HomeMy WebLinkAboutTHE TABLELANDS BLK 7 LT 2The Tablelands
Block
Lot 2
7
#051-801-34
Municipality of Anchorage Page 1 of 3
Development Services Department
On-site Water and Wastewater Program
4700 South Bragaw Street
P.O. Boz 196650 Anchorage, AK 9951M50
www.d.anchorage.ak.ua (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40246 PID Number. 051-801-34
S inell Homes Inc.
Wastewater System: New
Aaa.w:
1900 W. Northern Us. Blvd. Anch. AK 99515
ABSORPTION FIELD
�. "~0ra"M:
3445678 Four 4
S' Wide Trench
LEGAL DESCRIPTION
SWr�a
low 0ig1/ ffloft Va :
.45 C. -VW
FL
B,oCt l.[ Babd .n:
7 2
C4Fe, b pp ba can W" Vr .
dm F•F.:
Tablelands
2 FL
4 FL
Tmmho: Rte: b.caon:
FY.CG.d.bowa,4+�4V...:
Gnw Lapin:
1.3 FL
138 FL
Well: AWWU Water System
5 FL
2
>10 FL
CM.dn IRMY.A B. C):
TaY�•: Crrd b:
rK
A
1,380 FIT
ASTM 3034 PVC
Chrr:
o.b D,a.a: arx wrr lw:
FL
Sanders & Sanders
8/18.20/2004
Y.b.
F Vsw n
C~V wa.b.
TANK
GM
FIL
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other
To
Septic
Absorption
Ult
Holding
.
From
Tank
Field
Station
Tank
sr.er W»
Anchorage Tank
1,250
w.
>200'
>200'
N/A
NIA
>25'
Steel
Two (2)
6.1.w.
>100'
>100,
NIA
NIA
LIFT STATION — NONE ON LOT
La Lkr
>5'
>10'
NIA
N/A
C.M
FmKiwi a
>5'
>10,
N/A
NIA
b.
b
u.bbr..n
None
Noted
°y
Ra rb:
BENCH MARK
First Fkwr Slab
100.0 FL
Engineers Stamp
���rawssa
-opt E gCaq�a.♦
Inspections performed by. TLK Dates: 181 8/18/2004
49th lV 3'�♦♦,
2nd 8119/2004
,r
+•—
Department of Health and Human Services approval
MICHAEL C. ANDERSON�
'.
♦ �f� No. CE -4391 r
♦♦♦♦a
Revieow wed and approved by & llmatt Qom. Date:
�
�� 9 ESS1tl�P:�
Permit No. SWD40246
TY
m
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT Page 2 of 3
4700 South Bragaw Street Anchorage. AK 99519-8055 - 343.7904
OnSite Wastewater Disposal System or Well Inspection Report PID No. 051-801-34
SAMBAR LOOP o
L -
— --------
vac Bodes
THE TABLELANDS SUBDIVISION
LOT 2, BLOCK 7
40,556 S.F.
PLAN AS -BUILT
SCALE I' - 40'
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage. AK 995193655 - 343-7804
On.Sne Wastewater Disposal System or Well Inspection Report
Permit Number. SWO40246
93.18'
93.21'
TBM -
PID No.: 051-80134
N
v
Y
C
r N
S U
Scale: 1' - 20'
98.39'
X93.26'
97.86'
\ 93.32'
Geotextlle Fabric
Dralnfletd Rock
L) CU
S
U
9758'
83.00'
GentpWift Fabric
Dralnfletd Rock
88.99'
PROFILE AS BUILT
Scale: 1' - 20'
98.39'
X93.26'
97.86'
\ 93.32'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION. LOT 2, BLOCK 7, TABLELANDS S/D
PERFORMED FOR: SPINELL HOMES
DATE: 8/18/2004 PROJECTNo.: M0442
PARCEL IDA: TECIINICLAN: T.L. KIMBROUGH
DErnt I TEST HOLE #2
r77/� OB/OG
2
3
4
READING
MOIST SLIGHTLY COMPACTED
POORLY GRADED SANDS
SP
NET TIME
(MINUTES)
6
NFT DRQ
(FINCHES)
7
8/18
MOIST GRAY SILTY -SANDS
10:12
W/GRAVELS SOME COBBLES TO 10'
8
MEDIUM COMPACTION
10:42
30
GM
9
3
11
13
L-162
WAS GROUND WATER ENCOUNTERED? No
IF YES @ WHAT DEMr
DCMI OF WATER AFTER MONITORING:
DATE OF MONITORING:
SITE PLAN
u0TH
SEE FUTURE ASRUILT
0%
DATE
READING
G OSS TIM
MINUTES)
NET TIME
(MINUTES)
DEPTH OF
WATER
(INCHES)
NFT DRQ
(FINCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
8/18
1
10:12
8.13"
2
10:42
30
7.5"
.63" '
3
11:12
30
6.87"
.63"
4
11:42
30
6.25"
.62"
PERCOLATIONRATE- 48 (MIN/INCII) PERC. IIOLE DIA V jINCIIES)
TEST RUNUETWEEN�_FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. SOILS ENCOUNTERED SAME AS THI,
TEST PERFORMED BY VETECII ENGINEERING TECIINICAL SERVICE. I, MICIIAEL E. ANDERSON CERTIFY THAT
TRIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUMCIPLE GUIDELINES IN EFFECT ON TIIIS
DATE: 1/12/2005
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.muni.orglonsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Anderson Engineering
Legal description: The Tablelands. Block 7. Lot 2
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on —
❑ Calculation error in design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate.
❑ Discrepancy In information submitted. _
❑ Topographic information missing or inadequate.
❑ Incomplete; missing
❑ Incomplete; missing
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils information submitted. _
❑ Well tog required. _
❑ Omission in narrative. _
❑ Insufficient fill over tank or field.
Name of reviewer. Julie Makela. P. E.
Date: 1/25/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
• MUNICIPALITY OFANCHORAGE yLo
Development Services Department
On -Site Water 8 Wastewater Program 1
4700 South Bragaw Street 1
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jul 07, 2004
Expiration Date: Jul 07, 2005
Permit Number: SW040246 Parcel ID: 051-801-34
Legal Description:tTHE TABLELANDS SUBDIVISION BLOCK 7 LOT 2'
Design Engineer: 0014 Anderson Engineering Site Address: 22703 SAMBAR LOOP
Owner Name: SPINELL HOMES, INC Lot Size: 40556 SO. FT.
Owner Address: 22703 SAMBAR LOOP Total Bedrooms: 4 Permit Bedrooms: 4
EAGLE RIVER. AK 99577 -
This permit is for the construction of:
❑V 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 catling
(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.
5. The following special provisions.
ADDITIONAL TEST HOLE NEEDS TO BE PERFORMED FOR ALTERNATE SITE DURING CONSTRUCTION
Received By:
e
Date:
Issued By- Date: INIC,
Municipality of Anchorage
• -► Development Services Department :•'
Building Safety Division
_
On -Site Water and Wastewater Program y
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
r ON-SITE SEWER/WELL PERMIT APPLICATION �•iy
FOR A SINGLE FAMILY DWELLING"
Parcel I.D. _USI —� l- Permit Number SW
Property owner(s) Sdnell Homes, Inc. Day phone 344-5678
IZAMaaiiling address (1)1900 Northern Lkft Bhrd, Suite 2o1 Anchorage, AK 99517
Maittng address (2) .29? 3 �tm Pktr l r c p E - R Zip Code CIg5 q *:l
Legal description (Lot, Block & Sub'd.) Lot 2. Block 7. Tablelands Subdivision
Legal description (Section, Township & Range)
Lot Size 40,556 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
(Rev. 12100)
-V 175-
AL
7S
`L 6-oy
5-LPX'r-0 UN
Fees:
Date of Payment
Receipt Number.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
July 3, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 2, Block 7, Tablelands Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The owner of Lot 2, Block 7, Tablelands Subdivision intends to construct a new 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 served
by a community water system and no conflicts exist with adjacent septic systems or
wells. The attached Site Plan and backup documentation identify the location and
configuration of the proposed septic system and alternate site. The water service line is
also shown. The current drainage pattern along with spot elevations are identified on
the Site Plan. The drainage pattern vAi be maintaaied after development of this lot is
complete.
A test hole recently placed on the lot indicated silty sand and gravel in the area of the
absorption trench. The accepting soils were tested and found to have a percolation
rate of 48 minutes per inch. Groundwater was found during excavation at 13' below the
surface and was noted during the monitoring period at 14'. Our design includes the
placement of a new 1,250 -gallon septic tank a" with 2 - 67' long by 5' wide by 4'
effective depth absorption trenches to collect and treat the sewage generated in the
house. The bottom of the trenches will be 7' below the surface. A flow splitter valve will
be placed to assure even flow to each trench. The distribution pipe will be 3' below the
surface. A minimum of 3' of cover will be placed atop the trenches and a minimum of 4'
of cover will be placed atop the new septic tank
The ground surface on the lot slopes at shallow grades from south to north 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
Lot 2, Block 7, Tablelands
July 3, 2004
Page Two
new septic system will be constructed a minimum of 10' from the water service
proposed for the lot and on adjacent lots. It will also be constructed a minimum of 100'
from any surface water 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
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,
mid, E ate►
Michael E. Anderson, P.E.
Attachments
4q!n JS'�
MICHAEL E, ANDERSON
%, No. CE -4181
SAMBAR LOOP
o
L=145.15' F.=270.CC'qq 100'
97 .E f;S22, -----_ 7
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L. 510'
Q. .
Fear Bedroom
NO�IM
(r zstattoo to
Sptleo TOM
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U
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THE TABLELANDS
SUBDIVISION
LOT 2, BLOCK 7
40,556 S.F.
CF
.S
VS SITE PLAN '�'`49t`
104 SCALE Y a 40'@'W'-"""
�j1e17111CL c ANOER�1t j
No. CC e301 ` C
LOT 2, BLOCK 7 TABLELANDS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5' Wide Trench System
Perc. Rate: 48 Min.finch 1,250 Gallon Septic Tank
Application Rate: A5 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/..45 GPD/SF (Application Rate) =1,333.3 SF Absorption Area
1,333.3 SF/5 SF -.5 (Red. Factor) = 133.3 LF Trench Length
THEREFORE: Construct 2 - 67' Long x 5' Wide x 4' Effective Depth Absorption Trenches.
Flow Line Elevation In Trenches 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. Provide 2" of Insulation and 2' of Cover if Necessary.
5'
TYPICAL ' 5WIDE TRENCH SECTIO"'
(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 Services in the Area.
Minimum 100' Separation From Surface Water or Streams.
Natural
2'S^
Backfill
Geotextile
Fabric
6"
4" Perforated
PVC (Holes Down)
2'5"
Drainfield Rock
5'
TYPICAL ' 5WIDE TRENCH SECTIO"'
(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 Services in the Area.
Minimum 100' Separation From Surface Water or Streams.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 2, BLOCK 7, TABLELANDS S/D
PERFORMED FOR: SPINELL HOMES
DATE: 6/23/2004 PROJECT No --M0442
PARCEL IDN- TECHNICIAN: T.L. KIMBROUGH
DrrTH TEST HOLE # 1
(fm)
1
2
READING
OB/OG
MOIST SLIGHTLY COMPACTED
NET TIMEJ
(MINUTES)
DWATERF
(INCHES)
NFT DROP
(INCHES)
POORLY GRADED SANDS
3
6/23
SP
4
8"
5
2
2:55
6
7.25"
.75"
7
3
MOIST GRAY SILTY -SANDS
30
6.63"
W/GRAVELS SOME COBBLES TO 10'
8
4
MEDIUM COMPACTION
30
6"
GM
9
10
11
12
13
14
15
16
17
18
19
SLOPE
Opo
SITE PAN
U
SFF FUTURF ASRUII.T
WAS GROUND WATER ENCOUNTERED? YE5
IF YEs a WHAT DEPDP IS'
DEPTH OF WATER AFTER MONITORING: 14' 0%
DATE OF MONRORINO: 6/29,01.
BOH / WATER SEEPAGE
DATE
READING
GROSS TIME
(MINUTES)
NET TIMEJ
(MINUTES)
DWATERF
(INCHES)
NFT DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
6/23
1
2:25
8"
2
2:55
30
7.25"
.75"
3
3:25
30
6.63"
.62"
4
3:55
30
6"
.62"
PERCOLATION RATE- 48 (MMNCH) PERC. HOLE DIA g. �� (INCHES)
TEST RUN BETWEEN�DT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/02/2004
Lot 2, Block 7, Tablelands
July 3, 2004
Page 3 of 3
MATERIAL SPECIFICATIONS:
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
(Caukler, 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.
Lot 2, Block 7, Tablelands
July 3, 2004
Page 2 of 3
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 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.
ONSITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2, BLOCK 7, TABLELANDS 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 2 new 67' long X 5' wide X 4' effective depth
absorption trenches at the location also shown on the Site Plan. The
distribution line in the trenches will be placed at 3' below the existing ground
surface. Total depth of the trench will be 7' below the existing ground
surface. A flow splitter valve must be placed to assure even flow to each
trench. A separation distance of 10' from any water service and 100' between
the septic tank and absorption trench and any surface water must also be
maintained. A minimum of 3' of fill is required over the absorption trenches
and 4' over the septic tank. In lieu of the required fill 2" of insulation and 2' of
fill may be placed.
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 od*rwise.
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.
Municipality of Anchorage :...:
Development Services Department T
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bregaw St. . ,
&.
P.O. Box 1966W Anorage, AK 99519-66W ..
www.ci.ardxwage.akus
(907) 343-7904 .
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING "
Parcell.D. 051.801.34 HAA# - t)SnOa'
:. Expiration Date: a /1aj= 1 p
1. GENERAL INFORMATION"
Complete legal description _Lot 2. Block 7. Tablelands Subdivision
Locati(m (site address or directions) 2�L103 Sambar Loop
Current Prop" owner(s) Seinen Homes. Inc. Day phone 11&5m .
Marling addiess ..`: •'_' 19001ilorthem Liahts Blvd. •-Anchorage. AK 99517
Lending agency Day phone
Mailing address
Real Estate Agent.
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: - Four (4)
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Wen
❑
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. DSO 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 then 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
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
or 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 Enaineering :Phone 571.7773
Address RO. Box 210773 Anchonae. AK 99524
Engineer's Printed Name _Michael E. Anderson, P.E. Date 111201005
5.-DSDSIGNATURE : ' - .. .
Approved for. ` ,' �i . , bedrooms.. - >; -� !
Disapproved.
0.
Conditional approval for bedrooms, with the following stipulations:
AN
Q ••. . : Ao': -
Additional Comments �� Q: '• G�%
..- ° wPSS RAM -• -
' 1- ��/I. N'MYNI .•
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HAA Checklist ' X Maintenance Agreements
Septic System Advisory Supplemental Engineers Report
Well Flow Advisory .Other .
By � • _ _ k m Q. D_ , •...
By: p Original Certificate Date:
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Conditional approval for bedrooms, with the following stipulations:
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Additional Comments �� Q: '• G�%
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_-Attachments:.,,.. • .;•,-.:w. •V•,..M. 'I
HAA Checklist ' X Maintenance Agreements
Septic System Advisory Supplemental Engineers Report
Well Flow Advisory .Other .
By � • _ _ k m Q. D_ , •...
By: p Original Certificate Date:
I
Municipality of Anchorage ;
• Development Services Department
Building Safety Division
Onsite water a wastewater Program `.
470D South eragew St
P.O. Bax 196850 ArrJxnp, AK 99519-6650
www.ci.andtorage.ek.us
(9D7) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Well type _ NA, B, or C provide PV1SID t _
Date completed _ Sandery seal (YM) —
Total depth rt. Cased to rt.
- FROM WELL LOC
Date of test
j Static water level fl.
Well Log (YM)
Wires properly protected (YM)
Casirp 1004 (above ground) in.
AT INSPECTION
fl.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Colifann - eolorries W ml. Nitrate mg.A. Other bacteria eolonies1l00 ml.
Date of sample: Collected by:
B. SEPTMMOLDINO TANK DATA
Tar* Typ"Wenal O dsmw Date irtstatled tIN1180tI4
Tank aim Jj _ gal. Number of Compartments; Cioarmuts (YM) Y
Foundation deanorlt (YM) Y Depression overtw* (YM) g High water alarm (YM) N
Date of P{ueping Pumper Nswconstlydon
C. ABSORPTION FIELD DATA '
Date installed 11191 M _ T Soil rating (g.p.d.Ats or N2to&m) AGS System type S MRIs Sh81ew Trench
Lergth 138 R Wkfth' S rt. Gravel belowplpe 4 ~ fl.
Total depth ¢ 1t. ERabsorption area l j&fe Monitoring tube Y Depression over field t(
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fkud depth in absorption field before test _ In. Water added_ gal. New dapth in.
Elapsed Time: _ min. Final fluid depth _ In. Absorption rate M g.p.d.
Any rojuverration treatrnau (Past 12 moa (YM & type) N N yes. give date
D. UFT STATION p
pate installed Size in gallons Manlwle/Aocess (YIN)
•Pump on' level at _ in. 'Pump oir level at _ in. High water alar level at in.
Datum Cycles tested Mew alar a =A regriremerns?
E SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT Ta-'
Septic tar*M station on -lot, NIA On adjacent lots IVA
Absorption field on kit W On adlaoent lots NIA
Public sewer main NIA Public sewer mantioleldeanou NIA
Sewer /septicservice Sne NIA Holding tank NIA
SEPARATION DISTANCES FROM GEPTICMOLDING TANK ON LOT TO:
Building foundation 3S Property line >' Absorption Belli >S
Water main Mir Water service line N7 Surface water 3107
Wells an ado ent lots 3200
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 317 Building foundation 310' Water main AT
Water Service line I'm Surface water MW orlvevray, varkirplvetrids stomps 3S
Curtain drain None Noted Wella on a4aceru lots320E
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 hevedelermined through field inspections and a 49tH
review of Murddpal records that the above systems are in
conformance with MOA HAA guidelines in eRect on ft4M '
wWU c imr
wao
Engineer's Printed Name MkheM ILArrdaMn PL
Date MIMS �APGESStO'w
HAA Fee S .117-5-0 Waiver Fee S
Date of Payment t. 1,211 10 { Date of Payment
Receipt Nurttber Receipt Number
MAV. Iuol
1t1=40'
2004-25
THE TABLELANDS SUBDIVISION
LOT 2, BLOCK 7
40,556 S.F.
SAMBAR LOOP
o_
GASTALDI LAND SURVEYING
JEFF A. GASTALDI, R.L.S.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 99502
PHONE 248-5454
CRID DATE
NW 1559 10/22/2004
F.B. JOB NO.
04-13 TLS27
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
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