HomeMy WebLinkAboutSTUCKAGAIN MANOR BLK 2 LT 4Onsite File
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MUNICIPALITY OF ANCHORAGE
DEI`_ ,TMENT OF HEALTH AND HUMAN SERV., :S
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name_ _
A \
DISTANCES
TO
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
L 11k,
Ph�(s)Cl_r'/7 Pe t No. No. of Bedrooms
WELL
LBT LINE
LecAL oescamnoe
Lot
Block
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III:UaO
FOUNDATION
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Town ip, Range. Section _
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TI j([j l W C�
AS-BUILT DIAGRAM
driveway, water bodies,
(Show location of well,
etc,)
property
septic system, p p
lines, foundation,I
y
TANKS
f� SEPTIC ❑ HOLDING
WellCapacity
6962
in gallons
/';W
Material
e—cw L
No. of Compartments
1 11P!6
TYPE OF SYSTEM
d
TRENCH ❑ BED ❑ W, DRAIN ❑ OTHER
Depth to pipe bottom tram
anginal grade },FTUa
Total depth from original grade
R, FT
�•
V
Fill added above original grade
FT�-
Gravel depth beneath pipe
I _ FT
Gravel length /
FT
Gmvel width
Lt is FT
Total ab do area
3 SQ FT
Distance between lines
FT
�v
Number of ISoil
n
ratingPipe
SQ FT
material r/J�
CA 6;7LACI �..��%
1
Installer
Date Installed
WELLS
PRIVATE ❑ OTHER (Identify)
Ct
n
F
7
Glassine time (A,ILC)
u
Total Depth
FT
Cased to
FT
Installe,
Date Installed.
REMARKS:
LljL T i
Seale:
Inspections Performed by:
ENGINEER'S SEAL
Date.
4
IA 4 AS certify that thisins
a Ion was performed according to all
Date:
KGs_
Municipal an Slate hideInes if�llecl'o�is tlale�ra�- • �f
Health Department Approval:
72-013 (3/85)
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0-11-1140 1 100 FO� e?w 0-- 1 -F N1 Q F� 14 14 C1 VA C3 Q 11 C3 E=_1
DEPARTMENT OFAEALTH AND ENVIRONMENTAL PROTECTION-�°
825 L STREET, ANCHORAGE, AK 99501 `*�x
264-4700
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q-3 N1 !H;'M -FE=
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9W FF_ L_ L_ F-� F=
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,
PERMIT ND: 850400
STANLEY KNOWLTnN
'
DATE ISSUED: 07/08/85
-[ '/]'��/\
�}[_/
APPLICANT:` STANLEY KNOWLTON
ADDRESS: 8023 E 11TH
COURT
ANCHORAGE,
AK 99504
CONTACT PHONE: 333~2757
LEGAL DESCRJP: SUBDIVISION:
STUC.AGAIN MANOR
LOT: 4
BLOCK:
2
SECTION: 6
TOWNSHIP:
12N
RANGE: 2W
LOT SIZE: 1^25A (SQ^FT"
OR ACRES)
MAX BEDROOMS: 4
'
Listed below are the options
available to
you
in designing
your septic
system. Choose the option
that best fits
your
site.
0- Q E=1 1`4110 F-1
JE n
L%J n Fz;z #CA :1
NJ
'DEPTH TO PIPE BOTTOM (FT")
4^0
4"0
4^0
GRAVEL DEPTH (FT.)
5,0
0"5
3"5
TOTAL DEPTH (FT")
9"0 �
.
4"5
7"5
GRAVEL WIDTH (FT")
2,5
16"0
5"0
�
GRAVEL LENGTH (7^>
34"0
32"0
37^0
GRAVEL VOLUME (CU. YDS.
�
17"4
19"0
27.5
(GALS)**
1,250.0
1 250 0 **
r "
0 *
1 250*.m.TANKSIZ�
, "
SOIL RATING (SQ"FT./BR)
85
85 �`
85
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS .
I certify that:
1" I Am familiar with the requirements for on-site sewers and wells as set'
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2, I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3" I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
' sewerage system on this or any adjacent or nearby lot.
4" I understand that this permit is valid for A maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) .AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) HS~BUILTS `
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED(--��~/,
DATE:
APPLICANT:
STANLEY KNOWLTnN
'
DATE:
ISSUED BY '
/
SOILS LOG
(�7o
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
u*\ 825 L. Street, Anchorage, Alaska 99501 264-4720
w SOILS LOG - PERCOLATION TEST
` p
PERFORMED FOR: TA•AI A<m0 V/LTo til DATE PERFORMED: 6120 O _
LEGAL DESCRIPTION: LoT •Rj IC rCt �JTUC��'Q��IIJ %'i Q.N b_ l2 12
�EPTH 1TI.��%t2RW
SLOPE SITE PLAN
rel F -T -T -T -I I
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e o e 50'r 4tA' Sav Cn
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Qu.OQ ita�aV�s
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7
8
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.JP
10-40
11
Q
r
• r�
Gross
Time
Net
Time
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S„v� C 2Ay
12
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13
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14
15
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16
18-
2225-L
20
�OtI �
COMM
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER i S
ENCOUNTERED? _L� V L
O O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
6p N RATE C96 r�/%V a// i.r+irrtrtes/incM"�
TEST RUN BETWEEN FT AND FT
CERTIFIED BY:
DATE
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904 e
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 020-521-23 - Expiration Date: 6�
1. GENERAL INFORMATION
Complete legal description STUCKAGAIN MANOR S/D; BLOCK 2, LOT 4
Location (site address) 10031 FARPOINT CIRCLE, ANCHORAGE, AK, 99507
Current Property owner(s) JAMES ANDERSON Day phone
Mailing address
Real Estate Agent
6220 FARPOINT CIRCLE, ANCHORAGE, AK, 99507
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
W aiver/Variance request
Received by:
COSA to be release
Day phone
clhemise requested by the engineer.
Date: _ 1111
P -V Il awrovix
COSA Fee $ � QIJiDUC C0� VA). Waiver Fee $
Date of Payment Date of Payment
Receipt Number( �p Receipt Number
COSA 4 DSC I9 / 0 �Y Waiver #
Distance:
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
E
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
clhemise requested by the engineer.
Date: _ 1111
P -V Il awrovix
COSA Fee $ � QIJiDUC C0� VA). Waiver Fee $
Date of Payment Date of Payment
Receipt Number( �p Receipt Number
COSA 4 DSC I9 / 0 �Y Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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 al! applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LU). attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSO Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation -
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being seared by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden detects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
otherperson or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
Phone 337-6179
Date t t I 13 t q
4
Original Certificate Date:
Nn
t �i31t:f ••'��:
pF��}���lt Irrr
F
ON-SITE ' Y
WATER AND
WASTEWATER oz
PROGRAM c,
nicipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
he
u n the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist �� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory . Other
(Rav 1MI91171
If more than 1 septic system is on the lot:
COSA Checklist If of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:
STUCKAGAIN MANOR SID; BLOCK 2, LOT 4
Parcel ID: 041-023-04
A. WELL DATA 'WELL FLOW TEST PERFORMED BY AAROW PUMP AND WELL SERVICE AFTER PUMP INSTALL.
Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (YIN) YES
Date completed 8/28/1985 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth 162 ft. Cased to 161 ft. Casing height (above ground) 12+ in.
Date of test
Static water level
FROM WELL LOG
8/28/1985
103
Well production 8
WATER SAMPLE RESULTS:
AT INSPECTION
"OCTOBER 2013
112+/- ft.
*7+ 9-P M.
Coliform 0 colonies/100 ml. Nitrate 3.0 mg./L. Collected by: GEG, Ltd.
Arsenic: ND ug./L. Date of sample: 11/4/2014
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments ?
Date installed 9/30/1985
Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 11/8/2014 Pumper MCDONALDS PUMPING
C. ABSORPTION FIELD DATA
Date installed 9/30/1985
BELOW EXISTING GRADE
Soil rating (g.p.d./Wor 02Em 85 System type DEEP TRENCH
Length 34 ft. Width 2-5 ft. Gravel below pipe 5 ft.
Total depth `10.4 ft. Eff. absorption area 340 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test '"8/8/2013 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test DRY in. Water added 800 gal. New depth DRY in.
Elapsed Time: min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
"`HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE-SOAKED ON 8/7/13 WITH OVER 2000 GALLONS.
D. LIFT STATION
Date installed_
"Pump on" level at in.
Size in gallons Manhole/Access (Y/N)
"Pump off' level at we er alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 1
Absorption field on lot 100'+ On adjacent lots 1
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank NIA
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 101+ Water main N/A
Water service line 101+ Surface water 100'+ Driveway, parking/vehicle storage '0'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
'SEE ATTACHED LETTER REGARDING DRAINFIELD IN DRIVEWAY. NOTE: ENTIRE SEWER LINE BETWEEN HOUSE
AND TANK WAS REPLACED IN SUMMER 2013. FCO AND PRE TANK CLEANUOT WERE ADDED DURING INSTALL.
FCO IS APPROXIMATELY 9' FROM THE FOUNDATION.
G. ENGINEER'S CERTIFICATION
n
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 1 l 113 bq
(Rev. 10/12112)
0
�?OFESSION��
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS -- .- --
November 11, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road,
Anchorage, Ak 99519-6650
(907) 343-7904
REFERENCE: Waiver for Stuckagain Manor S/D; Block 2, Lot 4.
To whom it may concern,
As can be seen on the attached C.O.S.A. paperwork and waiver drawing, the drainfield on the
property extends into the gravel driveway. We request that you waiver the distance from the
drainfield to driveway to 0 feet. The following items are justification for this request:
At the time of the system installation (1985), MOA code did not forbid the installation of
driveways over the drainfield.
The system has approximately 5' of soil cover. According to pictures of a repair provided
to us by the owner, the system appears to be insulated. In short, the system appears to have
reasonable frost protection.
The cleanout pipe in the driveway was capped below grade and protected with a steel cap
before backfill. Even if this pipe was not accessible in the future, double cleanouts and a
new monitoring tube on the west end of the drainfield provide cleanout access and
monitoring capability.
Based upon the aforementioned facts, we believe there is minimal risk associated with granting
this waiver. If yhave any questions, please contact us at 337-6179.
Sincerely,
r.EM'.S. ey A'.; Ga ss,
President; v
VA �d y`Tu,; re d ,
3701 East TudoroR"a`6-'Suite 101 `Anc o�Alaska-99507-1259
Phone: (907) 337-6179' Fax: (907) 338-3246' Website: www.garnessengineering.com
9o�-f`
RESIOENYIAL 6 COMMERCIAL WATER AND WELL SERVICES
MINI AND EMERGENCY SERW CES AVAILABLE
FREE ESTIMATES
Ywrr
6630 Lxat8^h:`a
Fn�Ror'n9na1aa4a
9550d "•.A�b;f a:; � fm! J �EaI
To whom this may concern. I John Netherton had performed a flow test at Stuckagain Manor blk
2 It 4 in February of 2012. At that time the well was in disrepair and the original structure still stood on
this lot. In Oct of 2013 after the new structure had progressed enough I had installed the pitless adapter
and had replaced all the down hole components during my time with Aarow Pump and Well. After
completion of the needed repairs another flow test was conducted per owners curiosity, as we knew
the water level had barely come down during the prior flow test and the owner wanted to see exactly
how much the well would produce having a new strong dependable pump down hole. The well was
pumped and the water level once again stabilized. The output of the pump was 7 gallons per minute.
Knowing these facts we can ultimately conclude that the well located at this property does indeed
produce substantially more than previously recorded. The well at this time will produce 7 +gallons per
minute. If any additional information is required please feel free to contact
Sincerely, John Netherton
907-230-1868
per;
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` E95fA/ENT
Municipality of Anchorage
• '� Development Services Department
Building Safety Division s E.
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite "� {
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING �{{r�
Parcel I.D. 041-023-04 COSA# S oC `# T _
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
STUCKAGAIN MANOR: BLOCK 2, LOT 4 ✓
10031 FARPOINT CIRCLE * ANCHORAGE, AK
FORECLOSURE Day phone
Day phone
Day phone
Mailing_ address
Unle6s otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Individual On-site
0
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 samples. (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, 1 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. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments, GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this repolthy any
other person or party is not authorized, nor will it confer any legal right whatsoever;
5. DSD SIGNATURE
Approved for bedrooms.
Phone 337-6179
Date 7, 1* r
Disapproved.
Conditional approval for _y__
lj) bedrooms, with the following stipulations:
I. eSP-D`��r_ 1UAIIv,iSInJJD�Y�I'}AAAMLlnPPOOKari 4il6 M#Jiio A/
,9. 7/iEsPrrlAd dia11imy mm�%skIl k rptvlycfed bo 8//51-12,
3,
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
CA
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By.
(Rev. 11/05)
es' SN" C AN QP•'••• ••
0."
�' ON-SITE ••.�fi
WATER AND
WASTEWATER
PROGRAM
CP /1 //a,
Original Certificate Date:v,� 8.1107
rrA.
ess:4c���o0
Disapproved.
Conditional approval for _y__
lj) bedrooms, with the following stipulations:
I. eSP-D`��r_ 1UAIIv,iSInJJD�Y�I'}AAAMLlnPPOOKari 4il6 M#Jiio A/
,9. 7/iEsPrrlAd dia11imy mm�%skIl k rptvlycfed bo 8//51-12,
3,
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
CA
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By.
(Rev. 11/05)
es' SN" C AN QP•'••• ••
0."
�' ON-SITE ••.�fi
WATER AND
WASTEWATER
PROGRAM
CP /1 //a,
Original Certificate Date:v,� 8.1107
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: STUCKAGAIN MANOR; BLOCK 2, LOT 4 Parcel ID: 041-023-04
*WELL TEST PERFORMED BY AAROW PUMP AND WELL SERVICE.
A. WELL DATA **TO BE REPAIRED IN SPRING 2012.
Well type PRIVATE If A, B. or C provide PWSID# N/A
Date completed 8/28/85 Sanitary seal (YIN) YES
Total depth 162 ft. Cased to 161 ft.
Well Log (YIN) YES
Wires properly protected (YIN) **NO
Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/28/85 *2/16/12
Static water level 103 ft. 109 ft,
Well production 8 g.p.m. 3.5 —9-p m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate Lmg./L. Collected by: GEG, Ltd.
Arsenic: P—Cug./L. Date of sample: 2/15/12
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (YIN) UNK Depression over tank (YIN) UNK
Date of pumping
Pumper
Date installed 9/30/1985
Cleanouts (YIN)
UNK
High water alarm (YIN) N/A
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 9/30/85 Soil rating (g.p.d./ft or /bdrm 85 System type TRENCH
Length 34 ft. Width 2.5 ft. Gravel below pipe 5 ft.
Total depth UNK ft. Eff. absorption area340 ft2 Monitoring tube UNK Depression over field UNK
Date of adequacy test N/A Results (Pass/Fail) * 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 >= N/A g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
*SEPTIC ADEQUACY TEST AND SEPTIC TANK PUMPING WILL BE PERFORMED IN SPRING 2012 BECAUSE NO
SEPTIC PIPES COULD BE FOUND DURING INSPECTION. REQUESTING A CONDITIONAL COSA AT THIS TIME.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YM)
"Pump on" level at in. "Pump off" level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
*E. SEPARATION DISTANCES
*SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot UNKNOWN On adjacent lots 100'+
Absorption field on lot UNKNOWN On adjacent lots
Public sewer main N/A Public sewer manhole/cleanout
Sewer /septic service line — Holding tank
Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+
*SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation — Property line — Absorption field —
Water main —
Wells on adjacent lots —
Water service line — Surface water —
*SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
Building foundation — Water main N/A
Surface water
Curtain drain NONE KNOWN Wells on adjacent lots
Driveway, parking/vehicle storage —
F. COMMENTS *ALL SEPARATION DISTANCES TO PROPERTY'S SEPTIC SYSTEM WILL BE CONFIRMED
SPRING 2012, ONCE ALL SEPTIC PIPES ARE FOUND AND ADEQUACY TEST IS PERFORMED.
G. ENGINEER'S CERTIFICATION
ooP�F,......... �9SOp0
.�
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in Q•""""' "' """'• •""•'
conformance with MOA COSH guidelines in effect on this
date. Je f ey A. ss:
Engineer's Printed Name JEFFREY A. GARNESS QO m CETT795}} m�
2 2'B i �4ppfee lIAv�
Date / V%Qlb ofessW
�U
COSA Fee $ 7 S% Waiver Fee $
Date of Payment A � //� Date of Payment
Receipt Number &•5q Receipt Number
(Rev. 11/05)
'*9Wv
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 �/ �L&
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Ln-rW 31- Z ST0e,I-eAC7k,,Al '-/AWCr I SEG I Ia'Nt��w
Location (address or directions)
(b) Property Owner STAW I�Noui ohf Telephone: Home "S33 Business
Mailing Address 10011 F-AaPolkT. (-r2—
(c)
r2(c) Lending Institution C CtV T r�! Li s -- Telephone D IGK k dV-y1.A-
Mailing Address L
(d) Real Estate Company and Agent
Address
[7
Telephone
(e) Mail the HAA to the following address: or: Check here E�, if hold for pick up.
List contact person and day phone number below. n
r2-74-39 P?
2. TYPE OF RESIDENCE
Single -Family I (
Number of Bedrooms KV
3. WATER SUPPLY
Individual Wellp[[\ Community ElPublic 11Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Ic
Public ❑ Community O Holding Tank 11Note: If m munity.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(Rev8/861 Front
5. 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 dale of this inspection. rJ
Name of Firm ��'>`lt.r.� Telephone g��
Address
Date AAw G �, , / 92,
6. DHHS APPROVAL
Approved for %lif �i bedrooms by
Approved A Disapproved
Terms of Conditional Approval
kit
a....Y..
2225-E • •.,
luli@ 25. 191
Conditional
CAUTION
Seal
Date ��-���1/c17
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 doesthis as a courtesyto purchasers of homes and theirlending 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 (Rev 8/861 azok
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
0� pCV4WATn AUTHORITY APPROVAL
w4IC0111 s RNCE CHECK IST- FEBRUARY 1984(HAA)
VA
ENY1?'0W 264-4720
APR b 1987
RE�E��ED
Legal Description: -1-o �1-8K ST-Qc LN
Well Classification 'R,)�_5 If A, B, C, D.E.C. Approved (Y/N) t
Well Log Present (Y/N)— Date Completed 8'o�r> �%> Yield o 1 V1 y�r/�7�67
Total Depth ) L21 Cased to —_01 Depth of Grouting
Static Water Level 10 ?2 Pump Set At
Casing Height Above Ground > f °� it
Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) P!�
Separation Distances from Well:
k
To Septic/Holding Tank on Lot lao On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 7 1 AD ; On Adjoining Lots > lt9
To Nearest Public Sewer Line N o() To Nearest Public Sewer
Cleanout/Manhole 13 b 15�- To Nearest Sewer Service Line /on, /Lot
Water Sample Collected by ( Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed y� ; s ' Size /0-50 No. of Compartments
Standpipes (Y/N) 1410 Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) 1�y Date Last Pumped 1'4-ea.0
Pumping/Maintenance Contract on File (Y/N) N�%r for MAS
Holding Tank High -Water Alarm (Y/N) W/A Temporary Holding Tank Permit (Y/N) WA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well lam*
To Property Line
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-028(11184)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 86 Type of System Design I le -le Iveil
Date Installed �0�(4 Length of Field 3 L/ __-
Width of Field - 51 Depth of Field q- 5
Gravel Bed Thickness _
Square Feet of Absorption Area WU Standpipes Present (Y/N) i u2iy _
Depression over Field (Y/N) N Date of Last Adequacy 'Test N G= tY/
Results of Last Adequacy Test I'MA
Separation Distance from Absorption Field:
To Water -Supply �r'� n .r r
PP Y Well To Property Line — 1
To Building Foundation b To Existing or Abandoned System on
Lot NVN)l On Adjoining Lots /o 0 ./. _
To Water Main/Service Line F To Cutbank (if present) 1\/0IW
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Are
Comments
D. LIFT STATION
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 "
I certify that I have checked,
/verified p/r conformed to all
/ OA and HAA guidelines in effect on the date of this inspection.
Signed �. n/e/ICYC�V�GIAX Date Y Lq7
Company MOA No.
Receipt No.�� l �G
Date of Payay ment
Amount: $ Z(I�p�/
Page 2 of 2
72-026 (11/04)
v. 2225E ;nY
R1N[ 25, 1971
. e`o
Engineer's Seal
_Q
v. 2225E ;nY
R1N[ 25, 1971
. e`o
Engineer's Seal
vu 2Q
�ZOA ANCHORAGE. ALASKA99501
CONSULTING ENGINEER (� TELEPHONE: (907) 279-3916
LEGAL:
R E S I D E N T I A L W E L L I N S P E C T I O N
— — — — — — — — — — — — — — — — — — — —
LOT 4. BLOCK 2. STUCKAGAIN MANOR
LOCATION:
10031
FAR POINT CIRCLE
y `'"4
At
t,
OWNER:
STAN
KNOWLTON
TYPE OF WELL:
SINGLE FAMILY
t.. ' q. .T -i
WELL LOG AVAILABLE:
YES
o. 2225E
n-�
�r JUNE 24,
INSTALLATION REQUIREMENTS
MET: YES
WELL YIELD FROM WELL
LOG:
8 GALLONS PER
MINUTE"h- --
PUMP YIELD:
6.5+ GALLONS
PER MINUTE
DATE OF INSPECTION:
APRIL 3, 1987
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6 PLUS
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE. AT THE START OF THE TEST WATER
LEVEL WAS FOUND AT 103 FEET BELOW TOP OF CASING. AFTER 10 MINUTES
OF PUMPING THE WATER LEVEL WAS AT 112 FEET. DURING THE NEXT 30
MINUTES THE WATERLEVEL DROPPED TO 120 FEET. THE WELL RECOVERED TO
112 FEET IN 5 MINUTES. RECOVERY WAS SLOW AFTER THIS LEVEL WAS
REACHED.
THIS WELL CAN PRODUCE AT A RATE OF SIX GALLONS PER MINUTE
CONTINUOUSLY FOR MORE THAN FOUR HOURS
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON
APRIL 4, 1987. TEST WAS NEGATIVE.
TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is 150 gallons of water
per bedroom per 24 hours.This well surpasses this requirement.
The assessment of the condition of this well applies only to the
conditions as of this date. The flow rate of the well may change
due to subsurface conditions that may not be observed from the
surface, and changes in land use and other factors that may
impact the conditions of the aquifer feeding the well.
��3W 151h AV
)20ANCHORAGE�ALA- K 203
CONSULTING ENGINEER TELEPHONE (907) _)7 39,
6
S E P T I C S Y S T E M A D E Q U A C Y T E S T
— — — — — — — — — — — — — — — — — — — — — — — —
LEGAL: LOT 4, BLOCK 2, STUCKAGAIN MANOR
LOCATION: 10031 FAR POINT CIRCLE
OWNER: STAN KNOWLTON
RESIDENCE: SINGLE FAMILY, THREE BEDROOMS
WELL: PRIVATE, ON SITE
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP. 1250 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 340 SQ. FT.
SOIL RATING: 85
INSTALLATION DATE: SEPTEMBER 198/5/
DATE OF PUMPING: NOT PUMPED, NEW SYSTEM /,,? dln 10,4
DATE OF TEST: NOT TESTED, NEW
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND
WITH 4.5 FEET OF COVER AND 50.5 INCHES OF LIQUID.
CLEAN OUT TO TRENCH WAS FIVE FEET DEEP AND DRY. TR_E_NCH SUMP WAS 9
FEET DEEP AND DRY.
TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater levels that may fluctuate during the
year, and the water usage of the family being served by the
system. These conditions are outside the control of the evaluator
of this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.