HomeMy WebLinkAboutGREEN FOREST UNIT 1 LT 3AOnsite File
Green Forest Unit 1
Lot 3A
PID# 018-011-83
Formerly Green Forest Unit 1 Blk 2 Lots 3 and 4.
v
O
Municipality of Anchorage ."'~
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
www.ci.anchorage.ak.us (907) 345-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT
Permit Number: $/~ O ~ O I '7,~- PID Number:
.am, t41~c ~c~n~co,,'~ WastewaterSystem: [] New [] Upgrade
~dress't'~'2 0 ..Cnou..,~ l.~e~ Ot't;,~ ABSORPTION FIELD
Phone Number of Bedrooms:
'~ &~-."-~. ~. ,.~yq ~1~ I-I DeepTrenc~ FI Shallow Trench ~"Bed rl Mound I-I Other.
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION I, ~
Block: Lot: Subdivision: Depth lo pipe bottom from original grade: Gravel depth beneath pipe:
Township- Range: Section: Fi!~ added above original grade: Gravel D~ngth:
Well: -~/~r [] New [] Upgrade Grav,,,,idth: ~0 Ft. Number of lines:~ Oistancebetweentines:l~ FI.
P~pe Material'
Class,flcatlon (Private. A. B. C). Total Depth: FI. Cased to: FI. Total absorption area:C~0~''- O
Dafter , Date Drilled: ~tatic Water Level; Installer. Date Installed:
¥,e,dG.M I"um" s''at: .,. Ic''ng Ne'¢' ~°¥' G'°"''":~ TANK
SEPARATION DISTANCES I~ septic I-1 Holding I-1S.T.E.P. [] Other:
Fromm,~ Manufacturee Capacay:
TO Septic Absorption Lift Holding Public/Private
Tank Field Station Tank Sewer Line ~1'~ ~./'~ O/'~' T~-..x ~ ~' I ~"{~ Ga,.
Material: Number of Compartments:
~e, ~ 3,c, , itS' - _ ~,'z.~' E/.-eel
Surface Water '~"__~"~'~'__tt.~' '__ -- ~~// S,,: Oal. u.n~ta~,ura~.LIFT STATION
Foundation
CuC, a,n Dra,n ~"~' ' * ~0 ' "/" ,,,,-- -- / X pump Make & Model Elecb'ica, Inspe~on, performed b~
Remarks'
r~o,,~r__.,t, c,,.,.,.r.,--~ ,,- I,,,.,,,,r .,,,. ~:,I.¢ rgo~.,,,,, o/r,d,~ ~ U.,".rt'~..umeoCO,,,,",,eva:.on
i~v~l~'. I.O".~R~ ~l~t'r ¢'a~clr ~la¢~'qndcr n~e.o t~'o( Engineer'sStamp
Inspections performed by: ~'lct ~q=,~, 7~ ~'...'c Dates: 1st, ~//o/o¥
Development Services Department Approval ,/ --,...-...,.-.-...-,.,..
Reviewed and approved by: ~JA,~ //,] P~- Date: ¢ - / '7-
..~ · :.,>;~, .... ...."~.~
PERMIT NO: SW040175
PID NO: 018-011-83 o ~
SWING TIES:
FROM: COR. "A" COR. "B" COR. "C" COR. "D"
TO:
S.T.C.O. "E" 17' 50.5'
S.T.C.O. "F" 11' 58.5'
DBLC.O."G" 10' 62'
VALVE "H" 10' 63.5'
BED C.O. "1" 25' 75.5'
BED C.O. "J" 30' 75.5'
BED C.O. "K" 33.5' 75'
BED C.O. "L" 37.5' 75'
BED M.T. "M" 41' 89'
BED C.O. "N" 48' 102.5'
BED C.O. "O" 51' 103'
BED C.O. "P" $4' 102.5'
lIED C.O. "Q" 55.5' 102.5'
NEW 20' x 30' __
SOIL ABS. BED
T.H.
#1
LOT 3A, BLOCK 2
GREEN FOREST #1
NEW 1250-GALLON
TIC TANK
I,F,
WELL
PAGE 2 OF 3
ORIGINAL
SOIL ABS. BED
LOT 3A, BLOCK 2, GREEN FOREST SID #1
SEPTIC SYSTEM UPGRADE
AS-BUILT PLAN VIEW
FLATTOP TECHNICAL SERVICES SCALE: 1" = 30'
14530 ECHO STREET DRAWN BY TFM
ANCtIORAGE, ALASKA 99516 JUNE, 2004
PERMIT NO:
SW040175 PAGE 3 OF 3
Pld NO: 018-011-83
c.o. (TYP)
2.0' SOIL
-- FINAL GRADE ELEV. 85.8'
5' SOIL
COVER
! 250-GALLON
INV. TANK INV.
92.3' 92.6'
BOT. EXC.
81.2'
GROUND
20'x30'
SOILABS. BED
SEWER GRAVEL
4" DIA. F-810
PERF. DIST. PIPE
INV. 83.6' (TYP)
ISF FILTER SAND
TOP ELEV. 83.1'
LOT 3A, BLOCK 2, GREEN FOREST SlD #1
SEPTIC SYSTEM UPGRADE
AS-BUILT PROFILE VIEW
FLATTOP TECHNICAL SERVICES NOT TO SCALE
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 J UN E, 2004
.... : 1203-29A
0-2833
~.~_~NC~OAUI Ii'lENT AS lLi.:gl~] El,IT
· 1[I.~ ~ORE£N£N'I'~ made and entered Into ~his 12th day' of
Ala=~a noa-p~o~lb electric] coops=abOVe membership co~pogablon
~cho~age~ Alaska~ he~elaa[~e~ oalZed "Flr~ ~a~y" a~d
Cooper and Oania Coope~ o( Anchorage, Alaska~ heretnafte~ called
'docond Party', ~I'I~ESSETI!
~ER~$, First Pa~ty occupies an easement through the
center of Lob Three "A" (3A), Block ~o (2), Ocean
~ubdivl~lon, ~choraqe necordlng Dlstrlcb~ ~laska; as shown on
the ca,built prepared by Co~Mll~ and Associates and. dated ~bo~r
26~ 1988, and
WHEREAS~ Secoltd Party Jtas constructed a gept~o s~stem
witl{ drain fleld Which encroac]ms approximately Ten Fae~ (~0
onto the foregoing ~asement a~d a water l~ne which crosses
~; TilE~O~E~ ~or ~nd Jrl consldeFa[[on si
m~ual agreements.and o~her good and valuable oonsldera[lon~
FeeeJp~ of ~l~[oh Is hereby acknowledged, t~h-s~ PaFEy, fo~
Partyta enuroao~ent on the acid easemea~ for the purpose
· mentloned~ subject to the followlgg conditlon~
1. Seco~td Party will bold Flrs~ Party harmless f~om
liability, for a~y injury or damage ~o any porso~l or
~hloh may r~oul.~ from such ~ncroacl~ent.
2. The said encroar~l~e~t will be without prejudice to
First ~arty~s full enJo~enb o~ a~iy and a11 rights it I~y have
and to such easement.
3. Any facilities or propor~y of Fl~at Party which
are damaged or destroyed aa a r~ault of such encroao~nt will
~'epatred or replaced at no cost to First Party.
4. Second Party wl'll co~ply with all . applloabl~
savory codes and regulatlol~s.
relo~a~lo~ or modification of les iacllltles ~o aceo~ato the
said e~oroacl~ent will bo paid by Second Party.
By Its execution of thl~ Agreement, Second Party
agrees, for itself, its ~uoces~ors, a~d assigns, that
e~oroao~t upon the aamed easen~Ilt as herelnabove ~n~toned
will be sub~ec~ to the foregoing conditions.
Ag~ee~nt ~o bo executed by their duly a~bhorlzed
and age,ts as o[ the day a2d year first above me~tloned~
CHUgACH ELECTRIC
ASSOCIATION~ INC.
Gel~eral Manager
· Rice.and J~Bia COoper"
(Second Party.)
~i~k Cooper ./; '
~,5RW2/37/8
Cable Television
of Alaska, Inc.
September 28, 1988
Nr. Rick Cooper
10680 Comodre Drive
'Anchorage, Alaska 99515
Dear Mr. Cooper:
Sonic Cable has no objection to the encroachment of a septic tank
into a platted 10' utility easement located west of Lot 3, Block
2, GreenForest Subdivision.
Acceptance and use of this letter of non-objection by yourself,
your heirs, and your assigns, or your successors shall constitute
agreement to the following conditions:
e
Sonic wt11'be held harmless, now and forever, for any damage
or injury to any person or property as a result of this
encroachment.
Any Sonic facility damaged or destroyed as a re6ult of this
encroachment will be repaired at no cost to Sonic.
Any Costs incurred by sonic for special construction neces-
sitated by this encroachment will be borne by the property
owner.
All applicable safety code regulations will be observed and
maintained.
This letter of non-objection will in no way preclude Sonic
f~om full and enjoyment of its rights within any portion of
its ~ight-of-way.
Sincer~ly,
Joe Miller
Risk ~anageme~t
Sonic Cable Television
attachment
JM/sla
TOTRL P. 86
JAN-~-l~00 1~: ~
oo
ENSTAR Nalural Gas Cemlmny
A DIVISION OF SEAGULl. ENERGY CORPORATION
3000 Spenard Road
p.o. Box 190288
Anghorsge, Alaska 995194)288
(~) 2T~.~1
September 30, 1988
To Whom It Hay Concern:
EHSTAR I~atural Gas Company has no objection to the encroachment
into the easement on Lot 3 Block 2 Green Forest 5ubdlvision.
Si ncerely,
Bob Godfroy
Distribution Engineer
SG/jkk
JAN-2~-1900
Mayor
ANcIi I ¢i,; W^'I'EI{ a W^STI WA'i'I,m' I 'rlL, rr¥
Eltglneering' & Plan,lng Division
401 W. Inlernalional Airporl Fiend
Anchorage. Alaska 99518-1104'
September 30, 1988
P. 04 .
Owned by the
Municipality Ol An'chor~ge
RE: Green Fogest Subd., Unit No. 1, Block 2, ~ots 3 and 4
TO Whom It May Concern: '
The Anchorage Water and Wastewater Utility has to objection to
the encroachment into the easement on Lot 3 Block 2 Green Forest
Subdivision.
Sincerely,
TZNA R. HAWLEY
Engineering Technician l!
Engineering & Planning Division
Anchorage Water s Wastewate~ Utility
JAN-~O-l~00
14:22
September 27, 1988
OV,,,r*I I'y tim
Rick & Janis Cooper
10680 Commodore Drive
Anchorage, Ak99515
~heAnchorage Telephone Utility (ATU) has no objection to the encroachment
into a platted easement located on the vest property.line o[ Lot ~,.Blk 2,
Oreen :Torest Sub., Unit {1, ~ith a soil absorption septic system.
as depicted pn the a~built drawing at'~a~hed ~ ~- ' '
no~ a~tached [] .
Acceptance and use oE this letter of non-ob~ection by yourself, your heirs,
your assigns, or your successors, viii constitute agreement to the [ollovin§
s~ipulations=
ATU viZ1 be held harmless, nov and forever, for any damages or injury
to any person or property as a resul~ o[ chis encroachment.
Any ATU facility damaged or destroyed as a result oE this encroachment
will be repaired at no cos~ to ATU.
3. Any costs incurred by ATU £or special construction necessita~ed by this
encroachment will be borne by the property owner.
~. All applicable sa£e~y code regulations will be observed and maintained.
5. This letter of non-objection ~ill in no way preclude ATU from full use
and enjoyment of its rights within any portion of its right-of-way.
Sincerely,
ANCIIORAGE TELEPIlONE UTILITY
Victor P. Slaughter, Supervisor
Outside Plan~ Engineering
DATE~
MUNICIPALITY OF ANCHORA GE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 09, 2004
Expiration Date: Jun 09, 2005
Permit Number: SW040175
Legal Description: [~IS.~E_~.~.~_OREST~[INIT~'~I-.ET~"3A"?'.~
Design Engineer: 0019 Flattop Technical Services
Owner Name: Alf AAnenson
Owner Address: 12530 SNOWBIRD DR
ANCHORAGE, AK 99516-2606
Parcel ID: 018-011-83
Site Address:
Lot Size: 36851 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
r~ Disposal Field ~-~ Septic Tank [] Holding Tank D Privy
r--] Private Well
Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received ,, 7 Issued By~
Municipality of Anchorage
Mark Beglch, Mayor
Building Sa. feW Dhqsion
P.O. Box 196650 · 4700 Bragaw Street
Anchorage, Alaska 99519-6650 ° (907) 343-8301 ° Fax (907) 343-8200
http://xxxxxv.muni.org
4/22/2004
Ted Moore
Flat Top Technical Services
14530 Echo Street
Anchorage, AK 99516
Subject:
Waiver Request for Green Forest #1 Block 2 Lot 3A
WaiverRequest #WR040036
Parcel ID #018-011-83
Dear Ted Moore:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
5.0 feet.
This waiver approval applies to the existing absorption field to property line separation
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 concems or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
oe~Goodall
Civil Engineer
On-Site Water & Wastewater Program
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastcwater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorag¢.ak.us
(907) 343-7904
Waiver Review Worksheet
WP#: 040036 PID#: 018-011-83 HA#:
Permit:
Date Received: 6/9104
Legal Description: Green Forest #1 Block 2 Lot 3A
Engineer:. Ted Moore
Flat Top Technical Services
14530 Echo St
Anch, AK 99516
Applicant: Alf Aanenson
Waiver Requested: 5' Lot Linw Waiver
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmBmmmmmmmmmmmmmmmmmmmBmmmmmmmmmmmmmmmmmmmmm~mmmmmmm!
Waiver is Granted: Waiver is net Granted:
List Conditions or Reasons for above:
Name of Reviewer
Rec#: 53160 Amount: $175 Date Paid: 61912004.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLI'NG
Parcel I.D.
Property owner(s)
Mailing.address (1)
Permit Number SVV~r-/'O/'~'J'''
Day phone "=~:~;~~'~"~'
Mailing address (2)
Legal description (Lot, Block & Sub'd.) /,,
Legal description (Section, Township & Range)
Lot Size .,~'f" t ,,q.r' IAcres/Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
ID Well Only []
r'-I Water Storage []
I-"J Jacuzzi []
r'"] Water Softening Unit ['-I
ID '
I certify that the above information is correct. I fudher certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or' authorized agent)
Permit Fees:
Waiver Fees:
Date o[ Payment:
Receipt Number:
Date of Payment:
Receipt Number:
(Rev. 12J00)
...... :. ~4~.~ ~JJ l{J?~(~ '~ · .~ ~ ~ ' t ~'~*~ *~~. ~,~'~ ~, ~"" ..~"7~'~,
. ~ . .. . , , ~. . ~'~'~ .. . · .
C~ & EN~ON~NT~ ENG~EER~G * ENERGY CONSERVA~ON & ~YS~
~ODORE F. MOORE, P.E.
PH: (907) 345-1355
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
June 3,2004
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
Dear Sirs:
The purpose of this letter is to provide the required design nan'ative in support of our application for
a permit to upgrade the wastewater disposal facilities on Lot 3A, Block 2, Green Forest S/D #1. The
existing soil absorption bed is currently operating in a surcharged condition. We are also requesting a
lot line waiver allowing the absorption bed to be constructed within 5 feet of the north property line
common with lot 5. Soils logs, pert test results, a site plan, design drawings and specifications are
enclosed for your review.
The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil
log, the native material betWeen 0.5 and 2.5' below ground level is a slightly silty sand with a measured
pert rate of 2 minutes per inch. The underlying material is sandy silt which is permeable based on the
absence of groundwater in the test hole as monitored during break-up. The best solution appears to be to
construct a soil absorption bed that discharges into the shallow sand stratum. Using the soil application
rate of 1.2 gpd/sq.ft specified in the wastewater ordinance, reduced by a factor of 1.5 because the
proposed system is a bed, this 3-bedroom residence requires a total absorption area of (3 x 150)/0.8 =
563 square feet. The propOsed 20' by 30' bed design has a total absorption area of 600 square feet.
The topography of the lot in the area of proposed construction slopes down towards the west at
approximately 5%. As I discussed with Joe Goodall on June 1st, the proposed bed is 20 feet wide
because shallow borings indicate the receiving sand stratum becomes thinner to the south of the
proposed construction area. In order to promote the longevity of the system I have slightly oversized the
bed and underlain it with washed ISF filter sand with an average thickness of over 12 inches.
Issuance of the requested 5' lot line waiver will allow placement of the bed so as to optimize
utilization of the native sand stratum. Because of the location of the curtain drain on Lot 5
approximately 30-feet north of the bed, this area cannot be used for future replacement systems on Lot
5, so there will be no adverse impacts to granting the waiver. Since the topography slopes down
towards the west there will be no conflict between the proposed system and the existing curtain drain.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
I
LOT 3
BLOCK 1 .".
R 100'
WELL.--
LOT 4
BLOCK 1
WELL \
LOT 5 ~
BLOCK 2
SEPTIC
AREA
',,
,---5% '~';'.
20'",
!
I
!
!
I
l
I
l
LOT 2
BLOCK 2
100'
ABANDON &
REPLACE
SEPTIC TANK /
#1 ', ~.ULL RUN"
..... _,,_ DIV. VALVE
~ - ' RETAIN
CONSTRUCT NEW ~, SOIL ABS. BED
,,' ~ 20' x 30' SOIL ABS. BED~
· , 1.0' AVG. ISF FILTER ·,
SAND & 0.5' WASHED
\ ~ SEWER GRAVEL ·, ·, /
, ,'LOT3A, BLOCK2 / ',
/
\! GREEN FOREST #1 / '
~ R 100'/
~ ,'~ WELL /
..,;' \ /
-.-3..--¥,, .... ,,...,,,. ,,~.*
.,t~,,.% ..,,.-,... ;~ ~
I
~ ':.%, .,' .~.~"/~ ii
\
SEPTIC
AREA
/
/
/
/
/
/
LOT 2
BLOCK 3
SEPTIC
AREA
LOT 3A, BLOCK 2, GREEN FOREST SlD -7=f' I
SEPTIC SYSTEM UPGRADE
SITE PLAN
FLATTOP TECHNICAL SERVICES I INCH = 50 FEET
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 MAY, 2004
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
20
C.O.
J
4" DIA.
F-810
CONSTRUCT NEW
20' x 30' SOIL ABS. BED
w. 1.0' AVG. ISF FILTER SAND
& 0.5' WASHED SEWER
GRAVEL UNDER DIST. PIPE
INSTALL
"BULL
DIV. VALVE
TO ORIG.
ABS. BED
4" DIA.
D-3034
PLAN VIEW
SCALE: 1" = 10'
-- DBL. C.O.
FROM
FDN. C.O.
ABANDON & INSTALL
NEW 1250~ALLON
SEPTIC TANK
CLEANOUT (TYP)
/ , M, ONITOR TUBE
//!
/_/ h 2" RIGID INSULATION
1/2 - 2 1/2 WASHED GRAVEL
BO~-FOM
OF
EXCAVATION ~
~ ISF FILTER SAND
(<1% PASSING #200)
_.~.~%~.'.,~,.,..,,,.,oo o,-,...,.,,.,,,, ,,,,,,
· ,~.~"~--~u, ~ % ,.,n~.,oo-o,-,.,.,,.,,, ,~ -"A"
~.',.'.<'~'-'..;..-.~4 .,,,~,,, o,..,,, ~..,,,_
?t'?"-.° ,~.';
~: ~:- ~ q.~ ~ 1"% :. 't,.'~'.. ,-- LOT 3A, BLOCK 2,' GREEN FOREST #l
'"'°'"""'"" .... '" .... ¢ SEPTIC SYSTEM UPGRADE
;'~ - - · , PL^~ AND C~OSS-S~CT10N
~.~,/::..~:~,",,, ..*' ~ ,~..' FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN
.... ,{: ,,'<' ~. ,--,~r~, ~':~f~." ~45~o ECHO STREET I DRAWN nY: TFM
· ,...~. ........ ....~? ANCHORAGE, AK, 99516 ~ JUNE, 2004
TEST HOLE
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~ot 3A._Block2_G~een_EomsLS/_DJ~l
DATE PERFORMED: May_21_,_2004
PERFORMED FOR: AIf_Aanensen
DEPTH
(feet)
1--
2--
3--
4--
5--
Pt.
SP Slightly silty sand
ML Sandy silt
BoH.
10--
12--
13-
154
16-
SLOPE
Depth to Groundwater Date
Nq groundwater 5/21/04
M.T. D_.ry 5)_2_~704
3LO
#1
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
_~5_/21 12'~-Presoak 31
12" resoak 31
AdcJ water & start 3:49 27
#1 3.:-5~ 5 23 4
Add water 3:54:50 27
#2 3.~5§.:50 5 23 1/8 ! 3_7_/8
Add water 4:0_-0:_20
#3 4:0_5:_2.0 5 23.3/16 3 19/1__6
!
PERCOLATION RATE 2 (minutesfinch) PERC HOLE DIAMETER 5"
TEST RUN BETWEEN 1.5 FT AND 2.0__ FT
COMMENTS:
PERFORMED BY FLATTOP TECHNICAL SERVICES. I~.<..,~-~ ',/'/L~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: ~-'c'~1~. ~ Z~'O~/'
TEST HOLE
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: __Lot_3A_,_Block_2_Gmen_EomsLS/D_~_l
DATE PERFORMED: May_21, 2004
PERFORMED FOR: AIfAanensen
DEPTH --
(feet)
1
Pt and fill
MUSM Sandy silt
SP/SM Somewhat silty sand
Variable depth b.g.l.
ML/SM Sandy silt
Damp, lenses of
saturated SP
SLOPE
Depth to Groundwater Date
.__N o_g r_o_u n_dwate r 5_/2_1/_04
Water~ 10.0'. b._g.I. 5/28104 S'
I
SLOI
SITE PLAN
#1
17 "'~
19--
20~
B.Ho
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
_5/_21 12" Pre_s_oak 27 .... 112
12" resoak 27 112
Ad_d__~t__er & start 3:25:45 23 3/8
#1 3:35:45 10 19 114 4 1/8
Add water 3:36:30 23_316
#2 3.-46.:30__ 10 19_3_/_8 4
Add water 3:47 2333318
#3 3:57 10 19_3/8 4
PERCOLATION RATE 2.5 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5.0 FT AND 5.5 FT
COMMENTS:__Spil__str~t_ifi_cation is very inconsistent. Scattered lenses of SP/SM in ML strata are saturated.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I._~,~ ~/J,'?.~,-~-~, CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~J~(
~t~p Tec~nb:alServ~es
14530 Bcbo Street, Anchorage, AK 99516
Plmne (907) 345-1355
Lot 3A, block 2, Green Forest S/D #1
12530 Snowbird Drive
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandonment of an existing septic tank and replacement of
it with a new 1250-gallon septic tank in the same location that discharges effluent into a new 600 square
foot soil absorption bed with an effective washed gravel depth of 0.5 feet, which is underlain by ISF
filter sand.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations :from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with MuniCipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved at~er settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
a~er the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 Septic Tank:
2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top
and burying elsewhere on site.
2.2 The new 1250-gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil in the same location as the original tank. Each compartment shall be
equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it
shall be insulated with 2 inches of approved burial type, rigid insulation.
2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the
waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot.
A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be
installed within 5 feet downstream of the septic tank. A "Buli Run" diverter valve shall be installed
downstream of the double cleanout allowing future reconnection to the original soil absorption bed as
desired by the homeowner.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by stripping approximately 1 foot of organics
and shallow sandy loam from the 20- x 30' bed area. The long axis of the excavation shall parallel an
existing contour
3.2 The bottom of the excavation will not be level. Any compacted or smeared surfaces shall be
raked to allow proper infiltration. A minimum of 6 inches of compacted ISF filter sand shall be placed
in the excavation so as to create a level surface approximately 6 inches below ground level at the high
point of the excavation. For estimating purposes the contractor should assume that the average sand
thickness will be over 12 inches in order to compensate for the slope of the topography. The ISF
.filter sand must have <1.0% passing the #200 sieve and is available from North Star Sand and Gravel
3.3 A total of 1.0 foot of washed sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 0.5 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" washed gravel as supplied by North Star
Sand and Gravel
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A
minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thic 'kness is less
than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the
gravel, in addition to the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have
the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and
seed to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A total of 5 engineering inspections will be required during the course of the project: (1) initial
stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it conforms with the soil test information, (3) after the ISF filter sand
has been placed, (4) after the washed sewer gravel is in place and the distribution pipes have been laid
and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (5) after
rough backfill and grading is complete. The septic tank requires one inspection at%r it is set level and
the piping connected, but prior to backfill. This inspection may be incorporated with any of the above
inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
MUNICIPAMTY OF ANCHORAGE
DEPARTMEN'r OF HEALTH AND HUMAN SERVICES
Environmental Heallh Division
825 "L" Street, Anchorage, Alaska 99502, TeLephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Addcess
Phone(s) Permd No No ol Bedrooms
7JGAL DE,,CRIPTIO"
TANKS
DISTANCES
SEPTIC ABSORPTION WELL
TANK FIELD
WELL /"7~> I /~,~1
LOT LINE ,~('), 5~' /Z~'1
FOUNDATION
/L; i
/0/
-,~S-BUII_'r DI^GRAM ~Show location o[ well. septic system, p~operty hnes Ioundabon.
SEPTIC [] HOLDING
TYPE OF SYSTEM
[] "FRENCH .~' BED ~] W. DRAIN [] OI'HER
Gravel depth beneath pipe
~), /'~ FT
.... ,,.,,d,h 2. 0 !
7 ~'~'~ ~']) $(~ Iq .~ FT
WELLS
~] PRIVATE [~ OTHER (Identify)
Classlhcahon (A.B Ct , JTota[ D~e-~ J Cased
REMARKS:
FT
',' ' elines in effect un Ibis dale
Munlclpa[ and Slate guId ·
M U N I C :1: F' ~p~ ~.r. :1] "1" Y 0 I:::' A Iq C I'"1 0 R A G E
D~.~par,'l:.ml.:.:!r'rl~. o~:' Health & Human ~ii~ePvic:es
~!~:!'~!;~ L.. S'Lr'.ee't..~, Ar'~chc:)r'.age, Alaska 995()1
A N C H 0 R A[~I'.~.:, AK 9951,5
Day I='hc)r'~e ,",
5 ?, 2.-... 1;:~
S-c.,~,c: t :i. on: ;29 7'o~n sh :i. p: 12N I::,'.ang e '.' ,3W
I.,.o'L ,%i?,e 17652 (sq,, ~"t,,,, I:~r'.
Max Bedr'ooms: I"h:i.s Per'm
SE}]:::'TIC; 'TANK:: MJ.r'~:i. mum 'Lcrl..al sep'L:i.c '('..arlk capac::i.'l:.y," :1.,()()O (:!a:l. Ions,, Each
· Lank mLl~!;'l:, have at .I.E, aSt ~?. compai','l'..mer-r'Ls. ]'.)~:ep'N'l 'Lo top ~f' septic tanl.,:(s)
· 1',~.:.:,~.:~'1'.. r'equir'es ir't~iuJ, at:J.c)r'l i]w.;;)r' tar'iR (~i),,
F:'I:ROVIDI}ii: C,I...EAIq OUT AT IL:,'ACI"J E:X'TRI~i]¥1I"r'Y 01=' ,~;;Ii:.::EI:::'AL:)t:i[ BED.,
I t',l:iiB]"AI.J.... MOI',t I TOR :1: NG TUBE I N '~I~]':EI'" A['E": BED ,,
I::RESE:RVIJ;~D AREA ['.',AL.['.',LJLA]'):[)N EXCL.LIDI~)]'.) AI:RI:~:A ENG:[NI~:ER SHOWED
I~{J:NCI::~[)A[',HI~J~:D ON WEI..J... RADIUS F'ROM L(]'T 5,
I CEF;'.T :l: I::'Y TI"IA'T'~
J.~ I am ~'ami :1. :i. ar' w:i.'[..h 'l'..he n~.?qt..tir'ements t'c)r', cln..-.si'l'..e sewer's and we~ ls as set
f'c:,r'tl'"~ by the I~h..tr'iicipa].:i. ty (:t[' (.'~l"lchc)r'a¢:le (MI)A) ar'id the ~B't'..a't:.e of' h].asl.;:a.
;2,, :[ wi:l.]. :i. nsta].], the sy~it, em in acc:cu"dance ~,~:i. th a:l.l MOA c:cx::les and
:3, :1: w:i.].l adher'.~;.~ to) all I~l(::)h anti State of' A].a~ika r'(,.'.)qu:i.r'emen'Ls t'(:H' 'LI]e set I::)a(:::l.,:
d :i.s'l:.an(::es f Pc:m) al]~/ ex ist :i.n~l ~?~e]. 1 ~, was'Lewa'[.er, clJ. sposa], system c:)r'.
4,, :1: urldePs'Land that 'Lhis per'.m:i.'l:. :ks valid ~'or. a maximum (::)[ :3 I::~(.):,dr'(::~(:~ms,
a 1 so und~r's't:..and 'Lha'l. the (:::a[:)a(:: :k ty c) {' the '~'.(:)'~..~'~ ], ~B'V~i~:.,(.alI) :i ~[!i ::~.~; [:)E,)CiI"
art v (a::,r1:1. a r. (.~] ~a mr~,)ri '1: w :i :1 :!r' e:, "::l u :[ r'. (~.) a n a d d i 'L i (:) r'l a ]. p (.'::, r' m :L '['.. ,,
... , ....
MUNICIPALITY OF ANCHORA(~D
DEPT, OF HEALTH &
I:NVIRONMENTAI. PROTECTION
'William S..S.mJtt~
ELEVATIONS BASED UPON ~L)M~-/) DATA.
AREA OF LOTE~,r'7~? $.E
F/NISH FLOOR E£EVATION . //o, o
PREPARED FOR,
~\\~? .. iD ~,u'~ ',.
/
~-.~. ,
L~,'GHND.~
/~ Iron pipped/or tabor
It /~ f~ r~ponslbl/lty of ~ ~r or builder,
pr/or to construct~n~ fo ~rlfy proposed
qrod~ relotlv~ to f/n/shed grad~ and utility
connect{ohs and
any e~m~ts, ~ve~nfs, ot r~str/cflons which
do not ~ppe~r on t~ rocordod ~ubdivision
plot,
DI?Y/N BY: ~.~c DATE: ~'~.¢½ ~:,~ S~AL E' /:~o SHEET ^'0. / of/
GRID
PLOT PLAN
PREP,:RED BY
CO,,IV,/IN E} ASSOC/ATE'S
{000 E. DIMONO BLVO.
SdiTE 20,5
AIVCtIORAGE, ALASKA B-eSl5
(907) 522-131l
Consulting Ellglneers
1000 E. Dimond Blvd. * Suite 205 * Anchorage, Alaska 99515 · (907) 522-1311
August 3, 1988
Municipal Department of Health
and Human Services
On-Site Diivision
825 L. Street
Anchorage, Alaska 99501
SUBJECT: SEWER PERMIT REQUEST FOR LOT 3A, GREEN FOREST SUBD.
Gentlemen:
We are requesting the issuance of a permit to construct a
septic system on Lot 3, Green Forest Subdivision. This
property is currently in the process of a short plat to combine
Lots 3 and 4 into a single lot (Lot 3A). Since the owner has
possession of both parcels and is currently in the process of
filing the plat, we request approval be issued to construct the
on-site sewer system.
It is the owner's intent to construct his dwelling and well on
the existing Lot 4 and the sewer system on the existing Lot
This should create no legal problems and we would have no
problem with your approval stating that it is for use only to
serve Lots 3 and 4 as a combined lot 3A.
Should you have any questions
information, please ]et us know.
Ver~ truly y?rs,
C@R~ & ASSp~IATES, INC.
·
Presid~/
enclos~es
or need any additional
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
At J6 ''~ .
~¢. 1 1988
RECEIVED
EASEMENT DEDICATION
Whereas, Lots 3 and 4, Block 2, Green Forest Subdivision
are jointly owned by Rick C. Cooper and Janis L. Cooper in the
Anchorage Recording District.
Lot 3, Block 2, Green Forest Subdivision is hereby set
aside for the purpose of a wastewater disposal area for Lot 4,
Block 2, Green Forest Subdivision until such time as City
sewers are constructed to serve the area.
The owners of Lot 4, Block 2, Green Forest Subdivision
shall have rights to utilize all portions of Lot 3, Block 2,
Green Forest Subdivision, except other easement areas, fOr
wastewater disposal as described above.
This document has been executed and agreed to this 4th
day of August, 1988, in Anchorage, Alaska.
Jan~s Cooper .
ANCHORA6E, ALASKA
Subscribed and sworn to before me, in my presence, this 4th day
of August, 1988, a Notary Public in and for the State of Ala~*ka. -
BY RICK C. COOPER AND JANIS L. COOPER
My commission expires
REOUESlt:U BY
ADDRESS ~ . ....
o
/
SEWER SYSTEM LOCATION
NORTH
LOT k~ 8LOCK
% ~t ,¢,-r.o¢,~[
SECTION/TOWNSHIP/RANOE
Z?, TIz.,~.. ,ff...
Or{AWN OY~
PLAN
SUBDIVISION
OCTE~INEO 8yusE OF CLOTH TAPE.A~O
HOT OY SUflVEYIHO TECHNIQUES.'
pREPAREO FOR,
& associates,inc.
Consulting Engineers
~ ~.~ ,.-"(ENGINEEf~
~,,~,~,,, CE - 6793
12001 Industry Way · Bldg. B · Suite Eleven * Anchorage, Alaska 99515 * (907) 345-4440
PERFORMED FOR: ~&~ ~ST6N~ ~ ~ DATE PERFORMED:
LEGAl_ DESCRIPTION:.~N ~T ~ Township, Range, Section: ~, ~,
WAS GROUND WATER
ENCOUNTERED? N C~
s
L
DEPTH?IF YES, AT WHAT ~..j/j~,f !,
I]~pth Io Waler Alter
hlonitorin¢
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19~
20~
/ /
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER __
__ FTAND __.FT
COMMENTS
P R ORMEO : A,
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECi' ON THIS DATE. DATE:
72-008 (Rev. 4/85)
THAT THIS TEST WAS PERFORMED IN
& associates,inc, k%~ ~o~
PERFORMED FOR: AC~ ~Y~T~ [~ DATE PERFORMED:
LEGAL DESCRIPTION:~ ~~ ~. Township, Range, Section: ~, ~,
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT 0
DEPTH? P
E
§eplh Io Water Aller
~aniloring? Oale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(m~nules/inch] PERC HOLE DIAMETER
COMMENTS
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
TEST RUN BETWEEN FT AND FT
·
~ I CERTIFY THAT THIS TEST WAS PERFORMED
72-008 (Rev, 4/85)
& ~ssociales, inc.
Consulting Engineers
12001 Industry Way · Bldg. B · Suite Eleven ,, Anchorage, Alaska 99515 · (907) 345-4440
PEREOR ED EOR: AC G'AG
LEGAL DESCRIPTION:~~
~"--O'~-..~'~""' ,._,~,h,.~T°wnship, Range, Section: "~, IA, ALCVS~¢,
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SLOPE SITE PLAN
\L.T
WAS GROUND WATER
ENCOUNTERED? ~ ~ /'
S
DEPTH? p
E
Depth lo Waler Afler
~0nit0ring? ~?--~"'~ Dale: '-~,/~
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
TEST RUN BETWEEN __
· (minules/inch) PERC HOLE DIAMETER __
. FT AND FT
COMMENTS
/.
ACCORDANCE WITH ALL STA'fE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~..~/4
72-008 (Re;.. 4/85)
Par ~:::~,:1. I d ;: 0 l.~:il.--C) 1. :1...- 15
f'c:,r"N'i by Ll'le.:, I'lu.n.i.c::i.l:)a.liL¥ oi
ar'id J.r'~ i:::ch"npi:i, al / c: (.:...; ~.,,~J.t,l"i 'Lhe:, d(..i~fs:i.l{li~ c:l'J.'L(.:~,r':i. 41 (::)f 'l:.h:i.~ pepmil'
· :S,,i ~a~:i.:l.J. a(::ll'm~r'ize I:.o a.I] FIE)(.1 And
~:! .i-;I ,,m:::~.)~i~ f rmm ~an's,' ~.~x J.~st. J.m::J ,,,~e)t 1 ~, ~,,,ua~M'..~:~wa't.~:.z,r, d :i.~M:~o~a:l. ~y~'l:.{{,:,m or' pLfl::) 1 :i.c
a 1 !2;o Lu'l(::h.7;~ r'. ~i'(~. f~ll(.:l 't. hal.. !'. h e~ c: alU) ac: i '!'. y o ~ I... h t:.~ 'L o'L a ] ~y~!i'l'. (:.:m'~ J. fi~i :2; b e:'X'r:l I" c)c)m~!!i ar'i d
,'::tl'J y EH"i ]. ,'::t P ~J 6;:'fh~:~'FI 4. W i .I. I I' (~, (:l~.~ :i. r' (x~
'"' 'X~ ¢' '"" '~ ~ ~ ........................................
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological & Geophysical Surveys
// Drilling Permit No.
LOCATION OF WELL (Please complete e[the'r lo, lb or lc.} A.O.L. No.
lc OISTANCE AND DIRECTION FROM ROAD NTER ECT NS 3. OWNER OF WELL:
5. DATE OF COMPLETION
" IO. STATIC WATER LEVEL: ~ ff. ,
OCT ~ ~gS~ Leng,h of Drop Pipe 1,. c~poci,y __g.p.m.
T his~~~~~ / 'we" was d riliede~/¢ ~ ~ ~ a~er/~ r is~.{cli .... this rep or, is true to t~f~ m y~/~knowiedge~ and belief;
.I
t I I I I I I I I I I~-
~ Municipality of Anchorage
({,~,~ Development Services Department
~,~,~=~'~ :~,],] ~ ' ' Building safety Division
~' ' ' On-Site ,Water and Wastewater Program
- ' ' ' : '4700 South Bragaw St.
~ a ~ ~ ' ~.ci.anchorage.ak.us
' - ' CERTIFICATE OF HEALTH AUTHORI~ A~PROV~ ~ "' FOR A SINGLE FAMILY DWelLING .....
Parcel I.D; 0~ '~1'- ~3 H~ :
Expiration Date:
1. GENERAL INFORMATION
Complete legal description /.,o
Location (site address or directions)
Current prpperty owner(s) ·
Mailing address I
Lending agency .~ ~-
Mailing address
Day phone
Day phone
Real Estate Agent ~',l,e~.~l~
Mailing Address ~;/1! "C."
Unless otherwise requested, HAA will be held by DSD for pickup.
2. 'NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
~ Individual On-site []
r-i Individual Holding tank [--I
[] 'Community On-site []
[] Public Sewer []
The Municipality of An;:horage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations'given in paragraph 4 by an indepen, dent 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.
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(ar~) safe, functional and adequate for the number of
bedroom's 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.
Engineer's Printed'Name ~eo~e
DSD SIGNATURE
~ App.rov,ed for ~
Disapproved.
Conditional approval for
.bedrooms.
bedrooms, with the following
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
By:
X
Maintenance Agreements
Supplemental Engineer's RepOrt
.Other
Original Certificate Date:
(Rev. 01/02)
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 !!! ti!
HEALTH AUTHORITY APPROV^L CHECKLIST .'
-]: .]Welltype ..~ If~, B, orC providePWSlD ~ -- , Well L~(~/N)
:' '~ Date ~t~/~ ~ ~.'.Sanita~ seal~(WN) .~ :Wires ~roperly~p tected (Y/N)
: ~::Tota~ ~ft. , Cased to. I~ t . ff ,Casing height (ab~ ve ground)
- ' 'vvell production ~. ; 'g.p.m. . .. ~ g.p.m.
;WATER SAMPLE RESULTS~ ' ;~.. ~ ; ~.: ' ~~ : ' "
~ ni~ '< { ~/0~ te acter,a colonies/100ml.
~, ~ Colifor ,,~ 'colonies/lOOml. Nitrate 0.' ~mg./I..,4; 0 h r b ' '
; .... - : -- mg./I. : Date o~s~ie~:~ Collected b?
:. B. SEPTIC/HOLDING TANK DA~A ~ :
~,~. . TankTyPe/Material: ~~ / ~(~ :- ,~., ' Date.installed ;~ ~LIe ~o~
': Tank size t 2~0: gal.'.' , [Number of:Compa~nts ~ Cleanouts (Y,
-:'- :Foundat0ncl~an0ut(Y/N) r DepresSion bver tank (YIN) ~':~ Highwateral.~r~:(y/N) ~.~.
C.' ABSORPTION FIELD DATA [- ~ ?,' ..... .. ;: . .. ,,
D. LIFT STATION
Date installed
"PumPon" level at.__
Size in gallons
"Pump off" level at~
Datum Cycles tested
SEPARATION DISTANCES , ·
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
Se~tib taflk/lift *' '
stabon on lot
Absorption field on lot
Public sewer ma~n
Sewer/s&l~tic service line '~, 2,d'/.
..- ' * "On adjaC'e~i'lots'.:.'~, "l O¢5 "
On adjacent lots
~ pUblic sewer manhole/cleanout
"','HOlding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~"' ~, ;
Building foundation ~' ' ',', Property line
Water main ~/.4. '.; "'" :: .-' ", '. Wa{er service line ~" ~ '
Wells on adjacent lots~ ,~O'Z, i,. -
,SEPARATION DISTANCE FROM'A'BSoRPTION FIELD ON LOT TO:
Property line ~' ' Building foundation
Water Service line, ;>;' I~ * ', Surface water ~,
:Cudain d~:~in ",~ ~,-'~" ', Wells on adjacent' lots',
F., COMMENTS
ENGINEER'S CEkTIFICATION
I certify tl~at:l"'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 dbt~.r
Engineer's Printed Name -'r'~
Date. ~-'~..4'**~_. ?I~'~ ~_c:;)O ~/' :.:. ~ ' '
Absorption field ~ ~l.i' ;
Surfa~water, ~. toO~ i,
Driveway, parking/vehicle stor~ige ~"~' 'Y.~ '
HAA F~e'*$ ' '-' .,3'.~
Date of Payment
Receipt
Number _
(Rev. 12/01) ,. ~ pY"Y'~
: ::... ~ ':
-WaN, er Fee $
Date of Payme~nt
Receipt Number
J 8Z C7X
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # t'~\& - C'1\ \ -~,~ HAA # ~ Gl ~°~ ('bL~'-~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent d'--'~ c ~' /XZA~/~,
Address 3 ~0 [ '~ "
Telephone
Telephone: (home) 3' YJ,-- gZ6'E Business
~%Y Telephone
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms
3, WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2 .
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, Iverifythatmyinvestigationofthis
Health Authority Approval shows that the on-site water' supply and/or wastewater disposal system is 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 in compliance with all Munioipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Date D ~c
Telephone
Engineer's Seal
6. DHHS APPROVAL
Approved for ,,~
Approved' -'~
· __Disapproved Conditional
/2-/¢ -87
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations givenin paragraph 5 above by an independent professional engineer
registered in the State of Alaska. 'l'he DHHS does this as a courtesy to purchasers of homes and their lending
institutions in ordertosatisfycertain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
A. WELl. DATA
Well Classification _
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description: /.o¢' .~,~,,
Well Log Present (Y/N)
Total Depth ! ('/ .Cased to I
Static Water Level ,~'/'
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
'I'o Septic/Holding Tank on Lot I ~5'
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line --~ ~oo
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
Date Completed /¢/87
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
If A, B, C, D.E.C. A~p_roved (Y/N) N,
Yield ,y¢'~ ?-~," {Ov?-
ItC' ~
To Nearest Public Sewer Cleanout/Manhole
~' v e.~ ;Date
; On Adjoining Lots ~ <oo '
c.c. ; On Adjoining Lots ~ ~'oo ·
SEPTIC/HOLDING 'rANK DA'rA
Date Installed ~? 2'~'/'6g] Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) N,A.
Holding Tank Fligh-Water Alarm (Y/N) hi,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well 15'~" ~',~/~ c.c.
To Property Line ¥~' ~.¢r a./-
To Water Main/Service Line ~ ro
To Stream, Pond, Lake or Major Drainage Course
Comments N.c,e'4 ,~o'- ./~, nor- ~ cc,¢~1
! ~"~'¢¢'~ ¢' NO1 of Compartments
Air-tight Caps (Y/N)
N
Foundation Cleanout (Y/N)
Date Last Pumped N,,'~. (.occ~/¢,
; for Al,//.
Temporary Holding Tank Permit (Y/N) /V,
To Building Foundation
To Disposal Field
I1'
72-026 (Rev 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata lb-dj
Date Installed ¢; / ~d" / ~,¢
Width of Field ¢¢' '
Square Feet of Absortion Area -7
Depression over Field (Y/N) /"/
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /1¢" ;,-,~,'~ ~',~'
To Building Foundation
Lot N,,4..
/Z~:,(r-,~ Type of System Design
Length of Field 2' 7: ~,- '
Depth of Field £'
Gravel Bed Thickness o,,5- '
Statndpipes Present (Y/N)
Date of Last Adequacy Test u /-.~¢ /~
To Property Line 3'o '
To Existing or Abandoned System on
; On Adjoining Lots ~' -?~' '
To Water Main/Service Line ~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutback (if present)
>,/,
[3. LIFT STATION N,
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guid~l~,'~u effect on the date of this
inspection.
Signed ~~
~.~ ............ , .........1...'~nglneer s heal
Date P~c
Receipt No.
MOA No. ~9 - ~..,4' ~.
Receipt No. ¢¢ ( "'%---~ -')~
Date of Payment ,,//c-~
Amount: $
72-026 (Rev. 7/88) BBck
Waiver Fee: $
Date of Payment
Page 2 of 2
MUNICIPALITY OF ANCHORAGE /'~
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
:\ ~ - &:.\ \ ' ~Od~¢~"~ NAA # t;_~ ~ o~.-~,~ L'L; !~:,
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner 1~' :~0:~: Telephone: (home)
Mailing Address
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here Iq, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family~ Number of bedrooms ~
3. WATER SUPPLY
Individual Well~' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site,~ Public [] Community [] Holding Tank ID
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of thevalidation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Date ~¢¢~
6. DHHS APPROVAL
Approved for Y
Approved ~'~
_ bedrooms by
Disapproved Conditional
Terms of Conditional Approval
Engineer's Seal
Date
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S above byan independent professional engineer
registered in the State of Alaska. The DHFIS does this as a courtesy to purchasers of homes and their lending
institutions inordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88)Back Page 2 of 2
A. WELL DATA
Well Classification
(/~ MUNICIPALITY OF ANCHORAGE (MOA)
Heal,tb~Authority Approval (HAA)
OF ANC
,~,~L~l~¥ [~/lZ~I~Jlr~ST - FEBRUARY 1984
F.N~N-~Ai. S~.~,VIC~-S PlV~ 343-4744
MAR 1989
RF_C VF-D
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Yield
Well Log Present (Y/N) ~"
Total Depth /('~ / ~ Cased to / ~., / ~
Static Water Level ..5~ ~
Casing Height Above Ground_ ¢~-. ~
Electrical Wiring in Conduit (Y/N)
Date Completed d///? ,¢/~,~
Depth of Grouting ~k,!~ ~
Pump Set At / -.-%'~ -5~
Sanitary Seal on Casing (Y/N)
y Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /7~_2 / ; On Adjoining Lots /'~:~)
To Nearest Edge of Absorption Field on Lot //;¢,-~ / ; On Adjoining Lots ,.~/~72 /
To Nearest Public Sewer Line //~-'///::)r' To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~/~2~':'..~ /
, ·
Water Sample Collected by ~-,'£--4~-t~v/ ,/~'¢.ZJ£ ~--f' , Date _,-
Water Sample Test Results .~)~,-FI
Comments &iLEL~) ~/Z£LL. ~.~/C:--~z./": <:¢/¥?/~
B. SEPTIC/HOLDING TANK DATA
Date Installed ""~/~'~/'_~Size /~ ~'<:::;2 No. of Compartments
Standpipes(Y/N) V ___Air-tight Caps(Y/N)
Depression over Tank (Y/N) /
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) /¢--'"//~'-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well //7~--) i
To Property Line '~ /
To Water Main/Service Line '~/~2 /
To Stream, Pond, Lake or Major Drainage Course
Foundation Cleanout (Y/N)
Date Last Pumped '/("'/~f-,//
/!,_,]//'3~_ ; for A//~
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field /~-) /
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~-~D
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field _ ,,~ ~,,
Depth of Field_
Gravel Bed Thickness ~2,
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well //¢:2~ ,_~' /
To Building Foundation /O ? ~
Lot /L'///~r' ;On Adjoining Lots
To Water Main/Service Line ~/~'2 ? To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway. Parking Area, or Vehicle Storage Area ,~ ~-O
To Property Line ?~:?' ~ /
To Existing or Abandoned System on
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical
Comments
Dimensions
Manhole/Access (Y/N)
/ k./~- ~ Vent (Y/N)
~/'~ Pumping Cycles during Adequacy Test.
**Check Permitt~e/¢ Bedroom FCtting Against HAA Request**
I certify that I/f~;~e ~checked/~ver~ied, or conformed to all MOA and ~AA%
inspection.
Signed
, ate
MOA No.
Receipt No. ~-'~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
effect on the date of this
Engineer's Seal