HomeMy WebLinkAboutTONJESS ESTATES BLK 3 LT 14Onsite File
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Municipality of Anchorage Page 1 of 4
Development Services Department - -
On -Site 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: SW020037 PID Number: 051-632-03
Name:
MM&M Contractinq
Wastewater System: New
Address:
P.O. Box 670495 Chu iak AK 99567
ABSORPTION FIELD
Phone: Number of Bedrooms:
688-1236 Three 3
Deep Trench
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
.6 GPD/Ft'
11.5 Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
3 14 Ton'ess Estates
3.5
8
Ft.
Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
3 Ft.
50 Ft.
Well: New
Gravel width:
Number of lines:
Distance between lines:
3 Fl
1
Ft
Classification (Private, A, B, C):
Total Depth:
Cased lo:
Total absorption area:
Pipe Material:
Private
260 Ft.
52.5 Ft.
800 Ft'
ASTM D3034 PVC
Driller:
Dale Drilled:
Static Water Level:
Installer:
Date Installed:
Sullivan Water Wells
4/14/2001
53 Fl.
MM&M Contracting
8/7-10/02
Yield:
Pump Set at:
Casing eight Above Ground:
TANK
1 GPM
Ft.
>2 Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublic/Private
Manufacturer:
capacity in Gallons:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,000
Wel
>100'
>100'
N/A
N/A
>25Y
Material:
Steel
Number of Compartments:
Two (2)
Surface Water
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
Lot Line
>51
>10,
N/A
N/A
Size:
anu ac urer:
Gal.
Foundation
>51
> 10,
N/A
N/A
'Pump on" level at:
in.
Pump off" Ievel at:
in.
High water alarm at:
in.
Curtain Drain
None
Noted
Pump Make & Model
Electrical Inspections performed by:
Remarks:
BENCH MARK
Insulation over Septic I anK.
Location and Description:
Garage Slab.
Assumed Elevation:
100.0 Ft.
Engineer's Stamp
E1�♦♦♦i
q�
,�....qS
AV
Ar;.,�♦♦
Inspections performed by: MEA Dates: 1St 8/7/02
r .49th
.. . 00
r
2nd $/10/02
!� 1)
MICHAEL E. ANDERSON i
Department of Health and Human approval
♦i�/�.,•. No. CE -4381
nnS(nervices
Reviewed and approved by: ��}i
V 1
•.���_��
♦����Fo p""'••••"" �•P� `�•�
n��rK Date: i i
(Rev. 10/99) tr
�S2 ct �"s0 Y a h �/2�i Jl-Zo6 3
',,1�\\\S\\�� ••
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5� U2 �Z'a X0 0.O I
Municipality of Anchorage Page 2 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: SW020037
PID No.: 051-832-03
I L_ f -A I N F_N Ij L-) U I I I
Scale: I" = 50'
Municipality ofAnchorage
OEVEOPK8ENTSERVICES DEPARTMENT
470USouth BnagawStreet Anchorage, AK.8051S-G855-343-79U4
On -Site Wastewater Disposal System orWell Inspection Report
Permit Number: SVVO20037
Page 3 of 3
PID No. O51 -O32-03
PROFILE AS-BUILI
Scale: 1^ = 10'
FROM : COUNTRY REALTY PHONE NO. : 9076881238 Oct. 14 2882 02:15PM P7
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F'R~:: COUHTR¥ REPL.TY
PHONE NO. : 907~8812~8
Oct. 14 2002 02:lSPH
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 WASTE~VATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Renewal
Date Issued: Mar 18, 2002
Expiration Date: Mar 18, 2003
Permit Number: SW020037
=llLegal Descripti0n:"TONJESS ESTATES BLK 3 LT 14
Design Engineer:. 0014 Anderson Engineering
Owner Name: MM&M CONTRACTING
Owner Address: P.O. BOX 670495
CHUGIAK, AK 99567-0495
Parcel ID: 051-832-03
Site Address: 021625 TONY CIR
Lot Size: 38951 SQ, FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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.
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 SEWERA/VELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 05
~t~oRoo~7
Permit Number SW(") I(")0~~) LJ
Property owner(s) r'~m,4 ~
Mailing address (1) ~.O,"~JO
Mailing address (2) ~ At,.~ 'T'c~L{
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size "~:~ ~"[ Acres(~) Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] 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 Tn accordance with applicable Municipal Codes.
(Signature of property owner or ~horized agent)
Permit Fees:
Date of Payment:
.ecei,t .umber:
(Rev. 12/00) ~'X
Waiver Fees:
Date of Payment:
Receipt Number:
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 I WATER SUPPLY PERMIT
Initial I Upgrade
Date Issued: Mar 16, 2001
Expiration Date: Mar 16, 2002
Permit Number: SW010034
Legal Description:~'~l~-~STATE" Bi~0~'I~'~' ~6~'"~"'
Design Engineer: 0014 Anderson Engineering
Owner Name: MM&M CONTRACTING
Owner Address: P,O, BOX 670495
CHUGIAK, AK 99567-0495
Parcel ID: 051-832-03
Site Address: NHN TONY CIRCLE, CHUGIAK, ALASKA
Lot Size: 38951 SQ, FT,
Total Bedrooms: 3 Permit Bedrooms: 3
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. Ail 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.
Issued By: ~
Parcel I.D.O.~"l
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
Permit Number
Property owner(s)..MM&M Contracting
Mailing address (1) P.O. Box 670495 Chuglak, AK 99567 - O,~'~'
Mailing address (2)~/'/M TO,MN ~.IREI.£, (.,ttUOIFt~ ,l:jl(
Legal description (Lot, Block & Sub'd.) _Lot 14, Block 3, Toniess Estates
Day phone 688-1236
Tip Code qq5'67
Legal description (Section, Township & Range)
Lot Size~cres/~.
Number of Bedrooms Three (3)
THIS
THIS
APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
I"-I 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 property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
March 13, 2001
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 14, Block 3, Tonjess Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 14, Block 3, Tonjess Estates Subdivision intends to construct a three-
bedroom home on the currently vacant lot. We are therefore applying for a permit to
construct a new septic system on the lot to serve the new 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. It also shows the location of the
alternate site and the proposed well for the lot. Existing drainage patterns are also
shown and will not be altered by the development of the lot.
Several test holes have been placed on this lot over the past years. All of these holes
reveal well to poorly graded gravels with percolation rates between 12 and 17 minutes
per inch. Two test holes at the proposed location for the new,absorption trench
revealed well to poorly graded gravel with some silt to depths of 21. No groundwater
was noted in either test hole during excavation or during the monitoring period. We are
therefore proposing to place a 3' wide by 50' long absorption trench with 8' of drain field
rock beneath the distribution pipe. The pipe will be placed a,t 3.5' below the existing
ground surface and the total depth of the trench will be 11.5. A minimum of 3' of
cover will be placed over the trench to prevent frost penetration and possible freezing.
The ground surface on the lot slopes as shown on the attached Site Plan with a
substantial drop from behind the proposed absorption trench to the roadway. The area
for the new absorption trench, however, is fairly fiat. The new trench will be constructed
parallel to the contours of the surface in conformance with Municipal requirements.
Grading will be accomplished to assure surface drainage is away from the new trench.
The existing drainage pattern on the lot will not be affected during development.
If the system is constructed in accordance with our design the following statements
apply:
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.
Lot 8, Block 3, Tonjess Estates
March 12, 2001
Page Two
e
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
II
5527 52-~g
THIS PROJ
/4
11
,
AREA MAP
SCALE 1"-- 100'
· TO.Nj
' ~ I Pro'posed
· '.1
CIRCLE
edroom
000 Ga ~oln
~ Tank
- TH2 '
Alternate
Site
LOT 14, BLOCK 3,
TONJESS ESTATES
SI___TE PLAN
SCALE t" = 40'
LOT 14, BLOCK 3, TON JESS ESTATES
SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home
Perc. Rate: 17 Min./Inch
Application Rate: .6 GPD/SF
Deep Trench System
1,000 Gallon Septic Tank
8' Drainfield Rock
3 Bedrooms X 150 GPD 1.6 GPDISF = 750 SF of Absorption Area
750 SFI16 SFILF -- 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 3.5' Below
Existing Ground. Total Depth of Trench to Be 11.5' from Existing Surface. Mound Over
Trench if Necessary to Provided Minimum Cover of 3'.
NOTE:
Perforateh ·
fie d"
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
.... .......
Municipali~ of ~chorage ~[.~~~:~~
Depa~ment of Heal~ & Human Se~ices '~.~'.. c~-43s~ ..~
825 L Street, ~chorage, AK 99502~650 ** ~. .. ~?.
SO~LS LOG - PERCO~T~O~ TEST 't[~" ....... ~'
Pedormed For: MM&M Contracting Date PeEormed: 1/26/94
Legal Description: Lot 14. Block 3. Ton!ess Estates
3
4
5
6
7
8
9
10
1
1:
13
14
15
16
17
1 OGIOL
SLOPE SITE PLAN
North
18
21
GWIGM
See Site Plan
Well Graded
to
Silty Gravel
South
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring None P
Date: 3111/01 E
Bottom of
Test Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
1 26-Jan 2:37 7.75"
2 3:07 9.5" 1.75"
3 3:08 8.5"
4 3:38 10.25" 1.75"
5 3:39 8.13"
6 4:09 9.88" 1.75"
Perc. Rate: 17 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 5 Ft. and 6 Ft.
Comments: Perc. Cavity Presoaked Prior' to Test.
Performed By: Alan Harala. I, ~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/12/01
:3." 49
~ ...... I ...... ~...~1~ .... 4,-,
Munioipality o[ ~nchora~e
~. ~%MICHAEL ~ ANDERSON,. ~ ~
Depn~ment of Henlth ~ Humnn ~e~ices ~f ~ -. CE -4~B1 .. ~ ~
82~ L ~treet, ~chorage, AK ggs02-0GS0 ~ ~ · · ~ ~
~OIL~ LOG - PEROO~TION TEST ~?~ ~ .... ~Z~ ~
Performed For: MM&M Contracting Date Pe¢ormed: 1126/94
Legal Description: Lot 14. Block 3. Ton!ess Estates
SLOPE
North
OGIOL
GPIGM
GWIGM
Well Graded
to
Silty Gravel
1
11
12
13
14
15
16
18
21
South
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring None P
Date: 3111101 E
SITE PLAN
See Site Plan
GPIGW
Clean
Well Graded
Gravel
Dry
Bottom of
Test Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
I 26-Jan 2:45 6.12"
2 3:15 8.62" 2,5"
3 3:16 6"
4 3:46 8.5" 2.5"
5 3:47 6.5"
6 4:17 9" 2.5"
Perc. Rate: 12 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 5 Ft. and 6 Ft.
Comments: Perc. Cavity Presoaked Prior to Test.
Performed By: Alan Harala, I, ~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/12101
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 14, BLOCK 3, TON JESS ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,000 gallon septic tank at the location shown on the site plan;
Work also includes the construction of a new 50' long X 3' wide X
8
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3.5' below the existing
ground surface. Total depth of the trench will be 11.5' below the
existing ground surface. All components of the septic system must
be placed a minimum of 100' from the existing well on the lot and on
the adjacent lot.
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 verification 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
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be be procured from an approved
source and installed at the location shown.
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.
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.
Lot 14, Block 3, Tonjess Estates Subdivision
March 13, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
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.
A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
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.
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.
Grade area surrounding the absorption trenches 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.
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).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
Lot 14, Block 3, Tonjess Estates Subdivision
March 13, 2001
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. Ail 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 inspecbon 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,cLanchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
iFOR A SINGLE FAMILY DWELLING
Parcel I.D. 051.532.03
GENERAL INFORMATION
Expiration Date:
· o I
Complete legal descnpbo?. Loti 14, Block 3~ Tonless Estates Subdivislon
Lo~ation (site address or direfitions) , Tony Clrcle
Current Property owner(s:
Mailing address
Lending agency
Mailing address
MM&M Contractinq
P.O, Box 670495 Chuqlak, AK 99567
Day phone, 688.1236
Day phone
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPleLy:
Individual Well
Individual Water Storage
Community Class ! Well
Public Water System
Three (3)
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank. []
C0mmunity On-site []
Public Sewer []
The Municipality of Anchorage D, eve!opment 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) fo,'r properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval are
valid for 90 days from the date of:issue for propedies served by a private or Class C well and may be reissued with
new water sample results less thin 30 days old. (Cedificates may be reissued for a period of up to one year with
valid water samples.) Certificates:are ~/alid for one year for propedies 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 En.qineerin.q
Address. P.O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson, P,E.
Phone 522.7773
Date 1125/2003
DSD SIGNATURE
· "/' Approved for "~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(Rev.
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Cedificate Date,/J?~ ,l~'
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & WaStawater Program
4700 South Bmgaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorege.ak.us
(g07) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot t4. Block 3. Tonless E~tates Subdlvlalon
A. WELL DATA
Well type prlv~s
Date completed 4/t4/2001
Total depth 260 ft.
IfA, B, or C provide PWSlD #
Sanitary seal (Y/N) ¥
Cased to 52.5 ft.
FROM WELL LOG
4/14r 1
1 g.p.rn.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~1 colonies/100 mL
Date of sample: 1/6/2003, , ,
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matadal ,
Tank size t.000 gal.
Foundation cleanout (Y/N) Y
Data of pumping
C. ABSORPTION.FIELD DATA
Nllrata 2.23 mgJl.
Collected by:. Alan
Number of Compartments
Depression over tank (Y/N)
Pumper 1~/~
Parcel ID: 051.532.03
Date Installed EI11/2002
Length .~
Total depth ,14.5 ft.
Date of adequacy test
Well Log (y/N) y
Wires propedy protected (Y/N) y
Casing height (above ground)
AT INSPECTION
Other bacteria ..[. colonies/100 mi.
, If yes, give date
Ruld depth in absorption'field before test In. Water added gal.
Elapsed Time: min. Final fluid deplh in. Absorption rata >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~
For bedrooms
New depth in.
g.p.d.
$oll rating (g.p.d./fl= or ~/bdrm) .6 6PD/SFSystem type,,Ippep Trench
ft. Width :[I fl. Grovel below pipe ~
Eft. absorption area 800 ft2 Monltadng tube Y Depression over field N
Results (Pass/Fail)
Date installed 1~T~20~)2
Cleanouts (Y/N) y
High water alarm (Y/N) H
in.
fL
g.p.m.
D. LIFT STATION
Data installed
'Pump on" level at in.
Datum
E. SEPARATION DISTANCES
S~ze in gallons
'Pump off' level at
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main NIA
Sewer/septic service line >25'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & drcuit requirements?,
On adjacent lots >100'
On adjacent lots >100.
Public sewer manhole/cleanout NIA
Holding tank ~I/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line >5'
Water service line >10'
Building foundation >5'
Watar main NIA
Wells on adjacent lots >100.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation >10'
Surface water >100'
Wells on adjacent lots >100'
Absorption fiel~ >5'
Surface watar >100'
Water main >10'
Driveway, parking/vehicle storage ,>25'
Property line >11)'
Water Service line >10'
Curtain drain None Noted
F. COMMENTS
Jn.
G. ENGINEER'S CERTIFICATION
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 Michael E. Anderson, P.E.
Date 1~25/TM
HAA Fee $ ,~'?~'
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Data of Payment
Receipt Number