HomeMy WebLinkAboutKNIK HEIGHTS BLK H LT 5Onsite File Knik Heights Block H Lot 5 #017-372-05 (Rev U5/02/18) Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211253 PID Number: 017-372-05 Dwelling: [E Single Family (SF) El with ADU El Duplex (D) 0 Two Single Family Project: El New Z Upgrade Name WILLIAM & EDNEY HUPPRICH ABSORPTION FIELD 19 Deep Trench M Wide Trench F71 Bed ❑ Mound Site Address 12940 BAINBRIDGE ROAD, ANCHORAGE El Other Phone71 f Bedrooms Soil Rating Total depth from original grade 74 0.6 GPD/SFI 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 5 FL Subdivision Block Lot KNIK HEIGHTS H 5 Fill added above original grade VARIES 1.03 — 1.88 Ft. Gravel length (2 X 40') 80 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From I Tank I Field Tank Line 800 Ft' 2 10+ Ft. Well 100'+ 100'+ '+ 25Manufacturer TANK 0 Septic El S.T.E.P. 171 Holding 0 Other GREER Capacity 1250 Gal. Surface Water 100'+ 1001+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ NA Foundation i 10'+ 10'+ LIFT STATIONManufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer JRS Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 1s 7/28/21 nd 7/29/21 Location and description dates: 2 3'd7/29/21 4" 7/30/21 TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL kk� Aq Conditional Approval: Date Awl C2. - TH Curtis Huffman Septic System Approved - Date • CE 128991 7/30/202.1. Note: this approval does not include well permit requirements. (Rev U5/02/18) PERMIT: OSP21253 PID: 017-372-05 Lot 5 43,500 s.f. FD F I MT K CO MT CO J 10' UTIL ESMT. � *BM—TMH C E INSTALLED NEW 1250—GAL HDPE SEPTIC TANK WITH NEW DCOs. A—C=66.4'F00 z / ,p rtis Huffman FIRST WATER CONSULTING DATE: 8/3/2021 13030 Sues Way CO MT B -C=67,6' DRAWN: FWCS SCALE: 1" = 30 O O 8 ESMTS & WELL RADII STAKED AT CONST. SHED FirstWaterAK®gmail.com J( O -D=70.9' TH21-1 EXISTING FIELD C 0 4 C 95.90 CO G MT - D = 71.1' r H INSUL. Cl 3 �Co A - E MT 95'32 FD F I MT K CO MT CO J 10' UTIL ESMT. � *BM—TMH C E INSTALLED NEW 1250—GAL HDPE SEPTIC TANK WITH NEW DCOs. A—C=66.4'F00 / ,p rtis Huffman FIRST WATER CONSULTING DATE: 8/3/2021 13030 Sues Way CO MT B -C=67,6' DRAWN: FWCS SCALE: 1" = 30 DFCOM 99.90 CO DCO DIV 8 PAGE: 1 OF 1 FirstWaterAK®gmail.com J( A -D=70.9' 95.90 B - D = 71.1' INSUL. A - E = 7 4.5' 95'32 SPLITTER 1250 -GAL 95.15 B- E= 7 3 7' HDPE TANK A -F=107.9' S 89 58'W 1300' B CA CO MT 7 FINAL GRADE I 86.80 84.92 ORIGINAL GRADE FILTER FABRIC TH21-1 2' ORG/OL 92 8,.92 SEWER ROCK 32 76.92 SM/ml 82.22 CO MT FINAL GRADE CO MT 82.15 B -F=110.4 81.12 NO GRND. A - G -12 3.8' ORIGINAL GRADE/—WATER 6/25/21 B -G=144.8' FILTER FABRIC 16' A—H=136.4' 78.12 78.12 BOH SEWER ROCK 65.12 B -H=154.2' SEPTIC SECTION 73,12 73.12 RELATIVE ELEV. TO A -I=1342' SCALE: NTS LOWER TRENCH B -I -1376' KNIK HEIGHTS BLOCK H, LOT 5 SUPPORT$SERVICES: ' OF \�\ A J=1423' PREPARED FOR: �`� AZ`�� B -J=141.0' WILLIAM & EDNEY HUPPRICH 6�� � 1 A -K=129.6' 12940 BAINBRIDGE ROAD � � �* CJ TH* B -K=131.7' ANCHORAGE, AK 99516IN / ,p rtis Huffman FIRST WATER CONSULTING DATE: 8/3/2021 13030 Sues Way SURVEY: KGL ,; 1 r� CE 128991 w Anchorage, Alaska 99516 DRAWN: FWCS SCALE: 1" = 30 ' 8/3/2021 .04" � j (907)350-9566 PAGE: 1 OF 1 FirstWaterAK®gmail.com Lot 15 I Lot 4/ DRIVEWAY ENCROACHES ONkO ADJACENT N 89' 'E/300' LOT I y J \ \ 1 STORY RESIDENCE WITH WALKL}UT BASEMENT`°5� C� " 10.7' x 11.7' RETAINING WALL 7.11' BALCONY `i'• SHED ABOVE DECK "' Z �. ro ^O WOODEN WALKWAY C? SEPTIC PIPES 63 w �0? WELL Lot 14 6j 2.1' x 18.7' CANT 87.0' \ 2g,9 MANHOLE CANT WITH FIREP CHASE Lot 5 / 2.1' AND 18.7' BALCONY ABOVECK V 43,500 s.f. / t_S 89'58J300' \ 10' UTILITY EASEMENTS Lot 13 I I Lot 6 30.0' I PLOT PLAN AS BUILT X SCALE —IL 550' GRID SW 2836 Project No. 21-394/A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in C. , (907) 522-6476 Phone 000pOppp (907) 522-4625 Fax oo OF q�ppp Professional Land Surveyors kenolongsurvey.com c �. . q jonothanOlangsurvey.com Al. �,.•' A ' •.Se4h. I hereby certify that I have surveyed the following described property: 0AV(-�X'' 7-41 LOT 5, BLOCK H, KNIK HEIGHTS SUBDIVISION (Plot No. P-452) o 49TH * Anchorage Recording District, Alaska, and that the Improvements situated thereon are """"""""' ""'•"" within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed 0'p' 'KENNETH G. x premises and that there are no roadways, transmission lines or other visible DO 1 I easements on sold property except as Indicated hereon. �y, G .�S-5202.• y�o Dated this the 2 = Day of 1�U at Anchorage, Alaska �4 `�a • • • • • o O 0 �� ppRa�SSIONA�� It is the responsibility of the owner to determine the existence of any easements, 040000�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Wate r & Vwa stewater Pro g rarn PO BW 1966K 4744 Elmore Road Anamrage. ,mks W51 MVSO Phnna_ ('907) 343-7004 Fax: (907) 3d-3-7997 h�Ipl�wrw.rrNaru .4�jr4„Y31C On -Silo Wastewater Disposal System Permit Permit NiAmber: OSP211253 Work Type: Septic Upgrade Tax Cade Number: 01707205000 Site Legal Addr-ess' KNIK HEIGHTS ELK H LT 5 G,2836 Site Mailing Atldriess= 12940 BAINBRIDCE RD, Anchorage Clwdrier= HtjPPRIC H WIUTAM R & Oesign Englnee ; FIRST WATER C*NBULTIN This permit is for the construction of: Effectoae Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 7 1!702 1 7F21IW22 43500 Q Disposal Field 0 5eplic Tank ❑ Holding Tank ❑ Privy D Private W9111 11 Water Storage All construction shall be in accordancewith., 1. Tih a attached epproued design_ 2- Al l r uiremen is specAed In Ancho rage Mu ral-cipal code Chapters 15.55 a nd 15.65 and the State of Alas ka Wastewater Disposal Regulations (1 G72) and Drinking Waller Regulalions (1 M\ 80) 3_ The wastewater code raquVas Ingpectlorrs duririg EN IThe onglrl00r Shall noli:ry tft 1>+ 16pment Services Department per AMC 15.65_ Provide notffrcation by calci rig J907j 343.-7904 (24f7). 4. Frorn 0clober 15 to April 15, a su bsurfaae sail absorption system uncle r nonstruetlon during freezi ng wealher Shall be elther; a. Oponeid and Gloved on tho -aarne day, or b_ Covered, sealed, and heated to prevent freezing Riaciaived E : P21/2021 Dale: Date:. 4 MUNICIPALITY C Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 017-372-05 Property owner(s) WILLIAM & EDNEY HUPPRICH Day phone Mailing address 12940 BAINBRIDGE ROAD, ANCHORAGE, AK 99516 Site address 12940 BAINBRIDGE ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) KNIK HEIGHTS BLOCK H LOT 5 Legal description (Township, Range & Section) Lot Size 43,500 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: _#J�' cl 5 Date of Payment: a �2 I Receipt Number: 21 I O2 2 Permit No. 05 P2_11 2.53 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 12, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: KNIK HEIGHTS BLOCK H, LOT 5 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install two deep trenches and 1250-gallon tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on June 15, 2021. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 10-15% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211253, Rebecca Carroll, 07/21/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211253, Rebecca Carroll, 07/21/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211253, Rebecca Carroll, 07/21/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: KNIK HTS. BLOCK H,, LOT 5 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/1/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 SM/ml 5 6 7 8 9 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/25/21 30 min 6” 3 3/16” 30 min 6” 3 3/16” 30 min 6” 3/2/16” PERCOLATION RATE 10 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 6/25/21 TESTHOLE # 21-1 DATE PERFORMED: 6/15/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: BILL HUPPRICH 7/1/2021 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211253, Rebecca Carroll, 07/21/21 Lot 15 Lot 4/ — DRIVEWAY ENCROACHES ONkO ADJACENT N 89' 'E/300' LOT �Q.� \ \ I J'PSQ4 1 STORY RESIDENCE WITH WALKgUT BASEMENT RETAINING WALL 7.0' BALCONY ABOVE DECK . Z 10.7' z 11.7' SHED --,,,,,,,,m ,��� WOODEN WALKWAY N o I e? w t02 WELL o Lot 1'4 f SEPTIC PIPES o, cFck 71 I \ a TEST 2.1' . 18.7' CANT 87.0' 0. / u HOLE \ 299 2.1' CANT WITH 2.2' FIREPLACE CHASE Lot 5 / AND 18.7' BALCONY ABOVE DECK \ CA 43,500 S.f. S 89'58!j300' \ 710. / UTILITY EASEMENTS Lot 13 I l Lot 6 I I• • PLOT PLAN AS BUILT X SCALE 1" —=50' GRID SW 2836 Project No. 21-394/A1 inc. (907) Daryl Avenue, Anchorage, Alaska99515-3049Lang & Associates, (907) 522-6476 Phone (907) 592-465 Fax Professional Land Surveyors pF q��oo� kenOlan surveycom jonaihanOlongsurvey.com SOP S QO I hereby certify that I have surveyed the following described property: LOT 5, BLOCK H, KNIK HEIGHTS SUBDIVISION (Plat No. P-452) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the Zti, Day of Jv ` at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. r* 49TH •'•.•�* • K.• •Ml ,c- 1[mty .•�S-5202.••' y�p0 pq Ngo �Q� �F'ESSIONAU �o AECC963 MUNICIPALITY OF ANCFIORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division ¢ / F ,~ 7 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 05- ,~TRENCH [] BED [] W. [] OTHER or~glnalDeplh togladuplpe bottomr.~lf Ol/~ ¢' FT I oral deplh Ir o~gin~l grade FT /~0 ,{) --~" FT ,..~ / ,~. PRIVATE [] OTHER ('1~_ In~ Date REMARKS: FT F'r y _p c . DISTANCES SEPTIC TANK ABSORPTION I:IELI] ( 10¢ % WELL WELL Scale: Inspecbons Pe~..~mod by was pellorflled according to all ENGINEER'S SEAL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17, 18- 19- 20- ~1~"~/-//'/,.~' Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN S L IF YES, ATWHAT O DEPTH? p E Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~FTAND L~ FT COMMENTS ~ PERFORMED BYS & $ ENGINEERI.N,G :110~4 ~aCe ~r ~~~~ C~T~Y THA~ THIS TEST WAS PERFORMED IN ACCORDANCE ~"~*~A~'~PAL GUI~FFECT ON THIS DATE. DATE: ¢2~¢ ~ 72-008 (Rev. 4/85) / - ~/ E) I',1 ....~i~; :1; "1' Ei: i:: IE I/,; IE IR I:::' Ei; IR ?1 :I: 'T' l!i!', r'f Cl :i. r / c,:,! c.! p El 1 c:m' I.' I: I...I :1:I\lt:::'Ql::q¥1 .O =, I.~1~ H ,, !!!;. t:;:'F/:1: Eli;:?. "l"f,:] :1. S1" 8,: 2NJ::) :[ I\l,filPl!ii:i:]T :1: l:)l',l!?i BY [!i:lxll3 1BtlE:IE:I:R, ]: I:::' r'~F:l"lEl::i ::::::::::::::::::::::::: I'"IEILIF;~E;!~ Ci':,]L..!.... ::!:".zl.:::.!;..~,(I.,~l~t:l. {.~hlD LI!i:AViJ}: [f..~ [:::[~iIxI!!ii'I"IRL.II:::T F:'l:!!:l::i'. li!i:l',lt3:l:l,,If, ii:E:l::i'.li!i F.Y'I'T~'.'ff]H!!~:!:) AF:'Iu:'I::ID',?IiDD I:::'li!:l::i'.lq :1: T liii: X F::' :1: IRliES :1. 2/:::.!; :1./138 ,, F'IEFi'.Iq :!: 'I Vf.~l... :1: ]:) FEll:i: f.~ [;3 ]: 1',1(31..1:~ I:::'AM ]: I...Y I:;il!![[/i ]: D[!!:IqC;I!~ E!I\II....Y ,, GR ~'ER ANCHORAGE AREA BOROI t O~:,~RTMENT OF ENVIRONMENTAl. QUAI..I,~ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC MAILING :2 ADDRESS ///%) LEGAL DESCRIPTION //' DISTANCE FROM WEI.L/Y~,.; ?/,',,~-,'.~7~:?~__ MATERIAL LIQUID CAPACITY_//.''~ ( GALLONS. INSIDE LENGTH. PHONE ,*).>' ;' //./? NUMBER OF / COMPARTMENTS INSIDE WIDTH ,~) DEPTH LIQUID SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMEIER MATERIAL > (' - OR WIDTH /--' , LENGTH /' , DEPTH DISTANCE FROM WELL ~:~"~A~w~ /~'~ ~)/~; BUILDING FOUNDAIION ~'~ ( TILE DRAIN FIELD: DISTANCE FROM WELL_ FOUNDATION ,NEAREST LO1 LINE NUMBER OF LINES .~"-~- DISTANCE BEIWEEN LINES ~'~ fRENCH WIDTH ABSORPTION AREA./ SQ. Ff. LENGTH OF EACH LINE TOTAL LENGTH OF LINES IN. IO~AL EFFECTIVE DEPTH: 'lOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE/~:Erl/C' DEPTH NEAREST - LOT LINE , SEWER LINE .. DISTANCE FROM _ WATER ,BUILDING FOUNDATION. ___ SAMPLE SEPTIC / SEEPAGE . .: , TANK "~'; /,':C/',';: , SYSTEM ~,'(E,,'::'x..(.~_, CESSPOOL DIAGRAM OF SYSTEM , NEAREST OTHER , SOURCES___ DISTANCES: ix';,~ :> .' lh//i).')//. ,., / ,.,~ t ~,/~1,~ ~ DATE GREAl'ER ANCHORAGE AREA BOR,,..;UGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 0-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LEGAL INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED TNROBGH ~---/"""~, SOIL TEST RESULTS COMPLETION DATE ANTICIPATED SEEPAGE PIT -- , DRAIN FIELD , OTHER To s El N ST A L L E D B Y NOTE: THIB PERtYIIT 18 NOT VALID WITHOUT SOIL TES~' FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOLJT FINAL INSPECTION BY THE: HEALTH DEPARTMENT AUTItORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK S]ZE /g:/~'~ TYPE MINIMUM DISTANCEB, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT '~/~ ~ SEPTIC TANK TO SEEPAGE PIT WALL--/~" , SEEPAGE PIT WATER MAIN TO SEPTIC TANK DRAIN FIELD , DRAIN FIELD · DRAIN FIELD ALSO CONSIDER AREA WELLS. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABL. E CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, DIAGRAM OF BYBTEI~I Certificate of On -Site Systems Approval Parcel I.D. 017-372-05 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS BLOCK H LOT 5 Expiration Date: 1V0V �, 20� Location (site address) 12940 BAINBRIDGE ROAD ANCHORAGE AK 99516 Current property owner(s) WILLIAM & EDNEY HUPPRICH Mailing address Real estate agent Day phone 12940 BAINBRIDGE ROAD ANCHORAGE AK 99516 Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System 4 TO 0Z+ A ® Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA # 0,5 e � f V_1'1-? Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 7130/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the 1 system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the yy well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies orTH •' J (� discrepancies exist can be given by First Water Consulting & c •• i�j FRFs .. ........ 6. DSDSIGNATURE Curtis Huffman V/ / System #1 Approved for bedrooms ���$����s� • CE 128991 ROFOS �t`�'�-.®.m System #2 Approved for bedrooms ���PROFESS Disapproved Conditional approval for bedrooms, with the following stipulations: �= 0V4 -SITE NAT „ATEA PROGRAM JJ 0 By: Original Certificate Dater 070.2 l The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: KNIK HEIGHTS BLOCK H, LOT 5 Parcel ID: 017-372-05 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled *6/23/1978 *(PER MOA DOCS) Total depth *286 ft Cased to *140 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/8/2021 Static water level at beginning of test 152 ft. Well production at time of test 1.2 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.880 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 7/13/2021 Comments B. TANK DATA Age of tank(s) NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank * Standpipes/foundation cleanout per record drawing Date of pumping * C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: *NEW SYSTEM D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ALL standpipes present per record drawing Total measured depth from grade 9.9 ft (max) Measured depth to pipe invert from grade 4.9 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NEW SYSTEM Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 7/31/2021 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ~.)l "~ DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) . ,5- Location (address or directions) (b) Properly Owne,'PEr,'¢ ~'/r/~'-Z~m..$'* m Telephone: Home Mailing Address /'~--~/--/O (c) Lending Institution , Telephone Mailing Address. Business (d) Real Estate Company and Agent Address (e) Telephone Mail the HAA to the followina address: or: Check here ~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-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 the legality and status. SEWAGE DISPOSAL Onsite/~ Public[] Community[] Holding Tank[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Fronl \ '~pOM s,JaeujOua IBUO~$S@~oJd. ,, eql Ul. SUOlSSlUJO. . JO sJoJJe JOJ elqlsuodssJ, lou s~ ........ e~BJoqou'¢ jo/~iHedlolun~ eq/'panss~ si ejeOljl~Jeo e el~p az,qeue Jo suo!loadsu! lonpuoo jou op SHHQ ~o se@/~old~u~ 'sluau~aJ!nbaJ elels pu~ leJepa~ u!epao ,~Js!ies oi Jap Jo u! suoiin]ilsu! l~u!pu@l J!aql pue sauJoq Jo sJaseqoJnd oj ~salJnoo e se s!qi saop SHHQ aql 'e)~SelV jo elelS aql u! peJejs!DaJ Jaeuj6ua leUO!SSajoJd ~uepuedapu! ue /~q a^oqe B qdeJSeJed u! ua^!lb suo!jeiuasaJdaJ aLIi uodn AlUO peseq saleo!~ll~a3 le^oJddv A~poqlnv qileaH sanss! (SHHC]) seo!^JaS UeLUnH pue qlleeH jo lueLuued@Q eSeJoqouv jo ,~J]ledjo!uniA! aq.L N 0 IJ. rl~';:) leuo!l!puoo uo loelle u! suoilelnl~eJ pue 'seoueufpJo 'sepoo elelS pue ledio!unvI lie HI!M eaueilduJoo u! s! LUelS,~S lesods!p JeleMelSeM Jo/pue ,qddns JeleM alis-uo eq1 'uo!loedsu! pue uoileb!lse^u! XuJ uJoJi pue Sel!I eBeJoqouv 1o /~l!led!ofun~ alii LUOJ~ peulelqo uoileLuJo~uf aql uo peseq iegll ,~fJe^ Jequn~ I 'uiaJeLI paleoipu! eJmon4s jo ad,~l pue suJooJpeq ¢o JeqLunu eLI1JoI alenbape pue leuo!loun~ 'ales s! LueisXs esods!p JeleMalseM Jo/puB Xlddns JeleM el!s-uo eql ~eLi1SMOLIS le^oJddv ,q.Joqlnv LIlleaH s!q1 jo uoijeB!1seAu! XuJ leql ,~IpeA I 'MOlaq UA~oqs elep uoilepife^ alii jo se pue olaJeLt pexgje leas XLU ,~q paftcJao sv NOI/¥1NIdO:INI aNY YJ.¥a 'H:::)~l¥:aS a-II:t 'S±S:a± 'SNOI/O:IdSNI 9NlalAO~tcl INIJI-I 9NII:I~]:INIeN:I ~U_~NICIPALITY OF ANCHORAC/~UNiClPALiTY OF ANCHORAGE (MOA) ENVi~C, NMENrAL SERVICES DIVI,~i~LTH AU'rHORITY APPROVAL (HAA) CHECKLIST - FEBRUAFIY 1984 A JG 1 5 L988 264-4744 RECEIVED LegalDescriptJon: ~'0~- ~'(_/?/ ) WELL DATA Well Log PresentCW-~) _/___ Date Completed 6/~ ,.~/'~ ~ Yield /, & ' . // Total Depth ~'~"¢' Cased to /' 4zzO Depth of Grouting ¢0 Static Water Level /' ~ ~' ' Pump Set At ~ Casing Height Above Ground / ~ ~ ~ Sanitary Seal on Casing ) Electrical Wiring in Conduit N) Depression Around Wellhead (Y Separation Distances from Well: To Septic/hl4~:~:~Tank on Lot ~'~o c~z.- ; On Adjoining Lots /"~D To Nearest Edge of Absorption Field on Lot //'~::~L~ ~-- ; On Adjoining Lots ./"~'D ~- To Nearest Pu bile Sewer Li ne/.t//~)/,~-¢r To Nearest Public Sewer Cleanout/Manhole ~. To Nearest Sewer Service Line on Lot Water Sample Collected by Wate r Sa m pie Test Res u its <~-~/~ .-Z~/,5--~'/,,~ ~ .~'-'~/~y ~ ,~,~ .--C- Comments SEPTIC/HOLDING TANK DATA Standpipes (~,N) Air-tight Cap (~_~N) Foundation Cleanou~N) Depression over Tank (Y~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) '/~ / ~ ; for Holding Tank High-Water Alarm (Y/N) ~/t.//,/'2,-- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/~Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026 IRev B 86~ Fronl Soils Rating in Absorption Strata Date Installed ¢¢ //'-~/~'~ Width of Field ~', ~ Square Feet of Absorption Area Depression over Field (YN~. Results of Last Adequacy Test ,/d //2). Separation Distance from Absorption Field: To Water-Supply Well 'fo Building Foundation Lot ¢70 To Water Main/Service Line f To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Are.a Comments .~/c.~,,.," ~ ~ - ~-~/pF,¢-~/~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~.,~D --/:- To Cutbank (if present) D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M/dA an/d HAA guidelines in effect on the date of this inspection. Signed 5&~ENF. MNEF. RING Date ~///'/// C 17034 Eagle RiYer L°°p Road Ne,42~ No. o m pa n~91e River, Al~.ka 99577 Receipt No. Date of Payment Amount: $ Page 2 of 2 72 026 IPev 8 861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPOR~ BY SAMPLE for Work O~der ~ Date Report Printed: JUL 22 88 ~ 14:13 Client Sample tD:LR, BI{ KNIK HTS. PWSID :UA Collected JUL 19 88 @ Il:dO hrs. Received JUL 19 88 ~ 12:30 hrs. Preserved with :4 DEG. C Analysis Completed :3UL 21 88 Laboratory S pe E? yDE Released By : ~ ~ ~ Special ~nstruct: Client Name : S & S ENGINEERING Client Acct: SNSENGP P.O,~I NONE REC'D Ordered By : RJS Send Reports to: 1)S & S ENGINEERING 2) Chemlab Ref ~: 1845 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits NITRATE-N ND(O.IO) ms/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. I Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT-Less Than, GT=Graater Than APPLIC FILLS OUT UPPER HAl ONLY PropertyOwner~/(/j~.~/ /.~..). ~( ~c?r/ ~ ~'~///~,/~:'~/ Phone Mailing Addre~ .... ,, /, j,. (. ' Zip Code Buyer Address Zip Code Lending Institution /'~//~7~-),%//_ _ ~ '/ Phone ~ealty ~o, & Agent Phone Addres~ .~' Zip Gode Type of Residence ~Single Family ~ 'Multiple Family No. of Bedrooms g Other Water Supply  Individual f.( ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community~- ~..~ ,( L..~ ' For wells drilled prior to that date, give well depth (a[tach Jog if awilable). Sower ~isposal Year Individual Installed:  Individual ~ublic OHIHy Whon Gonnoc~eO ~o ~ublic ~tility: ~ Holding Tank NOTE: THE INSPECT~ON FEE MUST ACCOMPANY ~ACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Field Notes: Inspector ( ) APPROVED BEDROOMS MUNIC!P,~LITY OF ANCHORAOE I%Pt, OF h~AI.TH & /~NVII~ONM~ N I'AL PROI-ECTION 'CONDITIONS OF AA~TA~- -VJ~-~. ( ~)~DISAPPROVED ( ) CONDLTrONAL APPRO.VAL* BY: ("~(~- Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size