HomeMy WebLinkAboutCURRIN LT 1Currin
Lot 1
#017-341-16
Municipality of Anchorage Page of Z
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SL,) dip o S 6 �( PID Number: Of '34 I ^
Name:/`7 Ck I .
K n j
Wastewater System: .New ❑Upgrade
Address:
ABSORPTION FIELD
Phone:
No. of Bedrooms:
a( Deep Trench C Shallow Trench G Bed C Mound C Other
LEGAL DESCRIPTION
Soil Rating:
0' �
Total Depth from a7 grade:
GPD/S Ft
Lot: Block: Subdivision:
Depth to pipe bottom from original grace:
Gravel depth Dene to pipe
G
�• �! Ft
Fr
Township:
Range:
Section:
Fill added above on �i al grade:
Gravel lengtn:
r
2 i Ft
SCJ Ft
WELL: grNew ❑Upgrade
Gf1vQ1 Wi01" 20
Number 0,llnes:
o°WCa Demean kraal:
Ft
Ciassibca((yll//on 1Privale. A.B.C):
Pit
Total Depth:
Cased To:
Total absorption area: `
Pipe material: •�
!.
24& FI
2•{(o Ft
T / 0 SO Ft
303
Driller: O
Date)INI ea:
!
Stauc water Level:
I SSS
Installer:
SP
Date in Iced
r
04
00
Ft
rL M"!::eyw-It,
Yield:
A�
/V 4
Pump Set at:
Casing Heignt Above Ground:
Z.
TANK
GPM
((r1k gyry Ft.
Ft,
SEPARATION
DISTANCES
1 ?�Septic ❑Holding 3S.T.E.P.
To
S"lic
AD nn.c ,
4n
Hoid.ng
Phain P.rvata
Manu@cturer.
Capacity m gallons:
From
Tan.
l id
Su.on
Tank
Smr4nas
/119.
/2Q0
Welt
/Op��
/OJ
04
Matenst:
51• -et,
Numoer of Compartments:
?_1
r
Water Surface
�
/oo�*
/o
LIFT STATION
Lot
/
y0 t' 'T
r
+-
r
Size ns: Manufacturer.
Line
Foundation
/�
'LQ�.f-
/
"Pump on" level at:
'Pump I a[:
High water alarm at:
CurtainK
&1_4
Pump Make & Model
Electrical Inspections performed by:
Drain
Remarks: geril 10{- k l, Q IV -CV
BENCH MARK
")
nor NMMOAU raY� e0irA
Location and Descri/prion: .yf�1
AD til ,J r
Assumed Elevation:
UO. fy0 c.
+f�BlN6l4'E�\�
...
0. • A [.qs�l
II
49tH
Inspections performed by: t�/Il�hae(T1�Qryct+loon Dates: l s
'•" ""
2nd T� y °d Zip,
SAICHAEL N. :00
j �0, CE -9 69
f
Department of Heal and Human Services approval
f;if+f.sl z;,• :�6�_r
r
Reviewed and approved by: Date: 2 U2
72-017 (pit. 2191( MOA 25
Permit No. SW000364
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 1, CURRIN SUBDIVISION PID No.: 017-341-16
I I '� ADJACENT SEPTIC '
0 ADJACENT WELL 100' RADIUS
a I ------N 88'39'17' E 262.75'
�\ .0.6 MONITORING TUBE
z SEPTIC FIELD
DOUBLE C.0.3 & 4
\ .( TANK C.0.1 k 2 WELL 100' RADIUS
0
� cv
WJ
W
W D
D
� o
W
O W
O •'
n o
N
3
in
a
\\ \ C.0.2
A
B
GRND.
PIPE
ELEV.
\\%.0.5
COI
55.5
1,250 GALLON
99.5
96.56
SEPTIC TANK A
/moi
C.0.1
9.6
99.24
96.72
TCO2
13.0
HOUSE 4
99.0
CO3
W
24.0
99.1
95.88
C04
11.4
24.0
99.1
95.88
WELL w
o
-----------�
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Z
666
10' TELECOM AND ELECTRIC EASEMENT
77.7
N 89'58'05' E ',242.53'
— G R I F F I N R 0 A D—
ASBUILT
SCALE: 1"=40'
MARK
A
B
GRND.
PIPE
ELEV.
ELEV.
COI
55.5
44.5
99.5
96.56
CO2
22.2
9.6
99.24
96.72
TCO2
13.0
21.5
99.0
CO3
11.4
24.0
99.1
95.88
C04
11.4
24.0
99.1
95.88
N�
20.6
45.5
97.5
95.1
666
1 66.1
77.7
97.98
95.05
SEPM
N
-10
U.
OF• Alga 111
M *:49TH •:*+�I
10'- MICNAEL N. ANDERSON :0
a't �'•• CE 9469 �� j
LEGAL DESCRIPTION: 10,1- / Crylrj n Township. Range, Section:
DEPTH/�• /�SLOPEE SITE PLAN
1FFFT O� • a � 1 1 1 1 1
I y:j
1
2 ] 1
LsGSPi
4
5
6
7
/we �/, /rG
s] I Tshd.r w/O PA,
WAS GROUND WATER
to
10
/L
ENCOUNTERED? /L
11
i
:•49*H
9
kf
Municipality of Anchorage
e ...
/.
.:4
• ..
...
DEPARTMENT OF HEALTH & HUMAN SERVICES
• •*- �
• • �=
625 "L" Strom Anchorage, Alaska 99502-0650
MICHAEL N. ANDERSON
SOILS LOG — PERCOLATION TEST
f
��•. CE•9469
•
tri qOw
PERFORMED FOR: A4Iek9tr
DATE PERFORMED:\
LEGAL DESCRIPTION: 10,1- / Crylrj n Township. Range, Section:
DEPTH/�• /�SLOPEE SITE PLAN
1FFFT O� • a � 1 1 1 1 1
I y:j
1
2 ] 1
LsGSPi
4
5
6
7
/we �/, /rG
s] I Tshd.r w/O PA,
14
15
16
17
16
19
20 t I 4
U PERCOLATION RATE f Z (mmutayulcnl PERC HOLE DIAMETER
�`-TEST RUN BETWEEN FT AND—f—FT
COMMENTS I --Z y y 4*/-rM Q 0
PERFORMED BY: � lle• CA 1,clt/^ 1 CERTIFY THATT IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE �� I m
WAS GROUND WATER
to
10
/L
ENCOUNTERED? /L
11
IF VES. AT WHAT
DEPTH?
12
13
Oto to Wow A49
Pnv aim
14
15
16
17
16
19
20 t I 4
U PERCOLATION RATE f Z (mmutayulcnl PERC HOLE DIAMETER
�`-TEST RUN BETWEEN FT AND—f—FT
COMMENTS I --Z y y 4*/-rM Q 0
PERFORMED BY: � lle• CA 1,clt/^ 1 CERTIFY THATT IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE �� I m
Rick Mystrom
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 1" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http:lN✓wnv.a.anchorage.ak us
Permit Number: #SW 000364 Date of Issue: 9-11-00
Date Started: 10-1-00 Date Completed: 10-2-00
Legal Description: Currin Lt 1
Property Owner Name & Address: Michael Hutchins
Parcel Identification Number: 017-342-16
Is well located at approved permit location? ® Yes ❑ No
Borehole Data:
Soil Type, Thickness & Water Strata
Depth (ft)
From To
Method of Drilling ® air rotary ❑ cable tool
Casing type: steel
stick-up
0
2
Wall Thickness:. 025 inches
silt
2
4
Diameter: 6 inches Depth: 246 feet
gravelly silt
4
18
Liner Type:
silty cobbly gravel w/bldrs
sandy silty gravel
water sand &grave!
18
230
241
230
241
246
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 155 feet
Pumping level: 246 feet after
2 hours pumping 10+ gpm
Recovery Rate: 10+ gpm
Method of Testing: air lift
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: Bentonite # 8 Volume: 1 b¢
Depth: Start 0 feet Stopped + feet
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Clorine Tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
P O Box 110496
Anchorage AK 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
rnamar nr fha wall Axillar ehall a '.'Al Ino fn tha nla f of"'l I4h R, ".'m Carvirac within rn 'lave of rmm�latinn
Municipality of Anchorage
y� George P. IPuerch, Mayor
BtAldind Safety M ision
P.O. Box 196650 • 4700 S. Br-agaw Street
Anchorage, Maska 99519.6650 • (907) 343.5301
h llp://ai%ic.cl.ancliorngc.ak.us
5/21/2002
Michael N. Anderson
Anderson Construction & Engineering
4640 Shoshoni Ave.
Anchorage, AK 99516
Subject: Waiver Request for Currin Subdivision Lot 1
Waiver Request 4WR020016
Parcel ID #017-341-16
Dear Mr. Anderson:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
2.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
A;-'/- Atiz
Daniel J. Roth
Civil Engineer
On -Site Water & Wastewater Program
Municipality of Anchorage
Development Services Department
� Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WR020016 PID#: 017.341.16
Date Received: 5116102
Legal Description: Currin Subdivision Lot 1
Engineer. Michael N. Anderson
Applicant: Michael Hutchins
Waiver Requested: Lot line waiver of absorption field to North lot line of 2 feet
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: Waiver is not Granted:
List Conditions or Reasons for above: 51EF_ n 7Tri,-j/ F_,0 L E /T /E' 0.r T u S T/Fl e -X rlON
Date: 17 o /0 2 By: 044
Name of Reviewer
Rec#: 19790 Amount: $150.110 Date Paid: 5116/2002
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DEARMOUN ROAD
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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
ONSITE WASTEWATER DISPOSAL SYSTEM f WATER SUPPLY PERMIT
Initial
Permit Number: SW000364
Legal Description: CURRIN LT 1
Date Issued: Sep 11, 2000
Expiration Date: Sep 11, 2001
Parcel ID: 017-341-16
Design Engineer. 0088 Anderson Construction & Eng'g Site Address:
Owner Name: Michael Hutchins Lot Size: 40089 SQ. FT.
Owner Address: 570 Gamer Rd. Total Bedrooms: 4 Permit Bedrooms: 4
Cave Junction , OR 97523 -
This permit Is for the construction of:
❑; Disposal Field Z 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 notify 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 sail 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.
Y " 6 -0O 7I19cijco I2E ✓l. tl a -s -le N t�N2,
/1-3-00
Received By:
Issued By:
Date: v
Z,
Date: 9 -//- O -r)
Michael N. Anderson, P.E.
4640 Shoshoni Avenue
Anchorage, Alaska 99516 RECEIVED
Phone 345-3377
Fax 345-1391 NOV 0 3 2000
Nov 3, 2000
Department of Health and Human Services
P.O. Box 6650
Anchorage, Alaska 99519-6650
Re: Lotl Curin Subdivision Permit # SW000364
To Whom it may concern:
t,;u•i.c,patry of Anchorage
O.,pt Haatth d Human Sarvices
This is a request for a revised permit to the above location. The new well has been located on the
opposite end of the lot due to the reshaping of the lot and a drainage ditch being located on the
south side next to Griffin Road. When the grading was finished standing water was found in the
road easement. Thus a new test hole was excavated on the north west end with the same soils as
the original test hole, silty gravel to a depth of 19 feet, with no water table found. This revised
plan will be a better layout and will give 100 feet to any surface water. The new test hole log will
be included with the ashuilt drawings.
If you have any question please call me at 345-3377
Sincer 1�
ichael Anderson, P.E.
DESIGN CRITERIA:
4 BDRM X 150 = 600 GPD
SOILS = 600/0.8 = 750 SQ FT REQ'D
750/14 = 54'
I / a
TRE "H: RR`
7' EPF`ECTIVE2.v
54'I L- - ----- -�
NG
' I
/ I EXISTING WELL \
/
/ I 100' RADIUS
I/
I
t
I
I
i
I
0
a
0
a
Z ADJACENT SEPTIC
9'17" E 262.75'
H#2
— NEW 1,250 GALLON
SEPTIC TANK /
L NEW SYSTEM
I--------�
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U
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/ w
/ I
/ o
/ p
Ic
/ IG
/
F
—
--r-- — — — —— —J 10
N 89'58'05" E\ 242.53'
- G R I F F I \N R 0 A D -
SEPTIC DESIGN PREPARED FOR
MIKE HUTCHINS
LOT 1
CURRIN SUBDIVISION
PREPARED BY
MICHAEL N. ANDERSON, P.E.
14250 N. GOLDENVIEW DRIVE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1 "=60
) OVER
aSRIC
ADJACENT SEPTIC
NI \
NI
31
IN �
I
o \
\
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ZI \
1
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i
.TELECOM AND ELECTRIC Ell,
/
/
NOVEMBER 3,2000
Y
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.........
\
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Z
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Z ADJACENT SEPTIC
9'17" E 262.75'
H#2
— NEW 1,250 GALLON
SEPTIC TANK /
L NEW SYSTEM
I--------�
I�
U
' IJ
/ w
/ I
/ o
/ p
Ic
/ IG
/
F
—
--r-- — — — —— —J 10
N 89'58'05" E\ 242.53'
- G R I F F I \N R 0 A D -
SEPTIC DESIGN PREPARED FOR
MIKE HUTCHINS
LOT 1
CURRIN SUBDIVISION
PREPARED BY
MICHAEL N. ANDERSON, P.E.
14250 N. GOLDENVIEW DRIVE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1 "=60
) OVER
aSRIC
ADJACENT SEPTIC
NI \
NI
31
IN �
I
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ZI \
1
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.TELECOM AND ELECTRIC Ell,
/
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NOVEMBER 3,2000
Y
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.........
Michael N. Anderson, P.E.
4640 Shoshoni Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Sept 6, 2000
Department of Health and Human Services
P.O. Box 6650
Anchorage, Alaska 99519-6650
Re: Lotl Currin Subdivision
To Whom it may concern:
This is a request for a permit for a new 4 bedroom residence being developed on the above lot.
Two test holes were excavated for the soils investigation. The first test hole was on the west end
of the lot and had about five feet of overburden. Therefore I moved east along Griffin Road and
found good silty gravel and no water. The perc was 12 minutes per inch thus the new system will
be a deep trench with 7 feet of effective depth and 54 feet long. The lot is 0.9 acres with the
natural slope being to the south-west as the plan shows. None of the surrounding properties will
be effected by this new upgrade.
If you have any question please call me at 345-3377
Sincere) An'L
Micarson, P.E.
I
NEW WELL
100' RADIUS
r I
o �
a i
I `
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I
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I
N 88'39'17" E 262.75'
10' TELECOM AND ELECTRIC EASEMENT
N 89'58'05" E 242.53'
SEPTIC DESIGN PREPARED FOR
MIKE HUTCHINS
LOT 1
CURRIN SUBDIVISION
PREPARED BY
1
1
1
I
I
I
1
C.O.
ADJACENT SEPTCI
/47
�sqs
- G R I F F I N R 0 A D -
MICHAEL N. ANDERSON, P.E.
14250 N. GOLDENVIEW DRIVE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1"=30'
AUGUST 28, 2000
THg1
MONITORING TUBE
I
I
/7
� IW
V� I
U I
K
r-
IO W
u I
EXISTING HOUSE
d I
/
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o
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/
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o
/
I
/47
'
/
I/
NEW 1,250 GALLON
TANk
SEPTIC TANK C.O.
1
'IIt
-------------'
L___________DOUBLE
C.O.
L.
10' TELECOM AND ELECTRIC EASEMENT
N 89'58'05" E 242.53'
SEPTIC DESIGN PREPARED FOR
MIKE HUTCHINS
LOT 1
CURRIN SUBDIVISION
PREPARED BY
1
1
1
I
I
I
1
C.O.
ADJACENT SEPTCI
/47
�sqs
- G R I F F I N R 0 A D -
MICHAEL N. ANDERSON, P.E.
14250 N. GOLDENVIEW DRIVE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1"=30'
AUGUST 28, 2000
THg1
MONITORING TUBE
DESIGN CRITERIA:
4 BDRM X 150 = 600 GPD ,
SOILS - 600/0.8 —750 SQ FT REQ'D -
750/14 = 54'
10' DEEP
7' EF�ECTIVE
2.0' IDE— —
54' LONG
I /-
�N
R�
/- c.\)
/ I
I
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I
NEW WELL
I 100' RADIUS
---------- I JJJJ`.
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= I
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ADJACENT SEPTIC
E 26275'
1
I
1
1
1
1
1
NEW 1.250 GALLON
SEPTIC TANK
THI1
N 89'58'05' E 242.53'
- G R I F F I N R 0 A 0 -
SEPTIC DESIGN PREPARED FOR
MIKE HUTCHINS
LOT 1
CURRIN SUBDIVISION
PREPARED BY
MICHAEL N. ANDERSON, P.E.
14250 N. GOLDENVIEW DRIVE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1"=60'
OVER
BRIC
1c.v �1
I� cl;I
IW �I
I� 31
O O
IW of
Io ZI
F I
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------
10' TELECOM AND ELECTRIC EASEMENT
SYSTEM
AUGUST 28,2000
0FA�`>l
y: `s Q • Zeal
:49TH • ;
M.ICI:AEI N. A. X RSCN•.
'%• CE 9'69
1 i Pn°cEESSIs' �'�'=
e ti MunicipaUty of Anchorage
DEPARTMENT OF HEALTH b HUMAN SERVICES
825'V Street. Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: Mf �e'C t� {` �Cf ti ti DATE PER
LEGAL
2
KI
4 Foo4� `�r'�I� `iroYe
5
GM
6
7
8
9
Township, Range. Section:
SLOPE
10
WAS GROUND WATER
N
ENCOUNTERE0?
it
AkCf RSLN��
CE V.9
It
IF YES. AT WHAT
DEPTH?
12
W to Wer Ae
13
Mawrup? 1.1�nG But
14
15
16
17
le
19
OF A�•q
SITE PLAN
UPERCOLATION RATE Iminutavincnl PERC HOLE DIAMETER
rr- ff TEST RUN BETWEEN1 S FT AND (C' FT
'OMMENTS �'{- NOIG chm—_ �o rc)*Q.
PERFORMED BY: k O'Q int AL I CERTIFY THAT T IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE yr5ov
72-= (Ft". 4,951
......s
�
�V0,% MICHAEL N.
AkCf RSLN��
CE V.9
It
SITE PLAN
UPERCOLATION RATE Iminutavincnl PERC HOLE DIAMETER
rr- ff TEST RUN BETWEEN1 S FT AND (C' FT
'OMMENTS �'{- NOIG chm—_ �o rc)*Q.
PERFORMED BY: k O'Q int AL I CERTIFY THAT T IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE yr5ov
72-= (Ft". 4,951
FEB -12-2001 NON 12:17 PN KC CORPORATION FAX NO. 9072788018 P. 01
From : PLPItE DRILL 907 345 0202 Feb. 12.2@01 e1:21 tY1 P01
Municipality of Anchorage
Department of Health and Human Services
V6 *V street
P.O. Bat 1ONM Aneh SP. Aiaslca Yclili-0
mck A" mn MmW~v sneroses skoa
k%W
Permit Number: NSW 9W64 Date of lace: 1.1100 Parcel Identification Number. 017,42.16
Dole Sbrled: 10-1.00 bate Completed: 1¢2-00 Is well loceted at *Mwevod permit I00e110n7 ® Yes Q No
Lent Tkocriptloot Currin Lt 1
Property Owwer Naraa ! Address: Michaet Nutching
Aonhole Dazs.
Mob (n)
Metpod of DrIWv; N,& rotary ❑ 0" tool
Soil Typo, niemm A Wala Stmla
Tram
To
Caning type: W
stick-up
0
2
WallTbicknea:,025 urcha
set!
2
4
Diameter. 8 htches Dcpth: W feet
graveky MT
4
18
Liner Type:
a�ffY c0bbly wvvei w/Malta
18
230
1)ianvwr ixbcs Depth-. _facet
Gstcg stickup above gnooad: 2 ftmt
sandy stay gramf
230
241
Static water level (from ground level): ZRRet
waleraend & grave!
211
246
TampIRS level:-Z4e foci aft"
2 hours pumping ,f+ gpm
Recor•ry Rate: lQ+ ilpn
Method of Testing: AM
Well Intake Opeaiag Type:
® Open End ❑ Open llolc
❑ scroctwd Sun � foot Stoprod — fact
❑ Perforations Sten foot Stopped _ teat
Groat Type: Begionfls 4 8 Volamtu j -y
Ilepth: Sun 0 foot Supped ± fees
Pomp: Intake Depth _ h d
IlunV sire _ bp Brand Name
Well Didateded Upon Completion? ® Yes ❑ No
Method of Dwateetloa:
Comments -
Wall Driller. AtpMe Dilft d EnlerpAaes
P O Boz 110496
Anobora0e AK 941811
Attention: The well dnlla shall provide a wall Ing to Urn property owner whhin 30 days of complollon and the property
M•..w n ltu %-,I fwn" .Ivan .w...iA. • wan inn to IM nmo wr I r..Mr. L 1 J••.•.w Cwr ;i wam. fin A.w Af rn.. A ;,.•
Municipality of Anchora
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 s Fax (907) 343-7997
http://www.muni.orci/Onsite
Development Services Department
On -Site Water and Wastewater Program
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Jeff Garness
Legal description: Currin Lot 1
❑Permit ®C.O.S.A. ®Inspection Report
n,e.nr
SFr
J
V n
Department
The attached paperwork has been reviewed and is being returned for the following reasons:
1. Updated water samples required.
Name of reviewer: Jeff
Date: 1-19-10
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage . E
• '� Development Services Department -.``.
Building Safety Division ` s
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-341-16 COSA# 10Q00�
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
Expiration Date:
5025 GRIFFIN ROAD * ANCHORAGE, AK 99516
RAY LEGURUE Day phone
5025 GRIFFIN ROAD * ANCHORAGE, AK 99516
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
E
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
947-5909
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
E
Individual Holding tank
❑
Community On-site
❑
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 period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems 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 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
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 Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of 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 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 MDA 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 person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone
337-6179
Date I D /z.6 0C,
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By:
(Rev. 11105)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Repot
Other
Original Certificate Date:
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE
OF ON-SITE
SYSTEMS
APPROVAL CHECKLIST
Legal Description:
CURRIN
LOT 1
Parcel ID: 017-341-16
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 10/2/2000 Sanitary seal (Y/N) YES
Total depth 246 ft. Cased to 246 ft.
FROM WELL LOG
Date of test 10/2/2000
Static water level 155 ft,
Well production 10+ g,p,m,
WATER SAMPLE RESULTS
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 24 in.
AT INSPECTION
10/13/2009
222 (t.
5.26 9.p -m.
Coliform Q colonies/100 ml. Nitrate Ie a t mg./L. Other bacteria colonies/100 ml.
Arsenic: N 0 ug./L. Date of sample: 10/13/2009 Collected by: GEG Ltd.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 11/4/2000
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 8/19/2009 Pumper AROUND THE CLOCK PUMPING
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
Date installed 11/4/00 Soil rating .p.d./ r ft2/bdrm) 0_8 System type TRENCH
Length 50 ft. Width 2 ft. Gravel below pipe 7.5 ft.
Total depth *10 ft. Eff. absorption area 750 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 10/13/2009 • Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 51 in. Water added 605 gal. New depth 63 in.
Elapsed Time: .1 E0 min. Final fluid depth 54 in. Absorption rate >= 600+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off'
Manhole/Access (Y/N
Hiah water alarm level at _
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot too '+ On adjacent lots 100'
Absorption field on lot 100,+ On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
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 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *21 Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*WR#020016
G. ENGINEER'S CERTIFICATION
1 certify that t 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 10 1 "lu e)
COSA Fee S lig 0
Date of Payment ///
Receipt Number OJr a 3
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
SGS Ref.#
1095560001
Client Name
Gayness Engineering Group, Ltd
Project Name/#
Currin Ll
Client Sample ID
Currin Ll
Matrix
Drinking Water
PWSID
0
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
10/26/2009 13:40
10/13/2009 14:30
10/13/2009 15:40
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
PQL
Units
Method Container ID
Limits
Date Date Init
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
EP200.8 C
(<10)
10/22/09 10/23/09 NRB
Waters Department
Total Nitrate/Nitrite-N
1.81
0.100
mg/1,
SM20 4500NO3-F B
(<10)
10/20/09 LCE
Microbiology Laboratory
Colony Count 0 col/100mL SM20 9222B A (<200) 10/13/09 DLC
Total Coliform 0 col/100mL SM20 9222B A (<I) 10/13/09 DLC
Fecal Coliform 0 col/100mL SM209222B A (<I) 10/13/09 DLC
4.
7-a-im
Municipality of Anchorage
Development Servides Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-341-16
1. GENERAL INFORMATION
Complete legal description Currin Lot 1
HAA #� D
Expiration Date: D 28 04
Location (site address or directions) 5025 Griffin Rd, Anchorage, AK 99516
Current Property owner(s) James & Isabel Giles
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
5025 Griffin Rd., Anchorage, AK 99516
Day phone 336-0811
Day phone
Beth Simpson / Dynamic Properties Day phone 727-2384
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well✓❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the ate of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water sampl
des.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated 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 Watkins Engineering, Inc.
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis
Phone 349-1851
Date 7/23/04
:
5. DSD SIGNATURE y,•., Cindy W. Ellis
X_ Approved for —4—bedrooms. , CE -10577 `F
-..
Disapproved. ssioiw o *
Conditional approval for bedrooms, with the following stipulations:
'S C'
Additional Comments `c ini°Tc
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: C�L�' Original Certificate Date: z 8 ��
(Rev. 01102)
IVAU111G.
Developmi
8
r)n.RifwI
korage
partment - + i <;
-ogram
I'IY�VY.
ft."Moo 2 ¢8q ft,
Bumper wvuulariu vuniNn'_y qr.
k
pmt �a y�y a
�!'IGLY �NIN e ;F w.,v/.vrv" il 111111
8ti °b�'Cs
Soil rating jQ51hr ft2/bdrm)OT8 System type deep trench
. TMjC m RoWO,. w .`.`m`�'e.� " '�' : W ".w"k.'r�,�'xi'S. a"%�
ft id,h•g Gravel Below p pe 7• ft. �$
_ ft. -' ff 'a corp ron ares - Monitorin
g tube _ Depression over (e d _
acy est T .� Results (Pass/Faiq PA�"� Fora bedrooms..
V':"7'"SOME n +
e�t'„�'•�'"s
5
;a a.n. ..a I ,ar.-.a ,aw, xl ,.� ; ttWil .,,, c.. k'.. h �_ . �A •C"rw
Pump o High water alarm level at in.
.ty
n.,m.. w%ad kexm xev.',
Cvcle§ festeii beets alarm & circui"t requirements.
line
on aalacent rots ,vim
fetermined through field inspecfl6ns and
*' 49Th
"*
records that the above systems are in
tOA HAA guidelines in effect on this date
Fame Cindy W `Ellis j r
��U��,���> .:ti ;.1�>v �„���,�;.�a� ..���„�.��
��'•• CE-los» ; •�c`
.. ,:< ,n..uw ,✓:. ..C:i+ ... .m ,x,.a. .,r-<wYax'rk:� „a�..,
,,,,r ...
'3' C'�( Date of Payment
,..
,
rr
�h _ Receipt Number
07-23-04 11:52AM FROM -CUE ESI, SGS ENV SERVICES
ii
—S&%—
)GS Relit
1044287001
Tient Name
Watkins Engineering
Project Name/ti
5025 Griffin
Client Sample ID
5025 Griffin
Matrix
Drinking Water
PWSID
0
--------------
Sample Remarks:
Results PQL
Waters Department
Nitrate -N 1.04
9075615301 T-227 PA2/02 F-418
All Dates/Times are Alaska Standard Time
Printed DatelTime 07/22/2004 14:50
Collected DatelTime 07/16/2004 11:10
Received DatwTime 07/16/2004 14:20
Technical Director / Stephen de
Released By
Allowable Prep Analysis
Units Method Committer ID Limits Date to
0.100 mg/L EPA 300.0 H (<=10)
07/16/04 JR
Microbiology Laboratory 07/16/04 DK
Total Coliform
0 col/100mL SM209222B A (<-1)
00'95 L 3„SS, L ❑00 S
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Municipality of Anchorage o
• Development Services Department
j Building Safety Division
/ On -Site Water and Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519650
www.ci.anchorage.ak.us
(907) 343-7904 F .`U
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. vi -3W^ I. Co HAA# H R 0 ;2 o O
Expiration Date: / - / S 0 3
1. GENERAL.INFORMATION
Corrplete'legal description.
,.Location.(site addre;;.ocdieections)
Current Property owne(s) Nit r k aT ( 44m t e- ti ir e, Day phone z s S, - Z -t4 2 5 -
Mailing address p 7 5 ti s Fob ✓r � t c w u �h � (1 /t �
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:'
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
1A
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated 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 14 c -k a-PIAIt. 4 j C V 4 0A P, fz�/. // Phone
Address y&zUo QosAon Ae—J�-cAA ?q5(& J/
Engineer's Printed Name NSI -r k uP I A( Xh 4 r i fah Date &//570 2_
OF
:4
5. DSD SIGNATURE �/�NX36W N. 46DERSCN
Approved for bedrooms. f 1)/or •Q•?,,
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
���� t�Ch0
\\ri
r
\ G • r
Jam: ON -Silt •• "G).:
Additional Comments WATER AND rn
WASTEWATER
PRO -RAM
O.(� RA
�IJ�CC�pENT
i� ``\`
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: 6�11�/ ut✓. ���� Original Certificate Date: 10 — /.S- 0;2�
(R. o1IC3)
OCT -15-02 10:02 AM DIRT MAN MIKE
•�: �•i..�.a •,iator ari :a;;a•a;ar ..•1; Bpi �3C ;?�,.
ti': 'e•": !2't:SM ifC14".'if Fr:;F: vlpMrl. Sr:
r . CT►E Env,ronM#nl$l6$rvicer b+c.
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Municipality of Anchorage
• Development Services Department e
Building Safety Division?'.
On -Site Water and Wastewater Program 1
4700 South Bragaw St. ' " "•
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.ancharage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. HAA # W20200
Expiration Date: 0,Z / /OZ
1. GENERAL INFORMATION
Complete legal description Cu rr, n Lv+ .5 /P
Location (site address or directions)
Current Property owrier(s) —M(I-6 r I V% 4 r 6,M s Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
0 G n, MW W CaV'c_
Day phone
TiRESA 9ELL Day phone
PRuDraTi,aL T.9Ckk-RI -
Unless otherwise requested, HAA will he held by DSD for pickup.
12 `%r2 S 23
2. NUMBER OF BEDROOMS:
`f
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
,Q
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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 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) 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.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated 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 Mte'�' XnJ eq xn // 0, Lz,
Address q(p StioS�on� �nr�i/f% 99S((o
Engineer's Printed Name AIT /%r�ir�i
5. DSD SIGNATURE
Approved for 4_ bedrooms.
Disapproved.
Phone 3` s--3,3 ?-;-
Date
.r F
.r 1 ..F q 1
EN S 'Ylll
i*:49T0.-0. �) :*!�
I .pO: WCHAEL N. �ANDERSON . �c %
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
F.
ON-SITE
WATER AND
wASTEU�ATE
PRDGRAM
��j��JJim IIj11,�I,
Maintenance Agreements
Supplemental Engineer's Report
Other
By:�/ / C(tc�C� 9 Original Certificate Date: f 2 1 02
(R.r. IZOC)
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.cLanchorage.ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 4, 4Y- / Cu r r, m Parcel ID: CJ/ 9 - 3 At / -I %
A. WELL DATA
Well type r, t+rt �eIf A. B, or C provide PWSID # _
Date completed /DO Sanitary seal (YIN)
Total depth r (L ft. Cased to !tL& ft.
FROM WELL LOG
Date of test ro s. eo
Static water level
Well production A9 1< g.p.m.
Well Log (Y/N)
Wires property protected (YM) - X—
Casing height (above ground) min.
AT INSPECTION
ft.
9.p -m.
WATER SAMPLE RESULTS:
Coliform -Lcolonies/100 ml. Nitrate Q, 4(0 mg.A. ,` // ,A� Other bacteria -(—colonies/100 ml.
Date of sample: Z f/ 0 E/ Collected by: M IV 4
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material - dc7 •� l
Date Installed //� u
Tank size 12Sb gal.:.: Number of Compartments?- Cleanouts (YIN)
Foundation cleanout (Y/N) Depression over tank (Y/N) 1 High water alarm (Y/N)
Date of pumping ' Pumper
C. ABSORPTION FIELD DAT47.
Date installed A o Soil rating (g.p.dJfV or ft2/bdrm) System type 'F r er r � ,
Length ft Width Z , O ft. Gravel below pipe 7 ft.
Total depth q'5- ft. Eff. absorption area 75V fe Monitoring tube Y Depression over field 2V
Date of adequacy test � Results (Pass/Fail)
Fluid depth in absorption field before test e in. Water added gal.
Elapsed Time: /_ min. Final fluid depth 7e_1' in. Absorption rate >=
For bedrooms
New deptf�n.
g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at _in. 'P lfsieDE
Da Cycles tested
E. SEPARATION DISTANCES
_ in. High water alarm level at
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankiliftl4ation on lot lot)
r
r
Absorption field on lot / !Py +-
Public sewer main N /,4
Sewer /septic service line
Meets alarm S circuit requirements?
On adjacent lots U r if—
On adjacent lots / 0 D r rL
Public sewer manhole/cleanout N
14
Holding tank N 1,4 .
SEPARATION DISTANCES FROM SEPTIC) TANK ON LOT TO:
Building foundation to 1.1 Property line `4 d /� Absorption field /V
Water main N Water service line (od /� Surface water /00 {
Wells on adjacent lots (4J ( -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line S 1 f Building foundation 7-0 /F Water main /u d
r
Water Service line /OJ I Surface water /0 0 It- Driveway, parkirVwhicie storage/011)
Curtain drain 1,4 Wells on adjacent lots /oo
r
F. COMMENTS
att OFG. ENGINEER'S CERTIFICATION d4p % ...... t.'QS%%1�
I cedffy that I have determined through field inspections and 00 y •y 1'
review of Municlpal records that the above systems are in Of 90 i V k
conformance with MOA HAA guidelines in effect on this data.
IM .. .....
Engineer's Printed Name t �e c � A( /FA YI cj. r f 6u�t % JO :Wit ;
rte•• 9 9 •�``i
Date S�iS/o z.- f �lif+le':'•.::•?•'.�E'1�0��
HAA Fee $ 3735-
D ate
?TDate of Payment
Receipt Number U q ? R ()
(Rev. 72(00)
Waiver Fee $ /25,0
Date of Payment S�Y o -L—
Receipt
LReceipt Number O ( 1,4Q 0
In.
CTLE Environmental Services Inc.
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All Dstes![unes ire Alaska Standard Time
Printed Dalcaime
002S2CO2 16.13
Collected DeWrinte
03.26.2092 1::30
RecrlvedDtteltltw
04126,2002 16:25
Technical Df�ctn St n C. Ede ._
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