HomeMy WebLinkAboutMCKINLEY HEIGHTS #1 BLK 6 LT 2McKinley
Heights
lock 6
Lot
O§
Municipality of Anchorage e " °°•
Development Services Department
•�:1
Building Safely Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-79D4
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030338
PID Number: 051-213-05
Name:
Richard Mount
Wastewater System: ❑ New ® Upgrade
Address:
PO Box 670316 Chualak. AK.
99567
ABSORPTION FIELD
Phone:
Number of Bedrooms:
® Deep Trench 0 Shallow Trench 0 Bed 0 Mound C3 other:
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
1.2 GPD/Fir
7 Ft.
Block: Lot: Subdivision:
2 6
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
McKinley Heights No. 1
3.4 Ft.
3.6 FL
Township: Range:
Section:
Fill added above original grade:
Gravel Length:
0.4 — 0.99 Ft.
41 Ft.
Well: El New El Upgrade
Gravel width:
Number of lines:
Distance between knee:
5 FL
FL
classification (Private, A, B. C):
Total Depth:
Cased to:
Taal absorpuon area:
Pipe Material:
Private-Existing
Ft.
Ft
375 Fts
D3034 & F810
Driller:
Date Drilled:
Static Water Level:
Installer:
Date Installed:
Ft.
Calkins Const.
9/3/03
Yad:Pump
Set at:
Casing Height Above Ground:
TANK
GPM
FI.
FI
SEPARATION DISTANCES
® Septic ❑ Holding ® S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
PubliclPrivat
anuacluier:
pauty:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1250 Gal.
Well
100'+
100'+
NA
NA
2$'+
Material:
Numberof Compamnents:
Steel
2
Surface Water
100'+
100'+
NA
NA
LIFT STATION
La Line
5'+
10'+
NA
NA
tze.anu
ac urer:
Gal.
Foundation
5'+
10'+
NA
NA
'Pump on le"el al:
'Pump off level at:
High water alarm at:
in.
In,
in.
curtain Drain
NA
*509+
NA
NA
Pump Make d Model
Electrical Inspections performed by:
Remarks:
*none known
BENCH MARK
Previously existing septic
system
Location andDescription:
Top of sana tube
abandoned. Pre-tank line,
tank &
Assumed Elevation:100
FL
field insulated. Grinder pump/basin
installed inside foundation.
Engineees Stamp
y�P,�E•OF.q4.gs�
Inspections performed by: KND Engineering,
Inc Bt 9/3/2003
i
.Dates:
Asea. ......«......... .:..•
2nd 9/3/2003
/ Will.04"0006 ..•• ..•.
Developmen ervices Department Approval art" lolzo11o3
ro-; Kenneth M. D : :1
Reviewed and approved b .
PP Y
Date: /o I-z' uT
J+•• CE 7116
��� 9F� a•........••••� ��r"�
(Rc%, 1'--'00)
1���FESSI _•a
AS -BUILT SYSTEM DETAILS/SITE .PLAN Permit SW030338
MCKINLEY HEIGHTS SUBDIVISION, ADD. #1, BLOCK 6, LOT 2 PID4051-213-05
SLOT! - MT
LOT 2
3
SCALE, 1' _ 5D-�
A -C= 33.3' 00.33 100.1 9 9
B -C=11.8' N g
A -D=12.4 6 � ! 100.2 FINAL GRADE 99.6
B -D=12.4'
A-E= 42.7' 11
MIN 7 T rARIc a DSIAA,m
vAR11
B-E= 29.1' A 1250 GAL
A -F= 72.6' d /� SEPTIC 95.81 95.8
B -F= 43.71 " /. TANK M : II :-::::::: ' 'SEWER ROCK II QE as•
PREPARED FORT SCALE, NTS 84 2
RICHARD MOUNT
P.O. BOX 670316
CHUGIAK, AK 99567
(907) 688-5437
FlELD BOOKS I COMPUTED:
BOUNDARY: NA DRAWN:
STAYING: NA
CHECXM:
ASBUar: NA
DATE.
DWG. FILE:
GRID:
AGAD ^LE' 03071.DWG I JOB N" 03071
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
BI11
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW030338
Legal Description:'MCKINLEY HEIGHTS #1 BLK 6 LT 2
Design Engineer: 0070 KND Engineering
Owner Name: RICHARD MOUNT
Owner Address: PO BOX 670316
CHUGIAK . AK 99567-0316
Date Issued: Aug 27, 2003
Expiration Date: Aug 26, 2004
Parcel ID: 051-213-05
Site Address: 021808 ROBIN DR
Lot Size: 34412 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[A Disposal Field Z✓ Septic Tank Holding Tank Privy E] Private Well Ej 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 engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
9-2-0 5 .9ijei 76 -G (G(J %c,ci
l h$ ;Ole,, vJi oa
Received By.
Issued By:
h i yi- / /r 11`1 le;- V/ hili Y ,b G�
C0MW O. 7�Vx
91Z9�j ?
Date:
Date: g 2 710
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Property owner(s) Richard Mount
Mailing address (1) PO Box 670316: Chugiak; AK 99567
-Maitit~ddress (2) '2/,~O~ /~O~l/v' J?/~l I/F. / ~_/'-//4'~-/,~/~
Legal description (Lot; Brock & Sub'd.) McKinley Hts.; Add. #1; Block 6; Lot 2
Legal description (Section, Township & Range)
Lot Size
Acre~
Number of Bedrooms 3
Day phone~__
Zip Code
THIS APPLICATION IS FOR:
Sewer Only [] Well Only
Sewer and'Well [] Water Storage
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub [] Jacuzzi
Swimming Pool [] Water Softening Unit
Therapy Pool []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Sign~.u~o~er or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev, 12/00)
waiver Fees:
Date of Payment:
Receipt Number:
~ND ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
August 26, 2003
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Sewer Upgrade Permit - McKinley Heights, Add. No.1, Block 6, Lot 2
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. The existing tank has collapsed and the existing septic system is within the 100' well
radius. On August !9, 2003 one testhole was performed for the proposed system. The
results of these tests are attached. The general slope of septic upgrade location is flat.
We have designed our system utilizing the existing testhole that was excavated for the
existing 3-bedroom house. The lot is served by an individual well, located on the south-
central portion of the lot. We propose to install one 5' wide shallow trench. Water was
not encountered during the excavation and measured at 12.5' during monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lOts by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
~D Engineering
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
Owners/Excavators Specs
WELL
WASTEWATER
MCKINLEY HEIGHTS
DISPOSAL SYSTEM DETAILS/SITE PLAN
SUBDIVISION, AD]], #1, BLBCK 6, LnT 8
BLI
LOT 2
3
DESIGN DETAILS
3 BDRM X 150 GPO = 450 GPO
450 GPO/L8 GPO PER SQ, FT, (<1 MIN/IND= 375 SQ, FT
(375/5'(W)) X ,54(RF) (3,5' GRAVEL) = 40,5 FT, TRENCH
USE 1 TRENCH - 41 (L) X 5' (W) X 3,5'(D)
To'cai dep~ch oF system is 7,0' ~om opi~inal opade,
To~al depth oF g~ave{ below distribution pipe is 3,5',
PRESSURIZED SYSTEM DETAILS
1, RESIDUAL HEAD = 5'
8, HOLE SIZE = 3/16' = 1.O0 GAL, PER HOLE 8 30 PSI
3, 30 GALS (PUMP DELIVERY)/1,00 GALS,/HDLE = 30 HOLES
4, 41 LF LATERAL/30 HDLES = 1,367' SPACING PER HOLE
5, ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS.
NDTES~
1. USE 1500 GALLDN S.T.E.P, TANK, INSULATE IF <4' DF CDVER.
INSULATE TRENCH WITH 8' HD BURIAL FDAM.
3. CDNTRACTDR WILL ENSURE MINIMUM 87. SLDPE INTD SEPTIC TANK,
4. ADDITIDNAL FILL WILL BE ADDED DVER SYSTEM TD ACHIEVE
MIN. 3' CDVER IF REQUIRED.
.~...'"~'~'~""~ 5, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FDUNDATIDNS AND ALL DTHER SETBACKS.
PREPARED FOR:
RICHARD MOUNT
P,D, BOX 670316
CHUGIAK. AK 99567
(907) 688-5437
FIELD BOOKS ¢OUPUTEg:
~Ra~: VBG
CH£C~EO: KMD
~^~ 8/25/05
c~o: NW1058
^cA F~LZ: 03071.DWG ao~ No.: 03071
Scale; 1d= 100'
PAGE 1 OF 8
~f~ ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696,6111/FAX (907t696-8111
WaSTFWAT£R ]}ISPF1S,aI_ SYSTFM 9FTalL. S
MCKINLEY HEIGHTS SUBDIVISION, ADD, #1, BLOCK 6, LOT 2
PROPOSED
SYSTEN
EXISTIN~SLOPE
SEPTIC PiT
TO BE
AI~ANC PROPO~
GAL
FLAT
03~:i
~E
PREPARE]] FDR:
RICHARD HBUNT
P,D, BOX 670316
CHUGIAK, AK 99567
(907) 688-5437
scc[e~ 1'=
PAGE ;~ DF a
FIELD BOOKS co~Pu1~-o:
DRAWN; VBG
STAKING: NA CHEO<~0: KMO
A~U~T: N A
o~. n~: o~o: NW1058
~~) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
^CA~ nL~: 03071.DWG ~o~ No.: 03071 696--6111
~ND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for: Richard Mount Date
Project: McKinley Hts. Add. #1, B6, L2 TEST HOLE # 2003-1
2-
3-
4-
5-
6-
7-
8-
9-
18-
Depth
OL/ORG
GP/SP - broWn/gray, sandy
gravel w/occ, cobbles to 1'
cOarSe sand and moisture
increasing w/depth
SW/SM - moist gray sand w/
trace of silt- increasing w/depth
B.O.H.
Insitu material suitable as filter
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? 12.5' Date? 08/26/03
Reading Date Gross Net Depth to Net
. Time Time Water _Drop
1 8/19/03 1:00 6'
2 1:05 5 min dry 6'
3 * 1:06 · 6"
4 1:11 5 min dry 6'
5 * 1:12 6"
6 1:17 5 min dry 6"
7 * 1:18 6"
8 1:23 5 min dry 6'
9 * 1:24 6'
10 1:29 5 min dry 6"
11 * 1:30 6"
12 1:35 5 rain dry 6'
· Water Added
19-
20-
HOLE PRESOAKED
PRIOR TO TEST
Percolation Rate < I (rain/in) Perc Hole Diameter
Test Run Between 4 feet and 5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
(907) 696-6111/FAX (907) 696-8111
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS
LEGAL DESCRIPTION: McKinley Heights, Add. No. 1, Block 6, Lot 2
GENERAL:
1. The scope of this project includes the installation of a septic tank and/or drainfield to serve a
single-family residence on the referenced property as delineated on the attached Municipality of
Anchorage (MOA) permit and site plan.
2. Construction shall be in accordance with the approved site plan and design drawings; MOA
permit with any special provisions or conditions, m~d all applicable State and Municipal
Wastewater Disposal Regulations.
KND Engineering, Inc (KND) assumes no responsibility of the accuracy of the as-built survey
. provided by the owner.or owner,s representative ......
The owner or contractor is responsible to notify the engineer of any discrepancies n0t a On the
design plans or drawings prior to commencing work. These discrepancies could be, but not
limited to, possible encroachments, surface water, varying soils, unplatted easements, types or
use of dwellings on or adjacent to property, nearby public wells, etc.
5. The contractor shall be responsible for locating any necessary underground utilities, easements,
property lines and surface water. The owner and/or contractor shall ensure, if deemed
appropriate, that a registered land surveyor prior to construction flags all setbacks.
6. The contractor shall be responsible for verifying all pertinent separation distances and
component layout.
7. Unless specifically agreed otherwise, the property owner shall be responsible for final grading
areas 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.
8. The MOA Development Services Department On-Site Water & Wastewater Program must
certify contractors installing wastewater disposal systems. Owners installing their own systems
must also receive prior approval from said MOA Department.
SEPTIC TANK / HOLDING TANK / LIFT STATION INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction. shall
include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded with proper material and compacting to prevent
damaging, settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade.
4. Septic tanks installed with less than 4 foot of cover shall be insulated. The contractor will
ensure that the fill over the tank does not exceed the burial depth rating.
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 feet from the tank. The second cleanout, in line, 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.
Page 1 of 3
Reference: McKinley Hts. #1, B6, L2
Date: 08126/03
Page: 2 of 3
7. All H.D.P.E. tanks shag have a vertical length of 4-inch perforated drainpipe besides the tank
extending to the bottom of the tank to above grade to monitor ground water.
8. All tanks shall be anchored when there is not enough adequate soil cover to resist buoyancy
forces in high-groundwater areas.
9. All holding tanks and lift stations shall have an audible and visual alarm inside the residence.
10. All lift stations shall be wired in compliance with the Uniform Electrical Code and all MOA
guidelines.
11. The contractor shall remove the old tank, or abandon it in compliance with the Uniform
Plumbing Code. The contractor is solely responsible for the abandonment procedure.
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 excavaction become smeared,
they must be raked or scratched (roughed-up) before gravel (sewer rock) placement.
2. Once the sewer rock is installed, the distribution pipe is installed level with the perforations
facing 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..M0ni~orin. g tubes..shall be four- (4) ~ch diametert ~talled approximatelY.in the 10cation.s
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 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.
6. All advanced technology waste water disposal systems (Advantex, Biocycle, Intermittent
Dosing Sand Filter, etc...) shall be constructed, installed, maintained and monitored per
manufacturer's specifications and MOA requirements.
MINIMUM MATERIAL SPECIFICATIONS:
1. A MOA approved septic tank manufacturer must construct any septic tank proposed for
installation.
2. The following pipe materials are MOA approved for use in septic system installations:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
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 #200 sieve. If deemed necessary, a sieve analysis should be performed.
7. When sand is being used as a filter material, its gradation specification must conform to current
MOA or DEC requirements.
Reference: McKinley Hts. #1, B6, L2
Date: 08/26/03
Page: 3 of 3
INSPECTIONS:
Typically there will be 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 sewer rock, distribution
lines, standpipes, and cleanouts, but before the placement of the silt barrier, insulation, or 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. The inspecting engineer is to be contacted
at least 24 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 contractor's
activities.
The owner shall contract with the contractor to perform the work outlined in these specifications and
attached plans and in accordance with the attached MOA permit. All materials, components, and
construction practices shall comply with the MOA's and the Sta~e of Alaska,s latest ordinances,.
regulations, or policies regarding wells and septic Systems. The failure of the inspecting engineer to
notice a material or construction non-compliance does not relieve the contractor of his/her
responsibility to correct such deficiency. There will be no contractual arrangement existing between
the contractor and KND Engineering, Inc. KND shall be the owner's representative and will inspect the
work as stated above to document the contractor's activities. Final acceptance of the contractor's work
rests with the owner and the MOA.
KND 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. KND's inspecting engineer will not be responsible for
the construction means, methods, and techniques, sequence, procedures or the safety precautions
incident to this project.
BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER AND/OR
WASTEWATER SYSTEM (S), THE PROPERTY OWNER~ CONTRACTOR, AND WELL DRILLER
ACKNOWLEDGES HAVING READ AND ACCEPTED THESE SPECIFICATIONS.
Owner: Contractor:
NOTE: EXCAVATOR SHALL HAVE THE WELL RADII MARKED
PRIOR TO CONSTRUCTION.
GP"ATER ANCHORAGE AREA BORO~'~H
HEALTH DEPARTMENT NO.
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
533
INSPECTION REPORT ON-SITE SEWAGE DI?>gSAL SYSTEM
NAME:, ' ~ ADDRESS ~)¢~ ~ ~ ~' ~ ~' ~ PHONE
LOCATION
SEPTIC TANK: / / // J
~iSTANCE FROM WELL ~'J -~ ~ NUMBER OF
MATERIAL COMPARTMENTS
LIQUID CAPACITY ~'z~ GALLONS. INSIDE LENGTH~~ ~/ ~J /~ ~LIQUlD
.INSIDE WIDTH DEPTH ~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS I OUTSIDE DIAMETER OR WIDTH / ~L~ ,LENGTH ? ~' , DEPTH
LINING MATERIAl ~ ,~' ,~ DISTANCE FROM WELl. BUILDING FOUNDATION
NEAREST LOT LINE ~ '~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTA NEAREST LOT LINE. OF LINES.
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
d~ DISTANCE FROM WATER
WELL: TYPE~ ~ 1 ~! ; DEPTH , BUILDING FOUNDATION. SAMPLE NEAREST
NEAREST SEPTIC ~(,~C SEEPAGE /~ ,~ OTHER
, , SOURCES
LOT LINE . SEWER LINE , TANK ~ , SYSTEM CESSPOOL
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED[ Y '~-~ J""'7 ': '
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
~,~" ~/~f..~c~?'/::C-/~r/x.:'/Jjp~
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS //~
COMPLETION DATE ANT,CIPATSD /?:/
SEEPAGE PIT. , DRAIN FIELD . , OTHER
~.~"~/~,~/~-~/) O.~y/ NOTE: THi~ PERMIT I~ NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ~,:~ TYPE 'g;--~--'¢¢/--'~ /'~Z~'~-~/~
MINIMUM DISTANCES, REQUIREMENTS
SEPTIC TANK TO BEEPAGE PIT WALL /~
WELL TO SEPTIC TANK
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
, DRAIN FIELD
ALSO CONSIDER AREA WELLS.
, SEEPAGE PIT
SEPTIC TANK, ,;~-~-~ SEEPAGE PIT ,~2~ / , DRAIN FIELD '¢~
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
~EXLTH AU~-HORITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE With SAID CODE.
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-213-05
1. GENERAL INFORMATION
Expiration Date: C —:J ® — 2®ze
Complete legal description McKinley Heights #1 Block 6 Lot 2
Location (site address) 21808 Robin Drive Chuqiak, AK 99567
Current Property owner(s) Thomas M. Craig ' Day phone
Mailing address
Real Estate Agent
21808 Robin Drive Chugiak, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Individual
Individual Well
®
Holding Tank
❑
Individual Water Storage
❑
Community
❑
.Community Class —Well
❑
Public Sewer
❑
Public Water System
❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 56-D Waiver Fee $
Date of Payment 3/;z /_/ Lao 20 Date of Payment
Receipt Number 666316 Receipt Number
COSA #D c5 C g61114 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-ske 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 _ARCTERRA CONSULTING, INC. Phone 696-6111
Address _ 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date -S12.0 z
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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 well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future ate\
occupants or can ArcTerra guarantee that no unseen i OF A��
encroachments, deficiencies or discrepancies exist.
! * 49TH'.
6. DSD SIGNATURE
4 System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
bedrooms.
9 KENNETH M.
7116
lla AW
.Conditional approval for bedrooms, with the fol1QWRk
Oil -SITE r
--
piv2ATER�=
1
PRC7Of,P,M
11E}}11}1���
Original Certificate Date: 3' �� I - 202r?
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
Legal Description:
COSA Checklist
McKinly Hights #1 Black 6 Lot 2
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth 86 ft
Cased to 40 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 19 in.
Date of flow test for COSA 3/13/20
Static water level at beginning of test 27 ft.
Comments **:Well flow test preformed by Sullivan Water Wells
B. TANK DATA
Age of tank(s) 17 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49
0 Standpipes/foundation cleanout per record drawing
Date of pumping 3 .11 –Z 0
D. ABSORPTION FIELD DATA
Parcel ID:
Structure served by this system i
051-213-05
Well production at time of test 1.1 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes No
® Coliform bacteria is Negative
Nitrate 14.0* mg/L ElNitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by Areterra Consulting
Date of Sample 225/20 & *3/13/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift'station years
Lift station material
Comments:
Which system tested (date installed) 9/3/03
Adequacy test date 32/20
® ALL standpipes present per record drawing
Results ❑✓ Pass For 3 bedrooms
Total measured depth from grade 8.75 ft (max)
Fluid depth prior to test 4 in
Measured depth to pipe invert from grade --L—ft (min)
Water added 600 gal
❑ NIA – pressurized field
New depth 16 in
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Elapsed time 30 min
® Code -required soil cover over field
Final fluid depth 4 in
® System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 2000 gallons
If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
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
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
0 Yes
if No . ft
Neighboring Tank> 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25'Z Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
0 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
Surface Water > 100'
Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
0 Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
0 Yes, if No ft
Water Service Line > 10'
® 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
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 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..
COSA Checklist yellow sheet
DEVELOPMENT SERVICES DEPARTMENT
On -Site water and wastewater Section
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC201116
Subdivision: McKinley Heights #1, Block: 6, Lot: 2
A water sample revealed a nitrate concentration of 14.0 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
R,
Ma�Ung Address P O Box 196650 * Anc�iorage, Alaska 99519 6650 *www murn org 4
907-343-7904
Fax: 343-7997
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC201116
Subdivision: McKinley Heights #1, Block: 6, Lot: 2
A water sample revealed a nitrate concentration of 14.0 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
R,
Ma�Ung Address P O Box 196650 * Anc�iorage, Alaska 99519 6650 *www murn org 4
lot ULLIVAN
WATER WELLS
Drilling • Piling • Pumps
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259
TO: Dea Duffus
JOB LOCATION: 21808 Robin Drive
Chugiak, AK 99567
Flow Test Report
Flow test after liner installation
Resting Static: 27'
Max draw down: 76' (pump intake)
Well Yield: 1.1 GPM
Date: 3-13-20
TO: Tom Craig
TERMS: 1 ½ % interest per month on unpaid balance
QTY. DESCRIPTION OF WORK PRICE AMOUNT
1 Well Camera – High Nitrates
Static 14’
Pump at 79’
Casing ends at 8’ with small amount of water entering at that level.
Pitless at 4’.
Return to re-camera while drawing static down to identify any other
aquifers/water bearing fractures in well. Found at 32’, 42’, 59’, AND 70’.
N/C
Total: $400.00
No discounts will apply if invoice is not paid within 30 days.
If paying with credit card please add a 3.75% credit card fee.
If invoice is not paid within 90 days a lien will be placed on the property.
Thank you,
Bill & Cole Sullivan
DATE COMPLETED:
3/5/2020
WORK ORDERED BY :
PHONE
907-360-9728
DATE OF ORDER
3/5/2020
ORDER TAKEN BY CUSTOMER ORDER NO.
DAY WORK CONTRACT EXTRA
JOB NAME/NUMBER
JOB LOCATION
21808 Robin Dr
JOB PHONE
907-360-9728
STARTING DATE
3/5/2020
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259
TO: Dea Duffus
JOB LOCATION: 21808 Robin Drive
Chugiak, AK 99567
Nitrate Liner Report
Date: 3-13-20
4" Liner installed to 40'. Grouted annular seal with tremie pipe from bottom (shale trap) up.
Received Date/Time 02/25/2020 13:25
02/25/2020 12:30Collected Date/Time
1200736001
Matrix
SGS Ref.#
Client Sample ID 21808 Robin Drive
Client Name
Project Name/#
Printed Date/Time 03/04/2020 14:14ArcTerra Engineering and Surveying
Technical Director Stephen C. Ede
McKinley Hts #1 B6 Lot 2
Drinking Water
Sample Remarks:
Parameter Results LOQ Units Method
Allowable
Limits
Prep
Date
Analysis
Date InitContainer ID
Metals by ICP/MS
DMM03/03/20EP200.8ug/LArsenic 02/28/20ND5.00 (<10)B
Waters Department
EWW02/28/20SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 13.4 0.400 (<10)*C
Microbiology Laboratory
M.A02/25/20SM21 9223B100mLE. Coli Negative 1 A
M.A02/25/20SM21 9223B100mLTotal Coliform Negative 1 A
2
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-213-05
GENERAL INFORMATION
Complete legal description
Location (site address) 21808 Robin Drive, Anchorage, AK 99567
COSA # O ~ ~/\1 {~C:~
Expiration Date: _,-~* ~ .5-"*- / /
McKinley Heights Subdivision, Block 6, Lot 2
Current Property owner(s) Richard and Ruth Mount
Mailing address P.O. Box 670316 Chugiak, AK 99567
Day phone
Lending agency
Day phone
Mailing address
I~al 'Estate ~gent
Mailing Add?~s
U~.(e~s'othe. g/visb, fb~uested, COSA'will be held by DSD for pickup.
NUMBER OF BEDROOMS: Three (3)
Day phone
'TYPE Q.F WATER SUPPLY:
IndividU~l'Well []
Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
~/ Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date 5/17/2011
bedrooms, with the following stipulations:
By:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
dginal Certificate Date: '-~- ~,- ~"~'~ / /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Lot 2, Block 6, McKinley Heights Subdivision
Parcel ID: 051-213-05
Well type Private
Date completed 10/20110
Total depth 86 ft.
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to 20 ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D .ug/I
SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal.
Foundation cleanout (Y/N) Y
Date of pumping 7/16/10
ABSORPTION FIELD DATA
g.p.m..
Well Log (Y/N) ~ ~
Wires properly protected (YIN)
Casing height (above ground)
AT INSPECTION
4/18/2011
18.5 ff.
1.1 g.p.m.
>18 in.
Date installed 9/3/03 Soil rating (g.p.d.lft2 or ft21bdrm) 1.2 GPD/SF
Length 41 ft. Width 5 ft.
Total depth 8 ft. Eft. absorption area 375 fl~ Monitoring tube
Date of adequacy test 4/18/11 Results (Pass/Fail) Pass
Fluid depth in absorption field before test' 13
Elapsed Tim~: 1,440 min, Final fluid depth 13
Any rejuvenation treatment (past 12 mo.) (YIN & type)
System type. 5' Wide Trench
Grave! below pipe 3.6 ft.
Y .Depression over field N
For 3 bedrooms
in. Wateradded 750 ~gal.' Newdepth 19 in.
in. Absorption rate >= 450 g.p.d.
N If yes, give date
Number of Compartments Two
Depression over tank (Y/N) N
Pumper Sanitary Pumpers
Date installed 9/3/03
Cleanouts (Y/N)
High water alarm (Y/N)
Nitrate 6.80 mglL Other bacteria colonies/100 mL
Date of sample: 5/4/11 Collected by: A. Harela
De
LIFT STATION
Date installed
"Pump on" level at~
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
'Pump of~' level at~
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
in.
Septic tank/lift station on lot >1oo'
Absorption field on lot >1oo'
Public ~ewer main NIA t
Sewer/septic service line >25'
Animal containment areas >50'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
in.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main >10' Water service line >10'
Wells on adjacent lots >150'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >to'
Curtain drain None Noted
N/A
>100'
F. COMMENTS:
Absorption field >5'
Surface water >100'
Building foundation >10' Water main >10'
Surface water >100' Driveway, parking/vehicle storage >25'
Wells on adjacent lots >150'
,
G. ENGINEER S CERTIFICATION
' ~a ~s that the above sy~ems am in
~n~an~ w~h MOA COSA guidelines in e~ on this date.
Engineers Pd~ed Name Mi~el E. ~demon, P.E.
Date 5/19/2011
COSA ~ee ~ ~ 0 ~ ~a~ve~ ~ee ~
Date of Payment ~ / ~ ~ ~) Date of Payme=
Re~ipt Number ~ ~ ~ Re~ipt Number
(Rev. 11/05)
Municipality of Anchorage
Community Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 111169
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 6, Lot 2 of
McKinley Heights #1 subdivision. This inspection revealed a nitrate
concentration of 6.8 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
SG,S .....
SGS Ref.# I! 11702001
Client Name Anderson Engineering Printed Date/Time 05/13/201 I 8:14
Project Name/# McKinley Hght Sub Add#1 Lt2 B6 Collected Date/Time 05/04/20! ! 20:50
Client Sample ID pp well water from hose bibb Received Date/Time 05/05/20! ! 8:49
Matrix Drinking Water Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/05/1 I 05/09/11 NRB
Waters Department
Total Nitrate/Nitrite-N 6.80 0.100 mg/L SM20 4500NO3-F B (<10) 05/05/1 I AYC
Microbiology Laboratory
Colony Count 0 col/100mL SM20 9222B A (<200) 05/05/11 SDP
Fecal Coliform 0 col/100mL SM20 9222B A (<1) 05/05/11 SDP
Total Coliform 0 col/100mL SM20 9222B A (<1) 05/05/11 SDP
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
Lot 2, Block 6 McKinley Heights
Well cased to 20' with bedrock from 20' to 86'. No liner in well and no perforations noted with
camera.
Brian R. Wille
Aarow Pump & Well Service LLC
/ SETnC
2.4-'x30.2' SHED
LOT 3
~'x 12.2'
8.2'xl 6.3'
GREEN HOUSE
LOT 2
33,803 S.F.
STORY RESIDENCE
100' PROTECTIVE WELL RADIUS
PLOT PLAN
AS BUILT X SCALE 1' = 50' GRID NW 1058 Project No. 11-036
Lo ng (907) 522-6476
Registered Lend Surveyors (907) 522-4625
kenOlangsurvey, com/ JonathanOlangsurvey.¢om
&: AssocJofes, inc. ::soo Daryl Avenue, Anchorage, Alaska 99515-3049
Phone
Fax
I hereby certify that I have surveyed the following described properh/:
LOT 2, BLK 6, McKINLEY HEIGHTS SUBD, ADD ~1, (PLAT P-629)
Anchorage Recording District, Alaska, and that the impravemenf~ situated thereon are
within the properly lines and do not encroach onto the properly adjacent fheralo, fhal
no improvements on the praperb/ b/lng adjacent theralo encroach on the surveyed
premises and that there are no roadways, fransmlsMon lines or other vlMble
easemenf~ on said properly except as indicated hereon.
Dated this the .~uf~ Day of ~(~cL. , l~t( , at Anchorage, Alaska
If is the responsibility of the owner fo determine the exi~fence of any easemenl~,-
covenants, or re~frlalions which do not appear on the recorded subdivision plat.
Parcel I.D. #
1.
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
GENERAL INFORMATION
Complete legal description
T15N R1W Section 16
Location (site address or directions)
21808 Robin Drive, Chugiak
McKinley Heights #1, Lot 2, Block 6
99567
Day phone 688-5437
Property owner Co] ] ins & Ruth Mount
Mailing address P.(~- F~× 670316, C-hugiak, AK
Lending agency Lynn/City Mortgage
Day phone 694-8505
Mailing address 11401 Old Glenn Hwy., Eaqle River, AK 99577
Agent N/A Day phone
Address
Unless Otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 '%,
TYPE OF WATER SUPPLY:
Individual well x
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site x
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State AD£C
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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 Eaqle River Enqineerinq Services
Phone 694-5195
Address _ p n Pox 773294, ~.anl¢ p4vCr; AK 9_q577
Engineer's signature ~~'
Date
o
DHHS SIGNATURE
/~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72A325 (Rev. 1/91) Back MOA #21
n '
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: MOK/NLEi Hf1(7hr/S lor2 � Parcel I.D.
Ti514 /2/w 5afoN16
A. WELL DATA
Well type &W,466 If A, B, or C, attach ADEC letter. ADEC water system number W14
Log present (Y/N) NO Date completed Z9 *7/ /' Driller /2I4KI
Ci6!y
Total depth - 9 Si (/NSp 122T� Cased to
Acs. ~,( ryD °' "Casing height
9
�
Sanitary seal (Y/N) yE5
Wires properly protected (Y/N) y6s
rn
WELL LOG
AT INSPECTION
zDateFROM
Date of test
Gf �o�s�
07 -
C
$
Static water level
2 rL
ro
Well flow
rni"1
g.p.m. O. 6 g p m,<
11
-
T
< z
Pump level
77
^'
00
ZZ
'
N
r�
SEPARATION DISTANCES FROM WELL TO:
z
Septic/hefdtrrg tank on tot :5 07 TNrn�� d. Ec ; On adjacent lots
Absorption field on lot //0
; On adjacent lots
Public sewer main Public sewer manhole/cleanout 1114
P/2/VAle
Pttb sewer service line Z r..r..r fc Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate /Y'q �L Other bacteria 144*�K
Date of sample:6�11019 2 Collected by: FNC�/NE��
B. SEPTICI**LBfNfl TANK DATA
Date installed Tank size 5,9 Compartments Z
Cleanouts (Y/N) %SES Foundation cleanout (Y/N) yES Depression (Y/N) /1d
High water alarm (Y/N) Alarm tested (Y/N) N�A
i
Date of pumping 0Coygz9 SW S
SEPARATION DISTANCES FROM SEPTIC/HGLINNG TANK TO:
Well(s) on lot 515 / On adjacent lots 71-/0D / Foundation 4 3 J
To property line *Idr Absorption field 39� Waterawi4Wserviceliner�O�
>�
Surface water/drainage _� NZA ,
7228 (Rev. 3/91) Front MOA 21 k\ CONTINUED ON BACK PAGE
C. LIFT STATION '
Date installed
Size in gallons
Vent(Y/N)
"Pump on" level at .
High water alarm level
Meets MOA electrical codes
,.
SEPARATION DI CE FROM LIFT STATION TO:
Manufacturer
nhole/Ac.rmY/N)
"Pump off' level at
Cycles tested —
Well On adjacent lots Surface water
D. ABSORPTION FIELD DATA /
Date installed 7Z2/7Soil rating _e-6 System type 217-
Length
/TLength Width -Gravel thickness 6 Total depth $. S
Total absorption area -3 3 C Cleanouts present (Y/N) YGc�
Depression over field (Y/N) ND Date of adequacy test 0&210197,
Results (pass/fail) /��9SS for bedrooms
Peroxide treatment (past 12 months) (Y/N) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot r�00 On adjacent lots 21-101.)l Property line try
To building foundation �%� To existing or abandoned system on lot N41
On adjacent lots f 3 U Cutbank NIA Watermetifl/service line riv
Surface water N�'`( Driveway, parking/vehicle storage area *'iv
Curtain drain NONE A�P4LE/47'
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
rdG f3Fe'�E
Signature '� ,•. •Y '''1�n
Engineer's Name
(L�/L/17-1
Date �. ll � .., ............:... �.
;lout: A. Buten
3:p �ROFr� l�*�Y ,.
HAA Fee.$ _ 170 - JD Waiver Fee: $ ~ ,
Date of Payment — — Date of Payment
Receipt Number Z Z Receipt Number
72-026 (Rev. 3/'81) Back MOA 21
Eagle River Engineering
P.O. Box 773294
Eagle River AK 99S77
Attn= Louis Butera
3330 INDUSYRIAL, AV.=NUB
2505 FAIRBANKS STRfBT
NORTHERN TESTING LABORATORIES, INC.
FAIRI~ANK~, ALASKA 99701 (907} 45~.3116 ,, FAX 456-3125
ANCHORAGE, ALASKA 99803 (907) 277.8378 · FAX 274.9645 '
Report Date= 06/15/92
Date Arrived: 06/11/92
Date sampleS: 06/10/92
Time Sampled= 1645
Colleoted By'= LB
Our Lab #:
Location/Project:
Your Sample IDs
Sample Matrix~
Al18041
McKinley Height~ 2/6
Water
MDL ~ Method Detection
Limit
Flag Definitlions
B = B~low'Regulatory Min.
H ~ Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Method Paramster Units R~$ult Flag MDL Analyzed
EPA 353.3 Nitrate-N mg/1 1.8 0.1 06/11/92
Reported By: Susan C. T~f~ntal
Microbiology supervisor
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
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)
(b)
'
Location (address or directions)
Property Owner /'~/'J irma
Mailing Address
Telephone: Home Business
3201 C Street, Anchorage, Alaska 99510
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e)
Mail the HAA to the followine 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
Well'~ Community [] Public []
Individual
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 Front
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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
Address '~- ~'~,,~
Date /'~--~ / /
Telephone
DHHS APPROVAL
Approved for 2'~ ~.~.2 bedrooms by
Approved .... ~ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Municipality of Anchorage Depadment 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 DHHSdoesthisasacourtesyto purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2 72-025 IRl~v 8/861 Back
OF P�Ct10oPG OlS
e� ti
RQ C
A. WELL DATY1
1`0 ')
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4744
/'1
Legal Description: LXT I / 8LOCk�6`
m�lanit.EY H�Ic�KTs syeaU
Well Classification Pf1' Uf» If A. B. C, D.E.C. Approved (YIN)
Well Log Present (YIN) Date Completed !97! Yield 'rNf57 �T �.8 rPM
Total Depth %R'f if- Cased to Esf.V.4/'r78Depth of Grouting
Static Water Levellkl57M - Pump Set At UNK
Casing Height Above Ground Sanitary Seal on Casing (YIN) YES
Electrical Wiring in Conduit (YIN) yes Depression Around Wellhead (YIN) �Jo
Separation Distances from Well: 1
To Septic/Holding Tank on Lot Jr4 (OK AT INSTML) ; On Adjoining Lots F 100
To Nearest Edge of Absorption Field on Lot 4 (00r ; On Adjoining Lots + I Opt
To Nearest Public Sewer Line +10o, To Nearest Public Sewer
Cleanout/Manhole +151 To Nearest Sewer Service Line on Lot t ZS
Water Sample Collected by LA0PFCA R Date
' T
Water Sample Test Results J6AW?_F�
Comments Fr.Nr O N Hs DAtA
B. SEPTIC/HOLDING TANK DATA
Date Installed Size 12.50 No. of Compartments Z
Standpipes (YIN) YES Air -tight Caps (YIN) y125 Foundation Cleanout (YIN) Yes
Depression over Tank (YIN) O Date Last Pumped 1/7-4 19e
Pumping/Maintenance Contract on File (YIN)
Holding Tank High -Water Alarm (YIN)
;for
Temporary Holding Tank Permit (YIN)
Separation Distances from Septic/Holding Tank: /
To Water -Supply Well 5!f AT I10 To Building Foundation 44
r r
To Property Line -1- To Disposal Field
i
To Water Main/Service Line 4-10To Stream, Pond, Lake, or Major Drainage
Course f ($Q
Comments 25 r r2t)Wau
Page 1 of 2
72-026 IP" 8.861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata g5 / 6P(LM Type of System Design
Date Installed 7171 Length of Field 14 -
Width of Field r4" Depth of Field 6
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
I Gravel Bed Thickness
A33G Standpipes ES Present (Y/N) Y
00 Date of Last Adequacy Test f�2�1 gS
si'MsFA92P l for, 25 &D-8-0
Separation Distance from Absorption Field: I f
To Water -Supply Well (15f To Property Line /0
To Building Foundation f {OZ •� To Existing or Abandoned System on
Lot -410 ; On Adjoining Lots -4-10 ,
e
To Water Main/Service Line + To Cutbank (if present) IJP- I�SFrl�r
To Stream/Pond/Lake/or Major Drainage Course 4150
To Driveway, Parking Area, or Vehicle Storage Area 4 10 �
Comments
D. LIn TATION NA
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) —
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
•• Check Permitted Bedroom Rating Against HAA Request e•
certify that have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed {N- � e _ .. Date r1ab 11,
%g pg
Company
Receipt No. o` `
Date of Payment
fel MOA No.
C)
0
Amount: $ O �
Page 2 of 2
72-026 (Rey 61661 Back
4�OF A1,4ttj
e
oo
�rN 4' TH
ee.e �...:...�
�i,..i. ...... ....• 0
Q
Cary .Mea /
�• 353 �j
III
••. .•••'"�C'es
B111% ROFESSONP��
00meae�®'
fe
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tom^=; Car �y S. Menet W
��� ��•.� 353 VV •: �`"� /
pROFESSI�N��
LOCATIO�\��sv��
Client's Name:
Address:
BESSE, EPPS & POTPS
2220 FAST 88 AVENUE
&4CH RAGE, AR 99507
(907) 349-6451
WATER WELL TEST
w
Date: /— 26-98
Subdivision: %,i,LeY H/c�
Lot:c-`—
Block:_�
TESTER: C,
Initial Reading on Meter:_ 1 y �+ � 01.1e;4 --7 -, D t--
3 l3ci Qysp -
DRAW
DOFIN TIME GPM
NOTES:
P.cduc"ra harze: V t5 GPJI
GALLONS
VOLUME
I
GALLONS FIELD
TOTAL MONITOR LEVEL
C7
i
METER
READING
2-!- :cur Capacity O DO Galles
600 UNIVERSITY PLAZA WEST SUITE ,;
2505 FAIRBANKS STREET
FAIRBAHKS ALASKA 997,39
&NCHORAGE. ALASKA 99503
}07.479-3115
907-277 8375
Besse, Epps, & Ports Date Arrived: 1/26/88
2220 E. 88th Avenue Time Arrived: 1505
Anchorage, Alaska 99517 Date Sampled: 1/26/88
Time Sampled: 1344
Attn: Andy Ports Date Completed: 1/29/88
Source:
Parameter Unit Result ADEC MCC*
Nitrate-N mg/L 2.3 10
Reported By: ~ Date: 2/02/88
* MCC = Maximum Contaminant Concentration
600 UNIVERSITY PLAZA WEST SUCYE ,a F;,iRB,~,';KS AL>~SKA;_~/E9 907-479 3115
2505 FAIRBANKS STREET ANCH'S'~,~QE. ALASK~ 09503 907-277'8378
Quality Control Report
Client: B.E.P.
ID#: A012688-4
Listed below are quality control assurance reference samples with a known
concentration prior to analysis. The acceptable limits represent
a 95% confidence interval established by the Environmental Protection
Agency or by our laboratory through repetitive analyses of the
reference sample. The reference samples indicated below were analyzed
at the same time as your sample, ensuring the accuracy of your results.
Sample # Parameter Unit Result Acceptable Limit
EPA WS378-6 Nitrate mg/L 0.33 0.28 - 0.34