HomeMy WebLinkAboutKAHN LT 2Kahn
Lot 2
#051-241-52
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191434 PID Number: 051-241-52
Dwelling: ., Single Family (SF) o Duplex (D) o Multiple (SF and/or D) Project: o New I Upgrade
Name:
EMILY BAKER
ABSORPTION FIELD - EXISTING
o Deep Trench o Shallow Trench o Bed o Mound
Address
18811 K & R STREET, CHUGIAK, AK 99567
o Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
KAHN 2
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
Tol
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
Ftz
--
-- Ft.
Well
100'+
NA
NA
NA
NA
TANK X Septic o S.T.E.P. o Holding e Other
Manufacturer
GREER
Capacity
1000 Gal.
Surface water
100'+
NA
NA
NA
Material
HDPE
Number of compartments
2
Lot Line
5'+
NA
NA
NA
NA
Foundation
! 10'+
NA
NA
NA
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
NA
NA
NA
NA
Remarks Existing septic tank decommissioned
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
per code, new tank installed 5' from &
Connected to existing field w/ DCO.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer RPC
Drainfield CO/MT 3034
Inspector FWCS / MNA
BENCH MARK (Assumed elevation) 100 ft
Inspection
15t 10/10/19 2�d 10/15/19
Location
Location and description
3m 4th
TOP OF MANHOLE
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
t.9TH
VCHAEL N. ANDERSON:
No. CE 9468
/
�q
'
r
Approve - Date �C�'l �l�
10/15/19 c5
')?CV;rssio-'
inspection Keport_a--i--iz.aoc
W
Z
n
O
=
O
o
M
v
M
CIO
O
M
O
O
A -C=23.0'
B -C=48.5'
A -D=32.5'
B -D=51,2'
PID: 051-061-16
PERMIT: OSP191052
N89°53'43"W 296.74'
10.3' - _-----
N
SHED
GARAGE W Z j
x x "' Q
�_xJ
38.3'
A -i N
W
DECOMMISSIONED EXISTING PATIO �
SEPTIC TANK & INSTALLED o N
NEW 7000 -GAL S.T. Fp Fri
W/ DCO & FCO. n= DRIVEWAY (A
x
BM wm _
MH N C17
DCO
C • i F p 8
DC Q
DECKO
O WELL
SUMP
S89 3'43"E 1 1 296.81' X
/+ +
+ i \ x
K&R STREET —+� }\-x—x—x--x—x x—x—I
ALE: 1' = 50
FCO,j(j` COf` MH CO CO
II ! 996 CO\ 99.5 (l FINAL GRADE
INSULATION
7,000 GALLON 5.05
HDPE TANK EXISTING FIELD
SEPTIC SECTION
SCALE: NTS
PREPARED FOR: SUPPORT®SERVICES:
t w 'k
EMILY BAKER ��� OF Al-,,
KAHN LOT 2 FM C. 5
18811 K & R STREET, CHUGIAK, AK 99567 *.4 9TH �*
Michael N. Anderson, P.E. DATE: 10/15/2019 P MICHAEL N. ANDERSON
4661 Natrona Ave. �r' No. CE 9469 Atf
DRAWN: FWCS 10/15/19
Anchorage, Alaska 99516 '�o �'AW
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' p?OFESSIOO
9/30/19
MUNICIPALITY OF /ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICMELL PERMIT APPLICATION
Parcel I.D. 051-241-52
Property owner(s) EMILY BAKER Day phone 9073609890
Mailing address 18811 K & R STREET, CHUGIAK, AK 99567
Site address 18811 K & R STREET, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) KAHN LOT 2
Legal description (Township, Range & Section)
Lot Size 44812 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
ED
(w/wo ADU)
Septic Tank
El
Upgrade x
Duplex (D)
ElHolding
Tank
❑
Renewal ElMultiple
Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is, in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
Permit No. 08IQ IU3U Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
September 27, 2019
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: KAHN LOT 2
To whom it may concern:
The owner has requested we proceed forward to obtain a septic permit to upgrade the
aged septic tank on the subject lot. The proposed upgrade will serve the existing 2-
bedroom house.
The lot and area are served by private water. The proposed design will not impact any of
the neighboring properties due to the lot layout. Please contact Brent M. Western or me if
you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191434, Rebecca Carroll, 09/30/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191434, Rebecca Carroll, 09/30/19
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE [] NEW
LEGAL DESCRIPTION
LOCATION NO. OF BEDROO~
DISTANCE TO:
~ Manufactu ~'C
~ kiqz~ ~ ~all° ns IF ,~,MA~[: Inside I.n~th ~idth Eiqu,d d0,th
O ~ ~ Manufacturer Material Liquid capacity in gallons
NO. of ,inos// Lengtl~ch
~ ~ Top of ti~o ~n~graOe Material beneath ti,e ~ ~¢nches Total effective ,bsorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diamete Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class~ ~ ~/~De th ~ Driller Distance to lot line PERMIT NO.
m ~u~ldin~ foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
REMARKS
Rev. 3/78)
MUNICIPALITY OP ANCHORAGE
YOF,0
e. DEPARTMENT `' 'LTH & ENVIRONMENTAL PROTECTION
i ENVIRONMENTAL ENGINEERING DIVISION 3
/ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAMe
❑ NEW
f
lS
t�
UPGRADE
MAILING ADDRES '' -7J'
vi r)
C r
LEGAL DZESCRIPTION
LOCATION
NO. OF BEDROOMS
Well /
Absorp��n �rea7L
Dwe ling / -'
PER I1 )T N.O./ /�
` �,
U
DISTANCE TO:
�.
_
'
C
y
Maur /
No, of compartments -
wManufacture
NC U/G�l C
��
N4
Liq. Dcijy�gallons
IF H ME MAD E:
Inside length
Width
Liquid depth -
al 14
DISTANCE T0:
Well
Dwelling
_ .__.-
PERMIT NO.
__0 z 4
x r
Manuf[urer- --��-- -- -- - � `"'7
ac
te
Marial
Liquid capacity in gallons
O
W
DISTANCE TO:
Well / �.
/�Q -,'.
Fou n at'Lon / -.�-
Nearg lot link+ -e4—
j�
PERTs T NA 1 1
L 5
f
Trenchy'�idth -
^inches
Distance bet
-0
a a a
Z
No. of lines/
Length-¢9�e4��ch lfne
.JtJ —
Total II gth Vest-
--
(,�%
�e�lines„
Top of til o finist grade
Material beneath tile / /,
Total effective bbsorption area
inches
Length
Width
Depth
PERMIT N0.
Lu
(7
Q F "
Type of crib
Crib diameter
Crib depth
Total effective absorption area ?�
aE[
W
,��
U.1
N
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO. 4: f.xA3r,
J.
r
U.1„
Building foundation
Sewer line
Septic tank _ ',j
Absorption arga(s)
DISTANCE TO:
r .'•'.`.:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
--"-
REMARKS-
J
^
07 C.
LJ GLC • ' �,,'.��
'
�i "«° ��•PALITY
F
H ALT
Is
r /
”, DEPT. OF
. Ro6ert A. - 7�'�.h ��' ENVIRONMENT
9 f457_E MAR
APPRO ED •� /�/j DATE (
i
LEGAL;.';jLs(t�iir'tl
fir,
1r,
R1VER,
ALASKA
cos
005
77
ftI
�'I
Oi'-~--S I TE
PERMIT NO. ( 82~0~0 )
APPLICANT JEFtNETTE K~HN
LOCAT I 0N
LEGAL
~dLINICI~',RLITY ~DF
DEPARTMENT L HEALTH AND ENVIRONMENTAL ,,40TECTION
025 'L' STREET, RNCHORRGE, BK. 99501
264-4728
SE~4E~I F"ERP1 IT
SRI BOX 2170 S BIRCHWOOD 688-27~5
TI5NRiW S19 L4~ BIRCHWOOD S LOT SIZE 99999~ SQUARE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: DRRINFIELD
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT?BR)= 85
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[:,EPTH= 6 L E ~'-!,.3 T H = 2..: ~'----'~ mSRAYEL DEPI-H= --.~:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCRYRTION (IN FEET).
THE T~:E~-JCH ~4I[)TH IS 5. E~OE~ FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE ENCRVRTION (IN FEET).
F-: E L-';'!. Ell I REC~ SEPT I
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TI~-~£~ (2) I~4SPE~2:TIO~-~S ARE REQUIRED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL RND RNY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MR9 APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS ARE
RVRILRBLE TO INSURE PROPER INSTALLATION.
PE~:I'I I T E;~(P I ~:ES E)ECEi-'IBER _~-~L_. ---1---~--~ E:2
I CERTIFY THRT
t: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2[ I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
'-:,IuNEC .' ______F}~ I CANT JER~TTE K ~J~N
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
[] PERCOLATION
TEST
SLQPE
5
7
8
9-
DATEPE" O"MED:
/ /
SITE PLAN
10-
11
13-
14-
15-
16-
17-
18-
20-
WAS GROUND WATER
ENCOUNTERED?
P
E
IF YES, AT WHAT
DEPTH?
Gross //Net Depth to Net
Reading Date Time, ~..~7.~:.. ~ ~-_, .,~ ~.',, ~T me Water Drop
PERCOLATION RATE /J~ {minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS
72-008 (6179)
11Do
I� �z
ANCttOHAGiF. ALAS>KA.9,1502-0650
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit #: 840599
January 31, 1985
TO: Permit Applicant
SUBJECT: T15N R1W Section 19 Lot 43
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
if you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
onsite sewer system, the original as -built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264--4720.
Sincerely,
Keith E. Bandt SSu�peYvisor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
P1 ILJI����������3����� ~ v
DEPARTMENT OF HEALTH AND ENVIRONM�NTAL PROTECTION
825 L STREET, ANCHORAGE, Al.' 99501
264-4720
C.111 VA_����� ����� � ����� �������
ic:
QATI"" ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LOT SI2E:
MAX BB0ROOMG:
84O599
07/2O/84
C/O S & G ENG/G KEITH BAI-;::ER
SRB 196X
EAGLE RIVERv AK 99577
6911-2979
SUBDIVISIONX NA
SECTION: 19 TOWNSHIP: 151\1
1^25A <SQ^FT. OR ACRES))
3
LOT: 43 BLOCK: 1\10
RONBE- 1W
Listed be*low are the options available to you in designing your septic
system" Choose the option that best fits your site"
IF A LIFT STATION IS INQTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECT AND INSPECTION MUST BE OBTAINEZ); (2) AS-BUILTS
WILL NOT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRIC L BY A LICENSED ELECTRICIAN"
DATE:.
~~y��~_��_^~~^_~
ED
APPLIS & S ENG/(3 KEITH BAKER
ISSUED BY DATE:
~F FR, EF. I[N-1 C-:" 111 -111
tAj=
]"�r-:'e:% 1.' H"'j
DEPTH TO PIPE BOTTOM (FT.)
5.0
6,0
5.0
GRAVEL DEPTH (FT.)
3"0
O.5 `
2"0
TOTAL DEPTH (FT")
8"0
6"5
7.0
GRAVEL WIDTH (FT.)
2.5
17,0
5°0
8RAVEL LENGTH (FT")
63.0
34.0
53.0
GRAVEL VOLUME (CU,YDS,)
20"4
21.4
24.5
TANK SIZE (8ALS)
1,000°0 **
1,000.0 Ix. X- 1,000.0
**
SOIL RATING (SQ"FT"/BR>
125
125
125
** TANK MUST HAVE AT
... ... ... ....
LEAST TWO COMPARTMENTS
.... ...��������������
I certify that:
,
1 I am familiar with
the requirements for
on-site sewers and
wellsr as set
forth by the Municipality
of Anchoragm
(MOA) and the State
of Alaska"
2^ I will tho
system in accordance
with all MOA codes
and regulatians,
and in compliance
with the design criteria
of' this permit.
I will adhre to all
3" e
MOA and State of Alaska
requirements
1*01, the set. back
distances from any
existing well, wastewater
disp0sZ11- system or public
sekverage system on
this or any adjacent
or nearby lot.
4" I understand that
this permit is valid
for a NaxiInu0 of'3
bedrooms and
any eDlargemeO� will.
r84quire an additional
permit.
IF A LIFT STATION IS INQTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECT AND INSPECTION MUST BE OBTAINEZ); (2) AS-BUILTS
WILL NOT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRIC L BY A LICENSED ELECTRICIAN"
DATE:.
~~y��~_��_^~~^_~
ED
APPLIS & S ENG/(3 KEITH BAKER
ISSUED BY DATE:
K SOILS LOG
%o
MUNICIPALITY OF ANCHORAGE
® +.� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720 ....:.
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: /Tf-/ 1�/7K �� DATE PERFORMED: �- i� �6P7K
LEGAL DESCRIPTION: L�C�T •�L-� t� ��I, 7—/S -
D SLOPE
�� LjCZ-v(4n11c_
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
50N/�)`/ v,e,PvC l C/OD
S
r7M
SFiN•D% (77264
WAS GROUND WATER
ENCOUNTERED?
t�i�tr-�,� Ci-/ri•8�i�
IF YES, AT WHAT
DEPTH?
COMMENTS /YtG
PERFORMED BY:
72008 (6/79)
%1
111
S
j f L
O / 4- 7--
P
E
1�2 i
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE A/A _(minutes/inch)
TEST RUN BETWEEN FT AFT
�i; __,,gni:, 'EJ•}::
CERTIFIE
DA?
(��ertifte� drilling ���r�
OOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
rr��
OWNER OF LAND r7,'� h l�!r'Q N/fJ DEPTH OF WELLQt4V6 14&
ADDRESS ti1/,' 60Y To r..)nSTATIC LEVEL OF WATER FF.
LEGAL DESCRIPTION 4�>eJ 'f t__L`] 715i) /Ai 1<+�..j ��7 DRAW DOWN FT. -
DATE . Started �1!"d 1,rn r�� -^Ended 21 `�! r"" GALS. PER HR 1:710
PERMIT NUMBER { '8LL1L�^ KIND OF CASING
13d; 0;5ion hof
KIND OF FORMATION:
FromFt. to ~ FL t�IJr"d $yOr v From « Ft. to Ft. S R ':l 4
From Ft. to LL -Ft. (24 k-1 iyA 7 °�-
From _L -Ft. to r"
Ft. i n) r5 -u; 4 (! 4..,f
From Ft. to -Ft, x s� -
From :2rFt. to 44 Ft.
From_4-Q Ft. to_Ft. S
From '73 Ft. to I D I Ft. J/ {
From Ir ) 1 Ft. to—/ -7- Q Ft. , d A S 7',.-.)
From l 70 Ft. to ca6> Ft. S',4 ,v,o S ;_0 A.),Z
From Ft. to Ft.
From Ft. toi U Ft. it J(J $ Jai, eJ
From ��Ft. to Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
_Ft.
MISCL. INFORMATION
From
Ft. to Ft.
From
Ft. to Ft. _
From
Ft. to-Ft.—
oFt._From
From-
Ft. to Ft., —
From Ft. to Ft—
From
Ft. to Ft.
From
Ft. to Ft. -
From
Ft. to Ft.
From
Ft. to Ft.
From
Ft. to Ft.
From
Ft.hWlRCt2ALt1Ftl pFANEI 10RAG2-
DEPT. OF HEALTH &
From
Ft. FNVIRC1NenF —
From
Ft. to--Ftl
From
Ft. to Ft.
From
Ft. to R E CE I V,/
E® -
From
Ft. to Ft.
From
Ft. to Ft
DRILLER'S NAME ` �'r
PERMIT NO: 8bO072
DATE ISSUED: 03/13/86
APPL[CANT: HARVEY OH JEANETTE KAHN
ADDRESS: SR1 BOX 2i70
CHUGlAK� AK 99567
CDNTACT PHONE: 688~2735
LEGAL DESCRIP: SUBDIVISI8N: KAHN LOT: 2 BLOCK: NA
SECTION: 19 TOWNSHIP: 15N RANGE: 1W
LO| SIZE: 1.5� (SQ.FT. OR ACRES>
1 certi�y that:
1. I am {amiliar with t|�e requirements �or on-site sewers and wells as set
<orth by the Municipa1ity o� Anchorage (MOA) and the State o� Alaska.
2. l wil] insLa1l the system in accordance with all MOA codes and regulations,
and in compliance wiLh the design criteria of this permit.
3. [ will adhere Lo all MOA and Staequirements /or the set back
distances �rom any existing woll, wasLewater disposal sysLem or public
sewerage system on U1is or any adjacent or nearby lot.
5lGNED DATE:
AFH.ICANT '
lSSUED BY DA[E:
DEPARTME�T DF HEALTH
AND ENVIRONMENTAL PRDTECTION�'�
825 L STREET,
ANCHORAGE, AK 995O1
c��
PERMIT NO: 8bO072
DATE ISSUED: 03/13/86
APPL[CANT: HARVEY OH JEANETTE KAHN
ADDRESS: SR1 BOX 2i70
CHUGlAK� AK 99567
CDNTACT PHONE: 688~2735
LEGAL DESCRIP: SUBDIVISI8N: KAHN LOT: 2 BLOCK: NA
SECTION: 19 TOWNSHIP: 15N RANGE: 1W
LO| SIZE: 1.5� (SQ.FT. OR ACRES>
1 certi�y that:
1. I am {amiliar with t|�e requirements �or on-site sewers and wells as set
<orth by the Municipa1ity o� Anchorage (MOA) and the State o� Alaska.
2. l wil] insLa1l the system in accordance with all MOA codes and regulations,
and in compliance wiLh the design criteria of this permit.
3. [ will adhere Lo all MOA and Staequirements /or the set back
distances �rom any existing woll, wasLewater disposal sysLem or public
sewerage system on U1is or any adjacent or nearby lot.
5lGNED DATE:
AFH.ICANT '
lSSUED BY DA[E:
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 051-241-52
EP cA N�:;
ANCHORAGE
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description KAHN LOT 2
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: t — (san 7 Q
Location (site address) 18811 K & R STREET, CHUGIAK, AK 99567
Current property owner(s) EMILY K BAKER
Mailing address
Real estate agent
18811 K & R STREET, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $S5b
Waiver Fee $
Date of Payment ION -119
Date of Payment
Receipt Numbernn 6 Q,Jr� b
Receipt Number
COSA # [j/pna lL �-t /
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 10/7/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change L�
due to subsurface conditions that may not be observed from the surface, changes in land use, C O Al
local soil characteristics, groundwater levels that may fluctuate during the year, quality of ,
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to✓):A 77
these various and dynamic characteristics and are outside the control of the evaluator of the � * `� 9 TH
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by FWC5 and Anderson Construction & Engineering.
�_ lCCiiAl1. i`. A.ti[)EF�S'+7\
No. CE 9499
6. DSD SIGNATURE 1 10/7/19 ..'
System #1 Approved for bedrooms , �a�ss►°vs�
System #2 Approved for bedrooms
Disapproved
Conditional approval for
bedrooms, with the following stip
y: L-- Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: KAHN LOT 2 Parcel ID: 051-241-52
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 3/14/1986
Total depth 210 ft
Cased to 48 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 9/25/2019
Static water level at beginning of test 13 ft.
Well production at time of test 0.77 gpm
Comments
B. TANK DATA —10/10/2019 -1000 GAL
Age of tank(s) NEW years
Tank type/material SEPTIC / HDPE
Measured operating fluid level in septic tank
® Standpipes/foundation cleanout per record drawing
Date of pumping
Structure served by this system
Water storage tank volume NA gallons
Well disinfected for coliform test? ® Yes ❑ Nc
® Coliform bacteria is Negative
Nitrate mg/L ® Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected byFWES�r
Date of Samples 9/26&10/10/2019
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA — 60'L x 5'W x 3.09'ED —1.2 GPD/SF = 517 SF
Which system tested (date installed) 10/1982
® ALL standpipes present per record drawing
Total measured depth from grade 6 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist copy 2.docx
Adequacy test date 9/25/2019
Results N Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 4 in
Elapsed time <5 min
Final fluid depth 0 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No ft
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if. No
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
® Yes if No ft
Property Line > 5'
® Yes
if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No ft
Private Wells > 100' ® Yes if No
Water Main > 10'
® Yes
if No ft
Community Wells > 200' ® Yes if No _
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' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
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 copy 2.docx
Aw AOr
OF A�
MICHAEL N. ANDERSON.
No. CE 9469 W
10/10/19.' G4~
ft
M
a F P FJ z +'
www.muni.org/onsite
Well Water Advisory
Certificate of On -Site Systems Approval # OSC191474
Subdivision: Kahn Lot: 2
MR.
This well's productivity was determined to be .77 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31
gallons per minute or 150 gallons per day per bedroom. Although the subject well
currently exceeds this minimum requirement, the production capacity can
fluctuate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
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�. K & R STREET
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
KAHN SUBDIVISION
LOT 1&2 PLAT 84-300
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. cinder no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary Iines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE:scuE E-MAju
OCT 14, 2019 1"=50'
19-104 DRAWN BY: ONECKM BY/PE' #UkBER BOOK AGE:
JLS NW0954 190158
L A ND���
1881 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
F-
O
J
Municipality of Anchorage
'��PAGS
Development Services Department
ell,
s
Building Safety Division �• x
On -Site Water and Wastewater Program s A E T -y
4700 Elmore Roao
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. 051-241-52 COSA1149 _
Expiration Date: —'
1. GENERAL INFORMATION
Complete legal description KAHN LOT 2
Location (site address) 18811 K&R STREET, CHUGIAK, AK 99567
Current Property owner(s) HARVEY & JEANETTE KAHN Day
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
18811 K&R STREET, CHUGIAK AK 99567
Unless otherwise requested, COSA will be held by DSD for pickup.
Day phone
Day
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
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 ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 05/14/2012
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
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist. It
5. DSD SIGNATURE
Approved for J bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ON-SITE
PROGRAM
By r lL� Original Certificate Date:
(Rev. ti/OS). `�
i I
Municipality of Anchorage �ros
• 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 CHECKLIST
Legal Description: KAHN LOT 2 Parcel ID: 051-241-52
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # _
Date completed 3/14/1986 Sanitary seal (YM) Y
p.m -
Total depth 210 ft.
Cased to 48 ft.
FROM WELL LOG
Date of test
3/14/86
Static water level
12 ft.
Well production
1.5 9 -
WATER SAMPLE RESULTS
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 18 in.
AT INSPECTION
5/4/2012
ft.
0.64 9 -
p.m -
Coliform NEG colonies/100ml- Nitrate ND mg/L
Arsenic: ND mg/I Date of sample: 5/4112 Collected by: ArcTerra
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 101982 Tank size 1000 gal.
Number of Compartments 2 Cleanouts (YIN) r Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
High water alarm (YM) N Date of pumping 5/4/12 PumperTRRs
C. ABSORPTION FIELD DATA
Date installed 101982 Soil rating (g.p.d./ft2 or ftZ/bdrm) 85 System type Trench
Length 30 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 5.85 ft. (Measured 5/4/12)
Eff. absorption area 259 ft Monitoring tube Y Depression over field N
Date of adequacy test 5/4/12 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 550 gal. New depth 4.2 in.
Elapsed Time: 25 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date -_
D. LIFTSTATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _in. "Pump off' level at _in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 751+
Sewer /septic service line 251+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 100'+
Manure/animal excrete storage areas loo'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 51+
Water main 10'+ Water service line 101+ Surface water loo'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 101+
Curtain drain 50'+ (None Known) Wells on adjacent lots l00'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and /►,
review of Municipal records that the above systems are in Z
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 5/14/12
COSA Fee $490.00
Date of Payment -65-
Receipt Number 60537"1b
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage a.
Development Services Department
Building Safety Division s E I..
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) 4 211149
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot 2 of KAHN subdivision, the well's
productivity was determined to be 0.62 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is 0.31 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE`
FOLLOWING DESCRIBED PROPERTY:
_
DATE.
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
S�y
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID;
EASEMENTS, COVENANTS, OR RESTRICTIONS
iN4v119s'/
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB.*
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
DiiAWAN:
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MUNICIPALITY OF ANCHORAGE
e., t DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 3/17/86
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2 Kahn Subdivision, formerly Lot 43 T15N R1W Sec. 19
Location (address or directions)
K&R St.
(b) Applicant NameJeanette Kahn Telephone: Home 688-2735 Business N/A
Applicant Address SR 1 Box 2170, Chugiak, AK 99567
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder] ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution N/A Telephone
Address
(e) Real Estate Company and Agent N/A
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family ® Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well 0 Community ❑ Public ❑
Note: 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 Q 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 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
R1
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Heath,
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
Telephone
Address EAGLE RIVER ENGINEERING SERVICES
EAGLE RIVER, AK 99577
Date P. O-. BOX -7 82 4
694-5195
DHEP APPROVAL
Approved for bedroom
Approved Disapp
Terms of Conditional Ap oval —
,01 C�^e- °� �� Engineer's Seal
e 8� FF
-fro,O' 66.400�60,04 e600 •oo0•00'•, o A
f-
gt^fie...6 0.... ...... tFelGerrP
Louis A. Buiera
C'r.iP�^o6 CE -5736
G e e•�..C9 ..r
< 40n
0
•u r4C� ane en nx..•e t ���
Lo
poor•-' 'to" ,,_:
.-
s by _ato
roved Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (11/84(
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH &
HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION
CHECKLIST - FEBRUARY 1984 NAAR 17
(9�
264-4720
Legal Description: 1- 0- - `'
>
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A. WELL DATA
Well Classification IOC` /t,�A r /: If A. B. C, D.E.C. Approved (Y/N) /t,/ /4V
Well Log Present (Y/N) y Date Completed -3zz4/1.rfG Yield
Total Depth_� /O / / Cased to yds'" Depth of Grouting A/A)
Static Water Level lln� Pump Set At '&6 %-
Casing Height Above Ground Sanitary Seal on Casing (Y/N) —�
Electrical Wiring in Conduit (Y/N) X Depression Around Wellhead (Y/N) tel✓
Separation Distances from Well:
i
To Septic/Holding Tank on Lot On Adjoining Lots
i f/Do
To Nearest Edge of Absorption Field on Lot On Adjoining Lots '
To Nearest Public Sewer Line _'y/4 / O To Nearest Public Sewer
Cleanout/Manhole '��h ^� _ To Nearest Sewer Service Line on Lot /
Water Sample Collected by C -4s /e- i ; Date 2
Water Sample Test Results _S4 t
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N)%' Foundation Cleanout (-Y/N)
Depression over Tank (Y/N) /V Date Last Pumped��
Pumping/Maintenance Contract on File (Y/N) N�� ; for
Holding Tank High -Water Alarm (Y/N) 0'�/* Temporary Holding Tank Permit (Y/N) 11-114
Separation Distances from Septic/Holding Tank:
To Water -Supply Well To Building Foundation
To Property Line 4-11 To Disposal Field 6 -
To
To Water Main/Service Line _tau To Stream, Pond, Lake, or Major Drainage
Course /1/0. e �i f 1,
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata !FS Type of System Design
Date Installed _ ,fJG% /J3 Length of Field
Width of Field S Depth of Field
Gravel Bed Thickness 3
i
Square Feet of Absorption Area 5 Standpipes Present (Y/N)
Depression over Field (Y/N) _A-) Date of Last Adequacy Test
Results of Last Adequacy Test ,Su %'S 7e, /I
Separation Distance from Absorption Field:
To Water -Supply Well To Property Line
To Building Foundation To Existing or Abandoned System on
Lot yam' On Adjoining Lots
To Water Main/Service Line '�� To Cutbank (if present) a 7'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
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, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date 3% %%G
Company G�G :,S', MOA No.
Receipt No. a:2 -�; -) is/ -A
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
• tf '�,�
Engineer's Seal
J COEOppCecp oJ. C ri
. CUG uCCJ°'.'O<1d00000e 0O CpU 0 �-�--
�''^L> Louis /t. Butara
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MUNICIPALITY OF ANCHORAGE
z.� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
CASE REVIEW WORKSHEET
CASE NUMBER:
S-7495
DATE RECEIVED:COMMENTS
DUE BY:
SUBDIVISION OR PROJECT TITLE:
Lots 1, 2 Kahn Subdivision
( ) PUBLIC WATER AVAILABLE
( ) COMMUNITY WATER AVAILABLE
( ) PUBLIC SEWER AVAILABLE
COMMENTS: See conmients
in this packet, thl De t req ests n to on he
pla : no co tructi
of septic tem in great tha % s op .
if be systemsign
is u d, it must b 10% slope r less.
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MEMORANDUM
DATE: March 5, ,1984
ro: Community Planning Department
FROM: Health and Environmental Protection
SUBJECT: Cases Due for Review - March 16, 1984
The Environmental ,leatlh Division of the Department of Health
and ]Environmental Protection Department has reviewed the
following cases and has these comments:
S-7495: Lots 1, 2 Kahn Subdivision
This department has reviewed the soils logs for
the proposed subdivision, as submitted. 'The
logs indicate a 85 square foot per: bedroom rating
and a water table at twelve(12) feet. The soils
logs do not indicate the location of the soils
test or the lot number.
Prior to final. approval this Department must have
water table monitoring for thir_ty(30) and a trite
location of soils test and lot number submitted
to this Department with the subdivision case
number shown on the paperwork.
S-7496: Mc Kenzie View West Subdivision
Public sewer and water is located to the proiect.
S-7497 Lots 1, 2 Lintner Subdivision
This department has reviewed the solls test
submitted for Lot 1. and it indicates the lot will
support on --site sewer, however_, water table
monitoring will be required for thirty(30) days
and submit findings to this Department with the
subdivision case on the paperwork prior to final
approval.
S--7498: :Lots 20A, 2013, 23A Hamann Subdivision
This department has reviewed the soils tests fol
Lot 20A a�. the NVI corner of the property. The
test, as submitted, will, support onsite sewer..
However, addressing Lot 23A, this Department's
fi].C's show no approval of an on --site sewer system
for the said lot.
S-7499: Lot:: 1.6A -•l, 16A-2 William Lloyd Subdivision
Public sewer and water is- located to the project.
S--7500: Loi: 1A Block 1.02 Anchorage Original Townsite
Public sewer and water is located at the n.roject.
John [7. Lynn
Environmental Specialist
91-oio (4/76)
SOILS LOG
57,E
MUNICIPALITY OF ANCHORAGE
0
EPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION I PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720 -- `r +
SOILS LOG — PERCOLATION TEST -
PERFORMED FOR: 41 r/ 15/1K/•%iC DATE PERFORMFD: - / �n2_�ryA�'
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LEGAL DESCRIPTI
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SITE PLAN
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ENCOUNTERED? /-;S O r
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IF YES, AT WHAT
DEPTH?
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-Reading
Date
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Net
Time
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PERCOLATION RATE(minutes/inch)
TEST RUN BETWEEN -- FTA - — FT
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PERFORMED BY: �/� �%li;f�":'.r _, CERTIFIE Y' _ _ DA1
72-008 (G/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Qr�C �KAv6V DATE PERFORMED:
LEGAL DESCRIPTION:
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C
WAS GROUND WATER S
ENCOUNTERED? L
7� D
P
IF YES, AT WHAT ^ / E
DEPTH?w/
6d SOILS LOG
❑ PERCOLATION
TEST
SITE PLAN
92-
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SLOPE
C
WAS GROUND WATER S
ENCOUNTERED? L
7� D
P
IF YES, AT WHAT ^ / E
DEPTH?w/
6d SOILS LOG
❑ PERCOLATION
TEST
SITE PLAN
92-
-
2_: J.
Reading Date Gross Net Depth to Net
Time.... : Time Water Drop
L�J
PERCOLATION RAFE ----qA—-(minutes/inch)
TEST RUN BETWEEN -_ _._ FT AND _ _ FT
COMMENTS_-ZV,,ZZ '0 sef/y O� �tlr5If-C 4 6h(a(2,'•4./6 c- R ' %O
S E Y 7 d A
PERFORMED BY: ,% / c' �, CERTIFIED BY:
gw4els—
r DATE:-
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72-008 (6/79)
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MEN
Nor
ONE
Reading Date Gross Net Depth to Net
Time.... : Time Water Drop
L�J
PERCOLATION RAFE ----qA—-(minutes/inch)
TEST RUN BETWEEN -_ _._ FT AND _ _ FT
COMMENTS_-ZV,,ZZ '0 sef/y O� �tlr5If-C 4 6h(a(2,'•4./6 c- R ' %O
S E Y 7 d A
PERFORMED BY: ,% / c' �, CERTIFIED BY:
gw4els—
r DATE:-
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72-008 (6/79)
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