /~3't4,/ 5'kC ].~'" ..~/E
Lot Size 45,704 SF Acres~ Number of Bedrooms Test Well
2,
THIS APPLICATION IS FOR:
Day phone 522~1616
Zip Code
Sewer Only J-'J Well Only []
Sewer and Well [-'l Water Storage []
Sewer Upgrade r-J
THIS PROPERTY CONTAINS:
Hot Tub [--I Jacuzzi []
Swimming Pool I-"J 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~
Date of Payment:
Receipt Number: ~""~
(Re~. 12/oo)
Waiver Fees:
Date of Payment:
Receipt Number:
i.O
\
;velopment Iuformation:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
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. 015-054-21
GENERAL INFORMATION
Complete legal description
Location (site address)
COSA # (~0__~
Expiration Date:
Lot 18, Autumn Ridge Subdivision
9487 Autumn Ridge Circle Anchorage, AK 99507
Current Property owner(s) Aurora Loan Services, LLC
Mailing address 2617 College Park Drive Scottsbluff, NE 69361
Day phone
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise, r~equested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Six (6)
Day phone
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
· Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site 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-Site 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 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
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 9/25/2011
~.~e' .:,~: II '.
....
m ~ e'~ ~ ~ .... . ~ ~
bedrooms, with the following stipulations:
Attach merits:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev 11/05)
'~)~Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
· 4700 Bragaw Street
P.O. Box lg6650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7g04
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type Private
Date completed 4/27/01
Total depth 32o ft.
Lot 18, Autumn Ridge Subdivision
Date of test
Static water level
Well production
· WATER SAMPLE RESULTS:
Coliform 0 colonies/i00 mL
Arsenic: N/D mg/I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Stee~
Tank size 2,ooo gal.
Foundation cleanout (Y/N) Y
Parcel ID: 015-054-21
If A, B, or C 'provide PWSlD # ~ Well Log (Y/N)
Sanitary seal (Y/N) Y Wires properly protected (Y/N)
Cased to 320 ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
4/27/01 9/9/2011
147.8 ff. 191.0 ff.
30 g.p.m. 4.3 g.p.m.
>18 in.
Y
Nitrate .10 mg/L Other bacteria 0 colonies/100 mL
Date of samPle: 9/9/2011 Collected by: B. Hippe
Date installed 8/3/2002
cleanouts (Y/N) Y
N.. High water alarm (Y/N) N
Number of Compartments Two
Depression over tank (Y/N)
Pumper
Soil rating (g.p.d./ft2 or ~/bdrm).8 GPD/SF
Width 3 ft.
Eft. absorption area 1,136 ft2 Monitoring tube
System type Deep Trench
Gravel below pipe 8
Y Depression over field...N.
Date of pumping No Sludge Noted
C. ABSORPTION FIELD DATA
Date installed 8/5/2oo2
Length 71 ff.
Total depth 16-18 ft.
Date of adequacy test 919111 Results (Pass/Fail) Pass For Six bedrooms
Fluid depth in absorption field before test o in. Water added 917 gal. New depth
Elapsed Time: o min:' Final fluid depth o in. Absorption rate >= 900
Any rejuvenation treatment (past 12 mo.) (YiN & type) If yes, give date
in.
g.p.d.
LIFT STATION
Date installed
~Pump on' level at
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at ~
Cycles tested
in.
SEPARATION DISTANCES FROM VVELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer/septic service line >25'
Animal containment areas >50'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >1oo'
On adjacent lots >1oo'
Public sewer manhole/cleanout
Holding tank N/A '
Manure/animal excrete storage areas
N/A
>100'
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 >1(~0'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >10'
Curtain drain None Noted
COMMENTS: Well is Encased in a Watertight Vault in the Driveway.
Absorption field >5'
Surface water >100'
Building foundation >10'
Surface water >100'
Wells on adjacent lots >100'
Water main >10'
Driveway, parking/vehicle storage >25'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 9/25/2011
COSA Fee $ /...~O[ O --
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
F-
F
9V_~
0'~
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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 ..
· CERTIFICATE OF HEALTH AU'[:HORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 15-054.21 HAA # O
Expiration Date:
1; GENERAL INFORMATION
Complete legal description . Lot 18, Autumn Rid.qe Subdivision
'Location (site address or directions) Ziemlak Circle
Current Property owner(s)
-.. Mailing address .........
Lending agency
WoodBuilt Homes
8524 Pluto Drive Anchoraqe, AK 99507
Day phone 346.2985-
Day phone
Mailing address
Real Estate.Agent
Day phone
. -.M~iling;Address ..
, ~,~ L~ ,-~.
.... :.,..:' Un/ess otherWiSe.requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYpE ·oF'WATER SUPPLY:
lndivid[J~l Well
, Individual Water"Storage
Corr{m~ity Class,
Public Water System
Well
'six
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site [~
[] Individual Holding tank [-I
[] Community On-site r-']
[] Public Sewer [--I
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 reissded 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. .
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 Gu!delines 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 Enqineerin.q
Addres's P.O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name Mi~:hael E. Anderson,. P.E.
DSD SIGNATURE
tv/''' Approved for ~ bedrooms.
· Disapp.roved.,
COnditional approval for
Phone 522.7773
Date 10/19/2003
bedrooms, with the followin'g stipulations:
'Additional 'Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisbry
X
Maintenance Agreements'
Supplemental Engineer's Report
Other
By:
Original Certificate Date:.
(Rev. 12J00)
Municipality of Anchorage
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) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot t8, Autumn Rid,cie Subdivision
Parcel ID: 015-054-2t
A. WELL DATA
Well type private If A, B, or C provide PWSID # ~
Date completed 4/27/2001 Sanitary seal (Y/N) Y
Total depth ,320 ft. Cased to 320 ft.
FROM WELL LOG
Well Log (Y/N) Y
Wires properly protected (Y/N) y
Casing height (above ground) 24
AT INSPECTION
in.
Date of test 4/2712001
Static water level 147.8 ff.
Well production 30 g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/lOOml.
Date of sample: 10110/2003
SEPTIC/HOLDING TANK DATA
Nitrate .296 mg./I.
Collected by: MEA
Other bacteria .0. colonies/100 mi.
Tank Type/Material ,,$ePtiCtSteel
Date installed 8/3/2002
Tarik size ,2~000 gal.
Foundation cleanout (Y/N) Y
DaTM of I~umplng
Number of Compartments ;2
Depression over tank (Y/N) Fi
Pumper New Construction
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 815/2002
Length 7_11
Total depth 16-18 ff.
Date of adequacy test
Soil rating (g.p.d./ft~ or fl2/bdrm) .8 GP. DISF
. ff. Width 3 ft.
Eft. absorption area 1~136 .fi2 Monitoring tube Y
Results (Pass/Fail)
System type DeepTrench
Gravel below pipe 8 ff.
Depression over field N
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). N If yes, give date
LIFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at~
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main NIA
~ewer/septic service line >25'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout NIA
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building fOundation >5'
Water main NIA
Wells on adjacent lots >100'
Property line >5'
Water service line >10'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field >5'
Surface water >100'
Property line >10'
Water Service line >10'
Curtain d~ain None Noted
COMMENTS
Building foundation >10'
Surface water >100'
Wells on adjacent lots >100'
Water main >10'
Driveway, parking/vehicle storage >25'
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 HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 10119/2003
HAA Fee $
Date of Payment
Receipt Number ~
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number