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HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 1 BLK 2 LT 22Glenn View Estates West #1 Block 2 Lot 22 #051-793- 18 . • Municipality of Anchorage Page 1 of 3 Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw 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: SW020064 PID Number: 051-793-18 Name: MM&M Contracting Wastewater System: New Address: P.O. Box 670495 Chugiak, AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: 688-1236 Four (4) D t�-p _ ealtew-Trench LEGAL DESCRIPTION Solt Rating: .8 GPD/Ft= Total Depth from ongmal grade: 9 Ft. Block: Lot: Subdivision: 2 22 Glenn View Est. West Phase I Depth to pipe bottom from original grade: 3 FI. Gravel depth beneath pipe: 6 Ft. Township: Range: Section: Fill added above original grade: 1 Ft. Gravel Length: 67 Ft. Well AWWU Water System Gravel width: 3. Ft. Number of lines: 1 Distance between lines: N/A Ft. Classification (Private, A. B. C): Total Depth: Ft. Cased to: Ft. Total absorption area: 804 Ft= Pipe Matenat: ASTM D3034 PVC Driller. Date Drilled: Static Water level: Ft. Installer. MM&M Contracting Date Installed: 7/24-29/02 Yield: GPM Pump Set at Ft. Casing Height Above Ground: Ft. TAN K SEPARATION DISTANCES ® Septic ■ Holding 0 S.T.E.P. 0 Other. To From Septic Tank Absorption Field Lift Station Holding Tank dubliclPrivate Sewer Line Manufacturer: Anchorage Tank Capacity in Gallons: 1,250 Well >200' >200' N/A N/A >25' Matenat : Steel N ot Compartments: Tw Tw o (2) sudacewater >100' >100' N/A N/A LIFT STATION — NONE ON LOT Lot Line >5' >10' N/A N/A Size: Gal. Manufacturer: Foundation >5' >10' N/A N/A 'Pump of level at: in 'Pump off level at: In. High water alarm at: In Curtain Drain None Noted Pump Make & Model Electrical Inspections performed by: Remarks: 2" Insulation Atop Septic Tank. BENCH MARK Location and Descnption: Finished Floor. Assumed Elevation: 100.0 Ft. Engineer's Stamp -1� a ...44 44ai .44 c.,\.•••• \574'.. ? :}n/�( 49th :lilt• ..4 .. , � MICHAEL E. A\DERSCV •• :, hO. CC-4381 • 0 :.t: j i Inspections performed by: Mike Anderson Dates: tat 7/24/02 rid % 2 • /29/02 Department of Health and Human Services approval Reviewed and approved by: � V /2Y. / L.c. Date: 17� 3-0 3 • •••1•'p`p' • %••• ins sssss+•• ..- (Rev. IQN9) Q munlclpaltry OT Ancnorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW020064 • A 8 S1 S2 M1 C4 C5 29.0 34.7 65.7 36.9 65.4 26.9 33.0 36.8 67.7 36.4 POLLY CIRCLE rage z or s PID No. 051-793-18 to •1 It C4 TFJ1 Four Bedroom Home Altemate Site C5 M1 PLAN AS -BUILT SCALE 1" = 40' ", �4 c 14f-. , $ MI •i MICHAEL E.OERSON f 41,1p t... No. CE -43431 i ... 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. SW020064 FF El. 100. Page 3 of 3 PID No.: 051-793-18 1250 Gallon Septic Tank fU < 2 1- 93.5 93.5 - 89.4 ,Q.e_ot,Iztlig Fgbris_ DrainField Rock 89.4 67' PROFILE AS -BUILT Scale: 1' = 10' 83.4-' 75.5 .�V MIEwAEL E.ANDERSON i Gni • u t.. Na. cc -et FROM : COUNTRY REALTY • 1' 0' PHONE NO. : 9076881238 Mar. 20 2003 12:40PM P2 PO• fkr4j i o' CC • Nj .4.1 H AS -E( Jnr- • . Jiie7eby certify that•1 have survgyed the following descnbed prolierty. 2•• c. it 2- . Y.:nn w.t-z t_t..pjf a. S.6 •'t✓o., ';:. , T f rk.1, i w, S .t • Anchorage Recording Precinct. Alaska, and that the i xtprove- tnents situated thereon are within the pmperty:Uines and do not overlap or encroach on the property lying adkent thmto, than no improvements on property /yang adjaeer�4. thereto enc aeh'. on the premises In question and that there are'no •toadwaysA•' • transmission lines or othei visible easements on sald,proper ' rretirr ai kvi;ra«a.: l,:.en.. . • . . , Dated at'Eagle River, this, x' � day of • . Phone (907) 694'. Alaska • at et/ • 200L •::...:' ROBER"T;C.JOHNSON:;. •.• •..••• Registeisd Land Surveyor No.:.,880'LS ' . Bou 77.0436, Ea g% River: Afazka-99577. 7- z zi- 0 2 c 60b, 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: Apr 12, 2002 Expiration Date: Apr 12, 2003 Permit Number: SW020064 Parcel ID: 051-793-18 Legal Description: GLENN VIEW ESTATES WEST PH 1 BLK 2 LT 22 Design Engineer: 0014 Anderson Engineering Site Address: Owner Name: MM&M Contracting, Inc. Lot Size: 40002 SQ. FT. Owner Address: PO Box 670495 Chugiak , AK 99567 - Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: E✓ Disposal Field E✓ Septic Tank ❑ Holding Tank ❑ Privy [] Private Well El 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. O. The following special provisions. THE PERMIT IS CONTINGENT ON ADDITIONAL TEST HOLE LOGS AND PERCOLATION TESTS BEING SUBMITTED PRIOR TO CONSTRUCTION OF THE SYSTEM FOR REVIEW WHICH VERIFY SOIL CONDITIONS. PERCOLATION TESTS MUST BE PERFORMED A MINIMUM OF 6 FEET BELOW GROUND SURFACE. 7//5/02 S E APR/root-AL s oq s I-ts T A S .46-f!EG Agv»E, Received By: Issued By: Date l Date: 4//2/02. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ns i -713- / gv Permit Number SW 020064 Property owner(s) MM&M Contracting, Inc. Day phone 688.1236 Mailing address (1) P.O. Box 670495 Chuoiak, AK 99567 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 22, Block 2, Glenn View Estates West Subdivision Phaself' 1 Legal description (Section, Township & Range) Lot Size 1/01 COa Acres/Sq.Ft. Number of Bedrooms Four (4) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only ❑ Water Storage 0 0 ❑ Jacuzzi ❑ ❑ Water Softening Unit ❑ 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: G/Oc • c.c.Waiver Fees: Date of Payment: Date of Payment: Receipt Number: / 8 053 Receipt Number: (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: July 11, 2002 TO: Dan Roth FROM: Mike Anderson, P.E. SUBJECT: Lot 22, Block 2, Glenn View Estates West Subdivision No. 2 Septic System Construction Permit No. SW020064 A second test hole was placed on the subject lot on July 10, 2002, in conformance with the permit issued for the construction of a septic system on the lot. The location of the test hole is shown on the attached site plan. Soils encountered were similar in nature to those found in Test Hole No. 1 with percolation rates between 6 and 15 minutes per inch. This test hole verifies the consistency of the soils in the area of the absorption trench and the design will not be modified. Please let me know if you have any questions. ..7\SS33o""4 18L4-37 '6N t `id a ♦ •'. 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L4 9L 9I £L ZL LL 01. 6 8 L puss 1111m 9 lanai° 'TI!S 9 INS/N19 p Z'ON 310H1S31 10/90 3dOlS 11 eseyd sa}e}s3;saM may\ uue10'Z)1001S'ZZloi :uo!}duosea le6al :pawaoJJed a}eO 6u!}0eJ;uo0 W??WIN :Jo3 pumped 1S31 N011V100213d - 901 SIIOS 61.966 >1y '•UOuy 10046 me6e.i8 ylnoS 00/.17 wea6oad Jalema}seM pue JaleM °lieu° uo!s!n!O !Tales 6u!pI!n9nuewpedeQ seo!AJas;uawdolanaa a6ejoyouy;o A}!led!Olunyl .9Z•Z ..9L'£ 6£:L 9 .9'1. 60:L 17 „9Z•Z .5L•9 80:L E 2L•Z .9•E 8E:9 Z .8£•1. 80:9 IPP -0I. L douO }aN Ja}eM 01 Uldap mil leN aw!l ssa0 aleG 6u!peaa ueld ellS aas ^oc)\ss3.1dad roLtL \`o 0.•Q• • y. 7) WA l§74 • 18£17- 30 '%;1� ;;; Z NOSa3C�EW '3 l3VHJCt3 0:l 4 ��..� HS bt7..• 0 .v,si 0Q a 747 NVld 311S 3 d O 1 S ON :aleQ 6uuopuolN Jaw Ja}eM o} y}dap LUIdaO IegM 'seA ll 6paJa;unoou3 Ja}empunoa0 sem 4lnos UIp°N aloes ;sal ;o wo;;oa 81. L4 9L 9I £L ZL LL 01. 6 8 L puss 1111m 9 lanai° 'TI!S 9 INS/N19 p Z'ON 310H1S31 10/90 3dOlS 11 eseyd sa}e}s3;saM may\ uue10'Z)1001S'ZZloi :uo!}duosea le6al :pawaoJJed a}eO 6u!}0eJ;uo0 W??WIN :Jo3 pumped 1S31 N011V100213d - 901 SIIOS 61.966 >1y '•UOuy 10046 me6e.i8 ylnoS 00/.17 wea6oad Jalema}seM pue JaleM °lieu° uo!s!n!O !Tales 6u!pI!n9nuewpedeQ seo!AJas;uawdolanaa a6ejoyouy;o A}!led!Olunyl ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522.6779 (FAX) April 7, 2002 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 22, Block 2, Glennview Estates West Subdivision Phase Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 22, Block 2, Glennview Estates West Subdivision Phase II intends to construct a new four-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic system to serve the 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 water service line on the lot and the test hole location along with the septic systems located on nearby lots. Existing drainage patterns are shown and will not be altered by the development of the lot. We recognize the soils information submitted with this permit application for this system is less than satisfactory. We are requesting, however, that the permit be issued based on this information as the subdivision has been proven in the past to have suitable soil conditions for the construction of on-site system. Weather conditions at this time make it difficult to complete additional test holes without increased costs. Additional test hole logs and percolation tests will be submitted prior to the construction of the system for your review which verify the soil conditions. The test hole placed near the location of the proposed absorption trench indicates clean gravel and sand with varying amounts of silt. The percolation test completed in the material resulted in a rate of slightly more than 7 minutes per inch. No groundwater was found during the placement of the test hole and none was noted during the monitoring period. We are therefore proposing to place a 3' wide deep absorption trench system with 6' of gravel beneath the distribution pipe. The total depth of the trench will be 9'. The distribution pipe will be placed at 3' below the ground surface to provide sufficient drop from the septic tank to the absorption trench. The total length of the new absorption trench will be 63'. 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 Lot 22, Block 2, Glennview Est. West, Phases April 7, 2002 Page Two will be constructed a minimum of 10' from the water service on the lot. 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. The subdivision is currently served by a community water system. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments i 49th �:\ jai • • as•s. '••� / 300 00 SN., TWUc t Ecce (Hot 5.71 OSS na �j `MES• FM -L Ijtsi r 7 12 :,.:1:isa`il:c8i4;arz�2's9. o �N9i4; tc-t 0 a >5 • 4 CF jf• -�•'• J • 49th } %.1.1.." t • • •. 4 E� • ANDERSON t W �� No. CE-43811vip ii� = �si •4• • • 1 ROW. R r z7�1330_ AREA SYSTEM PLAN SCALE 1" = 100' o• solYoo•t.,-/;.* .1 :HI.sIoo-w, r. POLLY CIRCLE • e,Ic mI.� WI 3 N mm Four ome Bei H do 10' Utility Easement 1351 y1,250 Gallon Septic Tank .y, QTH1 63' Long X 3' Wide X 6' Eff. Depth Abs. Trench Alternate Site SITE PLAN SCALE 1" = 40' .P...... E.�A ir{t 1 49th • MICHAEL E. ANDERSON Li •j�ifl., No. CE -4381 e1 \.r LOT 22, BLOCK 2, GLENNVIEW ESTATES WEST SUBDIVISION, PHASE fi � DESIGN FACTORS: Four Bedroom Home Pere. Rate: 6.67 Minilnch Avg. Application Rate: .8 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gallon Septic Tank 6' Drain Field Rock 4 Bedrooms X 150 GPD / .8 GPD/SF = 750 SF of Absorption Area 750SF/12 SF/LF = 62.5 LF Trench Length Therefore: Construct An Absorption Trench 63' in Length by 3' Wide With 6' of Drainfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing Ground. Total Depth of Trench to Be 9' from Existing Surface. Mound Over Trench or Provide 2" of Insulation to Provide Frost Penetration Protection. NOTE: 6" 6' 0" 4". Perforated PVC (Slots Down) • Drainfield .Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' From Water Service Line. Minimum 4' Separation From Groundwater. • Minimum 100' Separation From Wells in the Area. .. - 49th • • /` F` MICHAEL E. ANDERSON �,, .•��f �•, No. CE -4381 JJ\i • Municipality of Anchorage Development Services Department/Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw Street Anch., AK 99519 SOILS LOG - PERCOLATION TEST Performed For: Arctic Devco/Turner Construction Date Performed: 4/20/99 Legal Description: J of 72 Block 7 Glenn View West Fstates Phase II SLOPE • will L MICHAEL E. ANDERSON t W a I. off. No. CE -4391 PROF' ESS 1 _ OG/OL 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21 SM TESTHOLE NO. 1 GM/SM Med. Dense w/GP & SP North South Was Groundwater Encountered? If Yes, What Depth? No Depth to Water After Monitoring 5/15/99 Silt Increasing Date: None w/Density Bottom of Test Hole SITE PLAN See Site Plan S L 0 P E Reading Date Gross Time Net Time Depth To Water Net Drop 1 21 -Apr 10:05 r 2 10:35 30 2-8/16" 4-8/16" 3 10:36 7" 4 11:06 30 2-8/16" 4-8/16" 5 11:07 7" 6 11:07 30 2-8/16" 4-8/16" Perc. Rate: 6.67 Min./Inch Perc. Hole Diameter. 6" Test Run Between 3 Ft. and 4 Ft. Comments: Perc. Cavity Presoaked Prior to Test. Test Hole Placed During Construction Performed By: KND. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/4/02 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 22, BLOCK 2, GLENNVIEW EST. WEST SUB., PHASE 11 GENERAL: 1. The scope of this project includes the procurement and placement of a new 1,250 gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 63' long X 3' wide X 6' effective depth absorption trench at the location also shown on the Site Plan and at the configuration shown. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 9' below the existing ground surface. The new absorption trench must be placed a minimum of 10' from the water service line on the property. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. Lot 22, Block 2, Glennview Est. West April 7, 2002 Page 2 of 3 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if Tess than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). • Lot 22, Block 2, Glennview Est. West r ' ' ' April 7, 2002 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D.051-793-18 1. GENERAL INFORMATION 0 HAA # j -/,Q- 0 3 0 1/ 7 Expiration Date: 17L — 3 - L! Complete legal description Lot 22, Block 2. Glenn View Estates West Subdivision Phase 6 Location (site address or directions) Polly Circle Current Property owner(s) MM&M Contracting Day phone 688-1236 Mailing address P.O. Box 670495 Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well _ Individual Water Storage Community Class A Well Public Water System Four (4) TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicableiMunicipal and State codes, ordinances, • and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage. 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: Phone 522-7773 Date 3/27/03 "Z;5‘.?!..T.. &'• • 49;h lV ,: `�� y 71, • LeCNAEL E. ANDERSON ' `5 : I1.1-.% No. CE -4231 ' 44 .. CFESS1Ct ,...... c`1kttttt gt!,(l7, ,,, Additional Comments , ' • ON-SITE ••.,i; `C • *AI AND • 1nr • WASTEWATER : 6. PROGRAM "))'»j,!1)))J Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: (Rev. 12/00) Original Certificate Date. — 3 . 3 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 22. Block 2. Glenn View Estates West Phase I Parcel- ID: 051.793.18 A. WELL DATA Well type AWWU If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed _ Sanitary seal (YM) _ Wires properly protected (YIN) , Total depth ft. easel to ft. , Casing height (above ground) FROM WELL LOG AT INSPECTION in. Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 ml. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 724/2002 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (WN) Y Foundation deanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YM) N Date of pumping Pumper Recent Construction C. ABSORPTION FIELD DATA Date installed 7292002 Sod rating (g.p.d./ft2 or ft2/bdrm) .8 GPD/SF System type Deep Trench Length 67 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 804 ft2 Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test _ in. Water addedgal. New depthin. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump off" level at _ in. Datum Cycles tested Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent Tots Public sewer main Public sewer manhole/deanout Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5' Water main NIA Water service line >10' Absorption field >5 Surface water >100' Wells on adjacent lots WOW >'=•oo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS Driveway, parking/vehicle storage >10' 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 HM guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 3/27/2003 O'**,OF "`'4 49 ..,:..i ■ U CNAEI E. ANDERSON wC'-' ♦ k ♦ f': No. . CE -4381 i HAA Fee $ 37S Date of Payment .�- 'L $ 01 Receipt Number 033 0 g Q (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number