HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 3 LT 3Hampton Hills
Block 3
Lot 3
#015-134-68
Municipality of Anchorage Page 1 of 3
Development Services Department
Building Safety Division
OniSite Water and Wastewater Program 4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 995146650
www.cl.anchorage.ak.us (907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO10092 PID Number: 015-134.68
N'm''
Haller Construction
Wastewater System: New
AtIO IMM,
10100 Hampton Drive Anch., AK 99516 '
ABSORPTION FIELD
Phone: raanb. aaeeeana:
244-7086 Five 5
Deep Trench
Sot Rat.y:
Total Date, kore ong.W pate:
LEGAL DESCRIPTION
1.2 GPOVFt
10.5 Ft.
sloe,: Lot Swdram:
Depm to ppe ocean from ongnal pate:
Gra el duel beneath P":
3 3 Hampton Hills
3 Ft.
7 Ft.
Toane1W: Range: Semon:
FA atter above orlgnel gree°:
Genal Lenign:
.5 Ft.
61 n.
Well: New
CM rem:
3
Nunber d ane"ml
1 NH
DrP;-e—.P;eane°:
Ft.
- FL
C4uibritan (Pmale. A 9. C):
Taal Depth: euet n:
Total absool area:
P" Melenal:
Private 1
200 Ft. 200 Ft
854 FJESV�12,16/01
STM D3034 PVC
Deer
Heft Driflin
Dna DVlet: Shoe Waler Leel:
6/11/01 160n.
aetai
Acrea e S stems
I
penp509:
1
ca" H..Vd AbaeCr :
TANK
20 GpLa
Ft.
>2 Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
From
Absorption
Field
lNt
Station
Holding
Tank
iNPmate
s. Line
"'
Anchorage Tank
" '
1,500
wel
>100'
N/A
N/A
>25'
Steel
Two (2jSuhmewater
gtn"k
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
La Line
>10'
N/A
N/A
Gal.
F.,daben
1 >5'
>10'
I N/A
N/A
en tenet atM.
k
ti
raw w
in.
I None
lNoted
I
Pu" Makeaalutel
P,eW"k.pemaaWonnetby
Datanorae
ReemLF
BENCH MARK
2"Direct Esury insulation over ep Ic an
Mn
Garage Floor.
bvawn:
100.0 FL
ngineers tamp
.a�aaaga�
OF �a���•/
Inspections performed by: MEA Dates: 1" 7/12/01
49 h
2nd 7/16/01
Department of Health and Human Services approval
MICHAEL E. ANDERSON
i
0
Date: �' -2 g' �
q� if No. C[-aJet?�
RF �..
Reviewed and approved by:
�� „
4aoil
(rw. Iowa)
ESSt��i••
aaaaaaa�•
O
O
O
Municipality of Anchorage Page 2 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw, Street• Anchorage, AK 99519-6650 .343-7904
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number SWO10092
IS 85*22'25"E
AS -BUILT
SCALE I"= 40'
PID.No. 015-134-68
S1
.2
S2
.2
C3
K96.086.8
M7
3.5
C4
4.2
IS 85*22'25"E
AS -BUILT
SCALE I"= 40'
PID.No. 015-134-68
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO10092
PID No. 015-134-68
PROFILE AS -BUILT
Scole: i- - 10'
HEM DRILLING
3540 AKULA- DRIVE
ARCHORAGE. AK 99SIG
(907) 345.0599 :•�y;-0
LOCATION OP WELL (Pleeae cereplete oNher to. to er lo.)
le. ===
le. 1/�alra.
la. OI3TANCI1AND DIRECTION FROM ROAD INTERSECTIONS
-00'., IPAUn Ji Z'11ea\ sEd
sl...l Address 06 --XA g l"Le:n�I2
S. WELL LOG Feet
Motorist Type .__aur
16. WATER WELL CONTRACTORS CERTIFICATION:
Section
WATER WELL RECORD -
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
DIVISIOM Of 040109leal d GOOPhysleal SDrvtys
Drilling Permit No.
d. WELL DEPTHS timet
\ ( I B. OAT%� 0l tOM7llt ION
")66etlem AD ft.
A.D.L. No.
11. ofIat
Township N�
Ra No$
913Msridlon
Mabrlal: (3Noet Cement
•�
ll.
IS. PUMPI (Ir evble) NP
alla
WO
i
3. OWNER Of WELL
• •
..Addh.ii--:-h ! gess
_
� y
1
n
a
_
d. WELL DEPTHS timet
\ ( I B. OAT%� 0l tOM7llt ION
")66etlem AD ft.
An, pumping g.p.m.
11. ofIat
0. ❑Cebu leer ISA Rolery 00rlvan 0Dug
'��
❑ Auger oJoltot' [3 Barad ❑ Olherl
Mabrlal: (3Noet Cement
7, USE: Domestic. PeblloSupply ❑ Industry
ll.
IS. PUMPI (Ir evble) NP
alla
O Irrigalles Recharge ❑ Commonest
I
O Test Wall Olher:
•
S. CAS N61 O Threedcd idl Welded
diem, In,
tom It. Depth Weight
Blom, In, le 11, Note Bllckup Ile
Ob
ELL,
_Olamelersilset
leoglh7
=1MIlling
ft. aed
Gravel Pack
10. STATIC WATER LEVET
❑ Above et Set" land *surface pollee
Equipment used: '
11,PUMPING LEVEL below lend surface and YIELD
11. cleat
An, pumping g.p.m.
11. ofIat
be'. pumping o•P. m.
12.GROUTINO Well Ore Yl edi
Yee No
Mabrlal: (3Noet Cement
0OIhv1�
ll.
IS. PUMPI (Ir evble) NP
alla
Length of Drop Pipe .
IL eePaeily _ g,p,e.•
O Subm, O Jet O CceIr111u1
Other
Id RPYee 74
=1'0o P M,
I IS. Weler Temperature o M p O C
my Iu•1.e1a11Ye eed Ute •yowl It I900 N the base or my b e.l•dga aed belief.
e Nemo D`[�
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DIIIrIe=Ileo: WIIITC•SIals OGGS. PINN•Orill" CANARY•
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MUNICIPALITYOFANCHORAGE
EA1C"1VEE,R
Development Services Department
O�
L oCHT/o4e fA'OM
On -Site Water 8 Wastewater Program
774r-
NORrH SN7E
4700 South Bragaw Street
TO Saw.ri-f S/oE. HE
(MIKE AA4ent"),
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SWO10092
Date Issued: Apr 30, 2001
Expiration Date: Apr 30, 2002
Parcel ID: 015-134-68
Legal Description: HAMPTON HILLS SUBDIVISION BLOCK 3 LOT 3
Design Engineer: 0014 Anderson Engineering Site Address: 10100 HAMPTON DRIVE
Owner Name: HALLER CONSTRUCTION Lot Size: 66095 SO. FT.
Owner Address: 10100 HAMPTON DRIVE Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE. AK 99516 -
This permit is for the construction of.,
M Disposal Field ❑✓ 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 ( 1 BAAC80 ).
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.
6-7-0/
EA1C"1VEE,R
CALLAO f 10
G01N(, TO Nova WC LL
L oCHT/o4e fA'OM
774r-
NORrH SN7E
of PROPERTY
TO Saw.ri-f S/oE. HE
(MIKE AA4ent"),
5raMo meaer k/iU RE NO IMP.*ery AR C0A1F1-1CTS PY MOVIA16- TWE
WELL ro oTUER Pltopv_n r1ES.
Received By:
Issued By:
Date: ?§—) 4
Date: — fJ — l
Municipality of Anchorage
�•'` °O.
• .� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program SA I,
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015--134 —68 Permit Number SWO/0072
Property owner(s) Haller Construction Day phone 244-7086
Mailing address (1) P.O. Box 110731 Anchorage AK 99511
SITE
Meiling address (2)10/00 H/4/4FrOA/ pR /VF Zip Code _y9s/6
Legal description (Lot, Block & Sub'd.) Lot 3, Block 3, Hampton Hills Subdivision No 1
Legal description (Section, Township & Range)
Lot Size. b f:�, U 'r2 Acre q.F Number of Bedrooms Five 5
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ® Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment: rl° + `V 1
Receipt Number. `3126
(Rev. 12100)
Waiver Fees:
Date of Payment:
Receipt Number.
ANDERSON. ENGINEERING.
P.O. 130k 240773
ANCHORAGE,'AK 99524
522.7773 522-6779 FAX
April 18, 2001
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 3, Block 3, Hampton HillsSubdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 3, Block 3, Hampton Hills Subdivision Intends to place a new 5 -
bedroom home on the lot. We are therefore applying for a permit to construct a new
well and septic system on the lot to serve the proposed home. The attached Site Plan
and backup documentation identify the location and configuration of the new well and
septic system and the parameters used in the design. It also shows the location of the
test holes and the alternate septic site. Existing drainage patterns are shown and will
not be altered by the development of the lot.
Two test holes were placed at the proposed location for the new and alternate
absorption trenches and revealed well -graded gravel with minor amounts of silt up to
15%. No groundwater was noted in the test holes during excavation and none was
noted during the monitoring period. The soil percolated at a rate of nearly 5 minutes
per inch. Conditions are excellent for an onsite septic system. We are therefore
proposing to place a 3' wide by 45' long by 7' effective depth absorption trench to treat
the septic effluent. The pipe will be placed at 3' below the existing ground surface and
the total depth of the trench will be 10'. A minimum of 3' of cover will be placed over
the bed to prevent frost penetration and possible freezing.
The ground surface on the lot slopes as shown on the attached Site Plan with steep
grades from east to west near the eastern portion of the lot. The slope becomes flatter
proceeding westward and is nearly flat at the location of the new absorption system.
The new trench will be constructed parallel to the contours of the surface in
conformance with Municipal requirements. Grading will be accomplished to assure
surface drainage is away from the new trenches. The existing drainage pattern on the
lot will not be affected during development.
If the system Is constructed In accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
In the area or those to be constructed in the future.
Lot 3, Block 3, Hampton Hills Subdivision
April 17, 2001
Page Two
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments40 TH
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A : MICHAEL E. ANDERSCN
CE -4381
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THIS PROJECT
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AREA MAP
SCALE 1" =100'
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*.MICHAEL E. ANDERSCN : v
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Sept_'i�
System
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SepticGTankn
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LOT 3
SITE PLAN
SCALE V = 40'
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�.4 •�°: MICHAEL E ANDERSON•��
0� J� CE -4381 ���r
LOT 3, BLOCK 3, HAMPTON HILLS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home Deep Trench System
Perc. Rate: 4 MinAnch 1,500 Gallon Septic Tank
Application Rate: 1.2 GPDISF 7' Drain Field Rock
5 Bedrooms X 150 GPD 11.2 GPDISF = 625 SF of Absorption Area
625 SF114SFILF = 44.6 LF Trench Length
Therefore: Construct an Absorption Trench 45' in Length by 3' Wide With 7' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing
Ground. Total Depth of Trench to Be 10' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
r ii/av
; `w•..
/r/.. .v� ��
Natural
21611
Backfill
..
.
'Geotextile .
Fabric
4^ Perforated '
PVC (Slots Down)
7'.
�.
.
Drainfield,
2
Rock:
3.
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Water Service Line.
Minimum 100' Separation From Well
`tom:
*. 49JH *�
:-*.MICHAEL E. ANtOERSCN
Jf CE -4301
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: Rich Haller
Legal Description: I nt'I Rlnck 3_ Hampton Hills No. 1
SLOPE
OG/PT
Silty Gravel
<15% Silt
GM
Bottom of
Hole
Was Groundwater
Encountered? No
If Yet, What Depth?
Depth to Water
After Monitoring None
Date: 3/31/01
Date Performed:
a
A : MICHAEL L ANDERSON . Q
��'• CE - 4331
pROFESS10N�����
10/gP/Ofl����
MWIM
Reading
Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
15 -Oct 12:12
.75"
2
12:42
30
7.25"
6.5"
3
12:43
.625"
4
1:13
30
7"
6.375"
5
1:14
.75"
6
1:44
30
7.125"
6.375"
Perc. Rate: 4.7 MinAnch Perc. Hole Diameter: 6"
Test Run Between 5 Ft. and 6 Fl.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mik . A� nderson- I, Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/11/01
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: Rich Haller Date Performed:
Legal Description: I nt 3 Block 3- Hampton Hills No. 1
SITE PLAN
n *.MICHAEL L ANDERSON
`��•• CE -4381
O�Ilk 40FESS10�a���
10/11Mi;L,LaV'-
OGFPT
Silty Gravel
<15% Silt
GM
Some
Cobbles
Bottom of
Hole
Was Groundwater
Encountered? No
If Yes, What Depth?
Depth to Water
After Monitoring None
Date: 3/31101
Reading
Date Gross
Time
I Net
Time
Depth To
Water
Net
Drop
1
15 -Oct 12:17
1"
2
12:47
30
7.25"
6.25"
3
12:48
1"
4
1:18
30
7.125"
6.125"
5
1:19
1"
6
1:49
30
7.125"
6.125"
Perc. Rate: 4.9 MinAnch Perc. Hole Diameter: 6"
Test Run Between 5 Ft. and 6 Fl.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson. I, Mi .ha .I . Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/11101
ONSITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 3, HAMPTON HILLS SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,500 gallon septic tank at the location shown on the site plan.
Work also Includes the construction of a new 45' long X 3' wide X 7'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3' below the existing
ground surface. Total depth of the trench will be 10' below the existing
ground surface. All components of the septic system must be placed a
minimum of 100' from all wells in the area.
2. 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.
3. 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.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. 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 1,500 gallon septic tank must be be procured from an approved
source and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
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.
Lot 3, Block 3, Hampton Hills Subdivision
April 11, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. 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.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. 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.
6. 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.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 3, Block 3, Hampton Hills Subdivision
April 11, 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. All 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 fabric, 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 preparing the certified as -built of the completed system.
Municipality of Anchorage .10.
Development Services Department 01 ;�e
Building Safety Division'
On -Site Water and Wastewater Program ,. 1.:
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015.134-68 HAA #
Expiration Date: (7.:Z,
1. GENERAL INFORMATION
Complete legal description Lot 3 Block 3 Hampton Hills Subdivision
Location (site address or directions) 10100 Hampton Drive
Current Property owner(s) Ronald F. Philippsbom Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
3111 B Wendy's Way Anchorage AK 99517
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Five 5
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
®
Individual On-site
Individual Holding tank
❑
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
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 less than 30 days old. (Certificates may be reissued for a period of up to one year with
..I:d ....tn �..�) �.. �'C.... t.. . ..I:a iC . iC nrt: . 1. I _ O . �� �..:..
. . .... ... ..... ..4 C.0 V...... - C^C yCu. ' p.�V" .CS ucrvcG D C8S3 A C, v .�a..S Cr a puV.
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, 1 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 _Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 5114102
S. DSD SIGNATURE
I� Approved for
Disapproved.
5r bedrooms.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
ON-SITE
WASTEWATER
PROGWN
By: _/, J'� 1z �i�� Original Certificate Date:�-
(Rn. 1700)
Municipality of Anchorage
' Development Services Department
Building Safety Division <
On-Slte Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
vwvw.ci.anchorage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot ]. Block ]. NamOton H it$ SubdWislon Parcel ID: 015.13468
A. WELL DATA
Well type PdMe If A, B. Or C provide PWSID #
Date completed 6n1@001 Sanitary seat (YM) Y
Total depth 200 ft. Cased to 200 ft.
FROM WELL LOG
Date of test 6n1f2001
Static water level 160 ft.
Well production 20 9—
p.m-WATER SAMPLE RESULTS:
Wag Log (YEN)
Wins property protected (Y/N) Y
Casing height (above ground) >24 in.
AT INSPECTION
ft.
g.p.m.
Cofdonn -9—colonies/100 ml. Nitrate ]At mg.A. Other bacteria 0 colonies/100 ml.
Date of sample: 988002 Collected by: Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank TYpe/Matenal Seotic/Steel
Tank size 1 S00 gal.
Foundation cleanout (YIN) Y
Number of Compartments 2
Depression over tank (Y/N) N
Date installed 7n211001
Cleanouts (YIN)
High water alarm (Y/N) N
Date of pumping Pumper WA
C. ABSORPTION FIELD DATA
Date installed 7116=1 Soll rating (g.p.d W or ft'/bdnn)12 GPD/SF System type Deep Trench
Length 61 ft. Width ] ft. Gravel below pipe 7 ft.
Total depth 11 ft. Elf. absorption area 854 ftz Monitoring tube Y Depression over field N_
Date of adequacy best Results (Pass/Fall) For _ bedrooms
Fluid depth In absorption field before test _ in. Water added_ gal. New depth,_ in.
Elapsed Time: _ min. Final fluid depth ` in. Absorption rate >=
Arty rejuvenation treatment (past 12 mo.) (Y/N & type) N If yesgive date
pA.
D. LIFT STATION
Data installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at _in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot MW
Absorption field on lot MW
Public sewer main WA
Sewer /septic service line >2S
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots MW
On adjacent lots MW
Public sewer manhole/cleanout WA
Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S Property line >S'
Absorption field >S
Water main WA Water service line MV
Surface water MW
Wells on adjacent lots MW
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >17 Building foundation >70'
Water main Mr
Water Service line >10' Surface water >IW
Driveway, parkingNehide storage >2S
Curtain drain None Noted Wells on adjacent lots MW
F. COMMENTS
G. ENGINEER'S CERTIFICATION
P�; •" .
•4
I certify that I have detemdned through field inspections and
W * : 9 T`1';
reof Munfc#W records that the above systems are in
.
♦•• ....44-
conformance wiview
on
wink MOA HAA guidelines in effect this date.
µ ... .
Engineer's Printed Name Michael E. Anderson. P.E.
CE -4381 :: �•!
Date 5114102
HAA Fee $ r� 3 -7S ay
Date of Payment J /.l O 2—
Receipt
Receipt Number
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
MAY -11-02 09:41AM FROM -CUE ENVIRON►ENTAL SRV
CUE Environmental Services Inc.
CT&E Ref 9
1022460001
Client Name
Anderson Engineering
Project l4anw#
llampton I ills
Client Sample ID
Lot 3 Block 3
Matrix
Drinking Water
Ordered By
PWSID
0
Sample Remarks
9075615301 T-773 P.02/03 F-135
All DatesMmes are Atalka Standard Time
Printed Date/time
05/10/2002 10:51
Collected Datefriime
05/08/2002 15:30
Received Datefrime
05/082002 16:45
Technical Director
Stephen
By tc G
Released
Allowable Prep Analysis
Parameta Resutu PQL Units Method Limits Dau Date ]nit
Waters Department
Niwato-N 3.41
Microbiology Laboratory
Total Coliform 0
Received Time May -11. 8:51 AM
0.200 mg/L EPA 300.0 (<10) 05/08102 1DT
coV100mL SM189222B (<1) 05/08/02 KAP
O
0
N
0
0
0
0
iJ
1 "=40'
76-141
HAMPTON HILLS SUBD.,
LOT 3, BLOCK
66.095 S.F.
j�
83°00'00" E' 374.48'
lo_
O_U71L ES{�T
I
I
UNIT NO. 1
3
(APx)
I SEM SYSTEM BUILDING
BUIInING
(SEE NAIL.)
w I LOT 3
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1
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WELL
S 85°22'25"E 273.95'
OF
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/ .........................40
♦,A. . Jeffery A. Gostaldi o`
vie. m�I
♦ "� •. LS -6091
•eFeaA ••....NN•.. 5J.`
�. rofessionol
BUILDING DETAIL
SCALE: 1"=20'
FINAL CTRIICTIIPF AC—R►III T
GASTALDI LAND SURVEYING
JEFF A. GASiALDI, R.L.S.
4726 WEST 88Th AVENUE
NCHORAGE, ALASKA 99502
PHONE 248-5454
GRID I DATE
2540 5/8/2002
F.B.( JOB NO.
02-04 HH133
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBIUIY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT.. ALASKA
NOTE: NO CORNERS SET THIS DATE.
0