HomeMy WebLinkAboutFARLEY LT 118 ALot 118 ,
#051 - 151-33
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
~NEW
[] UPGRADE
MAILING ADDRESS
LEGAL
DISTANCE TO:
Manufacturer
Manufacturer
DISTANCE TO:
No. of lines
Top of tile to finish grade
Inside length
Dwelling
IF HOMEMADE:
Well
Le n gt h ~ach/e~o
DISTANCE TO: W~,~
Class Depth
Foundation
I Dwelling ~-- I~
Building foundation
DISTANCE TO:
OTHER
PIPE MATERIALS
NO. OF BEDROOM~,~
Material
Nearest lot line
Trench w dth
No. of compart'me~.
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Total length of lines Distance between lines
inches
Material beneath tile Total effective absorption area
inches
Crib depd._ Total effective absorpt~z.~
B u ildig~ f,.~ nd~t~ Nearest Ioybe ~ /
~ ~ PERMIT NO.
Driller ~ Distance to lot line
Sewer line Septic tank Absorption area(s)
SOIL TEST RATIN(~~
I NSTALJ~I
LEGAL
06/19/02 WED 14:313 FAI 2738445 PRUDENTIAL VISTA R.E. {~1002
o.s/~,~/oz...ToK.xa: zT,~. ~. ,. ~., .~,~r~..~..~ ..... ~w~-~,~.~-. -~ ~,~
· ' ' ,. ~ ,'.:.,.,~. ~;'.,.. ,.......:. , ...~., .~ ,... ~ '~':L~,a~.F.~-~" · "~. ~ '~'" . j , ,~z.. ,..~., ~ · ... · ·
~'~ M;W' ~, ~' ~ ·
Well
Well pumping
of d~wdoim Irma stage
(minute)
Depth in f.t trom
· 41 ~0 03
51 ~ 59
105 ~ 122
Bedrock - Gr~,~on~
'. 3:
i ~11 t1.....~ IP,,li Z C:: ]:: Ir-.. F::~ lt.._..T.. -f" '%-' #.'L-, F= FIt J"..& C. F"~ ,J F..: IF:.~ ~'.~ E:'L'_
DEF'FIf~:THEI'.,ITOF:: HE"FILTH FIND IEI'.,I',,,'IF.'Cd'.]HEN"I"FII._ F'ROTECTIOi'.,I
8;..T."..5 '" L. '" STREE~7t", FINCHOI:~:FIGE., FIK
264-4}"'26) : FII'.,ICHOF.:RGE 6:~,::I--2:L".~::'£ : ' EFIGL. E R .I: ',,,' E R:
F'EF::H I T I",10.
FIF'PL.. ]:. CFIi'.,H": THOHF~S; I.,.I GLEIqN PHONE:
F~I:)[:,RES;S: ::;R .T. BOX
CI...IU(:~ I F:II<., FIK
LEGI:~L DESCF.'. I F']' ]: ON - ?,LIE,'[) I ',,,' I '.51 ('d'.d: -
L. OT :;51 ZE E:.~ 5;Q. FT. 'TOI4NSH I F': :1..5N
I'IFI;:.:;IHUH NLIMBER OF E:EE:,t:;.tOOMS = 3 :SOIL F.:FITING =
LI::STE:E:, BELOkl FIRE THE OF'T:i:.OI'-~:S Fi'v'FIIL. f:tBLE TO 'T'OU IN [;,E'..F, IGi",IIi'.,IG 'T'"'._R' ""z, EF]'I..' ' 'P
S'¢'.STEM. "' H '-" '" 'BE THE OF'T'II3N THRT E:ELT',T FITS 'T'OUR
I.,.IIB, TH = ;2:..5 FT.
LENGTH = 42:. E.1FT.
TO]"FIL DEPTH = .5. C~ FT.
I.]iRFIVEL I}EPTH = iL E~ F']'.
G F.:R'v'EI... 'v'OLI.JME .... ::1. T'::.
TFINK :S I ,.:.":E: .... :;L.,
I.,.I I [:,TH = :1.4.
I....E:i'.,tGTH =
TOTFtL DEF'TH =
di'F.'.A',,,'IEI.... [:,E:F'TH =
C:iRFI',/E].. VOLLli'iE = ::L4.
TFIi'.,IK ~.'; I. ;:"::': E ..... ::1...,
li..-JI :.ii .r..;:,, E..': El::, .F...:: tF-':~ ..T.: ti"-& F'
I,.I ]: E:,TH = 5.
LENGTH .... .J.~7;.
TOTFIL DEPTH = .5.
GRFt'v'Et... DEPTH = J...
GF..'R'v'EL ',,,'OL. IJh'IE = :1.2.
! NQTE ! -REQUIRES INL=,ULRTION
! Ni])TE ! ..- MFt'T' REQUIRE LIFT STFITION
i]:1..i. 'T' [:C:.!;.
GFILLONS (TNO COHF'FIRTHENT '1'FINK;.',
TANK S']IZE = ::1..., C~Cq[i!L E~ GRLLON:.S ,::TI.,.II:'i CCIMF:'FtF. tTMENT TANK)
Z ..E,FT[F~ THFIT:
:1.. I Rl'"l FRHILIFIR I.,.IITH THE RE6!UIF.:EHENTS F:OR CH-::SITE :5ENEF.:S FINE:, WELLS FIS 2;ET
FORTFI 1:.3'¢ THE I"ILINI(]IPI=IL. I T'T' C)F .FINC:HORFIGE RI"4[:, THE STR"rE OF RLFtS;KFI.
"" ........ ',,,'E[:,
2.I 14II....L.. INSTFtLL THE :E;'T";:];'T'E:M IN FI('.':CC)F.:E:,FIi'.,ICE I.,.IITH ]'HE CO[:,E2] RN[:, Hf:I',,,'E RE..EI
F~ ~TF"¢ OF TFIE: CO[:,E SI...IMHFIR'¢ FIN[:, E:,IFiGF.:FIH FIT"f'FI(.]FIHENTL:'; I.,.tHZCH IL:'; PFtF.:T OF THIS
F'EF4:H I T.
~: I IJNE:,EI'7:!~;TFIND THRT THE ON-SITE :SEP.IER .=, r..., rEII f,'IFW F.:EQLIIRE ENL. FIRGEMENT IF THE
RE:'S):E:,ENL'::E Z:rS, REHO[:,EI_E£:, TO ]:NCI_U[:,E MORE THFff'4 2: E:EE:,ROr'd"I"S;.
F..E:.F,..Ill]' IIFFLI .Iff4] H1:.%:i THE F4.'[::,F I',Iz, IE, IL]:T~ TO II'.,IFORM FEF._-,_I'.,INEL DURING
THE INSTFILLFITIL")N ):I',I.:,FE_.TZ_I'L=, OF Fli'.,I'¢ WELLS FIE:,JFICENT TO THTS FF._FEF. Tr FINE:,
THE I'.11 HEER OF'" RESZE:,EN]ES, THFIT THE P.IELL. I.,.IZLL SER',,,'E.
IF:' I::1 I....IFT :E;TFITIOI'-,I :1:':; INSTFILL. E:[:,., FIN ELE:CTRICFIL F'ERMIT FIND II'-,!SF'EC:TZON MLIST
BE OE;TRiI'-4EI:). Ft:S-E:UIL. TS; CFINNOT BE RF'F'F.'O',,,'EE, I.,JITHOI_rT F:IN EL.ECTRICFIL INSF:'EC]'ION
F.:EF'(]F.:T. ]'HE EI....ECTF.:ICFIL I.,.IORK I"IIJ:ST E:E [:,ONE B'¢ FI LICENSEE:, ELECTRICIFII'.L
S':I,]NED: ~..._.~..~ ...............................
FIPF'L. ICRN]: THOHFI:.S kl ,:.'.q_~'4 .~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: .~-~-~
LEGAL DESCRIPTION:
3
4
6
7
8
9
GW
5~c ~
SLOPE SITE PLAN
f-
10
11
12
13
14
15
16
17
18
19
20
~/AS GROUND WATER
o
YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE /~//~ (minutes/inch)
COMMENTS
PERFORMED
72-008 (6/79)
TEST RUN. BETWEEN FT AND -- FT
/
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
v^',~v.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-151-33
1. GENERAL INFORMATION
Expiration Date:
Complete legal description FARLEY SUBDIVISION; LOT 118A
Location (site address or directions) 21313 JAYHAWK DRIVE * CHUGIAK, AK 99567
Current Property owner(s) THOMAS &: REBECCA GLENN Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone
MICHALLE CULVER w/ PRUDENTIAL VISTA Day phone
4241 B STREET ANCH. AK.
727-8480
Unlessothe~erequested, HAAwillbeheldbyDSD ~rp~k~.
2. NUMBER OFBEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
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 pdvate 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.
Note:Alaska WaterandWastewaterConsultants, Inc. shall bepaid$ 1,4~'OT;'~at, crpdorI
to closing for the engineering sen~'ces provided.
I
4. STATEMENT 0FINSPECTION BY ENGINEER
As cerb*fied by my seal affixed hereto and as of the validation date shown below, I vedfy 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, funcfional 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.
Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. CARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the ~ime of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the contrel of the e valuator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
· any warranty or future estimate of how long the system will conb'nue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorfzed, nor wilt it confer any legal fight whatsoever.
5. DSD SIGNATURE
~ Approved for --~ bedrooms.
Disapproved.
Conditional approval for __
bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
7-
Municipality of Anchorage
Development Services Department
Building ,~ety Division
On-Site Water & Wastewater Program
4700 6oulh Oragaw St.
P.O. Box 196650 Anchorage, AK g9519-6650
www.cLanchorage.ak.us
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Legal Description:
A. WELL DATA
Well typ~ PRIVATE If A, B, or C provide PWSID/t N/A
Date completed 11/12/1983 Sanitary seal (Y/N) YES
Totaldedth 122 It. Casedto ltl It.
FROM WELL LOG
43 It.
<1 g.p,m.
HEALTH AUTHORITY APPROVAL CHECKLIST
FARLEY SUBOMSIONi LOT 118A Parcel ID:
051-151-33
well Log (Y/N)
VVIms pmperiy protected (Y/N)
Casing height (above ground)
AT INSPECTION
6/21/2oo2
49 It.
1.0 g.p.m.
Coliform 0 colonies/100 mi.
Amenic: N/A mgJL.
B. SEPTIC/NOLDING TANK DATA
Tank Type/Material ~ I'LLL
Tanksize 1250 gal. Number of Compertmente 2
Foundation cleanout (Y/N) Y~S Depression over tank (Y/N) NO
Date of pumping 6/21/2002 Pumper
¢. ABSORPTION FIELD DATA
Nitrate 3.1g mgJL. Otberbecte~
Data of ~ample: 6/25/2002 Collected by:
YES
YES
12+ in.
0 colonies/100 mi.
AIG~C, INC.
Date Installed 11/5/lg83
Cleanouts (Y/N) YES
High water alarm (Y/N) N//A
JR'S PUMPING
Date installed ~ Soil rating (g.p.dJit~o~ 85 System type BED
Length 28 fl. Width 14+ .It. Gravel below pipe 0.5
Total depth _ s It. Eft. absorption area 592 fl' Monitoring tube YES Depmsston over field__
Dateofedequacytast 6/21/2002, Results(Pass/Fail) PASS
Fluld depth in at)sorpflon fleld before test 0 in. Wateredded2000gal.
Elapsed 'nme: 0 min. Final fluid depb~ 0 in.
Any rejuvenation Ireatment (past 12 mo,) (Y/N &
New dept~
Absorption rote >- 450+
NONE KNOWN If yes, give date
NO
For 5 bedrooms
0 in.
,g.p.d.
O. LIFT STATION
Date installed Size in gains
'Pump on' level at in. 'Pump ofl" n. High water alarm level et in.
~ Cycles tested. Meets alarm & circuit requirements?
E, SEPARATION OISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
SePtic tenldlift station on lot100'+
Absorption field on lot 100'+
Public sewer matn N/A
Sewer/septic eervice line 25'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' Proper'b/line 5'+
Water main Nt/A Water sewice line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Property line 10'+
Water sen, ice line 10'+
Curtain drain NONE KNOWN
F. COMMEN1~
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspec#ons end
review of Municipal tecorde that the above systems are in
confon'nence with MOA HAA guidelines in effect on this date.
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deenout N,/A
Holding tank N/A
Absorption field 5'+
Surface water 100'+
Water main N/A
.Driveway, paddng/vehicle storage. 10'+
Engineer's Prlntefl Name
Date
Waiver Fee $
Date of Payment
Receipt Number
,l~tK CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name~
Client Sample ID
Ordered By
PWSID
Se~ple Rcm~l~:
1023769001
AK Water & Wastewat~r Consultants Inc.
Farley S/D; Lot 11SA
Farley S/D; Lot I IgA
Drinking Water
All Dates/Times are Alaska Standard Time
I'rtnted Date/Time 06/27/2002 10:32
C~41e~ted Date/rime 06/25/2002 8:22
Received Date/Time 06/25/2002 13:40
Te~bnlcnl Director Stephen.~s~Ede
Relensed fly ~~
Results PQL Units
· Allowable P~p Analysis
Method Limits D~ie Date Init
Waters Department
Ni~mte-N
3.19 0.200 mg/L EPA 300.0 (<!0) 06/25/02 JDT
Microbiolo~y Labor a t ot~J'
Toul Colil'orm
~I00mLSMIS9222B
(<1)
06/19/02
05/2S/02
~'£D 14:34 FAX 2738445
13:19 FA~ 273844~
PRUDENTIAL VISTA R.E.
PgUUt~t'iAl~ V i ~t'I'A
~003
48.§' a
N 8ge~l'~ I"E
N I9*~O'2?'W I~0.00' (R)
dAYI-IAWK DRIVE