HomeMy WebLinkAboutMUIRWOOD PARK BLK 4 LT 1rwood Park
Block 4
Lot 1
#011-422-78
Municipality of Anchorage Page 1 of 3
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: SW020379
PID Number: 011.422.78
Name:
Harding Homes of Alaska
Wastewater System: New
Address:
7220 Sitkin Circle Anch., AK 04
ABSORPTION FIELD
Phone:
Number of Bedrooms:
Deep Trench
337-9109
Four 4
LEGAL DESCRIPTION
Soil Rating:
1.2
Total Depth from original grade:
10
GPD/Ft'
Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
4 1
Muirwood Park
4 Ft.
6 Ft.
Township: Range:
Section:
Fill added above original grade:
Gravel Length:
0-1 Ft.
43 Ft.
Well: City Water
Gravel width:
3-5
Number of lines:
1
Distance between lines:
Ft.
Ft.
Classification (Private, A, B, C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Ft.
Ft.
516 W
ASTM 3034 PVC
Driller:
Date Drilled:
Static Water Level:
Installer:
Date Installed:
Ft.
Sanders & Sanders
11/15/2002
Yield:
Pump Set at:
Casing eight Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublic/Private
anu ac urer:
apace y in a ons:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250
Well
N/A
N/A
NIA
NIA
N/A
Material:
Steel
Number of CompaFRe_nts:
I Two (2)
Surface Water
>100'
>100'
N/A
NIA
LIFT STATION -- NONE ON LOT
Lot Line
>5'
>10'
N/A
N/A
ze
Manufacturer:
Gal.
Foundation
>5'
>10''
N/A
NIA
"Pump on eve at:
"Pump o eve at:
Highwater aarm a
in.
in.
in.
Curtain Drain
None
Noted
Pump Make & Model
Electrical Inspections performed by:
Remarks:
BENCH MARK
Location and Description:
Northeast Corner of Slab Under Front Steps.
Assumed eva ion:
100.0 Ft.
Engineer's Stamp
it
.:95
.................
♦♦
�:Cl
Inspections performed by: MEA
Dates: 1St 11/15/02`=
49th ': ♦�
�.. ..... ..t.....�
Department of Health
2"d 11/15/02
and Human Services approval
o....._.... ........................ .... ....0q 0 q ' MICHAEL E. ANDERSON
00. :'�Ar
♦ % •.� No. CE -4381 •' _,
♦♦♦♦�h'Fp
Reviewed and approved
U J Pd, Date:1 d "��}�fl3
p••...........•'P� ��:
(Rev. 10/99)
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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
t l-15- -02- @ lam:
f/-/r;-Pz G i'. 3o
Date Issued: Oct 01, 2002
Expiration Date: Oct 01, 2003
Permit Number: SW020379 Parcel ID: 011-422-78
Legal Description: MUIRWOOD PARK SUBDIVISION BLOCK 4 LOT 1
Design Engineer: 0014 Anderson Engineering Site Address: NHN PARK WEST CIRCLE
Owner Name: HARDING HOMES OF ALASKA Lot Size: 40001 SQ. FT.
Owner Address: 7220 SITKIN CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, A 99504 -
This permit is for the construction of:
0✓ Disposal Field []✓ Septic Tank E] Holding Tank 0 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.
Received By:
Issued By:
Date:✓
All
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. 011-422-78 Permit Number SWO20379
Property owner(s) Hardinq Homes of Alaska Day phone 337-9109
Mailing address (1) 7220 Sitkin Circle Anchorage, AK 99504
Mailing address
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size 40,001 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
p Code
Number of Bedrooms Four (4)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade (.._)
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
AsIffiff
(Signature of property owner or authorized agent)
Permit Fees: t q(jc'
Date of Payment: 9 ( Zee' 6 7✓
Receipt Number:-t—f- I
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 .522-6779 (FAX)
September 26, 2002
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw.Street
Anchorage, AK 99519-6650
Subject: Lot 1, Block 4, Muirwood Park Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 1, Block 4, Muirwood Park Subdivision intends to construct a 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 new home. The attached Site Plan
and backup documentation identify the location and configuration of the new septic
system and alternate site and the parameters used in the design. Also identified on the
plans are the proposed water service line, test hole location and the locations of the
facilities on the adjacent properties. Drainage arrows are also shown and current
drainage patterns will be maintained stained after cvnstr uction.
The test holes placed near the location of the proposed absorption trench indicated fine
sand with a slight amount of silt to a depth of 6'. The sand below this level became well
graded and contained substantial amounts of gravel. The new absorption trench will be
placed in both soil strata and we have used an application rate of 1.2 gallons per day
per square foot. No ground water was found and none was noted during the
monitoring period. We are therefore proposing to construct a deep absorption trench
system with a 35' long trench with an 8' effective depth. This length is approximately
3.75' longer than design requirements. The distribution piping depth will be 2' below
the surface. Total depth of the trench will be 10'.
The ground surface on the lot slopes at shallow grades from east to west. The
absorption trench will be constructed parallel with the slope as much as possible in
conformance with Municipal requirements. All components of the new septic system
will be constructed a minimum of 10' from the water service line on the lot and on the
adjacent 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:
Lot 1, Block 4, Muirwood
September 26, 2002
Page Two
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 the Municipal 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,
'J'kj f' a"�"
Michael E. Anderson, P.E.
Attachments
OF,
49th _ •y�
.A t MICHAEL E. ANDERSON C
&�sNo. CE -4381
••�=f���ROFESSIU ��
SCALE 1" =100'
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7�A s MICHAEL E. ANDERSON
#c No. CE -4381
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O ti Alternate Site --63' Long x 3' Wide S
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Bedroom I I
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5 Septic Tan I
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a 35' Long x 3' Wide I
::u 6 8' Effective Depth
3l a Absorption Trench
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SITE PLAN
SCALE I,,= 30'
1.V;fp
lik0
LOT 1, BLOCK 4, MUIRWOOD PARK
SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 1-2 Min./Inch 1,250 Gallon Septic Tank
Avg. Application Rate: 1.2 GPD/SF 8' Drain Field Rock
4 Bedrooms X 150 GPD 11.2 GPD/SF = 600 SF of Absorption Area
600 SF/16 SF/LF = 31.25 LF Trench Length
Therefore: Construct an Absorption Trench 35' in Length by 3' Wide With 8' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 2' Below Existing
Ground. Total Depth of Trench to Be 10' Below Existing Surface. Cover Over Septic Tank
a Minimum of 4' or 2" of Insulation and 2' of Cover.
�_.
Natural -
1'6" Backf.ill Geotextile
Fabric
OL1
4" Perforated
PVC (ASTM 3034)
8'0"
Drain Field
Rock.
3'
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 10' Separation From Water Service Line.
0
•M %\
n? MICHAEL E. ANOERSON
7
No. CE -4381
��4,fROFESS�CJNPiq
LOT 1, BLOCK 4, MUIRWOOD PARK
SUBDIVISION
(ALTERNATE SITE)
DESIGN FACTORS:
Four Bedroom Home
Perc. Rate: 20 Min./Inch
Avg. Application Rate: .6 GPD/SF
SYSTEM REQUIREMENTS:
Deep Trench System
1,250 Gallon Septic Tank
8' Drain Field Rock
4 Bedrooms X 150 GPD /.6 GPD/SF = 1,000 SF of Absorption Area
1,000 SF/16 SFILF = 62.5 LF Trench Length
Therefore: Construct an Absorption Trench 63' in Length by 3' Wide With 8' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 2' Below Existing
Ground. Total Depth of Trench to Be 10' Below Existing Surface. Cover Over Septic Tank
a Minimum of 4' or 2 of Insulation and 2' of Cover.
M
Natural-
19601
atural1'6" Backfill
Geotextile
Fabric
6"
4" Perforated
PVC (ASTM 3034);
i
8'0"
Drain Field
Rock
3'
OF
TYPICAL DEEP TRENCH SECTION 'v�P�E. �s'•
(NO SCALE)4
,,. 9th
...... f
....
NOTE: Grade Area Over Trench to Drain Away. 0 ...... „ „ .. .
Minimum 6' Separation From Bedrock. i �? CHAEL E. ANDERSON;;
Minimum 10' From Lot Line. No_ cE-4381'
Minimum 4' Separation From Groundwater. �i��Fs;• •,..•�
Minimum 100' Separation From Wells in the Area. isf ; i-10A''W �
Municipality of Anchorage
Development Services Department/On-Site Water and Wastewater Program
4700 South Bragaw Street, Anchorage, AK 99516-6650
SOILS LOG - PERCOLATION TEST
Performed For: White Raven Development
Legal Description: tot 1. Kincaid Park Subdivision
SLOPE
1
PT/OL
2
3
4'
5'
6
7
8
9
10
11
12
13
14
15
16
17
18
SM
20% Silt
3/4" -.2"
Cobbles
GP
North
South
Was Groundwater
Encountered? No
If Yes, What Depth?
Depth to Water
After Monitoring None
Date: 2/28/02
Date Performed:
...JTF .... ..'•..�Ar
Air
♦�
�
414 �'ROFESS\�N�i••
1/21/02 �11%SISLU ••
9
Reading Date Gross
Time
SITE PLAN
Depth To
Water
Net
Drop
22 -Jan 1:07
258.51''
.:
1:22
00
TK=6
�69 sq. ft
1:23
o
'
O O N
p
15
O
.81"
1:39
8.75"
1:54
15
40.001 sq•f
.75"
2:18
co
O O p
2:33
15
9.56"
.81"
LL=3'.42'
R=20.00
238.51':: .
50.0@'''
"W
4$5.01' '(R&M)
KI_NCAID _
ROAC
9
Reading Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
22 -Jan 1:07
8.75"
Performed By: Alan Harala. I, Michael E Anderson Certify That This Test Was Performed
1:22
15
9.63"
.88"
1:23
8.75"
1:38
15
9.56"
.81"
1:39
8.75"
1:54
15
9.5"
.75"
2:18
8.75"
2:33
15
9.56"
.81"
Comments: Test Cavity was Presoaked Prior to Test.
Performed By: Alan Harala. I, Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/2/02
..M -
Municipality of Anchorage
Development Services Department/On-Site Water and Wastewater Program
4700 South Bragaw Street, Anchorage, AK 99516-6650
SOILS LOG - PERCOLATION TEST
Performed For: White Raven Development
Legal Description: Lot 1. Kincaid Park Subdivision
SLOPE
1
6
7
8
9
10
11
PTIOL
SM
GP/SP
Was Groundwater
Perc . Encountered?
Rate
1 Min. If Yes, What Depth?_
Per In Depth to Water
After Monitoring _
Date:
3/4" - 2"
12 Cobbles
13
North
South
None
2/28/02
Date Performed:
SITE PLAN
1/21/02
wig
pROFESS10N' i�
Reading Date Gross
Time
Net
Time
Depth To Net
Water Drop
22 -Jan 4:12
8.5"
4:22
15
14.5"
4:23
8.44"
4:33
15
14.31"
4:35
8.44"
4:45
15
14.25" .
4:47
8.5"
4:57
15
14.31"
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 1, BLOCK 4, MUIRWOOD PARK SUBDIVISION
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
and the construction of a new 35' long by 3' wide by 8' effective depth
absorption trench also shown on the Site Plan. The total depth of the
trench will be 10' below existing ground and the distribution pipe will be
placed at 2' below the surface. All components of the septic tank and
absorption trench must be constructed a minimum of 10' from the
water service to be constructed 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.
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. The 1,250 -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.
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.
0
Lot 1, Block 4, Muirwood
September 26, 2002
Page 2 of 2
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
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.
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 Hl or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
Lot 1, Block 4, Muirwood
September 26, 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.
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
011,422-78
1. GENERAL INFORMATION
Complete legal description
Muirwood Park Slk 4 lot 1
ZD
COSA #—! 1d1
Expiration Date: C-1 '- -09
Location (site address) 7577 Park West Orde,Anchorage, AK99502
Current Property owner(s) Randal b Julie Hames Day phone
Mailing address 7577 Park West Or., Anchorage, AK 99502
Lending agency Day phone
Mailing address
Real Estate Agent Mary Tutterow / Dynamic Properties Day phone 261-7682
Mailing Address 3111 C street Suite 100, Anchorage, AK 99509
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
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 Department (DSD) issues Certificates of On -She Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on -she wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems 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. (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 Certificate of On -Site Systems 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 WaWns engineering, Inc.
Address PO Box 110449, Anchorage, AK 99511-0443
Engineer's Printed Name C4ndy W. Enis
b. DSD SIGNATURE
Approved for --!/— bedrooms.
2
Disapproved.
Phone 907349}7851
Date 6)_ll—Og
49 n7
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(R.n „As)
I Certificate Date:_ 6 , 0 8
Municipality of Anchorage
/ • Development Services Department
Building Safety Division
Onsite water & Wastewater Program '
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.8650
www.muni.orglonsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Muinvood Parc Bbdc 4 Lot 1 Parcel ID: 011-422-78
A. WELL DATA public Water service
Well type _
Date completed
Total depth ft.
Date of lest
Static water level
If A, B, or C provide PWSID #
Sanitary seat (YIN) _
Cased to ft.
FROM WELL LOG
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Arsenic: mg/I
B. SEPTICIHOLDING TANK DATA
ft.
g.p.m.
Nitrate mglL
Well Log (YIN)
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
ft.
9 -
p.m -
Other bacteria colonies/100 mL
Date of sample: _ Collected by:
Tank Type/Material Steel Septic Tank
Tank size 1250 gal. Number of Compartments 2_
Date installed 11/1512002
Cleanouts (YRJ) Yes
Foundation cleanout (Y/N) Yes Depression over tank (YIN) No High water alarm (YM) NIA
Date of pumping 8-28-2008 Pumper Northland Pumping
C. ABSORPTION FIELD DATA
Date installed 111152002 Soil rating (g.p.d./ft= or ft'Ibdrm)1.2 System type Deep Trench
Length 43 ft. Width 3 - 5 ft. Gravel below pipe 6 ft.
Total depth 10 ft. Eff. absorption area 516 ft Monitoring tube Yes Depression over field No
Date of adequacy test 8-28-2008 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 2 in. Water added 1121 gat. New depth 6.5 in.
Elapsed Time: 7 min. Final fluid depth 1.75 in. Absorption rate >= 600 g p•d•
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed N/A Size in gallons Manhole/Access (Y/N)
'Pump on' level at _ In. 'Pump Off" level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
High water alarm level at in.
Meets alarm & circuit requirements?
Septic tank/lift station on lot NIA On adjacent lots
Absorption field on tot On adjacent lots
Public sewer main
Sewer /septic service line
Public sewer manhole/cleanout
Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 12.5' Property line 40' Absorption field IT
Water main 40'+
Wells on adjacent lots 200'+
Water service line 62' Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 25' Building foundation 10' Water main 25'+
Water Service line 42' Surface water 100'+ Driveway, parking/vehicle storage 14'
Curtain drain NIA Wells on adjacent lots 200'+
F. COMMENTS:
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 COSA g/uiid'e"li�n/e"s" in
effect on this date.
Engineer's Printed Name
Date 9 -// -D 8
COSA Fee
Date of Payment
3o r
Receipt Number 8 �Q
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
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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. 011-422-78 HAA #__�j
Expiration Date: D l 4-04
1. GENERAL INFORMATION
Complete legal description Lot`l,.Block 4, Muirwood Park Subdivision
Location (site address or directions) Park West Circle at Kincaid Road
Current Property owner(s) Harding Homes of Alaska. Day phone 337-9109
Mailing address 7220 Sitkin Circle Anchorage, AK 99504
Lending agency
Day phone
Mailing.address
Real Estate Agent
Day phone
Ma'ijing A dress.
Unless othervvhWfequested, HAA will be held by DSD for
pickup.
23k=`NUMBER OF BEO�OOMS:
Four 4
r {
3. TYPE,0F'WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual°Well'
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community _Class Well
❑
Community On-site
❑
Public Water System
®
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 seined 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 Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson P.E. Date 10/10/2003
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedroom's, with the following stipulations:
tflf(f
Additional Comments S z - Q -RITE
WATER AN�CDm
PROGRAM
'09 ))
0 f))- i
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date: / d —
(Rev. 12/00)