HomeMy WebLinkAboutAUTUMN RIDGE LT 21Autumn Ridge
Lot 21
#015-054-24
Municipality of Anchorage Page 1 of 3
Development Services Department
onSde Water and Wastewater Program
4700 South Bragsw Street
P.O. Banc 196650 Anchorage, AK 995196650
wWw.ai.enthorage.ek.us (9071343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. 5=12443 PID Number. 015-054-24
n.aa: Wastewater System: New
Crown Pointe Inc.
A,W••• ABSORPTION FIELD
5400 Abbott Road Anch. AK 99507
Peau weera ^• Deep Trench
345-6277 Five 5
Sad R.uq. Taal Doge baro anD.W vaw.
LEGAL DESCRIPTION .7 craFP 12 Ft.
BatuLa 6Wervanrc
D.Whb P"DDaan hen a�PW V•e•'
Cava EaDFl Dansae�pp'.
8 Fi
21 Autumn Ride
4 Ft.
Towiwr.p� aaga. asGh.e
Ful aeew aEaw aq'�W prtl..
Crave LsnpR
70
1 Fn.
Fn.
cr.rsi w.m[
nw,Rer a rr.:
u.Wv Dawe«, rr.:
Well: New
3 Fc.
1
Ft
Cwsr� iPmaa, A 0. ck Tow pwm: Cassa b'.
60
TOW asap", nw Pp nAerarW.
1.120 F� ASTM D3034 PVC
Private 64 n. Fl
Deur. Das Dnssa sw¢We Uva-.
.*WW Dau.»c
sanders & 5andere 11/8/2002
AI ine Drillin 11/10/2002 36 Fr
n.n Punpsaa c...v •Craw
TANK
10 Ci I F 2 FI
SEPARATION
DISTANCES
0 septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To Septic Absorption
Lit Holding wwPdvme
Lwja ,,, 1.500
Anchorage Tank
From Tank Fceid
station Tank sewerune
Mama. nh,aer a Lanp�anan
Wait >10a >100'
N/A N/A >25'
steel Two 2
LIFT STATION — NONE ON LOT
&rlra war
>109
>109
N/A
N/A
tat.
- aCi1IM:
Lava
>9
AU
N/A
N/A
ca
'PunD an level a
'PunD aH' Isva a
/lqh war aero a.
Foe i,xl
>5
A(y
N/A
N/A
im
n
yr
-7-V-1
puDpMau aMoes
EINmr "Pdtcpa WMttWW
Cutin Dlan
None
Noted
F7
Rana.F
BENCH MARK
Loulanw Der+Won-
Dack Door Stoop Southwest Side.
/unanee EMvaiae
100.0 FL
Engineer's Stamp
d �i
Inspections
perfomvd by. MFA Dates: 1a 11/8 02
49 h•�4
S
2na III&LO2
• 32,
00, A UIC �R C. •ANDERSON
Department of Health and Human Services approval
.,as'f ria. CE -4381
Reviewed and approved by: Date:.6:2?-O 3
�a O P� ••
h�� E55t .••
law. nowt
w
o,
.YLT9 3.60.OZ.[0 S m
4Sy11.1 WS3 '3 V '1 .01
Z
�0L F® v
CD
n N Z
r p
� N ?
W 170l� O
UJO
W C
Er
d
0
N 0 Z q'U K
DO0 'm0, vN Zc>'
m y 3 u o 0 W CD to
C wit N N 3 m m
o �
JJ o® i O D O
co
0 Ln
CD
cn ,(1
z
•�', _0 0 _ En
_
_Qj! % ♦ : 0
i O r R O14GN+ 'CD c&
/? f. S {O0 GAGA D O �I
I•hL � A 1 / I 4 N f P N r
� G O N m
•� ''•.. Y •''• �1 O A N Ol
v
z
10' T. & E. ESMT. o
p
N 0908'59'W 116.34'
m
tuk
N �
A W
N
O
—w
W
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519.6655 - 343-7904
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number..SW020226
IACKitLL
Page 3 of 3
PID No. 015-271-62
0
N
U f= S U
70' Trench Length -
tti
PROFILE AS -BUILT "` NEO. CE -4381 RS°;
Scale: 1' • 10' .._. •'.01
FROM : ALPINE DRILLING FAX No. : 907 345 0202 Jan. 09 2003 09:44AM P2
Municipality of Anchorage
Department of Health and Human Services
825'L' Street
P.O. Box 196650 Anchorage. Alaska 99519-6650
Rick Myst hm:rnw.w.U.anchorage.at.Us '
Mayor
Permit Number. #SW 020443 Date of Issue: 10-31-0 Parcel ldentifevfioe; Nuiobcr: 015-054-24
Date Started: 11-10-02 Date Completed: 1-1 is well located at approved permit location? 0 Yes Ll No
Legal Des-miption: Autumn Ridge Lot 21
Psoperty'Owner Name & Address: POO n fti to l c.
Borehok Data:
Depth (ft)
hlatl+od of Drilling ® air rotary ❑ cable tool
;oil Type, Thiclmest3 WaWSUAa
From
To
Casing type -.&el
stick-up
0
2
Wall Thicicncss:.250 inches
2
4
Diameter: g inches Deptb: 60 feet
DfgBRlCS & Sit
48
LinerTypc
grdvemysflt
4
putt inches Dep$1 12'to 14 'feet
Sift
48
52
Casing stickup above ground: -2 feet
gravelly silt
52
55
Sft c water level (frvat Pound level): Xfcet
silty mfer send d gravel
55
58
ruzup;eg level 55 feet after
gravelly aft
58
64
2 hours pumping. 10 Spin
Remi -try Raw.. 10 em.
t+4ahW of Testing: air M
Well Intake opening Type:
0 {fit mad D open Holc
I] Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
(;rest Type: hentontre M Volume:
Lbz
Depth: Start p feet Stopped y feet
Pump: IntakeDcpth feet
p=p size hp Brand Name
Wen Disinfected Upon Complciion? ® Yes ❑ No
;Nltfaod of Dbinfcctiow ddorine tablets
Cummeats:
Well Driger: A0w Dn'#kV & Enterprises
PO Box 110496
Anchorage Alaska 99511
Attcatioo: The well driller shalt provxle a wtlt log to the properly owner within 30 dais of completion WA the property
I(- 6-0z- 02
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-SiteWater& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Oct 31, 2002
Expiration Date: Oct 31, 2003
Permit Number: SW020443 Parcel ID: 015-054-24
Legal Description: AUTUMN RIDGE LT 21
Design Engineer: 0014 Anderson Engineering Site Address:
Owner Name: Crown Pointe, Inc. Lot Size: 40377 SO. FT.
Owner Address: PO Box 112313 Total Bedrooms: 5 Permit Bedrooms: 5
Anchorage . AK 99511 -
This permit is for the construction of:
0 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.
Received By:
Issued By:
Date: 11 -V -o2_
Date: 10131107,
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 SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D15'-1)541-.9 Permit Number SW020443
Property owner(s) Crown Pointe, Inc. Day phone 345-6277
Mailing address (1) P.O. Box 112313 Anchorage AK 99511
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 21 Autumn Ridge Subdivision
Legal description (Section, Township & Range)
Lot Size 40,377 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Five (5)
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: S'S 0 Z' I Waiver Fees:
Date of Payment: /0-Z f - 0 L Date of Payment:
Receipt Number: Z74/3 e 1 Receipt Number:
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
October 28, 2002
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 21, Autumn Ridge Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 21, Autumn Ridge Subdivision intends to construct a new five -
bedroom home on the property. We are therefore requesting a permit be issued for the
construction of a new well and septic system to serve the new home. The attached
Site Plan and backup documentation identify the location and configuration of the new
well and septic system and the parameters used In the design. Also identified on the
plans are the alternate site, test hole locations and wells and septic systems on the
surrounding lots. Drainage arrows are also shown and current drainage patterns will be
maintained after construction.
The test holes placed near the location of the proposed absorption trench and alternate
site indicated gravel with sand and some silt. The percolation rate on the material was
measured at 6 to 35 minutes per inch. No ground water was found and none was
noted during the recent high water period. We are therefore proposing to place a new
1,500 -gallon septic tank with a new 70' long absorption trench with 8' of gravel beneath
the distribution pipe. The total depth of the trench will be 11' below the surface with the
distribution pipe at 3' below the surface. We have used an application rate of .7 to
design the absorption trench as an average for materials expected to be encountered in
the trench. An adjustment will be made in the field if soils are not consistent with our
assumption.
The ground surface on the lot slopes at varying grades from east to west. The
absorption trench will be constructed parallel with the slope as much as possible in
conformance with Municipal requirements. All components of the new septic system
will be constructed a minimum of 100' from the wells in the area. The system will also
be constructed a minimum of 1 00'from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
Lot 21, Autumn Ridge Subdivision
October 28, 2002
Page Two
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,
ma''t e- �,
Michael E. Anderson, P.E.
Attachments
U
WC.AEL C. ANDERSON
No. CE -438'
•`_� 4W) �10� � CA�LMG�
404.9
, + ,r
+
�,_•_ � I45.474/ ft.
5 I ,-
40.381-sq.ft j T14-12
i
40.196 s ft.
r" I
IH
40.516 ft`
J
f/
40.4 sq% \ 40.167 sq.f`tl \ o
kft.
\ o./\i BANDON
i RIVE WAY W �%
rth8• �9 \\,IH
v
_ft. •�-- �C•--•-tet \TI � � `"4—
�54.849\sq ft _ \ Th
�J
�1J
IH -3 Q -\ ,\ ,45,Mr—sq f
%
\
49th -32
, �•/`���,�, �.\�� �` , `—
�. -: gYSTEM P
� f., % MiCNACL E. ANCCRSW " .� `• � \ .��-'�� .
_ AREA
C ON
\
SCALE 1" =100'
T 31
•323 sq.f
A _J
'Trees
1 44sq
ppSt1NG ..
w .
0
• .iL'£9 3"60.0Z.£0 5
`6� pSt�1e1 'IMS3 '3 V _1 .01 _
p0 Proposed
/ T Well
/ A ® u
o O to
u
1 N
4
1 u1OI, x
1 " 48.5'
1 Fa
1 Five 44.6'
1 room
1 1 ! e
e
1 ai1,500 Gallo
ofdP Septic Tank 35'.
wN :{ 1 1 TH2O
{� �1
r 1" JAS
70 I
ii+ l X 81
Absoi
1 Alternate
Site
1 Till
i
1
1 edo
1
1
1
1
1
10' T. do E MT.
T.
u N 00.08'59"W 116.34'
SITE PLAN
SCALE 1" = 40'
3
X 3' Wide
ctive Dep
kL57•
49th4
M MICHAEL E. ANDERSON V
LOT 219 AUTUMN RIDGE
SUBDIVISION
DESIGN FACTORS:
Five Bedroom Home
Pere. Rate: 6-35 MinAnch
Avg. Application Rate: .7 GPDISF
SYSTEM REQUIREMENTS:
Deep Trench System
1,500 Gallon Septic Tank
8' Drain Field Rock
5 Bedrooms X 150 GPD 1.7 GPD/SF = 1,071.4 SF of Absorption Area
1,071.4 SF/16 SFILF = 66.9 LF Trench Length
Therefore: Oversize the Trench From Design Requirements. Construct an Absorption
Trench 70' in Length by 3' Wide With 8' of Drainfield Rock Beneath the Distribution Lateral.
Distribution Lateral to Be Placed 3' Below Existing Ground . Total Depth of Trench to Be'
11' Below Existing Surface. Cover Over Septic Tank a Minimum of 4' or 2" of Insulation
and 2' of Cover.
Natural
266'; 1 1 Backfill
6"
®MOVEM
3'
Geotextile
Fabric
40)
eld Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells In the Area.
Minimum 10' Separation From Water Service Line.
3 49th
MICHAEL E. ANDERSON
No. CE -4381 f
0
- o
Municipality of Anchorage
Department of Health 8 Human Services 0 �: u'aAu E. A xeson
NO. CE -4381
825 L Street, Anchorage, AK 995024)650
SOILS LOG - PERCOLATION TEST ���i,� PROrEss�:•�•
Performed For. Bob Klein Date Performed: 12/2/99
'Legal Description: t of 21 _ Autumn Ridge S1 rtuiivision
SLOPE SITE PLAN
11 I OG/PT
4
6
SWGM
7
8
Gross
Time
Net
Time
Depth To Net
Water Drop
1 6 -Dec
Was Groundwater
9
4-
Encountered? No .
12:12
30
If Yes, What Depth?
10
12:14
Depth to Water
4-
4
After Monitoring None
11
9" 5' .
Date: 1/22/00
t2
4-
Reading Date
Gross
Time
Net
Time
Depth To Net
Water Drop
1 6 -Dec
11:42
4-
2
12:12
30
9" 5"
3
12:14
4-
4
12:44
30
9" 5' .
5
12:45
4-
6
1:15
30
9' 5"
Hole
19 Pero. Rate: 6 Min./Inch .. Perc. Hole Diameter. 6"
Test Run Between 4 FL and 5 Ft. '
Comments: Percolation Cavity Presoaked Prior to Testing. _
Performed By: gale- I,Micha ISE- Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date:: 1120100
1.
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502 -OM
SOILS LOG - PERCOLATION TEST
Performed For. Bob Klein Date Performed:
c,�...
Legal Description: 1 of 1 Autumn RgjgP � rv��ion _
SLOPE SITE PLAN
1� OG1PT n
iii
6.
SM
n th.._.. ,.6
r
r 4 C.Z C. ANDERSON
�!�.•'t, No. CE -4381 J
1212199
3
Dry
®®��'
Was Groundwater
..
Encountered?
No
If Yes, What Depth?
Depth to Water
After Monitoring
None
Date:
1122100
Dry
®®��'
l
..
• �' Sr
�Nmm®
Hole
19 Perc. Rate: 35 MinAnch Perc. Hole Diameter. 6',
Test Run Between 4 Ft. and 5 FL
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: A. Hafal'1 I, Michael F Anderson Certify That This Test Was Performed
In Accordance With All Stale and Municipal Guidelines In Effect On This Date: 1120!00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 21, AUTUMN RIDGE 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
and the construction of a new 70' long by 3' wide by 8' effective depth
absorption trench also shown on the Site Plan. The total depth of the
trench will be 11' below existing ground and the distribution pipe will be
placed at 3' below the surface. All components of the new absorption
trench and septic tank must be constructed a minimum of 100' from
wells in the area and 100' from any surface water.
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.
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
1. A new 1,500 -gallon septic tank must be procured from a certified
septic tank manufacturer.
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.
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.
Lot 21, Autumn Ridge
October 28, 2002
Page 2 of 2
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.
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, 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.
Lot 21, Autumn Ridge
October 28, 2002
Page 3 of 3
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.
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Braga~ 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
IJIN
Parcel I.D. 055 4-24
1. GENERAL INFORMATION
HAA# hZC�2 SSG
Expiration Date: i 0 - - 0 3
Complete legal description I of 2.t Autumn KW4Q 6ubdlvl ton
Location (site address or directions) 71P 'a k Circla
Current Property owner(s) crown pointe -7-R157'�
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
individual Well
Individual Water Storage
Community Class Well
Public Water System
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL~
®
Individual On-site
Individual Holding tank
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
are
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval
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
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Finn Ane .rFon nalneeriny Phone _522-7773
Address P.O. Box 240773 An .horanrAK AA524
Engineer's Printed Name-ltchael F. Ane rson r Date __ 5/25/2003
y MICHAEL E ANIDt�I
5. DSD SIGNATURE y i'•.,L No. cEr3el .r
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
NAA Checklist x Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date: 7-1—o3
4�
Municipality of Anchorage
,• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 190850 Anchorage, AK 99519.8850
www.ci.anchorage.ak.us
(907) U3-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: tet 21 Autumn Rldua Subdivision Parcel ID: -215-05424
A. WELL DATA
Well type Pdli s
Date completed 11110 002
Total depth eft.
Date of test
Static water level
Well production
g.p.m.
If A. B, or C provide PWSID # _
Sanitary seal (YIN) Y
Cased to eft.
FROM WELL LOG
11f1012002
36 ft.
10
WATER SAMPLE RESULTS:
Coliform -�L-colonieslto0 ml. Nitrate 2.65 mg./l.
Date of sample: 612312003 Collected by: MFA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SeWdIAM
Tank size 1.500 gal. Number of Compartments j
Foundation cleanout (Y".Y Depression over tank (Y/N) b
Date of pumping
C. ABSORPTION FIELD DATA
Weil Log MN) Y
Wires properly protected (Y/1) Y
Casing height (above ground) min.
AT INSPECTION
ft.
Other bacteria _j_ oolontes/100 mi.
Date installed 11812002
Cieanouts (YM)
High water alarm (YIN) N
Date installed 111=02 Soil rating (g.p.d./fe or fe/bdrn) .7 GPDISF System type DOD Trench
Length 70 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth n ft. Eft. absorption area 1.120 fe Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass/Fall) 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 >= 9-P.d.
Any rejuvenation treatment (past 12 moa (YIN & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Aooess (YIN)
'Pump on' level at _ in. •Pump off" level at _ in. High water alarm level at
Datum Cycles tested Meets alarm & circuli r uirem t 7
eqen s
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 3,100 On adjacent lots 3,100'
Absorption field on lot 3,100' On adjacent lots 3,100'
Public sewer main WA Public sewer manhoWcleanout WA
Sewer /septic service line _3,1.5 Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 3,5 Property Ane 3,Z Absorption field_a
Water main WA Water service line 3,101 Surface water >,IIV
Wells on adjacent lots 3,100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 3,10 Building foundation 3,10' Water main 3,10'
Water Service line >10' Surface water _3,100' Driveway, parking/vehicle storage 3,40'
Curtain drain None Noted Wells on adjacent lots 3,100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION 4-0, rCvF7
,gyp,'.,..............
I certify that I have determined Mro
ugh flefd inspections and =+r
review of Municipal records that the shove systems are hn 4 h
confbrmance with MOA HAA guidelines in effect on this data.COMM
T
Engineer's Printed NameMichael E Andenon P E ` c �tmntsol
No. etwa i
Nr
Date 60I2003
HAA Fee $ -3-7S-
Date
%5Date of Payment L— 2 3 o 7
Receipt Number 37 f $ j S v
(Rev. 12(00)
Waiver Fee $
Date of Payment
Receipt Number,
in.
6-27-03;10:20AM;
SGS ReLB
1033685001
Client Name
Anderson Engineering
ProjectName/x
Lot 21 Autumn Ridge
Client Sample ID
Lot 21 Autumn Ridge
Matrix
DrinIcing Water
Sample Remarks:
;907 5615301
All DatesMmes are Alaska Standard Time
Printed Date/time
06/26/2003 14:07
Collected DateMme
06/23/2003 14:00
Received Date/time
06/23/2003 1423
Technical Director
St�C.Ede
Relns��✓
r 2/ 3
Allowable Prep Analysis
parameter Qualifiers Results PQL Units Method Container ID Limits Date Date Inst
Waters Department
Nitrate -N 2.65 0.100
Microbiology Laboratory
Total Coliform 0
mg/L EPA300.0 B (<`•10) 0623/03 JJB
coV100mL SM18922213 A (G=1) 0623/03 KAP
:907 5615301 0 3/ 3
6-27-03;10:20AM: .
ME Environmental Services Inc..
10 Laboratory Division �rrr®atar�%t�,a�®vstlr�®af'rr''taerrzc'i.�''rur�ssa"®saar�+s�•eogr
200 W. Potter Drive
)rinl&g Water Analysis Report for Total Coliform Bacteria Teaehor.° AKS9618-1605
Tel:
r E S E E ORE COLLECTING SAMPLE '
Fax
BEAD INSTRUCTIONS ONREYEID FRS $ T^ 1. TO BE COMPL�I7
E ..
o PUBLIC WATER SYSTEM I.D. S
o PRIVATE WATER SYSTEM
O SaldResnfu O Sendfaroice
YY yYYa .
as e a
OM Y U
v
o s GIewlrJ
R,
04
Send/evoke
SAMPLE DATE: ,
Month Day Year
SAMPLE TYPE:
Routine
o Repeat Sample (for routine sample
withlab reGno.
p -Special Purpose
SAMPLE LOCATION
1 >' ZI Lnur P ' TLcIo
Comments:
O Treated Water
Untreated Water
Time Collected
Collected By
rkas Prim
Analysis shows 199 Water SAMPLE to be:
Satisfactory
p Unsatisfactory
O Sample over 30 bouts old, results may
be unrcllablc
0 Sample too long in tausit; sample should
not be oven Vhours old at examination
to indicate reliable results. Please send
new sample via special -::2-�l -o S. il.
D2teReceive'd lSS
Time Received Gu 2
An Began 1-1 w
Analytical Method: ��ai�cilter
1 . • . , ,. _01 mi. '
1033685 tesult• Analyst
All .111111 fd,Zs,�
b
' Aent to A.u•t:.C. Meh FDW Jun Fazed
Date: Time:
Client notified of unsatisfactory results:,
Phoned Spoke with razed
Date: T=w.
BACTERIOLOGICAL NVATER ANALY�SI1S RECORD
I . 4 S lu�E, cou
pih/l0•MUG Result: Total Coliform
Colonies/100 0Membrane Filter.. Direct Count
Verification: LTB BGB
COLIFIRNI
Fecal Coliform Confirmation
C011formiloo MI
Fin2l Membrane Filter Results
Time brs
Reported By atO
TNTC- ra. NYa,Mer rs GYar
Oa-01h<VdVMe
IfUtSES Member Of the SGS Group (SocidtdGdndraledeSurveillance) _
MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA
ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA, ILLINOIS,
u 0 0 p
i CA z � I
m rl
WT
` ro
cn
0
� C: p z
c�
cz:
0 = cZ0�cv�ov
�0c����
.. �O Z W z0 Z m
a z
o m mcy�2yiAm$p�!
i o zc-q
m504o �z
gig o�
m ;9 (A m _ z0 -9 nQS
mo�
�
En
'*1
_ C O m N
m 63� 0
> 2 � 2 8 zi
3� 218510 9
31,3,81 �tf1W31Z
w
0
.4L'£9 3.,60.01.£0 S
.01-
all
4f#+ 0�9`
i
0 0
aY�:
; r
tri
,fir
A
r
AV
416
31,3,81 �tf1W31Z
w
0
.4L'£9 3.,60.01.£0 S
.01-
co
c
0 0
Z
-G)
o0
r
a x
4
C
C
z
i
0 0
v
i
tri
i
m
1
�
1
�
1
1
46.2'
1
l
1
1
gig 42.3'
1
2z
1
7-
03 o
it l
(N
1.
P Im40
vi
� 1
1
1
�
1
11
c
1
1
1
1
m
1
c
-ri
L------------
10' T. & E. ESMT.
N 00908'59"W 116.34'
co
c
0 0
Z
-G)
o0
r
a x
4
C
C
z
0
0 0
v
tri
0
z