The URL can be used to link to this page

Home My WebLink AboutBLUEBELL LT 1Bluebell Lot 1 #020-101-22 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH 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 Permit Number: SW990209 PID Number: 020-101-22 Name: Michelsohn & Daughter - Wastewater System: M New ❑ Upgrade Address: 750 W. Dimond Anch., AK 99515 - ABSORPTION FIELD Phone: 522-3375 Bedrooms: - ❑Deep Trench ❑Shallow Trench XXBed ❑Mound ❑Other Five Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION 3 GPD/S .Ft. 1.5' Lot Block. Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 5 1 Bluebell +.5 FL • Ft. Township: Range: Section: Fill added above original grade: Gravel length: 30 FL Ft. Gravel width: - Number of lines: 4 Distance between lines: 2.5 WELL: M New ❑ Upgrade 12 Ft. Ft. (Private, A,B,C): Total Depth: Cased To: Total absorption area: 360 Pipe material: Anch.Tank Kit ivate 167 Ft. 20 Ft. so. Ft ECla�iEfi�tton -. Alpine Date Drilled: 9/2/99 Static water Level: 18 Installer. Acreage Systems Date installed: 7/27-30/99 Ft, Yield: 4 Pump Setat:. Casing Height Above Ground: f� TANK GPM. F - 2 Ft. SEPARATION,DISTANCES ❑Septic ❑Holding )3.T.E.P. To Septic Absorption Lin tioldirt ubllWrivate Manufacturer. - Anchorage Tank Capacitym allons: 2, O0 - _ From 'rank Field Station Tank Sewer Lines Mat:eel Number of Compartments: Well, >100' >100' >100' N/A_ >25' 2 -+ Lift Station Surface >100' >100' >100' N/A _ N/A - LIFT STATION- - Water Lot > r, f- > 1 r > 5 t N /A N /A Size in gallons: Manufacturer. - 500 Anch. Tank/Orenco Line >5' >10' >5' N/A N/A "Pump on level at: ."Pump off' level at - High 4wa water alarm at 40" Foundation 40" Pump Make &Model Electrical Inspections partonned by: Curtain None oted n Lot Orenco Muni. of Anchorage Drain BENCH MARK' Remarks: Well is Cased to Bedrocks 2" Insulation Over Tank and Location and Description: Basement Level West Drainfield.. Door Threshhold. - - Assumed Elevation: Bottom of Bed is 6' Above _ 1 100.0 ENGINEERSSE4 Bedrock, obi i by: 7/27/99 A uarala DateS:1St yv Inspections performed a /27/99 2nd 4/10/00 ax; maVs.t + f Department of Health and Human Services approval S Reviewed and approved by: v Date: 72-013 (Rev. 9/91) MOA 25 Permit No. SW990209 Page 2 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH 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 Description: lot 1, Bluebell Subdivision TH #6 M` j Flush, (Valves I I _ I I I I I MT 4 0 I � TH #2 I 1 I I I I I I I � o I Oj' I r 2 MT 3 74.5 I °p I � LEGEND MT = monitor tube C = cleanout SP = stand pipe Reserve Area TH #3 2,000 oallbn S. T. E.P. O a. Hd�E S 1 Co Z�• B swing ties A B S1 26.6 15.4 Control Panel _ 5 BR Hse I I Air Pump and I Gauge Located I in Finished Basement t 1 I 1 1 41.9 I S2 35.4 25.8 MH 37.6 28.5 MT 1 58.5 61.5 \ MT 2 69.8 71.3 \\ MT 3 62.5 49.8 MT 4 72.5 60.4 - \ PLAN a3° k _vv` 2g�s0�' YR.4t 2 dYt .ef-a nt 4, '- ^— Permit No. SW990209 Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH 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 Description: Lot 1,Bluebell Subd. PIDNo: 020_101-22 MH door 1002 SZ S TH#3 threshold 1 2" I)ow y 986 co, i0,00 insulati - - i 960 2.,000 gallon 95 MT 4 911.E MT 954 S.T.?.P -`INV INV , 91 919 % r 3 14 SCH 40 955 _ s a n. d �7 PVC suplly line_ INV ism !(— -ELEVATION As- Bit_ LEGEND MT = monitor tube j V, = 10' C = clean out SP = stand pipe r kZ a7Y�S-s� tt� 4$a�"""�s 9n1k'ii < e� - s ON 05-10-2000 02:31PM FROM CreativehKitchenhDesign TO PROPEMY OWNER UAINTENANC E AGROWWr ONSITE WASMWATETt Mlg. OtrAL SXSTT3M 5226779 P.02 TAn -mag meet, dated _, rade between tete Municipanty of And -mage L�epttrtment of Ievleh and T uutaat Servlcw (DH�IS) and the property .owrter(a) Of t: reI. alnebel2 Subdivis an 17v4 aS+te atrrertt fa made for the purpose of maintaining an 0444e wastewater disposal system ort tiro sukft-t property. The property cwrter(s) agree to the foilo>n'ing: The prop" ewrM(a) w9l have an atmual inopeetion of the system perforated by a registered professional engijw= This>nsp"Qn *hall vett that all effluent and air Pumps, linters, and alarms are ftutatioru _ as designed„ Any delicieneies shall be bexre d a and the eiltthex+s statement that the *'stent is functioering as desiped shall be fr'[ed annually rvfth the QHHS. =r'opertY O%VTw Nem® "s U.a. (notarize Here) Carl 1 1t S 3 iabco 1 7,,'L d MWON tVVuTl eL%ulC tN A+304;oJL 0' 6lY1yni5%tm spIyeCv u )MV:%V ON, 'l. iR% Received Time May -10• 1:37PM TOTRL P.02 From : ALPINE DRILL 907 345 0202 Apr.03.2000 09:56 PM P01 Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Mystrom hitp://www.cl,ancl)oiage.Bk.tis Mayor Permit Number: NSW 990209 Date of Issue: 7-20-99 Parcel Identification Number: 020-101-22 Date Started: 9-2199 -Date Completed: 9-2-99 is well located at approved permit locati01179 Yes D No I.egal Descriptio Bluebell Lot 1 Property Owner Name & Address: Michelsohn & Daughter 750 W Dimond Blvd # 100 Borehole Data: Soil Type, Thickness & Water Strata Stick-up gravel fill oranic and silt gravelly silt bedrock H2O MAY 01 2000 MK yyJ 1U Depth (ft) I7om TO 0 2 6 12 16 140 Municipality of Anchorage Dept. Health & Human Services 2 6 12 16 Method of Drilling ® air rotary 0 oable tool Casing type: steel Wall Thickness: .250 inches Diameter: 6 inches Depth: 20 feet Liner'Iype: Diameter: inches Depth: feet Casing stickup above ground: 2 feet. 167 Stutic water level (from ground level): 16 feet 150 Pumping level: 167 feet after 4 hours pumping 4 gpm Recover' Rate., 4 gpm Method of Testing: airlift Well Intake Opening Type: [] Open End ® Open Hole [] Screened Start foci Stopped feet D perforations Start. feet Slopped feet Grout Type: bentonite # 8 Volume: I bar Depth: Start 0 foot Stopped feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected -Upon Completion? 0 Yes D No Method of Disinfection: Comments: Well Driller: Alpine Drilling & Enterprisesl P.O. Box 110496 Anchorage AK 99511 Attention: The weit.itrittw cbal!#rrevidoarrali 1�e4lrap'y"""r°r♦vithinaN dciysvf<°roplet.ion and aho properly numnr nr 16n well AriRnr .d+s11 nrnvi it. a +.tall b+., 1" 16e Ileal nr'I ]eMfl+ R, 14moan terviree witfiin (n ttavq /+r nmm�lrlinn Received Time Aar. 4• 811 R MUNICIPALITY OF ANCHORAGE Department of Health and Human Services � ` t On -Site Services Program L t 2 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial I'%, �L - borbrn LzA.n Date Issued: Jul 20, 1999 Expiration Date: Jul 19, 2000 Permit Number: SW990209 Parcel ID: 020-101-22 Legal Description: Bluebell Lt 1 Design Engineer: 0014 Anderson Engineering Site Address: NHN //// Owner Name: Michelsohn & Daughter Lot Size: 53561 SQ. FT. Owner Address: 750 W Dimond Blvd #00 Total Bedrooms: 5 Permit Bedrooms: 5 Anchoage , AK 99515 - This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. bIDSF - this permit is for a bottomless Intermittant Dosing Sand Filter System. The maintenance agreement was received with the permit. Received By: Issued By: Date: -7kt/q�) l /��— C tl a(� Date: 7.20-99 IPROFMTY OWNER AGRUMENT FOR THE ALUNTENANCF, OF ANr ONSITR WA STEWATUR DISPOSAL SYSTEM 11 This agreement, dated 6 19-99, is made between the JV(irnicipality of Anchorage Dcpattme f A and Human Serv1= (ABX5) and the property owaer(s} oh, . %n t n n n t This agreement is made for the purpose of maintain an ori -site Wastewater disposal system on the subject property. The property owners agree to the following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional en,ineer. This inspection and operation stawment shall verify that the engineer has inspected Q effluent and air pins, timers, and alarms, and that an deficiencies have been re aired and that the system is function' Q as deli ed. fi,d er KI ich a soh w v 1� AV e r t S e groper y wt sure. e wckL et paper cworl�'s181icj c� Fu Lb--uv6 uek Tofemo ANb Kin 3eotoo. Sod- is a `s�fcSAL 6. c Sigpature} (Signature) (Prhaw Name) (Printed Name) Sere-------- --.-- State of on Chi. 6-'11day of � L personally appeared before m who is pareonally known to me whose identity t proved on the basis a whose iaexitity I proved on cbe:bathiaf a credi to be the sigaar of the above docwQant, and 'he/she ac'lu.oarledoil a signed it. ovary public My commission expires WWN7-1 July 7, 1999 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 1, Bluebell Subdivision Septic System Design Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 1, Bluebell Subdivision intends to construct a five bedroom home on the lot. We are therefore requesting a permit be issued to construct a septic system and well on the lot to serve the home. The attached site plan and backup documentation describe the proposed system and the location of the proposed well. The testholes placed on the lot revealed poorly graded silty gravel with bedrock between 5.5' and 6'. No groundwater was encountered during excavation nor was any noted during the monitoring period in January of this year. Some water was seen during breakup at the interface of the gravel lense and bedrock. We have therefore designed an intermittent sand filter system to provide separation distance from the bedrock/. The distribution pipe will be placed at 1' above the original ground surface and at least 6' above the bedrock layer. The ground surface of the lot slopes from the east to the west at varying grades. The absorption bed will be placed in an area with a slope of 10% or less. The bed will be constructed perpendicular to the slope in accordance with Municipal criteria. The lots around Lot 1 are currently undeveloped and no conflicts were found with wells or septic systems on adjacent lots. If the system is constructed as designed the following statements apply: Lot 1, Bluebell Subdivision July 7, 1999 Page Two 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. 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 reserved 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. ao Attachmentsd� uvxw11 f� eRa K! NOTE: z o V3 19 LOT 1, BLUEBELL LOT 2 (VACANT) TH6 Reserve' 10' Wide X 36' Long Intermitt nt +yp Sand Filter (See Details) site i )1 6 , 'L H3 Air' Line TR2 " lw"''HDPE Line Sloped to y Drain to Lift Stlation p- All,Connections Stainless Steel 2,000 ° Gal. S.T.E.P: ° Air Line S all Be 2" Tank HDPE Insul ted With 'z" { 'Foam Pipe, rap Inside a 5 BR House Schedule 40 PVC Jacket. { 3' Minimum Burial. lo Conflicts With Air Comprelsor Shall Be feigghboring Wells and Located in Garage-, eptic Systems s Contractor She. Provide 0-10 psi Pressure Gauge in the Garage. Air Compressor Shall a Thomas Ind°Istries_ Model 5070 As Supplie, By Anchorage Tank 'I I I SITEPLAN , (Proposed)1d' vie SITE SCALE 1' = 30' I @ Well dQ\1MILE M�i sa' LOT 1, BLUEBELL SUBDIVISION DESIGN FACTORS: 5 Bedroom Home Perc. Rate: 4 to 5 Min./Inch Application Rate: 3 GPD/SF SYSTEM REQUIREMENTS: Bottomless Inter. Sand Filter 2,000 Gallon STEP Tank 2' Lake Otis Sand or Equal Air Supply Line (Anch. Tank) 6" of 3/8" Pea Gravel 5 Bedrooms X 150 GPD = 750 Gallons Per Day 750 GPD/3 GPD/SF /10 LF (Width of Bed) = 25 LF Length of Bed Therefore: Construct a Bottomless Intermittent Sand Filter System 1 0' Wide X 36' Long. Distribution Piping to be Placed at 1' Above Original Ground Surface. 2" High Density Direct Bury Insulation and 2 ' Protective Cover Over Filter. MYJOOD DANK Mr 3/ q" PVC LAIWA5 (ff 4) Mr AKOIN7EN11��D� � 1 � 2 FEET MN, OF I'Ll is M AX. . ,Ffrl ", I' I r PROFILE 2" 'Direct Bury - VITFAM Insulati om FCA LKAVEI, FLS BAKg2 �ArZW EM DED 1 " r BOTTOMLESS SAND FILTER DETAIL (NO SCALE) NOTE: Grade Area to Drain Away. Maintain 6' Separation From Bedrock., Provide 4' of Cover or 2" Insulation and 2' Cover. L ER £iraia, LOT 1, BLUEBELL SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: 5 Bedroom Home Bottomless Inter. Sand Filter Perc. Rate: 4 to 5 Min./Inch 2,000 Gallon STEP Tank Application Rate: 3 GPD/SF 2' Lake Otis Sand or Equal Air Supply Line (Anch. Tank) 6" of 3/8" Pea Gravel 5 Bedrooms X 150 GPD = 750 Gallons Per Day 750 GPD/3 GPD/SF /10 LF (Width of Bed) = 25 LF Length of Bed Therefore: Construct a Bottomless Intermittent Sand Filter System 1 0' Wide X 36' Long. Distribution Piping to be Placed at 1' Above Original Ground Surface. 2" High Density Direct Bury Insulation and 2 ' Protective Cover Over Filter: s 11/4" DIA 5oi 40 WC 01XW1 a UIE li m 51tr fAwK Atm MAMfOW COL TACW AT 3/ 4", DIA XH. 40I'VI 2Ffl�f.01T= (HM5.5fW5,MV MSM f h720JIDED VAI.Vi`.5 pMOeNCO 1 \ Rk YOiZZ%• G0WW0PATWIXTMfNTGP i•r :.m. Of ac •N FIM A6•mEwnew ra N • r ♦LE5). (Wmi FWIBGTU covrz) PLAN VIEW_ BOTTOMLESS SAND FILTER DETAIL (NO SCALE) NOTE: Grade Area to Drain Away. Maintain 6' Separation From Bedrock. Provide 4' of Cover or 2" Insulation and 2' I PERFORMED: LEGAL DESCRI 2 . e �3t o e a /D P p e 6 7 8 9 10- 11 12 13- 14 51617 15- 16- 17 ,8 19 20 COMMENTS Municipality 91 Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 ••L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST John Berggren ION: Lot 1, Bluebell Subdivision ?T)oG o, (�M LII /�5 �t4t'orX SLOPE WAS GROUND WATER ,I ENCOUNTERED? /V li D :li IF YES, AT WHAT rp DEPTH? Depth to Water Mmi ring? /lhllll��r Dolt g9 Y° DATE PERFORME SIT .P Reading Date Gross Time PERCOLATION Net Time Depth to Water Net Drop li D :li 3,0 O 7 ,— --7,— PERCOLATION RATE 1� (mmmevmch) PERC HOLE DIAMETER v TEST/RUNqq /BETWEEN !/ _FTAND I -A FT Ell PERFORMED B% --T I ? P'hL� C��HHA TYIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE , L j7/(q/4 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: John Berggren LEGAL DESCRIPTION, Lot 1, Bluebell Subdivision to �Prhto Net Wtii� ater D,op P6P'T� rr/o6- 3;L 2:5� cL- 2- 3�0 17 - 18- 4 – 5- 6- 7- 8- 9 10- WAS GROUND WATER I/ ENCOUNTERED? IV e) 11 IF YES, AT WHAT lc> 12- DEPTH? 13- Depth to Water Alt Monitoring? 01 14- T�ele =—TD�grh m to �Prhto Net Wtii� ater D,op Ev 3-- is- 3;L 2:5� 16 - C' 17 - 18- 19 - COMMENTS Z�5 7/ DATE PERFORM AmAka L 9, EAN -t N .,'LOTi 1* LO it Reading Gr= Time T�ele =—TD�grh m to �Prhto Net Wtii� ater D,op Ev 3-- 3;L 2:5� C' PERCOLATION RATE 1; (mmutewinChi PERC HOLE DIAMETER to -7, TEST RUN BETWEEN FT ANCr— FT 7—� ��IFY THAT THIS TEST WAS PERFORMED IN Z7 Y'� PERFORMED BY, ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. — :7j-7199 Municipality of Anchorage . DEPARTMENT OF HEALTH 8 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: John Berggren LEGAL DESCRIPTION: Lot 1, Bluebell Subdivision DFCT' �f t N LCL 2 I 3 4 j 6 7I 8_ 9� SLOPE 10 Qy1i T WAS GROUND WATER . I /L I 11:125 a I 3. Sio ENCOUNTERED? 11 — 6,12 IF YES, AT WHAT 12 DEPTH? 13 I 1 � 13.2 penin i g? Atter � b MNlurmp? oh o paw 4M 14- 15- 16- 17 47516-17 18- 19- DATE 819 � Qy1i T /L I 11:125 a I 3. Sio OWE DATE PERFORM SITE PLAN t - N_ Reading Dace Gross Time Net Time Depth to Water Net Drop /L I 11:125 I 3. Sio I 6,12 I r 11 � 13.2 i I 20 PERCOLATION RATE > (mmme inZcchl__PERC HOLE DIAMETER r/ 1 TEST RUN BETWEEN' Z �7 FT AND — FT COMMENTS �'r /A.�///t-/ WLrS 6rC D zl0 PERFORMED BY r / I � �"' tfT" TIFY THAT TH SS�TpEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4,85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 1, BLUEBELL SUBDIVISION GENERAL: 1. The scope of this project includes the procurement and placement of a new 2,000 gallon combination septic tank/lift station and pressure distribution system. Work also includes the construction of a new 36' long x 10' wide Bottomless Intermittent Sand Filter. A minimum of 2' of Lake Otis Sand or material meeting the attached specification must be imported and placed in the filter area. The filter must then be constructed atop the imported material. Distribution piping must be placed V above existing ground to provide 6' separation from bedrock. 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. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. The 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/LIFT STATION INSTALLATION 1. The 2,000 gallon septic tank/lift station is to be constructed by a certified tank manufacturer. Construction shall include an 18" manhole for access to the lift station. 2. The septic tank/lift station shall be sufficiently bedded to prevent settling or shifting of the tank. Lot 1, Bluebell Subdivision July 6, 1999 Page 2 3. All standpipes shall extend a minimum of 12 inches above final grade. 4. Septic tank/lift stations installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 5. A foundation cleanout shall be installed one to four feet from the building foundation. No cleanouts are required between the I i f t station and the drainfield in a pressure distribution system. 6. Final grading over the septic tank/lift station shall be such that a positive slope exists away from the septic tank. ABSORPTION BED CONSTRUCTION: 1. The absorption beds shall be constructed to the dimensions shown on the design. The bottom of the bed 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 locations shown on the design. must be perforated. diameter and installed at the The portion in the drainfield rock 5. Direct bury insulation must be placed over the distribution system when less than 3' of backfill depth is available. Finish grade over the bed must be mounded to prevent settlement or depressions. MATERIAL SPECIFICATIONS: 1. The lift station must be constructed by a Municipally approved septic tank manufacturer. An Orenco 20 OSI 05 HHF - 5 is recommended. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Lot 1, Bluebell Subdivision July 6, 1999 Page 3 Cast iron (perforated and solid), ASTM D3034 or PVC (Perforated and solid), ASTM F810 or HDPE (perforated, but not solid) and ASTM D2662 or ABS (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, Fernco, or equal). 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. EQUIPMENT SPECIFICATIONS: 1. Air Supply Line Shall be a Wasteflow Emitterline, 1/2" Inside Diameter from Anchorage Tank. Line shall be insulated with 1/2" foam pipe wrap inside a 2" Schedule 40 PVC Jacket buried a minimum of 3' below the surface. 2. Air Compressor Shall be a Thomas Industries Model 5070 as supplied by Anchorage Tank. Compressor shall be located in the garage or crawl space. 3. Pressure Gauge from 0 to 10 PSI Shall be furnished and installed in the garage. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. 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. ,Lot 1, Bluebell Subdivision July 6, 1999 Page 4 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 the second inspection. The contractor is responsible during the layout of the system to assure that all separation distances from adjacent wells in the area are met. 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 Parcell.D. o90-101- 1. GENERAL INFORMATION Complete legal description Lot 1 Bluebell Subdivislon Location (site address or directions) _6005 Bluebell Drive HAA # Expiration Date: 3' 3 Current Property owner(s) Shure Totemofi° Day phone 944-1404 Mailing address Lending agency Mailing address Real Estate Agent 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 Well Public Water System Day phone Day phone 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. 1 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 Anderyon En_girieering Phone 1529.-7773 Engineer's Printed Name MIchae E_ Anderson, P_E_ Date 6/171200.3 ��c At 114 %jj % .4S is 0 +� : MICHAEL E. ANDERSON � 5. DSD SIGNATURE �I9%f CE -4301 ar Approved for bedrooms. f 444% Or,ISS010' 4,, Disapproved. X Conditional approval for 5 bedrooms, with the following stipulations: At the title transfer, the new property owner shall sign the attarbL-d maintenance agreement, which shall be returned to this office before an unconditional approval is issued. Attachments: HAA Checklist x Septic System Advisory Well Flow Advisory WASTEW ATER Maintenance Agreements Supplemental Engineer's Report Other By: 4% Original.Certificate Date: M., 17a Municipality of Anchorage Development Services Department Building Safety Division " On -Site Water & Wastewater Program `" r t T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 1. Bluebell Subdivision Parcel ID: 020.101-22 A. WELL DATA Well type Private If A. B, or C provide PWSID # _ Date completed 917/1999 Sanitary seal (Y/N) y Total depth -W—ft. Cased to eft. FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform -L-oolonies/100 ml. 'Nitrate 63 mg./I Date of sample: 6/31403 Collected by: A. Harala B. SEPTIC/HOLDING TANK DATA Well Log (YM) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 n. AT INSPECTION 6I51�' 003 _ 22 ft. 1.5 g.p.m. Other bacteria 3 colonies/100 mi. Tank Type/Material agPlSteel Date Installed 7/2711999 Tank size 2000 gal. Number of Compartments $ Cleanouts (Y/N) Y Foundation cleanout (YIN) X Depression over tank (Y/N) H High water alarm (YIN) N Date of pumping 6f161200 Pumper A Plus Home Services C. ABSORPTION FIELD DATA Date installed 1=929 Soil rating (g.p.d./ft? or fe/bdrrn) 3 GGPDISF System type Bottomless Sand Filter Length 30 ft. Width 12 ft. Gravel below pipe .5 ft. $60 ft2 Monitoring tube Y Depression over field NTotal depth kt. Eff. absorption area Date of adequacy lest 51512003 Results (Pass/Faiq Pasl For I bedrooms Fluid depth in absorption field before test Q in. Water addedL gal. New depthQ in. Elapsed Time: Q_ min. Final fluid depth Q_ in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 7/2811999 Size in gallons 500 Manhole/Access (Y/N) Y "Pump on" level at 40 in. `Pump ofr level at 40 in. High water alarm level at 45 in. Datum Bottom of Tank Cycles tested >10 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main NIA Sewer /septic service line >2Y On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout NIA Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parkingtvehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION is 1��=•O.....4q,0 I certify that / have determined through field inspections and * •4g� •`%�,��0 review of Municipal records that the above systems are in N •OP • • 1b• conformance with MOA HAA guidelines in effect on this date. s .NN N•NfN++.+.s• • 1. Engineer's Printed Name Michael E. Anderson, P.E. ♦�, f�� .CE -4881••?.: e Date 6/1712003 HAA Fee $ 3 75 Date of PaymentO3 Receipt Number 3-7320 (Rev. 1200) Waiver Fee $ Date of Payment Receipt Number 6-1e-03;14:40 ;CT and E Anderson Engin. :5615301 # 2i 2 CT&E Environmental Services Inc. 200 W. Potter Drive Anchorage, AK 99518-1605 Tele hone: 0 -2343 s 1: -301 200 W. Potter Drive Anchorage, AK 99518-1605 Drinking Wafer Analysis Report far Total Coliform Bacteria Ter: (1907) 562-2343 vnen nV.cTxUCTIONSONRMI'EIU—F$.1,-MjjFXO)z:j�CO.LLECTJNG.S'4MP'rE Fax,(907) 561-5301 ❑ PUBLIC WATER SYSTEM I.D. # P"PRIVATE WATER SYSTEM O Send Results O Send Invoice ts my.nY vM Ln' a b SAMPLE DATE: e: >1outh SAMPLE TYPE: ra Rnt}titte Repeat Sample (tor rop[ine sample withilab rP.Lmo''. _ ) ❑ Special Purpose SAMPLE,LOpJ,CATION Comments: p'a . 0t 1 Year p Treated Water p' T.)ntreated•\'Vater Time Collecteil :20 Collected BY. Ae BACTERIOLOgICAL WATER ANALYSIS FMC:QRD MAO -MUG Result: Total Colifvm Coli „ Membrane Filter: Direct Count 0 CvloniesllQb attl .Verification: LTB T.GB _ COLIFIRM j Fecal Coliform Confirmation Analysis shows this Water SAMPLE to be: Satisfactory ❑ ' Unsatisfactory' ❑ Ssnple over 30 hours old, results may beunreliable ❑• too Tong iri.transit; sample should Mai be,oveajPhours old'at examination to indicate reliable results. Please sead .unVsamplei via special delivery•mail. Ante Iteceiired Cl Time}teceived G��a Analysis Began �� U Analytical Method:Membrane Filter O MMQ-MUG * Number of colonies/100 ml. �lf 1,4 Result* Analyst 1033 33 �J nch Fbks hn l.:.l t Faxed Date: Time: Clien?notified of unsatisfactory resulis: ❑ ❑ Phoned Spoke with Faxed Date: Time Final MembrRne 1terResults RcportedBy, t /• Collformf100 ant Time _.1..•as hrs TNTC- Too Numerous To Count OR 'Ocher Rae6rlo Merrber of the SGS Group (Socidtd Gdndrai:de Surveillance) -- SGS Ref.# 1033130001 Client Name Anderson Engineering Project Name/# Lot 1, Bluebell S/D Client Sample ID Lot 1, Bluebell S/D Matrix Drinking Water Sample Remarks: Parameter Results Waters Department Nitrate -N 0.527 Microbiology Laboratory Total Coliform 89 OB, No Coli All Dates/Times are Alaska Standard Time Printed Date/Time 06/09/2003 10:47 Collected Date/rime 06/03/2003 11:40 Received Date/Time 06/03/2003 12:37 Technical Director Stephen C Ede Released (� PQL Units Method 0.100 mg/L EPA 300.0 Allowable Prep Analysis Limits Date Date Init (<=10) coU100mL SM189222B (<=l) 06/04/03 3S 06/03/03 KC 2 � v MEMORANDUM DATE: May 11, 2000 TO: Jeff Poet ,/j FROM: Mike Anderson, P.E.r" SUBJECT: Lot 1, Bluebell Subdivision Septic System Maintenance Agreement Certificate of Health Authority Approval: Attached "is the septic system maintenance agreement for Lot 1, Bluebell Subdivision. I have also made a note on the as -built concerning the depth of bedrock under the absorption bed. This should complete the paperwork necessary for the issuance of the Certificate of Health Authority Approval. Please let me know if you have any .further questions. , (A N W C) L4 TRACT A N 89'56'32" E 168.75' 10 T&E EASEMENT ___________________________________________I____ ' I I I I I I � I _ I I D I ry n � m I M � D N LOT 1 m M M ,z I � O I A I ' n Septic n Vents. zz.z 47.1 coI M a i 3.7 4.0 'O I J I /N N 74,5 , 3 , l i I I I I I. I - I ----------------------------------------------- 33' -------------------- - - 33' SECTION LINE EASEMENT ------------------------------------ 10' ------10' T&E EASEMENT N 89'56'32" E 113.61' 49THpp �....:.....' ......y.. V pp Mork E. Dovis Q QO" LS -7338 QQ Q0�4p' •.......• ''.ca�,oQ r0fessionO� `'oo. 0 0 C3 CJt M 2 - -% Ilr P.R 1pgRjlR PC Ig II4 EXCLUSION NOTES: It is the owners' responsibility to determine LEGEND: SET FINDRED - ORDEar: PAUL M I. D H E L S O N the existence of any easements, covenants, or restrictions 5/8"RB W/CAPQ 5/8" RB (j which do not appear on therecorded- subdivisions plot. NOTE: 3.25•' AL.MON, {rj MONUMENT. Under no circumstancesshould. any data hereon be used for HUB & TACK p .` construction or for establishing property lines. FENCE–—X—. X - - - -- SURVEY CERTIFICATION: LANTECH hos conducted a OVERHANG– physical survey of this property as shown on this WOOD DECKS– drawing and that the improvements situated there CONCRETE– on are within the property lines and no encroach– ASPHALT– mentS exist other than noted. GRAVEL– A S— B U I L T O F: LEGAL DESCRIPTION: SEPTIC STANDPIPES– VE AWELL- LAND LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS 440 WEST BENSON BLVD. # 103 (fox) 561-6626 cox - ANCHORAGE, ALASKA 99503 (907) 562-5291 LOT 1 WORK ORDER NUMBER: DA7E:' SCALE: PLAT NUMBER: MARCH 24, 200 DRAWN 9Y: CHECKED BY 1' =40' CRD NUMBER: 99-57 BOCK/PACE: BLUEBELL SUBDIVISION' 99-L-3848 WLJ I KEN 3338 458\72 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage. ak. us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 020-101-22 HAA# 4BL(-(`_, 6 -J-( Expiration Date: GENERAL INFORMATION Complete legal description Lot 1, Bluebell subdivision Location (site address or directions) Current Property owner(s) Michelsohn & Daughter Day phone 522-3375 Mailing address 750 W. Dimond Blvd. Anchorage, AK 99515 Lending agency Mailing address Real Estate Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: Five (5 ) 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 ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 72-025 (Rev. 01!00)' aje(] ansslaa s(00/LO nay) SZO-SL _ S :ale(] uoljejldx3 Ca o - i / Js :ale(] aleollpa(] leul6u0 p ; :Ag a8yl0 (aoslnPV MoIH IIaM luodaa s,jeoulbu3 leluawalddnS �(Aoslnpy Ovals (S olldaS sluaulaaa6y aoueuejuleW isINOOy0 VVH : sluaw yoelly sluawwo(] leuoll!Ppv �,;suQllelndll,s 6u!mollol ayl yllm 'swooapeq jol lenoidde leuoll!Puo(] 'panoiddesl(] swooapaq aol panojddy 3l nIVNDIS SHHO •9 00/LZ/b ale4 3-d 'uos.zapuy •g jaegotw bZS66 NV 'absso>youy £LLL-ZZS auoyd buz aweN oaluud s,J8aul6u3 £LLObZ X09 'O'd ssaippy .xaaurbug uosaopuy w113l0aweN uollepelsul to aw!l ayj le 1094a ul suollelnbai pue •seoueuipio 'sepoo alelS pue led!o!unW a gso.Idde Ile qm eouelldwoo ul sl wals{s lesodslp aalemalsem jo pue Alddns jalem alls -uo ayl 'uogoedsul pus u011e6ilsanul AW woal pue salg 06ejoy0uy to Ll!led!o!unW eqj woj; pauielgo uollewjolul ayj uo paseq leyI AliJan iaylinj I wajay poleolpul ainjonils jo adAj pue swoojpeq jo jagwnu ayl )oj ajenbape pus leuogounl 'a}es sl Ovals (s lesodslp aalemajsem jo/pue Clddns aalem ails-uo ay11eu3 mot's uogso!Idds lenaddy Al!aoglnH glleaH 841 jol sawlepinS lenaddy AluoylnV glleaH ayl w paulllno sainpeowd uo paseq u01je6gsanu1 AW Mqj AI!JeA I 'mo aq umoys alsp uolleppen ayj to se pue olaaay paxllle leas Aw Aq pallllaa0 sy 833NION3 AS N01103dSNl 301N3W31V.LS •9 Municipality of Anchorage • '� Department of Health and Human Services RE CE I VE D Division of Environmental Services Y On -Site Services Section 825 "L Street Room 502 A P.O. Box 196650 Anchorage, AK 99519-6650 APR 27 2000 www.ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGF "11PnNMEWAL SERVICF� f,,,, HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 1 , B1 nahal 1 Suhrli vi ai on Parcel I.D.: 020-101-22 A. WELL DATA Well type Private If A, B, or C provide PWSID # Datecompleted 9/2/99 Sanitaryseal Y Total depth 16 7 ft Cased to 20 ft (Bedrock) FROM WELL LOG Date of test 9/2/99 Static water level 18 ft Well production 4 g.p.m WATER SAMPLE RESULTS: Well Log !3 Wires properly protected Y Casing height (above ground) 24 in. AT INSPECTION w 9 -p.m Coliform 0 colonies/100 ml Nitrate 1 .04 mg/I Other bacteria 0 colonies/100 ml Date of sample: 4/13/00 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel STEP Date installed 7/27/99 Tank size 2, 000 gal Number of Compartments 2 + Lift Station Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm Y Date of pumping New Construction Pumper N/A C. ABSORPTION FIELD DATA Dateinstalled 7/28-30/9$oilrating (g.p.d./ft2orft2/bdrm) 3 GPEsystemtype Bottomless Sand Filter Length 30 ft Width 12 ft Gravel below pipe .5 ft Total depth 0 ft Effective absorption area 360 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Const. 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.) (Y/N & type) N If yes, give date N/A 72-026 (Rev. 01/00)' D. LIFT STATION Date installed 7/28- 0/99 Size in gallons 500 "Pump on" level at 40 in "Pump off" level at 40 in Datum Bottom of Tank Cyclestested New Const. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access Y High water alarm level at 45 in Meets alarm & circuit requirements Y Septic lank/lift station on lot >100' On adjacent lots > 10 0, Absorption field on lot >100, On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation >51 Property line >5' Absorption field . Water main >10, Water service line >10' Surface water _ >5' >100' Drainage >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 10 ' Building foundation > 10 ' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehiclestorage >25' Curtain drain None Noted Wells on adjacent lots >100' 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 HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 4/27/00 HAA Fee $ J U -b c P -7i Waiver Fee $ _ Date of Payment �Z&7) n Date of Payment Receipt Number w to %f��%�� Receipt Number. 72-026 (Rev. 01/00)' � N610