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HomeMy WebLinkAboutKIMBERLY MANOR BLK 1 LT 3Kimberly Manor Block 1 Lot 3 #017-074-11 Municipality of Anchorage Page 1 Dt 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 PID Number:017-07-322 I Permit Number: SW920092 Name: Wastewater System: 0 New -❑ Upgrade Calvin R. Jones a0ar.s:: 2180 Tasha Drive Anch., AK ABSORPTION FIELD Phone: No. of Bed(dams: 276-1726 I Four 4 1 10 Deep Trench C Shallow Trench C Bed G Mound C Other LEGAL DESCRIPTION So'lRating: Total Death fromo1g2z; grade: .45 GPO/an Fr ,5� Y� Lot: 3 Block: 1 Kirt)be '11y nManor c"tn to pope bottom grace Gravel depth beneath pipe 8.5' F' Ft. Township: Range: Sedaon; Fill added above anginal grade: Gravel length: 1 83.2' 2' Ft ct WELL: CZ New ❑ Upgrade Gravel . d`"' 31 Numb 2ol lines: C'' Obeteeen rhes Ft Ciasslpcation (Pnvate. A.B.Cl: I Total Depin: Cased To: Total absorption area: 1,414 Pipe material: 1 ASTM D3034 PVC 240' Ft. 240' Ft., so Ft Griper. Date Drilled: SUt'c wattl Level: Installer. Date installed: 1 Denali Drilling 6/12/ 9 140' Ft. C 8 N Construction 6/17-18/9 Yield: 21 Pumo Set at: Casing ne'gnt Above Ground:5-7 TANK GPM Ft. Ft. SEPARATION DISTANCES XSeptic ❑Holding Cs.T.E.P. To Sepuc Aesoml'on Lin ei -g l' pmiue Manufacturer. Capacity in gallons: From I Tin. I FrM Slat" Tan" s. -«U." Anchorage Tank 1,250 1 Well >100 >100 N/A I N/A >25' Mate tee1 Nimber TwoCompalments. at Surface I >100 >100 N/A N/A N/A LIFT STATION N/A water Lot >5' >10' N/A N/A N/A S':e'n gallons: Manufacturer. i Line >5' >10' I N/A N/A N/A 'P' level at: ump on 'Pump olt level at: High water alarm at: 1 Foundation Curiain None Ion Lo I Pump Ma"e d Model Electrical Inspections perrormed bY: Dram BENCH MARK Remarks: Se tic Tank and line under driveway insulated with 2" of Direct Location and Gescnptlon: Garage Floor Slab Burial Insulation. Soils Encountered I I Assumed Elevation: in Abosrption Trenches Were Consist- 1100.0 pi ent with Those in the Testholes. E,{,! G1)sf fi2R'S SEA L ,gym I e0` Inspections performed by: - MFA -Dates: ist 6/17/98 2nd 6/18/98 ,.... ,. 1.�'ffiFtgE.A!��u74;�/ 3rd 7/17/99 Department of Health and Human Services approval riYii� c -r �O ` •% D by: ate: Reviewed and approved Rev :301].Pn 9x911 UCA:s Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Weil Inspection Report Permit Number SW9800092 LEGEND C - Cleanout M - Monitor Tu SV- Splitter V (Zabel 220 PID No. 017-073-22 Wedl A B C6 46.8 65.5 C4 56.2 68.2 DV 48.8 56.6 S2 46.0 52.8 M1 66.2 61.2 1,250 Gall CS ° M1 e ® C lve Tli2 SV C4 PLAN AS -BUILT SCALE 1- - 30' Four Bedroom Home O H1 Alternate Site i °M2 C7 COX DRIVE 0 A U municipality OT Ancnorage rage a or a DEPARTMENT OF HEALTH AND HUMAN SERVICES • ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW980092 PID No. 017.073-22 73' " C'm> rn N UUN 94.5 2" Insulation 11 90.9 1,250 Gal Sep. Tank 95.0 EU 42.1' EAST LATERAL N ins x UE E 90.2/ 2" Insulati , . I fes.... ♦...o4i l.. o.. F...i .. Drainfield Rock R1 _B 41.1' I PROFILE AS—BUILT w751.o LH1 Gttf:L HORIZONTAL SCALE 1" = 10' NO VERTICAL SCALE a J C' U 90.2 JLL 19.199 04:26PM DEMALI DRILLING 907 562 5971 P.1/1 r. . .� Munieipahtcr of Anchorage Department of Health and Human Services E25 "L! Street Rici Mvsrrom• P.O. Box 196650 Anchorage. Alaska 99519-6650 Ma VC/ Permit Number SW980092 Date Of Issue 5- 1 - 98 parcel Identification Number 017- 07 - 322 Date Started 6 .2 - 98 Date Completed 6 . 12, 98 Is well located at approved permit location? F Yes G No Legal Description Block Lot Property Owner Name & Address: Kimberly Manor 1 3 Calvin R. Jones 2180 Tasha Drive Anchorage, AK 99502 Borehole Data: Depth Method Of Drilling: 12 air rotary 0 cable tool r To Soil Type b Thickness & Water Strata From Casing Type: steel Well Thickness•,,Z1Qnches Silty. clay and sand 0' 30' ie inches, depth 00 feet Uner Type: Diamete =inches, depth feet Hard packed clay b gravell 30' 1 Casing Stickup Above Ground: 2 • I fee; Loose gravel, sand, and Static Water Level (from ground level): 140 feet moisture 60' 8011 Pumping Level; feel, after hrs.pumping5_7 apm Recovery Rate: qpm Hard packed clay b gravel 80' 120' Method Of Testing: Loose gravel, sand, and Well Intake Opening Type: 0 Open EndI Open Hole moisture 120' 130' 0 Screened; Start feet Stopped feet 0 Perforations Start feet Stopped I feet I Silty clay 130' 175' Gravel and sand with GroutType: Bentonite volume 200# small amount of water 175' 185' Depth: from 0 feet, to 12 feet Pump Intake Depth: 201 feet Weathered bedrock 185' 190' Pump Size 114 hp Brand Name Goulds Weather fractured bedrock Well Disinfected Upon Completion? Q Yes 0 No with some water 1 0' 2oo' Method Of Disinfection: Well sanitizer pellets Bedrock with several comments: fractures 200' 240' Well Driller Name Jordan Wininger Company Denali Drilling, Izi. RECEIVED JUL 21 1999 Mailing Address 6000 A Street gept•NealthlHuman Services Zip City Anchorage State AK 99518 Attention: The well driller shall provide a well log to the property owner within 30days of I completion and the property owner or the well driller chall provide a well log to the Dept. of Health & Human Services with?ecei_ved TimexJul-1 3:26PM l_L_'�w 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:SW980092 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:JONES CALVIN R OWNER ADDRESS:2180 TASHA DRIVE ANCHORAGE, ALASKA 99502 PARCEL ID:01707322 LEGAL DESCRIPTION: KIMBERLY MANOR BLK 1 LT 3 LOT SIZE: 36800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 10'•SL,-)QM DATE ISSUED: 5/01/981 EXPIRATION DATE: 5/01/99 1V.OUarn n-06 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 BV * ���/��`L�' � ad-. ISSUED BY: DATE: 5'1096 DATE: 5--%-/8 i ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX April 23, 1998 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 3, Block 1, Kimberly Manor Subdivision Septic System Design ' Impacts to Adjacent Properties Dear Onsite Services Engineer: We hereby apply for a permit to construct a well and onsite septic system on Lot 3, Block 1, Kimberly Manor Subdivision. The attached site plan and backup documentation identify the size and location of the new septic system and reserve site to serve the four bedroom home to be constructed on the lot. The well location is also identified and the 100' protective radius is shown. No conflicts exist between the well and other septic systems in the area. Testholes placed on the property revealed gravelly silts which percolated between 30 and 60 minutes per inch. We have designed a deep trench absorption system with 9' of effective depth because of the I slow percolating soils and the limited area available on the lot for a system. The total depth of the system will be 12' below the surface. Some water was noted in Testhole No. 1 during the monitoring period so the reserve site is designed for a total depth of 11' with only 8' effective. I The surface of the lot slopes from east to west at shallow grades approximating 2%. The lot also slopes from north to south at a grade of nearly 1%. The area designated for the system is fairly flat. A flow diversion valve will be placed to assure an even flow of effluent to each absorption trench. Lots to the north and south of this lot are currently vacant and septic systems to the east and west have been functionirig for more than 20 years in what appear to be similar soils. Lot 3, Block 1, Kimberly Manor April 23, 1998 Page Two If the 1 2. 3 0 system is constructed as designed 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., The subdivision is currently served by a community water system. 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. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 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, -rYl.e.� C, mac„ Michael E. Anderson, P.E. Attachments LOT 3, BLOCK 1, KIMBERLY MANOR ���• 160.00 >o �o t Iea.ao Iao .! I 140.41 1'0 Zama IkL� UPPER H Ii THIS PR( M I S • yaQ•t= • pyli (M . v "o ^' R r� C2. 11.so . �,••_4S II I II I I I it IZ 1I g II VACANT I i I W I 1 11 I • I I� I ^ I o I 9 05 ��lyop° o _ 1` �\ _ I _ Cox ^ Warr• Bk ` 71 VACANT 00f Warrant] 0444 / 8k 71 PI 1' d r. _ RgBeil AREA MAP SCALE 1" = 100' �. 4331 E J`! Well ' LOT 3, BLOCK 1 KIMBERLY MANOR :\ 4 Bedroom Home / 1,250 Gallo Septic Tank ° Flow Splittec cqt 33 c ® TH1 X79'L fiectiveWid th 0TH2 Alternate Site Absor tion Trench s 20' A art co SITE PLAN SCALE 1" _ •30' n : IXCHa E. ANDERSM j; , 4331-E }tom i LOT 3, BLOCK 1, KIMBERLEY MANOR DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 31 to 60 MinJinch 1,250 Gallon Septic Tank Application Rate: .45 GPO/SF 9' Drainfleld Rock 4 Bedrooms X 150 GPD / .45 GPD/SF = 1,334 SF of Absorption Area 1,334 SF/18 SF/ LF of Trench = 74 LF Trench Length Therefore: Construct a Deep Absorption Trench System With Two Laterals Each 37' in Length with 9' of Drainfleld Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 3.0' Below the Origlnal Ground Surface. Flow Splitter Required to Evenly Distribute Effluent to Each Trench. 2'6" Ai 9' Natural Backfill Geotextile Fabric 4" Perforated PVC (Slots Down) nfield 3' TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 3' of Cover over Septic System. Minimum 4' Separation From Groundwater. Minimum 10' Separation From Lot .Line. lu .� .�.� TH .n. !� •l7 c..!w�....�c r UCK-Ia E /ANDErRSJid 4331-E% O of DEPARTMENT OF HEALTH & HUMAN SERVICES = Z' S"at t Androrage• Alaska 99=-06.50 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Rick Jones DATE I�'GAL OLUMIF ca"m nam • oT•. 2 s 4 QT p 'O .7 a s • 70 11 •12 • t3 14 75 OL TSrA0Cr A10- °. � GM sour wrr•+ • Grz vGrl_ a To (. Ora I T7mr •' I Ti"" Wam f I 0 m , I N Ir. I N:30 I — 1 6• c" 1 0Z_ 76 •oma � Y{LSI9b 17 A 7a , I 80rrVM of P;I c 1s m U 8 T.. PEACOLATfON RATE G � (rtunlaasrvxt+l PERC HCL' DIAMETER {i • . TES. RUN BETWEEN s rr ANO G rr I .. C;,MMENTS 'Perrolation Cavitv PrPaoakoA Prior to Test i Mcg, i PERFORMED or. t FY THAT TMS , .WAS PERFORMED W Ar-=RDANCB WITH ALL STATE ANO MUNIC:PAL GUIDELINES W EFFE.=. ON THIS OATc OATS • '6,47 L ,2 -ma IR". VSSI Township, Range. Seciolr WAS GROUND WATER NO vices MTEREW IF YES• AT WHAT DEPTHT � w Atdr/G' y,�4/23/98 I. .' �.<<G CS�F ��• •;4�5,.� r. � C - MME (. Ora I T7mr •' I Ti"" Wam f I 0 m zr=1 I N Ir. I N:30 I — 1 6• c" 1 0Z_ 1 6.334" I ,.�• lwf Ijr: i0 1 is- 1 71' 'v- S I 1 S:30 1 iy I % 1 • ".. I 11 I i t !� DEPARTMENT OF HEALTH 3 HUMAN SERVICES % `i M`a :. ••x.11 . 8251: S"crL Anchorage. Alaska 94502 -MM /• SOILS LOG — PERCOLAON TEST�f-�7 TI %� • RI'CH.IELE.0EK0:1; ' ���� 4391•E •Ss ✓ PERFORMED FOR: Rick Jones DATE MF 4%16/•9 LEGAL DESCRIPnoN: Lot 3 . Block 1 , • Towrattip. Range. Saeio(t oaPrN Kimber ey Manor SLOPE Sr'M PLAN aEETI I . OL 1 2 3 4 r 0 ' Twot,c nlo. L 74 WAS GROUND WATER NO ENCOUNTERED? IF YES. AT WHAT DEPTH? � agr 0=4/23/98 20� PERCOLATION RATE Std I $ ^' • ._.. (mruaarwcn( PERC MOLE DIAMETER . TEST RUN BETWEEN S FT AND ` FT . . COMMENTS 'Percolation Cavity P eGoaker1 Prior o Testa ® Hi =®EmmI nIF-am- Z=m COX Dri've� Rsdry Dam Gros rN ' . N�: TIm* Dom to Wow • N •. it I • I' Drop •.. 0-1 05- 1 s: w S 3S 1 Sc 5D/S 1 675' 77'r :ar IS • I I 1 � 1 1 PERFORMED BY: M E%1 I ' ' •t' -=`•t- ' ` ai:,L RTIFY r71(AT TtIIS TEST WAS PERFORMED W ACCORDANCE W)TH ALLSTATE AND MUNIMPAL GUVELNES W EFFEC• ON THS DATE DATE 724" (Rev. alas) . I ('Re-, aj_)&t GS. Municipality of Anchorage Development Services Department e'E`: Building Safety Division / On -Site Water and Wastewater Program , y r 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING �Nv �n^'' ff Parcel I.D. OI -��4- I COSA # C:�GC.J1_11)w Expiration Date: C1 7 1. GENERAL INFORMATION Complete legal description Location (site address) +541 Cox r',,j e Current Property owner(s) Will;:,.. Sfi I I Day phone 563 - 6051 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: i 3. TYPE OF WATER SUPPLY: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 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 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 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 A;necrztAli- Phone 219-3ilb Address 7D3 W. 15th Engineer's Printed Name, 5. DSD SIGNATURE Approved for Disapproved. _ bedrooms. Date ti V . , °;• i 5?,'-u;s aua:cLA„o: i Conditional approval for bedrooms, with the following stipulations: WASTFWATER Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rw. 7105) FM SCS Ref.M 1072637001 All Datts/1'imes an Alaska Standard Time Client Name Tobbcn Spurkland P.G. Printed Date/rime 06/152007 14.15 Project Name/# Kimberly Manor Lot3 AlK ► Collected Date/Time 06/082007 11:00 Client Sample ID Kimberly Manor Lot 3 ISi K ► Received Date/time 06/082007 14:15 hlatrit Drinking Water Technical Director Stephen C. Ede PIVVSID 0 Sample Remarks: 4500-NO3 - Total NitrateMitritc -The matrix spike recovered below the QC criteria. The batch LCS is within QC limits. Allowable Prep Analysis Parameter Results POL Units Method ContainerlD Limits Date Date Init Waters Department Total Nitratc/Nitritc-N 0.656 0.100 mg/L SM20450ONO3-F D (<10) 06/09/07 JDS Microbiology Laboratory Total Coliform 0 col/IOOmL SM209222B A (<1) 06/08/07 DLC Municipality of Anchorage Development Services Department iBuilding Safety Division On -Site t 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 p Parcel I.D. hl' 1 COSA # Expiration Date: t7 G GENERAL INFORMATION Complete legal description ki.e�e�l� �ahor Lo� 3 'F31(Yt� Location (site address) IS41 Cox Drive I Current Property owner(s) W;11;&,% Sim Day phone SLS -1(6051 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: I 3. TYPE OF WATER SUPPLY: Day phone Day phone 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 ❑ I 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 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 engineers 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 SpyrO aria E , ^v,r , nt Phone 62L o (0 Address 7.03 W. I S11144._ 2o% dam, L __ AIr cra c,.., Engineer's Printed Name 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Conditional approval for Date 2."49.39111. .=b �'P,.pF A(4�1✓II i . 49?! ( !� •i TARS E. S. JR -CV hD :cc tso i bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate -Advisory the By. 1.4/ Original Certificate Date: — 06 (Rw.. 77)05) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHI Legal Description: k 12#Ay tAC%A0'- La} 3 3 1 Parcel A. WELL DATA Well type -Rai If A. B, or C provide PWSID fl = Date completed 41219% Sanitary seal (YIN) Total depth Z40 ft. Cased to Z00 fl. FROM WELL LOG Date of test b IZ 8 Static water level Well production 7 9 P -m. WATER SAMPLE RESULTS: Coliform _�__coloniesl100 mL Nitrate 1-4.+ mg/L Arsenic: _At D ppb date of sample: JZI 04 B. SEPTICIHOLDING TANK DATA TankType/Malerial Ti1niC S>�G Tank size 1240 gal. Number of Compartments �• Well Log (YIN) y Wires properly protected (YIN) %r i Casing height (above ground) > 1$ in. AT INSPECTION 9ZOfo I ff n. 6-5 g.p.m. Other bacteria 0 coloni I /100 mL Collected by: C. 5 Date installed y g v Cleanouts (YIN) Y Foundation cleanout (YIN) / Depression over tank (YIN) _!�L High water alarm (YIN) /y Date of pumping C. ABSORPTION FIELD DATA Date installed 411140 Length ft. Soil rating Pumper T9s4t•5 I (g.p.d./ft2 or ft2/bdrm) 0.45 System type _P tp Width 3 ft. Gravel below pipe 11.5 ft. I Total depth I'L ft. Eff. absorption area t you ft2 Monitoring tube --7—Depression over field /V Date of adequacy test iota Results(Pass/Fail) F465 For bedrooms t3, Fluid depth in absorption field before test in. �vwater added gal. New depth;} in. Elapsed Time: 144b min. Final fluid depths in. Absorption rate >= SOD I g.p.d. Any rejuvenation treatment (Past 12 mo.) (YIN 8 type) Lo If yes, give date I J , D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' leve _ in. 'Pump off_ ff lev _ in. High water alarm 1 in. D Cycl sted Mae l 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 r+ Absorption field on lot ( 00'4- Public 0'+'Public sewer main NSA Sewer /septic service line 725 r + Animal containment areas 50 1+' On adjacent lots 100r + On adjacent lots 100 1 t Public sewer manhole/cleanout Ao a Holding tank N fh Manure/animal excrete storage areas 100'11- SEPARATION 00'} SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'(- Property line 10'f- Absorption field 51+ Water main nr1A Water service line 50 *+- Surface water Al. 0 1 Wells on adjacent lots (00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: , Property line 10 r t• Building foundation 10 t Water main N/A Water Service line 2S'+" Surface water A/ 0 . Driveway, parking/vehicle storage 3 f Curtain drain -Al. 0 . Wells on adjacent lots 10-1 F. COMMENTS G. ENGINEER'S CERTIFICATION ' 1P, * I certify that I have determined through field inspections and i Ca review of Municipal records that the above systems are in 49m conformance with MOA COSA guidelines in effect on1 this date. Engineer's Printed Name Ldfs $Wr1z 1 -Andy/ PSR Date —161 '1 11(l 1 Sco 20�L��-' z ot. COSA Fee $ q-3 0 Date of Payment Receipt Number g� q (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ALL BEARINGS AND DISTANCES SHOWN ARE RECORD. UNLESS NOTED OTHERWISE. EXCLUSION NOTE: IT IS THE RESPONS181LITY 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_. AS -QUILT CERTIFICATE: I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 3, ©LOCA' 1, lOAADERLY' AAANOR S1JBDA6%SION AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. La LOT. 3 BLOCK: fL7 V 1� SUBONISION. /ft.1/BL Rl. Y AM AWY? �� SUJJOJVJS'ION SECTION25 TOWNSHIP 12 N NANCE 3 W . .� «� SEWARD MFRIDIMI Eric F. Fugleslod re o PUT No. P 476 t •.. N0.7218-S,•��s ANCHORAGE RECORDING DISTRICT 9940 ERIC P. FUGLESTAD LAND SURVEYOR Q 3500 CRIrTEN01 HOMER. AK 996 T.7.5-1911 FAX Ax 23 ?.75-86.79 DAR: .FIB MMDER I.B. MI•INfR. /mac-99-01.05 EPF117.Z whl . TMAMM. aEL ED. 1" =50' EPF ep( AS -BUILT ••• +-,z— urs N--a9�5�71 \ urs Urs 150.00' _] �/5 rCI 'ED /55RCBAR UMAT\YP) T / RCBAR WIRED PLASTIC \\ — CENCRAL IUSE CAP \ ASEMENT r 3 \\T It 1 (35,178 S. F) ^p b WELL p 3 of N T fool WCLL r7 I PROTECTION ry I RADIUS LQ to 6 W) C/0 e i / \ 3 STORY V WOOD FRAM 40.50' I thou \ r O M A --- -- - O 3 • AW. VENTS VENTS 3 U C/O's o C/ ,ALU. SEPTIC hl M. T. & C/o 70.00' L�81.71'/ n o /. V — /� FT Ci O!I F(MOMAi N 89'54' W IDRIT7,57' NOTE: ALL BEARINGS AND DISTANCES SHOWN ARE RECORD. UNLESS NOTED OTHERWISE. EXCLUSION NOTE: IT IS THE RESPONS181LITY 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_. AS -QUILT CERTIFICATE: I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 3, ©LOCA' 1, lOAADERLY' AAANOR S1JBDA6%SION AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. La LOT. 3 BLOCK: fL7 V 1� SUBONISION. /ft.1/BL Rl. Y AM AWY? �� SUJJOJVJS'ION SECTION25 TOWNSHIP 12 N NANCE 3 W . .� «� SEWARD MFRIDIMI Eric F. Fugleslod re o PUT No. P 476 t •.. N0.7218-S,•��s ANCHORAGE RECORDING DISTRICT 9940 ERIC P. FUGLESTAD LAND SURVEYOR Q 3500 CRIrTEN01 HOMER. AK 996 T.7.5-1911 FAX Ax 23 ?.75-86.79 DAR: .FIB MMDER I.B. MI•INfR. /mac-99-01.05 EPF117.Z whl . TMAMM. aEL ED. 1" =50' EPF ep( AS -BUILT r4 EQ AZunicipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program S. ; . 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 c� Parcel I.D. 017-073-22 HAA# �wboSY / Expiration Date: i- 310-63 1. GENERAL INFORMATION Complete legal description Lot 3, Block 1, Kimberly Manor Subdivision Location (site address or directions) Cox Drive Current Property owner(s) Calvin R. Jones Day phone 272-6511 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 2180 Tasha Drive Anchorage, AK 99502 Unless otherwise requested, HAA will 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 Four 4 Day phone Day phone 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 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, 1 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 Slate codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson. P.E. Date 10/27/02 5. DSD SIGNATURE Approved for-4—bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WATER AND Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: /(J, / Original Certificate Date: Q – 3 O IRI. MOO) it Municipality of Anchorage ° Development Services Department'_`' Building Safety Division On -Site Water & Wastewater Program f "' 4700 South Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 3. Block 1. Kimberly Manor Parcel ID: 017.073.22 A. WELL DATA Well type Private If A. B, or C provide PWSID # _ Well Log (YIN) Y Date completed 611211998 Sanitary seal (YIN) Y Total depth 240 ft. Cased to 240 ft. FROM WELL LOG Date of lest 6112/1998 Static water level 140 ft. Wires property protected (Y/N) Y Casing height (above ground) >24 in. AT INSPECTION 1014R002 137 ft. Well production 5.7 g.p.m. 3.5 g.p.m. WATER SAMPLE RESULTS: Coliform • 0 colonies/100 ml. Nitrate 1.28 mg./l. Other bacteria 0 colonies/100 ml. Date of sample: 1011812002 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 611712002 Tank size 1.250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YM) Y Depression over tank (YM) N High water alarm (YM) N Date of pumping 61112002 Pumper Isaac's C. ABSORPTION FIELD DATA Dale installed 611811998 Soil rating (g.p.d./W or ft'/bdrm) .45 GPDISF System type Deep Trench Length '83.2 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth 12 ft. Eff. absorption area 1,414 ftl Monitoring tube Y Depression over field N Date of adequacy lest 101412002 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 38122 in. Elapsed Time: 1,440 min. Final fluid depth 38122 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) JL Water added632 gal. New depth49133 in. Absorption rate >= 600 g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot >100' Absorption field on lot >100' Public sewer main NIA Sewer /septic service line >25' Manhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout NfA Holding lank NIA in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >S Absorption field >5' Water main NIA Water service line >104 Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage )'W 2 � Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Date of Payment !O ” L OZ Date of Payment Receipt Number Z9 /t.7 Receipt Number (Rev. 12100) G. ENGINEER'S CERTIFICATION •' : ; `;'. „� �S; I certify that I have determined through field inspections and ,4 ; 491" , review of Municipal records that the above systems are in �../J conformance with MOA HAA guidelines in effect on this date. f,:•:a ... V -- Engineer's Printed Name Michael E. Anderson, P.E. Fy ✓y.•' 47 1 ,''„' Date IOt27f02 ZF'.7CfESS'• 4Y4;y N HAA Fee $ 37 S ` Waiver Fee $ _ Date of Payment !O ” L OZ Date of Payment Receipt Number Z9 /t.7 Receipt Number (Rev. 12100) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) October 13, 2002 Mr. Calvin R. Jones 2180 Tasha Drive Anchorage, AK 99502 Subject: Lot 3, Block 1, Kimberly Manor Subdivision Well and Septic System Inspection, Testing and Certification Dear Rick: At your request we inspected the well and septic system on the subject lot to determine if they met the requirements for certification by the City. Prior to the inspection we inspected the Municipal records and found the septic system was originally constructed in June of 1998 and is composed of a 1,250 gallon septic tank and 2 absorption trenches each approximately 42' long with 9' of gravel beneath the distribution piping. A flow splitter valve is in place to evenly distribute effluent from the septic tank to each trench. The accepting soil material in the absorption trenches is a tight silty gravel with a percolation rate of 40 minutes per inch. The well was also constructed in June of 1998 and is 240' in depth with 6" steel casing the entire depth. We probed the monitor tube at the end of the westerly trench and found nearly 22" of water. The monitor tube in the easterly trench had 38" of water. We then injected 632 gallons of water into the post tank cleanout and the water was distributed to each trench. The water level in the westerly monitor tube rose to 33" and the water in the easterly tube to 49". The water level was checked approximately 24 hours later and was found to have receded to the elevations recorded prior to the test. We conclude from this test the trench is capable of absorbing more than the required 600 gallons of water per day and meets Municipal requirements for certification. It must be noted, however, that the lifespan of a septic system is affected by many variables and no guarantees or warrantees as to the future life of the system are made or implied as a result of our test. The static water level in the well was originally measured at 137' below the ground surface. Water was allowed to run freely from the well through a hose bib and through a 5/8" hose and measured with a volumeter. Flow was measured at an average rate of slightly more than 3.5 gallons per minute with the static water level in the well dropping to 165'. Once flow from the well was stopped the static water level returned to its original level in an hour. The well is therefore capable of producing in excess of the required 600 gallons per day. A sample from the water system was taken to the laboratory for analysis and found to be free of coliform and other bacteria with only a trace of nitrate content. The well and water are therefore eligible for Municipal certification. We noted the sanitary cap on the wellhead was loose. It was reset and secured during our inspection. Similarly, two septic system cleanouts were replaced and raised above ground. Sincerely, n n Michael E. Anderson, P.E. Attachments