HomeMy WebLinkAboutLOMA ESTATES BLK 3 LT 11Loma
states
Lot 11
Block 3
#020-0c 2-38
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231162 PID Number: 020-092-38
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
LAWRENCE & ALISA DAVIS
ABSORPTION FIELD — ADVANTEX FAP 2.0
❑Deep Trench ®Wide Trench ❑Bed ❑Mound
Site Address
17001 BELARDE AVENUE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4"
2 GPD/SF
1 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
0.5 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
LOMA ESTATES 3 11
Fill added above original grade
VARIES 2.9-2.92 Ft.
Gravel length
60 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
300 Ft2
1
-- Ft.
Well
50'+
50'+
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX
Manufacturer
ORENCO / ANCH. TANK
Capacity
1500 Gal.
Surface Water
50'+
50'+
Material
COMPOSITE PLASTIC
Number of compartments
2
Lot Line
10'+
10'+
NA
Foundation
10'+
10'+
61n eT N ADVANTEX FAP 2.0 SYSTEM
Manufacturer
ORENCO
Capacity
1500 Gal.
Remarks New 4BR Advantex System w/ T MOA sand
below 0.5' ED.
Alarm location
BASEMENT
Electrical installed by
BRICKWELL
Installer MIKE N ANDERSON
PIPE MATERIAL House to tank 3034. Tank to 3034
drainfield
Drainfield 3034 CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspdection 15` 8/14/23 2nd 8/15/23
Location and description
3`d 8/16/23 41h 8/178/23
TOP OF MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
OF A
Conditional Approval: Date
r
TH
Septystem
Approved
�.• Curtis Huffman...:
q �j
�� cG, •. CE 128991 �`� ;WDate
�1 V'r,F�•. 8/22/2023.•\Pxw
PROFESSIONr
Note:��s/approval does not include well permit requirements.
kRCv VJ/UL/ 10)
PID:020-092-38PERMIT:OSP231162
FIRST WATER CONSULTING
LOMA ESTATES BLOCK 3, LOT 11
" = 40'
11131 Mll., t , H.1 A3A.A.
AS -BUILT OF:
LOMA ESTATES SUBDIVISION
LOT 11 BLOCK 3 PLAT 76-262
SURVEY CERTIFICATE::[, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing, and that the
improvements situated here -on are within the property lines and no
enchroachments exist other than noted. Under no circumstance shouh
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary Iines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE: E-MAIL:
AUG 22, 2023 1 "=40' schuller0ok.net
2.3-094 DRAWN BY: CHECKED BY GRID NUMBER: aocm ACE:
JLS SW3337 230271
Q FND 5/8" REBAR
,,,�•.>®► sup
AW O F 4
AW
,� �, • � � �'t o .s r
oe
/ 49TH? ?A - - I •' 4
.......... .. .....�
.;U �. i'/
@ HN L. SCHULLER.• O m -
LS -10408 �.-
��, • . , . ,�'' �� 1831 Talkeetna Street
aQ, �.'�Z • • ' Anchorage, Alaska 99508
�r4'' �r
a fe a\ L .■, (907) 227--1455 office
��� s s!a`�'�►•.. (907) 274--4992 fax
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231162
Work Type: Septic Upgrade
Tax Code Number: 02009238000
Site Legal Address: LOMA ESTATES BLK 3 LT 11 G:3337
Site Mailing Address: 17001 BELARDE AVE, Anchorage
Owner: DAVIS LAWRENCE ELLIS JR &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
cnr
Dehartnneut - —
6/26/2023
6/25/2024
44510
❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: S L1� �-✓ G Date:
Issued By: �/j,� , �� Date:
4
MUNICIPALITY OF ANCHORAGE
-
Development Services Department �'
P P - Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 020-092-38
Property owner(s) LARRY & ALISA DAVIS Day phone
Mailing address 17001 BELARDE AVENUE ANCHORAGE, AK 99516
Site address 17001 BELARDE AVENUE ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) LOMA ESTATES BLOCK 3 LOT 11
Legal description (Township, Range & Section)
Lot Size 44,510 Sq. Ft. Number of Bedrooms
.19
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
®
Initial ❑
Single Family (SF) IN
Septic Tank
X❑
Upgrade IN
(w/wo AD U)
Duplex (D) El
Holding Tank
ElRenewal
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Siignature. of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No. Ce?
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
June 15, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: LOMA ESTATES BLOCK 3, LOT 11
The septic system has been found failed and will be completely decommissioned
and per the owner we request a septic permit to upgrade the existing septic system
on the above referenced lot. We propose to install a shallow trench with an
Advantex system to serve the existing 4-bedroom residence per the attached design.
The design is based on the recent test hole conducted in the spring of 2023.
Groundwater was observed at excavation at 5’ and 4’ at monitoring of this test hole.
The slopes are moderate at 5-10% at the proposed upgrade location. The lot and
area are served by private water with no known private wells within 50’ of the
proposed septic system. Based on visual observations and review of available
information, the design will not impact any of the neighboring properties. Please
contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231162, Curtis Townsend, 06/26/23
FIRST WATER CONSULTING
LOMA ESTATES BLOCK 3, LOT 11
DESIGN CALCS:
NO WELLS WITHIN
50' OF PROPOSED
SEPTIC SYSTEM.
NO SLOPES >25% WITHIN 35'
OF PROPOSED FIELD.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231162, Curtis Townsend, 06/26/23
FIRST WATER CONSULTING
DESIGN DETAILS:
LOMA ESTATES BLOCK 3, LOT 11
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231162, Curtis Townsend, 06/26/23
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOMA ESTATES B3, L11
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 6/9/2023
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
4
SM/GM
5
6
7
8
9
10
11
BOH
12
13
14
15
16
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
6/7/23 30 min 6 11/16
30 min 6 11/16
30 min 6 11/16
PERCOLATION RATE 44 (MIN / INCH)
TEST RUN BEWTWEEN 2 & 3 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: YES
IF YES, AT WHAT DEPTH: 5
DEPTH TO WATER AT MONITORING: 4
DATE: 6/7/23
TESTHOLE # 23-1 DATE PERFORMED: 5/31/23
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: LARRY DAVIS
6/9/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231162, Curtis Townsend, 06/26/23
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Municipality of Anchorage Page _
DEPARTMENT O'F HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 o Telephone: 343-4744
.On-Site Wastewater Disposal System and/or Well Inspection Report, -'
Permit NumbeF. :SW000358 ' PI'D Number:
N~%ck 'Ra~' ' . Wastewater System: [] New. [~ Upgrade
,ddr~: · ABSORPTION FIELD
'17001 Belarde' Dr. Anchorage, AK 995 6
.ho.e:. 3~5--6399 :Three (3) [~DeepTr~nch X]Shallow'$rench []Bed []Mound' [lOth'er
Soil Rating: . . Total Depth from original grade:
-'.. ·LEGAL·DESCRIPTION ' · ' '.8 . GPocs~'F; -:5 '.
· · ' ' I '' ; '. ~' Ft ' Ft.
....... ' ra ' "' 5 " · 'J
· WELL:. . [] New .... [] Upg de · ;....:. : . - . Fr- .....
class '( ...... " ' ' ' · ~ ' ASTM D3034~PVC.'
· -EXistln¢ ":.' ',''' Ft.-. .."" Ft. ' u~2 · · SO. Ft · ·
.'."..'--"'~:..-" ': .' .. . .' ".. - ..':; ~ ""-. :.:n~ 'Acreage. 'system's · ,9/14-15/00' ":"
Surface >10'0' :;;'100' N:/A".. N"/'A. 'N/A' '-,'->.' '. · '.-..";LIFTSTATiONL ~')A": :"'
.': Lot -.' >5.!: >10 ~/A [~/A N/~' szenga[ons: Manufacture~ '- : '/ - ' -
F0Unda~On '' '~5!' (:.. ¢ - · : ¢ , - · ., , '..' .'.[.......:' . [.';.'. ..'. [... '. .
I".- '. ', '.': "-'-": :"-':-'. : ' · :'-':"~ ~a'" '""":"" ' ':" BENCH 'MARK '' -'.'"": .'
R~marks:. ':.'Exis~i-ng':Sept~c Tank P p ' ' · .-'-"- .. - ·
· Z:abel? Flow-..D~=certer Valve,.place · .' · - ' ':..- · .' -- ':.;.' -'.' - · . .' ".:... -': .
· ed Ih TO ot'd Absorpt'~on' .- · ' " : "" : ' 100' n''' ":'''
and -T. , - .. , . · · . -..- .- . . '... . '- . .... .. , .u." "- "Ft
.__, ,.. ::.-..., .. .... -... .,. ..-..'.,' :.-.-.-... .:,.,~.~..~ .-...
· ... ...:. ,.. . . .- ...... ... .. ..- ~¢ *~.~,~.~¢~....¢,.,
-'" ' ·" ' ' ' ' ' ' '' ' ' '':' '^"'14/00 ' 4'*"~'~*'~'" '~'"'~'~/'~'
Inspections performed by: ' MEA - · . - Dates_.ls~ (~.~:..~f.~.~
· . 2nd 9/15/00. :~
- Department of Health and Human Services approval..... - ,~.. ..
... :.- : ... ./~, .~,. :.- , . . · --. : · . '--'.',,i¢';,! .. .
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 2 of 3
Permit Number SW000358
PID No. 020-092-38
B C D
31.5
35.0
36.5
71.1 69.75
54.5 59.75
~::' '..?..i:'-.: ?::. ,-'-.":: i::~ ?~."!.~:':~0,~:';:~:':.?I~..';~:;':..~:~::
PLAN As-BUILT
· :. .-. N 45.0000 E ·120.00.
-DAVIS DRIVE
SCALE 1" = 40'
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 995'19-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 3 of 3
Permit Number SW000358
PID No. 020-092-38
To
HOUSe3.4 /
1, 0
Sep. Ta~k~ 93.2
LEGEND
C Cleanout
M Monitor Tube
S Septic Tank Vent
DV Flow Diverter Valve
TH Test Hole
43I-
88.2
Geotextile Fabric
Drainfield
t ~ 84.9
Rock ~
81.6
75.0
31'
PROFILE AS-BUILT
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 07, 2000
Expiration Date: Sep 07, 2001
Permit Number: SW000358
Legal Description: LOMA ESTATES BLK 3 LT '11
Design Engineer: 0014 Anderson Engineering
Owner Name: Rick Ray
Owner Address: 17001 Belarde Dr.
Anchorage, AK 99516-
Parcel iD: 020-092-38
Site Address: 017001 BELARDE AVE
Lot Size: 44510 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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 noti~ DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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, sea[ed, and heated to prevent freezing.
Received By:
issued By:
Date:
Date: ?- 7-00
August 23, 2000
Municipality of Anchorage
DepartmeC~t of Health and Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 11, Block 3, Loma Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite services Engineer:
The existing absorption trench on Lot 11, Block 3, Loma Estates Subdivision has failed
and must be replaced. This system has been in use s~nce 1977 so soils on the lot can
be considered conducive for the treatment of septic effluent. We are therefore applying
for a permit to construct a new absorption septic system on the lot to serce the 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 ,e, xisting well on the lot and a well previously abandoned. Both
wells are more than 100 from all, components of the e~(isting and proposed septic
system.
Two test holes were rece,n, tly placed on the lot in the area of the new absorption trench.
Both holes revealed similar materials with well §faded silty gravel with a percolation
rate between 8 and 10 minutes per inch. No groundwater was encountered in either
excavation and none accumulated during [he monitoring period. We noted the soil
materials were much looser t,o, ward the top of the test holes so we have designed a 5'
wide absorption trench With 3 of gravel beneath the distribution pipe.. The total length
of the trench will be 64'. The total depth of the trench from original grade will be 5'. Fill
will be placed over the trench to provide a minimum of 3' of cover.
The ground surface on the lot slopes from east to west at between 10% and 15%. It
also slopes from north to the south at varying grades. The new trench will be
constructed parallet to the contours of the surface 'n conformance with Municipal
requirements. Grading will be accomplished to assure surface drainage is away from
the new trench.
f the system s constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse ~mpact on the wells
in the area or tr'ose to be constructed in the future,
2. The system, if constructed as designed, will have no adverse impact on existing
Lot 11, Block 3, Loma Estates Subdivision
August 23, 2000
Page Two
septic systems in the area or those to be constructed in the future.
3. The system if constructed as designed, wil have no adverse ~mpact on reserve
space, either surface or subsurface, on any lots located in tl~e 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
J
IH~$ PRO,15CT ~
AREA MAP
SCALE 1" = 100'
"., .. i ............. n,~ fl' I)£.¢£tMP/I6
SCOPE OF WORK: -" -
1. Verify the Foundation Cleanout. Place New if Necessary.
2, Expose and Inspect Existing Septic Tank,
3. Place New 1.000 Gallon Septic Tank if Necessary,
4. Place 2 Post Tank Cleanouts.
5. Place Flow Diverter Valve.
6. Connect Existing Trench for Future Use.
7. Construct New 64' Long X 5' Wide X 3' Effective Depth
Absorption Trench,
8. Regrade All Disturbed Areas.
9. Revegetate Area As Required.
/i// //fi
/
/ / ~Existing Absorption
~ Trench
1 / / TH' ~ Flow Diverter
/ Valve
~ / TH2 ~
g 1,000 Gallon
~/ / septic Tank
/ Three
Bedr°°m
/ /
/ /
/ / ~. /
- /
~xisting
/ ~ Well /
/
/
/
/
/
/
SITE PLAN
SCALE 1" =40'
LOT 11, BLOCK 3, LOMA ESTATES
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home
Perc. Rate: 10 Min,/Inch
Application Rate: .8 GPD/SF
5' Wide Trench System
Verify Existing 1,000 Gallon Tank
3' Drainfield Rock
3 Bedrooms X 150 GPD / .8 GPD/SF = 562.5 SF of Absorption Area
562.5 SF/5 LF (Width)*.57 (Red. Factor) = 64.1 LF Trench Length
Therefore: Construct a 64' Long X 5' Wide X 3' Effective Depth Absorption Trench.
Flowline Elevation in Trench to be 2.0' Below Original Ground Surface. Total Depth to be
5.0' Below Existing Ground. Mound Over Trench to Provide Minimum of 3' of Cover.
Natural Backfill
(2' Minimum)
1.5' 2" Insulation
or 3' Cover
.5~
4"PVC (Holes Down)
Drainfield Rock
NOTE:
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock,
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater,
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For; Rick Ray
Legal Description: Lot 11. Block 3. Loma Estates Subdivision
;LOPE
North
11
12
13
14
15
16
17
18
OG/OL
GM
TESTHOLE NO, 1
21
So~th
Was Groundwater
Encountered? No
If Yes. What Depth?
Depth to Water
After Monitoring None
Date: 8~22~00
Bottom of
Hole
Date Performed:
SITE PLAN
See Site Plan
S
L
O
P
E
Aeading Date Gross Net Depth To Net.
Time Time Water Drop
1. 12-Aug 2:54 - 1" .
3:24 30 4" 3" '
.. 3:25 · 1"
· · 3:55 30 4" 3"
3:56 . I" '
, ' 4:26 30 4" 3"
Perc. Rate: 10 Min./inch Perc. Hole Diameter: 6"
Test Run Between 3.5 Ft. and 4.5 Ft.
Comments: Test Hole Presoaked Prior to Test.
Performed By: Mike Anderson. I, Michael E. Anderson Certity That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 8~23~00
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0659
SOILS LOG - PERCOLATION TEST
Performed For: Rick Ray
Legal Description: Lot 11. Block 3. Loma Estates Subdivision
2
I O6/OL
GM
TESTHOLE NO. 2
5
6
7
8
9
10
11
SLOPE
North
South
Was Groundwater
Encountered? NO
if Yes, What Depth?
Bottom of Depth to Water
Hole ~ After Monitoring None
Date: · 8/22/00
Date Performed:
SITE PLAN
See Site Plan
S
O
P
E
13
14
15
16
18
21
Reading Date Gross Net-. Depth To ,Net
· Time Time Water : Drop .
3:26 30 4.5" ' . 3.5"
3:27 1"
· 3:57 30 4.5" 3.5"
Perc. Rate: 8.6 Min./inch Perc. Hole Diameter: 6"
Test Run Between 3.5 Ft. and 4.5 Ft.
Comments: Test Hole Presoaked Prior to Test.
Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 8/23/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 11, BLOCK 3, LOMA ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the exposing and verification for
continued use of the existing 1,000 gallon septic tank. If the tank is
found unacceptable for continued use work will include the
procurement and placement of a new 1,000 gallon septic tank at the
Iocation shown on the Site Plan. Work also includes the construction
of a new 64' long X 5' wide X 3' effective depth absorption trench at
the location shown. The distribution line in the trench will be placed at
2' below the existing ground surface. Total depth of the trench wilI be
5' below the existing ground surface. Care must be taken to assure
100' separation from the existing and abandoned wells on the property
to all components of the new septic system.
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.
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.
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 1,000 gallon septic tank must be be procured from an approved
source and installed at the location shown on the plans if the existing
tank is found unacceptable for continued use.
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.
Lot 11, Block 3, Loma Estates Subdivision
August 23, 2000
Page 2 of 3
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:
The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed levei 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 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.
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 trenches 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.
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).
Lot 11, Block 3, Loma Estates Subdivision
August 23, 2000
Page 3 of 3
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 m~nimum of two inspections. These
inspections must be conducted under the supervisicn 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 [he time of inspection.
Contractor shal provide a copy of alt field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
S~p. 28. 2000 1(3:25 PM
DEPARTMENT OF NATURAL ~E~;~'RES.'.', ;';,2: :) :~
:. ' ¥;'. :"." , ' ' - ~U7 ft, · ~ ~ ~ ,~: ~.~.~,
.... :~,. ... - , · ,, . .~; ; :.
.,.~..;,,~.....~:. ,; ' ' .. :, . '.. , .', , , ' · ,,... ....
,: .~-, ....'.' .... . · ' ) · '";-:~!
:: :,',.:...:;.~... . .......
~.~..,,~,.... , ~ ... .. ,,: , : · ,,,.¢~
'; ' ' ~'h'l~.~ i ~0~ drlllpd.undtr mi Ju~lldloIl~n 0¢¢ this reperl I~ true fo the heel of ~ ~nowle~ge'On¢ bellif; : ,~ .. :~
: I,-,~ .';~
Ocg' O"t. I
GRE,,...Ek ANCHORAGE AREA B0k. JL,.,'
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME J~. - ~'~"ILL-,-/~/r~ MAILING ADDRESS ~.~-']~--~----O
LOCATION ~-~V/~ (~ '~ ig~'C(_ t20*'~[~ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE --
FROM W E LL"~/~0
INSIDE LENGTH
MANU FACTU RER.~L'~
INSIDE WIDTH
MATERIAL ~
LIQUID DEPTH
NUMBER OF
'~_~
COMPARTMENTS
LIQUID CAPACITY ¢/~ddGALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
FOUNDATION
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH-- IN. TOTAL EFFECTIVE
ABSORPTION AREA /-'1/'~")--' SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER £ ~/ it
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE~ .IN. ABOVE TILE IN.
WELL:
TYPE_ CONSTRUCTION DEPTH
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE__ SEWER LINE__, TANK__, SYSTEM
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
SEWER LINE DEPTH:
PIPE MATERIAL:~/~
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE 7 -- (i/~ ')'} APPROVED /~-' ....
G.A.A.B.
-%:
FERIIIF NO.
[:,EPFIRTHEI"JT
L--~ E IL_ L
~:'a:-]'~ TRURO DRI',/E 507
F4PPLIE:RNT M.C. STILLER.,
LOCRTION [:~VIS & BIDELL RDS
LEGRL L'I.± B]: LOMR ESTRTES LOT SIZE
T~'PE OF SOIL RBSORBTION Sb'S]'EM IS: TRENCH
MR,"4IMUH NUP1BER OF BEDROOMS = ~ SOIL RRTING (SL.] FT,.'"BR)= t25
THE REQUIRED SIZE OF THE SOIL RBSORPTION S'¢STEH IS:
E:,EF'TH= 12 b i..=- t'-.~ L~ T H = --~-:: 2 ,-~ F-." R "..-" E L- E:.EF'TH=
4D600 SQLIRRE FEET
'THE LENGTH [:,IHENSION IS THE LENGTH (IN FEET::, OF THE TRENCH OR [:,RRINFIEL[:,.
THE [:,EPTH OF R TREN_.H OR PIT IS THE [:,ISTRNCE E:ETHEEN THE SURFRCE OF THE
GROUN[:, RND THE E:OTTOM OF THE E::4CR',/RTION (IN FEET::,.
THERE IS NO SET HI[:,TH FOR TRENCHES.
THE GRR'v'EL DEPTH IS THE HINIMUM DEPTH OF ~RM,EL E:ETHEEN THE OUTFRLL PIPE
RN[:, THE E:OTTUH OF THE EXCR'¢RTION (IN FEET).
E:FICKFZLL~NG OF ~N'¢ =,~=,]EH H~THOUT FZN~L ZNSF'EE:TZON ~ND RF'F'RO"2~L E"¢ THZS
DEF'RRTMENT W~LL BE SUB..~ECT TO pROSECUTZON.
MZN~I'tUM DZSTRNCE BETHEEN ~ HELL RN[:' ~N'¢ ON-S~TE SEHRGE
100 FEET FOR R F'RZ',,,'RTE 14ELL OR 2~3~3 FEET FOR R F'UBLZE: HELL.
HELL LOGS RRE REC!U~RED ~ND MUST BE RETURNED TO THE DEPRRTMENT 14ITHZN
OF THE WELL COMPLETZON.
'BF'EC:IFICRTIONS RN[:, CONSTRUCTION [:,IRGRRMS ARE R'ERILRE:LE TO INSURE F'REIF'ER
I NSTRLLRT I ON.
I CERTIF'¢ THRT
UN _,I'TE .-,EHEF._ FIN::' klEI_LS RS SET
t.: I Rf'l FRMILIFIR HITH THE REQUIREMENTS FOR - -': - -":
FOF.:TH E:'¢ THE MIJNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE '=;'eSl'EM IN RCCOF.:[:,RNCE HITH THE E:O[:,ES.
=,EHEF.. S'¢STEM r,lR'¢ REQUIRE ENLRF.:GEHENT IF THE
3:: i UN[:,EF.:STRN[:' THRT 'THE CIN-S I-rE "- -' .
F.:ESI[:,ENCE IS REMO[:,ELE[:, TO INCLUDE MORE THRN ]: E;E[:,ROOHS.
S I GNE[:,: - ~--
RF'PLICRNT M.C. STILLER
MUNICIPALITY OF ANCHORAGE
4"N
Development Services Department � Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-092-38
Legal description LOMA ESTATES BLK 3 LT 11
Site address 17001 BELARDE AVE
Expiration Date: 12/13/23
Current property owner(s) DAVIS LAWRENCE ELLIS JR &ALISA A
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By:
zz
Original Certificate Date: 9/13/23
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory X
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval—June 2022
MUNICIPALITY OF ANCHORAGE
Q
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 020-092-38
Complete legal description LOMA ESTATES BLOCK 3 LOT 11
Location (site address) 17001 BELARDE_AVENUE ANCHORAGE, ALASKA 99516
Current property owner(s) DAVIS LAWRENCE ELLIS JR Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ® AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for: Distance:
Expedited review requested: ❑
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 2 d0
Date of Payment1 %2023
COSA # D5G7 2, I ��D6
Waiver Fee $
Date of Payment
Waiver #
COSA Application 2022.doc
COSA Checklist 2022 copy.docx
COSA Checklist
Legal Description: LOMA ESTATES BLOCK 3 LOT 11 Parcel ID: 020-092-38_
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/15/87 Total depth 307 ft
Cased to 68 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 5/19/2023
Static water level at beginning of test 65 ft.
Well production at time of test 0.7 gpm
Water storage tank volume 250 approximate gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 2.84 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 5/19/2023
Comments
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NA
Required maintenance completed, if AWWTS
Comments: NEW ADVANTEX SYSTEM
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA - NEW ADVANTEX SYSTEM
Which system tested (date installed) AUGUST 2023
ALL standpipes present per record drawing
Total measured depth from grade 3.9 ft (max)
Measured depth to pipe invert from grade 3.4 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY*
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth (ED) remaining 6 in
Comments/Deficiencies: Approximate total measured depths from existing grade. *ED – existing/used/remaining – new
field.
COSA Checklist 2022 copy.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No *50+ ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No *50+ ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No *50+ ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No *50+ ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII SEPARATION DISTANCE
REQUIREMENTS.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/22/2023
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
8/22/23
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
w
www.muni.org/onsite
Well Water Advisory
Certificate of On -Site Systems Approval # OSC231306
Subdivision: Loma Estates, Block: 3, Lot: 11
This well's productivity was determined to be .7 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 4 -bedroom residence is 0.41
gallons per minute or 150 gallons per day per bedroom. Although the subject well
currently exceeds this minimum requirement, the production capacity can
fluctuate and may be insufficient to meet your needs.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
� MaUmg Address P`' O�'`Box 196650 *Anchorage; Alaska 99519 6650 *www muni org �
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this `V" Day of k fl Qf of 20'..x, by and between
T_herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as AN ADVANTEX SYSTEM
located at (legal description)
LOMA ESTATES BLOCK 3, LOT 11
2. Maintenance, Repairs and Altex•atious.
(Owner is required to read, understand and initial each section)
E'/4�2,Throtighout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the terra of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
DS includes an annual maintenance fee (typically $400 to $600).
2tle� Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
214Z
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of
iS
l Owner acknowledges that the Municipality may request records of maintenance and
os
repairs from the manufacturer's representative or maintenance provider.
e�P Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
os assessed in accordance with AMC 14.60.030.
ZyIe�1� Owner agrees to grant the Municipality reasonable access to test and inspect the
DS LIV
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
os Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
5guidelines for the construction, maintenance and repair of the Owner's AWWTS.' Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver ofthe provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: " (signature)
- t / it = (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
Date; 1 z. z�sz3
The foregoing instrument was acknowledged before me this lVbday of S•
2023, by PkGlae,� QY,Yl�1K6SC
1, Vv& T &
NOTARY PUBLIC FOR LASKA slate ofAlaska
My Commission expires: NOTARY PUBLIC
Carrie Nordlof
My Cornmission Expires Jan 10, 2027
MUNICIPALITY:
By: (signature)
(print name)
Date: I / 3
Title:
(rev. 05/18/2018) Page 3 of 3
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.akus
(907) 343-4744
Parcel I.D. 020-092-38
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date:
Lot 11, Block 3, Loma Estates
Location (site address or directions) 17001 Belarde Drive
Current Property owner(s) Rick and Suzanne Ray Day phone 345-6399
Mailing address 17001 Belarde Drive Anchorage, AK 99516
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Three (3)
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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. Cedificates
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.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on tile
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 in compliance with all applicable Municipal arid State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone
Address P.O. Box 240773 Anchorage, AK 99524
522-7773
Engineer's Printed Name
Michael E. Anderson¢ P.E. Date 9/29/00
DHHS SIGNATURE ~
Approved for bedrooms. '~'~? ~ .. '~ ~,
,, ~.~,., ~,
Conditional approval for __ bedrooms, with the following stipulations. · . ·
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
75-025 (Rev 01/00)'
Legal Description: Lot
L'- Municipality of Anchorage k_J
Department of Health and Human Services
Division of Environment,a,I Services R
E C E I V E
On-Site Services Section 825 "L Street Room 502~
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us OCT 0 3 Z000
(907) 343-4744
CH E MUNIClPAUTY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL CI~iI~ToNMENTAL SERVICES 01ViSl0N
11, Block 3, Loma Estates Parcel I.D.:
A. WELL DATA
Well type Private
Date completed . 6 / 1 5 / 8'Sanitary seal __
Total depth 3O7 ft Casedto 68
If A, B, or C provide PWSID #
¥
ft
FROM WELL LOG
Date of test 6/1 5/87
Static water level 62 ft
Well production .37 g.p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi Nitrate 1 · 67 mg/I
Date of sample: 9/22/00 Collected by: M~.A
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Date installed 9/14/00 Tank size
Cleanouts ¥ Foundation cleanout. ¥
Date of pumping: New Construction
C. ABSORPTION FIELD DATA
020-092-38
Well Log ¥
Wires properly protected ¥
Casing height (above ground) 10
AT INSPECTION
9/23/00
63
.5
ft
g.p.m
Other bacteria 0 colonies/100 mi
1,000 gal Number of Compartments 2
Depression over tank N High water alarm
Pumper N/A
in.
Date installed 9/15/00 Soil rating (g.p.d./ft2 or ft2/bdrm) .8
Length 74 fi' Width 5 ft Gravel below pipe 3 ft
Total depth 5 ff Effective absorption area 649 f¢ Monitoring tube ¥
Date of adequacy test New Const. Results (Pass/Fail)
Fluid depth in absorption field before test __ in Water added__
Elapsed Time:. min Final fluid depth in
Any rejuvenation treatment (past 12 mo.) (Y/N & type).
N
System type Shallow Trench
_ Depression over field ~
For bedrooms
gal. New depth.__
Absorption rate >=
.If yes, give date __
in.
g.p.d.
72-026 (Rev, 01/00)*
LIFT STATION - N/A
Date installed
"Pump on" level at in
Datum
E. SEPARATION DISTANCES
Size in gallons __
"Pump off" level at __
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot > 100 '
Absorption field on lot > 100 '
Public sewer main N/A
Sewer/septic service line > 25 '
in
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements
>100~
On adjacent lots
On adjacent lots > 100 '
Public sewer manhole/cleanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation > 5 ' Property line > 5 '
Water main N/A Water service line > 10 '
Drainage > 100 ' Wells on adjacent lots > 100 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water > 10
Wells on adjacent lots
N/A
Property line > 10 '
Water Service line >10 '
Curtain drain ~/A
COMMENTS
Absorption field >5'
Surface water >10o '
Water main N/A
Driveway, parking/vehicle storage
>100'
Second Well on Lot Exceeds Separation Distance to
Septic System.
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 9/29/00
HAAFee $ i~'~ --~
Date of Payment / (~/.,~-/~-~0
Receipt Number /¢.'-~.~L') ~.~..~>
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. O{~O ~ ~
During a recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot /~
Block ~ of A O~ ~7-~r~&Subdivision, the well's
productivity was determined to be _~,~ gallons per minute.
The minimum well productivity required by this Department
(~MC 15.55) for a _~ bedroom residence is O, ~1 gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of ncn-criticat water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
