HomeMy WebLinkAboutSUN VALLEY NORTH BLK 4 LT 9Sun Valley
North
Block 4
Lot 9
#050-652-12
,,,r _; :_ ,;__,- ^_ ~. _lwumc,lJanty,u,~_mcnorage Page 1 of 3
Development S~ices Depa~ment
On-Site Water and Waste~ter Pr~mm
4700 Sou~ Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
~.ci.anchomge'.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030072 PID Number: 050-652.12
Na~:
Hailer Construction Wastewater System: New
Address:
P.O. Box 110731 Anch., AK 99511 ABSORPTION FIELD.'
Phone: N~er of Bedrid:
245.3010 Four {4) Deep Trench
LEGAL DESCRIPTION ~, ~,~: ,?~ ~ o,~,~ ~:
~k: Lot: SubdM~on: Dep~ to pl~ ~ttom from odginal grade: Grovel depth ben.th ~pe:
4 9 Sun Valley Nodh 2 ,,. 10
T~shlp: ~nge: S~ion: F~II added ab~ ~nel ~de: Grovel Leng~:
1-3 rt. 85
WEll: New Gm~l ~dth: Nu~er ol lines: ~ Die.rice between lines:
3 ~. 1 ' ~t.
I
Classifi~tion (Pd~te. ~ B, C): To~l Depth: Cased Io: To~l ab~ area: P~pe ~terial:
Private i53 152 1,700 Fe ASTU3034 PVC
Ddlle~ ~te Dffiled: StaSc Wa~er Level; ~s~tler: Cate Installed:
Hefty Drilling 5~8~2003 126 ~L BTH Construction 5/13-t4/2003
~eld: 4 GPM ~J Pu~ Set at:R.lJ Casing ~ eight~2~O~FLG~nd: TANK
SEPA~TION DISTANCES ~ Septic D Holding D S.T.E.P. D Othe~
T~ To Septic Absorption Lift Holding =ubli~Hvate ~nu~acturer; ~pa~[y m ~allons;
F~o~
Tank Field S~fion Tank Sewer Line Anchorage Tank 1,250
Material: Nu~er of Coca--nfs:
>~00' >100' N/A N/A >25' Steel Two (2)
W~I
~=.w=,,~>100' >100' N/A N/A ~ ~ LIFT STATION- NONE ON LOT
~o,u.= >5' >10' N/A N/A~ =,=e.
GaL
~.~t,o. >5' >10' N/A N/A -~u~o.-,~v~,.~: -~po,~,~.,~,:
In, In.I In.
Cumin Drain None Noted m~ ~. ~.~, ~,~:.., ,..~o.. ~..o~
"~"~': BENCH MARK
LO~t~O~ 8~ ~es~tptio~;
Garage Slab.
Assu~d Elemtion:
100.0
Engineer's Stamp
Inspections performed by:A. Harala Dates: 1't 511312003 * 49 h ·
2~
511412003
~ MICHAEL [. ANDERSON
Depadment of Health and Human Se~ices approval ~ ~;,, Uo. c~-~,
Reviewed and approved b Date: /2 '~ ~- 0 ~
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 -
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030072
Page 2 of 3
PID No. 050-652-'
ELXHORN
C k,fl $1 $2
S2
C4
Ul
C5
M2
16.8 7.0
23.6 12.5
4~).o I so.9
46.1 156.4
81.8 167.1
7.3.5 J59.6
PLAN AS-BUILT
SCALE ~,° = 50'
MICHAEL £. ANDERSrlN
No, CE-4381
LOT 9, BLOCK 4, ~SUN VALLEY NORTH SUBDIVISION
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Ancl'iorage. AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030072
Page 3 of 3
PID No. 050-652-12
F101.3
II ~ /~ ~' .
· I Il,E50 Gotton~
· /IS.p*~: T~..I~
95.~ I I 95.35
94,$
84.7 '
99,8
......... Ge__o~,ex__.~!le_ F.__o.lo r-l.._.~ ..........
]:)rcdnFletd Rock
85'
84,55 /
78.2
94.9
PROFILE AS-BUILT
Scale: 1" = 10'
Municipality of Anchorage
4700 South Br-agaw Street Anchorage, AK 99519-6650
Development Services Depadment
SOILS LOG - PERCOLATION TEST
t t ¢ --
'1
3
4
1
1o
12
14
17-
i'
oo
SITE *P L~". H
WAS G~OUND 'WATER' ;
ENCOUNTERED?
IF Y~. AT WHAT O
DEP~? p
Grot Net · ' ' ] DePth to' Net
~-' .
PERCOLATION RATE __ (minute~/inch) Pc. AC HOLE DIAMETER
TE~-r RON SET~'vE. EJ~ ~ FT AND F'T
I ~TJFY T~T ~HtS
~CCORDA~ICE WiTH AL.L STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE_:
TEST WAS PERFORMED IN
zz-z~f
ICERFORMED FOR:
FROM FAX NO. :245-3010 Dec. 02 2003 12:21PM P2
:HALLER CO
HEFTY 'DRILLING
3540 AKULA DRIVE
ANCHORAGE, ALASKA 99516
(907) 345-0593
STATE OF ALASKA
. ~.:. ·. DEPARTMENT OF NA:FURAL RESOtIRCES
"MINING, LAND, WATER HYDROLOGIC SURVEY
WATER WELL LOG
Drilling Started:._~.~/., a~ O/.=~_, Completed: ~. / ~ / 0.~_
Meridian ................. Township ...... Range Section ... ~ of .... ~ of .
Late N . . ' ...... Long: W ......_NAD: 2.7 OR 83 Elevation:
BOREHOLE DATA: (from ground surface) Depth Drilling method: ~-..Air rotary, ~ Cable t.~l, Other
Mater/al: Type. Cxalor & wetness [ F_rgm. ] To Well use: D Public supply, g, Domestic, D Other
· 7tx Depth of hole: I ~ fl, Casing stickup: ~ R '-'
~- ~,~/ Casing diameter: L inches Casing depth
· ~ ~ Staficwat:r(froh~opofcaslng): /~' fton ,~/ OC".'
Recovery rate: e./. gpng Method of testing:
x.g... -- Well intake opening tTp¢: 3~:)Pen end. D Open hole
~ Screen type: Slot/mesh size
:'__~J~.t~d q ~,'a ,I 1/-'J ]4Ad 1~O i/ ~.]_ ~ Perforated;Start: fl, Stopped
Stag: fl, Stopped
Note:
Depth; from fl, to ft
Pump intake depth:
__ Pump size bp, Brand ~n~: .
Was well disinfected upon eqmpl~ion? ,~3Yes, ~ No
Method
Driller comment.s/d/sclaimers: .............. ' ...................
Company Name:_. HEF~I-Y
Mailing Address:. 3'540 A'KULA DRIVE
city:. ANCHORA~_~._State: ALASI~ ~Zip:. 99516
i Phone Number :. _'1 ,-907-345-0,5~:~ -
~ ~ Drillers Slgnatura: ~
.Oa.O~0. ~. 1~.020 ~ AK ~ulaflot~ l I ~C 95.140).
DEPARTMENT OF NATU~L RESOURCES
Mi.I.g, ~nd& .Water Hydro,lc
550 W 7th Ave. S~t¢ ~A
Ancbo~AK
W~lepbone (~) Z69~639 and FAX (~7)
Within thc City of Anchorage, it is required Lhat a copy of the Well log
sent to fl:e approp~at, city offlcc w/dlht 60 days and that another cop>, of
the well log be sca to the well/properly owner w/t~[n 30 days.
Permit Number: ·
Date of Issue: , / '"
Parcel Identification Number .
Is wen localed at approved perrait Ideation? ,'2 Yea or G No
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 / WATER SUPPLY PERMIT
Initial
Date Issued: Apr 10, 2003
Expiration Date: Apr 09, 2004
Permit Number: SW030072
Legal Description': ~.Sbh~/~lle¥ N0-rth'BlOck ~'4~Lot 9?'
Design Engineer: 0014 Anderson Engineering
Owner Name: Hailer Construction
Owner Address: PO Box 110731
Anchorage, A 99511-
Parcel ID: 050-652-12
Site Address: 22339 Elkhorn Cir
Lot Size: 82059 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
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.
Received By:
Issued By:
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.
Permit Number SW 0'~00
Property~owner(s) Hailer Construction
Mailing address (1) P.O. Box 110731 Anchoraqe, AK 995,11
Day phone 245.3011)
Mailing address (2)
Legal description (Lot, Block & Sub'd.)
Zip Code
Lot 9~ Block 4, ,S,aa~,at~ North Subdivision
Legal description (Section, Township & Range)
Lot Size ~:~SF Acre~s~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Number of Bedrooms Four (4)
r--] Well Only []
I~ Water Storage []
I-"1 Jacuzzi []
'['-I Water Softening Unit ' []
I certify that the above information is correct. I fudher' cedify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev, 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
April 7, 2003
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 9, Block 4, Sunvally North Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 9, Block 4, Sunvally North Subdivision intends to construct a four-
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 well and
the new septic system and alternate site and the parameters used in the design. Also
identified on the plans are the test hole locations and well and septic systems on the
surrounding lots. Drainage arrows and contours are shown indicating the current
drainage patterns. The drainage patterns will be maintained after construction.
The test holes placed near the location of the proposed absorption trench indicated silty
gravel with varying amounts of sand and a percolation rate of 57 minutes per inch.
No ground water was found during placement of the test holes and none was noted
dudng the monitoring period. We are therefore proposing to place a 1,250 gallon'septic
tank and a new 80' long by 3' wide by 10' effective depth absorption trench. The trench
will be oversized due to the slow percolation rate of the accepting strata. The total
depth of the trench will be 12' below the surface with the distribution pipe at 2' below
the surface. Sufficient fill will be placed to prevent freezing of either the septic tank or
the absorption trench.
The ground surface on the lot slopes as shown on the site plan from north to south at
varying slopes. 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 any surface water and
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
Lbt 9, Block 4, Sunvally North
April 7, 2003
Page Two
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
Unedeveloped
1_0
11
6
8
AR EA MAP '"'"'""""""'"':
No. C[-438!
AlternotE
Gollon
80' Long X 3' W~de
X 10' Effective Depth
Absorption Trench
SCALE 1" == 50'
LOT 6, BLOCK 4, SUNVALLY
SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 47-57 Min./Inch 1,250 Gallon Septic Tank ·
Avg. Application Rate: .45 GPD/SF 10' Drain Field Rock
4 Bedrooms X 150 GPD 1.45 GPD/SF = 11333.3 SF of Absorption Area
1,333.3 SFI20 SFILF = 66.7 LF Trench Length
Therefore: Construct an Absorption Trench to Oversized Dimensions 80' 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 Each Trench to Be 12' Below Existing
Surface. Cover Over Septic Tank a Minimum of 4' or 2" of Insulation and 2' of Cover.
Cover Over Trench 3'.
6~
10'0"
I
Natural.
Backfill
!
Geotextile
Fabric
4" Perforate~ PVC/
Schedule 40
DrainfielG Rock /
3~
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
Development Services Department
4700 South Bragaw Street Anchorage. AK 99519-6650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
'=,' ~.~-" ' A _~"-..'~7 *. -
· .Cn% NO CE-438~ :~
DATE PERFORMED:
Township. Range. Section:
5
6
"~o'-
11-
'12-
IF YES. ATWHAT · ' : L
O
· DEPTH? p
E
.~,~;,~? None 0~ 4/1 '/03
13-
.14 -
15
2O
r'E.COUmO.
TEST RUN 8ETWEE~ ~'~ .
__ {rn;nu~c~/inch) PERC .HOLE DtAMETER .
nANO ~'"~ rT
II
..................... t ...... ,- -~,,u ..u~,ulr~L {~umoc. Llmr..S iN E;'F~.C.T ON THiS DA~F_ DATE:
CERTIFY THAT THIS TEST WAS PERFORMED IN
Municipality of Anch~)rage
~. ·
Development Se~,ices Depadment
_ . ,,:~:....~....~2~
4700 S~uth Bmgaw Strut ~age, AK ~519-6650
SOILS LOG- PERCO~ON ~ST
LEGAL DESCRIPTION: ~ T '~, ~1< ~ Tow~hip. Range, Secfion~
x,
20 '
14
15
PERCOLATION RATE '~'''] CminutcS/inch} PF-.RC .HOLE DIAMETER __ - -
TEST RUN BE'T'VV~ '1' (~' ' F'T AND ~* ~:" FT
'2
6
7
13
14
15
i6
17
18
19
20
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH/),ND ENVIRONMENTAL PROTECTION
"' 826 L. ~,t~e~t..~*mh~raOmo Alatk~ g~01 ~1(344720
[~sol LS I. OO
SOl L$ LOG -- PERCOLATION TEST
· SLOPE
o o
SITE PLAN
Y
N~. ~1,~
ENCOUNT~:RED~'
IF Y£8o AT WHAT
DEPTHS'
PERCOLATION RATE _ . [mlnule~m~h)
'' TEST RUN BETWEEN . ~"'/. ~ · FT AND __- ~-/~' O: FT
..~(~ · ~
· Flar~12 2003 8: 29RPI ~)TH Constructi on, LLC
AAUNIC:IPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROT£CTION
825 L. Strmmt, Ammh~o~, Alaska ggS01 2B4.4920
SOIL~ LOG -- PERCOLATION TEST
PERFOR.MED FOR:
!
2
3
4
'6
6
7
9
10
11
13"
14
15
16
17
18
19
20
~^SENCOUNTERED,GROUNC ~ATERI~ ~ [
. .o
SITE PLAN
IF YES, AT Id,TI'AT
· .. DEPTH~
Cole Oro~ Net D.pth to Nat
PERCOLATION I~TE /~/4 Cmlnule,lln~hl
O^TU, /
?2.oo.e [6/7l*)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND'MATERIAL SPECIFICATIONS
SUBJECT: LOT 9, BLOCK 4, SUNVALLY NORTH SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,250-gallon tank at the location shown on the site plan. Work
also includes the construction of a new absorption trench 80' long by
3' wide by 10' effective depth also at the location shown on the Site
Plan. The total depth of the trench will be 12' beloTM existing ground
and the distribution Pipe will be placed at 2' belowithe surface. All
components of the new absorption trench and septic tank must be
constructed a minimum of 100' from any surface water or wells in the
area. A minimum of 4' of cover is required over the septic tank and 3'
over the absorption trench. In lieu of cover 2" 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.
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
pdor approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from a certified
septic tank manufacturer if the existing tank is found to be defective.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
All standpipes on the septic tank Shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
Lot 9, Block 4, Sunvally North
April 7, 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 drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
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.
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. 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 vedfy this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
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, Fernco, or equal).
· Lot 9, Block 4, Sunvally North
April .7, 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 ~,\
B[~ilding Safety Division ."J
· 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
Expiration Date:
GENERAL INFORMATION
Complete legal description. _.Lot 9, Block 4, Sun Valley North Subdivision
Location.(Site address or directions) Elkhom Circle
Current Property owner(s)
Mailing address
Hailer Construction
P.O. Box 110731 Anchoraqe, AK 99511
Day phone 245.3010
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
e
Mailing Address
"unl~S otherwis'e requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual'Well
Individual Water Storage
Communi.ty Class
Public Water System
Well
Four (4)
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 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 fbr properties served by a private or Class C well and may be reissued with
new v~at~r sarhpl~ 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 propedies served by Class A or B wells or a public Water
system. The Mun, icipality 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 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 P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 12/2212003
5. DSD SIGNATURE
V Approved for _ �' bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
j 'UNS1-1 -0
SE M : WATER AND
WASTEWAT
PROGRAM •
t
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
BY: 4eOriginal Certificate Date: 12% — 2 G • 0.3
(Rev. 12/00)
' 't ' . ~ :Develol3ment"' ~" ~ :'"'= ~'Servlces ~ "Department i i::~i ~ ~ i~i
, ' '~ ' .; . ~ Bu'd'ngSafetyDiv's'on ,'; ~, ' , , ' " '
,.~: ~ ,.~ i ~ ~ On-Site Water &:Wastewater Program, ' : ~ ;:' ~
.', '~ .... ' : ' ,. :. ';,',~700'SouthBragawSt ' , ~ . ' . ,,~ :~:' .
· , . ,. :;,P.O. Box196650 ~Anchorage, ~K 99519-6650', : "~' ::,;~ ~['
......... ~ , ,,~ ,~.c.anchoraoe.aE.Us :. ~, ~ ..... ,,
.............. 907 343-7904,, , ,, ,
"~ ~ ' ': , ,'; ~EAUTHAUTHORITY-~PPRDVAL'~M~U~LI~/.:
Legal Descripton'. Lot ~9, Block ~ 'Sun Valley No,h Sub~lvlsmn~ '- .... ~ ~ ~ Parcel'lD '~050'65242
WELL DATA ,.., ~ . ~ . ~
Wellt~ePrvate : .... :,~,.: :~,~:lfA, B. orCprowdePWSIDfl~ .... ~, ~,~,.,WellLog~/~)y
Dat6 comp et'e~ 5/81~0'03:' .'., ;~ S&nit~ ~bal ~(Y/N) Z J' :~ i: ~ ~ir~ Pr~p'e[ly Protected (~/N) Y
.., ......... , , ,,, , ........ ., ,,. ...... ..
Totalde-th 153 ff :' : CaSedto ,152 ft ":~ ,'~ ' ~1: [jCasnghelght(aboveground) 24 , n.
,:~ ; .,. ': ,';~,'~FROMWELELOG,'" .... :,':, ~,l,~ ~ATINSPECTION : ',' ]~ '
WATER SAMPLE RESULTS..,,. : ,, : ~. ,~ ,~' ~: , , ~ ,, , ,,,~
C01ifo~m 0 'colonies/100~ ', :~ ~, 'Ntrater'.761 mgT., :: ,, ~"'. {' ~t~er, bac~ena-,0 ?~lomes/100ml.
Date of sample: , 1~5/2003 ....... ~ ,Collected by. ,. MEA .... ~ ...... F
SEPTIC/HOLDING TANK DATA ~,~ ~, , , ~ ...... I~ ' ' ~ '~ ~"
TankTvae/Material, Se~ticlStee~ ~ ~; ~tl; ,,:; '..,:~ ;',;'; = ;:; [ ,~ ',~ ~'t, ~Date installed ~5fl312003 =~
T~nksize :;1250~ gal.::::'.'-,, ~ ;'Nbmber,of~Co~padments[ '[ ' [:'~ i~l~anouts(Y(N)Y .~
Foundation cleanout (Y/N) Y ','~ Depression Over tank'ff/N) N: ~ ~High water alarm (Y/N) N
ABSORPTION FIELD DATA ,: '. ,' ~'~,,, ~; ,, :~ , , : , ' ., , :
D~te instal 60 =a4)2~ ::' ~, ~so rat,nfl (g.p.d./ft~ or ft2!bdrm):45 GPDISF ;: System type', Deep',Trench
Tnf~l ~nlh ~ {t ....... Eft absorot~on areal.700 ft . ' Momtor ng tube Y De ress on over field N ,,
'D~te ofade°Uacvtest' ': i ":~ , ' ',~ 3 Red,Its (Pass/Fa') ,~:,.i '~ ~: :: '.: ,, Fo~,~ bedrooms
Fuiddepthinabsorptonfedbeforetest,':{l[.,n].';: ,: Vi: :e:added'~:~ ,'. gal. , New depth_ __ in.
5( i', ,, ,, : ,~ : . : : ~ ~ t : ,.~ : : ; l: ~ :[[ ~ ~ , ,~ , ,, , : , .
Elapsed Time' ~ ::. m n: ~,' ~ Fha flud depth , '.: :!~ln.' ~ :~,: Absorption rate ,>= :l: , g.p.d.
' ' ·" ' ..... :" ' ......... ~: :~. If yes ivedate , ._
Anyrejuvenatlontreatment(past12:mo.)( ~:~&~ype)~ .. ~~ ,g -
::~ ;~' ;: ""'~ ;~': "' : l:; l~~ :." i [ ~:, '~,:l; ~.,: '
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
in. "Pump off' level at in
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL. ON LOT TO:
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main N/A Public sewer manhole/cleanout NIA
Sewer /septic service line >25' Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field >5'
Water main NIA Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and my49 h
review of Municipal records that the above systems are in 0: ...... ......••T �' • ••••••
conformance with MOA HAA guidelines in effect on this date. �:`...... _
MICHAEL E. ANDERSON '
i
Engineer's Printed Name Michael E. Anderson, P.E. ��rs�: No. CE-4361.v~�
Date 1212212003 #iZ14JAfR0FESSI4N���
h1Awwww��
eav
HAA Fee $ Waiver Fee $
Date of Payment
/'z- zz-o3
Date of Payment
Receipt Number 4-57 V Receipt Number
(Rev. 12100)
1~--17--03~ 5=4~PM=
SGS Refit/
Client Name
ProJ ec~ Name/#
Client Sample ID
Matrix
1037927001
Anderson Engineering
Sun Valley North S/D L 9 B 4
Sun Valley North S/D L 9 B 4
Drinking Water
;907 5615301 # 2/
All Dates/Times arc Alaska Standard Time
Printed Date/Time 12/17/2003 16:28
Collected Date/Time 12/15/2003 12:45
Received Date/Timeff 12/15/2003 14:20
Technica! ~~ ~
Released By"~ v ... - - I
Sample Remarks: '
Allowable Prep Analysis
Parameter Results PQL Unit~ Method Container ID Limits Date Date Init
Waters Department
Ni~xate-N 0.761 0.100 mg/L EPA 300.0 B (<ri 0) 12/15/03 JJB
Microbiology Laboratory
Total Coliform
TNTC OB
col/lOOmL SMI8 9222B A (<ri)
12/15103 DKC
- PRELIMINARY -
11
LOT
7,32~
BLOCK 4 HAS
SQ.FT. OF AREA ..
T H F~L.O~ .IS ~RD
6
10
FOR: ttALLER CONSTRUCTION'-'
8-14-03
LanMa k : ' Grid
93~0 Vanguard Drive, S~ite ~0~
~chor~ge, ~aska 99507 :'-.. Drawn by
· I hereby certify ~at ~e ~roperty described ~e~eon ha~ .been ~eyed
by me: or ~ my direction, end ~ the i~pravemen~ situ~Led ~ereo~
are within ~e propar~y line~ and do not overlap or encroaeh"'~ the
propcr~y .tyk~g adjacent ~ercto unless othevwiee shu.x.. That
impro~emer,~ on fl~e prope~y lying adjadent thereto encroach
premi~e~ in question and ~n~ there are no roadways, ~anxmission '-'.
Hnee er ether easemen~ on said property except a~ sho~. '-
It i~ the responsibility of ~e owner or bu~der, prior %0 construction,
to verify proposed building ~cade relative to finish grade ~nd utility
connec~ous and %o determine the existence of ~ny easemen%~, covenant,
or res~ietions which do no( appe~ on ~e recorded subdi~sion plat.
.~%~d dJh%anee~ prevail over sealinE.
~ep'roduction may eauee di~l.c,r~on.
Scal~
1" =80'
Plot Plan
2300238
?ield Book
Legal Description
9 I Block 4
SUNVALLY NORTH
SUBDIVISION