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HomeMy WebLinkAboutGLENN VIEW ESTATES NORTH BLK 2 LT 7Glenn View 'Estates North • #051-811-51 Municipality of Anchorage Page 1 of 3 Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196550 Anchorage, AK 99519-6550 www.d.anchorage.ak.us (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW040001 PID Number: 051.811-51 : NNana &MContractin Inc. Wastewater System: New Addiness P.O. Box 670495 Chu iak AK 99567 ABSORPTION FIELD "I Nt ramw ot B80roau: 688.1236 Four 4 5' Wide Trench LEGAL DESCRIPTION Sal Retina: 1.2 Total Depth moronel Wade: aloe: lot: SubE'imion: 2 7 Glenn View Estates North WDIFe Dapll b pips bmran hom mlaiml Wade: 2 6 Ft. (yam dopffi bah per: Town,Mp: Rte: Section: Ft. Fa 800,E ebow oriprW Wad,: 4 Ft Ge`al tanWh: 0-2 Ft. 97 Ft. Well: Municipal Water System c"" WKW 5 Nunberor6nb Dn.1—betweenline,: Cluaificatim (Prirem, A a. c): Total Depth cued W. R. low, ab,apbon arae: 1 Ft . Ft. Ft 970Fe ASTM 3034 PVC Driller Dery Drilled: State Watar l.svot: e FL MM&M Contracting, Inc. 7114.15/04 Rumastet eaano nae,ora,u DPM Ft. Ft TANK SEPARATION DISTANCES ® Septic I] Holding ❑ S.T.E.P. 0 Other 7o Septic Hoddirg iaprhata From Tank Tank Sewer Line Anchorage Tank 1250 s we" >200' WA >25'Steel Two (2)sariaoewater >100' I>200'NIA WA LIFT -STATION — NONE ON LOT Lau* )'T N/A orFoiretotien >S WA D ""D arm Sit n. h. In. Wolin train None Noted "'""'0 "'"�°" Ebariul ""padi0ro °°"O"r"d W. BENCH MARK Locaborl p on: Garage Man Door Threshhold. 100.0 Ft. Engineer's Stamp ..�p"wapaOF a • Inspections performed by: T.L. Kimbrouoh �L Dates: 1° 7/14104 ; 49th 2n0 7115/04 •E. ;Ao�- Department of Health and Human Services approval MICHAEL ANDERSON No. sCE-4381 Reviewed and approved by: ;� l�• �� Date: —/ (7- 0 #4�PFo`LLa-aX„.� leer. lave) co- /// /, l� �.• �1� PR0FESS\Ci" ,41,111 1,\ � Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 Permit Number: SWO40001 On -Site Wastewater Disposal System or well Inspection Report 4 ti m m I �i ac N N Whispering 15 T and E Easement A B S1 48.9 41.s S2 44.1 45.5 G 47.5 88.2 C5 84.3 52.7 M1 1 82.1 152.1 ®TH1 Birch Four Bedroom Home Alternate Site i Orme Page 2 of 3 PID No. 051-811-51 I cs c4 M1 I LOT 7, BLOCK 2 GLENN VIEW ESTATES NORTH SUBDIVISION I I —I ----------------- I I 37.5' Electrfcal Easement I i Z awti N51 53'22"E 171.85' AS -BUILT PLAN SCALE 1" = 30' 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 No.: SWO40001 TBM GARA DOOR THR SAS LIFT VAULT PID No. 051-811-51 u � a 'S INSUL. PROFILE AS -BUILT Scale: 1' - 10' ' • MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 7, BLOCK 2, GLENNVIEW ESTATES N PERFORMED FORL_ MM8M roNTRQ TIN INC. DATE: 7/14/04 PROJECT No PARCEL ID#• TECHNICIAN: T -L. KIMBROUGH DEPTH (feet) 09/OG 2 El 1 TEST HOLE #. 2 DRY SILTY GRAVEL $ WITH SAND GM 9 - Ll 1 O WAS GROUND WATER ENCOUNTERED? NO IF YES ® WHAT DEPTH? I L DEPTH OF WATER AFTERMOMTORING. NONE DATE OF MONITORING: 2 4 m 17 SITE PLAN r SEE SITE PLAN 1 2% DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH oP WATER (INCHES) NET DRQP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 7/14 1 1:52 8.1211 2 2:02 10 4.75" 3.37" 3 2:03 8.5" 4 2:13 10 5.25" 3.25" 5 2:14 8.25" 6 2:24 105.13" 3.12" PERCOLATION RATE 3 (MIN/INCH) ?ERC. 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 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 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial J-114bq IL4(S rnIGIM 12W Date Issued: Jan 07, 2004 Expiration Date: Jan 06, 2005 Permit Number: SW040001 Parcel ID: 051-811-51 Legal Description: �Ieiin"xliew Estates Noitt`Btock2;Lot7r Design Engineer: 0014 Anderson Engineering Site Address: Unknown Owner Name: MM&M Contracting Lot Size: 40673 SQ. FT. Owner Address: P.O. Box 670495 Total Bedrooms: 4 Permit Bedrooms: 4 Chugiak , AK 99567 - This permit is for the construction of: F✓ Disposal Field ❑✓ Septic Tank E] 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: Date: Issued By: Date: Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragew St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION .FOR A SINGLE FAMILY DWELLING Parcel I.D. CF-;;, C, \— J 1 Permit Number SW Property owner(s) MM&M Contracting Day phone 68.1238 Mailing address (1) P.O. Box 670495 Chualak, AK 99567 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 7. Block 2, Glenn View Estates North Subdivision Legal description (Section, Township & Range) Lot Size 40.673 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 and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 4f0 p Waiver Fees: Date of Payment: IZ - Z9 -D 3 Date of Payment: Receipt Number: 4 (a Uo l C Receipt Number: (Rev. 12100) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX December 20, 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 2, Glenn View Estates North Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 7, Block 2, Glenn View Estates 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 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 proposed septic system and alternate site. No conflicts exist between the well and septic system on this lot and on adjacent properties. Drainage arrows are shown indicating the current patterns. The drainage patterns will be maintained after construction. A test hole placed on the lot in the area of the new absorption trench completed by Tobben Spurkland, P.E. indicated silt with gravel with a percolation rate of 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. Insulation will be placed atop the trench as necessary to prevent frost penetration. In lieu of insulation 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 south to north toward Whispering Birch Drive. 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 adjacent lots. It will also be constructed a minimum of 100' from any surface water in the area. Lot 7, Block 2, Glenn View Estates North Subdivision December 20, 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, s '� 'f ai" Michael E. Anderson, P.E. Attachments 2 yMICHAEL E. ANDERSON 4 N0. CE -4381 j Whispering Birch _ 15'7ane Easement Four Bedroom Home _I a I 5• 1,250 Gallon M x t5• Septic Tank 50' Long x 5' Wi x 4' Effective De Absorption Tren I ®THt Alternate Site I p I N D V I I I LOT 7, BLOCK 2 GLENN VIEW ESTATES NORTH I SUBDIVISION I I --I------------------ I I I 37.5' Electrical Easement I N51 53'22"E 113.99' SITE PLAN SCALE 1" = 30' LOT 7, BLOCK 2, GLENN VIEW ESTATES NORTH SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom House 5' Wide Trench System Perc. Rate: 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 (Acation Rate) = 500 SF Absorption Area 500 SF/5 LF (Widthp .5 (Red. Factor) = Vol5LF Trench Length THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be 6' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. 1"6" 6" 4'0" Natural Backfill Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 10' Separation From Water Service Line. Minimum 100' Separation From Surface Water or Streams. MCMEL E. N MMC No. CE4381 FROPI : COUNTRY REALTY � w r PHONE NO. : 9076881238 Dec. 05 2003 09:45AM P3 .�• Q l ar�u�r. •� `1,:,•'ln�.�•r�.rav in Services4epaiuriv 'v,,: -T�. rw_ci.L1: •.:, �54 :r ! � T ' •:; Safelyf7tv�'t0e w ,:. W••_••••a•••«••- Net Oro* Iwo 7R ' tt'.' �. Ort•Site.,W2t@rand1N25tetraterPmptam _ ?'_ ,�� ''r Depth to Water After' D(i� 0 P •47DaSaWDl3ragavrSL a . eL f)2 - L• 30 P.O. Ser 11915SWAndtaage.AK 99579.6650 e 2a.cfandittramak. f - 3 fl (907) 343-790: w .• L : �_. ..'J' 3 v 3 a . - ear ^ •- :r ..'." . . ..i. Soils Log: - Percolation Test w Performed For: -Date Performed: Legal Description: �� 1 � � 1�./d• To mft. R21100r SaCtion: Site Plan ' f D2P t 6- 8. 9- 13- 14is- 16- 17- is 1's- COAANIENTS oR6AN1, tP' T 5m:s ML Ire cL,a WAS GROUND WATER T, Gross Time ENCOUNTERED? NAC) Net Oro* Iwo 7R 6 IF YES. AT WHAT DEPTH? Depth to Water After' D(i� 0 P Monitoring? a Detc eL f)2 - L• 30 Reading Date Gross Time Net Time Depth to Water Net Oro* Iwo 7R E SOA L 0 t lb OL 1:, L• 30 0 K I m e tsv 3 fl t A + 3 v 3 a a�nr 6} PERCOLATION RATE h — to nw4s& a) PERC HOLE DIAMETER (6 " TEST RUN BETWEEN FT AND PT PERFORYIEO BY: CERTIFY , S _ 1 (. S CERTIFY THAT THIS TEST VJAS PERFORMED iN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (/ZB/O Z- i ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 7, BLOCK 2, GLENN VIEW ESTATES NORTH SUBDIVISION 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 2' below the existing ground surface. Total depth of the trench will be 6' 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 2, Glenn View Estates North Subdivision December 20, 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: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. Lot t, Block 2, Glenn View Estates North Subdivision December 20, 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 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). 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 M Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Pax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-811-51 1. GENERAL INFORMATION Expiration Date: 7_a `1-2,©2-Z Complete legal description GLENN VIEW ESTATES NORTH BLK 2 LT 7 Location (site address) 22501 WHISPERING BIRCH DR, EAGLE RIVER AK Current property owner(s) RICARDO RODRIGUEZ Day phone Mailing address SAME Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ED Water Storage ❑ Holding Tank ❑ Community Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. Date of Payment Date of Payment Receipt Number 0c)(7 S9 Receipt Number COSA # (OS C 2 0N U Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 8-5-20 49TH+ l% .• r�4 6. DSD SIGNATURE e., . System #1 Approved for 4 bedrooms �J" : • • • • • • • • • • • •.. 4 I A •• MICHAEL N. Al\0LR5CN•;��- System #2 Approved for bedrooms r� �•. CE 9469 Disapproved �lr�,yF•. Conditional approval for bedrooms, with the following. stipulations K I QITC g WATER AND G WASTE ATER o J J:�10110 SER\]NG�1,\� Original Certificate Date: 25 r, -_',+20-e0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other CASA Checklist blue sheet 19TOR"Evei Legal Description: GLENN VIEW ESTATES NORTH BLK 2 LT 7 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Comm. Water B. TANK DATA Age of tank(s) 16 years Tank type/material Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 7124/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 7115104 ❑ ALL standpipes present per record drawing Total measured depth from grade 7-7 ft (max) Measured depth to pipe invert from grade 3.7 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-811-51 of Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: ' steel septic tank Adequacy test date 7/24120 Results El Pass For 4 bedrooms Fluid depth prior to test 30 in Water added 600+ gal New depth 34 in Elapsed time 1440 min Final fluid depth 30 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes; enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑j Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ❑✓ Yes if No ft Water Service Line > 10' ✓❑ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' El Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5'✓❑ Yes Yes if No ft Wells on Adjacent Lots: ✓❑ Absorption Field > 5' Q Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10'✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' F/1 Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorege.ek.us (907) 343-7904 ZD CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 51.611.51 HAA # 6 1* Q Cc 53 Expiration Date: l a— i 0— O 5� 1. GENERAL INFORMATION Complete legal description _ Lot 7, Block 2. Glenn View Estates North Subdivision Location (site address or directions) Whisoerina Birch Drive Current Property owner(s) _ MM&M Contracting Day phone 688.1236 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 670495 Chualak, AK 99567 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 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 onsite wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal aff;xed 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(ars) 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 Enaineerina Phone 522.7773 Address P 0 Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 121612004 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Car ificate Date: 2— . " O inunicipanty of Anchorage • Development Services Department 4 f Z Building Safety Division On -Site Water & Wastewater Program SA "' 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 7. Block 2. Glenn view Estates North Parcel ID: 051-811-51 A. WELL DATA Well type _ If A, 8, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth -fl. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft ft. Well production g.p.m. g.p:m. WATER SAMPLE RESULTS: Coliform colonies/100 m1. Nitrate mg.A. Other bacteria colonies/100 ml. Date of sample: Collected by B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date Installed 7/14/2004 Tank size 1.250 gal. Number of Compartments $ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alar (Y/N) N Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date installed 7-I5- 0j' Soil rating (g.p.d.e or fe/bdrm)1.2 GPD/SF System type 5' Wide Trench Length 97 ft. Width 5 ft Gravel below pipe 4 ft Total depth 7-8 ft Eff. absorption area jMfe Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) 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.) (Y/N& type) N If yes, give date Date installed °Pump on' level at_ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump ofr level at _ in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot �^ Absorption field on lot Public sewer main N/A Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >9 Absorption field >5' Water main N/A Water service line >10' Surfacewater >100' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propertyline >10' Building foundation >10' Water main >10' Water Service line >11W Surfacewater >100' Driveway, parkingtvehicle storage >25' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION ���'�p� ......"......71 �r I certify that / have determined through field inspections and :t4` 49th review of Municipal records that the above systems are in r •••••- •••••• Jt;1 conformance with MOA HAA guidelines in effect on this date. �,iac Engineer's Printed Name Michael E. Anderson, P.E. ���r�k, No, ¢-4M Date 12/6/2004 -'shej�; p� HAA Fee $ 5 55?- Waiver Fee $ Data of Payment 1 PwrY•F Date of Payment Receipt Number IV 14 r -D \Am Receipt Number (Rev. 12/00) 0 06 04 10:07a 9J Corp s , I I 1 I I 4,1 ;1 Yom_ Ga N�:• 1 p. o�uloi�„ sa u'r _. � _`^_. � t..: r.., Lina ,'-. er `l• 37 s 51�.r, (7/. 6949210 0 IS 'j' E L• Farr.'{'• AS -BUILT P•I that I. have surveyed the following described 1 hereby cemfY KoPerty; IRi.�w• 604 '4Ys No, •j. and that the improve - Anchorage Recording Precinct, Alaska, Imes and do not �P or encroach on am within tltj pro aediacent thereto, that on the peRYggyd'7a no improvements. n PIOPn a thatdtheeretars no rothereto adways, on the pre via easement on said prop" transnUSsiGn linea or other except as indicated hereon. Dated at Eagle River, Alaska 200y_ this Z day �f ROBERT C. JOHNSON � % Registered Land Surveyor No. B80 -LS SCALE: Box 77-04%. Eagle River, Alaska 9957 1 F` ` Phone (907) 694-2544