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HomeMy WebLinkAboutMALINOIS LT 1McI inois Lot 1 #015-143-06 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 Name: ~N~ ~V~ ~ WastewaterSystem: ~New DUpgrade Address: ~l~ ~oT~ ~o~ ABSORPTION FIELD Phone: ~No.o~rooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound DOther Total Depth from original grade: Lot: Block: Subdiv~ion: 3ep~h [o pipe bottom from original grade: Gravel depth beneath pipe Township: I.~ngo:~ ~ i Fill added above original grade: Gravel length: WELL: ~New ~ Upgrade ~rave~ width: Classificalion (Private, A,B,C): Total Depth: J Cased TO: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Instager: Date installed: Yield: Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufactu~r: ~ Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ W~" I~ ' /50 / -- I~O / Materiab~/~ ~ ~. Number of Comp~ment,: Surface W.t~r h ~ N ~- LIFT STATION LineL°t ~ O t ~ O I Size in gallons:I~ Manufacturer: CurtainDrain ~ ~ ~ Pump Make & Model ~ Erectrlcal Inspections performed by: Remarks: BENCH MARK Inspections performed by: ~ Dates: 1st Department of H h and e~ices approval Reviewed and approved b ~ Date' 72-013 (Rev 9/91) MOA 25 ~' B£NCH MARK ++ · 49~¼ No, CE-~2~5 ~ iI ~ SCAL~ i~ = SO F~ SWING TIES: AD $2 BD 28 FT TANK CO AE BE 31 TANK CO AF 44 BF $4 DBL. CO CG 97 k(T BH 77 BED CO CH BI 74.5 C! 97.5 MT EJ 75 BED CO CJ 96 BK 69 BED CO CK 9O BENCH /dARK: GARAGE FLOOR SLAB ASSU/dED ELEK 100.00 FT TOBBEN SPURKLAND P.E. 203 W ~Sl'H. AVENUE ARCH. AK. 9950! PERMIT # SW920i67 LOT 39 SECTION 22, l'12N, DAVID L. KLENK DATE: WARCH 7, i997 I SHEET: 2/3 GRID: 2657I I 015-142-25 ~m 45 ~ 4-1NON Iv;ONITOR ~ 0 4-INCH ~ONITOR 4-INCH DISTRIBUTION PIPE ~8 ~2 ~ STANDARD BED ~25o GAL SEPTIC TANK ANCHORAGE TANK ~8 FT X 45 FT CLEANOUTS AND WONITOR  ~ D. of Cover WON/TOR ~02 ~ ~%~. NO RECORD EX/ST OF CONSmUCT/ON INSPECT/OW ~ ~ ~ _~. PERFORWED WHEN SYSTEW WAS INSTALLED IN ~992 ~.'~?.. No CE-eee~z~~ ,~ BENCH ~ARK: GARAGE FLOOR SZAB ASSUMED ELEK ~O0. O0 FT TOBBEN SPURKLAND P.E. BLM LOT 2~ S~C. 22 T12 , R3~ SEPTIC SYSTEW AS BUILT 20~ ~ 15TH. AVENUE DAVID L. KLENK ~ DATE: WARCH fS, ~997 ~gNC~ AK. 9950~ O~)' 279-591~ I1J15 TOTEW ROAD I SHEET; J/J GRID: 2637 PEN~IT NO SW920167 PID NO 015-142-25 12522~95. DWG ToSPURKLAND PoB 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM APPROVAL AND HAA BLM LOT 39, SEC. 22, T12N, R3W David L. Klenk RECEIVED MAR 1 4 1997 Municipality of Anchomgo Dept. Health & Human Services Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 March 13, 1997 We are submitting an application for the approval of a well and septic system for this lot. In 1992 a well and septic system permit was issued for a four-bedroom residence. The well mad septic system was installed in 1992, but an As Built and final approval request was not submitted to DHSS. A notification that the permit had expired was mailed to the owner on July 8, 1993, but he did not react to the notification. The property is presently being transferred to new owners and an approval of the septic and well systems are needed. Based on the design submitted by Carey S. Meyer P.E. On June 23, 1992, and field measurements made by T. Spurkland P.E. on March 12 and 13, 1997, the attached As Built documentation is being submitted for your review. The field observations match the proposed design. The septic system was not excavated to verify exact elevation of the tank inlet and outlet, the presence o£a silt barrier, or the levelness of the distribution pipes. I was informed by Mr. Daniel Roth on March 7th. that excavation of the system would not be required if the field measurement basically matched the proposed design. The new owners would like to move into the residence by the end oftkis month. The transfer company will not allow early occupancy mtless the well and septic systems have been approved. We request an approval of this property at your earliest convenience. Yours H,qR-':~i-i':Jg? 10:3~ FLP, TTOP TECH. SUCS. STATE OF ALASKA DEPARTMENT OF NATURAIL RESOURCE8 DIVISION OF WATER Y,/ATF~ 1NEU. RECORD WELL OWNER: METHOD OF ~ULUNG: ~'alr rotary [3 ~blet, ool WELL #~rI'AKE OPENING TYPE: J~ open e~J C] Iot~med O~VEL PA~:. Volume GROUT TYPE: Vo~ ~t; DEVELOPMENT / 9UMFING LEVEL AND YIELD: PUMP INTAKE DEI~H'. r ~ ft Ho~ec CONTRACTOR INFORMATION: Rb'MARK~',; PLEASE MAIL WHITE COPY OF L~ TO: DNRIOIVI~ON OF WATER ' PO BOX 77Z116 EAGLE RIVER AK 99577-2116 TOTRL F'. 01 PAGE 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:SW920167 DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP OWNER NAME:KLENK DAVID L & ROBYN O OWNER ADDRESS:il315 TOTEM RD ANCHORAGE, AK 99516 DATE ISSUED: 7/02/92 EXPIRATION DATE: PARCEL ID:01514225 LEGAL DESCRIPTION: T12N R3W SEC 22 LT 39 1 OF 7/02/93 1 LOT SIZE: 108900 (SQ. ~FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 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 (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS BED DRAINFIELD MUST BE INSTALLED IN ACCORDANCE WITH PAGE 3 OF 3 OF THE APPROVED ENGINEER'S DESIGN DATED 6/23/92. THE TOTAL DEPTH MUST NOT EXCEED FOUR FEET. RECEIVED BY: ~ ~~ DATE: ASC© ENGINEERS · ARCHITECTS · SCIENTISTS · SURVEYORS June 23, 1992 Mr. Dan Roth Municipality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, Alaska 99501 Re: Septic System Approval BLM Lot 39 Dear Mr. Roth: Attached is the permit application for a Septic system on the above referenced lot. Below is a narrative of probable impacts to adjacent properties. 1. Wells - There are no existing wells within 100 feet of the proposed new septic system. Wastewater System - No existing on-site wastewater systems are located within 100 ft. of the proposed well on this lot. The proposed well/septic system will not adversely affect the development of systems on the adjacent lots. Reserved Snace - Additional area is available to the east of the proposed field. Separation distances to adjacent wells will be maintained if the future field is developed. Drainage - The lot is moderately steep (10%). Positive drainage away from the field will be maintained. No concentrated surface water will be directed toward the field and no existing streams are within 100 feet of the proposed field. The installation of this on-site system will have no adverse impacts to adjacent well or septic systems. The proposed system's separation distance radius will include parts of adjacent lots, but will not eliminate the ability to construct on-site systems on these lots. ,-.. -' 0~' Very truly yours, ~.~.:o.-- Sr. Civil~nginedo/ ~-~ ~, ~Z~/~J~ CSM:CC:1110-0026.022 ~,~0~ES~- :" 301 ARCTIC SLOPE AVENUE, SUITE 200 · ANCHORAGE, ALASKA 99518-3035 (907) 349-5148 · FAX 1907) 349-4213 Permit No. Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:343-474¥ On-Site Wastewoter Disposal System and/or Well Inspection Report Legal Description BLM LOT 39 PID No: WELL WELL WELL 0 0 t SCALE 1" = 100' X qXISTING DRAIN FIEL£ S ,g o UNDEVELOPED / La 15' TH 0~- TH#1 TH#2 .F //4 ~-PROPOSED 1250 GAL SEPTIC TANK f_- LOT 39 >OSED WELL ~- PROPOSED HOUSE R= 1 O0 ~/~ NOTE: · NO SURFACE WATER OR CURTAIN DRAIN WITHIN ~' ~¢~ ";~ 100' OF THE PROPOSED SEPTIC SYSTEM. 49th Permit No. Page 5 of 5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone;345-4744 On-Site Wostewater Disposal System and/or Well Inspection Report Legal Description BLM LOT ,39 PID No: AREA OF SEPTIC MIN OF 750 S.F. AJ A- 45' TO SEPTIC TANK SECTION A-A 5 LIMITS OF EXCAVATION DATE: 6-22-92 PREPARED BY: KMA SUBJECT: Septic Design SHT: ~ OF 5 ARCTIC SLOPE CONSULTING GROUP, INC. ABSORPTION FIELD DESIGN CALCULATIONS (SHALLOW BED SYSTEM} TEST HOLE #1 PERC = 0.8 GAL/SF/DAY TEST HOLE #2 PERC - 08 CAL/SF/DAY TEST HOLE #3 PERC = 0,8 GAL/SF/DAY TEST HOLE #4 PERC - 0.8 GAL/SF/DAY TEST HOLE #5 PERC = 08 GAL/SF/DAY USE PERC RATE OF 08 GAL/SF/DAY THIS STRUCTURE HAS THREE BEDROOMS; EACH BEDROOM GENERATES ISO GALLONS OF WASTEWATER EACH DAY 4 BEDROOMS X 150 GAL/DAY = 600 GAL/DAY 600 GAL/DAY 0 $ GAL/SF/DAY 750 SF REQUIRED USE THE FOLLOWING DIivlENSIONS TO CONSTRUCT FIELD: SEE SHEET ,3 OF 5 FOR DESIGN 301 ArcUc Slope Avenue Anchorage, Al< 99518-3035 PHONE (907) 349-5148 FAX (907) 349-4213 ARCTIC SLOPE CONSULTING GROUP, Engineers · Architects · Scient;sts - Surveyor's SOILS LOG - PERCOLATION TEST PERFOR_.M~D FOR: LEGAL DESCR/PTION: DEPTH 1 SLOPE SITE PLAN ? N COMMENTS WAS GROUND WATER S ENCOUNTI~ED? ~ O L IF YES) AT WHAT DEPTH? O P Gross Net D~DIh to Net R~ading Date Time Time Water Drop PERCOLATION RATE 2, ~,~ ~'''~/;,~ (mlnut~s/inch) PERC HOLE DIAM~ER ~" T~T~UN S~V~EN ~ ~ ~D $ V; Fr PERFORMED BY: 1'~; /[~c[~o-.~. I ~,~_,, ~'/~-...,~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANC£ WITH ALL STATE AND MUNICEPAL G UIDELINE3 IN EFFECT ON THIS DATE. DATE: 7 SOILS LOG - PERCOLATION TEST LEGAL DESCRIi:TION: ~ ~_/F~ PEP~O~ FOR:~ COMMENTS DEPTH SLOPE SITE PLAN t N WAS GROUND WATER ENCOUN l iaF,~D? IF YES, AT WI{AT DEPTH? Deplh to Water Al~r PERCOLATION RATE ~ m ,'~/;~ (minutes/inch) PERC HOLE DIAMETER TEsr RUN s~w~s~ -~ PT AND 3 ~.. ~ PERFORMED BY: I'~,~$~ A-cl,¢,,,~.,~ I ~.~,~v' /~z'~.~' CERTIFY THAT THIS TEST WAS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ / / ~ / ~ Z , ~'~A.~CTIC SLOPE CONSULTING GROUP, SOILS LOG - PERCOLATION TEST LEG D SC O 8/- n") DEPTH SLOPE SITI/PLAN t N WAS GROUND WATER S ENCOUNTEILED? /~o L ll= YES, AT WHAT DEPTH? -- O P Mo.ite~ng? /¥ ' Oa~ ~ft~/~ s Gross Net Depth to Net Reading Date T~me Time Water Drop PERCOLATION RATE ~-, 7 ,~',,n (n~nuteslinch) pERC HOLE DIAMETER ~ '; TEST RUN BETWEEN 2 V,~ FFAND 3 FT EOMMF. NTS ?p.I~FORM!=DBY: ~E~'~'~k {~0~(~']~/1~{~'~ [ ~11~ ~'~' CERTrFY THAT THIS TEST WAS PEP. FORMED IN '~ ARCTIC SLOPE CONSULTING GROUP, INC. SOIJ_,S LOG - PERCOLATION TEST DEPTH SLOPE SITE PLAN ? N WAS GROUND WATER s ENCOUNTERED? ~J ~ L IF YES, AT WI{AT DEPTH? -- 0 Monitoring? PERCOLATION RATE 'Z, ~ (minut:s/inch) PERC HOLE DIAMETER TEST RUN BETWEEN Z t/2- FT AND ~ FT COMMENTS PERFORMED BY: 1{',7,~ .A~-k~,,m,~,~ I ~.~y ~ ~y~ CERTIFY THAT THIS TEST WAS pEILFORMED IN ACCORDANCE WITH ALL STATE AND MUNIC~AL GUIDELINES IN EFFECT ON THIS DATE, DATE: LEGAL DE~CPdPTIO~: /~ .L ,/~ ~_~ ~ SOILS LOG - PERCOLATION TEST DEPT~ SLOPE STTE PLAN f N WAS' GROUND WATER S ENCOUNTkF. ED? /]J~ L IF YES, AT WHAT DEPTH? -- O P Depfl~ to Water After E PERCOLATION RATE ~--, ~ (minmes/ineh) PERC HOLE DIAMETER. TEar RUN BE~FWEEN ~ I/2_ Fl' AND '~ Fr PEI~:ORMEDBY: I/'-'~'/'1z''~ AC("'e~'~"~a;~! I C~y ~ ~-y~f. CERTIFY THAT THIS TF~T WAS PERFORMED TN &CCOILDANCE WITH ALL STATE AND MUNICIPAL GUIDELINF~ IN EFFECT ON THIS DATE. DATE: • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 W.I Certificate of On -Site Systems Approval Parcel I.D. 015-143-06 1. GENERAL INFORMATION: Complete legal description Malinois; Lot 1 Location (site address) 11315 Totem Road *Anchorage, AK Expiration Date: c7 W-2 Z -z z Current Property owner(s) Mark Miller Day phone 907-301-9000 Mailing address Real Estate Agent 11315 Totem Road *Anchorage, AK 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5,5o Waiver Fee $ Date of Payment /� % Date of Payment Receipt Number 0 5511 yG Receipt Number COSA # CSS C ,Q,,2 1193 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: JeffreyA. Garness Date: b f 1.b1 Z -2 - In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system = in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the _ evaluation. Separation distances were measured to readily identifiable features. Hidden defects or - - encroachments may exist that were not identified during the evaluation. The operational life of all wells _ and septic systems depend upon a variety of variables, including but not limited to, soil conditions, -• ... • • • groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to adequately in perform the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE 46— System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the #AECC884 P���Y 0F« 4(� J= ON-SITE WATER AND �t jog Pt oz J� ROGF�, M By: Original Certificate Date: - 7_7 Z Z 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 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 Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Nitrate Advisory Arsenic Ad/Ivi__so��ryl �— Other S'f-/ `r -G% t1C,p l�p(v,Yt•oy�/ r Legal Description: Malinois; Lot 1 Parcel ID: 015-143-06 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 4.6+ gpm Date drilled 7118192 Water storage tank volume - gallons Total depth 138 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 138 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 0.218 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L On Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG LTD Date of flow test for COSA 6/2/22 Date of Sample 6/2/22 Static water level at beginning of test 91.8 ft. Comments *Installed after 7/6/92 - See MOA records B. TANK DATA Age of tank(s) *29+ years Tank type/material " ' Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/15/22 f D. ABSORPTION FIELD DATA C. LIFT STATION ❑ Required maintenance completed Age of lift station year Lift station material Comment Which system tested (date installed) 1997 Adequacy test date 6/2/22 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade *4.5 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.1 ft (min) Water added 604 gal ❑ N/A — pressurized field 0 New depth in Monitor tubes go to bottom of effective. If not, state 0 depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced nla gallons If y n/a es, enter date Comments/Deficiencies: *At South-west Manitoring Tube - North-East monitoring tube Is nonfunctional COSA Checklist yellow sheet Q, E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *5+ Community Sewer Manhole/Cleanout > 100' Q Yes if No ft � Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if. No ft Holding Tank > 100' H Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 0 Yes if No ft Q Yes if No ft ft if septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [�✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' [✓ Yes if No ft Property Line > 5' ✓[j Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Cly„ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ✓1 Yes if No ft Community Wells > 200'✓Q Yes if No ft Water Service Line > 10' P11 Yes if No ft if septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ED Yes if No ft If absorp#ion field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *Met code at time of installation 29+ year old septic tank is approaching the end of it's useful life, G. ENGINEER'S CERTIFICATION - OF I certify that 1 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.4 COSA Cheddist yellow sheet V0- v.... QO ,J Gar ess.: Q 9. CE -79 33 40Pd i'r o f e s si-1101 #AECC884 Septic 'Wank Advisory Certificate of On -Site Systems Approval #OSC 221293 Subdivision: Malinois lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this COSA / property is all most 30 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced Mailing Address P O Box 196650'* Anchorage, Alaska 99519 6650 *www muni org 0 = 0 > 0 S. a, 3,1 0 :r 7o Q 00; -4 0' 0 to C) 0 IM 0 3m3",0 mr a 0 > 0 o 03 0 3 -0 0Cz 9'0-, 0 z (A 9:2 EF 0 0 t 0 Oc 3 0 o :3.0*0 M -1 F:50 0 0 x 3 a CLO > C 0,40 0, 0, a -Z:2 0.2 0 a -u 0 3 0 0 0.3 m 0 0 (A 0. 0 0 Qz* 0, 0 01 o 6" C, -,2-y 0 0s 0 0 0 3 0 0 CL -3 E!. * a 0 -CA :r3 0 X U7 Is 0 4 —14 m o 0 0 a0 0 Cr 0 0 go -1 *0 � mw t 30.0' Lot 1 S no I J 0 D / E E S TSA T E S Lot 2 I Lot 3 3*57'07"E 365.47' SEPTIC PIPES 00 4.9'x76.2' DECK CONCREM. 16.7 WOOD SHED —SEPTIC PIPE 186.9' 0, �0 3,/ 0 - :CANT LCONNY WELL GRAVEL CON(fRtft 50. < F /2.0 LO 1 12.2 50. 1' GREENHOUSE T N 89'57 'x8.4' PORCH 117.7' L©t 1 2.52 Acres Lot 2 CT M Lot 2 (0 co O� Parcel I.D. # 1. .(~ MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O..Box 196650 Anchorage, Alaska 99519-6650 343-4744 cERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# GENERAL INFORMATION Complete legal desCription Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /'7/ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: / Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality ~nd status of system. ?2-O25(Rev. 1/g1) FrOnl MOA#21 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 of this Health Authority Approval application shows that the on-site water supply ,,~ · and/or Wastewater disposal system s safe, funct ona and adequate for the number of bedrooms an'dtype 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 in compliance With all Municipal and State codes, ordinances and regulations in effect on the date of this insPection. ~ i : NameOfFirm ~'~'~ ~UY~I~c~ ~,~ Phone ~-~-~/~ AddreSs Engineer's signature DHHS SIGNATURE Approved for (~-(~- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtssyto purchasers of homes and their lending institutions in order to satisfy 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 omissions in the professionaiengimi~er~ work.~ Municipality of Anchorage ENVI ON mf .SEEVI( i 4 199 DEPARTMENT OF HEALTH & HUMAN SERVICES UAR Environmental Services Division 825"L" Street, Room 502 ' Anchorage, Alaska 99501' (907) 343-474~ E C E I V Health Authority Approval Checklist Legal Description: "~LH/~vJc ~oq, A. WELL DATA Well lype ~ Log preseet (Y/N) 7 Total depth [ '~t'~ ~ Sanitan/seal (Y/N) 7 IfA. B. or C, attach ADEC letter. ADEC water system number Date completed 7/~/~?~. Cased to ) 3op ~Z~ Casing height (above ground) FROM WELL LOG /,,-/, ,_ Wires properly protected (Y/N) / AT INSPECTION Date of test S~atic water level 7 :~ ~'"~- · Well production /-//t~ WATER SAMPLE RESULTS: Coliform ~ [~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Tank size /,,-2 ~O Number of Compartments Depression (Y/N) J'"] High water alarm (Y/N) ~"/ Pumper (g.p.d./fl o ..... c~.'xn) O, Date installed Foundation cleanout (Y/N) Date of Pumping ~2-/]'7/ C. ABSORPTION FIELD DATA Date installed System type ~ ~ Total depth Length J-//~'/5-~ Width J g /,7~7 Gravel thickness below pipe ~ Effective abso~fion area ~/~ fl %offitoring Tube present(Y~) ~ Depression over field (Y~ h ] ~ ~ bedrooms Date of ad~uacy test ~ff¢ 7 Results (Pass,ail) ~ For Fluid depth in abso~tion field before test (in.); ~ I~ediately ~erp~Og~. water added (in.): ~ ~ Fluiddepth/~.~(ins.)Minutes later: /qhr~ Abso~tionrate = /p~ g.p.d. Peroxide treatment (past 12 months) (Y~) ~ o Ifyes, give date D. LIFT STATION ]"//~ Date installed Mauimlc/Access (Y/N) High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ] ~ O ~"~ Size in gallons "Pump on' level at* "Pump off' level at* ]~0~+~ ; On adjacent lots I~0q' ~4- ; On adjacent lots Public sewer manbole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation f ~ ]~'~ Property line b O ~ ,t:: z¢ Absorption field Water main/service line 7ff '£d~Surface water/drainage Na~ ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION HELD ON LOT TO: Building foundation Surface water ]']¢~z Water main/semce line /tgi9 ~ ,k"~A- Driveway, parking/vehicle storage area ] O /~--~7 Curtain drain Novu~ Obi, Wells on adjacent hits /50 ~ F~ Propertyline /.~'~ ENGINEER'S CERTIFICATION 1 certify that I have determined thrufield inspections and r&view of Municipa! records that the above systems are in confomnance with MOA ~4A guidelines in effect on this date. Signature Engineer's Name HAAFee $ 3 ~ , ff'~ Dateof ayment Receipt Nnmber e'~Tq ( i~ ~9 Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: SEPTIC SYSTEM ADEQUACY~ TES~ :?. 4 edroom System. BLM Lot 39, Sec. 22, T12N, R3W 11315 Totem Road David L. Klenk Single Family, Four Bedrooms On Site Single Family FROM MUNICIPAL RECORDS: TANK: Anchorage Tank 1000 1250 Gal. 2 Cornpart. ABSORPTION SYSTEM: Bed, ABSORPTION AREA: 810 Sq. Ft. SOIL RAT1NG: 187.5 INSTALLATION DATE: 1992 WAIVERS GRANTED: None Required DATE OF LAST PUMPING: Isaacs, March 12, 1997 DATE OF TEST: March 13, 1997 TEST PROCEDURE: System was inspected and measured. Tank was found with 6 feet of cover and with a liquid level of 49 inches. Three clean outs were found in the bed. These cleanouts were 4 feet deep and dry. Two monitors were found 4.5 feet deep and dry. On March 12th. 1000 gallons of clean water were added to the bed. 5 inches of liquid were observed in the monitors. The next day no water was observed in the monitors. An additional 1000 gallons were added. Again the water levels in the monitors were observed at 5 inches. 19 hours later the water levels were 1.5 and 2.5 inches respectively, indicating that the system was operating satisfactorily. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactorily for current or future occupants. All septic systems ultimately fail. Some systems last 15-20 years, others fail after less than five years.