HomeMy WebLinkAboutKNIK HEIGHTS BLK B LT 6KnI*k Heights
Block B
Lot 6
#017-033-06
Municipality of Anchorage page 1 of 2
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: -5W 9S01 jj
PID Number: O(7o 3306
=7111M
(joQ{imer Wastewater System: ❑New ,1 r ❑Upgrade
Address:
126'Yo Riot sumo,( Rd, 4/?cA, 9900 ABSORPTION FIELD
Phone:
r-/3- _ 3/S No. of Bedrooms:
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION Soil Rating: Total Depth from original grade:
Lot: Block: GPD/S . Ft.
Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Prn, k #er 'hfJ
Townshi Ft. Ft.
P: Range: Section: Fill added above Ong"
ri inal rade:
9 9 Gravel length:
WELL: i5x,.rh ❑ New ❑ Upgrade Gravelwi— dth --
;lassificaiion (Private, A, B,C): Total Depth: Cased To:
Total absorption area
Ft. FI
fold: Date Drilled: Stalk Water Level:
Installer:
Meld: Ft. .lSu� 2l/e
Pump Sei I Casing Height Above Ground:
From
Well -
Surface
Water
Lot
Line
Foundation
Curtain
Drain
_ GPM I
Ft
I
SEPARATION
DISTANCES
w0,/ cr
To Septic Absorption
Lift Holding
Tank Field
Station Tank
> (ao'
Remarks:
an Ic.
yO
Per- D
a c�uullt/ hw
w0,/ cr
ryp ro u�liC
Dlfl�-t
cutian he
n e'-
PGiroom,J qn
r- Y hedre
ce V if in
T__
/iv/a (/ aw
b
1967
Number of lines: I Distance between lines:
Pipe material:
Date installed:
B /z/9s'
TANK
® Septic ❑ Holding ❑ S.T.E.P.
'ublic/Private Manufacturer: Capacity in gallons:
---]
Sewer Lines Greer Co Sp
Material: Number of Compartments:
5/Frl Z
LIFT STATION
Size in gallons: I Manufacturer:
"Pump on" level at: f "Pump off' level at: High water alarm at:
Pump Make & Modnl Electncal Inspections performed by:
BENCH MARK
Location and Description:
(t+ncrebe S/cc y of flire/A-
hot a of rel,, OIUOr
//67
!c. re L4 0r, y 12,J qu! 7qn k
Inspections performed by: f-'-1ahlo„ Testi S,, Dates: 1St .9/z/9,s'
2nd
Department of He and Human Services approval
Reviewed and approved by:
Date:_ 23�.�
72-013 (Rev. 9/91) MOA 25
Assumed Elevation:
1610,0
ENGINEER'S SEAL
PERMIT NO: SW950134
PID NO: 01703306
------------ -1
SWING TIES
FROM: COR. "A" COR. "B"
TO:
S.T. C.O. "C" 33' 67'
S.T. C.O. "D" 43' 76'
PIT C.O. "E" 47' 67'
FINAL
GRAD
1 1-0 SEEPAGE PIT
INV.
85.1
EXISTING
SEEPAGE
O Citi
DOUBLE C.O.
m
/ w
O
X
0
„B" z oc
�o
�w
Xm
w'
KORN
A"
PAGE 2OF2
NEW 1250 GALLON
SEPTIC TANK
PLAN VIEW
SCALE: 1" = 30' -_0"
WELL
yY•�"� �Yrr as Y•, Ar, t: n
� �It`t Ynx��x}lA
as YYY ..I Y!!!••P'Y'. tlIII Y•wt�
—_ FROM HOUSE : THEODORE F. xjooac '
" •'u CE - 589 Y`
NEW 1250 GALLON # "`Y. •'•. Y•` "��
SEPTICTANK INV. �?y." �•••••,h
85.5'
LOT 6, BLK. B, K N I K H GH, T944'-F
SEPTIC TANK REPLACEMENT
AS -BUILT INSPECTION REPORT
PROFILE VIEW FLATTOP TECHNICAL SERVICES SCALE: AS -SHOWN
NOT TO SCALE 14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 AUGUST, 1995
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE LL_ - D
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:SW950134
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:BOEHMER TIMOTHY J & KIM E
OWNER ADDRESS:12640 RIDGEWOOD RD
ANCHORAGE, AK 99516
PARCEL ID:01703306
LEGAL DESCRIPTION:
KNIK HEIGHTS BLK B LT 6
LOT SIZE: 43500 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 6/28/95
EXPIRATION DATE: 6/28/96
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 BY:
ISSUED BY:
DATE:
DATE:. 6 Z2 2p�j _
rL
----------------
ABANDON
EXISTING
1250 GALLON
INSTALL NEW SEPTIC TANK w
1000 GALLON 0
SEPTIC TANK 2
° ° ~
DOUBLE C.O. Z O 9ro
CC 0'
X m
O uJ co
i
i
EXISTING
SEEPAGE PIT
m_
HOUSE
SPECIFICATIONS:
The existing 1250 gallon septic tank is to be
properly abandoned by pumping, removing top,
and backfilling with clean material. If the waste line
leading to the replacement septic tank passes over
the excavation for the existing tank, then special
care shall be taken to ensure that it is bedded on fully
compacted soil.
The new 1000 gallon septic tank shall be M.O.A.
approved and set level on undisturbed soil outside the
100 foot radius from all private wells. A double cleanout
shall be installed between the new tank and the
existing seepage pit/
WELL
WELL --
T Ll
ELL
fE-f10
�•••.•
THEODORE F. MOORE
':. t •• CL - 3589
C;AAB HD-. GI ITER ANCHORAGE AREA BORO' H
G,, ARTMENT OF ENVIRONMENTAL QUALI a
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ' �%
NAME�,rC'I(Il1:U jr h(,Isl00it, "4-3_� bill lq 1
—ADDRESS � I1 ,`�[_ / PHONE f., -t -G;
LOCATION_ I�r1)64-k)CC.6 CI ( IAl'i '(PLA; KD LEGAL DESCRIPTION LAll I I I"-, IQlli
CFDTIr- TANIle
DISTANCE FROM WELL_ >l- MATERIAL NUMBER OF —
COMPARTMENTS
LIQUID CAPACITY---GALLONS.LIQUID
__. INSIDE LENGTH INSIDE WIDTH DEPTH_ -
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PIIS_ OUTSIDE DIAMETER--- �- OR WIDTH �`T_, -. � , LENGTH %�/ , DEPTH,
LINING MATERIAL >> (,CICZ'J-L � fr;S . DISTANCE FROM WELL_ /% _ BUILDING FOUNDATION =` (" ,
NEAREST LOT LINE l�' �- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) -J•� SQ. FT.
TILE DRAIN FIELD:
---" � �-- TOTAL LENGTH
DISTANCE FROM WELL FOUNDATIONNEAREST LOT LINE OF LINES ,
NUMBER OF LINES DISTANS�_BETG/EEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA_ ''maySQ. FT. LENGTH OF EACH LINE _
DEPTH: TOP OF TIL TO FINISH GRADE___ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:DISTANCE FROM WATER
TYPE /rl>DIb'. IOP11( L!) , DEPTH /G, ` BUILDING FOUNDATION. p•J __ SAMPLE AE"r" ti ``' NEAREST
NEAREST SEPTIC SEEPAGE / OTHER
l U ( �' 1i , CESSPOOL /V� VG , SOURCES �� —ic.v
LOT LINE ,SEWER LINE ,TANK SYSTEM___
OF SYSTEM
DATE _ ;1/�' APPROVED
r,nnrz
GREATER ANCHORAGE AREA BORUUGH 2127
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE. ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM o APPLICATION AND PERMIT
NAME OF APPLICANT ���G�i/j���� `� r MAILING ADDRESS �'j�S `������/�- PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION ADT-4� .✓J`�C�ll� .0-""�� /�T J `/�/
INSTALLATION OF: SEPTIC TANK L/ SEEPAGE PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE
FINANCED THROUGH
L' TO BE INSTALLED BY //x ��'c •' 11 �4
SOIL TEST RESULTS-�- NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
/,-% i
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ��=5� C. TYPE-s����� � SEEPAGE AREA SIZE ����--TYPE
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
i
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT `: C DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /_/
SEPTIC TANK 5 SEEPAGE PIT �'" G DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK `�SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, _S C , SEEPAGE PIT y DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
C_
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE /'�J'/�`� APPLICANT'S SIGNATUF
r) 'r 11 A P. I r:
35001 TUD0P f
A'iCHOROE, ALASKA 9 19 5 2
Performed For Mir. Del-li).sijann Date Performed
Lena] Oescrintion: Lot 6 BiocL Subdivision Knilc 1.1 tS
This Form Reports Soils L c) clT <X Per-olation Test
Oen t h
Date
G rn s s Time
Feet
Soil Characteristics
Net
I
The soil conditions viey,e
vory ey..vatio iyi thic
2 Soil
'Me cyrn to Gw 'hnd Some
-oebble and coarse sa.nd
I ),y E, x - s111he MI ,and Ch
4=
appeared pr.
A
coe,,tinp� on the larier
pnxticles. The Sp liad S 0 Tat]
0A
-A
pebble sizecl ptirticles _qnd
n. fEUrly hi c h Silt content.�
-
6
7-
---- -
to
--- -----------
In S -TT
Pprcolation Rate
S S 1op( ----Wes t
Was Ground
Water Encountered? No
0
q S t. Iti
f) tr.
De n t h of
Inlet:— _ __4, _ f -(.,. e t
If Yes, AL
what Depth?
E N T S
------
'w ot-155, sof-t/lod-rju
I foot sp jt_ 1- 5 0 Sq
IU
e a d i n q
Date
G rn s s Time
I Net Time
'Ienth to 11,0
Net
r.
-A
--- -----------
F—
Pprcolation Rate
Prn r) o s e
q S t. Iti
f) tr.
De n t h of
Inlet:— _ __4, _ f -(.,. e t
_X,
-1 ei T
r e n c h e e t
E N T S
joot__Gr, ),t. 22_�_ q
'w ot-155, sof-t/lod-rju
I foot sp jt_ 1- 5 0 Sq
-ft/bdrfn
calcilloted aver,ge--
1 hq rm
Test Performed
v pey.,cco
e
-\ Municipality of Anchorage
'y sy
Development Services Department
Building Safety Division
_
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING 636190
1 p
Parcel I.D. 017.033 06 COSA # 6 D b 1$0
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Let 6, Block B, Knik Heights Subdivision
Location (site address) 12640 Ridgewood Road Anchorage, AK 99516
Current Property owner(s) Lynn Lawrence, Carol and Jay Shelley Day phone 240-0024
Mailing address 12640 Ridgewood Road Anchorage, AK 99516
Lendfic agency Day phone
Mailing address _
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
;. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual On-site ❑
Individual Water Storage ❑ Individual Holding Tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfar of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Appro%al
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of Onsite 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 Anderson Engineefing Phone 522'7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson. P.E. Date
* 49-M
0 r.UO1Aa 9. ANDERSON:,t'
b. DSD SIGNATURE�s� C=-4381
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By. r 0= Original Certificate Date:%91�
(Rs+. 1IM5)
Municipality of Anchorage o
Development Services Department =
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onshe
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 6• etoc4
A., WELL DATA
Well type I'dvate
.4 `Date completed 1972
Knik Helahts Subdivision
If A, B, or C provide PWSID # _
Sanitary seal (YM) Y
Total depth 165 ft Cased to 165 ft.
FROM WELL LOG
Date of test
Static water level
. Well production
ft
9 -
p.m -
WATER SAMPLE RESULTS:
Coliform 0 coloniesM00 mL Nitrate 1.62 mg/L
Arsenic: Nro ug/I Date of sample: E0108
B. SEPTICIHOLDING TANK DATA
Tank Type/Material septlGSteet
Tank size 1.250 * gal. Number of Compartments Two
Parcel ID: 017-033-06
Well Log (YM) N
Wires property protected (YM) Y
Casing height (above ground) >18 in.
AT INSPECTION
5/2212008
123.4 ft.
Other bacteria 0 colonies/100 mL
Collected by: J. Davis
Date installed 82195
Cleanouts (Y/N) Y
Foundation cleanout (YM) Y Depression over tank (YM) N High water alarm (YM) N
Date of pumping ' 8/82007 Pumper Roto Rooter
C. ABSORPTION FIEF DATA
Date installed 6/9/M Soil rating (g.p.d.e or ft2/bdrm) i60 SFBDRM System type Absorption Crib
Length 25 fL Width 20 ft. Gravel below pipe 6 R
Total depth t 12.3 ft Eff. absorption area 534 ftp Monitoring tube Y Depression over field N
Date of adequacy test 522106 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 60 in. Water added 1.625 gal. New depth 72 in.
Elapsed Time: 1.440 min. Final fluid depth 60 In. Absorption rate >= 600
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. UFT STATION
Date installed Size in gallons
'Pump on' level at_ in. 'Pump oft level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots 91—
Public sewer manhole/cleanout N/A
Sewer/septic service line >25' Holding tank N/A
Animal containment areas None Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >5' Property line >5* Absorption field >S
Water main N/A Water service line >10' Surface water >700'
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 >227
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS' Well on Lot Is 91' From Neighboring Absorption Trench on Lot S. Trench Was Placed in 1975 After the Well was
In Place. See Separation Distance Waiver.
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 COSA guidelines in effect on this date.
Engineers Printed Name Michael E. Anderson, P.E.
Date 6172008
COSA Fee $ 14;:�o c
Date of Payment (f 'Irl
Receipt Number (ClA f i0'
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number,
Aa J6 ANDERSON � v
j 4381
fo �9 ^0 h.• .A�' .�
PROF
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Johns, Jr. & Assoc.
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ER
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• FOR M INITIAL TRANSACTIaN ONLY AND ASSLWU M ANCIAL UAULrrf ONLY FOR TN[ COST OF THE SURVEY.
ZO'd S8175 Z99 406 1S3 -rdMJ H1S1A-"llN3an8d Z£:TT 8002-G0-Nnf
SGS RcEll
1082162003
Client Name
Anderson Engineering
Project Namdd
Water Samples
Client Sample ID
12640 Ridgewood Rd.
Matrix
Drinking Water
PWSID
0
Sample Remarks:
An Dates/rimes are Alaska Standard Time
Printed Date/rime
05/302008 13:39
Collected Date/time
05202008 11:40
Received Date/time
05202008 13:30
Technical Director
Stephen C. Ede
Allowable Pnrp Analysis
Parameter Results POL Units Method Comiiner ID Limits Date Date Intl
Metals by 1CP/MS
Arsenic ND 5.00 ug/L EP200.8 , C (<10) 0522/08 0523/08 NRB
Waters Department
Total NitmtrJNiuitc-N 1.82
Microbiology Laboratory
Colony Count 0
Total Coliform 0
Feed Coliform 0
1
0.100 mg/L SM20 4500NO3-F B (<10)
coV100mL SM20 9222B
coV100mL SM20 9222B
wI/IOOmL SM20 9222B
A (Q00)
A (<1)
A (<I)
0529/08 LCP
0520108 DLC
0520/08 DLC
0520/08 DLC
Municipality of Anchorage
% 1:0. Mx 19(;G90 • .Vwhonige, Alaska W519 -CM) . 4700 Elnmrc &md
Office: (19M.M.KY)l • rm: (9117) M-82IY0 hllp://niminiml.m,
Mayor MarkJ3cyich Development Semiccs Department
June 16, 2008
Michael E. Anderson
Anderson Engineering
P.O. Box 240773
Anchorage, AK 99524
Subject: Waiver Request for Knik Ileights, Block B Lot 6
Waiver Request WR#: 080029
Parcel ID # 017-033-06
IIA080180
Dear Michael E. Anderson:
Toent S,
,os,.,.
�-
Af
Department
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field to the private well has been approved. The approved separation distance
is 91.0 feet. The absorption field in question is located on Lot 5.
This waiver approval applies to the existing absorption field to private well separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Deb Wockenfu
Civil Engineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
/ 4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:080029 PID#:017-033-06 HA/Permit# IIA080180
Date Received: June 16, 2008
Legal Description: Knik heights, Block B Lot 6
Engineer.
Michael E. Anderson
Anderson Engineering
P.O. Box 240773
Anchorage, AK 99524
Applicant: Lynn Lawrence
Waiver Requested: 91' from well to absorption field on neighbors lot
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
jec 60.1tc rlica
owns ...... wassessess ... message ... ...... e....... ... some*
Waiver Is Granted: X
List Conditions or Reasons for above:
Waiver is not Granted:
Date:l6 16108 By:Deb W�kenfuss
Name of Reviewer
,m........ message .... gamesome ... .ssoese...•............ assessess.... seen@.
Rec#: Amount: $ Date Paid: 6 11 612 0 0 8
Knik Heights, Block B Lot 6
Parcel ID: 017-033-06
Waiver for 91 feet from field on Lot 5 to well on Lot 6
Issued June 16, 2008
General
1. From the water sample, total coliform was 0, and total nitrates was 1.82 mg/L.
2. Any overflowing sewage would move away from the well head.
3. The location of the system is in a visible area and any surfacing effluent will be seen and
corrected.
ADEC Criteria
Water Table
Depth of water bearing zone in well
Assumed bottom of field
1'(53/190) + 7
165 feet
12.5 feet
152.5 feet
Soil Sorption
Soil descriptions from well log of neighboring property - Knik Heights, BB L5
Points
7.3
Water Table Gradient -
Water table slopes toward the water source 0.7
Assume -20.9% slope
Horizontal Seoaration
91 feet between septic field and well
x = 16/25 + 2.0 2.64
Total Points 14.5
As per ADEC waiver guidelines, with a point value of 14.5, No bacteriological pollution possible but chemical
pollution possible but unlikely from household chemicals. Mitigating factors used to approve the waiver Include a
large amount of clay shown in the well log and if there was any overflow sewage, it will have to cross the driveway to
get to the well head.
DEC PTS Depth From
Depth To
Thickness
Calc. Pts
Clay w/ 20% sandy gr
5.5 12.5
28
15.5
0.56
Clay
6 28
65
37
1.46
Grav W/ 30% clay
1 65
133
68
0.45
Sandy grav w/ 20% cl
2.5 133
165
32
0.52
0
0.00
0
0.00
152.5
2.99 3.0
Permeability
Soil descriptions from well
log of neighboring property - Knik Heights, BB L5
DEC PTS Depth From
Depth To
Thickness
Calc. Pts
Clay w/ 20% sandy gr
2 12.5
28
15.5
0.20
Clay
0 28
65
37
0.00
Grav W/ 30% clay
1 65
133
68
0.45
Sandy grav w/ 20% cl
1.5 133
165
32
0.31
0
0.00
0
0.00
0
0.00
152.5
0.96 1.0
Water Table Gradient -
Water table slopes toward the water source 0.7
Assume -20.9% slope
Horizontal Seoaration
91 feet between septic field and well
x = 16/25 + 2.0 2.64
Total Points 14.5
As per ADEC waiver guidelines, with a point value of 14.5, No bacteriological pollution possible but chemical
pollution possible but unlikely from household chemicals. Mitigating factors used to approve the waiver Include a
large amount of clay shown in the well log and if there was any overflow sewage, it will have to cross the driveway to
get to the well head.
Waiver WR080029 HA 080180
Knik Hell
Water Table Gradient Calculation
Knik Heights, Block B Lot 6
340'
6/16/08
No well Log,
use Lot 5 log
Knik Heights,
RR L6
122
94'
0'
5'
,Uox 1:$69p :STAY: 1 ounrE A ANC1101tACP:v ALAsuA 9950.1",
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 169 feta
DRILLED AT THE RATE OF 416.50 PER FOOT.
PROPERTY OWNER Ns, DouC].ns LonGacrn 272-1'101 3137 Mtn nerry Rd. 11 750?.
LOCATION OF WELL SITE;,.. It. B?1.. B 'uL^
n `
DRILLER
_cu�1e C1Ans 9; Jumpart Drilli.ne wuvAs
WELL LOG:
0---- 280 Bra,. -m- c]Ay with 201, s_-ndy
^P--65' Clzy. Spv,ml oohbles.
65---133' Gravel with 30;• 0 ay binder.
S..ndy travel. 20;, blue clay.
05=-193' Wate; bearinS Eravol. Cased to 169 fa<•t.. Silty Prow 165 to 16R, Very ro<,d
water bearing Cravel producing, Ehht GY1. 117 foot head with a 5 nlnutP Aill r^.cwcry
on !.Lll draw down. —�
Voly '
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH 8
ENVIRONMENTAL pROTECf1ON
MAR 989
RECEIVED
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OFF: P.788.50
THANK YOU VERT MUCH. roil In E�,11 na oS Ji.]y SpLk. i -+a , ` •-.. .
BERhLAUS OF RAMPART DRILLING WORKS
DATE..-P!i]JAJ JuIT• t.h.75 �,��
SERVICE CHARGE OF ty.% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNT`
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It is the responsibility of the owner toldeterbinj CN -1
hRw<K,np2.Ay
the existence of any easements, covenants, 'or he -which do I�gti.�="!s
divisionnplat. Undernot no circumstances shouldappear on'theeanyub (�Ij� �,
data hereon be used for constructsgn or for estab- RTS oraEeoRD,aT li°S' kn+osl
1lshin9 boundary or fence 11nes. The surveyor take° SHOWN
HNMEONREcoROEo PLAT. ARE -NO
relnonsibility for the initial transaction only.
• • -- _LEOCND
LOT BLOCK MAIi CAI MOMUM(MT
IV451 %� a; (PLAT NG•,_) IROM _.
140M MFR OR COIL IMO
ANCHORAGE RECORDING DISTRICT Q MYv A TACK
1426 HYD£j{ STfR££r
ANCHORAGE, ALASKA 995O1t ay514 S'
ie I
ITE: %F�e •Fl tIOU. uAL[:/�= J�O� �WOAW?a_
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LOT 2. BLOCK C.
KNIK HEIGHTS S/D
I
LOT 15, BLOCK B. i
C;,, KNIK HEIGHTS S/D
i LOT 2. BLOCK B.
KNIK HEIGHTS S/O
I
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;
I
1
1
1
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-----------------
-----------------I
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--------------LOT
LOT 3, BLOCK C.
KNIK HEIGHTS S/D
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LOT 14, BLOCK B ,
I
KNIK HEIGHTS i i
i LOT 3.H BLOCK B.
KNIK HEIGHTS S/D
ARE�D
(�
Ro6SED SEPTIC UPGRADE i
i
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(SEE DESIGN. PACE 2 OF 2). 1
I / \
fOV-____-______�
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WELL LOCATION UNKNOWN
(100'+ TO PROPOSED SEPTIC)
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EXISTING SEPTIC SYSTEM
(\ LOT BLOCK C.
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Sf� KNIK HEIGHTS S/D
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BEDROOM HOUSE
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LOT 12, BLOCK B, 1
1 KNIK HEIGHTS S/D
� HEIGHTS S/D i
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LOT G. BLOCK C•
KNIK HEIGHTS S/D
i
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�/ LOT BLOCK B.
On` /. KNI HEGHTS S/D 1
I LOT 8• BLOCK B.
1 KNIK HEIGHTS S/D
i
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ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
8901 DEBARR ROAD SUITE 2B. ANCHORAGE. AK 99504
p ,• ii���
7
PHONE: (907) 337-8179/FAX: (907) 338-3248
00
O
D O
LEGAL DESCRIPTION:
"LOT
KNIK HEIGHTS SUBDIVISION; 13, BLOCK B.
..... ••••. .........
TYPE OF WORK:
SITE PLAN FOR SEPTIC UPGRADE
••• 0
Ga ss;
Op .•• E_79 •�d°•�O�
VVVVA
PREPARED FOR: PHONE NUMBER:
JAMES AND WILMA SPEARIN 345-0816
0
4��Op0000�a6�p
GATE:
DRAWN BY:
SCALE.
PAGE:
1 OF 2
5/25/99
J.L.M./K.D.W.
1 = 100'
Print Map
Page 1 of 1
1". 100'
k•ik helhrs &.(,k 6 Lr 6
bttp://munimaps.muni.org/mox52/advanccd.cfm?action=mox52_view_printablemap 6/16/2008
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....ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (F
June 9, 2008
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot 6, Block B, Knik Heights Subdivision
Separation Distance Waiver
Well to Neighboring Absorption Trench
Dear On Site Services Engineer.
The well on Lot 6, Block B, Knik Heights Subdivision was constructed in 1972. The
absorption trench on Lot 5 to the north was constructed in July of 1975. A recent
inspection of both lots indicated the 6" cast iron cleanout at the south end of the trench
on Lot 5 is 92.5' from the well on Lot 6. The trench sidewall is estimated to be 91' from
the well. A waiver is therefore required since the well is less than 100' from the
absorption trench. The responsibility of the waiver remains with Lot 5 as the absorption
trench was placed after the well on Lot 6 was in place.
No well log is available for Lot 6. Documentation in the Municipal files indicates the well
is 165' deep with 6" casing the entire depth. The static water level was recently found
at 123.4' below the surface. Water samples taken from the well indicate no coliform,
bacteria or arsenic and only 1.82 mg/liter of nitrate content. The well is therefore not
influenced by the absorption trench to the north.
The well log on Lot 5 indicates clay and cobbles from 28' to 65' below the surface. Clay
is also indicated in the well lot to the bottom of the hole. This clay layer would act to
restrict the permeability of any surface water or septic effluent and protect the
underlying aquifer. We therefore recommend a waiver be issued allowing the
absorption trench to remain in its current location at 91' from the well.
Sincerely,
Michael E. Anderson, P.E.
Attachments
AMCHAEL E ANDERSON ;,Z i
JC. -43at ��ao
-ob .• Ear
�f 'PFp•••. ...•• ` r
l
.. MUNICIPALITY OF ANCHORAGE
• ^ DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Bax 196650 Anchorage, Alaska 99519-6650
343-4744 -
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # l' r� ' HAA
1. GENERAL INFORMATION
Complete legal description , &vc4c
Location (site address or directions) `fin %1_.nLcwtao9 TZpA-ib
Property owner 11ffi 0174 / 8OL14M M, Day phone S45 - 3f4 6.
Mailing address I, oop 12,0"
Lending agency Day phone
IkAmMnn oAArcee _
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:�H ��) ✓
3. TYPE OF WATER SUPPLY:
Individual well XX x x
Community well
Public water
NOTE: If community well system, provide written confirmation from State gDEC attest-
ing to the legality and status of systema
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xy, Y,
Holding tank /i.
Community on-site .r
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
- 72-025 (Rev. 1/81) Front MOA #21 - - - -
�M vow �oEa E«A •"d) Td0-ZL
-MioM sdaeui6ua leuolssa}oid ay} ul suoissiwo ao sjoaja jo; elglsuodsaa
}ou si 96ejoyoud }o �4!ledioiuny4 ayl •ponssi si a}eollpgo a ajolaq e}ep azAleue ao suoi}oadsui }onpuoo
}ou op SHHQ }o saaAoldwEl •s}uawa.)inbei a}els pue leaapa} uppeo d}sl}as u}aapio ui suol}n}l}sul 6ulpuel nay} pue
sawoy }o saaseyoind olAsalinoo esesly} saop SHHa ayl •eMseM0 a}e}S ay2, ul pajalsift i9auibus leuolssa}ad
}uepuedepul ue Aq anoge 9 ydei6eaed ul u9n16 suopluesaidej eq} uodn Aluo paseq sapnip}jao lenoiddv
/4uoy4ny y}leaH sanssi (SHHO) seoiu@S uewnH pue y}leaH }o }uawljeda(3 96ejoyouv }o 1411ed 6!unV,l ay,j:
a}ei]
:suol}elndl}s buimollo} ay} y}lnn 'swooapoq
(rt,�' StS'. .e eoe�otpot
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s}uawwo0 leuo!}!PPb
ao} lenoidde leuol}lpuoo
panoiddrsia
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ale(] A ain}eu6ls s, aaul6u3
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•uol}oadsul sly} }o a}ep ay} uo }oage ul suol}eln6ai pue 'saoueulpao
'sapoo a}e}g pue ledlolunw Ile yiien aouelldwoo ul sl wa}sAs jesodsip aa}enna}sem ao/pue Alddns
ja}em a}is-uo ay}'uol}oadsul pue uol}�6i}sanul AW woal, pue sail} 96eaoil0uy to /,}ijedloiunW ay}
woa; poule}go uol}ewiol,ul ay} uo paseq }ey} i4jJ9naay}jn} l •ulaaay pa}eolpul ainIona}s jo ads(} pue
sLuoojpeq;o aagwnu ay} jo} a}enbape pue leuol}oun} 'ales sl wa}sAs lesodslp aa}ema}sem ao/pue
Aiddns as}enn a}ls-uo ay} }ey} snnoys uol}eolldde lenoaddy /X}laoylny y}lua sly} 10 uol}e61}sanu1
Aw pegj ,4laan l 'molaq umoys a}ep uol}epll-en aq} }o se pue o}aaay paxl}}e leas Aw Aq paijllieo sy
U33NION3 AS N01103dSNl ,10 1N3W31d1S_ 'S
FCEIVED
• Municipality of Anchorage APR 16 199,7
DEPARTMENT.OF HEALTH & HUMAN SERVIC g
Environmental Services Division 060t;�ftS1ih'A[ umarthe
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: _Lo7-� 0 &C-0tiL_ g'j "ill-. j.fT_'� -_ Parcel I.D.:
A. WELL DATA
Well type • (21VA-iC If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Date completed
1q'7L-
Total depth /,�
-- Cased to f' + SCasing height (above ground)
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
FROM WELL LOG
Wires properly protected (Y/N)
AT INSPECTION
- 3 Z -b lg I
rl9•. '7'
g.p.m. --I, 'Z_ g.p.m,
j Nitrate �� ! L- Other hactaria
Date of sample: 13) ZA 1Q 7 Collected by:
B. SEPTIC/HOLDING TANK DATA
_. AI)lo.&&
A
Date installed Tank size 1j Ztmoo Number of Compartments T-- Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Al
Date of Pumping 14 ZO 19L Pumper /2-001-C72-
C. ABSORPTION FIELD DATA
Date installed '7 Z' Soil rating (g,p.d./ft2 or ft2/bdrm) System type 1..124 a
Length 47 t �" Width ?_ 7 It Gravel thickness below pipe � /0
p•p � Total depth
Z,
Effective absorption area 53 /=r Monitoring Tube present (Y/N)-K- Depression over field (Y/N) _ Pj
Date of adequacy test7, e) .7 Results (Pass/Fail) PA$$ For I T7 Vii.- bedrooms
Fluid depth in absorption field before test (in.); 3 0 a Immediately after,60l?gal. water added (in.): _
Fluid depth 3D'1 (ins) Minutes later: /1 AS, Absorption rate = i f�bD
p g.p.d.
Peroxide treatment (past 12 months) (Y/N) / If yes, give date
72-026 (Rev. 3/96)*
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APR -03-1997 15:01 CT&E ESI ANCHORAGE
CT&E Environmental Services Inc.
CT&E Ref.,#
Client Name
Project Name/#
Client Sample W
Matrix
Ordered By
PWSID
971520001
Anderson Engineering
L6, Bik "B" Knik Heights S/D
Private Well Water
Dzznlang Water
Sample collected by: A. H,
Parameter
Nitrate -N
Total Coliform
907 561 5301 P.02iO3
Client PO#
Printed Date/Time 04/03/97 12:43
Collected Date/Time 03/27/97 10:30
Received Date/Time 03/31/97 17:00
Technical Director: Stephen C. Ede
Released lay JAP4%---C
Allowable Prep
Results PBL Units Method Limits Date
0.100 U 0.100 mg/L EPA 300.0
2 OR COL/100 ML W/O COLI SM18 92220
Analysis
Date Init
04/01/97 SPM
04/01/97 RAM
APR -07-97 MON 02:35 PM DYNAMIC PROP. 261-7600 9072677670 P.02
i
I,
INVOICE
Ng
SEWER N DU�
DRAIN
"rQrvcuy �a '%aud[ea CLEANING SERVICE
P,O, BOX 112688 PHONE 345-2513 ANCHORAGE. ALASKA 89511-2688
F�
Job Addros9
DgrTE
SAL �M ,,,,/
TE 5-30 AY U9 OMEFl OFlDE /
�m
ROTO-ROOTER SERVICE: CALL 1411S.
@
STEAM THAWING HRS,
@
TRIP CHARGE HRS.
@
OVERTIME CHARGE HRS_
@
ADDITIONAL LABOR CHARGE HRS.
PUMPING SERVICE (GAL.) HRS.
@
c@
�J�CGU
HYDRO -JET SERVICE HRS,
@
TV CAMERA INSPECTION HRS.
@
MATERIALS
PLEASE PAY FROM THIS INVOICE
TOTAL
-^
TOTAL FOOTAGE CLEANED OR THAWED A0LA ES USED
PROS LE CAUSE OF STOPPAGE /4vu9,fpJ
:', iSC)
LINE CLEANED
❑ JOB NOT QUARA TED F0FALLQ#NG REASON
WORKACCEPTEO BY I�`—
MUNICIPALITY OF ANCHORAGE (�
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date June 15, 1987
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 6, Block B Knik Heights Subdivision, Plat P452, Anchora
2.
Location (address or directions)
12640 Ridgewood Road, Anchorage, Alaska
(b) Applicant Name Hylen, Inc.Telephone: Home 333-7517 Business 561-5411
Applicant Address 3820 Lake Otis Parkway, Anchorage, Alaska
(c) Applicant is (check one): Lending Institutional ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution 1 nn Telephone
&(n�
Address °� h Cd LAA cL Lx , -h Pr*-) 0—Y, - Q_ npL is t v
pOL SCY't - a.G�°tom
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
HOLD FOR PICKUP
TYPE OF RESIDENCE
Single -Family CX Multi -Family ❑
Number of Bedrooms 4
Other
3. WATER SUPPLY
Individual Well EJ Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite�b 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
72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 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.
Name of Firm QUADRA Engineering, Inc. Telephone 276-3770
Address 1057 Vilest Fireweed Lane, Suite 230, Anchorage, Alaska 99503
Date
Jtzne 12 , 1987
AF "1
• Y P e
• THas C'
�f q'�—` i
dead ® Engineer's Seal
7.o�YPo•••p•re•°e•se•ee •e.• B
i1 Se seaa•e6iidiseft iii .1(e
vn;Micheal E. Andarson
_N °e 4381 • E
lF ° ee• •• • 'C�
pgOFESSIONP��.:
6. DHEP APPROVAL�J
Approved for `1' bedrooms by Date �—
Approved X Disapproved Conditional
Terms of Conditional Approval
1,
. Chep
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. 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.
Page 2 of 2
79-025 (11/841
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPALITY OF ANCf-oMag HEALTH AUTHORITY APPROVAL (HAA)
DEPT. OF HEALTH &
ENVIRONMENTAL PROTE(:TION CHECKLIST - FEBRUARY 1984
264-4720
'JON 2 51987 Legal Description: Lot 6, Block B
Knik Heights Subdivision
A. WELL DARECEIVE1J
Well Classification —
Well Log Present (Y/N
Total Depth 165'
Static Water Level
Individual
N
Cased to
nnI
If A, B, C, D.E.C. Approved (Y/N) _
Date Completed Yield
]-65' None
7.6 Gal/Min.
Depth of Grouting
Pump Set At 1501+
Y
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N _
Separation Distances from Well:
To Septic/Holding Tank on Lot — 50 On Adjoining Lots 2001 1 1751+
To Nearest Edge of Absorption Field on Lot 116 On Adjoining Lots 150 +
None
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole None To Nearest Sewer Service Line on Lot None
Water Sample Collected by Mike Anderson ;Date June 11, 1987
Water Sample Test Results Satisfactory _
Comments Vertical separation between well and septic tank is 10'+,
Probability of well contamination is slight because of topography.
Waiver has been granted,.
B. SEPTIC/HOLDING TANK DATA
c
Date Installed
8/9/72 Size 120
Standpipes (Y/N) y— Air -tight Caps (Y/N)
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N) _ N/A
Separation Distances from Septic/Holding Tank:
50'
To Water -Supply Well
39'
To Property Line
To Water Main/Service Line N/A
Course
Comments
Page 1 of 2
72-026(11/84)
2
No. of Compartments
y
Foundation Cleanout (Y/N) _
Date Last Pumped 9/28/85
N ;for
Temporary Holding Tank Permit (Y/N)
y
N
10'
To Building Foundation
40'
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
N/A
Septic system has not been in use since OctobE%r of 1985.
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VIVO 01313 N0I1dH0S8V '0
a n as
401 E. FIREWEED LANE
ANCHORAGE, ALASKA 99503-2197
(907) 276-3770
JOB ([ / (- r-^ �� ....
SHEETNO. OF _
CALCULATED BY DATE
CHEDBY ——DATE_
i SCA
-- --�� yVL;a-
_ Z � LarirltaiMENT --_ .-
r: of
SIt/w1ErB ,.
_ m\.\,CHEMICAL & GEOLOGICAL LABORATORIES Oh ALASKA, INC5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
LTORIEFEDERAL TAX ID # 92-0040440
ABORA
ANALYSIS REPORT BY SAMPLE
Cl lent PO# : VERBAL Req #:
Client SnpI ID: 12640 RIDGEWOODRD.
Sample Rec'd : JUL 1 87
Ordered By : MIKE ANDERSON
Send
Reports To: GUADRA ENGINEERING
1057 W FIREWEED LANE #230
ANCHORAGE, AK. 99503
Work Order No. : 1418
Client Account : OUADRAP
Date Report Printed: JUL 8 87 9 13:03
Re I eased By : 2 �dc-f —
Reports Address #2
MIKE ANDERSON
Special ROUTINE SAMPLE COLLECTED BY MEA 7-1-87 & SUBMITTEDTO LABORATORY
Instruct:
Chemlab Ref #: 6778 Lab Snp) ID: 1 Matrix: Water
Parameter Tested Result/Units Method
----------------------------------------------------------------
NITRATE-N 0.23 mg/1
Sample ROUTINE SAMPLE:
Remarks: ANALYSIS COMPLETED:
- ---LABORATORY SUPERVISOR: STEPHEN C EDE
1 Tests Performed See Special InstructionsAbove
ND= None Detected * See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than
Allowable
Limits
10
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date September 30, 1985
1. GENERAL INFORMATION
(a) Legal Description (include lot, blocl(, subdivision, section, township, range)
Lot 6, Block B Knik Heights Subdivision Plat P452, Anchorage
Location (address or directions)
12640 Ridgewood Road,_ Anchorage, Alaska
(b) Applicant Name R. S. James Telephone: Home 345-5152 Business 265-8133
Applicant Address 12640 Ridgewood Road, Anchorage, Alaska 99516
(c) Applicant is (check one): Lending Institutior>DM ; Owner/builder El ; Buyer 0 ; Other 0 (explain);
(d) Lending Institution {� �Vf-,A- BAY- Telephone
Address v ,i - nPA6- - z 9,1 DTZ i Cd ¢ o f f C7
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
R. S. James, 12640 Ridgewood Road, Anchorage, Alaska 99516
2. TYPE OF RESIDENCE
Single -Family Ill Multi -Family ❑ Other
Number of Bedrooms —_�®� 1401-
3. WATER SUPPLY
Individual Well ER Community E] Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite IN Public CI Community E7 Holding Tanl< E]
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 72-025(11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 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.
Name of Firm QUADRA Engineering, Inc. Telephone 276-3770
Address 401 E. Fireweed Lane
Date October 7, 1985
Anchorage, Alaska 99503
OF At0jt��r� S°00406000
n�°°
G
oo v is
oaban0eaoo°o°a°°c•o0
�m Michaol E. Anderson f e
ri '° 43111 • E e
C�<%Or00 Gn°°°BO \1 p
10FESalO�,
Engineer's Seal
6. DHEP APPROV L
Approved for 4eZfro ms by CL Date —
Approved Disapproved _— Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. 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.
Page 2 of 2
77-f)M f11/B41
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
MUNICIPALITY OP ANCHORAd
DEP'L OF HEALTH & HECKLIST -FEBRUARY 1984
ENVIRONMENTAL PROTECTION 264-4720
Legal Description: Lot 6 , Block B
OCT 01985 Kni:k Heights Subdivision
A. WELL DATA RECEIVED
Well Classification Individual If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) N Date Completed Yield 7.6 Gal/min.
Total Depth 165' Cased to 165'i-,' None
Depth of Grouting
Static Water Level 120' Pump Set At 150'+
Casing Height Above Ground 4 Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N
Separation Distances from Well:
To Septic/Holding Tank on Lot —50 ; On Adjoining Lots 200' , 175' +
To Nearest Edge of Absorption Field on 1_ot 116' �' ; On Adjoining Lots 1501+
To Nearest Public Sewer Line _ None To Nearest Public Sewer
Cleanout/Manhole None To Nearest Sewer Service Line on Lot None
Water Sample Collected by Alan Harala ; Date Sept. 30, 1985 --�
Water Sample Test Results satisfactory
Comments Vertical separation between well and septic tank is 101+,
probability of well contamination is slight because of topography.
B. SEPTIC/HOLDING TANK DATA
Date Installed _8/9Z72 Size 1250( -
Standpipes (Y/N) y — Air -tight Caps (Y/N)
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N) N
Holding Tank High -Water Alarm (Y/N) N/A
Separation Distances from Septic/Holding Tank:
To Water -Supply Well — 50'
To Property Line 39'
To Water Main/Service Line _ N/A
Course N/A
Comments
Page 1 of 2
72-026(11/84)
No. of Compartments 2
Y Foundation Cleanout(Y/N)
Date Last Pumped 9/28/85
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
10'
40'
O
KI
To Stream, Pond, Lake, or Major Drainage
V. C
SIP 1ti
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401 E. FIREWEED LANE
ANCHORAGE, ALASKA 99503-2197
(907) 276-3770
ANCHORAGE
JUNEAU o BETHEL
October 28, 1985
Municipality of Anchorage
Department of Health
and Environmental Protection
825 L Street
Anchorage, Alaska 99501
Attention: Susan Oswalt
Subject: Lot 6, Block B, Knik Heights Subdivision
Waiver of Horizontal Separation
Dear Ms. Oswalt:
We hereby request a waiver of horizontal separation between
the well and septic tank on the subject lot. The well and
septic system were originally approved by the Greater Anchor-
age Area Borough in 1972. A copy of that approval is attach-
ed.
The well is located approximately 10 feet higher in elevation
than the septic tank with the ground level sloping away.
It is unlikely the effluent could flow uphill into the well.
Water quality tests on the well water indicate satisfactory
results.
There is no evidence of effluenct leakage
of the septic tank. For the reasons
feel a waiver should be granted.
Sincerely yours,
Michael E. Anderson, P.E.
MEA/ jb
xc: R. S. James
around the inverts
mentioned herein I
a n aa•
401 E. FIREWEED LANE
ANCHORAGE, ALASKA 99503-2197
(907) 276-3770
joB LO_� X r3 Kn//e
SHEET NO. - OF
CALCULATED BY DATE
CHKEOBY DATE_
SCA
i
MUNICIPALITY F• ORAGF
/ DEPARTME OF HEALIH(A�1 RONMEN _ PROTECTION
82.5 L S r.E}t ��AA��rttc. ora e, Alaska -99501
Date Received: May 20, 1977
TimeTi
xilk
irne Ik 3 : ..cLe��--- DateDate'11Z�iDate:Lnsp1..lL.f—__
REQUEST FOR APPROVAL, OF INDIVIDUAL SEWER AND WATER FACILITIES
1.. bending Institution Request. National Bank of Alaska % Ruth
Mailing Address: Post Office Box 8-3589 99509 Phone: 279-2506
w K ii
2. Property Owner.: Gordon Anderson Phone: 344-6414
Mailing Address.
3. Legal- Description:
Lot 6 Block B Knik Heights Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number. of: Bedrooms: 4 Ir
Number of :Bedrooms:
Conmis-init-y/Public System ( )
17
--- _.�-__— Well Log on File
Bacterial Analysis jik
5. Well. >ysi:em: Individual well (x)
Permit it _ _ Depth of well
Construction
6. Sewage Disposal_ System: On -sate System (x)
Permit,
Septic Tank Size
Absorption Area
Public Utility ( )
Instal—lc /77--7_ .1nrstalIer
P,50 Manufacturer
Soils Rate
7. Distances: Well to Septic Tank
to Sewer Line
to Nearest Lot: Line
Nearest Lot line
Material
to Absorption Area
Absorption Area
UNIUV HTY OF ANC""
d
;iii?(t
25-1 8 Tudor 7 l•'i - 2221
IND 11. WU!a.l.. [ VY!'.R :incl Vii/+,'I"t:Ft
1. Type. o'; Insp c (on C,IViRO _ VA.. ,_--.-- FI IA . . _ __-- Col\"v �
2. Property Owns
G y y
f V Phone Z� ZZs'j
3. Narnl. of Boyer:
J
Nbiling fddilmss• _ .___/� - l 1 % — _ `fav Phone
n. Nam, of L.endinc Institution: /u __.__ _—_----._._-.-----___--
Phone �7
IVia;llr;g Address:
5. Nam(: of Realtor or Agent: — _-- -----_---_-.-__._--
����
Ahailiny /lddress:
hionc
6. L.egai Dc,sc.r!piion:--'`
Location: --
7. '1 ype of f aciliiv to be inspected:..--_----- S
3. bVater Sul-gply
I`y)e of Supply' Public Utility ---------
If Individual, nurnher of dwell;ngs preset?tl;/ ser ocl
If lndividual, depth of (Nell
9. Sewtage Disposal System
Type of Syslt.,m: Public Utili y
If Indivirh!al, date of irlstnllation
P00S7 (1'74)
No. Bdrm .._...-_.
-- Individual_._.------`.-�-_-----.—.__._-..-
individual (on -0e)
Page Two
Department of Health and Environmental Protection
Request for Approval. of Individual Sewer. and Water Facilities
Legal Description:
Comments:
Lot 6 Block B Knik Heiqhts Subdivision
A.ffadavi.t Attached: ( )
Approved:
Disapproved:
Letter. Attached: ( )
Date: _L,'e" —Z--7
Date:
Department Worksheet:
V
13 �`
N
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
30 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received Y- i S '�2 S
Time of Inspection /O. - o o 4 /%%.
Date of Inspection y- 02,2 -7f-
REQUEST
7sREQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES ------- r�
FOR
Approval requested by:
Mailing Address: ` � — phone:
Property Owner: / /`i� Phone:
Mailing Address:
3. Legal Description
4. Location:
5. Type of facility to be inspected No. of bedrooms
6. Well Data:
A. Type i b[)iV?0ij Aj, B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed << �j `)"�., B. Installer _
C. Septic Tank: 1. Size 2. Manufacturer`:.a�,{_'_
D. Seepage Pit: 1. Absorption Area `3 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank Absorption area Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank I , Absorption area
C. Absorption area to nearest lot 'line
EQ -034 (1/74) Page 1 of two pages
GRI AI k AIICIIORAG[ Al;i.j, lDOlt("��li
D rnc!nt of F11vir011;1]_
3330 "C" St., AnC;ior,a9e, Alaska 99503 - 274-`1561 ���1 �7t
REQUr_ST FOR APPROVAL. of ri�
INDIVIDUAL SFWER & WATER FACII ITIf_S 1 w`
1. Type of Inspection/: CPiRO VA FHA _ CONV
2. Property 0 s,r n e r
Nailing Address:�
a�( '14 Ur,yf`fhone Y�-Oo���
3. Name of Buyer:
Mailing Address: ��' , - //G� zs/a J�J '""
T� y Plroneal���
4. Sarre of Lending Insi;itution: S /Uaf
Hailing Address: 8
5. Nave of Realtor or Agent: ILI/ru`_
Mailing Address: Phone
G. Legal Description: L-_a%_�" _/. __ •/, G; �/C,,�`�/� j ,��
Location:
Y/ �' y� C�� all n /�� CSI V � � rl � C:✓ L �) �� � �
G
7. Type /of Facility to Ile inspected:'`«, _ r rms,
_ c"----�
�ty�l3d
8. Water Supply
Type of Supply; Public Utility Individual
If Individual, number of dvrel Iings presently served C/1l
i
If Individual, depth of veil(
9. Sewage Disposal System
Type o System: Public Utilii:y inti victualz.''
o n - site )
If Individual, date of installation -' ^—
Page 2 of two pages - Req. - 'or Approval of Individual S . Water Facilities
Legal Description
Comments
Approved
Disapproved
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date