HomeMy WebLinkAboutL & T LT 3L+T
Lot 3
#051-282-42
�.. r_._..T. .l
Municipality of Anchorage •• '�•.
Development Services Department = ^r•'' `��•
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Braga'.v SL
P.O. Box 196650 Anchorage, AK 99519-6650 Page, of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEMAND/OR WELL INSPECTION REPORT
Permit Number: 5 PID Number: 05_(— Q — Z1
Name: R`obe'rt ctfer
Wastewater System: W New El Upgrade
Che - 0 773303 Ea to ;✓er ") q 577
ABSORPTION FIELD
Phone: I G-+ Number of eehcoms'
3
O Deep Tnrrch K5>•anaw Trench p Bed O MarA O Cher.
LEGAL DESCRIPTION
Sod plating: I ^
GPOIF,s
Taal Depth rran original grade:
% p,,
Block Let: Subeivisiom L47-
Depth to pipe bottom from original grade,
3 FI.
Gravel depth beneath pipe: /
, 1 /1 FI.
Township: Range: SecSore
..
FJ added above original grade: .F.
Gravel Length: —3
..
• Ft.
U FI.
Well: New ❑ Upgrade
Gravel width
S
Numter Gres:
I
Distance between lines:
Ft.
FL
Classlf=r Cn (Private, A, B. C):
l%I� %
Total Depth:
Z Ft.
Caused to: 1 s R
Ft
oral absarylion ares
3<SOFls
Pi `Material: C
5 / l6
r. F
�(/ k%
Date Dell
d t7 02
Static Water Levet
2- FL
hsta:ler. f
wcQ �xta� ��,�
Data Instated: / / !^Q ^
o^ 6 p(J
Y.e'd: Pump Set at I
7-20
Casing HeigM Above G1=4
2,
TANK
GPh1 FL
LS Ft.
SEPARATION DISTANCES
[Septic ❑Holding ❑S.T.E.P. ❑Other.
To
From
ptic Se
Tank
Absorption
Field
Lift
Station
Holding
Tank
PubUGPrivat
Sewer Line
M M"� , .
e �q5�/mss
capaaty.
lox Gal.
Wet
�1 % 1
1�J,1/D
.^h D \
a
�`
�^
"'1e� +
C—JI 5
Material'
Number of companmenls:
Surface Water
160'+
.�
LIFT STATION
LCI L(re
47%
-71— I
Sae: hlanula=rer,
'Perp on' level at •P;m�cfffrlevei at Hgh water alarm at:
Foundz:icn
aJ�
O_)L
N. h h
Cwtzin Crain
(7�
p
Pump Make d h:cdel :eCrcal Inspacbons perfenned by
Rema`:
BENCH MARK
Locabon and Des=;Lcn: /1
f1
1{.Cio a II
a /� 1\ Assumed E!e bcr..
bo r,1FL
^E-nL,GiL't C(Sa�t2mp
--C OF
.. .
t. 'y..........
♦. r' vLv
17034 Eagle River Loop Road, No. 204
Inspections
performed Dates: 1
2nd I(J
JL�ri7`✓`�++r;.......J
_
Developmen rvices Department Approval
r�r.
�jl •i: R03E ci C. COY.'Ar! i ,�10
c. esoI : ,�•
++4t<
Reviewed and approved by: Date: 2t
r'
;:
tan I_tnl \
PERMIT NO. SW0201 53 PAGE 2 OF 3
DEPARTMENT ANDhHUM9AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Te�l�ephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 3, L&T S/D P.I.D. NO. 051-282-42
!ay Apr/C
apx- `A
LOT 2
NEW 1000
GALLON HOPE—
SEPTIC TAN
K
DBL1 & OBL2-
MT
C
♦T
PIONEER DRIVE
/ --- 208-L.M.RESERVATION EASE/ENT/TE& ELETRIC EASEXISTING3 BEDROOMHOUSEFCO BT._wC01
h'
SCALE: 1" 50'
a'.
-,-3 Is
ROBERT C. COWAN
% CE .8801 , \•,
PERMIT No. SW020153
PAGE 3 of 3
Municipalit of Anchora e
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Te�I hone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 3, L&T SSD P.I.D. NO. 051-282-42
ST 1 ST2 �-- 98.9'
FINAL GRADE
NEW
95.8 1000 GALLON
POLYETHYLENE
SEPTIC TANK
CO1
CO2 MTl lcol = 99.4'
CO2 = 98.9'
i -FINAL GRADE
INSULATION
•
Slit
MTI = 91.4'
NO WATER FOUND
8+4' B.O.H.
2" INSULATION
95.5'
N. T. S.
C),
�.Gr�
Municipality of Anchorage t'%-.,'jL>NGINEER:§'t9EALy.-- it
Development Services Department
Building Safety Division 1 , ,• .y •e.-
y�. On -Site Water and Wastewater Program
4700 South Bragaw St. �'•... «^'"' 'r' `"'^: ` r
P.O. Box 196650 Anchorage, AK 99519-6650n i RceEaT
www.cl.anchoraae.ak.us
(907) 343-7904 +tit `'� •. �� `.�
J..
?�VfollTsl,'o
IOL ion Test
Performed For. 2 l Date Performed:
Legal Description: L..3-�5 /10 Township, Range, Section:
15-
16-
17-
18-
19 -
COMMENTS
Q�
(�-/)/�/D.
'S ct�
WAS GROUND WATER
/�
ENCOUNTERED?
/V0_
/ V
5
IF YES, AT WHAT DEPTH?
L
P
Depth to Water Aker
Monitoring?
f�(�
�/� 7 -- E
Date:
'p 2�
Site Plan
Reading I Date I Gross Time I Net Time I Depth to Water I Net Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutesnnch( PERC HOLE DIAMETER _
FT AND Fr . /
/ L &elt L L- A/'OcJ/ Q -e
PERFORMED BY: S & S ENGINEERING I ��...� CERTIFY THAT THIS TEST WAS
PERFORMED IN ACtRfi9111>vA�f4A 0► IPA GUIDELINES IN EFFECT ON THIS DATE. DATE: 'G//S �0 2
Eagle River, Alaska 99577
�'y'.-""^�"A'^/-�4"-.�'.'^^twwrA'^�.r^v.a....+.�.r..mv:C�..r�'v.�. �...v •^'A^^7-•....--..•�-.rte.-.-.+.-.--.+,-.---•�..•.--.r.-.�.a....,...v...,� _
I
A
OWNER OF LAND: &0164 I 1 rt 0f rrg, BORE HOLE DATA
Certiff eb ;Drilling log
by
DOC CO. dba -
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 TELEPHONE 688-2750
ADDRESS:44
LEGAL DESCRIPTION: �_� � o r 3
DATE:
PERMIT NU BER: -I Date of.ig�,�.._
TAX IDENTIFICATION NUMBER:_- [��-
Is well located at approved permit location? SYes U No
Method of Drilling: it rotary -J cable tool
Depth of well:
Casing Type - e S� Wall Thickness d 5�4 inches
Diameters inches, depth r� feet
Liner Type: t'�s)-J�
Casing Stickup Above Ground: d • feet
Static Water Level: / a feet
Recover Rate: I o gpm n
Method of Testing: � 1 N J »'1,0
Well Intake Opening Type: U open end �n hole
1- Start feet Stopped feet
� Greened
U Perforations Start _ feet Stopped feet
Grout Type: ac.J7l"f � ff r Volume CHI 4S
Depth: from D feet, to a feet
Well Disinfected Upon Completion? &�s O No
Method of Disinfection:
Comments:
DEPTH
Frt,m To
Driller'$ Name I/7, 1 s
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation.
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 / WATER SUPPLY PERMIT
Initial
Permit Number: SW020153
Legal Description: L & T LT 3
Design Engineer: 0003 S & S Engineering
Owner Name: Robert A. Shafer
Owner Address: PO Box 773303
Eagle River , AK 99577 -
Date Issued: Jun 07, 2002
Expiration Date: Jun 07, 2003
Parcel ID: 051-282-42
Site Address: 018318 PIONEER DR
Lot Size: 51476 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.
FV Disposal Field Q✓ 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
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.
5. The following special provisions.
AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL
SOILS/PERCOLATION/GROUND WATER MONITOR TEST IN THE VICINITY OF THE PROPOSED ORIGINAL
AND REPLACEMENT WASTEWATER ABSORPTION FIELDS.
Received By:
Issued By:
Date: 6 % 0?�
• Date: Z7 Loz
• 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.ek.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D�5 l — 02139- - ya Permit Number SWQ?,Q.a3
Property owner(s) & . 9 6 a.� t4z' Day phone log 4 - Z l $ S
Mailing address (1) 0 0>' —77 330 3 ='� �� /0v< ,r<
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) o} i �- a S LX ►.51 O R
Legal description (Section, Township & Range)
Lot Size 55±��t -Aeres/Sq.Ft. Number of Bedrooms 3
Sl, �{-71P
THIS APPLICATIOON IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub „) I ❑ Jacuzzi ❑
Swimming Pool 1`r/ ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above 1 ration is orrect. I further certify that this application is being made for a
Single Family Dwellineand is in ac rdance with applicable Municipal Codes.
(Signaturer y ow or authorized agent)
Permit Fees: im Waiver Fees:
Date of Payment: boZ Date of Payment:
Receipt Number: c2�07 42 Receipt Number:
(Rev. 12/00)
HEALTHAUTHOR TY
APPROVALS
SEWERS WATER
MAN EXTENSIONS
SEWER d WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELLINSPECTION
6 ROW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL6
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER P.E.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
June 3, 2002
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 3, L & T S/D
It is requested that you issue a permit to install a well & septic system to serve the
proposed three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
of the test hole is located on the attached site plan. At the time of excavation 1/29/87 water
was not found. After seven days of ground water monitoring the test hole was found to be
dry.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent.any future development on any of the adjacent
properties.
If you require
Enclosure
Shafer, P.E.
information, please contact us.
17034 NORTH EAGLE RNER LOOP • SUME 204 • EAGLE FINER ALASKA 99577
DESIGN CRITERIA:
3 BDRM = 450 GPD
SOILS = 1.2 GPD/SO.FT.
450/1.2 = 375 SO.FT. REO'D.
TRENCH CRITERIA:
7' DEEP
4' EFFECTIVE
5' WIDE
38' LONG
-------------
elecom & Elect Esmt — — — —
o,aRE �C
r
IN
STRUCTURES, EASEMENTS, OR ENCROACHMENTS TH
SHOWN ON IS SITE PLAN ARE AS SHOWN ON
AN AS–BUILT SURVEY DRAWN BY:
WILLIAM D. FLEMING
IT IS THE RESPONSIBILTY OF THE CONTRACTOR
TO VERIFY EASEMENTS, REQUIRED SEPARATION
DISTANCES, AND PROPERTY LINES PRIOR TO
CONSTRUCTION.
PIONEER
• TH (S&S
MIN. 25'
SIDE YARD yI
�R'4C
DRIVE
CONTRACTOR IS REQUIRED TO
OBTAIN UTILITY LOCATES
PRIOR TO ANY EXCAVATION
WORK.
ALL PORTIONS OF SYSTEM
WITH LESS THAN 3.5' OF
COVER REQUIRE INSULATION.
_ I
- _-----
MIN. 50'
FRONT YARD
TH wc) WELL
/
H
100'
100.E
�=
vVA104
PROPOSED
BEDROOM
>>
HOUSE 1
100'
WELL RADIUS
LOCATION)
����
A!�J.
4s A,'
%
v� �o
(APPROXIMATE
INSTALL
\
CO T
MIN.
50'
BACK
YARD /
o
/ <
<<
A
17034 EAGLE RIVER LOOP ROAD
EAGLE RIVER. ALASKA 99577
PHONE# (907)694-2979
FAX# (907)694-1211
LOT 3,
liuwr� nr:
J.H.M.
T SUBDIVISION
4402
/
tic
/'
EW 1300 GALLON/
48 25%+
HDPE SEPTIC TANIy
/
INSTALL
DOUBLE
/
CLEANOUT
/
NEW TRENCH
/
/
/
'
yop'44'..
/
1 OF OF 1 1 1" -
...„......r..
1457.1
a••wM••.it` A'
FA/ -1112 11:041 Free-FILTEITIAL JACK 11011627111 1-660 VQCl/604 F-112
tent By: Alaska Water and Wastewater tion; WI Y.w az+o; Peo•io•uid lswo; r■ge old
ALASKA
WAT�R
CONSULTANTS.
& WASTEWATER
INC. s�:• ': f
0 ...........
'
L=DESCRF110N:
L k T 6 ml
n tm 3. a e A...
air '• "�� }
PERFORMED
FOR:
IKVXJOIW
�f
W DAR: ZrMIZOWCEPTH
ORGANICS
eet
=_-
HOLE I b��0teeiee�
WIL 91 SSIFICAMONS
GW ORG
J
GP ML
TO
GP
GP /SP
cc CL aka Did.
Still mm
,� ,•..
CH / ,
Sm OtHi
!
a
ee mow.
ScSIM
7
:•
G. Oft DYIATER DATE
a
r
DRY
.w
Dar 1:t soos ,
10
•w;; t
DATE READING CLOC4 NET TIME WATER LEVEL
TIME (M!NUTES) REAPING
NET CFO?
(INCF@S)
11::'
Y^�t
GP/SP
W/ SOME
uj1
SILT
(MORE SILT
S
01
W/ DEPTH)
G
n
EO 5
t6
,V
to
ea,+t
20pti OF �{A
1T
2�.y\
,e
RCOLATION RATE <1 MIN./INCH) PER.:. HOLE CIA a ONCIES)
19
EST MIN BETWCEN 7A FT. AND M T.
2CL
FOX HOIR PRESOAK WAS PE;wmR *D: ❑ YES ONO
SO:Ls
LOGGEO
BY:
PERCOLATION TEST PEWMC IEC 9Y: CALEB CALL
CCMMENTS.•
MM WM SOILS
W LL A-7 AS A tAND FUM
. .
AW.wINC. G
DTREY A. QARNESS. CDU" TWIT TNZ ERFORIJED IN ACCOROANCE
PERFOED
RM BY
WITH ALL
S ATE
AND ICIPAL
IDELWES IN EFFECT ON THIS DATE 2
oe
Municipality of Anchorage
PARTMENT OF HEALTH & HUMAN SERVICES
825 ••L" Street, Anchorage, Alaska 99502-0650
SOIL§ LOG — 0EAcoLATION TEST
No. 140.1 :
`� ��X0•FE$5 �
DATE PERFORMED:
LEGAL DESCRIPTION: -L bs 3 L4 Sij&b. ToWnship,flange, Section: 2a -&j P/�../ Sty y
DEPTH�Z_ �,//t.5 SLOPE SITE PLAN
FT
1 S j'''t
2
GP
3 I�brH /3nue.,�dX
�� q"- Ibr•
4-
6
6-
7-
7e0
8-
A;
t0
12
% Q
13
14
15
is
17
18
is
4 •
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED? �I�t
S
IF YES, AT WHAT L
DEPTH? of A - p T
E
oto to !Yater An
Monitoring? nada
Reading to Gross Net Depth to Net
Time Time Water Drop
� I I 1 I• I
PERCOLATION hA7E (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN _ FT AND
0 T
S & S ENGINEERING
PERFORMED O: CtRTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH Itt7141X1MNA1 &(99AM3UIDEIINES INE ECT ON THIS DATE. DATE: 8
72-008 (Rev. 4/85)
nG
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907) 694.2979
FAX (907) 694-1211
HEALTH AurHMTY
ON-SITE WASTEWATER DISPOSAL SYSTEM
APPROVALS
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
WATER
SEWERMATER
AWN EXTENSIONS
REFERENCE: Lot 3, L & T Subdivision
June 3, 2002
SEWER Q WATER
INSPECTION
GENERAL:
1.
The scope of this project includes the installation of a 1300 gallon Premier
ENGINEERINGSTUOIES
polyethylene septic tank and a new trench to serve the proposed three
ANDKMATS
bedroom residence located on the referenced property.
2.
Construction shall be in accordance with the approved site plan and design
WELLINSPECTION
drawings, Municipal permit with any special provisions or conditions, and all
a FLOWTEST
applicable State and Municipal Wastewater Disposal Regulations.
3.
The contractor shall be responsible for obtaining any necessary underground
SITE PIANS
utility locates.
4.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
ROADDESIGN
5.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
SOILTEST
own systems must also receive prior approval from the Municipal Health
Department.
PERCOLATION
SEPTIC TANK INSTALLATION:
TEST
1.
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
STRUCTLIRA IL
AECHANICAL
INSPECTIONS
2.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
r
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP 0 SUITE 204 • EAGLE RIVER. ALASKA 99577
Page 2
Lot 3, L 3 T SID
June 3, 2002
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
of the monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 3
Lot 3,L&T31D
June 3, 2002
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of PiM Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
. Page 4
Lot 3, L & T SID
June 3, 2002
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
Municipality of Anchorage
oa s
• Development Services Department
Building Safely Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, Am 99519-6650
www.ci.enchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-282-42 HAA#
.Expiration Date: 17-10-03
1. GENERAL INFORMATION
Complete legal description Lor 3 T. Iv T S„hrl ivis inn
Location (site address or directions) corner of Carlisle & Pioneer Drive
Current Propertyowner(s) Robert Shafer
Day phone
694-2185
Mailing address 17034 N. Eagle River Loop Ste 202 Eagle River, AK 99577
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless offierwise 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
3
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
B
Individual On-site
a
❑
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.) Certirt6las are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicated herein. I furtlier verify that based on the Information obtained from the
Municipality of Anchorage files and from my Investigation and Inspection, (tie 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 S & S Engineering Phone 694-2979
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan Date 6(/G/o3
�`(, OF
S. DSD SIGNATURE 1 1 ROBERT C. COWAN f ti
`�� • C.-8801 ``�'%
Approved for _ bedrooms.,rl��,� s%wi
Disapproved. t�y�;S%ti
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
By: + Original Certificate Date: CO 03
(rtes. 12M)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L-07- L 4 T s 1A Parcel ID: OS/
A. WELL DATA
Well type PRiv,fr&
Date completed6h7/42
Total deptha 4 D ft.
Date of test
j Static water level
Well production
i
If A, B, or C provide PWSID # —
Sanitary seal (9/N)y'/1
Cased to i:1—ft. ro A R,
FROM WELL LOG
6/1 -)/aa
WATER SAMPLE RESULTS:
la
ft.
%-7 g.p.m.
Well Log `JN) Y e 1
Wires properly protected 6)N) YC Jr
Casing height (above ground) 3 0 in.
AT INSPECTION
g.p.m.
Coliform n colonies/100 mi. Nltrate0'2- tL mg./I.
Arseni ' ' o� 1 mg./I. Date of sample: S"/» /0 3
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SE 40r I c- I/ fl O N E
Tank size 200 0 gal. Number of Compartments 2
Foundation cleanout (O/N) Yw !! Depression over tank (YO Nv
Date of pumping roti - %4 4/ Pumper
C. ABSORPTION FIELD DATA
Date installed 611 C/c Z
Length 3 '9 ft.
Soil rating .d./ft r ftZ/bdrm)
Width .Sv
I. DL
ft.
Other bacteria O colonies/100 ml.
Collected byl3 & S ENGINEERING
17034 Engle River Loop Road No. 204
Engle Rive/1(.,/c)-2-
r, Alaska 99577
Date installed 6 / 16 /o Z
Cleanouts ON) Ye s
High water alarm (Y& w o
SN^«ow
System type 7-44cN a.M
Gravel below pipe # ft.
,
Total depth i 4ft. Eff. absorption area 38D ft' Monitoring tube yts Depression over field N0
Date of adequacy test ✓ 1 A " """' Result ail) Far 3 bedrooms
Fluid depth in absorption field befo esr in. Water added_ gal. New depth_ in.
Elapsed Time: Final fluid depth _, in. Absorption rate >= g.p.d.
Any re' ation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Ma ss (Y/N)
"Pump on" level at :in. "Pump off" I _ in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1 ab On adjacent lots /D o
Absorption field on lot j a ° On adjacent lots 10 o t
Public sewer main N A Public sewer manhole/cleanout .014
Sewer /septic service line a s Holding tank ^/ A4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundationl a r Property line T Absorption field 7
Water main 1J 1.4 Water service line /0 t Surface water J00 �F
Wells on adjacent lots ) 00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i Property line 'y S Building foundation IS Water main D1 A
Water Service line l a �� Surface water 0 '*Driveway, parking/vehicle storage So f
i
Curtain drain NoN Wells on adjacent lots 10 e7 y
F. COMMENTS
G. ENGINEER'S CERTIFICATION
i
I certify that I have determined through field inspections 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 as t /LT C. cowAN
Date G /6 /'0 3
HAA Fee $ 3 7J`. ° o
Date of Payment e / t to 3
Receipt Numbery 3 0-7 a L
(Rev. 12/01)
p \ROBERT C. C6NM f
tci� :4 U 8301 ;
Waiver Fee $ _
Date of Payment
Receipt Number
j•w���'•M!/4.{i/1..fvY.YL.YJ�1!!Ji•°�MMJIJW. L:.....�. �.n _
JUN -09-2003 11:26 S&S ENGINEERING 907.'694'1211 P.01
ppppr�,,. CUE Environmental Setvlccs Inc. .•,�''
OMr rrr�r�rrar.�I�r✓rr,.rp✓meq✓°. .. • . .. � .. •� !1`
7
CM ReL11
1023846001
Client Name
Anchorage Well &, Pun)p Service,
Project Namd9
-Glenn L. 3 �. 0 j
Client Sample ID
Shaffer
�1=trlY
Drinking Watei
Ordered By
MISID .. ..- -
0 - ._ .. _.. .
Alt Dttesnimes are Alaska Standard Time
Printed Datelrlme 07/0112002 14:53
Collected Date(rlme 06/2612002 12:00
Received DateMmc 06,Q712002 0:35
TeehaicaiDirector Stephen C de
._ Releeseii
Sonple Remarks:
Allowehto Plcp
Analysis
Prrstwer
Results PQL
Units rlcthod
limits Date
Data Init
Metals Department
Arsenic
0X011:1 0.00100
mg/l. EPA 200.9
(<0.05) 05/2992
07/01107 IMP
waters Department
Nitrate•N
0.21x) U 0.200
rng/L GPA 300.0
(<)01
00/27/02 JDT
Microbiology Laboratory
Total Coliform 0
F'
' col/tUOmL SM l � X2228. '
r�
(<t) 06127/02 )CAP
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