HomeMy WebLinkAboutPIONEER ESTATES BLK 2 LT 3Pioneer
Estates
Block 2
Lot 3
#057 - 091 - 09
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: .Wfl7' s PID Number* 057-09-109
Name:
Corliss Kimmel
Wastewater System: 0 New 0 Upgrade
Address: P.O. Box 874064 Wasilla, AK
ABSORPTION FIELD
Phone: No. of Bedrooms: hre
Te
D Deep Trench XXShallow Trench 0 Bed 0 Mound 0 Other
LEGAL DESCRIPTION
Sail Rating:
1 • 2 Gaprsb. Ft.
Total Depth frorn,original grade:
4'
Lot: Block: Subdivision:
3 2 Pioneer Estates
Death 10 pipe bottom Rom original grade:
Ground Surface Ft,
Gravel depth beneath pipe
4 Ft,
Township: I Range: Section:
Fill added above original grade:
2' - 4' Ft.
Gravel length:
40 Ft.
WELL: ZXNew 0 Upgrade
Gravel width: 5
Ft.
Number of lines:
1
Distance between lnes
— Ft.
Classification (Private. A.B.C):
Private
Total depth:
. 1 Ft.
Cased To:
; r Ft.
Total absorption area:
400 sa. Ft.
Pipe material:
ASTM D3034 PVC
Griller.
M—W Drilling
Date Orlled:
10/6/98
Static Water Level:
50 Ft,
Installer.
Hamilton Exc.
Date installed:
R/11-7n/g
Yield:
8 GPM
Pump Set at:
Ft.
Casing Height Above Ground:
2 Ft.
_
TANK
SEPARATION DISTANCES
_-
gSeptic 0 Holding ❑S.T.E.P.
TdIfir
From
ii,,
Aosorotion
Field
lilt
Station
Holding
Tank
ublic/Pnvate
Sewer lines
Manufactures
reer
Capacity in gallons:
1.,000
Number of Compartments:
fan
Well
>1001
>100'
N/A
N/A
N/A
Material:
Steel
Surface
Water
>100'
>100'
N/A
N/A
N/A
LIFT STATION - N/A
Lot
Line
>5'
> 1 0 '
N/A
N/A
N/A
Size in gallons: 1 Manufacturer:
Foundation
> 5'
> 1 0 '
N/A
N/A
N/A
"Pump on" level ar:
"Pump oft' level at:
Nigh water alarm at:
Curtain
Drain
None
on Lot
Pump Make el Model
Electrical Inspections performed by:
Remarks: 2" Direct Bury Insulation
BENCH MARK
Placed over Tank and Absorption
Location and Description: Topof Finished
Trench.
Floor.
Assumed Elevation:
1 0 0 F,
•
01/3.4t°' * k-a,-Qiii)
° ° ° n ° ° ° ° x°'
Inspections performed by: J • Nicodemus Dates: 1 st 8 / 1 1 / 98s^
2nd 8/14/98
h 0 pDEB O
d 081st °,0„V,,;.
v °°° b ',„:. 0
O ° °00909°° `.`-r1
�1 r �'E O --t,-
Department of Heal and Human Services approval
Reviewed and approved by: Gi�tGt� Date. /- 7,5--?
r2.)t: a.v 3,911'ACA z5
Permit No SW980255
Page 2 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 u Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lot 3, Block 2, Pioneer Estates
PID No • 057-09-109
ROCHELLE AVL
0
WELL
GRAVEL DRIVE
1 2'
1" = 30'
100' well rod./
C5
1. NO ADJACENT WELLS WITHIN 100'
12.013 A(2/91) MOA 25
LE'G iVL
SI SEPTIC CLEANOUT COMPARTMENT -1
S2 SEPTIC CLEANOUT COMPARTMENT -2
C CLEANOUT
M MONITOR TUBE
MI
C3
o "C4
1H
31
Alternate Site
F�4 fF� ER 5 $ QL
i*
49The %�%0 *.
o
4;1;1:: ° �O^w�eFPooVT'�i
VA '` �c�lNA..k. M�DEH$O
4,1314 >°
e4
A
B
C
CI
6.4'
31.6'
SI
13.1'
46.1'
S2
188'
51.0'
C2
24 3'
56.0'
C3
25.7'
57.5'
C4
38.0'
69.2'
MI
39.4'
69.2'
M2
34.4'
473'
C5
35.2'
46.2'
12.013 A(2/91) MOA 25
LE'G iVL
SI SEPTIC CLEANOUT COMPARTMENT -1
S2 SEPTIC CLEANOUT COMPARTMENT -2
C CLEANOUT
M MONITOR TUBE
MI
C3
o "C4
1H
31
Alternate Site
F�4 fF� ER 5 $ QL
i*
49The %�%0 *.
o
4;1;1:: ° �O^w�eFPooVT'�i
VA '` �c�lNA..k. M�DEH$O
4,1314 >°
e4
Permit No. SW980255
3
Page
of
3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lot 3, 'Block 2, Pioneer Estates
PID No • 057-09-109
PROFILE LOT 3. BLOCK 2. PIONEER ESTATE'S
C1/ EL =102.1
EL=99.3
SI 52/C3 C4
M/T TYPICAL
TYPICAL
1 MIN COVER Vi 2'
INSVLAIION BOARD.
NEW 1000 GAL.
TWO COMPARTMENT
SEPTIC TANK
with 2" Insulation
EL =96.1
EL=91
EL=84.1
EL=98.6
C4 MI
SE'CTIOIV
010 SCALE
CAPPED MONITOR
TUBE
FILTER FABRI
C
4 MIN COVER Vi 2' M2
!NSIAA/I0N BOARD
ORIGINAL
- 2-1/2' 0IA
SEPTIC ROCK
NO SCALE
OL
GW
t
W Wo
+ �r
,v WATER
1(40') PERF. PIPE
INSTALLED LEVEL
TH (HOLES DOWN)
GE'NE'RAL IVO
INSULATION BOARD WAS
INSTALLED OVER SEPTIC
SYSTEM WITH 2'+ FILL
FOR 4' MIN COVER.
ALL PIPE 1S PVC SCHED 40
UNLESS OTHERWISE NOTED.
LL'CE'ND
C
L52Ls1
MT
CLEANOUT
SEPTIC CLEANOUT COMPARTMENT I
�:PTIC CLEANOUT COMPARTMENT 2
MONITOR TUBE
72-013 A (2/91) MOA 25
IMPERMEABLE 9'
LAYER 10'
11'
12'
BOTTOM OF HOLE
M -W DRILLING, Inc.
P.O. Box 110378 • 10330 Old Seward Highway
(907) 349.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner CORLISS KIMMEL/THOMAS TEALLOW/GRANDPRE' DOMESTIC
Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
LOT 3, BLOCK 2, PIONEER ESTATES: EKLUTNA
EKLUTNA, ALASKA
Size of casing 6" Depth of Hole 260 feetCased to 184.73
feet
Static water level 5° ft WOW( (below) land surface. Finish of well (check one) open end ( X ) ;
Screen ( ) ; Perforated ( X ).
Describe A ym perforation 72 ',T082 ' AND 102TO 1 07' :4 ROWS OF 1 "X3/8" SLOTS
Well pumping test at 8-1 0 gallons per
of drawdown from static level. ,
Date of completion 06 OCTOBER 1”8__
( 34.0 (minute) for 72 130 ft
AS BUILT NOTES:1) DRY GROUT WITH 2 SACKS OF
BENTONITE GRANULES. (2) WATER FROM PERF'S RAN OU
IN BEDROCK FRACTURES SO BEDROCK HOLE BACKFILLED
WITH GRAVEL AND PLUGGED WITH BENTONITE CHIPS AT
WELL LOG 207' TD
hours with
Depth in feet from
ground surface
0 TO 2
2 TO 5
5 TO 20
Give details of formations penetrated, size of material, color and hardness
CASING STICK UP
FILL
GRAVEL: BROWN, SANDY
20 TO 29 SAND: GRAVELLY, WET
29 TO 44 SAND: GRAVELLY
44 TO 66
66 TO 82
82 TO 102
102 TO
SAND: GRAVELLEY, SILTY
AS ABOVE: TO WET ..
GRAVEL: SANDY, SILTY
RECEIVED
JAN 14 1999
Uo
P Heaithry of �irlChor�.t1-10
& f fuman ServiceR
112 GRAVEL: SILTY, WET, DIRTY
112 TO 186
186 TO 260
TO
TO
TO
TO
BOULDER GRAVEL: SILTY, SANDY
BEDROCK: GREY BLACK SILTSTONE ARGILLITE,WITII MAYBE
'a GPM FROM SPORADIC FRACTURES
INA Certified Contractor
N` No's, 814 913
Certificate &
1 — CUSTOMER
MUNICIPALITY OF ANCHORAGE
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:SW980255
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:KIMMEL CORLISS
OWNER ADDRESS:PO BOX 874064
WASILLA, AK 99687-4064
PARCEL ID:05709109
LEGAL DESCRIPTION:
PIONEER ESTATES BLK 2 LT 3
LOT SIZE: 103200 (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:
PAGE 1 OF 1
DATE ISSUED: 7/23/98
EXPIRATION DATE: 7/23/99
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 BY:
ISSUED BY:
DATE:
1/LL /16
DATE: 7 .23 . / C)
ERSON ENGINEERING
P.Q. BOX 2407'73
ANCHORAGE, AK 99524
X22-'7773 X22-6779 (IFAX)'
July 13, 1998
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 3, Block 2, Pioneer Estates Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
We are hereby applying for a permit to construct a new well and septic
system on Lot 3, Block 2, Pioneer Estates Subdivision. The lot is currently
vacant with no development on any of the surrounding lots. The attached
site plan and backup documentation identify the size and location of the
new septic tank and absorption trench to serve the home. It also shows
the location of the proposed well and the 100' protective radius.
Testhole No. 1 which was placed near the area of the proposed absorption
trench and consisted of well graded sands and gravels which percolated at
a rate in excess of 1 minute per inch.. Groundwater was noted during
excavation at the 8.5' level and remained at that level during the
monitoring period. We are therefore proposing to construct a 5' wide
trench system with 4' effective depth. Total length will be 40' with the
distribution piping at the existing ground surface. Total depth of the
trench will be 4'. Insulation will be placed atop the trench to protect
against freezing.
The surface of the lot slopes from north to south at varying rates with
grades ranging from 6% to 10%. The slope in the area of the proposed
absorption trench is fairly flat with a minor slope from east to west. The
lot is relatively large and sufficient area exists for the placement of the
new and reserve site and the well radius. No conflicts exist between the
septic system area and other wells or septic systems in the area.
Lot 3, Block 2, Pioneer Estates
July 13, 1998
Page Two
If the system is constructed as designed the following statements apply:
1. The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
3. The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
4. The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
ROCHELLE AVENUE
e
AI
0
Zi
Sib
Proposed
Well
Three
Bedroom
Home
100' Well
TH2
Alternate
Site
1,000 Gall.n
eptic Tan
40' Long 5'
Wide X ' Deep
Absorp ion
Tren h
<'
NOTE: No Wells or Septic Systems Within 200'
Of The Proposed Systems.
SITE PLAN
SCALE 1" -. 50'
LOT 3, BLOCK 2, PIONEER ESTATES
SUBDIVISION
DESIGN FACTORS:
Three Bedroom Horne
Perc. Rate: LT 1 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,000 Gallon Septic Tank
4' Drainfield Rock
3 Bedrooms X 150 GPD / 1.2 GPD/SF = 375 SF of Absorption Area
375 SF/5 LF (Width) X .5 (Red. Factor) = 40 LF Trench Length
Therefore: Construct a 5' Wide Absorption Trench System With One
Lateral 40' in Length with 4' of Drainfield Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at the Original Ground Surface.
5'
Drainfield
Rock
TYPICAL WIDE TRENCH SECTION"'
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Lot Line.
kfidellAEL
\ 4381-
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 '1.* Street, Anchorage, Alaska 99502-0650
SOILS LOG - PEFICOLAT1ON TEST
_SENG.INEOSSErik,L1
..)
•.•
(
< • * • ri .
Gary Smith - Grand Pre Homes 40-0 °V•IA"
OATE PEFIFORM,ekt__
LEGAL DESCRIPTION: Lot 3 Block 2
OL
Pioneer Estates
4
-
.. 8
' •
• ' •
9-
10 -
12
0
• ..
- • •
SoTro PA
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
Township, Range. Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT VVHAT
DEPTH?
E
aeon to walsr Atter 6v., zz1,13..
*mitring? Date
Reading Date
Gross
Time
Net
Time
Death to
W311!
Net
Dram
PERCOLATION RATE > 1 (minutes/meg PERC HOLE DIAMETER 8 it
TEST RUN BETWEEN 2 FT AND -a-- FT
COMMENTS
PERFORMED V: J NtcndP11111 11-4.4-&-C"I—CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
Gary Smith - Grand Pre Homes
(EN GIP„EgR'SSEAL)
f�Js„ rl .:
OATEPERFOPIME04-• 6/18 98.
LEGAL DESCRIPTION: Lot 3 Block 2 , Township, Range, Section:
OL Pioneer Estates
10
11
12
13
14
15
16
17
18
19
20
Qo't•DM of
_ri-i Jo .
SLOPE
WAS GROUND WATER
ENCOUNTERED? `ice S
IF YES, AT WHAT
DEPTH?
3
Depth Io water Ahern
Mani aring7 pate
S
L
0
P
7/0/q6
SITE PLAN
N
Reading
Cate
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE > (minutesnnetlt PERC HOLE DIAMETER 8 "
TEST RUN BETWEEN
FT AND - FT
COMMENTS Mara Than 50 of Maf-aria1 Pas S Na 4 GiPVP'
PERFORMED BY• ,7 _ Ni codcpmnc
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
C. ./L/t�CBR-'flitY THAT THIS TF,ST WAS PERFORMED IN
72-008 (Rev. 4/85)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 2, PIONEER ESTATES SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and
placement of a new 1,000 gallon septic tank. It also
includes the construction of a new 40' long by 5' wide by 4'
effective depth absorption trench at the location shown on
the site plan. The distribution piping must be placed at the
original ground surface. The total depth of the trench must
not exceed 4'. Direct bury insulation must be placed atop
the trench along with 2' of cover as protection against
freezing.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be procured from an
approved source and installed at the location shown.
Lot 3, Block 2, Pioneer Estates
July 13, 1998
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum o f
12 inches above final grade.
5. Tanks installed without 4' of cover shall have a minimum o f
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trench shall be within 2"
of level.
2. Distribution piping must be placed level with perforations
down atop a level bed of drainfield rock. Rock should then
be placed over the pipe to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Lot 3, Block 2, Pioneer Estates
July 13, 1998
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trenches to drain
away.
8. A minimum 2' of accepting soil is required below the
drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated,
but not solid) and ASTM D2662 or A.B.S. (perforated and
solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Lot 3, Block 2, Pioneer Estates
July 13, 1998
Page Four
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be i n
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as -built
of the completed system.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 057-091-09
1. GENERAL INFORMATION
Complete legal description
HAA# 65 Otto y
Expiration Date: 2 ') G -o6
Lot 3; Block 2; Pioneer Estates
Location (site address or directions) 38150 Rochelle Ave. Chugiak, AK 99567
Current Propertyowner(s) Corliss Kimmel n Day phone 344-8497
Mailing address (�0 1;t4,'4 G< I-NhU Qwevt NG- agSi 4 -
Lending agency Day phone
Mailing address
Real Estate Agent
Mailing Address
James Riley Day phone 248-8700
2921 Pelican Dr. Anchorage, AK
yAK995002
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
/1 //7/s,j•-
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 7®
❑ Individual Holding tank 0
❑ Community On-site 0
❑ Public Sewer - 0
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm S & S Engineering,
Phone 694-2979
Address17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name ORO 4.47- (1 �pwef./ Date 1/ / S /05-
,.� 15F q =ltt
a 4.)
.....'.4
5. DSD SIGNATURE °6 71 % aoemr t COWANit
��
l/: Approved for
3 bedrooms. iteb CE•6E0I fri
Disapproved. teN 1tihit,:+, .'.:1
sem.
Conditional approval for bedrooms, with the following stipulations:
By:
Additional Comments
al)OFAN1/4
��4
J2•; • O••s
WATER AND • m
N -SITE
WASTEWATER
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements •
Supplemental Engineer's Report
Other
. (Rev 01/02)
Original Certificate Date: 1 J 1 -06-
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Loi 3 Q 1, o cif a Piotife,t. Es?,
A. WELL DATA
Well type pa Voir If A, B, orCprovide PWSID#=
Date completed IDA v Sanitary seal (5b/N) YE
Total depth a CO ft. Cased to ) 4 rft.
FROM WELL LOG
/o (6 /iI Y
Date of test •
Static water level
Well production
CO ft.
k '�O
g.p.m.
WATER SAMPLE RESULTS:
Coliform s7 colonies/100 ml. Nitrate 0.131 mg.//
l.
Date of sample: /obT/os Collected by:
Parcel ID: oS7— 09I — 09
Well Log t &I) ' t S
Wires properly protected (ON) Yk. S
Casing height (above ground) 1 W1- in.
AT INSPECTION
11/a/os
'7 5�
y. /
Other bacteria
Arsenic: = mg./I.
B. SEPTIC/HOLDING TANK DATA
54 -PT s c ( STE Q.
Tank Type/Material
Date installed
ft.
g.p.m.
0 colonies/100 ml.
$ & S ENGINEERING
17034 Eby* Pay.r hoop Koad No. 204
Eagle River, Alaska 99577
$
/id se
Tank size /000 gal. Number of Compartments 2- Cleanoutse N) iLf'
Foundation cleanout &�'N) Yes Depression over tank (Y6 ✓0 High water alarm (Ye r0
Date of pumping ‘k -1 12.001- Pumper J%s S Loc -4/0)
C. ABSORPTION FIELD DATA
Date installed viiiim %r Soil rating •.d./ft2 •r ft2/bdrm) )_a System type T R EN c N
Length 4 O ft. Width ft. Gravel below pipe i/
Total depth 7 ft. Eff. absorption area
Date of adequacy test 1, �a f° S Results Fail) r4 -5J
Fluid depth in absorption field before test 0 in.
Elapsed Time: 11 min. Final fluid depth
y!0 ft2 Monitoring tube YE -5 Depression over field ow o
For 3 bedrooms
Water addedg i0gal. New depth S in.
O in. Absorption rate >= A%SO g.p.d.
ft.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
a * s KNOW.✓ If yes, give date
r
D. LIFT STATION
Date installed Size in gallons
'Pump on level at _ in. "Pump off' level at _ in
Datum -sed
E. S PARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot )0 0 f On adjacent lots
Absorption field on lot /0 4 f On adjacent lots
Public sewer main H lA
Sewer /septic service line a-5- (÷
Manhole/Access (Y/N
water alarm level at
Meets alarm & circuit requirements?
%00 rf
in.
Ji o -�
Public sewer manhole/cleanout A/
Holding tank N l A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
1
Building foundation C 4- Property line ' t Absorption field S f
r
Water main » /4 Water service line /0 t Surface water / 0 0 et
Wells on adjacent lots
per 4 -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation /0 r">A Water main Y 14
/ 0 0 I+ Driveway, parkinglvehicle storage CO 14 -
Property
Property line /0 i
r
Water Service line ft' l- Surface water
Curtain drain N eN li. kNcwrr Wells on adjacent lots /00
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Ra a EAT C. Cbis4 d
Date f / 210.1-
HAA
/°r
.15"- OF At Qi
.r '.F ............^I
r ,C )",
r'.t;
HAA Fee $ 430 41)
Date of Payment
I t fI L1 i05
Receipt Number q(0(0 Clen
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
LEGEND:
MEASURED DATA Q•s'
RECORD DATA N 90'00'00" W
RECOVERED l'i' REBAR 0
CLEAN OUT
0
M
ROCHELLE AVE
N 89'55'30" E
258.00'
1
ttLL \: 7
GRAVEL DRIVE r'
LOT 2
v
10W.ITY EASEMEAT
w
0
O
0
O
O
z
0
f")
1 STORY WOOD HOUSE
W/ DAYLIGHT BASEMENT
f4' EAVE TYPICAL)
CONrt
LOT 3
103,200 sq.ft.
RECERTIFICATION
THIS IS A RECERTIFICATION OF AN MORTGAGE SURVEY
DONE BY THIS COMPANY ON SEPTEMBER 11, 1998.
O
O
LOT 4
N 00604'00" E