HomeMy WebLinkAboutTHE VILLAGES LT 1Th
Village
Lot !
#020-29! -55
Municipality ofAnchorage Page I of
Development Services Department
euilding Safely Division
On.Site Water and Wastewater Program 4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANO/OR WELL INSPECTION REPORT
Permit Number: SW010202 PID Number: 020-291-55
n~,,: Wastewater System: New
David M. Tish
P.O. Box 1'13261 Anch, AK 995'11 ABSORPTION FIELD
w,,~,: m,,~,~ ,~ s~,,,,: Deep Trench
345-5798 Four (4)
LEGAL DESCRIPTION .8 ~ 7
'1 The Villages 3 ~. 4
· 5 f,. 80 f~.
Well: New 5 r~.
Private 267 ~. 3.03. r,. 800 fe ASTM D3034 PVC
Alpine Drilling 6/26/01 82 ,,. Denali Sewer & Drain 6/22-25/01
v.: i ~=,.~p s,.: lc.m, ~ ,,~,. c,,o~: TANK
4 c,,u ~. >2 ~
SEPARATION DISTANCES E~ s~c n Holding [3 S,T.E.P.
T.~,~To Septic Absorption Oft Holding ~blic/P~vate
'rank Find St,,on Ta,k S~.,,U,, Anchorage Tank -1,250
w., >'100' >'100' N/A N/A >25' Steel Two (2)
s~...w.,, >-100' >-100' N/A N/A ~ / LIFT STATION - NONE ON LOT
~ >5' >!0' N/A N/A
~ >5' >-10' N/A N/A '~'~'~" '~"~ ~'"~'~' '
c~,~:.~ I None Noted '~"~'~'*~
e~.,~: BENCH MARK
Z" Direct Uury Insulation Over beptic lank and
Garage Floor.
100.0
Engineer's ,51a m p
Inspections performed by: A. Harala Dates: 1" 6/22/01
Department of Health and Human Services approval
Reviewed and approved bY~~ /[~. P~¢~. Date: ~. q_~.~
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Page 2 of 3
Permit Number $W010202
PID No. 020-291-55
THE
S 89'57'; F E 254.65'
A B
S1 64.6 50.5
S2 74.2 60.4
C4 78.5 78.3
M 1 76.5 76.2
C5 125.2 100.8
M2 124.7 100.4
Porch
.isting
Ccovel
-- Drive
\ Lot ~1
\ 1.97 Acres
\
N 89'5T01" W 142.22'
TRACT 7B-1
PLAN AS-BUILT
SCALE 1" = 60'
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw SL~eet Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW010202
Page 3 of
PID No. 020-291-55
~---~~/!~2,5'0~ 97.1
Sep"c~c T
2' In/"0sil.BACKIrILL
94.S
/.
Geotextite Fob~'ic and 2' Insulation
91.5 / Dr'eintield Rock
,/~78.8
Pipe -
PROFILE AS-BUILT
Scale: 1= .,, 10'
Municipality of Anchorage
Department of Health and Human Services
825 'L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom htr p://www.cl.anchora.~e.aK.ua
Mayor
Permit Number: #SW 010202 Date oflssuc: 6-21-01
Date Star~&l: 6-22-01 Date Completed: 6-26-01
Legal Description:
Property Owner Name & Address:
Parcel Identification Number:. 020-291-55
Is well located at approved permit location? [] Yes [] No
The V#laqes Lot I
David Tish
PO Box 113261
Anchorage, Ak 99511
Borehole Data: Depth (It)
Soil Type, Thickness & Water S~ata From To
stick-up 0 2
organic & silt 2 4
gravelly silt 4 21
Silty gravel 21 42
silt 42 93
Bedrock 93 267
H20 250 267
Method of Drilling [] air rotary I"'l cable tool
Casing type: steel
Wall Thickness: .025 inches
Diameter: _~ inches Depth: 101 feet
Liner Type:
Diameter: __ inches Depth: ~
Casing stlckup above ground: _2 feet
feet
Static water level (from ground level): 82 feet
Pumping Icvel:, 267 feet after
~0 hours pumping ~_ gpm
Recovery Rate: _~ gpm
Method of Testing: airlift
Well Intake Opening Type:
[] Open End [] Open Hole
[] Screened Slart ~ feet Stopped ~
[] Perforations Start ~ feet Stopped
feet
Grout Type: Bentonite # 8 Volume: I bg
Depth: Start 0 feet Stopped+feet
Pump: Intake Depth feet
Pump size __ hp Brand Name __
Well Disinfected Upon Completion? [] Yes [] No
Method ofDislnfection: .OIodne Tablets
Comments:
Well Driller:
Alpine Ddlling & Enterprises
P 0 Box 110496
Anchorage AK 99511
Attention: Thc well driller shall provide a well log to the property'owner within 30 days of completion and the property
Municipality of Anchorage :?
George 15 Wuerch, Mayor ~.
Building $~ffciy Division ~
I'.(). Ikm 196tkqo · 47(~) s. Bragaw Street
Anchorage, Alas~ ~)519-(~) * (~)7) 3~3-~01
]ltlp://x~x~v.ci.anchoragc.ak.us
May 21, 2002
David M. Tish
PO Box 113261
Anchorage AK 99511-3261
Subject:
On-Site Water and/or Wastewater Permit.
Permit Number: SW010202
~Legal Description: The Villages Lot I '
)
Dear David M. Tish:
An On-Site Water/Wastewater Permit, number SW010202, issued by this office for a single-family
system, will expire on June 21, 2002. This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to
this office for review, approval and documentation. This as-built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As-built inspection
reports are required to be submitted within 30 days ofthe completion ofthe system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
Dan Roth, Civil Engineer II
Acting Manager
On-Site Water and Wastewater Program
Enc: Copy of permit
MUNICIPALITY 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 I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 21, 2001
Expiration Date: Jun 21, 2002
Permit Number: SW010202
Legal Description: The Villages Lot 1
Design Engineer: 0014 Anderson Engineering
Owner Name: David M. Tish
Owner Address: PO Box 113261
Anchorage, AK 99511-3261
Parcel ID: 020-291-55
Site Address: NHN Villages Scenic Pkwy
Lot Size: 85918 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
i'~ Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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.
Received By: *'7~-,~-~ ~ ~ Date:
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
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-291-55
Permit Number SWO ] O ~. 0 ~.
Property owner(s) David M. Tish
Mailing address (1) P.O. Box 113261 Anchora.qe, AK 99511-3261
Me~,~j address (2) b/I.{-fq ~;ll~tz,~-_~,~_.'-'~,Z.~.o~j.t
Legal description (Lot, Block & Sub'd.) Lot 1t The Villa.qes Subdivision
Legal description (Section, Township & Range)
Lot Size ~ I ~' Acres/~
Day phone 345-5798
Zip Code
Number of Bedrooms Four (4)
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 cedify 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:
Receipt Number:
(Rev. 12JO0)
~t~/o ~
~ -
~7o!
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
- - .1~;0: Box' 240773 -
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX}
June 12,2001
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 1, The Villages Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 1, The Villages Subdivision intends to construct a three-bedroom
home on the lot with a detached garage. The garage will also have one bedroom and a
bathroom which will tie into the septic tank. We are therefore applying for a permit to
construct a new septic system on the lot to serve the new home. The attached Site
Plan and backup documentation identify the location and configuration of the new
septic system and the parameters used in the design. Also identified on the plans are
th~loca~ion of the existing well along with the test hole and the existing absorption site.
Existing drainage patterns are shown and will not be altered by the development of the
lot, We have surveyed the area and the new system will not conflict with other wells or
septic systems in the area.
Three test holes were recently p!aced on the lot to dete?ne subsu.ff, ace conditions.
Soils were found to be gravel with varying amounts of silt. Percolation tests in the
matedal indicated rates approximating 9 to 10 minutes per inch with one test over 40
minutes per Inch. No groundwater was found dudng the excavation and none was
found dudng the monitoring pedod. We are therefore proposing to place an absorption
trench 75' long by 5' wide with a 4' effective depth to treat the septic effluent. The
distribution pipe will be placed at 2' below the surface for a total depth of 6'. The trench
will be placed as shallowly as possible to take advantage of the looser material.
The ground surface on the lot slopes as shown on the attached Site Plan with grades
from east to west that flatten in the area of the proposed absorption trench. The new
absorption trench will be constructed parallel to the contours of the surface as much as
possible in conformance with Municipal requirements. Grading 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:
1. The system, if constructed as designed, will have no adverse impact on the wells
Lot 1, The Villages
'June 12, 2001
Page Two
in the area or those to be constructed in the future.
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
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7T73 522-6779 (FAX)
MEMORANDUM
DATE: June 21, 2001
TO: Dan Roth
FROM: Mike Anderson, P.E.
SUBJECT:
Lot 1, The Villages Subdivision
Septic System Design Revision
I have revised the location of the proposed absorption trench for Lot 1, The Villages
Subdivision. The new location is outside the screening easement. I have also
relocated the alternate site to the proximity of Test Hole No. 3. Please review the
attached revised site plan and issue the p.e. rmit for construction of the new system.
Thank you for your prompt review of this rews~on.
VACANT
THIS PROJ!
..Well
Well
We!
Abs. ,nch j m
· O
-- m
I LOT. 2. LOT 3
AREA MAP
SCALE'1" = 100'
' P.r~ep~ed
r4 TH2
w~th
'l
Garage
,~OTE:
t~
Insulate Over
Under Driveway.
F/owing Drainage
'SITE PLAN.
Line
'SCALE 1" = 50' ' '
LOT 1, THE VILLAGES SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home
Peru. Rate: 10 Min./Inch
Application Rate: .8 GPDISF
5' Wide Trench System
1,250 Gallon Septic Tank
4' Drainfield Rock
4 Bedrooms X 150 GPD 1.8 GPD/SF = 750 SF of Absorption Area
750 SFI5 LF (Width)*.5 (Red. Factor) = 75 LF Trench Length
Therefore: Construct a 75' Long X 5' Wide X 4' Effective Depth Absorption Trench.
Flowline Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be 6'
Below Existing Ground. Mound Over Trench to Provide Minimum of 3' of Cover or Provide
2" of Direct Bury Insulation.
4!
4t' PVC ASTM D3034
D~ainfield Rock
NOTE:
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Well.
Performed For: Dave Tish
Legal Description: Lot 1. The Villages Subdivision
SLOPE
North
5
6
1
11
12
13
14
15
16
17
18
OGIOL
GM
Municipali~ of ~chomge ~,~
825 L Sb~t, ~chorage, AK 99502~650
SOILS LOG - P ERCO~ O N TEST
Date Pedo~:
SITE
21
South
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring None P
Date: 6/12/01 E
Bottom of
Hole
See Site Plan
6%
Reading Date Gross Net Depth To Net
Time 13me Water Drop
9-Jun 11:44 3.5'
12:14 30 4.25" .75"
12:15 3.44"
12:45 30 4.12" .69'
12:46 3.5"
1:16 30 4.19" .69"
Perc. Rate: 9 Min./Inch Perc. Hole Diameter:. 6'
Test Run Between 4.5 Ft. and 5.5 FL
Comments: Test Cavity was Presoaked Prior to Test.
Performed By: ~ I, M3;J~ Certify That This Test Was Performed
In Accordance With Ail State and Municipal Guidelines In Effect On This Date: 6/12/01
Performed For: Dave Tish
Legal Description: Lot 1_ The Villages Subdivision
2
3
4
10
11
12
13
14
15
16
17
18
OGIOL
GM/SM
GM
Gray
21
.....
Municipali~ of Anchorage ~ ~~
Depa~ent of Health & Human Se~s ~ ~. ~[ ~. ~[~sc~; ,~ ~
Date Pedo~: ~
SLOPE SITE P~N
North
South
Was Groundwater
Encountered? No
If Yes, What Depth?
Depth to Water
After Monitoring None
Date: 6117J01
Bottom of
Hole
See Site Plan
S 6%
0
Reading Date Gross Net Depth To Net
'ime Time Water Drop
9-Jun 12:31 4.06'
1:01 30 7.44' 3.38"
1:02 4"
1:32 30 7.31' 3.31"
1:33 4.12"
2:03 30 7.38" 3.25"
Pero. Rate: 9 MinJInch Perc. Hole Diameter:. 6'
Test Run Between 5.5 FL and 6.5 FL
Comments: Test Cavity was Presoaked Prior to Test.
Performed By: ~ I, MLcjlaeLE..~:~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 6/12/01
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: Dave Tish
Legal Description: Lot 1. The Villages Subdivision
SLOPE
North
9
10
11
12
OGIOL
GM
Gray
14
15
16
17
18
South
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth lo Water O
After Monitoring None P
Date: 6/12/01 E
Bottom of
Hole
21
Date Performed:
SITE PLAN
See Site Plan
6%
Reading Date Gross Net Depth To Net
Time Time Water Drop
9-Jun 3:16 5.125"
3:46 30 8.375" 3.25'
3:51 5.19"
4:21 30 8.38" 3.19"
4:22 5.12'
4:52 30 8.25" 3.12'
Perc. Rate: 10 Min./inch Perc. Hole Diameter: 6"
Test Run Between 6 Ft. and 7 FL
Comments: Test Cavity was Presoaked Prior to Test.
Performed By: ~ I, ~ Codify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 6/12/01
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 1, THE VILLAGES SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,2500-gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new 75' long X 5' wide X 4'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 2' below the existing
ground surface. Total depth of the trench will be 6' below the existing
ground surface. A minimum of 3' of cover is required above the
absorption trench to protect against frost penetration. Ail components
of the septic system must be placed a minimum of 100' 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
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing thei.r own syste.ms must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must 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" cleanouts 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 1, The Villages
June 12, 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:
J
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.
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 vedfy the septic tank and drainfield are a minimum
100' away from any pdvate 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 ,s available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
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 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.
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 1, The Villages
June 12, 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 preparing the certified as-built of the completed system.
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 HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-291-55
1.
Expiration Date: 4:~ _ /.7( . ~) ~
GENERAL INFORMATION
Complete legal description Lot t~ The Villaqes
Location (site address or directions) V~lla.qes Scenic Parkway
Current Property owner(s) David M. Tish
Mailing address P.O. Box 1t3261 Anchora.qe, AK 99511
Lending agency
Day phone 345.5798
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four(4)
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
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
valid water samples.) Certificates are valid for one year for propedies 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. Anderson En.qi~eerinfl
Address P.O. Box 240773 Anchora.qe, AK 99524
Engineer's Pdnted Name Michael E. Anderson, P.E.
5. DSD SIGNATURE
J Approved for ~ bedrooms.
Disapproved.
Phone 522.7773
Date 6/3/2002
· '..,.-
-
.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
O~Site Water & Westewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
~v.ci.anchorage.ak.us
(9O?) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
WELL DATA
Well type Private
Date completed 6J26/2001
Total depth 267 ft.
Date of test
Static water level
Well Ixeductton
WATER SAMPLE RESULTS:
C~Jform 0 celonies/100 mi.
Date of sample: 5/29/2002
SEPTIC/HOLDING TANK DATA
Tank Type/Material EeOc/Steel
Tank s~ze tl250 gal.
Foundation cieanout (Y/N) Y
Date of pumping
C. ABSORPTION FIELD DATA
Date installed 6/25/2001
Length 00
Total depth 7_ f.
Date of adequacy test
If A, B, or C provide PWSID #
Cased to 101 fl.
FROM WELL LoG
~2 ft.
4 g.p.m.
Nitrate 2.05 rog JI.
Ca~ected by: MEA
Number of Compartments _2
Pumper New Construction
Pamel ID: 020-291-55
well Log (Y/N) Y
Wh'es pmpedy protected (Y/N) Y
Casing height (above ground) >24
AT INSPECTION
g.p.m.
iN.
Date installed 6/22r2001
Cteanouts (Y/N) Y
High water alarm (Y/N) .N
Soil raUng (g.p.d./fl2 or ft2/bdrm) .8 GPD/SF System type Wide Trench
ft. W*~th 5 ft. Gravel below pipe 4 ft.
Eft. absorption ama 800 ft2 Monitoring tube Y Depre~___-!on over field N_
Results (Pass/Fail) For bedrooms
Fluid depth in absorptk:m field before test in. Water added gal. New depth in.
Elapsed T~me: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenaUon treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. UFT STATION
Date instaJted
'Pump on' level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level at __in.
Cycles tested
Manhole/A_ _,?~_ _~ (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >t00'
Abserption field on lot >100'
Public sewer main
Sewer/septic sen~ce line >25'
On adjacent lots >100'
On adjacent lots >t00'
Public sewer manhole/cleanout N/A
Holding tank N/A.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Properly line >5'
Water main N/A Water sewice line >t0'
Wells on adjacent lots >t00'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Propely line >10'
Water Service line >10'
Curtain drain None Noted
F. COMMENTS
Building foundation >t0'
Surface water >100'
Wells on adjacent lots >100'
Absorption field >5'
Surface water >t00.
Water main >t0'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspectione and
mv~w of Municipal records that the above systems am in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 6/3/02
in.
t~Y-31-O20Z:35P~ FROI~CT&E ENVIRO~NTAL SRV
Zt~.~ CT&E Environ,nentalServlces Inc.
9075GI530T
T-083 P.OZ/03 F-681
CT&£ Rtf~ 1023025001
Client Name Andiron Encmeeting
Project ~am~ Lot 1, ~e VilI~R~
Client Sample ID ~T 1, ~e Villages
Matrix ~inking Watrr
Orde~d By
PWSlD 0
Sample R~mar 'ks:
~atara DelinqUent
Hilrate-N
2.O5
All Dates/Times are Alaska Standard Time
Printed Date/Time 05/30/2002 16:47
Colleaed Datu'Tlme 05/29/2002 10:00
Received Date/Time 05/29/2002 12:30
Uniu
Allowable prep Analysis
Mahod Limits Date Date Init
0.200 mg/L EPA 300.0
(<10]
05/29/02 JDT
laicrobiolo!r~ Laboratory
Total C01ifonn
col/I OOmL SMIS9992B
05/29/02 KAP
Received T me May.3l. l:44Pbl
~Y-31-OZ 02:35~ FROJ~.-CTA£ ENVII~ON~NTAI. S~V 90'~SGIS~D1 T-OS] P.03/03 F-681
J
GT&E Environmental Sewtc~ Inc.
Tet: tgO"fl 541.2343
· · g Water Analysis Report for Total Coliform Bacteria ~
this W~ SAMPLE to
U~
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~B~T OF: LEG~DESC~ON:
~USION N~: It
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~ ~GES S~D~ION ~T 9 8-92) ~.
APRIL ~2, 2002
~ M~ 3637 2001-21