HomeMy WebLinkAboutT12N R3W SEC 33 LT 41DEPT. OF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER AND WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, Al( 99501 http://www.state.alcus/dec/home/htn] TONY KNOWLESj GOVERNOR RECEIVED 28 1998 Municipality of Anchorage Oept. Health & Human Services Telephone: (907)269-7696 Fax: (907) 269-7650 April 29, 1998 Ms. Susan Nolan 14260 Rocky Road Anchorage, Alaska 99517 Subject: Lot 41, Section 33, T. 12 N., R. 3 W., SM, Anchorage, Alaska, Public Water and Wastewater Disposal Systems, ADEC Project Number 188, Review Dear Ms. Nolan: I have reviewed your April 8, 1998 submittal regarding the upgrade of your single f2mnily }]omc into a Bed and Breakfast. Based on this review, I have the following comments. From thc submitted information, it appears that the existing water system met all regulations and guidelines when it was installed. Based on this information and the fact that the demand on the existing water system will not be increased, it appears that the water system will be able to meet the demand without modifications. Therefiwe, the existing Class C Public Water System serving the two bedroom Bed and Breakfast and a two room single f2mily residence located on the above-referenced property is approved fnr the concerns of this Department. A final Operation Certificate, constituting this approval, is enclosed. By opening a Bed and Breakfast in your home, the existing water system classification changes fi'om private to public. The Department is assigning Public Water System Identification (PWISD) Numbers to all public water systems. The PWSiD Nnmber assigned to your public water systems is 218568. This number will need to be placed on all forms requesting analytical results. I recommend that you yearly monitor for total coliform bacteria and nitrates (as nitrogen). Since the existing wastewater disposal system has not been operating at full capacity, it should be able to accept the volume of wastewater fi'om a two bedroom Bed and Breakfast and a txvo bedroom single family residence. Thus, in accordance ~vith the provisions of 18 AAC 72, Wastewater Disposal Regulations and the Department's guidelines, the wastewater disposal systeln serving the facility on the above-referenced property is approved for operation. A final Operation Certificate, constituting this approval, is enclosed. Municipality of Anchorage PaR. / 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: ~L~'~,'~_~ PID Number: O~ ~ ~ ~~ ~ ~;~,~. ABSORPTION FIELD Phone: ; ~ ,~ , ~ / ~ ~ No. of ~edrooms: ~ ~ ~'~ - '~ ~ ,' ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: ~. GPD/Sq Ft Lot: /~ ~ Block: Subdivision: Depth ~o pipe bottom from enginal grade Gravel depth beneath pipe Number of lines: 0istance between lines: WELL: ~ New ~ Upgrade- Graveldepth: /.O Ft ~ ~ Ft Casing Height Above Ground: SEPARATION DISTANCES ~s~p,io g Ho~i.g ~ S.T,E... TO Septic Absorphon Lilt Holding ~ublic/Priv~te Manufacturer: Capacily in gallons: ~ ~ ' :', ~ / Material: ~g~ ~. ~ Number°f Compartments: % Surface w~,~, ~ ~ ~ ~ ~ LiFT STATION Line ~OO m '- Electacal Inspections perf~ by: ~ ~ Remarks: .~XIrP~ ~dcO ~.~ _ BENCH MARK Location and eescription: ~ ~. J AssumodEJovation: /~,¢ ENGINEER'S SEAl,. ~.~ Robert E. Knig~ ! Department of He~l HU ~vices appr 't ~ '.. ..' ~ 72-013 (1/gl)MOA25 Permil No. Page of 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: '. '-" - PID No.: 72 013 A (Rev 9/91) MOA 25 Permit No. Page of 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 LegalDescription: ~'~[:"' ~-~,z. ~ ''~ r~,/ ~' ~.: ~- ~ ?/ ,,o~o.: Or / ! '~ ~Oa ~ 72 013 A (Rev 9i91 ) MOA 25 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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910338 DESIGN ENGINEER:ROBERT KNIEFEL, P.E. OWNER NAME:NOLAN PATRICK M & OWNER ADDRESS:3230 E 142ND AVE ANCHORAGE, AK 99516 DATE ISSUED:10/23/91 EXPIRATION DATE:10/23/92 tz-~ iL~ PARCEL ID:01819209 LEGAL DESCRIPTION: T12N R3W SEC 33 LT 41 SEC 33, T12N, R3W, SM LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS ]PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 (ISAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ELECTRICAL PERMIT IS REQUIRED FOR LIFT STATIONS. SAID PERMIT MUST B~ O~T~INED ~OM BUILDIN%~A~ET~,_ AT ~500 T~DOR RD. V,*,'/~ ~,~ ,~ ~.-."~',~ ~',../'~X~' ~,,,,l~ ~ DATE: DATE: SYSTEM DESIGN GUIDELINES AND NARRATIVE Rabbit Creek Small Tracts, Lot 41 14260 Snowshoe Lane 1. System Design = 4 bedrooms x 300 sf/bed. = 1,200 sf 2. Absorption Bed = 15' x 80' = 1,200 sf All materials, construction methods and required inspections to follow MOA rules and regulations. The contractor ]s responsible for obtaining electrical permits and inspections as necessary and notifying the Engineer and the MOA at least four hours in advance of all inspection needs. Contractor will insure no additions or changes have been made to the location of wells and septic systems on the ad3acent lots prior to the time of construction of this system. If any changes to those systems have occurred, the engineer should be immediately contacted for review and possible changes will be made as necessary. The OBZEill er ~L material will be remoYed to the underlxiDg gra~.].ly ~nd material under any The lot ]s generally flat in the area of the new field. The Installation of the system will have little or no effect on the surface drainage, ground water, or the adjacent systems in the area. 7 The septic system tank should be pumped on a annual basis. 8 The lift station shall be a MOA approved system, Acreage Systems or equal. Based upon the EPA Design t4anua], fig, 7- 28 the piping is to be a 2" manifold from the llf~,#station to the field and 1 1/'4" crc perforated pipe with ~"~/'~ hcles on a 5' spacing. This totals 45 holes for the field, The 1 ift station pump shal 1 meet NOA standards and produce at least 40 ft of head at 10 gpm. The dose cycle floats shall be set to produce 100 gal lotls per acne, The high water alarm in the lif~ stat]on shall be set to produce at least 150 ga]lons of reserve storage above the a]arm. ~ ~ Robert E. Knlelo~ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: ! 2 3 4 5 6 7 8 9 10 11 12 13 14 15 17, 20- SI. OPE WAS GROUND WATER ._.~ S ENCOUNTERED? OeCh Io Water filler ~" Menitorino? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ; F~o. ~ /cO...,~ 3" 3" 5 0°~ f' ,",. ,( ],F fi/ /ato ,, _ ~ / , ~ PERCOLATION RATE TEST RUN BETWEEN /¢__ FT AND /Tz' ¢FT 700 PERFORMED BY: ~"~ H~, O~' I 5,~ { C~ CERTIFY THATTHISTESTWASPERFORMED N 72-008 (Rev 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 $OIL8 bOG ~ PERCOLATION TEST DATE PERF( LEGAL DESCRIPTION; Township, Range, Section: SLOPE SITE PLAN 1 2. 3 4 5 6 7 8 9 10- 11 12 13 14 15 16 17 18- 19- 20- ENCOUN'rERED? S L IF YES, AT WHAT O DEPTH? E oepm ID Water Allot ~/~ ~onltorino? Dale: ,/ Reading Date Gross Net Depth to Net Time Time Water Drop ? -I~-~l ~ s ~-?~_. / ,, 5'~ /O~,,,~. ~/.o PERCOLATION RATE ~- _ (mmules~lnch) PERC HOLE DIAMETER h TEST RUN BETWEEN ~' FT AND FT COMMENTS t ~ ~ / ~//Jf ~ CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: 1 2 3 4 5 6- 7 9 10 11 12 13 14 15 16 17 18- 19- 20- COMMENTS SLOPE 1 ENCOUNTERED? . SITE PLAN S IF YES, AT WHAT ~ El L DEPTH? , O 0,,i,,0 w,,,t A,,o, /.//~. ,,i,. #o J~b.~ Monitoring? //// . ~ Reading Date Gross Net Depth to Net Time Time Water Drop / It ~ -~'-~ / o ~,',~ ~.o ~" ~ ,~ 7~ l~ ~ ,'~ ? ,~ ~" PERCOLATION RATE __ TEST RUN BETWEEN ~/ (m~nutes/~nch) PERC HOLE DIAMETER ~ // ACCORDANCE WITH ALL STATE AND MUI'41CIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 (Rev. 4/85) ACREAGE TANK L~F'I SI'Al ~ON Power Cabl High Watem Level A Cable to Hous Finish Grade sty Sump Lid 1/4" mg ~q" Inlet High Water Alap~ Pump on/off ].$0 gal. Reserve Capacity CV 12" gravel or crushed tone backfil[ H.D.P.Eo LIFT 5'IAI'[ON D.H.H.S. PERMIT il M5-9!-0~.03 II HAAS 8, ASSOCIATES INC, TEL No.907-$49-8791 eoct~ ~anhole on ~o project O~er ~p~ of pl~ ~n be ouqel, ~a~ Intel ~nd ouzel ~[~ lo ~o s~l~ t~Wet b4~e ~re availobte from ADS m~nhoW b~o, u)~d wl~, N, 13 plo APr. 2,92 10:29 F.UI ill tequlr~ ueng ~l~ll~ ~v~l~ble ~o~6nl~ 8u~h ~amn~, ~ ~ ~ f~c~o~ wetd~ ~e~er lo In~c~s ~ Th~e Itjh[ du~ ~p~ b~ JM~Ja~on~ do ~o~ have m,o ) ~kflll r~ulromon~ as manhole~ in ~e ~afllo fight 01 nhOa ~e, ~lnl~h bacilli ~ bo Ola~ t or 2 matorla~ u~, When u~lng be k~ lid, ~llow ~o i~he~ lop ~J ~O nmnholo n~k lo ~e fin~hed grade. I~Nnhol~t ~n ~ IMl~il~ in ~e Ifa~o tt§i~t of way er~d ~.'. ~at40n ~o~s and upper unll ~n ~ In~llod. Ctu~h~ iron frame and 1~ should bo eel O~ ~p of ~. ~notole, ~,(: anhote n~h ~n ~ ~lmmod with O ~w lo make fiq¢ I~t 1'. ~n~ll~f, 1t2 I~ 3/4 I¢¢ m~imdm 1111, well ,.2321 a~lo~ ~e u~ of 1.11~ Inoh m~tmum alia agoro0Ate, b, ~) ~l por~n~g~ of fi¢~, gnnaralJy g~nula MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorag0, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAMe- [PHONE ~,N EW MAll.lNG ADDRESS ~ DESCRIPTION LOCATION [' / ~.~ IF ROMEMADE: NO. OF BEDROOM Abso, ptton area Well Dwelling DISTANCE TO: I Manufacturer DISTANCE TO: / ~'~ ~ No. of Ii,les .::,:~ '~'."~ of tile to finish Typo of crib Crib diameter Well DISTANCE TO; Building foundation DISTANCE TO: /. ~ .Crib depth Building foundation Driller '~ewer lin~ ~ 2 OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS PERMIT NO. No, of compartments Liqukl depth PERMIT NO. PER IT NO. Distance between lines Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to 19t line PERMIT NO Sept,c tank I Absorption area(s} /~ /~.~ I ' APPROVED DATE LEGAL bltlN[CIPALLTY OP ANCHORAGE Departnlan ,)f Ileal tb and Environmeuta Protection Pouch 6-650, Anchorage, AK On-site Sewer~PermiU IIANDWRITTEN Lot Size: __!:~__:_>_=p./~? .__(Sq. Et. or Acres) ].ocatien ..... t),/--'52 ............................ Max Bedrooms ........ Listed be]ow are the eptions aw~ilable to you in desigeing your septic system. Choose the option that best fits your site. ............................................................................................................. TRENCH ~BED~. W, DRAIN Del)th to pipe bottom(ft.) Crave]. depth (ft ) ' ~5-' Total depth (ft.) - ~ f~ Grave] width (ft.) :~-~/~' Tank size (ga],) Soi] rating (sq~t,/br) ** Gravel length 75 feet requires multiple runs (not exceedJng 75 feet each) ** Tank must have at least two compartments ............................. ..... ...... ..................... ..... 7:: 1.I am familiar w~th the requirements for on-site sewers anc~ forth by the Municipality of Anchorage(MOA) anti the State of 2. I will install the system in accordance with all MOA codes and regulations, and :in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing wail, wastewater dJsposa] system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximnm number of bedrooms stated above, and any enlargement or modification will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAl, PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUII. TS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE " I N ELECTRICAL WORK HUST BE DONE BY A LICENSED ELEC]RIC. A S IGNEO: ....... ~ A ~3_ ~ DATE: Applicant ]}I]:::'ARTFIIii:!qT 01::: I!EAI..I'H AND I!:NV:[I::;'.E)Iql41ENTAI, 264 47?0 :l. 3 ;t 2 :l. ~A Y W :[ l'4i:) D I::~ ]: Vt: Ai'qCI'IORA(:~I :, AK '795:1.6 3Zl5'' :!,796 GRAVE!:I.. DI:F:"fI'I (F:'T,,) 'I'I]TAI,.. Dt:FI'i'I (1:::'"I',) (:]RAVI!!:,!,. E)I::~AVI:I,. I,..~]*,I!:;TI'I (F:"I'.) GRAVI:]., ]'ANIC SO;II... ) ( S(]! ,, F' '1" ,, / B R ) E~¢GIWEER~G GEC ,OGY Consulting and Services, Arctic-Subarctic ~.5.-~ox"u~'is'g ...... Anchm~ge, A~,~ 99511 SOILS LOG - PERCOLATION TEST JAMES II. ROBERTS, PL, 360 West Benson Blvd., Anchor,~ge, AK 99503 [ 'C~SOI CS LOG ~--; /.~,/~ ./~COL^1,ON TEST LEGAL 3 4 5 10 - 13 14 15 16 17 18 19 20 SLOPE SITE PL/tN COMMENTS WAS GROUND WATER SL E ~EE pYTESH'?AT W H AT Ne[ Drop MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION 825 L. Street, Ancl~orage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG I~f/ PERCOLAI ION TEST DATE PERFORMED:~/2, .¢_,/¢~:~f LEGAL DESCRIPTION: L.o'¢' ~1¢ I~ GL ~ 6 10 SLOPE 11 14- 15 16 17 18 19 2O COMMENTS SITE PLAN ENCOUNTERED? IF YES, AT WHAT ~' I'i2a O I / Gross Net Net Reading Date Time Time Drop PERFORMED BY: ~ or /SOn , (~ o,~,~lo,'' 72-008 (6/79) ~ I-I a 0 PERCOLATI{ o,~oq IN RATE , (mi~ I 0:~ 4-0 _ ~ o~4 I Depth to water TT/4 ~ - i.37 i,4,~ res/inch} TEST RUN BETWEEN __ } --- F~! ~0' ~ FT /dOA ,57' g' 3 ~ 09.4 V .145 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & GeophysicRISurveys c~.~-~ISTANCE AND DIRECTION FROM ROAO iNTERsECTIONs ~L;?r' O~ ANCHo DEPT~F ................ ENVIRONMENTAL PROT~ ON ' EIVED ~.&abL,_ ~!J~ I?'~ U~L~.L~'~U~ Z ~ ~d..~ .J ~.i,_: .EEL/ ~2_~_~._-~ l~ Meridian OWNER OF WELL; Addreel: WELL OEPTH: (final) 5, OATE OF COMPLETION e. Eicon,. ,oo, I~"o'o,y OOri~e. FOoug E] ^.aa, 0 d.,,.d O Oo,.d O O.h.,: ] Threaded [] Welded ~.. to I $ ,5- .. O.pth in. to fl. Depth SIIckup,__ f f. ft. lO. STATIC wATEE LEVEL: ~ s~ th 2,1 ,~ll)~)"/. Date [~]Atlove or [] Below land surface j ~ ~..ft. otter ~/~. hre. pumplno ,~ (.) g.p.m. HP ft. copocHy [] Cenlriflcal [] Olhef [~F • „ AUr !t _ Municipality of Anchorage 5 6 913 9 70 ,_° On-Site Water and Wastewater Program (907) 343-7904 ry e T Y Certificate of On-Site Systems Appro., - I ti Parcel I.D. 018-192-09 Expiration Dat . of s L= 5 -2.L - 7 1. GENERAL INFORMATION: Complete legal description T12N R3W SEC. 133; LOT 41 Location (site address) 14260 Rocky Road Anchorage 99516 Current Property owner(s) Jim& Mary Young Day phone 227-9116 Mailing address 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 0 Community Class Well ❑ Community 0 Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: (6 Date: OX/i7 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ '5 2 I Waiver Fee $ Date of Payment 5/2311 1 1 Date of Payment Receipt Number 65 L90, Receipt Number COSA# OGCI111 $ 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 ctlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site /ater 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: Gal/less Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 / Engineer's Printed Name: Jeffrey A. Garness Date: / Z/( , / 000p_ �, In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o in accordance with the guidelines and regulations established by the Municipality of Anchorage and 'K\c,O. " 0 • • • c.;l industry practices. The reported results describe the condition of the system/s on the date/s of the O P. y Oh evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �'� Vn o;J.' 4•'T encroachments may exist that were not identified during the evaluation. The operational life of all wells � * �� ) •��V� 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 4VA workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and .. Q are outside the control of GEG. Satisfactory test results do not guarantee future performance of the -f -y A. . -.s: a system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of c/(IV' 3 CE 795 the well or septic system. GEG makes no representation whether an alternative well or septic system Q 9'� •• Z2 • .coQ can be installed on the property in the event either of the current systems fail to perform adequately in Q , e',. • ... Ci„, " the future. The content of this report is for the sole benefit of the person/party that retained GEG to 004°'Profess\o '°oma perform the evaluation. Reliance upon the information provided in this report by any other person or 'O000' ' party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE l I System #1 Approved for `1 bedrooms System #2 Approved for bedrooms Disapproved .�`\( OI_ A/UC , Conditional approval for bedrooms, with the folid ing stipta ons:' ON-bt G) 01 \Nps-rER AND WASTEWATER g71- pKOGF\A�4 �rr /l Original Certificate Date: �/ ,------ 2 c[ ^! 9 7 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 ?6 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Certificate of On-Site Systems Approval Checklist Legal Description: T12N, R3W, SEC 33, LOT 41 Parcel ID 018-192-09 A. WELL DATA Well type PRIVATE If A, B. or C provide PWSID# N/A Well Log (Y/N) YES Date completed 6/22/85 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 136 ft, Cased to 135 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/22/85 4/24/17 Static water level 38 ft. 22,4 ft. Well production 20 g.p.m. 4.4+ g.p.m. WATER SAMPLE RESULTS Coliform ND colonies/100 ml Nitrate ND mg./L. Other bacteria N/A colonies/100 ml. 4/24/17 & Arsenic: ND ug./L Date of sample: 5/5/17 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA 32 YEAR OLD SEPTIC IS APPROACHING THE END OF ITS USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 7/24/85 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) YES Date of pumping 4/25/17 Pumper NORTHLAND PUMPING SERVICE C. ABSORPTION FIELD DATA P*BELOW EXISTING GRADE Date installed 10/29-31/91 Soil rating 6._:p.d./f or ft`/bdrm) 2 System type BED Length 80 ft. Width 15 ft. Gravel below pipe 1 ft. Total depth *4.6+ ft Eff. absorption area 1200 ft: Monitoring tube YES Depression over field NO Date of adequacy test 4/26/17 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 600 gal New depth 1 in. Elapsed Time: 1125min_ Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - -ELEVATIONS AT THE BOTTOM OF BOTH BED MONITORING TUBES WERE WITHIN 1/2 INCH OF EACH OTHER. -WATER WAS INTRODUCED THROUGH MONITORING TUBES. *SEE MOA ELECTRICAL INSPECTION **3 CYCLES WERE TESTED IN THE LIFT STATION D. LIFT STATION IN MOA RECORDS SEPERATE FROM ORIGINAL ADEQUACY TEST ***14" BELOW INVERT OF 4" LINE COMING INTO LIFT STATION. Date installed 10/29-31/91 Size in gallons 500 Manhole/Access(YIN) YES "Pump on" level at 40 in. "Pump off' level at 36 in. High water alarm level at ***54 in. Datum BOTTOM OF LIFT STATION Cycles tested **3 Meets alarm&circuit requirements? * E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *NO ANIMALS AT TIME OF INSPECTION Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75 + Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas *90' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10' Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS oo600p4� G. ENGINEER'S CERTIFICATION o0c OF A L„,, I certify that I have determined through field inspections and 0 � . 4! T- 7;,V0V0 review of Municipal records that the above systems are in vA conformance with MOA COSA guidelines in effect on this VA date. 0 Q Je r: A. Gayness. Engineer's Printed Name JEFFREY A. GARNESS QO —7� opt Jl 44 ::‘,",,,. s •E. 9- ° Date c/z. /1 f� .._�. Z .1 aa> 40eaprofess\° z #AECC884 ��OpOo�o COSA Fee$ Waiver Fee$ Date of Payment Date of Payment Receipt Number Receipt Number (Rev.11/05) • S GE 8v •-_6..7, Municipality of Anchorage . On-Site Water and Wastewater Program gill (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 018-192-09 Expiration Date: )..-` 1 d --( 0 1. GENERAL INFORMATION: Complete legal description T12N R3W; SECTION 33, LOT 41 Location (site address) 14260 Rocky Road*Anchorage,AK 99516 Current Property owner(s) Jeffrey&Margaret Osselbum Day phone 412-298-9475 Mailing address 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 ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: _ Date: 9/i /i A COSA to be rele d to the enginss otherwise requested by the engineer. COSA Fee $ 1'46)�/ Waiver Fee $ Date of Payment � 15` t Date of Payment Receipt Number 6 81-569 Receipt Number COSA# 6 5( I g 111(0,2 Waiver# /VV 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: i3/3 f i tg opOppp�. In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A I`' N in accordance with the guidelines and regulations established by the Municipality of Anchorage and � .••• •• �4r, industry practices. The reported results describe the condition of the system/s on the date/s of the J �1 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or • " " .. OV encroachments may exist that were not identified during the evaluation. The operational life of all wells q H Ni .*v and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q 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 /••,• .1 are outside the control of GEG. Satisfactory test results do not guarantee future performance of the r '•ie'�-A. Gor -ss. system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of Qn 9 c — the well or septic system. GEG makes no representation whether an alternative well or septic system • UQ . • .c p can be installed on the property in the event either of the current systems fail to perform adequately in %�f� (3).31). 1•p cc'% the future. The content of this report is for the sole benefit of the person/party that retained GEG to ���pyofesslonO\ ` perform the evaluation. Reliance upon the information provided in this report by any other person or �OOppo' • party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for ( bedrooms System #2 Approved for bedrooms Disapproved • �- Conditional approval for bedrooms, with the followp g stiputitJn: ILk \NPS Gr. F. Vk • 1 Original Certificate Date: 9 / 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-1O.12.doc Certificate of On-Site Systems Approval Checklist Legal Description: T12N, R3W, SEC 33, LOT 41 Parcel ID: 018-192-09 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 6/22/85 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 136 ft. Cased to 135 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/22/85 4/24/17 Static water level 38 ft. 22.4 ft. Well production 20 g.p.m. 4.4+ g.p.m. WATER SAMPLE RESULTS: Coliform N�‘:r colonies/100 ml. Nitrate NS) mg./L. Other bacteria N/A colonies/100 ml. Arsenic: 4 5 ug./L. Date of sample: 8/17/18 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA 33 YEAR OLD STEEL SEPTIC TANK IS APPROACHING THE END OF IT'S USEFUL LIFE. 51" OF LIQUID ON 8/29/18 Tank Type/Material SEPTIC/STEEL Date installed 7/24/85 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 7/16/18 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA "BELOW EXISTING GRADE 0 0.$C Date installed 10/29-31/91 Soil rating ,c�.p.d./f or ft2/bdrm) � System type BED Length 80 ft. Width 15 ft. Gravel below pipe 1 ft. Total depth *4.6+ ft. Eff. absorption area 1200 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/26/17 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 600 gal. New depth 1 in. Elapsed Time: 1125 min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - -ELEVATIONS AT THE BOTTOM OF BOTH BED MONITORING TUBES WERE WITHIN 1/2 INCH OF EACH OTHER. -WATER WAS INTRODUCED THROUGH MONITORING TUBES. -MONITORING TUBES WERE DRY ON 8/29/18 0 *SEE MOA ELECTRICAL INSPECTION **SEE 2018 MAINENANCE LOG COMPLETED BY D. LIFT STATION IN MOA RECORDS A+ HOME SERVICES Date installedl0/29-31/91 Size in gallons 500 Manhole/Access (Y/N) YES "Pump on" level at ** in. "Pump off' level at ** in. High water alarm level at ** in. Datum •* Cycles tested ** Meets alarm & circuit requirements? * E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *NO ANIMALS AT TIME OF INSPECTION Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75 + Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas *90' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ' 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10' Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS r 'i C co. ' A-T j!1 E 0oo600ppO, G. ENGINEER'S CERTIFICATION oo, .OFjx./.6>I0b .Ap � I certify that I have determined through field inspections and g . 9 y_iii , review of Municipal records that the above systems are in d' D conformance with MOA COSA guidelines in effect on this 0. • , .��°' vA date. Q '•.J f' •. Garn-ss: Engineer's Printed Name JEFFREY A. GARNESS Q • 0o9� • CE • . t.;p� Date 9/4i d 0� ��iP.Sroiff°sioin!..<‘c;5 ' 30 ! AECC884�\ o" # OOoo COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number - Receipt Number (Rev. 11/05) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ID 907-343-7904 On-Site Water and Wastewater Section \ Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # 0SC181462 Subdivision: T12N R3W Sec 33 Lot: 41 The septic tank for this property is 33 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. oil s i' t } S ski � .., .; } * .r A il "' 1.,44• . '-';-A741`' ' f. Vii. a y� w��y(���� r. L. ti 4 ,: . 1 43' t la . , r *4' � L `t Mailing Address: P.O. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org X05 Go-' • MUNICIPALITY OF ANCHORAGE % 4 evelopment Services Department '` Phone: 907-:i43 7x04 : 907-343-799 )n-Site Water & Wastewater Section 7 Lift Station.IPump Vau`+t Maintenance Log wwner J e 9f 0. 2e1,61.,/_„:3_ Street Address )hone '4 l2•Zi8 94 la Lega Desc — PID_ 5ef},tjc Taipk: ,� 'Sludge level 'finches -Pumping: required Xe.;z r 4� -Pumping completed Lift station; -2)4'18' -Pump basket cleaned yes 64S- -Effluent filter cleanedy. of 4 -Control floats cleaned () ro -Proper float settings confirmed yes, -Operation satisfactory (i_D tD. Alarm System; ��� -Dedicated electrical alarm circuit no -Audible and visual alarm inside dwelling -Alarm system operation satisfactory= not satipfactory Manlile Riser -Ground water intrusion at riser to tank connections 9. -Ground water intrusion around pipe penetrations es (TA -Weep hole functional rao -Manhole lid. Functional pi Insulated yes Properly Secured _ n Other -All manufacturer required inspections and maintenance completed Comments: Maintenance Provider. �•.. Tom;=h n ician k r c 13 e S _— Date of maintenanceaSSAaj A pi Comoany A U -s 11601 Sec i Signature Dateaky/ Mailing Address: P. 0. Box 1966x3 'Anchor:me. Alaska 99519-6650 ' wvrw.muni.ord 0 ��res-ry , ':S�OO — f� 7,-4L5•591.. &NA.iC 1LT' I(^,.. • L5•591a }OO 1td0 c.amn+" � • . jATJ^� • 1 r 1 5 39'59'40'W 339.6.1. iul 11 DiAi o 1 °e D :D O Cl Dd/ Daws. ,...//:........:// '"y 0.0 '. , i" Up) 5111:141' 0 /ex TOe�v[r•aa • _r , 9 • as1:11roX"�10.X � Ci D"�Cr t ? - M 7 IV TI T v ., 1 r) � D v • r . a el Dc_a 5 _? 592-4"E ..29.5 • • r -.5-3**ii SUlVE' ' w).:ORrIERS 5E7 11415 Cu.,,,,,CCC,.......,--,1,...1. • 1 F1ERE'3Y CERTIFY 1 H...1:HAVE eE1:FOR.r..lEC'- _...... :.If'k:Tf:.,i..E 1r,:,,,•ih_+10;,:-,e.n4 t,vl, • • . . OE''R!2E:.er..OP i' • • C-_ 1'L�,:Ir.a .n..n.ici.,- Ia.d.0 is JL 1EL.;SLC'i1 G(:4ITi}FIIV=Air•T„bv:.l. " F ....'1',.-:';.•E T . . F4G. Yi FIFA t. SCE..:7 E.,-.,;;.... .. _ _. '-IC:^:A ri:.CTE^ _ .._`_ •___.,.", ___ ,.u".1 .T �...:;r::.r�...,.1...ne.vv $npulry n"c ReJly. 1 C,A7:C AT ANCHORAG:AC-SI.A'IRIS -T1; .L_L•..."i,I DA7.RG..6.',.-.ice: rnA4 k:1•,:pg I.:itJ i.)LhbIIM0 YXL.AA: Lii:i_i I p.a' I. YF!TEM!1Ei ';lin•• ',IJ "'iiI ,,LII ;:1!0 11.R`f`111� . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anci~orage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone 4 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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 and status of system. 72-O25 (Rev. 1/91) Front MOA ~t21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, J verify that my investigation of this Health Authority 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 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. NameofPirm l~ I~~-~-~- ~-~/C'~,-,t~-~'?_.,~,-~ Phone ~7~--- Address CJ0 ~--I /w~ ~ ~ E-~ ~ Engineer's signature ~~~ Date ~ ~ &~ 0 DHHS SIGNATURE ~- Approved for Disapproved. ~7~-' bedrooms. Conditional approval for bedrooms, with the following stipulations: 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 courtesy to 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 professional engineer's work. 72-025 {Rev. 1/91) 8ack MOA #21 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 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWFLLING GENERAL INFORMATION Complete legal description Location (site add'ress or directions) Property owner Lending agency Day phone Ma'iling address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: L/ \~ 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 L"'"'/ Holding tank ~-~ Community on-site · Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 =, ~IAr~'MENT (DF 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 is 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 ~nd/or wastewater disposal system is in compliance ~vith all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ..~'~'/~2y ~'P~/';'I,-C-CYt.~d,' Phone ' Address 7~ ~'dZ Engineer's signature Date ,~/~/~ '7~ DHHS SIGNATURE Approved for bedrooms. Disapproved~ /~-- Conditional approval for '¢~ bedrooms, with the following stipulations: Additional Comments Final DHHS approval will be issued at such time that the bedding and backfilling specifications for the ADS Lift Station are rc ......... i~ baddee~-asa~b{ ....... led in ac~/.ce.~ the existin~g approved specifications. 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 courtesy to 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 professional engineer's work. 72~)25 (Rev. 1191) Back MOA ~F21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST . .,. Legal Description: 7"~'~/~// /?2~'~ ~fJ t,..~.~,( ..:~ Parcel I.D. A. WELL DATA Well type [~-I ') '~ ~ If A, B, or C, attach ADEC letter. Log present (Y/N) Y'~ ~ Sanitary seal (Y/N) Date completed Casedto /,.~ ADEC water system number ~~Z 2 '~ Driller W, Casing height Wires properly proteoted (Y/N) FROM WELL LOG Date of test Static water level We, .ow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ,/L/./~- Sewer service line g.p.m. AT INSPECTION z g.p.m2 ~ .- ~ ~oo~ ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: "~ ~ ~'' ~ "~ '~'~ SEPTIC/HOLDING TANK DATA Date installed 7-- ?0'- 4~,~' Tank size / ~ ''~'~ Compartments Cleanouts (Y/N) %I Foundation cleanout (Y/N) ~'¢ Depression (Y/N) High water alarm (Y/N) ~ ~ Alarm tested (Y/N) ~¢- & Date of pumping /O:~ f ~' ~ f Pumper ~5~ ~ % SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / ~ ~'~"- To property line Absorption field Surface water/drainage _ I __ Foundation / Water main/service line 72 026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed /k.~ '~ '~' ¢¢[ Size in gallons .~-"¢ O Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) Y "Pump on" level at Manufacturer__ Manhole/Access (Y/N) kC' "Pump off" level at Cycles tested / SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /~'~ f On adjacent lots _Surface water D. ABSORPTION FIELD DATA Date installed /~'~' Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ~- ~ ;* System type ~-~'¢~','"4 Gravel thickness__ ° '~ Total depth /, O Cleanouts present (Y/N) t/ Date of adequacy test _~'u//~ ~¢~ ey~/d~* for ~/ bedrooms ~¢~ If yes, give date_ /~// SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~7~ 2 ! To building foundation // On adjacent lots ~©! Surface water /"~'/,~ Curtain drain On adjacent lots ~,~¢O -/ ¢- Propertyline To existing or abandoned system on lot ~'~- / Cutbank_ /,~//,~z/. Water main/service line Driveway, parking/vehicle storage area. ~ dp t E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and NAA guidelines i~¢~!,~ji~e! his inspection. Signature ~¢~' Engineer's Na~ ,~¢/~ Date ~/¢/~ ~¢~ HAAFee$ // ,f7¢ ¢_2¢.) Waiver Fee: $ Date of Payment ~ ~¢:~"'~'~' ~-- ,~ % Date of Payment Receipt Number ~ ~ ¢ (~ Receipt Number 72 026 (Rev, 3/91) 8ack MOA 21 TO: The for MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL TH & HUMAN SERVICES On-Site Services Transmitt~l Sheet ~,1~. attached paperwork has the L EGA L: been reviewed and is being returned following reason(s): Discrepancy in legal description and/or owner name. Discrepancy in number of bedrooms. __ Signature and/or stamp missing on __ Show measured distances to sewers/wells, curtain drains' and streams within 200 feet of proposed system. ___. Replacement disposal site not shown and/or tested. __ Calculation error in design. __ Show locations of all soils, percolation or water table tests. __ Proposed system too deep for soil test submitted. __ Topographic information missing or inadequate. Narrative missing or inadequate. __ Additional soil/parc test needed. __ Sand filter requirements not satisfied. __ Water monitoring results missing or inadequate because __ Incomplete; missing __Well log required. __ Water sample unacceptable because re-submit your l'lBt(-dl-B;,' 'fUE !: ~4 P, O1 KNIEFEL ENGINEERING 8451 MILES COURT ANCHORAGE, ALASKA 99504 (907}337-s560 March 30~ 19S2 Mr. John Smith On-Site Services Manager Department of Health ~nd Human Services Municipality of Anchorage 825 L Street Anchorage, Alaska 99501 SUBJECT= LOT 41, SEC, 33, T13N, R3W Dear Mr, Smfth; ! understand the only way we can release this project from hostage ts to change the ]irt station bedding material specification. Following 18 my submittal for that change:' "The lift station shall be bedded on 12" of type I or 2 ~--gravel material, or NFS gravel/sand mixture that provides free flow of water."-- ~-~' -- This should replace the ~nfo~mation contemned in the original submittal for the l~ft station material for the "Acreage S~stems" Lift Station. If you have any additional questions or comments~ please don't hesitate to contact us, Respectfully Submitted, KnJefel Engineering bert Kntefel, P,E, KNIEFEL ENGINEERING 8451 MILES COURT ANCHORAGE, ALASKA 99504 (907)337-6560 March 14, ].992 Mr. John Smith ~ On-Site Services Program ~ Z~ %'~ Department of Health and Human Services <~.. ~, ¢~ Municipality of Anchorage ~'~6 ~ ~ 825 L Street '~%~ ~ ~. Anchorage, Alaska 99501 '~,~o~ ~ ~ SUB,IECT: LOT 41, SEC 33, Ti2N, R3W "~'~ Dear Mr. Smith: ~:~ % You have requested additional information concerning the lift station bedding material for the system installed at the above lecatJon. This is the third letter I have written on 'this subjec{ within the past two weeks. As noted on the original d~awJ ng for the lift station design, the station manhole contaJ net should be bedded in crashed rock or gravel type materials. This lift station was bedded in SP (sand and gravel) ma[er]al which I consider to he an acceptable material. As the designer for this system I feel it is my responsibility f~T' 'ch~; materials nsed in the system installation. Until such ~ ~me as t-he lift station container manufacturer hires a ~ ~g~.s~ ered engineer in the Sta~e of Alaska bo certify the <hn't airier appl{cation or the MOA wishes to accept full ~.~speNsibi].ity for the lift station design and I am no longer :~ .spohsJb]e, I wi] I stand by the installation for this system. Ti? backfi, ll material used for this lift station is appropriate a d wa~ installed with proper caze. added item, I am no longer wi]ling to accept ye"hal (r such as was exhibited at bhe recent meeting h0tween .~ , Mr. Leo ]~rownhlg, Mr. Sandor Manyoky and othex melllbers star . As I was not present to at least defend ' , .hl,= action,],~., ~ wa~ a totally improper forum for ' ~' v~>ur ac ~.ses in this case and other recent actions I '~ ceq~ost th~ ali co~ m~,n =. regarding my abilities MANHOLE INSTALLATION GUIDELINES I. A~rACHMENT TO THE STORM SEWER BASE ADS N 12 smooth interior polyethylene pipe can be factory welded into the storm sower base to lit tbe requirements for each manhole on tbo project The 3' bigh storm sewer base can accept pipe up ~o 24" diameter. The 4' high storm sower base pipe up to diameter Othe~ types of pipe can be used with tbe ADS storm sewer base This normally requires cutting the opening in the base on the job site. This opening can easily cut wdb an electric or regular hand saw A~tachments to the Sanitary Sewer The sanitary sewer base has five inlel locations and one outlet Eacb inlet and outlet can accept 4" 12" SDR 35 pipe Gaskets lo provide a watertight connection from tbe SDR 35 pipe to the sanitary sower base are available from ACS II. EXCAVATION AND SEDDING Excavate the hole a~ leasl 6' "in diameter and at least 12 inches deeper that the finished elevation of the invert of tho manhole base *Place t2 incbes of crushed rock or gravel in the bottom of the ¢~" hole to provide a stable base for the manhole In all cases, ~ project specilications should be adhered to. orientation of the outlets. Ilk ~TTING THE OPENINGS pipe other than N-12 Storm sower bases which are to be used with N-12 pipe can be ordered with N 12 stubs welded into Ihe base at the factory The sanitary sewer base will accept 4" 12' SDR 35 pipe in into the inlet outlet surface. Note lubricate the SDR 35 pipe and insert it into the gaske~ IV. BACKFILl-lNG THE BASE ,~Tho Base should be backfillod with crushed rock or gravel to a ~ll' ~,~dep[h of at least three leo[ above Ihe invert el the manhole, g may be necessary ~o hold the bose in place during backliliing Care should be taken to backfill around tbe base uniformly V. A~FrACFIING THE ELEVATION SECTIONS AND UPPER UNITS The elevation sections and upper units can be stacked on ~he base The joint is a tongue in groove design and can be made wale[light if required using commercially available sealants such as Ramneck or ADS Gasket 4885A8 Vi. BACKPILLING THE MANHOLE ELEVATION SECTIONS & UPPER UNITS ADS manholes can be installed in the tralfice right of way end can support 14-20 Live loads when properly installed. rThe base must be ba. ckfilled with granular material, Einish backfill can be Class 1 or 2 material up to grade (see note for delinition of Class 1 and 2 backfill). This backfill must be placed uniformly in L12 inch lifts and compacted, Once Ihe base is set and backfilled, the elevation sections and upper unit can be installed. Crushed stone or gravel must be backfilled uniformly around lhe seclions to the lull height of the finished manhole. Tralfice applications require a concrete collar at least 8" thick and al least 5'~0" in diameter around the manhole neck. A standard cast iron Ira, me and lid should be set on top el the concrete. The manhole neck can be trimmed with a saw to make linal grade adjustments. ~'Class 1: Angular, 1/2 to 3/4 inch maximum size, well graded crushed stone, coal, slag, cinders or crushed shells (ASTM D 2321 allows the use el 1 1/2 inch maximum size aggregate, but ~he use of such largo sizes ~s not consistent with the requirements lor unilorm haunching and embedment, particularly for small pipe) Class 2: Clean, coarse sands and gravels with maximum particle size el ti2 to 3/4 inch including variously graded sands and gravels containing small percentages el fines, generally granular and noncohosive, either wet or dry (ASTM D 2487 soil types GW, GP, SW and SP are included) MUNICI?ALITY OF ANCHORAGE MEMORANDUM DATE: March 13, 1992 TO: FROM: John Smith, P. E., Program Manger, On-site Services Department of Health and Human Services Robert binson, Civil Engineer, On-site Services Department of Health and Human Services SUBJECT: Installation Criteria - ADS Lift Station T12N R3W Section 33 Lot 41, Permit # SW910338, #018-192-09 PID Attached is Bob Kniefel's response to our letter dated February 25, 1992 (copy attached) which still doesn't satisfactorily answer our questions on the backfilling requirements. The backfilling requirements and specifications established by ADS are as follows: 1. Base Section - bedding "Place twelve (12) inches of crushed rock or gravel in the bottom of the hole to provide a stable base for the manhole." "The base should be backfilled with crushed rock or gravel to a depth of at least three (3) feet above the invert of the manho].e." Manhole Elevation Sections and Upper Unit - backfilling "The base must be backfilled with granular material. Finish backfill can be Class 1 or 2 material up to grade. This backfill must be placed uniformly in twelve (12) inch lifts and compacted." Note: Class 1 = angular 1/2" to 3/4" maximum size well graded crushed rock Class 2 Clean coarse sands and gravels NFS generally includes GW, GP, SW and SP soils). It should be quite simple for Kniefel to modify or amend his installation specifications for the Acreage Systems (ADS) lift station but he continues to resist doing so. I will not approve the attached as-built for T12N R3W Section 33 Lot 41 until this matter is resolved. ljm:411 KNIEFEL ENGINEERING 8451 NILES COURT ANCHORAGE, ALASKA 99504 (907) 337-6560 Harch 11, 1992 Robbte Robineon On-Site 8ervtcea Program MOA Department of Health and Human 8ervice~ 825 L Street Anchroage, Alaska 99501 SUBJECT; Lot 41, Sec, 33, TI2N, R3W, 14260 8howshoe Lane Dear Mr. Robinson: You have sxproased soma concerns about tho backfill material used for the tnatal'lation of the lift station at this site. As noted on the aa-built, the station was bedded in SP material which consists of Oravele and sands and is ~n appropriate bedding material for the lift station, The general ~eetgn for the lift station calls for gravel material for the bedding which the SP material qualifies, If you have any additional ouestions or comments, please don't hesitate to contact us, R~epectfu]ly Submitted, Kniefel Engineering 9[:6 QH& ~6-~[-N~N Tom Fink, Mayor N ur icipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 February 25, 1992 343-4744 Robert Kniefel, P. E. Kniefel Engineering 8451 Miles Court Anchorage, Alaska 99504 Subject: T12N R3W Section 33 Lot 41, PID #018-192-09, Permit #SW910338, As-built Drawing Dear Mr. Kniefel: This will continue correspondence regarding the ss-built drawing of the recently upgraded wastewater disposal system on the above referenced lot ending with your letter dated February 14, 1992. The subject as-built drawing cannot be approved until you comply with the following: ~ ~.~, 1. It must be shown, on the as-built, that the electrical inspection was made by the MOA Building Safety Division instead of the "Electric Doctor". 2. It must be shown, on the as-built, that the old absorption was abandoned and how abandoned. ~O.Q~~ 3. It must be shown, on the as-built, that the lift ~__~/~/ station was bedded and backfilled with "SP" material. Subsequent to satisfying the above requirements, the subject as-built drawing will be PROVISIONALLY approved because the SP material utilized in the bedding and backfilling of the lift station is not in conformance with the "Acreage Systems, Inc., Residential Lift Station Specifications; August 1990", paragraph 1.4 which stipulate that "12 inches of crushed rock or gravel will be used to bed the base section and backfilled around its exterior with crushed rock or gravel." (~opy attached) The SP material used in bedding and backfilling the subject lift station does not meet this specification. Additionally, we call your attention to AMC 15.65.150.E which requires that the as-built drawing must be submitted to the Department within 30 working days from the date of the final inspection of the on-site wastewater disposal system. The as-built shows the installation was completed on October 29, Kneifel Engineering February 21, 1992 Page Two 1991, however, the as-built was not received by this office until February 19, 1992. Since this is not the first time there has been a considerable time lag in your submittal of an as-built drawing, we urge you to be more punctual in the future as-built submittals. If there are any questions, please call Robert W. Robinson Civil Engineer On-site-Services our office at 343-4744. cc: John Smith, P. E. Program Manager On-site Services ljm:406 Lift Station Specifications August 24, 1990 page two A standard cast of the concrete neck filled polyethylene lid shall meet all Standards. iron frame and lid are installed on top in p]iace of the standard concrete lid. The concrete and frame and requirement of MOA Public Works 1.2 Sump Section Joints -- The joint between each sectio~n shall consist of a watertight joint of tongue in groove design. The joint is made watertight using Ramneck sealant installed according to standard manhole procedures. 1.3 Sump Penetrations -- Ail penetrations for inlet, discharge and electrical wiring shall be made watertight with factory supplied rubber gaskets, The penetrations are made using appropriate hole saws to bore through the outer surface at other than structural seams or within three inches of section joints. The properly sized gasket is inserted into the hole and checked for proper seating. The pipe or cable is then lubricated and inserted through the gasket. All ]3o1% penetrations for the attachment of accessories (junction boxes, etc.) will follow the same procedures as above and use 304 SS bolts and metal washers with rubber gaskets on both sides of the sump wall. 1.4 Sump Material Installation -- The ~ hole for the manhole/lift station is excavated to a 6' diameter and a depth 1' deeper than the fi6ished elevation of the manhole base. .The bottom of the excavation is filled and leveled 'wi~h 12" of crushed rock or gravelw,(i.e. sewer rock). The base section is placed on the' gravel material, checked for levelness and o~ntation, and uniformly backfilled around its exterior with crushed rock or gravel. The additional sections are added as per the requirements in section 1.3. The back~ill for the elevation sections and the top neck section are uniformly backfilled in compacted 12" lifts to the final grade. The finish elevation of the top of the neck will be set to provide at least a 2" clearance above the final grade. KNIEFEL ENGINEERING 8451 MILES COURT ANCHORAGE, ALASKA 99504 (907)337-6560 February 14, 1992 Mr. Robbie Robinson DHHS 825 L Street; Anchroage, Alaska 99501 R[C[IVED You have requested additional information installation of the on-site system for the Following are the answers to your questions: concerning the above property. 1. Copy of Electrical :Inspection -- attached Beclding Material for Lift Station -- The material used for the bedding consisted of SP material, 3. The existing bed was abandoned by disconnecting the p i pes. Respectfully submitted, Kniefel Engineering TEL No. POOYIN~ ~ ~ POUNOATION ~ ~) CALL .,.--.---- MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF i~ALTH AND ENVIRONb~NTAL PROTECTION APPLICATION FOR H~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name.~'/r/~ ~_..?~/~o~Telephone - ~ome~ P~ Busln s Applicants Address../ ~.~ ~- j x~ ~g--~*'~/~-~'~ ~-~//~ (c) Applicant is (check one) Lending Institution ~ ; ~,er/builde~ ~ J j; (d) Lending Institution Telephone Address (e) R~al Estate Co. & Agent Address w Telephone (f) Mail the H~ to the following address: T__ype of Residence Single-Famil~ Number of Bedrooms Water Supply_ Individual Well~.~ Multi-Family Other (describe) Community ~ Public ~-~ Note: If community well system~ must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposa~l Onsite~ Public ~--~ Community ~ Holding Tank~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] e Engineering Firm Providing Inspections~ Tests~ File Sear.qh~ Data snd Information 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for tho number of bedrooms and typo of structure indicated herein. I further verify that, based on the informatign obtained from' the Municipality of Anchorage files and fro~,~y investigation and inspection, the on-site water suppl~ and/or wastewater disposal system is in compliance with all Municipal and State (.odes, ordinances, and regula- . ~' · tions in effect on the date of this inspection. ~AME~ B. RObeRTS, PE, Name of Firm ~,N~ ~ ~u~vr.~o, __ Telephone .~'~ 360 West Benson B~d,, ~207 Address Anchorage, AK 99503 ~'~ ~ (ENGI~ER SE~) Approved for ~*~ bedrooms By~ ~~~g;~o Approved ~ Disapproved -- Condition~ __ Te~s of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PIfRCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEILAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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 PROFESSIONAL ENGINEER'S WORK. (DHEP SF~AL) RR4/ej/D18 [Page 2 of 2] 7 -19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: MUNICIPALITY OF ANCHORAQ~ DEPT. OF 'rlEALTH & ENVIRONMENTAL PROTECTION RECEIVED Well Classification ~/~/.~,/~ If A, B, c~ C, D.E.C. Approved(Y/N) Well Log P~esent (Y/N) ~" Date Completed .~/~/~ ~,/F~ Yield ~3~ Total ~Dth /~ ./~_ Card to /~ ~ .. ~ ~Dth of G~outing ~ Static Wate~ ~1_ ~ , , , ~ ~t At /~5' ~ Casing ~ight ~ve G~ound ...... ~w~/.~/~ Sanitary ~al on Casinfl (Y~) ~ Elec~ical Wi~ing in ~nduit .(Y/N) ~" ~p~ession ~ound ~l~ead (Y~)~ Sep~ation Distance f~ ~11: To ~ptie~oldin~ Ta~ ~ Lot /~/ ~ ~ ~joining Lots ~ To ~a~est Edge of ~so~ption Field on ~t~ ~; ~ Adjoining ~ts ~;~-~ To Newest Public ~ Line ~/~ To ~est Public ~ Clean~t/Manhol~ /~/~ To ~est ~ ~vi~ Li~ on ~t /~ Watez~ Sable Colleated By ~ ~,~ ~-- ; ~te /~~' Wate~ S~le Test ~sults ~//~~ ~ C~nts B. SEPTIC/HOLDING TANK DATA Date Installed *7____/'gz~/~{~ Size /~,~_2 ~.~./ . No. of Compartments ~. Standpims (Y~) ~ Ai~-tight Caps ~__ Foundation Cleanout (y~) ~_ ~p~ession o~ Ta~ (Y~) /t/ ~te ~st Pu~d ~ ~,~//~/) Pu~ing~aintenan~ Contract ~ File (Y~) ~/~; fo~ ~/~ Holding Ta~ High-Wate~ Ala~ ~) ~/~. ~ra~y Holdi~ Tank ~rmit ~ Separation Distan~b ~ ~ptie~oldinq Tank: [Page 1 of 2] To B~ilding Foundation To Disposal Field. / To Stream, Fond, Lake, c~ Major D~ainage 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Z/~,~ Width of Field /~ .f/z Square Feet of Absorption A~ea Depression over Field (Y/N) /%/ ~9/?~./~_Type of System Design ~/ Length of Field. ~ Grail ~d ~ick~ss _~ ~ ~ Stan~i~s ~esent (Y~) ~te of ~st A~a~ Test Results of last Adequacy Test. ~q~ ,.,~ Separation Distance f~om Absorption Field: To Water-Supply Well /-~ ..~/~ To P~operty Line ~'? To Building Foundation -~ ~, .~/~ To Existing o~- ~Abandoned System cn Lot_. /~/~,~_ ; On Adjoining Lots To Water Main/Service Line /C)~ To Cutbank( if present) To Stream/Pond/Lake/o~ Majo~ D~ainage Course ~ To D~iveway, Parking A~ea, o~ Vehicle Sto~a~ A~ea ~/) Cor~rents De Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles do~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request certify that I have checked, verified, c~ conformed to all MOA HAA C~d~lines in effect on the date of thisi~n~ S igne ~~7~ *~"'~~z~ Date C ~"I' J~ES ~BERTS, P~, RLS MOA NO. 360 West Benson Blvd,, #207 KB1/dS/s Anchorage, AK 99503 [Pa~e 2 of 2] 2-15-84