HomeMy WebLinkAboutVERN HAIK LT 6V rn Haik
Lot 6
#051-061-84
MM~M Contracting
P.O. Box 670495 Chugiak, AK 99567
P~e: 688-1236 T~ree
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 o Anchorage, Alaska 99519-6650 o Telephone: 3434744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW000192 PlO Number:_ 051 -061 -84
Wastewater System: · ~ New [] Upgrade
ABSORPTION FIELD
Deep Trench E] Shallow Trench [] Bed O Mound [3 Other
11
. 8 GPD/S~. Ft.
LOt: 6 Block: Vern HaiL 4
TOWnShip: t Range: I Section: ~]1 added above origln~ll grade: Grave] lengm:
WELL: .-.. [] New [] upgrade . -.. I 3
Clas~ific~t,o, ( Pri~ate. A.B.C): TO~I ~pm: Case TO: Io~l absorption¢~ p,~ materbl:
class A PWS Ft. Ft. ' SO. Ft. D3034 PVC
grilteE - ?. MM&M
Wel~ N/A
LEGAL DESCRIPTION
Surfaoe
- .Water
Lot
Line
Foundation
~nchora( ~-·Tank
Two
- LIFT STATION -_
Orain
'!.~m~rks: Insulation Over Tank.
BENCH MARK "
Top'.of Front Deck.-. '...-
..... . .: . t00.'0
Inspections performed by:. MEA ' ' · : Date~: 1st 8/2 / 00"
· ' 2nd 8/3/00
Department of Health and Human Services.approval ' '
Reviewed and approved by:~ ifA/' 'ff4::;2¢.~ Date:'~ '~L'~:tgi0
· - .-: ..:.';3 -. · : .-/ : '. : '-. ',- -...
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
on-Site WasteWater Disposal System or Well InsPection Report
Permit Number SW000192
Page 2 of 3
PID No. 051-061-84
DAWN LANE
/
/
Ii
15' Utility Easement
~TH2
Alternate Site
C ~ ~ 4
C3 .
__ Home ~-~J S1
Water
Service
O
Z
O
A B- C
S1 9.8 21.4 ·
S2 7.1 27.1 -
C4 21.5 78.3
C5 28.8 ~ 39.2
M1 17.4 68.5
PLAN AS-BUILT
SCALE 1" = 30'"
Page 3 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,0. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW000192
PID No. 051-061-84
$
I / I ~1,ooo
o /o / /n-~ 4~allon
~4°/~/~/;~-~ e p. Tan
94.0
98.5
/
Geotextile Fabric
Drainfield Rock
86.9
80.0
32' '
PROFILE AS'BUILT
~,94.0
MEMORANDUM
DATE:
September 29, 2000
TO:
FRO~:
Dan Roth/Jeff Poet
Mike Anderson, P.E.
SUBJECT:
Lot 6, Vern Haik Subdivision
Certificate of Health Authority Approval
Separation Distance to 25% Slope
I again inspebted the final grading over the absorption trench on Lot 6, Veto Haik
Subdivision on September 28, 2000. The contractor was on site and had recently
completed additional grading on the final ground slope immediately north of the trench.
The intent was to achieve a proper set back distance from the final ground slope to the
edge of the new trench. The easterly 30' of the trench is of no concern as the finished
ground slope is less than 25% and no separation requirements are necessary. The
finished slope at the westerly end of the trench however is at or slightly steeper than
25%.
An elevation was taken at the finished elevation on the edge of the trench and another
at 35' to the north. The difference was found to be -9.3' which equates to a 27% slope
or slightly greater than the 25% allowed. The slope when extended from 2' above the
distribution pipe at a 25% grade descends to an elevation of-10.25', which is below the
ground surface at this point. In summary, the 25% slope when extended downward
from 2' above the distribution pipe at the edge of the trench will not intersect existing
ground. No further grading is therefore necessary and the septic system is acceptable
for certification.
ANDERSON ENGINEERING
P.O. Box 240773
ANCHORAGE, AK 99524
(907) 522-7773
Cell (907) 441-4000
JoB Lot 6, Vern Haik Subdivision
SHE~ NO OF
MEA 9/29/00
CHECKED 8Y DATE
SCALE Horiz. 1 "=10 ' Vert. 1 "=3 '
MEMORANDUM
DATE:
September 20, 2000
TO:
FROM:
Jeff Poet
Mike Anderson, P.E.'~~
SUBJECT: Lot 6, Vern Haik Subdivision
Certificate of Health Authority A'pproval
Attached is a copy of the Soils Log for Test Hole No. 3 completed during the
construction of the absorption trench on Lot 6, Vern Haik Subdivision. The soils
encountered in this test hole were identical to those encountered in Test Hole No. 1
with a percolation rate of 15 minutes per inch.
Please et me know if additional information is required prior to the issuance of the
Certificate of Health Authority Approval for this. lot.
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: MM&M Contracting
Legal Description: Lot 6, Vern Haik Subdivision
~LOPE
OG/OL
Test Hole No. 3
Date Performed:
t
SITE PLAN
See System Site Plan
1
11
12
13
14
15
16
17
18
21
Silty Sand
w/Gravel
SM
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring P
Date: E
Bottom of
Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
· Perc. Rate: 15 Min./In. Perc. Hole Diameter:
Test Run Between:
Comments: Soil Material is Identical to That Encountered in Test Hole No. 1.
Performed By: Tim Kimbrough 1, i h I E. Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 6/14/00
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONiSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 23, 2000
Expiration Date: Jun 23, 2001
Permit Number: SW000192
Legal Description: VERN HAIK LT 6
Design Engineer: 0014Anderson Engineering
Owner Name: MM&M Contracting
Owner Address: PO Box 670495
Chugiak, AK 99567-
ParcellD: 051-061-84
Site Address:
Lot Size: 24731 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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 of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must nofif~ DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
Received By:
Issued By:
Date:
June 14, 2000
Municipality of Anchorage
Department of Health and Human Services
825 "F" Street
Anchorage, AK 99502-0650
Subject:
Lot 6, Vern Haik Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Pro oerties
Dear Onsite Services Engineer:
The owner of Lot 6, Vern Haik Subdivision intends to construct a three-bedroom home
on the lot. We are hereby requesting a permit be issued to construct a septic system
on the property to serve the house. The attached Site Plan and backup documentation
identify the location and configuration of the new system and alternate site. I! also
provides details as to the soils conditions and percolation rates in the area of placement
for the septic system The subdivision is currently served by a community water system
and no conflicts exist between the new septic system and water service lines in the
area
Two test holes were placed on the lot to determine the Subsurface soil characteristics.
Both holes were similar and revealed silty sand material with some gravel. The
percolation rate varied from 5 to 15 minutes per inch. The system is designed for the
slower rate of 15 minutes per inch. No groundwater was encountered during the
placement of the test holes and none was noted during the ensuing monitoring period
We have therefore designed a deep trench system wi!h 7' of dra n field rock beneath
the distribution piping. 'The piping will be placed at 3.5 below the surface and the tota
depth Of the new trench will be 10.5'. A minimum of 3' of cover will be provided over the
trench and 4' over the septic tank.
The groune surface on the lot slopes from east to west at gradual and varying slopes
up to the mid point of the lot where it slopes much more dramatically. The new system
will be constructed in an area where the slope is fairly flat. The absorption trench wil
be placed parallel to the contour lines in the area and at least 50' l'rom any break in
grade greater than 25%.
If the system is 'constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no aaverse impact on the wells
in [he area or those to be constructed in the future. The subdivision is currently
served by a community water system
Eot 6, Vern Haik Subdivision
June 14, 2000
Page Two
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as desigr~ed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area
The system, if constructed as designed, will have no adverse impact on drainage
patterns in ti~e area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
III
THIS
59o52,35,,
Access
',asement
7
AREA MAP
SCALE 1" = 100'
N89°55'26
I
t
C
r
DAWN LANE
10' utility Easement
3'
41' Lonq x
x 7' Elf. Depth
Absorption Trench
Bluff
Area
~oTH1 Alte
Site
0% l%r
SITE PLAN
SCALE1"=30'
NOTE: Lot Is Served By A Community Water System. No Conflicts Between
Tank and Water Services or Mains in the Area.
hate
0
Z
0
LOT 6, VERN HAIK SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home
Perc. Rate: 15 Min./Inch
Application Rate: .8 GPD/SF
Deep Trench System
1,000 Gallon Septic
7' Drainfield Rock
Tank
3 Bedrooms X 150 GPD / .8 GPD/SF = 562.5 SF of Absorption Area
562.5 SF/14 SF/ LF of Trench = 40.2 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral 4 1 '
in Length with 7' of Drainfield Rock Beneath the Distribution Pipe.
Distribution Pipe in Trench Placed at 3.5' Below the Original Ground Surface.
Total Depth to be 10.5' From Original Ground Surface. Insulate or Mound Over
Trench to Provide a Minimum of 3' of Cover.
6';
Backfill
3'
__Geotextile
Fabric
4" Perforated
PVC (Slots Down)
~Drainfield
Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE:
Grade Area Over Trench to Drain Away.
Provide 3' Cover Over Trench and 4' Over Tank or Insulate.
Maintain 10' Separation From Lot Line,
Maintain 10' Separation From Water Service Line.
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: MM&M Contracting
Legal Description: Lot 6, Veto Haik Subdivision
;LOPE
OG/OL
Test Hole No. 1
Date Performed
SITE PLAN
See System Site Plan
1
11
12
13
14
15
16
17
18
21
Silty Sand
w/Gravel
SM
Bottom of
Test Hole
Was Groundwater
Encountered? No
If Yes, What Depth?
Depth to Water
After Monitoring None P
Date: 6/14/00 E
Reading Date Gross Net Depth To Net
Time ~Time Water Drop
1 6-Jun 9:00 2"
2 9:20 30 4" 2"
3 9:21 1.75"
4 9:51 30 3.75" 2"
5 9:52 2"
6 10:22 30 4" 2"
Perc. Rate: 15 Min./In. Per,c. Hole Diameter: 8"
Test Run Between: 6' and 7'
Comments: Test Hole Presoaked Prior to Percolation Test.
Performed By: Tim Kimbrough I, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 6/14/00
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: MM&M Contracting
Legal Description: Lot 6, Vern Haik Subdivision
OG/OL
Test Hole No. 2
5
6
7
;LOPE
Date Perforrr
CITE PLAN
See System Site Plan
8
9
10
11
Silty Sand
w/Gravel
SM
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring None P
Date: 6114100 E
12
13
14
15
16
17
18
21 '
Bottom of
Test Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
1 6-Jun 8:50 2"
2 9:20 30 8" 6"
3 9:21 1.75"
4 9:51 30 7.75" 6"
5 9:52 2"
6 10:22 30 8" 6"
Perc. Rate:5 Min,/In. Perc. Hole Diameter: 8"
Test Run Between: 6' and 7'
Comments: Test Hole Presoaked Prior to Percolation Test.
Performed By: Tim Kimbrough I, Michael E. Anderson Certify That This Test Was Perfo~
in Accordance With All State and Municipal Guidelines In Effect On This Date: 6/14/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 6, VERN HAIK SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,000 gallon septic tank at the location shown on the Site Plan. It
also includes the construction of a new 41' long x 3' wide x 7' effective
depth absorption trench. The total depth of the trench shall be 10.5'
below the existing ground surface. In addition, the trench must be
placed a minimum of 50' from any break in grade greater than 25%. A
minimum of 3' of ground cover is required over the trench and 4' over
the septic tank to prevent freezing. Direct bury insulation may be
placed to reduce the amount of protective cover.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all appiicable State and Municipal Wastewater
Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. The new 1,000 gallon septic tank must be procured from an approved
source and installed at the location shown on the plans.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade. ,
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 6, Vern Haik Subdivision
June 14, 2000
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
A silt barrier or geotextile fabric must be placed between the drainfietd
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
Grade area surrounding the absorption trenches to drain away.
A minimum 2' of accepting s0il is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall 'be fitted with watertight couplings
(Caulder, Fernco, or equal).
Lot 6, Vern Haik Subdivision
June 14, 2000
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes; cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
COSA to be released to the engineer, unless otherwise requested by the engineer
COSA Fee $V1Jaiver Fee $
Date of Payment 191961426 96 Date of Payment
Receipt Number CjieReceipt Number
COSA # .: 0 �yC' �otl D9 ... Waiver #
i
,. ,- .. Y•' ,..;r..-.. �9.'. �'-. , 'Ch ,<!i2iLLr .-'3�:5. k..'G7{�wdv"�:.i�tY:fv`ikl@htl'i-.?rF,i.t,M,,.,i l:'•::31'•ii': ..�:_�. `'�, L. ....si7.-,.:ACiF..G,.
5. STATEMENT OF INSPECTIONBYENGINEER
As certified by my seal affixed hereto and as of the validation date shown pelow, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval'Cuidelines 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 furthef:4 enfy'th'ai" used-ofa 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. I acknowledge that On -Site staff may visit the site. to verify the information:submitted.
Name of Firm Crewdson Engineering LLC Phone 907-280-9493
x020:
System #1 Approved for ,3 bedrdloms '
System #� Approvec>l for bedrooms
Disapproved
Conditional approval -for ' '"bedrooms;'inith the`foltovuing stiputatior����
,. ,. .` r'f, t. ., . t: ... ', Fv!tlC 1 ,:7; .)). !}i.- ..r. .,... ,j", :•s,)+i7?.rC- ..! . of ti,.. ,,`,
4.
By: ---- Original Certificate Date: 3
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given In ara ra h 5 an Inde endent rofessional cliril'ert Int erre" isteried In thd'State of Algike" l'"unici alit of Anchorage is
9 P 9 p Y P P 9 9 P Y _ 9
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: _..-....... ...
COSA Checklist . X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory .... Uther ...._ ...r
COSA Checklist blue sheet
' l .
F
COSA Checklist
Legal Description: Vern Haik Lot 6 Parcel ID: 051-061-84
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. urcI
Public Water System #211431
Comments
B. TANK DATA
C. LIFT STATION
Age of tank(s) 19.8 years
❑ Required::maintenance,completed
Tank type/material Steel
Age of lift station years
Measured operating fluid level in septic tank 49°
Lift station material
❑ Standpipes/foundatfon c(eabout per record drawing
Comments:
Date of pumping 4/20/2019
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/3/00
Adequacy test date 3/12/20
❑ ALL standpipes present per record drawing
Results M Pass For 3 bedrooms
Total measured depth from grade 11.3 ft (max)
Fluid depth prior to test 18* in
Measured depth to pipe invert from grade 4.3 ft (min)
Water added 450+ gal
❑ N/A — pressurized field
24*
New depth in
❑ Monitor tubes go to bottom of effective. If not, state-
75
depth into effective
Elapsed time min
❑ Code -required soil cover over field
Final fluid depth 19* in
❑ System presoaked
Absorption rate `450+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) No
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencieslincludes approximately 18" of sludge
in bottom of monitor tube
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
elle: (Please enter distances if less than required or if community well)
Public Water System #211431
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No 5+* ft
Surface Water > 100' Yes if No
ft
Property Line > 5'Q Yes if No ft
Wells on'Adjacent Lots:
Absorption Field > 5' Yes if No ft
Private Wells ,> 100' „- M✓ Yes .]f` No
Water Main > 10' ` Yes if No ft
Community Wells > 200' ✓V Yes if iso
ft..
Water Service Line > 10' Yes if No ft
If septic tank is under driveway comment below
From Absorption Field 66 C'ot to (please enter distances if
less than required)
Building Foundation > 10' Yes if No ft
If absorption field is under driveway- comment below
Property Line > 10' Yes if No ft
Wells on Adjacent Lots:
Water Main > 10' Yes if No ft
Private Wells > 100' U Yes if No
ft
Water Service Line > 10' F/ Yes if No ft
Community Wells > 200' Yes if No
ft
Surface Water > 100'✓Q Yes if No ft
F. ENGINEER'S COMMENTS
per inspection report approved on 9/29/2000
„r. 0f A4 Xis
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections
and review / * ' H .*I
•
of Municipal records that the.above systems are in conformance with'
MOA COSA
l '
guidelines in effect on this date.
p Jarr3
p
i
cii
COSA Checklist yellow sheet
Municipality of Anchorage
Development Services Depsrtment
Building Safe~ Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O, Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 051-061-84
1. GENERAL INFORMATION
Expiration Date: Z'- / 7- /¢'~
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
VERN HAIK LOT 6
24738 CHUGIAK DRIVE *CHUGIAK , AK 99567
CHARLES MIESLER Day phone
24758 CHUGIAK DRIVE *CHUGIAK ~ AK 99567
Day phone
c/o
AGENT
GORDON SLOANE W/ REMAX Day phone
110 W. 38TH AVE. *ANCHORAGE, AK 99503
244-3381
Unless other~ls.e requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class A Well · Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
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 pedod 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.
STATEMENT OF iNSPECTiON BY ENG N~ER
c~luxeu~ eLo aS ~,~ ,.i¢e Vc~nuc~uO~i
As cer~/fied by my seat ~'-~' ~ .... and ×,,~ .~,.,~,, _ date shown be/ow, I verify,i,~ ...... ,,,y
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this appfication,
shows th.2t the on-s/re ~4~,'.er supp!y ~nd/or ,.,.~ste~ter dispose! system, is (~re) safe, functiona! and ~o'equ~te
for the number of bedrooms and type of structure indicated herein. I fu~her verify that based on the
IR; .F.~,-~ ;~,a.,~o~~,,,~'~t~*~i~"l ,¢ro,~,, .,,~¢'/~~,~,4 .-~ i,-. b-~ ~..~h~yl¢-~,~'F/~'~R'~r~"'~~,,,~,,~,~ .,~il~ ~,,~ ,-~ ,.,/,, ~,,, .Fr-,,~ ~ ,,,.~/', ' ' ~-',.-¢~'~, ,[~w'c"~'f~/w~¢'i'~'~ a,~H,,~ "'~t-'~'~' ',i~e ,-~,'-fi,"~ r~ .,,~f~z~
on-site water supply and/or wastewater disposal system is(are) in compliance with afl appficab!e Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 357-6179
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date ~/¢(=,//¢
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidefines & 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 afl 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 control of the evaluator 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. GEG, LTD. can 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 this report is for
t,he 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' 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory'
Well Flow Adviso~
Nitrate Advisory
ArssRic ^ ~' ':
Maintenance Agreements
Supplemental Engineer's Report
Original Certificate Date: ~ - / 7 -//
Municipality of Anchorage .......
Development Services Department
Building Safety Division < ' "
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
Legal Description: VERN HAIK LOT 6 Parcel ID: 051-061-84
A. WELL DATA
Well type A If A, B, or C provide PWSID# 211431 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)_,.--""'"'
Total depth ft. Cased to ft. Casing height ~d) in.
FROM WELL LOG AT INSPECTION
Date of test ~_
Static water level ~ _ .ft.
Well production _...--~ g.p.m. _ g.p.m.
WATER SAMPLE R~8~~~.
Coliform _..---~colonies/lO0 mi. Nitrate mg./L. Collected by:
~ ug./L. Date of sample:
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tanksize 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date installed 8/2/00
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
Date of pumping gl/3 o/10
' /
ABSORPTION FIELD DATA
Date installed 8/3/oo
Length 41 ft.
I'BELOW EXISTING ORADEI
Soil rating (g.p.d./ft2o~ 0,8
Width 3-5 ft.
Total depth '11.58 ft. Eft. absorption area 574 ft2 Monitoring tube YES
Date of adequacy test 8/10/11 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 22 in. Water added 1217gal.
Elapsed Time: 0 min. Final fluid depth 22 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
TRENCH
System type DEEP
Gravel below pipe 7 .ft.
Depression over field NO
For 3 bedrooms
New depth 22 in.
450+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at
Size in gallons
Manhole/Access
in. "Pump off" leveL--High water alarm level at
Cycles tested.
in.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Meets alarm & circuit requirements?
COMMUNITY WATER
On adjacent lots
On adjacent lots _.-.-~
.P_ubtic-s~wer manhole/cleanout
Public sewer main ~
Sewer/septic serv~ -----~, Holding tank
~nt areas, storage areas
Manure/animal
excrete
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water. 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 200'+
Water main N/A
Driveway, parking/vehicle storage
10'+
F. COMMENTS
*ASSUMED PER AS-BUILT SURVEY-C/O IS VERY
G. ENGINEER'S CERTIFICATION
! certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date ~ /I/o /l/
CLOSE TO 10' SETBACK.
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
8251K
DAWN LANE
LOT 5
N89°52'35"E 125.63
15' Elec. & Telecomm. ~
Easement
LOT 6 ~
33
?
\ - I/ I o
Gravel ddveway
C°nc' b'°ck re" I
~1 ~ ~ z -,-
~
~Sto~FZHouse:[ '~ Z = SCAL~: 1"=40'
62.0 J-
~onc. block ret wall [ '
chain link fence (~p) :~ 33
.
LOT 7
~ OF AL~), I hereby~at Ihave ~do~d a MoAga~e'sins~o%
~. · .... '~"-
J~ '-~ ~ VERN HAIK SUBDIVISION
2.."49TH~ '".~ ~
...... ~ ..........
_~/~' ~ improvemen~ situated ~ereon am ~i. ~e prope~ lines
rrea wala[Ka ~ ~ ro n
..'~' adja~t ~ereto, ~at no impmvemems ~ ~e p ~ ~ g
¢ffO~ ...... "~ ~ ~ ws[ble easemen~ on said pro~ ex.pt as ~nd~t~
Dated at Anchorage, Alaska
this 28th .day of March ,2008
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES
PLAT ARE NOT SHOWN HEREON. FB 08-2, pg 15-16 Engineers and Surveyors
BE (907-248-1666)
Municipality o.f Anchorage
Development Servtces Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.a nchorage.ak.us
(9O7) 343-79O4
CERTiFiCATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-06t-84
Expiration Date: ...5"--- '7- O ~
1. GENERAL INFORMATION
Complete legal description Lot 6~ Veto Haik Subdivision
Location (site address or directions) 24738 Chu,qiak Ddve
Current Property owner(s) Geor,qe and Dawn Haynes
Mailing address 24738 Chuqiak Drive Chu,qiak~ AK 99567
Lending agency
Day phone 265-2758
Day phone
Mailing address
Real Estate Agent Lynn Swanson Day phone 689-6464
Mailing Address '16635 Centerfield Drive Ea,qle River~ AK 99577
Unless otherwise requested, HAA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS:
Three (3)
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A_.. Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individ,u, al On-site []
Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Depadment (DSD) Issues Cedificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
titJe (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 less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) CedJficates are valid for one year for properties served by Class A or B wells or a public
water system. The MunicipaIity of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Legal Desczipt]on:
WELL DATA
Wee type ;;ass A
Data completed
Total depth
Date of test
Municipality of Anchorage
Development Services Department
Building Safety Division
'On-Site Water & Wastewafer Program
4700 South Bragaw St.
P.O. Box 196650 Anclxxage, AK 99519-6650
www.cLanchomge.ak.us
(Sm3 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 6, Vem Halk ~_,~ ~h,~dslon
Parcel ID: 051-~61.84
~f k e, er c provide PWStO #~'5'2 t- £,~-OA~e~ Log (Y/N)
San~,ry sea~ (Y/N) W~.as prepe~y pmtactad (Y/N)
Cased ta __lt. Casing height (above ground)
FROM WELL LOG AT INSPECTION
Static water level
weu producflun
WATER SAMPLE RESULTS:
Date of saml:de:
SEPRC/HOLDING TANK DATA
Tank Type/Material ~e~d~teel
Tank~ze '1,~00 gal.
FoundaUon deanout (Y/N) Y_
Date of pumping
ABSORPTION FIELD DATA
Date installed ~r2000
Length 4t
Tot~ depth 11 fl.
Data of adequacy test
g.p.m, g.p,m.
Numb~ of Compartments _2
Depression aver tan~ (Y/N) N
Pumper ~ Pumping
C4eanouts Om) Y
High water alan~ O'/N) N
For bedrooms
Now depth in.
g.p.d.
Fluid depth in absorption field before test in. Water added gal.
Elapsed Time: min. Final fluid depth in. Absorption rote >=
Any rejuv~natlon Ireatmeflt (past 12 mo.) (Y/N & type) N
Soil rating (g.p.dJIt~ or ~AxIn~) ,.8 OPD/SF, System type
lt. Width ~5 ft. Gravd below pipe 7
Eft. absoq:)tlon ama 574 fl~ Monitoring tube Y Depression over fluid N
Results
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051 -061 -84
1, GENERAL INFORMATION
Complete legal description
HAA# 0 0
Expiration Date:
Lot 6, Vern Haik Subdivision
Location (site address or directions)
Current Property owner(s) MM&M Contracting D~y phone
Mailing address P.O. Box 670495 Chugiak, AK 99567
688-1236
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
=
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS: Three
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class A Well []
Public Water System []
(3)
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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 less than 30 days old. 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.
5. 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 the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is 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 in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation,
Name of Firm
Address
Ande~on Engineering Phone .~773
P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DHHS SIGNATURE
/,.--"'" Approved for ~ bedrooms.
Disapproved.
Conditional approval for
Date 9/14/00
bedrooms, with the following stipulations,
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
Legal Description:
A. WELL DATA
Well type A
Date completed
Total depth
- Municipality of Anchorage E C E I V E D
Department of Health and Human Services ~[p [ 4 20~)1]
Division of Environmental Services
On-Site Services Section 825 '%" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650MUNIOIP/~,ITY OF ANCHORAGE
www. ci.anchorage.ak.us F-.NVIRONMI~NTAL SERVICES DtVISION
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 6, vern Haik Subdivision
Sanitary seal
ft Cased to
FROM WELL LOG
Parcel LD.:
051=061-84
If A, B, or C provide PWSID # 211431 Well Log
Wires properly protected __
ft Casing height (above ground) __
AT INSPECTION
Date of test
Static water level ft
Well production g.p.m
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Date installed 8 / 2 / 00 Tank size
Cleanouts ¥ Foundation cleanout ¥
Date of pumping New 'Construction
C. ABSORPTION FIELD DATA
Nitrate mg/t Other bacteria__
Oollected by:
ft
g.p.m
in.
colonies/1 O0 mi
1,000 gal Number of Compartments 2
Depression over tank N High water alarm __
Pumper N/A
Date installed 8/3/00 Soilrating (g.p.d./ft20rft2/bdrm) .8
Length 41 ft Width 3-5 ft Gravel below pipe 7
Total depth 11 fl Effective absorption area 574 ft2 Monitoring tube
Date of adequacy test New Const. Results (Pass/Fail)
Fluid depth in absorption field before test __ in Water added
Elapsed Time: min Final fluid depth in
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
N
System type Deep Trench
ft
Y Depression over field N
For bedrooms
gal. New depth
Absorption rate >= __
If yes, give date __
in,
g.p.d.
72 026 (Rev. 01/00)'
D. LIFT STATION - N/A
Date installed
"Pump on" level at __ in
Datum
E. SEPARATION DISTANCES
F.
Size in gallons
"Pump off" level at in
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Manhole/Access
High water alarm level at ~n
Meets alarm & circuit requirements
No Well on Lot - PWS
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation > 5 ' Property line > 5 '
Water main N/A Water service line > 10 '
Drainage > 100 ' Wells on adjacent lots > 200 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 10 ' Building foundation > 10 '
Water Service line > 10 ' Surface water > 100 '
Curtain drain None Noted Wells on adjacent lots > 200 '
COMMENTS
Absorption field _ > 5 '
Surface water > 100 '
Water main N/A
Driveway, parking/vehicle storage > 10 '
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 effebt on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 9/14/00
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*