HomeMy WebLinkAboutMARYLAND LT 4-AMaryland
Lot 4A
#015-082-33
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: SW000062 PID Number: 015-082-33
Name:
Wastewater System: IN New ❑ Upgrade
MIKE THOMAS
AddresP.O. BOX 770110 EAGLE RIVER, AK 99577
ABSORPTION FIELD
Phone:
(907) 694-2202
No. of Bedrooms:
3
■Deep Trench [3Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soll Retail: 1 0
9 Total Depth from originalgrade:
6-10.5 FL
GPD/Sq.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
4A — MARYLAND
5.43-6.33 FL
4.17 pt,
Township:
Range:
Section: —
Fill added above original grade:
Grovel length:
45
—
—
0'-0.5' Ft.
Ft.
Gmvel width:
Number of line.:
Dietance between Iinee:
WELL: INNew [IUpgrade
5
ft 1
— Ft.
Classification (Private, A. C):
Total Depth:
Caved To:
201
Total absorption area:
450
Pipe material:
ASTMD-3034/F810
PRIVATE
201 �,
pL
so. Ft.
Driller.
ALPINE DRILLING
Date Drilled:
6/1/00
Static Water level:
58
Installer.
SAUNDERS & SAUNDERS
Dale installed:
5/4/00
Ft.
Yield:
Pump Set Al:
Casing Height Above Ground:
TANK
100 GPM
U.K.Ft.
2 Ft.
SEPARATION
DISTANCES
■Septic ❑Holding ❑S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer.
ANCHORAGE TANK
Capacity In gallons:
1 000
From
Tank
Field
Station
Tank
sewer unee
100'+
100'+
—
—
25'+
Material:
STEEL
s:
Number of compartments:
2
Well
Surface
100'+
100'+
-
-
-
LIFT STATION
Water
Lot
5'+
10'+
—
—
—
Size In gallon:
Manufacturer.
P
Line
'Pump on' level at:
Pump off
High water alarm at,-
l:Foundation
Foundation
5'+
10'+
—
—
—
Curtain
Pump Make
aectrIcal Inspectlons performed by:
Drain
NONE
KNOWN
BENCH MARK
Remarks:
lscaaon and Description:
GARAGE SLAB
Assumed Elevation:
97.24
Ft
ENGINEER'S SEAL
90�O4
o OF �p
AWWC INC.
Inspections performed by: Dates: 1st s/4/oo*.:....
:...:....��
2nd 5/4/00
D
3rd 5/24/00
• e r A. rn ss:� "
Department of Health and Human Services approval
-7953 ; •: o0
O
4�44C
Reviewed and approved by: Date: "� �'��
Professlo�000
72-013 Rev. 9/91) MM 25;��Lff
PERMITNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SWO
SW000062 015-082-33
/—
100' WELL RADIUS — — -
-_-- I — — / eco
r
70' IfBl11Y PASMENf
bb
NEW1000
N
SEPTIC A K B 9NOVSE
/ NEW WELL
TOBBEN SPURKIAND, P.E. ` �i
TESTHOLE \ SCO J
_ d
ALTERNATE SITE ^ S(1 e A 3
V
NEW DRAINFIELD
A B
G
ST1
19.8
24.7
ST2
14.6
30.0
DBL1
12.4
35.5
DBL2
11.6
37.4
C01
14.0
45.3
MT1
37.5
58.9
CO2
59.4
73.7
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.-- =
6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK 99504 • PHONE (907)337-6179' FAX (907)338-324
PREPARED FOR: PHONE NUMBER:
MIKE THOMAS (907)694-2202
LEGAL DESCRIPTION:
MARYLAND SUBDIVISION; LOT4A
TYPE OF WORK:
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
7/19/200
4WN BY:
C.J.G.
1LE:
1" = 40'
;E NUMBER:
2OF3
r —
Ze**luFeV1A. sS:
PERMFrNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SWO
SW000062 015-082-33
f07 OP TANK -
Af IN.Ef - 92.64
0061%
-96.72-
NVEI?f OF P"_
AT IN.Ef - 92.06
511
6m - 97,5+/ -
5f2
NM 1000 6&0m
5�PTIC TANK
�f0P 0PTMK
Af 0Ln f - 92b4
\wff OP PLN6
Af 01111.if - 91.92
mNLH - 87,12 (AV6.)
DATE: oo6pppp
6/23/00 o OF A� 40
j
—
DRAWN BY:
r7m! a _QpP �............ 5040
ALASKA WATER & WASTEWATER C.J.G.
SCALE:
CONSULTANTS, INC. - T Q O
-- Q
6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, AK 99604 • PHONE (907)537-6179 • FAX (907)3583246
N.T.S. ....... ... ............
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MIKE THOMAS (907) 694-2202 3 OF 3 ' J fre A. GO ness.
LEGAL DESCRIPTION: ppm—7953OQ
MARYLAND SUBDIVISION; LOT 4A, p f `o
WORK:TYPE OF o�
PROFILE AS- BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �04o4pp000Qoo
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: MARYLAND SUBDIVISION; LOT 4A,
PERFORMED FOR: MIKE THOMAS
DATE PERFORMED: 5/4/00
DEPTH
(feet) ORGANICS TEST HOLE #1
����
1 '
2 SOIL CLASSIFICATIONS �-
5
6
7
8
9
10
11
12
ML WITH
READING
GW
=
ORG
FINE SAND
GP
ML
GM
CL
GC
OL
_ St
��\O �OEeNo
�OBEN
UL
SW
MH
SP
CH
msc
SM
OH
GW/SW
COMMENTS:
DEPTH TO DATE
GROUNDWATER
DRY 1 5/4/00
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
_ St
��\O �OEeNo
�OBEN
V�SVPV��
PEEF 5 ���5 NOSE
P E 5
PERCOLATION RATE
TEST RUN BETWEEN
(MIN./INCH) PERC. HOLE DIA. 6 (INCHES) I
FT. AND FT.
PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
Jun -23-00 01:38P THE THOMAS CO. INC. 694-5202 P.02
Mumcipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 198850 Anchorage, Alaska 99519-6650
Rick MystrOm http:/A v w.ci.anchorage.ak.us
Mayor
Permit Number: #SW 000062 Date of Issue: 4-14-00 Panel Identification Numbcr..01&0B2-33
Date Started: 5-2k-00 Date Completed: 6-1-00 Is well located at approved permit location'? ® Yes ❑ No
Legal Descriptio Maryland Lot 4A
Property Owner Name & Address: Mike Thomas
PO Box 770110
Eegle,pivK Ak99677
Borehole Data:
Depth (ft)
Method of Drilling ® air rotary ❑ cable tool
Soil Type,'I'hicknu%s & Water Strata
From
To
Casing type: steel
stick-up
0
2
Wall Thickness: .025 inches
gravelly silt w/cobbles
2
15
Diameter: 6 inches Depth: 201 feet
silty cobbly gravel
silty sandy gravel
gravelly silt
silty sandy gravel sand &water
15
29
58
82
29
58
82
89
Liner Type:
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 58 tect
Pumping level: 201 feet alter
silt -wet
89
104
2 hoursu in r 100+
P n?p b ^ 6Ptn
silty gravel
104
135
Recovery Rate: 100+ gpm
gravelly silt
135
182
Method of Testing: airlift
Well intake Opening Type:
silty sandy water 182 195
water sand & gravel
195
201
® Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
❑ Perlbrations Start feet Stopped feet
Crout Type: Bentonite # 8 Volume- I br
Depth: Start 0 feet Stopped ± feet
RECEIVED
Pump: Intake Depth ._ feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
JUL 19 2000
Mum(,,,ai iJ .., 1—norage
Dept. Health & Human Services
Method of Disinfection: Clorine Tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
P O Box 110496
Anchorage AK 99511
Attention: The well driller shaTt provide a well log to the property owner within 30 days of completion and the property
noonv,,A inn in drn 1'1 n nr Hvotth R. LLmion C.•.nirae r.�iti.:., Arl nave nf..nninlntin.,
JUN -21-00 02:24 PM KENNETH G LANG 9075224625 P.01
COO
\ �o
JQ�pPt, w a:20.00• \9N
1 4.
1318'
i
Mo
ap
Lot 3—A 11 m 1 ti Lot S—A
M
I to
toI
I � I sEvnc a.eu+oure
I I �
A9EMENTSE
I 5' z 20' ANCHOR
EASEMENTS
I 1
20, TET.ECOM. 6 ELECT. EASEMENT
,I 9 OOr04'40% 157.04' — —
1 Lot 28
rV0APM -WI \Mw 4 � 1pjmc�
PLOT PLAN _ ASBUILT X- SCALE 1� ' 50' GRID 2439 Project No. 00-33
Lang a Aasoctatese Ince 11500 Daryl Avenue, Anchorage, Alaska 99515
907 522-6476 Phone
Registered Land Surveyors 9073 522-4625 Fax
1 hereby certify that I have surrwwyysd the following described Properly:
Lot 4—A, MARYLAND SUMOIVISION
Anchorage Rwordtnp District, Alaska, and that the Improvements eltuaMd
Meson am within the property Ilnes and do not encroach onto the Proppeerty
adjacent thereto. that no Improvements on the Properly lying adjacent thereto
encroach on Me surveyed pnmlese and that Men are no roadways, transmission
IIm, or other visible "cements on Bald property except as Indicated heron.
Dated this the —:1! Day of TuNv 2oou. at Anchorage. Alaska
It Is the responsibility of the owner to determine the existence of any
weements, covenants, or resMallom which do not appear an the recorded
subdivision plot.
) NSFeIC I ON -
MUNICIPALITY OFANCHORAGE
���,J,�
Department of Health and Human Services
On -Site Services Program
625 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW000062
Date Issued: Apr 14, 2000
Expiration Date: Apr 14, 2001
Parcel ID: 015-082-33
Legal Description: MARYLAND LT 4-A
Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 006601 JOLLIPAN CT
Owner Name: Mike Thomas Lot Size: 53606 SQ. FT.
Owner Address: PO Box 770110 Total Bedrooms: 3 Permit Bedrooms: 3
Eagle River , AK 99577 -
This permit is for the construction of:
❑✓ Disposal Field Z Septic Tank ❑Holding Tank ❑Privy ❑✓ Private Well ❑Water Storage
All construction must be in accordance with:
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: l/– bV—zc0C1
Issued By: �/i'�� / �(/ Date: Ll –/ Z/– 0 D
ALASKA WATER �& WASTEWATER
+, ^ :�,:__—, . .",- CONSULTANTS, INC. as....
April 7, 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 4A, Maryland Subdivision
To whom it may concern:
The proposed 3 bedroom house will be served by a private well and septic system. A test hole
was excavated on the property in the are of the proposed septic system. The proposed septic
system will be designed around the 30 foot radius of this test hole . We are proposing that a 1000
gallon septic tank and a five foot wide drainfield be installed. Comments regarding the proposed
design are summarized as follows:
1. SOILS: Attached is a log done by Tobben Spurkland, P.E., which shows the soil
classifications, groundwater monitoring, and the percolation test results. The soils at the top of
the test hole is a loam/silt and a ML material mixture to a depth of 4 feet. At 4 feet the soils
transitions to a gravely sand material to a depth of 15 feet (bottom of test hole). No groundwater
was encountered during the excavation of the test hole. A percolation test was performed
between the depth of 6 feet to 6.5 feet which had a percolation rate of <1 minute/inch. It is
assumed that the insitu sandy soils will act as a sand filter, an application rate of 1.0
gallons/day/ft2 will be used.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.0 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 450 ft2
f Total Depth: 8.5 feet (max.)
g. Effective Depth: 4 feet
h. Width: 5 feet
i. Reduction Factor: 0.5
i. Minimum Length: 45 feet long
j Effective absorption area = 450 ft2
6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average
topography of this property is a 7 to 14 percent running from approximately southeast to
northwest; 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
aeeietanrr
, M.S.
NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soil log, and
a 7 page construction specification letter which are all part of the design package for this septic
system.
6901 Debair Road, Suite 2B— Anchorage, AK 99504— Ph: (907)337-6179— Fax: (907)338-3246
I —F—
I
I LOT 10 %
I I NEfTLETON ACRES #2
LOT 16, BLOCK 2 I / \
ROCKHILL SUBDIASIONI I /
I I / LOT 11 LOT 12
// NETTLErON ACRES #2 NETTLEfON ACRES #2
I
Lr----------------------- -------------------I
i— — — — — — — — — — — — -- — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ---
I I
I I
I cs-EPTIC AREA
LOT 17, BLOCK 2 I I LOT 3A \\
ROCKHILL SUBDIVISION MARYLAND S/D \\ LOT 2
t MARYLAND S/D
I I I `-VACAND
-_� I I
-�
'----------- --- I-
1 1 ra___-_- TESf� OLE
N67 I I I ALTERNATE
m0 I I it SITE
JOk01?
I I L
(PROPOSED SEPTIC SYSTEM PROPOSED
N o= (SEE DESIGN, PAGE 2 OF 2) 3 BEDROOM \ /
o"roy ( I j HOUSE
S I I MARYLANDAS/D
I / I 7
AREALOT
\\\ // MARYLAND S/D
i I � � y �
/
I i LOT 6A
)I MARYLAND S/D \
I I
DATE:>2i�tc
4/7/2000
EKmiDRAWN BY: `�J S,�
ALASKA WXrL4 R & WASTENVATER J. L. Qlr"
V
74ij,
CONSULTANTS, INC.,-- w°^ SCALE: „ _ G•*,: t .
6901 DEBARR ROAD. SUITE 28 • ANCHORAGE, AK 99504 • PHONE (907)337-6179 • FAX (907)338.1246 1— 100
vn
PREPARED FOR PHONE NUMBER: PAGE NUMBER: A
MIKE THOMAS (907) 694-2202 1 OF 2 q f re A. ness:'
LEGAL DESCRIPTION: �iI P C -79$3 c�:^
MARYLAND SUBDIVISION; LOT 4A
TYPE OF WORK:ied/'rofessio���-
SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM ' �., >
4/7/2000
0� �F
q
�.,........
I
BRAWN BY:
I
J.L.M.
I
100' WELL RADIUS
,
I
WASTEWATER
:•
SCALE:
w _ CONSULTANTS, INC. 3«,,.,:• "x
6901 DEBARR ROAD SUITE 2B • ANCHORAGE, AX 99504 • PHONE (907)337-6179 • FAX (907)338-3246
a, —
—
�40'
......... ....
P
.........
REPAIRED FOR: PHONE NUMBER:
PAGE NUMBER:
MIKE THOMAS
(907) 694-2202
10' UnLnY EASMENr
fr y . Garness;'
Q 9j '•, C 7953 ;' m
4p��a '•.,, c���o
�4ed /'�o fessiono\�oo
�4pp0000�
.GAL DESCRIPTION:
MARYLAND SUBDIVISION; LOT 4A
'PE OF WORK:
AND SEPTIC SYSTEM
DESIGN OF PROPOSED WELL
LOCATION
PROPOSED DRAINFIELD. EXCAVATE
A TRENCH THAT IS 8.5 FEET
DEEP (MAXIMUM) BY 5 FEET WIDE
/
\0
BY 45 FEET LONG. ADD 4 FEET OF
/
CLEAN, WASHED SEWER DRAINROCK.
INSTALL TRENCH PARALLEL
/
TO ALL SLOPE CONTOURS.,,;`.';t=,;
TEST HOLE DONE BY
I
GO
TOBBEN SPURKLAND, P.E.
at y �h
VMT
2-1
PROPOSED
WELL
ALTERNATE SITE --"'
ITE /
3 _Np\ ,00
J
co
C 0
n \
O
\
INSTALL DOUBLE
CLEANOUTS
PROPOSED 1000 GALLON
SEPTIC TANK
/
/
\ f
4/7/2000
0� �F
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Is,%
BRAWN BY:
__,.. w..
J.L.M.
p
a
,
ALASKA WATER &
WASTEWATER
:•
SCALE:
w _ CONSULTANTS, INC. 3«,,.,:• "x
6901 DEBARR ROAD SUITE 2B • ANCHORAGE, AX 99504 • PHONE (907)337-6179 • FAX (907)338-3246
a, —
—
�40'
......... ....
P
.........
REPAIRED FOR: PHONE NUMBER:
PAGE NUMBER:
MIKE THOMAS
(907) 694-2202
2 OF 2••J
fr y . Garness;'
Q 9j '•, C 7953 ;' m
4p��a '•.,, c���o
�4ed /'�o fessiono\�oo
�4pp0000�
.GAL DESCRIPTION:
MARYLAND SUBDIVISION; LOT 4A
'PE OF WORK:
AND SEPTIC SYSTEM
DESIGN OF PROPOSED WELL
LOCATION
LOT 10
NETREFON ACRES #2
LOT 18, BLOCK 2
ROCKHILL SUBDMSION
LOT
11
L 12
NETTLETON
ACRES #2
NETTLEfON CRES #2
[SEPTIC AR
LOT 17, BLOCK 2
0 3A
M D S/D
ROCKHILL SUBDMSION
LOT 2
YIA�S/D
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YLANDA D
r
CSEPnC
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AR
MAR D S/
LOT 6A
MARYLAND S/D
DATE:
4/ /2000
DRAW BY:
K.D.W.
s
l n — 10
6901 DEBARR ROAD, UI 2B • ANCHORA
, AK 99504 • PHONE ( 337-6179 • FAX (907 8-3246
PREPARED FOR
ONE NUMBER:
P GE NUMB
XXXXXX XXX
(907) XX —XXXX
V OF 1
SCR TION:
Y ND SUBDI 104;
LTYPEOF�AORK:
LOT 4
OGRAPHICAL DRAWING
Mav-31-00 02:19P THE THOMAS CO- INC_
�. Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825"U' Street, Anchorage, Alaska 99502-0850
SOILS LOG PERCOLATION TEST
694-5202 P.01
(ENGINEER'S SEAL) �•
PERFORMED FOR: ` 1 (...n`� �C7An_� tL �`-s DATE PERFORMED: ••b 111 (Q O „r
LEGAL DESCRIPTION:- 7 I• AN -0 L6 -rNA Township, Hangs,. Section: _
D H I SLOPE SITE PLAN
1 1 TI
LOA.",
2
3
IP YES, AT WHAT
oF,P fN1
Dian Is WTlor Ali
NoNt"Ifinl DTIG
■gym OEM
MINN MEMO'
■E lummom
■u■■ um.
SOTTLO0-1
16
01= HGI.L
17
18 1
19
UU
COMMENTS
P'RCOLATION MATE ImirmAes/meh) PFRC HOLE DIAMETER
I1
Tt S'. RVVN BETWEEN —. �..,,..-FT AND u FT
PERFORMED BY: r • 5 I �. ±> CERTIFY THAT THIS TEST WAE'PERFORMEO IN
ACCORDANCE YRTH ALL STAT E ANO MUNICIPAL GUI DEI. INNS IN EFFECT ON THIS DATE) DATE:
72-OOR (ROY. 486)
00-1 Gni�
Municipality of Anchorage O
i` Development Services Department .-44 '�`
Building Safety Division C
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. 015-082-33 HAA# _ 111r, rc
1. GENERAL INFORMATION Expiration Date: _ 3� i z a?
Complete legal description MARYLAND S/D; LOT 4A:
Location (site address or directions) 6601 JOLLIPAN COURT
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
STEVE & DEBORAH MARINEAU Day phone 240-4230
6601 JOLLIPAN CT. ANCHORAGE AK. 99516
Day phone
GINA DUNDAS w%JACK WHITE Day phone 230-9699
3201 "C" ST. SUITE 200, ANCHORAGE, AK. 99503
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
■
Individual On-site
E
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 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 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 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 fries 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 28 ' ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date t I lei 101
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, 000b�40 �4
conscientious engineering analysis of the system in accordance with ADEC and MOA o OF
DSD Guidelines & Regulations. The reported results described the performance of the Ov•i
system under the conditions encountered at the time of the test, and separation !V-1
distances measured to readily identifiable features. The operational life of all wells and 491 y*
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 OO t, e r A. am s,. f
there are no hidden defects or encroachments. AKWWC, inc. can therefore not provide Q 9 E —795
any warranty or future estimate of how long the system will continue to meet the Q04/e c��opG
operational requirements of the ADEC or MOA DSD. The content of this report is for 0 ed o� �o
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.
�O000 0
5. DSD SIGNATURE
/ Approved for bedrooms.
Disapproved. Yf 0F,4
Conditional approval for bedrooms, with the fllowing stipulations\���V�4P' . • • ' • Cyp
j`�� • ON-SITE •:'�
WA,t' mAND • m=
WASTEWATER
HROGRAM
•A .
IJCO
V/ "RvtVTSEV�q
Attachments:
HAA Checklist Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: 1i Original Certificate Date: 1Z/1Z1rZ__
(Rev, 17,1) .
i
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.d.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: MARYLAND S/D; LOT 4A; Parcel ID: 015-082-33
A. WELL DATA
Well type PRIVATE If A, B. or C provide PWSID# NIA Well Log (YM) YES
Date completed 6/1/00 Sanitary seal (Y/N) YES Wires properly protected (YM) YES
Total depth 201 ft. Cased to 201 ft. Casing height (above ground) 19'+ in.
FROM WELL LOG AT INSPECTION
Date of test 6/1/00 11/21/02
Static water level 58 ft, 46 R
Well production 100+ G.P.M. 3.4 g.p,m.
WATER SAMPLE RESULTS:
Collform colonies/10 mi. Nitrate • a mg./L. Other bacteria . colonies/100 mi.
.Op2
Arsenic: mg./L. Date of sample: 11 /25/02 Collected by: AKWWC, INC.
B. SEPTICIHOLDING TANK DATA
Tank Type/Matedal SEPTIC/STEEL Date Installed 5/4/00
Tank size 1000 gal. Number of Compartments 6 Cleanouts (Y/N) YES
Foundation deanout (YM) YES Depression over tank (Y/N) NO High water alarm (YM) N/A
Date of pumping 11/26/02 Pumper CHUGACH SEWER & DRAIN INC.
C. ABSORPTION FIELD DATA '" DRAINFIELD ABSORBED WATER FROM C/O AS FAST AS ADDED
Date installed 5/4100 Soil rating 002Pr ft'/bdrm) 1=0 System type DEEP TRENCH
Length 45 ft. Width 5 ft. Gravel below pipe 4.17 ft,
Total depth 9.6-10.5 ft. Eff. absorption area 450 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 11/21/02 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY in. Water added 567 gal. New depth 0 In.
Elapsed Time: '" min. Final fluid depth DRY 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/Aces (YIN)
"Pump on" level at in. "Pump off" IwvQI of in. High water alarm level at in.
Datum ICycles 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 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON 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 25'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
Date I -'q'q A L
HAA Fee $ 375 " --
Date of Payment 117-/16/0z
Receipt Number tib I 1 1A
(Rev. I V01)
Waiver Fee $
Date of Payment
Receipt Number
JUN -21-00 02:24 PM KENNETH G LANG
%kvo
9073224623 P.01
CFVR'( 4000
"",\%
/ L•xs.es' ��A
4,y
CT
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522-6476
Registered Land Surveyors (9073 522-4625 Foxne
a, l
w
d
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�; 4g1y
edjoasnt there%, that nes Improvements on the property Iying adjacent thereto
enarooch on the surveyed wW ow then an rw roadways, tronemfedon
I
er?TC n[,woun
i
Doled this $9 -:�— Day of 7-1JN4 .7&9,0 of Anahorage, Alaska
IN
w
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5�korosf
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ICDRAINAGE
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EASEMENTS ANCHOR
MENTS
14
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— — — —
ELECT. EASEMEl11
20' TELECOM. a —
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Lot S-A
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PLOT PLAN _ ASBUILT -1 SCALE I- - So' GRID 2439
Project No.
Long & Associatese Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515
522-6476
Registered Land Surveyors (9073 522-4625 Foxne
pF
I Woby oMly thof I have wrveyed the following described p:oporfr.
Let 4-A. MARYLAND summsl6N
Anchorage Roeording 0~. Alaska, athat the tthe htednprovemonte saua
tlwrson en wAMn the property Anes and do net enaroach onto the pmpwty
�P
�; 4g1y
edjoasnt there%, that nes Improvements on the property Iying adjacent thereto
enarooch on the surveyed wW ow then an rw roadways, tronemfedon
prwnteee
Angie or other vl@Wo ememonft on eald property except as tndloaled hereon.
•, '..KENNETH
Doled this $9 -:�— Day of 7-1JN4 .7&9,0 of Anahorage, Alaska
LS--!
A Is the mspensRdllty of the owner to defermMe fM existence of any
easements, covenanle, or reehtoNone which do not appear on the recorded
®ra,Fse
subdivision plat.
00-33
12-09-02 10:50 FROWCUE ENVIRONIOTAL SRV
CUE Environmental Services Inc.
CT&E Ref.N
1028042001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/N
Maryland L4A
Client Sample ID
Maryland L4A
Matrix
Drinking Water
PWSID 0
Sample Remarks:
9075615301 T-050 P.02/03 F-748
All Dates/ Imes are Alaska Standard Time
Printed Date rime 12/09/2002 9:11
Collected Date/Time 1125/2002 16:00
Received Date/Time 11/2};(2002 10:30
Technical Dkfelor) SteMeM C. Ede
Releasi"�
Allowable Prep
Analysis
Parameter
Resoles
PQL Units Method
Limits Date
Date Init
Metals Department
Arsenic
0.00200 U
0.00200 mg/L EPA 200.9
(<=0.05) 11/27/02
12/05/02 IMP
Waters Departm Miz
Nilrate-N
0.200 U
0.200 mg/L EPA 300.0
(<=10)
11/26/02 JS
Microbiology Laboratory
Total Coliform
0
col/100mL SM189222B
(r --I)
11/26/02 KAP
�A6
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907)343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel I.D. # 015-082-33 HAA # fMC011Q&14
1. GENERAL INFORMATION
Location (site address or directions) 6601 JOLUPAN COURT ANCHORAGE AK
Property owner MIKE THQMA5 Day phone( 694-22Q2
Mailing address P.O. BOX 770110 EAGLE RIVER AK 99577
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XXX
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $850.00 at,
or prior to, closing for the engineering services provided.
5. 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 of this Health Authority Approval application 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 insp4tion, the on-site water supply and/or wastewater
disposal system is in compliance with all Municipv nd State codes, ordinances, and regulations in effect
on the date of this inspection. "
Name of Firm
Phone _(907) 337-6179
Address 6901 DEBARR ROAD B ANCHORAGE, ALASKA 99504
Engineer's Signature Date
In conducting this evaluation, Awwic I C. tte pted to provide a thorough, conscientious engineering analysis of the
system in accordance with ADE C and O D t 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, ground water levels that may fluctuate during the year, and the water oo�opp
usage of the family being served by the system. These conditions are outside the control of o 0 F AC 4
the evaluator of the system. Satisfactory test results do not guarantee future performance �........ Sp4
of the system, nor do they guarantee that there are no hidden defects or encroachments. app
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the p ;
system will continue to meet the operational requirements of the ADEC or MOA DHHS. , , , ; ; - •
The content of this report is for the sole benefit of the owner listed above. Any A ,
reliance upon or use of this report by any other person or party is not authorized, Q....v . ....... . ........
nor will it confer any legal right whatsoever. 7n fr A. r- ss;'
6. DHHS SIGNATURE
_IG Approved for 3 bedrooms
Disapproved
Conditional approval for
Additional Comments
0
—7953
' ............ �cq
Pr o f e s sionooc
bedrooms, with the following stipulations:
Date 7- �21- O 0 _
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending institutions in order to satisfy certain 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. 1/91) Back MOA #21 Computer Version
Municipality of Anchorage IK K E I V E I)
DEPARTMENT OF HEALTH & HUMAN SERVI S
Environmental Services Division 19 2000
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
MUNICIPALITY OF ANCHORAG
A§
"'MENTAL SERVICES DIVr"
Health Authority Approval Checklist
Legal Description: MARYLAND SUBDIVISION; LOT 4A, Parcel I.D.: 015-082-33
A. WELL DATA
Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A
Log present (YIN) YES Date completed 6/1/00
Total depth 201' Cased to 201' Casing height (above ground) 24"
Sanitary seal (Y/N) YES ' Wires properly protected (Y/N) YES
FROM WELL LOG
AT INSPECTION
Date of test 6/1/00
Static water level \58' —�
Well production +LLLg•p•m• g.p.m.
WATER SAMPLE RESULTS: /
Coliform Nitrate ° S rn�/ L Other bacteria
Date of sample: 7-/1- OO Collected by: A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
Date installed 5/4/00 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N)
Date of Pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date installed 5/4/00 Soil ratin p.d./ r ft2/bdrm) 1.0 System type TRENCH
Length 45' Width
Gravel thickness below pipe 4.17' Total depth 9.5'-10.3'
Effective absorption area 450 SQ. FT. Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
Pass/Fail For 3 Bedrooms
Date of adequacy test NEW Results ( )
Fluid depth in absorption field before test (in.); Immediately after — gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate =
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96r Computer Version
If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
"Pump on"
*Datum
Size in gallons
"Pump off' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septictholding tank on lot 100'+ On adjacent lots
100'+
Absorption field on lot 100'+ On adjacent lots
100'+
Public sewer main N/A Public sewer manhole/cleanout N/A _
Sewer/septic service line 25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ _
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Surface water
Curtain drain
F. ENGINEER'S
1 certify that I
of Municip n
with MOA A,
Signature—
Engineer's
Date
Building foundation 10'+ Water main/service line 10'+
Driveway, parking/vehicle storage area 10'+
Wells on adjacent lots 100't
fie inspections and review
s tems are in conformance
on Ithis date.
GARNESS
HAA Fee $ � (D ' C) �
Date of Payment
Receipt Number O G S55i / (70b
b
72-026 (Rev. 3/98)* Computer Verslon
Waiver Fee $
Date of Payment
Receipt Number
re A. G ess;•
—7953
•,.
Pro f e s slonoo�
07-17-00 08:49 FROM -CTE ENVIRONMENTAL
CUF Environmental Services Inc.
CT&E Ref.#
1003728001
Client Name
AK Water & WasTewater Consultants Inc.
Project Names#
Maryland S/D Lot 4A
Client Sample 11)
Maryland S/D Lot 4A
Matrix
Drinking Water
Ordered By
PWS1D
0
Sample Remarks
5615301 T-445 P.02/03 F-897
Client PO#
Printed Date/Time 07/1412000 16:12
CollectedDate/Time 07/11/2000 11:45
Received Date/Time 07/11/2000 14:10
Technical Director Stephen CEdde�i
Released By *0 r
AL towapte Prep Analysis
Paramerer Resutrs Pot. units Method Limits Dare Dare Init
NaSBrs nenartment
Nitrate -N
0.500 u
0.500 MSIL
EPA 300.0
Mro$. biofoor LAboratory
Total Coliform
0
col/100ML
SM18 92228
10 maA 07/11/00 SCL
07/11/00 KAP