HomeMy WebLinkAboutHULSE #2 LT 10Hul
Lot 10
#050-521-73
Municipality of Anchorage ."', '-'-:,
Development Services Departmenti~r~?"~'
Building Safe~ Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.--
P.O. Box 196650 Anchorage, AK 99519-8650 Page ~ of .~.
.. www. ci. anchorage ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020114 PID Number: 050-521-73-000
REKER WastewaterSystem: [] New [] Upgrade
POB 772904 EAGLE RIVER AK g9577 ABSORPTION FIELD
NA 10 HULSE ADDITION #2 0 ~t. 0.7
EXISTING PRIVATE ~,. ~, 245 ~ pvc sch 40~ astra 3034
~, midni~htsunexcavatin~ 612~2002
ID Septic ~ Holding ~ S.T.E.P. ~ Othe~ ADVA~
S
EPARATION
DISTANCES
Tank Field Station Tank s~ L,.e ~ ORENCO 1500+~
w. +100 +100 +100' n/a +100' FIBERG~SS 2+ pump basin
~=w.. +100 +100 +100 ~a ~ / LIFT
STATION
180 ~ ORENCO
~ 30' 75' 40' n/a~ 36 ~ 34 .~ 38
PEF~0 orenco SPARROW ELECTRIC LICENSED ELEC.
advantex ~0 system InstallS. existin~ tank pumped crashed and BENCH MARK
buH~ onslte, existing leachfield abandon~ in place. New TOP OF WELL CAP
leachfield has 1.25' laterals with 118" o~ce spaced at 2' with 2 ~
100
runs of pipe. each mn of pipe has a cleanout at ~e end marked
Engineers Stamp
Inspections pedormed by: EAGLE RIVER ENGINEERIN Dates: 1" ~/~ ~ ~a/~-~ ~-~ ·
Development Se~ices Depa~ment Approval ~"~'~--'--~"~
Permit No., 020114 Page 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage. Alaska 99519-6650 Telephone: 345-4744
On-Site Wostewoter Disposal System and/or Well Inspection Report
of 2
Legal Description: , HULSE #2, LOT 10
PID No.: O50-521-73-000
RIO0.O'
L=89.15'
R=50.O0'
SCALE:
HOUSE
/
/
MI'H2
./I '- I~[ \,... II \,.,.. I~''~ --~---
~ES[ LOtiONS ~[ ~[D OFF THE HOUSE LaoTIaN
FROM 1985 ~BUILT SU~ ~O ~E CORRECTED FROM
OUR PERMIT SUBMI~AL 5-02.
TEST HOLE
MONITOR TUBE
SEWER CLEAN OUT
WELL
EASEMENT
LEACH FIELD
DRN['WAY
· 6/24/02
ENCINEER'S SEAL
~.- ........· ~
LOUIS A. BU~RA
~-25-2002 09:12;~1 Fl~tl E.R. Engtneertn9 Suc$. TO 34379<3? P.O~
Office: (907'} 344-5539
"SPARROWSi'
ELECTRIC INC
7310 Bulen Ortve · Arctmmge, AK 995C7
FAX: (~:)7) 344,55,38
'"SPARROW'3"' .~[.,F~"f'I~: Z'tAS W'~.E.D THIS SYS~'F.,M ACCORDING TO MANUFAC'fURES
RE, COMIdI~AT/O~ ~ TO MUIq~C1PLE, STATE AND~ NATIONAL 1E2.E, CTRIC COi)~
STANDARDS.
TH~ WORK ON Tlt~ ~ ~ 1 ~M WAS I~D bY' JOURI,/LrYMAN ~1 ~CTR/C~AN,
SYSTEM C14ECY~ ~ t'ERFOR~F_D AT JO~SrTE t.~ON ,C~Ota~...~'~O1~T C~F ~:~O~,CT.
I~3¢'ESIONALLY YOURS:
MUNICIPALITY OF ANCHORAGE
Development Services Depa~lment
On-Site Water & Waslewater 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: May 15, 2002
Expiration Date: May 15, 2003
Permit Number: SW020114
Legal Description: HULSE#2 LT 10
Design Engineer: 0024 Eagle River Engineering Services
Owner Name: Reker
Owner Address: 25449 Crystal Creek Rd
EAGLE RIVER, AK 99577-0000
Parcel ID: 050-521-73
Site Address: 025449 CRYSTAL CREEK DR
Lot Size: 72745 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] 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
Wastewatar 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.
Issued By: J~'
Date:
Date:
Municipality of Anchorage
Development Services Department
Bui{ding Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 A~chorage, AK 99519-6650
www.ci, anchorage, ak. us
(907) 343-7904
ON-SITE SEWERJWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
ParcelI.D. C35"~)" 5'-~1 - 77-.).~o
Permit Number SW OZ, O//~t
F=rc;o~· c'.':nor(s)
Mailing address (1)
Mailing address (2)
Day ~hcne
Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Let Size /-P + Acres/Sfl-EL
'"/o~ 7q~- "
THIS APPLICATION IS FOR:
Sewer Only 1-']
Sewer and Well []
Sewer Upgrade ~,
THIS PROPERTY CONTAINS:
Hot Tub []
Swimming Pool []
Therapy Pool []
Number of Bedrooms ,, z./,,
Well Only []
Water Storage []
Jacuzzi
Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is ?n accordance with applicable Municipal Codes.
(Signature of property owner er authorized agent)
Permit Fees:
Date of Payment:
Receipt Number.
(R...v. 12/C0)
Waiver Fees:
Date of Payment:
Receipt Number,
Eagle River Engineering Services
Louis Butcra, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
May29,2002
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 10 Hulse Subdivision #2 Addition, ADVANTEX SYSTEM
Dear Mr. Cross:
When excavating for the original permit #20114, septic tank replacement, xve discovered a high ground
water situation. The existing leachfield will therefore have to be replaced and due to limited area available
and separation distance to ground water table requirements we are utilizing the Advantex system. An area
has been cleared and a bench constructed that will accommodate a 5' wide leachbed and 35' horizontal
distance to change in slope of 25%. This bench was created out of a 25% slope and the native soil material
that will accept effluent has been percolation tested in 3 different holes on the uphill side of this bench.
We do not believe that construction of this system on this benched slope will result in any surfacing of
effluent. Adjacent to the bench and relative to the uphill side, a deep hole was excavated with ground
water monitor installed that was placed to determine ground water table separation of+2' will be obtained
as assumed allowed by Advantex. The system will utilize the Orenco lift pump basin to the leachfield. The
existing leaching system will be completely abandoned. We would like to start xvork on this system
immediately for home closing.
The proposed revised septic system upgrade will have very limited impact on adjacent properties for the
following reasons:
I. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
This permit is for replacement of the septic tank and leachfield with an Anchorage tank
Advantex system, requiring reduction in leachfield area and 2' vertical separation to
ground water table.
Surface drainage will only be affected at the leachfield site and will not affect the
neighboring properties.
This work will not affect the reserve area on adjacent lots. lfyou have any questions please call our office
at 694-5195.
Louis Butera, P.E.
k2002\02.004n UAR.DOC
~ / \ R--50.O0'
~ .~, ~ i L-89 15'
o J~luu.u ~ 1 - ·
~C ~ - ~EST HOLE
~STAL CREE · - UONITO. TUBE
THIS IS NOT AN ~ND SU~ AND IS ~ ~1~ o - SEWER CLaN OUT
BASED OFF AN AS BUILT SURV~ DONE IN 1983 ~ + - WELL
LOCATIONS ARE APPROXIMATE. - .... ~SEMENT
'~ - PROPOSED L~CH FIELD
NO SURFACE WATER c
~--.- EXISTING L~CH FIELD
NO KNOWN CURTAIN DRAINS ~- DR~AY
WERE/SEPTIC SITE. PLA
LEGAL: HULSE ~2, LOT 10
EAGLE RIVER ENGINEERING SERVICES' ~ '~ou,s ~. Bu~R~ ·
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907] 694-5195 FAX: (907] 694-3297
EAGLE RIVF-
ENGINEERING SE..,ICES
P. o. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
SCALE
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
[~agle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER
LEGAL: Lot 10 tlulse Subdivision #2 Addition
REV June 1 I, 2002
A. GENERAL
I. The well and septic plan is for a 4 bedroom single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of llealth and State Department of
Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval.
B. ADVENTEX SYSTEM AND SEPTIC TANK
I. Septic tank shall be a fiberglass 1500-gallon tank capacity of MOA approved construction for use with Advantex
system. Install as per manufacturers recommendation. Existing tank is to be pumped and properly disposed of.
2. Install one AX-20 filter pod over septic tank capable oftreating 600 gallons per day ofwaste flow.
3. Install Orenco 24" pump basin PB-2496 outside septic tank, with OSI pump model PEF 40 and controls to allow 23
gallon dosing of septic leachfield. Set pump float to 13.5" above pump, timer for 1 minute dose time. Controls to be
installed to MOA code by licensed electrician.
4. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all applicable
codes.
C. DRAINFIELD TRENCII
I. The trench is to be located in the benched area shown on tile site plan, this area will require building out tile
transition of the slope to allow leachfield placement 35' from the edge ora change in slope of +25% or extending
the top of slope.
2. The total depth of the drainfield excavation is not to exceed 2' relative to gruund elevation at ground water monitor
tube and located in scarified native GM soil material. The bottom of the trench shall be level, plus or minus 1.5"
prior to placing sand. A 2' layer of coarse sand is to be placed over the native soil material to allow an effective
depth of 4' to the measured ground water table level at the ground water monitor tube.
3. A one foot layer of gravel is to be placed over the sand material. The effluent piping is to be buried within tile
gravel layer with 2" of gravel cover over the piping.
4. The completed trench gravel and piping is to be covered with typar fabric material.
5. Soil or combination of soil and extruded board insulation to a depth of+3' or equivalent is to be placed over tile
leachfield. The upper slope may be raked down over the leachfield to provide cover material.
6. Existing trench is to be abandoned in place with pipes cut offor removed.
RECOMMENDED LEACIIFIELD DIMENSIONS:
TOTAL DEPTtl = 4' above water table. GRAVEL DEPTtl = 0.$' under effluent pipe, 2" over pipe
DRAINFIELD LENGTtl = 45' DRAINFIELD WIDTI! = $'
SOIL RATING -- 4 GPD/fl2 BEDROOM CAPACITY = 4
EFFLUENT PIPE = 11/4" from pump basin to leachfield then manifold to I" PVC with I/8" holes oriented down
spaced at 2' OC. 2 runs in leachfield 2' between pipes 1.5' from sidewalls of trench.
Twenty-four (24) hours notice required for all inspections.
~2001\02-004 adventcxTrench- spec.doc
Total Dynamic Head (TDH), feet
m
Mumczpality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG "-- PERCOLATION TEST
15.
16.
17
18
Louis ~ B~e .~ F
19
20
,/-././Se. ~ ~. Township. Range. Section.
I
I
,--t' '1' I
li\l i
WAS GROUND WATER
ENCOUNTEREO~
SITE PLAN
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I I I t I I I I I
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I I i I I I I I I
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Municipality of Anchor3ge
Cevelcpment Services Oepar~.ent
n~cl~'l~
P.O. Box 1~ ~e.
Soils Log - Percolation Test
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~.~ ~:
13-
15-
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17-
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CCMMENT$ ,Z~--' ~/ ~, r_-.~-.,
T~hlp. Range. Se~on: :T I~/I/, ~ I I/V ~,,le Plan
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Municipality of Anchorage
Ceve!cj:me~t Semites Oe~'~men~
C~-~,te ~ter a~d W~t~ater
4~ ~ 8~3w SL
P O. 9ox 1S~ A~o~e. AK ~951~6~0
Soils Log - Percolation Test
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Rea¢ing
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Municipality of Anchorage
Cevelc~ment Se~/ices Oepar',m. ent
C~;te ~ ~ Wu~tee P~
P O. Box
· ' .,..
Softs Log - Percolation Test
2-
3-
4-
5-
6-
7-
8-
11-
12-
13-
15-
16-
17-
18-
19-
20-
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER. ALASKA 99577
Phone 694-5195
CHECKED BY DATE
o --50.00
~ R;0~.0, ", L'--89"s' , ,
0F OPE
o
._ ..... -- ~ ~ ~~~~
~ ~C~Ys... ~ - TEST HOLE
~ I~L C~ · - MONITOR TUBE
BASED OFF AN AS B~T SURV~ ~ONE IN 1983 ~ ~ + - WELL
LOCATIONS ARE APPROX~TE. ~ ..... ~SEUENT
............... ~ t ~----:- PROPOSED L~CH FIELD
~ - DR~AY
WELL/SEPTIC SITE PLAN
LEGAL: HULSE ~2, LOT 10 ~
OWNER: REKER -
CONTRACTOR: N/A 9~
~O"~02-O0~WS/D*TE: ~/29/02 I SCALE ~ = 6O': ~~~...~
EAGLE RIVER E~CI~EERI~G ~ERVICEE ~ ..~ou~s*.
P.O. ~o~ 773294 ~,~ .... .... ~=
~ RIVER, ~. 995?7 '~.~ '"
frilI
(907) 694-5195 ?AX: (90~) 694-g29~
/"%, MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~;TION
· ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ~ IPHONE I [~'~EW
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Well ~ Absorpt~n~e~ v Dwelling
o'T z4J
t~[O O Material
I F HOMEMADE: I Width ~ Liquid de~pth
NO. OF BEDROQ~
PERM' COa O
No, of compartments
Liq. capacity in gallons
D STANCE T~
Inside length
_.~Dwe ng
Man~
Well
DISTANCE TO: Well P ~-i~/"
No. of line~ I L,cj;gJ~b of each line
Top of tile to finish gr2de~ ~. /3,,2.S
F°~a~0T-/ /~,.~) INearest lOt line
Total length o;~ lines I Trench wicJ&h.,
tOO I D(.~ inches
Material beneath tile
PERMIT NO.
PERMIT NOir..~ O (~ '~'~
Distance ~,~een lines
Total effective absorl~(~r~
Length ! Width Depth
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Depth Driller Distance to lot line
Building foundation Sewer line Septic tank
DISTANCE TO:
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST RAT~/N~ ~)¢ !
REMARKS
A~ DATE LEGAL
by
[DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK. ALASKA 99567 · TELEPHONE 688-2769
OWNER OF LAND
ADDRESS ~' ....
LEGAL DESCRIPTION
DATE - Started ,Y;"
PERMIT NUMBER
/ :; -,, ~, DEPTH OF WELL __:
~ / /~ /47 STATIC LEVEL OF WATER F'r.
~?,' ~/~,. ~, .'~: ~'~',:5~,:~? ,:~:~ ~:~ ~DRAW DOWN FT.
Ended ,; .- 7f ) GALS PER HR
KIND OF CASING ~ '"~ ~'t'~
KIND OF FORMATION:
From Ft. to ,~::~'~Ft. ~ ,.dcf' ,~' ,:, .~r,~ ,/.~-~ - -,~- From.-
From ~, Ft. to / :i/ Ft. ~ < ? ~ ,~ ..... : -:~ ~,~,::'~rom~
From ' -i Ft. to ,~ ,-) Ft. , ~,- .,~,K,,~ :-,' ,'- From~
From
From. Ft. to Ft. . ,,:, 7 2~ .... >'~'; ~:'~ From
From Ft. to ,' ,.
From_~_Ft. to Ft.
From ~_Ft to. .Ft
From Ft. to Ft.
From Ft. to Ft,
From ~ Ft. to Ft.
From __ Ft. to Ft.
From __ Ft. to.~.Ft.
From. Ft. to Ft.
From___Ft. to. Ft.
From Ft. to. Ft.
From Ft. to Ft
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft
Ft. to Ft.
From Ft. to__Ft.
From Ft. to___Ft.
From Ft. to__Ft.
From Ft. t¢' Ft.
From__Ft. to Ft.
From ~ Ftfto Ft.
From__Ft. to__Ft.
From Ft. to Ft.
From__Ft. to .Ft.
From Ft. to Ft._
From Ft. to Ft.
From Ft. to Ft~
MISCL. INFORMATION:
7
PERMIT NO.
APPLICANT
LOCATION
LEGAL
SMOOT CONST INC
LtO HULSE #2
~'~UN~Cz~t ~l ~l'~' OF
DEPARTMENT OF'HEALTH AND ENVIRONMENTAL PROTECTION ~]~.
' 825 "L' STREET, ANCHORAGE, AK. 99501
264-4?20
WELl. ,~ND ]3N ' S ItE SEt4ER PE~:F1 I T/-
6~4-9455
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDRLOM=. = 4
PO 80.;~ 1811 E.R. 995??
LOT SIZE 999999 SQUARE FEET
SOIL RRTING (SQ FT/"BR)=
THE REQUIRED SIZE OF THE _-,LIL ABSORPTION SYSTEM I:,:
[:"EPTH= 8 LFNiSTI-I --q-5 GRR~'EI DEPTH= 4
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
8ND THE BOTTOM OF THE E×CAVATION (IN FEET).
REC-!LI I RED SEPT I C Trl~-~( S I ZE: 1258 GFtLLO~-IS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RE_tDENuE_ THAT THE WELL WILL SERVE.
TWO ( 2 :) I ~'.iSPFE:T I OF4S RRE I~..EQLI I REC',
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT HILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE NELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC NELL
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE NELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERI~I I t E;-(P I RES [~ECEMBFR __'~-1 .. I --q-8;'
I CERTIFY THAT
i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
-~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
Rq.E_ I ~.ENCE~ ' I_'~._REMO[:ELED~ TCI ~gDE'l MORE THAN 4 BEDROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERFORMED FOR:
,.EGALDESCR,PT,ON: Llo H UL'SE ~'l:)P '~'Z.."
DATE PERFORMED:__
[] SOILS LOG
PERCOLATION
TEST
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
O-/
NO. ]732-E
Juno 22~ J ~6~
SLOPE
WAS~RO~NDW^TER /')0 [
ENCOUNTERED?
0
P
E
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
%l../ - -- 5' ~t .._
I
'i'~P, ER CO LATIO N RATE__ J "~"~ (minutes/inch)
'EST RUN BETW FT AND ~"'"1~,~.~, FT
PERFORMED BY: ~~~~1~__
Parcel I.D.
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.a k.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY AF PROVAL
FOR A SINGLE FAMILY. DWELLING
Expiration Date:
Location (site address or directions)
Current Property owner(s) .~,.~, ,~,-"~ ~,'?,,-.,,2. ,~'~'/<--,Day phone "~=?-,~'~-~,7
Mailing address f~,~/~
1. GENERAL INFORMATION
Complete legal description ~--
Lending agency
· Mai"i
Real E
Mai
Unless
2. NUME
Day phone
DISPOSAL:
Indk
Corr!
Pub!
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 horneowners. Ceait~cates 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
vatid 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 cmissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER '
· "-'"'Name of Firm
Address
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 an~.fype of structure ndicatad herein. I further verify that based on the information ~'btained from the
Municipalit~h~Anchorage flies and from my investigation and inspection, the on-site wate~ supply, and/o,r,
wast~.w..a~r.~P~sal system s(are) n compliance with all applicable Municipal and State codes ordi~ances,...~
a~n. d...[e~u,~l~.'~o~s' in effect at the time of installation. . ' ;~' ~g'
Phone 4>"~' -$'/¢~
Engineer's Pdnted Name ~..~/..~; ,~zz. ~
5. DSD SIGNATURE
/ Approved for L~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date: ~ -.-.'~. ~ c ~
Legal Description:
A. WELL DATA
Well type
Date COmpleted g'~'
. Total depth ,/~90 ft.
Mnnicipality 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
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C provide PWSID # ,4/,~
Sanitary seal (Y/N) ,W
Casedto t'~' ft.
FROM WELL LOG
,~/'.3. ft.
/'G" g.p.m.
Parcel ID: ~'~- -~'~/- '7.,q -ooo
Well Log (Y/N) Y
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~) colonies/100 mL
Date of sample: ~--2~'- 0.2.
B, SEPTIC/HOLDING TANK DATA
W~ras propady protected (Y/N)
Casing height (above ground)
AT INSPECTION
ft.
/o z./ g.p.m.
in.
System type
Gravel below pipe 4), ~ ft.
__ Depression over field
For l/ bedrooms
New depth ~ in.
""'"'- g.p.d.
If yes, give date- '
Tank Type/Material ~ee'~¢',,-,,.."~.,, .~'-,,'~'?/<
Tank size /)'"'~ gal. Number of Compartments
Foundation cleanout (Y/N) ~Y "Depression over tank (Y/N)
Date of pumping /v'~./ 7"/~,,v~ Pumper
C. ABSORPI'ION FIELD DATA
Date installed ~'--d .2 Soil rating (g.p.d./ft2 er-~-&~n) ~/
Length ~ 5-' ft. Width :~' ft.
Total depth ~ ft. Eft. absorption area 3-~-~' ft~ Monitoring tube
Date of adequacy test ~V£~, ~c;e~,~/ Results(Pess/Fail).
Fluid depth in absorptio~ field before test ' ' in. Water added ~gal.
Elapsed Time: L,,-~ min. Final fluid depth ~ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Yin & type)
Date installed ~ -- Oe~..
Cleanouts (Y/N) ~/'
High water alarm (Y/N) ~
Nitrate ~o,~ mg./I. Other bacteria ~ colanies/100 mi.
Collected by: ~c,~/~ ,~., ,,~,,.
D. LIFT STATION
Date installed Z~'- ~,~- Size in gallons
'Pump on" level at "~' in. 'Pump
Datum ~ ~ ~ Cy~test~
E. SEPA~TION DI~CES
SEPA~TION DIST~CES FROM WELL ON LOT TO:
Septic ten~ s~tion on lot
~sorption field on lot ~ =
Public s~er ~in
Sewer/seHic sewi~ line /~
SEPA~TION DIST~CES FROM SEPTIC/HOLDING T~K ON LOT TO:
Building foundation
Water main
Wells on adjacent lots
ManholeJAccess (Y/N) )/
High water alarm level at, ~ J' in.
Meets alan~ & circuit requirements? .YzC'J-
On adjacent lots
On adjacent lois '/'/~'-~"
Public sewer manhote/cteanout
Holding tank
Absorption field
Surface water
Property line .~-~
Water service line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
F. COMMENTS
G. ENGINEER S CERTIFICATIO
I certify that I have determined through field inspections and
conformance with MOA HAA guidelines in effect on this date.
Encneer's Printed Name Z,,,,~ ~,,~
~.~..._ C~'" ..'"_~FF -
De,e
HAA Fee $~L~L~~
Property line ~5'- / Building foundation ~'5,'" Water main
Waler Service line /z//?/ Surface water Y'/~',, / Driveway, parking/vehicle storage
Curtain drain ,,v/.~ Wells on adjacent lots -/-/,~',~' /
\
'%,
AS BUILT SURVEY'
I hereby cer~ifv that a s_urvey of ~t ~ ' , 8took
Subdivisio~ was made on .b~ ~
and
that the improvements situated thereon are within the property lines
and do not overla~) or encroach on the properW lying adjacen't thereto.
that no improvements on property lying adjacent thereto enCroach on
the premises in cues,ion and that there are no roadways, transmission
lines or other visible easements on said properS.' except as indicated
hereon.
Dated at Anchorage. Alaska. ~is '~'--~ day of
19
CONSTRUCTING ENGINE=RS° INC.
SRA Box 60, Anchora(2eo Alaska 9950?
~-25-2002 ~9:llAH FROH E.R. Engineerln9 .~,c~.
CT&E Env~ronmen:~l Se~lces Inc.
5435'997 P.~4
CT&E Ref.~ 1021543001
Oleut Name Eagle l~ive~ Englnetring
~j~ Nam~ ~I~ fi2, ~t 10
~t Sample ID ~ ~2, ~[ lO
O~e~ ~
PWSID 0
Nm'a~e.N
AIl Date~gTIm~ are Alaska Standard Time
Printed Date/Time 03/29~2002 9:57
Coll,.~ct ed Da t e/'l~ me 03/2~2002 16:00
l~.ce]ved DatdT'une 03/27/2002 9:00
U~m Mcd-,~ Umiu Duc D~ l~it
0.2o9 0.200 mg/L EPA 300.0 (<10) 03/'2'//02 ~DT
~i¢~obiolo~y Laboratory
To~l Coliform
coL'lOOmL S~,{18 9999n (<1)
03/27/02 SBH
Jun-24-02 11:04A Perm4t Counter 907 343 8250 P.02
Municipality of Anchorage
Development Servic~ Department
Building S~'c~ Division
On-Site Wattr and Wa.~cwatcr Pmg~
4700 Bragaw Sa'cot
P.O. Box 1966~ Anchorage. AK 99~19-6650
www.¢Lanchomge.~k.u$
PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE
WASTEWATER DISPOSAL SYSTEM
This agreement is made for the purpose of maintaining an on-site wastewater disposal system on
the subject property.
The property owners agree to the following:
Submit to th- Mvnicipality of Anchorage, on a~: am.ual basis, an inspection and operation
statement from a registered professional engineer. This inspection and operation statement shall
verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any
deficiencies have been repaired and that the system is functioning as designed.
(Signature)
(Signature)
(Printed Name)
(Printed Name)
(Notary Seal Here)
COUNTY OF
I certify that I knOw,or have ~atisfa~tory evidence that
~-v~ /~ /~-~e~ ~ //t~~ ~' ~ is the person who
/appeared before me, an~said person acknowledged that (he/she)
signed this instrument~nd acknowledged it to be (his/her) free
and voluntary act for the uses and purposes mentioned in the
instrument.
Dated: ~ ~ O°°~
th State
Notar~P~ub, lic~ iq and for e
Residing at: ~/~
.......... : appoxnt expires~ ,-.~--~F
VIRGINIA GOERZ
NOTARY PUBLIC
STATE O~.,W~SHINGTON
OOMMISolON EXPIRES
JANUARY ,15, 2004
APPLI?' NT FILLS OUT UPPER HA ONLY
Property (~'ner _:~ '~(..2d..~ '? (~.)2.,~? % /~.~.~: /_~ /~ .~ Phone
7
Lending Institution G C~ ¥9 ~(~._ X I ~ C'~ Phone
Phone
Realty Co. & A~nt
/
Address 1/~? Zip Code
Legal Description ~ )~ [~( ¥ [ ~ ~
Street Locatim
T~of Resi~nce ~
~ Single Family
~ Multiplo Famll~ ~o. o[ Bodroo~
~ Other
r Supply
,,~ ~ ~C~ A~ACH WELL LOG. A w~l log is requ,red for all wells drilled s,nce June 1975.
Individual
~ ~[~ For wells drilled prior to that date. give well depth (attach log if available).
Community
~ Public Utility
Individual ~ ~ q~ ~-~q ~ -q ?~ Year individual Installed:
~ Public UliliJy When Connected ~o Public UliliJy: ~-~
~ Holding T~nk
NOTE: THE INSPECTION FEE ~UST ACCOMPANY EACH ~E~EST BEFORE ~OGESSING CAN BE INITIATED.
Time Time
Date Date Date ~ Date
Inspector InSpector Inspector Inspector
~ ~ ~ ,? ' MUNICIPALITY OF ANCHORAGE
. ECE! ED
( ~ APPROVED BEOROOM8 'GONDITIONS OF APPROVAL
(/ ) DISAPPROVED
DATE ~'~ ~
SOHS ~fing D~e ~we~ ~ns~Hed ~eH To Absorption A~e~ / ~ ] We~ Log ~eceNed