HomeMy WebLinkAboutMUIRWOOD PARK BLK 4 LT 5Muirwood Park
Block 4
Lot 5
#011-422-82
Municipality of Anchorage Page I of 3
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
wwvv.cLanc~orage.ak.us (907) 343-7904
ON-SITE WASTE'WATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:. SW040022 PID Number. 01t-422-82
m,~. Wastewater System: New
Harding Homes of Alaska
~....~ ABSORPTION FIELD
3657 Eestwlnd Drive Anchorage, AK 99516
.~, d ~.-- 5' Wide Trench
337-9t09 Five (5) ~,..~.
LEGAL DESCRIPTION 1.0
4 5 Muirwood Park 4
1-3
Well: AWWU Wate~ System 6 ~,. I - Ft
.. Ft 830 ~ ASTM 3034 PVC
rt Sanders & Sanders 15/19-20/2004
,.~ i__~, i c.,~, .~,~.. c~.~ TANK
SEPARATION DISTANCES ra Sortie E] ~oe~ng D S.T.E.P. 13 O~he~.
' TF~ Sopt]c Absorptior Lift Holding ,ut~ic/Pdvate 1~500
Tank Fiekl Station Tank Sev,~C~e Anchorage Tank
w., N/A N/A N/A N/A N/A Steel Two (2)
~.,..-w.~ >100' >100' N/A N/A ~ / LIFT STATION - NONE ON LOT
~.,, >5' >t0' N/A N/A V c~
c,,,~ ~.~ None Noted
,...~: BENCH MARK
lmncn is b' wine X U,~' Long W~ 4' [-~ecave ueptn. Top of Pile Cap North Column ,~pport Upper Deck.
t00.0
Engineer's Stamp
2'~ 5/'~104
Depar{.ient of Health and Human..,~erv~s approval
rO
O0
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK, 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW040022
Page 3 of 3
PID No. 011-422-82
1,500 G~tto~ %
~eptlc T~nl,, 4.35
98,3 ·
98.0
......... Ge~tex~ [~_..~b~'lc ...........
~-- 78.0
~)r~lnFletd Rock
88.3
83' (T~'ench Length)
NT$
02.36
PROFILE AS-BUILT
PROJECT #:
PERFORMED FOR:
LEGAL DESCRIPTION:
5
7
8
18
COMMENTS:
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTHENT
SOUTH BRAGAW STREET, ANCHORAGE, AKggSIg-0650
SOILS LOG - PERCOLATION TEST
Hardinq Homes ot Alaska
DATE PERFORMED:
Lot 5, Block %,, Muirwood Park Subdivision
TEST HOLE # tSA ~LOPE
Organic Material
OL
Silty Gravel
With Sand - GW
SITE PLAN
SEE SITE PLAN
WAS GROUNDWATER
ENCOUNTERED? No S
L
IF YES, WHAT DEPTH'~ 0
P
DEPTH OF WATER
AFTER MONITORING: E
DATE:
GROSS NET DEPTH OF NET
READING DATE TIME TIME WATER DROP
Start 10/28 10:0] 8.0"
1 10:13 10 Or¥ 8"
Recharge lO:l& 8.0"
2 10:2& 10 Dry 8"
Recharge 10:25 8.0"
3 10:35 10 Dry ~"
PERC RATE: 1,~I MIN./INCH PERC. HOLE DIAMETER:
TEST RUN BETWEEN & FT. AND S FT.
Test Hole Pre Soaked Prior to Percolation Test.
TEST PERFORMED BY: MEA I, J'41~H.6,EL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANLm
WITH ~J-L STATE J~ID MUNICIPAL GUIDELINES ON THIS DATE: 21912005
'ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE:
February 15, 2005
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 5, Block 4, Muirwood Park Subdivision
Certificate of Health Authority Approval
Test Hole No. 15A performed during construction of the absorption trench on Lot 5,
Block 4, Muirwood Park Subdivision had a percolation rate of less than 5 minutes per
inch. The soil material was so loose that the side walls of the deep trench would not
hold and the design was changed to a 5' wide trench, which actually was constructed 6'
wide. The average absorption rate of material encountered in the trench was 1.0
gallons per day per square foot. The total length of the trench was 83' resulting in a
total absorption rate of 830 square feet which is in excess of 750 square feet required
for a four-bedroom home. The absorption trench is therefore adequately sized based
on soil conditions found on site.
The inspection report and Health Authority Approval Checklist have been revised to
reflect this condition. Please let me know if you have additional questions.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Pro~jram
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Feb 18, 2004
Expiration Date: Feb 17, 2005
Permit Number: SW040022 Parcel ID: 011-422-82
Legal Descr ption: .MUIRWOOD PARK SUBDIVISION BLOCK 4 LOT 5 ~.
Design Engineer: 0014 Anderson Engineering Site Address: NHN PARK WEST CIRCLE
Ovmer Name: .HARDING HOMES OF ALASKA Lot Size: 40338 SQ. FT.
Owner Address: "~I~'~PARK WEST CIRCLE Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE, AK 99502-
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.
Issued B~.. _ _
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 SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parce i.D.
Permit Number
Property owner(s) Hardinq Homes of Alaska
Mailing address (1)7220 Sitkin Circle Anchoraqe, AK99504
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 5, Block 4, Mulrwood Park Subdivision
Legal description (Section, Township & Range)
Lot Size 40,338 SF Acres/Sq. Ft. Number of Bedrooms Five
Day phone 337.9109
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: L[BO -
Date of Payment: ~,!
Receipt Number: "~ ~ L~
(Rev, t2/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
February 11, 2004
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 5, Block 4, Muirwood Park Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 5, Block 4, Muirwood Park Subdivision intends to construct a five-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to serve the new home. The subdivision is
currently served by the Municipal 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.
Test holes placed on the lot in the area of the new absorption trench indicated sand
with silt underlain by gravel with percolation rates ranging from 3.2 to 7 minutes per
inch. No groundwater was found during excavation and none was noted during the
monitoring period. We ar~,therefore proposing to place a new 1,500-gallon septic tank
along with a 67' long by wide by 7' effective depth absorption trench to collect and
treat the sewage generated in the house. The bottom of the trench will be 10' below
the surface. A minimum of 3' 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 northeast to southwest 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
Lot 5, Block 4, Muirwood Park Subdivision
February '11, 2004
Page Two
100' from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
t. 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,
Michael E. Anderson, P.E.
Attachments
SCALE 1" = 100'
VACANT
Z
I: i
I} .42' 'i
~ R=2b. O0 '
Ngo'oo'oo"w 48~,01'"(R&~M) ~
'60
,
61
N 00'09'48'V/ 110.19'
LOT 5, BLOCK 4, MUIRWOOD
PARK SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom House Deep Absorption Trench System
Parc. Rate: 7.5 MinJInch 1,500 Gallon Septic Tank
Application Rate: ,8 GPD/SF 7' Drainfield Rock
5 Bedrooms X 150 GPDI,8 GPDISF (Application Rate) = 937.5 SF Absorption Area
937.5 SFI14 SF/LF = 66.96 LF Trench Length
THEREFORE: Construct a 67' Long x 3' Wide x ?' Effective Depth Absorption Trench.
Flew Line Elevation In Trench to he 3' Below Original Ground Surface. Total Depth to be
10' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
2"5"
7'0"
Natural
Backfill
Geotextile
-- Fabdc
4' Perforated
-- PVC (HoPes Down)
-- Drainfield Rock
TYPICAL DEEP TRENCH SECTION
(.o SOALEI
NOTE: Grade Area Over Trench to Drain Away, ~"~ 49~h
Minimum 6', Separation From Bedrock. ~..~
M nimum 4 Separation From Groundwater. ~ ~
Minimum 10' Separation From Water Service Line. ~
Minimum 100' Separation From Surface Water or Streams. ~e~ ,
~.... ..........
Municipality of Anchorage
Development Services Department/On-Site Water and Wastewater Program
4700 South Bragaw Street, Anchorage, AK 995166650
SOILS LOG - PERCOLATION TEST
Performed For: White Raven Development
Legal Description: L°t 5 Kine. aid p~rk Subdivision
;LOPE
6
Date performed: 1/23/02
SITE PLAN ,.~
· . ,,,,.~,:., ~ ,: ,:::....~ ~ ~ ~
': ~ ....-.... -. ~.~ '~ . ~ ..-~ ~. ',
~ -~ ,, '.. -,-~'..',-.'.~'.
OGIOL
SM
18%-20%
Silt
North
South
10
11
12
13
14
15
16
17
18
19
Dry
L
O
None
--2/28/02
Was Groundwater
Encountered? No
If Yes, What Depth?
Depth to Water
After Monitoring
Date:
GPIGM
Reading Date Gross Net Depth To Net
Time ~ime Water Drop
24-Jan 11:57 7.75"
12:07 10 11.13" 3.38"
12:08 7.75"
12:18 10 10.75" 3"
12:19 7.75"
12:29 10 10.63" 2.88"
12:31 7.75"
12:41 10 10.63" 2.88"
2%4"
..':~'.
Bottom of ~ ~
Hole Perc. Rate: 3.5 Min./Inch Perc. Hole Diameter: 6"
Test Run Betwe(~n. 15...5 Ft. and 6.5 Ft.
as'Pr d P '
Comments: Test Cay w esoake rior to Test ....
performed By: ~ I, ~ich~el F. Anderson · C~rtify That This Test Was performed
In Accordance With All State and Munic pa Gu delines In Eff,e. ct ~n This Date: 3/2/02
Municipality of Anchorage
Development Services Department/On-Site Water and Wastewater Program
4700 South Bragaw Street, Anchorage, AK 99516-6650
SOILS LOG - PERCOLATION TEST
Performed For: White Raven Development
Legal Description: Let 5 Kincaid Park Subdivision
SLOPE
North '"
OGIOL
4
SM
7 18%-20%
Silt South
9
10
11
13
14
15
Date Performed: 1/23/02
SITE PLA ~.. ,,..'
...,
/ ~ , .'
/ ~' ~-,~ ,. x '.. '-'<~'~,~,~"X~&
/ I~- ~"': '~' x <, '., , .~.~%~<~
/ ...'. % -. '.
Was Groundwater
Encountered? No S
L
If Yes, What Depth? O
GP Depth to Water
After Monitoring None
Date: ?J28/02_' E
2"'4"
Reading Date Gross Net Depth To Net
'ime Time Water Drop
24-Jan 11:50 6.25"
12:05 15 9.44" 3.19"
12:06 6.25"
12:21 15 8.31" 2.06"
12:22 6.25"
12:37 15 8.25" 2"
12:38 6.25"
12:53 15 8.25" 2"
Bottom of Perc. Rate: 7.5 Min./Inch Perc. Hole Diameter: 8"
Hole ,i Test Run Between 5.5 Ft. and 6.5 Ft.
C~mments: Test Cavity was 15resoaked P, ri~oi; to ?est ' ,
Performed By: 6JaJ3.1:J~a~. I, Michn"el F:.~ Anderson Certify That This Test Was Performed
In Accord.~nce With All State and Munidpa Guidelines In Effect On This Date: 3/2/02
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 5, BLOCK 4, MUIRWOOD PARK SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a new
1,500-gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 67' long X 3' wide X 7' 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 10' below the existing ground
surface. The new absorption trenches must be placed a minimum of 10' from
the water service line on this and adjacent lots. A minimum of 10' must
separate the trench from the lot line,
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. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
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.
o
Contractors installing wastewater disposal systems must be certified by the
Municipal Department of Health and Human Services for system installations.
Owners installing their own systems must receive prior approval from
D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,500-gallon septic tank must be procured from 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 5, Block 4, Mulrwood Park Subdivision
February 11, 2004
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.
4
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 drainfleld 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 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.
L~t 5, Block 4, Mulrwood Park Subdivision
February 11, 2004
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 ('rypar, 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 mlmmum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as-built of the completed system.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 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. o:~:~-422-82
1. GENERAL INFORMATION
Complete legal description
Muirwood Park Block 4, Lot ,;
COSA # _~-D ~_~ \/1;~ ~.~
Expiration Date: ~ -/,~ -/,~_
Location (site address) 7/+:~9 Park West Circle, Anchorage, AK
Current Property owner(s)
Mailing address
Lending agency
John & Anne Monaco Day phone 23o-7z24
74~9 Park West Circle, Anchorage, A~ 99~;o2
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless othe~, ise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TypEoF WATER ~' :'
SUPPLY:
IndiVidual Well []
Individual water Storage []
Community C'lass ~ Well []
Public Water System []
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 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 sample results. (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 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 Pannone Engineering Services, LLC Phone 272-823.8
Address P.O. Box ~oo2~7, Anchorage, AK 995~.o
Engineer's Printed Name Steven R. Pannone, P.E. Date 9171~-~-
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water
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 this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ~.....'"..,~' ~'~"1~ ....... ~'""~
performance nor give any estimate of how long the system will continue to meet the operational
· . . ~ . "2 ....... ?~"~
requirements of the MOA DSD The content ofth~s report ~s for the sole benefit of the owner hsted
· · .
above. Any rehance upon or use ofth~s report by any other person or party is not authorized nor will it
confer any legal right whatsoever·
5. DSD SIGNATURE
t,,,"'" Approved for ~ bedrooms·
Disapproved·
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
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: Muirwood Park Block 4 Lot ~
Parcel ID: ozz-422-82
WELL DATA
Well type AWWU If A, B, or C provide PWSID # ~¢~og (Y/N)
Date completed_ '"'~ Sanitary seal (Y/N)__ ~s properly protected (Y/N)
Total depth ~ .ft. ___ '~ased to~___}.~ft. ~ Casing height (above ground)
~taattiecC fwta~tr level //~ ~-- ft.
Well production / I \ g.p.m.~ ~__ g.p.m.
WATER SAMPLE RESUI.~: -- ~ -
__c~ies/100 mL Nitrate_ __ mg/L "~
Coliform
Arsenic: / ug/I Date of sample: Collected by:
in.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Anchorage Tank Steel
Date installed ,;l=.ql:zoozr
Tank size ~;oo gal. Number of Compartments _~ Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y
Date of pumping ~;/5/2o~
Depression over tank (Y/N) N
Pumper A+ Home Services
High water alarm (Y/N) N/A
C. ABSORPTION FIELD DATA
Date installed ,~1',~1',oo,. Soil rating (g.p.d./ft2 or ft2/bdrm) z.o
Length 8:t ft. Width 6 ft.
Total depth 8_ ft. Eft. absorption area 8=lo ft2 Monitoring tube Y
System type Wide Trench
Gravel below pipe /,
Depression over field N
Date of adequacy test ~l~lAo~z Results (Pass/Fail) __
Fluid depth in absorption field before test ~_5 in.
Elapsed Time: 3_~ min. Final fluid depth ~_S in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
Pass For .5 bedrooms
Water added75o gal.
New deptha~ in
· .~.~,
Absorption rate >= 7~o+
g.p.d.
If yes, give date
.IFT STATION
Date Size in gallons
"Pump on" ~ in. "Pump off" level at~
Datum Cycles te~
SEPARATION DISTANCES
SEPARATION DISTANCES FROM
Septic tank/lift station on lot
Absorption field on Iot~
Public sewer main
Sewer/septic line
Animal areas
in.
Manh, (Y/N)
water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
acent lots
Public ~hole/cleanout
Holding.ta~k . ~
Manure/animal excrete st~:~-~ge
areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line ~o+
Water service line
Building foundation ~o+
Water main ~o+
Wells on adjacent lots NA
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~o+
Surface water ~oo+
Wells on adjacent lots NA
Absorption field
Surface water :~oo+
Water main . 75+
Driveway, parking/vehicle storage..~o+
Property line ~o+
Water Service line zo+
Curtain drain None Known
COMMENTS
in.
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 COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone, P.E.
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
gl712o~-~-
Waiver Fee $
Date of Payment
Receipt Number
MUnicipality of Anchorage
Development Services Department
Building Safety DMsion
On-Site Water and Wastewater program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 1t.422-82
Expiration Date: ~,~_ /~. C:2 ~
1. GENERAL INFORMATION
Complete legal description _Lot 5, Block 4, Mulrwood Park Subdivision
Location (site address or directions)r~j~ Park West Circle t~ c~ ~ ~
Current Property owner(s) _Hordinq Homes of AJaska . Day phone 337.9t09
Mailing address 3657 East,~,nd Drive Anchoraqe, AK 99516
. Day phone
Lending agency
Mailing address _
Real Estate Agent _
Day phone
3. 'i'YPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class. . Well
· Public Water System
Mailing Address _
Unless othen/vise requested, HAA ~ill be held by DSD for pickup.
2. NUMBEROF BEDROOMS: Rve~
· TYPE OF WASTEWATER DISPOSAL:
~r~ Individual On-site []
Individual Holding tank E~
I-'1 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
Health Authority Approval are required for the transfer of
engineer registered in the State of Alaska. Certificates of disposal and/or water
h~meownem. Certificates of Health Authonty Al.?proval a.m
title (except between spouses) for properties served by single family on-site wastewater
supply system. DSD also issues HAAs upon requ~ ~
of issue for propertJ erved by a pnvata or Class C well end may be reissued ~nth
valid for 90 days from the date year with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one
valid water samples.) Certificates are valid for one year for properties served by Class A or B v/ells or a public water
system. The Municipatlty of Anchorage is not responsiblo for eh'ors or omissions in the professional engineer's
wo~.
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 ind,~:ated herein. I further vedfy that based on the information obtained from the
Municipafity 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.
Nam~ of Firm .Anderson Enqlneertnq PhOne _522-7T/3
Address P~.O. Box 240773 Anchora.qe, AK99524
Engineer's Printed Name ._Michael E. Anderson, P.E. Date __ 2/9/2005
5. DSD SIGNATURE
_ Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the followin~ stipulations:
Additional Comments _
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other _
BY:~'~~'/ /'/"~' P~ Original Certificate Date:. o."~. -/ (~ -CO.5'"'
Municipality of Anchorage
Development Services Department
Building Safety Division
On-SM Water & Wastewater program
4700 Sout~ Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anc~omge.ak.us
(9O7) 343-?g04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot fl. Block 4, Muh-~,c,,~ Pa~ Subdivision
A. IlI~EII DATA
Well type .
Da~ completed
Tol~ depth
ff A, B, or C provide PWSID #
Sanita~ seal (Y/N)
Cased to f~
FROM WELL LOG
Parcel IO:~
Welt Log (Y/N)
Wires property p~u'~:~l (Y/N)
Casing height (above ground)
AT INSPECTION
Date of test
Static water ks, vel
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mi.
Date of sample:
B. sEPTICJHOLDING TANK DATA
Tank Type/Materiel ~
Tank siz~ t~00 ~8l.
Foundation deal.out (Y/N) Y
Date of pumr~ng
C. ABSORPTION FIELD DATA
.ft.
g.p.m.
Number of Compartments
Depression over tank (Y/N)
Pumper ~l~w Construction
.It.
g.p.m.
coloniea/100 mL
Date installed
Cleanouts (Y/N) Y
High watm' alarm (y/N) N
Total depth ~. ft.
Fluid depth in absorption field before test . in. Water added
Elapsed Time: _ ,. min. Final fluid depth in.
Any rejuvenation treatment (pest 12 mo.) (Y/N & type) H
Sollmting (g.p.d./fl~ or~rodrm)'SGPD/SF Systemb/pe ~'WldeTrench
fL Width ~i , ft. Gravel below pipe 4
Eft. al~orptlon ama 1~30.it2 Monitm'ing tube Y Depression over field N
Results (Pass/Fail)
gal.
For bedrooms
New depth in.
. g.p.d.
If yes give date _
D. UFT STATION
Date installed.
'Pump on' level at, in.
Datum
E. SEPARATION DISTANCES
Size in gallons.
'Pump off' level at ..
Cyclos tested _
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic lank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Manhole/Access (Y/N) _..
High water alan~ level at
Meets alarm & circuit r~ment~?.
in.
On adjacent lots
On adjacent lots.
Public sewer manhole/cJeanout
Holding lank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Water main >10'
Wells o~ adjacent lots >200'
Properly line >5'
Water sewice line >t0'
SEPARATION DISTANCE FROM AESORFTION FIELD ON LOT TO:
Property line >t0' Building foundation 710'
Water Service line >10' SurPace water >100'
Curtain drain ~ Wells o~ adjacent k:~ts >200'
F. COMMENTS
Absorption field >0'
Surface water. >100'
Water main. >t0'
lot is Sen~l by AWWU Water ~,~,,.
G. ENGINEER'S CERTIFICATION
I c?tlfy thet I have determined through field inR~ecSons and
mwew of Municipal mcon~s that the above systems am in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael F_ Anderson. P.E
Date
HAA Fee $
Date of Payment.
Receipt Number
(Rev. 12~0o)
Waiver Fee $
Date of Payment
Receipt Number
MUIRWOOD
LOT
2002-88
PARK SUBDIVIS
5, BLOCK 4
40,338 S.F.
ON
Z
8.O'
STO0~
£XlSTINC BUILDING
A.C. DRIVE
1 ":50
\
\
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PARK WEST
CIRCLE
FINAL STRUCTURE AS-BUILT
AS = BUILT HEREBY CERTIFY THAT I HAVE SURVEYE[
PROPERTY DEPICTED ABOVE AND THAT NC
GASTALDI LAND SURVEYII E;NCROACHMENTS EXIST EXCEPT AS INDIC~
JEFF A. GASTALDI, R.L.LIT IS THE RESPONSIBILITY OF THE OWNER
4726 WEST 88TH AVENL DETERMINE THE EXISTENCE OF ANY EASEk
ANCHORAGE, ALASKA 995 ~20VENANTS OR RESTRICTIONS WHICH DO
PHONE 248-5454 APPEAR ON THE RECORDED SUBDIVISION
UNDER NO CIRCUMSTANCES SHOULD ANY
(;RID DATE HEREON. BE USED FOR CONSTRUCTION OF
ESTABLISHING BOUNDARY OR FENCE LINE<.
2123 2/4/2005
ANCHORAGE RECORDING DISTRICT, ALAS
F'.B. JOB NO.
04-02 MWP54 NOTE: NO CORNERS SET THIS DATE.
THE
TED.
TO
rENTS,
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PLAT.
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FOR