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HomeMy WebLinkAboutKNIK HEIGHTS BLK H LT 6f— Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 950135F_ PID Number: ��?— 37z —DCv Name: _BHN /�AG/tiE/� Wastewater System: Y ;New ❑Upgrade Address: Lz� CcE�6cA/�r� Al 2-0/ 9 95i'7 ABSORPTION FIELD Phone:No. �L�ibY (/ ve q of Bedrooms: �koeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 1 Total Depth from original grade: Lot: Block: Subdivision: 6 14,C16ftT� Depth to pipe bottom from original grade: Gravel depth beneath pipe 1JJ4 2 , 9 Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: I Ft. Ft. WELL: New ❑ Upgrade Gravel deWh: Number of lines: Distance between lines: 1V l D7N -3 Ft. Classification (Private, A,B,C): 10Vim'/?� AZ � Total O Depth: 5 Ft. Cased To: /3 Ft. Total absorption area: . . 1 86 SoFt Pipe P 30-3vial:A?NI Driller: /gz_101N6 Date D 'lied: 0 9 Static Water Level: /& i3 Installer: 46^C164 Date installed: Ft. a�/9sr Yield: / D Pump Sett aS n Casing Height Above Ground: � T TANK GPM / ► /47 Ft. Ft. SEPARATION DISTANCES kSeptic ❑ Holding ❑ S.T.E.P. To Septic From Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Menu actuurer: -ANCN k Capacity in/ gallons: / Z S Well 7V()0f1019 / Zi Material: C� GGi Number of Compartments: Surface LIFT STATION water LotO ¢ / �/D f / D Size in gallons: Manufacturer: Line Foundation f 5 f /v IV 1A "Pump on" level at: "Pu po " level at: High water alarm at: Curtain Pump Make el Electrical Inspections performed by: 4 Drain Remarks: BENCH MARK Location and Description: a tt o.h of Hre S'. cl a .v y Assumed Elevation: FL ENGINEER'S SEAL .., q Y_ r a aj vr � /—his /19 aC ��•ae Inspections performed by: Dates: 1s V 4� p9 m•r a.a s• se •a•.•e •. a �� ql 2nd e9 0/ r Vie, .•....• ••..� Louis A. Butora • •� W Department of H alth an H Services approval®Q'®.„ . CE G73G��q� fol 8 '�OFESStON' Reviewed and approved y: Date: �'o xv,�•��' 72-013 (1/91) MOA 25 I Permit No. SW950138 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: KNIK HEIGHTS LOT 6, BLK H PID No.: 017-372-06 N 69'56'27' E 10' UTILITY EASEMENT _ — — — 300.00 F 1250 GAL D SEEPTIC TANK Q W / X f A J 213 N A MUUSE / 190 p o LUT 6 n 2� 5 80 B I WELL I � L 700 SWING TIES; WELL A -C = 62.7 LUT 7 B- 40= 47.8 SCALE 1" = 60' B -D = 77.8 A-E = 25.5 B-E = 47.6 • - MONITOR TUBE o - SEWER CLEANOUT ¢ - WELL — - LEACHFIELD n 7 EASEMENT EL.EVATl❑NS BOTTOM OF HDUSE SIDING 09/15/95 (NOT TO SCALE) V ASsuMED ELEV = 100.0 ENGINEER'S SEAL o�ooOp�� ORIGINAL O ��• 0F: 1. ,�4 O GROUND = Q [1 00 LEVEL AT: V 95.0 �-' rte•' 4 TH I d I �/ •`' 4' 3' NO GWT O 77.0 TANK N.`\ \ \ O �•. LOUIS A. BUTERA r 53.5 S END 92.1 N END 92.1 Q G� w 93.8 CE -6736 �p \HT C 83.0 ROFESSO ••.•••. 4����O000�6P6� From : RLP I.' E DRILL 907 345 0202 Nok.-. 07. 1995 10: 14 P11 P01 RECEIVED N 0 V 1 4, 1995 STATE OF ALASKA DEPARTMENT OF OATU14AL RESOURCES Municipality of i• ncherageDIVISION OF MINING & WATER MGMT LOCATION OF WELL i3ept. Health & human Services WATER WELL RECORD BonOUGH SURIttVIBIOP/ L N=K RECTION nTRe n=OM TOVMMIP AANOo MENtMAtf ON ❑E ❑$ ow LOCATIONISKETCH: WELL OWNER: DEPTHS MEASURED FROM sing top ❑ground surface WELL DEPTH: DATE OF O K)N Depth of hole:_ JCA it ..— �` BORWOLE DATA;Depth Depth of CaSing:l�' it Materiel Type and Color From TO DEPTHSTATIC WATER LEVU: ® _V 1_ft below N top of casing CI ground surface Date: METHOD OF DRILLING: 4q air rotary ❑ cable tool 1 ❑ other USE of WELL; domestic ❑ Inlgation ❑ monitor a❑ 100, public supply © other CASING-STIC Mom_ rp in. to IS 90' 1_ft. 'L;'% Casing type�� in, to WELL INTAKE OPENINO TYPE: ❑ open and 0 screened perforated 5rbpon hole . sal, 14 Depths of openings: �� to tdgrZ it - SCREEN TYPE: Diam: in. (" SlotlMeem $ize: _ t.wg ft �3 GRAVEL PACK TYPE Volume used: _ Depth to top: GROUT TYPE: Volume: ' A(E Depth: from_ ft to _ ft DEVELOPMENT NIETI 00: � Duration: PUMPING LEVEL ANDJIELD: It after his pumping gpm PUMP INTAKE DEPTH: 1t Horsepower; WELL DISINFECTED UPON COMPLETION? YES ❑ NO CONTRACTOR INFOI ON: A A eggs ed ut:Irre ame ,Signature of AuthorizodB BEntehvR DAte REMARKS; PLEASE MAIL WHITE COPY OF LOO T0: ONRfDtVISION OF MININQ & WATER MGMT 3601 C St, Suite 800 Anchorage, AR 99503-5935 Ph(907)762--253a,FAx(907)562-1384 AUG -30--95 WED 9 : 3 is A P . 02 LOCATION OF WELL ,STATE OF ALASKA DEPARTMENT OF NATURAL ItMURCFS pivisioN OF MINING & WATER MMMT WATER WELL RECORD lOROYOff SU LOT eLOClt 6pCStOH O7RACi90N 70VYNSNIP MN96 M1tERIptpN '►}- �/ LAN SIE . / ❑S ©W LOCA'nONISKETCHr WELL OWNER: DEATHS MEASURED FROtt-Ocasing top C WwM surface WELL DEPTH: DATE OF COMPLETION Depth of hole: g ft Depth of casing: 80REiOLE DATA: Depth Mateffal Type dint$ CoKu' From To " DEPTH TO STATIC WATER LEVEL: 67 ^1 {,eft below 0 top �o}f•' caslnp 0 QnnrrW surface Date: J� METHOD OF DRILLING: Mrair rotary 0 cable toad 0 other USE OF WELL, Tdcmes is © irrigation ❑ monitor M public supply 0 other CASINO STICK. ft. Diem: in. to f '1t Casing type: _ „A;, , in. to .I e' ft WELL INTAKC OPENING TYPE: Ct open end Li aoreened C3 perforated open hole Repths of openings: to SCREEN TYPE: Dlam: in. —,Length: f , 8t vmosh Size: ft GRAVE. PACK TYPE: Volume used.. Depth to top: I ! / p GROUT TYPE: „- _ Volume: — f V Depth: from _ _ tt to tt DEVEI.OPMENT M HAD: �. 00-T Duration, PUMPIN(#„1.1VE. AND YIELD: m Municipality oI Anchor< e ices Dept. Health & I luman Se ft after hrs pumpin��j ,pJNO PUMP INTAKE DEPTH: ft Horsepow&;4 WELL DI$INFECTED UPON COMPLETION? L't{.YES q .• �•,,, ._..l ,�....-.., �1.4 �f --" f = _ ,.a<. .ill:. • EMARKS: PLEASE MAIL WHITE COPY OF LOG TO' DNRIDIV191ON OF MINING & WATER MGMT 3601 G Skf Suit® 800 __Anchovagq, Ak 99SO3-8936 ntiran��'f�=�_a+;'ta 1+«v+Qr17V�:R7-1,Rk� PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 -� 1e? ANCHORAGE, ALASKA 99519-6650 R ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950138 DATE ISSUED: 6/30/95 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 6/30/96 OWNER NAME:HAGMEIER JOHN C & JUDITH A OWNER ADDRESS:13000 BAINBRIDGE RD ANCHORAGE, ALASKA 99516 PARCEL ID:01737206 LEGAL DESCRIPTION: KNIK HEIGHTS BLK H LT 6 LOT SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION 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: DATE: J DATE: lO ` )e�) e", Louis I3utem, P.E. Registered Civil Engineer June 21, 1995 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Knik Heights Lot 6, Block H 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 lot size. 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. rn 7- r 9 N co 0 n z Znn v O o Fn c O R, \G:\WPDOCS\1995\95-051A. NAR P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907)694-5195 • Fax (9071694-3297 L❑T 14 L❑T 13 L❑T 12 LOT 5 N 539'56'27' E 10' UTILITY EASEMENT 300.00 115% G A x N2 RIS U r LOT 6 D Pol Z-uz/ L 111 NO SURFACE WATER NO KNOWN CURTAIN DRAINS LOT 7 1250 GAL SEPTIC TANK TH I // WELL & SEPTIC SITE PLAN LEGAL: KNIK HEIGHTS LOT 6, BLK H OWNER: N/A CONTRACTOR: HAGMEIER JOB4 95-051 A DATE: 06/21/951 SCALE 1" = 60' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694-5995 FAX: (907) 694-3297 0 - PROPOSID WELL LI7T 7 TEST HOLE MONITOR TUBE SEWER CLEANOUT WELL PROPOSED LEACHFIELD EXISTING LEACHFIELD EASEMENT OF AV s � 49TH � o ' �00 ...... — .......... 00 ! .. Of 0I G LOUIS A. BUTERA - j -p CE -67-36 CE -6736 �_AV — f� o v � � pRaFESSIONP�' �s o EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694.5195 JOB_ SHEET NO. CALCULATED BY CHECKED BY_ srni r OE_ DATE DATE Single Family 4 Bedroom Dwelling Iznik Heights Lot 6, Block II 4 Bedroom Capacity = 600 GPD Soil Rate = 48 min/inch 0.45 GPD/ft2 application rate for trench system Required Absorption Area = 600 gpd / 0.45 application rate = 1,333 square feet 13666 SF / (7' rock x 2) = 120' Trench Dimensions: Gravel Depth = 9' Gravel Length = 75' Total Depth = 12' - f Loo'; A. Eu!cra Vi < C ° 4 I+O hex e�ra('o l.!:7 PR y nea. G: \WPDO CS\1995\95-051 A. CAL vannuc' mu.i is,nn� sro:ei mr,.i imnn�ni n., i.. c -m° U— man m m.W Pxms m'. i Farr rnr ma SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: ISnik Heights Lot 6, Block H A. GENERAL. 1. The well and septic plan is 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 requirements. 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. B. TRENCH 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 sewer line is to replace the existing sewer line that leads to the existing pit. 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. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 12' GRAVEL DEPTH = 9' under pipe, 2" over pipe TRENCH LENGTH = 75' TRENCH WIDTH = 3' SOIL RATING = 0.45 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallon minimum Twenty-four (24) hours notice required for all inspections. G:\WPDOCS\1995\95-051A.SPC +.. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED r.P .. r s :age Y,AJ19 f!E/GHTS LEGAL DESCRIPTION: �O� (3L�' /r township, Range, Section: I;,,dPv4----- SLOPE SITE PLAN 2 3 a 5 6 7 - 12� _(`^ 13 V' 16 17 18 19 20 COMMENTS T ?S0/L (S/4-4) S14.7 wlIrM 5Alki.D MEo/vM DISE G� C1iz5Y SAMC As GP L S�tNDy 64-AVaj vj!�&SE WAS GROUND WATER ENCOUNTERED? /w S � (SM) IF YES, AT WHAT L DEPTH? O _ P SILT kwrH SAI'I'D E 1'y6D UM D1wSE Depth In Water After 7 S Monitoring? �,— gate: LT C796y BU'170M or t/01-6 Reading Date Gross Time Net Time �3eou ' Ca a L r lows A. t'ijicra /0//U" 971t,, 35 J ✓. I 7 tin -In,aa (.[-u J?. DATE PERFORMED: Q�g �2_ Y,AJ19 f!E/GHTS LEGAL DESCRIPTION: �O� (3L�' /r township, Range, Section: I;,,dPv4----- SLOPE SITE PLAN 2 3 a 5 6 7 - 12� _(`^ 13 V' 16 17 18 19 20 COMMENTS T ?S0/L (S/4-4) S14.7 wlIrM 5Alki.D MEo/vM DISE G� C1iz5Y SAMC As GP L S�tNDy 64-AVaj vj!�&SE WAS GROUND WATER ENCOUNTERED? /w S � (SM) IF YES, AT WHAT L DEPTH? O _ P SILT kwrH SAI'I'D E 1'y6D UM D1wSE Depth In Water After 7 S Monitoring? �,— gate: LT C796y BU'170M or t/01-6 Reading Date Gross Time Net Time Depth to Water Net Drop L r 30 /0//U" 971t,, 35 / PERCOLATION RATE (minutes inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND _2_ FT PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /5; Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: HIfri Lq u aoNs% ("U, /'(IC . DATE PERFORMED:_ 0&1/1yZ9Cj A4&119 H51orvHT5 LEGAL DESCRIPTION: (O -r �2 Township, Range Section: DE _ 7F, SLOPE SITE PLAN 1� 1 TOPSo�c. z 3 4 5 D 6 °o 7 8 9 10- 11 12 13 14 15- 16 - 17 18 19- 20 COMMENTS GM G46Y Di✓NSE rti ZIZOWAI �SM ) Sjr, W/7M SAND �1. 7�G 2EY nnC' MSD lVM LNys� WAS GROUND WAl ENCOUNTERED? IF YES, AT WHAT DEPTH? ER NO S L O P E Depth to Water Aller Monitoring? �2mY Date: G�1i�yr Reading Date Gross Time Net Time Depth to Water Net Drop l O(n lS 95 3 /U; q9 n PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN �_ FT AND --z-- FT PERFORMED BY: s ����� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: G� 72-nna iaa� afns, J'L119t1st 't Cir 1977 0 ilfUiycir�/,�Y1 > 4`Y cih?1e 6t1iG Ac)i Jr� e 1. I.i�F k '0503 `Alba 4iCu - lmbj ou i }l.t�f= C 3 Ifs i;3 J ® ; iw lot C?fli".3i G 801J«r Ari 3 1Xi `3aP {"C'il trJi' EAfCCJL?r(4) i.i }y):C)vEc(`4 :Z C'C '.1i ] i% :L'RS d A qa �JG Al (Awt l-rit�'. I EaU'#il ,i.(1S.f C' .eisil 1.�7 Public :i 4.vJ(p'r and 1�6!tOr 3, iiC3C c1tTEi?_.�,G tlr.'. i.1�1:• l'�"!.�.i U/G: 11.! �ietric$wx, 7 1)'.1x1 �iCT E'7 g"I'� � � e E (?I, (:C U`,IJ7 t�Ca.,j.l lilCli't:?Ci 00 � :t G'C?� PJ� �;�2 If tilere e f1F o filly LOS 14. ljuchhok, r A2. ;:z in i,' c-- :'j. £� �,ra f3 f 1 j21 Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I D. 017-372-06 Expiration Date: �® ' 02 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS S/D BLOCK H LOT 6 Location (site address) 13000 BAINBRIDGE ROAD, ANCHORAGE, AK, 99516 Current Property owner(s) Mailing address Real Estate Agent NAN FARRELt Day phone 13000 BAINBRIDGE ROAD, ANCHORAGE, AK, 99516 Day phone 2. TYPE OF DWELLING: P Single Family (w/wo ADU) U8 Nil I I ❑ Duplex S L ❑ Multiple Dwellings (Single Family.and/or Duplex) JUN 2 7 2014 3. NUMBER OF BEDROOMS: 4 348-0066 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by. Date: COSA to be released to the engm6e less otherwise requested by the engineer COSA Fee $ Date of Payment & III i Receipt Number (o`S`�[ COSA # �� 12—C, 1 Waiver Fee $ Date of Payment Receipt Number Waiver # 1 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. 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 test results do not guarantee future performance of the system, nor 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 operationafrequimments 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 ofherperson orpany is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System#1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date bedrooms, with the following stipulations: CE 7g 3 .tor�7/ Prof e s s1ot`0c OF Af fir ON-SITE WATER AND WASTEWATER oz f�RAM \�'1 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory reev Mims Nitrate Advisory Arsenic Advisory Other If more than 1 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 H, LOT 6 Parcel ID: 017-372-06 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/25/1995 Sanitary seal (Y/N) YES Total depth 245 ft. Cased to 153 ft, FROM WELL LOG Date of test 8/25/1995 Static water level 125 ft, Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 12/18/2013 121 ft, Well production 2 —9-p m. 1.82 g.p.m. WATER SAMPLE RESULTS: G Coliform colonies/100 ml. Nitrate �•� mg./L. Collected by: GEG, Ltd. Arsenic: L_) Qg./L. Date of sample: i / B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Date installed 9/5-7/1995 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 9/16/2013 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 9/5-7/95 Soil rating OEEDbr ft/bdrm) 0.45 System type TRENCH Length 77 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth *12.8 ft. Eff. absorption area 1386 ft' Monitoring tube YES Depression over field NO Date of adequacy test 12/18/2013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 8 in. Water added680 gal. New depth 16 in. Elapsed Time. 1095 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level atwa er alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ Property line 5'+ Absorption field 5'+ 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 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. Engineer's Printed Name JEFFREY A. GARNESS Date 61�9j1:� (Rev. 11105) MO \ZU N M M, LU Z (n ZQ Z Z)U O `` ---- ZStVd ?Jld — JNINb G d0 SIS` E3---- (038) .L9*Lt,9Z M,OO.ZOD00 N , .09' Lf,9Z r t ab02i 300188NId8 o_ o zoo ^v ) :L0'9bl M- ('0321) .00.917 L M,,00.60o0U N � a 0 5 ZEEZ .0•Lf ,o'tf b6 D z ,Z'Lf OL 0'9 0'ft J m T) o 0'B U � m b J-) O t!) Q z —J 0 W ,vtt a, o .CLL IO W � w .0 nW orf ^�? _w b# cD Z J rn0 a)C14 n w W - Z c4 0 U -)I W 90 I N z I I I I I I I Iw V) I � � I I �I to io I i rl I I � I I I I o I I I I I I I I I I L-------1WS3 *mn Ol Q 0 0 M R I. VA H v 038) M.00.ZMO N (0321) .00'9174 FFM I I 1 i w w z 0 z? z Zoo J z >> om < to t N ¢ En J � m 3 0 v H v 038) M.00.ZMO N (0321) .00'9174 FFM I I 1 i w w z 0 z? z Zoo MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ? On -Site Services Section I P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 017-372-06 1. GENERAL INFORMATION HAA it -� G l' O0'1_2 Complete legal description i f-0 - Knik Heights Lot 6, Bloc]< H Location (site address or directions) ti tj` 13000 -)Bainbridge, Anchorage Property owner John Hagmeier Day phone 243-6789 Mailing address 2204 Cleveland Avenue, Suite 201, Anchorage, Ak 99517 Lending agency NSA Day phone Mailing'address Agent NJA Day phone 'Address individual Community well ' Public water NOTE: If community well system, provide written confirmation'_ from State ADEC attest - Ing to the legality and status of system. , ii 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 Date �� ..�:... n... � x ferq � c1` kouis A._By � . ,W r,xQa E-6,36 pp R nt %W,gROFESS��Na° CAUTION i ' The Municipality of Anchorage Department of Health and Hui arvices (DHHS) issues"Health Authority . Approval Certificates based only upon the representations glv paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS a this`as a courtesy toapurchasers of homes and their lending institutions in order to satisfy certain federal am ::.:ate requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1FJ1) Back MOA N21 1 0yaga"�'� 6.. - DHHS SIGNATURE Approved for bedrooms. Disapproved. x' f Cond(tionaf'approval for, `' bedrooms', with he following stipulations. �> , i I Qll I 5S5 Additional Comments " " y L By: _ Date CAUTION i ' The Municipality of Anchorage Department of Health and Hui arvices (DHHS) issues"Health Authority . Approval Certificates based only upon the representations glv paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS a this`as a courtesy toapurchasers of homes and their lending institutions in order to satisfy certain federal am ::.:ate requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1FJ1) Back MOA N21 1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMANS �[ utvuFArvcHu,<"mi, WATALSERVICES DIVISION Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) p4t1147444 199 Health Authority Approval Checklist E C E 1V E Legal Description:—/C�/[�,�/ lC�ftf-S Parcel I.D.: �'7 — 3`7 Z -0� A. WELL DATA to (60 o0'H 7 I Well type &1147-C IfA, B, or C, attach ADEC letter. ADEC water system number _- 1// Log present (Y/N) 5 Date completed Total depth Z tj s _ Cased to /cI r r Casing height (above ground) Sanitary seal (Y/N) _ �� Wires property protected (YM) _ 7u FROM WELL LOG Date of test o / J Static water level /7"5 5 11 Well production G g. p. ill. WATER SAMPLE RESULTS: Coliform Date of sample: AT INSPECTION g.p.m. Nitrate / (2j M L.-- Other bacteria ` /uCollected bv: B. SEPTIC[HOLIMNG TANK DATA Date installed _ Q Z/95" Tank size /Z S O Number of Compartments _ Cleanouts (Y/N) Y Foundation cleanout (YIN) Yes Depression (Y/N) NO High water alarm (YIN) A44- Date % Date of Pumping NaO _ Pumper C. ABSORPTION FIELD DATA Date installed b y 9� _ Soil rating (g.p.d./ft' m+2/b'�nr) _ , �a S System type?_ C/s/C// Length Width//��4t/y3 Gravel thickness below pipe �%_ Total depth /7" Effective absorption area /3YW Monitoring Tube present(Y/N)Y— Depression over field (YIN) Date of adequacy test 66V Results (Pass/Fail) For Fluid depth in absorption field before test (in.); Fluid depth _(ius.) Minutes I Peroxide treatmren 2 months) (Y/N) Inm=ate -alb gal. water added (in.): r—. Absorptionratc = g. p. it. If yes, give date bedrooms D. LIFT STATION Date installed Manhole/Access (YM) High water alarm level at* Cyc1 E. SEPARATION DISTANCES Size in gallons *Datum at* "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/fielding tank on lot On adjacent lots Absorption field on lot �/ S 7 ; On adjacent lots Public sewer main /v/�� Public sewer manhole/cleanout Server /septic service line ,kloU 7 /V 1A Lift station M //q SEPARATION DISTANCES FROM SEPTIC/HObBING TANK ON LOT TO: Building foundation S ! Property line G{ � t Absorption field Ti t Water w aiVservice line Surface water/drainagef� Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Z/ 1) 7 Water iiK4Wservice line / Driveway, parking/vehicle storage area /00 Curtain drain N/A Wells on adjacent lots �-/Oa 7 Property line Z - C)/ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor6Kt af/he� t7bw a,stgS(¢nr ire in conformance lvith MOI H�IA guidelines in effect on this date. ��� s,^.qr 1 ��yp Nd °via d�. lits �K 7/ Signature ��'a n�"aonse. oe+�ur•o A... `• •..m ........no.. •o•.. Engineer's Name L OU1 %]�J%ti/2/1 t ��r `Eugineeritig, al:mcrc: CE -6736 .,Z. Date �' `C "a ee "� �aeV E ---------------------------------------------------------------------------------------------- -------- -------------- HAA ---���5�-------------- HAA Fee $ & Waiver Fee $ Date of Payment 1 � -ILA -C1 Receipt Number cw-i -i S I Rev. 8/95 OSS: haa.wk.doc Date of Payment Receipt Number 11/13/95 12:13 COMi ERC IRL TESTING 4 '�07 e!)4 5ryv ALCT&F Lnvironmental Sorvim Inc. ®r�wr CT&H Ref.# 95.5068-3 Matrix. WATRR Mien.t 6ainple TD KNilf HTS G/H Clieht Name EAGLE RIVER RNUINE@RING oxdared By LAURA Project Name Project# PW31D UA Sample H®tnarks: ,iANPLE COLLECTED ItY; L.D.M. Nu. tits' W/ yl WORK OxLL927 1956:1 Printed Da,to 11/1.3/95 0 12:19 11Ls. collected Date 11/03/95 P 14:10 hrG. Received Date 11/03/95 0 15:00 11sld. Teclvi.ieal Direr_Cak- ❑TEP11Eti c. etas Reloaaed }iy�• � � sea Slay❑1R.1 Instructiyttp A2�ove UA q Unavailable Sec Sample kiemarks Above NA - Not Analyzed Uhdetectecl, Haported valves is the practical quantification limit_ LT a Lena Than ID Secondary dilution. GT = Greator Than or! Allowah2e Ext_ Anal Farameter -----------------------------,.--------- Results Qual .__..___., Unita ------- Methoa Limits Date Date lniC Nitrate -N 7.105 Ing/l. „___-___„__-___e_.___.____,.________________________„,, EPA 353.2 10. 11/10/95 4fdP. sea Slay❑1R.1 Instructiyttp A2�ove UA q Unavailable Sec Sample kiemarks Above NA - Not Analyzed Uhdetectecl, Haported valves is the practical quantification limit_ LT a Lena Than ID Secondary dilution. GT = Greator Than