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Home My WebLink AboutT14N R1W SEC 20 W2SW4SW4SE4TI4N RIW tion 20 W2 $W4 SW4 $E4 #0§0-721-31 Municipality of Anchorage Development Services Department Building Safely Division/On-Site Water and Wastewater Program 4700 South Bragaw Street P,O, Box 196650 A~chorage, AK 99519-6650 www,cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020332 Tom and Rebecca Caldwell 4313 Wisconsin, #5 Anchorage, AK 99517 245-0703. Six (6) LEGAL DESCRIPTION Wl/2 of SWl/4 of SWl/4 of SE1/4 14N lW 20 Well: New Private 200 Sullivan Water Wells 1 9/6/02 6 c~u ] r~, >2 F~ SEPARATION DISTANCES Septic Absorption LiE Holding Tank Field Station Tank w. >100' >100' N/A N/A 21 95 s~=w.,. >100' >100' N/A N/A ~. >5' >10' N/A N/A .,~, >5' >10' · N/A N/A c~.~,,. None Noted L. xlstmg Well I. illed With Concrete, Capped and Covered with Concrete. Existing Absorption Crib Crushed and Backfilled. 4" Insulation Over Service line From House to Tank. Northerly Trench More Than 35' From 25% Break in Grade. PID Number: 050-721-31 Wastewater System: Upgrade ABSORPTION FIELD 5' Wide Shallow Trench 1.2 ~ 5 8O0 Acreage Systems so.~u,. Anchora§e Tank >25' Steel Page I of 3 Inspections performed by: Mike Anderson Dates: 1" 9/8/02 2"" 9/9/02 Department of Health and Human Services approval Reviewed and approved by: ~,~'~ ~ ~/~(./ p,*~/~ Date: I/- ~. J-O2- Top of Concrete Footing Second Deck Support From the North. 100.0 rL Septic LIFT STATION I BENCH MARK Engineer's Stamp -' w'..-" ~ %?a"-- ........ ' FI. Fe ASTM D3034 PVC 0/8.0/02 TANK Municipality of Anchorage Development Services Department Page 2 of 3 Building Safety Division On-Site Water and Wastewater Program On-Site Wastewater Disposal System and/or Well Insp.ection Report Not Daylight Less Than 35 From Trench~ C5 M~=~SV /~IOTE: 4" Insulation Over Llne~ . ......; .~'~;',~ S1 49.6 56.7 ~ S2 57.7 68.2 ~ SV 64.4 75.4 o~°~ . ~ C6 102.2 109.7 .oo ~M2 99.5 106.9 ' 'M.1. 93.7 98.8 101.0 SITE PLAN SCALE 1" = 40' Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number. SW020332 Page 3 of 3 PID No. 050-721.31 4° ulation 7.3 2° Insulation ~',0O0 ~allon Septic Toni< 2· fOG BACKFILL Insulation 98.4j 95,8 / BACKFILL 00.0 02.3 88.1 / 40' Tpench Length Both T?enches Some Vith Exception o¢ Insulation PROFILE AS-BUILT Scole: 1' - 10' FILE No.679 llx14 '02 11:13 6~NER OF LANS~- ID:F-I~NTIEE PARTS FflX:19072579961 PAGE 5 : . · ........ *. .............. '. .... . .-',~--~,-?-"~':,-.-. .::' .7 "t'~""~ '['i[tilig 3 0g ":!;i.'" ' m ertifie)).'.. " : ' , 7, ": ,-.I:~DC.CO.{~·'. : . , ' : '. ' '. · · · ' '' · WATER %]$"ElJCBi:m 8ULI~I.V~ ..... RO. moX e?~?i~,' CHU~IAI;(, ALAeKA 90Se?' '*m TELI?HONm ~ae-2?~' .. ,... · . ' .' .. · .: ' . ..: . · ... . . .. : / BO~G HOLE DATA : ':" : '" ". -/ · . .. ' ." ... .' ..: DEPTH '. "' . · ·:'ADDRESS: ..... Fe- T.. .' ' .' · ' '; "'.;"' .= ':.' . .. · L~dXLDE~'C'~mf~O~;~}'~'~m";" Y~c'~n ' ~. ~ ' O~,~ ."*.r/'~'J~.,m .':'~' · . . ... . . . . , . .__ :._~___.~f ..~'.:.': .' '.',':' ..-'..~.::... ..' · '.' ' '. · ':' ' --"5 0 "'"0~1~ ./.'~n~-7. "' ' De~:th'of*e,~' ~o~ ~' . i~.':. '~ ~'~ ~' .:' (~'*).": '. .~.. .............. ~ .... ' :.":73'~ ~ · ' ': '.... . ,: ~An I. /i~ ll'J~,7~' ' .... ' .... b;~, ~;~; ;;,~ ~ ....... ~ .............. ...... . . .. ..... .. .. , , . .. ,.~.~.~ . '"hg:~fl~k ~e G " ; ' ' ' :::". :' feet..'~; .;.. '. ·~"'..." ' " ' "'"' ...... ~.'... " ' ~et~od6fTeeUng:" ~/~ ' ' ' ' '" " ' '" ' ' Op~l~pe: Qo~e~end ~openhofe .... '-Welllnta~' '. ' ' ' ' : ' Q ~c~n~: ' .' ~t~ feet Sto~pe~" , fe~t: ' ' -'.. .. · · '" '6P~" .... ' .... :"' "~ ~" · :.. '~.r ' rforatl~ . :~ta~ fee o~ped .... .... -..~ ..- . :. :... " ' ~th ~rd~ o" ' '- '" foot .... '" ' .Wet) ~ t on' ton ~No " '" .... -' '"" ' ' ~ .... ~ ~ .. .......... ....'....... ..... .,........: : m e~ta:].~:"' ',.' · * · ' ' "" , . ; ;] .....: :..-- .'." '. .. · ' , ..... .'. ]. : ...'..'.']....::.'. ·: ..... ' "" "4. . . '' , ' ' .. ', '~' .," : ' ".' ': ~' ,'" ' e' : ..' . : . · ,A~E~6N:~ It ja the re~Popslbill~ oj th~ pro~y owner to s~bmlt.n'Copy of.~e ~e~[ log to't~e pro,er aat~br[~J.UU~l~lpaflty. :, · of ~horage: ~pa~t of Hearth & Human'Se~Ioe~ anCot.Debarment'of ~nvffonmeqtal 'C~e~kt~on,';UatSu 'Borough: :...' De~entofEnvl~m~talCons~atlon.. : · .. . · ......... , . ..... .. · .... .: ....:...; .... '.*'.'..,' '.-.z ;' ".~. Received Time H0v.14..10:55AM .' '.]" '" ?" .". ;": · '"'.'~'..'... ' '.' ".;.'L'?. · '" ": ":'"~ 7 '" MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (gO7) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Sep 06, 2002 Expiration Date: Sep 06, 2003 Permit Number: SW020332 Parcel ID: 050-721-31 Legal Description: TI4N RIW SECTION 20, W1/2 OF SWll4 OF SWI/4 OF SEll4 Design Engineer: 0014 Anderson Engineering Owner Name: thomas and rebecca caldwell Owner Address: 4313 wisconsin st, apt 5 anchorage, AK 99517- Site Address: 4313 Wisconsin STreet Apartment 5 Lot Size: 206700 SQ. FT. Total Bedrooms: 6 Permit Bedrooms: 6 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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,Naska 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. ;-The original well needs to be decomlssloned according to AMC Code 15.55.060. Please state what was done with this old original well on the As-built. -The septic system needs to be a minimum of 35 feet horizontal distance from a slope greater than 25%. Please show this separation distance on the As-built. Received By: Issued By: ~ Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program ~llll~ '1~ P.O. Box 196650 Anchorage, AK 99519-6650 ~ ~. ~11~1 ~' www.ci.anchorage.ak.us ~l~V -- (907) 343-7904 ~' ' ON-SITE SEWEPJVVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number SW Property owner(s) Thomas and Rebecca Caldwell Mailing address (1) 4313 Wisconsin Street, Apt. 5 Anchoraqe, AK 99517 Mailing address (2) Legal description (Lot, Block & Sub'd.) W1/2 of SWll4 of SW114 of SEl14 Legal description (Section, Township & Range) Lot Size 5 Acres Acres/Sq. Ft. THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone 245-0701 Zip Code Section 20, T14N, RtW Number of Bedrooms Six (6) [] Well Only [] [] Water Storage [] [] Jacuzzi [] I~ Water Softening Unit [] I cedify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: ...ANDERSON ENGINEERING:-:::, · i: P.O. BOX240773 :: :':: -"-.: ANCHORAGE, AK99524':':' ~ :'' :: 522-6779 (FAX) · · . . September 6, 2002 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Wl/2 SWl/4 SWl/4 SE1/4, S20, T14N, RIW Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer:. The owner of the subject lot intends to upgrade the septic system on the property to accommodate a six-bedroom home. A new well will also be drilled so the required 100' separation can be obtained. The well and septic system currently on the lot are less than 40' apart. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the home. The attached Site Plan and backup documentation identify the location and configuration of the new well and septic system and the parameters used in the design. Also identified on the plans are the existing well location, test hole location and the locations of the existing absorption cdb on the lot. Drainage arrows are also shown and current drainage patterns will be maintained after construction. The test hole placed near the location of the proposed absorption trenches indicated fairly clean gravel with sand and varying amounts of silt. Fractured bedrock was found throughout the material. No impervious layers were encountered. The matedal absorbed water well with a percolation rate of 1 minute per inch in the accepting layer. We are therefore proposing to construct a shallow absorption system with 2 - 5' wide by 40' long trenches with a 4' effective depth. The distribution piping depth will be 2' below the surface. Total depth of the trench will be 6'. A flow splitter valve will be placed to insure even flow to each of the trenches. The existing absorption crib on the lot will be pumped, crushed and backfilled. The sewer service line from the house will be insulated with 2" of direct bury insulation under the driveway to prevent freezing. The existing well on the lot will be abandoned in accordance with ADEC requlations. The ground surface on the lot slopes has been carved from a hillside and is as shown on the attached Site Plan with steep slopes from south to north and are neady flat at the homesite and near the location for the new absorption trenches.The absorption trenches will be constructed parallel with the slope in conformance with Municipal requirements. Some slope flattening may be required to the north of the new trenches to provide proper separation. Ail components of the new septic system will be Wl/2 SWl/4 SWll4 SEll4 Section 20 September 6, 2002 Page Two constructed a minimum of 100' from the new well to be constructed on the 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: to 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. o 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 ~tion D~pth~ ~ Valve~X~SC ~tion 00 ~ ic Tank Exist NOTE: insulation Requi] Over Li~e Under Drive Wa' SCOPE OF WORK: · Proposed well N 1. Pump, Crush and Backfill Existing Absorption Crib. ' "~' 2. Abandon Exlsting Well in Accordance With ADEC Requirements. 3. Intersect Existing Sewer Service Line. 4. Place New 2,000 Gallon Septic Tank. Construct 2 New40' Long x 5' Wide x 4' Effective Depth Absorption Trenches With Bull Run Splitter ValYe. 6. Flatten Slopes to the North of New Trenches to Provide Minimum Separation. 7. Regrade All Disturbed Areas. 8. Revegetate Area As Required. SITE PLAN SCALE 1" = 50' 330.0* NOTE: No Confllcts With Wells or Septlc Systems on Neighboring Lots. · ANDERSON ENGINEERING P.O, Box 240773 ANCHORAGE, AK 99524 (907) 522-7773 Cell (907) 441-4000 ............ ;.-..~ .............. ' .....-.l ........... ~.~. i ~ ; ~ ~ , : I ~ ~ . I ~ Dr~ve Way ....... % . ~ .... I , .... '-'"'-~"~ ..... · ; . · , , ~ ~ x, , , . .. ' - Wll2 OF SWll4 OF SWll4 OF SEll4 OF SECTION 20, T14N, R1W DESIGN FACTORS: 6 Bedroom House Perc. Rate: I MinJInch Application Rate: 1.2 GPDISF SYSTEM REQUIREMENTS: 5' Wide Trench System 2,000-Gallon Septic Tank 4' Drain Field Rock 6 Bedrooms X 150 GPDII.2 GPDISF (Application Rate) = 750 SF of Absorption Area 750 SFI5 LF (Width)* .5(Red. Factor) = 75 LF Trench Length Therefore: Construct Two 5' Wide Absorption Trenches Each 40' in Length For a Total Length of 80'. Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be 6' Below Existing Ground. A Zabel or Bull Run Flow Splitter Valve Must Be Placed to Assure Even Effluent Flow to Each Trench. Maintain 10' of Separation Between Each Trench. Provide 3' of Cover or Place 2" Insulation and 2" of Cover Over Trenches. 4' of Cover Required Over Septic Tank. 4~0~ Natural Backfill '5'0" · I I C~otextile Fabric 4" Perforated PVC (ASTM 3034) Drainfield Rock NOTE: TYPICAL WIDE TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' From Wells in the Area. Minimum 10' Separation From Water Service Line. Municipality of Anchorage Building Safety Division/On-Site Water and Wastewater Program 4700 South Bragaw Street, Anchorage, AK 99519 SOILS LOG - PERCOLATION TEST Performed For: Tom Caldwell Legal Description: W1/2 SWl/4 SWll4 SEl/4 Section 20 T14N R1W SLOPE OG/OL · TESTHOLE NO. 1 Date Performed: SITE PLAN See Site Plan 5 6 7 8 9 10 11 Gravel with Sand Silt and Fractured Bedrock Was Groundwater Encountered? No If Yes, What Depth? Depth to Water After Monitoring None Da[e: 9/4/02 S E 12 13 14 15 16 Bottom of Hole Reading Date Gross Net Depth To Net Time Time Water Drop I 29-Aug 1:13 1.25 2 1:23 10 Dry 10 3 1:24 1.25 4 1:34 10 Dry 10 5 1:35 1.25 6 1:45 10 Dry 10 17 18 21 Perc. Rate: 1 Min.llnch Perc. Hole Diameter: 6" Test Run Between 4.5 Ft. and 5.5 Ft. Comments: Perc Cavity Presoaked Prior to Test. Performed By: MEA. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 91410;2 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: Wll2 SWll4 SWl/4 SEll4 SECTION 20 T14N RIW GENERAL: The scope of this project includes the procurement and placement of a new 2,000-gallon septic tank at the location shown on the site plan and the construction of 2 new 40' long by 5' wide by 4' effective depth absorption trenches also shown on the Site Plan. The total depth of the trenches will be 6' below existing ground and the distribution pipe will be placed at 2' below the surface. A flow splitter valve will be required to assure even flow to each trench. 2" of Insulation must be placed over the service line and under the ddveway from the tank to the absorption trenches. Ail components of the septic tank and absorption trenches must be constructed a minimum of 100' from the proposed well 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. The existing absorption crib on the lot must be pumped, crushed and backfilled. In addition, some slope flattening may be required to assure proper separation distance from the new absorption trenches. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and veril~cation of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive pdor approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. The 2,000-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. · W112 SWll4 SWl/4 SEll4 Section 20 September 6,' 2002 Page 2 of 2 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 budal insulation. 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. 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 tube~ must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. o Contractor shall vedfy the septic tank and drainfield are a minimum 100' away from any pdvate water wells in the area, 150' from a Class "C" Well or 200' from any community well. 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. 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). 'Wll2 SWll4 SWl/4 SEll4 Section 20 September 6, 2002 Page 3 of 3 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). 5. A permeable geotexfile 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. .~k~as~ CT&E Environmental Services Inc. CT&E Rtl.# Client Name ProJect Client Sample ID blatrh PWSID Sample Rerr~k~ 1027892001 Anderson Eng~cering MP 4.2 Hiland Rd'~ ~ ~ er' ,5'bJ I]¥ OrSuOq'~ O0 ~ 4.2 Hiland Rd/-- ,, 0 All Dates/Times are Alaska Standard Time Printed Date, rflme 11/19/2002 15:04 Collected DatWTime 11/15/2002 14:30 Recelved Date/Time 11/15/2002 15:20 Tecbnlcal Director · Stephen C. Ede Released B~v~~ ~ R,~ult~ PQL UniLs MetJ~d Allowable Prep Analysi~ Limits Date Date Init Nat:ers Depar t:menl: Ni~xate-N 1.29 0.600 mg/L EPA 300.0 f<-lO') 11115/02 JS _ Microbiolo!;ly Laboratory Total Colifon~ col/lOOmL SMI8 9222B (<-I) 11/15/02 KAP Received Time Nov.19. 5:04PM CT&E Environmental Services Inc. Laboratory Division. " 2('0 Wo Potter Drive Drinking Water Analysis R¢?ort for Total Col}form Rneteria'. A~eho,age. ^K SSs~ S-~ 60S ' --w ...... Tel: (907} 562-2343 ~ INSTRUCTIONS ON REV_FJ~SE SIDE ~E]:ORJE COLLECTING S/IMP£E Fax: (907) 661-5301 : MUST BE COMPLETED BY WATER SUPPLIER El PUBLIC WATER SYSTEM I.D- # IIIII Q PRIYATE WATER S. YSTEM 0 SenttRe~uits 0 SendInvolce Month .Day Year ,IRP LE TYPE: outine . .,,re Treated Water Repeat Sample (for routine sample Untreated Water · with lab ref. no. · ) Special Purpose Time Collected SA~,~PLE LOCATION. Collected BY TO DE COMPLETED BY LABORATORY Analy~$ shows this. Water SAMPLE to be: ~/ ~atis factoty ' O Unsatisfactory [1 Sampli over BO hours old, results may ' · be unreliable Sample too 'long in transit; sample should not be owr~hours old at examination to indicate reliable results. Please send new sample.via special delive~ mail. Date Received' Time Received i ^naiy,is Analytical Method: ~'~Memb~anc Filter · t:l IVEVIO-MUG * Number of colonies/100 mi. Lab Ret'. No. Result* Analyst Sent to A.D.}LC. Anch ~ks Jun U Fax~ Date: Time: ~ient notified of unsatlsfacto~ resul{s: Phoned Spoke with Faxed Date: Time: 'F/YMt ~_ I ~JI BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total C~llform E. Cell Membrane Filter: Direct Comtt ( ) __ Colonies/100 mi v Verification: LTB EGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filter R~sults Coliform/100 mi ..... Received /ime_','t0v.19.~ 5:04P~°fthesosGr°up(s°clat6GaneraledesmvelRance) ENVIRONMENTAL FACILITIES IN ALASI~A. /'~ -~-~,a. SLORIDA. ILLINOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA ' Municipality of Anchorage Development Sep.,ices Depzrtment Building Safely Division On-Site Waler and Wastewaler ProGram 4?00 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wvc, v.ci.anchora ge.ak.us (907) 343-7904 O CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-721-31 1. GENERAL INFORMATION Complete legal description Expiration Date: W112 of SWll4 of SWII4 of SEll4 Section 20 T14N R1W Location (site address or directions) 6?;6 Hiland Road Current Property owner(s) Tom and Rebecca Caldwe!l Day phone 245-0701 Mailing address 4313 ~,qsconsln St.. Apt. t~o. 5 An.._choraqe. AK 9951 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: six (6) 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class__ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in pe:aGraph 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 be[v,,een spouses) for propedies seA, ed by a single tamiIy on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to hcmeowners. Ce.lificatos of Hea~th Authority Approval are, valid for 90 days from the date of issue for prcparties sat.,ed by a private cr Class C ,.ve~l and may be reissued wi!h new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year wilh valid water samples.) Certificates are ~/alid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchora.ce 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 vcrify 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 insta!lation. Name or Firm Anderson Enqineerinq Address P.O. Box 240773 Anchoraqe, AK 99524 Engineer's Printed Name I'Jichael E. Anderson. P.E. Phone 522-7773 Date '1f117102 DSD SIGNATURE L/''''/ Approved for 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 ' Original Certificate Date: //- :~. ! - O ~ Legal Desc~ption: WELL DATA Well type Private Date completed IF6/2002 Total depth .200 lt. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (9O7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST W1/2 of SW1/4 of SW1/4 of $E114 Section 20 T~I4N RIW IfA, B, ~rC provide PVVSID # Sanitary (Y N) Y_ C,~sed !o ~1 F~OM WELL LOG Par(e{ ID: 050-721-$1 Date of test Static wate~ leveJ Well production 6 WATER SAMPLE RESULTS: ' Cottfo~m 0 colonies/100 mi. Date of sample: 11/15/2002 B. SEPTIC/HOLDING TANK DATA Tank Type/Mate~al. 8eDtl~/Stset Tank size 4000 , gal. Foundation cleanout (Y/N) Y_ Dale o~' pumping C. ABSORPTION FIELD DATA Date installed 9B/2002 Length 80 Total depth 8_ ft. 9/6/2OO2 95 Nil~ta 1.07 moji. Collected by: MF~ Well Log (Y/N) Y Wres properly protected (Y/N) Y Casing heighl (above ground) >24 AT iNsPECTION iN. Number of Compartments _2 Depression over tank (Y/N) ~_ Pumper New Construction Other bacteria 0 colonies/100 mi. Date installed 9/8/2002 Ctaanouls (Y/N) Y High water alarm (Y/N) N Date of adequacy test Results (Pass/Fall) Fluid depth in absorption field before test _ in. Watm' added gal. Elapsed Time: __ min. Final fluid depth __ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Soil rating (g.p.d./it~ er ~/bdrm) t.2 GPD/SF System type 5' Wide Trench fl. Width S fl. Gravel below pipe 4 fl. Eft. absorption area 800 ~ Monitoring tube Y Depression over field N Fo~ bedrooms New depth in. g.p.d. If yes, give date D. UFT STATION Date installed 'Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons *Pump off" level al __ Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >t00' Absorption field on lot >t00' Public sewe~ main N/A Sewer/septic service line >25' in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >t00' On adjacent lots >100' Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Properly line Water ma~n N/A Water service line Welts on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line >10. Water Service line >t0. Curtain drain None Noted F. COMMENTS Building foundation >t0. Surface water >100. Wells on adjacent lots >1.00' Absorption field >5' Surface water >t00' Water main >t0. D~veway, parking/vehicle storage >25' G. ENGINEER'S CERTIFICATION I cen~fy 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 Michael E. Andemon. P.E. Date 11117/I)2 HAA Fee $ Dale of Payment Receipt Number {Rev. 12/00) .,, (,,,-).. ~ .;r*' ,~. · c . sl .... ..',. ,;,.~-~:....'. Wa~ F~ $ Date ~ Payment R~ipl Num~