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Home My WebLink AboutBENSON #3 LT 8Benson #3 Lot 8 #051-281-76 Municipality of Anchorage Page of Z 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: 5W94,07-12 PID Number: 051— Z6 — 76 Name: Wade, Wastewater System: X New ❑ Upgrade Address: Poae 7 Ead? ejveeAL ABSORPTION FIELD Phone: t,9q_ 9B74 No. o Bedrooms:. ❑ Deep Trench � Shallow Trench O Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Sod Rating: Total Depth from original grade: -Z GPD/Sq Ft, Lot: Block: Subdivision/: ,'A3 Depth to pipe bottom from original grade: Gravel depth beneath pipe 8 ns0 Cl 7 -- . '/B Ft 3-1 Ft Township: Range: section: Fill added above original grade:. r Gravel length: / 0.Y AIT ods Ft. 6 Ft. WELL: P4 New ❑Upgrade Gravel width: Number Of lines: 0;7. Deraeen kna: Ft. '^ Ft. Classification (Private. A.B.C): , X/ Total De the Cased To: Total absorption Brea: PipsLmaterial: ✓2 G 3 Ft. T3 Ft. /o+ ...F, / /0 17 30'S Driller. I✓11raMs Dalepr led: 67& 9G Suhc Water level: 211 Installer. W.a keep Cons-. Date Installed: l0A FL yield: Pump Set at: 66 Casing height Move Ground: 2. TANK /.2. GPM bAPA,701017FI. Ft. SEPARATION DISTANCES Peptic E3 Holding ❑S.T.E.P. To septic Absorption Lm Nowing lubikvilrii Manufacturer. capacity In gallons: / From Tank Field Station Tank Sewer Llrros o o O Welt /Do'f' /06,+ -- SO r+ Material: STEEL Number of Compartments: Z waters 100'4- /00'+ — — /00'+ LIFT STATION Lotr Line /0 + /D f — — 1 O1. Size In gallons: Manuf urer. Foundation "Pump on" level "Pump 0 I at: High ware farm at: Curtainr * `J + — — Pum!M dModel I ElectflG pections performed Drain 501+ O '– Remarks: None ,t'newn BENCH MARK Location and Description: r Will oe' Assumed Elevation: /00 Ft ENGINEER'S SEAL '��\\i OF wCj.� IF01,4;9TH Inspections performed by: 99D Dates:1s 10110/f/_ 2nd ro .. ... ............. � •�... Department of Health and Human Services approval a �^'- Kcm:oCZE .. 1145 Reviewed and approved by: Date: '2 % fF ••..�G�s�: 0 PRQ" FESSI��P�o' 73-013 (Rev. GAI) MOA 25 < IwJU v A -C=25.75 B -C=37.0 A -D=31.4 B -D=43.1 A -E=46.5 B -E=58.7 A -F=85.1 i02�-YbM AS -BUILT SYSTEM DETAILS/SITE PLAN LOT 8, BENSON S/D ADDN. #3 RESERVE 5 0' 8 x x 0 � W 4a qo _100 000 GAL WX SEPTIC y w TANK AW �� OF. ALgAll Vr S i * 49 *+l / KENN6CEI1 b ....FUS:' a: / . ..'L �FesstoTtp� i 1000 GAL S. ry Q 0 M= OM WELL 00 BLM L ) FINAL GRADE TRrtp rwlc\ SEWER ROCK 46' — P.I.D #:051-281-76 PERMIT N:SW960217 MT ELL 49 SCALE- 1' = 50' 6 86.9 WATER MODIFIED DESIGN DETAILS 82.4 a 1. 3 BDRMS X 150 GPD = 450 GPD. 2. 450 GPD/1.2 GPD PER SO. FT. = 375 SO. FT. 3. (375 SO. FT./ 5 )X .58(rF) = 43.5' 4. NEW PROPOSED -USE SINGLE TRENCH 44' (L) X 3' (D) X 5' (W). 5. TRENCH AS CONSTRUCTED -46'(L) X 3.1'(D) X 5'(W). WADE CHARLES P. 0. BOK 772461 EAGLE RIVER ALASKA 99577 SCALE, KND ENGINEERING 20441 PTARMIGAN'BLVD EAGLE RIVER, AK, 99577 (907)696-6111/FO.x (907)696-8111 DATE- 10/26/96 ]DRAVING 0 SCAI F, AS NnTFI) I 96039 -SI RUCINM ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 1 (907)696-6111/FAX (907)696-8111 October 30, 1996 RECEJvED Municipality of Anchorage 3 1996 Dept. of Health & Human Services DCT On -Site Services Sectionncnofago Munlc'P31"'J 01 an$pry1Ces P. O. Box 196650 Dept. Health & Anchorage, Alaska 99519-6650 Subject: Lot 8, Benson S/D, #3 Gentlemen: Attached are the inspection report and as -built for the subject well and septic installation. Modifications in the construction of the building foundation required that the septic system be lowered. Due to our attempt to keep a minimum of 4 foot of separation between the system and the water table observed in one of the testholes, and maintaining the system within the 30 foot radius of the testholes, we modified the design from a 4 foot deep by 2 foot wide trench to a 3 foot deep by 5 foot wide trench. Design calculations for the modification are shown on the as -built drawing. All other conditions remained the same during the construction with the exception that there was no water observed in either of the two testholes prior to construction. If you have any questions about this application, please call me at 696-6111/FAX 696- 8111. Respectfully submitted, EHID Engineering Kenneth M. Duffus`�I�E. attachments: As -built Drawing Inspection Report ' PAGE 1 OF 1 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:SW960217 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:WADE CHARLES OWNER ADDRESS:P.O. BOX 772461 EAGLE RIVER, ALASKA 99577 PARCEL ID:05128176 LEGAL DESCRIPTION: BENSON #3 LT 8 LOT SIZE: 43939 (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: DATE ISSUED: 7/26/96 EXPIRATION DATE: 7/26/97 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. SPECIAL PROVISIONS: RECEIVED BY: A A+ &a� DATE: 7-,z 9 _% (� ISSUED BY DATE: -< ,� - Z 1"I" D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 /FAX (907)696-8111 June 24, 1996 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot 8, Benson SID, #3 Gentlemen: Attached are the soil logs, percolation tests, and water monitoring results for the above lot. Based on the soil information, we have designed a shallow drainfield. The topography of this lot is very flat. There are no surface water sources within 100 feet of the proposed disposal area, nor no known curtain drains within 50 feet. The new well will be sited near two existing wells to minimize the impact of protective well radii. The development of this lot will have no adverse impact on any other area wells or sewer systems. If you have any questions about this application, please call me at 696-6111/FAX 696- 8111. Respectfully submitted, lESH D Engineering enneth M. Duff s attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test SITE PLAN WASTEWATER DISP❑SAL SYSTEM LOT 8, BENSON S/D ADDN. #3 KAMKOFF AVENUE RESERVE E LOT 7 /AREA AREA < I �I PROPOSED SYSTEM 130' w I Li I WI I �I a4 _ z J V I I 50' I 50' I I I I I I �.*.491H ..VDUS. * �� .CE-7�v4 �f'ESSIOTlp4 � 0 PROPOSED 0 0 WELL BLM LOT 49 LOT 4, BENSON #1 NO WELL WITHIN 200' OF SYSTEM LOT 5, BENSON #2 LOT IS FLAT W/ 0-1% TO THE WEST HAKLD FUK: KND ENGINEERING 20441 PTARMIGAN BLVD WADE CHARLES EAGLE RIVER, AK, 99577 P. 0. BOX 772461 (907)696-6111/Fckx (907)696-8111 EAGLE RIVER ALASKA 99577 D.1E- s-i7-9sll. 7,z. DRAWING I icko r • 'W.1 96039 S-1 DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM LOT 8, BENSON S/D ADDN. 3 CO CO CO CO CO HT CO o' OF ALAS 77 �+ KENNETH M. V FUS ova / \ �fESSIDNpy �� m TOTAL DEPTH GRADE 7.0' WATER IN TH DESIGN DETAILS I FROM ORIGINAL #1 AT 12' 1. 3 BDRMS X 150 GPD = 450 GPD. 2. 450 GPD/1.2 GPD PER SQ. FT. = 375 SO. FT. 3. 375 SO. FT./ 2 X 4 = 47.125' 4. USE SINGLE TRENCH 48' L X 4' DEEP. 5. TOTAL DEPTH OF SYSTEM WILL BE 8.0'. 6. 2' HD INSULATION TO BE INSTALLED OVER SEPTIC TANK, 7. CONTRACTOR TO VERIFY AND INSURE 2% GRADE FROM HOUSE. WADE CHARLES P. O. BOX 772461 EAGLE RIVER ALASKA 99577 KND ENGINEERING 22041 PTARMIGAN DR EAGLE RIVER, AK, 99577 DRAWING M 96039 S-2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: K" I.QP les DATE PERF( LEGAL DESCRIPTION: 1018 Arn5012 Township, Range, Section: ZHwg 3M [121511Q 1 OG SLOE SITE PLAN 1 d—Pi// 2 K 4 GPl.SP W/4I Av� 5 `mrd rot vel Ic(j c"i 6 PE R.C. 7 8 9 10 11 12 13 14 15 16- 17- is- 19 - 20 6 17181920 COMMENTS WAS GROUNDWATER ENCOUNTERED? S T WHATL A//. � O P E r After 7- Batt IF YES, A DEPTH? Depth to Wile Monitoring? Reading Date Gross Time Net Time Depth to Water Net Drop C) 5- 29 b* 7A — 3.5" — 1 62.2 1 m .S- 1" to 24 b.15` 1.15' 6:25 ,'1S`1. b, 2b • 1S" l' b+21 5' b 6 29 min PERCOLATION RATE (minuievmch) PERC HOLE DIAMETER TEST RUN BETWEEN 5 FT AND (" FT PERFORMEDBY: 1 ��-4'r r2. 2.5 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 IF" 41115) e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: W d/ rharl _5 DATE PERFORMED: LEGAL DESCRIPTION:/45 KP.M60/1 "wb *-3 Township, Range, Section:?/-/. #/ OQ pur SLOPE SITE PLAN `// DEPTH 8" MG 1 Kennon AL D CE 7116 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 'S W 1v/Soa7e g/atv�� {,P Zr deG�a5Oi �de�7fh `;7e� 9l-vd in layers RL COMMENTS �O�C v /GSoQ exZ WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? �2� p E Depth N Water Atter Abllitarlllg? 4 Date: 6-- - Reading Date Gross Time Net Time Depth to Water Net Drop O S" — I r —' Y•5" S 16 b :09 1" PERCOLATION RATE 1 (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 5 FT AND b FT PERFORMED BY: AW191 . yen At TT ILS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 61v& 72-M (Rev. Mas) W cc w V) W 31• X 4� Y r,. Q c7 OD Uco T U •tL 1.7 � v: iI• � a O � .o: r'1! 0 P X A Vf A V t} t t Oi ! t w rii I� i !! t} t t o < 3 0 0 I i t t ! ! ! ! i !! t} t t i ( � L4 i i sic i o CI! I 1 ;LL I _qe! F H F F F !-• F a h� i i E i 1 i i 1 1 i i i 1 I I G 1 1 I 1 1 i a 0 00y�. 0 0 y0� y0y� yay� y0� I0'd L4409LE 'JNI9lINQ swuiniIM Amr E I i 1 1 i 0 m w r•1 MUNICIPALITY OF ANCHORAGE o , Development Services Department' 1' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-281-76-000 Expiration Date: 12/5/2023 Legal description BENSON #3 LT 8 Site address 16111 CLINE ST Eagle River AK 99577 Current property owner(s) RICHARDS MARY X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 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 X Well Flow Advisory Absorption Field Advisory Nitrate Advisory x Tank Age Advisory x Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY 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. 051-281-76 Complete legal description Benson #3 Lot 8 Location (Site address) 16111 Cline Street, Eagle River, AK 99577 Current property owner(s) Mary Richards Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ■❑ 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: U Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 26 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench 0 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 $ 5-S-0 Waiver Fee $ Date of Payment Z3 Date of Payment COSA # 2 c, 2 3 l 3 n J Waiver # COSA Application—June 2022 Benson #3 Lot 8 051-821-76 8.1 8/1/96 43 N/A 43 6.34 18+ 8/14/23 Forge Engineering 24 8/2/23 48" 6/6/23 JRs Septic 10/96 7.8 4.9 N/A N/A N/A 8/14/23 0 844 0 120 0 > 450 34 0 34 Benjamin Schiller, P.E.8/14/23 (907) 522-7773 MUHMPA U TV OF A HCHO RA GEE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231309 Subdivision: Benson #3 Block: , Lot: 8 907-343-7904 Fax: 343-7997 The septic tank for this property is 26 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. 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. MUNMPAUT1 V OF ANCHORA, GE DEVELOPMENT SERVICES DEPARTMENT 0/, A, ' On -Site Water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC231309 Subdivision: Benson #3, Block: , Lot: 8 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.34 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. L.5 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. 051- 201-76 HAA# 050211 Expiration Date: . ! — / - O 5 1. GENERAL INFORMATION Complete legal description Q en -son 63 Loy 8 Location (site address or directions) Ilottl Gine. 5T - Current Property owner(s) Sieve Ze�3e_ Day phone 2.3S-5611 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 17500 Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: :3 3. TYPE OF WATER SUPPLY: Individual Well ER Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ 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 Sp.>rkla�� E%;neerinb Phone 219-'Mito Address 207, W. 15F5 203 99501 Engineer's Printed Name Toln6,. Date � y zoo 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following Additional Comments — .eH.oweaY• � A iC .r�.tfA.T•�i • 'P' rd } '• ,rFi r ON 69E WATER AND •: VAST - PROGRAM Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to Insure the wells continued suitability. Current nitrate concentration is 5.27 mg/l. EPA maximum concentration Is 10.0 mg/l. i)Iorc Information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (0 0 )Rw 0IM2) 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: &(%Son 113 w 'b Parcel lb: 051- 2Zt- -46 A. WELL DATA Well type f'r"v;,,6 If A, B, or C provide PWSID # Date completed�1b, Sanitary seal (YIN) y Total depth 33 --ft" Cased to—q3--ft. FROM WELL LOG Date of test 1 9 Static water level 24 ft. Well Log (YIN) y Wires properly protected (YIN) Y Casing height (above ground) 2S n. AT INSPECTION N40S ft. Well production 12 g.p.m.•a g.p.m. WATER SAMPLE RESULTS: Coliform --,K—colonies/100 ml. Nitrate 5.2-4 mg./I. Other bacteria colonies/1001Imi. Arsenic: 5 mg./I. Date of sample: SIN ]005" Collected by: Lw'5 SP1LLAA B. SEPTICIHOLDING TANK DATA _' TankType/Material AnA ciEcAe- To..k /J}e¢1 Date installed IglI9b Tank size 1000 gal. Number of Compartments Z Cleanouts (YIN) Y Foundation cleanout (YIN) _y_ Depression over tank (YIN) V High water alarm (YIN) Date of pumping 5110L0 5' Pumper .1 Q F60 C. ABSORPTION FIELD DATA Date installed 410-1114 Soil rating (g.p.d./ftZ or ft'/bdrm) System type S - tJ?cie Length % ft. Width J5 ft. Gravel below pipe 3.1 ft. Total depth 8 ft. Eff. absorption area 3qk ftZ Monitoring tube �_ Depression over field Al Date of adequacy test 4 4 n J Results (Pass/Fail) P4ss For, bedrooms Fluid depth in absorption field before lest Q in. Water added 4Y70 gal. New depth 0 in. Elapsed Time: O min. Final fluid depth 0 in. Absorption rate >= 410 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) /None- Knowr If yes, give date — D. LIFT STATION Dat>on" Size in gallons Manhole/Access (YIN) 'Put_ in. `Pump off" I at _ in. High water alarm I al in. DatCycl ested Meets alarm circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 71001 Absorption field on lot %/001 Public sewer main MIA Sewer /septic service line '750 r On adjacent lots 71001 On adjacent lots 11001 Public sewer manhole/cleanout n/�A Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >25 r Property line >e Absorption field >5 1 Water main Nf A Water service line 7 50Surface water Al. O . Wells on adjacent lots 7 125' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 710 Building foundation > 3S' Water main /V/A Water Service line > 501 Surface water AI -0- Driveway, parking/vehicle storage > 50' Curtain drain N%A Wells on adjacent lots > 1001 F. COMMENTS G. ENGINEER'S CERTIFICATION 1 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. f � Engineer's Printed Name 1 0 Date M HAA Fee $ /7 Date of Payment — y/so,lo 7 Receipt Number r 3 (Rev. 12101) Up Waiver Fee $ Date of Payment Receipt Number 1• SGS ReLH Client Name Project Name/M Client Sample ID hfatris Sample Remarks: 1052380001 Tobbcn Spurkland P.E. Benson #3 Lt 8 Benson #3 Lt 8 Drinking Water All Dates/rimes are Alaska Standard Time Printed Date/Time 05/20/2005 13:32 Collected Date/rime 05/042005 10:45 Received Datc/rimc 05/042005 15:20 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 5.00 U 5.00 u8/L EP200.8 A 05/10/05 05/12/05 TK Waters Department Nitrate -N 5.27 0.100 Microbiology Laboratory Total Coliform 1 OB. No Coli mg/L EPA 300.0 A (<=10) 05/05/05 JJB coV100mL SN120 92228 A (<-I) 05/04/05 TLF 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) 843-7904 CERTIFICATE OF HEALTH AUTHORITY•APPROVAL FOR A -SINGLE FAMILY DWELLING Parcel I.D. _051.281.76HAA 10 2 Expiration Date: R - 2 a - o / 1. GENERAL,INFORMATION ..` Complete legal description - Benson #3. lot 8 Location (site address or directions) 4 ?' Current Property owner(s) _Wade Charles Day phone _694-9874 Mailing address.. P.O. box 772461 Eagle River AK Lending agency, . Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3 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 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 KND Engineering Phone 868.3791 Address 20441 Ptarmigan blvd.. Eagle River, AK. Engineer's Printed Name Kenneth M. Duffus Date _ a cE t7F At e. 5. DSD SIGNATURE 4� f'•. c` 71 IS —� Approved for bedrooms.daQnO•pRO...... Disapproved. !o*asv 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 By; a"&_ _ ".-, /,6,;. // a Original Certificate Date: Jam' 2 2' 0 (Rev. MOM 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.d.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Benson #310 8 Parcel ID: 051.281.76 A. WELL DATA Well type Rlht#S# It A. S. or C provide PWSID # Weft Log (YAV Date completed Sanitary seal (YIN) T Total depth -AL-ft. Cased to 43.s ft. FROM WELL LOG dol Date of test 29 - Static water level at5/ ft. Web production 9 -p.m WATER SAMPLE RESULTS: Conform 0 colonies/100 ml. Nitrate 4.10 mg.A. B. SEPTIC/HOLDING TANK DATA Tank Type/Materlal BTEEL Wires property protected (YIN) v Casing height (above ground) AT INSPECTION 24 ft. 8 g.p.m. Other bacterla_&L colonies/100ml Date installed 10110198 Tank size 1000 gal. Number of Compartments z Cleanouts L—Foundation cleanout L ---Depression over tank J--Hlgh water alarm 119 Date of pumping 3111101 Pumper JR'S C. ABSORPTION FIELD DATA Date Installed 10110198 Soft rating (g.p.d.Rl° or fl /bdrm)1,_ System type WIDE TRENCH Length 4— ft. Width 5 ft. Gravel below pipe 3.1 ft. Total depth 4.8 ft. Eft. absorption area $96+ fe Monitoring tube Y_ Depression over field N Date of adequacy test 5112101 Results (Pass/Fall) _ P_ For,L_ bedrooms Fluid depth In absorption field before test Q_ in. Water added An gal. New depth 2 in. Elapsed Time:((,(' min. Final fluid depth Q in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N N yes, give date D. UFT STATION Date installed _NIA Size in gallons Manhole/Access (YM) 'Pump on' level at _ in. •Pump ofr level at _ in.High water alar level at In. Datum Cycles tested Meets alarm b areuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 1001+ On adjacent kits 1001+ Public sewer manhole/cleanout 1001+ Holding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line T—++ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main 10'+ Water Service One 10'+ Surface water 1001+ Driveway. parkingNehide storage 2T# Curtain drain 504 Wells on adjacent lots '+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cerdly that I have determined through field in ug spectlonsand 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 STAMP Date _ Zl V/o / HAA Fee S 1019 Date of Payment ,S d Receipt Number /(P� RM.12MM Waiver Fee $ Date of Payment Receipt Number WAY -21-01 09:14 FROM- kkeCUE Environmental Services Inc. � rrrrrrirrrirrrrr� CUE ROO Client Name Project Name/# Client Sample ID Matrix Ordered ay PWSID 1012622001 KNO Engineering Denson N3 Lot 8 Denson #3 Lot 8 Drinking Water A T-856 P.02/03 F-197 Client POp Printed DONYTIme Colketed Date/rime Received Datc/rime Technical Director Released By 05/21/2001 8:49 05/14/2001 11:15 05/14/2001 16:20 Stephen i4 Ede ParameterResults PRL UnitsMothod Allowable Limits Prep Data Analysis Date Init srats,� tfaoa�p9� 0 0 caVlOotnL SM18922211 NitrataN 4.10 0.500 MIA EPA 300.0 (<10) Microbiology Laborate TotalColirorrn 0 0 caVlOotnL SM18922211 05/14/01 SCL 05/14/01 KAP