HomeMy WebLinkAboutDENALY BLK 1 LT 8b
.n ly
lock I
Lot 8
067-041
-14
MuniCipalitY of Anchorage
Development'serVices Department
Building Safety Division ~'
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O, Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW010197 PID Number: 067-041-14
Name: Wastewater System: [] New [] Upgrade
Sudsbury & Sons. Inc.
Address:
11239 Aurora St., Eagle River, AK 99577 ABSORPTION FIELD
Phone: Number of Bedrooms:
696-1610 ' 4 [] DeepT..ch "Shal,owTra,c~ [],ed []
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION 1.2 G,D~F~ 6.96 Ft.
Block: Lot: Subdivision: Depth tn pipe bottom from odginal grade: Gravel depth beneath pipe:
I 8 Denaly 2.96 Ft. 4 FL
Township: Range: Section: Fill added above odginal grade: Gravel Length:
1.4+!- Ft. 52
Gravel width: Number of lines:IDistance between lines:
Well:
New
Upgrade
5 Ft.
Classification (Private, A. B. C): Total Depth: Cased tn: Total absorption area: Pipe Material:
Private 201 Ft. 200 FL 520 Fe D3034 & F810
Driller:. Date Drilled: Static Water Level: Installer.. Date Installed:
M-W Drilling, Inc. 612512001 50 FL Sudsbury & Sons 612712001
Yield: Pump Set at; I Casing Height Above Ground: TAN K
100+1- G,. unknown Ft.. 2
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
' ~.~_'~'~.~o Septic Absorption Lift Holding Pubtic/Private Manufacturer:. Capacity:
Tank Field Station Tank Sewer Line Anchorage Tank 1250 Ga,.
Material: Number of Compa~lments:
w.li 100'+ 100'+ NA NA 25', Steel 2
S.,facaWatar 100'+ 100'+ NA NA ~ $':'e: Manufacturer:LIFTSTATIO~J
Lot u.. 5'+ 10'+ NA NA Gal. I "'g" wa~r ~tam, at;
Fo~nda,on 5'+ 10'+ NA NA -~ump o..~,v..t; ~ ~"'1
ecu~nDrai. NA *50'+ NA NA ~ E,ec~ca,,.,pec~en,
Rame~,: BENCH MARK
*llone known
Location end Description:
insulation over tank and field Bottom of siding
Assumed Ir. levabon:
100
Engin~,~,~Starnp
Inspections performed by: KND Engineering Dates: 1't 612712001 _ ~__~;5~'r.
.2~, 612812001/ / ..
Development Services Departmen.t Appr'o'"v~l la/~/~t---~
~e~ie~ow) ed and approved / _/~/. /~)~ Date: //-7--O/ ~i?~,;'*,.....,...,.,~,~2~''~'
AS-BUILT SYSTEM DETAILS/SITE PLAN Permit S~/010197
DENALY S/D, LOT 8, BLOCK 1 PIDflO67-041-14
~~ ~ / 40,784
~~Z O. 94 A C R
~ FINAL GRA~E
~_D= 2G.B~
A-F= 58.4' R /~ SEPTIC ~ ' ~ ~
/
~-F=54.7' ~ / ITANK I~ SEWER ROCK
~~~ O~ ~ PREPARED FOR: SCALE: NTS
~ ~ EAGLE RIVER, AK. 99577
' S EIELD B~KS C~ ENGINEERING
s,~ ~t~[~ KMD 80441 PTARMIGAN BLVD.
~%~~ *~': SEW~O o,m ~/7/0~ EAGLE RIVER, AK 99577-87~6
' ~ ~ ~s,o~ ~ ~,: ,~ h..,~...?....,.......?.....?.?.~.~.:,~....:...........?,..~...?.~.~?.??:?:~m]
*~r~:01065.DWG ~"': 01065 (90T)696-OlII/FAX (90T)696-8111
/
Job No.:
Permit No.:
Project No.: ·
01-169
SW010197
~' NIA
Nt-W Drilling, ]:nc.
· P.O. Box 110378·Anchorage, AK 99511·
· 907-345-4000 · 907-345-:3287 Fax·
Groundwater IFeH As-Built & Lolz
· Well Owner:
· Legal Description:
Sudsbury and Sons
Lot g, Block I Denai¥ Subdivision
r:zo~le River, Alaska
· Use of Well:
Domestic
Construction
· Hole Depth: 20 I' · Casing Size:
· DrilIMethod: · Air Rotary
6" · Cased To: 200.02'
· Well Completion- Open end X Screen ~ Perforated · Screen/Perforation description: None
· Material:
Perf.
Method:
A 53 Steel
· Grout Notes: Well dry grouted with 12 sacks- No. 8 bentonite granules
· Well Development: Method: Air surge Notes:
· Static water level (SWL) 50.05' (above) ~ ..... 9 top of casing (TOC).
· Wellyleld test at ! 00+_ gallons per mlnute (GPM)/£al!ar~
wlth ! 00% of drawdown (DD) from static level ($WL).
· Method: Air
I hours
· Date of completion: 25 June 2001 · Pump Install:
Well Log
Depth in feet from
top of casing. Details of formations penetrated? size of material, color and hardness.
0 TO .2 Casing stickup
2 TO 6 Soil With cobbles: brown
6 TO 12 Gravel and sandy silt: gray
12 TO 14 Gravel and sandy silt: gray, damp
14 TO 57 Gravel: dry
57 TO 64 Silty sandy gravel: .,damp
64 TO 180 Clay: gray, stiff
180 TO 201 Sandy gravel
TO
TO
TO ~//"'~ ~
To a,
TC) ' ~"~
TO ~r~ified
TO ~ate ~To'a. 814 & 97:3
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 19, 2001
Expiration Date: Jun 19, 2002
Permit Number: SW010197
:,Legal Description: ,DenalY Subdivision Block 1 Lot 8 :'
Design. Engineer: 0070 KND Engineering
Owner Name: Sudsbury & Sons
Owner Address: 11239 Aurora St.
Eagle River, AK 99577-
Parcel ID: 067-041-14
Site Address: NHN Denaina Dr.
Lot Size: 41172 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
r~ Disposal Field r~ 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
~:5~:The following special provisions. ' ' ';
' ~-, !, PRIOR TO CONSTRUCTING THE WATER WELL, THE WELL' DRILLERSHALL SUBMIT ~ DRit~LIN'GiPLAN TO
i. THIS OFFICE. THIS PLAN SHALL SHOWHOW THE WELL CONSTRUCTION WILL PREVENT ALL LEAKING
i; 'THROUGH THE CASING ANNULUS FROM THE CONFINED AQUIFER..
Received By:
Issued By: Date: ~ ",/9 "' ~:Tj'
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P,O. Box 196650 Anchorage, AK 99519-6650
www.ci,anchorage.ak.us
(907) 343-7904
ON-SiTE SEWER/VVELL PERMIT APPLiCATiON
FOR A SINGLE FAMILY DWELLING
Parcel I.D. Ob7" ~"//~/N
Permit Number swOIO I ~ 7
Property owner(s) Sudsbury & Sons, Inc.
Mailing address (1) 11239 Aurora St.,.Eagle River, AK 99577
address (2) D
Legal description (Lot, Block & Sub'd.) Denaly S/D, B1, L8
Legal description (Section, Township & Range)
Lot Size 41,172 Acres/Sq. Ft.
Day phone 696.1610
__.Zip Code
Number of Bedrooms 4
THIS
THIS
APPLICATION IS FOR:
Sewer Only [] Well Only []
Sewer and Well [] Water Storage []
Sewer Upgrade []
PROPERTY CONTAINS:
Hot Tub [] Jacuzzi []
Swimming Pool [] Water Softening Unit []
Therapy Pool []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: 7 ~-'//~'~-''
Date of Payment:
Receipt Number: ~"~'~'
(Rev, 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
]~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
June 7, 2001
Munidpality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer & well permit - Denaly S/D, Block 1, Lot 8
Gentlemen:
The owner has requested we proceed forward to obtain a well and septic permit on the
subject lot. On May 31, 2001 we dug one testhole for the proposed system. The results
of this test are attached. The general slope of this lot is from northeast to southwest at a
grade of approximately 3 - 8%. An individual well will serve the lot. We propose to
install a 5' wide shallow trench for the proposed 4-bedroom house. Water was not
encountered during the excavation or monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
](~ID Engineering
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
ELL
& /ASTELFATER
DENALY
DISPOSAL SYSTEM
LOT 8, BLOCK 1
DETAILS/SITE
PLAN
7
40,425 SF
0.93
VACANT
VACANT
8
41.172 S~
o. g5 ACRES
4
40,224 SF
0.92 ACRES
22
40,189 SF
0.92 ACRES
VACANT
40,542 SF
0.93 ACRES
VACANT
BLOCK
9
40,784 SF
0.94 ACRES
NO PUBLIC VELL$ VITHIN 200'
PROPOSED SYSTEM.
NO PRIVATE VELLS VITHIN
PROPOSED SYSTEH EXCEPT AS I~TED.
NO SEPTIC SYSTEHS VITHIN
PROPOSED VELL EXCEPT AS NOTED.
DESIGN DETAILS
4 BDRM X 150 GPO = 600 GPO
600 GPO/12 GPO PER SQ. FT, (1,74 MIN/IN}= 500 SO. FT
(500/5'(V)) X .5(RF) (4.0' GRAVEL) = 50.0 FT. TRENCH
USE 2 TRENCHES - 50 (L) X 5' (W) X 4.O'(B)
Totot depth oF system is 7.0' ?rom origino! 9rode.
Toted depth oF grovet betow distribution pipe is 4.0' .
NDTES:
1. CONTRACTOR & ENGINEER TD VERIFY INTEGRITY DF SEPTIC TANK AND
REPLACE AS REQUIRED. INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES VITH 2" HD BURIAL FOAM.
3. CONTRACTOR VILL ENSURE MINIMUM 2X SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL VILL :BE ADDED OVER SYSTEM TB ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR ;/ILL ENSURE ALL SEPARATIONS TO ADJACENT
~/ELLS & SEPTICS.
PREPARED FOR:
SUDSBURY & SONS, INC.
11239 AURORA ST.
EAGLE RIVER, AK. 99577
(907) 696-1610
FIELD BOOKS
BO..~DAR~
STAK~
ASO~T: SEWARD
rILE::
~ ~c: 01065.DWG
COMPUTED:
DRAWN:
Sc(lie: 1°= 100'
PAGE 1 OF 8
ENGINEERING
c~£cxco: KMD
DAm 6/7//01
cram, SW363
aoe No,: 01065
20441
PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(9071696-6t''/FAX (907)696-8111
ED)
WASTEWATER
DENALY S/D, LOT 8, BLOCK 1
DISPOSAL SYSTEM DETAILS
PROPOSE D 4
BDRM SFD
O. 95 ACRES
PROPOSED 1850
GAL S.T.
CO TH
jFCO
~o M1
MT
VACA
PREPARED FOR:
SUDSBURY & SONS° INC.
11839 AURORA ST.
EAGLE RIVER, AK. 99577
(9D7) 696-1610
FIELD BOOKS
STAKING:
SEWARD
^c~ r~: 01065.DWG
CO~I~J 1'[0:
c~rcxto: KMD
6/7/01
SW363
~ ""'" 01065
Scare'- 1'= 80'
PAGE 8 DF 8
~[D ENGINEERING
20441 PTARMIGAN BLVD.
[EAGLE RIVER, AK 99577-8736
`.v~v~>~v~v~:~:~v:~v~<~:~:~<~?~<~v~???~:~?:~.~:~
9071696-611 I/FAX (9071696-8111
~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for:
Sudsbury & Sons, Inc.
Date Performed: 05/31/01
Proiect:
Denaly S/D, Block 1, Lot 8
TEST HOLE # 01-1
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-~
16-
17-
18-
Depth
Org - soft, brown, moist loam-
GP - firm density, gray sandy
gravel, moist, minute trace '
of silt, w/cobbles to 8" &
SM lenses up to 4"
B.O.H.
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO What depth? N/A
Depth to water after monitoring? DRY Date? 06/07/01
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 6/1/01 1:00 6" .
2 1:10 10 rain dry 6"
3 * 1:11 - 6- .
4 1:21 10 rain dry 6"
5 * 1:22 - 6"
6 1:32 10 rain 15/16" 5 14/16"
7 * 1:33 - 6"
8 1:43 10 min 3/16" 5 13/16"
9 * 1:44 - 6"
10 1:54 10 min 4/16" 5 12/16"
11 * 1:55 6" .
12 2:05 10 min 3/16" 5 13/16"
· Water Added
19-
20-
HOLE PRESOAKED
PRIOR TO TEST
Percolation Rate 1.74. (min/in) Perc Hole Diameter ,
Test Run Between ~ feet and. 4 feet
11
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
..cb
Municipality of Anchorage
Development Sen/lees 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. 067-041-14
GENERAL INFORMATION
Complete legal description ]',n t-.
Location (site address or directions)
HAA# (~ L/-O '1, cl 7
Expiration Date: - / - O
99577
Current Property owner(s) Deirdre Moore
Day phone 622-2520
Mailing address
Lending agency
same
Day phone
Mailing address
Real Estate Agent
Donna Alderman
Day phone 6Rq-6&6R
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY: '
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
· Individual Omsite :~
Individual Holding tank -I--I
Community On-site I'"l
· Public Sewer r-]
r
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 pdvate or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a pedod of up to one year with valid water samples.) ·
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the prOfessional engineer's work.
STATEMENT OF INSPECTION BY. ENGINEER~ ' r.
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. ! further vedfy 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 Finn S & S Engineering
Address 17034 N. Eagle River Loop Ste. 204~Eagle
Engineer's Printed Name Robert C. Cowan
bedroomsi'
DSD SIGNATURE
~ Approved for .L~..
'Disapproved.
Phone 694'2979
River, AK 99577
Date ,-%--///'7
-':.;
tI .*' ,.,~
~ : --BERT
%
Conditional aPl~roVal for' __ bedrooms, with the following stipulations':
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Fiow Advisory
Maintenance Agreements
SupPlemental Engineer's Report
Other
By:
(Rev. 01/02)
Original Certificate Date:.
i 01-o ¥
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: LO1"¢ i ~'~0(--~ 1 ! ~7~/~-! ~' ~'/~"~,
WELL DATA
Co
Well type ~ F If A, B, or C provide PWSID # '"'-
Date completed ~ ('~/O ( Sanitary seal (Y/N) .~
Total depth ~ ! ft. Cased to z~ '/'
ft.
FROM WELL
Date of test ~ / '~_...~"
!
Static water level ~-~7 ft.
Well production / O~ '~'
. ,-- g,p,m,
WATER SAMPLE RESULTS:
Coliform O colonies/100 mi.
Arsenic: O,l~,Z' mg./l.
SEPTIC/HOLDING TANK DATA
/
Tank Type/Materia / <J
Tank'size .~.,~)gal. Number of Compartments
Foundatiori cleanout (y/N) y Depression over tank (Y/N)
·~.~/~ /_L' ~j'~ j./
Date of pumping ~f'[~,[O-~ Pumper
Length ~/
' ft. Width
Total depth ~ ~ ft~ E~. a~sorption area
--
Date of adequa~ test
Fluid depth in absorption field before test ~ in.
Elapsed Time:~0 min. Finalfiuid depth 0 in.
Any rejuvenation treatment (past 12 mo.) (YIN & ~e)
Nitrate l~/z~-~'~mg ,/],
Well Log (Y/N) '~'/'
Wires properly protected (Y/N) ~/'"
Casing height (above ground)
AT INSPECTION
~"~t2 Monitoring tube ~
Results (Pass/Fail) ~
Water added~,? gal.
g.p.m.
Other bacteria
Collected by:
//~ ' colonies/100 mi.
Date installed ~,
Cleanouts (Y/N)
High water alarm
System type ~' H. '7--K~-Lc-/''J
Gravel below pipe ~-~ ft.
Depression over field /'J
For +.., bedrooms
New depth I ,,in.
Absorption rate >= ~ OO g.p.d.
If yes, give date
.! D.. LIFT STATION . ! i
:*i'i.:il~' : ~ j
,, ~i~)i Date installed Size in gallons ~I -, Manhole/AccesS (Y/N)
· . ," "Pump on", level at "Pump o~ level at'.' !,~ in.j High water alarm level at
: Datum " Cycles tested! i i Meets alarm & circuit requirements?
E. SEPARATION DISTANCES '
SEPARATION DISTANCES FROM WELL ON EOT. TO: J; J '
l..(~)i~ 1 ~ lOin adjacent lots / ~:)l~ ! d-
On adjacent lots :[ (~ O / //'-
/
/'~ /1-r'!.. ' ' PUblic'sewer manholelcleanout. ~¢J,
SeW~/septic service'line .· '~'~' ~ H~ldin~ tank .
SEPARATION DISTANCES FROM SEPTI'CI~ TANK ON LOT TO: /
'' "'' '! t1,.]...' . :, ~'
Buildingfodndation I I. i: L,/·..7- Pr°p?rtyline I~' ~i , . Absorption field
Watermain It.' . Wai~r Service line /I'/..Z. Y-- Surface water/,v.,.._...
Wells, on,a~Jjacent . i : "'
SEP~AP,~, ,TION DISTANCE FROM ABSORPTION FIELD ON LOT TO: : , . --
· ; I I' .- ~ ' ' I, I :: ? , J [
Property line/ ~., ~T' Building foundation', /l (~), ~ Water main
~'~ ~ ~l I ~ ,. ,,: ~ , ,~ ~.
Water Se~ice line ) ~ ~ Su~acewater ] ~,. ~: Drive.y. parking~ehicle storage. / J~ j
I ce~i~ ,hat lhave dete~ined through field inspection~ and ~' ~~~~
review o[ Mumc~pal records that the above ~ystems are ~n ~
conformance w~th MOA H~ guidelines m effect on th~s date? ~ [ 'm,~, . :. - ~: . -~': ~ ~' ~ , . -
EngineersPrintedN~m~ ~0~,~. C.~ 4 ~ ~2~t",..~ . ; ..... ~'~
,, H~hee ~. ' , , Waiver Fees
, ',~ ~ /o ~,.- ~ .,..-
~ Date of, Payment ~l .I ~ ~te'of Pa~ent .
Receipt Number O ~ ~ ~ ~:~' !1~ R ;eiptNumber
. (Rev. 1~01) ' '
, [ ~ '] ''
[~
05-13-04 08:12AM FROM-CT&E ESI, SGS ENV SERVICES 9075615301 T-322 P.02/03 F-944
SGS Ref.#
Client Name
Project Name/~
Client Sample ID
Matrix
1042280001
S & R Engineering
Lot 8, Block 1, Denalv S/D
Lot 8, Block 1, Denaly
Drinking Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 05112/2004 6:50
Collected Date/Time 05/05/2004 12:46
Received Date/Time 05/05/2004 15:12.
Technical Director ~, Step,In2. Ede
Allnwnblc Prep Analysis
Panunet= Results PQL Units Method Container ID Lirp{rs D~c Date Init
Metals Department
Arsenic 0.00200U . 0.00200 mg/L EP200.9 C (<---0.01) 05111/04 05111/04 KAV~
~aters Department
Nitratc-N 0.478 0.100 rog/L, EPA 300.0 B · (<=l 0)
05/06/04 JM[
Microbiology Laboratory
Total Coliform
0 col/lO0mL' SMI8 9222B A (<=1) 05/05/04 DK(
Time: 10:'35 AM To: T&mmy ~ 69~-1211
page: "002-002
v 1G O1 12:29p 'SUDSBURY~S&SOMS
90? GgS 1GI~
p.G
ASBUILT ~ $]F, CI..RD & ASSOC.TA
T-
HEREBY' CERTIFY .THAT ] HAVF ~..[AZE, S LAND .~,71t.~TH'G 694-0829
?IiJII,;AIEU. IT IS THE REsPONsIBIUTY OF THE
_O~._.l~ TO DE'rERMIN£ THE: iLrXI~IT..NC~ OF ANY
ISlON PLAT. UN ' I
· --,, ,,'~,A n~ BE USED H0CLD
Parcel I.D. 067.041-14
Municipality of Anchorage
Development iServices 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
Expiration Date:
GENERAL INFORMATION : ...-, .
Complete legal descdption? ' DENAL¥:L0T 8, BLOCK 1
Location (site address or directions)' NHN 0enaina Drive, Eaqle River, AK 99577
Current Property owner(s)
Mailing address
Lending agency
Sudsbury & Sons
11239 Aurora St., Eagle River, AK 99577
Day phone 696.16i0
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise 'requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
e
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class .~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] !ndividual On-site []
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development services Department (DSO) 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, Cedificates 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. 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 vedfy 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.
Phone. '696-61il
Se
Name of'Firm KND Engineering
' Address 20441 Ptarmiqan Blvd. Eagle River, AKi 99,577
Engineer's Printed Name Kenneth M. Duffus
L]L "bedrooms.
DSD SIGNATURE
~ Approved for
Disapproved.
Date. 11107101
Conditional apP'roVal for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
SuPPler~ental Engineer'sReport
Other
Original Certificate Date:.,
(Rev. 12/00)
DeveloPment Services Department
i ~ ~ i~ . Building Safety Division '.'
· , on-Site water & Wastewater prOgram
:: .,; : '4700 SOuth Bragaw St. :
P.O. Box 1196650 Anchorage, AK: 99519-6650
~' '~ :~ www'ci'anch°rage'ak'us ":
:; (907) 343'7904
..HEALTH AUTHORITY APPROVAL CHECKLIST
f~; :i' : parce iD: 067.041-14
;cription:
DATA' -
Legal D(~s( Denaly Lot 8, Block
A. WELL : , -' . :
...... l! ~_~
Well type privet
: 'I!: i':
Date completed 612512001_ · ..... ry ,_
_.. ~ji'_,L' :20i
/0tel Oe~pt!l: . ·
, ,' ,"! j,i
Date Of t,,est: ·.. . .6125101 ,. ,:.
static water level 50 ft.
Wires properly
Casing height
AT INSPECTION
IN) Y.
!ot~ted (YIN) Y ,
)ove ground) - 2'
Well production : ~ .100+1- g.p.m
wATER SAMPLE RESULTS: . · · , ~ ' :' '
Coliform Ji :0 :coloniesll00 mi. .Nitrate 0.63_ mg.ll. : l:i ~
Date of's~mple: ~013tI0~, . .Collected by: KND Engineerin.q "' ~
B. SEPTIC/HOLDING TANK DATA
, I~ I~ ~';.
Tank .'rYis~/Materlal Anchora.qe Tank I Steel' ~ 'I ~
Date installed' It ]~" i'.~6128101 yank size: 1250 _- gal. Number of CompadmentS2
Cleah'~t~' '~Founda!i0n cle.an°uty--~epressl0n over ..... tank~High water alerm;,. ~NA
Date ~! ~;~ing-''NA;''newtanldsYstem:['-Pumper ~' i;:'i'[~ ~ ':
C. ABSORPTION FIELD DATA. " :: . 'r.! !~t/~
' ~ ~ '~ ' ': ' ' - System type Shallow Trench
'il! ~, ~,. 612710t" Soil rating ig.p.d.Ift~ or'ft2/~drm) 1.2j
Date:installea . ~ ~ i~~ !
'~i .. ,~ : '.-, · , ~'.': , ~ ~!. ~[ ' :
· ;,[I, ,,, :-. :,, '%,~,,¥'," .' :ft : Gravelbelow, p~pe 4 ff. :;,
Leng~n oz :: ,~..~.~,u,,,., · , "
Total' ~lel~th~' 7 ft. 'Eft. absorption ~rea '~520-ft~ Monit°ring tube ~Y_..: .Depress~o.n o, ver field N
Date '~ adequacy test NA-news¥{tem: :. Results (paSs/Fail) Pass For I bedrooms
Fluid ~epth~ in absorption field be!oreltest 'in:: Water added '::gal',tlI!' .:' New' depth
Elap;~dt'Tilme: :rain. :.. Final:fluid depth ., in.'! ' Absorl:)tion~ rate >= .
1 ' ' ! lfYes, give ~late
treatment (pastil2 mo.) (YIN & type)
Any .mjdvenation
ill ,'
oth~el~!~blacteria 0 c01onies/100ml
in.
. g.p.d.
D. LIFT STATION
Date installed NA
"Pump on' level at in.
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot t00'+
Public sewer main 75'+
Sewer/septic Service line 25'+
Size in gallons ~ Manhole/Access (Y/N).
?ump off,, level at __ in.High water alarm level at
Cycles tested Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
'Holding tank - 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT,TO:
Building foundation 5'+ Propedyline. 5'+ '-,
Water main 10'+ Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water Service line
Curtain drain 50'+
COMMENTS
Building foundation -10'+
Surface water 100'+
Wells on adjacent lots 100'+
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 Kenneth M. Duffus
Absorption field 5'+
Surface water ~00'+
Water main 10'+
Date .1tl0710t
100'+
Driveway, parking/vehicle storage-25'+
in.
HAA Fee $300
Date of Payment
ReceiPt Number
(Rev. 12/00)
Waiver Fee $
Date Of Payment
Receipt Number
riOV-07-01 Og:46AU FROU-CT&E ENVIRONI~NTAL SRV
~d~t~. CT&E Environmental Services Inc.
9075615301 T-g35 P.02/03 F-563
1017626001
KND Engineering
Denal¥, Lot 8, Block 1
Denaly, Lot 8, Block 1
Drinking Water
CT&E Ref.# Client
Client Name Printed Date/Time I 1/05/2001
Project Name~ Collected Date/Time 10/31/2001 15:30
Client Sample ID Received Date/Time 10/31/2001 16:30
OrderedMatrix By' TeehnlcalD~,~j~S;p~hen~
PWSID 0 Rclcnse~[~~,,~ W/
Sample Remarks:
Allowable Prep
Parameter Results PQL Units Method Limits Dam Date Init
Waters Department
Nitmtc-N
0.631 0.500 mg/L EPA 300.0 (<:10) 10/'31/01
M£crobiolo~y Laboratory
Total Coliform
0 col/100mL SMI8 9222B (<1) 10/31/01