HomeMy WebLinkAboutHILLSIDE NORTH #8 BLK 4 LT 6Hillside
North #8
Block 4
Lot 6
#041-033-16
Municipality of Anchorage Page 1 Of 4
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:-gwoonrild PID Number: 041-033-16
Name: Monica Beisel
Wastewater System: 0 New O Upgrade
Address: 8041 Chipper Tree Cir.
ABSORPTION FIELD
Phone. 344-7489
No. of Bedrooms: 4
C;DeepTrench OShallowTrench ❑Bed OMound ❑Other
LEGAL DESCRIPTION
Soil Rating;
Total Do Oft original grade;
.2 GPD F
Lot: s��he�v�
Block: 4 H i l fg tLgw N . %/ 8
�N to pipe botlom from original grade:
Gravel depth beneath pipe
6
FI.
4.4Ft
Township;
Range.
Section:
Fill added stove original grade:
Gravel length:
Ft
r1l a Ft
WELL• (21 New O Upgrade
Gravel width:
Numberllines:
Du
Iansuc
n/aFI
FI.
Classification (Privet.• A•B.C):
Private
Total Depth:Cased
(ol
To:
Total absorption area:
540
Piga material:
ASTM D3034
FI.
(n/ Ft.
FI
Driller.
Data Grilled:
Sialic Water Level:
Installer:
ed:
Dale instV:2
-25-00
At -phi
G-rv•at
yZL FI.
Groeneweg
Yield:
Pump Sol at: I
Casing Height AOw'e Ground.
TANK
SO GPM
Jk_ + FI.
2.0 Fl.
SEPARATION
DISTANCES
lb Septic 0Holding 0S.T.E.P.
To
Septic
AbWP11•n
On
Halidlnp
vale/Pdvat.
Manufacturer:
Anchorage Tank
Cap}eltY Iq gallons:
7 Ab
From
T.ak
Field
Mslim
T..a
Sewer Lkwe
Well
195
146
n/a
n/a
n/a
Material:
Steel
Number of Compartments:
2
Surface
106
135
n/a
n/a
n/a
LIFT STATION
water
Lot
139
120
n/a
n/a
n/a
Size In gallons:
Manufacturer.
Line
Foundation
29
25
n/a
n/a
n/a
'Pump On'levelofr
to vel al:
Migh water alarm at:
Curtain
Pump Make B Model
eculcal Inspections performed by:
n a
n/a
n/a
n/a
n/a
Remarks:
BENCH MARK
Locallon and Description:
TBIM - Top of concrete Slab
west face of garage
As120sumed6.5 Elevation:
Ft•
ENGa4E1<N3.]
1t O F. A aq 1l
9t
5 .t4 00
Inspections performed by: 1�E� Nr� Dates:lst�
�,
. i.• . • ••e •e
/
-..........
2nd s 60
.. ......
�III �; DEE MI ll
�•, CE•5 7
f
Department of Health and Human Services approval
ll�f'°Fo'•••• ••''����"
Reviewed and approved by: Date: L S- O f
?2413IR" "11 MOA 25
Permit No
SW000034
Municipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Well & On—Site Wastewater Disposal System
Legal Description:
Page 2 of 4
W.O. 20424
Date 8/21/00
LOT 6 BLOCK 4 HILLSIDE NORTH ADDN. #8 PID No. 041-033-16
WELL
\ v
100' WELLI
zD RADIUS I �
\\ \\ m I
\ \ \ \rn T.B.M. TOP CONIC.
\\ \\ FLOOR ELV.a1206.151 c
FF -1206.15 I
\\ \\ I \\ EHOU EG >N I
\ \ A LOT 6 my 1
\\ \ I \ 1 e r0 1
OPPOSING iN I
\ \ \ CLEANOUTS i
I 1 \ \ 1250 CAL. STEL A I
\\ \ \\SEPTIC TANK m 1
\ I \ 1I
TH/1 Ti 1.4 L.F. DEEP 1
TRENCH I
MTURE SITE FOR
I I I \ \ \ 1REPLACEMENT SYSTEM
I I I \ \ \ e TH12 I
a 1
1 1 1 R \ \ ��
1 1 1
m% A \\ RADIUS
ST HOLE
1 1 I N 1\ \
1 1 \ \ \
1 1 \ I \
`1 1
LOT 5
BLOCK 5
I UNDEVELOPED
I LEGEND
I • CLEAN OUT
I • MONITORING
I TUBE
1 x T.B.M.
N
M
1 PIN
1 a
I �Z
1 :C
7- IC
1 ''N
1
a
A
r7
1
1
SCALE:
RECORD DRAWING
DHI CONSULTING ENGINEERS
CML • SURVEYING • PLANNING
11 Td�pDen�� (V07)bN-1016
7n1 (907)u4-130
\ _ M • M� M. •NIA �•MY.•..y.. Y M��
1" =
XDENNI6 DEV(;I; � A
•#P'`rf•••• CE 58 �••'/e
Pilo •••NN•• �
DATE' 4
tl�
Permit No.SW000034 Page 3 of 4
W.O. 20424
•
Municipality of Anchorage 9/14/00
Department of Health and human Services Date
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Proposed Well & On—Site Wastewater Disposal System
Legal Description: LOT 6 BLOCK 4 HILLSIDE NORTH ADDN. #6 PID No. 041-033-16
DRAIN
FROM
*ALL ELEVATIONS ARE TO INVERT OF
PIPE UNLESS OTHERWISE NOTED
PROFILE
rFINISH
CRADE —
CLEAN OUTI
END OF
TRENCH
NOTE:
1 ALL CONSTRUCTION COMPLETED IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS
OF THE MUNICIPAL CODE AS CURRENTLY AMENDED.
2 INSTALLED NEW 1250 CAL. , TWO COMPARTMENT, SEPTIC TANK.
X All PIPr K PVC CONFORMING TO ASTM D3034.
SYSTEM PARAMETERS
DESCRIPTION
AS CONSTRUCTED
DESIGN
APPLICATION RATE =
1.2 G.P.D./S.F.
1.2 C.P.D. S.F.
TRENCH LENGHT =
61.4 FT
56.o FT
EFFECTIVE DEPTH =
4.4 FT
4.5 FT
ABSORPTION AREA =
540.0 S.F.
500.0 S.F.
NUMDER BEDROOMS
4
4
42K 40
RECORD DRAWING
SCALE: NTS
.• OF At,4 \
Fr QTH V
CE 5807 _•-AAr
r • IN
NH
Telepbmat (907)544-1356 7a (907)544-1363 \ \, iofess�'o
Soo ■ 96130 vm . • su9-aa Aaabsya. a MIS DATE \ \ Ik���'��I
Permit No. SWO00034
Page 4 of 4
W.O. 20424
Municipality of Anchorage 9/14/00
Department of Health and Human Services Date
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Proposed Well & On—Site Wastewater Disposal System
Legal Description: LOT 6 BLOCK 4 IIILLSIDE NORTH ADDN. #8 PID No. 041-033-16
THR1 _
0
OR SILTS W/ ROOT
MAT -FROZEN TO 8'
2.0'
'('S SILTY SAND W/ GRAVEL -DRY
/ OCCASIONAL BOLDER TO 2'
7.0'
n
/ SILTY SANDY GRAVEL
VATH ROCK TO 6'
d OCCASIONAL BOLDER TO 2'
-6
o/.
T.
12.5'
Z
a
2
TO S
TO BEDROCK OR
IMPERMEABLE LAYER
ABSORPTION TRENCH -TYPICAL SECTION
SCALE: NTS
PROPOSED FINISH GRADE
RIGINAL GROUND
GEOTEXTILE FABRIC
4" PERFORATED PVC PIPE
® 0.00% SLOPE
SEPTIC ROCK PER
M.O.A. SPECIFICATIONS
FG �_- ,IIZPr
iAi-ATH
P sDENNIS C y HIGH j i
s!' CE 5807 ��
� � a Flofess�a�.•
DATE
r
Rick Mystrom
Mayor
Municipality of Anchorage
Department of Health and Human Services
825'1' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.cl.anchorage.ak.us
Permit Number: #SW 000034 Date of Issue: 3 -20 -DO Parcel Identification Number: 041-033-16
Date Started: 6-14-00 Date Completed: 6-14-00 Is well located at approved permit location? ® Yes ❑ No
Legal Descriptioq — Hillside North#8 lot 6 blk4
Property Owner Name & Address: John Harvey and Monica Beisel
8041 Chipper Tree Cir.
Anchorage, Ak 99507
Borehole Data:
Depth (ft)
Method of Drilling ® air rotary ❑ cable tool
Soil Type, Thickness &: Water Strata
From
To
Casing type: steel
stick-up
0
2
Wall Thickness: .025 inches
organic and silt
2
4
Diameter: 6 inches Depth: 61 feet
silty gravel
gravel
4
17
17
38
Liner Type:
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
gravelly silt
water sand & gravel
38
54
54
61
Static water level (from ground level): 42 feet
Pumping level: 61 feet after
2 hours puunping 50+ gpm
Recovery Rate: 50+ gpm
Method of Testing: airlift
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
[]Perforations Start feet Stopped feet
Grout Type: Bentonite # 8 Volume: 1 br
Depth: Start 0 feet Stopped ± feet
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Clorine Tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
P O Box 110496
Anchorage AK 99511
Attention: The welt driller shall provide a well log to the property owner within 30 days of completion and the property
Hamm n� t1,e well '641, 1 21 . I , -,.Al tnnlnthe n nt ♦,P iJ." k LtAft Aava of rmm�lMinn
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 I WATER SUPPLY PERMIT
Initial
Permit Number: SW000034
Legal Description: Hillside North #8, Lot 6, Block 4
Design Engineer: 0060 DHI Engineering
Owner Name: John Harvey & Monica Beisel
Date Issued: Mar 20, 2000
Expiration Date: Mar 20, 2001
Parcel ID: 041-033-16
Site Address: 8041 Chipper Tree Cir.
Lot Size: 111514 SQ. FT.
Owner Address: 8041 Chipper Tree Cir. Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage , AK 99507 -
This permit is for the construction of:
E Disposal Field M✓ 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 DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 3434744 ( 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 B,
Issued B,
Date:
Date: 3-20-00
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On -Site Sewer/Well Permit Application
NOTE: APMirAlkm mu•1 M IBlMmd tnmMetrq SINGLE FAMILY DWELLING PRIM hhufnn Nomhm
Property Owner Name _9C7hn PRV��/___Qn,cc _user ____ Day Phone 3_ 7y�
Mailing Address$01n ,�Y7 _C/?�6 �a Zip Code /SO
Legal Descri ton �T
` i
gp ma=y nk k
vi
Lot Size
Number of Bedrooms:
Inspections will be conducted by: r /
/` Approved Engineering Firm
Municipality (permit lee included)
Does your house contain any of the following: Ilot Tub. Swimming Pool. Therapy Pool. Jacuzzi.
or Water Softener Unit? tlE If yes. which one? _—_
This application is for: Sewer Only __ Sewer and _ Sewer Upgrade Well Only
I certify that the above Information is correct. I further certif I this ap ication is being ade for Ingle Family Dwelling
and in accordance with applicable Municipal codes.
lormy n en Odner �rKtC[l
Fees: -`---0 __ necetpl It
/70121n , MPRI
Permit No. Municipality of Anchorage Page 1 of 7
Department of Health and Human Services W.O. 20424
ENVIRONMENTAL SERVICES DIVISION Date 03/03/00
P.O. Box 196650• Anchorage, AK 99519-6650• Tel: 343-4744
On—Site Waste water Disposal System/Well Inspection Report
Legal Description: LOT 6 BLOCK 4 HILLSIDE NORTH ADDN.#8
SITE NARRATIVE
Lot 6 Block 4 HILLSIDE NORTH Subdivision ADDITION #8 (a 2.56 Acre lot) is
bordered on three sides by a 50' public right of way & on the north by a large
undeveloped lot. Lot 6 is undeveloped and the septic system design is based on
a four bedroom single family house as shown on the drawings.
WELLS:
The proposed well will be located near the north property line. Its protective well radius
will over lap onto the lot to the north (lot 5).
This overlap will not unduly im act this lot. There is enough room
on lot 5 (the lot to the north to place a well, septic system & reserve area.
SEPTIC SYSTEMS:
None of the lots surrounding lot 6 have septic systems or wells at this time. The
proposed septic system on lot 6 will not effect the future placement of septic systems
on any of the surrounding lot.
DRAINAGE:
Drainage in the area is generally from east to west. Lot 6 has a moderate to steep
slope from east to west. The lot can be graded to prevent any ponding of water over
or around .the proposed well and septic system. There is a stream on lot 6 to the
west of the proposed septic system and a drainage easement to the north.
There is enough room on this lot to place the proposed & replacement septic system
without encroaching on the 100 set back areas of the creek, drainage
easement or proposed well radius.
�....%%
4!< OFAi 44
;DENNI DEE it �; i
s :• C 580 •:
DATE
C. FILE 424NARRATIVE_
Permit No. Page 2 of 7
Municipality of Anchorage W.O. 2042403/03/00
Department of Health and Human Services Date
ENVIRONMENTAL SERVICES DIVISION
P.O. Boz 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Well & On—Site Wastewater Disposal System
Legal Description: LOT 6 BLOCK 4 HILLSIDE NORTH ADDN. #8 PID No.
SYSTEM DESIGN CALCULATIONS
1. NO. BEDROOMS = 4
2. USE TRENCH SYSTEM
3. ABSORPTION AREA = (# BEDROOMS)(150 GPD/BR)
TRENCH APPLICATION RATE
_ (4)(150) = 500.0 SF
1.2*
4. TRENCH AREA = 2(DEPTH OF GRAVEL)(LENGTH) = 500 SF
FOR GRAVEL DEPTH = 5.5'
LENGTH OF TRENCH = 46'
PERCOLATION RATE
PIT & TRENCH MOUND & BED
APPLICATION RATE APPLICATION RATE
MIN/INCH
GPD/SF
GPD/SF
0-1
NOT SUITABLE
NOT SUITABLE
1-5
1.2
0.8
* 6-15
0.8
0.5
16-30
0.6
0.4
31-60
0.45
0.3
GREATER THAN 60
NOT SUITABLE
NOT SUITABLE
FILTER LAYER
1.0
.7
awns
Permit No.
Page 3 of 7
W.O. 20424
Municipality of Anchorage 03/03/00
H 141kd H S Date
Department of ea an uman erviCez
ENVIRONMENTAL SERVICES DIVISION
P.O. Boz 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Well & On—Site Wastewater Disposal System
Legal Description: LOT 6 BLOCK 4 HILLSIDE NORTH ADDN. #8 PID No.
1100'
C'-1
z—
C>0
0M
SCv
0W
rn
00
\
\
I1, IV\\\
LOT 5
BLOCK 4
UNDEVELOPED
�TkE EASM'T �
�l1
PR
c N
Z m
1 � < 6o
0
EQ I
c
�z
rrn 0 o
I p oN
N
O
�I
1 � I OaN
I 2ron Oz
I I 0
I I �7
19 1 I Nisi
wAd 1' I ❑�A
r) I ;a 9 b,
X o�m
2m 1 1 d
s '• CEM07 ,
4� fes6
SCALE: 1" = 100' DATE ���•.••�a
rJ
Permit No.
Page 4 of 7
W.O. 20424
Municipality of Anchorage Date 3/3/00
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Boz 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Well & On—Site Wastewater Disposal System
Legal Description: LOT 6 BLOCK 4 HILLSIDE NORTH ADDN. X18 PID No.
I
"--p OPOSED
L J LL�
100 DRAINAGE
EASE ENT SET
`\BACK OUNDARY
1 ih �FFa1299.5
BFF.1 99.0
\1
\i
�
Z
I\
�!l
I \
\\
\ 12 0 GA
\\SE
STELE
1 ►
TI TA
\
K
1
1 \
\
1 1
1 ►
1 A
\
1 1
\
I it 1 m
>rn
\ \
\
1 cI I
\ \
'rn\
\ r1
\1
\i
�
Z
I\
\ ` I
c
z m
1rn 04
/ I o NN
/ I I I
Q_'I o I
/ ' I
L1215=�
a�
I I �Z
�4 I I __
ri I I I o
3Z I I I I rn
a I I
n 1
LEGEND
I I ■ CLEAN OUT
I • MONITORING
I I L TUBE
I
FOR I
T SYSTEM i !
1
:ST HOLE
S /
/
/
J /
♦-0:0 `, 1
1
q,�W
DATE %jL%'0
Permit No.
Page 5 of 7
W.O. 20424
Municipality of Anchorage Date 03/03/00
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Boz 196650 • Anchorage, AK 99519-6650• Tel: 343-4744
Proposed Well & On—Site Wastewater Disposal System
Legal Description: LOT 6 BLOCK 4 HILLSIDE NORTH ADDN. #8 PID No.
0.—TH#1
ORGANIC SILTS W/ ROOT
2.o, � MAT -FROZEN TO 8"
SILTY SAND W/ GRAVEL -DRY
OCCASIONAL BOLDER TO 2'
7.0'
b° in
vi
-c SILTY SANDY GRAVEL
y WITH ROCK TO 6"
OCCASIONAL BOLDER TO 2'
/,
ya 12.5'
:�. to
TO SEASONAL HIGH
od' WATER LEVEL
•
18.5 . B.O.T. '
TO BEDROCK OR
IMPERMEABLE LAYER
ABSORPTION TRENCH -TYPICAL SECTION
SCALE: NTS
PROPOSED FINISH GRADE
ORIGINAL GROUND
GEOTEXTILE FABRIC
4" PERFORATED PVC PIPE
A 0.00% SLOPE
SEPTIC ROCK PER.
M.O.A. SPECIFICATIONS
1;ZcYiseO 3.17.00 `
MUNIMPAUTY OF ANCHORAGE
DEPARTMENT OF HEALTH k HUMAN SERVICES
625 V S7REET, ANOMACG ALkWA 66502-0660
SOILS LOG -PERCOLATION TEST
TEST HOLE 1 ot.
IpjPERFORMED FOR: MONICA BEISEL & JOHN HARVEYDATE PERFORMED: 2-29-00 4!��6CE 587
LECAL DESCRIPTION: LOT 6 BLOCK 4 TOWNSHIP,RANGE.SECTION: •
H.S.N. X18 W.0.204N
+� ORGANIC SILTS W/ ROOT
MAT—FROZEN TO 8"
2 _-
3
3
4," ••
"r�` SILTY SAND W/ GRAVEL—DRY
>I OCCASIONAL BOULDER TO 2'
5 t•._...
6
7
8
9
10
11
12
SLOPE
SITE PLAN
13 fir/ OCCASIONAL BOULDER TO 2'
14 /</
15
16
17
18
B.O.T.-18.5'
19
20
PERCOLATION RATE: 1.25 (MINUTES/INCH.) PERCHOLE DIAMETER: 6'
TEST RUN BETWEEN: e' FT. AND B'-8" FT.
PERFORMED BY:DEE h cREMY HIGH CERTIFY THAT THIS TEST WAS PERFORMED W ACCORDANCE WITH
ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 03-09-00
�r
lull
j
s •/
WAS GROUND WATER
S
t•
ENCOUNTERED 4
NO
L
/
0
!
IF YES. AT WHAT
DEPTH 4
E
/
SILTY SANDY GRAVEL
DEPTH OF WATER
NO WATER
03-09-00
W/ ROCK TO 6'
AFTER MONITORING 4
DATE:
13 fir/ OCCASIONAL BOULDER TO 2'
14 /</
15
16
17
18
B.O.T.-18.5'
19
20
PERCOLATION RATE: 1.25 (MINUTES/INCH.) PERCHOLE DIAMETER: 6'
TEST RUN BETWEEN: e' FT. AND B'-8" FT.
PERFORMED BY:DEE h cREMY HIGH CERTIFY THAT THIS TEST WAS PERFORMED W ACCORDANCE WITH
ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 03-09-00
Permit No.
Municipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Boz 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Well & On—Site Wastewater Disposal System
Legal Description:
Page 6 of 7
W.O. 20424
Date 03/03/00
LOT 6 BLOCK 4 HILLSIDE NORTH SUBD. #8 PID No.
NOTES:
1 ALL CONSTRUCTION SHALL BE IN ACCORDANCE NTH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS
OF THE MUNICIPAL CODE AS CURRENTLY AMENDED.
2 INSTALL NEW 1250 CAL. SEPTIC TANK AS SHOWN ON THE DRAWINGS. SET TANK LEVEL & RECORD INLET AND
OUTLET ELEVATIONS OF THE TANK. TANK SHALL BE PLACED ON UNDISTURBED NATIVE SOIL. PLACE OUTSIDE
PROTECTIVE WELL RADIUS.
3 SITE TOPOGRAPHY TAKEN FROM AERIAL MAPPING. EXISTING STRUCTURES, WELLS, SEPTIC
SYSTEMS OBSERVED WITHIN 200 FT. OF PROPOSED SYSTEM SITE ARE SHOWN ON DESIGN DRAWINGS.
4 ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION
INTO THE SYSTEM.
5 CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES, PROPERTY LINES, EXISTING WELLS, WATER WAYS,
SURFACE AND SUBSURFACE DRAINAGE FACILITIES, LAKES, PONDS, AND OTHER FACILITIES REQUIRING
SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM. CONTRACTOR TO STAKE PROPOSED SYSTEM
PRIOR TO CONSTRUCTION. NOTIFY THE ENGINEER OF ANY OBSERVED CONFLICTS PRIOR TO CONSTRUCTION.
6 NOTIFY THE ENGINEER AND DHHS 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF
THREE INSPECTIONS ARE REQUIRED. THE FIRST INSPECTION SHALL BE OF THE SUBGRADE, PRIOR TO PLACING
SAND FILTER. THE SECOND INSPECTION SHALL BE AFTER THE PLACEMENT OF GRAVEL, DISTRIBUTION
PIPING, STANDPIPES, TANK, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD INSPECTION SHALL BE
AFTER THE WORK IS COMPLETED.
7 CONTRACTOR SHALL DELIVER TO THE ENGINEER A SET OF RED -LINED, AS -BUILT DRAWINGS SHOWING ALL DATA
AS SPECIFIED IN SEC. 15.65.F.2, 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF
THE FINAL INSPECTION. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT.
THESE AS-BUILTS SHALL BE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWING TO DHHS.
B STAKE ALIGNMENT OF SYSTEM WITH MARKERS SHOWING THE PROTECTIVE DISTANCES FROM WELLS AND
OTHER BODIES OF WATER PRIOR TO BEGINNING INSTALLATION.
9 ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE
ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN.
Permit No. Page 7 of 7
Municipality of Anchorage W.O. 2042403/03/00
Department of Health and Human Services Date
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744
Well & On—Site Wastewater Disposal System
Legal Description: LOT 6 BLOCK 4 HILLSIDE NORTH SUBD. #8 PID No.
NOTES:
10 EXCAVATE THE ABSORPTION FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL. BOTTOM do SIDES OF TRENCH SHALL
BE SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE, AND END OF TRENCH BOTTOM. CONSTRUCTION
EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE
OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL
11 PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL
OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO t 1" PRIOR TO INSTALLING THE PERFORATED PIPE.
12 ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER—APPROVED EQUAL. MIN SOIL COVER
SHALL BE 4 FT (OR 2' SOIL AND 2" INSULATION BOARD — SEE NOTE 13)
13 ALL INSULATION BOARD SHALL BE 2" THICK DOW HI -35 INSULBOARD OR ENGINEER—APPROVED EQUAL.
CENTER INSULBOARD WIDTH OVER PIPES, FIELD, AND SEPTIC TANK.
14 GEOTEXTILE SHALL BE MIRAFI 1405 OR ENGINEER—APPROVED EQUAL LAP ALL JOINTS 2' MIN.
15 COVER THE DISTRIBUTION PIPE WITH MIN 2" SEWER ROCK, AND COVER WITH GEOTEXTILE BEFORE PLACING
INSULATION AND BACKFILLING.
16 MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS.
17 SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MIN. SLOPE, AND 3:1 MAX SLOPE, AND IN SUCH A MANNER THAT
PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6' HIGHER THAN
SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MUNICIPAL SPECS.
18 RECORD THE FINISH GROUND ELEVATION OVER TOP OF TRENCH.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 041-033-18
1. GENERAL INFORMATION
Complete legal description Hillside North #8 Blk 4 Lot 6
HAA # n50i¢ l�
Expiration Date: /ot.
Location (site address or directions) 9787 Middlerock Rd, Anchorage
Current Property owner(s) Monica Beisel & John Harvey Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
9787 Middlerock Rd, Anchorage, AK 99507
Day phone
Mary Tutterow, / Dynamic Properties Day phone 261-7682
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested. HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Q
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. 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. (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 Firm Watkins Engineering, Inc.
Phone 349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443 .
Engineer's Printed Name Cindy W. Ellis Date 11-z5-0:5
5. DSD SIGNATURECin'
W. Ellis
Approved for bedrooms. c�`•., CE.sosn
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By Original Certificate Date: 1
F.OIM2)
;a Y t}P .
Additional Comments
ON-SITE
.WAST
-
PROGRAM
J o•
� '
JJJ C�17 • ... • • S
1
\��
Attachments:
HAA Checklist X
Maintenance Agreements
Septic System Advisory
Supplemental Engineer's Report
Well Flow Advisory
Other
By Original Certificate Date: 1
F.OIM2)
E
Municipality of Anchorage ..
• Development Services Department
Building Safety Division
On -M Water 6 Wastewater Program '
I' 4700 South Bragaw St,
' P.O. Bar 1965M Anchorage, AK 99519.6650
www.muni.org/ornslte
r (907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Hillside NOM 08 Slk 4 Lot 6 Parcel ID: 041-033.18
A. WELL DATA
wait pe Pd K A, B, or C provide PWSID 4 _
Date completed° Y0° San" seal (Y/N) Yes
Total depth 81 fl. COW to 81 fl.
FROM WELL LOG
Date of test June 6, 2000
Static water level 42 R,
Well production 50 g,p,m,
WATER SAMPLE RESULTS:
Col f rn 0 colonieal100 ml. Nitrate 4.12 mg.4.
Arsenic: NA mgA. Date of sample: 11445
B. SEPTICMOLDING TANK DATA
Tank Type/Material Steel
Tank size 1250 gal. Number of Campardnents 2
WOO Log (Y/N) Yes
Wires property Protected (YIN) Yes
Casing height (above ground) 24 in.
AT INSPECTION
Oct 12, 2005
47
R.
92 9 -
p.m -
Other baderia 0 colonies/1100 ml.
Collected by: Rocky Trainor
Date installed May 25. 2000
Cleanouts (YM) Yes
Foundation deanout (YM) Yea Depression over tank (YIN) No High water alarm (YM) NIA
Date of pumping 9/30/2005 Pumper Isaac's
C. ABSORPTION FIELD DATA
Date Installed 5/25/00 Soil rating (g.p.dAe or felbdrm) 1_2 System type Deep Trench
Lem 61.4 IL Width 3 fl. Gravel below pipe 4.4 ft.
Total depth 12_5 R. Eft. absorption area 640 fly Monitoring tube Yes Depression over field No
Date of adequacy test 10/1212005 Results (PasafFeiq Pass For 4 bedrooms
Fluid depth in absorption field before test 13 in. Water added 00" gal. New depth so.7S In.
Elapsed Time: 91 min. Final fluid depth 17 In. Absorption rate >= 6W g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give date
D. UFT STATION
Date installed WA Sae In gallons
'Pump on' level at _ in. 'Pump oir level at _ in.
Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 146
Absorption field on lot 137'
Public sewer main 100'+
Sewer /septic service Une 120'
Manhole/Acoess (Y/N)
High water alar level at in.
Meets alarm & circuit requirements?
On adjacent lots 1W+
On adjacent lob 100'+
Public sewer manhole/deanout 100'+
Holding tank WA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 2' Property line 137'
Water mein 100'+
Wells on adjacent lots 100'*
Absorption field IV
Water service line 100'+ Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 113' Building foundation 25' Water main 100'*
Water Service line 100'+ Surface water 100'*
Curtain drain N/A Wells on adjacent kris 100'*
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
nrvisw of Municipal records that the above systems are in
conformance Wfih MOA HAA guidelines M effect on this date.
Engineer's Printed Name Cindy W. Ellis
Date 11 - 05
Driveway. WkbVNehkde storage 80'
HAA Fee E 9� . Co Waiver Fee S
Date of Payment 1,* Date of Payment
Receipt Number - ���� Receipt Number
(Rev. 17/01)
MY W. Ellis
CE - loan
FTq
SCS ReLM
1057452001
All Datcs?imes are Alaska Standard Time
Client Name
Watkins Engineering
Printed Dalcrrime
11232005
11:39
Project Name/#
Hillside North H8 BIM Lot6
Collected Datemme
11/042005
8:55
Client Sample ID
Hillside North 08 BIM L4)t6
Received Dstdrime
11/042005
10:28
Matrix
Drinking Water
Technical Director
Stephen C. Ede
PWSID
0
Sample Remarks:
Allowable Prep
Analysis
Parameter
Results
PQL Units
Method Containcr ID
Limits Date
Date Init
Nitrate -N
4.92
0.100 mg/L
EPA 353.2 B
(o-10)
11/41/05 AZS
Microbiology
Laboratory
Total Coliform
0
coU100mL
SM209222B A
(o-1)
11/04,105 TL.F
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