HomeMy WebLinkAboutVOYLES BLK 2 LT 6Voyl
Block 2
Lot 6
#051-064-68
Municipality of Anchorage Page. I of_~-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: .~.)c~LJO~;;L PID Number:
Name:~A~y A. H~/~ Wastewater System: ~.New ~ Upgrade
Address:¢~0~ A~(T/C ~V~, ~5 ABSORPTION FIELD
Phone: ~-~ ~No. of Bedrooms:~ B Deep Trench ~ Shallow Trench ~Bed BMound ~Other
LEGAL DESCRIPTION so, Rating: O . ~ GPD/Sq. Ft. Total Depth from5 '°rigi"81 grade:
Township: IRange: ISectl°n: Fill added above original grade: Gravel length: ~ ~~O/
Number of lines: Dfstance between lines:
WELL: ~ New ~ Upgrade Gravelwidth: ¢ Ft. ¢ /~ Ft.
Classification (Private. A.B.C): Total Depth: Cased To: Total absorption 8rea: Pipe material:
Date Drilled: StaticWater Level: Installer: Date installed: ~- ~
Yield: Casing Height Above Ground:
7.0GPM IPump Set at: O~ Ft,I J~"~ Ft. TANK
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
To Septic Absorpt{on Lift Holding Public/Private, Manufacturer: Capacity in gallons: /~
¢ Material: Number of Compartments:
Water /OO~ ¢O0'e ~ ~ ~ LIFT STATION
Lot r t ~ Size in gallons: Manufacturer:
Foundation
Curtain Pump ~ectrical Inspections performed by:
Remarks: BENCH MARK
.ocation and Description:
Assumed Elevation:
EN~ ....
Eagle RIver, Alaska 99577 2nd ~'~% ~ .o~Rzc. cow~
Department of Health~ Human~ices approval 'e,~, ........ .;,~
Reviewed and approved b~ Date:/ .~
72-013 (Rev 9/91) MOA 25
Permit No. $W940282 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
LOT 6, BLOCK 2, VOYLES S/D 05106468
Legal Description: PID No,:
~01
NEW
'i25'0'"G~L
qEW TRENCHES
,IEW 1250 GALLON
TAN
PROPOseD
4 BDRM
LOT 6
GR/,J}E
FINAL
206 MI'
86.4' 86,6
A 82.0' WATER FOUND
7-22-94
A B
FCO 19' 28'
ST1 10' ,34
ST2 12' 41
C01 16' 46'
..CD2 I..7.'... &TZ
C03 60' 69'
C04!55' 93'
C05 75' 86'
C06 69' 06'
MT1 48' 86'
..b!.Z~ .~.6.L. ....~i.
72-013 A (1/93)
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99561 · TELEPHONE 688,2759
ADDRESS ~m~ ~C~/Q~ l~ /]~ STAI'I(' LEVEL OF W,~TER FT.
LEGALDESCRI~ION Lt3,V ~, /;'c~ d d 0 ~C~ DRAW DOWN FT,
DATE.~Starte0 ~ : ' -Ended Y/e~..= ,:. :~h,',~,GALS. PERHR''
PERMIT NUMBER KIND OF cASING`
KIND OF FORMATION:
From~, FI, to ~/ , Ft. ~)d~,)deq~d From FI. to
FrOm Zt' Ft. to ~).~Ft. ~,~,~,/]I~.'V ' Fro,n~F,. to Ft.
From-~Ft. to ~fO Ft. ,~n'Od ~ ~n,J~ F,'om _Fi. to
From~ Ft. to /'7¢-.Ft..,..,5 I~' r ,$ ~AOD_ Fr,,,,,~ FL to
From/7~ Ft. to~Ft. ~"/~7~ [--~"30 30P/XFl'om .Ft. to
Fromm. Ft. to Ft~ <' Ld ~ '{~Z ~, From.~Ft Io
&g~JC~ ? From.~.Ft. to
Prorate0 Ft. torJOgFt' / ~'¢[Od
From FL to Ft. t ~ From ~ Ft. to
From Ft. to
From__.Ft. to
F(..
Ft
FI,
Ft. , /
' Ftor:q:~.~ 0 lqqE
.,,: .:. ,. , roa th & I- jjman Serwce~
Ft. Fro',~ ' ' '"'Ff~t;' ' Ft
Ft From Ft. to Ft.
From__.Ft. to Ft.. From Ft. to Ft._
From__Ft. to Ft. From__FI. to Pt.
From Ft. to Ft. Front __Ft. to Ft.
From .Ft. to Ft.. From Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME ( '~.... _t:,.~
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940282
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HENIN CHANCEY A &
OWNER ADDRESS:3605 ARCTIC BLVD.
ANCHORAGE, AK 99503-5789
PARCEL ID:05106468
DATE ISSUED: 8/10/94
EXPIRATION DATE: 8/10/95
LEGAL DESCRIPTION: VOYLES BLK 2 LT 6
LOT SIZE: 55733 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE MAXIMUM TOTAL DEP~q-%OF THE DRAINFIELD MUST NOT EXCEED
4.0 FEET. / ; .
-- ~ DATE:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
July 22, 1994
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
AND REPORTS
WELL INSPECTION
& PLOWTEST
SITE PLANS
ROAO DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Voyles Subdivision; Block 2; Lot 6
Request you issue a permit to drill a well and install a septic system
to serve the proDosed four bedroom house on the referenced property.
Test holes were excavated and percolation tests performed. The
approximate location of the test holes are located on the attached site
plan. At the time of excavation water was encountered at 10.5 feet in
test hole %1 and after seven day ground water monitoring water was
found at 9 feet in test hole #1 and 10 feet in test hole #2.
This property has enough area for a future septic upgrade which can be
seen on the attached site plan. We do not anticipate any adverse
effects on neighboring properties by the installation of the proposed
septic system.
If you have any questions, or require additional information for your
review, please contact us.
/LSU/jk
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP , SUITE 204 · EAGLE RIVER, ALASKA 99577
(...P o~dO
~<~
0
o<< ~
NVqd Ills [
PERFORMED FOR:
LEGAL D E SCR IPTION :~C_~
1
0~.
6-
7-
8-
9-
10-
11
13
14
15
16
17
18
lg
2O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
'~--"~"-~ ~ ~'~ DATI
'~/~ Township, Range, section:
WAS GROUND WATER
SLOPE
ENCOUNTERED? ~'~
S
IF YES, AT WH T
DEPTH?
I~onitorJnJ]? J~" Bal/e:
/
(ENGINEER'S SEAL)
SITE PLAN
Reading - 'Date Gross Net Depth to Net
Time Time Water Drop
TEST RUN BETWEEN _...~_ F~AND
COMMENTS
............ 17034 ~agio R,ve~ Loop Road No 204 /.,~ ~
PERCOLATION RATE ~;'~'~ (m~nutes/~nch) PERC HOLE DIAMETER
CERTIFY THA'[ THIS TEST WAS EERFORMED IN
DATE:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
PERPOR ED OR:C. 4A FY HF. J/ v
LEGAL DESCRIPTION: LOT ~!
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DAT[
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
DEPT.?
Depth to Water ADor//~)
Monitoring? ~ ~" Dale:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
I: 5':/- "- ~14' '
PERCOLATION RATE __
TEST RUN BETWEEN ~---?'?¢"~_____ Fit AND
COMMENTS ~tt?
ACCORDA CE Wl~~ ~L GUIDELINE~FF~T ON THIS DATE.
72-008 (Rev. 4/85) Ea~lO
(minutes/tach) PERC HOLE DIAMETER
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
ON-SITE WASTMWAT~ DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MAT~IAL SPECIFICATIONS
R~'~a~NCE: Voyles Subdivision; Block 2; Lot 6
The scope of this project includes the installation of a 1250 gallon
septic tank and two five foot wide drainfields to serve the proposed
four bedroom residence for the referenced property.
Construction shall be in accordance with the approved site plan and
design drawings, Municipal permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater Disposal
Regulations.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling. On all leachfield mound systsms, the property owner shall be
responsible for ensuring a satisfactory vegetation growth over the
mounded area.
Contractors installing wastewater disposal systems must be certified by
the Municipal Health Department for system installations. Owners
installing their own systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALbATION:
1. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
2. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
3. Ail standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
4. Septic tanks installed with less than 4' of cover shall be insulated.
Page ~o
Voyles Subdivision; Block 2; Lot 6
July 22, 1994
A foundation cleanout shall be installed one to four feet from the
building foundation. In the line between the tank and the leachfield
there shall be two adjacent cleanouts (unless an effluent pumping system
exists within the septic tank). These cleanouts shall be located on
undisturbed soil not more than 10' from the tank. The first cleanout,
in line, shall be to clean toward the leachfield. The second cleanout
shall be to clean toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope
exists away from the septic tank.
ABSORPTION TRENC~/DRAI/gFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the
sidewalls of the excavation become smeared, they must be raked or
scratched (roughed-up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to be installed
level with the perforations faced downward. Gravel is then to be placed
over the distribution pipe to provide a minimum of 2 inches of cover
over the pipe.
A silt barrier must be installed between the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel
surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter and installed
approximately in the locations shown on the design. The portion of the
monitoring tube extending through the gravel shall be perforated from
the bottom of the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as noted on the
design.
Backfill over the final gravel layer must not be less than twenty-four
(24) inches. Insulation must be installed when the backfill depth is
less than thirty-six (36) inches. The finish grade over the trench must
be mounded to prevent the formation of a depression after settling.
MINIMUM MAT~.~tIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
¥oyles Subdivision~ Block 2; Lot 6
July 22, 1994
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe Perforated
Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM FS10 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a t!ppe of pipe other than listed above must be approved by the
inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal)
must be installed between the final leachfield gravel layer and the
native soil backfill.
6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel
with less than 3% passing the %200 sieve.
7o When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C. requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
1. The first inspection must be conducted after the excavation of ditches,
pits, trenches, or beds and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled before this
inspection.
2. The second inspection must be conducted after the placement of the silt
barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
Page Four
¥oyles Subdivision; Block 2; Lot 6
July 22, 1994
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the
installation of multiple trenches, sand filters, pressurized distribution
systems, etc. Thus, the inspecting engineer is to be contacted at least 24
hours prior to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work outlined in
these specifications and plans and in accordance with the attached M.O.A.
permit. There will bs no contractual arrangement existing between the
contractor and S & S Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to document the
contractor's activities. Final acceptance of the contractor's work rests with
the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project
or the failure of the contractor to carry out the work in accordance with these
construction documents. S & S Enginsering's inspecting engineer will not be
responsible for the construction means, methods, techniques, sequence,
procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-064-68
1. GENERAL INFORMATION
Expiration Date:
Complete legal description VOYLES SUBDIVISION; LOT 6, BLOCK 2,
Location (site address or directions) 23539 CHANDELLE DRIVE * CHUGIAK, AK 99567
Current Properly owner(s)
Mailing address
· Lending agency
Mailing address
Real Estate Agent
Mailing address
CHANC------------------EY HENIN Day phone 688-7499
P.O. BOX 670903 * CHUGIAK, AK 99567
Day phone
CONNIE HR'FI'INCA w,/ COLDWELL BANKER Day phone 229-4783
10928 EAGLE RIVER ROAD ' EAOALE RIVERI AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
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 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.
Note: Alaska Water and Wastewater Consultants, Inc. shaft be paid $ at, or prior
to closing for the engineering services provided.
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 heroin. I further verify that based on the
information obtained from the Municipality of Anchorage fi/es and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(am) in compliance with ali 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
Addmss 6901 DEBARR ROAD, SUffE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this eva/uafion, AWWC, Inc. attempted to provide a thorough,
conscientious engineedng 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 time of the test, and separation
distances measured to readily identifiable features. The operational life of ali wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate du6ng the year, and the water usage cf the family being served by the system.
These conditions are outside the control of the e valuator of the system. Satisfactory test
results do not guarantee future perfon'nance of the system, nor do they guarantee that
there are no hidden defects er encreachments. AWWC, Inc. can therefore not previde
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DiD. 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 er pady is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
~[ Approved for 4 bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations:
NOTE: The well for this Drooertv meets ex,st{n? ~tate .n~ M,,.{~{pnl ~ Th~
are nitrates present. It is su§Eested that periodic testing he performed to insure
the wells continued suitability. Current nitrate concentration is 5.97mg/1. EPA
maximum concentration is 10.Omg/1. More informatiom on nitrates is available
from the On-Site Services Program, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flew Advisory.
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date: ~"''/--'g"" ~'~'~
Municipality of Anchorage
Development Services Department
Bulldlng Safety Division
On-SIts Water & Wsstewater Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ct.anchorage.ak.us
(go7) 343-7904
Legal Description:
A. WELL DATA
Well type Im~VA~
Date completed
Tolal depth 201
HEALTH AUTHORITY APPROVAL CHECKLIST
VOYLES SUBDMSION; LOT 6~ BLOCK 2, Parcel ID: 051-064.-68
9/1994.
If A, B, or C provide PWSID~ N/A
Sanitary seal (Y/N) YES
Cased to 201 ft.
FROM WELL LOG
9/1994.
165 .fl.
8.0 g.p.m.
YES
YES
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi.
Arsenic: N/A mg./g
SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Dale of pumping 1/.30/2002 Pumper
Nitrate ~'?~_~mg.lg
Date of sample: 5/8/2002
Well Log (WN)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
1/30/2002
172 .ft.
6.3 g.p.m.
12+ in.
Other bacteria .~(~__.colonies/100 mi.
Collected by: -
Date installed 5/26-7/5/95
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
dR'S PUMPING
C. ABSORPTION FIELD DATA *UPPER TRENCH WAS TESTED ONLY.
Date installed 5/26-7/5//95 Soil rating ~r ft~odrm) 0.6
. Length 120' (20 60';~fl. Width 5 fl.
Totaldepthl0.8 +/-ff. Eff. absorpbonaroa1035 fl2 Monitoring tube YES
Date of adequacy tast 1/50/2002 Results(Pass/Fail) *PASS
Fluid depth in absorption field before test 0 in. Water added 1064 gal.
16.5/
Elepsed Time: 9 min. Final fluid depth 7 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
System type DUAL TRENCH
Gravel below pipe .3 ft.
Depression over field NO
For 4. bedrooms
New depth 17 in.
600+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed Size in gallons ~ _
'Pump on" level at in. "Pump off" in. High water alarm level at ,in.
Datum Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'-;- Properly line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
N/A
Absorption field. 5'+
Surface water. 100'+
Water main N/A
Driveway, parking/vehicle slorage 25'.+
Property line 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
COMMENTS
953 .."
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 I IAA guidelines in effect on this date.
Engineer's Printed.Na~e
Date ~'/~/~ ~--'
JEFFREY A. GARNESS
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-064.-68
1. GENERAL INFORMATION
Expiration Date: .~'-- ~ - O ~
Complete legaldescription VOYLES SUBDMSION; LOT 6~ BLOCK 2,
Location (site address or directions) 23539 CHANDELLE DRIVE ~' CHUGIAK, AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CHANCEY HENIN Dayphone 688-7499
P.O. BOX 670903 ~' CHUGIAK, AK 99567
Day phone
Dayphone
Unlessotherwiserequeste~ HAAw~beheldbyDSD ~rp~k~.
2. NUMBEROFBEDROOMS: 4
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. Cedificates 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, I vedfy that my
investigation, based on procedures outiined in the Health Authodty Appreval Guidelines forthi$ application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
forthe number of bedreoms and type of structure indicated herein. I further ve~f~/ 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.
Address 6g01 DEBARR ROAD. SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. OAENESS, P.E.
Phone 337-6179
Date
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. affempted te pmvide 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 Eme 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, end the water usage of the family being sen/ed by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future peffotrnanca of the system, nor do they guarantee that
· therearenohiddendefectsorencroachments. AWWC, Inc. canthereforenotprevide
any warranty or future estimate of bow long the system will continue 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 peraon or party is not authorized, nor will it confer any legal #ght whatsoever.
5. DSD SIGNATURE
Note:
There are nitrates present.
WATER AND :
Approved for L.~ bedrooms. ~ :. WASTEWATER
Disapproved. ?. ;. PROGRAM ...
~ ¢^ .. - · ',d"'~'
Conditional approval for bedrooms, w,th the fllowing stipulations: ¢'--2Y'~/_' ..... °',,~%<~.~',"~
The well for this nrooertv meet~ e~q~t~n? ~t,~. ~n~ ')'fu'~'ft, qp,,~l ~n~!l)l)))))) It ~S suEEested that periodic test~n~ ~e perfo~d
to insure the wells continued suitability. Current nitrate concentrations i~
· 6.38 mF/1. EPA maximum concentration is lO.0 m~/1. More information 6n 11{tTate.,
is available from the On-Site Servlece Pro§ram.at 343-7904.
Attachments:
HAA Checklist ~ Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
(Rev.
Original Certificate Date: ~ - -~ ' 0 ,','2
Legal Oesalptlon:
WEII DATA
Well ~ pt~VA~
Date completed
Total depth 201
Date of test
Stetlc water level
Well production
Municipality of Anchorage
Development Services Department
Bu~d~lg Safety Oivtsk~n
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
wvnv.cLanchomge.ak.us
(07) ~43-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
VOYt. ES SUBDMSION; LOT 6~ BLOCK 2~ Parcel ID:
051-064-68
WATER SAMPLE RESULTS:
If A, 6, or C provide PWSlD~ N/A
Sanitary seal (Y/N) YES
Cased to 201 ft.
FROM WELL LOG
9/1994
165 It.
8.0 g.p.m.
well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
1/3o/2oo2
172 lt.
6.3 g.p.m.
12+ in.
Coliform O colonies/100 mi.
Arsen~. N/A mgJL.
SEPTIC/HOLDING TANK DATA
Tank Type/Material
Nr~'ate (~.1,~ mgJL.
Date of sample: 1/30/2002
Other bacteria
Collected by:
Tank$1ze 1250 gal. Number of Compartments 2
Foundation deanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 1/30/2002 Pumper
ABSORPTION FIELD DATA
Date installed
Length 12o' (2 O sO')lt.
TotaldepthlO.8 +//-lt. Eff. apso~tlonare8 1035 fi=' Monitodngtuba YES
Date of adequacy test 1~30/'2002 Results (Pass/Fall) *PASS
Ruiddepthina20~tJonfleldboforetest 0 In.16.5/ Wateradded1064gal.
Elapsed Time: 945 min. Final fluid depth 7 in.
Any rejuvenation treatment (past 12 mo,) (Y/N & type)
cctonies/lO0 mi.
- ~ ~,~.z~I
Date installed 5//26-7/5/95
Cleanoute (Y/N)
High water alarm (Y/N)
JR'S PUMPING
*UPPER TRENCH WAS TESTED ONLY.
SoU rating {~r lt¥odrm) 0.6 System type DUAL TRENCH
Width 5 ft. Gravel below pipe 3
Depression over field NO
· For 4 bedrooms
New depth 17 in.
Absorption rate >= 600+ g.p.d.
NONE KNOWN If yes, give date -
D. LIFT STATION
Date ins~lled Size in gallons M~
"Pump on' level et in. 'Pump . High water alarm level at __ .in.
~ Cycles tested Meets alarm & drcult requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM wELL ON LOT TO:
Septic tan~ilt station on lot 100%
Abserptlon field on lot 100'+
Public sewer main N/A
Sewer IseptJc service line 25'+
On adjacent lots 100'+
on adjacent lots 100'+
Public sewer manhole/deanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSoRPTIoN FIELD ON LOT TO:.
· Property line 10'+
Water sewice line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Absorption field. 5'+
Surface water. 100'+
Water main N/A
D~veway. parlong~ehlcie storage 25'+
G~ ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal mcerds that the above systems ere/n
confonwance with MOA HAA guidelines in effect on this date.
Engineer's Print~_l_ ~ame
Date ~Z'~r'/O 7--'
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
0
0
0
0
0£'£ I ~ 3. I I.~0~00 ~
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