HomeMy WebLinkAboutCHESTER CROMWELL LT 78AChestee
C omwell
Lot 78A
#05 ! - ! 03- 27
Municipality of Anchorage
· Development Servlces Department ,'-*,' %'
Building Safety Division ~,' , '..
On-Site Water & Wastewater Program, 4700 South Bragaw St. "~ I~11
P.O. 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: SW010490 PID Number: 051 - 103-27
Name:
TROY LEWIS Wastewater System: [] New · Upgrede
P.O. BOX 211171 * ANCHORAGE, AK 99521 ABSORPTION FIELD
(907) 351-5824 4 r'lOeep Trench · Shallow Trench O Bed mMound r'lOther
LEGAL DESCRIPTION ~, ro~: 1.2 c.~o/s.., to,°, ~,,. ,,o~ w,~,2.67_5.96
- 78A CHESTER CROMWELL 0.67-3.96 .. 2
- - - SEE DWG. n. 70+
WELL: [] New [] Upgrade 5 n. 1
~ n. n. 500+ so. ri. D 3034/ F-810
~ *EXISTING TANK
SEPARATION DISTANCES - Se~t~ r'l Hofdlng I-I S.?.IF.P. O Other
Tank Field Station Tank s*..r u,-* ANCHORAGE TANK 1250
We, I00'+ I00'+ - - 25'+ STEEL 2
Su~fo~e Wo~e, 100'+ 100'* - - - LIFT STATION
Curtain Drain NONE~ KNOWNI /~'mP ~*~.~: eecu~ca~ ~c~. e*,~e~s ~
Remarks: *THE EXISTING SEPTIC TANK WAS INSTALLED BENCH MARK
IN 1994. THE TANK WAS FOUND TO BE OF GOOD BACK DOOR THRESHOLD CLOSE TO POINT "A"
INTERGRITY ON 5/10/2002.
1 00.00
Inspections performed by: AWWC, INC. Dates: 1st 5/10/02 ~?.*.c_~..?;i ! (' ' '/~J ~' '''-'3~
Development Serviqe~ Department Approval u~, ... ~ ...'
P...,....c.; AS BUILT DRAWING
SWO10490 - 051 -103-27
~EXISTINO SEPTIC SYSTEM~ / O~ [DETAIL
[ ~ THAT S[RV[S LOT 788; / ~/ ~0
~ // ~ CHESTER CROMWELL S/O~ ~Z
-- ~150' WELL ~DIUS N
N~N / ; ~EXISTING 1250 GALLON
' ~/ [ ~EPTIC TANK INTEGRI~
x% TEST H~LE ~1 ~ ~ ~ ~ ~-- ~-o~
ST~ ~ ~~x,~ LOCATION) '
ST2 ~4~ ~T:~ - ' '~ ~ ~ ~
DDL1 47.0 63.6 - ~x ~ SEE D~AIL A ~ I
FO 47.7 64.2 - / ' x X ~
DBL2 48.7 64.8 - - ~X ........ ~'-'~
D~L3 47.4 63.6 - / x ~[XISTING ~[O TO ~[
D8L4 48.7 65.2 - USED AS A RESERVE SITE ~5 & S ENG.
CO1 55.5 85.8 81.3 (APPROXIMATE LOCATION)
Mil 54.6 84.2 81.2
C02 118.1 - 133.3
MI2 115.6 -- 131.7
ll~SI~ ~WI'ER & ~SI'E~WI'ER
PREP~EO FOR: PHONE NUM~[R: PAGE NUMBCR:
TROY LEWIS (907) 351-5824 2 OF 5
LOT 78A1 CHESTER CROMWELL SUBDIVISION
AS-BUILT OF SEPTIC SYSTEM UPGRADE
.E".,.NU..£.: AS BUILT DRAWING
SWO10490 ' 051-10,3-27
FINAL GRADE - 96.92+
TOP OF.TANK AT---~ =
INLET 92.92 ~ /--TOP OF TAI~cK AT
_~ OLIILET 92.84
\ /
INVERT Or BUN¢ INTERGRITY VERIFIED ~--INV[RT or BUN(;; AT
AT INLET-92.34 lJ ON 5/10/02. OUTLET ,= 92.09
\/
MONITORING TUBE-~ j~LEANOUT
FINAL GRADE /---ORIGINAL GRADE
-- · - · / HIGH -- 95.00
/ LOW -- 9=1.71.
FILTER FABRIC--~
i [~~NV~RT 0¢ D~STR~BUT~ON
: ~:~:~:~ LINE = 91.04 (AVG.)
"--BO'FI'OM OF' TRENCH
= 89.04 (AVERAGE)
................... CONSULTANTS. INC. ~ ...... 1"
'REP~ED FOR: mONE NUMBER: PAGE NUMBER: I~ q '*'
TROY LEWIS (907) 351-5824 5 OF 3~,[ tie
LOT 7aA; CHESTER CROMWELL SUBDIVISION q~p4~'..
PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE
AI.,ASI(A ~WATER & '~VASTI~YVAI~ER ~a~-~...'
ISOIL LOG - PERCOLATION TESTI
'EDAL DESOR,PT,ON: LO. 78.: CHESTER CROM.E.L ./0
PERFORMED FOR: TROY tE~S DATE: 5/10/2002 'q~, '"...Xi ...... '"~,v~"~,
DEPTH i ....
(~e~t) :==:.- ORGANICS ITEST HOLE #1 [
-'?o% SOIL CLASSIFICATIONS
2- ~';' '°°° ~
.... °~"' ::~':'-'.'o :--' GW ~ ORG
? ,'.oo~ -
· ,~: 0oo -.ff../ ~, ,-'-'"'-7. GP ~ I'lL
e '.o°¢: GM " ~ CL
4-- ~ 'o"'~, GW/SW ~ Ge OL
5--' c: . ~% SP CH
· o..-o,~ SH ,/,,,Y,; OH
6--' ~'"t°°°" ,~?"~,~-,, SC SEE AS-BUILT DRAWING
: ~.',~oo~,
7-- ~' '~°°" DEPTH TO
· ': o~° DATE
:o .,',oo ~ GROUNDWATER
~ - ~ 10' 5/10/02
lo' 5/13/02
9-! ~ ItIIi 10' 5/17/02
it2H''H'~' DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
11
~ J~!J~ , - ,---- O~/SJ"d TildE (HINUTES) READING (INCHES)
~2-:~J Jt!J;~: 5/10/02 1 - -
lJilI! _2 - 2 01
13- ,__ 3 - _
~ 4 __- 2 o' ___6~
14-, ~.o.u ........... 5 ..... _._~- __ .7_ ............... 6"_ ...............
, 6 - _ ...... _2 ........... 0". ........... 6;' ......
15--
17--,
I
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19-
TEST RUN BETWEEN 5.0 FT. AND 5.5 FT.
20-- ~ A FOUR HOUR PRESOAK WAS PERFORMED: D YES · NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS
COMM~'~J~S.iNSITU SANDY SOILS FROM 8' - 10' WILL ACT AS A SAND FILTER.
PERFORMED BY A.W.W.C., INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS VIAS/PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
DEPTH TO
GROUNDWATER DATE
10' 5/10/02
10' 5/13/02
10' 5/17/02
MUNICIPALITY OF ANCHORAGE
Developreent Sen/ices Depa~'tment
On-Site Water & Waslewater Pregram
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(gO7) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Dec 19, 2001
Expiration Date: Dec 19, 2002
Permit Number: SW010490
~Legal Description: CHESTER CROMWELL LT 78A'
Design Engineer:. 0003 S & S Engineering
Owner Name: R. C. Cromwell
OwnerAddress: P O BOX67620222
CHUGIAK, AK 99567-0222
ParcellD: 051-103-27
Site Address: 020616 JEHOVAHJIREH ST
Lot Size: 55692 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] 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 cf 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 Apd115, 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 preven! freezing.
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 SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLI'NG
Parcel I.D. ~)5~.o 'Ij, O~ - '~
Permit Number
Property owner(s)
Mailing address (1)
Mailing address (2)
Day phone
Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size 5 ,~! (,0 ~,"~' -Ae~s~
THIS APPLICATION IS FOR:
Sewer Only ~
Sewer and Well
Sewer Upgrade ~
THIS PROPER~ CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Number of Bedrooms
Well Only []
Water Storage []
Jacuzzi
Water Softening Unit
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) 17034 Eagle River Loop Road, No.
Eagle River, Alaska
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ROBERT C. COWAN. P.E.
November 9, 2001
ClWL ENGINEEP. S
(907) 694-2979
FAX (907) 694-1211
PEgCOLATION
TEST
MUNICIPALITY OF ANCtIORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 78a, Chester Cromwell S/D
It is requested that you issue a permit to upgrade a septic system to serve the existing
four bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
ofthe test hole is located on the attached site plan. At the time of excavation on 10/4/01 no
water was found. After seven days of ground water monitoring the test hole was still found
to be dry. An additional test hole xvill be percolated at the time of excavation.
We do not anticipate any adverse effects on neighboring xvells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system xvill not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
RCC6hm
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577
A~ A~-I~UII.T SURVEY DRAW~ ~Y: ,~r~·
SOI~
CPD/SQ
600/1.2 = 500 SQ }~. REQ'D. [7 IS TIlE RESPONSIBiLTY OF TIlE CONTRACTOR }, ~.~ RO3ERT Q COWAN /~ ~
I)lb-rihcgs. lAD PROPERTY ~NgS PRIOR TO J} ~ .~ r~' ~
I
20 Uhl [sml I
INSIALL DIVERIER VALVE ~°~X [XlSItNG 1250 GALLO
~X X SEPIIC lANK (VERIFY INIEGRIIY
& ~[PLAC[ IF NECESSARY)
EXISTING 20' TR[NC~' I
ALL PORIIONS OF SYSI[M
WITH LESS IHAN 5.5' OF
COVER REOU~[ INSUL~IION.
Municipality of Anchorage
Development Services Department ,,~ ~.~, ~ ,
Building Safety Divlsion '*
P.O. Box 196650 Anchorage, AK 99519-6650
www~d.anchoraae.ak.us
(9o7) 343-?~04
Soils Log - Percolation Test
1-
2.
3.
4-
7-
10-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
Reading Date Gross Time Net Time Depth to Water Net Drop
-
/ /0 /O /B" (~,,
Io 1o I~;" 4,"
/o Io /~ ?z~ ~'~
lO tO 14 Y~." 5'yz'
IO ~o 147~,, ~',~.,.
TEST RUN BET~NEEN a~- FT AND ~' FT
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
¢,% %5 \¢j5 Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
~~' ~' ~&j t~)~~'1~.' ' ENVIRONMENTAL SERVICES DIVISION
~ .O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater DisPosal System and/or Well Inspection Report
Permit Number: ~VO~¢~ PlDNumber: ~-
Name~/~C~ ~'d~ C ~Z WastewaterSystem: O New ~pgrade
Address~o. ~OX ~Z O~Jt ~U¢/~, ~, ~ ABSORPTION FIELD
Phone: ~ '~ ~o.o~edrooms: ~OeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
i /
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION GP~sq. ~.
Lot: Block: Subdiv~ion: Depth to pi~ bottom from original grade: Gravel depth beneath pipe
Township:~[ ~'~~ Ra~ ~ ~ Section:~ ~ Fill added above original grade: Ft. Gravel length: Ft.
Gravel width: Number of lines: I Distance be~een lines:
WELL:
New
~/~ ~ Upg rede Ft.m Ft.
Classification (Private, A,B,C): / Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. SQ. Ft.
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Ft.
Yield: GPM IPump Set at: Ft. ICasing Height Ab°ye Gr°und:Ft. TANK
SEPARATION DISTANCES ~e,tic ~ Ho~Uing ~ S.T.E.,.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capaci~ in gallons:
From Tank Field Station Tank Sewer Lines ~5~ ~r ~ ~ ~ ~
Well- /~/ /0~ ~ ~ ~ Material: ~ Number °f C°mpa~ments: ~
Sudace LIFT STATION
Water /~ ~ 1~4 ~ ) ( ,
Lot~ Size in gallons:[ Manufacturer:
Cu~ainDrain ~ ~ . ,~ ~ Pump Make & Model,I Em~trical Inspections pe~ormed by:
Remarks: ~. ~//~ ~ ~. /~2~ BENCH MARK
Location and Description:
· m Assumed Elevation:
~.....- ~....~1.. ·
Inspectionspedormedb /~ Dates: 1st ~(,/~/ ~'~9~ % *~'
Department of Heal,and HHman Se~ices approval ',~:h.~.,_~ .... ;.......~;~
Reviewed and approved by: ~~~' ~ Date: ~-~- ~ ,,. ~0~ESSt~
72-013 (Rev, 9/91) MOA 25
Permit No.
Page
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
Legal Description: 6o/" ? ~ /~
0
PID No.:
ENGI
No. CE-5325
72-013 A (Rev. 9/91) MOA 25
Anchorage, Alaska 99519-6650
Date:
To:
From:
Subject:
September 5, 1995
File, Lot 48A Chester Cromwell Subdivision
Daniel J. Roth, Civil Engineer, On-Site Services ~
On-Site Wastewater Disposal System Inspection Report, Permit Number
SW940292
The approval signature on the subject document dated August 25, 1995 is for the septic
tank installation only. In no way does this give approval to the non-as-builted drainfield.
At the time of Health Authority Approval request, the drainfield may be subject to further
documentation.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940292
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:CROMWELL RUFUS C JR
OWNER ADDRESS:P.O. BOX 670222
CHUGIAK, AK 99567
DATE ISSUED: 8/15/94
EXPIRATION DATE: 8/15/95
PARCEL ID:05110327
LEGAL DESCRIPTION: CHESTER CROMWELL LT 78A
LOT SIZE: 55692 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT IS FOR THE CONTRUCTION OF:
SEPTIC TANK 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:
DATE:
DATE:~~/~
July 25, 1994
Municipality of Anchorage
Environmental Services Division
P.O. Box 196650
Anchorage, AK 99519
Re: .Sewer Upgrade Permit for BLM Lot 78A Chester Cromwell ,Sub.
Dear Sirs:
On May 22, 1994 an adequacy test was performed at the subject lot with
a four bedroom house an a septic system that was reported to be installed in
1960. The system passed the test, however, requires the seepage crib to be
replaced with a 1250 gallon septic tank. The crib shall be abandoned and a
test hole dug to 14' depth to verify that na groundwater is located in this area.
Other pertinent information is as follows:
The septic system is located in an area with less than a three percent
slope and has adequate room for a replacement drainfield. The ground
slopes away fram the well site and na drainage courses are within the
area.
There are no apparent impacts to adjacent properties with this proposed
upgrade and its location meets ali current separation distance
requirements.
The attached site plan shows the proposed location of the septic tank
replacement for issuing the permit. The permit fee has been paid. If there are
any questions concerning this matter, please contact me at 696-3437. Thank
you.
Sincerely,
r, P.E.
CE5325
-I
Municipality of Anchorage
Development Services Department
Buitding 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'
Parcel I.D. 051-103-27
1. GENERAL'INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date: ~/'--
LOT 78A; CHESTER CROMWELL S/D
Location (site address or directions) '
Current Property owner(s)
Mailing' address
Lending agency
Mailing address
Real Estate Agent
Mailing address
20616 JEHOVAH JIREI~ STREET * CHUGIAK, AK
TROY LEWIS Dayphone 351-5824-
P.O. BOX 211171 * ANCHORAGE, AK 99521
Day phone
Day phone
Un/ess 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 homeownem. 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 Water and Wastewater Consultants, Inc. shall be paid $
to closing for the engineering services provided.
at, or pdor
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 out#ned in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorege fi/es and from my investigation and inspection, the
on-site water supply and/or was/ewe/er disposal system is(am) in compliance with all applic, ab/e Municipal
end State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS. INC. Phone
Address 6901 DEBARR ROAD. SUITE 2B "ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
337- 6179
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results desc.~fbed the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate dudng the year, and the water usage of the family being served by the system.
These conditions ara outside the control of the eva/ua/or 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, AW1NC, Inc. can therefore no/provide
any warranty or future estimate of how long the system will continue to meet the
operational roquiroments 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 repod by any
other person or porly is not au/ho#zed, nor will it confer any legal #ght whatsoever.
DSD SIGNATURE
Approved for ~
Disapproved.
Conditional approval for __
bedrooms.
bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
~_ · WASTEWA]I:~, : :
.......
Manitenance Agreements '"~,;.~ ~¢~;'*'
Supplemental Engineers Reo~ ~Jjjjj))))})))))l
Other
(Rev. 12~I)
Original Certificate Date: ~ - I ,~ - O.~---
Legal Descdption:
A. WELL DATA
Well type PRIVATI~
Municipality of Anchorage
Development Sewices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 ,South Bragaw St,
P.O. Box 196650 An(tim'age. AK 99519-6650
www.ci.anct~orage.ak.us
(g07) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LOT 78A; CHESTER CROMWELL S/D
Parcel ID: 051-105-27
If A, B, or C provide PVVSID# N/A
Well Log (Y/N), NO
Date completed UNKNOWN Sanitary seal (Y/N) YES
Totaldepth 125'+ It. Casedto 40'+ fi.
FROM WELL LOG
Date of test
Static water level
Well I:m:Muction .,Y g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi. Nttrate0o'~hlg.A..
Arsenic: N/A mg./L. Date of sample: 5/17/02
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1250 gal, Number of Compartments 2
Foundation cteanout (Y/N) *YES
Date of pumping 5/17/2002
C. ABSORPTION FIELD DATA
Date ~stefled 5/10-11/02
Length 70+ .It.
Depression over tank (Y/N) No
Pumper.
soil rating ~:l.:~lc~r lt~edrm) 1.2
Width 5.0 .lt.
Wires pmpedy protected (Y/N)
Casing height (above ground)
AT INSPECTION
5/10/2002
115' lt.
5.16 g.p.m.
Other bacteria
Collected by:
*INSIDE: FOUNDATION
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
dR'S PUMPING
YES
Total depth .5.e-e,4 It. Eft. absorption area 500+ It~ Monitoring tube YES
Date of adequacy test NEW Results (Pass, Fail) -
Fluid depth in absorption field before test - in. Water added - gal.
Elapsed Time: - min. Final fluid depth - in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) -
18+ in.
colonies/100 mi.
AKWWC, INC,
/1994
YES
System M~e 5-WIDE
Gravel below pipe 2,0 fi.
Depression over field NO
For 4 bedrooms
Now depth - in.
- g.p.d.
If yes. give date -
O. LIFT STAr)ON
Date installed Size in gallons Me~.~~__ _
"Pump on" le~gh~ wa rte alam~ level at ~ in.
~ Cycles tested. Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldlllt 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/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 sen/ice line 10'+
Wells on adjacent lots * 100'-t-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
Building foundaMon 10'+
Surface water 100'+
Wells on adjacent lots '100'+
Absorption field 5'+
Surface water. 100'+
· 150'+ TO WELL ON LOT 78B
Water main N/A
Driveway, parking/vehicle storage 25'+
F. COMMENTS
7953 ."
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 Illame
D.te
JEFFREY A. GARNESS
HAA Fee $
Date of Payment
Receipt Number
(Rmv.
Waiver Fee $
Date of Payment
Receipt Number