HomeMy WebLinkAboutKENO HILLS #1 BLK 4 LT 6Keno Hills #1
Block 4
Lot 6
#020-171-15
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: ________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage Page / of
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: S iY/ qL 60 b �LPiD Number: D,9D -;71— 1---)
Name:
Wastewater System: New ❑ Upgrade
Address:
ABSORPTION FIELD
Phone:
No. of Bedrooms:
Deep Trench ❑ Shallow Trench ❑ eetl ❑ Mound 0 Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth fromdrigi net grade:
/.z GPD/
(-/ tAt. K
Lot: Block: Subdivision:
Depth
Depth to pipe bottom fmm original grade:
Gravel depth beneath pipe
1.1 P (may � — 'T
o I i_L- S
l Ft.
6- Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
`^ ` . _ Ft.
;L Ft.
WELL f2/New ❑ Upgrade
Gravel width:
Number of lines:
0stance between lures:
I
Ft.
j
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
i� 1 ✓A- r iE
9,t nn -v Ft
:3 Ft.
!'7 G V 806 Ft.
Driller:
Date Drilled:
Static water Lave"
lq
Installer:
II�Q keI
Date instgllfd: �y
�/�f �1L
/ALPit-4
5.17. q(f,
FL
/G,
Yield: _
Pump Set at:
'ap Sce
Casing Height Above Ground:
TANK
.� GPM
r t N Ft.
r F Ft.
SEPARATION
DISTANCES
t (Septic ❑ Holding ❑ s.T.E.P.
To
Saptlo
Absorption
Lift
Holding
Publlc/PrIvaie
Manufacturer:
Cap city in gallons:
From
Tank
Field
Station
Tank
Sewer tinea
<591 0--
/,12-;j0
weir
i
l;ZU
! 3I.
>o'l
Material:
S ��e
Number of Comp menta:
Surface
+�Xl=
io2o` `=
LIFT STATION
Lot
j-
?()
f •[-
Size in gallons:
Manufacturer:
Line
Foundation
q I
"Pump on" level at:
"Pump off" level at:
High water alarm at:
Curtain
NON&
11.4",
Pump Make & Model
Electrical Inspections performed by:
Drain
e.
Remarks:
BENCH MARK
Location and Descriptions.
Assumed Elevation: • r'
/ilrl-'-
�,tIG)NfiER'SpSEAL
?�yxi
Inspections performed by: Dates: 1st I.
+' r.
2nd 12r �L
s
Department of Health d Hu Se vices appr v
Reviewed and approved by: ate:
-
S r
724)13 IRep. 9/911 MOA 25 V
History and reasoning for approving the Inspection Report for permit SW960062
History:
• It appears to have never been approved because of an outstanding review comment
regarding the drainfield possibly being less than 6 feet above the bottom of the testhole.
• In 2013 a COSA was approved without addressing the unapproved 1996 Inspection
Report. The COSA indicated the total depth of the drainfield was not too deep for the
test hole.
• Today, 12/3/15, COSA OSC151634 indicates the total depth of the drainfield is not too
deep for the test hole.
• The well log found in On -site's file for the property shows the same soils found in the
soils log extending to a depth of 38 feet below grade.
• In light of all these facts, On-site decided to approve the Inspection Report.
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No. CE -2225
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PRIMARY
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BENCH MAg,�K•'f 0 DATION"
ASSUMED £LEVAFy DO
TDBBEN SPURKLAND P.E. LOT 6, BLOCK 4 KENO HILLS #1 SEPTIC SYSTEM AS LT
203 W 75TH. AVENUE
ANCH. AK. 99501 KEN BECKLEY DATE: JUNE 29, '1996
1 - 17300 ASHLAND DRIVE _ SHEET: 2/3 GRID: 3438
12
42
CLEAN OUT AND MONITOR ---
Standard Trench
2' Wide
42' L ong
14' Deep
6' Sewer rock
4' Cover
PRIMARY TRENCH
NO SCALE
/— Cleanouts
9&
RLfa
REPLACEMENT TRENCH
V
c
f 5 8 f0 ■► w
a
-O-O-
CLEANOUT
1250 got Septic tank
Monitor,
f NwE-'SS
Mirof'/ 140
IF .•.•.•.•.•.•.•r,•,•,m o,•,a•g,.g ,go
'�, ,
INVELE. 91.40
85. Ji -
6 Ft
OF Septic Rock
NO BEDROCK
NO GROl
TER 1250 gal. septic tonk GREER
NU SCALE TESTHOLE , DEEPEND TO 20 FT.
6
BENCH MARK •• rouNDA
ASSUMED ELEV. loo.00 FT
17JO0 ASHLAND DRIVE�,
LOCATION OF WELL
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
CONTRACTOR INFORMATION: REMARK; :
PLEASE MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF MINING & WATER MGMT
3601 C St, Suite 800
Anchorage, Ak 99503-5935
Ph(907)762-2538,rax(907)562-1384
]DRouOH
]LOCK
SECTION OTRS
SECTION
TOWNSHIP
RANGE
MERIDIAN
'
LLOT
e.
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ON
1
❑E
Y/
QS
❑W
LOCATION/SKETCH:
WELL OWNER:
DEPTHS MEASURED FROM:❑casing top ❑ground surface
WELL DEPTH: 5DATE OF COMPLETION
52,ADepth of hole: � `�� It
Depth of casing: –4=ft –5�
BOREHOLE DATA: Depth
Material
Type and Color From To
r
DEPTH TO STATIC WATER LEVEL:
/9 it below map of casing ❑ ground surface
'!
/
Date: S ! 77 1 9_
^
METHOD OF DRILLING: $ air rotary ❑ cable tool
❑ other
USE OF WELL: /9 domestic Q irrigation ❑ monitor
� c�Y
o400Q
❑ public supply Q other
CASING STICKUP: .:2 ft. Diam: In. to _ ft
p
$
Casing type: in, t0 ft
WELL INTAKE OPENING TYPE: ❑ open end ❑ Screened
C7 perforated /j' open hole
Depths of openings: to it
SCREEN TYPE: Diam; In.
Slot/Mesh Size: Length: ft
GRAVEL PACK TYPE:
Volume'used: Depth to top:
GROUT TYPE: Volume:
Depth: from - it to ft
t'
DEVELOPMENT l ETPD: Q`(�
Pncv%otal
t ut pSe
r
PUMPING LEVEL AND YIELD:
�Z �it after ;2—� hrs �
Ngatth &
--- pumping gpm
pt
PUMP INTAKE DEPTH: ft Horsepower;
WELL DISINFECTED UPON COMPLETION? S YES ❑ NO
CONTRACTOR INFORMATION: REMARK; :
PLEASE MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF MINING & WATER MGMT
3601 C St, Suite 800
Anchorage, Ak 99503-5935
Ph(907)762-2538,rax(907)562-1384
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PAGE 1 OF 1
+ , MUNICIPALITY OF ANCHORAGE - 1 C`m
' DEPARTMENT OF HEALTH AND HUMAN SERVICES CLU
P.O. BOX 196650, 825 "L" STREET, ROOM 502-A
ANCHORAGE, ALASKA 99519-6650 hc40, cuw �`p
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ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960062
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:SCHMIDT FAMILY TRUST
OWNER ADDRESS:17300 ASHLAND DR
ANCHORAGE, AK. 99516
PARCEL ID:02017115
LEGAL DESCRIPTION:
KENO HILLS #1BLK 4 LT 6
LOT SIZE: 133729 (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:
DATE ISSUED: 4/29/96
EXPIRATION DATE: 4/29/97
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
ISSUED BY
5 -da 96
Ew
CdrvSYdU /��
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_(Z7,7 A/ jg WAS G CNa�
DATE: Vl36/1?6
DATE •�J G6/
T.SPURKLAND P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 6, BLOCK 4, KENO HILLS
Ken Beckley
No Ground Water or Impervious Layer to 16 ft.
Use Standard Trench
Soil Rating.
< 1 min/in = See Sieve Analysis
Use 1.2 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 15011.2 =125 sq.ft..
Total area required: 4 x 125 =
500 sq. ft.
Finish Floor Elevation Basement
1062
Septic Tank Inlet
1060
Septic Tank Bottom
1056
Ground Elevation at Absorption Field 1064
Testhole Total Depth 16
Bottom trench elevation 1054
Rock depth 6 ft.
Top of Rock Elev. 1060
Length of trench 500 / 12 = 41.67 ft.
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH 42 FT
TOTAL WIDTH 2 FT
TOTAL DEPTH 10 FT
ROCK DEPTH 6 F
COVER 4FT
SEPTIC TANK 1250 GAL
NOTE: PUMPER ACCESS
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are natural surface / sub surface drainage courses on this lot. Proposed septic system is more than 100 feet
distant from any surface water
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
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LOT 3
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SCALE 1" k 10Q FT,
we]1
250 — 300
IIUbULN J UKKLANU F.L. I I LOT 6, BLOCK 4 KENO HILLS #1 I I SEPTIC SYSTEM DESIGN I
203 W 15TH. AVENUE - DATE: APRIL 5, 1996
ANCH. AK. 99501 KEN BECKLEY
(OA7) 970_:ola 17300 ASNLAND DRIVE SHEET: 1/3 GRID: 3438
r
25 0 25 50 75 100 125 1,511
SCALE- I' - 50 FL
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No, CE -2225 ��?;J
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PRIMARY TRf
30I'_
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TOBBEN SPURKLAND P.E.SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE LOT 6, BLOCK 4 KENO HILLS #I
ANCH. AK. 99501 KEN BECKLEY DATE: APRIL 5, 1996
-- 17300 ASHLAND DRIVE SHEET: 2/3 GRID: 3438
0
w
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0
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42 — s — — 10 1�-� to a► =�
I a
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CLEAN OUT AND MONTOR CLEANOUT
1250 gal Septic tank
Standard Trench -
2'
Vale
42'
Long
10'
Deep
6'
Sewer rock
4'
Cover
NO SCALE
Mira Fi 140
6 Ft of Septic Rock
Cleanouts
4' Cover
NR SCALE
0
Monitor
1054
NO BEDROCK
NO GROUNDWATER
49th
SPURKLAND
rr_o�os
Exist, Ground
4' Min Cover
over Tank
1056
1,150 gal, septic tank
BENCH MARK GARAGE FLOOR
ASSUMED ELEV. lo72
TOBEEN SPURKLAND P.E. LOT 6 BLOCK 4 KENO HILLS SEPTIC SYSTEM DESI6N
Anchorage
Ak 9DATE: Ave
Anchorage KEN RRCKLEY APRIL 5, 1996
Anc9501
,,,, ,,.., 17300 ASHLAND DRIVE SHEET: .3/3 GRID: 34.?A
• s,
OW
PERFORMED
LEGAL
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "U' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
SLOPE
(ENGINEERS SEAL)
?� � aU n •e I �'. `9
DATE PERFORMED:
Section:
9 d d
D U
10
11 ® a
12 r
6 �
13 r J
b
14-
15-
4 15
16
17
T3
}
>0 �i d1Nt
_ A,7- ,-1
WAS GROUND WATER �)
ENCOUNTERED? V
S
IF YES, AT WHAT L
DEPTH? L p
E
Depth to Water Alter r
Monitoring? Dale: •b
Reading Date Gross Net Depth to - Net
Time Time Water Drop
19
20--e_e— 017 r• mr71v� '
xe `
y7, �7� PERCOLATION RATE < (minutes/inch) PERC HOLE DIAMETER
FfTEST RUNBETWEENFT AND FT
COMMENTS S -Ca
PERFORMED BY: _ J , ->- I Y _ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
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• Municipality of Anchor °
On -Site Water and wastewater Progra NOV 1 7 2015 r
(907)'W-1904 s A e r r
CERTIFICATE OF ON-SITE SYSTEMS A VAL_
Parcel I.D. 020-171-15 Expiration Date: 3 i 1
1. GENERAL INFORMATION
Complete legal description KENO HILLS #1 BLOCK 4, LOT 6
Location (site address) 17300 ASHLAND DRIVE, ANCHORAGE, AK 99516
Current Property owner(s) ROBERT & KAREN WENTZ '' Day phone
Mailing address 17300 ASHLAND DRIVE, ANCHORAGE AK 99516
Real Estate Agent Day phone '
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or. Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank
Community Class Well ❑ Community El
Public Water, System ❑ Public Sewer El
WaiverNariance request for: Distance:
Received by:
COSA to be released to the engineer, unless of - i quested by the. engineer.
COSA Fee Waiver Fee $
Date of Payment t It g f L 5 Date of Payment
Receipt Number 6-7d}5 EJ Receipt Number
COSA# o5Ct s I (0314 Waiver#
5. 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. t (further verify that based on the information
obtained fromithe 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 ARCTERRA CONSULTING, INC. - Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 11-17-2015
Engineer's Comments: This investigationwascompleted in compliance with ADEC and MOA regulations. The assessment of the: condition
of the well and septic applies only to the conditions: as of the day -tested. The: flow andabsorptionrates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may. fluctuate
during the year and the water usage of the family being served by the. system. The operational life of all well and septic systems are
subject to these various and: dynamic characteristicsandare outside the control of the
evaluator of the well and septic system. Therefore;
ArcTerra can not giveany estimate of how long a
system: will function satisfactory for current or future.
occupants or. can ArcTerra guarantee that no unseen OF AL\
encroachments, deficiencies or discrepancies exist. / 4
�� ,
Ar
'0'* 4,9 Tx 1
6. DSD SIGNATURE
System #1 Approved for bedrooms.` ; 6
System #2 Approved for bedrooms. ,,nom° <� /'7 is °i
°�oFesstoNA`' �
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Y1
OF.,,1
WATER AND
�� PP�CIGRAM�o^
By: 1 Original Certificate Date: Z�% C
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 byan independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work:
7. ATTACHMENTS::
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 1a-10-12.dw _ -
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this SYS—tem _
Certificate of On -Site Systems Approval Checklist
Legal Description: KENO HILLS#1 BLOCK 4, LOT Parcel ID: 020.171.15
A. WELL DATA
Well type PRVr If A, B, or C provide PWSID # _
Date completed 5117/1996 Sanitary seal (YIN) Y
Total depth 226 ft. Cased to 63 ft.
FROM WELL LOG
Date of test 5/1711996
Static water level 19 ft.
Well production 5 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 0.974 mg/L
Arsenic: ND ug/L Date of sample: 11.6.2015
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL
Tank size 1250 gal Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping 512212015 Pumper A+
C. ABSORPTION FIELD DATA
Date installed 5/2211996 Soil rating (g.p.d./f:2 or a/bdrm)1.2
Length 42 ft. Width 2 ft.
Total depth 12.5 ft. (Measured 11-6-15) Eff. absorption area 504 ftZ
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) 18+ in.
AT INSPECTION
11.6.2015
ft.
Collected by: ARCTERRA
Date installed 5/2111996
Cleanouts (YIN)
High water alarm (YIN) N
System type DEEP TRENCH
Gravel below pipe 6 ft.
Monitoring tube _Y Depression over field N
Date of adequacy test 11-6.2015 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in.
Elapsed Time:1 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
Manhole/Access (Y/N)
"Pump off" level at —in. High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOTTO:
Septic tank/lift station on lot 1001+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer/septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
On adjacent lots 1004
On adjacent lots 1004
Public sewer manhole/cleanout 1001+
Holding tank 100'+
Manure/animal excrete storage areas 1004
Building foundation 51+ Property line 5'+ Absorption field 5'+
Water main 101+ Water service line 10'+ Surface water 100'+
Weiss on adjacent lots 1001+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 101+
Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 104
Curtain drain 50'+ (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 COS4A guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 11-17.2015
COSA canary sheet 2-645:ddc
—d � \
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/ // e� �r Apr
� �%' a�g�tORAt' .s
Parcel I.D. 020-171-15
�c e�
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: S –7 ( 3
KENO HILLS #1 BLOCK 4 LOT 6
17300 ASHLAND DR., ANCHORAGE, AK 99516
Current Property owner(s) KEN BECKLEY
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Fxj Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone 345-4552
Day phone
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: NONE Distance:
Received by: _ _� Date: ' 9
COSA to be released to t e engineer, unless otherwise requested by the engineer. -
COSA Fee $ `T ID —
Date of Payments ! r'� _
Receipt Number
COSA#— OS
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. 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 SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
System #1 Approved for _ bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Phone 279-3916
Date 5/1/2013
N,
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7, a
itoo d
bedrooms, with the following s0��RStSIU�`
By: G Original Certificate Date: —7-13
The M nicip� ity o orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheet ° n ..
Nitrate Advisory.
Arsenic Advisory''
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: KENO HILLS #1 BLOCK 4 LOT 6
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #-
Date completed 5/17196 Sanitary seal (YIN) Y
Total depth 228 ft. Cased to 63 ft
FROM WELL LOG
Date of test 5/17196
Static water level 19
Well production
5
WATER SAMPLE RESULTS
ft.
g. p. m.
Coliform NEG colonies/100 mL Nitrate 0'924 mg/L
Arsenic NO ug/L Date of sample: 4122/13
B. SEPTICIHOLDING TANK DATA
Tank Type/Material GREER/ STEEL
Parcel ID: 020-171-15
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) >18 in.
AT INSPECTION
6/12/12
17
4.1
ft.
9 -
p.m -
Collected by: ANSON MOXNESS
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping APRIL 22, 13 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date installed 5/21/1996
Cleanouts (YIN) Y
High water alarm (Y/N) N
Date installed 5/22196 Soil rating (g.p.d./fiz or ftz/bdrm) 1'2 System type DEEP TRENCI
Length 42 ft. Width 2 ft. Gravel below pipe 6 ft.
Total depth 13'2 ft. Eff. absorption area 504 fe Monitoring tube Y Depression over field N
Date of adequacy test 6/12/12 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test O in. Water added 600 gal. New depth 1 in.
Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons -
in. "Pump off' level at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot >100'
Public sewer main NA
Cycles tested
>100'
Sewer /septic service line 25
Animal containment areas >50'
Manhole/Access (Y/N) ---
in.
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots >100,
On adjacent lots >100,
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas >100,
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 91 Property line >5
Water main NA Water service line >10,
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10 Building foundation >10
Water Service line >10
Curtain drain >50'(N.O.)
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water >100'(N.O.)
Wells on adjacent lots >100,
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 LARS SPURKAND
Date 10/16/12
COSA brown sheet 10-10-12.doc
Absorption field >5
Surface water >100- (N.O.)
Water main, NA
Driveway, parking/vehicle storage >5
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PLOT PLAN _ AS BUILT X SCALE 1" - 50' GRID 3438 Project No. 12-051/A1
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Registered Land Surveyors (907) 522-5478 Phone
9 Y (907) 522-4925 Fax
ken0iangsurvey.com m OF
A/ / JonafharMongsurvey.co•.......... qr�
I hereby S.
BLOCK
4h I have surveyed the following del (Pio p1-42)•
!AT 5, BLOCK 4, KENO t. Al SUBDIVISION, ADDN ipt (Plc} 71-42) (,; •:
Mohoroge Recording DIsMo}, Alaska. and that the Improwm•nts sl}uaiad thereon aro # : 49� ••. a
within the property lines and do not encroach onto the =adjacent """""""'•'• f'••••••••••
no Ira rovements on the thereto, that
P property lying ys. trans thereto sor on the surveyed
Promises and that there aro no roadways, transmission lines or other visible :r:: • Q Al.....
eacemants on said properly except as Indicated heroon. KENNETH G. t'ANCC
5202
Dated this the I Day of 'Su.,,c• , 2o11, . of Anchorage. Alaska y¢,r�1t11- �p
It is the responsibility of the owner to determine the existence of any easements, , '�fESS1aHN.1P'
covenants, or restrictions which do not appear on the recorded subdivision plat.
