HomeMy WebLinkAboutKNIK VIEW BLK 1 LT 6Knl*k View
Block 1
Lot 6
#051-031-29
Inspection Repoli 9-1-12.do'
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page d of ff
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP131211
PID Number: 051-031-29
Dwelling: X Single Family (SF)
❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade
Name:
Gary & Susan Larsen
ABSORPTION FIELD
Dee
❑ p Trench El Shallow Trench El Bed El Mound
Address
22509 Inlet Vista Drive, Chugiak, AK
❑ other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(907) 750-8203
4
0.8 GPD%SF
10.47 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.47 Ft.
Gravel depth beneath pipe
6 Ft.
Subdivision
Block Lot
Knik View
1 6
Fill added above original grade
Varies 0.5-1 Ft.
Gravel length
65 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
780 Fel
1
N/A Ft.
Well
*
*
NA
NA
25+'
TANK J9Septic E:1 STEJHolding E]Otherrr k fgTj '
Manufacturer
Anchorage Tank
Capacity
1250 Gal.
Surface water100+'
100+'
NA ''. NA
Material
Number of compartments
Lot Line
10+'
**6'
NA '; NA
Steel
2
NA
Foundation
5+'
10'
NA
NA
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
NA
NA
NA
Gal.
Remarks *Subdivision is on public water.
Pump on level at
Pump off lev
High water alarm at
in.
**Requesting a waiver of
6' from leach field
to west lot line.
yyyin.
Pudel
mp mn ake a o
Electrical Inspections performed by
to
MATERIAL House to tank D3034 Tank ld D3034
PIPE MMdrainfe
Installer
Dean Construction
Drainfield F81 Operf CO/MT
Inspector F. Kenley
BENCH MARK (Assumed elevation) 100 ft
Inspdates: 1" 7/22/13
7/23/13
Location -and description
aro
2.,
4tn
N.E. Corner of house @ Point A. See Pg. 3
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
En �eyf r�stamp
�}
Conditional Approval:
Date
�h
41�2�d� OCG iY Y.
Approved (
rt/ L f '' Date - . / 2
t 2i 1 4
Inspection Repoli 9-1-12.do'
/
Lot 5
SEPTIC
SYSTEM
0 /
TH#®
/ a col
/ T
Co I
C
/ o(-) A II
m -0 H5 3111
/ New 65'X6'E.D.2.5'widey/MT2
/ TH#4®WCO2
/
Lot 7
DOUGLAS T. KENLEY, P.E. Ciml Engineer
ME.NmtleYrai • (99117161%3
1°`"' Gary Larsen
View S/D, Block 1, Lot 6
09 Inlet Vista Drive, Chugiak, AK %D °u°BF'°-050-721-28
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SHEET 2 of 4 �
LEACH FIELD PROFILE
FILL ADDED ELE VARIES 101' TO 101.5
100.05' ORIGINAL GRADE ® T.H.-3
FROM EXISTING
RUN DIVERSION VALVE
6' E.D. X 65'
LONG TRENCH.
BOT.=89.45'
BOT.=89.58' BOT.=89.59' BOT.=89.58'
GROUND WATER EL' @ 7/22/13 NONE
BOTTOM OF TEST HOLE #5 81.95'
NOTES: REFERENCE POINT WAS 4.87' LOCATED @ TOP OF FOUNDATION
BLOCK SHOWN ON DESIGN P. 2 OR 3 MARKED A.
SWING TIES
A
B
C01
19.8'
54.0'
MTI
18.6'
52.4'
DIV. VALV.
17.5'
49.5'
CO3
17.0'
48.7'
TEE
29.0'
26.0'
MT2
47.0'
18.5'
CO2
56.3'
22.0'
NOTES:TEE WAS LOCATED AT THE MID -POINT OF 32.5'
FROM THE END OF THE 65' LONG TRENCH.
DOUGLAS T. KENLEY, P.E.
ME.Nq Wr Cln* . Pa[m ,Al W • (Wi)lJ goo
`"'n Gary Larsen
U`''° Knik View S/D, Block 1, Lot 6
J°BBBR22509 Inlet Vista Drive, Chugiak, AK
. 7/24/13 CHfgtEOi DTK "" FK
CMI Engineer PROFILE
""°B`"051-031-29 °E ""B"BEA; OSP 131211
NTS JOB "H"BEB: 13116 SHEET 3 OF 4
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Do glas T. Kenley
AIW
ROFES���'+�a``r
\��\
Municipality of Anchorage °` Nr
j' P.O. Box 196650 • 4700 Elmore Road
Anchorage Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
_ Department
Development Services Division
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: osp131228 COSA#: osc131362 Permit#: osP131211
PID#:051-031-29
Legal Description: Knik View B-1 L-6
Engineer: Doug Kenley
Applicant: Gary and Susan Larsen
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 6.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
.............................................................. a . . . . . . . . . . . . . . . .
Waiver is Granted: X Waiver is not Granted:
Date: *� f� Approved lo:
Na wer
............................................ ... .. ......................
Rec#: 005625 Amount: $200.00 Date Paid: 7125113
**** VARIANCEIWAIVER REVIEW ****
Douglas T. Kenley, P. E. 9806 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073
July 25, 2013
Municipality of Anchorage
On -Site Services
4700 South Bragaw
Anchorage, Alaska
Re: Gary Larsen
Knik View S/D, Block 1, Lot 6
22509 Inlet Vista Drive
Chugiak, Alaska
REQUEST FOR WAIVER OF LEACH FIELD TO LOT LINE AND CONDITIONAL COSA
A Narrative was filed at the MOA dated July 19, 2013, at which time Permit #OSP131211 was
issued to upgrade the failed septic system. After construction and receipt of the land surveyor's
plat, it was discovered that the leach field was 6' from the west lot line of the above property.
Therefore, we are requesting a waiver from leach field to lot line.
We are also requesting a Conditional COSA to monitor the water level in test hole #5, which
monitoring will end on July 30, 2013. During construction, it was discovered that the outlet of the
tank was lower than the pert pipe. Test hole #5 was dug on July 23, 2013, to establish a 6'
separation from bed rock and to remain 5' from ground water.
If you have any questions, please call me at (907) 746-1073 or 243-5372.
Sincerely,
U
Douglas T. Kenley, .E.
PE #8176
ELE 100.05'
Organics
GW
SP
W/SOME LARGE
ROCKS
SP
W SOME LARGE
R CKS
GP
SOILS LOG — PERCOLATION TEST
TEST HOLE #5
m a,: ,° w 3- 3-0�
�.
_a
�p 3 ML
GM CL
Lc OL
;p u„°$•..e,. a SW MH
H..
�S::j5:.ya'sc CH
SM / OH
Sc
DEPTH TO
GROUNDWATER
DATE
N/A
7/23/13
7/30/13
G
S -1-i.3
7/23/2013
4.87' REF — 100.00'.
-e-c
DATE READING TIME NET TIME WATER LEVEL NET DROP
(MIN.) READING (IN.) (IN.)
S. Of H. PERCOLATION RATE (MIN./INCH) PERC. HOLE DIA. (IN.)
ELE. 81.95' TEST RUN BETWEEN FT. AND FT.
PRESOAKED FOR FOUR HOURS YES NO
COMMENTS: HOLE WAS USED TO CONFIRM SEPERATION FROM BED ROCK & GROUND WATER. IT WILL ALSO BE
USED FOR 7—DAY MONITORING,
PERFORMED BY: FRED W. KENLEY I, DOUGLAS T. KENLEY, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
DOUGLAS T. KENLEY, P.E. Civil Engineer
9 E.NMHUAN. PoImx,Nrke98&5 (BOn f,a-ton
111T: Gary Larsen
Knik View S/D, Block 1, Lot 6
.nox<ss 22509 Inlet Vista Drive, Chugiak, AK "
wTc 7/24/13 c..' DTK I w"_ FK •'F. NTS
LOG
1-031-29 -OSP 131211
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On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP131211
Tax Code Number: 05103129000
Work Type: Septic
Permit Effective Dates: July 19, 2013 to July 19, 2014
Design Engineer: DOUGLAS T KENLEY
Subdivision: KNIKVIEW
Site Legal Address: KNIK VIEW BLK 1 LT 6G:1557
7- 2 z- i, -,j ) f
Owner/Address: LARSEN GARY WILLIAM &
SUSAN JEAN 2832 DARLING AVE FAIRBANKS AK 997095842
Site Mailing Address: 22509 INLET VISTA DR, Chugiak Lot Size in Sq Ft: 20276
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage
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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: Construction may proceed at your own risk before the 7 day water monitoring
is complete. Please submit stamped and signed results with the As -built Inspection Report.
7/21�/3 reid GhGng1e C)Jec
/77 C4 Q o A ""1",
Received B)
Issued By:
-?I &Ocecq of yiqu(
, .,r 65 �e�f
_o7e
l8' te,thole-
owl,7 /ISIS �r7 AA/
�YroWna ovafe� rHon�for��q
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program s
ON-SITE SEWER/WELL PERMIT APPLICATION
r
Parcel 1. D. 051-031-29 RUSH! y�
Property owner(s) Gary and Susan Larsen J Day phone 1 (907) 0
Mailing address 2832 Darling Avenue, Fairbanks, AK 99709
Site address 22509 Inlet Vista Drive, Chugiak, AK
Legal description (Sub'd., Block & Lot) Knik View S/D, Block 1, Lot 6
Legal description (Township, Range & Section)
Lot Size 20,473.2 Sq. Ft. Number of Bedrooms
4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank ElUpgrade 0
Duplex (D)
❑
Holding Tank ElRenewal ElMultiple
Dwellings
❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
or authorized agent)
Permit/Rush Fees: 530 sill Waiver Fees:
Date of Payment: 111013 Date of Payment:
Receipt Number: O2s_I:6 Receipt Number:
Permit No. 051'131a-» Waiver No.
Permit App_"-:. :'-:c.
Douglas T. Kenley, P.E. 9806 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073
July 19, 2013
Mr. Doug Larsen. Owner
Inlet View S/D, Block 1, Lot 6
22509 Inlet Vista Drive
Chugiak, Alaska
PERCOLATION TEST RESULTS
AND
GENERAL SITE INVESTIGATION REPORT
On July 9, 2013, an adequacy test was attempted. The water elevation within the leach
field was measured at 1-1/2" from the bottom of the distribution pipe. After the
introduction of 86 gallons of water into the system, water could no longer be heard
running in the clean-out. Checking the monitoring tube showed that water had risen 3"
above the invert of the distribution pipe. Flow was cut back to a trickle and let run to see
if it would drop down at all. The water was turned off and the level was checked again
two hours later and the water depth was measured at 38-3/4" from the bottom of the
monitoriung tube, representing a Y4" drop over the two-hour period. The water depth was
again checked on July 10`x' and was found to be 38-1/2" from the bottom of the
monitoriung tube. A total of 139 gallons had been introduced during the test. Based on
these readings, the system was considered to be in a failed condition.
To facilitate the permitting and installation of a replacement leach field, a test hole was
performed on July 17, 2013. The test hole was dug to a depth of 16.7' and a monitor tube
was installed. No ground water was observed during the excavation of the hole. It is
proposed that the replacement system be installed in the area designated on the original
design documents. A percolation test was performed which showed that the soils
percolated at a rate of approximately 12 minutes per inch. It is proposed that a 3' wide, 7'
E.D., 60' long trench be installed as the replacement system. The proposed design is
sufficient to serve a four-bedroom house on the above -referenced 0.47 acre property. The
Knik View S/D is served with public water.
The lot slopes approximately 0-1% in the area of the proposed leach field. The parcel is
treed with spruce, birch, and alder, with birch being predominate.
On-site observation and physical survey show that there is a private wastewater disposal
system within 100' of the proposed system.
It appears that there is no potential for contamination of adjacent water wells or streams.
Mr. Gary Larsen. Owner
July 19, 2013
Page 2
The proposed system will have no measurable impact on reserve space, surface or
subsurface, or on drainage to adjacent lots.
Please consider this report as a request for review and approval of the attached design
drawings for a replacement on-site wastewater disposal system.
We have verbally requested permission from the On -Site Services Department to proceed
with construction of the replacement trench without waiting to check the water level in
the monitor tube after 7 days.
If there should be any questions concerning the percolation rate or characteristics of the
site, please call me at (907) 746-1073 or 243-5372.
Sincerely,
Douglas T. Kenley, P.E.
PE#8176
SEPTIC SYSTEM SPECIFICATIONS:
1. ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH THE M.O.A.
WASTEWATER CODE CHAPTER 15.65.060-
2. EXISTING 1250 GALLON TANK TO BE LEFT IN PLACE.
3. SERVICE LINE TO DRAIN FIELD SHALL BE 4" DIA. ABS PIPE.
4. DRAIN FIELD LINE SHALL BE 4" DIA. 3034 ASTM PIPE WITH HOLES LAID DOWN
5. NEW LEACH FIELD TO BE PLACED IN ALTERNATE SITE WEST OF EXISTING FIELD
NTH A DIVERSION SPLITTER & 14' SEPARATION BETWEEN TRENCHES.
6. PROVIDE 10' MINIMUM SEPARATION BETWEEN EDGE OF TRENCH AND FOUNDATION.
7. PROVIDE 10' MINIMUM SEPARATION BETWEEN SEPTIC SYSTEM AND PROPERTY
LINE.
8. PROVIDE 200' MINIMUM SEPARATION BETWEEN SEPTIC SYSTEM & PUPLIC WELLS,
100' PRIVATE WELLS & SURFACE WATER.
9. FOR APPLICABLE EXCAVATION, TRENCHING, AND SHORING SAFETY STANDARDS,
CONTACT THE STATE OF ALASKA, DEPARTMENT OF LABOR, OCCUPATIONAL
SAFETY AND HEALTH COMPLIANCE CONSULTATION, AND TRAINING DIVISION OF
LABOR STANDARDS AND SAFETY AT 269-4955.
10.PROVIDE INSULATION OVER DRAIN FIELD IF ANY AREA IS FOUND TO HAVE LESS
THAN 3' OF COVER. BOTTOM OF DRAIN FIELD IS NOT TO BE PLACED LOWER
THAN EL. 94.75'. BASIS OF ELEVATION IS A RIDGE ON TOP OF FOUNDATION BLOCK
LOCATED 0 POINT A ON SITE PLAN P. 2 OF 6.
DRAINFIELD CALCULATION FOR TRENCH
SOIL TYPE: POORLY GRADED SANDS WITH ROCKS & BOULDERS (SP)
PERCOLATION RATE: 12 MINUTES PER INCH
APPLICATION RATE (AR): 0.8 GAL./DAY/SF
DESIGN (4) BEDROOMS: DISCHARGE = 4 BEDROOMS X 150 GALLONS/DAY = 600 GALLONS
ABSORPTION AREA = 600 GALS PER DAY/0.8 GALS PER DAY/SF = 750 SF
EFFECTIVE DEPTH = 7'
TRENCH LENGTH = 750 SF/(2X7') = 53.6'. USE 60.0'
• ASSUMES DOMESTIC WATER USAGE FOR RESIDENTIAL HOME CONSUMPTION.
• CALCULATION METHOD OBTAINED FROM MUNICIPALITY OF ANCHORAGE "WASTEWATER
DISPOSAL CODE REGULATION" FEBRUARY 14, 2003; AMC 15.65, TYPICAL DEEP TRENCH
FIELD REQUIREMENTS AND SPECIFICATIONS.
DOUGLAS T. KENLEY, P.E. Engineer "`'""'1q
ME.XaM•IaC . M .,u 11I a . ,M„,�M, CALCULATIONS
'U°"Gary Larsen
F0.Yi Knik View S/D, Block 1, Lot 6
�22509 Inlet Vista Drive, Chugiak, AK
rre 7/19/13 1M. DTK °R' FK
1-031-29 '""':
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j 160x,, . CE -817 'SAW
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tt8
tat 9
Loc 10
Lot 11
ALDER LEAF COURT
244.3__ I l I
DOUGLAS T. KENLEYB P.E. CIA Engineer DESIGN
MOB EXp9MxCIrtY. PNnwAIW NFS (W'/j]WOTd
p1nn. Gary Larsen
22509 Inlet Vista Drive, Chugiak, K
/19/13 `""`" DTK °"°"` FK AB"" 1" = 100'
13116 SHEET 2 OF 6
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Doug T. Kenley
I PF% CF -817f �```�i
('I�1F� ROFESSVONP���
�Aater S Lrvice (SYSTEM
pprox. oc.
168.68'
.168.68'
No slope >25% w/in 100'
of septic.
n 30.7
S
w & ° o—/
0A� /
Cj) /
idence
6
T.H.-4
36
9 4' \
DOUGLAS T. KENLEY, P.E. a,„I Enginrer DESIGN
MENwtl 'Cr . . (pp7pT i 1d
w., -Gary Larsen
.Knik View S D, Block 1, Lot 6
'122509 Inlet Vista Drive, Chugiak, AK p01"110 050-721-28
7/19/13 `”""� DTK 0" FK 1" = 20' J00 X0NBfA` 13116 SHEET 3 of 6
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LEACH FIELD SECTION
- PROPOSED FILL ADDED ELE. 100.55
100.05' ORIGINAL GRADE ® T.H.-3
2" INSULATION
IF NEEDED—
BULL RUN DIVERSION VALVE
FLOW SPUTTER
ENTERS ® MID -POINT 97-05'
96.57OFPIPE
TOP OF GRAVEL
INVE7' E..
LONG TRENCH.
89.55' --/NONE
BOTTOM OF TRENCH GROUND WATER EL' ®7/18/13
BOTTOM OF TEST HOLE 83.35'
NOTES: REFERENCE POINT WAS 4.87' LOCATED 0 TOP OF FOUNDATION
BLOCK SHOWN ON DESIGN P. 2 OR 3 MARKED A
DOUGLAS T. KENLEY, P.E.
am BExwnw.n,u...wn...tr..u6 . WFIT» m
%1HBGary Larsen
' Knik View S/D, Block 1, Lot 6
i0 22509 Inlet Vista Drive, Chugink, AK
"'x'7/19/13 1 °NF DTK °"""" FK xue
ITEM
LEGEND
1
Bull Run DIV. VALV.
2
FLOW SPLITTER
3
CO -1
4
MT -1
5
CO -2
6
MT -2
EXIST. 1,250 GAL.TANK (TO REMAIN)
Civil Engineer
NTS
—031
PROFILE
13116 (SHEET 4 OF 6
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"pROFESSIOq�
ELE 100.05'
hganics
W
P
V/SOME LARGE
CKS
P
V SOME LARGE
CKS
ig
B. of H.
ELE. 83.35'
SOILS LOG — PERCOLATION TEST
DEPTH TO
GROUNDWATER
DATE
NONE
7/11/13
NONE
7/18/13
7/17/13
1
7/17/2013
4.87' REF = 100.00'.
See attached site plan &
Page 4 of 5 on leach
field elevations
GATE
READING
TIME
NET TIME
(MIN.)
WATER LEVEL
READING (IN.)
NET DROP
(IN.)
7/17/13
1
3:45 PM
----
8
----
4:15 PM
30
5-12/16
2-4/16
2
4:16 PM
— — — —
8
----
4:46 PM
30
5-6/16
2-10/16
3
4:50 PM
— — — —
8
----
5:20 PM
30
5-8/16
2-8/16
4
5:22 PM
— — — —
8
----
5:52 PM
30
5-8/16
2-8/16
PERCOLATION RATE 12 (MIN./INCH) PERC. HOLE DIA. 6 (IN.)
TEST RUN BETWEEN 7 FT. AND 7-1 2 FT.
PRESOAKED FOR FOUR HOURS YES7 N0
PERFORMED BY: FRED W. KENLEY I, DOUGLAS T. KENLEY, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
OF qtqs��++
AWS.• I
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DOUGLAS T. KENLEY, P.E. Ergine., SOILS
woaexwttxarnrt • v.�.,,,r+usww loor)nsnon LOG �� •Doug T. Kenley
'Gary Larsen CE -8116 ••��
a. Knik View S/D, Block 1, Lot 6 �� �llt• '�( (":6 •13' ��\�
s
22509 Inlet Vista Drive, Chugiak, AK 051-031 —29 °FPY""`�"°` I�;F�PROfESS10NP-�
°"" 7/19/13 1 tl1 : DTK I °P: FK I � NTS '1pB MUYB°` 13116 SHEET
ELE 100.05' SOILS LOG — PERCOLATION TEST
Organics
TEST HOLE #4
GW
.0 GW 1110
,.
IIIIIIIIII
Isc
"NNNNSID
W�SOME LARGE
���
R CKS
SP
W SOME LARGE
R CKS
GP
B. of H.
ELE. 83.35'
DEPTH TO
GROUNDWATER
DATE
N/A
7/17/13
7/17/2013
4.87' REF = 100.00'.
DATE READING TIME NET TIME WATER LEVEL NET DROP
(MIN.) READING (IN.) (IN.)
PERCOLATION RATE (MIN./INCH) PERC. HOLE DIA._ (IN.)
191 TEST RUN BETWEEN_ FT. AND FT.
20
PRESOAKED FOR FOUR HOURS YES NO
'OMMENTS: HOLE WAS USED TO CONFIRM SOIL CONDITIONS. IT WAS NOT NEEDED FOR OTHER
COVERED ENOUGH OF TRENCH.
AS T.H.
PERFORMED BY: FRED W. KENLEY I, DOUGLAS T. KENLEY, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
DOUGLAS T. KENLEY, P.E. CIA Engineer
me.Nd mm • PMr,YrMYB919 • mn?mon
'Gory Larsen
Knik View S/D, Block 1, Lot 6
..22509 Inlet Vista Drive, Chugiak, AK PO"
mfr: 7/19/13 IFDTK °ROec FK I — NTS
LOG
—031-29
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Municipality of Anchorage Page _ 1 of a
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:SW`950�39 PIDNumber: I O?�la a —
Name:
Wastewater System: 0 New ❑ Upgrade
Address: lr1p P-�IAQ�SJILL.� WA 4aa�n
I I
ABSORPTION FIELD
Phone:
No. of Bedrooms:
❑Deep Trench ,W Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
I
Total Depth from original grade:
8 r
-2_ GPD/So. Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
l4 I Kw I K -E'
'31 Ft.
?� r Ft.
Township: —
Range: —
Section:
Fill added above original grade:
Gravel length:
67-5 /1 Ft.
5p
� Ft.
WELL: u El New El Upgrade
Gravel width: P
Number of lines:
Distance between lines:
FXISTI
�Ft.
Ft.
Classification (Private, A,B,C):
n
Total Depth:
Cased To:
otal absorption area:
Pipe material: Aso'WN
CCASC
J /a
FL
Ft.
�7 Op S0. Ft.
f�S$UP303 1-
Driller:
Date Dril
Static Water Level:
Installer
500THFO¢14 L/lotJ51
Date installed:
II- II- q5
Ft.
Yield:ump
Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
;ZSeptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
AuCHOo_AdI�-% MtWe-
/a 50
Well
aova-
aovfi
_�
?S -r
Material:
S"I'EE-L-
Number of Compartments:
�-
Surfac
14-
1 Uvh
_
—
LIFT STATION
Watere
100
_
Lot
i
t
Size in gallons:
Manufacturer:
Line
IC) d
(D d–
—
—
—
Foundation
I
w a i
"Pump on" level at:
"Pump otf� Il at
water alarm at:
Curtain
Pump Make�ej
ecfrical Inspections performed by:
Drain
Remarks: 1 v ESLD^fit,
BENCH MARK
and Description:
11 1 1Location
N77 H.4 fYT"GnQ-- 5 MJF tZ�L 1L 7 t
-r—' /�
IGS Or- f;o"DAT(O o`r 6)
No�
�C7`i1 NEP— A
Assumed Elevation:
1400
S & !i ENGINEERING� 7... W .. .....:.......
Inspections performed 4 a4 eagle River Loop Road, No.2a'Dates: 1st I (-la -9s ;�
,�
Eagle River, Alaska 99577 j1 ,^f �`
2nd 11 � 11 � 45 J R0 ERT C. COWAN t801
p �,
Department of Heal -and uman Services approval '
Reviewed and approved by: Dater
72-013 (Rev. 9/91) MOA 25
Permit No.
SW950239
Page 2 —of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Pin N� .
LOT 6, BLOCK 1, KNIK VIEW SURD. 05103129
Legal Description: _
72-013 A (Rev. 9/91) MOA 25
PINA
GRADE
MT1
C05 99.91
100.9'
R
NEW
94.!"X12.60
GAL
�� 7'
93.8'
SEPTIC
TANK
90.8'
cl 3 q
NO (?4o.CocGc
.2 G., wAr4/2
SEPTIC
RESERVE AREA—
N
A
B
—
-
FCO
8'
NEV
1250 GAL
ST1
11
51'
r,4
I I
C01
1 4
50'
sr2 )
I I I
CO2
15'
50'
sn ° ° co!
CO2 I
I j ATHQ2
CO3
37'
56'
co
I
CO3 I
C04
50'
80'
0
�
I IAI
i
C0545'
41'
YE IVE
0
IIT"K'I
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44'
3-8-
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_
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Y W
Y I I
�L �lATt
COS
LOT 6NEW
TH
TRENt
P
..........` 7sFQ@
A " '• .ryQ
n nsyJps / e.o•/euJq/rY//
P� § ROBERT C. COWAN i a
a Gj i'. ci: • 8601
SCALL: 1" =
72-013 A (Rev. 9/91) MOA 25
(ENCAl ti-o5AAL)
,s ���
A,
1,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST` t .,�'v�- tLr1 ✓ zr—
r' –^ ItoeIPT C. COINAN "� z
CE - 6601 7 f
PERFORMED FOR: I�� V J(5�1/�1I G— DATE
LEGAL DESCRIPTION:_l�U"i- �P hJv�1L I Y—rl t IL Township, Range, Section: - - •-
14
zl)
10
11
12
13
14
15
16
17
18
19
\ F�til
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
0
DEPTH? p
E
Depth to Waler er
Monitoring? Date: 17i3a i _
Reacting Date Gross Net Depth to Net
Time Time Water Drop
20 I PERCOLATION RATE (minutesimch) PERC HOLE DIAMETER
�J TEST RUN BETWEEN FT AND I _ FT
COMMENTS 4V J (t—(L(3fzA)K'° C t{— J
PERFORMED BY: S & S ENGINEERING _ Iy/�t/ „kp, �� CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 F.aglo River Loop Road No. 204—`�`��
ACCORDANCE WITH e6bfbTKAIWIAWip�IkUIf ,t -,GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-66.50
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950239
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:SCHMELZER FAMILY TRUST
OWNER ADDRESS:P.O. BOX 799
MARYSVILLE, WASHINGTON 98270
PARCEL ID:05103129
LEGAL DESCRIPTION:
KNIK VIEW BLK 1 LT 6
LOT SIZE: 20276 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: (
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
3Psr
DATE ISSUED: 8/23/95
EXPIRATION DATE: 8/23/96
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
ISSUED BY
DATE:
DATE: -23 0�7
�'2- F i��- I-/1/G/N�FF�R G/l�q,���p uPbrr�P��a 7`a Foul Rr�Ao/laatic�
S & S1 ROBERT C.COWAN, RE,
alneeRInG - ROBERTA. SHAFER, P.E.
EAGLE August 28, 1995
�zn CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
41'r, C",�B
HEALTHAUTHORITY Municipality of Anchorage V
APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street U n%U,;;:, , J9,9' -
ox
6650
SEWER&WATER Anchorage, 9Alaska 99519-6650 epi y�'a/th4 NQ11)
9e
MAIN EXTENSIONS V%Coo
REFERENCE: Lot 6 Block 1 Knik View Subdivision
SEWER&WATER
INSPECTION
Dear Mr. Daniel J. Roth,
A permit (SW950239) was issued on the referenced property on
AND REPOORTSRTS Y g
ENGINESTUDIES 8_23-95. This is to inform you of the change from three
bedrooms to four bedrooms. (design attached)
We do not anticipate any adverse effects on neighboring
WELL INSPECTION properties due to the change.
& FLOW TEST
If we may be of further service please contact us.
Sincerely,
SITE PLANS
ROADDESIGN Robert C. Cowan, P.E.
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
S&S1
,ineeRtnG
August 17, 1995
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
SEWER & WATER
MAIN EXTENSIONS
REFERENCE: Lot 6, Block 1, Knik View SSD
Request you issue a permit to install a septic system to
SEWER&WATER
serve the vthree bedroom house on the referenced property.
INSPECTION
P'Q0 P4 i f J
A test hole was excavated and a percolation -test performed.
The approximate location of the test hole is located on the
attached site plan.
ENGINEERING STUDIES
AND REPORTS
At the time of excavation no water was encountered in the
test hole and after seven day ground water monitoring, the
monitoring tube was found to be dry.
WELL INSPECTION
&FLOW TEST
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
SITE PIANS
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
ROAD DESIGN
Sincerely,
;a(�Y.4 i��"`a-�
SOIL TEST
Robert C. Cowan, P.E.
RCC/gk
PERCOLATION
Enclosure
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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NV1d 311S 1 OJ7 = „L
o Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 •'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
CE -8801
PERFORMED FOR: I % SDATE PERFORME[S} F
I a
LEGAL DESCRIPTION: �"r l✓1��L 1 �.� 1� Township, Range, Section:
\ SLOPE SITE PLAN
2 ,
3
4
G
5 �
6
6•'
7
8
9 U
10-
11-
12-
13
0 11 12 13
14-
15
16-
17
81920 18-
19-
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED? l O
S
IF YES, AT WHAT L
O
DEPTH? n P
E
MonttDepth to Wale At
)(� _ 3�Ip�s
Monitoring? l4`-JVr �fl —pale:
Reading Date Gross
'rime
Net
Time
Depth to
Water
Net
Drop
2
_
� al
PERCOLATION RATE 1 (minutesnnch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND S FT
PERFORMED BY: S & S ENGINIeERING — I Irb i W", �o CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No. 204
ACCORDANCE WITH A1-�g$�TAJ E Ar,NDIaSU aICIPAl�UIDELINES IN EFFECT ON THIS DATE. DATE:
'/2-008 (Rev. 4/85) G 1 NI 41 K YY7�
s&S�
3ineeRznG
HEALTH AUTHORITY
APPROVALS
SEWER& WATER
MAIN EXTENSIONS
ROBERT C. COWAN, P.E.
ROBERT A. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SYSTEM CIVIL ENGINEERS
694-2979
CONSTRUCTION PRACTICES FAX(AX (907) 694-4-
1211
and
MATERIAL SPECIFICATIONS
Lot 6, Block 1, Knik View SSD
August 17, 1995
1. The scope of this project includes the installation of
a 1000 gallon septic tank and a five foot wide
SEWER&WATER
drainfield -to serve the proposed three bedroom
INSPECTION
residence for the referenced property.
2. Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
ENGINEERING STUDIES
AND REPORTS
y p � an special provisions or conditions and all
applicable State and Municipal Wastewater Disposal
Regulations,
3. The contractor shall be responsible for obtaining any
WELL INSPECTION
&FLOW TEST
necessary underground utility locates.
4. Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
SITE PLANS
subsequently depressed from soil settling. On all
leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation
growth over the mounded area.
ROAD DESIGN
5. Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
SOILTEST
systems must also receive prior approval from the
Municipal Health Department.
PERCOLATION
SEPTIC TANK INSTALLATION:
TEST
1. A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
STRUCTURAL&
MECHANICAL
2- The septic tank shall be sufficient) bedded to
p Y
INSPECTIONS
prevent settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a
ONSITE
minimum of 12 inches above final grade.
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577
Page Two
Lot 6, Block 1, Knik View S/D
August 17, 1995
4. Septic tanks installed with less than 4 ft. of cover shall
be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed --up) before
gravel (sewer rock) placement.
2. Once the gravel .is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
5. Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
Page Three
Lot 6, Block 1, Knik View S/D
August 17, 1995
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast
Iron
Yes
Yes
ASTM
D3034
(PVC)
Yes
Yes
ASTM
F810
(HDPE)
Yes
No
ASTM
D2662
(ABS)
Yes
Yes
Use of a type of pipe other than listed above must be
approved by the .inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the 4200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 6, Block 1, Knik View SID
August 17, 1995
INSPECTIONS:
Typically there will be a minimum of three (3) :inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic: tank
may be set in place, but may not be backfilled before
this inspection.
2. The second inspection must be conducted after the
placement: of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 2.4 hours prior
to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor- to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and
S & S Engineering. S & S Engineering shall be the owner's
representative and will. inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR OWNER
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
hUlfir
RUSH! ;
Certificate of On -Site Systems Approval
Parcel I.D. 051-031-29
1. GENERAL INFORMATION
Complete legal description
Expiration Date: 7 - 2. J -1,
Knik View S/D, Block 1, Lot 6
Location (site address) 22509 Inlet Vista Drive, Chugiak, AK
Current Property owner(s) Gary and Susan Larsen Day phone 242-4763, 242-4761
Mailing address
Real Estate Agent
Audrey Mason, ReMax of Eagle River
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone 622-3344
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
U
Public Sewer
❑
West
lot !ire to !each field.
6'
WaiverNariance request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Oo 301- ZroS
Date of Payment 13
Receipt Number 0o55 -I 1
COSA # 05C -I 31 � � a
Waiver Fee $ �U^ 2D�,�u5 "p
Date of Payment
Receipt Number cx�'S-10 aS
Waiver #_ o503 19df
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 Douglas T. Kenley, P. E.
Phone (907) 746-1073
Address 9806 E. Northstar Circle, Palmer, AK 99645
Engineer's Printed Name Douglas T. Kenley Date/ZS 13
...d�A
49 1*
6. DSD SIGNATURE
V System #1 Approved for --4—bedrooms e ',
System #2 Approved for bedrooms 'r; t6E3
S%
Disapproved�x� .? .1.3
Conditional approval for bedrooms, with the following sttiipula&''-
V�Ilt
By: Original Certificate Date:i
The 6 niclp ty 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 blue shell;'- , c
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 View S/D, Block 1, Lot 6 Parcel ID: 051-031-29
A. WELL DATA
Well type Public
Date completed
Total depth ft
Date of test
Static water level
Well production
WATER SAMPLE
Coliform l
If A, B, or C provide PWSID #
Sanitary seal (Y/N) _
Cased to ft.
FROM WELL LOG
ug/L
g.p.m..
00 mL Nitrate mg/L
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material *Septic/Steel
Well Log (YIN)
Wires properly protected (Y/
Casing height (a ground) in.
AT I CTI
ft.
g.p.m.
Collected by:
Dateinstalled "11/10/95
Tank size *1250 gal. Number of Compartments *2 Cieanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N/A
Date of pumping 7/24/13 Pumper JR'S Septic
C. ABSORPTION FIELD DATA
Date.installed 7/22/13 Soil rating (g.p.d./fe or ftp/bdrm) *0.8 System type Deep Trench
Length 65 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth
11-12 ft Eff. absorption area 750 ft Monitoring tube Y Depression over field N
Date of adequacy test New system Results (PasslFail) For 4 bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) if yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump'on"'level at ' in. "Pumpofr level of in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot _
Absorption field on lot
Public sewer main
Sewer /seotieliervice line
Cycles tested
Manhole/Access (YIN) _
High water alarm level at
Meets alarm &
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Arflmal containment areas Manurelanimal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO
Building foundation 5+ k Property line 10+ ft. Absorption field 5+ ft.
Water main 10+ ft. Water service line 10+ ft. Surface water 100+ ft.
Wells on adjacent lots 200+ ft.
ABSORPTION FIELD ON LOT TO:
Property line **6ft. Building foundation 10+ ft.
Water Service line 1'0+ ft. Surface water 100+ ft.
Curtain drain None Known Wells on adjacent lots 100+ft.
Water main 10+ ft.
Driveway, parkingNehide storage 5+ ft.
F. COMMENTS
*From M.O.A. records. ** Waiver is requested for separation of leach field to
west property line. See attached letter.
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 Douglas T. Kenley
Date 7/25/13
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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. # - 0 S/ 0 3 /a i HAA #
1. GENERAL INFORMATION
Complete legal description Lot G; Stock 1; Knik View
Location (site address or directions) NHN TYV-et Vista Dative
Chuaiak. AK
Property owner
red
Schme2zeh
Day phone
Mailing address
P.O.
Sox 799 Man.yhvitTe,
WA 98270
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: _ 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADDC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX _
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) From MOA -21
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & S ENGINEERING Phone 6 `)h - �`j
age )ver Coop Roail No. 204
Address Eagle River, Alaska 99577 T
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date c / ( / q c
OF q
, i
;e [ ROBERT C. COWAN.••lf��
CE -ZuJI
A
bedrooms, with the following stipulations:
1tITir
Date G y�
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 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 (Rev. 1791) Rack MOA r2t
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES RECEIVE
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
JUN 6 1996
Health Authority Approval Checklist
DOW. Health l
lth& Human Survlces
Legal Description: Lel_ 6 enik V ecu-' Parcel LD.:_
A. WELL DATA
Well type A If A, B. or C, attach ADEC letter. ADEC water system number a 1.9 4/0 9
og present (Y/N)
Total dept t
Sanitary se�(Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING. TANK DATA
Date completed _
Cased to
\4 WELL LOG
Nitrate
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Other bacteria
Collected by:
Date installed II - I I - q S Tank size I f1i� Number of Compartments — P, Cleanouts (WN)4—
Foundation cleanout") �[_ _ Depression (Y qI L( High water alarm (Y/N)
Date of Prunping — r0-- 1 Pwnper -- n/ a.
C. ABSORPTION FIELD DATA
Date installed I I - ! _ Soil rating (g.p.d./ft' or ft/bdrm) /, 2 qPd System type J19//oc� �ien
Length SS ' _Width _ S Gravel thickness below pipe 2 � Total depth S �
Effective absorption area `��'�� -Monitoring Tube preseutCY)N) —t/ Depression over field (Y�J rI
Date of adequacy test F �� Results (Pass/Fail) _ —7— For _ - __bedrooms
Fluid depth in absorption field before test (in:); Immediately after i gaL water added (in.): -
Fluid depth (ns.) Minutes later:___ Absorption rate==9-p.d.
Peroxide treatment (past 12 months Y )
(I ) ( �'' � [f yes, give date
D. LIFT STATION
Date in d
Manhole/Access (YIN)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at* "Pump off' level at*
SEPARATION DISTANCES FROM WELL ON LOT TO: kll " C&mmu "' i7 Y C'4 6C
Septic/holding tank oil lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Oil adjacent lots
On ad' ots
sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM &EPTICHOLDING TANK ON LOT TO:
r
Building foundation Properly line t D Absorption field
Water main/service line IJ Surface water/drainage o� t .)— Wells on adjacent lots L•o p�_
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 3� / Water main/service line / h�
r �tk
Surface water l00 Driveway. parking/vchicle storage area L.'>
Curtain drain ntsn e— k176f,k, Wells on adjacent lots L v0 Property line /Q .
F. ENGINEER'S CERTIFICATION
1 certify that 1 have determined thru field inspections and review of Municipal records
in conformance with MOA HiM guidelines in effect on this date.
Signature L C �i✓' '
�J
Engineer's Name z` a��f� i o c Air ►3•• E'
Date SO
HAA Fee $ 2 J . 4-0 Waiver Fee $ _
Date of Pavment / (�� Date of Payment
Receipt Number (/ e�� Receipt Number
Rev. 8/95 OSS: haa.wk.doc
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ROBERT C. CO\
CE - 8001
are