HomeMy WebLinkAboutAUTUMN RIDGE LT 25Autumn Ridg
Lot
#015-054-28
N' at 08 *11' 04:39P Aichorage,Nel & PLnip,13gr 9072430742 P.1
Development Services Department
Building Safety Division
On -Site Water 4 Wastewater Program Z. ;,41i..�;'
4700 Elmore Street F.
P.O. Box 196650
Mark Beglcl n"lChoroge, AK 9952-9-6650
Mayor nsile
(407)34"3-7a04
Pump Installation Log
Well Drilling Permit Nunib,-r:
r_1 Date of Issue:
Parcel Identification Number: 015 - 061- .2
Lecral Description 131rick T
Lot Propert} Dvvjter -Name & Addres-,.
Ru4umn CU'J j -o— a 5 �-1 S:: 4vtv,�4"_ P�-.:C7-r C-car~-�r
Pump 111stallation Date:
Pump Intake Depth Below Top of NVell Casing- feet
Pump Manufacturer's Name 6-1
Pu Enp Model:
Pump Size 071 —hp
IPitless Adapter Burial Depth,. I L)
Pitless Adapter 11-Tanuf.,icturer's Name -
1 Pitless Adapter Installer:
fest
Well DisinfectedUpon C991plefi-on? e. Yes L No
Metbod of Disinfection
I Comments -
Pump Installer Name:
Company, AWPS
To. 7640 King Street
Mailincr Address: Aizhcrage,AK 99518
City: State: --Zip:
Attention: The pump installer shall provide a 1p -amp installation log to DSD within 30 0 days of pump installation.
Municipality of Anchorage Page 1 of 3
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Sb'eet
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: SW030016 PID Number: 015-054-28
"~'~: Wastewater System: New
Wood Built Homes
Address:
8524 Pluto Drive Anch., AK 09507 ABSORPTION FIELD
ph~e: Number of s.,oo.~:,.. ~,nee,~
Trench
346-2985 Five
LEGAL DESCRIPTION .45 G.~,Fe13
25 Autumn Ridge 3 n. 10
1-7 Ir,. 84
Well: New 3 Irl. 2 >20
Private 181 179.1 1,680 Fi, ASTM 3034 PVC
M-W Drillin9 718/2003 160 Ir,. Glacier Construction 412812003
· ,~d: 5+ G.M I """" s., .,:F,. C.~.., .,.hi>2~oveFl.~,~: TAN K
SEPARATION DISTANCES ~ septic [] Holding [] S.T.E.P. [] Other:
Tr,~'~.~o Septic Absorptiol~ Lift Holding )ublic/Private ~.~nulact~er.& h ,, Tank ~.,apac~y~ I~J~n~n
Tank Field Station Tank Sewer Line ,~nc.ora~e ,,,,,,,
w~, >100' >100' N/A N/A >25' Steel Two (2)
tolLmeSUdaceWater >100'>5, >100'>10, N/AN/A N/AN/A V ~...: LIFT~,.STATIONr,~.~,~c,.~: - NONE ON LOT
C~,~..F°"nd~"~..n >5'one >10' N/A N/A / ~X '~.m.,~-,~.,. '~..~o,,-,..~,.,:
N Noted ...~ ~e & Mo~ E,.~,,~, ,n,~.o~s ~o~
,e~r~,: BENCH MARK
Door Threshhold
t00.0 Irt.
Engineers Stamp
.......
· ,' %/ A ?:..fi,
Inspections performed by: A. Harala Dates: 1st 412812003 ~.~," 497. '~,,~
2nd 412812003 · ...... ~ ...........
Department of H~li~Human Services approval/., , ':~"e...~...~...'-~_- ~,~N° c.-,..,~_.........'"~=*'~_.__~_
Reviewed and approved by: Date: tZ.[]' J '~-'<~) ................. ~x~
l N31~35V3 '3:~l,O t
o~
9I'~E~I~,6~,9OoOON
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: SW030016
Page 3 of 3
PID No. 015-054-28
76,6--/
97,6
/
......... G ~_o_~.e x t It ~_ ._F .gb__~l~: .............
DrcdnPletd Rock
4;~' (Tpench Length) 77.1
I
70,0
WEST LEG
~ C7.0
84.0
74.1
Dr'(~lnFletd Rock ~ M4.0
42' (Trench Leno'th)
EAST LEG
PROFILE AS-BUILT
Scale: 1' = 10'
12/02/2003 15:59 3453287
Job No.: 03-148
M W DRILLING, INC
M-W Drilling, Vnc.
eP.O. Box H0378e Anchor~je, AK 995H+
+907-34§-4000 · 907-345-3287 Fax+
Project 'No.: N/A
PermitNo. SW0~0016
Groundwater Well As-Built & Loc
· Well Owner: Woodbuil~ Homc~ · U~e of Well:
9LegalDe~criptlon: Autumn Kidge, Lot25
~ nt~hO~e, Alaakn
Domestic
Construction
e tIole Depth: 181' eC.~slnl Stze: 6" e~ To: 179.13' e Materhd: A$3
· Delft Method: Air Rota~ Perf.
· Well Coml~letion- Open end X 8..creen peororatetl Metkod:
· $ceeen/Perfor~tton des~r~tlon.
· Gro,,t No2s: (1) S~ck- No. 8 bentonite [p~nules
· Note~:
· WellDevelo~menL' Method: Air surge Nott~:
· Static water level (SWL) 160' (~b~e) (below) top of casing flOC).
e Well yletd te~t ttt 5+ -gailons per mlnute (GPM)/ g~~) for ~
with 100% of drawdown (DD) from ltalic tevd ($WL).
eMethod: Air lift
I houri
· Date of completion: 08 Jul)' 2003 ·Pump in~tall:
Well La
Depth in feet from
top of cnsing. De~alls of formations pent~rated~ size of material~ color and harnlness.
0 TO 2.5 Casing ¢dckup
2.5 TO 35 Sandy silt
35 TO 55 Silty gravel
-55 TO 65 Sil~ sandy gravel
65 TO 85 Silty elay
85 TO 125 Gravelly silt: wet
125 TO 162 Clay: dense, with interbedded gravel !ayers
162 TO 170 Interbedded water gravel and silty clay layers
170 TO 180 Water gravel
TO ,,
TO
TO
TO
TO
f XXZ OF THE LOT IS COVERED.
LOT PG
S89°58'31~W318,68
~DECK
.~r~ ~..'. ~r
....~.~..,.",.?'~.: ~ ~ ~
~ _ ~::,:,.:.,':~:-7~ ~- ~/
j · ,~:?:,..~.,..,~ .: / ~-- -
/
~,,.., ...... ....:.. ~ ~..?~ .
/ ~,o'.~ ~.~T N89*53'31'E309,86
~APHI~ S~' ~ In~ -- ~0 ~eet
LBT
E4
15 7.5 ~5 ~0 60
~R~L DA~M W~ ~SUMED
FOR: ~ Date Scale Legal Oescrip~on
~ ~ Lot
LanMark Grid PLOT P~
Engineenng & ~un~'ing Ina ~ ~
9330 V~d ~ve. 8~ g03
~ehorale, ~aaka ~a507 Dra~ by Field Book S~D~SION
(aov) aaa-aoao ~ ~
~ hereby ce~y ~at ~e prope~y deathbed.hereon has been s~eyed
by me, or at my ~ecUon, ~d~at ~e ~provemen~ situated ~ereon
~e ~thln ~e property ~el ~d do ~ot overlap or encroach on ~e
prope~y ~g adjacent ~ereto ~ess o~e~se eho~. ~at no
~provemen~ on ~e prope~y l~g adjacent ~ereto encroach on ~e
pre~ses ~ ques~on ~d ~at ~ere are no roadways. ~s~ssion
~es or o~er easemen~ on s~d prope~y except as sho~.
It ts ~e respo~ib~ty of ~e o~er or b~der, p~or ~ co~cUon,
~ very proposed b~dln~ ~ade relaMve to f~sh ~ade ~d u~ty
co~ecMo~ ~d ~ dete~tne ~e e~stence of ~y easement, coven.S,
or res~cUons w~ch do not appe~ on ~e recorded subdi~sion plat.
MUNICIPALITY OF ANCHORA GE
Development Se/vices 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: Feb 05, 2003
Expiration Date: Feb 05, 2004
Permit Number: SW030016
,[_IJegal Description', AUTUMN RIDGE ..,L.T 25 ':
Design Engineer: 0014 Anderson Engineering
Owner Name: WoodBuilt Homes
Owner Address: 8524 Pluto Dr.
Anchorage, AK 99507-
Parcel ID: 015-054-28
Site Address:
Lot Size: 40357 SQ. FTo
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] Disposal Field i-~ Septic Tank
Holding Tank r~ 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.
Received By:
Issued By:
Date: ~"/~'//~,3
Date: ~/.~--/~ .~
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. 015.054-28
Permit Number .SW 0 ~ oo ! ~,
Property owner(s) WoodBuilt Homes
Mailing address (1) 8524 Pluto Drive Anchorage, AK 99507
Mailing address (2)
Legal description (Lot, Block & Sub'd.) Lot 25, Autumn Ridge Subdivision
Legal description (Section, Township & Range)
Lot Size ~F Acres/Sq,Ft.
~o,~,~-7
THIS APPLICATION IS FOR:
Sewer Only [--I
Sewer and Well I~
Sewer Upgrade I-"l
THIS PROPERTY CONTAINS:
Hot Tub I-']
Swimming Pool r-]
Therapy Pool D
Day phone 3462985
Zip Code
Number of Bedrooms Five (5)
Well Only []
Water Storage []
Jacuzzi []
Water Softening Unit []
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: ,~0 ~:~ ~ ~'~'
(Rev, 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
MEMORANDUM
DATE:
June 4,2003
TO:
Dan Roth
FROM:
Mike Anderson, P.E.
SUBJECT:
Lot 25, Autumn Ridge Subdivision
Permit No. SW03016
Revised Well Location
We have revised the location of the well on the subject plan to prevent the removal of
several trees. The new location is shown on the attached Site Plan. Placement of the
well in this area will slightly impact the vacant lot to the south. The topography on that
lot, however, dictates the house will be placed at the front of the lot with the septic
system in the lower back area outside the well radius.
"It appears the well can' be moved to the revised location without affecting the
development of any lots in the area.
~ ,,6~,90.00 N
Ill
71
L~
~q2,,~' 9 )I¥~II4IIStZ
\
\
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February 3, 2003
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 25, Autumn Ridge Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Proj3erties
Dear Onsite Services Engineer:
The owner of Lot 25, Autumn Ridge Subdivision intends to construct a 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 new home on the property. The attached
Site Plan and backup idocumentation 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 alternate site, test hole locations and septic systems and wells on the
surrounding lots. Drainage arrows are also shown and current drainage patterns will be
maintained after construction. All components' of the septic system will be placed a
minimum of 100' from wells in the area.
The test holes placed near the location of the proposed and alternate absorption
trenches indicated silty gravel and sand. The percolation rate on the material was
measured at 34 minutes per inch. No ground water was found during placement of
the test holes and none was noted during the monitoring period. We are therefore
proposing to place a new 1,500-gallbn septic tank with two new 42' long by 3' wide
absorption trench with 10' of gravel beneath the distribution pipe. The total depth of the
trenches will be 12' below the surface with the distribution pipe at 2' below the surface.
A flow splitter valve will be placed to assure even flow to each trench. Mounding over
the trenches to provide 3' of cover will be required.
The ground surface on the lot slopes at grades between 10% and 30% from west to
east. The absorption trench will be constructed parallel with the slope as much as
possible in conformance with Municipal requirements. All components of the new
septic system will be constructed a minimum of 100' from the wells in the area.
If the system is constructed in accordance with our design the following statements
apply:
]. The system, if constructed as designed, will have no adverse impact on the wells
L~3t 25, Autumn Ridge
February 3, 2003
Page Two
in the area or those to be constructed in the future.
The system, if constructed as ~lesigned, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
e
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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SERVICE HIGH SCHOOL
TRACT A
SITE ,
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": .' ' AREA SYSTEM PLAN
: NO. CE-4381
SCALE 1" = 100'
LOT 25, AUTUMN RIDGE
SUBDIVISION
DESIGN FACTORS:
Five Bedroom Home
Perc. Rate: 34 Min./Inch
Avg. Application Rate: .45 GPDISF .
SYSTEM REQUIREMENTS:
Deep Trench System
1,500 Gallon Septic Tank
10' Drain Field Rock
5 Bedrooms X 150 GPD / .45 GPDISF = 1,667 SF of Absorption Area
1,667 SFI20 SFILF = 83.35 LF Trench Length '
Therefore: Construct an Absorption Trench with Two Laterals Each 42' in Length by 3'
Wide with 10' of Dralnfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be
Placed 2' Below Existing Ground. Total Depth of Each Trench to Be 12' Below Existing
Surface. Cover Over Septic Tank a Minimum of 4' or 2" of Insulation and 2' of Cover.
Place a Flow Splitter Valve to Provide Equal Effluent Flow to Each Trench.
NOTE:
10"
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.
!
!
!
!
m
m
!
!
m_
Performed For: Bob Klein
Legal Description: Lot 25. Autumn Ridge Subdivisioll
SLOPE
1
2
3
5
6
OG/PT
TESTHOLE NO. 2
Gravel/Sand ·
Sor~e Silt
GM/SM
8
9
10
11
_'~,z. ~_o° /~. '-~/-..~¢,, '
Municipali~ of Anchorage
Depadment of Health & Human Se~ices
Dale Pe~ormed:
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water . 0
After Monitoring None ' P
Date: .1122/00 E
SITE PLAN
I.
l
l
!
12
13
14
15
16
17
1'8
10
Golden
Brown
Bottom of
Hole
Reading Date Gross Net DepthTo Net ~.
Time Time Water ' Drop
1 4-Dec 1:15 2.12"
2 1:45 30 3" ' .88" ·
3 1:46 2.25" · '
4 2:16 '30 ' 3.13" .88"
· 5 2:17 2.12"
6 2:_47 .' 30 3" , .88"
Pert. Raie: ~34 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 5 Ft. and 6 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: ~ I, Michael E. Anderson Certify That This Test Was Performed ·
In Accordance With All State and Municipal Guidelines In Effect On This Date': 1/20/00
Municipality of Anchorage
"n.'~ ,of u ,i~&Human ox :
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCEPTION TEST
"
.. Pe~ormed For: Bob ~lein Date Pe~ormed:
Legal Description: Lot 25. Autumn Ridge Subdivision
SLOPE SITE
..~' 1' OG/PT
2
I.! 3 TESTHOLE NO. 4
'5 Gravel/Sand
I. Some Silt ' '
!
!
t'
GM/SM
7
8
9
10
11
Was Groundwater
Encountered?
If Yes, What Depth?
Depth to Water '
After Monitoring
Date:
No S
L
O
· None ' · P
1122/gg E
12
15
16
17
.18
19
Bottom of
Hole
Rea.ding' Date Gross Net Depth To Net
Time Time Water Drop
1 7-Dec 10:45 2,5"
2 11:15 30 3.56" 1,16"
3 11:16 2.5"
4 11:46 30 3.38" .88"
5 11:47 2,5"
6 12:17 30 3.38" .88"
Perc. Rate: 34 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 4 Ft,.and 5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: ~ I, Michael E. Anderson Certify That This Test was Performed '
In Accordance With All State and Municipal 'Guidelines In Effect On This Date: 1120100
i'
.
· Department of Health & Human Services "~
' '. 825 L Street, Anchorage, Al< 90502-0650 '~~ ;'a'~'~'~ .... ..'~
LO -PERCOmT O 'rEST .
. ~,
Perfor ed For: Bob Klein' Date Perform~.~,~'~'~l'~7/gg
J Legal Description: Lot 25. Autumn Ridge Subdivision
· ' SLOPE· SITE PLAN
I:
2
3
4
5
.6
7
8
9
10
12
13
14
15
16
17
PT/OL
.TESTHOLE NO. 40
More
Silt
Was Groundwater
Encountered?
· If Yes, What Depth?
Depth to Water
After Monitoring.
Date:
No
None
1122100.
S
L
O
P
E
GP
Bottom of
Hole'
Reading Date Gross' Net Depth To Net
'i'im~ Time' Water. Drop
1 8-Dec .2:.12 3.38"
2 2:42 30 9.50" 6.13"
3' 2:46 3.38"
4 -3:16 30 8,56" 5.19"
5 3:17 " 3,38"
6 3:47 30 8.44" - 5.06"
Perc. Rate: 6 Min./Inch .Perc, Hole Diameter: '6" '
Test Run Between 6 Ft. and 7 Ft, '
COmments: Percolation Cavity Presoaked Prior to Testing.
Performed By: A. Harala. I, Michael E. Anderson 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 25, AUTUMN RIDGE SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,500rgallon septic tank at the location shown on the site plan
and the .construction of two new 42' long by 3' wide by 10' effective
depth absorption trenches 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. A flow splitter
valve 'must be placed to insure even effluent flow to each trench. All
components 'of the new absorption trenches and septic tank must be
constructed a minimum of 100' frOm the proposed well on the lot and
on adjacent lots. A minimum of 4' of cover is required over,the septic
tank and 3' over the absorption trench. In lieu of cover2' of direct
bury insulation and 2' of cover may be placed.
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.
e
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.
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 a certified
septic tank manufacturer.
e
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
budal insulation.
Lot 25, Autumn Ridge Subdivision
February 2, 2003
Page 2 of 3
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:
1. The draintield 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.
m
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.
Se
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.
e
Grade area surrounding the absorption trench to drain away.
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).
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 tiffed with watertight couplings
(Caulder, Fernco, or equal).
· Lot 25, Autumn Ridge Subdivision
February 2, 2003
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.
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 AUTHORITY APPROVAL
· FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-054-28
HAA# ~/~
Expiration.Date:
1. GENERAL INFORMATION
Complete legal description Lot 25, Autumn Ridge Subdivlslon
Location (site address or directions) Ziemlak Circle
Current Property owner(s) WoodBullt Homes
Mailing address 8524 Pluto Drive Anchora.qe, AK 99507
Lending agency
Mailing address
Real Estate Agent ·.
Mailing Address
Unless otherwfse ~equested, HAA will be held by DSD for pickup.
2. NUMi~ER OF BEDROOMS: Five (5)..
Day phone 346.2985
Day phone
Day phone
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Com.munity Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Departmer~t (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 fi:om the date.of issue for propedies 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.) Cedificates are valid for one year for properties served by Class A or B wells or a.public wa!er
system. The Municipality of Anchorage is not responsil~le for errors or omissions in the professional engineer's
work.
4. STATEMENT OFINSPECTION BY ENGINEER
Se
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 Enqtneerinq
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Phone 522.7773
Date 12/2/2003
DSD SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
· Well Flow Advisory
X
.... ..
..
Maintenance Agreements
Supplemental Engineer's Repod
Other
Original Certificat; Date:
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
HE, LTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Lot 25, Autumn Ridqe Subdivision
Parcel ID: 015-054.28
Well type Private If A, B, or C provide PWSID #.
Date completed 71812003 Sanitary seal (Y/N) Y
Total depth 181 ft. Cased to 179 ft.
FROM WELL LOG
Well L~3g (Y/N) Y
Wires property protected (Y/N) ¥
Casing height iabove ground) 24
AT INSPECTION
in.
Date of test
718/2003
160
5+
ft.
gp.m.
Static water level
Well production
WATER SAMPLE RESULTS:
ft.
g.p.m.
Coliform [ 0 colonies/100 mi.
Nitrate .1 mg./l.
Other bacteria 0 colonies/100 ml.
Date of sample: 11121/2003
Collected by:. TLK
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tanksize ! t,500 gal.
Foundation cleanout (Y/N) Y
Date of pumping ' ' .
Septic/Steel
Number of Compartments 2
Depression over t~nk (Y/N) N
Pumper New Construction
Date installed 412812003
Cleanout~ (Y/N) Y
High water [larm (y/Iq) Iq
C. ABSORPTION FIELD DATA
Date installed 412812003
Length 84
Total depth 14.21 ft.
Date of adequacy test
i Soil rating (g.p.d./ft2 or ft:~/bdrm) .45 GPDISF.
ft. .Width 3 ft.
Eft. absorption area .1 ~680 ft~ Monitoring tube Y
Results (Pass/Fail)
System, type .Deep Trench
Gravel below pipe 10 ft.
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.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
Absorption rate >=
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 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
Sewer/septic service line >25'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?.
On adjacentlots >100'
On adjacent lots >100'
Public sewer manhole/cleanout
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water serviceline >10'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >10'
Curtain drain None Noted
Building foundation >10'
Surface water >100'
Wells on adjacent lots >100'
Absorption field >5'
Sudace water >100'
Water main >10'
Driveway, parking/vehicle storage >25'
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 with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 12/?./2003
HAA Fee $ ,~'7 ~'
Date of Payment
Receipt Number
(Rev. 1~00) '
Waiver Fee $
Date of Payment
Receipt Number