HomeMy WebLinkAboutSCHROEDER EAST BLK 6 LT 12hroed r
ast
Block 6
Lot 12
#050-062-36
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 Page 1 of
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW010248 PID Number:. 050-062-36
Nome:
PHYLISS JANKE Wastewater System: · New r'-I Upgrade
Addre~e:
PO BOX 770567 ANCH. AK, 99577 ABSORPTION FIELD
No. of BedmomI:
Ph°ne:(9_ 07) 694-4351 3 1:3 Deep Trench 13 Shallow Trench · Bed
LEGAL DESCRIPTION ,,~ ,~.:
2.0 ~o,,~. r~ **2.0 ABOVE
Block: Lot: Subdlvieion: ~ ~ p;pe boom fr~m e~-fg~nel gM: Gr~vel de~t~ beneath pipe:
6 12 SCHROEDER EAST SEE DWG .. 0,25
Township: Range: Section: Ra eeeed ~ eddnel gm,e: ~ length:
- - - SEE DWG ~ 20
WELL: [] New [] Upgrade 18 r~ 8
CIoem11¢e~ (P~,~te. A,B.C): Tetel ~ C~eed To: Total et~eq~on ohm:
~,.~ ...-/~.~.._ ~ r, 360 ~... D 3034/F-810 SCH 40
Oa~e Odl~dJ: Sb~,lo Water Lmm4: Is~ta#e~ Dqte
~' n. $OUTHFORK CONST. 16-17/2002
~ .. . TANK
SEPARATION DISTANCES a S.pt~aD Holding · S.T.E.P. OOther
Tank Station Tank s,,.- ur.~ ANCHORAGE TANK 1250
we~I N/A N/A N/A - N/A STEEL 2
s.,~o~, woto. ~oo'+ ~oo'+ lOO'+ - - LIFT STATION
Lot Une 5'+ 10'+ 5'+ - - 1250IANCHORAGE TANK/ORENCO SYSTEMS
'Pump on' ~ m: I'Pu~np o~ ~ at:
FoundaUon 5%t- 10'+ 5'+ - - TIMER I TIMERI 45"
Curtain Dmin NOiNE KNOW~I P.mp ~ & u~x~: ~ ~
os, ..d
Remerks: *THIS IS A BOTTOMLESS INTERMITrENT BENCH MARK
SAND FILTER (ISF) SYSTEM. TOP OF FIRE HYDRANT
**:2.2 TO 5,2 OF M.O.A. APPROVED SAND FILTER
ADDED BELOW TOTAL DEPTH. 100.00
,T t7: I' '"-'Y*!
inspections performed by:, AKWWC, INC. Dates: 1st 4/16/2002 .... : ..... .-. ......... : ....
2nd 4/16/2002
3rd 4/17/2002 '~12~ !:'""'i
Development Services Department Approval ?0~J/....'L
R~viewed and approved ote:~ '/~'0~
P~.~.o,B~: AS BUILT DRAWING
SW010248 - 050-062-36
~ ~/ / I ~>._ / ~ ~N~ 1250 GABON
..... CONSULTANTS, INC.- 1" '
PHYLISS JANKE (907) 694-4351 2 Of 3
LOT 12, BLOCK 6; SCHROEDER EAST SUBDIVISION
AS-BUILT OF NEW SEPTIC SYSTEM
AS BUILT DRAWING
SW010248 -- 050-062-36
FFINAL GRADE -. 97.57 - 97.77 fTOP MH - 99.'/6
/
/
~ ~. -- ~ OUTLET 95.26
INSULA3']ON
/ I NEW 1250 GALLON
,,v~'r or BUN¢--' S.T.E:.P. TANK~--~NVERT Or BUNG
AT INLET - 94.76 AT OUTLET .- 94.59
FLUSHING VALVE ,,--'2x4 & PL~OOD BOX
ORIGINAL CRADE -'~ ~ t '
.- 92.03 - 92.57 [ ~-- J t -- /'
~ ' '" ~-.INSULATION
FIL'IE:R FABRIC
/ \ \ ~---INVERT OF' PRESSURE: UNE .- 94.83
BO3'TOM OF S'YSI'Ebl .- 91,38 - 92.39-J \ \
(JUST REMOVED ORGANICS) NR UNE -' 92.89 TOP OF SAND RL3ER - 94.58
J.L.M.
ALASKA WATER & &VASTEWATER ~,~:
-- 'CONSULT^~TS.~NC., .... ~.*-.." ..... ~..': ~.~.L.-I':.-..~
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
·
LOT 12, BLOCK 6; SCHROEDE:R EAST SUBDIVISION ~[~?~,~.:'-J. \ ..."<,,<~,~
PROFILE AS-BUILT OF NEW SEPTIC SYSTEM
Rlslr~ Son Electric Inc. ~07 62Z 6777 02/10/0~ 04~4~P P.001
I~isin~i .~n E_l~c'l:ri¢. Inc.
IZ[916 \~/~clLancl Priw,
(907) 622-6777
February 10, 2003
Re: Lot 12 Block 6 Schroeder East Addition
To Whom It May Concern:
The lift station at the above referenced property has been wired in accordance with NEC
and State/Local codes.
Thank you.
Kevin S. Horn~uckle, Owner
Administration License Number 1284
Spedal~ Contractor ticense Number 27285
Sent By: Alaska Water nnd Wa~t,".':n',or Cot:; 007 338 32,I6; Ireb-4-03 8:53AL~; Page 3/3
Municipality of Anchorage
Development Sen'ices Departmcn!
nuildinR SaDly Division
On-Site Water and Waslewatcr Pmg~
47~ Bragaw Street
P.O Box 196~50 Anchorage. AK 99519-6650
~ww ~i.anchoragc.ak.us
PROPERTY OWNER AGREEMENT FOR TIlE MAINTENANCE OF AN ON-SITE
WASTEWATER DISPOSAL SYSTEM
This agreement, dated ~ I ~) [03 , is made between the Municipality of Anchorage
Development Services Dcrart~hcnt (DsD) and the property owner(s) of.' ..... . .
This agreement is rnadc for the purpose of maintaining an on-site wastewatcr disposal system on
the subject property.
The properD' owners agree to the following:
Submit to thc Municipality of Anchorage. on an annual basis, an inspection and operation
statement from a registered professional cngineer. This inspection and operation statement shall
verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any
deficicncics have bccn repaired and thal Ibc system is functioning as designed.
(Signatnre~ . (Signature)
(Printed Name)
(Printed Name)
l~-14e Forcgoing Instrument ,,vas acknoxvledged bcforc mc
' _ ~-
~' e. my. h andse
~ Public (Si~nat~e)
(Notary's printed name) ~
My Commission ExpirOs ~~ ~ }'2005
MUNICIPALITY OF ANCHORA GE
Development Sen/ices 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 PERMIT
Initial
Date Issued: Jul 18, 2001
Expiration Date: Jul 18, 2002
Permit Number: SW010248
Legal Description!'SCHROEDER EAST B~K 6 LT 12
Design Engineer: 0041 AK Water & Wastewater Consultant
Owner Name: Phyliss Janke
Owner Address: PO Box 770567
Anchorage, AK 99577-
Parcel ID: 050-062-36
Site Address: 012535 HOPE CIR
Lot Size: 17596 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[~l Disposal Field ~ Septic Tank ~ Holding Tank ~ Privy
[] Private Well ~ Water Storage
Ail 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 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,
Date: 7-- 18-01
Parcel I.D..
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P,O. Box 196850 Anchorage, AK 99519-6650
www.cl.an~ge.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAHILY DWELLING
Permit Number
Property owner(s)
Mailing address {1)
Mailing address (2)
PHYLISS JANKE
P.O. BOX 770567 * EAGLE RIVER. AK 99577
Day phone §94-3479
Zip Code
Legal description (Lot, Block & Sub'd.) SCHROEDER EAST SUBDIVISION: LOT 12. BLOCK 6.
Legal description (Section, Township & Range)
Lot Size ~ '~ = -
17 ~?~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
AcredSq.Ft. Number of Bedrooms
[] Well Only []
[] Water Storage []
THIS PROPERTY CONTAINS:
HotTub ~[~ 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,
ALASKA WATER & WASTEWATER CONSULTANTSr INC.
Permit Fees:~.~C::) - ~
Date of Payment: 7/c//0 /
Receipt Number:, ~,~ ~,~ /
Waiver Fees;
Date of Payment:
Receipt Number:.
ALASI WATER & WASTEWATER
July 4, 2001
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Proposed Septic System for Lot 12, Block 6, Schroeder East Subdivision
(Bottomless Intermittent Sand Filter - ISF)
To whom it may concern:
The proposed 3 bedroom house will be served by a public water system and a private septic
system. We are proposing that a 1250 gallon S.T.E.P. tank and a Bottomless Intermittent Sand
Filter (ISF) system be installed. Comments regarding the proposed new system are summarized
as follows:
1. GENERAL: Several test holes were excavated on the northwest half of the property to
determine an area suitable for a septic system upgrade. Given the limited area around the test
holes and high groundwater, it is our opinion that a Bottomless ISF system is the most viable
option.
2. SOILS: See the attached log which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that due to the overall appearance of the soils, an
application rate of 2.0 gallons/day/ft2 should be used for the I.S.F. effluent.
3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF)
a. Pemolation Rate: 20 & 40 minutes/inch
b. Allowable Application Rate for ISF: 2.0 gallons/day/fi2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 225 fi2
f. Effective Depth below pressure pipes: 2.5+ inches
g. Width: 12 feet
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwxvc.com
h. Length: 30 feet.
i. Effective absorption area --- 360 fi2
j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank".
1. Sand Material: In accordance with M.O.A. latest standards
m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
We are proposing to excavate down to a depth of 0.5 feet (maximum - remove all organics),
place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of
sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals
midway in the layer. We will use a conventional S.T.E.P. (Anchorage Tank), equipped with a
programmable timer so that flow can be intermittently dosed to the ISF.
4. SURFACE WATERS: There is no surface water within a 100 foot of the the proposed
septic system upgrade.
5. TOPOGRAPIIY: The area around the proposed septic system is relitively flat. In short,
there are no slope concerns.
6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the
construction practices will comply with the M.O.A. "Intermittent Sand Filter Design,
Installation & Maintenance Manual". The contractor should read this document prior to
construction. Copies are available at the Municipal Onsite Services office (4700 South
Bragraw).
7. CLOSING: I am open to any suggestions from your department, which would be an
improvement to the proposed design. I am unaware of any adverse impacts this installation
would have on adjacent wells or septic systems. If you have any questions, please contact me at
337-6179. Thank) you for your assistance.
Jeffrt ~4~k][Otarnes~7, P.E., M.S.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwxvc.com
x' 'x.N'x, ,///' LOT ~9..,ocK ~= / / / .......... il i ~ \
x "' / SCHROEDER EAST S/D LU~ u, ULVU~ o; I I
',X'v'/'' / / / sc..o~.~, r,,~r
~t 13. BL~K 1; / I I / / I
m ~HROEOm ~ S/D I i ~ / ~
I I
,;~,' '~ ~/~
z/.- ~ scHro~r~s/~ / / / ~_~') ~/~ ~ / / /
..... ~// ~ ..~. ~ / / f.,~-~ ~ I ~ ~ / / /
' / ! /
6 i LOT 14. BL~K 6; I I
smro~o~r ~ S/D ~'x : ; ~+~
~ ~, SCHROEDER ~
.~.. ~_~ _': .......................... 7/4/2001 c:~~ ,
: ~ CONSULTANTs. INc.,'
6901 ~8~ ~. ~ ~B ' ~H~GE. ~ ~5~ * ~E (907~374179 * F~ (907~4~6 = 1 O0
~REP~ FOR PHONE NUMBS: P~E NUMBER:
DAN OR PHYLISS JANKE 694-~478 1 OF 5
SCHROEDER EAST SUBDIVISION; LOT 12, BLOCK 6,
SITE P~N FOR PROPOSED SEPTIC SYSTEM
/ / ~ / ~'-'PROPOSED BoTrOMLESS
/ / ~ / /~D RL~R (1~ ~. ~VA~
/ / ~ / lA ~H ~T ~S 0.~ ~ D~ -
/ / ~ / / ~IMUM ON ~HI~ S~D~ ~ 12
/ ~DE ~ 30 ~ LONG. ~D 2+
~ .~'/ /~ /~ 0.5 ~ OF P~ 0~ (SEE
~ ~/ /~ ~ / P~E ~ OF ~ ~R CON~U~ON
~ / / J ~ ~1~5 INCH HOPE UNE. BURIED
~ / / , / ~ / ~ DE~ MINIMUM ~D SLOPED
/ .~/ / I ~/ ~ ~CK TO ~1~ T~K FOR
~ ~PROX.
~m~. ~ CO--OR s~ ~ ////////////////~
PR~D~ A 0-~0 PS~ ~ AT ~ /////////////////
cu~ w~ NOT WORK. ~_ ~////////~
~o~ ~NDU~S aOD~ 5070. ~ ~--~.
UNE S~ BE 1/2 INCH D~DPE (1 XX ~
PIECE), INSUreD ~ 1/2 INCH F~ X ~
W~ (R3 V~UE). INSIDE A 2 INCH SCH ~ ~/~
40 ~ ~CK~. ~E UNE S~ BE % ~_
BURIED TO A MINIMUM D~-~ ~-~~T~ ~F C~Tn~ ~11
AUDIB~SU~ INDICTOR ON ~E O~IDE ~ REGI~RED ~D SU~OR PRIOR
OF ~E HO~E. { ~ JCO~U~ON.
.................................. g~ ~: · ,
AIASI WATER & WASTEWATER
~ :: CONSULTANTS, INC. l"
P.O. ......
PHYLISS JANKE (907) 694-4351 2 OF 5 ~_ kjle~ A. Oorness:
SCHROEDER EAST SUBDIVISION; LOT 12, BLOOK 6 ...Z
~E OF WORK: ~[~*Pr-. -goOO'
DESIGN OF PROPOSED S~lC SYSTEM (BO~OMLESS ISF) -,A%~~-.e..
~.--.-.12' x 30' BOTTOMLESS ISF.
/ NO UNER ON BOTTOM. PRESSURE
~r-'--NR UNE COIL SPACED AT ~---3/4" DIA. $CH. 40 F'VC LKIT_RALS / PIPING DESIGNED BY ORENCO AND
~ APPROX. 1.5 F[..LI'. ORENCO / (HO~r'"~. SHIELDS. AND FLUSHIN, G / SUPPUED BY ANCHOARGE TANK
[ "W~I~LOW' TYPE PROV1DED / VALVES PER ORENCO DESIGN)
/.
/.
\ ['7 5- , , ,'ri i i , i ; ; ~ :.. .,o',
~ I : '~ ~ i I i i i i i i i i i : : OI
I ' ,I ' I -'
~,~. I I
' ' ' ' ' '
FLUSHING: VALVES
~,,~ 4' DIA. MONITORING TUBE AT EACH PLYWOOD BARRIER
PROTECI'~
COVI3~. )
~ END. PERFORATED BET~£EN TOP AROUND PERIMETER
- OF' SAND AND DISTRIBUTION PIPE (EX'~D ABOVE GRADE')
"~ INVERT. (DRILL 1/4' DIA. HOLES)
PI_~N VIEW
,-.-FINAL GRN:)E
3/4' PVC LATERALS (TYP.5)~ / ~MONITORING TUBE (TfP.)
WITH THE PVC LATERALS BURIED -- -- -- ' ~
~,DW~,. THE ~M~ / I FI~'£"~'~R'C-7 / / '
USE BRACING AND / \ / ..... [ ..... / / / ~ r-ORtC~.~
· . .... ..,-, , .' .... '' .. '.'. '''.... '.'.~':;.I
/ r // .I .','.., · . ........ , ..... ..,,-,. , "::". '~i-.."/-..
/ ~.~.~,'~r "., ' ~" -~-,~"~.~ :. -"~'~,;~-:',',-:~"~ -~-'~ ~. ' L z
'~6 DEEP MAXIMUM
¢o~"o¢E~ ~,~.-/ PROFILE VIEW ,v
~ ?~M Iff lev A. Gamess.
J.LM.
ALASKA WATER & WASTEWATER ~.~
_ --- CONSULTANTS, INC. ~
N.T.S.
6901 DEBARR ROAD, SUITE ~B "ANCHORAGE, ,aK 9~50z. · PHONE (907t$$7-~179 · FAX (907~338-3Zt.6
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
PHYLISS JANKE (907) 694-4351 5, OF 5
LEGAL D r"::;CRIPTION:
SCHROEDER EAST SUBDIVISION; LOT 12, BLOCK 6,
PIPE OF WORK:
DE"TAIL OF BOTTOMLESS INTERMITTENT SANF FILTER (ISF)
'AI SKA ' VATER & WASTE VATER
....... CONSULTANTS, lNG. ,'- '
e~ot I~;~,&~R RO~), SU~ 29 * ,~ICH(3R~F.., ~ 99504 * FIdON~ (007)337-6179 · FAX: (907)3,3~-3246
ISOIL LOG - PERCOLATION T£STJ
LEGAL DESCRIPTION: SCHROEDER EAST SUBDMSION; LOT 12, BLOCK 6,
PERFORMED FOR:__ DAN OR..~PHYUSS JANKE DATE: 5/15/2001
~'-~' ORGANICS
ITEST HOLE
GM/SM/ML
GP
SOIL CLASSIFICATIONS
GP HL
GM CL
GC OL
SW MH
SP CH
SM OH
SC
DEPTH TO DATE
GROUNDWATER
4' 5/15/01
2'-8" 5/21/01
4' 5125/01
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (HINUTES) READING (INCHES)
5/17/01 1 2:50 ~ 6- ~
2 3:20 30 5 1/4' 3/4'
3 3:20 ~ 6'
4 3:50 30 5 1/4' 3/4'
5 3:50 6"
6 4:20 30 5 1/4' 3/4"
PERCOLATION RATE
TEST RUN BETWEEN
20 .(MIN./INCH) PERC. HOLE DIA. 6' (INCHES)
1.0 FT. AND 1.5 FT.
COMMENTS: PERC-HOLE WAS PRE-SOAKED FOR 4+ HOURS
JPERFORMED BY ALASKA WATER &: WASTE'WATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS t,~{AS/PERFORMED
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
Al ~AxSKA '~VATER & WASTEWATER
ISOIL LOG - PERCOLATION TESTI
LEGAL DESCRIPTION: $CHROEDER.~~ SUB.~_._DMSION; LOT 12, BLOCK 6..~.~, ~
PERFORMED FOR: DAN OR PHYLISS JANKE DATE: 5/15/2001
3'-6" ORGANICS
ITEST HOLE
GM/SM/ML
GP
SOIL CLASSIFICATIONS
ORG
~GP ~ML
GM CL
GC OL
SW MH
~SP CH
~ SM OH
~T~A SC
DEPTH TO DATE
GROUNDWATER
3' 5/15/01
5' 5/21/01
DRY TO 4' 5/25/01
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
5/17/01 1 2:50 6"
2 3:20 30 4 1/2" 1 1/2"
3 3:20 6'
4 3:50 30 4 1/2" 1 1/2"
5 3:50 6'
6 4:20 30 4 1/2' 1 1/2'
PERCOLATION RATE 40 (MIN./INCH) PERC. HOLE DIA. 6' (INCHES)
TEST RUN BETWEEN 1.0 FT. AND 1.5 FT.
COMMENTS: PERC-HOLE WAS PRE-SOAKED FOR 4+ HOURS
PERFORMED BY ALASKA WATER &: WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS WA/S I~ERFORMED
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE: -~'1[~/(9~
CHORD
N 3~28'53'E
1~0.27'(u~)
12
11
13
10' POlE ANCHOR
~F-' /
SCHROEDER SUBDIVISION
LOT 12, BLOCK 6,
h'lunicipality of Anchorage ·
Development Services Department
Builc~ing Safety Divisicn
On-Site Wator &'Wastewater Program
4700 Sou. th Bragaw St.
· P.O, Box 196650 Anchorage, AK 99519-6650
vc,vw.ci.anchorage.ak.us
(907) 343-7904
,CERTIFICATE" OF .'HE ALTH AUTHORITY'APPROVAL '.: . -F_OR.A',SINGLE FAMILY DWELLING
Parcel I.D. O~O-062£3~; HA,MC. -
1. GENEI~L INFORMATION Expiration Date:
'Completb'legaldescripti~n .~.OT 1'2, BLOCK 6; SCHROEDER EAST SUBDIVISION-
Location (site addi;'esS 0r directio~ns) HOPE.CIRCLE * EAGLE RIVER, AK .' '
· Current Property owner(s) PHYLISS JANK'E ....... Day phone .694:.-4351
Mailing"ad~lr~S~ . P.O. BOX'770567 * ANCHORAGE, AK 99577 .'
Lending agency ·
Day phone
Mailing address
.Real Estate Agent
r'J/lailing address . . -
Unless otherwise requestdd, HAA Will be held by DSD for pickup.
Day phone
2. NUMBER OF BEDROOMS:
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 ,., :'['TI '
Community On-site '[]
Public Sewer [] '
The Municipality of Anchorage Development Services Depadment (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 propedies 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 propedies served by a private or Class C well and may
be reissued with new water samples. (Cedificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for propedies 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.
o
STATEMENT OF INSPECTION BY ENGINEER' ·
As certified by my seal affixed hereto and as of tho va#darien date shown below, I ~,efify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the ag-site water supply and/orwastewater disposa! system is(are) safe, functional a. nd adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the M~micipality 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, ~nd regui~ti~ns in' ~ffe~t at iho'tim~'of [~s~allati~nl ~ ' ' - ' ' ' ' '
' .. ": ':' .! ' ~ .k ' ",." ~ !::. .' ,'-". ': .'"':i ..... " .':
Name of Firm ALASKA WATER &: WA.~TEWATER-CON~UI~ANTS, INC.
Address 6901 DEBAR~
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 337-6179.
Date .'. ~ I-~
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. Tho reported r~sults described the perforr~ance of the
system Under the conditions encountered at the time of the test,
distances measured to readily identifiable fe'aturos. The operational life of all .wells and
septic systems depend on the local soil~ boridition, g~undwater le[,els !het may
fluctuate during the year, and the water usage of the family being sen/ed by the system.
These conditions are outside the control of the evafuatcr of the system. Satisfactory test
results do not guarantee future £erformanco of the system, nor do they guarantee that
there are no hidden defects or encroachmFnts. AK[,~¥C, Inc. c~n therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of t.~is 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 authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE '
Approved for _'~ ' becir~oms.
Disapproved.
Conditional approval for __
bedrooms, with the fllowing stipulations:
.. -'.. o5,
- ~-. - u~-o-- .
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
~ ;. PROGB, AM .:.,... ~.
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ManitenanceAgreements ~' ""' ' "
Supplemental Engineer's Reort
Other
(Rev. 12,'01 )
Original Cerli{icate Date:
Municipality of; Anchorage
Development, Services Department
e.lkllng .~afsty Division
Or. ire wat_e~r &~a:$tewater Program
.4700 6pUU18ragawSt.
P.O: 80x ~96650~An~diorage; AK 99519-6650
www~ ~anchorage.ak. us
(907) 3~3-7904
HEALTH .~.UTHOPJTY APPROVAL CHECKLIST
Legal Oescrlptlorc .... LOT, 12,_BLOCK, £j:SCHROEDEE EAST SUBMSION
A. WELL DATA:
Well t~q3e ....
Date completed
Total depth ,
Pamel ID: ,050.062--56
Date of test
.~ductlon , .,. ,: ,g.p.m.
WATER SAMPLE RESULTS:
Coliform - colonles/100mL Nitrate, ,7 mg~.
Arsenic ,, - mg~. Date of sample:
SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL ,: , ,
Tank size ,~!250 gal. Number of Compartments ,,2
Foundatlon.cleanout (Y/N) YES
Date of pumping ,,, NEW
ABSORPTION FIELD DATA
SERVED' BY PUBLIC WATER
If A, B; or C provide PWSID~ Well Log (Y/N) ,
,,
Sanitary seal (Y/N)' wires pm~/N)
Case~tto ,it. ~ height (above ground) in.
FROM W~ AT INSPECTI:7- ,
.... g.p.m.
Other bacteda - colonies/100 mi.
Collected by: .... - ,,
Date installed ,. 4/,16-17//2002
Cleanouts (Y/N) , YES
Depression over'tenk (Y/N) .NO High water alarm (Y/N) ,, YES
Pumper, ,,:- ,.
*BIg/OW RNAL ~DF.. 2.2. TO 3.2 OF M.O.A. APPROVi~ ,~ND RLTER
ADDED BEU3Y/ fiNAL GRADE
Date i~lled A/15'17/2002 SOil rafing ~rfl~drm). 2.0 System type. BoTrOMLESS,..ISF
Length, 20, fL VVl'dth 18 fL Gravel below pipe ,0.25 ft.
Toteldepth ,,2.7-3:s ft. Eft. absorption, area 560, It' Monltorlngtube .YES
Date of adequacy test ~ , NEW , , Results (Pass/Fall) -
Fluid depthin absorption field, before;test ~' in. Water added - gal.
Elapsed Time: - rain. Flnat fluid depth -, In.
Any rejuvenation treatment (past 12 mo.){Y/N &,type) ~
Depression over field NO
For 3 bedrooms
New depth ,.- in.
Absorption rote >= ,,, T' __ g.p.d.
- If yes, give date .... -
D. LIFT STATION
Date installed 4/16-17/'02
"Pump on" level at T~4E~. in.
Datum BOTFOM OF TANK
E. SEPARATION DISTANCES
Size in gallons ,., 1250
"Pump off' level at ~lUER in.
Cycles tested NEW
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Manhole/Access (Y/N) YES
High water alarm level at 4,5 in.
Meets alarm & circuit requirements?. YES
SERVED BY PUBLIC WATER
On adjacent lots ~..---~
~er m°tSan hole/cleanout Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water. 100'+
Wells on adjacent lots 100°+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Water main 10'+
Driveway, parking/vehicle storage 10.'+
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.
Date
JEFFREY A, GARNESS
HAA Fee $
Date of Payment
Receipt Number
(Rev, 12/01)
Waiver Fee $
Date of Payment
Receipt Number
Sent By: South Forl( Construction;
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