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HomeMy WebLinkAboutSHACKLETON LT 22A-1#016-141-41 . .� Municipality of Anchorage •: Byak°", Development Services Department° Building Safety Division ; Onsite Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 page I of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION,, /REPORT Permit Number: (.) O I I PID Number: O 16 - I4il l Name. M I 1 I` e A en Wastewater System: [Z New ❑ Upgrade Mtlrosa: 4© dAas Road Aielyev3ek 5q515-yg ABSORPTION FIELD Phone:- / Number of Bedroom: 14 VU VL Deep Trench D Shallow Trench 0 Bad O Mound 0 Omer. k LEGAL DESCRIPTION Soil Rating. a Total Depth from original grade: 3 Block: Lot $UbtlIVINdn: .^ . GPD/FP Depth to pipe bottom from odeineI rade Ft. Gravel depth beneath pipe: 9, S I I Township: Renee: Section: Fl. Fill added above original grade: Ft. GraON Length: Ft. 35 FI. Well, El Upgrade Gravel width: Number W lines: Distance between lines: Cla❑New wtiop ( YG A 4 e Total Depth: Ceeed to: Ft 6 �n/9 p,, Total absorption area: S Ftr I Ft. 'JAPMaterial: 08 Ffl Q Duller Disler Date Drill Stetic Water Level: Installer. P ^ Q 4/1 Date Installed: �y —17-0 Yield p Set at Cuing Heigh Ground: TANK GPM FL Ft. SEPARATION DISTANCES KSepbc ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublkYPrivate anulscly r apaaitr: From T/^a��n�Ik Field. Station Tank Sewer Line Ah cora o, cel. weti �1. V •1 VVA^ 1 /0y't 11 --�� �— "")�f 2 1 MatenN: of Number of compartments: Surface, Water �WT W +F LIFT STATION Lot Lin. -31 t -771-0 7-] \ / rse: manufacturer Gel. Foundation 1 + O IIn. "Pump o C 'Pump oT IevN at: High water alarm of In. Curtain Drain �� A' /Ueyle I rooN, Pump Make a Model drial Inspections pedonned by: Remarks: * wayvcR R[m��sssn BENCHMARK Location and Description: Tep &� O LID W ✓t -`f I �.ry1jN K�TL /I 11 Assumed Elevation: I� Ft. D�Cop 'y. � . Al,A� hz s~ .c�`�j ' 'b? 20t" i i t tNQIN[[RING Inspections performed by: 1704 Bogle River Loop Road, No. � RMIF River, 1111113118 stat�2-17 ✓ »:. �. �....., .�.. 2nd 17-aAJ Development Services DepartmentApproval�"c, .......... � "ll, C. COWAN � �C Reviewed and approved by: Date: - - O at `:%�'-��6 (Rov. 12m) sit i��•O.tl; kr;i4a a PERMIT NO. SW0401 15 PAGE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tele hone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 22A-1, SHACKLETON S/D P.I.D. NO. 016-141-41 I I 22A-2 I 100, p0 wE« RADIUS 22A-5 KEYBOX W w LLJ Q w I B Q STH 1 F- J I ASPHALT O DRIVEWAY 22AI 4 BEDROOM I HOUSE o COI NEW TRENCH TI CO2 y A TBM STI T2 THp2 F-• FCO DBL2 x 1 DBL1 O 4 NEW 1GALLON250 SEPTICTNK C =AM. MC: -3 �21 �FZ I <� L---90'GS ---------- 10' UTILITY EASEMENT — — — — — — -- -- -- — -- — ----- SCALE: 30' 23A-2RAo��s 23A-3 *.,.:.R.$ Sate+ :c THIS PROPERTY f %-7 0 \N M 100 SERVED BY tip+l PUBLIC WATER M •» • ROBERT COWA/ CE-8Ol 4 0 PR L"Iaiwa�'� PERMIT NO. SW0401 15 PAGE 3 OF 3 Municipalityof Anchoro e DEPARTMENT OF HEATH AND HUMAN'SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 0 Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 22A-1, SHACKLETON S/D P.I.O. NO. 016-141-41 ST1 ST2 98.4' FINAL GRADE 2" INSULATION 95.1' NEW 1250 94.9' GALLON SEPTIC TANK A B FCO 3.0 * 1.0' ST1 23.0 41.5 Col =98.A' ST2 30.0 45.0 CO2=98.2 DBL1 35.0 47.5 DBL2 38.5 47,0 C 0 1 24.5 31 .5 MT1 23.0 32.0 CO2 1 56.0 52.0 FINAL GRADE—77 = OFFSET C01=94.4' SR CO2=94.4' N. T. S. MT1=85.8' p yjP..� ...... �s UPPP NO WATER FOUND ° 79.8' B.O.H. ,�.. 9�>4 RO ERT{,.QqyAtl f4 c CG Ott �? r• Date s gZ.;L 3 / 0 ROBERTC. CowAN, PE. ROBERTA. SHAPER, 0E. CIVIL ENGINEERS (907)694.2979 FAX(9o7)694-1211 NMTHAL fHMTY APPWWAIS Municipality of Anchorage SMR8WATR DEPARTMENT OF HEALTH AND HUMAN SERVICES M ME%TEMX" 825 L Street P.O. Box 196650 AnchorageA Alaska 99519-6650 SEWER& WATER MSpEcrm y REFERENCE: L0 T aaA' I S #CKL0#,Tdi✓ 8"NEERMOSTMES M1DREPMS The septic in petitions for t e referenced property were performed on l7 o and l7�0 . Prior to submitting the On-site Was ewa er Disposa System and/or Well Inspection WELLMPEMW Report we are waiting for the AS/3u i t -r jv-Ay ,y to be AFWWTEST Completed. If we may be of further service please contact us. SITEPTANS SincerelyA MOA MION lRo. CAwa P. . SOILTEST pEncoUTioH STRZt LEST � j M PEc00NS W SITE COPMALMTEI M" f 17034 NORTH EAGLE RNER LOOP SUITE 204 + EAGLE RIVER, XMKA 99577 !1 Municipality of Anchorage Ai-/ENGINEEF9M) Development Services Department ✓ ,, Building Safety Division a • y,r On -Site Water and Wastevrater Program .. 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519.6650 G OMAN CE -8801 www cianchoraoe.ak.us E (907) 343-r-04 �� .....�•�. �. Soils Log - Percolation Test 9 Performed For: M I K C A"eN__Date Performed:_ .7—IL6 �O Legal Description: " Y X d A- — S/ 1 g` kut rai✓ Township, Range, Section: slope�j Site Plan -re-.)7 14oLrt i 1 -L I I I I Depth n � 1_ z � ` 0A4z ANraS 2- Y q^ 3• L% y a� Ljf_t,L GM040 GAmiKL 4SA*D 5- N 0 ENCOUNTERED? Net Tune ` a 6-'';�1 L 0 Depth to Water After 7- Monitoring? E 8- T .17- 9 10- S P 4M•4.o 2- 12- 13- 13-14-15- 14- 15- .` 16- 6-18-19 18- 19 / Ao s WAS GROUND WATER N 0 ENCOUNTERED? Net Tune Depth to Water a IF YES, AT WHAT DEPTH? L 0 Depth to Water After _ p Monitoring? E Date: Reading PERCOLATION Date Gross Tune Net Tune Depth to Water Net Drop (! 4-6 ) O C AT h L 7`-0 T .17- PERCOLATION RATE—_(r.;rnae33r4l PERC HOLE DIXIE -TER TEST RUN Sc NEEN 31 FT AND FT COMMENTS S P $O)a.-j ro wli •L PA•fJ 7'1f4. IVQ- A/ it PERFORMED BY: S &S ENGINEERIINN.G�pp{ Oqt N��Qi CERTIFY THAT THIS TEST WAS PERFORMED INA ODI N{(�eO�L�4 A���"I""""SAL GUIDELINES 10 EFFEC70N THIS DATE'DATE: g//6 �0V MUNICIPALITY OFANCHORAGE Development Services Department (�/ ► 1� 6"i On -Site Water 6 Wastewater Program Zj It 4700 South Bragaw, Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: May 12, 2004 Expiration Date: May 12, 2005 Permit Number: SW040115 Parcel ID: 016-141-41 Legal Description: jHACKLETON'LT.1Z4-V Design Engineer: 0003 S & S Engineering Site Address: 011340 JOHNS RD Owner Name: Mike Allen Lot Size: 13206 SQ. FT. Owner Address: 11340 JOHNS RD Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99515-2926 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 specked 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. 5. The following special provisions. PRIOR TO INSTALLATION OPTHE SEPTIC SYSTEM; THE WELLVITH THE ENCROACHED Wta RAC (NEEDS TO BE PERMANENTLY DECOMMISIONED PER MUNICIPAL CODE. 8'1 BION - ?pE1VQ1 COrlITION NAS ct1A'vge_0 CvE 70 A/X iv 40_-,F rio�v ex Whiz=K t..l'NE '4o/0 gllte/dy Ford New TO 01�,d�/NAL 5,17_4E Wirr( AS—gaJr�T• Received By: DAwCE Vry-j. NEW 7',eSr r/Ot,E ti/ja �E'tr'p�y�EO Taevc y Lar}rtOv i /tENcrP h/ « BE�DERPl.cci�iy [.Oe.,rP,pni TES•t )•/oiLE w,t.` BE s.agi.,r�-Eb Date: Issued By. Date: 5 / 2 oY 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.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. cj & -11�/ - N/ Permit Number SW Property owner(s) (Y�lkz A\Xsn Day phone ZZ `j -8fo9.3 Mailing address (1) 17&00 SP&i n/ bR iU6 Mailing address (2 A K Zip Code c► `fS / 6 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 13 ZZ o�_�,eres/Sq.Ft. Number of Bedrooms —C THIS APPLICATION IS FOR: Sewer Only 10 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. (Signature of property owner or authorized agent) 40` `••" W" ""r"" Eyla Riva. AhWo "07 . a Permit Fees: � y GQ Waiver Fees: Date of Payment: 'r / -7 /o N Date of Payment: Receipt Number: (Rev. 12=) v P/ 77 1 Receipt Number: S&S E IYlLt?RIi1G ROBERT C.COWAN, P.E. 131 CNILENOINEERS (907)894-2979 May 7, 2004 FAX(907)694-1211 !HEALTHAUTHORrrY MUNICIPALI'T'Y OF ANCHORAGE APPPO`''"a Development Services Department P.O. Box 196650 Anchorage, AK. 99519 SEWER&WATER MNNE%TENSLONS REFERENCE: Lot 22A-1, Shackelton Subdivision SEWERaWATER It is requested that you issue a permit to install a septic system to serve the proposed WSPeC7M four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location DGMERNGSTUDUM of the test hole is located on the attached sitelan. At the time of excavation on 1/2/04 "REPORTS p water was not found. Ground water monitoring was observed on 4/20/04 and the test hole was still found to be dry. S�CTION TESTT We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SITEPLAM If you require additional information, please contact us. RAW DESIGN Sincerely, SOLTFST ob Ac P.E. RCC/jhm PERCOLAIM Enclosure TEST STRUCTURAL& MECKg4r& PlSPECTIONS CNSRE WASTEWATER TMSPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 SITE PLAN §!» � J }U �In> / � DESIGN I c = z � \� z n ° � \§ !}§ 2\ Q -g / k)\ ( /E --j 8'\ � .2 /* ?5 z _J _%« _ �G� fz U M/A / 6 .CIO §=E IN ,o' @_ \\G / � JOHN'S $§R o \� !jo x z � \� z n ° G# !}§ 2\ Q -g / k)\ ( /E --j 8'\ � .2 /* _ _J _%« _ �G� 31 S 3 Ea21av / .CIO ))\\ �>z IN ,o' @_ 6@�0 / � JOHN'S ROAD< o \� !jo x \/\\r % �w � 57 �e x0{\ \�\\ 05 `- _ Cr—r- o z § emr - — % (\ coo , »Q < _ KF z > y � \� z n ° K: y. !}§ 2\ � @ .< -g / k)\ o \/ --j 8'\ � .2 /* _J _%« _ o �G� 31 S 3 Ea21av / < IN ,o' @_ / � JOHN'S ROAD< !jo x @0®o % �w � x0{\ \�\\ _ o z �_ - — F coo : \ C/) o\ –1y b. m� R ic m � m � I . . � > y \� z n ° K: y. !}§ � @ .< -g / k)\ o \/ --j 8'\ � _J _%« _ o �G� 31 S 3 Ea21av / < IN ,o' @_ / JOHN'S ROAD< !jo x % � x0{\ _ §j !}§ \ -g / k)\ \�\\\ _ o . \ \ -g / \�\\\ _ ] \ @_ / - SITE PLAN DESIGN 1 1" = Z 10 icc, ..r�ty t�7 c� 904 �m0 cziM�-0 n x 0 rI� ONO c >Z 10' Util Esmt f�S ."O=N mz0 CCD nn z w VI. VI rQ C N o° co a Z1 0 0 z Ip�p� ON. A til 1•, Z 10 icc, ..r�ty t�7 c� 904 .��� :100 /z cziM�-0 n x IlHN21311V '71 10' Util Esmt n CCD nn � 04! Z1 0 0 Ip�p� ON. A til 1•, 0 =OWN I D o o D a -� O m r D M y I �w � O ro b u F X 00�o �.. -K 0oZ n C -1r 0 N DO Dr Z Z O C -u I m C Z O OWID T.Z M yZ m� N Ci TU]P d e F m{ MF- N n� 13 a i E nDiO "II 'Z uri x z 0 Am m - w la Z K — m \ I EFLAT — IG —�� uj 0 C 311S 10, min y E — — JOHN'S ROAD x� E — ymc� 20 m H I o KU N 0 E I m Z ri icc, ..r�ty t�7 c� 904 .��� :100 /z cziM�-0 n x IlHN21311V '71 MIN 10Ln' n CCD nn 04! Y+fin Ip�p� ON. A til 1•, D M �� _mJo ro b F X Z� �.. -K 0oZ N y Z M yZ I TU]P d e F m{ 000to t 5 c a O0rrl r nDiO "II 'Z uri x 0 m - coo C] Z K — m T0 uj 0 10, min y a — — — — ymc� m H x- d � � O �O,o iV LTJ r m Cn CD Z ri icc, ..r�ty t�7 M1116'=� .��� :100 /z cziM�-0 n x IlHN21311V '71 MIN 10Ln' n CCD nn 04! Z 03- xzzo n CCD nn I Municipality of Anchorage M.c CjEjINEER'S xw+f- Development Services Department', 9 Building Safety Division .. .. �...,f.. ...........:...... � y2 On -Site Water and Wastewater Program C 4700 South Bragaw St. s •- -- - P.O. Box 196650 Anchorage, AK 99519-6650 �� Y ROBERT C. COWAN �f2 www.ci.anchorace.ak.us 0��. CE -8801 + N44' 7) 343-7904 Soils Log t90Percolation Test tt@ zF°it X10"Ao+�- Performed Fnr: h11 K Yc• %f j - L 1f /✓ Date Performed: Legal Description: 1-(7T a W.#9 — / $#,I CKrL ry i- 51D Township, Range, Section: Depth VA (.4 to Gr' L 4 a I ` W/SW W �L GRkOt.D aQ•i tr &,Q 4,4L 4-00-4 6- 7- 8- 9- 10- 1 - 7-8-9- 10-1 WAS GROUND WATER IVO f'OtlR y ENCOUNTERED? s G-A4'stt4 IF YES, AT WHAT DEPTH? L O SAN 0 Depth to Water After Monitoring? - P Day. •E Date: aAELIPY a°•N. PERCOLATION RATE < 1 ('ninutesnnch) PERC HOLE DIAMETER (0-19 - TEST. RUN BETWEEN FT AND —_FT COMMENTS IN s/0 SO rA-I ro 7o WIA-L /0Y/JI/THE N0. +1 Si41Vf- PERFORMED BY: I �L CERTIFY THAT THIS TE§T Wo/S PERFORMED IN ACC ` JCEI_W4ol_, T$,�jTFRQNJNJ AL GUIDELINES IN EFFECT ON THIS DATE. DATE: L% ?-0/ ON Eagle River, Alaska M77 ROBERT C. COWAN P.E. CPALENGINEERS (907) 6942979 ' FAX(907)69+1211 ON-SITE WASTEWATER DISPOSAL SYSTEM HEALMAMHORFTM APPROVALS CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS SEWERSWATER AWN E(1ENDONS REFERENCE: Lot 22A-1, Shackelton S/D May 5, 2004 SETYEReGENERAL: r(sPEcnON oN 1. The scope of this project includes the installationof a 1300 HDPE gallon septic tank and a new trench to serve the proposed four bedroom residence � RSn,aEs located on the referencedro P PAY• 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all WELLMPMt" +FLOWTEST applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground SITE PLANS utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROAnoESIRN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing SOILTEST their own systems must also receive prior approval -from the Municipal Health Department. PEAwuTaN SEPTIC TANK INSTALLATION: TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. ,T„U,r„RAL& Construction shall include two 4" cleanouts for pumping access. uEtlVNOAI HSPEMONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ONWE WASTEWATER WSPOSALSYSnu DESM 17M NORTH EAGLE RNER LOOP 9 SURE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 22A.1, ahaekelton SID May S, 2004 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAHOULD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. A subsurface disposal field may not be located on a slope greater than 25 percent unless there is an approved exception documented. ` Page 3 Lot 22A•1, Ehackelton E/D May 0, 2004 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforate 59W Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 22A.1, Shaekeiton SID May S, 2004 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER 11 January 4, 2005 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907) 894-2979 FAX(907)694-1211 HEALTHAIRHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department SEWER&WATER P.O. Box 196650 MAIN EXTENSIONS Anchorage, AK 99519-6650 SEWER&WATER REFERENCE: Lot 22A-1; Shackleton Subdivision INSPECTION Request you grant a waiver on the referenced property for the horizontal separation ENGINEEISNCSTLIDIM distance between the leachfield and the Right of Way at 7 feet. AND REPORTS We do not anticipate any adverse effects to the' Right of Way or on the adjacent properties. WEUWSPECTION &FLOWTEST If you require additional information, please contact us. Sincerely, SITE PIANS L!• "- Oobert Cowan, P.E. ROAD DESIGN RCC/ts SOILTEST PERCOLATION TEST STRUcnAAL& MECHANrAL INSPECTIONS ONSITE WASTEWATER OISPOSALSVSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99s77 -A Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: 050003 PID#: 016-141-41 HA#:060007 Permit#:040115 Date Received: 01/06105 Legal Description: Shackleton Lot 22A-1 Engineer. S & S Engineering 17034 N. Eagle River Loop Ste 204, Eagle River, AK 99577 Applicant: Mike Allen Waiver Requested: Separation distance 7 Feet Absoptlon Field to Property Line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: Waiver Is not Granted., List Conditions or Reasons for above: Date: By: Rec#: 50291 Amount: $Ili.00 Date Paid: 1111/2005 Municipality of Anchorage. n �r t s P.O. Box 196650 • Anchorage, Alaska 99,519-6650 • Telephone (907) 34.3-&301 • Fm (907) 343-82(x) 4700 Bragaw Street • Anchorage, Alaska 99,507 Mayor Mark Begich www.mun).org Building Safety Division 11 January 05 S & S Engineering 17034 N. Eagle River Loop Suite 204 Eagle River, AK 99577 Subject: Waiver Request for Shackleton Lot 22A-1 Waiver Request #VrR050003 Parcel ID #016-141-41 Dear Mr. Cowan: Your request for a waiver of the required 10 feet from the Absorption Field to the Property Line is approved. The approved separation distance is 7 feet. This waiver approval applies to the existing Absorption Field to Property Line separations only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffoet Engineering Tech On -Site Water & Wastewater Program Community, Security, Prosperity 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 �o8tea- C-Ca,r9�/ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.016-141-41 HAA# Expiration Date: - / iZ - 0 6 1. GENERAL INFORMATION Complete legal description Lot 22A-1: Shackleton Subdivision Location (site address or directions) 11340 Johns Road Anchorage, AK 99515-2926 Current Property owner(s) Mike Allen Day phone 229-8693 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: it 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well Public Water System Day phone 24— I /l >40s - TYPE OF WASTEWATER DISPOSAL: Individual On-site KR 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 4 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. (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 applicable Municipal and.State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering IPhone' 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, Ax 99577 Engineer's Printed Name Robert C. Cowan Date 1 /1 /0S - y ROBERT C. COWAN 6. DSD SIGNATURE �" o, CE -8801 Approved for 4 bedrooms. �r� , .• l Disapproved. �i1��PisstoK� `-oar Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (Rev. 01/02) Original Certificate Dater j— 11 O J Municipality of Anchorage .E • "` Development Services Department _ 4 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: %D P4 K L. #- rO J Sl D Parcel ID: 016 - 11/ -4 A. WELL DATA Piot-, <- u4-rt2 Well type _ If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly protect /N) Total depth ft. Cased to ft. Casing hei above ground) in. Date of test Static water level Well production WATER SAMPLE Coliform FROM WELL LOG ml. Nitrate mg./I. Ars4a'- mg./L Date of sample: _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEAT c S T1, E 4. Tank size 1 S'0 gal. Number of Compartments A 9.p -m. Other bacteria colonies/100 ml. Collected by: Date installed8 /I 7 /O.a// Cleanouts&N) YE S Foundation cleanout &N) Y&J Depression over tank (Y/(D A+O High water alarm (YAJ N Date of pumping NIA " ME-'+ol _ Pumper C. ABSORPTION FIELD DATA Date installed 8117 O Soil rating g.p.d./ftZ or ft2/bdrm) System type -r RE N cH Length -3s- ft. Width 3 ft. Gravel below pipe 8- S ft. Total depth 13 ft. Eff. absorption area S-13- ftT Monitoring tube Y" Depression over field WO Date of adequacy test N4 — N 6w Results (Pass/Fa' L,—� For —,Y— bedrooms Fluid depth in absorption Feld before test _ i Water added_ gal. New depth_ in. Elapsed Time: _ min. Any rejuvenation treatme Fin id depth _ in. Absorption rate >= g.p.d. st 12 mo.) (Y/N & type) If yes, give date Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _ in. "Pump off' level at i igh water alarm level at in. Datum yc es tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot _ Public sewer main Sewer /s ice line _ On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 17 Property line 3 1 1 Absorption field Water main 10 + Water service line JO r4 Surface water /00 �4 i Wells on adjacent lots ) 0 b -i- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Property line Building foundation !O Water main /0 + Water Service line 10 �+ Surface water 100 + Driveway, parking/vehicle storage 6 '4- f f r Curtain drain /NoNf- K Now N Wells on adjacent lots oo i F. COMMENTS -* WArvEk Kcavb676.4 G. ENGINEER'S CERTIFICATION r 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. ` ROBERT c.townN n C€-8801 Engineer's Printed Name /COQ CAT Cy✓ AN s� Date % / 6 AO S— HAA Fee $ z T • �=Waiver Fee $ t 76 . Date of Payment 1 o S ' Date of Payment f I6 l c J - Receipt Number C9 C� 3 4 S (Rev. 12/01) Receipt Number 6 C a y,rC(n 3Ar_ ,/FiI�GKLfLto../ S'UFS f)fYI Sf C.t/ Lf1 T da 4 13,aoc S. A. FINAL STRUCTURE AS—BUILT Ab -tJ U 1 L 1 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASfALDI LAND SURVEYING ENCROACHMENTS E)aST EXCEPT AS INDICATED. JEFF A. GASTALDI, R.L.S. IT IS THE RESPONSIBILITY OF THE OWNER TO 4726. WEST 88TH AVENUE DETERMINE THE EXISTENCE OF ANY EASEMENTS ANCHORAGE, ALASKA 99502 COVENANTS OR RESTRICTIONS WHICH DO NOT PHONE 248-5454 APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR 2830 10/19/2004 ESTABLIS14ING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT. ALASKA F.B. JOB NO. 04-13 SS22A1 NOTE: NO CORNERS SET THIS DATE. 30• 1 "-20' Z'd BBBi-898-LOB ualla ONTW 44221 f0 BT aa0