HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 1 LT 1Prospect
Heights #5
Block i
Lot 1
#015-135-01
Development Services Department
Property Owner Name & Address:
-i4 + J,tue S/NY
/O�tao fit, oss D+Z
Pump Installation Date:
Building Safety Division
Pump Intake Depth Below Top of Well Casing:QbV feet
Pump, Manufacturer's Name: AV ►Y7GLif.+wnf�e9
On -Site Water & Wastewater Program
Pump Model: 1,)
4700 Elmore Road
P.O. Box 196650
• °
R
Mark Begieh Anchorage, AK 99507
_
s n
ETY
Mayor W W W.MUn1.or0/onsite
Method of Disinfection: CL ��C2e
i
- (907)343-7904
Comments:
Pump Installation Log
330 EAST 70 AVENUE
Well Drilling Permit Number: SW_ Date of Issue:
ANCHORAGE, AK 99518 -
Parcel Identification Number:-0-�.13C-64
AWPS.COM
Legal Description
�rO
t3 l L
Property Owner Name & Address:
-i4 + J,tue S/NY
/O�tao fit, oss D+Z
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing:QbV feet
Pump, Manufacturer's Name: AV ►Y7GLif.+wnf�e9
Pump Model: 1,)
Pump Size hp
Pitless Adapter Burial Depth: a feet
Pitless Adapter Manufacturer's Name: �P
Pitless Adapter Installer: k) A
Well Disinfected Upon Completion? [Yes ❑ No
Method of Disinfection: CL ��C2e
i
Comments:
Pump Installer Name: ��(,% l ANCHORAGE WELL & PUMP SERV.
330 EAST 70 AVENUE
ANCHORAGE, AK 99518 -
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Municipality of Anchorage Page 1 of 3
Department of Health and Human Services
Division of Environmental Services
On -Site Services Section 825 V Street Room 502
P,O. Box 196650 Anchorage, AK 99519-6650
w .d.anchorage.ak.us (907)3434744
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO10107 PID Number: 015-135-01
PWne:
Michelsohn & Daughter
Wastewater System: New
750 W. Dimond Anchorage, AK 99515
ABSORPTION FIELD
Pna»: """Dar0es0f0°e1''
Deep Trench
522-3375 Four 4
Sd Rs".
TNN tiepin Dan W" araea:
LEGAL DESCRIPTION
1.2 rrnFP
11 n.
Bmdt: let: Sudan :
Depth b pee p . can pnpaW Vane:
C/ depth eanaam ape:
1 1 Prospect Heights No. 5
4 n.
7 FL
Toamtap: Rage: s«ml:
Fi added N Qrge ai Vada:
0
Gaw LNgm:
40
_ Ft.
Ft.
G, a wpm:
/aanO d N.ss:
Vn a e 0enreen lines:
Well: New
3 Ft-
1
I FL
ciaufteaan (Prn ne. A 4 C):
Tow Deem: GsN p:
TOW ansapa.t Nae:
560
Pip. NNanal.
ASTM D3034 PVC
Private
143 Ft. 141 n.
Ft
Ries
AlDine Drillinf!
ONa Died: state: Wale, LM:
I 112 FL
YutaaN:
Cat's Eye Ext.
Date YWalml.
6/26-27/01
rWd:
pump set N:
c4sm Hngti Ae C400e:
TANK
7 cA I
FI.
2 Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Litt
Station
Holding
Tank
IuNWPrivate
s. Line
Anchorage Tank
1,250
We.
>100'
>100'
N/A
N/A
>25'
arta:
Steel
DN
Two (2)
suraeewatN
>100,
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
to Line
>5'
>10'
N/A
N/A
6N
Fa.wNbn
1 >5'
>10'
N/A
N/A
pn N.
in.
at.
in
watN N.
in.
I None
Noted
° L1o0e1
Eied, l i epacvana pNtarned Dr
R.t. Drat
BENCH MARK
w»M:
Southeast Corner of Front Deck.
scan:
100.0 FL
ngineers Stamp
ti444
4
.•�P�� OF .0 #
Inspections performed by: MEA Dates: 1N 6/26/01
2n4 6/27/01
Z` 49th
,—
Department of Health and Human Services approval
�� �'-� CHaEL E. AVDCRSDN/: W
Reviewed and approved by: Date: l�-��'� I
�
I��jfq No. CE-aSBI f'
���9fo`'� - "'���.••
lxev.lDvpt
444 �ESSI�P••
Municipality of Anchorage Page 2 of 3'
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW010107 PID No. 015-135-01
LbT 13A
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O Ft -
Ln
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W mlO L
m.
1
LOT 11
ZERM ATT AVENUE
'25"E 245.00'
& ELEC. EASEMENT
Alterna ly.b6C. "S21
Sit ®j
,'M1
CS
5=' 3 2s1
LOT 5
Well
W
0
C
i D
25.0•
iAEL E. ANDERSON
No. CE -4381 j
PLAN AS -BUILT
SCALE 1" = 50'
o
N
no'
ZERM ATT AVENUE
'25"E 245.00'
& ELEC. EASEMENT
Alterna ly.b6C. "S21
Sit ®j
,'M1
CS
5=' 3 2s1
LOT 5
Well
W
0
C
i D
25.0•
iAEL E. ANDERSON
No. CE -4381 j
PLAN AS -BUILT
SCALE 1" = 50'
Municipality of Anchorage Page 3 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650-343-7904
On -Site Wastewater Disposal System or Well Inspection Repoli
Permit Number SW010107 PID No. 015-135-01
U En 07 d CO U U
Ln�
UZ
89.5 i
t 4' 2.5' 18'
93.2
1 '
Cnntrxtiln Fabric
Drainfield Rock
40'
er
U
PROFILE AS -BUILT
1" = 10'
11 89.4
49th
iAEL E. ANDERSON
No. CE -4381 I
SLOPE
OG/PT
Silty Gravel
with
Sand
GM Was Groundwater
9 Encountered? No
It Yes, What Depth?
10 Depth to Water
After Monitoring None
11 Date: 713101
ifr
18
lm-iW
See Site Plan
Reading
Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
26 -Jun 1:15
Municipality of Anchorage�;-
�• ql :V
����
'..
Development Services Department/On-Site Water and Wastewater Program �; "' ' °' ' "V;
4700 South Bragaw, P.O. Box 196650, Anchorage, AK 99516.6650
P .)V'CH .AACL L. PY^GCC.: ,``"
Oct c� CE 4301
SOILS LOG - PERCOLATION TEST
; -
3
v'f OrESSV1��0
Performed For. Michaelson 8 Daughter — Date Performed:
6AA'1P,
:4t6��+�'
Legal Description: tell Block 1. Prospect Heights. Phase 5
4
SLOPE
OG/PT
Silty Gravel
with
Sand
GM Was Groundwater
9 Encountered? No
It Yes, What Depth?
10 Depth to Water
After Monitoring None
11 Date: 713101
ifr
18
lm-iW
See Site Plan
Reading
Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
26 -Jun 1:15
.75'
2
1:30
15
Dry
6'
3
1:31
.625'
4
1:46
15
Dry
6.125'
5
IIA7
.75-
6
2:02
15
Dry
6'
Bottom of Pere. Rale: 2.5 MinAnch Perc. Hole Diameter. 6'
Hole Test Run Between 6 FL and 7 FL
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson. 1, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 1214101
10-03-2001 05:04PM FROM CreativehKitchenhDesign TO
Muni
: P.O.
Mayor
Permit Number. 4SW 010107 Date
Date Started: 9 1501 Date Comp]
Legal Description: i I
Property Owner Nime & Address: 1
)ality of Anchorage
t of Health and Human Services
825'L' Street
196650 Anchorage, Alaska 99519.6656 '
M!plMw .etarciwrape.aku6
5226779 P.02
5-10-01 Parcel Identification Number. 015-135-01
:-01 Is well located at approved permit location? ® Yes ❑ No
Zermatt Circle
age, Ak 99516
Borehole Data:;Depth
(ft)
Method of Drilling ® air rotary ❑ cable tool
Soil Type, Thidaess 1C Water Strata
From To
t
Casing type: steel
sti kII -up
2
Wall.Thiclmcss: +025 - inches ,
gralYel%y Ji
33`
Diameter.cinches Depth 141 feet
silt i
I¢I�
33 .47
Liner Type:
gravelly silt
4Z1 136
Diameter: inches Depth: feet
68
Casing stickup above ground: i' fAet
bedrock
143
Static water keel (from ground level): 112 feet
:
Pumping level:feet after
2 hours pimping Z gpm
Recovery Rate: 7 gpm
Method of Testing: a/rlift
•
1
j
Well Intake Opening e•
Pe g •I`YP '
:
I
® Open End ❑ Open Hole
j
❑ Screened Start feet Stopped feet
�
❑ Perforations Startfat Stopped feet
I
Groat Type: Benronite # 8 Volume: jig
_ . .i
Depth StartQ fed Stopped ± fcd
PnutP: Irrfaire Depth..- .feet
Putrip sizes hp Bland lsaic
Well Disinfected Upon Completion'. ®;Yes ❑ No
Method of Disinfection: Clorine Tablets
Comments:
i
1:
Well Driilor: Alpine Drilling & Enterprises
P O Box'110496
1
Anchorage AK 99511
Son- The well driller shall provldel a ell log to the property owner within 30 days of completion and the property
nr flu wall A411" Aall %%all 1n fn flv rva w of 14.14, F. An A..'* ni w,vwwl..r:nn
Received Time Oct. 3. 4:12PIt 10� ��X�oTaG� P.ez
MUNICIPALITY OF ANCHORAGE
Development Services Department 2 ~� —27-L,( !� 1/ OOQ.n•
On -Site Water 6 Wastewater Program
4700 South Bragaw Street e-,, 19Y 1,9P-,kt
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM 1 WATER SUPPLY PERMIT
Initial
Permit Number: SWO1010T
Legal Description:' PROSPECT HEIGHTS #5 BLK 1 LT 1
Date Issued: May 10, 2001
Expiration Date: May 10, 2002
Parcel ID: 015-135-01
Design Engineer: 0014 Anderson Engineering Site Address:
Owner Name: ERNEST J. DANIELS Lot Size: 94705 SO. FT.
Owner Address: 10000 ZERMATT CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99516 -
This permit is for the construction of,
n✓ Disposal Field Q,/ Septic Tank ❑ Holding Tank ❑ Privy Q✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: 5411-01
Date: S— /0 — 0/
-� Municipality of Anchorage .
-. Development Services Department
Building Safety Division
On -Site Water and Wastewater Program s . ...
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. /S — / 35-- 0 / Permit Number SWO/0/07
ERMcSr J. PAmix4 s
Property owner(s) Michelsohn & Daughter Day phone 522.3375
Mailing address (1) 750 West Dimond Boulevard Suite 100 Anchorage AK 99515
SITE
(2411' 0000 ZERHAT% CIRCLE Zip Code
Legal description (Lot, Block & Sub'd.) Lot 1 Block 1 Prospect Heights Subdivision No. 5
Legal description (Section, Township & Range)
Lot Size 94,705 SF Acres/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 ❑
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.
00
(Signature of property owner or authorized agent)
Permit Fees: S WG% T0y
Date of Payment: v T G�
Waiver Fees:
Date of Payment:
Receipt Number: i) 6I 0 Receipt Number:
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
May 7, 2001
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 1, Block 1, Prospect Heights Subdivision No. 5
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The owner of Lot 1, Block 1, Prospect Heights Subdivision No. 5 intends to place a new
4 -bedroom home on the lot. We are therefore applying for a permit to construct a new
well and septic system on the lot to serve the proposed home. The attached Site Plan
and backup documentation Identify the location and configuration of the new septic
system and the parameters used in the design. It also shows the location of the new
well and its 100' protective radius. Also identified are the location of the test holes and
the alternate septic site. Existing drainage patterns are shown and will not be altered
by the development of the lot.
Two test holes were placed on the lot during the spring of 1999. Soils were found to be
well to poorly graded gravel with minor amounts of silt. Percolation tests In the material
indicated rates between 3 and 4 minutes per Inch which is consistent with rates
achieved on the lots surrounding this lot. Groundwater was not found during the
excavation and none was noted during the monitoring period. We are therefore
proposing to place an absorption trench 36' long by 3' wide with a 7' effective depth to
treat the septic effluent. The pipe will be placed at 4' below the existing ground surface
and the total depth of the system will be 11'. Mounding may be required over the
trench to provide the necessary 3' of protective cover.
The ground surface on the lot slopes as shown on the attached Site Plan with slight
grades from north to south. The new absorption trench will be constructed parallel to
the contours of the surface in conformance with Municipal requirements. Grading will
be accomplished to assure surface drainage is away from the new bed. The existing
drainage pattern on the lot will not be affected during development.
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.
Lot 1, Block 1, Prospect Heights Subdivision No. 5
May 7, 2001
Page Two
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
4Da
Michael E. Anderson, P.E.
Attachments
d
oP MICMhEL E. O.WDERSCN. , A0
GE . 4331
i�,,9eo FROFES. *V o~
6.99
I I PROJECT THIS PR`t
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1 100 {O •�,.MICHAEL E. PN.nEASCN •,, "�
AREA MAP ' CE"451 ""
SCALE I"=100'
13A
11
eoe
(A
0
eo
ZERMATT A1IfNUE
CA
0
' B,6
,
i
025-
M1
1
Prsel,.s PW red rQ
of
Pis ens
rRoome
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1
1
1 1
1 �
1
1 1 '
PROPOSED
1 HOUSE - ells
FIN FLR=812.0' p o
p U/ns all. 1 250 Gallon
• Aeptic Tanit�
1
1
1
oo /
Alternat :rAbsc
6�
Site '
LM TH1
94.705 SQ FT.
5 .
SITE PLAN
SCALE 1" = 50'
1
1
D
J
e•
A�
d
i467-4��9����T�H���� ���,�'..:.. 50ICHAEL E- AN
MICHAEL E. ANr, E2SCN -•V lr
# Vii• • CE -4331 c
44
LOT 1, BLOCK 1, PROSPECT HEIGHTS
SUBDIVISION NO.5
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 3-5 MinAnch 1250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 7' Drain Field Rock
4 Bedrooms X 150 GPD 112 GPD/SF = 500 SF of Absorption Area
500 517/14SF/LF = 35.7 LF Trench Length
Therefore: Construct an Absorption Trench 36' in Length by 3' Wide With 7' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 4' Below Existing
Ground. Total Depth of Trench to Bell' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
�-
�`
Natural
;
i
;Ceoteztile•
%Fabric%
Perforated-.='
PVC . (Slots' -Down)
7'
..
:`bra.in£ield
Rock-.':::: t' :.
. o /�•• IrY! N�
.
•
TYPICAL DEEP TRENCH SECTIONm..R,
(NO SCALE) OF �1 ^�'
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Well.
W.: P497N
CE 4331
. v
r
0
o MunicipaLty of Anchorage * 49— } Oo
TN yr
0.?ARTM.N7 OF HEALTH 3 HUMAN SERVICESt��/./7I...f, .,�
U�p925'L' Street Anchorage. Aluka 9°502-0`30
SOILS LOG — PERCOLATION TEST • MICHAEL - ANDCRSCN 40
CE -4381
PERFORMED FOR:, n. nielS % oval Fgtate romnany DAT=PERFORM_'.Sl.b
LEGALDESCRIPTION: T,Qt' I / Block 1 prnappc HE+ightc Nn 5 --
MOP_ SIT: PLAN
2 6'/O
3 P
19
F7
OL
TESTHOLE NO. 2
GP/GW
Silt Lenses
Bottom of
Testhole
WAS GROUND WATER
ENCOUNTERED?
W YES. AT WHAT
DEPTH?
/Ja
5
L
N A D
P
E
v �� y,� 1/27117
•
PERCOLATION RAT= `; t PERC HO'= DIAMETER
TEST RUN srrw_N S FT AND G F7
caMMENTS Perc Cavity presoaked prior to testing.
PERFORMED El•L Mr" I lyLC=� , FT THAT TH6TESTTWAS PERFORMED u
Michael E. Anderson 5-7-61
ACCORDANCE VMH ALt s7A iE AND MUNICIPAL GUIDELINES IN EFFEC T 'Che
OHS DATL DAT'_
7
a
9
,o
• b
70
. • �
72
1. e
t
13
•"
14
.
l
19
F7
OL
TESTHOLE NO. 2
GP/GW
Silt Lenses
Bottom of
Testhole
WAS GROUND WATER
ENCOUNTERED?
W YES. AT WHAT
DEPTH?
/Ja
5
L
N A D
P
E
v �� y,� 1/27117
•
PERCOLATION RAT= `; t PERC HO'= DIAMETER
TEST RUN srrw_N S FT AND G F7
caMMENTS Perc Cavity presoaked prior to testing.
PERFORMED El•L Mr" I lyLC=� , FT THAT TH6TESTTWAS PERFORMED u
Michael E. Anderson 5-7-61
ACCORDANCE VMH ALt s7A iE AND MUNICIPAL GUIDELINES IN EFFEC T 'Che
OHS DATL DAT'_
0 t�
• • "P,•• ••_„�.� •.1:x•.0
r
Municlpafity of Anchorage
DEPAFiTM=NT OF HEALTH L HUMAN S�VIC=S 00 ,,, ....: •:
EA
E25 -L' StreeL Anchorage. A1—U 495M -0--D a
SOILS LOG — PERCOLATION TEST rr` -.MICHAEL E. ANDERSON
�•, CE -4381
p_RFORM=D FOR: P.naniels % Real Pstatp Cmmnany DAT -z PTR FORmizj
LEGALD_S--RIP ION:Lnh 1 nlnrk 1 r Prncpprt Naighta No 5
SLOPE SITE PLAID
tF_=TI
OL
t
.ai•
I I I-
2
'.
I Waco I
I Dmo
tH I4,Zl 1111 4:07
T=T RUN ez7wE=N
3
at/
•
TESTHOLE NO. 1
4
u
d 4'
t3 ItH,o I212
I
I 5 z• 1
1 Ito 1 1 2:
I /S
�6GM
I
9
7
,
Silty Gravel
8
hr
with Sand
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I
9
d
•%
TO
t G
� 1
b�•
12
U
e
13
,.•.
14
o
/ t
17
0` I
•
e •'e
Bottom of
18
Testhole
19
WAS GROUND WATM Aic
-ENCOUNTEAD'•
IF YEL AT WHAT
DSP I K
0
0
i7lt"l�tcc G 799
I I
I I ( I
I I I-
R�°'9 I Daa I Time
Net
I Tann
I Waco I
I Dmo
tH I4,Zl 1111 4:07
T=T RUN ez7wE=N
F T AND FT
Wz. I I 2: LL
1 /S
J0.1 I13
d 4'
t3 ItH,o I212
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1 Ito 1 1 2:
I /S
I " 1
9
I
1 ' Y I
hr
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20
P7t(:OCATION RAT:
�
B N
Irtaruacraa0y P7i.^. MOLE Dw►eTrR
S
G
T=T RUN ez7wE=N
F T AND FT
OOMM:NTS Perc Cavity
presoaked prior
to
testing.
PERFORMED 6^ Mir if t ' " c"��' �l J� � � �""1FY ThU.T tMS teS wAs PERFORMED It
Michael E. Anderson
ACG^ .:JAlirE WITt{ ALL SAT. AND MUNICIPAL GLtjoe 1N_S IN EFF= -C ON ThCS DATE DAT
Municipality of Anchorage
,aa e.
-� 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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-135.01 HAA # 44016 /030
Expiration Date: 3 — 2' %' 0-2,
1. GENERAL INFORMATION
Complete legal description T" Lot 1, Block 1, Prospect Heights No. 5
Location (site address or directions) Zermatt Avenue and Zermatt Circle
Current Property owner(s) Michelsohn and Daughter Day phone 522.3375
Mailing address 750 West Dimond Anchorage, AK 99515
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
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
Four 4
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
OOe (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be 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 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 Anderson Engineering Phone 522.7773
Address _P.O. Box 240773 Anchorage AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 12/7101
e:. tel.••• •;�. ;\...
rig.` ' • ,a i --.ENGINEER'S
5. DSD SIGNATURE
Approved for l- _ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
WATER AND
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental. Engineer's Report
Other
By: Original Certificate Date:
Municipality of Anchorage ••,
• �' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
47W South Bragaw St.
P.O. Bou 196M Andx"ge. AK 99519-!3650
www.ci.anchorage.ak.us
(907)343-79D4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 1. Brock 11.yreseed Halelds No. S Parcel ID: 913135-01
A. WELL DATA
Wed type P"* If A, B, or C provide PWSID # _ Wed Log (YIN) Y
Date completed IMMM Sanitary seal (YIN) I Wires properly protected (YIN) Y
Total depth J43 ft. Cased to 1,41 ft. Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test dm12001
Static water level 112 ft. ft
Wed production 7 9•P•m• g -p -m -
WATER SAMPLE RESULTS:
Cddorm 0 coloniesiloo mi. Nitrate 9.15 mgJL Other bacteria -L colonies/100 ml.
Data of sample: ,1121412001 Collected by: Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matertal SeptldSteel Date installed 6120@001
Tank size j2W gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation deanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed 6VrM Shc rating (g.p.dAe or ft'Ibdrm)1.2 GPDI5F System type Deep Trench
Length 40 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth 11 ft. Eff. absorption area §-6002 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. Fkwi fluid depth _ in. Absorption rate >= g.p.d.
Arty rejuvenation treatment (past 12 moi (YIN & type) N If yes, give date
D. UFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at _ in.
Datum
'Pump off" level at _ k1.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllifi station on lot >IW
Absorption field on lot >100'
Public sewer main WA
High water alarm level at
Meets alarm b circuit dements?
On adjacent lots >700'
On adjacent lots MW
Public sewer manhde/cleanout WA
Sewer /septic service line >2S Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S Property line >T
Absorption field >S
Water main WA Water service line >10' Surface water >100
Wells on adjacent lots >IW
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property fine >10' Building foundation Air Water main >11P
Water Service line Mir Surface water MW Driveway. parka gNeNde =enrage >S
Curtain drain None Noted Wells on adjacent Ids >ttl0'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cert7y, that I have determined dough held inspections and
review of Municipal records that the above systems are in
cordbrmance with MOA HAA guidelines in effect on iNs date.
Engineer's Printed Name Michael E. Anderson. P.E.
Date 1217101
HAA Fee $ Soo
Date of Payment /Z-7-01
Receipt Number
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
rDEC -OT -OI 02:56P11 FROAI-CUE ENVIRONIENTAI SRV
r.
r ■ ztt CUE Environmental Services Inc.
. ■ . �rirr�rrrirr�rrrsrrrir
9075615301 T-876 P.01/02 F-823
Cf&E ReLN
1018274001
Client PON
Client Name
Anderson Engineering
Printed Date rime
12/07/2001
14:42
Project Name/N
Lot 1, Block 1, Prospect His
Collected Date/time
12/04/2001
13:30
Client Sample ID
Lot 1, Block 1, Prospect HIS
Received Date/time
12/04/2001
14:40
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Ordered By
Released B
PWSID
0
Sample Remarks:
_•
Allowable
Prep
Analysis
Parameter
Results
PQL Units Method Limits
Date
Date lnit
Ytat�r■ D�oartmant
Nitrate•N
3.15
0.500 mg/L EPA 300.0 (<10)
12/04/01 SCL
}{jerebioleav
La�oratory
0
col/100mL SM189222B (<1)
12/04/01 SBFT
Total Coliform
Received Time Dec. 1• 2:58PM