HomeMy WebLinkAboutAUTUMN RIDGE LT 16Autumn Ridge
Lo1' ].6
#015-054-19
Municipality of Anchorage
Development Services Depadment
On-Siie 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 AND/OR WELL INSPECTION REPORT
Permit Number:
Crown Pointe, Inc.
5400 Abbott Road
-~45-6277
SW020025
Anch., AK 99507
Five (5)
LEGAL DESCRIPTION
Autumn Ridge
Well: New
Private ~..o~, 243. n. 240.7
M-W Drillin§ 4/20/2003. 203 n.
I
25
2 r~
SEPARATION DISTANCES
Septic Absorption Eft
Tank Field Station
w,, >100' >3.00' N/A
s~,,~w,,.>lO0' >100' N/A.
>5' >3.0' N/A N/A
>5' >3.0' N/A N/A
None Noted
PID Number: 015-054-3.9
Wastewater System: New
Page 3. of 3
ABSORPTION FIELD
Deep Trench
.8 c~o~ 9
Ft,
FL
2.5 ~:,. 60
3 .. 3. ~,.
960 n' ASTM D3034 PVC
Sanders & Sanders 2/20/02
TANK
~ Septic n Holding ri SiT.E.P. J'-J Other:.
Tank Se~,ert.ine Anchorage Tank ~ 3.,500
N/A >25' Steel I Two (2)
~o. LI . - NONE ON LOT
BENCH MARK
Top of Finished Floor
300.0
Inspections performed by: Tim Kimbrough Dates: 1" 2/20/02
2''~ 2/20/02
Department of Health, ~,nd Human Services approval
~v~edandapprovedby~/.~//'/~/"~ ~/~, /4~)~t~Date: C~'"/"~-.-°~::~2--
Engineer's Stamp
.x............~.~
4gth [\ '-,~ *
Page 2 of 3
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
Permit Number SW020025
PID No. 015-054-19
10"t ~ E.
ZIULAK
CIRCLE
1"=40'
A B
S1 25.9 32.7
S2 33.6 39.2
C4 63.6 67.0
M1 106.4 78.4
C5 112.4 83.7
49',h
No.
$1
C4
----, /
B~8~oo~
~o~
Site
M1
C5
PLAN AS-BUILT
.S 83°42'05"E 78.51'
SCALE 1" = 40' ~1
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: SW020025 PID No.: 015-054-19
100.00 T ]~H-~_ 07.27
/ / / ISeptic Tc~nkl N
94.2
Dr'o. in f'ieid Rock
./-~76.5
PROFILE
$cole: I' - 10'
82.94-j
AS-BUILT
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
September 6, 2002
Jeff Poet
Mike Anderson, P.E.
Lot 16, Autumn Ridge
Certificate of Health Authority Approval
Soils encountered in the absorption trench constructed on Lot 16, Autumn Ridge
Subdivision were consistent throughout the entire length of the trench and were
identical to those shown on the odginal test hole submitted with the odginal design.
Test Hole No. 31 was composed of well to poorly graded gravel which pemolated at
less than a minute per inch. The trench, however, was designed for much slower
percolating soils with rates between 6 and 15 minutes per inch. We are confident the
absorption trench is adequately designed to serve the five bedroom home on the lot.
The septic system was constructed on February 20, 2002. Both inspections were
completed on that day.
Please let me know if you have further questions.
M-W Drilling. 'nc.
eP.O. Box 110378 tAnchoM9¢, AK 99Site
e90?-34~"g:X)0 * 907-34§-3:~87 Fax*
Groundwater Well As.Built & Log
Owner: L & H Construction ·
4, Leg~/D~o/gt/on: Lm 16 AutamnRidgeSubdivi~an- Aachoz~e
Job No.:
Pemflt No.:
Project No.:
Constructlon
eGroutN~: (I) Sack. No. 8 ben:~aite &ranule~
· Wd/De~ek~omo~. M-n.o~: Air surge
4 M~: A~ lift
I Itour~
eD~te~f~omplea~: 20 April 2001 ePitmpln~all:
0 TO 4.5
4.5 TO 15
15 TO 45
45 TO 52
63 TO 120
120 TO 135
135 TO 140
140 TO 146
146 TO 153
153 TO 180
180 TO 203
203 TO 224
224 TO 240
TO
TO
Well Log
Delalb of formati~aa I~metrated, ~ of ma~ettnt, color amd hardnma,
Cozing stickup
Silty, sandy gravel
Sandy gravel
Sandy gravel: damp
Silty clayey gravel
Silty, aandy gravel: gray
_Sandy sravel: brown__
Sandy gravel & clay
Clay
Gravelly clay
Sandy gravel: brown
Clay: blue, sticky
Silty, clayey gravel: brown
Gravel: come, water beari~n.g
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 PERMIT
Initial
Date Issued: Feb 14, 2002
Expiration Date: Feb 14, 2003
Penmit Number: SW020025
Legal Description: AUTUMN RIDGE LT 16
Design Engineer. 0014 Anderson Engin, eedng
Owner Name: Crown Pointe, Inc.
OwnerAddress: 5400 Abbott Road
Anchorage, AK 99507-
Parcel ID: 015-054-19
Site Address:
Lot Size: 48021 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:.
[] Disposal Field [] Septic Tank [] Holding Tank [] Pdvy
[] 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.
B.
Open and closed on the same day.
Covered, sealed, and heated to prevent freezing.
Received By: '~/' ~
Date: 2h4/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.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
,O.
Permit Number SW
Property owner(s) Crown Polnte, Inc.
Mailing address (1) 5480 Abbott Road Anchora(~e, AK 99507
Mailing address (2)
Legal description (Lot, Block & Sub'd.) Lot '16, Autumn Rid(le Subdivision
Legal description (Section, Township & Range)
Lot Size /,~ 0 ~--~ Acres/q~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Day phone 727-8167
Zip Code
Number of Bedrooms Five
[~3 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 in accordance with applicable Municipal Codes.
(Signature of properly owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
c~D 0 · ~,o
Waiver Fees:
Date of Payment:
Receipt Number.
ANDERSON ENGINEERING
P.O. BOX 240773 '
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMO
TO: Dan Roth
WITH:
MoA/Building Safety/On-Site Water & Wastewater Program
DATE: 2/9102
FROM:
Mike Anderson ~,_
SUBJECT:
Lot 16, Autumn Ridge Subdivision
Septic System Construction Permit
Additional Dimensions
MESSAGE:
The Site Plan for the septic system for Lot 16, Autumn Ridge Subdivision has
been modified to include dimensions from the house to the septic tank and from
the tank to the absorption trench. These dimensions along with the location of
the test hole should be sufficient to lay out the system in the field prior to
construction. Please let me know if you have additional questions.
35'
"/
ZI~AK -
CIRCLE
. Exletlng
W&~
~o' "'t--F-'- 1~
1,$00 GALLON
- SEPTIC TANK
~. lO'Long X 3' Wide
~ X 8' Effective Depth,
~ ~Al~..m,p,tI~n Trenoh
~) TH 3~
'SITE PLAN.
SCALE 1" = 40'
LOT ~'~ ~
Alternate Site
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
February 6, 2002
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Su~e~:
Lot 16, Autumn Ridge Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 16, Autumn Ridge Subdivision intends to construct a new five-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to serve the proposed 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
the location of the existing well on the lot and the test hole locations. Existing drainage
patterns are shown and will not be altered by the development of the lot.
Two test holes were placed near the location of the proposed absorption trench. These
test holes indicate clean well-graded to poorly-graded gravel with varying amounts of
silt. Percolation tests in the material resulted in rates of less than I minute per inch to
over 20 minutes per inch. The majority of the absorption trench will be constructed
near the material with the faster percolation rate. We have chosen, however, to use an
absorption rate of ,8 gallons of water per day per square foot of trench. No
groundwater was found during the placement of the test holes and none was noted
during the monitoring period. We are therefore proposing to place a 60' long deep
absorption trench system with 8' of gravel beneath the distribution pipe. The total depth
of the trench will be 10'. The distribution pipe will be placed at 2' below the ground
surface to provide sufficient drop from the septic tank to the absorption trench.
The ground surface on the lot slopes as shown on the attached Site Plan with very little
to no slope near the proposed septic system site. The new absorption trench will be
constructed on a fairly flat surface in conformance with Municipal requirements and
parallel to ground contours where possible. All components of the new septic system
will be constructed a minimum of 100' from the existing well on the lot.
· Lot 16, Autumn Ridge Subdivision
February 6, 2002
Page Two
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
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
"'THIS PROJECT
· ... AREA MAP
1" = 100'
~ ctRCLg
~ Existing ~.
t,500 GALLON
SEPTIC T~K
~ a0"Lo~ X 3' Wide
Alternate Bite -, ,.,, N<,. ,., .~-~, ,, .
·
:sITE PLAN
SCALE t" = 40'
LOT 16, AUTUMN RIDGE SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Five Bedroom Home
Perc. Rate: LT 1 to 26 MinJInch
Avg. Application Rate: .8 GPDISF
Deep Trench System
1,500 Gallon Septic Tank
8' Drain Field Rock
5 Bedrooms X 150 GPD 1.8 GPDISF = 937.5 SF of Absorption Area
937.5 SFI16 SFILF = 58.6 LF Trench Length
Therefore: Construct An Absorption Trench 60' 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' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum t0' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells In the Area.
"Perfcrm~,~;FOr:: Bob K~L~n
Municipality of Anchorage
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 99519,.6650
SOILS LOG - PERCOLATION TEST
Legal D(',~iptZon: Lot 16 A~q.Ridge ,~pbdiv[~in~
· : SLOPE
1
' TIO . :. · · '
I
GP/GW ' .;'. . . .
~.~..'...'- :'.'.'~; ..'...,.
... Was Gr~n~te~ "'
~gt~?.~...". · No .
. , EY~;.~t~?- .' ' ~ L ·
. ~toWat~" "-.' ''... .' O
' ". . ~ Mgn~ng ' .,,:' None= .~"" .'P
Date Pl~fc~m~d:.
· SITE PLAN
· ' · · '.. Reading. Date
'-13 -1' '.
· ' '15 ' ""' B~l~omof' "
'. . .''. Hole : · ',':'. 6~
11:19 . ..2.88' ' i'
11:22 3' . .' ·
' 11:24 ' ' 2 .11.12' '.7.12"
11:25: .'. 2,5' · = · :'. , :.
11:27 :"-"2.' ~ 10'' . "..7.5%.. '' ""
" ' ~l'es[ Run Between 4 Ft. and 5 FL . :,
· . In AccordanCe Wi[h All State and Municipal Guideline¥1n Effect On This Date: i . '.. '· 1/'20/00 .- . · '. ....: .'. '
Municipality of Anchorage
Building Safety Division
on-site water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 99519-6650
SOILS LOG - PERCOLATION TEST
Performed F°r:' Dob K3~i,~ .' Date Performed:
Legal Description: I et 16 'Auh~mn Ridge. Subdivision
. . SLOPE
... ' TESTHOLENO. 32 .... : ..
· 'B ':'.': .7-- "' · '~ .' '
. .: .; ' * Was Groundwat~ : ...... · ' · ·
· "u ' :'. ~' Enc6u~t~? ' '.."No ."'.. ''S ''-
· ..".'- ... ... lfY6~',WhatDept~?% ..'-':: ..""L .'-'..' ...... i."' :' ' '.
·. " ...*: :'.. , .... · .Deplh to.Water:.' '-.'.' ..: * ..- . ,., ' "O
'"'. 1'0 .. .... ' ' After Mffiito~ng~- ' '":No'nb ' ..' ' ~' P' .' .. '- .., '... ' · 5: .' ' :"* ". ".
1'1 · · .~. Date:· · lr22/o0: E · .' · :'
"'12 ',:::· ..'. '. '." · ,. Reading Date .-Gross "Net · Depth To' Net. ' ' ""
,' " ' .'" '. .' ." "'.. ': Time.. Time , '~Nater .' D~op
:. '.. '~3 '" ' " ' ' :' " : .2.8~ ".' ,' ',"
. · .:.: ...· ..... .. .1 ... 8~Dec 1'.3,7, · ... .
· ' .... :' ' : ' ":' .2 ...... 2;07...' 30 '.4.5" .' 1.63''.'?; ..~..' -:'
,. .' 41 ' '" .':.' ." :' · ' - . 3. "', ...... ,2:08' '-'' 3'. '.".-..:. ., :
· , .. ~...~ .. · . ' 4. :2:38 ....· '30 .425' · .1.25' .-.
· .2"15 ,'..'.........,-".' . .' ~?" ..,...'.- ..5. · ."" 2:39..' '.. .'3""..:.' .- '.i'..,'. '.
': ': "' '. ':,.' .. ' ;' ' · · ."6 · ,',.. :. 3:09 30.. 4.19" 1.19", - ' ':"
"."':'1':6''" ~'" ' ' " """ '' '" .' ' '"""':'"'"
· :.:..: ..'...: :..??: ............,... .. ..... ...·... .... ....., ,.:.... . .., .-,,. .......'..,...."
· -.'""17'"' ' ""':"" "' ':': " ...... :2."'' '' ,' · ' ' '
· ,....., .. ..
· . 18 ': '''~'..'v"''"' :'"~' ' "':'"' '" "'"":. ' :"".-.- :".--. ..... . '"':"".. · . -"'""'~ .....,.- .... .,... . '..
· : .' '19 ...- Bottom Of · '". "'..~ ' . · '- Perc: R.3te: 26 Min./inch :. . 'Perc~'Hole Diameb~..'6",. '...: ' ' f :..?'. :..
.' .. ;. · ' '- -.Hole .."' ". '':
·: :'i .': "'C0r~m~gts: perC°la~n'Cav~ Preso~l~6d'Pfior'to Yestir~g'.' ." '.'" ': ';
"" ' '" P~dom~ed ~y: ~:~. "". I, b~ic~a~ F A~d~so~ i'.-C~-tify Tl~at'Tfi}~"l:~,~W~ p~fform~:j: ' : ' · ""
.. ..... In Accordance With Ali Staie and Mun!cipal Guidelines In Effect On'This Date: '.. .' '1~20/00 . ... .~. ,".. '.. ·
MUNICIPALITY OF ANCHORA GE
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 WATER SUPPLY PERMIT
Initial
Date Issued: May 29, 2001
Expiration Date: May 29, 2002
Permit Number: SW010138
Legal Descripti0h: T12N R3W SEC 15 NE4 PTN '~
Design Engineer: 0014 Anderson Engineering
Owner Name: LH CONSTRUCTION
Owner Address: 5400 ABBOTT ROAD
ANCHORAGE , AK 99507-4364
Parcel ID: 015-051-04
Site Address: 005400 ABBOTT RD
Lot Size: 2214155 SQ. FT.
Total Bedrooms: 0 Permit Bedrooms: 0
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
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.
THIS PERMIT ISSUED FOR AN EXPLORATORY WATER WELL ONLY. UPON COMPLETION OF THE WELL
AND SATISFACTORY WATER IS ENCOUNTERED, THE WELL DRILLER SHALL PLACE AN APPROVED
SANITARY SEAL ON THE WELL CASING AND NO PITLESS ADAPTOR OR PUMP SHALL BE PLACED IN THE
WELL UNTIL A SASTEWATER DISPOSAL SYSTEM HAS BEEN CONSTRUCTED.
t.THIS.PERMIT ISSUED FOR PROPOSED LOT 16 AUTUMN RIDGE SUBD. ,'
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. 0/5' -- 05'/ -- 04'
Permit Number SW O I O 1 3~
Property owner(s) LH Construction
Mailing address (1) 12130 Regency Drive, Suite 201
~tr~
· l~alfin~address (2) ./Z'~rO{~ ~BSOT/'
EaRle River, AK 99'654
Day phone 522-16'16
Zip Code
Legal description (Lot, Block & Sub'd.) Proposed Lot 16, Autumn Ridge Subdivision
Legaldescription(Section, Township&Range) T IZI~ I~w ;~a I,r
Number of Bedrooms Test Well
THIS
Lot Size 45,704 SF Acres/q.~..~
2,
APPLICATION IS FOR:
Sewer Only
Sewer and Well I-']
Sewer Upgrade r"l
PROPERTY CONTAINS:'
Hot Tub r'-I
Swimming Pool
Therapy Pool
Well Only []
Water Storage []
Jacuzzi []
Water Softening Unit []
THIS
I cedify that the above information is correct. I fudher 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
Date of Payment:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
...'J'l g
;
......- ........ THIS PERIV /
o!
.,+-///
~velopment Irfformation:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw SI.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage,ak.us
(9O7) 343-79O4
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015.054-09
Expiration Date: /~;,~. -/
1. GENERAL INFORMATION
Complete legal description Lot 16, Autumn Ridge Subdivision
Location (site address or directions) Ziemlak Circle
Current Properly owner(s) Crown Pointe, Inc.
Mailing address 5400 Abboff Road Anchorage, AK 99507
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless othe~vise requested, HAA w#l be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Five
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
[]
Well r'-]
Day phone 727-8'167
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 Depadment (DSD) Issues Certificales 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, Cedificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewator 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 Anderson Enqineerinq
Phone 522-7773
Address P.O. Box 248773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson. P.E.
5. DSD SIGNATURE
[,~ Approved for ~ bedrooms.
Disapproved.
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
Odginal Certificate Date: ti_ [.,~ _ ~ ~
Municipality of Anchorage ,o
Development Services Department
Building Safety Division "i~1[ ~ '
On-Site Water & Wastewate~ Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www,ci,ancberage.alc us
~07) 343-79o4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Desoiption: Lot 16. Autumn Ridge
WELL DATA
Well type Pdvate
Date completed 4/20/2001
TotaJ dep~ 241 ft.
ff A, B, or C provkle PWSID # ~
San~ary se~ (Y/N) Y_
Cased to ~'41 ft.
Parcel ID: 015-054.19
Date of test
Static water level
Wail production
WATER SAMPLE RESULTS:
Celiform 0 c~onies/100 mi.
Date of sample: ~2002
SEPTIC/tiOLDING TANK DATA
Tank Type/Matedai 6e~c/Steel
Tank size t~00 gal.
Foundation ctaanout (Y/N) Y
Date of pumping
ABSORPTION FIELD OATA
Date installed 2t20/2002
Langm 60
Total depth 11.5 ft.
Date of adequacy lest
FROM WELL LOG
4t20r200t
203 ft.
25 g.p.m.
Wall Log (Y/N) ¥
Wh-as prepedy protected (Y/N) ¥
Casing height (above ground) >24
AT INSPECTION
Nib'ate .387 mg./I.
Collected by: MEA
g.p.m.
Other bacteria 0 colonies/lO0 mi.
Fluid depth in absorption fiald before lest in. Water added gal.
Elapsed 'time: __ min. Final fluid depth in. Absorption rate >=
Ax~y mjuvenafJon treatment (past 12 mo.) (Y/N & type) N
~y~,gNed~e
Number of Compartments 2_
Depression over tank (Y/N) N_
Pumper New Construction
C_,teancxtts (Y/N) Y
High water alam (Y/N) N
Soilrating (g.p.d./f~a*ft=/bdrm).aGPD/SF System type Deez)Trench
fl. Width 3 fi. Gravel balow pipe 6
Eft. absorp~ area 960 fi; Monitoring tube Y_ Depm~_ $~n over field N__
Results (Pass/Fall)
For bedrooms
New depth in.
g.p.d.
D. UFT STATION
Date installed
'Pump on" level at __ in.
Datum
E. SEPARATION OISTANCES
Size in gallons
"Pump off' level at __
Cyctes tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/tift station on lot >100'
Absorption field on lot >100'
Public sewer main
Sewer/septic service line >25'
Manhole/Access (Y/N)
High water alarm level at
Meets alaml & c~cuit requirements?
On adjacent lots >100'
On adjacent lots >100.
Public sewer manhole/cleaonut
Holding tank N/A
SEPARATION DISTANCES FROM SEPT}C/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water eewice line >10'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Propen'y line >10'
Water Service line >10'
' Curtain drain None Noted
F. COMMENTS
Building foundation >10'
Surface water >100'
Wells on adjacent lots >100'
ENGINEER'S CERTIFICATION
I certify that I have determined through.field inspecUons and
revfew of Municipal records that the above systems ara in
conformance with MOA HAA guidelines ~ effect on ~is date.
Engineer's Printed Name Michael E. Ancle~on. P.E.
Date 8/29/2002
Absorption field >5,
Surface water >100'
Wa~rnain
Dmew~,pa~4ng/ve~mrage ~
Waiver Fee $
Date of Payment
Receipt Number
iff.