HomeMy WebLinkAboutELMORE #1 BLK 5 LT 9
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
CAN -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221403 PID Number: 01817223000
Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Upgrade
Name
LINDSTAM LARRY
ABSORPTION FIELD
❑ peep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
4401 RIVERTON AVE
X Other
Phone
330-0133
Number of Bedrooms
3
Soil Rating
Total depth from original grade
2 GPDISF
5* F
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2 Ft
Gravel depth beneath pipe
55 F
Subdivision Block Lot
ELMORE #1 BLK 5 LT 9
Fill added above original grade
Gravel length
Township Range Section
- Ft.
30 F
Gravel width
10 Ft,
Beds: Number
3
of Lines
Distance between lines
3 F
SEPARATION DISTANCES
To,
Septic ^, Absorption
Lift Station
Holding Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank I Field
Tank Line
225 Ft
F
I
Well
{ 100'+ '� (�'-{-
(�' ¢
Da 25' +
TANK El Septic ® S.T.E.P. El Holding El Other
Manufacturer
Greer
Capacity
1500 Ga
i
Surface Water
� 1001+ � 1 00,+
100'+
na
Material
Number of compartments
Lot Line
10,+ 7'+
`I 0,+
I na NA
P IStc
Foundation 110'+
10'+
10'+
na
LIFT STATION
Manufacturer
Capacity
Remarks Air Compressor Alarm
Greer
500 Ga
Located In Crawl Space. * Field Measurements.
Alarm location
Post @ douse
Electrical installed by
rising son
Installer
PIPE MATERIAL 1 louse to tank D3034 Tank toSCh40
drainfield
+
Drainfield Sch40 COIMT ❑3034
Inspector NorthRirn Eng.
BENCH MARK (Assumed elovation) 100 ft
Inspdection 1'1 3/29/23 Zed 6/5/23
Location and description
3`,,' 6/8/23 4"'
Deck
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
OF
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Septic System
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c Steve Eng
Approved Date 31 ter, z r
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11•/•3 % 2�
Note: this approval does not include well permit requirements.
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NORTHRIM
ENGINEERING
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PO Box 770724
Eagle River. Alaska 99577
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118
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907.694.7028 44 11%4%23 UPGRADE SEPTIC Date.1/30/24 12 of 3
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N 89°52'00"E 208.71
-- RIVER TON A VENUE-- --- --- - - _ _ --
VO° SHANE A. HOLT NOTE:
Qn4,. LS-6914 S;�O DISTANCES SHOWN TO THE NEAREST
VV �a
rOfesFOOT TO PROPERTY LINES DUE TO
�psi°naI CONFLICTING SURVEY CONTROL
�DDOO;op�� IN THE AREA. FURTHER RETRACEMENT
MAY YIELD SLIGHTLY DIFFERENT DISTANCES
AND IS BEYOND THE SCOPE OF THIS SURVEY.
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT
ARE NOT SHOWN HEREON( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE_
ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON
AS-BU/LT SURVEY I" = 301
NO CORNERS SET THIS DATE
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I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 9 BLOCK 5 ELMORE 1ST ADD'N.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
'EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 19 TH DAY OF
/UNE , 2023
I HOL T LAPID SURVE) ING
THE SURVEY DATA OLJ THIS ORAWTNG IS FREPARED FOR THE OIM1AfR OFRECORD ONL Y. 9309 GROI ER DRIVE
ANYCOPYING• OR UTILIZING THE DATA HEREOANS PROHI8ITE0 UNDER COPYRIGHT LAW ANCHORAGEAK 99507
9108 10138232-19 223-8615
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: OSP221403
Work Type: Septic Upgrade
Tax Code Number: 01817223000
Site Legal Address: ELMORE #1 BLK 5 LT 9 G:3036
Site Mailing Address: 4401 RIVERTON AVE, Anchorage
Owner: LINDSTAM LARRY G & PAULA A
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
nt S
u - �
t
UeI)artment
11/7/2022
11/7/2023
41433
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
Special Provisions:
1. 7 day groundwater monitoring is required. Construction may proceed at your own risk before the 7 day
watermonitoring is complete. Please submitstamped and signed results with the As -built Inspection
Report. If the results require a design change,construction of the system will stop pending On -Site review
and approval.
2. An alarm on the air compressor is required. Please note the location on the IR.
-C, (A fo L'74 Ain, � i)ee r
Issued By:
Date:
Date: ( 2Z
9
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 01817223000
Property owner(s) LINDSTAM LARRY
Mailing address 4401 RIVERTON AVE
Site address same
Day phone 330-0133
Legal description (Sub'd., Block & Lot) ELMORE #1 BLK 5 LT 9
Legal description (Township, Range & Section)
Lot Size 41,433 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(M all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
0
Upgrade 0
(D) ❑
Holding Tank
ElRenewal
ElDuplex
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5q5 -
Date
`75Date of Payment: /0 31 -� %
Receipt Number: a 811 i/ , n
Permit No 6 S P of alL1Q3
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client ForrnsTermit Application.doc
SteveEng.com Elmore #1 B5 L9
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3-bedroom, single family home. This is a
developed subdivision. A reconstruction of the existing IDSF is planned + new 1250
gallon STEP Tank. The existing tank/IDSF to be decommissioned/removed. All old IDSF
material to be over-excavated and removed, replaced with new material. No conflicts to
the other lots will take place by this septic system construction upgrade. Previous deign
data to be used. Existing lot line waiver in place to 3 A previous application rate of 2
GPD/FT². Bed Length = 225 FT²/(10) = 22.5 Say 30 10 Pea Gravel & MOA Spec
Sand Per Profile Drawing. Easements depicted in the Plan view, private water wells serve
these lots. If no foundation cleanout, add double cleanouts prior to STEP tank. 5 trench
depth requested as before.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 1250 Gallon STEP Tank. MOA-Approved.
Decommission old tank per UPC. MOA-Spec Material Under Tank.
10 minimum between the tank trench, tank to house. 10 to property lines,
3 of cover or insulation is required for trench; 2 Minimum thickness for insulation
can substitute for 1 cover.
Tank & solid pipe must be set on well compacted, stable soil.
4 inch diameter cleanouts with airtight caps are required 1 to 4 from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10 from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Trench to be placed level, minimum of 4 to groundwater, 6 to bedrock.
Pea Gravel to be 3/8 2 MOA Spec sand beneath pea gravel.
Air Compressor & Air Line To meet MOA Specs.
Force main to be 1.25 Schedule 40 PVC or equal.
Distribution pipe to be 1.25 Schedule 40 PVC w/ 1/8 orifice @ 18 on-center.
Silt barrier (filter fabric) to be installed above the drain rock.
Smeared trench sides must be raked or scarified before drain rock placement.
The finish grade must be mounded to promote drainage away from trench.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221403, Deb Wockenfuss, 11/07/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221403, Deb Wockenfuss, 11/07/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221403, Deb Wockenfuss, 11/07/22
(rev. 05/18/2018) Page 1 of 3
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 ______ Day of ________________ of 20____, by and between
_________________________________, 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 _____________________________________________________________
located at (legal description)
_______________________________________________________________________
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
____ Throughout 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 term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
____ 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.
____ 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.
Paula Lindstam
Elmore Sub #1 B5 L9
4th November 22
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(rev. 05/18/2018) Page 2 of 3
____ Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer’s representative or maintenance provider.
____ Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
____ Owner agrees to grant the Municipality reasonable access to test and inspect the
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
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
guidelines 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 of the 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.
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(rev. 05/18/2018) Page 3 of 3
OWNER:
By: ______________________________(signature) Date: ______________
______________________________(print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this ___ day of _____________,
20___, by _____________________________.
____________________________________
NOTARY PUBLIC FOR ALASKA
My Commission expires: _______________
MUNICIPALITY:
By: ______________________________(signature) Date: ______________
______________________________(print name) Title: ______________
04/30/2024
VirginiaXXXXXXXX
2022
4th November
Paula Aileen Lindstam
Virginia
Paula Aileen Lindstam
Henrico
xxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
11/04/2022
Notarized online using audio-video communication
-- ~' ~ Municipality of Anchorage [~. -'.~:.~ :, ..
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw SL "~
P.O. Box 196650 Anchorage, AK 99519-6650 Page ! of ,,~
www. d.anchorage.ak.us (907) 343-7904 '
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION'REPoRT
Permit Number: --~V,/O3032q PID Number: O)o°-, /'7~-~_...T" "
~.~ ~'~ht~ C.~/..L~ Wastewater System: ~ New r-i Upgrade"
LEGAL DESCRIPTION 's~,~,~:
Tow~lship: Range: ~ Ira sdded above ~r'igmal grade: C..~av~e~
C.-~',~ ~,,idt~ Number ~l'line~ ~ Di..~ance between lin es:
Well: /[~rNew .~ Upgrade/ /~F,.
~uI r F~., Ft TANK
SEPARATION DISTANCES [] Sepl~c [] Holding ~S.T.E.P. [] Other:.
T~ Septic Absoq3Uon Uft Holding :a,,I,lia/P,~ate uanufaca~, i Capao,y:.
~ Numeef ~ Compartments:
Remarks:
~'/P_r'). ~J~t~g_~ ~Eo,,.f.~. BENCH MARK
~unle~ Shevaoon:
Engine e~.¥~.!a~m, p
[ Development Services Department Approval'
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AS-BUILT DIMENSIONS
A B
Septic Tank C.O. 1 62.8' 83.2'
Septic Tank C.O. 2 68.6' 87.2'
Filter M.T. 1 100' 111.3'
Filter M.T. 2 92' 102.2'
Filter M.T. 3 115.6' 116'
Filter M.T. 4 121' 123.5'
MUNICIPALffY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 22, 2003
Expiration Date: Aug 21, 2004
Permit Number: SW030324
Legal Description:llELUORE #! BLK ~.5 LT 9 .~
Design Engineer: 0041 AK Water & Wastewater Consultan~
Owner Name: Steve Cullen
Owner Address: 15148 Teakwood
Lake Elsinore, CA 99514-0330
Parcel ID: 018-172-23
Site Address: 004401 RIVERTON AVE
Lot Size: 41433 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
r~ Disposal Field r~ septic Tank E~ Holding Tank ~] Privy
Private Well
Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
C 7o .......
Received By: ~.~~ Date:
IssuedBy: ~ Date: ¢ / ~-- {q'rI '
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site ~Vater and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WR#: 030068 PID#: 018.172.23 HA#:.
Permit: ~ o~'~ z~ H
Date Received: .8112103
Legal Description: Elmore #1 Block 5 Lot 9
Engineer: Alaska Water & Wastewater
3701 E. Tudor Road Suite 101
Applicant: ,Steve Cullen
Waiver Requested: 3 Foot Lot Line Waiver between the proposed drainfield and the southern Lot Linc
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: ~ Waiver is not Granted:
List Conditions or Reasons for above: ~" ~ ~
Name of Reviewer
Rec#: 39998 Amount: $150.00 Date Paid: 811212003
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERHIT APPLICATION
FOR A SINGLE FAHILY DWELLING
Parcel I.D. D / C.~.... I ~ ~ -'"'L. "~ Permit Number
Property owner(s) STEVE CULLEN
Day phone (909) 678-5836
Mailing address(I) 15148 TEAKWOOD. LAKE ELSINOR[, ¢.A.
Mailing address (2)
Zip Code 9951
Legal description (Lot, Block & Sub'd.) ELMORE S/D
Legal description (Section, Township & Range) N/A
Lot Size.-l~'l {L.~ ~"~'-~ Acres/Sq. Ft.
~1: LOT 9. BLOCK ,5;
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only D Well Only,
Sewer and Well [--] Water Storage
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub [--~ Jacuzzi [~]
Swimming Pool r-] Water Softening Unit E~
Therapy Pool ~
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER &:: WASTEWATER CONSULTANTS, INC.
Permit Fees:.~ qO0
Date of Payment:
Receipt Number:
Waiver Fees: ~
Date of Payment:
Receipt Number:..~_.~I
ALASIG WATER & WASTEWATER
August 27, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REVISED DESIGN: PERMIT# SW030324
Reft Septic System Upgrade for Lot 9, Block 5, Elmore Subdivision #1
(Bottomless Intermittent Sand Filter - ISF)
To whom it may concern:
A permit was issued on 8/22/2003. During construction of the septic system, the well radii were
flagged and staked by a registered land surveyor and were noted to be encroaching on the
proposed drainfield. We are now proposing that a 1250 gallon S.T.E.P. tank and a bottomless
intermittent sand filter (ISF) system be installed. Comments regarding the design are
summarized as follows:
1. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and
the percolation test results.
2. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF)
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a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate for ISF: 2.0 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 225 ft2
f. Effective Depth below pressure pipes: 2.5+ inches
g. Width: 10 feet
h. Length: 30 feet.
i. Effective absorption area = 300 ft2
j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank".
1. Sand Material: In accordance with M.O.A. latest standards
m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: ak~vwc.com
We are proposing to excavate down to a depth of 5 feet (maximum - remove all organics), place
a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On
top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway
in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a
programmable timer so that flow can be intermittently dosed to the ISF.
3. SURFACE WATERS: There is no surface water within a 100 feet of the proposed septic
system upgrade.
4. TOPOGRAPHY: As can be seen on the attached topography site plan the average
topography in the area of the proposed drainfield is a 0-5 percent slope running approximately
northeast to southwest, there are no slope concerns.
5. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the
construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation &
Maintenance Manual". The contractor should read this document prior to construction.
6. CLOSING: I am open to any suggestions from your department, xvhieh would be an
improvement to the proposed design. I am unaware of any adverse impacts this installation
would have on adjacent well~; or septic systems. If you have any questions, please contact us at
337-6179.
Sincerel'
Thantk/~ou for your assistance.
~mess,-"P.E., M.S.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.cora
I I El. MORE $/D I~1: El_MORE S/D I~1: //ELMORE $/D
I I ~T 16. BLOCK 5; ~T 15. BL~K ~; ~ L~ 14. BLOCK ~;
~o~ ~u~ / IREVISED DESIGNI
I
I
/
I I ~ ~ORE S/D ~1;
I ~ ~ORE S/D fl; EmORE S/D fl;
/
'~ I ~o /
~ ~ ~o
I I ....
I L C ~ ~ ......
I I~ORE S/D ~1; I LOT 8, BLOCK 5;
I ~ ~ /
I ~ & / /
I ~ ~
~ORE S/D ~2; / N E~ORE S/D ~2; ~/
I ~ 3, B~K 7; / % ~T 4. BLOCK 7; /~
I I ~ / ~
I I ~ / ~
I I ~ // /~ ~ORE S/D ~2;
I I ~ ~~/ ~T 5, BL~K 7;
I I
I I
.... J I
..... 1 I
I
D~ ~: ~ .." '-:~.
AI.~~ WATER & ~VASTE~VATER ~ r,'~.¥ ~.~
5701 E. TUDOR ROAD. SUITE 101 * ANCHORA6E. AK q~507 · PHONE ~q07~31-617q · F~ (q07~38-32~6 1 ~ = 1 00~ ,
STEVE CULLEN (909) 678-5836 1 OF 5 ,:,: '..~e~r,,
EL o.E suemv s o. LOT eLOCK ,
SITE P~N FOR SEPTIC SYSTEM UPGRADE
""'=' ~VIS~D
~ N. co...m~. ~ ~ u~^~ ~, ?~ ,~,~? ._ DESIGN
~ ~H T~ H~ ~D A 30 PS% ~ ~L ~DT
~70, AS ~P~ ,Y ~ T~ ~ AIR ~ ~ ~/
~ P~ VR~ m3 V~. ~K A E ~H SCA~ PVC I
~"~ '~" ~='=' ~ ~= '- - - 7 .... ~.;~ -- - ~ - ~ -
~ .--:.*. .:.~- ;... ~ .
~ ~ / ~ ~ ~'~:'~" ~ ~ '; "~' I
FOUN~ON ~INSU~
c~o~ '~~FF;: ~ /
~N~ S~C ~ ~~]: ~.~:.:', ~ ~R CONPR~OR
~P~Y i ~ I ~ ~P~~::-:-':~5.:' A~ LO~O,
~"~- / '~~~ZF'~ o~
i~ / ~ /~ ~D.X -:~ ~ s~ eE
~ / ~ ~ ~ :h~'~ ~E PROP~
/ S~ D~L ~D PROR~ (PAGE 3 OF ~), FOR
CON~U~ON D~ ~D REQUIR~.
'RIVERTON AVENUE NOTE: ~E CO~CTOR S~ ~VE ~E SOre mT UNE
N / ~E 100 FOOT WE~ ~Dll ON THE SUBdECT LOT AND THE
~ 100 FOOT WE~ ~DIUS TO ~E SO~ F~GGED BY A
~ / REGI~ERED ~ND SURV~OR PRIOR TO CON'RUCTION.
. DA~ R~S~ D~IGN
AT,~~ IVATER & WASTE~TER ,~
5701 E. TUDOR ROAD, SUITE 101 e ANCHORAGE, AK gq$07 ' PHONE (907)357~179 e FAX (q07)338-3Z&6
v,~ ' .'
~ D~CR~O.:
z~o.z sumv~s~oN ~= ~or., .~ocx ~
DESIGN DRAWING OF PROPOSED SEPTIC SYSTEM UPGRADE
l= 30 FEET LONC '"'
lOUT I
FROM A~ I I ..... ~ I
COMPRE~OR '~ I ~I !
FROM S.T.E..P. TANK · I ; ......... -'1 I
I I Io
I ...............
SCH. 40 PVC. LATERALS NR UNE
w/ ~/a' D~ ORFIC[S
ORIFICE SHE]ID
FINAL GRADE
F INSULAI10N ,
MT lyf1' ORIGINAL GRADE
................... i--
'.° :'~:~'.'T'~''.f.' '7;A=~"='-~''.''
., .: ... ...... .r.Y.2 ............ ..
.-.: ..,.
2' MINIMUM 0 WITH THE PVC LATERALS BURIED
SAND FILTER---~ STALL AiR UNE 6' FROM MIDWAY IN THE STRATUM
BoTroM OF SAND FILTER (GRAVEL BELOW PiPE .- 3'+)
/;~~'~ ,-.,. DA~:/27/2005
....... DRAw. ~,:.~.W-%.~.."
ALA$I~ WATER & WASTEWATER s~c'J'o' ~¢~_~_~'][-..~
..
3701E. TUDOR ROAD, SUITE IOI o ANCHORAGE. AK 90507 * PHONE (907)557-6179 · FAX (907)558-32&6
,~.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ~ '
STEVE CULLEN (909) eTS-5s~e ~ oF ~ ~i."'"~
ELMORE SUBDIVISION #1; LOT 9, BLOCK 5, ~ ~%~r.~_~----- ~_'\ ........ '-~.~'~
DETAIL DRAWING OF BOTTOMLESS INTERMITTENT SAND FILTER (ISF) -~'~:~.~.'~.-'-.--
ALASg WATER & 'WASTEWATER ~1'i ~i!)~1~ "....?.0{
, ,, , , ,,,,,, CONSULTANTS, IUC.~ ' ' ' ''" .li~..~,~.]~ ......
3101 £. Tu00R ROAD. SUITE t0$ ' ANCHOR, ACC, AK. 99~07 · PHONE: (907)557-6179 ' FAX: (907)558-3245 ° WCB$1T£: Qk.~,~.=:c--'lr ~'' .......
]SOIL LOG PERCOLATION TESTI .... ~ .........
LEGAL DESCRIPTION: £LMORE ~1 S/D; LOT 9, BLOCK 5 Jet ess..'
PERFORMED FOR: STEVE CALLEN 8/1/2003 ~h~ '".. [ ....
~t e/. " ....... "
DEPTH ~ ~.~r 0 f e s s~O'.~
(feet) '~_-_-~i 0R~ANICS ITEST HOLE # 1 I
o ~,..~.~!:~ SO~L CLASSF~CanONS.
' ,,,..;:,.F....O~. , . , ~ '"
,3 ~ ~ g~; :~,~..q.: ..................... · ....
.~..::..i.,~;;: GM CL --, i__ -
-~!~'':~t'q GC OL ._a ..... ,. .......... -~-/---7/- ................. ",-
- ';'.,:,.,".-'?;"GW
\ ! ·
:-~.~.;k~!.5 0 ,, SW MH
5 --
;;:~ .,..-..< .~_';::., SM OH
. '..~:':.,.t,.?
~ .... ..., SC
7~~ DEPTH TO DATE ·
GROUNDWATER I ~
~..,:.-.2.,.~.~:, x x
o __ ,~,:',,;.e:~'* 9' 8/1/2003 /. x ~ I
~ ~.,,.-:,~i.¢. /. THt~ 1.~ '-,4 '
,7.~:~.?,:.~.t:.,~ / =.. ,=::.~- ---'
.:.o;..-',.:'~..'~ GW/GP '" ' ~
~--' ism-
9 -- :!..~.,;?,;',,_'.,,;~ .._ ~ .
· ,.,
..,,,,.,~:~., CLOCK NET TIME WATER LEVEL NET DROP
1 ~%~;'~' DATE READING TIME (MINUTES) READING (INCHES)
~ "B.o.~.
8/,/2003 ~..~?.0~./
12~ .
14-- -~"~ ~,~
18 ~
PERCOLATION RATE <1 O~II~./I~CH~ PERC. HOlE DIA. 6 (INCHES)
19~
TEST RU~ BETWEEN ~.0 FT. AND 4.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: [] YES [] ~0
SOILS LOGGED BY: SUSAN OSWALT PERCOLATION T~S,'D. PERFORMED BY: SUSAN OSWALT
COHMENTS:
PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY.,'~HAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS 'DATE:
~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LOCATION NO.~EDROOMS
~ ~,.~.c~.o: I~''/~, ~' I~.~-/~' "'"'~'dx'
~ ~.,~~..o.o,~o~:,..,,.
Liq. ca~3ilons IF HOME.DE: Inside length Width Liquid depth
0 ~ , Menufactu~er Material Liquid capacity in ~llons
Q Well
~ .,~.~.~.o: ~..~,./~, ~ ~tu""~"°"*~' "'"?'~""'
~ ~ ~ top ol til~ Io tini~h grade ~at~ri~l b~nealh til~
Length Width Depth P[RMIT
~ ~ Type of crib Crib diameter Crib deDth Total ef f~ti~ absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
d Class Depth Driller D~stance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(s)
OTHER
g
REMARKS
~,.I/~'
72-0~,,~ ev. 3/78J
M-W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner Jerry lT-~,n~ Useof Well
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing 6" Depth of Hole 121 feet Cased to I71 feet
Static water level 6_'; tr. (aha~): (below) land surface.
Screen ( ); Perforated ( ).
Finish of well (check one) open end ( XX );
Describe screen or perforation
Well pumping test at ~ gallons per
of drawdown from static level.
(minute) for I hours with 1,9~. -'*, ~
Date of completion
Depth in feet from
ground surface
WELL LOG
Give details of formations penetrated, size of material, color and hardness
0 TO 2
¢{~nin~, Stiok-up
? TO 3 CuL'"' -nic
TO
TO__
3--C~NTRACTOR
PERMIT NO.
APPLICANT
LOCATION
LEGAL
1.1LIhl I i_-~. I F'I=IL T T'-r"
DEF'ARTME~T ;~ HEALTH Ar'J.[:' ErI,,'IROr-~.IENT~L
B2~ 'LSTREET, R~CHORRGE, AK.. 95 _,t [~Cn ~-¢'~-.~
I,IELI Fit-iD CFF-I--S IlE SEI-~EF: PERl'd
GERALD HArISON SF'.R E:X 40-~?-G ANCH., RI( _~45-527~--
DEARr. IOUN
LT. 3 BLK. 5 ELI~IORE S?D ~/ LOT SIZE :1.500~Z'~ SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRRINFIELD
~IA×IMUM NUriBER OF E:E[:,ROOMS = _~
SOIL RFITING (SO FT?E',R>= 16~
THE REQUIRED SIZE Of THE SOIL RBSORPTION SYSTEM IS:
DEPth= 5 lEr~GtH= :~£~v3 G F,' R '-,-' E L DEPTH= . 5
~ THE LEHGTH UI~IENSION IS THE LE~aTR (IN FEET) OF THE TRENCH OR DRRIHF LD.
THE DEFITH OF R TRENCH OR PIT IS THE DISTANCE BETHEE~.~ THE SURFACE OF THE
GROU~.~D AND THE BOTTOM Of THE EXCRVRTIO~-~ (IN FEET>,
THE TRE~ICH I~I DTH IS 5. E~EzE~ FEET.
THE GRRVEL dePTh IS THE MINI~IUM dEPTH 0F GRRVEL BETI,EEN The 0UTFRLL PIPE
R~.tD THE BOTTOM 0F THE EXC~VRTION (IN FEET>.
F:EC.,Li I RED SEPT T C TFI~-~( S I Z_E= -i £~£~r-j GFiLLOhI_C.
PERMIT APPLICA~';T HAS THE RESPOr'ISIBILITY TO INFORm1 THIS DEPRRTr'IENT DURING THE
I~STALLATION INSPECTIONS OF Ar'l'~ I,~ELLS ADJRCENT TO THIS PROPERTY AND THE
t'~UI'IBER Of RESIDENCES THRT THE WELL [,IILL SERVE
T;-IO ( 2 > I ~$F'ECT I O~S RF-:E REQU I RED
BACKFILLING OF Ar-~Y SYSTEr'I l,llThOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTHENT WILL BE SUBJECT TO PROSECUTION.
~IINIMU~t DISTA~'ICE BETWEEN A I.IELL AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS
iE'~E'~ FEET FOR A PRIVATE WELL OR 150 TO 20El FEET FRObl R PUBLIC WELL DEPENDING
UF'O~-I THE TYPE OF PUBLIC WELL.
MINIMUbl DISTANCE FRObl A PRIVATE fELL TO R PRIVRTE SEWER LIHE IS 25 FEET AND
TO A COMMUr-IITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND I'IUST BE RETURrED TO THE DEPARTMENT I.IITHIN .~0 DRYS
OF THE WELL COMRLETION.
OTHER REQUIREMENTS MAY AFIpLY. SF'EClFICATIONS AMD CONSTRUCTION DIRGRRMS ARE
AVAILABLE TO INSURE PROF'ER INSTALLATION.
PEF;:rd I T E.~:F" I RES DECEtIE:ER
I CERTIFY ThAT
:I.: I R~,I FAMILIAR WITH THE REQUIREIiENTS FOR ON-SITE SEWERS AMD ~IELLS AS SET
FORTH BY THE HUNICIPRLITY OF Rr.~CHORRGE.
2: I I,IILL INSTALL THE SY5TE~I IN RCCORDRNCE l,lITH THE CODES.
~: I UNDERSTRND THAT THE ON-SITE SEHER SYSTEM HAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THR~'~ ~ BEDROOMS. ~ ~
.................
AF'PL I CA"it GEP~LD HRf'I~0N
............
PERFORMED FOR:
LEGAL DESCRIPTION:
1
,2
3
4
6-
7-
8-
9-
10-
11-
12
13
14
15
16
17
18
19.
COMMENTS
PERFORMED EY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
925 Lo Street. Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED: :~Z
.; SLOPE . SITE PLAN
-,WAS GROUND WATER S
ENCOUNTERED? /10 OL
,p
E
IF YES. AT WHAT
DEPTH?
SOILS LOG
PERCOLATION
TEST
Gross Net Depth to Net
Reading Date Time Time Water Drop
~zO :~-~ 6,s~- -- 2.-- .5-0' -- , .
6 ,. ~:~ IO ~-.36 .o~
PERCOLATION RATE / / (minutes/inch)
TEST RUN eETWEEN /7z FT AND ~ , FT
CERT, F,EO BY: OATE:
· Municipality of Anchorage
Development Services Department'"
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
.CERTIFICATE OF HF__.ALTH AUTHORITY APPROVAL
FOR A·SINGLE-FAMILY DWELLING
Expiration Date:,
mPiete I~al desc~i'Pti;:)n
· ': ..... ,' :.;..' ,
L~ocation ' . "
(site 'address or dIrections)
C'U~'ent Property owner(s) M~,ili0g .a...d. dress '
Lending agency
Mailing address
Real Estate Agent
Mailing Address
5',, /_o7-
Day phone ~d~-'..~/'~--
Day phone
Unless, otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER'OF.BEDROOMS: -~
TYPEOF WATER SUPPLY: '
Indi~,i~ual Well []
IndiVidual Water Storage
'Community Class -Well · D
Public Water System [--I
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank [--i
Community On-site [--J
Public Sewer F"]
I
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 pdvate 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 --wa/mvAn ,rah( trV �e,,Af c Phone 6?4`70dC
Address —L.7d,37 8_6_iM 14yj C,(,2ect_6
Engineer's Printed Name "51'6Vl- - f/
yjDate
Approved for
Disapproved.
OF A 1- 4 41
P
Eng
AE 6256 Cti
•* Ar
0 1W
bedrooms. Pin? E
X Conditional approval for bedrooms, with the following stipulations:
At the time of title transfer, the new property owner shall sign the attached
maintenance agreement which shall be returned to this office -before an I uncond-
Additional Comments
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
e -,Y OF A
0
ON-SITE
WATERANP--
WASTEWATER
PROGRAM
IT
By: Original Certificate Date: 1:21-Z14-03
(Rev. 01/02)
DevelOpment'services Depart ent
i ~ ? "~ Building Safety Division i
: oh-Site Water & Wastewater Program
i '. 4700 South Bragaw St.
P.o.iBoxi196650' Anchorage, AK 99519-6650
; !: www.ci.anchorage.ak.us !
~ . , . =(907)343-7904
HEALTH, , A THORITY . APPROVAL. CHECKLIST
.~L/4,,/O/~~* '. i/,,./~'LO¢_.,(/- ..C. /_.OT f ParcellD:D/,~-~'72.-~2~'~:::.
Legal Description:
A. WELL DATA
Well type t~ "
Date completed
Total depth' [211 ft.
JlA, B, or C prOvide PWSID #
S~an!tary seal (Y/N) ~
Cased to /'~ / ft.
FROM WELL LOG
Well Log (Y/N) :' ~//
Wires properly protected (y/N)
Casing height (above ground)~
· AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS(
!
Coliform (~ ~;olonlesll00 mi.
"' 'Arsenic:" '~ ~g./l.!
B. SEPTIC/HOLDING TANK DATA
ft.
g.p.m.
Nitrate , 3~-.~ mg./I.
Date of sample:
ft.
/, 7 g.p.m.
Other bacteria (~ . colonies/100 mi..
.,,
Collected by: ~;~/~.-~ i
Tank size /25G gal.I '= Number of Compartments
Foundation cleanout (Y/N)._~ 'Depression over tank (Y/N) /"'/
Date of pumping '~f~'[,d' ;"Pumper /V~ ~,~.¢.,-J
C. ABSORPTION FIELD DATA:,
Date installed /0/~/03 Soil rating (g.p.d./ft2 orft~edfl~)
Date installed .~/2[_.~/0.~
Cleanouts (Y/N) 7
High water alarm (Y/N) y
System type' -~'"~',~::
Length ~.~'O fi. I : : ~__~/t
~ Width' /~ ft. Gravel below pipe ft.i
Totaldepth ~ ft. Eff.,abs0rptionarea22-~'.ft2 Monitoringtube_~ Depression over field . ~/'..:
Date of adequacy test A(~"C~, &.~J'~,;C-,t,,~ Results (Pass/Fail) - - '/::',~,~ For ~ bedrOoms.
Fluid depth in absorption field be[ore test "'- in. water added ~ gal. New depth ~' .in.'
Elapsed Time: ~ min. Final'fluid depth -- in. Absorption rate >= '-- g.p.d..
Any rejuvenation treatment (past 12 mo.) (YIN & type) ~ If yes, give date "'"--
D. LIFT STATION
Date installed 2L//0-3 Size in gallons ST� 12X° Manhole/Access (Y/N)
"Pump on" level at ST'6 in. "Pump off' level at srh in.
f¢s -B u/c_'T
Datum SCC rc- ' rf'( (' Cycles tested
High water alarm level at STA in.
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES It Z /,/6 wF-L- G^1 4--a T 9, BLoC-I�- S
�'p 4, a 4�, 4?4 o ck S
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot G `r -
Absorption field on lot /cc) -(-
Public
Public sewer main
Sewer /septic service line
On adjacent lots 166111-
On
6G1'`'On adjacent lots / d, o 11
Public sewer manhole/cleanout
Holding tank k/4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation U / t Property line )e) �� Absorption field /� f
Water main A/M Water service line
Wells on adjacent lots ( G G r'
Sl4
� Surface water /06 r f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line S-► rt Building foundation 70 rt Water main N/,4
Water Service line
Curtain drain
F. COMMENTS
a c*- Surface water
Driveway, parking/vehicle storage /0
Wells on adjacent lots ICI r fi
w Q1- L o 6 yL'1 i si/gkE,-lc-y sTiScrEf
407- q 6Locrc y, SFfauu�,e6;+A Z-07- 71gcoc/cS
C v16 % i n16 7W(,- 46sJ</6
G. ENGINEER'S CERTIFICATION
QCT. 'ti �✓ r ° °° q e ° ° �' `� CR� 7J P
�,"`'7 's°a
1 certify that / have determined through field inspections and
review of Municipal records that the above systems are in
43 ° °° "
conformance with MOA HAA guidelines in effect on this date.
,
`
Engineer's Printed Name �T��/i` fit` 6�,\o,°
� 1� :. Steven W. _ng s vac
PE 6256
Date 103'F0
"°^•.®..� :��
5 �ROFESSIO '.
%
HAA Fee $ l Waiver Fee $
�� u Payment
Date of Payment I Date of
Receipt Number �'�" > ��� 1 Receipt Number
(Rev. 12/01)
5; 89752'00"~ 208.71
lO' UTILITY EASEHENT
Ld
54'
oVELL
N 8975P_.'OO"E ~08.71
RIVERTDN
AVENUE
AS-BUILT SU~/L'Y
NO CORNERS SET TH~ DATE I' = 50*
NOTE~
DISTANCES SFID~*/N Tn THE NEAREST
FI]BT TD PROPERTY LINES DUE TI]
CONFLICTING SURVEY CONTROL
IN THE AREA. FURTHER RETRACENENT
HAY YIELD SLICg4TLY DIFFERENT DISTANCES
AND IS J~EYDND THE SCOPE OF THIS ~URV~'Y.
THE INFORHATION HEREON IS FOR THE USE OF I~NDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFMCTS B~[
EXISTING STRUCTURES AND PLATTED LOT MNES OR EASEMENTS AND IS NOT TO BE USED fOR PosmONING ADOITIONAL
STRUCTURES OR FENCEUHES.
EASEMENTS OF RECORD, OTHER THAN THOSE SHGWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INOI,
NOTE: ANY FENCEMNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPRIETY U)
OR LOCATE STRUCTURE~.
AHY PAVING SHOWN MAY *BE APPROXIMATE DUE TO SHOW CONDITIONS.
I HEREDY CERTIFY THAT I HAVE PERFDRHED
I{]RT6A6EE'S INSPECTIEI~ OF THE FDLLI]~ING
DESCRIDED PROPERTY,
LOT 9, DIJ]CK 5, ELHORE NIl, I
ANCHORAGE RECI]RDIN6 D[STRICTo ALASKA' AND THAT
THE VISIBLE INPRDVEHENTS SITUATED THEREON A
~/ITHIN THE PROPERTY LINES AND HO VISIBLE
ENCRDACHNENTS EXIST OTHER THAN NOTED,
DATED AT ANCHOP. AC.,E, ALASKA THIS __20th .....
J~I~O~I]F __DECEHBER .......... 2003 .....
HDLTLAND SURVEYING 9108. FI~ 102-38
;EEL. 345-5513
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner /4/-/p=~' ~/0
Mailing Address ~,0. Po~
(c) Lending Institution /~. ~4.
Mailing Address
Telephone: (home) Business
Telephone
(d) Real Estate Company and Agent
Address O yO 0
Telephone
(e) Mail the HAA to the following address: (or check here B~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms
3. WATER SUPPLY
Individual Well ~
Community [] Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [] Public I-1 Community r-i Holding Tank r-I
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-Q25 (Re~. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal pffixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional end 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 in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
NameofFirm /C"lcr~' 7"¢,'A~¢~/ .~'.~'~';c~.r Telephone
Address I~.,c"3d ~=ch. 5",~... ,,,~ c~ o~'cz~,~ /-~/~-
Date
6. DHHS APPROVAL;
Approv[d for .,~ bedrooms by
~pprov~d ~. :Disapproved
'i'erms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
~-~s (.... 7/~) 8.¢~ Page 2 of 2
RECEIVED',-
A. WELL DA:r~, "
Well Classification ~-~
Well Log Present (Y/N~ ~
Total Depth I ~ ~ Cased to
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authorlly Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Date Completed 7/I,."
I P- I Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield $, Y ,e,~, pratt.
U'
H,/I.
Static Water Level ~O; Pump Set At I I~
Casing Height Above Ground I' Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) r Depression Around Wellhead (Y/N) N
SEPARATION DISTANCES FROM WELL: ' '. ' ·
To Septic/Holding Tank on Lo{ ' '120' ,A,'-c'.o, ; On Adjoining Lots
To Nearest Edge of Ab~orption Field on Lot '~' t$~'~ ; On Adjoining Lots ~ I~.,.C"
To Nearest Public Sewer Line H./t. To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Sen/ice Line .on Lot ;>. 2,f" ~
Water Sample Collected by '7-.~
; Date .,z-~o/~,~.,
WaterSampleTestResults .Cc~/1~:~tC/O~,y - ~ ¢ol,~,~ ~¢oo...~., ~. "~!
CommentsN ~E ~tll (o~ ~ L~. ~/~ ~ ~ 1~
B. SEPTIC/HOLDING TANK DATA
Datelnstalfed ~/~/~e Size ~0~.1 No. of Compa~ments
Standpipes (Y/N) Y Air-tight Caps (Y/N) ~ Foundation Cleanout
Depression over Tank (Y/N) ~ Date Lest Pumped
Pumping/Maintenance Contact on File (Y/N) H. 4. ; for
Holding Tank High-Water Alarm (Y/N) N, ~. Tempora~ Holding Tank Permit
SEPARATION DISTANCES FRoM ~SEBTIC/HOLDING TANK: .... -
~ ~ -. ~, ~.o, To Building Foundation
ToWater-Suppl ell ".18~* "'' ' "- ' '" '
To Property Line - ~' I~ ~- To Disposal Field
To Water Main/Service Line - ' ;:>
To Stream, "' ' ' ' ' ' ·
Pond, Lake 0[ Malo[ DramQge Course ..,
Comments ~J~ '~ b'E~:~. ' I
72'026 (Rev. ?/88) Fro~t page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field* ~ *''" :
Square Feet of Absortion Area
166" c:z '/~'ot .',.", ' Type of System Design
Length of Field
Depth of Field
~ ,, ~ Gravel Bed Thickness ~.o
¥~8 + 4',d~ Statndpipes Present (Y/N)
Depression over Field (Y/N) /~/ Date of Last AdequacY '~est
~. ,, Results of Last Ade~uacy Test ~-d~'o.~-t' ~-~,,' ..~ ~,~'r~o~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~'- t,,~O'
To Building Foundation ' ' t ;>' 6'o '
Lot
'7~¢,~c/,
To Property Line ;:,. ~ e
TO Existir~g or Abandoned System on
; On Adjoining Lots ' ' ,> ~'q '
To Water Main/Service Line ,> C.,~'~
To Stream. Pond. Lake. or Major Drainage Course
To Driveway. Parking Area. or Vehicle Storage Area
Comments
To Cutback (if present)
~,. lO0 m
D. LIFT STATION
Date Installed
· ' ~ize'in'Gal'lons" '
.... P~mp on" i~e~;el a( ' ' "'
High Water Alarm Level
Tested for ·
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
ManhOle/Access (Y/N)
, ,, . ':. d .... ump Off""Le~,elat '
" '" 't / )'Y'N;
.... .... Vent
' '. ' Pumpi'ng Cycles d~ring Ade~luacy.Test.
erm g Ag **
*'Check P itted Bedroom Ratin ainst HAA Request
I certifY.' ~at I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed .1~
' "" - ;? 49~ ~ ~3 Engineer's Seal
Date ~ /~,,
~OA No
.........
,
_ ~ . - .~,~ · ...... ':~
Receipt No., ~~/~--~//~ ' ' Receipt No.-~~
Date of Payment ~--/~-~ Waiver Fee: $
Amount: $ /~-~ Date of Payment
~ m-. tm) ,~ Page 2 of 2
,. APPLIC NT FILLS OUT UPPER HAI~ ~ONLY
Property Owner ~,~ j~ Phone
~ Single Family
~ ~mm~lly For wefts ~illed ~tlor to tha date. give well depth (attach I~ If available}.
~ Holding Tank
NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Inspector Inspector Inspector Inspector
~UNICIPALh'~* OF ANCHO~
RECEIVED
( ~ ) APPROVED ~DROOMS *CONDITIONS OF APPROVAL
( ) DISAP~OV[D
( ) CONDIT~NAL APPROVAL'
