HomeMy WebLinkAboutPETERS GATE BLK 2 LT 9Peter's Gate
Block
Lot 9
#051-541-19
Municipality of Anchorage
1 .. �.
• �e Development Services Department
Building Safety Division _ -
On-Site Water 8 Wastewater Program, 4700 South Bragaw SL
P.O. Box 198850 Anchorage, AK W519-6650
www.d.anchorage.akus (907) 343-7904 Page 1 of 3
OnSlte Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW000057 PID Number. 051-541-19
Name:MONTY & SUSIE BUYSE
Wastewater System: ■ New ❑ Upgrade
Address:
P.O. BOX 670185 ° CHUGIAK, AK 99567
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 229-4979 3
C! Deep Trench ■Shallow Trench aged 0Mound Gather
LEGAL DESCRIPTION
U4 stating: 1.0
Ted °� "'" ° a
GM/Sq. rt.
5.38-6.0 rt
Lot.• Block Subdivision:
9 2 PETERS GATE
Depth to pipe eodem fnm o,10 pose
Dnrd depth bwo th Poe
2.81-3.43
R 2.57 rt
Township: Range: Section:
N ended osew -10 pods
pre.el 1sr0ea
— — —
0.5-1.0
R 63 rt
WELL: ■ New ❑ Upgrade
frivol widw
5
Renew M 0.
1
DWe We. ors
—
rt
r,
Cl...11loellen A.e.c .
PRIVATE
Told D"W -Ft
200
To(:1a
Ted ak.erpeen enc:
500
Pipe lnoterloG
D 3034/ F-810
n
OMRrX ff.
so.
n
Dr ..
SULLIVAN WATER WELLS
Dob ".&
5/30/00
$taw Water twee
18
krwow
OWNER INSTALL
pee tntas.a
6/24/2DDo
ft
Tekk
"� A<
CO." f� mow fkar,&
TANK
2.0 aplf
UNKNOWN Fx
2.0 rt
SEPARATION
DISTANCES
■septic oNolding CIS.T.EP. Otkher
To
From
Sept
Tank
Abeo Bon
ILd
Uft
Station
Holding
Tank
/prMsb
s..er tkr.
Na`%Aod.er:
ANCHORAGE TANK
aapaab in gasone
1000
Well
100'+
100'+
—
—
25'+
uat.k& STEEL
"� a eoffw� 2
Surface Water
100•+
100'+
—
—
—
LIFT STATION
Lot Une
5'+
10'+
—
—
—
sw In a
mor.doch.
Foundation
5'+
10'+
—
—
—
an Wool at e:
Kph seer slam at
Curtain Drain
NONE KNOW
P,7 Mob a.etrkve erpedimr perfernrd sy.
Remarks:
BENCH MARK
UmUon ane powneb rc
TOP OF GARAGE SLAB
A...ned ID..albn 106.51 fl.
40600
0
0
�� • " '� • ;`5��0
000
Inspections performed by: AWWC, INC. Dates: 1st 6/24/2000
* • d *O�
2nd_6/24/2000
3rd 2/17/20010'
e r 'A. Garn.....
Department of Health and Human Services pproval
—7953
Reviewed and approved by Date:-7-4-01
4p° GrP�afeesta�o�bd
(R«. 12/00)�400000�
PERMrTNUMBER: AS—BUILT DRAWING PARCEL ID NUMBER:
SWO
SW00000057 - 051-541-19
0
NEW 7000
SEPTIC
OOA
/ C/of '
/ MT \ \
\\ \\ YT2�'�02
ALTERNATE SITE \ \
MALCOLM DRIVE
ALASKA NATER & AVASTEMVATER
CONSULTANTS, INC.
"I OERARR ROAD, SLNTE 29 • ANCHORAGE, AK 99504 • PHONE (907)317.6A9 • FAX (907)33S-52
DRNNFIELD
t�ze/zoot
RN BY: L
J.L.M.
1"=40'
EPARED FOR: PHONENUMBER: PAGE NUMBER:
MONTY & SUSIE BUYSE 907 229-4979 2 OF 3
yff.f
A. Gamess,rAL DESCRIPTION: Q, Q-7953PETERS GATE SUBDIVISION; LOT 9, BLOCK 2, ., A�0
IE OF WORK:
AS -BUILT OF WELL LOCATIONS AND SEPTIC SYSTEM �.00p000°oo\ �
PERMIT NUMBER: AS -BUILT DRAWING PID NUMBER:
051
SW000057 051-541-19
TOP OF TANK Al
INLET a 100.45
INVERT OF BUNG -
AT INLET - 100.01
FILTER FABRIC
INSULATION -
�FINAL GRADE 105.56
NEW 1000 GALLON
SEPTIC TANK
1 5
ALASKA AVATKR S WASTK«TATKR
CONSULTANTS, INC.
901 OFRARR ROAD, SUITE 2R • ANCHORAGE, AK 99306 • MONE (907)3372179 • FA% (907)338-32
EPARED FOR: PHONE NUMBER:
MONTY & SUSIE BUYSE (907) 229-4979
;AL DESCRIPTION:
PETERS GATE SUBDIVISION; LOT 9. BLOCK 2.
'E OF WORK:
PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM
FINAL GRADE
101.91-102.09
OF TANK AT
T - 100.45
`INVERT OF BUNG AT
OUTLET - 99.67
-ORIGINAL GRADE
100.61-101.23
INVERT OF PIPE
97.80 (AVG.)
BOTTOM OF TRENCH
- 95.23 (AVG.)
1
J.L.M.
N.T.S. v......... ... .. .....
NUMBER: � •
QO 2 ;Jet y Gayrnesues s--
QO° E 953
4 ..... .F
C1T�ertifiE Frilling Ea$
by
ooccW a.
SULLIVAN WATER WELLS
P.O. BOX 070271, CHUOIAK, ALASKA 1!607 • TRUPHONS et2-2761
• - • • /�... I l
ADDRESS
LEGAL DESCRIPTION
A-,n -' I
PERMIT NUMBER„Q�Date of laueA--J3. -D&
TAX INDENTIFICATION NUMBER,Q2SI — I
is well bested at approved permit location? es ❑ No
Method of Drilling: �rotnry ❑ cable tool
Depth of well: 10a
Casing Type Wall Thickness r .29'0 Inches
Diameter L. inches, depth/ feet
UnerType: ntawh=
Casing Stickup Above Ground: 9A feet
Static Water Level (from ground level): feet
Pumping level: feet after hrs. pumping spm
Recover Rate: -_Qpm
Method of Testing: A�
Well Intake Opening Type: ❑ Open End ole
Q Screened; Start feet Stopped feet
❑ Perforations Stat ,.,fleet- Stopped feet
GroutTypa;af—tTawhi'E me.4064LIT
Depth: from D feet, to '"�t
Pump Intake Depth: feet
Pump We hp Brand Name
Well Disinfeded Upon Completion? 6-Y6 ❑ No
Method of Disinfection:._Ctl�et�.t� 1 �1
Corunents:
6-13041A Des
Driller's Name
ATTENTION: it Is the responsibility of the property owner to submit • copy of the well tog to the proper slbtwit. Municipak
of Anchonspe: Department of Health 6 Human Services and/or Department of Environmental Conservad"L MatSu Borough:
Department of Environmental Conservation.
Tn/Tn �J AMnT- Yr- CC77AQQ Tn:nn CCCT/Tn/Tn
MUNICIPALITY OF ANCHORAGE
Department o1 Health and Human Services
On -Site Services Program r
625 L Street, Room 502 W �a IMOD @s�,,,
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW000067
Date Issued: Apr 13, 2000
Expiration Date: Apr 13, 2001
Parcel ID: 051-541-19
Legal Description: PETERS GATE BLK 2 LT 9
Design Engineer. 0041 AK Water & Wastewater Consulta Site Address:
Owner Name: Monty & Susan Buyse Lot Size: 47480 SQ. FT.
Owner Address: PO Box 670185 Total Bedrooms: 3 Permit Bedrooms: 3
Chugiak . AK 99567 -
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.
Received By:
Date: II—It-1-or-1
Issued By: Date: — 3— ao
ALASKA WATER & WASTEWATER
-- CONSULTANTS, INC.
April 11, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Well and Septic Design for Lot 9, Block 2, Peters Gate Subdivision
To whom it may concern:
The proposed 3 bedroom house will be served by a private well and septic system. Test holes
were excavated on the property in the ar6lof the proposed septic system. The proposed septic
system will be designed around the 30 foot radii of both test holes. We are proposing that a 1000
gallon septic tank and a five foot wide drainfield be installed. As can be seen on the attached site
plan and design, we are proposing two well sites in order to give the property owner the option of
either site. Comments regarding the proposed septic design are summarized as follows:
1. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and
the percolation test results. The soils below the organic layers are a GP/SP material to a depth of
4.5 feet in TH#1 'and to a depth of 7.0 feet in TH#2; and then the soils transitions to a
GM/SM/ML material to a depth of 12.5 feet in TH#1 and to a depth of 13.0 feet in TH#2 (bottom
of test holes). A small seep was encountered in TH#1 at 11.5 feet and no groundwater was
encountered during the excavation of TH42. The monitoring tubes were checked seven days later
and found both to be dry. A percolation test for TH#1 was performed between the depth of 5.0
feet to 5.5 feet which had a percolation rate of 5 minute/inch. A percolation test for TH#2 was
performed between the depth of 3.5 feet to 4.0 feet which had a percolation rate of <1
minute/inch. It is our opinion that due to the overall appearance of the soils, a application rate of
1.0 gallons/day/ft2 should be used.
2. TRENCH DESIGN:
a. Percolation Rate: <1 & 5 minutes/inch
b. Allowable Application Rate: 1.0 gallons/day/I12
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 450 0
6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246
f. Total Depth: 7.0 feet (max.)
g. Effective Depth: 2.5 feet
h. Width: 5 feet
i. Reduction Factor: 0.64
i. Minimum Length: 60 feet long
j Effective absorption area = 469 fit
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: As can be seen on the attached design, the average topography in the area
of the proposed septic system is a 3 to 15 percent slope running from approximately
cast/northeast to west/southwest; in short, there are no slope concerns. The trench is to be
installed parallel to slope contours.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
i., M.S.
NOTE: Attached is a site plan drawing, a design drawing, two soils logs, and a 7 page
constntction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)333-3246
I
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i
WELL RADIUS
I
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� \ ♦
'1 1 I
1
LOT 16. BLOCK 1.
LOT 6. BLOCK 2 \ \
\
PETERS GATE S/D
\
I
I
PEIZRS CATE S/D •
I I
/
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�\
♦♦\
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I JW WELL RADIUS
i
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,
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t
1
�100� W
\c) i t
I
I
LOT 5. BACK 2.
I
I
PETERS GTE S/D \♦ /
CL
LLI
PROPOSED '
\
3 BEDROOM I
HOUSE
\
1
(n
I
II
PROPMED1
ALTERNATE SrtE TH/1 It[ 100 WELL RADIUS I
j
<
ROPOSE0 SEPTIC SYSTEM
MALCOLM DRIVE PACE 2 OF 2
_ _(s�DESIGN. _
U
— — — — — — —
-------------
— — — — — — — — — — — — —
-------------
--�'c�__���`—
-------------
--------
--------------
LOT S. BLOCK 3.
PETERS GTE S/D
LOT 7. BLOCK 3.
PETERS GTE S/D
LOT 8. BLOCK 3.
PETERS GTE S/O
GTE:
4/11/2000{
/lL�
DRAWN BY:
ALEISI�_ R'Al'L'R & «'AS'1'LIVATLR
SGLE:J•L.M.
1 =
100179'
- -- — —• - -- CONSULTANTS. INC.
.......
• 41
6901 DFRARR ROAD, SU
F i I • AHONORAGF. AK 99504 • MDNF (907)157-0 FAX 907)555-3246
�.
....G?
PREPARED FOR PHONE NUMBER:
PACE NUMBER:
MONTY & SUSIE BUYSE (907) 229-4979
1 OF 2
e fre A. a ess, <;
4414 yJ % 795• ; •a'l
LEGAL DESCRIPTION:
PETERS GATZ-
SUBDIVISION; LOT 9, BLOCK 2,
y°�P�o
N!
/esslo0o:
TYPE OF WORK:
SITE PLAN
FOR WELL LOCATION AND SEPTIC SYSTEM
PROPOSED
WELL SITE /1 I I
I
I '
9 '
g � /
N / /
1�
J
-\ •\ \ ..._ SEPTIC T?
_ \
•� INSTALL ROUE
�RNATE
SITE
C
LEANO
U
T
,
VA
7�
\ \—PROPOSED DRAINnELD. EXCAVATE
A TRENCH TART IS 7 FEET DEEP
MAXIMUM BY S FEET WIDE BY
SO G. ADD 2.5 FEET
CLEANFEET NWWASHED SEWER
_ _ _ MALCOLM DRIVE _ \ ORAINROCK BELOW THE PIPE —
�WfTH 2 INCHES ABOVE THE PIPE.
\INSTALL PARALLEL TO CONTOURS.
DATE: opd�4
4/11/2000 pF �4p
DRAWN BY: O �` '• �. (10
ALASKA NATER & WASTE IVATRR SCALE: J.L.M.
CONSULTANTS, INC.`
6001 OFflARR ROAD, SUITE Tfl • ANONORAOF. AX 09504 • RIONE 001)771-0110 • FAXO])SSEJ740
1" c 40• ........ ........ ........
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MONTY do SUSIE BUYSE (907) 229-4979 2 OF 2
n _ e r A. arness•ess:
PETERS GATE SUBDIVISION; LOT 9. BLOCK 2. YQe' ' •.,,
WORK:E OF
DESIGN OF PROPOSED WELL LOCATIONS AND SEPTIC SYSTEM
ALASKA WATER
ATER CONSULTANTS, INC.
SOIL LOG - PERCOLATION TEST►
LEGAL DESCRIPTION: PETERS GATE SUBDMSION; LOT 9, BLOCK 2,
PERFORMED FOR: MONTY do SUSIE BUYSE
DATE PERFORMED: 3/15/2000
DEPTHTEST HOLE #1
(feet) ___ ORGANICS
1
3
9
11
12
13
14
SOIL
CLASSIFICATIONS
ORG
GW -
GP/SP ^°:a::+c
GP I
ML
IJ
GM
CL
/
GC
OL
° • o�
SW
MH
"�'•
SP
CH
3
SM
OH
6-
Sc
GM/SM/ML
15-
16-
17-
15
5161718
19
20
COMMENTS: PERK HOLE
DEPTH TO
GROUNDWATER
DATE
SEEP O 11.5'
3/15/2000
DRY
3/18/2000
DRY
3/22/2000
2:26
—
IV, \ , Z'
f �
` 8� TN/x
PROPOSED
3 ROOM
AHOUSE
L TE NA \
Tx+�� TE
1DO WELL us
F_L—ITP
REPOSED
SITE PLAN MALCOLM DR._y�y�___
I' - 100'
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
3/18/00
1
2:26
—
6'
—
2
2:36
10 MIN.
2-3/4'
3-1/4'
3
2:36
—
6-
4
2:46
10 MIN.
3-3/4'
2-1/4'
5
2:46
—
6
—
6
2:56
10 MIN.
4'
2-
7
2:56
—
6'
—
8
3:06
10 MIN.
4'
2-
9
3:06
—
6.
—
10
3:16
10 MIN.
4'
2-
11
3:16
6'
—
12
3:26
10 MIN.
1 4'
2'
PERCOLATION RATE 5 (MID
TEST RUN BETWEEN 5.0�{ IFT
2t
KED FOR 4+ HOURS F R T01Tr?
PERFORMED BY ALASKA WATER do WASTEWATER I,
THIS WAS PERFORM D N ACCORDANCE WITH ALL
DATE. DATE: i 1 00
PERC. HOLE DIA. 6' (INCHES) I
5.5 FT.
CERTIFY THAT I
.T ON THIS
ALASKA WATER & WASTEWATER
I SOIL LOG — PERCOLATION TEST I
LEGAL DESCRIPTION: PETERS GATE SUBDMSION; LOT 9, BLOCK 2,
PERFORMED FOR: MONTY do SUSIE BUYSE
DATE PERFORMED: 3/15/2000
eet =___= PTtl ORGANICS TEST HOLE #2
1
DEPTH TO DATE
GROUNDWATER
DRY 3/15/2000
y Vin=
DRY 3/18/2000
4
DRY 3/22/2000
GM/SM/ML
10 ,� I a
R:.•:
CL
SOIL CLASSIFICATIONS
CNNH •
2
1
IIIIIIIIIMH
PpZVI
R •xP`�
P5S050Ep
Nps
.3
.� .
`•:GW—
—
SM4.68 •
—
ORG
DEPTH TO DATE
GROUNDWATER
DRY 3/15/2000
y Vin=
DRY 3/18/2000
4
DRY 3/22/2000
GM/SM/ML
10 ,� I a
Il�lll!11
CL
GP/SP//.LG
CNNH •
1
IIIIIIIIIMH
PpZVI
R •xP`�
P5S050Ep
Nps
��
CHMSP
SM4.68 •
13
Sc
B.O.H.
DEPTH TO DATE
GROUNDWATER
DRY 3/15/2000
y Vin=
DRY 3/18/2000
4
DRY 3/22/2000
GM/SM/ML
10 ,� I a
1
1H/
DATE
READING
CLOCK NET TIME
TIME (MINUTES)
WATER LEVEL NET DROP
READING (INCHES)
12—'11Jr�i
PpZVI
R •xP`�
P5S050Ep
Nps
��
13
B.O.H.
14-
41516171
15-
16-
17-
1
1
1H/
DATE
READING
CLOCK NET TIME
TIME (MINUTES)
WATER LEVEL NET DROP
READING (INCHES)
PpZVI
R •xP`�
P5S050Ep
Nps
19 PERCOLATION RATE <1 (MIP
20 TEST RUN BETWEEN 3.5 FT
COMMENTS: THE INSITU SANDY SOILS SHOULD ACT A$ -d NO/FIIJ
PERFORMED BY ALASI
THIS WAS PERFORM C
DATE. DATE: 1�
WATER do WASTEWATER 1,
d ACCORDANCE WITH ALL
PERC. HOLE DIA. 6• (INCHES) I
4.0 FT.
CERTIFY THAT I
IN EFFECT ON THIS
PE-re2s G�,-rE-
Lo T 1 A 19L.ock Z1
To M.O.A./DHHS,
My name is Monty Buyse, 1 am a
General Contractor.
1 am building my own house in Chugiak
and 1 would like to do a owner install.
1 am quite familiar with septic installation.
Jody Maus, of Alaska water and
wastewater Consultants Inc. will be doing
the inspections on the installation. 1 am
looking at June 24925,&26 as the dates to
do the install.
My on site wasterwater disposal system/
water supply permit has been approved.
The permit # is SW000057.
Sincerely,
Monty Buyse
Municipality. of Anchorage -
�4
Development Services Departlment:
Building Safety Division
Onsite Water& WastewaterProgram
4700 Synth Brsgaw SL
P.O. Boz 190850 Anchorage, AK M19 -8m"
www.d.anchorage.akus
(907)343-7904,; '
CERTIFICATE OF -HEALTH AUTHORITY;"APPROVAL:.
FORA SING L'E;FAMIL•Y'DWELLING•,
Parcel I.D. 051-541-19
HAniiAl
1. GENERAL INFORMATION Expiration Date:
Complete legal description PETERS GATE SUBDMSI.ON: LOT: 9, BLOCK 2
Location (site address or directions) MALCOLM - DRIVE CHUGIAK., AK
Current Property owner(S) MONTY AND SUSIE BUYSE' Day phone 229=4979
Mailing address P.O. BOX 670185 '• CHUGIAK, "AK .'99567
Lending agency.Day phone :-'i
Mailing address
Real Estate Agent Day phone
Mailing address
Unless otherwise requested, HAA will be held by DSD for pickup:
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well i® Individual On-site
Individual Water Storage ❑ Individual Holding tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Health AuthorityApproval are required for the transfer
of titre (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 Authod yApproval Guidelines for this application,
shows that the on-sJte water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the
Information obtained from the Municipality of Anchorage riles 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 Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEWR ROAD. SUITE 213 ' ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineers Comments:
In conducting this evaluation, Aw1NC, Ina attempted to provide a thorough,
conscientious engineering anaysis of the system in accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results doscribOd the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable foatures. The opera floral life of all wells find
septic systems depend on the tical softs condition, groundwater levels that may
fluctuate during the year, and the water usage of the famfy being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee hrture performance of the system, nor do May guarantee that
there are no hidden defects or encroachments. AK=, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any rellance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
✓ Approved for - -�3 bedrooms.
Disapproved.
Phone 337-6179
Date 4 8/0,
Conditional approval for bedrooms, With the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
By 0, r A 2f!:� la' /0,0� Original Certificate Date: 3-&-01
(RW. =00)
r
Municipality of Anchorage
it 'f9 4
Development Services Department
w a
0"no Pra9remm ....
4700 South Bragaw SL
P.O. Banc 196650 Anchorage. AK 9951"M
waw cLandwrage akus
i
W343 -79W
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: PETERS GATE SUBDNISION: LOT 9. BLOCK 2 Parcel ID: 051-541-19
A. WELL DATA
Wen type PATE H A. B, or C provide PWSID# N/A
Date completed 5/30/00 SeM ary seal (Y/N) Y
(ar�0cm0
Total depth —20-011L Cased toro 31 t1.
FROM WELL LOCI
Data of test 5/30/2000
Static water level 16 —fl.
Wan production 2.0 —9.p.m.
WATER SAMPLE RESULTS:
WOO Lop (Y/N) YES
Who properly protected (Y" YES
Casing height (above ground) 24 in.
AT INSPECTION
Conform -6'
oolonftM00 ml.
Nitrate I • 'fl mgA.
Cather bac terla-E:)- colonlW100 mI.
Date of sample:
2/26/2001
Collected by:
AWWC. INC.
S. SEPTlCIHOLDINO TANK DATA
Tank Type/Materlal STEEL
Tank sloe 1000 gel. Number of Compartments 3
Foundation cleanout (YIN)YES Depression over tank (Y/N) NO
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date installed 8/24/2000 Solt rating QjjA> fe/bdrm) 1_0
Data Installed 6/24/2000
Cleanouts(Y/N) YES
High water alarm (Y/N) N/A
System type SHALLOW TRENCH
Length 63 R Width 5 fL Gravel below pipe 2.57 1L
Total depth'fi•7t—R Elf absorption area 500 fe Monito ln9 tubeYES Depression over flekl No
Date of adequacy test NEW Results (PaadFell) — For 3 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.
Arty rejuvenation treatment (past 12 mo.) (Y/N 6 type) — 11 yes, give date
D. UFT STATION
Date installed
'Pump on' level at—in.
E. SEPARATION DISTANCES
Stee In gallons
High water alarm level at in.
Cycles teased Meets at= & circuit nequlm=nts-
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAiR station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer hmeptic service One 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manholeldeanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIGHOLDINO TANK ON LOT TO:
Building foundation 5'+ Property One 5'+ Absorption told 5'+
Water main N/A Water service One 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1 o'+ Building foundation 10'+ Water main N/A
Water service One 106+ Surface water 100'+ Driveway. parldngfthlde storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lob 100'+
F. COMMENTS
0. ENGINEER'S CERTIFICATION
I cer* that I have determined through field Inspecdons and
review ofM~ records that the above systems are in
conformance with MOA HAA guidelines in eifed on this date.
EngineersZ N/���neee JEFFREY A. GARNESS
Date �'a,
HAA Fee S $ -3/,/l /17//1
Date of Payment U42/
Receipt Number A//ag/os
(nw.1z"
Waiver Fee S
Date of Payment
Receipt Number
