HomeMy WebLinkAboutSTUCKAGAIN MANOR BLK 1 LT 6tuckagain
Manor
Block 1
Lot 6
#041-023-21
Municipality of Anchorage Page of
__L
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: 15(A)q-7Q"o\L17 PID Number:
Name: /' ��
Gt
Wastewater System: ;9New ElUpgrade
Address: —QQ(g ��% �o`' � 1An�
/V tj -.
•�
7 ABSORPTION FIELD
Phone: No. ofBedrooms:
-�� C3
IdDeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: ^
Total Depth from original grade: t
L .2 GPD/Sq. Ft.
Lot:/ Block: Suubdiv' ion:
b S`
Depth to pipe bottom from originals de:
Gravel depth beneath pipe[
uC O.9
..J Ft.
�+ Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
FL
Ft.
WELL: New ❑ Upgrade
Gravel width:
Number of lines:
Distance lines:
Ft.
(
Ft.
Claspicat4on (Pr'vate, A,B,C):
/' V
Total Depth:
FL
Cased To:
Ft.
Total absorption area: p�
i 0 SO. Ft.
Pipe material: ��L j L� q
�lyi V37 F - D (V
Driller:
S I/; Wla�c�
Dae rille
Static We r Level:
�^�( c
Installer: /^ 64,
�I�T
Date installed: qp
V4/9 e
3V Ft.
lr UXlIfRt ✓t
Yield: Pump Set at:ing
10 L, I
Height Above Ground:
TANK
GPM K Ft.
Ft.
SEPARATION
DISTANCES
XSeptic ❑ Holding ❑ S.T.E.P.
To
From
Septic
Absorption
Lift
Holding
ublic/Private
Manufacturer:
T(2,1
Capacity in gallons:
Tank
Field
Station
Tank
Sewer Lines
(�,
1000
Welh
100
Im\,�L.
�C`1
�7 T
Material: I
(LIFT
Number of Compartments:
Watere
a6`T
)ODW\T
STATION
Lot(�\
�[55'��
Size in gallons:
Manufacturer.
Line
U
,
Foundation
13 �%%
•/
"Pump on" level at: "P otP' level at:
High water alarm at:
Curtain
Pump Ma oriel
Electrical Inspections performed by:
Drain
'\�
nP
Remarks:
BENCH MARK
Location and Description:
c) t
Assumed Elevation: 00
Pt
fMe
,41C 7 Mrd
S & S ENGINEERING
Inspections performed by: tFS:1st 3-41 /°1 g
A9
A
o[
Eagle River, Alaska 99577 2nd $c/fY/zt
/d
ROBERT C. COWAN 1
7 q$
al s: CE -8801
attt�PFOF,
Department of Health and Human Services approijal�
Reviewed and approved by: l�t Dater
t`�za�a�`�'`�
tZ- 14 tMev. mal) Munn
3u)
'PERMIT NO. SW970247
PAGE 2 OF 3
DEPARTMENT �F-IE/��TH SND HJM/�f� SERVICES
EE�IROE'����ENTA._ SERVICES DIV�S�0�1
�'''�-J �i`r�n'�^rC'J��'\• '� 1�','_ �. `�; �1 �i?.• c�IJ I�'/�, �'�! `1J_i L �I ����ri.-����1'� I��,`_rb�gT
LEGAL LOT 6, BLOCK 1, STUCKAGAIN MANOR P.I.D. NO. 041-023-21
/
/
/
/
/
/
/
-DBL1
DBL2
EWAY \
\
TH CO2
•/ iMT1
T 2 i- X\ 7
COlP�iSZ�`
SCALE: 1" =
p ROBERTC. COWANr
`v�f y CE
'PERMIT NO. SW970247 PAGE 3 OF 3
Ef�vI��N'�ENTQ� SERVICES CIU Si �N
'�fJ `�� T E Vv�T-,^,iR�• -� Iii T��i,T,:,l � t a 'r = Vv'.= l_ I^STP �Tl:�,f;
LEGAL LOT LOT 6, BLOCK 1, STUCKAGAIN MANOR P.I.D. NO. 041-023-21
ST1 ST2
FINAL
GRADE
101.8'
A B
FCO 52.0' 34.0'
ST1 31.5' 16.5'
ST2 32.0' 20.0'
DBL1 32.5' 24.5'
NEW
DBL2 33.0' 26.0'
96.6' 1000 GAL
C01 32.5' 27.5'
SEPTIC
96.4'
MT1 28.0 42.5'
TANK
CO2
FINAL GRADE
COI =
101.5'
CO2 =
101.0'
C01
= 95.7'
SR CO2
= 95.7'
N. T. S.
ENG
MT1 = 90.4'��
seeyd
,�•a
��P
,'� fe
i ��jl
.Ni
NO
WATER FOUND
Met
84.4' B.O.H.
_�![ , _•._,:.
RoAERi,C.
COWAN
s y: CE -8801 r -'/A
by
DOC C.. dba
LL�1is_- ER WELLS
P.09OX57(i�2jCPl GIAC,ALASICAJ9557 TELEPHONE888.2759
OWNER OF LA D�}�• t (g It /T�(t�L (IftI�' bE��PT.,,HO��F��WELL
ADDRESS' 59 Sj L00V60A/ I+ CIRC.ce STATIC LE EL OF WATER FT.
LEGAL DESCRIPTION L °T C, 63i k I S7JC,f` 444' DRAW DOWN FT.
DATE -Started 9 < Ended ,` GALS. PER HR o< OJ
PERMIT NUMBER SW 9+1 1�f 6 r
�4 KIND
KIND OF FORMATION: �}
From ID to-,2—Ft. From - Ft. to Ft.
From 01 Ft.to�F.t. oyE4-,(� 049A -) From Ft. to Ft.
FromFt. [o�j�t' Ft. .4� nJo 1 , bK��%t?L From - FL to Ft.
From��Ft. to_%l Ft. S,.,i -i-Gkt4Jrdt , From - Ft. to_ _ Ft
From__11LFt. to_& L_ Ft `' �!��4� From Ft. to Ft
,ppqq��
From (fl Ft. to FL
From_Ef..to'!�J Ft�ttd�'�'f - From Ft. to Ft._
From y� Ft. to-L30 Ft. ( L 4t 4 6'kA,e L. - From—Ft. to - Ft.
From/ a Ft. to /4�.Ft. .t'� .,,IQ. b.4 �--�+ hro r6/z- to Ft..
From Ft. to - Ft. From Ft. to - - Ft.
From Ft. to . ,Ft. >s . :°n1 Ft. to Ft.
-Fioifi''�`� s^'FLs'to`F"�"ier�-�-=Fts.-_.,sedR v'es,•, —�-•.- )��;F�t:.-tdr.�=:s� :. . _:: ,a ,.. ...
From I. to Ft. From_ Ft. to Ft.
From Ft. to - Ft. - From Ft. to- Ft.
From—Ft. to- Ft. - From—Ft. to- Ft.
From Ft. to - Ft. - - From Ft. to - Ft.
From 'Ft. to - Ft. - - From—Ft. to Ft /"
MISCL. INFORMATION: RECEIVED
OCT 311997
Municipality of Anchorage
Dept Health &Human Services
p
DRILLERS NAME
a --rm" 2�v f Y)
g ocC`
PAGE
11 OF 1 �" 5S'-�U
MUNICIPALITY OF ANCHORAGE - 61 1p m
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970247
DESIGN ENGINEERS & S ENGINEERING
OWNER NAME:BACHNER KARL A
OWNER ADDRESS:5951 LONGORIA CIRCLE
ANCHORAGE, AK 99504
PARCEL ID:04102321
LEGAL DESCRIPTION:
-:I pIOR BLK 1 ;LT' 6-,
LOT SIZE: 57793 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 8/08/97
EXPIRATION DATE: 8/08/98
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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED E
ISSUED BY
DATE: /-I - /7
DATE:
July 29, 1997
ROBERT C. COWAN, P.E.
ROBERT A. SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX(907)694-1211
HEALTHAUTHORITY
APPROVALS
MUNICIPALITY OF ANCHOBA(U[
ENVIRONMENTAL SERVICES
DIVISION
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services JUL 30 1997
P.O. Box 196650
MAIN EXTENSIONS
Anchorage, AK. 99519 RECEIVED
REFERENCE: Lot 6, Block 1, Stuckagain Manor Subdivision
SEWER & WATER
INSPECTION
Request you issue a permit to drill a well and install a septic system to serve the
proposed three bedroom house on the referenced property.
ENGINEERING STUDIES
ANDREPORTS
A test hole was excavated and percolation test performed. The approximate location of the
test hole is located on the attached site plan.
The monitoring tube within the test hole has been checked and found to be dry.
WELL INSPECTION
& FLOW TEST
This property has enough area for a future septic upgrade which can be seen on the
attached site plan.
SITEPLANS
We do not anticipate any adverse effects on neighboring wells, septic systems or drainage
patterns by the installation of the proposed septic system.
ROAD DESIGN
There are no points of contamination within the proposed well radius which can be seen on
the attached site plan.
If you require additional information, please contact us.
SOILTEST
Sincerely,
PERCOLATION
TEST
11
Robert C. Cowan, P.E.
RCC/jm
STRUCTURAL&
MECHANICAL
INSPECTIONS
Enclosure
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
t" - fi0' SITE PI AN DFSIGN
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: C L P 46� LL; N D DATE PER
LEGAL DESCRIPTION: LB T ` Q 1-a C�- / Township, Range, Section:
DEPTH I T UC -K R Gq I'/ hr 41 6A SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
P
P p009LI
G.RAOLD
S x4 P
6�0.N.
WAS GROUND WATER 0
ENCOUNTERED?
IF YES, AT WHAT —
DEPTH?
Depth to Water After Dk y 6 /9 9
Monitoring? Date:
Reading Date Gross Net
Time Time
Depth to
Water
Net
Drop
t` J0AX
/R7 :a? —
s
—
D -q
74 „
0/ N
3 A
'rA"
Its"
PERCOLATION RATE I (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN -7 FTAND 8 FT
J at D GI1VINKIMM111V
PERFORMED BY: EEms�{ Q�ai�n�rer eerr' - 1 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WI7Ti" 1t AeFE iYNCS�MUNICIFAL GUIDELINES IN EFFECT ON THIS DATE. DATE: G / J Q 7
72-008 (Rev. 4185)
Municipality of Anchorage
• '� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street f7
P.O. Box 196650
Anchorage, AK 99519-6650 (�
www.muni.org/onsite /Y i
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.l( - lJ" COSA#
1. GENERAL INFORMATION Expiration Date:
Complete legal description STUCKAGAIN MANOR SUBDIVISION, LOT 6, BLOCK 1
Location (site address) 6220 FARPOINT DRIVE * ANCHORAGE, AK 99507
Current Property owner(s)
JAMES
DAVIS
Individual Well
Day phone 830-1608
Individual On-site
Individual Water Storage
Mailing address
6220
FARPOINT DRIVE *
ANCHORAGE,
AK 99507
Lending agency
Mailing address
Day phone
Real Estate Agent TIM RITTAL w/ REMAX Day phone 248-2249
Mailing address 110 W 38TH SUITE 100 * ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
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 Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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 samples. (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, 1 verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. 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 reliance 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.
Date 6 /S/O :iL
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
WASTEWATER
PROGRAM
DE�JTSEA��1��
By: Original Certificate Date: — -7" 7
(Rev. 11105)
Municipality of Anchorage
• '� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: STUCKAGAIN MANOR SUBDIVISION, LOT 6, BLOCK 1 Parcel ID:0 W' D2 3-2
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 8/14/1997 Sanitary seal (YIN) YES
Total depth 141 ft. Cased to 141 ft.
FROM WELL LOG
Date of test 8/14/1997
Static water level 130 ft.
Well production 10 —
9 -p.m -
WATER SAMPLE RESULTS
Coliform a colonies/100 ml.
Arsenic: ALD—ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
STEEL
NitratetQ.aaamg./L.
Well Log (Y/N) YES
Wires properly protected (YIN) YES
Casing height (above ground) 18 in.
AT INSPECTION
5/17/2007
79 ft,
4 g.p.m.
Other bacteria colonies/100 ml.
Date of sample: 5/17/2007 Collected by: GEG Ltd
Tank size 1000 gal. Number of Compartments E
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO
Date installed 5/12/1998
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
Date of pumping 8/13/2006 Pumper McDONALD's PUMPING
C. ABSORPTION FIELD DATA
Date installed 5/12/1998 Soil rating (g.p.d./ft2o /bdr 1.2 System type TRENCH
Length 38 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth *10.5 ft. Eff. absorption area 380 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 5/17/2007 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test36 in. Water added 523 gal. New depth 36 in.
Elapsed Time: 1402 min. Final fluid depth36 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN
"Pump on" level atin. "Pump High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot
'v"
Public sewer main
N/A
Sewer /septic service line
25'+
Animal containment areas
50'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A 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 N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATIONU1
o .•r..
1 certify that I have determined through field inspections and Iff
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date. QQ J y A. Ga ess:•
Engineer's Printed Name JEFFREY A. GARNESS 04' , CE 79�
(CUs 0 2- p� o
P �a
Date
Prof
COSA Fee $ &V,3 (2, go
Date of Payment f (- . 110 TFC
Receipt Number J 7'! %() YJ/,lii✓
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
�- Municipality of Anchorage
' Development Services Department *_
Building Safety Division
Onsite Water $ 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
Parcel I.D. 041-023-21 HAA# Niq D/ 6 l 8 4
1. GENERAL INFORMATION Expiration Date:'9 — %" 0 /
Complete legal description STUCKAGAIN MANOR LOT 6, BLOCK 1
Location (site address or directions) 6220 FAR POINT, ANCHORAGE AK 99507
Current Property owner(s) KAL & CHRIS HAGLUND Day phone 335-1755
Mailing address 6220 FAR POINT, ANCHORAGE AK 99507
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone
GREG BRODERICK w/ PRUDENTIAL VISTA Day phone 273-7299
4241 "B" ST. ANCHORAGE, AK. 99503
Unless otherwise requested, NAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
l
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 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.
Note. Alaska Water and Wastewater Consultants, Inc. shall be paid $1110.00 at, or prior
to closing for the engineering services provided
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 AuthorityApproval Guidelines for this application,
shows that the on-site water supplyandlor wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. /further verily that based on the
information obtained from the Municipality ofAnchorage 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 213 * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. -
Date S ICi
Engineer's Comments:
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In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
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conscientious engineering analysis of the system In accordance with ADEC and MOA
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DSD Guidelines & Regulations. The reported results described the performances of the
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system under the conditions encountered at the time of the test and separation
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distances measured to readily identifiable features. The operational life of all wells and
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septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
Satisfactory
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These conditions are outside the control of the evaluator of the system. testQQ
do future the system, nor do they that
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results not guarantee performance of guarantee
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there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
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any warranty or future estimate of how long the system will continue to meet the
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operational requirements of the ADEC or MDA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
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5. DSD SIGNATURE
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Approved for 3 bedrooms.
-SITE
Disapproved.
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Conditional approval for bedrooms, with the fllowing stipulatiotta: o PROGRAM
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Attachments:
HAA Checklist `J Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
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By: 005;e4 -,/ ji`� Original Certificate
Date: -�E %— Q
(Rev. 17!00)
Municipality of Anchorage a
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program ,g "
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: STUCKAGAIN MANOR LOT 6, BLOCK 1 Parcel ID: 041-023-21
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 8/14/97 Sanitary seal (Y/N) YES
Total depth 141' ft. Cased to 141' ft.
FROM WELL LOG
Date of test 8/14/97
Static water level 130 ft,
Well production 10 —
g -p.m -WATER SAMPLE RESULTS:
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 18 in.
AT INSPECTION
4/20/01
79 ft,
3.83 g.p.m.
Coliform —0— colonies/100 ml. Nitrate O- b mg./L. Other bacteria_colonies/100 ml.
Date of sample: 4/20/01 Collected by: AWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matertal STEEL
Tank size 1000 gal. Number of Compartments E
Date installed
Cleanouts (Y/N)
5-12-98
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping `912212= Pumper N -Dons
C. ABSORPTION FIELD DATA
Date installed 5-12-98 Soil rating .p.d. r felbdrm) 1_2 System type DEEP TRENCH
Length 38 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth 10.7 ft. Eff. absorption area 380 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 4/20/01 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 11 in. Water added 6122 gal. New depth 22 in.
Elapsed Time: 110 min. Final fluid depth 18 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at n.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhola/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICAIOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 25'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 15'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through Beld inspections and
review of Municipal records that the above systems are in
conformance with MDA HAA guidelines in effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
Date dl /10/
HAA Fee $ SOO • CQ
Date of Payment 5-2-0/
Receipt Number 3 `%tri 3
(Rev. 12=)
Waiver Fee
Date of Payment
Receipt Number