HomeMy WebLinkAboutKENO HILLS #5 BLK 6 LT 4Keno Hills #5
Block 6
Lot 4
#020-171-32
Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 995196650
www.d.anchorage.ak.us (907) 945.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW040023 PID Number. 020.171.32
Name
Jeff Gorton Wastewater System: New
Addreea
17815 Ashland Drive Anchors a AK 99516
ABSORPTION FIELD
ft�
345-9105 our A
5' Wide Trench
LEGAL DESCRIPTION
� a
TdalDep"r`d"d'° "°"°"
1.2 cpofe
8 FI.
11 d LAX BtLdwe.m
Depth to Ddlom adn dpvw pads
Cravel depth 1,erYh ppe
6 4 Keno Hills No. 5
3 Ft.
4 FL
To.mrep Rana, swan
FY added eeore w9" U•de
Q> Length
1.3 Ft.
50 Fl.
Well: New
Gravel v.dN.
N m of Irw
D. W Eelraen Ynee
5 Fl.
1
- FL
CWUGutan 1pnvne,A B. Q.
Total Dean cuedto
dal aGeaptm res
ppe" arw
Private
186 FLI 27 FL
500 Fe
ASTM 3034 PVC
Ordrr
Date Droved stat: We. Level
inwal..
rw---Ww�
Alpine
7121104 21 FL
Alaska Pro Truck
71112004
YeW
3
Funp set
cee•a Aewe Grd.W
>2
TANK
cpm
Ft.
Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holing
utgripmate
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250
well
>100'
>100'
NIA
N/A
>25'Steel
Two (2)
Suranw"er
>100'
>100'
NIA
NIA
LIFT STATION — NONE ON LOT
Ld Line
>5'
>10,
NIA
NIA
cr
FouM"m
>5'
>10,
NIA
NIA
'�'p"'
"�°
,Qh'" "
in
ti
k
Cute: Dile,
None
Noted
Pump /AeLe Lw"4drullneped.ene
pedpmed GF
RemaMa
BENCH MARK
Garage Slab
100.0 FL
Engineer's Stamp
���.�waaaaa
?4
i
`7 +P'•''
1�
Inspections
Inspections performed by: AH Dates: 1" 711104
% 49th '� L
: ........;
nd
2 711104
r . ............._. ..__.......�.�
Department of Health and Human Services approval
0 .A, y N4tut L L. A"DI RSch W
Reviewed and approved b QA4 Date: -2 -OS9
-29-0f`'"
eb "••
Rt<. tarvpd
14 ............. P� :.
s4aa�;5;;��e.•
X
m
o ASHLAND DRIVE a
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Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO40023
PID No. 020-171-32
PROFILE AS -BUILT -
Scale: I"- 11(r
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: September 28, 2005
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 4, Block 6, Keno Hills Subdivision No. 5
Certificate of Health Authority Approval
The septic system on the subject lot was constructed by Alaska Pro Truck. They were
a certified septic system constructor at the time of the work. Their name has been
added to the inspection report.
The well log has been modified to reflect the proper legal description. We are unsure
as to why the well was placed in the location shown on the as -built. We cannot verify
the changed location was coordinated with the City so have paid the $115.00 review
fee.
Please advise if you have further questions.
WAIVER FEE: 1 t5 • Do
PAYMENT DATE: 91a s OS PC
RECEIPT#: 44OWS 44n
MUNICIPALITY OF ANCHORAGE
(MINUTES)
(INCHES)
•OF
DEVELOPMENT SERVICES DEPARTMENT
7/1/04
•••�Q�
�•'• ��
'
4700 SOUTH
BRAGAW STREET ANCHORAGE, AK 99519-6650 • `'•
10:30
9.375"
49th
SOILS LOG i..• !!!^��� � 0
2
10:40
....... _ .._ . _..._.. y
40�.RICINEL E ANIIERSQI j t
2"
LEGAL DESCRIPTION: LOT 4, BLOCK 6, KENO HILLS ��s+ No. cE e3e1 rf�:
�i •p�L9-or••�.•
PERFORMED
FOR' JEFF GORTON
•�����::::`'•••
10:41
DATE: 7/1/2004 PROJECT No
9.125"
PARCEL ID
(/• TECHNICIAN: Q. HARALA Pro/essio of Engine" Stamp:
DEM
4
TEST HOLE # 4
(fan)
2.125"
7"
OB/OG SLOPE SITE PLAN
10:52
9.5"
2
6
11:02
10
3
7"
4
oQs_a:VY;
S
SEE SITE PLAN
.Q
;>
8
o�•'-•• .-
•'`a'•�` °
SILTY SAND
,• . ; '�
SOME GRAVEL
9
SM
•'t` 4
I SEE FUTURE ASSUILT
WAS GROUND WATER ENCOUNTERED? No
L, •.
IF YES ®WHAT DEP'1T i7 4%
^s
DEPCH OF WATER AFTER MONITORING: Name
a • •' `
o,
DATE OF MONITORING: 718N
12
v ,�11
13
e
DATE READING GLOSS TIME NET TIME DEPTH
14—o
15—":Q�:o.;
16
4..:
BOH
17
18
19
20
PERCOLATION RATE; -1-4 PERC. HOLE DIA 6`•(INCHES)
TEST RUN BETWEEN: 4 FT, and 5 FT.
NONE
COMMENTS:
TEST HOLE PRE SOAKED PRIOR TO TEST. SAME MATERIAL AS TEST HOLE 3.
TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE:
4/5/2005
`MINUTES)
(MINUTES)
(INCHES)
NyFE;T DRQQP
(INCHES)
7/1/04
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
10:30
9.375"
2
10:40
10
2"
7.375"
3
10:41
9.125"
4
10:51
10
2.125"
7"
5
10:52
9.5"
6
11:02
10
2.5"
7"
Y
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 'L' Street
P.O. Box 196650 Anchorage, Alaska 99519650
http:/A w.e1.enchonge.aRoe
Permit Number: #SW 040023 Date of Issue: 2-18-04 Parcel Identification Number. 020-971-32
Date Started: 7-20-04 Date Completed:? 21-04 Is well located at approved permit location? ® Yes Q No
Legal Description: Keno HiNs # 5 Lot 4, Block 6 <r�'
'Property Owner Name & Address: Jeff Gorton
PO Box 110384
Anchorage. Alaska 99611
Borehole Data: Depth (it) Method of Drilling ® air rotary Q cable tool
Soil Type, Thidmess & Wata Strata From To
Casing type: steel
Stick up 0 2 Wall Thickness: J_50 inches
organks & alit 2 3 Diameter. 6 inches Depth: 2Z feet
gravelly sift 3 14 Liner Type:
bedrock 14 186 Diameter: inches Depth feet
Casing stickup above ground: 2 feet
Static water level (from ground level): ,ZLfcct
Pumping level: Mfect after
2 how pumping 2 gpm
Recovery Rate: I gpm
Method of Testing !e r o
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Startfeet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite # 8 Volume: L
feet Stopped 2 feet
If Pump: Intake Depth feet
u Pump size _ ho Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
Well Driller. Alpine Drilling & Enterprlses
PO Box 110496
Anchorage Alaska 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the properly
.........A.�..1/./.1//...t.//.....!�..�..///.. .. .L. n... .ftp.. W. � •/...-...I...:......!.4 •. in ./.... .t ......1..l..
MUNICIPALITYOFANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW040023
Date Issued: Feb 18, 2004
Expiration Date: Feb 17, 2005
Parcel ID: 020-171-32
Legal Description: KENO HILLS #5 SUBDIVISION BLOCK 6 LOT 4 "
Design Engineer: 0014 Anderson Engineering Site Address: 17815 ASHLAND DRIVE
Owner Name: JEFF GORTON Lot Size: 104544 SO. FT.
Owner Address: 17815 ASHLAND DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516 -
This permit is for the construction of:
❑✓ Disposal Field 0 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 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: 9
Date: 2 Ile 0 ¢
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site
i Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
ZD
Parcel I.D. 020.17132 Permit Number SW 0 400 2 3
Property owner(s) Jeff Gorton Day phone 229.2220
Mailing address (1) P.O. Box 110384 Anchorage, AK 99511
Slrf
-Mnitiag address (2)179/S pSHLgivD DR. r AV[N. 7Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
104 F44
Lot Size 2.4 kres Acre q.Ft
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ❑ Well Only ❑
Sewer and Well ® Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Paymi
Receipt Numb
(Rev. 12100)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
February 13, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 4, Block 6, Keno Hills Subdivision No. 5
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 4, Block 6, Keno Hills Subdivision No. 5 intends to construct a four-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to serve the new home. The attached Site
Plan and backup documentation identify the location and configuration of the proposed
well, septic system and alternate site. The lot is nearly 2.4 acres in surface area and
no conflicts exist between the well and septic system on this lot and those on adjacent
properties. Drainage arrows with representative surface slopes are shown on the Site
Plan. The drainage pattern will be maintained after development of this lot is complete.
Test holes placed on the lot in the area of the new absorption trench indicated sand
with silt and minor amounts of gravel with percolation rates ranging from 2 to 5 minutes
per inch. No groundwater was found during excavation and none was noted during the
monitoring period. We are therefore proposing to place a new 1,250 -gallon septic tank
along with a 50' long by 3' wide by 4' effective depth absorption trench to collect and
treat the sewage generated in the house. The bottom of the trench will be 8' below the
surface. A minimum of 3' of cover will be placed atop the trench and 4' atop the new
septic tank.
The ground surface on the lot slopes at shallow grades from east to west as shown on
the Site Plan. The absorption trench will be constructed parallel with the slope of the
ground surface as much as possible in conformance with Municipal requirements. The
new septic system will be constructed a minimum of 100' from the well proposed for the
lot and on adjacent lots. It will also be constructed a minimum of 100' from any surface
water in the area.
Lot 4, Block 6, Keno Hills Subdivision No. 5
February 13, 2004
Page Two
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
IACX� E-a�
Michael E. Anderson, P.E.
Attachments
*" L *V'
lr
MIDNAEL E. MDERSON
4 No. cE-4381 �
N89 5vi" 373 07
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AREA MAP
SCALE V • 100'
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LOT 4, BLOCK 6, KENO HILLS, ADDN. NO.5
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5' Wide Trench System
Perc. Rate: <5 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area
500 SF/5 LF (Width)' .5(Red. Factor) = 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be
8' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
TV
6"
4'0"
Natural
Backfill
5'
FI
Geotextile
Fabric
4' Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
P* E OF 4
(NO SCALE) �� p(.. ».._•'
NOTE: Grade Area Over Trench to Drain Away. : a/
Minimum 6' Separation From Bedrock. .'.... 49
Minimum 4' Separation From Groundwater. i.
Minimum 100' Separation From Well. 0 MC UEL E.ANOE0.50H
Minimum 100' Separation From Surface Water or Streams. 10, sA No. u4mi
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PROJECT #:
PERFORMED FOR: - Jeff Gorton DATE PERFORMED: 7/9/03
LEGAL DESCRIPTION: Lot 4. Block 6. Keno Hills Subdivision
TEST HOLE # 1 SLOPE SITE PLAN
Organic
Layer - OL
2
S
NET
TIME
L
IF YES, WHAT DEPTH?
0
3
:.:
AFTER MONITORING:
4
1
Silty Sand
30
Dry
SM
5
5:46
6
Some Gravel
7
30
Dry
12"
Recharge
6:17
8
12.0"
3
6:47
30
9
10—.
I I
Silty Sand
Tighter with Depth
12
v :..'.::;
SM
13
.•'LE0
49th
15
OA
1.... �
17-� I BOH -
s
:j
WAS GROUNDWATER
ENCOUNTERED? NO
S
NET
TIME
L
IF YES, WHAT DEPTH?
0
DEPTH OF WATER None
P
AFTER MONITORING:
E
MIn41LLL/JD[HSOH
u4ml
Vi
DATE: 7/15/2003
�I
o TH20
,� TH30
a I TH10
4%
i
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 7/9/03
5:15
12.0"
1
5:45
30
Dry
12"
Recharge
5:46
12.0"
2
6:16
30
Dry
12"
Recharge
6:17
12.0"
3
6:47
30
Dr
PERC RATE: 2.5 MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN 3.0 FT. AND 4.0 T.
COMMENTS: Test Hole Pre Soaked Prior to Percolation Test.
TEST PERFORMED BY: MEA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/12/2004
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PROJECT #:
PERFORMED FOR: Jeff Gorton DATE PERFORMED: 7/9/03
LEGAL DESCRIPTION: Lot 4. Block 6. Keno Hills Subdivision
TEST HOLE # 2 SLOPE SITE PLAN
z
GROSS
TIME
Organic
Layer- OL
DEPTH OF
WATER
NET
DROP
Start 7/9/03
4:30
3
8.5"
4
5:00
Silty Sand
Dry
8.5"
SM
5
8.5"
6
2
5:31
30
Dry
Some Gravel
7
5:32
8
3
6:02
30
Dry
BY
,•,.
WAS GROUNDWATER
9—
ENCOUNTERED?
Silty Sand
10
Tighter with Depth IF YES, WHAT DEPTH?
�.
$M DEPTH OF WATER
I I
AFTER MONITORING:
DATE:
12 -
OF
�...i%.� 49th....... .....0
E AMERSOR j W
W�
.�.. •' •� J`::, No. Cavi i ire
17--1 I BOH - 16'
NO
None
7/1S/2003
S
L
0
P
E
�I
o` TH2O
TH30
a I
THP
4%
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 7/9/03
4:30
8.5"
1
5:00
30
Dry
8.5"
Recharge
5:01
8.5"
2
5:31
30
Dry
8.5"
Recharge
5:32
8.5"
3
6:02
30
Dry
BY
FERC RATE: 3.5 MIN./INCH FERC. HOLE DIAMETER:
TEST RUN BETWEEN 4.0 FT. AND S.0 T.
COMMENTS: Test Hole Pre Soaked Prior to Percolation Test.
TEST PERFORMED BY: MEA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/12/2004
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PROJECT #:
PERFORMED FOR: Jeff Gorton DATE PERFORMED: 7/9/03
LEGAL DESCRIPTION: Lot 4. Block 6. Keno Hills Subdivision
•
49th='••':�}I�r
;h.
DOURLAWERUONL o. a4341
W
4.
17 -JI BOH - 16'r••�"�"
SLOPE
NO
None
7/15/2003
S
L
0
P
E
SITE PLAN
�I
o` TH2O
TH30
a I TH10
4%
READING DATE
GROSS
TIME
TEST HOLE # 3
Organic
DEPTH OFEDROP
WATERStart
7/9
Layer- OL
2
5:10
30
Dr
3
:.
5:11
8.5"2
Silty Sand
5:41
SM
5
� ,
Recharge
6
1
Some Gravel
7
3
6:12
8
Dr
~
WAS GROUNDWATER
9
ENCOUNTERED?
Silty Sand
10
:..' :
Tighter with Depth IF YES, WHAT DEPTH?
�.
SM
DEPTH OF WATER
11
AFTER MONITORING:
. '
DATE:
12
Y .. ..
•
49th='••':�}I�r
;h.
DOURLAWERUONL o. a4341
W
4.
17 -JI BOH - 16'r••�"�"
SLOPE
NO
None
7/15/2003
S
L
0
P
E
SITE PLAN
�I
o` TH2O
TH30
a I TH10
4%
READING DATE
GROSS
TIME
NET
TIME
DEPTH OFEDROP
WATERStart
7/9
4:40
8.5"1
5:10
30
Dr
Recharge
5:11
8.5"2
5:41
30
Dr
Recharge
1 5:42
1
8.5"
3
6:12
30
Dr
PERC RATE: 3.5 MIN./INCH PERC. HOLE DIAMETER:
TEST RUN BETWEEN 5.0 FT. AND 6.0 T.
COMMENTS: Test Hole Pre Soaked Prior to Percolation Test.
TEST PERFORMED BY: MEA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/12/2004
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 4, BLOCK 6, KENO HILLS, ADDITION NO.5
GENERAL:
1. The scope of this project includes the procurement and placement of a new
1,250 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 50' long X 5' wide X 4' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 4' below the existing ground
surface. Total depth of the trench will be 8' below the existing ground
surface. The new septic tank and absorption trench must be placed a
minimum of 100' from the well on this and adjacent lots.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Department of Health and Human Services for system installations.
Owners installing their own systems must receive prior approval from
D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
A new 1,250 -gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
Lot 4, Block 6, Keno Hills No. 5
February 13, 2004
Page 2 of 3
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. Contractor shall verify this condition prior to placement of the
rock. All pockets of unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
Lot 4, Block 6, Keno Hills No. 5
February 13, 2004
Page 3 of 3
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
Municipality of Anchorage
• -� Development Services Department
Building Safety Division
On -Site Water 8 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
V2
�11 FOR A SINGLE FAMILY DWELLING??,,
Parcel I.D. —'7I -�V
2_ COSA# q 0307
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KENO HILLS #50 BLOCK 6 LOT 4
17815 ASHLAND DRIVE • ANCHORAGE. AK * 99516
KYLE AND SALLY RANDICH Day phone 345-4134
17815 ASHLAND DRIVE " ANCHORAGE, AK . 99516
Day phone
JERI JEFFREY W/ PRUDENTIAL JACK WHITE Day phone 762-3108
3801 CENTERPOINT DRIVE #200 * ANCHORAGE. AK " 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 1 4
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
N
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 (les 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. Phone 337-6179
Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date f I c 1
Engineer's Comments:
In conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d 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 provido
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
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.
13.1 •"I�
f A. Go ness.
0 a CE -a`
' • qrl o� • VC
Conditional approval for bedrooms, with the flowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
(Rw JIM)
'R�4�vY OF',.,
c�Q.•' do
ONSITE
WATER AND
WASTEWATER
PROGRAM '
Original Certificate Date: - I - q - 0
Municipality of Anchorage .0 ,
�• -�� Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: KENO HILLS #5; BLOCK 6, LOT 4 Parcel ID: 0 V, o- /'7 1- 3.9,
A. WELL DATA *INTO BEDROCK
Well type MOTE If A, B, or C provide PWSID# N/A
Date completed 7/21/2004 Sanitary seal (Y/N) YES
Total depth 186 ft. Cased to '27 ft.
FROM WELL LOG
Date of test 7/21/2004
Static water level 21 ft.
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform n colonies/100 ml.
Arsenic: fJ0ug./L.
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 2 in.
AT INSPECTION
8/19/2009
31 ft.
2.26 g.p.m.
Nitrate mg./L.
Date of sample: 8 19/2 009
Tank Type/Material SEPTIC/STEEL
,
Tank size' 1250 gal. Number of Compartments 2
Other bacteria b colonies/100 ml.
Collected by: GEG Ltd.
Date installed 7/1/2004
Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 8/20/2009 Pumper _ MCDONALDS PUMPING
C. ABSORPTION FIELD DATA E ow EXISTING GRAD
Date installed 7/11/2004 Soil rating (2Yor ft'/bdrm) 1_2 System type SHALLOW TRENCH
Length 50 ft, Width 5 ft. Gravel below pipe 4 ft.
Total depth •9.6 ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/19/2009 Results (Pass/Fail) PASS 1 For 4 bedrooms
Fluid depth in absorption field before test 20 in:. Water added 600 gal. New depth 26.5in.
Elapsed Time: 140• min. Final fluid depth 25 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size In gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level i . High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfift station on lot 100'+ 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
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 10'+ 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
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date q/I Joe,
��i�i1.r' "i'"i►y��
A. Lorne s,
O� C 953 ,•';`FOS
q vA*'00resStu
/
COSA Fee S �1 / 0 " Waiver Fee $
Date of Payment 131/1 0 9 Date of Payment
Receipt Number_ O Co 03 7 3 Receipt Number
(Rev. 11/05)
SCS Retia 1094304001
Client Name Garness Engineering Group, Ltd
Project Name/9 Keno Hills #5 B6,LA
Client Sample 11) Keno Hills #5 B6,1A
Matrix Drinking Water
Printed Dau/rime
08312009 15:12
Collected Daterrime
08.'192009 18:00
Received Date/rime
08202009 8:10
Technical Director
Stephen C. Ede
Sample Remarks:
Alloxable
Prep Analysis
Parameter
Results
PQL
Units
Method Container lD
Limits
Date Date
hot
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
0826/09 0888/09
NRB
Waters Department
Total Nitrate .Nitrite -N
ND
0.100
mg(L
SM20 4500NO3-F
D
(<10)
0821/09
RJT
Microbiology Laboratory
Colonv Count
0
col/100mL
SM209222B
A
(<200)
0820/09
SDI'
'rotalColiform
0
col/IOOmL
SM209222B
A
(<1)
0820/09
SDP
FecalCuliform
0
col/100mL
SM20922213
A
(<i)
0820/09
SUP
RA
lAM1
MYA ff�0.
Ir ►R►Iw IIa�P
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PLIFT MAN «IAw.A/wwM�/ 1P� ! Professional Land Surveyors
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Parcel I.D.
1.
I,( VIA W11a(I(e2
Municipality of Anchorage i
Development Services Department �•'��
Building Safety Division
Onsite Water and Wastewater Program I `
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
171.32 HAA
Expiration Date: ,/ 2 L Z — D S
INFORMATION I
Complete
legal description Lot 4. Block 6. Keno Hills Subdivision No. 5
Location
site address or directions) _17815 Ashland Drive
Current FIroparty
owners) Jeff Gorton Day phone 3459105
Mailing
address 17815 Ashland Drive. Anchorage AK 99516
Lending agency
Day phone
Mailin
address
Real Estate
Agent Day phone
Mailing
Address
Unless o
erwise requested, HAA will be half by DSD for pickup. 1
2. NUMBE
OF BEDROOMS: Four 4 1
3. TYPE O
WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individ
IndividL
Iat Well ® Individual On-site
al Water Storage I
Community
❑ Individual Holding tank ❑
Class Well
❑ Community On-site ❑
Public 1
II
Vater System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificatesbf 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 requiro for the transfer of
title (except b6tween 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, 1 verify that rn 1 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 jAnchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disp,osal system Is(are) in compliance with all applicable Municipal and State code ordinances,
ordinances,
and regulations in effect at the time of installation.
Name of
Address
Phone
Engineer's Printed Name _Michael E. Anderson, P.E. Date _
:a
5. DSD SIGNATURE
Approved for _ bedrooms. •ssi
/:L•Clfif•Trf.7I
HAA C
Septic
Well F
02
(I«. IZW)
approval for bedrooms, with the following stipulations:
A
ow SITE
WATER AND •: n'.
AGER—r—=
PRO RAM :•
X Maintenance Agreements
Advisory Supplemental Engineer's Report
Other
Original Certificate Date: 'I
Legal
A. WELL
wen type
Municipality of Anchorage
Development Services Department
Building safety Division
On.Ske Water & Wastewater Program
4700 South Bragaw, SL
P.O. Box 198050 Anchorage, AK 995198650
www.cLanchorage.ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
If A. e, or C provide PWSID a _ Wen Log (1
Data comP�led
71211 4 Sanitary seal (Y" Y Wires property protected !(1'IN) Y
Total depth
14Lft. Cased to , jLR Casing height (above ground) —B—In.
FROM WELL LOO AT INSPECTION j
Date of tm
t 7@18004
Static wat�r
level Z1 rt• R !
Well prod
II
_ 3 g.p.m. e,p�
WATER SgMI
PLE RESULTS:
Coliform
I colonleV100 ml.' Nitrate -tL mg.A. Other bacteria -L colonies/100 ml.
Data of=
iple: ➢1128005 Collected by. _ AH
B. SEPTICAi
)LDING TANK DATA
Tank Type
ftterhd SeoticMeel Date Installed 1-tIMM!
Tank size
gal. Number of Compartments a Clearouta (YIN) Y
Foundation
cleanout (Y/N) X Depression over tank (YIN) if High water alarm (YIN N
Dab Of
ping Pumper -Now construction
C. ABSORPTION
FIELD DATA
Dab insfan
7118004 $oil rating (g.p.dA? or %Y/bdrm) 1.2QEM System type ode Trench
Length
IL Width 5 fk Gravel below pipe 4 It.
Total depth
IM R Eft absorption area AMfe Monitoring tube X Depression over field t(
Date of ade
quacy test Results (Pass/Fan) For _ bedrooms
Fluid depth
absorption field before teat _ in. Water added_ gal. New depth_ In.
Elapsed The:
_ min. Final fluid depth _ in. Absorption rate # g.p.d,
Ilrlation
Any reJwe
Vestment (past 12 mo.) (YM S type) N If yes, give date
D. LIFT STATION -
Date installed
'Pump on' level at _ In.
Datum
E. SEPARATION DISTANCES
Size In gallons
'Pump ofi level at _ lo.
Cycles tested
Manhole/Access (YIN)
High water alarm level at
Meets slam d dress
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septi tanMifE atWn on lot MW On adjacent ids
Absorption field on lot >tW On adjacent lots
Public sewer main WA Public sewer manhole/deanout WA
Sewer hhepou service one >25' Holding tank _NIA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation )f Property line _),I Absorption field >S
Water main WA Water service One >1C Surface water XW
Wells on adjeceet lots MW
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i
Property line Air Building foundation Mir Water main Mg'
Water Service l tie M(r Surface water MW Driveway, paddngNehide •forage >2S
Curtain drain None Noted Wells on adjacent lots >1W
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I ca►tlfY Met I have determined through field inspections and
review ofMunA*al recants Mat the above systems am in
conformance with MOA HAA guidelines in effect on this date.
Engineers Pdntm Name JA chsel E. Anderson. P.E.
Date 9t2glgS
I
HAA Fee $
Date of Payment 4 f AS
Waiver Fee $
Date of Payment
z 30
x
N
a
76-30
KENO HILLS SUED., ADDN. NO. 5
LOT 4, BLOCK 6
2.40 ACRES
N 89055'15"E 374.22'
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 99502
PHONE 248-5454
IGRID 3438 103/1/2005 I
BUILDING DETAIL
SCALE. 1 "=20'
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
F.B. JOB NO.
05-02 KHS546 I NOTE: NO CORNERS SET THIS DATE.
111=50'
AV �. •' 'f
� 9
w49TH.*
0 ..• .................41F
P
• Jeffery aetaldi ; AV
��
•. LS -6091
°^ : Ao
. B^BO' p ••........ yJ.I
a
royeeoional
LI
Ole 09-20-05;11:16 ;
r
SGS Ref. #:
Client Name:
Project Name:
Client Sample ID:
Matrix:
PWStD
Sample Remarks:
1055929
Anderson Engineering
Keno Hills No 5, L4, B6
Keno Hills No 5. L4, B6
Drinking Water
:907 561 5301
SGS Environmental Services Inc
200 W. Potter Drive
Anchorage, AK 99518
Tel: (907) 562-2343
Fax. (907) 561-5301
Ali dates/times are Alaska Standard Time
Printed DateMme:
09/20/05 11:10
Collected DateMme:
09/12/05 10:50
Received DateMme:
09/12/05 11:15
Technical Director.
Stephen Ede/%
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Bacteria 0.00 9222B 09/12/05 09/12105 if
Nitrate 1.20 0.10 mglkg EPA 300.0 10.00 09/12/05 09/12/05 mx