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HomeMy WebLinkAboutMUIRWOOD PARK BLK 4 LT 2Mu i rwood Park Block 4 Lot 2 #011-422-79 Municipality of Anchorage Page 1 of 3 Development Services Department On -She water and wastewater Program 4700 South Bragaw Street P.O. Box 1966W Anchorage, AK 99519-6650 www.ci.anchorage.akus (907) 3437904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 57W0203,98 PID Number. —011-422-79 Name: Crown Pointe Inc. Wastewater System: New Address: 5400 Abbott Road Anch., AK 99507 ABSORPTION FIELD Prom: Number or eearoana. Deep Trench 345-6277 Four 4 LEGAL DESCRIPTION Sai Rating Total Depth from original grade: .8 GPDIFfs 10 Ft. Bbble Lot: SuOdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 4 2 Muirwood Park 2 Ft. 8 Ft. Township: Renew Scion: FYI added above original grade: Gravel Length 2 Ft. 50 Ft. Well: Municipal Water System Gravel wdor 3 Number or Ynes: 1 Distance between Ines: Ft. FL Classification (Private. A, B. CK Total Depth: Cased to: Total absorption area Pipe Materiel: Ft. FL 800 Ftp ASTM 03034 PVC Ekillw. Date Drilled: Static Water Level: smaller. Date Installed: Ft. Sanders & Sanders 10/232002 vaso: Pump Set at Calling I eight Above Ground: TANK C -PM Fl. Ft SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ other. To Septic Absorption d.ift Holding ublic/Private ManulacALver.Capacityn an From Tank Field Station Tank sewerune Anchorage Tank 1,250 Visit >209 >200' N/A N/A >25' Materiel: Steel Numbs o/Comprbne W: Two 2 Sufacewater >100' >100, N/A N/A LIFT STATION — NONE ON LOT Lot Line >5' >19 N/A N/A V -G-im Gal. MantilacOxer. F�aadation >5' >10' N/A N/A 'Poop off' level at •Pump otr level at: High waleralann at hn In. None Noted Pump Make 6 Model Electrical Inspedlons performed bir C1rta'in Drain Stemadw: BENCH MARK Location and Descnptor Garage Slab. Anuned Elevation: 100.0 FL Engineer's Stamp •••�aaallll OF "44 ., • ••• s. Inspections performed by. A. Harala Dates: 10 10/23/02 2"d 10/23/02 /. ; MICHAEL E. 7NDERSON Department of Healt rid omen Services approval kW, •.+s��.,�r CE -4381 t ; \= _ and approved by: �y. Date: Sst d •• 'CQ • w� ...+„e�E 4s •y ESSt�:.•` �Rev'iewed � /,, llllaaa�� rn M N N O I' N ,9Z'69S=a ,Ll'£9�1 ,96'LOL 3.00,00.00 N o 'IVIS3 '3 V '1 ,0l a O a. Z 0 IL 1`0CL "�..' %q• i ;��••y -,.rte MW . 10 j Wt�D a m .-n N v a n ��annaaoo 0 * •1�6'• v rf f o� N.•mss ..... _ r a W? IR ao to m n o o n • �} •h•��Ikua G cm �` h N N V U V N OldN 0 O '� N C W W w �Cl)• $ O O>O W X-°° c y Co U)Q N 0 �` Z J n c�Z om Z 4 E « ��-� uE « °a «: W II W 3 W rn m s 3 ® i r- Q m N J c0 Q w� © a H Z U Ul 0 v U _ O C u J MN N V u a to 3 0 U) .9 VZ1-1 ,lCM 3.00,00.00 N ,00'0££-21 E o Z w 313813 1S3M NNVd m a 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.SW020358 PID No. 011.422-79 MCKFILL P Z N U S U 50' Trench Length 2 ••0� S'E NO. CE 1�9RSON PROFILE AS -BUILT ♦ sr •. .' Scote: 1" - 10' ��i e`• ................••:: f 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 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW020358 Legal Description: Muirwood Park Block 4 Lot 2 Design Engineer: 0014 Anderson Engineering Owner Name: Crown Pointe, Inc. Owner Address: PO Box 112313 Anchorage , AK 99511 - This permit is for the construction of- n-,' Disposal Field ❑✓ Septic Tank /0/Z3 Co. Il: sam" /O%3e -�)PNl Date Issued: Sep 18, 2002 Expiration Date: Sep 18, 2003 Parcel ID: 011422-79 Site Address: NHN Lot Size: 40039 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 ❑ 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. Received By: Issued By: Date, 4?/C:;Z IV IN =007 W1.5 i -� 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/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. d //- oz -L — 71 Permit Number SW0203.5"9 Property owner(s) Crown Pointe, Inc. Day phone 727.8167 Mailing address (1) P.O. Box 112313 Anchorage, AK 99511 Mailing address (2) Zip Code TacVK . Legal description (Lot, Block & Sub'd.) Lot 2, Block 4, Muirwoodigubdivision Legal description (Section, Township & Range) Lot Size q0 ID39 Acre q.Ft. Number of Bedrooms Four (4) 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 ❑ I 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. Y.�j��L 4 a4"�� (Signature of property owner or authorized agent) op Permit Fees: . Date of Payment: - D Z Receipt Number: (Rev. 12100) Waiver Fees: Date of Payment: Receipt Number: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) September 13, 2002 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2, Block 4, Muirwood Park Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 2, Block 4, Muirwood Park Subdivision intends to construct a four- bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic system to serve the new home. The attached Site Plan and backup documentation Identify the location and configuration of the new septic system and alternate site and the parameters used in the design. Also Identified on the plans are the proposed water service line, test hole location and the locations of the facilities on the adjacent properties. Drainage arrows are also shown and current drainage patterns will be maintained after construction. The test holes placed near the location of the proposed absorption trench indicated fine sand with a fairly large amount of silt to a depth of 5. The sand below this level became well graded and contained substantial amounts of gravel. The new absorption trench will be placed in both soil strata so we have used a blended application rate of .8 gallons per day per square foot. The percolation rate in the upper layer ranged from 20 to 40 minutes per inch. The lower layer was much faster and percolated at a rate of 1 minute per inch. No ground water was found and none was noted during the monitoring period. We are therefore proposing to construct a deep absorption trench system with a 50' long trench with an 8' effective depth. The distribution piping depth will be 2' below the surface. Total depth of the trench will be 10'. The ground surface on the lot slopes at shallow grades from east to west. The absorption trench will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. All components of the new septic system will be constructed a minimum of 10' from the water service line on the lot and on the adjacent lot. The system will also be constructed a minimum of 100' from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: Lot 2, Block 4, Muirwood • September 13, 2002 Page Two 1. 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. The subdivision is currently served by the Municipal water system. 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, nn Michael E. Anderson, P.E. Attachments ;.49 M'CMAEL E. ANDERSON No. CE -4391'••( y. �1; ........ FO a� _ .��aaag66 ro 49 L/ICHAEL E. ANCERSON �1 ;:�% NO. CE -4381 r' : 414,,pROF This ,Project VACANT I+, ' 590 QO'oo"E.: j':': .i,:�.;i',•;.A ��• 3 LA \ v 12 �•;'' ,Q�; ,�"�•.'\ �`'...: �`,; '.� IJV SQ / S1 TH-16 `♦ ~'.:t i.'; '::• ,t'..' \ \ / 52 OD z : 4o•3aa.aq.ri:, i+ S3 \ nr CPO Cr � pW.• + .;• 34 51A`.50Z \ • 'L'=45:1.5' .� CV. �iH`•ia" •1- s• �3g8`,••R=66,0;00z z 3 R=50.00TH '.::::1., 00 S 9'5012 i +• Vi 50.00' A+ : ` • •.. 'A ,+ • 55 \ \ + 1 �152182 }✓%'i. 4., sCP, � \ o L= 9 33 ; F ' a�%`- °: : R n(99100 40,039- s'. IL 1 ': ;'° :� "t '' • iO ' ` ✓ ORS 0,00 �._. ♦ is ' `- Z =32.18. -A - OF A 1t �\ 01 114- 9' :.; �,.%Q•• f•"� o of .+ 41; 07 sq•It. N p 4 J ONO t �NOI 3 , 'VACANT ! N90.00'00"E v �O F O N a � F s W SCALE 1" =100' .��aaag66 ro 49 L/ICHAEL E. ANCERSON �1 ;:�% NO. CE -4381 r' : 414,,pROF This ,Project VACANT I+, ' 590 QO'oo"E.: j':': .i,:�.;i',•;.A ��• 3 LA \ v 12 �•;'' ,Q�; ,�"�•.'\ �`'...: �`,; '.� IJV SQ / S1 TH-16 `♦ ~'.:t i.'; '::• ,t'..' \ \ / 52 OD z : 4o•3aa.aq.ri:, i+ S3 \ nr CPO Cr � pW.• + .;• 34 51A`.50Z \ • 'L'=45:1.5' .� CV. �iH`•ia" •1- s• �3g8`,••R=66,0;00z z 3 R=50.00TH '.::::1., 00 S 9'5012 i +• Vi 50.00' A+ : ` • •.. 'A ,+ • 55 \ \ + 1 �152182 }✓%'i. 4., sCP, � \ o L= 9 33 ; F ' a�%`- °: : R n(99100 40,039- s'. IL 1 ': ;'° :� "t '' • iO ' ` ✓ ORS 0,00 �._. ♦ is ' `- Z =32.18. -A - OF A 1t �\ 01 114- 9' :.; �,.%Q•• f•"� o of .+ 41; 07 sq•It. N p 4 J ONO t �NOI 3 , 'VACANT ! N90.00'00"E v 272:87;� 1 i'•.,1. 40431•'•�3g:ft "�' • :': ' S1 :t T. IH-10rrl 0, 4 61 V66 ls§JC r w r y fE' o .1 o j 62 VAC . ANT4o,bo1 svrr rn' . a'.,`•,' z\, L=3,.42 i1 `. R=20.00: ' 238.51 )0'•' 50.0 \ `ac �,, , : •' ,'+.; \ 00"w 485.01" (R&M) ` KINCAID ROAD s - -_----_-_- -_ „�.e: • T --M.R OL 5�..••• .. AIOA 272:87;� 1 i'•.,1. 40431•'•�3g:ft "�' • :': ' S1 :t T. IH-10rrl 0, 4 61 V66 ls§JC r w r y fE' o .1 o j 62 VAC . ANT4o,bo1 svrr rn' . a'.,`•,' z\, L=3,.42 i1 `. R=20.00: ' 238.51 )0'•' 50.0 \ `ac �,, , : •' ,'+.; \ 00"w 485.01" (R&M) ` KINCAID ROAD c L=63.17' R=589.28' S 00000'00"E 107.96' r -- r �. -- — -. — -- — — — — .- -- -- -. — — — — — — .- -- W dp z Na O<v -- a WO \ Z Z r / may, , V N Y w w (� U M o OLL: N MCD x / -� _-_ 0� p MD CO N 44.6' Z 4L � Four Q x; Bedroom, O O a� home K bi l o O 47.61 6' z a 44. 11 Gallo 1 - Se tic flank x -Z------ e �. o n x 33' 1 oa � . C'j, 49th 9'. MICHAEL E. ANDERSON No. DE -4331 ♦/f �hFO ESStUT::4 504 ng�x 3' 88 Eff. ^� ®g TiI® 'WIDepth Abs. Trec d iter Alternate , Service Site o Fed L=12.16' S 00000'00"E 126.71' R=330.00', o PARK WEST CIRCLE - C ITC 01 AAI SCALE 1" = 30' LOT 2, BLOCK 4, MUIRWOOD PARK SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 1 -40 Min./inch 1,250 Gallon Septic Tank Avg. Application Rate: .8 GPD/SF 8' Drain Field Rock 4 Bedrooms X 150 GPD 1.8 GPD/SF = 750 SF of Absorption Area 750 SF/16 SF/LF = 46.9 LF Trench Length Therefore: Construct an Absorption Trench 50' in Length by 3' Wide With 8' of Drainfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 2' Below Existing Ground. Total Depth of Trench to Be 10' Below Existing Surface. Cover Over Septic Tank a Minimum of 4' or 2" of Insulation and 2' of Cover. Natural 116" Backfill 6" TA ♦ Q e 81011 3' r Geotextile Fabric 4" Perforated PVC (ASTM 3034) Drain Field Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' From Lot Line. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. Minimum 10' Separation From Water Service Line. PT (2') SM (31) Perc. Rate 20-40 Min./Ii SW/SP (51) Perc. Rate 1 Min./In. �i • 49th iAEL E. ANDERSON JW I No. OE-e38i i �S�� .�' ESSIT-moi Municipality of Anchorage Development Services Department/On-Site Water and Wastewater Program 4700 South Bragaw Street, Anchorage, AK 99516-6650 SOILS LOG - PERCOLATION TEST Performed For: White Raven Development Date Performed: Legal Description: Lot 2. Kincaid Park Subdivision SLOPE SITE PIAN 1 2 4 5 6 11 14 North PT/0L South SP/SW 1/22/02 Was Groundwater 257. Some Encountered? No s : -': t 1L=63.17 22.16 40025 sq:ft. ` R=589.28, L Cobbles Depth to Water R=330.60 ; After Monitoring None i n+-9 E 12:05 n / 40,039 sa f6 7.75" 12:07 N® 6.63" 12:27 20 7.63" 12:28 6.75" Was Groundwater Net Time Some Encountered? No S 3/4"-5" If Yes, What Depth? L Cobbles Depth to Water 0 After Monitoring None P Date: 2128/02 E 15 Major Sloughing 16 17 . 7F Bottom of Hole Perc. Rate: 20 MinJlnch Perc. Hole Diameter: 7" Test Run Between 4.5 R. and 5.5 Ft. Comments: Test Cavity was Presoaked Prior to Test. Performed By: Alan Harala_ I, Michael E_ Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 312/02 Reading Date Gross Time Net Time Depth To Net Water Drop 23-Jan11:24 6.75" 11:44 20 7.88" 11:45 6.75" 12:05 20 7.75" 12:07 6.63" 12:27 20 7.63" 12:28 6.75" 12:58 20 7.75" Municipality of Anchorage :agt� ' w ......» .. ... t..• Development Services Department/On-Site Water and Wastewater Program ;1 t . „y... •;{ 4700 South Bragaw Street, Anchorage, AK 99516-6650 A'. MICHAEL E. ANDERSON 4 SOILS LOG - PERCOLATION TEST �i:,p% No. CE -4381 f- 1� Pfd •.......... - "P\ Performed For: White Raven Development Date Performed: 1/22102 ���%`5;:•`�` Legal Description: Lot 2. Kincaid Park Subdivision SLOPE SITE PLAN North 1 PT/OL s 3T, 2 =12.16; 257. i :L=63.17'. R=330.00 40025 sq;ft. ; ` R-589.28; 3P TM -y TESTHOLE NO, 9 Q7r i '2 t` 40.039 sq! It.: '. t 4 i SM f :a: 5 f r o: q '00,000W.61 10 11 1 14 15 SW/SP Was Groundwater South Some Encountered? No 3/4"-5" If Yes, What Depth? Cobbles Depth to Water After Monitoring None Date: 2/28/02 18 Bottom of 19 Hole Perc. Rate: 40 MinJlnch Perc. Hole Diameter. 8" Test Run Between 4 Ft. and 5 Ft. Comments: Test Cavity was Presoaked Prior to Test. Performed By: Alan Harala. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/2/02 P E Reading Date Gross Time Net Time Depth To Net Water Drop 23 -Jan 11:30 8.5" 11:50 20 9.06" 11:52 8.5" 12:12 20 9" 8.63" 3 20 9.13" 4 8.5" 112:13 4 20 9" ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2, BLOCK 4, MUIRWOOD PARK SUBDIVISION GENERAL: I. The scope of this project includes the procurement and placement of a new 1,250 -gallon septic tank at the location shown on the site plan and the construction of a new 50' long by 3' wide by 8' effective depth absorption trench also shown on the Site Plan. The total depth of the trench will be 10' below existing ground and the distribution pipe will be placed at 2' below the surface. All components of the septic tank and absorption trench must be constructed a minimum of 10' from the water service to be constructed on the lot. A minimum of 4' of fill must be placed atop the septic tank and 3' of fill above the absorption trenches. In lieu of fill 2" of direct bury insulation may be placed with 2' of fill atop the insulation. 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. The 1,250 -gallon septic tank must be procured from an approved septic tank manufacturer 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. Lot 2, Block 4, Muirwood September 13, 2002 Page 2 of 2 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: 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 trench 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 2, Block 4, Muirwood September 13, 2002 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 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Oil- 22-79 HAA Expiration Date: 1. GENERAL INFORMATION Complete legal description J..Qt�-2.Bl=k-4.-Mujrvoo4-EacLEuMivieion Location (site address or directions) _Earkwr,.et_Circle_ t =a Current Property owner(s) C.rolwrLPlrIriteJnc. Day phone _7_2Z -&J61_ Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Ila .II irr• :�.i i� 1• .. i• 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 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 valid 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 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 -Andero-ft-En9i1LaddL19 Phone -92 Address - . r :... <, :... Engineer's Printed Name _lAidjacLE,_AnA-rse)n-E.E- Date—5/M20_Q3 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: — - Original Certificate Date: S- 3 (Rev. 12100) Municipality of Anchorage Y . • Development Services Department Building Safety Division " On -Site Water & Wastewater Program ' ` ` " 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-8650 www.ct.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot Z Block, 4. Muirwood Park Subdivision Parcel ID: 011.422-79 a A. WELL DATA Well type If A, B. or C provide PWSID # Well Log (Y/N) _ _ Date completed _ Sanitary seal (Y/N) _ Wires property protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. r FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. i i WATER SAMPLE RESULTS: ' Coliform colonies/100 ml. Nitrate mg.n. Other bacteria colonies/100 ml. Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA i Tank Type/Material Sept Date installed 1012312002 „e/Steel Tank size 1.250 gal. Number of Compartments j Cleanouts (Y/N) Y i Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed 101231202 Soil rating (g.p.d./ft2 or f?/bdrn) 8 System type Deep Trench Length 50 ft. Width 3 ft. Gravel below pipe 0 ft. Total depth 12 ft. Eft. absorption area 600 ftp Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fait) 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 >= g.p.d. i Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date !i c D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump off* level at _ in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift: station on lot NIA Absorption field on lot NIA Public sewer main NIA Sewer /septic service line WA Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots WA On adjacent lots N/A Public sewer manhole/cleanout WA Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >E Absorption field >6 Water main >10' Water service line >10' Surface water >10T Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION C09;•'" . I certify that I have determined through field inspections and review of Municipal records that the above systems are in ; 49th ,` conformance with MOA HAA guidelines in effect on this date. iA`z �.... ................. ....j. ;MICHAEL •E. ANDERSON- Engineer's Printed Name Michael E. Anderson. P.E.�� �,;, No, CE_43e1 Date 5/3112003 ry HAA Fee $ 275 _ Waiver Fee $ _ Date of Payment G - L - 0.3 Date of Payment Receipt Number _3435Z— Receipt Number (Rev. 12/00) in.