HomeMy WebLinkAboutSTEELE ESTATES LT 1I Esta
Lot I
#051 - 122-61
Municipality of Anchorage Page / of.~'-
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
Permit Number:. ..B/~, ~5O2. Z, 7 PID Number:.
LEGAL DESCRIPTION
Wastewater System: ,~ew rm Upgrade
ABSORPTION FIELD
~'r~allow Trencl~ PI Red PI Mound 00tl~ar
Trench
so,, ..,,,..:
~ S.T.F-P.
SEPARATION DISTANCES
w.,, I,.,,,o.
Surface
Water
LIFT STATION
Lot
Une
Foundation /"/0 '
Curtain
Drain
Remarks:
¥
BENCH MARK
ENGINEER'S SEAl.
Inspections performed by: ~',~-,.~ 5' Dates: 1st/~,/;
, . . 2n~
...~.(ol/~l~. '' .
Depa~ment of mealTn anomuman ~e~lces approval
Reviewed and approved by: ~1~ [0~ .Date:
Municipality of. Anchorage Page / of
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
N,me: WastewaterSystem: ~ew D Upgrade
/25~3 ~/~ ~ E~ ABSORPTION FIELD
phone~U__~O~ No. of~ms: = Deep Trench ~.llowTrench OB~ OMound DOther
SEPARATION DISTANCES ~,ic e Ho,~.g ~ S.T.E.P.
Line Lot
Drain ,
Remarks: BENCH MARK
Inspections pedormed by:
Permit No. -- SW950227
Page. 2 of 2
Municipolity of Anchor(]ge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchoroge, Aloske 99519-6650 · Telephone: .345-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legol Description: STEELE LOT t
(ND]' TD SCALE)
PID No.: --050-122-6!
i
SCALE
' 1"=60'
· MONITOR TUBE
o SEWER CLEANOUT
WELL
L~HFIELD
-- -- - EJ~$EMENT
10-5-95
ENGINEER'S SEAL
~¢~." a ".~.
~'-
~%; .......... ,...~
EAGLE RIVER
ENGINEERING SERVICES
P,O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 95-078
Calculated By: LB
Date: 10/6/95
Legal: STEELE LOT 1
Single Family 3 Bedroom Dwelling
TEST HOLE '1
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom-- 450 gallons
Percolation rate = 11 minutes per Inch
Wastewater application rate = 0.8 gallons per day per square foot
Required absorption area = 563 square feet
Trench width(W)= 5 feet
Gravel depth(D)= 2 feet
Required length -- Shallow trench factor * Required absorption area / W
Shallow trench factor -- (W + 2) / (W + 1 +2 D)
Shallow trench factor-- 0.70
TotalExcavation Depth = 5.0 feet
Required length = 79 feet
( erlifieh rilling
b~
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99587 · TELEPHONE ~.2759
DATE- S~"ed Ended
PE~Mn NUMBER S~
/~)EI'TH OF V~ELL J /d~'
STATIC LEVEL OF WATER FT. / ~
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION: ...
From ~.~_.£t. to ~'" Ft. 0~'',-)t~'~ /30~'"/]~''~'~ From FI. to.'
From _l~ Ft. to ~'~" FI,
F,om 2,~ FI. to ~-C Ft.
From I I ~ FL ,o I I ~ F,.
From ,I / ~' Ft. to__FL
From ~ Ft. to FL
' F~m Ft. to Ft.
From Ft. to
From __ Ft. to
Ft.
Ft.
FI,
FI,
Ft.
Ft.
Ft.
Ft.
Ft.
From Ft. to Ft.
FI. lo--Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
Fmm Fi. to Ft.
Fmm Ft. to Ft
From __Ft. to__Ft.
From Fi. to Ft.
From Ft. to__Ft
From Ft. to__Ft.
From FLto Ft.
From Ft. to.~FI.
'From FI. to Ft
MISCL. INFORMATION:
RECEIVED
0BT 1 ? 1995
Munic~paht¥ o{ Ar~charage
Dept. Health & Human Services
DRILLER'S NAME C~''~ ~
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:SW950227
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:STEELE MARK J & KATHLEEN A
OWNER ADDRESS:17434 SANTA MARIA
EAGLE RIVER, ALASKA 99577
PAGE 1 OF
DATE ISSUED: 8/18/95
EXPIRATION DATE: 8/18/96
PARCEL ID:05112261
LEGAL DESCRIPTION:
STEELE ESTATES LT
1
LOT SIZE: 57452 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION 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 ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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.
Louis Burets, P.E.
Registered Civil Engineer
August 8, 1995
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Steele Lot 1
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic system will have very limited impact on adjacent properties for the following
reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve apace is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please emil our office at 694-5195.
Sincerely,
Louis Butera, P.E.
~G:\WPDO CS~ 1995\95-07SA.NAR
P.O. Box 77329.1 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax {907) 69,1-3297
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 95-078
Calculated By: LB
Date: 8/8~95
Legal: STEELE LOT 1
Single Family 3 Bedroom Dwelling
TEST HOLE
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 450 gallons
Percolation rate
Wastewater application rate
Required absorption area
Trench width (W)
Gravel depth (D)
11 minutes perlnch
0.8 gallons perday persquare foot
563 square feet
5 feet
3.5 feet
Required length -- Shallow trench factor * Required absorption area / W
Shallow trench factor -- (W + 2) I ON + 1 +2 D)
Shallow trench factor-- 0.54
Total Excavation Depth -- 6.5 feet
Required length-- 61 feet
_~.~.. .........
LOUIS A.
~'-. c[-~ .."(~
.............
~ - TE~T HO~
· - MONITOR TUD~
~ - WELt.
NO SURFACE WATER +100' PROPOSED L~CHn[~
NO KNOWN CURTAIN D~INS . ~SEMENT
~EPTIC ~ITE P~
OWNER: JOHN THOMAS ~<~.-'"
CONT~ACTOm ~/~ ~2..~9m~ ".~
EAGLE RIVER ENGINEERING SERVICES
EAGLE RIVER, AK. 99577
(~07) ~4-~ I ~ FAX: (~07)
PERFORMED FOR:
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "'L' Strew(. AnchO~lge. AJeskll 99502-0~50
SOILS LOG ~. PERCOLA'TION TEST
S-
6-
7-
8- ~
g.
wA~ GROUND WATER
ENCOUNTER ED?
12
13
IS
18
17.
18.
Ig.
I
t LEGALOESCRIFTtON' ~"t~,4c /' ,,4 Z,k~,~(M~/''~'''' ~'~' T~sh~p. Ra~.~i~:~)~ ~ [~
SLOPE SITE P~N
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Steele, Lot 1
08108195
GENERAl.
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
SFIALLOW TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth of
the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 6.5' at any point.
4. The sewer line shall be laid level to within 0.03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED I.EACHFIELD DIMENSIONg:
TOTAL DEPTH = 6.5' GRAVEL DEPTH = 3.5' under pipe, over pipe
TRENCH LENGTH =61 ' TRENCH WIDTH = 5'
SOIL RATING = 0.8 GPD/fta BEDROOM CAPACITY = 3
SEPTIC TANK = 1,000 gallons minimum
Twenty-four (24) hours notice required for all inspections.
G:\WPDOC$\1995\95-07SA.S PC
MUHMP „ UTY OF " HCHORAGE
O/,(rte
f -; tlti�
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 051 122 61
1
Certificate of On -Site Systems Approval
, Expiration Date:
GENERAL INFORMATION
Complete legal description STEELE ESTATES LOT 1
Location (site address) 22330 MIRROR LAKE
Current property owners) BROWN
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
I 'NUMBER OF BEDROOMS:
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
17 1
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: NONE 4 Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 9 1
Date of Payment
t gyri, go( (u S/ -I)
Waiver Fee $ _
d
7/2Z 2bZo Date of Payment
Receipt Number 30,t�
COSA# 05Cab 1 `-1 `1 b
61010h
Receipt Number
Waiver #
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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on -pita water cl_1nn[v and/ctr wastewater dianncal system is fnrel cafe, 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation.
Name of Firm C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
` 1` ` n A i Z A R'"I
Engineer's Printed Name �'nrLMo oH'-�Hnllvl
6. DSD SIGNATURE
-System A l App. - . -- f-. bedrooms
System #2 Approved for bedrooms
Disapproved
Date 8/28%2020
AW
OF A/�slli
�rc�'�P' • TH
CHARLES G BALZARINI P
r������is�' . • CE -13854 ..���;WW
�11Nk? PROFESSIONt'�
Conditional approval for bedrooms, with the following stipulations:
By: �� _ � � Original Certificate Date: 01-z3 r Z0
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
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 Other (Gini. e 2 'I r-
COSA Checklist blue sheet
•
Legal Description: STEELE ESTATES LOT 1
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
X Well log is filed with Onsite (or attached)
Date drilled 1995
Total depth 118 ft
Cased to 118 ft
F0 Sanitary seal is functioning correctly
MR Wires are properly protected
Casing height (above ground) +12 in.
Date of flow test for COSA 8112/20
Static water level at beginning of test 41 ft
Comments
B. TANK DATA
Age of tank(s) 25 years
Tank type/material STEEL
Measured operating fluid level in septic tank 50
0 Standpipes/foundation cleanout per record drawing
Date of pumping 6/3/2019*
D. ABSORPTION FIELD DATA TRENCH
Which system tested (date installed) 1995
X ALL standpipes present per record drawing
Total measured depth from grade 7 ft (max)
Measured depth to pipe invert from grade 5 ft (min)
❑ N/A — pressurized field
R Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 051 122 61
Structure served by this system 1
Well production at time of test 2.7 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ❑ N
❑O Coliform bacteria is Negative
Nitrate 2.18 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by C.Balzarini
Date of Sample 8/17/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/12/20
Results M Pass For 3 bedrooms
Fluid depth prior to test 7 in
Water added 450 gal
New depth 11 in
Elapsed time 30 min
MW Code -required soil cover over field Final fluid depth 7 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) If yes, enter date y NA
Gallons introduced NA gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0
Yes
Community Sewer Manhole/Cleanout > 100'
P7 Yes
if No
ft
0 Yes
if No
Neighboring Tank > 100' El Yes
if No
ft
Private Sewer/Septic Line > 25' F Yes
if No
Absorption Field on Lot > 100' El Yes
if No
ft
Holding Tank > 100' El Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' a❑ Yes
if No
® Yes
if No
ft
Surface Water > 100'
El
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' M4 Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100'
ft
ft
ft
ft
M
El Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100' 0 Yes if No
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200' 0 Yes if No.
Water Service Line > 10'
El Yes if No
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot 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'
El Yes if No
Water Service Line > 10'
El
Yes
if No
ft
Community Wells > 200'
El Yes if No
Surface Water > 100'
El
Yes
if No
ft
F. ENGINEER'S COMMENTS
Home has had approximately 4 months of usage
since last pumping.
Pumping not
required.
G. ENGINEER'S CERTIFICATION
I certify that 1 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. 9/18/20
COSA Checklist yellow sheet
of q�,, 1tl
C.
49 TH
W . .•
-�- �H �O
CHARLES G BALZARINI
r����c�s� • . CE -13854 • .��ieie
i llF9F0
PROFESSION
ft
ft
ft
ft
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On -Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC201490
Subdivision: Steele, Lot: 1
The septic tank for this property is 25 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Parcel I.D. #
1.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section .
P,O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
051-122-61 HAA# ~ ~'~cl-43~ ~ t'l ~
GENERAL INFORMATION
Complete legal descriptior~,l~2
St:eele ~' Lot I
Location (site address or directions)
NHN Lake Shore D=ive
Property owner John E. 13~mson Day phone
Mailing address 17345 Ranta Ma~-~a D'cive. Eaqle River. Ak 99577
Lending agency Nor~,~st/Don ~'esser Day phone
Mailing address 16635 Center~ield Drive, Eagle River, A~ 99577
Agent N/A Day phone
Address
696-50?0
694-114~
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. - TYPE OF WATER SUPPLY.'
NOTE:
TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual well x
Community well
Public water
If community well system, provide written confirmation from State ADEC att,'st-
ing to the legality and status of system.
X
Individual on-site .
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by ~ny seal affixed I~ereio and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows 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 ii in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date Of this inspection.
Nam~ of Firm ' E~cJle R±ver Engineerincj Serv£ces Phone 694-5195
99577'
Address P.O. Eox 773294, Eaale River. AK
Engineer'i signature
o..s S,G.^TU.E
~,; Approved for ~ bedrooms.
DisaPproved.
.. Conditional approval for
Date '///z'~/~2 ~''~
bedrooms, With the following stipulations:
Additional Comments
BY:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an Independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's'work.' '
, ~ Municipality of Anchorage
DEPAR'rMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L' Street, Room 502 · Ancllorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
Log pre~cm (Y/N) ~ Dam complctccl
To~U ~ //~'
Sanitary. scaJ
Casing height (above groundl
Wires property
Dal~ of test
Satic wat~ I~'~1
Weii production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
FROM WE[~ LOG
,$
AT INSPECTION
'~-- Nitratc
E SEi'FiC/Hi~ut~k~ TANK DATA
D'aminstaUed~T*-ksize ~/4~ Number of Companments ~ Cl~aaouts(Y/N)..~_..~
Fouadafio. clmaoal (V/N) /~ D~mssio. (Y/N) /Aff/~ Fli~h watcr alarm (V/N) ,,'A//-4
Soil rating (g.p.d./f~; ~ D.
~'1 Gravel thickness below pipe
Effective absoq~ion area ~d5 '~ Z~'Moaimria~ ~ preset(Y/N) y
Date of adequacy I~1
Fluid ~ in absorption field before test (in.);
Fluid depth (ins.) Minutes lat~':
Immcdiamly_ ~
----,~n rate = g.p.d.
If yes, give date
Date itmalled Siz~ in gallons
l~mhole/Access (Y/N'} "Pure "~:Me~T~'~'~* "Pump off' level
High water Mann level al* ~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic./hotdmg tank on lot
Absorption field on lot j/t:~ /
Public sc,vet main
~ /sepUc .rviee
: On adjacent lots
: On adjaeenl lots
Public sewer manhole./cleanout
L~n
SEPARATION DISTANCES FROM SEPTI~ TANK ON LOT TO:
SEPARATION DISTANCE FROM ABSORFHON FI~-I~ ON LOTTO:
c~i. d,~. /V/,'~
,/
Driveway. pa~king/.hide ~rage a~a /'~3 '
F. ENGINEER'S cisKTIFICATION
in conferee .i~ MOd [t~ ~idelines in effect on ~ date.
-
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
R~'~e~pt Number
Rex,. 8/95 OSS: haa.wk.doc
Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ I ~'~ at, or pdor I
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As ce~fied 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 Authodty 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 bedreoms and type of structure indicated herein. I further vedfy that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
NameofFirm ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Phone 357-6179
Address 6901 DEBARR ROAD, SUITE 2B" ANCHORAGE. AK 99504- "~////o/~
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date ~
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The repealed results descrfbed 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 during the year, and the water usage of the family being served by the system.
These conditions ara outside the control of the eveluator of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
there ara no hidden defects or encroachments. AKWWC. Inc. can therefore not provide
any warranty or futura 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
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 6ght whatsoever.
5. DSD SIGNATURE
J Approved for ~ bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisor,/
Well Flow Advisory
bedrooms, with the fllowing stipulations:
~: WATERAND :
PROGRAM .'
....
Manitenance Agreements >"/./.~;~ ~E,~
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Soulfl 6mgaw St.
P.O. Box 196650 Anc~e0 AK ~9519-6650
www.d.ancttorage.alc ss
(907)
Legal Description:
WELL DATA
Wall type Pt~VATg
Date completed
Total depth 118
Date of test
Static water level
HEALTH AUTHORITY APPROVAL CHECKLIST
STEELE EST. S/D; LOT 1
9/1995
ff.
IfA, B, or C provide PWSID# N/A
Sanitmy seal (Y/N) YES
Casedte 118 ft.
FROM WELL LOG
0/1995
18 ft.
Parcel ID: 051-122-61
Well production `3 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Amanic: N,/A mgJL.
SEPTIC/HOLDING TANK DATA
Tank Type/Material ~ l'P. P. L
Tank size 1000 gal. Number of Compartments
Foundation deanout (Y/N) YES
Date of pumping 5/2,3/2002
ABSORPTION FIELD DATA
Date installed lo/3/lgg$ Soil rating (l[~or fl~edrm) 0.8
Length 92(2046) ft. Width 5 ft.
Wall Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
5/25/2002
,32 fl.
2.6 g.p.m.
24+ in.
Nib'ate 1.7,3 mgJL. Other bacteria 0 colonies/100 mi.
Date of sample: 5/2,3/2002 Collected by: A'WWC. INC.
Date installed 10/5/1995
2 Cleanouts (Y/N) YES
Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Pumper CHUGACH
',lt:~;'l~u NORTH TRENCH ONLY
System M=e SHNJ_OW TRENCH
Gravel below pipe 2 ft.
Total depth ~'-1,' fl. Eft. absorption ama 657 fl2 Monitoring tube YES
Date of adequacy test 5/23/2002 Results (Pass/Fall) PASS
Fluid depth in absorption field before test 1.5 in. Water added '60,3gst.
Elapsed Time: *** min. Finst fluid depth ,3.5 in. Absorption rote
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
*~I'HE FIRST 227 GALLONS CAUSED A RISE OF
***THE LA, ST ,376 GALLONS CAUSED NO RISE. IT CAN BE SAiD THAT WATER WAS
BEING ABSORBED AS FAST AS IT WAS ADDED.
Depression over field NO
For 3 bedrooms
New depth**3.SIn.
450+ g.p.d.
D. LIFT STATION
Date installed
"Pump on' level at
Datum
E.
Size in gallons Manhole/Ace~<v (Y/I~)
in. "Pump off' I~vgl et In. High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
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
On adjacent lots
100'+
100'+
Public sewer manhole/cieanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Pmpen'y 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'+ Building foundation 10'+
Water sew.ce line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
COMMENTS
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 Pr~tecl. Name
Date "?/~c~/O 2.
N/A
Absorption field 5'+
Surface water 100'+
Water main N/A
Driveway. perking/vehicle storage
Fee $
Date of Payment ~7
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
10'+
JUN, 10. 2002 9:30AM LAND TITLE CCN?ANY
ASBUILT ... S~;~/JLt:LO & AS$0CT~[-T~ /~TD 5~VJ~"~t;G 69~-082~
I HEREBY C~TIFY .THAT I HAVE S~ED THE
. ~.~ OF A~_ ~ .,
FOLLOWING D~C~B~ PROPER~
INDICA~. IT IS THE R~N~BIU~ OF THE
Ilffi DO NOT ~P~ ON T~ ~ ~DI-
~ION ~T. UND~ NO ~RCU~NQES ~ F~ ~ DATA H~N BE ~ ~R CON~ION.
OF FENCE LIN~ OR ~R E~ISHING ~O D~WN~
ARY LINES.
06/10/2002 YON 08:29 [TX/RX N0 6464] ~002