HomeMy WebLinkAboutSHACKLETON LT 22A-2Shackleton
Lot 22A-2
#016-141-42
\ Municipality of Anchorage ice•,
�l
Development Services Department "
Building
Safety Division
- On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 3
www.cl.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATERDISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ��/l�0"fV' PID Number. 0 16 —
N.rM
Q e I1411 -ell Wastewater System: (4 New ❑ Upgrade
Aidr.I S D,-lve a r a e �� L'C 6
ABSORPTION FIELD
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LEGAL DESCRIPTION
See R.4ng
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V 13
BIGNt. Lot: ^ ^ _D S.baosm�
Depth w PM Wnom ft=mg,nr gni.
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SEPARATION DISTANCES
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To
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ublic/Private
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Remarks
BENCH MARK
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ssunNo I.v.POn.
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Engineers Stamp
S i S ENGINIIRING
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aa IV
Inspections performed by: 17034 Eagle River Le" Reed, H& Ms: 1"
* J u ale
Eagle vv, as a p
2nd
Development Services Department Approval
ben A..r
Reviewed and approved by: Date:3'/ 0-r6' /
', .,
(Rev. 17A101
'�CO,'t�.New•• �.�'�
14\ pMJF$34H^tlI wr
PERMIT NO. SW0401 44 PAGE 2 OF 3
Municipalit of Anchorage
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 22A-2, SHACKLETON S/D P.I.D. NO. 016-141-42
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PERMIT NO. SW040144
PACE 3 OF 3
Municipality of Anchorae
DEPARTMENT OF HEALTH AND HURAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 22A-2, SHACKLETON S/D P.I.O. N0. 016-141-42
STI ST2
A
99.7'
FINAL GRADE
FCO
2" INSULATION
96.2' NEWL 1250
96.0'
GALLON
—
17.5
SEPTIC TANK
ST2
—
11.0
51.5
DBL1
—
9.0
55.5
DBL2
—
9.0
C01=99.3'
CO1
30.5
CO2=98.7'
69.5
MT1
29.5
—
69.0
CO2
51.5
—
102.0
7.
FINAL GRADE
C01=95.9'
SR CO2=96.3'
W T.&
MTl =87.9' ♦
NO NATER FOUND
82.9' B.O.H.
r. ..... ............r s
A
8
C
FCO
—
25.0
32.5
ST 1
—
17.5
44.0
ST2
—
11.0
51.5
DBL1
—
9.0
55.5
DBL2
—
9.0
58.0
CO1
30.5
—
69.5
MT1
29.5
—
69.0
CO2
51.5
—
102.0
Municipality of Anchorage f
Development Services Department
BuOding Safety Division
0 yt On -Site Water and Wasbewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650 ..
� cianchomce.ak.vs
(c07)343 -TSCA r`
L r
Soil/s� Log - Percolation Test
Percrmed For: Date Par;ormM:
Legal Description: IwT ZZA' Z-5,"CILEL'RaA3'1ownship. Range. Sedon
Slope
Tis HQ�� � �TI—I F77—
to-
11 -
1
1
17
18
O IP_CenjolG.S
gm Flue. sAA1
Sl'
WAS GROUND WATER
ENCOUNTERED? S
'?00911 IF YES. ATYMAT DEPTH? L
6tZ4q%1P c
Depth to Water Aller p
6loniloring? E
519�� B,ZI oj/
Date:
M.0. if
Reading Date I GrossTane I Net Tune I Depth to Water I Net Drop
PERCOLATION RAT. PcK� c -UWJr TFR -
TEST RUN E=:NEER FT AND FT
COM&IENTS ,f0 o T7/C' S j -r
PERFORMED BY:� \\ I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES C: EFFECT ON THIS DATE. DATE:
110BERTC.COWAN, P.E.
ROSERTA. SHAFER P.E.
CML ENGINEERS
LL (907)694-2979
Date: �%la-3 A' m(907)694-121)
HEALTHARHDI1I1Y
APPROVALS
Municipality of Anchorage
SEWERSWATER DEPARTMENT OF HEALTH AND HUMAN SERVICES
TAANEXTENSIONS 625 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
SEWERS WATER
NSPECTION
REFERENCE: Lora a A4 - .SHA c K[k re N S/u
ENGINEERINGSTMES
ANDWPORTS The n c se tiia tions for the eferenced
p p property were
performed on I o and I o . Prlor to submitting
the On-site Wastewater Disposal System and/or Well Inspection
WELLNSPECTION Report we are waiting for the As/3w-iT Yult 4y to be
An.ONTEST completed.
If we may be of further service please contact us.
SITE PWS Sincerely j
RDADDESIGN jW2
Robert C. Cowanj P:E.
SOIL TEST
PERCOLATION
TEST
STRUCTUUL/
TAECTUNIM
NSPECTICNS
ON SITE
WASTEWATER
! DMPDSALSVSTEM
DESIGN
I 17034 NORTH EAGLE RNER LOOP • SUfTE 204 a EAGLE RIVER, ALASKA 99577
t
MUNICIPALITY OFANCHORAGE
/�kv
• Development Services Department
C6 " 1n' 1
Onsite Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
D\
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: May 25, 2004
Expiration Date: May 25, 2005
Permit Number: SW040144 Parcel ID: 016-141-42
Legal Description-,. Shackleton Lot 22A-2
Design Engineer: 0003 S & S Engineering Site Address: 11320 Johns Road
Owner Name: Michael Allen Lot Size: 13200 SO. FT.
Owner Address: 11600 Spain Drive Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage . AK 99516 -
This permit is for the construction of.,
❑.r Disposal Field ❑.r 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. i 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.
�Ifglo� _ TY{Enlc r{ c c�hrron/ t/�s ct/�t�v�Fb -t>oe
cJRTEZ Link i^tD P���E�� New 7-E37-N,0L-E hlil 2�R7�vt,
FOa N6 ti/ TrtENC y i-OL.R T/OV, ' /%V ENC r( wr a ` !3E PE?�P,t tl � [ ✓ /
%J ORI A/-+ L S/TE_ LOC /1-7-/" , TES T '040 L_,S "o I- 6'� sugr•, CTTF_.
(..l'rt-( A$—/3L�rt.7—.
Received By:
z
Date:
S`h. C /o SI
Issued By: -t Date: T ZS
Municipality of Anchorage
Development Services Department
Building Safety Division
i 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 SEWERIWELL PERMIT APPLICATION
FOR A SINGLE F=AMILY DWELLING
Parcel I.D. f-)1 (0— I u 1 -U Z Permit Number SW
Property owner(s) 021V-1- NUN\ Day phone ZZ `l ' 8 613
Mailing address (1) 1 t lc 00 S P Al o R e
Mailing address (2) Ak4S)a .e . AK . Zip Code 99S lI0
Legal description (Lot, Block & Sub'd.) Le -Ir Z7 -A- ?_ S h A oka\Fk dry S_ �
Legal description (Section, Township & Range)
Lot Size t S ! Z O 0
Atres/Sq.FI.
Number of Bedrooms •a
THIS APPLICATION IS FOR:
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.
zlt'�
S a S Vialk"It'"s
(Signature of property owner or authorized agent)
Epl• RtrK, Alaska flSTl
Permit Fees: O y Waiver Fees:
Date of Payment: S`/ } o �o +� Date of Payment:
Receipt Number: O Sl. S'09 Receipt Number:
(Rev. 12100)
S&
ROBERT C. COWAN, P.E.
CMLENGINEERS
(907)6942979
May 12,2004 FAX(907)6941211
!7,iniginjeexing
r MUNICIPALITY OF ANCHORAGE
APPROVALS Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
SEWER& WATER
UNNO`TENS10f8 REFERENCE: Lot 22A-2, Shackelton Subdivision
SEMR&WATER It is requested that you issue a permit to install a septic system to serve the proposed
GTpN four bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
ENOREERINGSTLOMS of the test hole is located on the attached sitelan. At the time of excavation on 1/2/04
ANO 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.
A DWTES;TON 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
SITE RIMS properties.
If you require additional information, please contact us.
ROAD DESIGN Sincerely, /
SOL TEST W/2. " "-
Robert C. Cowan, P.E.
RCC/jhm
PE1C0LAT" Enclosure
TEST
STRUCTIRIAL&
I Ea MOCAL
PRPECTWNS
CNSrM
WASTEWATER
CRPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577
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Municipality of Anchorage
Development Services Department
Building Safety Division •
yj On -Site Water and Wastewater Program
i 4700 South/ SP.O. Box 796650 Anchorage,
L
AK 99579-66:0
www.ci. anchoram ak.us
(907) 343-7904
Soils Log - Percolation Test
r
;t
;e 3^ ROBCRT C. COWAN • I,ti
CE -8801 ; A-
.-.tri. •- \:V^'-
Parfnn. ,Ni For- M 1 K $. A t L 4 A/ Date Performed:
Leval Descrip!°cn: LO T a- a• A — ;L S My a Vat. r o,� -s�n Township. Rarge. SaCion:
Depth
2' vRcA�,cj
16
4-
6.
7- t
8.
9-
10-
12-
13-
14-
15-
16- 1
17-
18-
1 9"
-
10-
12-13-14-
15-
16-
17-
18-
19- _
20-
Sih F.�4 SANP
5 -47 -
Reading
-q7 -
64, G/tAdgd
w �S wGRAvt L d- SANG
f'OOR4Y
S P G11A410
SArn
13.0.)1.
WAS GROUND WATER .N 0
ENCOUNTERED?
S
IF YES, AT WHAT DEPTH? L
Depth to Water After 0P P
Monitoring? pR E
Date: y a -o 0
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
Ga
Lo
A6041
F e)
tc Sf
TN/1,�
3/
")INV r/4
..
PERCOLATICN RATE < 1 (e M.IesMJ".) PERC HOLE DMIETER b - — S
TEST RUN BETWEEN 0 FT AND `% FT
CORILIENTS MO2d. •TNAN S'u 49u OF rH6. SP MATt4rAL w,P4-SS 7-Ai4.
PERFORNIED BY: S & S ENGINEERING
PERFORMED IN ACC • t!6 : wf Le
River, Alaska 99577
-/L rA, CERTIFY THAT THIS TEST WAS
IN EFFECT ON THIS DATE. DATE:
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
/EALTNALITHORITY
CONSTRUCTION PRACTICES
APPROYA S
and
MATERIAL SPECIFICATIONS
SEWER & WATER
MANOCTENSIM
REFERENCE: Lot 22A-2, Shackelton S/D
May 12, 2004
NS�PERC
GENERAL:
1.
The scope of this project includes the installation of a 1300 HDPE gallon
septic tank and a new trench to serve the proposed four bedroom residence
TLCIES
AAWREPO�RTSS
located on the referencedro e
P P rtY•
2.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
WEUISPECTION
VLOWTEST
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.
ROADDESI(N
5.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
SOLTEST
their own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
PEaCMATaN
TEST
1.
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cicanouts for pumping access.
STRUCTURAL&
MECHANICAL
OWECTI)NB
2.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
CN SITE
WASTEWATER
CISPOSALSISTEAI
CESIGN
17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577
Page 2
Lot 22A•2, Shaekelton SID
May 12, 2004
3. 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.
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 1011. 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/DRAINFIELD INSTALLATION:
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
Lot 22A-2, Shackelton SAD
May 12, 2004
MINI111U11 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 Perforated Solid
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, Femco, 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-2, Shackelton S/D
May 12, 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.
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
Parcel I.D.
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.ct.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
016-141-42
1. GENERAL INFORMATION
Complete legal description
HAA # n5m%3
Expiration Date: 3 � /'5 '— fl 6
Location (site address or directions) 11120 inhna Road 9�iS15
Current Property owner(s)Michael Allen Day phone 229-8693
Mailing address 11600 Spain Dr. Anchorage, AK 99516
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:
4
3. TYPE OF 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
ER
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 S Engineering Phone 694-2979
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AR 99577
Engineer's Printed Name_ Robert S. Shafer Date S -3-0S
S. DSD SIGNATURE
Approved for
Disapproved.
_#L bedrooms.
Conditional approval for
bedrooms, with the following
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other_
By: Original Certificate Date: -3 - �✓�yS,
(Rw. CIM2)
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: L6T VA - 2 5)444lLLLIC) " 51D Parcel ID: 0116 LIZ
A. WELL DAA_r �_� .
Well type _atL.tu- A, B. or C provide PWSID tl _ Well Log (YIN)
Date completed
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
Coliform
Sanitary seal (YIN)_ Wires properly protected (YIN)
Cased to ft. Casing height (above nd) in.
FROM WELL LOG ATINSP ON
ml. Nitrate mg./I.
ft.
Other bacteria colonies/100 ml.
mg./I. Date of sample: _ Collected by:
B.-SEPTIC/HOLDING TANK DATA
Tank Type/Material Z-EPTI G-. J ST-E•lr-L Date installed fay lb �o
Tank size 1260 gal. Number of Compartments _� Cleanouts aN)
Foundation cleanoutON) g Depression over tank (Y,0 MU High water alarm (YIN)
Date of pumping KkQ Pumper
C. ABSORPTION FIELD DATA _
Date installed Soil rating (g.p.d./ftZ or ftZ/bdrm)1.7. System type UEXP /?Lc+CICH
Length_) ft. Width 3 r ft. Gravel below pipe Pil ft.
Total depth ft. Eft. absorption area _JS2.b2 Monitoring tube y ES Depression over field No
Date of adequacy test Results (Pass/Fail) '— For—bedrooms
Fluid depth in absorption field before test — in. Water added= gal. New depth= in.
Elapsed Time: =min. Final fluid depth — in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) — If yes, give date
I
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
'Pump off level at _ in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON
Septic tank/lift station on lot
Absorption field on lot
Public sewer
service line
Manhole/Access (Y/N)
High water
On adjacent lots
On adjacent lots
at
& circuit requirements?
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation _�� Property line v1� Absorption field S y+
Water main r d 1+ Water service line Q + Surface water 100'4
Wells on adjacent lots�b0I -F
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I �K Building foundation (2 t Water main
Water Service line 10 1-i Surface water 100 It Driveway, parking/vehicle storage 5 4 -
Curtain drain Noun Y"L003 Wells on adjacent lots f QO ti
F. COMMENTS
G. ENGINEER'S CERTIFICATION
.` P1� "'•" '." ..
.�`
I certify that I have determined through field inspections and
x :%n ; ,,,
review of Municipal records that the above systems are in
•• �••-• - • • i
conformance with MOA HAA gul'onlines in effect pin thjs date.,
. » �.
.' S• A. C) ., -
• 1/
Engineer's Printed Name D �i
.�. usr-e
Date 3-3- CS
Si
HAA Fee $ 51.9 f
Date of Payment 314105
Receipt Number IDLIL431
(Rev. 12101)
Waiver Fee $ l qS-4-D
Date of Payment 3I LA106
Receipt Number (p L-1Lk3
in.
Fl STRUCTURE AS -BUILT
.011
� 0 1 1 it
I GASTAL.DI LAND SURVEYING
JEFF
WET ALDI. RLS.
WITH AVENUE
ANCHp & AL KA 9502
HONE 24a-5454
CRIO DATE
283010/19/2004
r. a. Joe N0,
13 . SS22A2
P�'H� DEPICTED T 1 HAVE SURVEYED THE
ENCRQ�C►1►lENTSTa� AND T NO
Dt5 THE TH ONSIBIUTY OF THE OEPT AS WNER To
ETERMINE THE EXISTENCE OF ANY CEMENTS,
AP THEORESTRICTIONS WHICH DO NOT
UNDER NO CIRCUMSTANCES SUSM�N PUT,
HERANY DATA
BE USED FOR CONSTRUCTION FUR
ESTABLISHING BOUNDARY OR FENCE UNES,
ANCHORAGE RECORDING DISTRICT,
NOTE: NO CORNERS SET THIS DATE.
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S&
FEALTHAUTHORITY
APPROVALS
SEWER& WATER
MAIN EMMONS
SEWER & WATER
INSPECTION
ENGINEERWGSTUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
i
ROADDESIGN L�
SOIL TEST
PERCOLATION
TEST
STRUCTURALS
WCwwIGL
INSPECTIONS
ONSITE
WASTEWATER
DSPOSALSYSTEIA
DESIGN
January 17, 2005
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519-6650
REFERENCE: Lot 22A-2; Shackleton Subdivision
ROBERT C. COWAN. PE
ROBERTA. SHAFER P.E.
CMLENGINEERS
(907) 6942979
FAX(907)694-1211
Request you grant a waiver on the referenced property for the horizontal separation
distance between the leachfield and the Right of Way at 3 feet.
We do not anticipate any adverse affects to the Right of Way or on the adjacent
properties.
If you
information, please contact us.
Sincerely,
S. Shafer, P.E.
17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RVER ALASKA 99577
Municipality of Anchorage
d�1 Ito. lkrx VXX:5D •Anchonigc, AlaskaN1519.(XkiO • Tckphonc (!X)7):"3- :X)1 • Fax (!X)7)84&tt(X)47(X) &tigam Street • Anehontl!e,Alaska!X6907 r
ww�w�.nnnd.org .
dlayor J/ark Bcgich
I tillding Safety Dli ision
08 March 05
S & S Engineering
17034 N. Eagle River Loop
Suite 204
Eagle River, AK 99577
Subject: Waiver Request for Shackleton Lot 22A-2
Waiver Request #WR050010
Parcel ID #016-14142
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 5 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,
Arzll�
Jeff Poet
Engineering Tech
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
ar Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 1%650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: 050010 PID#: 016-141-4
Date Received: 03104/05
Legal Description: Shackleton Lot 22A-2
Engineer. S & S EnafneeNng
HA#:050083 Permit#:
17034 u Eagle River Loop Ste 204 Eagle River. AK 99577
Applicant: Michael Allen
Waiver Requested: Seogration distance 3 Feet Absootion Field to Prooertv Line
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
...............................................................................
Waiver is Granted: v Waiver is not Granted:
List Conditions or Reasons for above:
Date: 3 — gK — O't"�
By:
.... a ... a ... ............ ...................
....................
Rec#: 64431 Amount: $17. Date Paid: 3/8/2005