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HomeMy WebLinkAboutKNIK HEIGHTS BLK G LT 5Knl*k Heights Block G Lot 5 #017-372-23 Municipality of Anchorage / Page / Of Z_ DEPARTMENTOF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _ -S Ly 95b3SG PID Number: 15!7'3'27--L3 Name: Wastewater System: ❑ New ❑ Upgrade Y pg Address: o y c c � vE ���/ �• ZO l 99� � ABSORPTION FIELD Phone: g a %�9 No. of Bedrr0000ms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: / Z Total Depth from original grade: ' GPD/Sq. Ft.. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe U f/ T � 61' S Ft. 7• EI Ft. Township: Range: Section: Fill added above original grade: Gravel length: 0, /,0 Ft. / L/ 'Yb Ft. WELL: J$Mew ❑ Upgrade Gravel dgpW.. Number of lines: Distance between lines: I 1tl Ft. I Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: P �I ✓i�E 22 5 Ft. / Ft. 8o SO. Ft. 303 /a AS1,/y Driller: Date Drilled: Static Water Level: Installer: l C���I +%PE Date installed: of 9 (r (,YiNE 2 9La / Ft. Yield:Pum -- f) Set at: Casing Height Above Ground: TANK GPM FL � Ft. SEPARATION DISTANCES )�-septic ❑ Holding T ❑ S.T.E.P. To Septic Absorption Lilt Holding Publie/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ��%(�%� Ti�Nk p (2 W811 / N; ' N/jJ NlA / O Material:��`� ell Number of Compartments: Watere ��Ob' 1\11A LIFT STATION Lotr O r 7 / / Size in gallons: Manufacturer: Line Foundation /l / / V I N /� _ "Pump on" level at: "Pump�S vel at: � High water alarm at: Curtain��� Pump Make & Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: ju P o F �UN C.trK it Sli✓� TH9E ^/, A=r/O /2 EAR AEC,{ Assumed Elevation: Ft ENGINEER'S SEAL �,J r • •a ��G z, }} Inspections by: Fes' C, S �� / \ �1 °BDpe •°° •<t°�•°°.�•°.�°° °l performed Dates: 1 st 2nd Q/ 1119& ll buC6a9paeprY°°a•p. suP ••J °qe .l a i� Lou is A. 2viern • Department of Healt and Huapproval ervices a roval ravr e - Reviewed and approved by: Date: �-Fj —96 �,:,:,` •' .v.• 72-013 t1/91) MOA 25 Permit No. SW950356 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 . Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: KNIK HTS LOT 5 BLK G PID No.: 017-372-23 A - C = 23.3 B - C = 40.7 A - D = 41.3 • - MONITOR TUBE B - D = 62.5 0 - SEWER CLEANOUT A - E = 56.9 -�- - WELL B - E = 41.2 - LEACHFIELD EASEMENT ELEVATIONS CONC. SAUNA TUBE, N. END REAR DECK (NOT TO SCALE) V ASSUMED ELEV = 100.00 ORIGINAL � GROUND = _ 100.00 LEVEL AT: 0 0.5'-1.0' ADDED FILL 99.0 �m I 4' $' NO GWT TANK 79.0 95.4 5.2 TR@D 94.5 TR@E 94.5 MTD 87.1 MTE 87.1 SCALE 1" = 60' 4/26/96 FROM Panasonic FAX SYSTEM PHCNE MG. - Sep. 14 1995 10:49PM P1 �_ .-c.+rvrr•....vw.,..s.�vytAN[a�.:.-.�.�..,...v...,.ca.s++-.., .� �.__� ti v. �....,.. _... ..x .- ;. amu, •,_, - .. .�ti.... -�__.. e..-.--.. ,. �, STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES y, .. DIVISION OF MINING & WATER MGMT v. ! WATER WELL RECORD LOCATION OF WELL ai:-• ....aaRCM1OH -� tor BL 444— S4L`OCFC f LOCATIONISKUTCH', DEPTHS MEASUREb i"R0M:F—Lcawn9-jMZj9round surface BOREHOLE DATA: Dapth Material Type and Color From To f 77 14 �. GUa.Y• /� p /3' RECE1 V SECTION QTRS - - . SECTION TOMtal ❑E FIANCE k1EPoQ1AN [IN ©s ❑w WELL OWNER; WE1f_ DEPTH;.. of DAr> aF coalPL� LDN Depth holo: : / Depth of casingft ! DEPTH TO STATIC WATER LEVEL- �,;Z t below R tap of casing ❑ ground surface Date: I 2- !_4 METHOD OF DRILLING: F air rotary 0 cable tool 0 other USE OF WELL. 9rZIomestia ❑ irrigation ❑ monitor ❑ public supply ❑ other___ CASING STICK-UP: raft. Diem: in, to ft Casing type: ,=in. to �ft WELL INTAKE OrPPMING TYPE ❑ open end ❑ screened R perforated y� open hole Depths of openings: eta /T, ujY ft ScHkEN TYPE: _ Diam:_ in. Slat/Mesh Size: Length: ft � GRAVEL. PACK TYPE: p Volume used: Depth totopes_ GROUT TYPF- Volume: Depth: from it to ft DEVELOPMENT METHOD: PUMPING LEVEL AND YIELD: APR 30 19 ft after hrs pumping v®pm Municipality ut An Ora90 PUMP INTAKE DEPTH: __ ft Horsepower: Dept. Health & HUma Service ' W>1.L DISENFECTED UPON COMPLETION? YES ❑ NO CONTRACTOR INFORMA N: REMARKS: RAIL WITE CPY OF LOG T, eg e d BUSI s a ne L ASE Z. G / !O F DNR/DIV S ON OFNMININGO& WATER MGM O. ignature of AUCharized ReSpPilsentaUve , ate 3601 C st, suite 800 Anchorage, Ak 99503-5935 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES \ P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950356 DATE ISSUED:10/23/95 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:10/23/96 OWNER NAME:BARNES MIRANDA P OWNER ADDRESS:2229 SUNRISE DR. ANCHORAGE, AK 99508 PARCEL ID:01737223 LEGAL DESCRIPTION: KNIK HEIGHTS BLK G LT 5 LOT SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (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: i"L'tv`— DATE. DATE: d l2 A C SYS �n81Q RA'Tex EnSAW(eadus, &wmk(M Louis Butera, P.E. Registered Civil Engineer October 16, 1995 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Knik Heights Lot 5, Block G Narrative & Permit Application Dear Mr. Cross: The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. R cri N A Z �y C1 C N Ci rt 2 \G AWPDOCS\1995\95-095A. NAR Dn a,.,, 77000A . c.,Ad Do.,,,, ni. 1— 00r7l . moi I,,,n, romi ron ❑nc , D,.. (on'71 con a')07 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694.5195 JOB SHEET NO. OF CALCULATED BY v v J DATE �-- CHECKED BYZ 0 b(P S" DATE CrAl F Iznik Heights Lot 5, Block G Single Family, Five Bedroom Dwelling - 10/16/95 5 BR x 150 gpd = 750 gpd Percolation rate = 1.24 min/inch = 1.2 gpd application for trench system 750 gpd / 1.2 gpd application rate = 625 SF Leachfield Dimensions: Trench width = 3' Trench length = 45' Gravel depth = 7' Total depth = 12' •• a yN 89 toQ••ido••an�Coo•ia.a•.!_i.n :l........ �'7 'ter-'"`_ ,.�1;�Sr se•a•pn r.fin rc �e� ,r Louis A.. 8ulera 4a w CE -6736 •r1� J r•r � SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Knik Heights Lot 5, Block G 10/16/95 A.CTFN •RAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage equirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. IRF -,NCI 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 12' at any point. 4. The effluent line in trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. R) COMMENDED I A HFI ..D DIMENSIONS: TOTAL DEPTH = 12' GRAVEL DEPTH = 7' under pipe, 2" over pipe TRENCH LENGTH = 45' TRENCH WIDTH = 3' SOIL RATING = 1.2 GPD/ftz BEDROOM CAPACITY = 5 SEPTIC TANK = 1,500 gallons Twenty-four (24) hours notice required for all inspections. G:\WPDOCS\1995\95-095A.SPC E F A I7 r--—— — — — — — — I I PRIVATE WELL +100, LOT s I I I I L I I I I I I I NO SURFACE WATER NO KNOWN CURTAIN DRAINS LOT 4 i APPROX. WELL LOCATION 300.00 / V • - ,00 �O SF -Plc 1 07 SEPTIC TANK WELL - _ - PRUP. d p m c0� a, WELL SITE EASEMENT � r r n ' I n xa ® v, >\ TH HOUSE El 1d +Ip 0 ti / / V • - MONITOR TUBE 1500 GAL/ I0� O SEPTIC TANK WELL - _ - D - d 300 00 EASEMENT 85 e o• v C LOT 6 VACANT 30' 1 30' ® - TEST HOLE • - MONITOR TUBE 0 - SEWER CLEANOUT ¢ - WELL - _ - PROPOSED LEACHFIELD - EXISTING LEACHFIELD - — - - EASEMENT WELL (Sc SEPTIC SITE PLAN LEGAL: KNIK HEIGHTS LOT 5, BLK G OWNER: N/A CONTRACTOR: HAGNIEIER J013# 95-095A DATE: 10/16/95 SCALE 1" = 60' EAGLE RIVER ENGINEERING SERVICE'S P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5995 FAX: (907) 694-3297 of���s o00 i * 49TH .4 of i s 0 ,6 , LOUIS A BUTERA �� j CE-6736�2®Aw OF Ak4til :49YN r...:.....,.>.s... o....... Municipality of Anchorage 100 -- .^ DEPARTMENT OF HEALTH & HUMAN SERVICES I''�"�'�•'.•..•.c•.•...%.� rn LOOI• A. autera wsv 825 "L" Street, Anchorage, Alaska 99502-0650 S c •, CE -6736 ' SOILS LOG — PERCOLATION TEST ,��� �'• PERFORMED FOR:itIGMF✓��� DATE PERFORMED: LEGAL DESCRIPTION: Township, Range, Section: %/zA/ Sec' 7�7 SLOPE SITE PLAN 1 � Ti'SO/L 2 3 SiNDY CavilVCZ- 4 oa 6 0 -y ShmoY 6,e,4VFL 4:7,aEY $ M avM Dc'Als�r- DAY 9 10 B' WAS GROUND WATER (, ENCOUNTERED? _ I IF YES, AT WHAT 0 12 DEPTH? NIA P E (7 Depth to Water After 13 Monitoring? —49Y Date: 0?4'7 —U1 - 0 b, Net Drop 1s q"05 �o- 16 S/iL u : 7-//,41 17 /L SM - M G _ 3/L / SlL'i w/ 55/4/4,0 1a v-\-- vr'4"l l0'C'1q5a 19 00L'D 'D Z,-/ 20 COMMENTS Reading Date Gross Net Time Time Depth to Water Net Drop 0l4k- T)N—o 5 q"05 u 2//10 /D/ S/iL 31 u : 7-//,41 /L 5/& _ 3/L / 3 /L iL /- „ BU779M Q,C �idjfPERCOLATION RATE /' �� (minutes/inch) PERC HOLE DIAMETER l% P TEST RUN BETWEEN T FT AND �'? FT PERFORMED BY: / N /' {� ' 1�—�S CERTIFY THAT THISTESTWAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 79_nnA 10— n,na, Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-372-23 Expiration Date: / I "J�' j -s 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS S/D; BLOCK G, LOT 5 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 12940 RIDGEWOOD ROAD, ANCHORAGE, AK, 99516 Day phone C/O AGENT 12940 RIDGEWOOD ROAD, ANCHORAGE, AK, 99516 JUDY ROSENBURG W/ PRUDENTIAL Day phone N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 229-1899 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site IN Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ _ Received by: 7_ j j � 1t Date: 4 d r ag u - COSA to be released to the engineer, unless otherwise requested by the engineer. - COSA Fee $ t -!U Waiver Fee $ Date of Payment ?-I& I ) 3c� � �� Date of Payment 7�✓ CA Receipt Number o 5 Receipt Number COSA # 05c- 13 ) 3116 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 . ANCHO Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lest results do not guarantee future performance of the system, not do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE r System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. WIT*I- 337-6179 AK, 99507 Date Y a 3 bedrooms, with the following stipulations: ` l� OF Alec rrrrr" ON-SjE WATER AND Zr .eTFWATEFt 5 VV hb.r, _- nAA U1 1 1 Original Certificate Date: a -16--/ Thenicip An orage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: / COSA Checklist t/ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11/05) If more than 7 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: KNIK HEIGHTS S/D; BLOCK G, LOT 5 Parcel ID: 017-372-23 A. WELL DATA *BEDROCK Q 137' Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 2/2/1996 Sanitary seal (Y/N) YES Total depth 225 ft. Date of test Static water level Well production Cased to *141 ft. FROM WELL LOG 2/2/1996 126 ft. 2 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: / v ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate' T I mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/19/2013 Date of sample: 7/19/2013 Tank Type/Material SEPTIC/STEEL lsa� Tank size 1-2*@1 gal. Number of Compartments ? 11116161 6�3 Collected by: GEG, Ltd. Date installed 1/11/1996 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/24/13 Pumper ONE STOP PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRAD Date installed 1 /11 /1996 Soil rating .p.d./ or ft2/bdrm) 1_2 System type TRENCH Length 46 ft. Width 3 ft. Gravel below pipe 7.4 ft. Total depth *11.9 ft. Eff. absorption area 680 ft' Monitoring tube YES Depression over field NO Date of adequacy test 7/19/2013 Results (Pass/Fail) PASS For _'bedrooms Fluid depth in absorption field before test 35 in. Water added 698 gal. New depth 53 in. Elapsed Time: 120 min. Final fluid depth 46 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off" E. SEPARATION DISTANCES level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankdift station on lot 100'+ On adjacent lots *100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS SEPTIC SYSTEM INSTALLED ON KNIK HEIGHTS; BLOCK G, LOT 6 ccu L-0 No —4 9 E- Fv%j c4D G. ENGINEER'S CERTIFICATION 1 certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's PrintfedJ�,Iame JEFFREY A. GARNESS Date �. 3 (Rev. 11/05) fire A. SS.: B�3T•' v � '�cA�oo d P�ofesSlootr �.; Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ei.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 131398 During a recent COSA on-site inspection and test of the potable water supply well on Block G, Lot 5 of Knik Heights subdivision, the well's productivity was determined to be 0.68 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be rennire11 rl This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. T al>.Sf1a a[RAaf 8lu➢ao TCnaot aLeLa.O Clabi... 4 S891 58' 001W 10' UTIL £SMT ! ! i I lU �I �I DI ! C,Oaz2/ G..E I I ! L-------------------� 10' UT€L ESMT , 8 30' UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTTOW OR FOR E—wASUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SUR%EY _ SURVEY TYPE _ _.... SYMBOLS I'MOARON AS-SVILT ........... SET REBAR ....,..... fax sTRuatUAE As-eUtT � DRAINAC£ .......... ASPHALT PLOT PLAN ... AS-BUtT ... LOT SURWY .. , TAMMY �O FOUND REBAR � WOOD FENCE :..: CONCRETE azzs.T ([a ASSUMED ELEV..K--}I—,E- METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEY'S NOTE: a kfflra `. a. 0 AS -BUILT STRUCTURE AS-8UILT t u..a r. A.er may as i OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE ' PROPOSED BUILDING GRACE RELATIVESHONN. FENCES, SPELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW SEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. 5R1 TYC nnefn�n cen„..,. .n. „tit,4, It Prepared by Robert E. Johns, Jr. & Assoc. ............. �'� P,.•°" ®r �••. Professional Land Surveyors 1700 IAALASKA '' ®®, _ nk Drim ANCHORAGE 895134 Scale: 11, _®s Rea Lot S.F. Rec. Plat File No. • -:' 0 0 Ye Date Surra d: 06/26/13 89.8' Checked b pnK ''vvfl 12 S �' �i RT H o°i Q $ 3T m Legal Deaa3 tion: 9 P Lot 55 BLOCK G eha�>..�s�� N LL KNIK HEIGHTS $ WELL WELL C)c EXISTING z O HOUSE m 2ff b �. � W of `� N❑ 1.L UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTTOW OR FOR E—wASUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SUR%EY _ SURVEY TYPE _ _.... SYMBOLS I'MOARON AS-SVILT ........... SET REBAR ....,..... fax sTRuatUAE As-eUtT � DRAINAC£ .......... ASPHALT PLOT PLAN ... AS-BUtT ... LOT SURWY .. , TAMMY �O FOUND REBAR � WOOD FENCE :..: CONCRETE azzs.T ([a ASSUMED ELEV..K--}I—,E- METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEY'S NOTE: a kfflra `. a. 0 AS -BUILT STRUCTURE AS-8UILT t u..a r. A.er may as i OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE ' PROPOSED BUILDING GRACE RELATIVESHONN. FENCES, SPELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW SEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. 5R1 TYC nnefn�n cen„..,. .n. „tit,4, It Prepared by Robert E. Johns, Jr. & Assoc. ............. �'� P,.•°" ®r �••. Professional Land Surveyors 1700 IAALASKA '' ®®, _ nk Drim ANCHORAGE 895134 Scale: 11, _®s Rea Lot S.F. Rec. Plat File No. • -:' 0 0 Ye Date Surra d: 06/26/13 Drawn by. RE RG Checked b pnK ''vvfl 12 S �' �i RT H o°i Date Drag: 06/26/13 Crid: W0 2836 13-28i .•' t ,♦qi i4k •profeaaona.'�C Legal Deaa3 tion: 9 P Lot 55 BLOCK G eha�>..�s�� KNIK HEIGHTS 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 Parcel I.D. # 017_372-23HAA #2 1. GENERAL INFORMATION Complete legal description Lot 5; Block° -G; Knik Heights Location (site address or directions) 12940 Ridgewood Rd. Anchorage, AK Property owner Jerry Wilt Day phone 348-0589 Mailing address 12940 Ridgewood Rd. Anchorage, AK 99516 Lending agency Mailing address. Agent Peggy Address Gonzales/Fortune Properties Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well xx Community well Public water Day phone Day phone 562-7653 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system 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 cWohis fiance with all Municipal and State codes, ordinances, and regulations in effect on the date inspection. Massa iN Name of Firm __ Phone 337 G/77 Address Engineer's signature Alaska Water & 30_T_ � WastewaterConsultant% km Mall be PAID $ loco or prior to, closing for the Engineering Services PraVI044 6. DHHS SIGNATURE r� Approved for bedrooms. Disapproved. Conditional approval for Additional Comments L'_ Date 4-2 P4 ESs�v r� bedrooms, with the following stipulations: 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-M(Pa.1/91) Back MOAN21 RECEIVED Municipality of Anchorage APR 2 3 1999 DEPARTMENT OF HEALTH & HUMAN SERVICE&CIPAUTYOFANCMO Environmental Services Division eNVIRONMENTALSERVICES DI 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LOT �;j ELK G/ 6jI1C PE16r+71 Parcel l.D.:_ 01? - 3?z` 2-3 A. WELL DATA Well type _ If A, 13, or C, attach ADEC letter. ADEC water system number Log present Q/N) 116 _ Date completed o�c2 k Total depths Cased to Casing height (above ground) Sanitary seal O/N) T �S Wires properly protected (Y/N)YES _ FROM WELL LOG AT INSPECTION Date of test aJ a 19 ikdL Static water level 12" Well production WATER SAMPLE RESULTS: (J'_/I g.p.m. ,0, 9 -p.m Coliform Nitrate 1.31 L Other bacteria Date of sample: �f �� I cm Collected by: _ W . B. SEPTIC/HOLDING TANK DATA Date installed (t q� _ Tank size i 0 Number of Compartments ^ Cleanouts ON) " z aW4700n (J NYJE2 Foundation cleanout (0q) �cGK � �h� Depression (YA No High water alarm (Y& hj Date of Pumping _! tJCI 9 8 Pumper /'I f- 9,wr, 56tyice-s C. ABSORPTION FIELD DATA Date installed l �(' _ Soil rating (g.p.d./ft2 or ftz/bdrm) '' _ System type r>E2 FIr=c,14 M�FHs Length �� Width _, 3 Gravel thickness below pipe �'� �eR"r Total depth 6 /VIT = q �u4N � `DONE 0(3St2VEo Effective absorption area 00 S/__ Monitoring Tube present (ON)ENp C�epression over field (Y1 = 30" Date of adequacy test `� b Results (Pass/Fail)_ For � l U F— bedrooms Fluid depth in absorption field before test (in.); 3?' S " Immediately after_3 , gal. water added (in.): �$ Fluid depth �g-s, (ins) Minutes later: I50 /Nil- Absorption rate = +?Sd g.p.d. Peroxide treatment (past 12 months)Imo_ If yes, give date o �( 72-026 (Rev. 3/96)` jkNpNr- Pr -A \ -ARAI Wt' -7 D. LIFT STATION Date�iled / v� Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES Size in gallons "Pump on" level SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot 1yU On adjacent lots I W a - Absorption field on lot /06 .4 On adjacent lots 100,+ Public sewer main N� Public sewer manhole/cleanout Sewer /septic service line Lift station HIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation S Property line Absorption field S Water main/service line I 1 Surface water/drainage o J, F Wells on adjacent lots r 4 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I D Building foundation to' ' Water main/service line to Surface water Driveway, parking/vehicle storage area Curtain drain NWells on adjacent lots job L F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that (mvxbmw stems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date �2 - A 9 HAA Fee $ ?J Waiver Fee $ Date of Payment .4 A?Date of Payment Receipt Number q % 6 [ 0 Receipt Number 72-026 (Rev. 3/96)* Von VV* �o brl V* 0. a JAIVIES P WILLIAMS :a 608 �Lo�•. C.E. _.•°ca�� 2uzlcl2«1z22 cx zs3zo Gs S e e o y« 2 3« 2 WATER >ss1 aov:sc22 R3z122 zuT202I22 A22 s z2. �q 61\ 3 oaring s cu=es« Health 2e«>o=»ty zpy««sa1 ox -a=te i::>ezt:cn as< tes? c« G+ pot=3:e mate« :apply xe:» cn sot SIoc2 _ c» yy (� zc36ivi:goIn, C a p=ores«»»Tty was bete«mic\z ao »e , 3 « gallons pe= '."he m:a»>oz x:11 y=oacc«iv:ty »e7,ic:6 3y «Kis oega=t>eat a(- I:.<:) 20« a «, -�_ KeJ«com =e::2:zce :: ./ / Ra:±csa ger mica«:. a�t>oegt tK� :obje=t we:::<==entry excee-d 2. m:s: z zaps:=csec%, a:: ye=ti:: :ez:e=:s2 are z6s::eJ t5=t «Ee please«:ca capacity o2 «>e sal: may ::s=t=ate. Jeet::=tica 02 non-:zlticaI vete= etas :e:5 as wa=x==y cars ass vate:fa2 :awns zee §=«seem say 3e seg=i=ea. IS_s a2-. "s msec be attached to a- cag=es o« t£e ss5ject gealts »o:5ocity eggrev=:. APR -21-99 13:44 FROM -CTE ENVIRONMENTAL CT&E Environmental Services Inc. rmaz�aecxasvr�.ar.� rvTeY E Rer,# 991606401 Client Name AK Water & Wastewater Consulianis Inc. Project Name;# Loi 5, 81k G Knl.k His Client Sample ID Lot a, Bik G Itnik His Matrix Ddiiking Waiet Ordered iiy PWSW 0 5615301 T-182 P.02/03 F-982 Clleni PO# Primed Date/Time 04/201991.6:38 Colteated Date/Time 04/16!99 1.5:40 Received Date/Time; 04116.'99 15:25 Techuical Director: Stephen C. Ede Released By ALLowatdte Prep Ana Ys is AararmT r Resutta PQL Uriiis Me[MM Llmi e, pare hate Ir.lt Total Cvtifvrm 0 COMM% SM13 92226 06/16/99 RMv Nitrate -N 1.31 0.500 mu/L LPA 300.0 10 max 04116/99 06/16/99 SCL ' 1 tcl'/ OR�3, 1/1-11) 1) 0191(110/ pr(f,/&hi� h h 9 'r70 5U,rv, - eo MUNICIPALITY OF ANCHORAGE fi • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.Q. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLIN�G� Parcel I.D. # 017-372-23 HAA # _Qi1zI �Lo � )l 1. GENERAL INFORMATION Complete legal description Knik Heights Lot 5, Block G Location (site address or directions) 12940 Ridgewood, Anchorgge 1 Property owner Hagmeier Const. Co., Inc. Day phone 248-6789 Mailing address 2204 Cleveland S11i-1'P 2n1 Anchorage, AK 99516 Lending agency N,1A Day phone Mailing address Agent Address N/A Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: i Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide Written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 Eagle River Engineering Services phone 694-5195 Address P.O. Box 773294, Eagle River, Ak 99577 Engineer's signature f Date 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments BY' .. LhO�\� j_fJ At����� :.... .......... 1 Louis A. 3ulurn ur • e< nom'. ne,• rl of mr bedrooms, with the following stipulations: Date .5-- 8 - & The Municipality of Aribhorage 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 professiohal engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025)Bay. 1191) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERUICRE C E I V E Environmental Services Division 825"1" Street, Room 502 0 Anchorage, Alaska 995019 (907) 343 -AT '70 eggs Municipality of Anchorage Kept. Health & Human Servlcee Health Authority Approval Checklist Legal Description: iV/ t/ /!a/fiTS Parcel I.D.: 0117 11 .3% Z -1 j A. WELL DATA GO7 S f�c610-e- C� Well type ?k'/b� If A. B. or C, attach ADEC letter. ADEC water system number Log present (Y/N) YL`s Date completed Total depth Cased to A// / Casing height (above ground) Sanitary scat (YIN) YC5 _Wires properly protected (Y/N) _ yl�'5 Date of test Static water level Well production FROM WELL LOG WATER SAMPLE RESULTS: AT INSPECTION g.p.m. g.p.In. Coliform Nitrate /- /I/Yh C7, Date of sample: O� / Z(L��/iP Collected by: 13. SEPTIC/TIAL-DING TANK DATA t- Other bacteria — Date installed (1�/& Tank size / 2rO Number of Compartments _�_ Cleanouts (Y/N)%'S Foundation cleanout (YM) _Y,55 Depression (Y/N) /t/d High water alarm (YM) /t//q Date of Pumping lVjG- J. Pumper C. ABSORPTION FIELD DATA Date installed > Z9Soil rating (g.p.d./ftz ac4dd=n) %` System type Length 4ttt, Width / Gravel thickness below pipe Total depth Effective absorption arca &qVi; Monitoring Tube present(Y/N)YC---SDepressionover field (Y/N) A16 Date of adequacy test 8 ay Results (Pass/Fail) gs sS For 177� bedroo ns Fluid depth in absorption field before test (in.); N/A Fluid depthN A _(ins.) Minutes later: — Immediately afters gal. water added (in.): -- Absorption rate = _---- g.p.d. Peroxide treatment (past 12 months) (Y/N) / /j/a If yes, give date D. LIFT STATION /,//4 Date installed Manhole/Access (YIN) High water alarm level at*' Cynics-t6fed E. SEPARATION DISTANCES Size in gallons-"` "Pump on" level at* "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/h@lding tank on lot A? Absorption field on lot Public sewer main A114 Sewer /septic service line Pa / Oil adjacent lots "4-100 On adjacent lots 71/00 Public sewer manhole/cleanout &M Lift station SEPARATION DISTANCES FROM SEPTIC/HOL-DMG TANK ON LOT TO: Building foundation /0 Property line so A Absorption field /,S/ Water nrnin/service line _Surface water/drainage f /pn Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation i Z 7 Water maiti/service line v/ Surface water -000 Driveway, parking/vehicle storage area 5� Curtain drain /ya& f /j�/�/1 /&jr/'%Wells on adjacent lots/y() Property line `7 F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and revietiv ofAdunicipal r,4'6ozc4, that the abave sysei�ns are in con%ormance ivith A10A HAA guidelines in effect on this date. Signature p.W 2QBi J:tx+ I J + Engineer's Name IgYe Date Ly i ee e _ .a -n a .. a .. . . _ . _n.. . e . ... .. HAA Fee $ 3 6D Cly Date of Payment l c- / Receipt Number /777 67 t Me= Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number CTS E Environmental Services 111e. Laboratory DIVisiOn Laboratory analysis Report C1'&E Ref.N 961492,961492003 ("l' t 5 nn It 11) KNIK HEIGHTS 51Ci 3 Collected Date 04/26/96 ten a p Matrix Drinking Water Technical Director: Stephen C. Ede PWSID 0 Releasedlly �i �' $`" /c ' Sample Remarks: Parameter Results QC Pat Units I{ethlyd fk(IOuable Prep AmLYSis lnit Qua1 Limits Data Date _ Nitrate -R 1.14 w 0.100 mg/L EPA 353.2 04 FM8 U - Undetected IJ - logs than Gt Greater than D seeandary pitution d Below the raiibratiun ra 200 W. Potter Drive, Anchorage, AK 98578-1605 —'lel: (907) 562-2343 FOX: (907) 561-6301 3180 P,9Uer Road, Fairbanks, AK 99708-6471 — Tel: (907) 474-8656 Fax: (907) 474.88II5 CHIGAFJ, MISSOURI. NEW J;~RSGY, 01110, WEST VIRGINIA ENVIRONMENTAL, FACILITIES IN ALASKA, CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND, MI