HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 1 BLK 1 LT 7Glenn View
Estates West
01
•
x#051-793-07
Municipality of Anchorage
Page 1 or 3
Development Services Department
On -Ste Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-65o
www.d.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
Permit Number. _ SW040002 PID Number: 051.793-07
wn»:
MM&M Cont ictin-g. Inc. Wastewater System: New
P.O. Box 670495 Chu lak AK 99567
Praa»:
ABSORPTION FIELD
N ober a seaOnea:
88-1236 F ur 4
5' Wide Trench
LEGAL DESCRIPTION
scif PW ` Total Dep1h*= original Way:
sbck car. Subdivisixr
1 7 Glennvlew Estates West No. 1
1.2 DPWe 7 Ft.
Dap; b plpebortom *oma isnai prede: Cray.l °'°" °""'4A
Townshp: �' sactiort
3 Ft. 4 FL
Faadded atfovs ppby Owns: Dreval Larpth.
Well: Public Water System
1-2 Ft. 95 Fr.
�'"""� Number of lines: Dlstarps beMaen hoes:
CWwfriralion (Privets. A B. C): Tay p�N. Caaad b:
5 Ft. 1 FL
TOW sOppG :a : Pipe Material:
ua xFt
Daft DdlMd: stip water Leval:
950 F!= ASTM 3034 PVC
Installer.
Ft
Ylea:
-. tats lromlled:
MM&M Contracting 6/28-29/04
Pump set at CaWrblata Abort Drain¢
filr%fTANK
SEPARATION DISTANCES
® Septic ❑ Holding 1] S.T.E.P. 0 Other
To Septic Absorption Lift Holding udkdPrivam
From Tank Field Station Tank Sa Line
in
Anchorage Tank 1,2$0
wan >200' >200' N/A N/A >25'
Steel
• Two (2
sMdx.wara, >100' >100' N/A N/A
LIFT STATION r NONE ON LOT
LN UN
>5'
>10'
N/A
FaugatWn
>5'
>10'
N/A
Fft
una a
curtain Drain None Noted
P1anpMGMamom EkctrGl nopspgepodanydbr
Remarks:
BENCH MARK
nsu a on er ep Ic an .
pian:
Finished Floor.
atiorl:
100.0 FL
Engineer's Stamp
Inspections T.L.
performed by: Kimbrough Dates: tat 6/28/04
i � 49th
2n° 6/29/04
Department of Health and Human Services approval
0.0.
MICHAEL E AN�Ep50ry
•�.
ifs; NO. CE -4381
Reviewed and approved by: Date: 1 - S- O
0i ..„ �� :••
♦a�ae�isksr:�� �.
k
Municipality of Anchorage Page 2 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. SWO40002 PID No. 051-793-07
S81 15'04"E 144:69'
\
A Br13
S1
10.3
15.8
S2
15.2
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44.8
66.8
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C5 64.0
C5� I
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M7
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O TH .
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Four
B Bedroom
Home
NS2
S1
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Atlemate 0
Site THt
I m
ioio
`
I,
U
C4
I
a
J
IS Li ility Easement
S89 59'03"W 177. 8'
Ross Voyles Avenue
PLAN
AS -BUILT
49th
::•:•• :•..�.".r:
- SCALE V - 40'
...
. Nl
�� ;NICHAEL E. ANDERSWI
j:
••,�����
LOT 7, BLOCK 1, GLENN VIEW ESTATES WEST SUBDIVISION NO. 1
�� �
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: SWO40002 PID No. 051-793-07
TBM = 100.00'
PROFILE AS -BUILT
Seale: 1" m 20'
t
cpi
�.0
PROFILE AS -BUILT
Seale: 1" m 20'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 7, BLOCK I, GLENNVIEW ESTATES WES
PERFORMED FOR_ _ MM&M CONTRA TIN INC.
DATE: 6/28/2004 PROJECT No M044
PARCEL 1D#• TECHNICIAN: T.L. KIMBROUGH
DEPTH I TEST HOLE
(feet)
OB/OG
1 SLOPE
2
3
4
5 0%
6
7 DRY POORLY GRADED SANDS
8 SOME SILT
SM
9
SITE PLAN
SEE SITE PLAN
10 WAS GROUND WATER ENCOUNTERED? No IF YES Q WHAT DEPTH? S
11 DEPTH OF WATER AFTER MONITORING: NONE 2%
DATE OF MONITORING: 7/5/04 (EPJ
i1
16 BOH
17-
18-
19-
DATE
71819
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DWPPTERF
(INCHES).
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/28
1
9:52
8.12"
2
10:02
10
4.75"
3.37"
3
10:03
8.511
4
10:13
10
5.25"
3.25"
5
10:14
8.25"
6
10:24
10
5.13"
3.12"
PERCOLATION RATE. 3 (MINANCH) PERC. HOLE DIA. �INCHES)
TEST RUN BETWEEN FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 11/9/2004
MUNICIPALITYOFANCHORAGEj'��L+�
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 PERMIT
Initial
Date Issued: Jan 08, 2004
Expiration Date: Jan 07, 2005
Permit Number: SWO40002 Parcel ID: 051-793-07
Legal Description:V31dnr(' Xjewsfafes West 1.'Block, 78
Design Engineer: 0014 Anderson Engineering Site Address: Unknown
Owner Name: MM&M Contracting Lot Size: 40021 SO. FT.
Owner Address: P.O. Box 670495 Total Bedrooms: 4 Permit Bedrooms: 4
Chugiak , AK 99567 -
This permit is for the construction of:
[✓ Disposal Field [✓ Septic Tank Holding Tank E] 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
Date:
Date: A9104
Municipality of Anchorage
Development Services Department x,
zr�
Building Safety Division
On -Site Water and Wastewater Program s . r
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
( FOR A SINGLE FAMILY DWELLING
Parcel I.D. Permit Number SW0406OZ
Property owner(s) MM&M Contracting Day phone 688.1238
Mailing address (1) P.O. Box 670495 Chuglak, AK 99567
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 7. Block 1. Glenn View Estates West Subdivision No.1
Legal description (Section, Township & Range)
Lot Size C _Acre Sq.Ft. Number of Bedrooms Four (4)
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 andis inaccordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: 5V0 t! Waiver Fees:
Date of Payment: /Z --TO - O 3 Date of Payment:
Receipt Number: Of4 IS -3 P— Receipt Number:
(Rev. 12100) -11
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
December 30, 2003
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 7, Block 1, Glenn View Estates West Subdivision No. 1
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The owner of Lot 7, Block 1, Glenn View Estates West Subdivision No. 1 intends to
construct a four-bedroom home on the lot. We are therefore requesting a permit be
issued for the construction of a new septic system to serve the new home. The
subdivision is currently served by a community water system. The attached Site Plan
and backup documentation identify the location and configuration of the water service
and proposed septic system and alternate site. No conflicts exist between the water
service and septic system on this lot and those on adjacent properties. Drainage
arrows with representative surface slopes are shown on the Site Plan. The drainage
pattern will be maintained after development of this lot is complete.
A test hole placed on the lot in the area of the new absorption trench completed by Ken
Duffus, P.E. indicated sand with silt with a percolation rate of 3.5 minutes per inch. No
groundwater was found in the monitor tube and none was noted during the monitoring
period. We are therefore proposing to place a new 1,250 -gallon septic tank along with a
50' long by 5' wide by 4' effective depth absorption trench to collect and treat the
sewage generated in the house. The bottom of the trench will be 7' below the surface.
A minimum of T of cover will be placed atop the trench and 4' atop'the new septic tank.
The ground surface on the lot slopes at shallow grades from east to west as shown on
the Site Plan. The absorption trench will be constructed parallel with the slope of the
ground surface as much as possible in conformance with Municipal requirements. The
new septic system will be constructed a- minimum of 10' from the water service on the
lot and on adjacent lots. It will also be constructed a minimum of 100' from any surface
water in the area.
Lot'7, Block 1, Glenn View Estates West Subdivision No. 1
December 30, 2003
Page Two
If the system is constructed in accordance with our design the following statements
apply:
1. 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,
Mj'.'L z Q't'
Michael E. Anderson, P.E.
Attachments
Alternate
Site
20'
90':gx'Wkk
X;EffectlDepth
Absorption Trench
1,250 Gallon
Septic Tank
Four
Bedroom M
Home I
15' Utility Easement
Ross Voyles Avenue_
NOTE: No Conflicts With Neighboring Septic
Systems or Water Services.
Subdivision Is Served by a Community
Water System. SITE PLAN
SCALE V-40
LOT 7, BLOCK 1, GLENN VIEW ESTATES WEST SUBDIVISION NO. 1
(D
U
0
LOT 7, BLOCK 1, GLENN VIEW
ESTATES WEST SUBDIVISION NO. 1
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5' Wide Trench System
Perc. Rate: 3.5 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPD/SF (Appplication Rate) = 500 SF Absorption Area
500 SF/5 LF (Width)' .5 (Red. Factor) = 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation In Trench to be 3' Below Original Ground Surface. Total Depth to be
7' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
Natural
Backfill
Geotextile
Fabric
6" j 4" Perforated
It PVC (Holes Down)
4'0 1 1 ,>---t— Drainfield Rock
5'
I4
TYPICAL 5'' WIDE TRENCH SECTI
s�P•••"'
NOTE: Grade Area Over Trench to Drain Away. ,.'
Minimum 6' Separation From Bedrock. r
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Water Service Line. 'Mkw�ue 'eas
Minimum 100' Separation From Surface Water or Streams: No. cE.se,
•m,..
KM
ENGINEERING
20441 PTAMv=AN BLVD.
F.AM.FRTVM nn-oowr7-9ne
SOILS PERCOLATION TEST
Performed for. _ Arctic Devc0Dote PerFormed: 04/2 /�99
Project: t.0t 7, ]Nock 1 Glenn View slates West TZST HALE 9 99447
1
2
s
4
S.
6•
7-
a. 8.
9-
30.
11-
12-
13.
1"12-13.
14-
zs-
16-
17-
1S-
19-
20-
ORG - brown, moist SEE ATTACHED 11T'E PLAN
FOR HOLE LOCATION
SM—mod. dense, brown c
Was Ctwind walsr enrouamsed? NO What depth? NA '
DepthmwatezattermoMtoringt NO Dace? OS/IS/99 —
9M - fncruAnfi density
w/de?tit. w/g avel & fine sand
acting
Date
toss
Time
Not
Time
pth to
Water
et
Drop
1
4/22199
1:00
7"
2
110
l0asia
914115"
32/16"
4
121
10 min
i 4 4 16"
212116"
5
"
1:22
7-
6
1;32
10 min
441160
212/1V
7
1:33
7"
_
8
1�3
10 min
4 2/16"
214/16"
9
•
1:44
7
10
1Z4
10 min
4 2116"
2'14116"
11
•
1:53
7"
12
2.05
10 min
4 2/16"
214/16"
•
Water
Added
HALE PRESOAKEDPercalatianRate M (min/R) Pere Fole Diameter
PRIOR TO TEST Tat Run Between _ ' _ feet and 4 feet
1, Ke=eth M Duffus, certify that this test was PerfOtmed in accordance with a1 State and Munidpai guidelines 1tt
eEea on this date.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 7, BLOCK 1, GLENN VIEW ESTATES WEST SUBDIVISION NO. 1
GENERAL:
The scope of this project includes the procurement and placement of a new
1,250 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 50' long X 5' wide X 4' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 3' below the existing ground
surface. Total depth of the trench will be 7' below'the existing ground
surface. The new septic tank and absorption trench must be placed a
minimum of 10' from the water service on this and adjacent lots.
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. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
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
A new 1,250 -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.
Lot 7, Block 1, Glenn View Estates West Subdivision No. 1
December 30, 2003
Page 2 of 3
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.
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:
I. Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
`Lot 7, Block 1, Glenn View Estates West Subdivision No. 1
December 30, 2003
Page 3 of 3
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 shallbe 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).
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 4WI
Building Safety Division
On-Site Water & 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. 051-793-07 COSA#
1. GENERAL INFORMATION Expiration Date: /
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
21400 LINDA JO CIRCLE * CHUGIAK, AK * 99567
DAN & SARAH PALMER Day phone
21400 LINDA JO CIRCLE * CHUGIAK. AK * 99567
Day phone
CHARLIE WHITLOCK W/ COLDWELL BANKER Day phone
360-3909
265-9165
3000 CENTRE STREET. #101 * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
E
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 samples. (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, t 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD, attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidefines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
ere are no hidden detects or encroachments. GEG, LTD, can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
_Z Approved for 4— bedrooms.
Disapproved.
337-6179
Date !Z 12
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
OF
ON-SITE
By: f ` 67rOriginal Certificate Date:
(Rev. 11105)
Municipality of Anchorage :y
• Development Services Department w
Building Safety Division
On -Site Water & 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 CHECKLIST
Legal Description: GLENN VIEW ESTATES WEST S/D #1; BLOCK 1, LOT 7 Parcel ID: 051-793-07
A. WELL DATA
Well type _
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
PUBLIC WATER
If A, B, or C provide PWSID#
Sanitary seal (Y/N)_
Cased to ft.
FROM WELL LOG
Coliform colonies/100 ml. Nitrate mg./L.
epic: ug./L. Date of sample:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Well Log (Y/N)
Wires properly protected (Y/N
Casing height (abo round) in.
AT I CTION
ft.
g.p.m.
Collected by:
Date installed 6/28-29/2004
Foundation cleanout (Y/N)
YES
Depression over tank (Y/N) NO
High water alarm (Y/N) N/A
Date of pumping 9/22/2011
Pumper
SANITARY PUMPERS
C. ABSORPTION FIELD DATA
Date installed 6/28-29/04 Soil rating .p.d./ft r ftlbdrm) 1_2 System type 5—WIDE TRENCH
Length 95 ft. Width 5 ft. Gravel below pipe 4 ft.
ii
Total depth 8� fit. Eff. absorption area 950 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/8/2012 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 5 in. Water added 101 Dgal. New depth 14 in.
Elapsed Time: 140 min. Final fluid depth13_25 in. Absorption rate >= **600+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
**ADDITIONALLY, LAST 290 (OVER 41 MINUTES) GALLONS CAUSED NO RISE IN LIQUID LEVEL.
TRENCH ABSORBED 374 GALLONS IN 181 MINUTES.
D. LIFT STATION
Date installed
Size in gallons Manhole/Access
"Pump on" level at in. "Pump off' level at
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service lines_
areas
at in.
Meets alarm & circuit requirements?
PUBLIC WATER
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM 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 200'+
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 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
*PER 2004 INSPECTION REPORT AND C.O.S.A. BY MIKE E. ANDERSON, P.E.
G. ENGINEER'S CERTIFICATION _ o
1 certify that l have determined through field inspections and p
review of Municipal records that the above systems are in gC7
conformance with MOA COSA guidelines in effect on this
date.ness.-Engineer's Printed Name JEFFREY A. GARNESS Q 9 I
Datevoa
��Qn�'r o f e ssio�°oo
COSA Fee $ !`1U Waiver Fee $
Date of Payment ![3�! Date of Payment
Receipt Number ooC/ `��j Receipt Number
(Rev. 11/05)
Jot
Municipality of Anchorage I Ia S
Development Services Department *A1
Building Safety DivisionOn-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. 051-793-07 HAA# f7taD
Expiration Date:
1. GENERAL INFORMATION
,Complete legal description
Location (site address or dir
Current Property owners) MM&M Contracting Day phone 688-1236
Mailing address P.O. Box 670495 Chualak, AK 99567
Lending agency __ Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA wiz1 be held by DSD for pickup.
2. NUMBER OF BEDROOMS:Four 4
iJ
3. TYPE' OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A 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 reissyed 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 Muhicipality of Anchorage is not responsible for errors or omissions in the professional engineers
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 Finn Anderson Enalneerina Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 11/9/2004
C`E
...
5. DSD SIGNATURE S :a r
fs No, cr-43,�`tit
✓ Approved for 1-� bedrooms. �i"si
•w..:„...
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: az Original Certificate Date:
(PW 12M)
_OIL_
_Municipality of Anchorage
Development Services Department
•' a°
Building Safety Division o
On -Site Water & Wastewater Program `
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cf.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
ti
Legal Description: ' Lot 7 Block 1 Glenn Vlew Estates West Sub. No.1 Parcel ID: 051-793-07
A. WELL DATA
( Welter -- If A, B, or C provide PWSID # Well Lo Y/N J
F Date completed 9 ( ) ------
Sanitary seal (Y/N
Wires properly protected (Y/N)
Total depth ft. Cased to
in. Casing height (above ground)
FROM WELL LOG
AT INSPECTION
Date of test
Static water levet
ft. n
Well production ft'
g.p.m.
WATER SAMPLE RESULTS:- 9.P.m.
Colfform colonies/100 ml. Nitrate
rn9•/1• Other bacteria colonies/100 ml.
Date of sample: Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Seotic/Steel
Tank size
Date installed 6/28/aona
7.250 gal. Number of Compartments
Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N)
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed 6/29/04 Soil rating (g.p.d.M2 or ft2/bdrm)1 GPD F System type 5' Wide Trench
Length 9-'-r- - --__ ft Width 6
ft. Gravel below pipel. ft
Total depth 7_8 ft Eff. absorption areao ftz
� Monitoring tube Y Depression over field N
Date of adequacy test ,
Results (Pass/Fail) `
For
Fluid depth in absorption field before test . bedrooms
in. Water added__ gal. New depthin.
Elapsed Time: __ min.. Final fluid deem. __ in.
Absorption rate >
Any rejuvenation treatment (past 12 mo. 9 P.d.
} (Y!N type) N If yes, give date �_
u. uri ag Size in gallons Manhole/Access (YIN)
Date installed -pump off" level at in. High water alarm level at in.
*pump On" level at , in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer manholelcleanout -------------
Public sewer main _KA__� AA__�
Sewer /septic service line Holding tank
SEPARATION DISTANCES FROM SEpTICIHOLDING TANK ON LOT TO:
Absorption field >S
Building I foundation >6 property line . >V
Surface
Water service line >1b' �rface . water >700'
Water main NrA
Wells on adjacent lots >200.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
line __
Water Service line >10>IV Building foundation �>lV Water main _?��
Property
Surface water _>I �OV Driveway, parking/vehicle storage �>V .
curtain drain _None—
one Noted Wells on adjacent lots _.>2W_
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 & Anderson �
Date 11 9 2004
HAA FeO'$ 5
Date of payment I
Receipt Number
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
0
C ANVER�
No. CE -4
"'M COUNTRY RERLTY
PHONE No- : 9076881238
Nov. 08 2004 10:54RM P2
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