HomeMy WebLinkAboutT15N R1W SEC 8 LT 214TISN RIW
.8
Lot
#051 - 154- 39
Municipality of Anchorage
Development Services Department .+~:~-~
Building Safety Division
On-Site Water & Wastewater Program, 4700 Bragaw St.
P.Oo Box 196650 Anchorage, AK 99519-6650 ~ ~
www.ci.anchorage.ak, us (907) 343-7904 Page 1 of
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: aSP1 01 252 PID Number: 051 - 1 5-459
Name:
MARTIN SCHWAN Wastewater System: [] New [] Upgrade
Address:
19651 SCENIC DRIVE *CHUGIAK, AK 99567 ABSORPTION FIELD
No. of Bedrooms:
Ph°ne:tg07), ' 688--4020 4 E] Deep Trench [] Shallow Trench [] Bed []Mound
LEGAL DESCRIPTION Sol, Rating: Total Depth from~e:
GPO/Sq. Ft. Ft.
Block: Lot: Subdivision: Depth to pipe bottom from orlglnol grade: Grovel d~'eneath pipe:
- 214 - Ft.~ rt.
Township: 1 5N Range: 1W Section: 8 Fill added above original grode:~ Grovel length:
./~-i Grovel width: Number of lines: between lines:
WELL: [] New [] Upgrade Ft. Ft.
Classification (Prlvote. A,B,C): Total Dep..~J3:~'"~ Cased TO:(BEOROCK)I Tatol ob~n ore~ Pipe materlol:
~ Ft.
rilllr:. Dote Drilled: Stotlc Water Level: Installer: Dote installed: /
Ft. RPC 10/.30 2010
Pump Set At: Casing Height Above Ground:
Ft. Ft. TANK
SEPARATION DISTANCES · Septic [] Holding D S.T.E.P. [] Other*
T~o Septic Absorption Lift Holding Public/Prlvot¢ Manufacturer: Capacity in gallons:
Tank Field Station Tank Sewer Lines ANCHORAGE TANK 1250
wel~ 100'+ - - - 25'+ STEEL 2
Su,oce Water ~00'+ .... LIFT STATION
Lot Line 5'+ _ _ _ _ Size in gallons: I Monufacture~
I
Foundation 5'+ .... "Pump on" level at: "Purer alarm at:
Curtain Drain ' NONE KNOWN . Pump Mo~col Inspections performed by:
1 I
Rem°ri<s: OLD TANK WAS DECOMMISSIONED PER UPC. BENCH MARK
Location and Description:
GARAGE DOOR SLAB
As .... d Elevation: 100,00 Ft.
ENGINEER'S SEAL
Inspections performed by: OEO, Ltd. Dates: 1st 10/30/201o
2nd - ~:=.,' ',-.,- o~
Development Services Department Approval ~.-.~"4~ o
Conditional approval: Dote: ~//////~
'(/^_ ". J/eflf/rEv ~Ao Go mess.:
Reviewed and approved by: i'/~¢/~'~ ~ //~,~ Dote',~, - ~'/I -
AS BUILT DRAWING
OSPl O1252 - 051-15-439
RlW, SEC 8, LOT 187 /
T15N,
:4.
ST1 27.6 7.0
ST2 35.5 14.5
DBL1 37,4 1 6.7 ~o
DBL2 39.8 i 16.7
FCO 2.5 23.0 DBL
T15N,
EXISTING ~ ~ J
RlW,
SEC DRAINFIELD %
8,
SCALE:
i I
1
CONS ULTANTS & GEN E~L CONT~CTORS ~ ...... ........ ; .......... ~... ~ ./l~ ~, .'t
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ~
LEGAL
DESCRIPTION: D~WN BY'
AS-BUILT DRAWING 11/5/2010
A B
ST1 27.6 7.0
ST2 35.3 14.5
DBL1 37,4 1 6.7
DBL2 39.8 1 6.7
FCO 2.5 23.0
(Rev. 01105)
~~: AS BUILT DRAWING ~*~'~
OSP101252 - 051 -15-439
INSULATION
FINAL GRADE = 100.35
ST1 ST2
TOP OF TANK ~ = =~ TOP OF TANK
AT INLET = 97.66~ ~ ~ /AT OUTLET = 97.64
~///, '/////////////////,
NEW 1250 GAL
INVERT OF BUNG SEPTIC TANK~INVERT OF BUNG
AT INLET = 97,05 ~ ~ AT OUTLET = 96,85
GXRN~S ~NGIN'EE~I'NG G~O'UP, Ltd
LEGAL DESCRIPTION: ' D~WN BY: ~vO~.
T15N, RIW, SEC 8, LOT 214 ~
PROFILE DRAWING 11/5/2010
(Rev. 01105)
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System
OSP101252
05115439000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: October 26, 2010 to October 26, 2011
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: T15N R1W SEC 8
Site Legal Address: T15N R1W SEC 8 LT 214 G:1257
Owner/Address: SCHWAN MARTIN K & NICOLE R
19651 SCENIC DRIVE CHUGIAK AK 995670000
Site Mailing Address: 19651 SCENIC DR, Chugiak
Permit
Lot Size in Sq Ft: 108900
Total Bedrooms: 4
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. Ail 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERHIT APPLICATION
FOR A SINGLE FAHILY DWELLING
Property owner(s) MARTIN & NICOLE SCHWAN
Day phone 688-4020
Mailing address 19651 SCENIC DRIVE *CHUGIAK, AK
Site address
Zip Code 99567
Legal description (Sub'd, Block & Lot ) T15N, R1W, SEC 8, LOT 214
Legal description (Township, Section & Range)
Lot Size i 0,% Sq. Ft.
N/A
Number of Bedrooms
4
THIS
APPLICATION IS FOR ( [~all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
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.
GARNESS ENGINEERING GROUP, Ltd.
Permit/Rush Fees:-- if:'.~.
Date of Payment:
Receipt Number:
(R~v. ~ ~/o5)
Waiver Fees:
Date of Payment:
Receipt Number:
GARNESS ENGINEERING GROUE Ltd.
CONSULTANTS & GENERAL CONTRACTORS
October 22, 2010
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Septic Tank Upgrade for T15N, R1W, Sec 8, Lot 214;
To whom it may concern:
The existing 4 bedroom house is served by a private well and septic systemu The existing septic tank was
inspected by the property owner and found to be badly corroded; there fore they would like to replace it.
We are proposing to remove the existing tank and replace it with a new 1250 gallon septic tank.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems°
If you have any questions, please contact us at 33 7-6179. Thank you for your assistance°
Jeffrey ~.~eXs's,._~.E.., M.S.
mreside~7 ~
NOTE: Attached is a site plan drawing and a design drawing, which are all part of the design package for this
septic system. (Contact G.E.G. Ltd for 7page construction specification letter.)
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
I TEN }A Avenue .......
' ~
L_d I
r~ T15N, RlW, SEC 8, LOT 187
T15N, RlW, SEC 8, LOT 188
T15N, RlW, SEC 8, LOT 21~
SCALE:
I 1" = 10o' I~ ~~
MARTIN a NICOLE SCHWANI 688-4020 I 1 OF 1 ~h.a" X, .... }~,.....' ...... ~
LEGAL DESCRIPTION: O~WN BY: ~ ~ ~ ~E-7955, ~ ~ /
S~TE P~. ~0/a2/20~0 ~~~
~ T15N, RlW, SEC 8, LOT 187 -
INSTALL A F.C.O IF'm ~
ONE,SNOT / /l~
PRESENT. ~ // / /
PROPOSED 1250 GALLON SEPT,C TANK. ED O0 / /
/
~ / ~ "--EXISTING 1250 GALLON
'-[ \ SEPTIC TANK TO BE
~ REMOVED, DISPOSED, &
T15N,
\ ~REPLACED WITH A NEW 1250 /
R1W,
SEC8, / ~GALLON SEPTIC TANK.
LOT u EXISTING ~ LLI
213 DRAINFIELD ~ ~ Z
NOTE: THE CONTRACTOR
SHALL HAVE ALL WELL RADII
FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO
CONSTRUCTION.
GEG, Ltd. HAS A 7 PAGE SPECIFICATION
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
CONTACT GEGo BY PROCEEDING FORWARD
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER, CONTRACTOR AND
PROPER'Pr OWNER AGREE THAT THEY SCALE:
HAVE READ THESE SPECIFICATIONS AND I I
AGREE TO ACCEPT THE TERMS AND 1" ~ 50'
CONDITIONS OUTLINED.
T15N, RlW, SEC 17, N2
PREPARED FOR:
MARTIN & NICOL ,.,_/~j
LEGAL DESCRIPTION:
T15N, RlW, SEC
TYPE OF WORK: DATE: '~.~'
SEPTIC TANK UPGRADE 10/22/2010
(Rev. 01/05)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL D ESC R'~6TIO N
LOCATION
[] UPGRADE
NO. OF BEDIMS
Manufacturer DISTANCE TO: I W;I~)¢~ ~'~ I Abs ° r P~:r~a r e~/'~.~ I ~.well'.l n.g~ IF HOMEMADE: Inside length I Width
Well
DISTANCE TO:
No, of c~ooZ~__~t? ~7~
Liquid depth
PERMIT NO.
No. of lines
Material Liquid capacity in gallons
Nearest lot line PERMIT NO.
Total length of lines Trench width Distance between lines
Total effective abs~l?~are~
Nearest lot line ~/- ~ ~
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
:rib diameter
Crib depth
Driller
Building foundation Sewer line
DISTANCE TO:
OTHER
PIPE MATERIALS
DATE LEGAL
F'ERMIT NO.
DEPRRTMEN]" OF HEFILTH RND ENVIRONMENTFIL F'ROTECTtON
825 "L." STREET., Ffl'.,ICHORRGE., FIK. S.~95F.~1
264-4720
l..-I IEE L_
,:: 83:0884 )
FF,[ ] ..HNF
LOC:FI'f'I ON
LEGFIL
~..~".E:ER.T L, MORHRN
LOT 2'.l.4 .,.~ ....,=, T:I. SN R:LN
F. 0.
LOT .=, I
-:,,.,-x ... 4i
,-- · : :,,: - -, , - c, ,,: ...... --. TFEN~.H
TVF'E OF :,u1L ~E,..A. RF'fIuN _,T_TEtl I_,. ' - -'
I"IF:INIMUt'I NL.IME:ER OF E, EDFL _t1.., :'-' 3:
'~ -' ,'SQ ' '"""'"'-
SOIL EHTIN.3 F'f, E,R .... '13:0
THE REQUIRED SIZE OF THE SOIL RBSORF'TION S¥S'TEM IS:
[::. E: F" -[" I-! == :};"" IL- ES t%11 ~'~Ji 1~ ~"q== :~!~/,. C.-ii E". R ".,,-" EE: L- E.:'~ E P T' ~"4='= 5";
]'HE LENGTN DIhlE:NSION IS THE LENGTH ,::IN FEET) OF THE 'FRENCH OF,' DRFt:[I',IFIEL. D.
]'HE: DEPTH OF F:l ]"RENCH OR PIT IS THE DISTFINCE BETWEEN 'THE SURFRCE 01::' THE
GROUND FIND TNE E:OTTOH OF TPIE E;:.:',C~VFITION (IN FEET).
THEFdF: IS NO SET I.,.IIDTH FOR TREIqCHES.
THE GRFIVEL. DEPTH IS THE HININIJN DEPTH OF GRRVEL BETHEEN THE OUTFFILL PIPE
FIND THE BOTTOM OF THE E:XCR',/I=ITION ,.'.'IN FEE:T).
I::'EFRMIT Fff:'F'LIC:FINT HFIS THE RESPONSIBILITY TO INFOI;.:M 'THIS [:,EPRRTMENT DURING THE
INSTFIL. LRTION INSPECTIONS OF RNh" I,.IELLS RDJFICENT TO THIS PROPERTY RND THE
NIJMBER OF RESIDENCES THRT THE WELL WILL SERVE.
......... "T i....I C, < 2 ::,, 3E ~"-.~ "-=.:. F=" E C:; T' I C~ ~"-,t :--~.'. R R E F~: E ~:." U ']E t:.", E: [:: ...........
BFiCKFILL. ING OF FI!",I'¢ S'¢STEH WITHOUT FINRL INSF'EC:TION FIN[:, FiPPR. OVRL BY THIS
DEPFiRTMENT HILL BE SUBJEC;T TO F'ROSECUTION.
MINtMLIM D.ISI"RNCE BETI.,.IEEN R NELL. RBID RNY 'ON-SITE SEI.,.IRGE DISI='OSRL SYSTEM IS
t00 FEET FOR FI F'RIVWrE HELL OR :L50 "FO 200 FEET FROM R PUSL. IC WELL DEPENDING
UF'CIN TNE T'¢F'E OF F'UE:LIC: NELL.
MINIMLIM DISTRNCE FROM R PRI',,,'FFI"E HELL TO F'I PR. IVWf'E SENER LINE IS 25 FEET FIHD
TO R COMMUNIT'¢ SEWER LINE IS 75 FEET.
HELL LOGS FiRE REQUIRED FIND, MI.JST BE RETURNED TO THE DEPRRTMENT HITHIN 3:0 DR~r'S
OF TNE NELL COHPLETION.
OTHER REOUIREHENTS MRV RPPL'¢. SPECIFICFITIONS RND CONSTRUCTION DIRGRRMS FIR. E
FIVAILRBLE TO INSURE PROPER INSTRLLATION.
I CERT I F"," THFI"r
±: I FIH FRI"IlL. IFIR NITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS RS SET
FORTH BY THE: MUNICIF'RLITV OF FINCHORFIOE.
2: t WIL. L tNSTFILL THE S~¢STEI"I IN F-ICCORDRNCE WITH THE CODES.
3.: I UNDERSTRN[:, THWF THE ON-SITE SEWER S'¢STEM I'qFt'T' REQUIRE ENLRRGEMENT IF 'filE
RESIDENCE tS REHODELED TO INCLUDE MORE THFIN ~: BEDROOMS.
._, I t3i',lE..D: ..............
F:IF'F'L. I.,I.~',FF E,ZIE~ERT L. I"IOFd'"IFIN
I S.SIJED B RTE
V4. 0
..... E:,[E F'FII:? T H E N T OF
F'ERHJ:T NO " ::2 ~:: ::d.
tr:'F L-[ CRNT
EEiRL
· I.._ I 'T %-" E, F' FI 1'-4 C':: I--t ~.-' '-'~: Fi ,~ E
.~EFILTH FIND EN',/IRONHENTIaL. P, TECTION
S]"R. EE"t'., Ri'.iCHC~RRGE., Rl-c.
264-,4720
L:~I"-.i--"~---; I TE SEL.IEI~: F'ERI'"I I 1'
E ~., E E.~-, I L i. IO[.::HRN
LOT '", .... T:L...N RZ[d
~.:1. ~. :EEC '-'" ·
'h'FE OF E3IL HE=uk. F fI.I,I .=T_TEi'~ I-,:
IFt;:",tI'iUH Ni..II'IE~ER OF E;EE:d~:OOHS ~ ¢
bL,, 62;:2--R
LOT ..':, I ',¢.E
~,,..-., ,~,., t.:1,
._a.,9.9'Zg'/*'9 SQURRE FEET
T~';;:E N,::H //,....%"~0//~¢t4
.... L IL RRTING ':":: .q FT/BR.~-
"FIE F'E.3 IDE[:. 'gZ;'cE' OF TPE SOIL RE:SnRF'TION S'¢STEH ~S:
....... ¢o,
THE LENGTH [)[I',IENS[ON ZS THE LENGTH ,::~N FEET::, OF THE TRENCH OR
THE [:,EPTH OF R 'TRENC~I OR F'IT I21 THE DISTRNCE BETklEEN THE SURFFIC:E OF' THE
GROUND FIND THE BOI'TOH OF THE EXCRVRTION <IN FEET:).
THERE IS NO STET HZDTH FOR TRENCHES,
'filE GRRVEL DEPTH IS THE HINIhlUH DEPTH OF 6RRVEL BETWEEN THE OUTFRLL PIPE
RN[:, THE BOTTOH OF THE E'XCRVRTION 4IN FEET).
~EF:HIT F1PPLtCRNT HRS THE RESPONSIE:ILIT'¢ TO INFORM THIS DEPRRTHENT DURING THE
:NSTRL.L~TION INSPECTIONS OF RN¥ WELLS RD.YRCENT TO THIS PROPERTY RND THE
~LIHE:ER OF RESIDENCES THITF THE WELL WILL SERVE.
T' I-,.t L--., *::. 2 ]:' ]: ["-,~ .':.'5, F' E C: "T
!:RCk:FILLING OF RN"r' S'~"SI"EW WII'HOUT FINRL INSF'ECTIOI",! RN[:, RF'F'F:O',,,'FIL. B't' THIS
;,EF'FIE:Tf,tEWT HILL BEE SI.lB.]ECl' TO F'ROSEC:LITIOI'4.
IINIf'IUH D.[STRNCE BE'T[,.[E':EN R [dELL RND RI'.;~-"~gN:'=:'[TE £-;EWFIGE E:,ZSPOSFIL :5'T':.E, TEH :(S
LOr."'~ FEET FOR R PRI'v'R'i'E WELL OF.' ::L50 TO 20'~0 FEET FROH R PUBLIC HELL DEF'END:[NG
.IF'ON THE 'f'¢PE OF F'LIBL. IC WELL
IINIf'IUH [:,IE;'T'RNCE FROH R F'RI'v'FITE HELL TO FI PRIVRTE SE[dER LINE IS 25 FEET RND
"0 R COHHLIt.iZ'T'¢ SEWER I...INE ZS 75 FEET.
IELL LOEi$ RRE ~:E[:.!Lll:RE£:, RHD P1UL=,T BE RETURNEr) TO THE [)EPFIRTHENT HITHIN 2:0 DR"r'S
)F THE NELL COI'!F'L. ETtON.
)THER REg!UIREHENT'.:':: i'*IFl"r' RF'F'L"r'. SPECZFICRTION'--'5
:¢'/FIILRBLE '1"0 ]:NSLIRE F;'ROPEEFd: :[NS;TlaLLFIT]:ON.
[ CERT] F'~" 'l'F.If:lT.
L.: I Ri'I FRHiLIRI;:' WiTH 'I'tiE REQUIREMENTS FOF.: OW-SITE SEWERS RND HELL.'::; FIS SET
:OF:TH E:'.? THE: HI. JN][C:IF:'RL~T"r' OF RHCHOF.:RGE.
~: i HILL 'INSTFILL. THE ':-.,¥STEH IN F:ICCORDRWCE HITH THE CODES.
!; I UNE:,EF.?TFIN[:, 't-Hi:Fr THE ON-,SITE SE[,.IER S'.¢STEH HR'¢ REQUIRE ENLRRGEHENT Il:: TFIE
· :EE:IDENCE IE; REHE~bE-LEL':, TO I i'.,ICLUDE r,'IORE THFIN 3: BEDId'.OOftS.
~,~.._SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
2
3
5
6
7
8
SLOPE
/'~ / D-~ ~ ~,1
SITE PLAN
10-
11
14
15
16
17
18
19-
20-
COMMENTS
PERFORMED B~:~;,:~:: 8RB IgBx
t- PH, 69~2970
72-008 (6/79)
WAS GROUND WATER
~_..L ~) ~.,"~ ~/~)~/~ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ ~. (minutes/inch)
TEST RUN BETWEEN . FT AND FT
/% /
APPLIC AT FILLS OUT UPPER HAL ONLY
Property Owner Phone
Realty Co. & Agenl Phone
Address Zip Code
Legal Description ~. "' ~ ~/ ) ]
~ Indlvldual ATTACH WELL LOG. A w~l Icg ts required for all wells drilled since ,June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Year Individual Installed: / '~ ~ ~
Time Time Time Time
Date Date Date Date
inspector Inspector Inspector Inspector
Field Notes:
(~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CO N DI~'IO NA~. A~P PROVA L *
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72.02313182)
ROBERTA. SHAFER
CIVIL ENGINEER
694.2979
ADEQUACY TEST
WATER AND SEWER iNSPECTION
WELL INSPECTIONS AND
FLOW TEST
SITE PLANS
ROAD DESrGN
SO~L ]'EST
ON SITE WASTE WATER
DISPOSAL SYSTEM DESIGN
EXCAVATION WORK
Hr. Mormon
P.O. Box 670376
Chugia~, Alaska
99567
January 25, 1984
Dear Mr. Mormon,
Reference: Lot 214: Section 8: T15N, R1W
A well and sewer inspection was performed on the systems located
on the referenced property as you requested. The horizontal
distances between the well casing and the septic system exceeds
100 feet. The well casing was examined and found to be equipped
with an adequate sanitary seal and conduit was extended from the
sanitary seal to the gronnd along the edge of the well casing.
However, part of the well wire was not in the conduit and ran
exposed between the well casing and the residence. It will be
necessary to have this well wire buried to a minimum of 24 inches
as soon as break up occurs in the spring. The ground around the
well casi ~g adequately sloped away from the well.
At the same time this inspection was performed, a water sample
was t~en from the house and submitted to Chemical and Geological
Laboratories of Alaska for coliform bacteria analysis. The results
of this test were satisfactory.
If we may be of further service to you,
contact us.
/
S re .,
~f~R S:bg
please do not hesitate to
cc: Municipality of Anchorage Department of Health and
Environmental Protection
SRB 196X EAGLE RIVER, ALASKA 99577
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. 0~'1- 15"9'-~' q
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Expiration Date:
Lot 214, ~ection 8, T15N, RlW, S.N.
19651 Scenic Drive Chu~iakr Alaska 99567
Cudent Property owner(s)
Mailing address
Lending agency
Robert & Valerte Morman Day phone
19651 Scenic Drive Chu~takr Alaska
Day phone
99567
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA wilt be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
Des Bailey/Keller williams Dayphone (907) 694-1234
11901 Business Blvdr Suite 105 Eagle Riverr AK 99577
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer I--I
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
btle (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 HeaIth 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 P~.n,~rd Engines"lng
Address PO Box 871347 wasillar Alaska
Engineer's Printed Name Paul E. Pinard. P.E.
DSD SIGNATURE
~ Approved for /-"/ bedrooms.
Disapproved.
Conditional approval for .__
Phone (907) 232-1347
99687
Date 1
E.
bedrooms, with the following stipulations:
Additional Comments
Attachments: HAA Checklist
Septic System Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
LegalDescription: ~ot 214, Sect,Ion 8, T15N, RlW, S.M. ParcellD:
A. WELL DATA
Well type Pvt
If A, B, or C provide PWSID # NA
Date completed Okn
(prior to 83)
Total depth 307+fi
Well Log (Y/N) N
Sanitary seal (Y/N) Y Wires properly protected (Y/N) ¥
Cased to 40+ ft. Casing height (above ground) 18+ in.
AT INSPECTION
10/13/09
FROM WELL LOG
Date of test
Static water level
Well production
ft. 9~ ft.
g.p.m. 3.1 g.p.m. (system)
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate I. 24 mg/L
Arsenic: ND ug/L date of sample: 10/8/09
Other bacteria 0 colonies/100 mL
Collected by: Pinard Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/MaJeri~,. Septic/Steel Date installed 1 0/83
Tank s~_~_9~.0._~ g~.;.' ;: .; Number of Compa~ments 2 Cleanouts (Y/N) Y
Fou~a~cl~t(Y/N) , Y .. Depress~onover~nk(Y/N) ~ High water alarm (WN)
Da[e~,e,e,,,~l,%~4/09 Pumper Sanitary Pumpers
Da~d~,t:;~oilrafing ~'.~/bdrm) 150 System~pe Seepage ~ed
Len th~4"n~O ~'~ Width 30 ~. Gravel below pipe
Total depth 3. ~t. Eft. absorpfion area 90~t~ Monitoring tube Y Depression over field N
Date of adequacy test 10/13/09 ResuRs(Pass/Fail) Pass For 4 bedrooms
Flu{d depth in absorption field before test 0 in. Water added 740 gal 0 in.
Elapsed Time: 240 min. Final ~uid depth 0 gp.d.
Any rejuvenation treatment (past 12 mo.) ~/N & ~pe)
New depth
in. Absorption rate >= 600+
None Known If yes, give date
D. LIFT STATION
Date installed
'Pump on" level at __ in.
Datum
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100 ' +
Absorption field on lot 100 ' +
Size in gallons
'Pump off" level at in.
Cycles tested
Manhole/Access (WN)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
in.
100'+
100'+
Public sewer main 100 ' +
Sewer/septic service line 25 ' +
Animal containment areas 1 O0 ' +
Public sewer manhole/cleanout 100 ' +
Holding tank NA
Manure/animalexcrete storage areas tiA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 ' + Property line 10 ' +
Water main 10 ' + Water service line 10 ' +
Wells on adjacent lots 100 ~ +
Property line
Water Service line
Curtain drain
F. COMMENTS
Absorption field
Surface water
10'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
1 o ' + Building foundation 10 ' +
10 ' + Surface water 100 ~ +
I~A Wells on adjacent lots 100 ' +
100'+
Date 'of Payment I [//~,?/~ ~ Date of Payment
Receipt Number /~2~" ~"'~.-~ Receipt Number
(Rev. 11/05) '
o. E. ,NEER S CER,,F,CAT,O.
confo~ance w,h MOA COSA guide/ines in effect on this date~~~~.....C
Engineers Printed Name Paul E. Ptna~d, P.E. ~~;~~
COSA Fee $ ~ Waiver Fee $ ' ~
Water main 50'+
DHveway. parking/vehicle storage 25" +
II- ,..c." oct
AS-BUILT
I hereby certify that I have surveyed the following described
property: _B._t-,~H~._~_~_'C=~. t q , .~c., ~
Anchorage Recording Precinct, Alaska. and that the improve-
ments situated thereon ere within the proI~rty lines and do
not overlap or encroach on the property lying adjacent there-
to. that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmi~ion lines or other visible easements on
said prol~,t~, except a~ indicated hereon.
Dated at Eagle River. Alaska
l,,hiq ~.5 ":'--~ nayo! M-~"~b~-~E:"~ 19~,~,
ROBE&T C. JOtIN$ON ~,' ,CC.;
$C, AT,I~< Registered Land ,%urveyor No. 880-LS
1~ ~ ~0' Box 456, Eagle River, Alaska
Phone (907) 604-2,543