HomeMy WebLinkAboutDENALY BLK 1 LT 3Densly
Block 1
Lot 3
#050-731-50
Municipality of Anchorage •' ••
Development Services Department
Building Safety Division •„��
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020090
Name:
PID Number: 050-731-50
Kirk Kniaht
Wastewater System: ® New ❑ Upgrade
Address:
NHN i I
ABSORPTION FIELD
Phone:
Number of Bedroans:
® Deep Trench O Shallow Trench O Bed O Mound E3 other.
LEGAL DESCRIPTION
soil Rating:
Total Depth from original grade:
Black: Lot: Subdivision:
1 3
1.2 GPD'Fe
Depth lo pipe bottom from original grade:
11 Ft.
Gravel depth beneath pipe:
Township: Range:
DENALY
Section:
2.96 Ft.
Fal added above original grade:
8.04 FL
Gravel Length:
1.08 Ft.
39 Ft.
Well: ® New ❑ Upgrade
P9
Gravel width.
Number of lines: Distance between lines:
CWssification (Private, A. B. Cl: Total Depth:
Cased to:
2 Ft.
Total absorption area:
1 NA FL
Pipe Material:
Private 123Ft.
17n
624 Fr
D3034 & F810
Driller Date Drilled:Static
M -W 7/16/02
Water Level:
Installer,
RPC
Date Installed:
1 Ft
9/27/02
Yield: Pump Set at
1 GPM UNKNOWN
Casing Height Above Ground:
TANK
Ft.
2 Fl
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Pnvat
Sewer Line
a ia adurer.
Anchorage Tank
apaaly.
1250GaL
well
100'+
100'+
NA
NA
25'+
Material.
Steel
Number of Comparbnens:
2
Sudace Water
100'+
100'+
NA
NA
LIFT STATION
Lot une
5'+
10'+
NA
NA
Zean"
"` 1e''
Gal
Foundation
5'+
10'+
NA
NA
nip ion level at:
'Pump oM level at:High
water alarm at:
n.
„
In.
Curtain Oran
NA
*50'+
NA
NA
V
Ramp Make d Model
Electrical Inspections performed by
Remarks:
*none known
BENCH MARK
Grinder pump w/in foundation
Location and puon:
Top of wellhead
Tank insulated
Aswmed Elevation:
100 FL
Engineers Stamp
1
OF 4t 11
Inspections performed by: KND Engineering
nSynates: 1 st 9/27/2002
,2nd 9/27/op
..... .............. ....:... j
Developmees Department Approval YA rrl°vlo3
nt
........ . .
�� Kannef:, At. Duff W r
�/
Reviewed and approved by: :Servi
Q
O " l7'O
Date
�tP b CE 7116 �•
F
9� •a
(Row 12m1
1 —
• -asp a.••• �.t��ANN
��� pROFESSI�NP.+�
AS -BUILT
SYSTEM
DETAILS/SITE PLAN
BOUNDARY.
DEN ALY S
LO 3, BLOCK 1
Permit SW020090
TOR TUBE FINAL GRADE
,
''�"
PID#050-731-50
W
GRID:
108.9WTOR
108.9
AC"O "1E' 01103A.DW
A -D= 38.5IW
N 06 LATH
rLL7D! Haat
7
vlmxs
LC)
a 1250 GAL
55,480 S
A-E= 40.0'
. € SEPTIC
1.28 ACRES
t
`
i
t' TANK
SEWER ROCK-
LARGE ROCK
` I
K FELL
96.88 TRENCH 1
(EROSION CO TROL)
.oma
`I
39'
I
�''•
EXISTING 4
BDRM HOUSE
00o
N
`
` `
:o •
CK
'bRlvr
899-7
LE, 1' a 5D' , v
I
• '
'.
WOOD
J
DECK
GRINDER PUM XI TING 1250
WIN i0UN0ATiATION
I
Sp' R
TELEPHONE
PREPARED FORt
KIRK KNIGHT
3628 GARDNER STIR.
ANCHORAGE, AK 99504
(907) 266-3291
FlELD BOOKS
Y 10.94
110.9 108.
BOUNDARY.
DRAWN:
A -C= 30.7'
N "�" °"
TOR TUBE FINAL GRADE
XT
''�"
B -C= 29.3'
W
GRID:
108.9WTOR
108.9
AC"O "1E' 01103A.DW
A -D= 38.5IW
N 06 LATH
rLL7D! Haat
vlmxs
B -D= 37.9'
a 1250 GAL
A-E= 40.0'
. € SEPTIC
104.9104.9
t
B—E= 29.2'
t' TANK
SEWER ROCK-
A—F= 74.4'
106.0 105.9
96.88 TRENCH 1
96.8
.oma
B -F= 66.7'
39'
I
PREPARED FORt
KIRK KNIGHT
3628 GARDNER STIR.
ANCHORAGE, AK 99504
(907) 266-3291
FlELD BOOKS
CoLfn
D:
BOUNDARY.
DRAWN:
VQQ
ST"NC:
CHECKED: KMD
ASOMT.
DATE:
11 1O
DWQ rU.
GRID:
SW36,
AC"O "1E' 01103A.DW
'OB N':
01103
90.87 SON
SCALE, NTS
Lt1dV L U) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
07/29/2002 311%, '4 3453287 M W DRILLING, INC
PAGE 03
� I
M -W Drilling, Inc.
• P.O. Box 110378 • Anchorage, AK 99511 •
9907-345-4000 0 907-345-3287 Fax*
Job No.: 02-121 Project No.: N/A Permit No. SW020090
Groundwater Well As -Built & Loc
♦ Well Owner. _
• Legal Description:
• Hole Depth: 123' ♦ Casing Size:
• Drill Method: Air Rotary
Kirk • Use of Welp Domestic
M RInn4 , 1 . 2
onstruct1011
6" •Cased To: 120.61' Walerial: A 53 Steel
• Well Completion- Perf.
mp Open end X Screen Perforated Method.
•Screen/Perforallon description: None
♦ Grout Notes: (7) Sacks -No. 8 bentonite granules
• Notes:
• Well Development: Method: Air surge Notes:
•Static water level (SWL) 13' (above) (below) top of casing (71p(.).
♦ Well yield test at 10 gallons per minute (CPM)ISeUe tsl►ei46our{6RM) for 24 hours
with = * of drawdown (DD) from static level (SWL).
Method: Submersible pump
• Date of eompletlon: _ 16 July 2002 ♦ Pump Install,
Depth In Leet from
too.of caslnr,
0 TO 2
•T VIA LV
of formations enetr■ted, size of material color and hardness.
Casin sticku
2
TO
9
Fill
9
TO
11
Topsoil
11
TO
-- 34
Gravel:. cobble --_.__-.._
.-._.____. ... _... .._
34
TO
36
Silt layer: brown
36
52
TO
TO
52
104
Siltysravel: c0bbley
Gravelly silt: gray
104
TO
117
Clay
117
TO
123
Water bearip&pavel
TO
TO
TO
TO
TO
TO
TO
TO
Cardttcatn Wits. &U ac Q'ia
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW020090
Legal Description: DENALY BLK 1 LT 3
Design Engineer: 0070 KND Engineering
Owner Name: KIRK KNIGHT
Owner Address: NHN BENDILENT CIRCLE
EAGLE RIVER, AK 99577 -
71a Z y
Date Issued: May 06, 2002
Expiration Date: May 06, 2003
Parcel ID: 050-731-50
Site Address:
Lot Size: 55480 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of.
0 Disposal Field Q✓ Septic Tank D Holding Tank Ej Privy Private Well F� 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: $ G
Date:.5146 G
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. DSW — 73/ — So Permit Number SW 7_02 0
Property owners) Kirk Knight Dayphone266-1ai
Mailing address (1) PO Box 2?0 a�, Anchorage, AK 89599
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd_) Denaly S/D, Rlock 1P 'Lot 3
Legal description (Section, Township & Range)
Lot Size 55,480
Acres/Sq.Ft.
Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
Sewer and Well
®
Water Storage
D
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
re of property owner or authorized agent)
Permit Fees: 94,010u
Date of Payment: _4
Receipt Number: /3G y-7
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
April 30, 2002
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer/well permit — Denaly SID, Block 1, Lot 3
Gentlemen:
Due to the location of the previous testhole, an additional testhole was performed on
April 19, 2002. We have designed our system utilizing the newly performed testhole
(TH#02-1) that was excavated for the proposed 4 -bedroom house. We propose to
install one T wide deep trench. Water was not encountered during the excavation or
during monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. All other items on the previous submittal will remain
the same. Please find the attached plan -design modifications for your approval. We do
not expect there to be any adverse effect on adjacent lots by the development of this
system.
If you have any questions, please contact me at 696-6111/FAX 696-8111
Respectfully submitted,
MD Engineering, Inc.
Attachments: Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER
i DENALY S/D,
S
NO K'BLM rs�TLEN,
_VITH7" R or
NO
PED STE" EXCEPT ASar
ETSr
MO SEPTIC SYSTEMS VTT Z ZW Or
PR�OSED VELL EXCEPT AS NOTED,
DISPOSAL
LOT 3, BLOCK
SYSTEM DETAILS/SITE
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/1.2 GPD PER SO. FT. (2.08 MIN/IN.)= 500.0 S0, FT
500/(21(W) X 8'(D)) (8.0' GRAVEL) = 31.25 FT.
USE 1 TRENCH - 36 (L) X 2' (W) TRENCH
X 8.0'CD)
T
Total depth of system Is 11.0' iron original grade.
Total depth of gravel below distribution pipe Is 8.0'
NOTES ,
I. USE 1250 GAL, SEPTIC TANK AND INSULATE IF <4' OF COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM, IF <3' OF COVER
3. CONTRACTOR WILL ENSURE MINIMUM 2X SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
R IF REQUIRED.
5. CONTRACTOREVILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS L SEPTICS,LOT LINES,FOUNDATIONS 8 ALL OTHER SETBACKS.
6. INSTALL A SOLID HANDLING GRINDER PUMP W/ BASIN L CONTROLS
WITHIN THE FOUNDATION.
7. SEPTIC LINE FROM HOUSE TO TANK ONLY SHALL BE PRESURIZED,
FROM THE TANK TO THE LEACH FIELD SHALL BE GRAVITY FLOW.
PREPARED FORS
KIRK KNIGHT
P.ANOCHORAGE,OAK399522
(907) 266-3291
HELD BOOKS:
eUU
aMD, AWN:
sTA BELL CHEo®:I
ASBLXr. DATE.
Dwc. Txt am
D "`E 01103.DWG 01-103
Scales 1'= 100'
PAGE 1 OF 2
ENGINEERING
PLA
20441 PTARMIGAN BLVD.
EAGLE RWER, AK 99577-8738
111
11
WASTEWATER DISPOSAL SYSTEM DETAILS
DENALY S/D, LOT 3, BLOCK 1
T�-I#99-\ V I 1
KNI\ED5PROP SED 4
BDRM HOUSE
PROPOSED GRINDE�Pmp
cC
'•. CE -7116 . /
/
•�urESSI01��' ./
r
1-1/4" PRESSURIZE
HDPE SEWER LINE
3,7'
PROPOSED 1250
GAL SEPTIC TANK
co
PREPARED FORT
KIRK KNIGHT
ANCHORAGEN AK 9TA04
(907) 266-3291
FIELD BOOKS
DOUND'r`' BFI I
DRAW:
srvo BELL
c"coE" KMD
A�1: 1 II
DAME
4
DMQ 11LL;
CRI?
SW362
�"D "�. 01103.DWG
0B ""
01-103
Scale) 1'= 20'
PAGE 2 OF 2
L]dV aV ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
—6111
1� �
W
1G\'\TD ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
��.tP��•OF'Q�:QS
..� ............ • ..i.• •
.. •• .•.."•••... ..
% CE 71 IkV
SOILS PERCOLATION TEST�QO�FOpROFESSION��`,
F� s
Performed for. Kirk Kni ht %
Date Performed: 4/_ 19/02
Project: enaly Block 1 Lot 3
TEST HOLE # 02-1
Depth
E
E
7
8
9
10•
11-
12-
13-
14-
15-
16-
17-
18-
19-
ORG - overburden '.v./ org.,
Frost to 1'
GP/GM - gray, med dense,
damp w/cobbles to 1
SM/ML - red/brown silty sand
GP/GM - gray, med dense,
damp w/cobbles to 1
same consistent soils
as from 1.5' to 4'
O.O.H.
HOLE PRESOAKED
20- PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? NO Date? 4/26/02
Reading Date
Gross
Net
Depth to
Net
Time
Time
Water
Dro
1 4/19/02
1:00
_
8"
_
2
1:10
lOmin
38/16"
58/16-
3
1:11
_
8"
_
4
1:21
10 min
31/16"
415/16"
5 "
1:22
_
8"
_
6
1:32
10 min
3 3/16"
4 13/16"
7
1:33
_
8"
_
8
1:43
10 min
34/16"
412/16
9
1:44
_
8..
-
10
1:54
10 min
34/16"
412/16"
11 "
1:55
-
81,
_
12
2:05
10 min
3 3/16"
413/16"
' Water
Added
Percolation Rate 2.08
(min/in) Perc Hole Diameter 6"
Test Run Between _—.5 feet and �_ feet
1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
Kai N D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
�����•OF�q4gsldl
.l y......�...y., .. m .
SOILS PERCOLATION TEST �4 Grp, ce 7176
0 op ....,. AX
Performed for: F. Robert Bell &Associates a14� R0FESS10N,r•�
Date Performed:_ 4/22'ao�'�
Project: Denalv Block 1 Lot 3 TEST HOLE # 99-7
3
4
5
fr
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19 -
SP — med.
•8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
Depth
(Feet)
SP—med. dense w/org., moist SE7ATTACHED SITE PLAN
OLE LOCATION
GM — med dense w/cobbles Was Ground water encountered? NO
moist What depth. NA
SM — Gray/brown silt, moist Depth to water after monitoring? NO Date? 5/15/99
GM/SM - med dense, brown to
gray, moist
w/ cobbles & boulders
3.O.H.
HOLE PRESOAKED
20- PRIOR TO TEST
Reading Date
Gross
Net
Depth to
Net
Time
Time
Water
Dro
1 4/23/99
3:00
-
81,
_
2
3:10
10 min
15/16"
7 1/16"
3
3:11
-
8"
_
4
3:21
10 min
15/16"
7 1/16"
5
3:22
-
81•
_
6
3:32
10 min
15/16"
7 1/16"
7
3:33
-
8"
-
8
3:43
10 min
1"
7
9
3:44
_
8"
_
10
3:54
10 min
i"
7"
11
3:55
-
8"
_
12
4:05
10 min
' Water
Added
Percolation Rate 1.43
(min/in) Perc Hole Diameter 6„
Test Run Between 3.5 feet
and _ 4.5 feet
I, Kenneth hf. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
Municipality of Anchorage
• Development Services Department *At
Building Safety DivisionOn-Site Water and Wastewater Program 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
+i (907) 343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: KND ENGINEERING
Legal description: DENALY SUBDIVISION BLOCK 1 LOT 3
The attached paperwork has been reviewed and Is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design.
❑ Additional soils information needed.
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate.
❑ Incomplete; missing
❑ Incomplete; missing
❑ Additional adequacy test information needed.
❑ Water sample unacceptable.
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
s. ❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field.
® Other. PLEASE PROVIDE A SECTIONAL VIEW OF THE PROPOSED HOIJSE FOUNDATION &
FOUNDATION DRAIN AND WIDE DRAINFIELD TO DETERMINE IF THE FOUNDATION DRAIN WILL
INFLUENCE THE DRAINFIELD.
Name of reviewer: DAN Date: 12/20/01
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program =
4700 South Bragaw St. "• �••
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage:ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-731-50 HAA #_��� �� 7,
1. GENERAL INFORMATION Expiration Date: — l 7=D -4 -
Complete
— —4
Complete legal
Location (site
Current Propertyowner(s)_KIRK KNIGHT Dayphone PGA -32A1
Mailing address
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
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 FirPhone (907) 696-6111
Address _70441 Ptarmigan d., Fngle River, AK 99577
Engineer's Printed Name Kenneth M ^„ff,ra Date 11 /13/2003
Engineer's Comments:
OF Ak, %%%
This investigation was completed in compliance with
,��E
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
Jzkv.. •''� ;n. ''•qs�
y;•' '•,9
i
conditions as of the day tested. The flow and absorption
•e:�
rates may change due to subsurface conditions that
$0606•••••••
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
ti •••• „•,•. �.
R. ; Kennet n M. Uuff,;t� c
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
J,•.• CE 7116 ti
f �F'•,•• •••'�i�'•
lifeof and stems are subject
charic acte outto side the
\;OFESSX
ious dIl
vardynam c characteristics and
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
_Z Approved for _ j' bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
QP„.,....,,...y ,
• ON-SITE
'
WATER AND
WASTEWATER
By: Original Certificate Date:�-
r
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program *+ .
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: DENALY, B1, L3
Parcel lD: 050-731-50
A. WELL DATA
Well t 'i ,
yp rivate If A, B, or C provide PWSID #
Well Log (Y/N)Y
Date completed 7/16/200 Sanitary seal (YIN) -Y— Wires properly protected (Y/N)Y_
Total depth 123 ft. Cased to,
120 ft. Casing height (above ground) 24"
FROM WELL LOG
AT INSPECTION
Date of test 7/16/02
Static water level 1 3 ft. ft.
i
i
Well production 10 9 -p.m g.p.m.
WATER SAMPLE RESULTS:
j
Coliform 0 colonies/100 ml.Nitrate 0.874 mgdl.Other bacteria 0_colonies/ 100 ml.
Arsenic:', mg./I. Date of sample: 1 1 /07/03 Collected by: KND 'Engin ring
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material _ SEPTIC/STEEL Date Installed 9/27/03 Tank size 1250_ gal,
Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) N_Depression over tank(YIN) I
( )� High 9 water alarm Y/N
Date of pumping NA - NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date installed -9/27/02 Soil rating (g.p.d./fe or ft�/bdrm) 1.2 System type -TRENCH
j Length 39 ft. Width 2 ft. Gravel below pipe 8 ft
Total depth ft. Eff. absorption area 624 ft2 Monitoring tube Y Depression over field N
Date of adequacy test _ NA - NEW SYSTEM Results (Pass/Fail) -- PASS For A bedrooms
j Fluid depth in'absorption field before test in. Water added gal, New depth n.
Elapsed Time: -----min. Final fluid depth in. Absorption rater >_ g.p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
j -
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in.High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'4-
Public
00'+
Public sewer main 75'+
On adjacent lots 100'+
On adjacent lots 10 0'+
Public sewer manhole/cleanout 10 0'+
Sewer /septic service line 25'+ Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 10 0'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10' +
Water Service line 10'+ Surface water 10 0' + Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ Wells on adjacent lots1 00'+
F. COMMENTS
Grinder pump installed w/in foundation OF-at.4
YOG. ENGINEER'S CERTIFICATION ��' •�
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Kenneth M. _Duffus
Date 11/13/2003
HAA Fee $375.00
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
.:=_.0000
os Kenneth M. 77,
���
G�I�UMUP UTY OF AHCHORA GE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-731-50
Legal description Denaly Bock 1 lot 3
Site address 25673 Bendilent Cir
Current property owner(s) Kirt Knight
Expiration Date:
12-1-22
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: �- `� Original Certificate Date:
9-1-22
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
COSA Approval June 2022
MUHMPAUTY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 05073150
Complete legal description DENALY BLK 1 LT 3
Location (site address) 25673 BENDILENT CIR
Current property owner(s) KNIGHT KIRK Day phone 308-3702
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 19 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $�� d Waiver Fee $
Date of Payment ` 30 - 2 z Date of Payment
COSA # G ZZ ) Y 4q 1 Waiver #
COSA Application—June 2022
Legal Description: DENALYBLK 1 LT 3
Parcel ID: 05073150
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/16/02 Total depth 123 ft
Cased to 120 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 8/10/22
Static water level at beginning of test 15 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 50
Date of pumping 6/15/22
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/27/02
❑ ALL standpipes present per record drawing
Total measured depth from grade 11.5 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
FOR Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
Well production at time of test 6+ gpm
Water storage tank volume0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 1.27 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by NRimEng
Date 8/10/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/10/22
Results ❑ Pass
Fluid depth prior to test 5
Water added 600 gal
New fluid depth 10 in
Elapsed time 30 min
in
Final fluid depth 5 in
Absorption rate 600 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 96 in
Effective depth used 5 in
Effective depth remaining 91 in
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot a 100' Community Sewer Manhole/Cleanout > 100'
EYes, if No ft [j] Yes if No ft
Neighboring Tank > 100' g Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft
Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Q Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft
Fol Yes if No ft
Community Sewer Main > 75' On Yes if Na ftManure/Animal Excreta Storage > 100'
[E Yes if No ft
El N/A — Served by Community Well (not on lot) or Public Water
From SepticlHolding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' E Yes if No ft Surface Water> 100' E Yes if No
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
n Yes
if No ft
Q Yes
if No ft
Q Yes
if No ft
F Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100' Q Yes if No
Community Wells > 200' Yes if No
If tank or field is under driveway comment below
ft
ft
ft
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm NorthRim Engineering Phone 694-7028
Engineer's Printed Name —Steve Eng Date 8126122
COSA Checklist June 2022
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YELLOW PLASTIC CAP (YPC)
WWOUND 5/8" REBAR
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A GAS METER
UTILITY POLE
GUY WIRE. -
TELEPHONE MANHOLE VAULT
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I HEREBY CERTIFY THAT AN
ACCURATE SURVEY OF THE
o SEPTIC CLEANOUT
FOLLOWING DESCRIBED PROPERTY;
UTILITY.PEDE:S7AL
LOT 3, BLOCK 1
ASPHALT DRIVEWAY
DENALY,SUBDIVISION
WAS MADE bNCWE AS 2003
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SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND 00
NOT OVERLAP OR ENCROACH ON
THE PROPERTY LYING ADJACENT
TO THE PREMISES IN ouEsrioN
AND THAT THERE ARE NO
ROADWAYS, TRANSMISSION LINES
OR OTHER VISIBLE EASEMENTS
ON SAID PROPERTY EXCEPT AS
INDICATED HEREON,
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