HomeMy WebLinkAboutKNIK HEIGHTS BLK B LT 14 Municipality of Anchorage Page ? of .;I' 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: _,[/[ ~1.(~.~,(') ~¢,-~ PID Number: Name: ~.~.:~¢z~/ ~.~¢~¢///~..~ / Wastewater System: ~ New ~Upgrade Address: ~ ~~~ ABSORPTION FIELD Phone: ~ ~ / No. o,~rooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION so~, Rating: ~, ~ GPD/Sq. Ft. ~ Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: ~~ ~ New ~ Upgrade Gravel width:~ Number of lines: Distance belween lines: ~ Ft. / / Classification (P~ Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft, ~ SQ. Ft, ~r,~,r: Date Drilled: Static Water Level: Installer: ~ield: Pump Set at: ~ Casing Height Above Ground:~,,~,~ GPM Ft. ~% Ft. SEPARATIONDISTANCE~, ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ME/~¢~.~¢ ~~ /~¢~ Lot ~-¢ / Foundatio~~ ,¢ q¢~ I ~ ~//' ~w ~¢ / ~¢d¢ /¢~ ~¢ ~ ~ "Pump on" level at: "Pump off" i;&l~: ater alarm at: Cudain Drain ~ ~¢ ~ ~,¢ ~ PumpMake&Model Electricallnspectionsperformed by: ~~ Remarks: ~¢~/ ~,~,,¢~z.~ /¢~ .~ BENCH MARK Location and Description:  Assumed Elevation: Inspecbons performed by: _~ ~' ~z.~)~ates: 1st ~/¢~ Department of Healt d Hu rvices approval Reviewed and approved by / - Date: /O-.~ ~L3 - J 72-013 (Rev. 9/91) MOA 25 Municipality of Anchoroge DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650. Telephone 54.3-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot /4, Block B, I<nil< Heights Subdivision PID No.: 72-013 A (2/91) MOA 25 ivlunioipolity of Anohoxoge DEPARTMF:NT OI= HEALTH AND HUMAN 8FRVlOFS ENVIRONMENI'AL SFFtVIOE8 DIVISION P.0. Box 196650 · Anchorage, Alaska gg51g 6650° Telephone 545-4744 On-Site Wastewater Disposal ~ystem and/or Well Inspeation Repod Legal Description: Lot 14, Block B, Knik Heights Subdivision PID No.: 8 72-0t3 A (2/91) MOA 25 Z ~ ~ · ~,~. ~, ...~?... . .............. ~ __ d 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:SW950187 DESIGN ENGINEER:DOUGLAS T. HENLEY, P.E. OWNER NAME:GRAHAM LARRY L & RENE L OWNER ADDRESS:12501 SHELBURNE RD ANCHORAGE, ALASKA 99516 PARCEL ID:01703334 PAGE 1 OF DATE ISSUED: 8/04/95 EXPIRATION DATE: 8/04/96 LEGAL DESCRIPTION: KNIK HEIGHTS BLK BLT 14 LOT SIZE: 43500 (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 (iSAACS0) . 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: AT THE TIME OF CONSTRUCTION ENGINEER SHALL EXPOSE AND VERIFY THE INTEGRITY OR BOTH EXISTING SEPTIC TANKS. RECEIVED BY: .,~_zr~.'j/, DATE: DATE: ~--~ --~"~ Douglas T. Kenley, PE HCOI Box 6034, Palmer, Alaska 99645 July 2, 1995 Municipality of Anchorage Health & Human Services On-site Services t~NVIRONMENTAL SERVICES DIVISION ,'UL 17 199~ RECEIVED Percolation Test Results and General Site Investigation Report of Lot 14, Block 8, Knik Heights Subdivision, Addition #5. Owner: Larry and Renee Graham On June 26, 1995 the above referenced 0.99 acre parcel was inspected for the suitability of installation of a replacement on-site wastewater disposal system. The site is located in Southeast Anchorage off Huffman Road on Shelburne Road. The system is being designed to meet the requirements of an existing four bedroom home. The planned system will include an existing 1,000 gallon concrete septic tank and a 500 gallon steel septic tank in series. The absorption system being replaced is a combination crib and 30 ft. long trench that have been tested and found unsuitable for further use. The proposed absorption system is comprised of a 63 ft long, 6 ft. deep trench designed in accordance with municipal standards. The developed parcel slopes from east to west with grade ranging from 0-10%. The immediate area that has been selected for the waste water disposal system has an average slope of 2% towards the west. The site is sparsely treed with birch, spruce, and alders. It appears that there are no obstructions that would prevent surface water runoff. On-site observation and field measurements show that there are no neighboring water wells within a 100' radius of the proposed system. However, field measurements show that the on-site well may be slightly within the 100' radius (see site plan, appears to be approximately 98 ft. separation) .No surface water was observed at the time of the inspection and it appears that there is no potential for contamination of future water wells. One single percolation test was performed at the site in dete~nining an adequate location for the waste water disposal system. An initial test pit for soil classification was dug to a depth of 17- feet. The substrata consisted of 2-foot of organic overburden overlying sandy silt and gravel with some silt near the bottom of the test pit. Neither bedrock nor ground water were observed. The percolation rate for the 'test pit was found to be between 8 minutes pet' inch at approximately 4-feet below grade. Sid!lcel'el3b pE~&~ DouglasU'F. Kgnley, CE #8176 If there should be any questions concerning the percolation rates or charactehstics of the site please call Doug Kenley at 746-1073 'The. ¢nro-p~ ~r~[.c ~oe.s ~' YNSV3V '~¥BOHDNV NOISIAIQaRS S~H~I~H ~IN~ g ~OOla '~ ~O~ ~VHVa9 ~N~a ONV ~a~¥q VW~V]V 'BBVBOHONV NOIBIAIa~B ~±N~J~H NINN ~ NO0~g '~ ~0~ ~VHVB9 3BNB~ QNV ABBV~ I ~ § Z ~ ~ o Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: Z. "'V ~"'¢~' ~ "~-~C'~z'"x~" ~z'i"'~"~' Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler Alter t Monitoring? ,~/"~'~',"c~ ~'~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ {m~nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~I~"~"'~F.~ AND ~ FT ACCORDANCE W~TH ALL STA~E AND MUN~CIPAL GUiDELiNES ~N EFFECT ON TH~S DATE. ~ATE: ~. ~ / ~ ~' 72-008 (Rev. 4/85) oGRE,' R ANCHORAGE AREA BOk Department of Environmental (~uality 3500 Tudor Road Anchorage, Alaska 99507 SH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ,ZZ~'~-/'/Z'~_. LOCATION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL /6'/~/'/-'/X-/MANUFACTURER ,/,/¢4~¢~2:;' .-~ ~¢~-',,4/' MATERIAL ~/2~'~/~'>'~;~' i~'~' COMPARTMENTS // INSIDE LENGTH _INSIDE WIDTH LIQUID DEPTH .LIQUID CAPACITY /~.,~z¢¢, .GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER ___OR WIDTH LENGTH ~'~--'~ DEPTH ~'~-~'~/-~'¢~RIB SIZE: DIAMETER DEPTH ~ DISTANCE FROM: WELL BUILDING FOUNDATION /[-'/~/¢~2¥/ NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION WELL: TYPE /--/?~/- //I/-~'/~/-]Z-g'ZX,/',~)CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION __ LOT LINE_ SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: _///~ PiPE MATERIAL: / Form PW-026 DATE __ DIAGRAM OF SYSTEM G.A.A.B. SI!~V/AGE DI,,,I O,;A!., G H SY,,i[:tgi .... APPLICATION AND PERMIT )7 ) PHONE 'rEsT RI:SUiTS .-"::OMPLETION DATE ANTICIPATED · OTHER TI-IlS PERMIT I,.q NOT V,ALID ~,ql'l'l-lOI, J'l" :5Xllh TES'i' __MZ~'JiLCLL.VA LI D_£].ELZg~ .... 5 ft. _ '-CU~DATION ,o SZEPAO~ PIT 20 ft. , DRAIN FIELD 'lSF}'TIC TANK TO SEEPAGE PIT WALl_ DRAIN FIELD 10 ft, DIAGI~/tdVl OF .eJY~3TIi}~ '. PEP/ .......... ~uL ~ MENT OF ENVIRONMENTAL qUA 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 ¥ CASE # De~th __Fet 1© Performed For.__.Nill P×c,,~, .~ ~__~___~__Date Performed~ Legal Descriptl~)ni'- Lot-l~ Bloc[i~-~'~Ubd~v~sion This Form Reports Soils L~g Soil Characteristics Silty Sar_dy Crsvel (OF) ~nd very sil%y &ravel and Interlaced layers of each of approx. 6" de-o~} e~ ch. Was Ground Water Encountered? If Yes, At What Depth? Gross Time Net Time Depth Proposed Insta~tio-lT: Seepage Pit x Depth Of Inlet Drain Field DeP~tom Of Pi, t ~~-~ COMMENTS:-~c~~ ~P-~-~.-.~,- :Pi ~ bed~o^ ~ '~.LL, N}a%.%i, CK _ a a er i ]e Y: National Tes[in December 31, 1979 Ron ald Baker Star Rouhe /, Box 1680!} Anchorage, Alaska 99507 Permit it 790638 Subject: Lob '[4 ~,.locxB ' B Nnik IIeighhs Subdivision A permit issued by th~s~, department ~.or~ well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated the permit, by authori_ty of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to decument the ins[za].iation date. If an engineer has inspected the installation of the on-site sewer system, please have ti~em send us the as-bui!hs for our files. If there are any further questions, please contact this office at 264-4720. LNB/ijw enc: Copy of Permit '" :::' :::' '- ; · ' ' ',' ::'h ':.: ..... : i" .... ~ ~" ' I ............. · ;~ ~i ~ '., ':, :q "," ' · :: ::: .... 1'" I, ~ i::: ' ~::' : ':.::i'":~' ~ ::: ....... '. "" '"'; ~' .... / / DEF'RRTMENT 14ERL-FH FIND EN',/IRONHENTRL ,°,25 ' L' STREET., RNE:HOf~:FIGE., RK. 9b.:,6J± 264.-4720 ~ i"-.9 E:, C:) I'-,! .... :EE; Z -'IF ~ S E: ~.1E F~: .'., ;'OTEET!EN F"~~- _ :~¢.E SQLIRRE F'E:ET LEGRL ~_ i~f '~/~ J~ i~/V/ ~' ~,-"f~ LOT PlRX~MUM N~ HBFR OF BE'B~'-~EPI': = ~ '~" ~ '%0]1 ~aTr~¢,'q~ THE REb. I_IZ~4ED .SZZE OF THE SOIl.. RBSORPTZON x, SSTEM IS~; THE LENGTH D]MENS:(ON ]:S THE I..EHGTH (.(N FEET) OF TI4E TRENCH OR DRRZNF[E[..D. THE DEF'?H OF R TRENCH OR P~T IS THE D]STRNE:E BETI.4EEN THE 5LIRFRCE OF THE GROLIIqE:, RND THE BOTTOM OF THE EXC:R',tRT]ON (ZN FEET). THERE ZS NO SET kl]E:,'FH FOR TRENCHES;. THE GRRVEL. DEPTH ZS TI4E MZN~MUM DEF'TH OF GRR'¢EL BETHEEN THE OUTFFILL P~PE RND THE BOTTOM OF THE ENCFI',?RT~ON ,']N FEE~ F'ERMZT RPPL~E:t~NT FIRS THE RE~PP~I~ZBZ[ ZT¥ Tq ZNFC~'M 'TH~ZG DEPFIRTMENT DURZNG 'rile NUP1BER OF RES~DENC:ES THRT THE [4EL. L 1.4Z~. SER~. /- DEPARTMENT HILt_ BE SLIB.]EC:T TCmX, F'~::LIT:[C)N. MiNZHUH DISTRNCE BETHEEN%FI 14ELTO, RND i80 FEET FOR R F'RIVRTE 14E~.: OR~ x. ~ - ¢.5k~ TO 200 FEE'r~ROM R F'UBI2~IC: PJE~I._ I)EP[~(DING UPON THE T'¢PE OF PUBLIC NEL. L 4ELL R :E REaU REC, at.4[::, rhiJs'r::ETURNEB' TO THE DEPARTMENT NITHIN 24a DR,'S OTHER REI~UIREHENg~ MFIM RPF'Lk. ',, SFEC'..[,~ICRTtONS BND C:ONSTRuc'rION DIRGRRHS RF~E RVRILRBLE TO INSOLE PROPER I NS~%RLLRT D~ -: - F~MZI..ZRF: P~TH ~ft~ RE~T~LJ~RE~,IENTS FOR ON-SZTE SEHERS RND I,IE:LLS RS ~ET FORTH E',M THE MLIN~E:Z F'~L.~ T~OF RNCF¢)RFIGE:. ~; I P~ILt_ INST~L.L THE S¥ST~~iCCORDFiNC:E NITH THE CODES. .~: ! UNDERST~3NE),'~M~T TUE ON-SI%ES SENER SYSTEM P1R~' RE~;!LIIRE ENLRRGEMENT IF THE ........................... ~PPI_ ~ C:~NT -~ - MUNICIPAl_Il Y OF ANCHOI?AGE DEPARTMENT OF HEAl.TH& ENVIRONMENTAl. PROTECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 I. Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE! DISPOSAl_ SYSTEM AND/OR WELl_ INSPECTION REPORT NAME _ IPHONE MAILING ADDRESS ' LEGAL DESCRIPTION LOT_ lUr, LOCATION o~ NE'W UPGRADE I o [ AbsorptionS'area DISTANCE TO: I r_ J ¢3.8, Manufacturer ~il~__..~ ~.,. l~iq. capacity in gallons-I ~ IIF HOMEMADE: Inside length DISTANCE TO: j Well Dwelling Manufacturer DISTANCE TO: Dwelling Le~nngth of each line No, of Jines / Top of tile to finish grade Length Width Founda[ion ~7 ¢ Total length of lines Material beneath tile Material Trench width ,~ ~,) inches Liquid depth PERMIT NO. [Class [ DISTANCE TO: Liquid capacity in gallons PERMIT NO~'~ _ -- Distance bet¢~ren lines Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line Depth Driller Distance to lot line Building foundation Sewer line Tote effective absorption area IPERMITNO. Absorption area (s) Septic tank OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS 72-013 (Rev. 317~) ~~ DATE LEGAL "FHE!: i ::L'.!::!L"F. !:::, ]: ,~'l~f~:i'.,f'~: :.: l]:l,~.,! :l:F_i; 'f'HE: I .::'H::F.'H ,::iH .I:::'j:'E"7':, CF' 'T'HE .... Frt~:i'..!I::':H (:)F~: "FI....E DE?'i"H OF:' F! -F!RE?',!CF! OF? F't"!" Z[S 7'HE r,'r,x""::ff. "~: j,,~:.i.j,~F:.::::~.i 'i'H.~:: ': F,F:'?:i:::-~: OF: "FIE:: g~F~rCiL!Blj:::, FIN[) THE [~',O'i-TC)H C F' 'FHE ~ :'::C: ::: ',,,'I:::FF ]' "F ,:: I J'.,~ FEE:"!' ...... -. - ............ ::,,::.. i,., :. '::','-I III !"l'~::'l::l J j:::'i~:' ,. I., _. THE: E',Cq"'i"C~H OF' "I'HE): J~:::'::C:Ft',,,'FIT :[ OI'.,~ ,:: [ I"~ !::'E~E"I" ). F:'F'F~' '~' :[ T F:tF'F'L.. ]: CFIN'?HF:F: T'I.~E F'F:'::: F' "~'. ':: I [~', ]: L.- ........ - ......... 1, , -I'": '[ Pi :"" fR.'"I !"l.tr'F [)I~::F'F~;:i"P'.~:2'..~"F :,ljF,'rl,.l"~ THE ] ",?':: ..F:t ...... :i~, ]".I'::F'~:: ........ Z::)F.:?::: OF' F~N'~.' I,.tELI....S I::l[)..:rl::!C:l:~:h:f't '1'0 T...I:[~E; ::'I~'";:,F~,T? FIND Additional trench not required. Permit ~ Applicant: .... ~ Oh ~ Location: ~'/%~ [ ~> F ~)~. Legal Description: l-! 6( ~/~0c/¢ Type of Soil Absorption System Is: MUNICIPALITY OF ANCHORAGE Department , ~ Health and Environmental ~rotection 825 Street, Anchorage, AK. 501 264-4720 * * * HANDWRITTEN PERMIT * * SEWER PERMIT J~ W ~ ~ Mailing Address: Phone Nu~er: ~_ ~ ~ LOt Size: Tren~.~ D~infield: ~eepage Bed:.~ __ Holding Tankh ~aximum N~Lmber of B~tr.~r~-s:/ "~o~i-l~a~ing<~'q.ft>br)~- /--% The Required Size of the Soil Absorption System Is: DEPTH _.LENGTH ~ . GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). %* REQUIRED SEPTIC(HOLDING) TANK SIZE = ~ GALLONS * * ~rmit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if to include more that~3~bedrooms. Issued by: ~ ~cw/~~_~.~_ Date: ~.-%~ CONSULTING ENGINEER 203 W, 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 May 26, 1982 Mr. Ray Rush SRA Box 1680-B Anchorage, AK 99507 SEWER ADEQUACY TEST LEGAL: LOCATION: RESIDENCE: WATER: SEWER SYSTEM: DATE OF TEST: TEST PROCEDURE: Lot 14, Block B, Knik Heights. On Shelburne, off Huffman. Four bedroom, single family. On-site well. From Municipal Records Tank: PreCon Concrete - 1,O00 gal. Absorption System: 8 x 8 x 6 loq crib. Absorption Area: 480 sq. ft. Soil Ratinq: 225 Installation Date: Sept, 1972 May 25, 1982. Tank was pumped and water added to crib in 500 gal. increments. The following readings of the liquid depth in the crib.f~ere ?\ taken., . Tobben Spurkland P.E. Mr. Ray Rush SRA Box 1680-B Anchorage, Al< 99507 Water Volume ~epth .... 47 5O0 51½ 1,O00 56 1,500 76 After 24 hrs. 43 TEST RESULT: This system absorbed in excess of 1500 gal. in a 24 hour period. It surpasses the municipal requirement for a 4-bedroom house. By adding a 500 gal. septic tank to the system, the whole system will meet the municipal requirement. PO,.Gtt 6-650 ANGHORAGE, Al ASKA 99~02 0650 264--41 I 1 HEALI'II AND EN\./IR,r)N¥,EN::\[ PROI~I:CTION June 15, 1982 TO: Whom It May Concern Subject: Lot 14 Block B Knik Heights Subdivision The sewer system on the above subject property was upgraded on June 14, 1982. The sewer system is now approved for a four(4) bedroom single family dwelling. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C, Pra%t Associate Specialist RCP/Ljw ��/�UHMPA3U Y O �\ HCHO QGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-033-34-000 Expiration Date: 10/28/2023 Legal description KNIK HEIGHTS BLK B LT 14 Site address 12501 SHELBURNE RD Anchorage AK 99516 Current property owner(s) KUBANYI DORIS MARIE X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: The existing drain field is at 85% capacity, leaving roughly 15% of the effective depth remaining. An upgrade may be needed in the future. The lower end of the drain field doesn't have the required soil cover and is potentially susceptibjP­to,Yreezin,g, during winter months. Original Certificate Date: 7/28/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory x Arsenic Advisory Other COSA Approval_June 2022 MUNMPALITY OF ANCHORAGE Development Services Department= Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-033-34 Complete legal description KNIK HEIGHTS; BLOCK B, LOT 14 Location (site address) 12501 SHELBURNE *ANCHORAGE, AK Current property owner(s) DORIS KUBANYI 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-338-1958 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic Jfl Concrete ❑ Fiberglass Age 28/51 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment COSA # 0 S C -- 3 l 2 `% Date of Payment Waiver # COSA ApplicaUan_June 2022^ I- A Legal Description: KNIK HEIGHTS; BLOCK B, LOT 14 Parcel ID: 017-033-34 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1972(?) Total depth *95.5+ ft Cased to UNK ft 0 Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/16/2023 Static water level at beginning of test 93.3 ft. Comments *PER GEG WELL FLOW TEST B. TANK DATA Measured operating fluid level in septic tank 56/38 Date of pumping it III�- ❑ Required maintenance completed, if AWWTS Comments: CONCRETE/STEEL- SEE ATTACHED PROFILE BY ANCHORAGE TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 8/4/1995 Q ALL standpipes present per record drawing Total measured depth from grade 10.1 ft (max) Measured depth to pipe invert from grade **1.91 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Al Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons date Any rejuvenation treatment (past 12 months) If yes, enter date - Well production at time of test 4.5+ gpm Water storage tank volume NO gallons Well disinfected for coliform test? ❑ Yes NX No 0 Coliform bacteria is Negative Nitrate 1.63 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Q Arsenic less than MRL (ND) Collected by GEG Date 6/16/2023 C. LIFT STATION ❑ Required maintenance Age of lift station years Lift statio erial Adequacy test date 6/16/2023 Results 0 Pass Fluid depth prior to test 45 in Water added 920 gal New fluid depth *75 in Elapsed time 120 min Final fluid depth 61 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 61 in Effective depth remaining 11 in Comments/Deficiencies: MT EXTENDS 74-76" BELOW THE CLEANOUTS. SYSTEM WAS APPROX 100% FULL AT END OF TEST **SEE EMAIL FROM OWNER REGARDING,FREEZING COSA Checklist June 2022 a E. SEPARATION DISTANCES From Private Well on Lot to:ea ter distances if less than required or if community well on lot) Septic Tank/Lift Station on of > 100' * Community Sewer Manhole/Cleanout > 100' es If No ft FE -1 Yes if No ft Neighboring Tank > 100' es if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' 170-1 Yes if No ft Holding Tank > 100' [E Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft Di Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes, if No ft 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑■ Yes if No ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' Di Yes if No ft M Yes if No ft Q Yes if No ft F!] Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑ Yes if No ft Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *1972 CONCRETE TANK IS 94' FROM WELL - MET CODE AT TIME OF INSTALLATION THERE IS NO FOUNDATION CLEANOUT - SEE ATTACHED PHOTO OF PIPE IN CRAWLSPACE THAT COULD BE USED IN LIEU OF FCO G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Engineer's Printed Name Jeffrey A. Gayness Phone 907-337-6179 Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 0 OF , O *�'......� .......� fh A. Garr ss, 409 f , CE— % 5 ! .c0G LICENSE r0, 68 �� o #AECC684 �dO�00'Od P,Ynaw+uu y *,rsa amtao°s A+ HOME SERVICES 907-345-1890 7400 Old Hillside Way Anchorage, AK 99516 (907)345-1890 info@aplusak.com DATE 07/06/2023 INVOICE# - 4204_ TERMS Due Upon Receipt DUE DATE 07/06/2023 BILI. TO SERVICE LOCATION Doris & Brian Kubanyi Doris &Brian Kubanyi 12501 Shelburne Road 12501 Shelburne Road Anchorage AK 99516 Anchorage AK 99516 (907) 388-8009 (907) 388-8009 JOB# DATE P0/RE1=# DESCRIPTION 1022831512 07/06/2023 Excavate and make the following repairs: Replace CO -2 that is filled w/ dirt, Replace septic pipes labeled T2-CO1 & T2 -CO2 that are separated at the 500 gallon steel tank, extend septic pipes labeled CO -3, T2-001, & T2 -CO2 above grade. *50% deposit required prior to the start of commencement of work If you have any questions or concerns, please do not hesitate to call our office at the number listed above. We are not responsible for underground utilities unless located by the Locate Call Center or settlement over disturbed areas. Pricing is subject to change in the event of unforeseen circumstances such as but not limited to ground water influx or sandy soils. If one of these events occur the customer will be notified and charged an hourly rate of $240 until event is remedied. A 3.7% per handling fee will be charged if paying by credit card (we accept all major credit cards), and a monthly 3% finance charge will be added to all past due invoices. Completion Notes: All repairs completed as specified. - ------ Signed --- Signed By: Doris & Brian Kubanyi Signed By: Invoice Total: $1,357.00 Deposits (-): $0.00 Payments {-): $1,357.00 Total Due: $0,00 Cogger, Benjamin M. MUMMMMMOMEMONEMM __ From: Jeff Garness <Jeff@garnessengineering.com> Sent: Friday, July 28, 2023 10:54 AM To: Cogger, Benjamin M. Subject: Soil cover issue at Knik Heights, Bk B, L14 - 12501 Shelburne Road, Anchorage. [EXTERNAL EMAIL] The following is some specifics regarding the drainfield soil cover issue at the subject property. I. The drainfield is a trench type system with 72 inches of effective depth. 2. Per the 1995 inspection report, the soil cover over the drainfield is 2.5 feet (no insulation was noted) at the shallowest end. In short, it appears that the system was originally approved with less than 3 feet of soil cover. 3. If you pull up the Google Earth "street view" for this property, you can see that the trench runs somewhat perpendicular to the slope. 4. Per our field notes, the upgradient trench cleanout invert is 5 feet below grade, so the soil cover is about 4.5 feet. 5. Per our field notes, the monitoring tube at mid -trench extends 10.1 feet below grade.............so the soil cover over the drainfield at mid -trench is about 3.5 feet deep 6. Per our field notes, the cleanout invert at the downgradient end of the trench is 23 inches below grade, so the soil cover over the drainfield is about 1.4 feet. 7. It appears that only about the last 15-20 feet of the trench is shy on soil cover. 8. The drainfield has been in use for almost 28 years. 9. The homeowner has stated that they have never had any issues with the septic system freezing. If freezing were to happen, it would likely only occur over a small portion near the downgradient end of the drainfield. It is my recommendation that the MOA issue the COSA with an advisory notice addressing the fact that a portion of the drainfield is shy on soil cover and potentially susceptible for freezing. Jeffrey A. Garness, P.E., M.S. President Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 Mobile: (907) 244- 9612 Website: www.garnessengineering.com GARNESS ENGINEERING GROUP, Ltd x ENGINEERING �SALES =CONSULTING drik ,,.. From: Doris Kubanyi <doris.kubanyi@yahoo.com> Sent: Wednesday, June 21, 2023 12:55 PM To: Erik Widger Subject: Re: 12501 Shelburne Ave. - 2023 COSA Erik Widger, We have never had any issues with the septic system freezing at 12501 Shelburne Road. Doris Kubanyi & Brian Baggett (Owners) MUNMPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231275 Subdivision: Knik Heights Block:B, Lot: 14 907-343-7904 Fax: 343-7997 The septic tank for this property is 28 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. 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. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description -'" '~ ' ¢/'~',- ~'~-'-'~ ~ ~-'"-~'-,~-- ~7/,----~-~- Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing address Day phone --~ ;~¢ -' ¢~--¢ Agent Address Day phone 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 AI~E;C attest- '-~ ~ <.,;, 0 2*. lng to the legality and status of system. ¢"7~ ~_: ~ .~ TYPE OF WASTEWATER DISPOSAL: ~,-o ~-'-, .~"- 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. 1191) Fronl MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system 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 ~;~,-~./~ ,¢.r- /.-?~..~-/~-.~._d~ ~?/ Phone ~' - Address ~('~.,I ~* ~C,'%~ ~,t~t~'~ ~-~-~ Engineer's signature '-, Date -?';. C? ' "'. DHHS SIGNATURE '",/' Approved for /\ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 satisfl/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 engineeCs work. 72~25 (Rav. 1/91) Back MOA ~21 Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/~f / ~//~'~2¢~,~_- ¢¢'/.-,,~-~,,¢-,¢',¢~,~ ParCel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed / ¢ ~.,¢~ Driller Date of test Static water level Well flow Pump level1 ~',,~r/. Cased to '~/¢ '+,'~,~ Casing height ? Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION .g.p.m. g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot /,0 2,, ,~/; On adjacent lots ; On adjacent lots J~ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: ~'/~ Nitrate Public sewer manhole/cleanout Petroleum tank /'~¢ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installec~¢'/-2 ~,,,-"" ,,¢--¢¢ ~-,¢,,.. Tank size Cleanouts (Y/N) /¢ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping .~'~'~./"/¢'¢~ ,¢' '~'~/'¢¢.~ Compartments / .<-~ o Depression (Y/N) Alarm tested (Y/N) "tj.¢'¢-I¢ Pumper _,t~ ..,~.~..~?--'..~.._...¢..~_~.~ -// SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /¢ ?¢~ ;~,,~. -'~ zz¢_2~n adjacent lots To property line j~ ~,¢- ~?¢ _Absorption field Sudace water/drainage , J,~ ~-' ~/'~ Foundation /¢ "~/~',/- Water main/service line 72-026(8/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DISTAN~CE~PR~M LIFT STATION TO: V'~el~ On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump o fl~.-vet'a'~ .Cy~ Surface water D. ABSORPTION FIELD DATA Date installed Length ,¢ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft~) Width ~/~/' Gravel thickness ~5'~E¢/~/ Cleanout present (Y/N) _ Results (pass/fail) -g¢~ ¢ System type ~',~ ¢ ,~"/' Total depth ¢~'/~ ~'. __Depression over field (Y/N) . for Bedroorns Aftertest //-/ If yes, give date _. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~ ?~-'/- On adjacent lots /~ '~/-/ Property line To building foundation /~ ~¢/:';P To existing or abandoned system on lot On adjacent lots ~ ~'/:,¢~ Cutbank /~2/¢.¢ Surface water .z~.//~/ Driveway, parking/vehicle storage area Curtain drain /,.2/'.~¢ Water main/service line E. ENGINEER'S CERTIFICATION Signature Engineer"s Name I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effectj2g.,~e.~{te~..~?..%t,.. '~"~\~',°f this ~"~"""~"'~,.o~,,,,,,.. [' ;' ~. -' ':'~:L,': ~.:::'.:: ::' (, .,., , -; ,-~,,,~ , .,,¥ HAA Fee $ Date of Payment Receipt Number 72-028 (3/93~° Back Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc, Laboratory Division r.~.,~.,~.~.,~r.,~.~:,~,~:.~,,..~:,,~:,~-.,,~.~.~.,~:,~~~~~ Drinking Water Azal},'sis P,,e, port for Total Colifom~ Bacteria ~ ". Anchorage, AK ~;~ I-~TT~UCTIOST O.Y ~FE~SIbE ~E~O~ COZLECTiVG Sq ~fpL~~ ~' ~ , ..~ .:ax: (907) ~6;-53G1 · .x ~L;$T SE CO:Nfl%ETEb BY \V.Z,T£~ ,7 PUBLICW.ATERSYSTES[I.D,$ ~ ~ ~ ~ .~ P~IVATg WATERSYSTgS[ $ A.M.'P L E DATE: £AMPLE P:TE: Repeat Sample ([or roudn~ Se, mpl~ wilh lab r~f, no, ) Special Purpose S AS'I::P L E LOCATION Time Collected CoINct~d BF /,/, .-:~ .o ./.~//.). Sample over 30 hou:~ old, results ma?' be u~raiiab[e ao¢ b~ o,,'~t 4$ hours old a( new sample via spezial ddive~ m~il. A nu l,','$is B~an Anal?'tienl ,,M,:thod: ,Z/ %[~mbrane Fii;er ' MMO'x (UG · ,N'=mber ot'zolonies..'!00 mi. Result* 95.,42o5 ~Q~ F'bk~ ,Jun Clien~ notified oFtmsadsD, c~oO. result.s: Da:t: Time: £. Coli c ,/;R~t,d,l=, ,AL gACiL!Z[~$ hq $'..~.SK;,, CALI,~OA,'*;IA..-".,O.=,;OA. [LL[:..iOi5. ,hlr~'.,qy-&,NO. ,'¢;iC)~:.3J,,',i, ,M;SSOLiql. k;:.'.., J---RS?', OMlO, WES? '.,hq,Z.. 09/29/95 14:48 COIqlqERCIAL TESTING ~ 90? 248 5774 N0.592 [P02 CT&E Ref.~ 95.4205-1 Ha~ri~ WATER Client Sarple ID L14 BLi~ K1;IK HT8 CT&E Environmental Services Inc, Laboratory Division ~ Laboratory Analvsis Report WORK Order 18307 Client Name DOUGLAS KENLEY,P,E, ~rintmd Date 09/28/95 ~ 07~44 hfs. Ordered By Collected Date 09/25/95 ~ 11~20 hfs, Project Na~e Received Date 09/2~/95 ~ 13:40 hrs, Projact~ PWSIO UA Technloal Director STEP~N C, EDE Sample Reularks: SAMPLE COLLECTRD BY; FRED ~. KENLEY. QC Allowable DXt, Allal Parame~ Rm~ul~s Q~al U~its Method Limi~ Dat~ Dat~ .................................. r ............................................................ 0~/26/95 DJ8 Nitra~e-N 0,44 t~/L EPA $~3.2 See 8peoi~ Inst~ic%iO~a Above ~A = Not Ana~y~~rl S~e Sample ~mark~ ~ov~ GT - Ora~ter Than 8~co)ldary dilution. CT&E Ref.~ Matrix Cliemt Sample ID 12501 SHEL~Lq~E Client Name A~ WATER & WASTEWATER SERVICES Ordered By JEFF GAP~SS Project Name Project# pWSiD UA CT&E Environmental Services Inc. L a b o r a t o W D i v i s i o n 95.: 27-1 Laboratory Analysis Report ' WA?ER WORK Order 14256 Printed Date 05/02/95 ~ 13222 hrs. Collected Date 04/27/95 ~ 20:00 hrs. Received Date 04/28/95 ~ 15~55 hrs. Technical Director STEPHEN C. EDE Sample Remarks: SA~IPLE COLLECTED BY: GARNESS. QC Allowable Ext. Azlal Parameter Results Qual Units I4ethod Limits Date Date init -~ ~ x~ 0.43 ~/L EPA 353.2 10. 05/01/95 Ct!R UA = Unavailable See Special instructions See Sample Remarks ~o';e NA = Nog ~alyzed Undetected, o~oo~r~d va!lie is the practica! qq~antification limit. LT = L~ss Than "-' .... GT = Greater Than Secondary diluticn. 200 W. Potter Drive, Anchorage, AK 9951 8-1 605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 _ CT&E Environmental Services Inc. La b o r a t o ry D i vis i o n Drinkin~ Water Analysis Report z%r Yotal Coliform Bacteria :oo w. Po=er Orive · ~ ' Anchorage, AK 995~8-1605 READ I3'5TR UCTIO>,T 03' REP'ERSE SIDE BEFORe' COL£ECThTG"SA,'~IPL£ Tel; (907) 582-2343 MUST BE CO.¥RaLETED BY WATER SL??L~R PUBLIC WATER SYSTEM I.D.~ I P~VATE WATER SYSTEM II Send invoice Month Da)' Year SAMPLE ~E: '~ Routine :, Treated V','nter ~ Repeat Sample (for routine sample /'~ Untreated ~Vater with lab ref. no. ) U Special Purpose Time Collected SA~LE LOCATION Collected By ~Z~i ~L~o~ ~ ~ ~p~ ~~ Fax: (907) 561-5301 TO ~E COMPLETED BY LABO~-kTORY Analysis shows this Water S:LYfPLE to be: ~ Satisfactory. m Unsatisfactory. O Sample over 30 hours old, results may be unreliable ~ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via speciallde[ivery mail. Date Received L~/ Time Received J Analysis Began Analytical Method: ~..D-/M, embrane Filter El MMO-MUG Number ofcolonies/100 mi. Lab Ref. ,,",'o. Result* SenIlo..\.D.E.C. ~ Fbks Analyst Jun ~.~_ Time: Client notified of unsatisfactory results: Phoned Spoke with Date: Time: Foxed Faxed BACTERIOLOGICAL WATER AMALYSIS I:~ECOtH) MMO-ML'G Result: Total Coliform Membrane Filter: Direct Count Verification: LTB Fecal Colii,orm Confirmation Final Membrane Filter Results /~ t~ ~..f :../ce._, Reported F,?' __>/ ' BGB Cot~ Colonies/100 mi CO LIFIR.',I Coliform/100 mi Date ~ '~5'5~ T~me / 5> 50 ~rs ~S~S PAR? ONE OF '"' ~ ~ FOLLow Member of the SGS Group(Soci6t~ G6n6rale de Surveillance) Municipality of Anchorage REQUEST FOR VOUCHER CHECK FROM: Health & Human Services (DEPARTMENT) TO: MUNICIPAL CONTROLLER DATE: September 20, 1995 1. R 49662 THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY __ 1099 VOUCHER NO. PAYMENT DT. V I VENDOR NO. REFERENCE NO. INVOICE DATE INV0[CE NO. ;HECK NO. CHECK DATE PREP APPR REQUEST THAT A MUNICIPALITY OF ANCHORAGE CHECK BE ISSUED TO: Name Douglas T. Kenley Address 7920 Honeysuckle Drive Anchorage, Alaska 99502 2. 'rHIS PAYMENTISFORTHEFOLLOWING(SUBSI~NTIATION ATrACHED): This application was to be for a Health Authority Approval ($300.00 fee) instea he paid for a Sewer Permit (Upgrade) ($320.00). Request the refund of $20.00 the difference between the two fees and the $300.00 per applied towards the Health Authority Approval. The system has been upgraded and inspected on August 5, 1995 so there is no need for another Sewer permit as there is one tha exists, Permit ~SW950187 Issued on August 4, 1995. ThaDk you~ 3. DISPOSITION OF CHECK: (1) ~X MAILTO PAYEE (2) r~ MAIL TO PAYEE WITH A'Iq-ACHMENT (3) [] NOTIFY PAYEE TO PICK UP IN TREASURY Name: Phone #: AUTHORIZED USE ONLY (6) [] NOTIFY DEPARTMENT EMPLOYEE WHEN CHFCK IS READY iN FINANCE Name: Org. #: Phone #: 4. ACCOUNTS TO BE CHARGED: Lot 14 Block B Knik Heights Subdivision ITEM ENTER ALL POSITIONS OF ACCOUNTING DISTRIBUTION NO. DESCRIPTION Org/CC AcctJObj Task Opt Cost Ctr, Wa/Wo AMOUNT  ..... ,:,*:i 2 0.0 0 a_ TOTAL AMOUNT OF CHECK $ 20 . 00 6. SIGNATURES (~t~,% 6%--%~.¢,,~,__.~¢,.,~ 343-4744 Employee ~'~ Phone No. Approving Authority 7. INSTRUCTIONS a. To be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash. Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7. c. Retain carbon copy for your file. 40-001 (Rev. 11/94)' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Services Division Telephone: 343-4744 ON-SITE SERVICES FEE DOCUMENTATION Date Paid: . Permit Number: Legal Description(s): ~ _~ ~. ~ ~ m~ _ ~ v ,. / Type of Payment: (Indicate Amoun~ Paid~ ~ ~ ~ 72-034 (Rev. 10/87) .'~ .............. Health Authority: '2oC-Y~, (::cD Excavator Permit: Sewer & Well Permit: Engineer Permit: Well Permit: Pumper Permit: Sewer Perm~.'lt?-- ~'~--¢'~ ~ ;5 Well Driller Permit: Copy Request: Tank Manufacturer: (Waste Treatment) DISTRIBUTION: WAIVERS' r-~ ~ LotLine: _ v...~ ~,.~ ~C~;- r'~/ Well to Tank: ~. Well to Field FieLd to Surface Water Tank to Surface Water WHITE--MASTER FILE CANARY~PROGRAM FILE Department of Hea . ~x SINGLE FAMILY DWELL G Lena] Descrintion ~ ~ ~ Number of Bedrooms: ~_ ~ % Approv~~irm ~ Municipal~~i~e~ Does your house contain any of the following: Hot Tub, Swimming Pool, The[~y.~a~[, or Water So~ener Unit? ~¢ ' If yes, which one? This application is for: Sewer OnLy ~__ Sewer' and Well __ ~ Sewer Upgr~e I cefli~ that the above information is correct. I fudher cedify that this application is being made and in accordance with ap¢licable ~unicical coOos. Fees: '"'"'~' Municipality of Anchorage ~.ge ._.Z_/o~ ~ 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: ,~t ¢,~(") ~¢,~ PID Number: ~ Name: ~¢¢ ~~~ / Wastewater System: D New ~Upgrade *~r.~: ABSORPTION FIELD No. of BeProoms: ~Deep Trench D Shallow Trench D Bed D Mound D Other Total Depth ~rom original grade: LEGAL DESCRIPTION Soil .ating: ~'~ GPD/Sq. Ft. ¢~/~ > ~ Subdiv~ion:. Depth to pipe bosom Irom original grade: Gravel depth beneath pipe Range: Section: Fill adPed above original grade: Gravel length: ~ ~ Ft. ~ D New D Upgrade Grave~ width: ' ~ ~/ Number of lines: Dis~n~n lin~: Classilication ( , , : Total Depth: Cased TO: Total absorption area: Pipe material: Date installed: Drillen % ~ ~te Drilled: Static Water Level: Installer; Yield: PumpSetst: ~noHeightAboveGr°und: ~=.,-~ ~ ~o,)M SEPARATION DISTANCE~ ~ptic u Hola~ng ~ S.T.E.P. From 3an~ Field Station %ank ~wer Lines ~ ~ ,~ ~[ ~ ~ ~ ~ ~ Water ,, I~e~t: ~water alarm Foundatio~¢ z e¢~ Cu~ain Drain ~ ~ ~/. ~ ~2 ~ pu,, M,ke & Mo,el Electri~l Inspections pedormed ' BENCH MARK .ocafion and D~cdption: Aesumed ELevation: Department of Health Huma ices approval ' "'¢"' ' ~" Reviewed and a*~roved by Dat ~ 72-013 (Rev. 9/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH A_ND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PER_MIT NUMBER:SW950187 DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E. OWNER NAME:GR.kHAM LARRY L & RENE L OWNER ADDRESS:12501 SHELBURiqE RD ANCHORAGE, ALASKA 99516 DATE ISSUED: 8/04/95 EXPIRATION DATE: 8/04/96 PARCEL ID:01703334 LEGAL DESCRIPTION: KNIK HEIGHTS BLK BLT 14 LOT SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PER. MIT 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 A_ND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-47~ ( 2~ MOUES ) (NOT REQUIRED FOR WELL ONLY PERle!T) 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: AT THE TIME OF CONSTRUCTION ENGINEER SHALL EXPOSE AND VERIFY THE INTEGRITY OR BOTH EXISTING SEPTIC TANKS. ISSUED BY: ~/~~ ~ . _ ;~. /' ' ' .-:i!u:.-.'?~;!.i~;?:i;~;,~ MUN C PALI'i';Y OF ANCHORAGE . ;~--. : .?:;i'.':-, ..: ' -'. ;~:~: .:.' -; ~-- :: ;"~::~: '..-'";~:: i~;i~:DEPARTMENT OF,HEALTH &"HUMAN SERVICES:;'! ~';.;::'~-~"~'.. . ...~.:.,.-~.~:'.., ..... :,"-::--',, ~'.'-~'~ ~J~,'~,~".-Div sion.of .Enwronmenta Servmes': ~ -:.: ~;-('?;~. .... i;.;..:~~ - -~: : ,~';~,,~';~ .v~ .',~,'~'7 [,~,~%~,~n,S te Se~ ces Sect on...q ?.,.~ ~;.:5.:~:;:,~,,c,;,~: ';:,~::~;,?{~;(~-~,.~5. t~¢~.O. Box a96650.,:Anchorage, Alaska.?, 99519- . __.: .. :; :;.: ,~....- . ~:;~,,~..?~.:? ~.< .~.¢~..: . ;..,~:~.Parcel:l.D.~. - -- ' ....... --'-"-~' ';'~:::.. "' ' ~ . :,7.'~L~ ~k';5 ,~ ;;,::~-&'~';;A~;~ ~u,; ;~:;~:~gqk~4~tq~Z &,:.':: ?.;. ':, ~--" ' ::';: -': ": LdT~Ys~;,:-;.'-~kq:?,-~ >:~' :;;¢~?<~.' ';~:;:;"~'?,l~5:~]~;;-g,"~ 'k;~':Sk~/~.;]~:'-;='~;:~L~W::'"--: . - ):..?,t::: .... :. "k:::;-.":7~ ;;~' .~: ',;' ~:,~:7~?~'~'~;'t;':< :r' , . ,...; ...... , ~ .. t.,~,~.:.. - ' ~';{;: ~., - ' ..,.-, ,~;~ ..... g5;':7.:{-~, :;: ':~ ~ .'- ...... "';?'~' 1.-'~ GENERAL~INFORMATION :- ..... ~-:'~.-,:, -,: ..... :-'::: :-'¢-~;':?';. ................. ; ............. Community ,well ............... - ....................................................... ,~ ......... NOTE If communit well system provide wrJ~en confirmation from State A~ a~est-'~ ~':¥. · mg to the legality and status of system.' ' ~ "7' ~'.:~' ~ ~ :'" '. .. .... -. ..... ....,,:.. .... ~.,..... ....... , ............... ~., -..._~ ~ .Community.on,site ~ . '.,,~,: ~ ~ , _ ........ . .. . .:.~..... ,:,:.~:~_ - _:. -Public,ewer" - .......................... , ..................... NOTE: If community,wastewater'system, provide written confirmation from Stat~'ADEC MUNICIPALITY OF A NCHORA GE DEPARTMENT OF HEALTH & HUMAN SERVICES On.-Slte Services Transmittal Sheet TO: LEGAL: /~.~/~_ The attached paperwork has been reviewed and is being returned for the 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. Ca].culation error in design. -- Show locations of all soils, percolation or water table tests. _ Proposed system to() 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 Please supply the necessary information and re-submit your request. You[~cooperat ion ~ appreciated. / LEA VE THIS FORM ATTACHED TO PAPERWORK /203-rev. 4~93 Alaska 'Water & Wastewater Services "Preserving The Last Frontier" JJUl]~ i ~ 1.99~ Nunioi. pal J. Ly o1: Al~chora. ge Dopart'.menh of HealLh and Iluman Services I)iv:isS, on cJf Environm~¢nlza] Services Anchorages, Alaska 995t 9-6650 Roi:: Sopgic System, Lei; ALt, n: Robby Robinsen L)ear Robby: Per- your commenLs dated 5/25/95 a con~ractor CA+ Homo Se:r-v&ces) was ~-oEa~nod to ro~ooa~e i;he out. leE on bho crib t;he 6 foo~ e].,gvat, ion. Once exposed, i~ was found t. hal: the pipe out. lei; ~as at Lhe 'bop of the c:rib and, t. herefore, could nol: be re]ocabed. It was aisc) discovered that. Lhe c:rib only 4.5 feel; deep below the Jnver'l; of the pipe,, and no1; 6 fooL, as shat;od on Lhe as--bui!g drawings. I was not on si. Be dt}t-Sng t, ho exoavagion, buL Hike B].ake%].oe, the owner o'F faxed me 1;he elevabions he "shot;" in the fie]id. Wi'bin informat~or~, :;.k is (Dear that bhe crib was completely full during the adequacy '~es'L (5/2/95) when &h was ovei-f'loming in~o ti'la surcl]argec! crib. ]tn shorg, the crib and the trench are fJ.t]l.e(J to capaciLy, add ah the end of t;heir useful Zt. is my rooemrner~daLion t:haL they be replaced wiLh a nero system. Zf you have any quosbJ_on, please call me a 6179 t:~'J, nco tel. y, // Graham5 ,, wp's Telephone: (907) 337-6179 · Fax: (907) 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504 MUNICIPALITY OF ANCHORAGE ~3EPARTMENT 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 DWELLING 1. GENERAL INFORMATION Completelegaldescription L-~T- tq-j ~- ~'..3 ~-.~-_ t4.~l~tq-~'"'-S ~'~:~ Location (site address or directions) Property owner Mailing address Lending agency _ Mailing address_ Agent ¢'J//~ Address .D,~ ~.~..' -~mi'Z~ tc.A~ Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Z~_. ,~ TYPE OF WATER SUPPLY: Individual well ~ Community well Pub Ilo water NOTE: If community well system, provide written confirn lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NO'I'E: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of s~/stem. 72-025 [Rev. 1/91) Fronl MOA #2~ STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system 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 inves.tigation 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. Alaska Water & Wastewater Services /~ Name of Firm n,~?~ RrnnttrlHnn nr /I Phone Engin~,s signature ------/~' -~ Date bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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-~25(Rev. 1/91) Back MOA Legal Description: A. Well Data Well type Log present (Y/N) Iq Total depth ,>. c[~ / Sanitary seal (Y/N) Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. o I-/- O '&..2, - 3z:b If A, B, or C, attach ADEC letter, ADEC water system number ~ /,'~' Date completed I c:J -7"Z ''~ Driller Cased to ,'~O/+ Casing height Wires properly protected (Y/N) 'q~-~ Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot -i-¢zs=~.~c~ ~, ~ Public sewer main N I,,~ ~ ..~.¢ .~ Sewer service line > ~-~ ~ "~"'~ WATER SAMPLE RESULTS: ~ _o. Goliform ~ ~itrato B. SEPTIC/HOLDING TANK DATA ~ Date installed ~z ~ ~ Tank size AT INSPECTION g.p.m. G. J g.p.m. / ; On adjacent lots >~> i, OO / ; On adjacent lots > ";- [oo Public sewer manhole/cleanout NJ/74- Petroleum tank /,4/~4 OF- o/aL'.'/ O'z~ ~'/j~ Other bacteria ,~ Collected by: ~~' ~0o ~ sq'c-~CCompartments J4.- I Cleanouts (Y/N) ",/¢-..-~ Foundation cleanout (Y/N) lq 0 Depression (Y/N) High water alarm (Y/N) /'J/~" Alarm tested (Y/N) ~J Date of pumping ~"'//./9%"' ~ 5'/~/,~' Pumper Ot.-_~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ I'Z On adjacent lots > IoO / To property line ~'C) +- Sudace water/drainage /-JO Absorption field Foundation Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE Size in gallons ~ "Pump off" Level at Vent (Y/N) '"""'"~' o on" level at High water alarm level -- ' -'~~cles tested Meets MOA electrical codes (Y/N) SEPARATi~,FT STATION TO: D. ABSORPTION FIELD DATA . Date installed ~"P. ~¢~ b//4./87. Soil rating (GPD/FF) Length q-c_s~: z~' Width 0'~6%u~eanou[ present (Y/N) "-{~.~ Depression over field (Y/N) Results (pass/fail) p¢,~ for ~ Bedrooms I ' 4I- ~/~" ~ ~ ~V~" . Aftertest ~: ~'-4" ~0 If yes, gbe date ~ 0 Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~, Z~r ~. ale On adjacent lots ~ '~ I 0 0 Property line To building foundation ~l ~ ~1o To existing or abandon~ system on lot On adjacent lots Sudace water Curtain drain E. ENGINEER'S CERTIFICATION ~ lA Water main/service line Driveway, parking/vehicle storage area I ce~'~ that I have Checked. verified, or co~ed to all MOA ~d H~ guidelines in effe~.o~be.~te off,is i~speotion. Signature _ EngineeC, Name 7~~~' HAA Fee $ ~ Date of Payment Receipt Number 72-026 (3J93)' Back Waiver Fee $ Date of Payment Receipt Number ,~X~q~.'..:'~t. ¥>".- '~.~,~;'-' ~;:~, . · - ~' '~ ' ~. SURVEY TYP~, J,~,.., . · ~., ~LOT ~LAN ',';;AS. BUI~..- LOT.SURVEY RECERTIFtCA~ION '~-B~IET- NO /-'/J ...... . ,, ..... :,.. NOTE~ FenQas Q're shown]~ fhe{f o~proxim~te.' ; ' loc~tlons enly, :I l_ce~~ h.~ n f%.?:..~ ,-= '~ ~"%e't :': "- ~ ron,rqber -[0und 0 set · IrO~ pipe ~roun~ G ~et bra~ ~ f~und , ~ .......sat ...... ~ ...... MAP INC. ~o ~own, '7-27-89 J , ~ CT&E Ref.~ Matrix Client Sample ID 12501 SHELBURNE Client Name AK WATER & WASTEWATER SERVICES Ordered By JEFF GARNESS Project Name Project~ PWSID UA CT&E Environmental Services Inc. 95.1 :-1 Laboratory Analysis Report WATER WORK Order 14256 Printed Date 05/02/95 ~ 13:22 hrs. Collected Date 04/27/95 @ 20:00 hrs. Received Date 04/28/95 @ 15:55 hrs. Technical Director STEPHEN C. EDE Sample Remarks: S~24PLE COLLECTED BY: GARNESS. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.43 mg/L EPA 353.2 10. 05/01/95 CMR See Special Instructions Above UA = Unavailable See Sample Remarks kbove NA = Not Analyzed Undetected, Reported value is the practical quantification limit. LT = Less Than Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 FI~IVIRf~NMFNTAI FACIIITIES IN ALASKA CALIFORNIA FLORIDA. ILLINOIS. MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OH[O, WEST VIRGINIA CT&F Environmental Services Inc. Laboratory Division r~r,~r~,~,ar, c'j.~,~-.~-.ar.~-~rjt,~-.~,,~.~,~~jj~t~tj~j~j~ Drinking Water Analysis Report for Total Coliform Bacteria 2oo w. Drive Anchorage, AK 99518-1605 RE.4D IWSTRUCTIO:YS O:V REVERSE SIDE BEFORJT~ COLLECTING SAMPLE Tel: (907) 562-2343 Fax: (907) 561 -5301 % PRIVATE WATER SYSTEM Send Itt voice SAMPLE DATE: Month Da)' Year SAMPLE TYPE: x~ Routine ~ Treated Water [] Repeat Sample (for routine sample ,,~ Untreated Water with lab ref. no. .) [] Special Purpose Time Collected SAM]?LE LOCATION Collected By Please print TO ~-E COMPLETED BY LABORATORY Analysis shows this Water S.<¥[PLE to be: Satisfactory [] Unsatisfactory [] Sample over 30 hours old, results may be unreliable [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special,delivery mail. / Date Received _ _t_//~ ~ Time Received ] ~ ~-~ Analysis Began Analytical Method: ..D-/Membrane Filter [] MMO-MUG * Number of colonies/100 mi. Lab Ref. No. Result* Sent to A.D.E.C. ~ Fb~ Jun Date: ~ Time: Client notified of unsatisfactory, results: Phoned Spoke with Date: Time: Analyst Faxed Faxed Comments: BACTERIOLOGICAL WATER AN.ALYSIS RECOtLD MMO-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB Fecal Coliform Confirmation Final Membrane Filter Results E. Coil Colonies/100 mi BGB COLIFIRM TNTC = Too ,Vur.~rous To Count OB = Other Bacteria Date ~ '2'0"57 Time / F_~ ~ hfs - OF ~ TO rULLOW Member of lhe SGS Group {Soci~t4 G~n~rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND Alaska Water & Wastewater Services "Preserving The Last Frontier" RECEIVED MAY 2 5 1995 Municipality el An¢lqorage Dept. Health & Human Services Municipality of Anclnorage Department of Health and Human Services Division of Environmental Services On-Site Services Section P.0. Box 196650 Anchorage, Alaska 995I_9-6650 Ref: Adequacy Test at Lot 14, 8k B, Knik Heights S/D Attn: Robby Robinsen Dear Robby: Based upon on our conversation today i prepared tine following report to document thc; adequacy test at the sub3ect property. of b~oloF7:ical additives), cor;ditioll of dFain pipe and pJpf~ 3o.~t)ts (which can be dama~Ted by se.~smie activity and deteF.~orate ~,~ th a~) ~ type of substances deposi ted in ob joG'ts), and 8he amount of water beillg intt'oducod on a continual basis. Consequet'~tly, the results of th.is adequacy test are only valid fop the specific day t:)f the test. GENERAL: i p(~rformed an initial site visit on 4/27/95 and found l;hat there was liquid backed ~lp into the 500 ga/lorl sepbS, c tank, however, there was only 3.9 feet of waten in the crib downstream -Prom it (the crib is 6 foot deep per 'bh8 J972 inspection nepor~). This lead me to believe that tlne~e ~as a blockage between the bank and the ct:ih. Upon further investigation by an excavator it was found that the cast iron g~avity line had clogged-up, b].ocking the flow. Zn addition, ~ noted that the clean-outs at the trench sump, and the l, O00 gal Ion concrete septic tank were separat, ed below grade. An excavator (Monte Acheson, 545--27~5) ~as reta~ ned by Mrs, Graham to correct the aforementioned problems. The line bebweel] the 500 gallon septic tank and the crib was replaced, and a set of double clean-outs was installed. These repairs were done after I performed the Telephone: (907) 337-6179 · Fax: (907) 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504 adequacy test (5/2/95). I have inspected the site since and fot.lll:] ishe system to be operating properly. ADEQUACY TEST: a. Trench- Upon inspecting the sump in the trench (5/2/95) Z noted that it d~d nob extend 5 feet beZo~ [he ~nvert ot' the p~pe (suppesed~y 5 'foot of dra&nrock, per t982 ~nspect~on report), but rather extended only 5.8 feet beZou the invent, fhe pumper' was later able to vacuum solids out of the trench so that it no~ exgends 4.45 drainpipe invert. Tt)e I:ota) trench depth is no~ 9.45 feet. All liquid depth measurements referred be Jn this report assume I;ha~ the tsr'ench is 5 feet; inches dee~. (6.5 inches below ~he invert of bbe drainpipe). Zn short, ~he brench was 89t full. b. Crib: ~?%o_r_.JLo,_t!~e::ad~e_qu_aqy__._t_est the liquj~d~__l,.~yxe_l_ in the crib was found to be 5.9 feet dee[_) .... The total depth of the crib belew ground level was measured to be 1].15 fee~. The gravel depth in the crib, per ~he 1972 inspection reporE, is 6 feet.. Zn shorl;, pr~or ~e running ~he adequacy test, lshe cr&b was 65% full. I initially .in~roduced Nat;er into the trench sump, at an average rate ol; 6,55 gpm, for a total of 20 minutes (127 gallons) . During that time the l~quid level ~n the sump rose 10.5 inches, submerging the top of the drainpipe. At that time Z t;hen began to introduce water into the crib (liqu:i.d level had not changed, 46.75 inches) at a rate of 6.04 gpm, for 80 minutes (485 gallons). The total volume introduced ~.nto the trench alld crib 485). During the first 40 minutes, the liquid level in the crib rose a total of 4.9 inches, to a depth of 51.6 inches, and then stabilized for the rest of the test. The liquid level in the trench continued to rise, as water migrated from the crib, to a depth of 76 inches (teta] rise of 22.5 D_~.~:.e~_~_~g~(~ test the 1 i crib was menitored. The level in the cr~_b was 4.5 inches~. ~(~D%. Based upoi] this data the septic system was deemed to be adequate for a 4 bedroom house (600 gpd). TRENCH OPERATES IN SURCI4ARGED CONDITION: it should be noted hhat the trench op~srabes in a surcharged condition even when the crib is not full. :fl appears that somewhere about the 4 foot ].eve]. in the crib that; ~,;ater spills ever into the brenc, h? P, tl:.ached is a drawing which shows some r-elative~, e, leval;ions between the trench and the crib. If you have any question, please Jef~ 'Consultant Gr'aham2.wps ~/o 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 DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Day phone Unless otherwise requested, HAA will be held for pickup. NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Public sewer 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 'H.~o,v, sj@au!6ue leUO!SSa,~oJd eqt u! suo!ss!tuo Jo sJOJJe JOj. @lq!suodseJ lou s! ebeJoulouv jo A~!led!o!unv~ @qj. 'p@nss! si @~eo!j!~Jeo e e~oteq etep eZAleUe ~o suo!toedsu! ~onpuoo ),ou op SHHQ jo s@@AOldUJ] 's~uaLua~!n bej e~,ets pue le~ep@J u!elJe3,0,s!~es o~ J@pJo u! suo!~n~!~su! 6ujpuel ~!eq~ pue seuJoq ~o s~eseqoJnd o~, Asepno3 e se s!q~ seop SH HQ eqj. 'e~SelV jo e~etS eq~ u! pa~e~s!Ba~ Jeau!6ue leUO!SSejo~d tuepu@d@pu! ue ~q e^oqe g qde~lSe~ed u! ua^!6 suo!~etuese~d@J eq~ uodn AlUO peseq e@teo!t!lJ@O le^o~ddv Al!Joq~,nv qtleeH senss! (SHHQ) s@o!AJa$ ueuunH pue q~leeH ~o tueuuiJedeQ e6e~oqouv jo Ai!led!o!unlhi slueuJwoo leUOR!ppv :suop, elnd!),s 8ut~OllOJ eqt q~!~ 'st,uooJpeq JOj leAoJdde leUO!~!puoo 'pe^oJddes!Q 'SLUOOJpeq _~ JoJ peAoJddv ~ :~I¢IJ.¥NgI$ SHHa 'sepoo e~e~S pue led!o!unlAJ lie q~!~ aoUe!ldgUoo u! s! Lue~sAs lesods!p Je~e~e~se~ Jo/pue Alddns Je~e~ e~,!s-uo eql 'uo!~o@dsu! pue uo!~e6!~s@^u! AuJ LUOJJ pue sel!J ebeJoqouv jo X~!ledio!unlN LUOJJ peu!e~,qo UO!~eLUJOJU! eq~ uo peseq ~eq~ Aj!Je^ Jeq~Jnj I 'u!eJeq pe~eo!pu! eJn~onJ~s jo edA~ pue suJooJpeq jo JequJnu aq~, Joj e~enbape pue leUOROunj 'ejes s! Luau, sAs leSOds!p ~e~e~e~se~ Jo/pue Alddns Je),e~ ei!s-uo eq~ ~eq~ s~oqs uo!~eo!ldde le^oJddV A~!Joq~nv q~leeH s!q~ jo uoRebRs@^u! ALU ~,eql Aj!Je^ '~olaq u~oqs e),ep uoi~ep!le^ eql to se pue o~eJeq pex!tte leds ALU Aq Pa!t!Ue3 sV I:I=IBNIIDN=1 ),8 NOI.LO=IdSNI JO .LN=IIN~.J.V/S 'G Municipality of Anchorage /~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Parcel I.D. If A, B, or C, attach ADEC letter. Date completed Cased to Well type Log present(Y/N) FROM WELL LOG ADEC water system number ~, ~ "7 ~ Driller ! ~' ~'"- Casing height Wires properly protected (Y/N) AT INSPECTION g.p.m. /<.2 m g.p. Total depth ~ ~ .~ Sanitary seal (Y/N) Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Sewer service line Septlc/h~ ...... ~-.ank on lot Absorption field on lot I ~ Public sewer main ~/A ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank J~ WATER SAMPLE RESULTS: Coliform ' ('~--" Nitrate /~/k'~ Date of sample: /()/"~'~ ~///~.~ Collected by: B. SEPTIC/~ TANK DATA '7,,% Date installed .Z. Tank size _/~O Cleanouts (Y/N) ~// _ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping Other bacteria Compartments Depression (Y/N) Alarm tested (Y/N) Pumper ~/.~ ~ ,~. ~/.~ SEPARATION DISTANCES FROM SEPTIC/H(it¢~I4~ TANK TO: Well(s) on lot ~., II ~ TO propertyline '~' ~:~ Surface water/drainage On adjacent lots _Absorption field '~ / t..~::~ Foundation ~ } ~/' Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION r',~//~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Length ZZ- j ~f2 Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ~ 7~'- System type ~_4-,~ ! ~-~ .~ Gravel thickness t',, ~ _.~ Total depth I '~ ~ Cleanouts present (Y/N) J~ Date of adequacy test -~""~ for /-7// bedrooms If yes, give date_ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots '~2 / u---c~ Property line To existing or abandoned system on lot Cutbank ~'~0 14 6- Water main/service line Driveway, parking/vehicle storage area / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec, t on the date of this inspection. Signature Engineer's Name HAA Fee $ .//'~,'~ Date of Payment Receipt Number 72-026 (Rev. 3191) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number LAB INBTRUCTIONS for WORKorder # 60124 Date Report Printed: OCT 29 92 @ 19:24 ChemLab Ref. # :926046 WORKorder :60124 Client Acct :TOBBENS Collected :OCT 29 92 @ 12:00 hfs. Received :OCT 29 92 @ 15:30 hrs. Promised :OCT 30 92 Analysis Completed : /O/Y~y~2~ Laboratory Superviso~ :STEPHEN ~. EDE Client Sample ID: 2920 lfdl~GET LANE Client Name :TOBBEN SPURKLAND, P.E. Ordered By : Preserved with :AS REQUIRED PWSID :UA MATRIX: WATER Sample ROUTINE SAMPLE COLLECTED BY: STUART. Remarks: C~emDab Extraction Analysis Analyst Sampl et~ Test-Parameter Method Units Result Date Date Signature 1 80153-NITRATE-N ......... EPA 353.2/300.0 mg/1 - - - ,'~Y~("~/~ ) /~/~ End of Sample~ 1 Lab Instructions on WORKorder# 60124 I Tests for this Sample. CIAL TESTING & ENGINEERING CO. AK DIV L & GEOLOGICAL,LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage. Alaska 99518. Drinking Water Analysis Report for Total Coliform Bacteria m TO BE COMPLETED BY WATER SUPPLIER ~ PUBLIC WATER SYSTEM I.D. # Ii I I I I I I PR VATE W^T SYSTEM : . Pho~qe No. Mailing Address City Slate Zip Code Mo. Year SAMPLE TYPE: ,~--'Ro utln e [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ; ) [] Treated Water ~.Untreated Water · SAMPLE No. LOCATION .~, 41 I Time Collected Collected .~ TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /~/.~ ~"/'~ ~-- Time Received J..~..~ ~ Analytical Method: Membrane Filter * No. of colonies/100 mi. I-ab Ref. Nc, Result* READ INSTRUCTIONS Membrane Filter: Direct Count BEFORE Verification: LSB Fecal Coliform Confirmation COLLECTING SAMPLE Final Membrane FIIte~_._l~esults Reporled By ~----~ ~//"---~ TNTC = Too Numerous To Count ~" OB = Other Bacte~ BACTERIOLOGICAL WATER ANALYSIS RECORD Coliform/100 mi BGB PART ONE OF TWO REMAINDER TO FOLLOW Coliform/100 mi Time: //._~ ~--.~ a.m. trveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING (~)~'-'1 - ('%.%~3---'~'-/ HAA# ~_\~.~ .,~,C-~ (_--~_'-~,~ 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) ...I Location (address or directions) (b) Property owner /~-'-0'-~ /'~ Ob ~ ~ Telephone: (home) --'~¢/- b--6dZ?-Business Mailing Address / 2 ~-0 / ..~ h E. / ~ ~-L-F' r3 ~ /~- ~- (c) t. ending Institution Mailing Address r~//¢,._ 'Telephone iq (d) Real Estate Company and Agent Address Telephone ~'~ ~/ '- '~ 0¢~/ Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: (e) TYPE OF RESIDENCE S ngle-Family ~ Number of bedrooms WATER SUPPLY Individual Well [~/ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site[~ 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. 72-025 (Rev. 7/88) Page 1 of 2 ~ jo ~ ~lSed '~pOM s,Jeeu!eua leUO!SSajoJd eql u! SUO!S$!LUO JO sJOJJa JOj elq!suodseJ ~ou s! ebeJoqou¥ jo/~!ledio!un~ eqd. 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XLU LUOJJ pUB S@I!J ee~JOL4OUV JO X~,!led!g!unlAl eqt uJoJJ peu!elqo uo!~,BuJJo~u! eq~ uo peseq jeq},/,~p@A Jeq~Jnj I 'u!eJeq pe~Bo!pu! eJm, onJis jo ed,~ pue suJooJpeq jo JeqLunu eq~, Jo~ etBnbepB pub IBUO!~OunJ 'e~es s! ku@is/,s IBsods!p JaiB~eiSBM Jo/puB ,~lddns J@JeM e~!s-uo eql tBClJ S/~OqS IB^oJddv X~poq~nV LI~IBeH siqj¢o uoRBe!~se^u!XLUieq~,,~tPe^l 'MOleq U~AOqSelepuoiJBp!lB^@qjJOSe pueo~eJeq peX!HBIBaS~LU,~q p@ffR~eosv NOIJ.¥1N~O4NI aN~' ~/J.'Ca 'Ho1:1~¢~15 ]-114 '$J.S]J. 'SNOIJ. O=IdSNI IDNIQI^OMd ~l=ll=l ~NIkI=I:INI~DN] .cj ~ MUNICIPALITY OF ANCHORAGE (MOA) MUNI%P~A. rU~.(~RA(~ Health Authority Approval (HAA) E I~ ..... " CHECKLIST.. FEBRUARY 1984 ~ NMENTA~ ~ ' 343-4744 REEEIVED A. WELL DATA Well Log Present (Y/N) ~I Date Completed to [+ Groutin Static Water Level ~ '~ / Casing Height Above Ground _ ,'~ / Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot //¢~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line . To Nearest Sewer Service Line on Lot Water Sample Collected by /~', ~/'~ ~/~.~ Water Sample Test Results '~/~> 7z~"t ¢'~-~;*'7 Comments Legal Description: If A, B, C, D.I=.C. Approved (Y/N) Yield Pump Set At //~ / Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots //~9~ / ~- '~'* ¢' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date B. SEPTIC/HOLDING TANK DATA ~,~.. · . /.5'~'~,/~-~ / Date Installed '/~'/?~2¢//¢~ Size /¢¢c,/-.¢¢~, No. of Compartments Standpipes (Y/N) ?~ _Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped _ ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well /~' / To Property Line ~'~;'~'~(7~ To Water Main/Service Line /C,?,,~_ 72-026 (Rev 7/88) Front To Building Foundation To Disposal Field /~/z- Y,4' To Stream, Pond, Lake or Major Drainage Course Comments ~ ??C,T~ ~".~?/')'/y'}'L '~_~.fr4 /¢~ ~' / Page 1 of 2 C. ABSORPTION FIELD DATA SoilsRatinginAbsorptionStrat~/v)'72-/~"D~/~.l Type of System Design Date Installed ~ ~,~:~ /~2~/~ Length of Field · ~ /~72~ /~/ Depth of Field Width of Field /~t~ ~z~:) ' Gravel Bed Thickness I ~,F:2 '/1~-~/,~/;~ ~ c'~(~.~J / · ' · Square Feet of Absortion Area /97'~ [;?'/) ¢¢~¢ ' Statndpipes Present (Y/N) Depression over Field (Y/N) /%/ Date of Last Adequacy Test Results of Last Adequacy Test ~-( '/~ -~-'~ ~''' / SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~ / To Building Foundation ~ / To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,.~--/'~- ,:¢ ~6~'(/~o-1~..~,~ ~-~/~,-~ ~-/~_.,~' .?X'/,~. ,./~-/'~,0~1~ To Property Line /'~- To Existing or Abandoned System on ; On Adjoining Lots ~'~ To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Code.~¥7~ Comments ~ Dimensions ~ M an hole/Access~.Y./N% "P.um¢'O~' Level at ,/~/~ Vent (Y/N) ,4 ,/4 Pumping Cycles during Adequacy Test. **Check Permitt~e~¢ Bedroom~ating Against HAA Request** I certify that I,,l~&e checke~' evevev~r'CCied, or conformed to all MOA and inspection. //////, ~/ / . Signedn Comps y Date MOA No. Receipt No, Date of Payment Amount: $ 72-026 [Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 effect on the date of this Engineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. P, ata P, upoi:t PrOrated: JUL 13 59 (! [4:44 Laboratory ;~up,3r'txsor :3Ti'.?lJ~tl C, I;b~ . l-!/] / / See Sc~mp]e [e~r~;n:ks Above LT-L,':xa Than, (J'l',,Groater Than A INC._ --~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, I TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria ~ TO BE COMPLETED BY WATER SUPPLIER d PRIVATE WATER SYSTEM C.o ¢,. ud l t',.J : z z - )5// Name Phone NO. t oo,~ ~ D/g.45,Mt3 Mailing Address City State SAMPLE DATE: ~'~---~ Em'"] ~ Mo. Day Year Zip Code SAMPLE TYPE: ~Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water [~Untroated Water SAMPLE NO. LOCATION I l ~---/'J j j~'- Time Collected Collected By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE ~OMPLETED BY LABORATORY SatiS shows this Water SAMPLE to be: isfsctory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: [~/,~ Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Analyst Result* FTq BACTERIOLOGICAL WATER ANA~.YSIS RECORD Membrane Filter;, Direct Count ~ Verification'. LTB__ (~- ___ BOB ~ Final Membrane Filter Results ~ Reported By~~'~v~ - Date--.~ Time: Collform/10Oml Collform/100ml -.? //~/.Z"'- aim. TNTC = Too Numberous To Cou PART ! OF' Z REMAINDER TO FOLLOW OB = Other Bacteria t STATEMENT ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 TERMS DATE BALANCE FORWARD ISAACS PUMPING SERVICE ,~,,,~ L^ST A,~OUNT THIS COLUMN lvl NI£'i ~"QFi'"' q-~i r~£¢\C;,. MUNICIPALITY OF ANCHORAGE t:,i/', , ~-~ ~.~ 10 825 L Street- Anchorage, Alaska 99501 ~4 ENVIRONMENTAL ENGINeeRING DIVISION ~ ~ .... ~ -~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEER FACILITIES" DIREOTION~; Complete all parts on page 1, Incomplete r~qoests will not be processed, Pleaso allow ten (10) clays for processing, 1. PROPERTY OWNER ~ PHONE ~AI LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER .... PHONE' Emery Olson and Janice Livin~stou MA~LING ADDRESS 3. LHMDIN~INSTITUTION ~ PHONE Security National Bank~ 276-6800 x261 MAILING ADDResS 2525 "C" Street Suite 502 Anchorage, AK 4. RMAI.TOR/~GEN~ ....... ~ PHONE Camille Peters (Kingston Peters, Ltd.)~ 276-6315 MAILING ADDRESS 2621 East Tudor .... Anchorage, AK r. 5.-~EGA L DESCRIPTION Lot 14 Block B Knik Heights Subdivision STREET LOCATION NHN Shelburne B, TYPE OF RESIDENCE NUMBER OF BEDROOMS :~ SINGLE FAMILY r~[] One ~I~}"7 'sF][~-'~ ~'if [] Other _ [] MULTIPLE FAMILY ' ~- 7. WATER SUPPLY INDIVIDLJAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since .June 1975. For wells drilled prior to the1 date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **if individual/on-site, give installation date If system ~s over ~wo (2) wears old an adoquacv test is required by this Departmenl NOTE: THE NSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3~78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TiME DATE DATE DATE INSPECTOR INSPEC'rOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] S~NGLE F~I_Y [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDI VI DUAL/ON -SITE DA-rE INSTALLED []PUBLIC UTILITY "~ __ "'-'~ Connection Verified INSTALLER [~]Septic Tank or [] Holding Tank Size: ! g..~ _ If Tank is homemade SOILS RATING -- TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line 4, DISTANCESwELL TO: '~ Z) Absorption Area to nearest Lot Line 5, COMMENTS .... ~' ' ' - ~ .. ^ ...... [] APPROVED FOR __ ~-- BEDROOMS E~-CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL ~ 72-010 (Rev. 3/78) October 8, 1979 Security National Bank 2525 C Street - Suite 502 /elchorage, Alaska 99503 Subject: Lot 1,1 Bloc~B~R~nik H~ig~l-s-.Subdivision Ronald/Su~ Pr~ Approval zor the ind~m+~d~ and water facilities can not be granted until the following items have been ~ompleted: (1) A water sample needs to be collected by this office. Please contact this office for an appointment. (2) Expose the standpipe to the seepage pit for our inspection and, also to insure the minimum distance requirements are met between your well and sewer system. {3) The septic tank pumped with a receipt submitted to this office. (4) An adequacy test be performed on the existing leaching area. 'Phis test will determine if the system is adequate according to Natienal Standards. A listing of private fi. mis performing the test is enclosed. (5) The application shows the number of bedrooms exceeds the' nun~ser the sewer systera was orJginally approved for. A 500 gallon tank will need to be installed. Please notify this department for a re-inspection when the noted descrepancies have been corrected. If there are any further questions, please contact this effJ. ce at 264-4'?20. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw October 25, 1979 ASI No. 03979 Mr. Ron Baker SRA Box 1680-B Anchorage, Alaska 99507 Re: Adequacy Test For Existing Septic System on Lot 14, Block B~ Knik Heights Subdivision Dear Mr. Baker: Ak your request our office conducted a percolation adequacy Lest on your existing septic system at the above-referenced location during the period ~ckober 23-25 , 1979. You reported that your septic system consists of ~eptic tank and seepage pit. The septic tank had not been pumped prior to the percolation test. Since the3-bedroom house had been occupied up to the time of the test, a normal deqree of saturation within the leach Field is assumed. in accordance with the Anchorage Municipal Code, Chapter 15.65, Waste Water Disposal Regualtions, any on-site sewage disposal system "shall have adequate capacity to properly dispose of the maximum daily sewage Flow." The maximum daily Flow is computed a~ 75 gallons per capita-day (gcpd). Since "the population of dwellings shall be estimated at two persons per sleeping room," the maximum daily sewage Flow For your3-bedroom house is 450 gallons per day (gpd). To test.the soil absorption capacity as well as the surge capability of your system, 110 percent of the mbximum daily f~ow or 500 gallons of clear water was added ~n 50-gallon increments to the seepaqe pit. The water was obta:~ned From your on-site private well at its maximum sustained rate of about_~ gallons per minute (gpm). The liquid leve]s were monitored closely to detect any backup in the septic system. Mr. Ron Baker October 25, 1979 Page -2- The attached Table of Test Data represents the depths of liquid in the septic tank and seepage pit, and the quantities of water added. The septic tank was determined to be 10.4 Feet deep (bottom of tank to ground surface) with an initial depth of 4.8 feet in the tank. The seepage pit was measured to be 10.6 Feet deep with an initial depth of 2.65 feet. Ground elevation at the septic tank standpipe is approximately 5 feet higher than at the seepage pit standpipe. The attached Summary of Test Results indicates that the liquid level in the seepage pit at the beginning of testing on Day 2 fell to O.05feet above its initial static level on Day 1, during a recovery period of 24 hours. On Day 3, the level had fallen to 0.10 feet above its static level on Day 2, during a recovery period of 25 hours. The level in the seepage pit at its highest level during the test ( 3.4 feet) was approximately 12 feet below the liquid level in the septic tank. Based on two days of testing, ~ average percolation rate for your existing septic system of approximately 455 gpd is indicated. Since an on-site sewage disposal system ~o~-~')-bedroom dwelling must be capable of disposing of 450 gallons of sewage per day, your septic system appears to be Functioning satis- factorily at this time. Many factors affect the operation of a soil absorption type of sewage disposal system. Soil type~ groundwater depth, age and history of maintenance of the system, and types of wa§re are a Few. This test has been performed in an attempt to determine actual soil absorption capabilities of your septic system under normal useage by considering the degree of saturation of the leach field and surge loads that might be imposed on the system. This test can only evaluate apparent performance at a given point in time, and cannot determine either the condition of the leach Field, seepage pit or other components of the septic system~ or the depth of the ~ater table. ~e appreciate the opportunity given to perform this adequacy test. If you have any questions regarding this test, please contact this office. Very truly yours , ~,~ .o. ALASKA SOILS INVESTIGATIONS ~ m ~ ",~ Stephen D. Sh~de~ P.E. ~¢~'% P~ojeet M~n~ae~ ~ 2m~.. ......... · ASI No. 03979 October 25, 1979 Page -3- Wtr Added, Seepage Pit Rise in Seepage Pit Rise in Septic Tank Gallons Wtr Added per Ft of Rise (gal/f~) SUMMARY OF TEST RESULTS Day 1 500 2 0.30' 0.70' 0.0' 0.0' 1667 857 Recovery Time between Test (Hours) Drop in Pit during Recovery Average RaLe of Fall (ft/hr Average Absoration Rate (gal/day) 24 0.25' 0.010' 417 25 0.60' 0.024' Mean=455 Adequacy Test for Existing Septic System Owner:. Mr. Ron Baker Project No. 03979 Address: SRA Box 1680-8 Anchorage, Alaska 99507 Legal Description: Con~onents of Septic System: Number of Bedrooms: 3 How long vacant: NA Test performed by: Oan Cooper Initial Static Levels: Septic Tank Lot 14, Block B, Knik Heights Subdivision Septic tank and seepage pit Occupied prior to test: Yes X No Last pumped: June 1979 Water meter/S.N. 22812186 4.75' j Seepage Pit 2.65' TEST DATA Liq~id[D~.pth~ ft * Water Meter I_Time Septic TAnk Seeoage Pit Added, gal Reading, gal Remarks --. , 10/23/79 9:21 6.15 8.35' -0- 17567 Begj, n Test 9:35 6.15' 8.3' 50 17617 9:45 6.15' 8.2' 50 17667 9:55 6.15' 8.1' 50 17717 10:03 6.15' 8.1' 50 17767 10:14 6.15' 8.1' 50 17817 10:22 6.15' 8.1' 50 17867 10:38 6.15' 8.1' 50 17917 10:53 6.15' 8.1' 50 17967 11:06 6.15' 8.05' 50 18017 11:13 6.15' 8.05' 50 18067 End Test 10:06 6.15' 8.30' 10/24/79 Ck Init Lev] 10:10 -0- 18068 Begin Test 10:17 8.25' 50 18118 10:20 6.15' 8.20' 100 18168 10:34 6.15' 8.15'... 150 18,218 *Measured firom top off stand pipe w/liqht orobe Owner: I.~r. Ron Baker Project No. 03979 Legal Description: Lot 14~ Block B, Knik Heiqhts Subdivision TEST DATA (Cont'd) ..." ' L'iquid Depth, ft Wate~ Meter Time Septi6' T~ 'Seepage Pit A~ded, pal Reading, gal Remarks 10:43 8.15' 200 18268 10:51 - 8.10' 250 18318 10:59 - 8.00' 300 18368 11:08 - 7.9' 350 18418 11:15 - 7.8' 400 18468 11:23 7.15' 450 18518 11:30 7.7' 500 18568 11:37 - 7.65' 550 18618 1~:45 6.15' 7.60' 600 18668 End Tesb 11:22 6.15' 8.20' 10/25/79 - Ck Final Lev. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received January 14, t977 Time of Inspection Date of Inspection ./-}~-]7 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Cony. First National Bank of Anchorage Post Office Box 4-2090 Phone: Richard/Arvilla Rutledge Phone: Star Route A Box 1589R 99507 274-1521 344-7212 3. Legal Description: Lot 14 Block B Knik Heights 4. Location: Shelborne Road 5. Type of facility to be inspected 6. Well Data: A. Type Individual C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: 1. Size D. Seepage Pit: E. Disposal Field: 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank Single Family No. of bedrooms 5 B. Depth D. Bacterial Analysis On-site system B. Installer 2. Manufacturer 1. Absorption Area 2. Material Total length of lines , Absorption area , Other contamination , Sewer Lines , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECl'ION 2~Y,q~xlY~l~l<~k~, Anchorage, AlaskaX3~Or4~ 276-2221 825 L Street 99501 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JAFI 1 4 1977 RECEIVED 1. Type of Inspection: CMRO VA 2. Property Owner: Richard and Arvilla Rutledge Mailing Address: SRA 1589 P~, 99507 3. Name of Buyer: Richard & Arvilla Rutledge · FHA CONV xX Day Phone:_. 344-7212 Mailing Address: 4. Name of Lending Institution: Mailing Address: ?. 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Lot Location: same . Day Phone:.. First National Bank of Anchorage O. Box 4-2090 (99509) .Phone: 274-1521 None Phone: 14, Block B, Knik Heights Subdivision Shelborne Road 7, Type of Fa, cility to be Inspected: SFD 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served .. If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms .... 5 ,Individual XX .Individual (on-site). XX 72-003(3/76) Page 2 of two pages .- R~ .,st for Approval of Individual Legal Description Lot 14 Block B Knik Heights ~er & Water Facilities Comments Approved Disapproved Date 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 reeuest for approval to be a true and accurate representation of the subject sewer and wa{er facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) can be, ~3iven, ~ - so that the up¢;~'ade C~ be' t~;~- 'Ehe eat~ns~on 22~r Or <:ome by th~ Sanitarian January 19, 1977 z~7~chor a.~ ~ Ala!lka 99507 Lot 14 ~31ock for ~ew~r a.~d watc~.r approval ~an not be i1, 1972, for z~. ~hre~ (3) b~lroom si~le fa~x~ily dwalltng. Your request l. ti~ ~or a five (5) bedroom siz~gl~ f~aily You will ne~d to follow the s~t of instru¢-ttons oncios(~d~ s<; ~hat %,~,~ know how your .~wer system is f'unc~ioning. k'ou wili~'une~d to acqutr(~ a p~r~uit from this offioe Do£or~ if th~c~ are any quos~ionu, pleas~ ~o~ta~L this offic~ at 279-2.511, e~t~n~iot% 2?.4 or at the ~kb~eoffices. Sanitarian