Loading...
HomeMy WebLinkAboutTONJESS ESTATES BLK 3 LT 14Onsite File . . . . . . . . . . . . . . . N IM n % t � o ��r w 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 $/10/02 !� 1) MICHAEL E. ANDERSON i Department of Health and Human approval ♦i�/�.,•. No. CE -4381 nnS(nervices Reviewed and approved by: ��}i V 1 •.���_�� ♦����Fo p""'••••"" �•P� `�•� n��rK Date: i i (Rev. 10/99) tr �S2 ct �"s0 Y a h �/2�i Jl-Zo6 3 ',,1�\\\S\\�� •• 11W 5� U2 �Z'a X0 0.O I Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW020037 PID No.: 051-832-03 I L_ f -A I N F_N Ij L-) U I I I Scale: I" = 50' Municipality ofAnchorage OEVEOPK8ENTSERVICES DEPARTMENT 470USouth BnagawStreet Anchorage, AK.8051S-G855-343-79U4 On -Site Wastewater Disposal System orWell Inspection Report Permit Number: SVVO20037 Page 3 of 3 PID No. O51 -O32-03 PROFILE AS-BUILI Scale: 1^ = 10' FROM : COUNTRY REALTY PHONE NO. : 9076881238 Oct. 14 2882 02:15PM P7 ' , ... .' ,~..'~ ..~."~'.t~,.~ .~ ." .,~,~,~ '.. . · ~ .'..~'. · .. ~ .... '~. . '.'.. ~ ' · .~.~ ~ ~. ..' .~...,~- " ~'.~.~ ~,'~-~ .~ ~ . ,, ~ ~ ~'~ ~ ~ ~ ~.;,~ .... ~ ~,~.~.~.~ ~-,...~. ~.~ '~ ... ,~'~'~:~{~,~.~~ ,'"~,~,~.~'*'-:~:;'~;~:~ .... ~2~,,,,:~;:~'.;'~.~-:..".'-' ',. ..'~: :*-'", ".~' '~:~ ,*.~-'~,~/.=~'- _ .. ....,. ~ ~,, .~.~,~. ~ ,:, · .~.L-.~'.,..:~-~....%~ .;~ * ~::~,~:~j~, . ~......~-. ,..~:~ .:...:',.-?.~ -.:~;;'.~.'. ,...;.. ~:%~ ~'~ . OWNEb OF ~ .................. , ,.~...., . · ~D~ES$:. ' ...... · .... · ~ :'. ~:.~.E~ '.'"'~~ '~/~'~ " , -,, .... , ...... . .....,. '~., .....,: , ..~ .~. ,...~..::. ... .Do~ · ...,. ,~ ..:.. .:.~, ... ,... :~.;..~J~'.-~,~.,~/~ .,.. . ,, ~ ~4~. .. ............ . J~ ... .:-'... :. · ... ~~.... .d:.?,. '" ,. · ....,......., .; M~t~ , ".. ' ' '. " ..... D~ .... /:?:...?.., "~1 ~ ~d~" · / ' ;.,...~ · :,:.:.~.:~% :': .".'.:__'__~:~ .: .. -'-'~ ;s" '~ E~ :. '~-;di~{ .... '. , :.. ~. · ..... , .... - .......~= ~ ~ ~b-~ ~.'~.~ ...... ....: ...... :;::~ {~$...; .~. ...j~ ..' · ,:....,: .... ,..,. · ?~.':~?~:. .: ~ ' .,-.-- · ..... , .. . . ..:.;' .. .~ : ..; ,,:.,, .... ..~... .... .? · ..... .'?' ':-.:;- '..i: :~::~" ;.~. ~; ..... . .,.. ~.,:.... ?, ...... , ..: , :. , ....... ~ ..... . , ................. ~ ~ . . :. ~ .;:'., ' I, .... . ,: ..... . ., .... :.- .: · :-. ': ..'." I · ", "'" "' "" "· ' ' .'' ' · .- · '' ' ~' ' , "-" % " ' '"~. "-'1' ' :' '" "" ' ~''' ~ c ~ ':"'.~'t{~:[JOOfTCO"=' '~ ...... '~ .... :"?::".' ,,.,.,~, ,, ,,....r, ,i~,o,. ~ ~, .~ ~P '" .... ...:;:i: :. ,~,.;~..~ i~j:....:.~ :.:.;-:,::..i .::..'..:'.: ~'1 .-" ' '~:>' :~ ~'. ' '.l". '..'.;;'.'..,:;'; · . .,. ,..,.....i...W ,. ~ ,. -. . .... ~ ~..- .,:.., ..... % ............ ; ........- . .~ ~, ?... . ,~.~.~,.,:~..~,.,.;:~,.~-~ .... . .. : ,,. ............... . ............ . · · ' n, I.~<~:~l, -!~ ~ ...... ...,..~ ~-_:.~:?...--~ -.~i~:~ .... .~...,:~ .~;~ ,;~i,:~ ~.;:..~ ~.%. ;-]r"'l" ~ ~'~ of t~'(' ~.~,l ~ 1~ lr1~ p'~p~ Out~ri~.':M~c~ A~ON:I~I~:~.F~'~'I~T~.~:.i'IT~-~]~:~.%~;:':,'.~.~:':.~".'', ~/,I, .."'. . i." ~ ~- .- .~.'~'..'-;~-~,,_~.-~'~'~". ,,. , ~.-,, ._ ~,~ ',.~~ -: ..... :;~: , ~ .,. 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