HomeMy WebLinkAboutKNIK HEIGHTS BLK B LT 10K nl"k Heights Block B Lot 10 #017-033-30 Municipality of Anchorage Page —L of -3 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: -SW 94DD3d PID Number: /PV7D333� Name Wastewater System: XNew ❑ Upgrade "°Ofeas' ABSORPTION FIELD Phone: No. or edrooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: _ Total Depth from original grade: , GPD/Sq FI Lot. Block: Subdivision: 7epth to �pe nom fro On9inel grade Gravel depth be� alh pipe y/ Ft FI Township. Range: Section: Fill added above original grade: Gravel length: �2 NW Ft Ft WELL New ❑Upgrade Gravel width: Numberorlines: Dlslan bebveen Lees: FI Ft Classification (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: Ft FI SO Ft Driller. Date rdled' Static water Level. Installer: Date installed: Z Ft j Yiei P 1p Set at: Casing He�gm Above Ground. TANK 57 GPM Ft Ft SEPARATION DISTANCES, KSeptiC El Holding ❑S.T.E.P. To Septic Absorption Litt Holding 'ubtic/Poral, fact reC Capacity in gallons: From Tank Field Slabon Tank Sewer Lines Man 0 Well a r N� yA �//� Material: Number of Compartments: SurfacWater Ned• Nie LIFT STATION oHc LotD s /D 7 Sae in gallons: Manufacturer: Line Foundation / v �` "Pump on" level at: "Pump off" level at: High water alarm at: CurtainN� h,� Pump Make 6 Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: O Assumed Elevation: ENG14;K;,VAL 40-111:46, 0 A4 rf` , ."; P. 4,N Inspections performed by: _&Fates: is ' 2nd�CaHaaG a. �Wltsapna?,wa fa EJ�r4.�. '•. ' Department of Hea a Hu vices approval � a 6281 14�z .•,aaea a.;' ��`�e' Reviewed and approved b . Date: 1� `soo 72-013 (Rev 991) MOA 25 ��✓. 1 8 /6 . ud Permit No. Page Z of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: , �X2d Q 107/6 T Lo�;7 Loy'/O ie A8 EHEC 6'U�r�'E ROAo 'W/NG 7Xe r,,W4EOZ,Z B A 'ter CO3 -49'7 /' 7'f %o " 1�,�� 456 36 6 22.010 A (A.. 0/91) MOA 25 ��'Ar r04 49'rN Urlw E NRlwn, h. .. a 6281,All �� A'�✓1 B�r6�3+9 � ✓ Z IO�S/Y� lcc� Permit No. s y1yF lhO3/) Page 3 of j Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: T/24. �3� �� �i� /f/%ii, PID No.: 42/Z333,42_ /"q' 45 B/ /f e"'W /s'Ys SuA;1 �GC/ : / v. / J. 4 ' 4 C�roVel 0y ldM ��� { �Y' Aw. i1/c//,50 •t �¢S - - �5. i///3.1.r�,�/s I T� •A//3 I sA 5)9 79 J:�Q��•OF•AC9'14 �� or Or x/.07 /yOliX /••••/�./•��j•/•J/•//•// `••• •.:••• /O C��721•Y I1�a// W. 0w1&gLWi&w, Jr. /9���/r�f�����v. = /DO d II '• a6281 ` ��• 72-017A (R•v. 9N1) MOA25 1 o l:7. .� i LOCATION OF WELL rSTATE OF ALASKA yJo ; v DEPARTMENT OF NATURAL ESOURCES DIVISION OF yAJUiJ O C kZ4 WATER WELL ECO D ROINc BOROUGH SUBONISION LOT BLOCK V j CULtUON OTRS SECTION TOWNSHIP RANGE MERIDIAN ❑N ❑E JX^ALL❑S 0 ❑W LOCATION/SKETCH: WELL OWNER: DEPTNSGMEASURED FROM:❑casing top ❑ground surface WELL DEPTH' DATE OF COMPLETION Depth of hole:It BOREHOLE DATA: Depth _ Depth of casing: / it Material Type and Color from To DEPTH TO STATIC WATER LEVEL• d Z /'_ft below P top of casing O ground surface Date: /1/7 !.Z METHOD OF DRILLING: Uair rotary ❑ cable tool sc ❑ other USE OF WELL:P domestic O irrigation O monitor 92 O public supply ❑ other CASING STICK- i[. Diam: �G in. tt 3'7 Casing type: in. to / 7Sft WELL INTAKE OPENING TYPE: open end O screened ❑ perforated ❑ open hole1Aj -_ / S Depths of openings: to ft SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: it ^ 17-5-1 GRAVEL PACK TYPE:, - Vuiume used: Depth to top: GROUT TYPE: Volume: Depth: from ft T to It DEVELOPMENT METHOD: at.4 _ Duration: PUMPING LEVEL AND YIELD: -L71 ft after _ Ars pumping ppm JUL C 1 11 3r7PUMP INTAKE DEPTH: it Horsepower: Municipality of A hora96 WELL DISINFECTED UPON COMPLETION? DYES ❑ NO �earcrra-r�v�r*a.� o�•�•�_� CONTRACTOR INFORMATIO REMARKS: Regi red Pusinefis Nam oy �� PLEASE MAIL WHITE COPY LOG TO: DNR/DIVISION OF WATERER Signature of Authorized Kespreptntative Date PO BOX 772116 EAGLE RIVER AK 99577-2116 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 825 L Street, Room 502 Anchorage, Alaska 99519-6650 RE: Permit Number: SW940030 9/20/94 Owner: Kolczak, Allan T. Address: 12701 Shelburne Road Anchorage, Alaska 99516 This letter responds to the your review comments dated August 16, 1994 regarding the above referenced on-site wastewater system. Comments will be addressed in the order they,were:presented. 1) The sewage line from the house to the septic tank is insulated beneath the driveway. 2) Cleanouts were installed on both ends of each of all three laterals on August 30, 1994. 3) The piping used for the cleanouts and monitoring tubes, which were not PVC, were replaced so that all risers are now PVC (ASTM D3034). 4) The monitoring tubes were replaced such that the perforations do not extend above the gravel in each trench. 5) Monitoring tube No. 1 was replaced. 6) Cleanout No. 3 was secured to the drain pipe. 7) A double cleanout was installed downstream of the septic tank, allowing cleaning in both directions. If you have any questions, please call me at 563-8102. Sincerely, Charles Wilson, P.E. L pT /O �GOc1c �iv t`7lE�G,'i/?s' alI;CS—//JSu4A7£D. f/ce_�o�Jt�o! ��—eac —cam©v51_ea n�!pl_7lvc�r irrtasY-/ S /Ian z/D��-���—�•�v.�r�—.,��c_.r��°�'� A�d�J!-BXImo�Ely��((ff��//.AA.GG � 6u/Ie�cu-91-Qf.�'1N % vol- enolel �� �iw �sdJJc /cY/ems aXvre %�KJ✓/Cf' /n pGjiMlYl O'7 e7 . /.lJ 0'H"M C'�iii dG /1 Clfs�:✓'J� 7�2 V /`ice 7Z /CLC-Xl--W Or .4.177/ cr Yrl% 7o4 lei,C. L/�o' -2 ,'127-Z- r 2rZ- G� GP z s 5/�! 11Ii 0 Page— Municipality age—Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P -O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal I Description: PID No.: I T 135 0 we .f , �iyEL BI/f�/YE f>'0.90 B ,q NW�,ns� SW�.ne� C'0.3 49'-'17 .. k�/•eTe�,t , ,. 7S/O 77.010 A,N,,, 0.N1j,J0A is r;f T�49H_ 9 � a :��l1�fitJ I Wliwn, h•� CE 6281 i iI: IEp.3�3f (z) So;r3' Z.11 'Oli /a -. l! C.vl, it 6C OAU\ I \ 04 /lL.• `: mP n\y Wti `tir' dcnkill 19) wwN si .w PNr sso L16 Commercial Testing & Engineering Co. Environmental Laboratory Services CT6I R.f.t 94.7739 Client RPO 1PO Raid Client PO MON/ 1P.CITWI) PO 1eq.1 Ret. Thu Date : 07/17/94 Client Nana s10LC1AI, ALLAN Contact Person tilling Address :ACCOONTS PATAItt 7831 RTANA (12701 3RP.LAORNP.) AICRORAC.R, Al 99507 5633 B Street Sample Acknowledgement Anchorage. AK 99518-1600 Tel: 1907) 562.2343 Ordered By :ALLAN 101.CIA1 Fax: 1907) 561.5301 VIA :RANO Dr.LTf1RID Seal :ALLAN T. 1O1.CZAI Reports :7931 RTANA (11701 SRI1.101)[I) To-ANCRORACI, AR 99SO7 (907) 261-3700INICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Additlanal Reporta AUG 10 1994 TO RECEIVED CTO Client SAem1Al SAnple DRacTiptlon PATAmltar Tasted Mathad •••••••••••••••••••....................................................................................... 1 12701 3"MAIIRNI RD Nitrate -N ►PA 153.2/300.0 Aar- 0,,"Pr& CGZ X -1/i lSo� /The shove samples were rarol"d on 07/25/94 aryl will receive the text an described Above, As par your regsust. These sAmplas will he disposal 30 dayR After completion of ArulyAlx unless pravlans arraoPwats have been mads. Sor technical information cell: S62-2343 Ask for Stephan Ida. for turnaround times or status cAll: S62-2343 Ask far RhardA DAvid nT MAN 1aAxa. v 6MISS Member of the SGS Group (Soci6td Gdn6rale de Surveillance) e ENVIRONMENTALFACILITIES IN ALASKA. COLORADO. FLORIDA, ILLINOIS, MARYLAND. NEW JERSEY. OHIO. UTAH, WEST VIRGINIA k✓r�a� .,�r�.��✓ �r usc/ +%� ir,Gl�. ISo F. Z� 3- //mac/ ��� r�a•J� o,, 1-1� MUNICIPAUTY OF ANCII Commercial Testing & Engineering Co. eNv1kONME)y�AtsERVICFSpryVISION �1� • Environmental Laboratory Services ►iiiiiiiiiii�����g������������ -.,.: R�� 5633 8 Street FEDERAL IDr 36-0997920 d't�' ��/�Kp� 518-1600 INVOICE 80712 07/26/94 Ellyn 4d7) 562.2343 aaaaaasaasaaaacssxsxcxzax Fax: (907) 561.5301 Client BPO : Remit To: WORKorder Date : 07/25/94 BPO Regi : P 0 Box 10001-019 ME Ref.* : 94.3739 Client PO :NONE RECEIVED Pasadena, CA 91110-1019 Account * : KOLCAC PO Req.i s Report Printed : 07/26/94 @ 16:15 ____��---------------------- ---------------------------------------------- SEND REPORTS TO: Bill To KOLCZAK, ALLAN ACCOUNTS PAYABLE ALLAN T. KOLCZAK 7831 KIANA (12701 SHELBORNE) 7831 KIANA (12701 SHELBORNE) ANCHORAGE AK- 99507 ANCHORAGE AK 99507 Contact Person : Phone : (907) 261-3700 Ordered By : ALLAN KOLCZAK Chealab Sp* Client Sample Desc. *** Test Parameter Tested Method Charge aaacasasaxazczszxascaasszzzaazaxxssasasszzassaaxzasaxcxxssmxxxsasassxzsscaxxxszszssxxxszsxasasas 1 12701 SHELBURNE RD 1 80153 Nitrate -N EPA 353.2/30 23.00 TOTAL DUE $ 23.00 aszaasssaasxz *+S lsatrix ID 1 a Water 3 = Oil 5 a other 7 = Solid 2 a Gas 4 w SSSoill�+6 = Liquid LLr��SGS MemberotlheSGSGroup(Socidt6GAn6raledoSurveillance) ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS. MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA • See Special Instructions Above UA -Unavailable •• See Sample Remarks Above -Lts Analyzed LT UeUndetected,Reportedvalueisthepracticalgantifiicationlimit. Than D-Secondarydilution. Gf�CccreaterThan 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562.2343 Fax: (907) 561-5301 c N�ngr1NMFNTAL FACILITIES IN ALASKA. COLORADO. FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO. UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Commercial Testing & Engineering Co. AUGJ���Q� ZA Environmental Laboratory Services "cc"" LABORATORY ANALYSIS REPORT RECEIVED CT&ERef.N 94.3739-1 Client Sample ID 12701 SHELBURNE RD Matrix WATER Client Name KOLCZAK,ALLAN WORK Order 80712 Printed Dale 07126/94 @14:18 hrs. Ordered By ALLAN KOLCZAK Collected Date 07124/94 @19:00 hrs. projectName Received Date 07125/94 @10:55 hrs. ProjectM PWSED UA Technical Director STEPLIE•NC.EDE Released 6j�:T—/ Sample Remarks: ROU TINE SAMPLECOLLECIEDBY: TOM KOLC7AK&WITNESSEDBYTHERESA ELLIOTT. QC Allowable EM. Anal Results Qual Units Method Limits Date Date Init parameter 0.10 U mg/L EPA 353.2/300.0 10 07/25/94 CNIR Nitmtc-N • See Special Instructions Above UA -Unavailable •• See Sample Remarks Above -Lts Analyzed LT UeUndetected,Reportedvalueisthepracticalgantifiicationlimit. Than D-Secondarydilution. Gf�CccreaterThan 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562.2343 Fax: (907) 561-5301 c N�ngr1NMFNTAL FACILITIES IN ALASKA. COLORADO. FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO. UTAH, WEST VIRGINIA PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 C Lo os6b ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940030 DATE ISSUED: 2/17/A3`%¢ DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 2/17/.94 (}'- OWNER NAME:KOLCZAK ALLAN T OWNER ADDRESS:12701 SHELBURNE RD ANCHORAGE, ALASKA 99516 PARCEL ID:01703330 LEGAL DESCRIPTION: KNIK HEIGHTS BLK B LT 10 LOT SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (16AAC72) 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 OR 343-4681 AFTER BUSINESS HOURS 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'PROVISI0NSc �,T-THE-TIME"OF-CONSTRUCTION"THE ENGINEER -SHALL. -CONSTRUCT A' !BOIL"TEST/PERC:"'TEST_-HOLE'-AT'THE'SOUTH END.OF THE PROPOSED" %BSORPTI0N TRENCH•TO-A`MINIMUM DEPTH'OF'SIX(6) FEET BELOW' THE DEEPEST PORTION OF THE ABSORPTION TRENCH AND'MONITOR FOR tGROUND PLATER FOR A MINIMUM OF SEVEN(7) DAYS. IF SOIL PERC. PIS MORE THAN 20 MINUTES/INCH THE -SYSTEM SHALL -BE -REDESIGNED. k,�.TO .45-.GALLONS/DAY/SQUARE'F0OT. RECEIVED BY: DATE • DATE: �;,,k i1GK�X7YS D EXr Ye /07/7 -.- i - -I^ • 1 (2)SD;r3' TrMG�C3 KD �To Exis� I tLeO � �e,�c�lfe oe/ e// Toq�F T Epxrs.�/ �, f. GD/Q''NC< T.N,f n Me T�3 �f'rrk ara vv r - moi' A /�CP�CA � !��L,O/1J��`•� /ate//� /�L�i/�l�rcl f eic Z�,/- = zD at ?P;O.Z f/� _ -/` 2�111.41s x /SD �wloeallwf - 4D42 �Pl� Ti9 = / Fo.� 7r�44 ,lam 2x �' ase(10SD. X �-- W;7;eee is oma„ .�. • OF A4 r ...... .... ... :... d v le � (hvl•• E Wilwn,k. � L 5D• d o a D 0. 21f0 �`/o�C ,t` CE 6291 O o�'T o ON SITE SEPTIC SYSTEM AND WELL PERMIT APPLICATION LOT 10, BLOCK B, KNIK HEIGHTS SUBDIVISION 1/29/94 AREA TOPOGRAPHY Lot 10 slopes from east to west at an approximate grade of 10 percent. There are no areas of excessive slope. The area of the proposed leachfield is well drained and slopes approximately 3 percent from east to west. There are no surface drainage courses within 100 feet of the proposed field. IMPACTS ON ADJACENT PROPERTIES All contiguous lots to the subject property are developed single family residences. All adjacent lots have on site systems that have no recorded problems. Location of a subsurface disposal field in the proposed location would have no adverse effects upon adjacent lots. SOILS AND GROUNDWATER Three test pits were excavated on the subject property on December 27, 1993. Groundwater was not encountered in any of the excavations. Percolation tests were run at all three test pits and the results were recorded on the attached soils logs. A groundwater monitoring tube was installed to a depth of 15' at test pit #3. No groundwater has been observed in the monitoring tube. Kolczak.doc .........7 • • 40TH Chale. E. Wiles , �.. CE 6281 �/� X e .r Municipality of Anchorage DEPARTMENT OF HEALTH 3 HUMAN SERVICES 825'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: / lrrf'/ �/f /�� DATE J� LEGAL DESCRIPTION: /� of gfq Q[6,(2 /I^/r. / ,p 2 3 //Ale U/7?✓C/ 4oy, .000J Zle � /045 56 .I � 9 , , ', 10 11 12 13 14 15 16 17 18 19 20 COMMENTS — Township, Range, Section: ' WArL`ROUND WATER ENCOUNTERED? IF YES, AT WHAT L T/L7CC �rA✓C DEPTH? E Dep to Water Arta / r Maniturinp7 Date: r No *cam 49TH* ••,•� Owrl•. E. VAI --,,Jr, SITE ®=m®m MR PERCOLATION RATE �L- c�� (minutevincn) PrERC HOLE DIAMETER .. Zzka-45 TEST RUN BETWEEN 4 FT AND StG_ FT PERFORMED BY: (- h/�'' ��N I r %/`�'� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72 -ODS (Rev. 4/85) y Municipality of Anchorage DEPARTMENT OF HEALTH 6 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Z:r r/r/�.(�",�il/c DATE PER LEGAL DESCRIPTION:Ln Ln 7"/m DE N E H. p.�k B, •i Drzrv.r%C3 //Di IFETI .J 2- 3- 4- 4 5- 6- 7- S. 8 9- 1012 to - 12 13 .I 14- 15- 16- 171 4 151617 18 19 45/ Ve/ WAS GROUND WATER ENCOUNTERED? �,owyjn IF YES, AT WHAT DEPTH? A411 h Septi to Wafter latter Monitoring] /!'o e�u<��� Section: SLOPE Galt air � Ar4 9TH ce'' ��....,, s\♦ • 'f f� • Ourin E. wlwn, k, .:�. •_ CE 6281 ®=®mm 20 4A o IL JI PERCOLATION RATE T,2 (minutevmcn) PERC HOLE DIAMETER TEST RUN 11 ��i �FT AND �fT COMMENTS/�i'i� PERFORMED 9Y: r ' I / , A `fJ//sj'' CERTIFY THA THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) 20 4A o IL JI PERCOLATION RATE T,2 (minutevmcn) PERC HOLE DIAMETER TEST RUN 11 ��i �FT AND �fT COMMENTS/�i'i� PERFORMED 9Y: r ' I / , A `fJ//sj'' CERTIFY THA THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 7;-�hz LEGAL DESCRIPTION: A/,—,e �2 DATE t,. *—/ // Townshio. Rance. Section:. �� /Yom UpTji a,��,TTT.I D�70//rCs (FEEiTI / Or /J 1 . d 2 ' • D' . ON/t 3- 4- 6- 7- 8- 9 C�/Cy %//y• 6 8 �M 9 to- 12 12 - 14 Pill COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? �[J� S IF YES, AT WHAT L DEPTH? P E Depth to Water After Monitoring? Date: qs�9 497th Cherlw E Wiley k. a 6281 I%%/_AI���� ` .. PERCOLATION RATE/Z/ (minutes/inch) PERC MOLE DIAMETER PERFORMED BY: ��F,?1� �!^'��3^N 1 �r'</ CERTIFY T T THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1 �D 72-008 (Rev. 4/85) Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 825 L Street, Room 502 Anchorage, Alaska 99519-6650 RE: Permit Number: SW940030 5/9/94 Owner: Kolczak, Allan T. Address: 12701 Shelburne Road Anchorage, Alaska 99516 RECEIVED MAY 91994 Municipality of Anchorage Dept. Health & Human Services The Special Provisions of the above referenced well and wastewater disposal permit required the excavation of an additional soil test pit near the south end of the proposed absorption trench. This letter presents the results of the additional soil and percolation test. On May 4, 1994, Test depth of 14.5 feet. attached soils log. groundwater monitori yielded a perc rate redesigned using an Design calculations system is proceeding design. Sincerely, Pit Number 4 was excavated to a total The results are recorded on the No groundwater was encountered, but a ng tube was installed. The perc test of 60 min/inch. The leachfield was application rate of 0.45 gal/day/sq.ft. are enclosed. Construction of the this week based upon this revised Charles Wilson, P.E. voIgC-id m fp vtp • r�>�4 e Munlclpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: �rN iS /G Pt�� DATE PER LEGAL °SEE E Da/4 er'u.y 2-1.1.1, 3 �+1 to 4 � ` 8-.1.1 . , 9 10- 11 0 I, 12- 13- 14- 15 2 13 14 15 16 //�� C9rct✓l/ Mea Pee-jv M� W 17 181 I �'b✓�%.,.��,:� 19 20 COMMENTS T SLOPE Section: WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to water After Monitoring? Wit PLAN PERCOLATION RATE (minutestinch) PERC HOLE DIAMETER TEST RUN BETWEEN._ FT AND 4.15' FT ,/ /• A PERFORMED BY: G e/ � 3 /�/z G'.a I / L!JCERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (A". &85) 8 —LL �i / 1 SCO ID B�K� L/ �/1/%//T 14V:11 f 4�N ;�517G /9-'5,Vs/ 1fe'-A /oN N`�^^ /Y SO// 7C5T � �crG Tc3T GUO� G�/^�`oir+lCA UP�✓o,Y. ;;` ' ��-`t�,a� a3 rc�aiicci �••�> %i� t�/9AD030, 7Xic �Tc//rG Yc4T y/e�cq a mor/lS/SY'./f �crG ra7`c o� d�r>/•r�s�i. 45 lix (�5> SD 2 X 3 w - T�HG4. . Z�e-'ee`i 7 7'/c 7o 31le ¢/ems a_5 Cleo - cel o.> l /i9; �ye -Ie -VWe -Ire.fe a.Cti O:."AVia_ OS jGrouwK off �9�f� Gf�S/qN. r r 5 �r;r/50 ' _ ChwW E VAtm^ Jr. Ci 6281 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street t ' F' P.O. Box 196650 ,1 a Anchorage, AK 99519-0650 e:-) www.muni.org/onsite (907) 343-7904 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 017-033-30 1. GENERAL INFORMATION Complete legal description Knik Heights Block B Lot 10 Location (site address) 12701 Shelburne Road, Anchorage COSA* O i' i) I-01 Expiration Date: Current Property owner(s) Betty & Lee Monthei Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12701 Shelburne Rd., Anchorage, AK 99516 Day phone Judy Rosenburg / Prudential Day phone 229-1097 3801 Centerpoint Dr., Suite 200, Anchorage, AK 99503 Unless otherwise requested, COSA wiX be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well❑ e ❑ Community Class Well s• as• CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 017-033-30 1. GENERAL INFORMATION Complete legal description Knik Heights Block B Lot 10 Location (site address) 12701 Shelburne Road, Anchorage COSA* O i' i) I-01 Expiration Date: Current Property owner(s) Betty & Lee Monthei Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12701 Shelburne Rd., Anchorage, AK 99516 Day phone Judy Rosenburg / Prudential Day phone 229-1097 3801 Centerpoint Dr., Suite 200, Anchorage, AK 99503 Unless otherwise requested, COSA wiX be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite 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 Onsite 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 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, 1 verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Phone 349-1851 Address PO Box 110443, Anchorage, AK 99511 Engineer's Printed Name Cindy W. Ellis Date 6. DSD SIGNATURE `, Ci y W. Eilis�� t Approvedfor (' _ bedrooms. _'', CE•rosn ,. Disapproved. ..�s...• +�sia+�ycs/ Conditional approval for bedrooms, with the following stipulai)o ss. - Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By Original Certificate Date: 10114107 (Rw 71X5) Municipality of Anchorage 0011 Development Services DepartmentBuilding Safety Division ` on -Ste Water & Wastewater Program 4700 . Box 198850 Bra Street P.O Anchorage, AK 9951943650 www.mun4orglonsto (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Knik Heights Block B Lot 10 Parcel ID: 0174)3330 A. WELL DATA Wall type Pri it A, B, or C provide PWSID If _ Well Log (YIN) Yes Data completed 4128184 Sanitary seal MN) Yes Wires Property protected (YIN) Yes Total depth L75—t Cased to 175 R. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test March 28. 1994 9/211/07 Static water level 117 R. 100 R. Well production 9 9 -P.M. 4.9 9 -P.M. WATER SAMPLE RESULTS: Coliform 0 colonies1100 mL Nitrate 0.101 mglL Other bacteria 0 colonies/100 mL Arsenic: 5.005 mgll Date of sample: 985107 Collected by: Rocky Trainor B. SEPTIC/HOLDING TANK DATA Tank TypWaterial Steel Septi Tank Date installed May 7, 1994 Tank size 1250 gat. Number of Compartments 2 Clearouts (YIN) Yes Foundation cleanout (YIN) YQ3 Depression over tank (Y" No High water alarm (YIN) WA Date of pumping 9128107 Pumper A* HOME SERVICES C. ABSORPTION FIELD DATA Date installed 5A0994 Soy rating (g.p.d.IRp or ftylbdrm) 0.45 System type Deep Trench Length 162 (3 trenches) R. Width 3 R. Gravel below Pipe 5.0 R. Total depth E._5_1_0_5—A Eff, absorption area 1820 R' Monitoring tube Yes Depression over field No Date of adequacy test 9/28107 Results (Pass/FOR) Pass For 4 bedrooms middleANeat Fluid depth in absorption field before test 010 in. Water added62225 gal. New depth 13.75113.75 in. Elapsed Time: 601198 min. Final fluid depth 12.7500.0 in. Absorption rate >= 600 g.p.d. Any reiuvenation treatment (past 12 mo.) (YIN &type) no if yes, give date 0. LIFT STATION Data installedNUA Size in gallons 'Pump on' level at _ in. 'Pump or level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on let 100'+ Absorption field on let 100'+ Public sewer main 100'+ Sewer /septb service Ane 100'+ Animal containment areas 100'+ Manhole/Access (VM) High water alarm level at in. Meets alarm & cftd requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank WA Manuretanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICOHOLDING TANK ON LOT TO. Building foundation 10+ Property Ina 10+ Absorption field 5+ Water main I W+ Water service line 50+ Surface water 100'+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line V Building foundation 10+ Water mein 1001+ Water Service line 50► Surface water 1004 Dray, Peter de sloag* 1 S+ Curtain drain WA Wells on adjacent lets 100'+ F. COMMENTS: 'Lot line waiver approved to north lot Ane. Water was put Into the middle and western trenches of the drainneld. The eastern drainfield is full. G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspections and � 49id review of Munith M records that the above of systems ata in W. Ellis con/ormance with Mt]ft COSH guidelines in etl'ed on this date. CI Engineer's Printed Name Cindy W. EIAs Date CE.laerr �` COSA Fee $ (1-30 - I!A—A2e� Date of Payment �b rJ/U Receipt Number O/OS-7 9673 (Rev.1 trod Waiver Fee Date of Payment Receipt Number SCS Ref.N 1075069001 L All Datesfflan" are Alaska Standard Time Client Name Watkins Engineering i/w;1c �QjG�:L15 PrintedDste/fime 10/12/2007 8:31 15:00 Project Name/N Knick H&S Dlk U Lot 10 l4` Collected Datelrime 09125/2007 Client Sample ID Knick II&S Ulk 6 Lot 10 Received Datefrime 09/2512007 15:21 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results POL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/03/07 10/10/07 M11 Waters Department Total Nitrate/Nitrite-N 0.101 Microbiology Laboratory Total Coliform 0 0.100 mg/L SM20 4500NO3-F D (<10) coV100mL SM2092220 09126107 1DS 09125/07 SDP Municipality of Anchorage • �j Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-033-30 1. GENERAL INFORMATION Complete legal description Knik Heights Block B Lot 10 Location (site address) 12701 Shelburne Road, Anchorage COSA #_ Expiration Date: / 0 — 6 — 0 6 Current Property owner(s) Tom & Theresa Kolczak Day phone Mailing address 12701 Shelburne Rd., Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Beth Simpson & Co /Alaska Group Day phone 727-2384 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 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 Onsite 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 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Address PO Box 110443, Anchorage, AK 99511 Phone 349-1851 Engineer's Printed Name Cindy W. Ellis Date 5. DSD SIGNATURE V� Approved for 'I bedrooms. Disapproved. 7- ZZ-0(�p Conditional approval for bedrooms, with the following stipulations: ON-SITE Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By, n.�,� lift. 0 4-4, ` Original Certificate Date: 0 6 (Rw.11M) Municipality of Anchorage • i' Development Services Department Building Safety Division On -SM Water & Wastewater Program 4700 Bragaw, Street P.O. Box 198850 Anchorage, AK 995198850 www.muni.org/onslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Knik Heklhts Biocic B Lot 10 Parcel ID: 017-033-30 A. WELL DATA Well We Pri If A. B, or C provide PWSID 0 Date completed 4/28194 Sanitary seal (YIN) Yes Total depth 17�5_fl. Cased to 175 11. FROM WELL LOG Date of test March 28.1994 Static water level 117 fl. Well production 9 g.p.m. WATER SAMPLE RESULTS: Conform 0 colonles/100 mL Nitrate <0.100 mg/L Arsenio <0_005 mgA Date of sample: =7/2008 B. SEPTICIHOLDING TANK DATA Well Log (Y/N) Yes Wires properly protected (Y" Yes Casing height (above ground) 24 in. AT INSPECTION June 26, 2D06 102 n. 4.3 g.D.m. Other bacteria 0 colonies/100 ml- Collected L Collected by: Cindy Enls Tank Type/Material Steel Septic Tank Date installed May 7.1994 Tank size 1250- gal. Number of Compartfrlents? Cleanouts (Y" Yes Foundation cleanout (Y)MYes Depression over tank (YAC NO High water alarm (Y" N/A Date of pumping May 4, 2006 Pumper McDonald's Pumping Service C. ABSORPTION FIELD DATA Date installed 5/7/19% Son rating (g.p.dAf or ft2Urm)OA5 System type Deep Trench Length 162 0. Width 3 n Gravel below pipe 5 R. Total depth 65.10.5 ft Elf. absorption area 1620 Monkoffng tube Yes Depression over field No Date of adequacy test June 26, 2006 Results (Pass/Fam Pass For 4 bedrooms Fluid depth in absorption field before test 0 &_i. Water added' gal. New depth 5/14.5 in. Elapsed Tine: 2401120 vin. Final fluid depth 3111 in. Absorption rate >• 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN a type) no If yes, give date D. LIFTSTATION Date installed WA Size in gallons Manhole/Access (YIN) 'Pump on, level at _ in. Datum E. SEPARATION DISTANCES 'Pump ofr level at,,,,` in. High water alar level at in. Cyder tested Meets alarm b circuit requiremerrts? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/titi station on lot 100'+ Absorption field on lot 100'+ Public sewer main 100'+ Sewer /septic service line 100'+ On adjacent kits 100'+ On adjacent lots 100'+ Public sewer manhole/deanout 100'+ Holding tank WA Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property #ne 10+ Absorption Reid 5+ Water main 100'+ Water service tine 50+ Surface water 100'+ Wells on adjacent kits 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 8' Building foundation 10+ Water main IW+ Water Service line 50+ Surface water 100'+ Driveway, parrcngNehida storage 15+ Curtain drain NIA Wells on adjacent lots 100'+ F. COMMENTS: 'Lot line waiver requested to north lot One. Water was out into the middle and western trenches of the draintleld. The eastern dralMield is tun. G. ENGINEER'S CERTIFICATION491 7 1 cerUry that I have determined through [fell irlspeXons and review of Munk0of mcords that the above systems are in conformance cult!► MOA COSA guldednes in effect on Ads date. t Y ERIS Engineers Printed Name Cindy W. Eats C=flixrr Date ? COSH Fee $ d/':% ' Date of Payment 'IJ -A4'1-49 410 Receipt Number 8 (Rev. 11 ASI Waiver Fee $ in ter — Date of Payment It irfD(� Receipt Number �3� Watkins Engineering, Inc. RO Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis@gcLnet July 22, 2006 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Knik Heights Block B, Lot 10 Request for Lot Line Waiver To Whom It May Concern: A lot line waiver is requested for the subject property for 5 ft to the north lot line. The septic system was installed in 1994, and the separation distance on the inspection report was 10 ft from the absorption field to the lot line. According to a survey dated July 21, 2006, by Ken Lang, LS -5202, the actual distance is 9.7 ft from the center of the cleanout to the lot line. Since the trench is 3 ft wide, and assuming that the cleanout is in the center, the actual separation distance is 8 ft. I do not believe that this reduced separation distance will adversely impact the property to the north. Thank you for consideration of this waiver request. If you have any questions or need further information, please call me at 349-1851. Yours truly, Cindy . Ellis, P.E. President 41a1r. Mayor Mark Begich Altmicipality of Anchorage o PO. IG.< L'NN:+O • .\nchumgc, .\In.lm!NA91!I Ia:MI • T:Icphmrc (!N17):S-1 i 7Ci111 • 1'us 1!X141337i!{C'INI 47(X) nnkom S( reel • .\nehonige, .Unskn RrA )7 mimmmLnrg Iltillding Safety IN -vision 7/26/2006 Cindy Ellis Watkins Engineering, Inc. P.O. Box 110443 Anchorage, Ak. 99511 Subject: Waiver Request for Knik heights Block B Lot 10 Waiver Request #WR060036 Parcel ID #017-033-30 HAM 060326 Dear Engineer, Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Oqll�1� / Jeffrey W. Poet Engineering Technician On -Site Water & Wastewater Program C011111iunhy, Security, Prosperity Municipality of Anchorage r Development Services Department ..r Building Safety Division :. On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: 060036 PID#: 017-033-30 HAM 060326 Permit#: Date Received:l7 17106 Legal Description: Knik Heights Block S Lot 10 Engineer. Cindy Ellis Watkins Enalneerinn_ Inc. P.O. Box 110443 Anchorage. Ak. 99511 Applicant: Tom & Theresa Kotozat Waiver Requested: a feet separation between absorption field and Property line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ............................................................................... Waiver Is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: �7 — a i a— o6 By: W ............................................ Rec#:7 17-06 Amount: $175.00 Dale Paid: 7-17-06 ........................ SHELBURNE ROAD (GRAVEL) to 17— L. 0 0 fA z 00 00 to r— fh X Ct 8 'W 0•l£ F; 0 .9 1 (A b. C' CA 01 T;oo sr L i.00IZO b -00s4 00 PLOT PLAN As Buia —2L SCALE —1L- -'4W GRID --28-36 Project No. 06-146 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 907) 522-6476 Phone Registered Land Surveyors (907) 522-4625 Fax OF At k9langle0alosko.nef / jelongisOolosko.nofsuo I hereby certify that I have surveyed the following described property. LOT 10, BLOCK W. KNIK HEIGHTS SUBDIVISION 49B Anchorage Recording District. Maska, and that the Improvements situated thereon are .............. .... . ........ within the property lines and do not encroach onto the property adjacent thereto, that no Improvements an the property lying adjacent thereto encroach on the surveyed ...... ... . . ... P m'$*s and re nd that theare n dwaye. transmission lines or other visible KENNETH G. easements on sold property except as Indicated hereon. 02 Dated this the St"' Day of U0CP at Anchorage. Alaska it Is the responsibility of the owner to determine the existence of any easements. covenants, or restrictions which do not appear an the recorded subdivision plot. SCS ReLN Client Name Project Name,! Client Sample ID Matrix Sample Remarks: 1063422001 Watkins Engineering Knik tits. Blk B Lot 10 Knik }Its. Blk B Lot 10 Drinking Water All Dates/Fimes are Alaska Standard Time Printed Date/Time 07/072006 16:45 Collected Date/Fime 06/272006 12:45 Received Date/Time 06272006 15:15 Technical Director Stephen C. Fde Metals Department hardness as CaCO3 Private Individual Analysis Aluminum Antimony Arsenic Barium Cadmium Calcium Chromium Copper Iron Lead Magnesium Manganese Phosphorus Chloride Fluoride Potassium Selenium Sodium Silicon Silver Thallium Sulfate ND 5.00 mg/l, SM20 23408 C 0629/06 07/03/06 MI I ND 20.0 ug/L EP200.8 C Allowable Prep Analysis Parameter Results PQL Unita Method Container ID Limits DH1e DH1e Init Nitrate -N ND 0.100 mg(L EPA 3532 B 06/28&'06 ALR Nitrite -N ND 0.100 mgt EPA 3532 B 06/2&'06 ALR Metals Department hardness as CaCO3 Private Individual Analysis Aluminum Antimony Arsenic Barium Cadmium Calcium Chromium Copper Iron Lead Magnesium Manganese Phosphorus Chloride Fluoride Potassium Selenium Sodium Silicon Silver Thallium Sulfate ND 5.00 mg/l, SM20 23408 C 0629/06 07/03/06 MI I ND 20.0 ug/L EP200.8 C 06/29'06 07/03/06 M11 ND 1.00 ug/L EP200.8 C (<6) 06/29/06 07/03/06 MII ND 5.00 ug/L EP200.8 C (<10) 06(29/06 07/03/06 Mil ND 3.00 ug/L EP200.8 C (<2000) 06(29/06 07/03/06 Mil ND 0.500 ug/L EP200.8 C (6) 06/29/06 07/03/06 Mil ND 500 ug/L EP200.8 C 0629/06 07/03/06 MI1 ND 1.00 ug/L EP200.8 C (<100) 06/29/06 07/03/06 Mll 18.1 1.00 ug/L EP200.8 C (<1300) 0629106 07/03/06 Mll 1010 • 250 ugIL EP200.8 C (<300) 0629106 07/03/06 MII 0.461 0.200 ug/L EP200.8 C (<15) 0629/06 07/03/06 MII ND 50.0 ug/L EP200.8 C 06/29/06 07/03/06 Mil 1.98 1.00 ug/L EP200.8 C (<50) 0629/06 07/03/06 MII ND 200 ug/L EP200.8 C 06/29/06 07/03/06 M11 16.0 0.100 mg/L EPA 300.0 B (Q50) 06129/06 06/29/06 DSII ND 0.100 mg/L EPA 300.0 B (a) 06(29/06 06/29/06 DSII 525 500 ug/L EP2t)0.8 C 06129/06 07103/06 Mll ND 5.00 ug/L EP200.8 C (<50) 06/29/06 07/03/06 Mll 78200 4000 ug/L EP200.8 C (Q50000) 01129/06 07/03/06 M11 5140 200 ug/L EP200.8 C 06/29/06 07/03/06 Mil ND 1.00 ug/L EP200.8 C (<100) 06/29/06 07/03/06 MI1 ND 1.00 ug/L EP200.8 C (a) 06/29/06 07/03/06 MII 17.5 0.100 mg/l, EPA 300.0 B (Q50) 06/29/06 0629/06 DSII SCS Re U1 1063422001 Client Name Watkins Engineering Project Named Knik fits. Blk B Lot 10 Client Sample ID Knik }Its. Blk B Lot 10 Matrix Drinking Watcr All Dates/Times are Alaska Standard Time Printed Date/Time 07/07/2006 16:45 Collected Date/Time 06272006 12:45 Received Date/Time 06272006 15:15 Technical Director Stephen C. Ede Allowable Prep Analysts Parameter Results PQL Units Method Container ID limits Date Date Init Private individual Analysis Total Dissolved Solids Zinc Nickel HCO3 Alkalinity CO3 Alkalinity Ol l Alkalinity Conductivity PH Alkalinity Total Coliform 213 10.0 mg(L SM202540C D (<500) 06/30/06 PLW 119 5.00 ug/L EP200.8 C (<5000) 06/29/06 07/03/06 NUI ND 2.00 ug/L EP200.8 C (<100) 0629/06 07/03/06 MI 132 40.0 mg(L SM202320B D 07/03/06 PLW ND 40.0 mg/L SM202320B D 07/03/06 PLW ND 40.0 mg/L SM20 2320B D 07/03/06 PLW 300 1.00 umhos/cm SNU02510B D 0627/06 CRY 8.01 0.100 pll units EPA 150.1 D (6.5.8.5) 06127/06 CRY 132 40.0 mgfL SM202320B D 07/03/06 PLW 0 col/100m], SM209222B A (<I) 06/27/06 TLF k MUNICIPALITY OF ANCHORAGE -�r -.DEPARTMENT OF HEALTH & HUMAN �TIV-Z ZA_­,��,, �,; Division of Environmental SASC�Ices')', ,-_ C IL 'On -Site Servim Sectlon.. 77 Box 196Mas I I k 1 89519 -MO ,;Anchorage, A P c 3434744 u'. .,CERTIFICATE OF HEALTH AUTHORITY, .'APPROVAL FOR A SINGLE FAMILY DWELLINGr cl Par6e HAA # :7 I I.D. #.2) 7 GENERAL INFORMATION :� Complete legal d(mcriptlon,­ ;46 7' -0 4, d Location (site address ddress or directi y.= h Day dne i) ;tProperty p owner Mailing address Day phone Lending agency' - Mailing iddriii a Day p on Agent , 4 Address dinle"s's"Otherwii 4, 2.,'., NUMBER 01F.B11 .-3.-'- TYPE OFbWATE �jiri water, ...... . . _P1 u. NOTE:` If torr �lngto 4 TYPE OF WAS- n,f I . f 7 F IAA will be held for I �, - Z, Z . 7 1 _. I I 11`4 ; .� � . -i , . ... I , . I statusofsystemr.,".' Ak POSAL* I 4, a6il well water, u. I �, - Z, Z . 7 1 _. I I 11`4 ; .� � . -i , . ... I , . I statusofsystemr.,".' Ak POSAL* I S. STATEMENT,OF INSPECTION BY ENGINEER As certifled by my seal affixed hereto and as of the validation date shown below,) verify that my investigation.of this HealttiAuthority Approval application shows that the on-site water supply and/or wastewater disposal system is safe,"functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 in compliance with all Municipal and State codes, . ordinances, and regulations )n effect on the date of this inspection. - ' --Name of Firm - — ar n• • Phone Address _ Engineer's signature Date" i OF �ti..... AAV 0. lq \� 2. CE 28 Ar 6 DHHS SIGNATURE ,Ar N __._. Approved•for,C' \� _bedroomsVL . Dtsapproved...,.� Conditions bedrooms, with the' 'followmg stipulations . t s r „. Additional Comments r :^4IY Date'i CA U TION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Aealth Authority . Approval Certificates based only upon the representations given in paragraph 5 above by an independent pro fesswnalengineerregisteredlntheStateofAleska.TheDHHSdoesthieasacou topurchasersoihomes rJ andtneirlendinginstitutionslnordertosa courtesy - tisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or.analyze data before a certificate is issued, The Municipality of Anchorage is��not` " responsible for errors or'omasions in the professionai ai ginewii work , 11r� 3 e x i ' ^r. i pr c w ✓ •v VI is 1 6' r , .ice 1' 72aafi.. uni Municipality of Anchorage AL s Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 9 �OT r� I 11 " Parcel I.D. KNlf< l �6IYIQ)r7S A. Well Data Well type Zt i L If A. B, or C, attach ADEC letter. ADEC water system number �i Log present (Y/N) E 4 Date completed �✓ " U// Driller f��Pi.>' % l IZ/1 " � l i Total depth Cased to Z 2 Casing height Sanitary seal (Y/N)—Y-CFS— c'S Wires property protected (YM) y27 e-- FROM WELL LOG AT INSPECTION Date of test rn Static water level �� ^ o m a Well flow g'p'm' g ,e Pump levell A c SEPARATION DISTANCES FROM WELL TO: Z Septic/holding tank on lot al 2 O ; On adjacent lots 9 Absorption field on lot / 3 d / ; On adjacent Public sewer main JVoniG` Public sewer manhole/cleanout Sewer service line IV'D AIZ�Petroleum tank Al oivt WATER SAMPLE RESULTS: Coliform. Nitrate �3 Z_0 Other bacteria - iat n� Date of sample: % — r� �— l �i Collected by: B. SEPTIC/HOLDING TANK DATA Date installed l Tank size :&-Z Compartments Cleanouts (YM) 1 Foundation cleanout (YM) _. Depression (YM) 1✓ High water alarm (YM) LY Alarm tested (YM) Date of pumping . . Y -2L Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: i Foundation Wells) on lot 1 a D On adjacent lots �l To property lineAbsorption field Z Q Water main/service line Surface water/drainage 14� CONTINUED ON BACK PAGE 72-026 ("3)' Front C. LIFT STATION Date installed Size in gallons_ Vent (Y/N)_ :ss (Y/N) 'Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed r_ , ZZ 9;i Soil rating (GPD/Ft2) System type s/ Length 1� Width 3 Gravel thickness Total depth Total absorption area -26 10 Cleanout present (Y/N) <<_s Depression over field (Y/N) , _ Date of adequacy test _ N Results (pass/tail) for Bedrooms Water level in absorption field before to 3G After to Peroxide treatment (past 12 months) (YM) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1,36 On adjacent lots Property line %G To building foundation �T� To existing or abandoned system on lot No'rif� On adjacent lots lynn" Cutbank Water main/service line l7ioit'_Z� Surface water iyo-Ir'T�f Driveway, parking/vehicle storage area _ O Curtain drain E. ENGINEER'S CERTIFICATION I certify That / have checked, verified, or conformed to all MOA and HAA guidelines in effect or ttpiAtQQf this inspection. ' Ar Signature H�<V .v 40 s= ..4. Engineer's Name Chen,. E. wjlw , Jr. A DateCE 62 1 HAA Fee $ 5ev • db Waiver Fee $ Date of Paymen Date of Payment Receipt Numb / Receipt Number 72-026 (W3)• Back