HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 20Pork
Block
Lot20
#051-491-33
Municipality of Anchorage Page
Department of Health and Human Services
Division of Environmental Sen4ces
On-Site Sen4ces Section 825 'L' Sb'eet Room 502
P.O. Box 196650 A~chorage. AK 99519-6650
v, ww.cLanchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW010172 PID Number: 051-491-33
Name:
Joseph P. and Connie G. Duran Wastewater System: New (~ Upgrade
2434~ Hearthstone Dr. Chugiak~ AK 99567 ABSORPTION FIELD
688-1236 Three (3) =O~T~.o~ ~S~o.T~ OM ~
LEOAL DESCRIPTION .8 ~' 3.S Ft.
! 20 Wynter Park No. 1 1 Ft. 2.5
2.5-3 Ft. 72
Well: [] New [] Upgrade c~.~: 5 Ft. "~'~'":'1 I°~'~'~":N/A
A Ft. Ft.562.5 Fr' ASTM D3034 PVC
Ft. MM&M Contracting 6/12-14/01
.,,.: ~ i.,,,~..~.,:Ft, ic.,~, ~,~.,~c.,,,~,:F, TANK
SEPARATION DISTANCES I~ septic I-I Holding I-1 S.T.E.P. n Other.
Tank Field Station Tank S~-,U~ Anchorage Tank 1,000
w. >200' >200' N/A N/A >25' Steel Two (2)
s~,~w..>100' >100' N/A N/A V ~. LIFT STATION,~.~,~: - NONE ON LOT
~. >5' >10' N/A N/A
c.,~o~.None Noted ~F,~.*,~,~
"'"'"": BENCH MARK
Existing Septic Tank Pumped Crushed and Top o! Foundation Cleanout.
Abandoned. Existing Absorption Trench Abandoned.
100.0
En~ir~eer's
Inspections performed by: Mike Anderson Dates: 1". 6/la/01 ~~."~
2"a 6/14/01 ~,'..,~lc~ ~.
Department of Health and Human Services approval ¥."'~; CE-4381 .'
Reviewed and approved by Date: ~ ',~/~" O/ -a~e~ ,,'.....'.'.,, ~'~,~
Munlclpalny Ot Anchorage I~age Z ot 3
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 Inspecti~.~..~.
Permit Number SW010112 ~ ~~491-33 ·
PLAN AS-BUILT
SCALE 1" = 3
A B
S1 11.6 39.2
S2 18.2 42.9
C4 57.9 53.8
M1 57.8 53.8
C5 77.3 103.2
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 3 of 3
Permit Number SW010172
PID No. 051-491-33
,,-
98.§
93.9 ~allo_n L\\\ It1~ ~
~ep.. Ta~
35'
90.0
Geotextile Fabric
Drainfield ~ Rock
72' (Trench Length)
2" Insulation
~'* ~" 86.6
_ 76.0-+
PROFILE AS-BUILT
1" = 10'
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK g9519-6650
(go7) 343-7g04
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jun 07, 2001
Expiration Date: Jun 07, 2002
Permit Number: SW010172
: Legal Description: WYNTER PARK #1 BLK I LT 20
Design Engineer: 0014 Anderson Engineering
Owner Name: JOSEPH P. & CONNIE G. DURAN
Owner Address: 24344 HEARTHSTONE DRIVE
CHUGIAK, AK 99567-6202
Parcel ID: 051-491-33
Site Address: 024344 HEARTHSTONE DR
Lot Size: 23483 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
construction must be in accordance with:
1. The attached approved design.
2. ,NI 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.
/ /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bregaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage .ak.us
(9O7) 343-79O4
ON-SITE SEWERJWELL PERMIT APPLICATION
FOR a SINGLE FAMILY DWELLING
Parcel I.D. 051-491.33
Permit Number SWO I O172.
Property owner(s) MM&M Contracting
Day phone 688-1236
Mailing address (1) P.O. Box 670495 Chuglak, AK 99567
~ address (2) 24
Legal description (Lot, Block & Sub'd.) Lot 20, Block t~ W~nter Pa~ Subdivision No. 1
Legal description (Section. Township & Range)
LotSize Z)~ 483 Acras~ Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Well Only
Water Storage
Jacuzzi
Water Softening Unit
I certify that the above information is Correct. I further cedify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or author[zed agent)
Date of Payment:
Receipt Number:
(Rev. 12J00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P:O: BOX' 240773
ANCHORAGE, AK 99524
522.7773 522-6779 (FAX)
MEMORANDUM
DATE: June 7, 2001
TO:
FROM:
Dan Roth ~
Mike Anderson, P.E.
SUBJECT:
Lot 20, Block 1, Wynter Park No. 1
Septic System Design and Permit Application
We placed a third test hole on Lot 20, Block 1, Wynter Park Subdivision No. I on the
slope above Test Hole No, 1 where the absorption trench is designed for placement.
The hole was excavated to 10' and revealed similar soils to Test Hole No. 1. No
groundwater was noted during excavation, but was found to be 8.2' below the surface
the. following day: The water in Test Hole No. 1 was found at 6.5' below the surface
which is slightly h~gher than previously measured.
Based on these groundwater elevations we have redesigned the absorption trench for a
total depth of 3.5', which is 4.7' above the current water table, The trench will be 72'
long x 5' wide and have an effective depth of 2.5'. We are confident the system will be
a minimum of 4' above the highest groundwater table in the area. Please review the
revised data and, if acceptable, issue a permit to construct the absorption trench as
revised. Thank you for your attention to this matter.
May 2512001
Municipality of Anchorage
Development Services Depadment
'On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 20, Block 1, Wynter Park Subdivision No. 1
Septic System Design and Permit Application
Impacts to Adjacent Prop. edies
Dear Onsite Services Engineer:.
The owner of Lot 20, Block 1, Wynter Park Subdivision No. 1 intends to construct a new
three-bedroom home on the lot. We are therefore applying for a permit to construct a
new septic system on the lot to serve the proposed home. The attached Site Plan and
backup documentation identify the location an,d, co..n.fig,uratio.,n of,the new.,septic s.y. stern.
and the parameters used in the design. A!so ~aen[i~ea on me plans are tne ~oca~!.o.n oT
the test hole and the alternate site. Existing drainage patterns are shown and w~ll not
be altered by the development of the lot. We have surveyed the area and the new
system will not confl, ict with other systems in the area. The subdivision is' currently
served by a community water system.
The lot is currently occupied by a mobile home. The mobile home will be removed from
the lot and the existing septic tank and absorption trench will be abandoned in
accordance with Municipal and State regulations. The septic tank will either be
removed from the site or pumped, crushed and backfilled on site. The new septic
system will then be constructed.
Two test holes were recently placed on the lot to determine subsurface conditions.
Soils were found to be fairly well graded sands and gravel with varying amounts of silt.
Percolation tests in the material indicated rates approximating 1 minute per inch in the
sand and 20 minutes per inch in the gravel. We are proposing a combined percolation
rate of 12 minutes per inch with an application rate of .8. No groundwater was found
during the excavation, but was noted at 7'and 6' below the surface in the test holes
during the monitoring period. We are therefore DroDosina to place an absorption trench
72' lona x 5' wide with a 2.5' effective depth to treat the septic effluent. The distribution
pipe {~'~1 be placed at 1' below the surface to provide as much separation as possible
from the water table.
The ground surface on the lot slopes as shown on the attached Site Plan with grades
from west to east, which flatten in the area of the test holes. The new absorption trench
will be constructed approximately 3' into the slope and parallel to the contours of the
surface as much as possible in conformance with Municipal requirements. Grading
'Lot 20, Block 12, Wynter Park Subdivision No. 1
May 25, 2001
Page Two
will be accomplished to assure surface drainage is away from the new trench. The
existing drainage pattern on the lot will not be affected dudng development.
If the system is constructed In accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
o
The system, if constructed as designed, will have no adverse impact on existing
septic systems In the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
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
?4
I
I I
44
fi7
Community Water Water
Water/'
45
22
'1
Community
Water
I$
23
AREA MAP
I0 II .s. CAL~ ~" = '~o0'
C~mmunity
Water
/
/
PROJECT 15
14
49T~ /;
17
)6
CE
NOTE:
HEARTHSTONE DRIVE
;0 Gallon
· · ~.ic Tank :.
Three
Bedroom -- - 25%
~louse' ~
.I
BLOCK 1
WYNTER PARK NO. I -
72' Lona x 5' ~
Wide x ~½'Ef.f:TH2_ -
Depth A~sorptlon Trenc
.Abandon Existing Septic Tan~ and
Absorption Trench in Accordance
with ADEC Regulations.
SITE PLAN
SCALE 1" = 30'
ANDERSON ENGINEERING
P,O. Box 240773
ANCHORAGE, AK 99524
(9O7) 522-7773
Cell (907) 441-4000
SYSTEM
LOT 20, BL0(~K 1, WYNTER PARK SUBDIVISION
No. 1
DESIGN FACTORS:
Three Bedroom Home
Perc. Rate: 1 & 20 MinJInch'
Application Rate: .8 GPDISF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,000 Gallon Septic Tank
2.5' Drainfield Rock
3 Bedrooms X 150 GPD 1.8 GPDISF = 562.5 SF of Absorption Area
562.5 $FI5 LF (~Nidth)*.64 (Red. Factor} -- 72 LF Trench Length
Therefore: Construct a 72' Long X 5' Wide X 2.5' Effective Depth Absorption Trench.
Flowline Elevation in Trench to be 1' Below Original Ground Smface. Total Depth to be
3.5' Below Existing Ground. Mound Over Trench to Provide Minimum of 3' of Cover or
Provide 2" of Direct Bury Insulation.
.r s' "' I
NOTE:
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
G~de Area Over Trench to D~in Away.
Minimum 6' Se~tion From B~r~
Minimum 10' Secretion From Lot Line.
=,n,=u= ro= roundw.te .
Minimum 10' Secretion From Water Sewice Line.
PERFORMED FOR:
LEGAL DESCRIPTION:
HUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 L STREET, ANCHORAGE, ~ 99502-0605
SOILS LOG - PERCOLATION TEST
CONSTRUCTION-PAUL HYERS
LOT 20, BLOCK 1, WINTER PARK SUBD.
I
2
5
6
7
8
9
18
TEST HOLE # .
OL / PT
WELL 6RAD[D SANDS
SW
WELLCOHPACTEO SILTY
SANDY-6RAVELS
SLOPE
0%
SITE PLAN
WAS GROUNDWATER
ENCOUNTERED? NO S
L
IF YES, WHAT DEPTH? 0
DEPTH OF WATER 7 ' P
AFTER I~0NITORING: E
DATE: 5/20/01
OX
BOTTOH OF HOLE
GROSS NET DEPTH OF NET
READING DATE
T~ME TIHE WATER DROP
Start 5/13/01 10 25 12"
1 10:35 10 10'
Recharge 10:36 12'
2 10~6 10 I0'
Recharge 10;:? 12'
3 10.51 10 10'
PERC RATE: 1 I'tlN./INCH PERC. HOLE DIAHETER: 6'
TEST RUN BETWEEN ~1 5 FT. AND & ~ FT.
COHHENTS: NO IMPI[RMEABLE$ ENCOUNTERE0 / TEST HOLE PRESOAKED PRIOR TO T(ST
TEST PERFORHED BY: .T.L. KIHBROUGH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFOEHED IN ACCORDANCE
WITH ALL STATE ./~ND J'*IUNIClPAL GUIDELINES ON THIS DATE:
2
§
II--
18
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK g9502-0605
SOILS LOG - PERCOLATION TEST
CONSTRUCTION-PAUL MYERS
LOT 20. BLOCK 1. WINTER PARK SUBD.
TEST HOLE #
0t / PT
POORLY GRADED SANDS
SP
WELLCOMPACTEO SILTY
SANDY-GRAVELS
GM
SLOPE
OX
O~
SITE PLAN
WAS GROUNDWATER
ENCOUNTERED? NO S
L
IF YES, WHAT DEPTH? 0
DEPTH OF WATER 6 ' P
AFTER MONITORING: E
DATE: 5/20/O1
OX
BOTTOM OF HOLE
GROSS NET DEPTH OF NET
READING DATE
TIME TIME WATER DROP
Start ~113101 10:30 12'
1 11.00 30 l.S'
Recharge 11.01 12'
2 1131 30 1.5'
Recharge I1;32 12'
3 1202 30 1.5"
PERC RATE: ~D MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN 3 5 FT. AND tt ~ FT.
COMMENTS: NO IMPERMEABLES ENCOUNTERED / TEST HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.L. KIMBROUGH
I, MI(~HAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE JLND MUNICIPAL GUIDELINES ON THIS DATE:
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
· SOILS LOG - PERCOLATION TEST
Performed For:~
LegalDescfiption: Lot~O. Blockl. W_vnterPark Subdivision No.i
SLOPE
North
2
3
4
1
11
12
13
14
15
17
18
OG/OL
SP
GWIGM
21
South
No'
Was Groundwater
Encountered?
If Yes, What Depth?
Bottom of Depth to Water
Test Hole After Monitoring 8.2'
Date:
S
L
O
P
SITE PLAN
See Site Plan
6/7101 E
Reading Date Gross Net Depth To Net
Time time Water Drop
Perc. Rate: 1 Min./Inch Perc. Hole Diameter:
Test Run Between Ft. and Ft.
Comments: Same Material as Test Hole No. 1.
Performed By: Mike Anderson. I, Mi~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 6/7101
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 20, BLOCK 1, WYNTER PARK SUBDIVISION NO. 1
GENERAL:
The scope of this project includes the abandonment of the existing
septic tank and absorption trench in accordance with Municipal and
State requirements. It also includes the procurement and placement
of a new 1,000 gallon septic tank at the location shown on the site
plan. Work also includes the construction of a new72 'long X 5' wide
X2~-,effective depth absorption, trench at the location shown. The
dis['ribution line in the trench w~ll be placed at 1' below the existing
ground surface. Total depth of the trench will be 4' below the existing
ground surface. A minimum of 2' of cover and 2" of insulation are
required above the absorption trench to protect against frost
penetration. All components of the septic system must be placed a
minimum of 10' from all wells in the area.
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
responstble 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
1. A new 1,000 gallon septic tank must be be procured from an approved
source and installed at the location shown.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4' cteanouts for pumping
access.
The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Tanks installed without 4' of cover shall have a minimum of 2" of direct
budal insulation.
Lot 20, Block 1, Wynter Park Subdivision No. 1
May 25, 2001
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 level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
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 vedfy this condition pdor 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).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
. Lot 20, Block 1, Wynter Park Subdivision No. 1
· May 25, 2001
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. Ail drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabdc, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in p'repanng the certified as-bu'It of the completed system.
GREi
~" ANCHORAGF AREA BOF' 'H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
NAME
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
PHONE
/ /
LOCATION
SI-- PTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MAN U FACTU R E R ,:ti'(/¢~,~ ~
_ INSIDE WIDTH
,-. NUMBER OF
~/~;' ~/; ~ { MATERIAL ~' ~;'d/~'~4' (~ COMPARTMENTS_ /
LIQUID DEPTH __ _LIQUID CAPACITY./~(i:(i) GALLONS.
SEEPAGE I~_1~ 7}?f;d4/I
NUMBER OF PITS / . DIAMETER ~//z// OR WIDTH , LENGTH2 / , DEPTH
LINING MATERIAL /,~¢~1(~ CRIB SIZE: ~IAMETER___DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION /~-/, NEAREST LOT LINE ABSORPTION AREA (WALL AREA)
.SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE ~(~''; J'lc/'/J/[/l] I ~ CONSTRUCTION DEP'FH
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION__ LOT LINE ., SEWER LINE TANK
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
_ t'('i/'
( ,.,;¢ ~/,1,,..,.~, ,..,. x
LOT SLOPE:
REMARKS:
-g,?/¢~-, c DIAGRAM OF SYSTEM
//£/,fz . l,) t /,/Vg
DATE
O Er E GEOTECHNICAL Er DEVELOPMEN'F CO.
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Ear/Ellis
694-2774 688-2280
Soils 8 Foundations Land Development
SO._] L LOnG
Performed for: Name:~>/-'~//~'FK ~Z:,~/~/~ ~¢sJ/J77/~l)l, No.,_
Mai'ltngAdd~ess: ~ ~ ,,
~Legal Description: ~LI~ I. ~T ~ , I~ ~1~ t~1~ L~'~.}~,
12
Ground Water Encountered: Yes_m- No ~ If yes, what depth
Proposed Installation: Seepage Pit ~ Drain Field_~_
Comments :_~L/a ~,~z)Unl~ IH /~'i~- ~,~_ /~:D~-:I~
Perfomed by:
, ~...' ... .~..: . :: . ,-.~~ : . ~,,- ~.. _ ..... ~: .~ ,'-..
~'-' ~ . ...... .......... FOR A-S NGEE FAMILY DWELEING: .... .: .- , ;,, .'..
~:., . .... ,.~ ~ ~., . ,. . : .... .. ... .... .' . J__~;~_ _~ ~-- .
~.....'.:'~:~. ~.' -. ~:-- ~.- ..-.E: ..:...''.'. :.'.{ ."':.' ....'.~':.:..:.'~~:.' ·
; , '.~ ...~:'.' ~. 't ' ;' : ~ -" ' -' ' ."' '; - '. %""' .... ~~
. ' ,,. . -. · . ;,~. t '{'.'.~ .. .,...: .. ,..' .. ,, -- . ,, , ' , .... . . ..,.. ~ - -
+ ,.~;:. '." ".".'{'_{' E~n (s,e a~dress orzd.recbons), ,'24~ Hea,hstone Drive= -,-'..~_, .. :_ .~., ~'
~'~ · . :,;'" IEStat~Ag ' }'Day~p
~.:~ ? Rea ent~ ~ ' ' , '..' ..... ' ' .: : .. ; one ............... · ....
· qu d,~?71~h'~db~DSDfo" k ........ -" '"-~' ". .... ;., '.-''-'
~, ~ '. Unless' ~he~ise m es~e e r p~c up.: :, · ,;, '; . . .,,, ,
'' ' :2. ~NU : -...Three ...... ..
." 3.' TYPE OF WATER sUPPLY:
' ~. ...... . hdvidua We · '
:, IndMdu~l Water, Sf0r.agel ,,r71 ..
· '. ,Pul~lic Water System' ' ITl·. "
TYPE OF. WASTEWATER DISPOSAl'..~.... ...
,,~,,v,,~,~ ,";'~:":'~':a',.,.-o,,r~;;-~:'e- ":' ..... :~:~F;R:.. _. .,..,.
IndividUal Holdir{g tafi'~" - [] ~' ' ....
Community On-si!e :_- , r~. ' '
Public Sew~r~ ,'
The Municipality of Anchorage Development-Services Depadment (DSD) Issues Certificates of Health Authority
Approval (HAA) based onty upon the representations given in paragraph.5 by an independent professional 'civil'-
engineer' registered in the State of Alaska. Certificates of Health Authority Approval ere required for the t~ansfer of,' '
title (except between spouses) for properties served by a single family on-site wastewater dispdsal And/or wate~
supply systere. DSD also issues HAAs upon request to homeowners. Certificates of Health A~thority Apprpval ar~ ·
valid for 90 day~ from the date of issue for properties sewed by a private or Class C Well and r~ay' be reissued with
new WateJ' sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
~alid water s;Jmples.) Certificates are valid for one year for propedies servc;d by Class A or B'w~lls'~r a'pt~blic
water syste~. The Municipality of Anchorage is not responsible for errors or omissions in th~ 'professional
engineer's work.
, ,.,..,-,.,.,,,.,-.-,- ~ .. , .- .... ..,~ ...~ ........ .:,~ :,.,~, .? ~ .;. , . ,: ........
,-.,, .- As ce~lied by my .s~..affixed herelo and as ~.th,e..v~al~at~on Oat,e, sh~ bel ..o~ !.v,e~lhat ~my~e~.~g~."~3l~,v ,, :_. ,,, ·
...... based on procedures'oull ned n the Health 'Authonty Approval Gu~delines for th2s
'-' ' '"on-s~te water supply and/or.wast _ew..~[~ disposal system I.s(are)sa[e,, funct.~nal ,a~nd a~,e~luate fo~lh~0um, ~,l~ei o[, · ........ ;.. ,;
.', ' bedrooms and type Of st~u, ,cture nd~cated hereto. I furlh~.vedty that based on the.,nfo,-mation 0btaL ,n~l'fro~. the ..: . : ... ,:~,,
· .... Muncpa tv of.Anch~:age ties'and fro/~,my nvestgabon'and msp~:t'h~n ,the on-site wat~' supp. ly~hd/~i'- ·
3- '. · wastowater·d~sposal system ~s{are) in eomphance w~th~all
'- Name of F~rm ,Anderson Engineenng ;'. ;~;
..... Address,PO,Box240773~Anchora,qe, AKg9524 ...................... ~..~ ,.. .... . .. ·
. .~n~ neers ,.~,,,,~ ~.,,,.,,.=, ...........
, '.'. , . · .. ~sapprove~.- ..... . ..
;. ~. ' ' '. ' 'Conditona aDDrova for' z~.,..
'. ' AdditionalComments.' t' ':' ' ·" .' '
Attachments:
HAA Checklist ' '
Septic System Advisory
Well Flow Advisory
Maintenance Agreements '- '.
Supplemental Engineer's Repoi-t ....
Other
Original Certificate Date:
Legal Description:
A. WElL DATA
Weti type A
Total depth
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,cLanchorage.ak.us
(gOT) 343-7g0~
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 20, Block 1, Wynter Parc Subcflvl$1on No, t
Parcel ID: 05t.491-33
ifA, B, otC provide PWSID #
Cased lo lt.
FROM WELL LOG
wen Log (Yin)
W~es properly protected (Y/N)
Casing heigM (above ground)
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Colite~ coinni~/100 nd.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matertal Sel~.~teel
Tank size t,000 gal
FoundaU~ deanout (Y/N) !
C. ABSORPTION FIELD DATA
Total depth _6 It.
Date of adequacy test
g.p.m.
g.p.m.
Number of Compartments
Depr,~___,~.i,:~ over tank (Y/N)
Pumper New Coflmuction
Date installed 6/13/2001
C~eanouts (Y/N) ¥
High water alarm (Y/N) 14
If yes, give date N/A
~ raflrq~ ~.p.dJft~ or ~/bdrm).BGPD/SF System type 5'WIdeShallowTmnch
It. ~ 5 fi. Gravel belaw pipe 2.5 fl.
Results (Pass/Fail) New Rx bedrooms
New depth in.
g.p.d.
Fluid depth in absorption field before test in. Water added gal.
Elapsed Time: min. Final fluid depth __ in. Absorption rate >=
Any rejuvenation b'eatme~t (past 12 mo.) (Y/N & type) N
UFT STATION
Date installed Size in gallons
'Pump on' level at in. 'Pump off' level at __ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot' N/A
Absorption field on lot N/A
Public sever main
Sewer/septic se~ice line
High water alarm level at
Meels alarm & Circuit requirements?.
On adjacent lots N/A
On adjacent lots
Public sewer manhole/deanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line >5'
Water se~tice line >10'
Building foundation >5'
Water main N/A
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field >5'
Sudace water >t00'
Property line >10'
Water Service line >10'
Curtain drain None Noted
Building foundation >10'
Surface water >100'
Water main >10'
[xtveway, parkJng/veh~e storage. >25'
Fo COMMENTS
Wells on adjacent lots >200'
ENGINEER'S CERTIFICATION
I certify that I have determined through field inspect~ns 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 7/1M)t
in.
*'L~':.' A .~'L~,~
,,,,, C~. '-~?' '"'Z
...' :-
Wab~ F~ $
Date ~ ~t
~ipt Num~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICr"S
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
Application Da!e ..
GENERAL INFORMATION (MUST RE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range) /
Location (address or directions)
(b) Property OwnerJ~/.f~//~/,'//"¢' -- ~.lephone: Home
Address/~'~''' ~/'-~¢/~'~ -7~ ~' ~/~Z. %
Mailing
(c) Lending Institution~ ' ~) ~ ~ ~ ~
Mailing Address ~ ·
(d) Real Estate Company and Agent
Address /~O~¢ ~/~. ~ ~
Telephone
Telephone
Business
(e)
Mail the HAA to the followino address: or: Check here, Z~ if hold for pick up.
List contact person and day phone number below.
S &-5-ENGINEER.lNG
17034 Eagle Rlxe~ Loop Road No, 204 ¢? d~' ¢ ~ ~ ¢ ~ ~,-
Eagle Rlver~ Alaska 99577
2. TYPE OF RESIDENCE
Single-Family/.~
Number of Bedrooms
WATER SUPPLY
Individual Well [] Community F] PublicA
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SI=WAGE DISPOSAL
OnsiteM Public [] Community [] Holding Tank
Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72 025 fray 8/86) Fronl
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Juvestigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is sate, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the inlormation obtained
from the Municipality of Anchorage files and h'om 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.
Name of Firm S & $ ENGINEERING
~E~gl~-Rl~r~.oop Road [~... ~,.
Address
Date
Telephone ,-~ ~'//-Z ¢-.~¢'
Approved for .7~.~.,.t/.,¢ (3~ bedrooms by Dale
Approved __/~/'~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Depadment of Health and Human Services (DHHS) issues Flealth Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in tile State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their leading 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.
Page 2 of 2 72 025 IRev 8/86) Back
MUNICIPALITY OF ANCHORAGE (MOAi
MUNICJPALI'~Y OF ANCHORAGE
Div~k~.TH,._._.. AUTHORITY APPBOVAL (NAA)
ENVIRONMENTAL
SERVICES
CHECKLIST - FEBRUARY 1984
264-4720
MAY 7 1987 Legal Description: --/-(~)'7-' ~,,oq ~//~
RECEIVED
WELL DATA
Well Classification _ / / -
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
TO Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot ~-(-~)~
To Nearest Public Sewer L ne
Cleanout/Manhole
Water Sample Collected Dy
Water Sample Test B~9~.ults
Cornments~ ,.r V',,J .~-
If A. B, C D.E.C. Approved
Date Completed Yield
Depth of Grouting
Pure a Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
· On Adlo~nmg LOtS
r"/" _; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on LOt
. Date
B. SEPTIC/I-fOLDING'rANK DATA
Date Installed ~"/'~//'~'~-- Size //zCg/~)C~ No. of Compartments
Standpipes (~) _ Air-tight Cap (~N) __ Foundation Clear ::)ut (Y,(~)~
Depression over Tank(Y~ Date Last Pumped ~:--~"/4 7~r~'¢/7
Pumping/Maintenance Contract on File (Y/N) ,/~dr,.//9 ; for
Holding Tank High-Water Alarm (Y/N) /,J
Separation Distances from Septic/~ Tank:
To Water-Supply Wel ~_~ r_¢
To Property Line ,.~C'~
To Water Main/Service Line
Cours/~
Comments ~;2~¢'~//¢' ~¢/~' ~ ~'
6/ /
Temporary Holding Tank Permit (Y/N) /~J
To Building :oundation _
To DJsoosal Field
To Stream Pond, Lake. or Major Drainage
Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design
Length of Field ~/0
Depth of Field //C~)
Gravel Bed Thickness ~7
Square Feet of Absorption Area F7 ~ ~ ~ Standpipes Presen (~,!)
Depression over Field ( Date of Last Adequacy Test
Results of Last Adequacy Test d / ~2 ~ / ~
Separation Distance from Absorption Field;
To Water-Supply Well ~ 4¢ o To Propedy Line ~O
To Building Foundation /~ ~ ~P~ To Existing or Abandoned System on
Lot ~u~ D ~ ; On Adjoining Lots ~
To Water Main/Service Line /¢ (~- To Cutbank (if present) ~o ~-~
To Stream/Pond/Lake/or Major Drainage Course ~ O ~' ~
TO Driveway, Parking Area, or Vehicle S~age Area ~
Comments ~/~ //~¢~
D, LIFT STATION
Date Installed Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Manhole/Access (Y/N)
"Pum~ Off" Level
/ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S~ENGi NEEEiN G Date
Compar~70~4~E~aa_le R~ L~ Road
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Telel~hone: (907)
Address'
ANCHORAGE/WESTERN OISTRICT OFF ICE
4137 "E" STREE[, SUITE 303
ANCHORAGE, ALASKA q9501
274-2533
[)ATE: A]):i i i ,_ 1.87
PWS ~.B.~} 21 t 431
To Whom it May Concern:
According to records on file in this of'lice the
~4ater System is in co,npliance wii:h the State Drinking
l,/ater Regulations
Sincerely,