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KASILOF HILLS BLK 9 LT 4
HomeMy WebLinkAboutKASILOF HILLS BLK 9 LT 4Kasilof Hills
Block 9
Lot 4
#015-131-02
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 LStreet -Anchorage, Alaska 99501 Telephone 764-472.0
ON-SITE SEWAGE:. DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
- _
NAME '-
PHONE
RICHARD D.LANTZ—
349-4156
L�YVEW
❑UPGRADE
--
MAILING ADDRESS
P.O. BOX 10-1073 ANCHORAGE, AK. 99511
LEGAL. DESCRIPTION
L4 B9 KASILOE HILLS SUBDIVISION
LOCATION
PROSPECT DRIVE
NO. OF BEDROOMS
4
Well Absorption area �^ Dwelling
U� DISTANCE TO: 102' 5' 14'
PERMIT NO.
820119
a Z
Manufacturer
GREER
Material
No. of compartments
wa
STL
2
N
Lic. rapacity in gallons
Inside length
Width
Liquid depth
IF HOMEMADE:
DISTANCE TO: Well Dwelling
PERMIT NO.
2 F
Manufacturer Material
Liquid capacity in gallons
Q
wm
���jjj""" WellW�ell��
DISTANCE TO: 114'
Foundation
20'
Nearest lot line
12'
PERMIT NO.
U_
No. of lines Length of each line
Total length of lines
Trench width
Distance between lines
ti?a
_ 1 6.3' _
63'
24 inches
f-
Top of tile to finish grade 4 i
Material beneath rile 48
Total effective absorption area
O
-
inches
504 s . f .
Length
Width
_
Depth _-_-_�-_- -
PI_RMIT NO.
w
-
C7
a h-
LU
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
a
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
DISTANCE TO:
Building foundation
Sewer line
Septic tank
_
Absorption area (sl
OTHER
PIPE MATERIALS
PVC, CAST
-
--
SOIL TEST RATING
-
125
INSTALLER
D & B GENERAL, INC.
-
—
NIS
REMARKS
�
CO
-- .„
[✓<
-e:`.. eo•e.e 9
Y��.e..e..e
:.r f(o.2100
V.
LEGAL
APPROVED DATE
E.F.F. 7/1/82
PELS
TYPE OF SOIL HBSDRPTION SYSTEM IS� TRENCH
MAXIMUM NUMBER OF BEDROOMS A. SOIL RHTING (SQ 1"T/BR4, 125
THE REQUIRED SIZE OF THE SOIL HBSORPTIOH �YSTEM IS�
�!E! 14 Q 1-1 Cie two 001 V WE-- 4�` �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHlNFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTFill CE BETWEEN THE SLAP Fly CE OF THE
GROUND HHD THE BOTTOM OF THE EXCHVHTIOM (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVATION (IN FEET)
lot 101 "T" 1-1 X win I Q QT EEE To" f- 1: Q -f- to! P-41 F< 10 X 21 T�n 1. Gy 10 0 C, 1 Ff 1 in, T41 nG
PERMIT HPPLICHNT HHS THE IBILITY TO INFORM THIS MPHRTMENT MRI44G THE
IPOSTAL! INT ION INSPECTIONS OF HNY HELLS RDJRCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THAT THE WELL NILL SERVE
� �1!-, rc� 31 11 MUMMIS117-1- X 00410 M NO: !Fi� 171 M KEY 1 - y 1 An TE7 AD"
BRCKFILLING OF RNY SYSTEM HITHOUT FINHL INSPECTION HND HPPROYRL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION
�M lot PVT 1: -T- W�E X 10" 1: 170 El: !FT �a P:-,� ir- I! :::R-���
I CERTIFY THHT
1� I HM F8MILIPAR WITH THE REQUIREMENTS FOR CIO `SITE SEWERS RND NELLS HS SET
FORTH BY THE MUNICIPHLITY OF ANCHORAGE.
2� I WILL WSTHLL THE SYSTEM IN HCCORDHNCE WITH 1H2 CODES
]� I UNDERSTHND THHT THE ON—SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4
~~�.
SIGNED�..~~_��.~~�._~~._~~—`_~~~���—�—��—�~^
HPPLICHNT RICHHRD D LHNTZ
IS
SUED �-~
BY
� ro U 01
^
7\
u
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{
SIZE OF THE SOIL f*iE:cORPTION IS:
������ ���J- "I= 1- —r- ���V r..`E ll,_ ������ �
THE LENGTH DIMENSION IS THE LENGTH (IN FF -.'ET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
THERE IS hli-I SET WIDTH FTIR TRENCHES.
THE I lRHVEL DEPTF.i IS THE 01INIMUM DEPTH OF GRAVEL BETI-IEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCHYRTION (IN FEET).
UP 1 EE- ��-11", 1 c: 1- F-4 r-4 �1 2-_'. IE-,�
PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION INSPECTIONS OF 8NY WELLS ADJACENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERYE.
BHCKFILLING Of" ANY SYSTI-M WITHOUT FINAL MAD APPROVAL BY T�IS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DI:..:THNCE BETWEPN A kIELL HND ANY ON-SI7E DlSPOSHL SYSTEM IS
1�0 FE�T FOR A PRIVATE W1ELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMI.M DISTANCE FROM H PRIVATE WELL TO H �RPVHTE SEWER LINE IS 25 FEET HND
TO A COMMUhIITY �EI,,JER LINE T.S.; 75, FEET.
WELL LOGS ARE RE(':.,!UIF--!ED AND MUST BE RETURNED TO THE �EPHRTtiErT WITHIN ]0 DHYS
OF THE WELL ��MPLETION
OTHER REQUIREMENTS MHY APP LY. SPECIF--ICATION�S AND CONSTRUCTION DIRGRHMS HRE
HVH�LH�L� TO INSURE PROPER I�ST��L��TION
r. "T' ������� �������� A.-
I CERTIf Y THAT
1: I HM FAMILIHR WITH THE ON—SITE 5EUERS AND WELLS HS SET
FORTH BY THE MUNICIPALITY OF HNCHORAGE.
2� I WILL INSTHLL THE SYSTEM IN HCCORDRNCE WITH THE CODES
]� I UNDERSTHND THHT THE ON --SITE SEWER SYSTE'M MAY ENLARGEMENT IF THE
R�SIDEN TO E rltDRE THAN � BEDROOMS.
HPPLIC.:At4;PlM/C BUII-D�RS
�
rel ��1 R., .1
4zl 0_.I 'T �-rn
�D F'
�����9,:1 C.- L_:
DEPHRT[,IENT .
HEALTH AND
ENVI�ONMENTHL
.<OTECTION
82� 'L'
STREET/ 501
264-47*20
������� �����-1 X Y
PERMIT
NO ( 810071 )
HPPLICHNT
M/C BUILDERS
BOX
2187
LOCATION
PROSPECT DRIV�
LEGHL
LOT 4 BLK ��SILOF'
HILLS
LOT SIZE 44]25 SQUARE. FEET
TYPE OF
SOIL HBSORPTT0N SYSTEM
I.�:; : TRENCH
MHX�MUM
NUMBER OF BEDROOMS n=
]
SOIL.
RHTING (SM FT/BR)=: 125
SIZE OF THE SOIL f*iE:cORPTION IS:
������ ���J- "I= 1- —r- ���V r..`E ll,_ ������ �
THE LENGTH DIMENSION IS THE LENGTH (IN FF -.'ET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
THERE IS hli-I SET WIDTH FTIR TRENCHES.
THE I lRHVEL DEPTF.i IS THE 01INIMUM DEPTH OF GRAVEL BETI-IEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCHYRTION (IN FEET).
UP 1 EE- ��-11", 1 c: 1- F-4 r-4 �1 2-_'. IE-,�
PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION INSPECTIONS OF 8NY WELLS ADJACENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERYE.
BHCKFILLING Of" ANY SYSTI-M WITHOUT FINAL MAD APPROVAL BY T�IS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DI:..:THNCE BETWEPN A kIELL HND ANY ON-SI7E DlSPOSHL SYSTEM IS
1�0 FE�T FOR A PRIVATE W1ELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMI.M DISTANCE FROM H PRIVATE WELL TO H �RPVHTE SEWER LINE IS 25 FEET HND
TO A COMMUhIITY �EI,,JER LINE T.S.; 75, FEET.
WELL LOGS ARE RE(':.,!UIF--!ED AND MUST BE RETURNED TO THE �EPHRTtiErT WITHIN ]0 DHYS
OF THE WELL ��MPLETION
OTHER REQUIREMENTS MHY APP LY. SPECIF--ICATION�S AND CONSTRUCTION DIRGRHMS HRE
HVH�LH�L� TO INSURE PROPER I�ST��L��TION
r. "T' ������� �������� A.-
I CERTIf Y THAT
1: I HM FAMILIHR WITH THE ON—SITE 5EUERS AND WELLS HS SET
FORTH BY THE MUNICIPALITY OF HNCHORAGE.
2� I WILL INSTHLL THE SYSTEM IN HCCORDRNCE WITH THE CODES
]� I UNDERSTHND THHT THE ON --SITE SEWER SYSTE'M MAY ENLARGEMENT IF THE
R�SIDEN TO E rltDRE THAN � BEDROOMS.
HPPLIC.:At4;PlM/C BUII-D�RS
�
M/C Builders
Box 2187
Anchorage, AK 99510
January 4, 1982
1
i'
January 4, 1982
Permit # 810071
Subject: LOT 4 BLK 9 KASILOF HILLS
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
V 6�
(Jjk�
Les N. Buchholz
Program Manager
Sewer and Water Program
Enclosure; Copy of Permit
I
Permit # 810071
Subject: LOT 4 BLK 9 KASILOF HILLS
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
V 6�
(Jjk�
Les N. Buchholz
Program Manager
Sewer and Water Program
Enclosure; Copy of Permit
A SOILS LOG
MUNICIPALITY OF ANCHORAGE
�. ❑ PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
e— T
PERFORMED FOR: �/°iirf/�'/s>./'/Y�J>�, DATEPERFORMED:
LEGAL DESCRIPTION: _ •-�r/.��-� 6 !'"s' --S ?/Q ` 7/(� 4'[/ n
SLOPE SITE PLAN
DEPTH
2
(FEET)
�)
Net
Time
Depth to
Water
Net
Drop
3
fie4-
ti>
5-
7
IQ)
:.5
r� a
6-
'<.
M r1% ,
7 -d
8
7-/f
9
10 vbclAl —1
11 AS GROUND WATER —�{A. L
a ,-Ei' E COUNTERED? V
°
12 E
IF YES, AT WHAT
DEPTH?
13
14-
15
16
17
18
19
20
PERCOLATION RATE _(minutes/inch)
TEST RUN BETWEEN FT AND — FT
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
ti>
7
IQ)
:.5
f�
10 vbclAl —1
11 AS GROUND WATER —�{A. L
a ,-Ei' E COUNTERED? V
°
12 E
IF YES, AT WHAT
DEPTH?
13
14-
15
16
17
18
19
20
PERCOLATION RATE _(minutes/inch)
TEST RUN BETWEEN FT AND — FT
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
T* z'
COMMENTS
PERFORMED BY:
72-008 (6/79)
CERTIFIED BY:
' DA
m
0
l0 --o
LOCATION OF WELL (Please complete either to, Ib or Is.)
K-1
Borough (( Subdivision Lot Bnlock Ib. 1/agtrs.
1. -es Q, _ t-` F-11 1 �;1, �.�. i� �f—of =of T
Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Upper O'Malley & Prospect
Street Address and Area of Well Location
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENI OF NATURAL RESOURES
Division of Geological a Geophysicol Surveys
Drilling Permit No.
A.D.L. No.
Section No. Township NL,Range [i�J Mori dion
3. OWNER OF WELL; Reggie Lantz
Address: P.O. Box 10-1073
Anchorage, Ak 99511
2. WELL LOG
Material Type
Feet Below
Surface _
Top
Balloon
-Light silty gravel
be Oroc - bl.ac -gray- a ecompos
0
T3-
13
5
hard gray black rock
15
131E
on" 01 nmPra'FP
1"54
177
ire vVl l' iV - .V i j I
I �j :_
4.
WELL(final) I 5. DATE OF COMPLETION
r77 rrDEPTH:
6.
Cable tool Rotary Driven
❑ Dug
Auger © Jetted ® Bored
Other
7.
USE: [A Domestic Public Supply
❑ Industry
F-1 Irrigation O Recharge
Com morical
Test Well F] Other:.
---
8.
CASING: Threaded ©. Welded
"^
diam.
r7
-6 —in. to�7�i1 Depth Weight �-.( _Ibs./ft.
diam.
in, to ft. Depth Stickup
_ ft.
9.
FINISH OF WELL
open hole
61:1
TYPO. ___--- __._-.__--_— Diameter:_
SIo1/Mesh Siae: _ _ Length:
Sot between fl. and
ft.
Backfilling Gravel pack
10.
STATIC WATER LEVEL: _ft.
E] Above or C] Below land surface
Dote
Equipment used:
II . PUMPING LEVEL below land surface and YIELD
fl. after hrs. pumping __ g.p.m.
ff. after hrs. pumping g. p. In.
12. GROUTING Well Grouted' Yes n No
Material: LJ Neat Cement Other:
13, PUMP: (if available) HP
Length of Drop Pipe ft. capacity
0 Subm. E1 Jot LJ Centrificol Olher
14. REMARKS :1
2z 9 P M
16. WATER WELL CONTRACTORS CERTIFICATION:
F15 Water lompe ratare
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief;
VZX_n 1 S l)rj7�i n r 9 Z7.t __ "-_3-3 7 _ - -
Registered Business Name Contract License Number
Add
ress.
Signed: Dote:
Authorized Representative
rre 02-WWR (11/81) Copy Distribution: WHI"fE-Sloto DGGS, PINK -Driller, CANARY-Caslomor
g, p. m.
u E)F �� C _-
LOCATION OF WELL
(Pleaso complete either Is, Ite or Ie.)
-- --]
la, Borough
- —
Subdivision Lot Block
(S J//'
// �/�
6Q/—
Ib. 1/ngtrS-
_—of__ot—.of�.—
Ic. DISTANCE AND DIRECTION
FROM ROAD INTERSECTIONS
0 Coblo tool
Rotary ❑ Driven Dug
❑ Auger
Street Address and Area
of Well Location
USE: Domestic
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL Rt' SO(1RES
Division of Geological EA GeCjNl,ysicoI
Drilling Permit No.
A.D.L. No.
Section NoTToven S hip Nl� Ronge
S l�
3. OWNER OF WELL:
2. WELL LOG I Feet Below
fdalorial Type_______
Surface
_Top Bottom
7
Address:
E r-1 Mari d i a n
W El I
4.
WELL DEPTH: ( find l l
I 5, DATE OF COMPLETION
fl. of lcr
hr s. pumping g.p m.
12.GROUTING Well Grouted:
G.
0 Coblo tool
Rotary ❑ Driven Dug
❑ Auger
EJJot ted Cl Dorod O1 tier
7.
USE: Domestic
�_� Public Supply Industry
Irrigation
�_� Recharge U Commerical
D Test Well
n Other.
B.
CASING: U Ihroadnd n Waldorf
diner
. in. to _.
_ It: DaPRt Weight Ihs./1t
diom.
1,. to
fl. Depth Slickup (1.
- 9.
FINISH OF VIELL:
Typo _—_.-._. _._
_._. �_ _". Oinmotor._
Slot/Mash SIzo:
Lnngth'.
Set betwaon
It and it
Dackfilling
_.__._. Gravel pact..___
10.
STATIC WATER LEVEL" ._ft.
Above or
lJ Delon land surface Date
Equipment used
11 . PUMPING LEVEL holow lend surface and YIELD
fl. offer
hie. pumpiny g.p.m.
fl. of lcr
hr s. pumping g.p m.
12.GROUTING Well Grouted:
�) Yes n No
Material Neat Cement
E Other' _
13. PUM P: (if available) IIp
--�— length of Drop Pipe it capacity gp. to
Subm. �_� jet [_� Conlrifical f7 Other
11, REMARKS
16. WATER WELL_ CON T RAC"toR S CERTIFICATION: - - - -- --
15 Water tom pa nif,; ----o 0 r CJ C
This well was drilled under my jurisdlclion and this report is true to the best of my knowledge and belief;
Registered Bust PassName Contract Lieonse Numbrr
Signed i`i' �rJz�.�C .' -- --- ------ Dat C
Authorized Reprt(sen talivo
Form 02-WYJR (11/61) Copy Distribution: WHIM -State DGGS, PINK-Drillar, CANARY- G,,tomer
u
1
Municipality of Anchorage
.�
• Development Services Department
Building Safety Division
/ On -Site Water & Wastewater Program
4700 B ox 1 Street R�Jy�
P.O. Box 196650 0 o f
Anchorage. AKrg/ons a `'r9/►
www.muni.orglonsRe
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. d f 5' 131 -Ooh. cosA# ��ti�
1. GENERAL INFORMATION
Expiration Date:
Complete legal description KASILOF HILLS; BLOCK 9 LOT 4
Location (site address) 10701 PROSPECT DRIVE *ANCHORAGE, AK
Current Property owner(s)
ED do CAROLYNN CROUCH Day phone C/O AGENT
Mailing address 10701 PROSPECT DRIVE •ANCHORAGE AK
Day phone
Lending agency
Mailing address
Real Estate Agent
BETH WEISER W/PRUDENTIAL Day phone 762-3111
Mailing address 3801 CENTER POINT DRIVE 200 'ANCHORAGE, AK 99503
Unless 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 On-site N
Individual Water Storage ❑ Individual Holding tank 13
Community Class Well ❑ Community On-site El❑
Public Water System El 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 engineers work.
4. STATEMENT OF INSPECTION 6Y ENGINEER
As certified by my seal arTxed hereto and as of the validation date shown below, t 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 watersupply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. /further verify that based on the
information obtained from the Municipality of Anchorage riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 3 0 8
Engineers 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 Me time of the test, and separation
distances measured to readily identifiable features. The operational file of a17 wells and
septic systems depend on Me 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. Sab'sfactory 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 report by any
other person or party 1s not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Z Approved for _
bedrooms.
Disapproved,
Conditional approval for
Attachments:
bedrooms, with the
�y
dlations:' t
ON-SITE
WAiE}U=
:�_(YASTEWATER
6. PROGRAM
V-
COSA Checklist
Septic System Advisory Arsenic Advisory
Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Reort
Nitrate Advisory %� Other
By: w / Original Certificate Date:
IFw t1/KI
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: KASILOF HILLS; BLOCK 9 LOT 4 Parcel ID: O /6-= 131
A. WELL DATA
N A Well Lo YIN YES
Well type MOTE If A, B, or C provide PWSIDt/ � g ( N)
Date completed 127 1982 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth
177 ft, Cased to 27.4 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test
7/27/1982 8/8/08
Static water level
UNK ft. 32 _ ft.
Well production 2.5 g.p.m.
1.7 g.p.m.
WATER SAMPLE RESULTS:
Coliform �— colonies/100 ml. Nitrate 6.46 mg -IL.
Other bacteria 0 colonies/100 ml.
Arsenic: ND_ _ug -IL-
Date of sample: 8 4 08Collected by: GEG Ltd.
B. SEPTICIHOLDING TANK DATA ' LOCATED BY GEG CONSTRUCTION CREW
Tank Type/Material
SPETIC/STEEL Date installed 7/1/1982
Tank size 1500 gal. Number of Compartments 2 Cleanouts _ (YIN) YES
Foundation cleanout (YIN) *YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 8/8/08 Pumper AROUND THE CLOCK PUMPING
C. ABSORPTION FIELD DATA a LowxisTiNG GRADE
Date Installed 7/1/1982 Soil rating (g.p.d./Wo /bdr 125 System type TRENCH
Length
63 ft. Width 2 ft. Gravel below pipe 4 ft.
Total depth _'*9 ft. Eff. absorption area 504 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/8/08 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth In absorption field before test 32 in. Water added 600 gal. New depth 32 in.
Elapsed Time: 0 min. Final fluid depth 32 In. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type)
NONE KNOWN If yes, give date----=—
D. LIFT STATION
Date installed Size In gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off" leve High water alarm level at in.
Datu Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot* 98, On adjacent lots 100'+
Absorption field on lot 1001+ On adjacent lots 100'+
Public sewer main — N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ 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 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*SEE ATTACHED WAIVER LETTER
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed N me JEFFREY A. GARNESS
Date 9).3�o$
COSA Fee S L -i 3 O+ 17.5 (2 us I+
Date of Payment 9 1 / L0�8p
Receipt Number_
(Rev. 11/05)
Waiver Fee $!, 01 )-U . O 0
Date of Payment / 4 1 a 2�
Receipt Number
Municipality of Anchorage
Development Services Department max;
Building Safety 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 # 080305
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 9, Lot 4 of
Kasilof Hills subdivision. This inspection revealed a nitrate concentration of
6.5 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.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank Icach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perforin an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
SGS Ref.N
Client Name
Project Name/N
Client Sample ID
Matrix
PN SID
Sample Remarks:
1084032001
Garness Engineering Group, Ltd.
10701 Prospect Dr
10701 Prospect Dr
Drinking Water
0
All Dates/Times are Alaska Standard Time
Printed Date/rime
08/192008 11:17
Collected Date/time
08/042008 12:30
Received Date/time
08/042008 14:30
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter
Results PQL Units Method ContaincrlD Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug(L EP200.8 C (<10) 08/10/08 08/15/08 hill
Waters Department
Total Nitratc/Nitritc-N 6.46 0.100 mg/L SM204500NO3-F D (<10) 08/18/08 JD7.
Microbiology Laboratory
Colony Count 0 coVl00mL SN1209222B A (<200) 08/04/08 DLC
Total Colifurm 0 coVl00mL SM209222D A (<I) 08/04/08 DLC
Fecal Coliform 0 col/100mL S\12092226 A (<I) 08/04/08 DLC
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Magor ,Mark Begich Development Seri -lees Department
September 5, 2008
Jeffrey Garness, P.E.
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, Ali 99507
Subject: Waiver Request for hasilof IIills, Block 9 Lot 4
Waiver Request WR#: 080062
Parcel ID # 015-131-02
IIA 080305
Dear Jeffrey Garness, P.E.:
ment... S.
Nov
Department
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to the private well has been approved. The approved separation distance is
98.0 feet.
This waiver approval applies to the existing septic tank to private well separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
fl7Gt/
xA
Deb Wockenfuss
Civil Engineer
On -Site Water & Wastewater Program
Co1)1lll(llihy, Security, Prosperhy
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WR#: 080062 PID#: 015-131-02 HA/Permit# IIA 080305
Date Received: September S. 2008
Legal Description: Kasilof Ilills, Block 9 Lot 4
Engineer:
Jeffrey Garness, P.E.
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Applicant: Ed and Carolynn Crouch
Waiver Requested: 98' from lank to well
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: X Waiver is not Granted:
List Conditions or Reasons for above: Ser% /tr 1�Ac
Points:
Date:1519 08 By: Deb Wockenfuss
Name of Reviewer
Rec#:89 494 Amount: $920 Dale Paid: 915/2008
Kasilof Hills, Block 9 Lot 4
Parcel ID: 01513102
Waiver for 98 feet from well to tank
Issued September 5, 2008
General
1. From the water sample, total coliform was 0, and total nitrates was 6.46 mglL.
2. Any overflowing sewage would have to travel around the house to get to the well head.
3. The location of the system is in a visible area and any surfacing effluent will be seen and
corrected.
4. The well head is higher in elevation than the tank standpipes.
ADEC Criteria Points
Water Table
Depth of bedrock in well 13 feet
Assumed bottom of tank 8 feet
5 feet
0.6
Soil Sorotion
Soil descriptions from well log
DEC PTS Depth From Depth To Thickness Calc. Pts
Tight silty gravel 2.5 8 13 5 2.50
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
5 2.50 2.5
Permeability
Soil descriptions from well log
DEC PTS Depth From Depth To Thickness Calc. Pts
Tight silty gravel 1.7 8 13 5 1.70
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
5 1.70 1.7
Water Table Gradient -
Water table slopes toward the water source 2.2
Assume 4.0% slope
Horizontal Separation
98 feet between septic tank and well
x=23/25+2.0
Total Points 9.9
2.92
A separation distance of 98' has points calculated at 9.9. If the well was moved so that separation distances were
met, the total points would be 10.0. The encroachment has existed for 26 years. Waiver approved.
HA080305
Kasilof 1
Block 91
10,
Adj
9/5/08
Nater Table Gradient Calculation
Kasilof Hills, Block 9 Lot 4
.asilof Hills,
dock 9 Lot 4
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GARNLSS ENGINEERING GROUP, Ltd.
• ... CONSULTANTS & GENERAL CONTRACTORS 9- __-
September 3, 2008
Municipality of Anchorage
Department of Health R Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref. Waiver Request from Well to Septic Tank: Knsilor Hills; Block 9, Lot 4
The existing 4 bedroom house is served by a private well and septic system. During our site investigation
work to obtain a COSA, we discovered that the well on the subject property is only 98 feet away from the
existing 1500 gallon septic tank on the subject property. We request you grant a 98 foot separation
distance waiver from the well on the referenced property to the septic tank. The following items are
justification for the waiver:
• The well and septic system are on opposite sides of the house. If effluent were to surface, it would be
unable to travel back towards the well head.
• The existing encroachment has existed for over 26 years.
• Attached is the well log for the referenced property. The well depth is 177 feet. The soil appears to be
variations of gravel, bedrock, and conglomerate. Also attached are 3 well logs from adjacent
properties.
• The topography of the lot is laid out in such a way that if the tank were to overflow, the effluent
would travel down the slopes in the complete opposite direction of the well head.
• We are only asking for a 2% variance.
• Recent water samples results indicated no bacteria present and nitrate levels to be 6.46 mgJL. In
short, the water quality is within MOA, state, and EPA requirements.
Based upon the aforementioned facts, it appears that there is minimal risk associated with the 98 foot
separation distance Waiver.
have 1[144u�-tjons, please contact us at 337-6179. Thank you for your assistance.
P.13.. M.S.
3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamcsscnginccring.com
I
98' WELL RADIUS O 100• WELL RADIUS I I
I I
EXISTING 4
BEDROOM
HOUSE /
I I
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GA_R_ N_E_SS ENGINEERING GROUP, Ltd. `y
CONSULTANTS& GENERAL CONTRACTORS . ' . ' ""' ..........
"I [ 11Od IbD. 1WR 101 • MKIEILG M N901 • F10t[ (Y01}ll)-tl» • IAIt (001)]]!'J]w • MOSIIL w..p�n/irM}arn
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:•; '••• Go • ••" ••.
ED & CAROLYNN CROUCH C/O AGENT 1 OF 1 O�Qoo F
e ' GHess:
CE— :i
LEGAL DESCRIPTION: DRAWN BY: '• I FG
KASILOF HILLS; BLOCK 9, LOT 4 PNB �Q �.s 5{•/fie'' F o0
TYPE OF WORK: GATE: 4OQofesslop
O4OpQOO�o`�
DETAIL DRAWING OF ENCROACHMENT 9/3/08
(RW. DUOS)
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services M
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # O I S 131 O Z- HAA # _ � QS r QL4&
1. GENERAL INFORMATION
Complete legal description L-.4 C'' k 9 Inas � to
Location (site address or directions) ic�7�t I�fvs �r
kr�_ch _9951(o
Property owner E� Cz�o1�n CYpJGa Day phone" L 66
Mailing address SAOAle' —
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well )<
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site k —
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72.-025 (Rev. 1/91) Front MOA 421
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 G-51 Phone 34c'ZoUO /699 9x98
Address 9(00) 3'.) n -e- Dv cl\ora e ,AK 9951
Engineer's signature �� `- Date y Z.! - 9 2 -
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
WTIC
OF At
iV
n 'SY1. i� • .
w
s0 1ND tl3' A AiDV
a�ee •. mcenama<saaa►CIAo n
jijuo22,1964i �ltAa
bedrooms, with the following stipulations:
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 engineers work.
72-025 (Rev. 1/91) Back MOA W21
® •.r Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L4 B9 ers 11"'_ 1401S Parcel I.D
015-"-131-07-
A. WELL DATA
Well type 1v If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) �^'�t�c DF)�?S Date completed 19$z Driller il to _
Total depth I Cased to 1 Casing height
Sanitary seal (Y/N) y Wires properly protected (Y/N) /
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
C.S
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot -1Cx'r
Absorption field on lot
-f- 100 1
AT INSPECTION
1-5-9-L -9-L MUNICIPALITY OF ANCHORAGE
— ---� MgVifteMMENTAL SERVICES DIVISION
dAN 2 4 1992
g.p.m. IO.ca g.p.mr. I `!
71_L7' RECEIVED
On adjacent lots � too
; On adjacent lots
Public sewer main 14 Public sewer manhole/cleanout
Public sewer service line "1" 1C-�,o Petroleum tank
WATER SAMPLE RESULTS: — 4��"`���'d
Coliform S Nitrate Other bacteria
Date of sample: I- 3-9Z
4-1 ob
4-10v
Collected by:
B. SEPTIC/HOLDING TANK DATA �l J
Date installed .J ALJ 198 Tank size I a Compartments
Cleanouts (Y/N)
R
Foundation cleanout (Y/N) _ I/ _. Depression (Y/N) �J
High water alarm (Y/N) N A Alarm tested (Y/N) ^iP4
Date of pumping ?" / 7 !�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot (lam On adjacent lots (1 Foundation
c
To property line f Absorption field * Water main/service line
Surface water/drainage 4-1oo
-t- 10 '
72-020 (Rev. 3/81) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed .
Size in gallons
Vent(Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
off' level at
High water alarm level Cycles tested
Meets MOA electrical codes (Y/N)
s'
SEPARATION DISTANO-FROM LIFT STATION TO:
Well on ot�� On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed ^1- 8
Length G3 Width
Total absorption area
Z
sb4 S f'
Soil rating IZi System type �11"SB
Gravel thickness `4- Total depth
Cleanouts present (Y/N)
Depression over field (Y/N) N Date of adequacy test
Results (pass/fail) 'P's
for
0
Y
1— 9— 9Z
4- bedrooms
Peroxide treatment (past 12 months) (Y/N) f.1 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot It, tC_X-3
To building foundation
On adjacent Ic
Surface water
Curtain drain
On adjacent lots '�-1 00
4 15'
+30 Cutbank
E. ENGINEER'S CERTIFICATION
Property line 1(51
To existing or abandoned system on lot N A
-+- Z's
Water main/service line a
Driveway, parking/vehicle storage area
+ 175
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
�; � y g, i' & V •
Signature
Engineer's Name
Date
� J
HAA Fee $ �r�o Waiver Fee: $
Date of Payment 2 Date of Payment
Receipt Number — -3 �c,�) Receipt Number
72-026 (Rev. 3/91) Back MOA 21
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456-3116 o FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 a FAX 274-9645
Constructing Engineers v Report Date: 01/14/92��
9601 Buddy Werner Drive
Anchorage AK 99516 Date Arrived• 01/09/92
Attn: -
Date Sampled: 01/09/92
Time Sampled: 1200
Collected By: CAL
Definitions
MDL = Method Detection
Limit
Our Lab #: A115952 B = Below Regulatory Min.
Location/Project: L4 B9 Kasilof Hills H = Above Regulatory Max.
Your Sample ID: Hose Bib E = Below Detection Limit
Sample Matrix: Water Estimated Value
IComments:
Date
Method Parameter Units Result Flag MDL Analyzed
---------------------------------------------------------------------------------------------
EPA 353.3 Nitrate -N mg/1 1.2 0.1 01/10/92
Reported By: William E. Buchan
Anchorage Operations Manager
2
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF IEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date 11-2--84
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 4, Blgq:
Location (address or directions)
10701 Prosect Driyt--
(b) Applicants Name Reaai.e La�j z Telephone - Homez�,.')QA ness
Applicants Address 10701 ProVg. -L
(c) Applicant is (check one) Lending Institution Owner/builder ;
Buyer ; Other (explain);
(d) Lending Institution 1st National Bank of Alaska Telephone 2J-2_1541
Address 646 W. 4th Ave. 99501
(e) Real Estate Co. & Agent None
Address
Telephone
(£) Mail the HAA to the following address:
Will pick up - Carolin Crouch
2. Type of Residence
Single -Family
Number of Bedrooms
3. Water Supply
Multi -Family
rI
Other (describe)
Individual Well ED Community = Public =
Note: If community well systern, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite! x l 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]
i
r
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 regula-
tions in effect on the date of this inspection.
Name ofnrnr-,tj,rj Telephone 561-1345
Address 150E Watt fifth n. o et �n n�' �P OF
4K.,c �ln
Date Noveml2aar
(ENGINEER SEAL)
6. _DHEP Approval vQ4�
Approved for L a bedrooms By ` Date
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
000° aesre a.d*.w a�
iid oy C. C L• g' �c�i
C,F.• 1 0 ����
0
pROFESSIO�P
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDP:Nr 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 REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIB;,E FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
OUNICIPAIT,y
NOV 2 1984.
Legal Description: L4, B9, Kasilof Hills Subd.
Well Classification individual If A, B, or C, D.E.C. Approved(Y/N) N/4 —
Well Log Present (Y/N) Y _ Date Completed 4_17-02 Yielder-���
Total Depth 1771 Cased to 27,5 Depth of Grouting M1ku wn
Static Water level 16.5' Pump Set At approx. 125!
Casing Height Above Ground 1211+ Sanitary Seal on Casing (Y/N)Y--
Electrical Wiring in Conduit (Y/N) Y Depression Around Vb llhead ('i/N) N_
Separation Distances from Well:
To Septic/Holding Tank on Lot 100'+ ; On Adjoining Lots 1001 +
To Nearest Edge of Absorption Field on Lot 100' + ; On Adjoining Lots loo, +
To Nearest Public Sewer Line N/A To Nearest Public Sewer
Cleanout/Manhole N/A
Water Sample Collected By
Water Sample Test Results
Conme nts
B. SEPTIC/HOLDING TANK DATA
To Nearest Sewer Service Line on Lot N/A
Duane Maney ; Date 11-1-84
Satisfactory for Total Coliform
Date Installed _ 7/82 Size �� snn No, of Compartments 2 __
Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) N Date Last Pumped 11/2/84
Pumping/Maintenance Contract on File (Y/N) NL_; for �-_�
Holding Tank High -Water Alarm (Y/N) N Temporary Holding Tank Permit (Y N) N
Separation Distances from Septic/Holding Tank:
To Water -Supply �\b ll 1001-F To Building Foundation 14,
To Property Line 51 + To Disposal Field 51
To Water Main/Service Line N/A To Stream, Pond, Lake, or Major Drainage
Course None Noted
Comments
�o C:' 6o
[Page 1 of 21
z-ls-a4
C. ABSORPTION FIELD DATA
Soils Rating in
Absorption Strata
125 Type of
System Design Trench
Date Installed
7/82
Length of Field
63'
Width of Field
2'
Depth of Field
81
Gravel Bed Thickness 4'
Square Feet of Absorption Area 504 Standpipes Present (Y/N) Y
Depression over Field (Y/N) N Date of Last Adequacy Test 11-2-R4
Results of Last Adequacy Test Adequate
Separation Distance from Absorption Field:
To Water -Supply Y+kll
To Building Foundation
100' +
20' +
To Property Line 10' +
To Existing or Abandoned System on
Lot None On Adjoining Lots 30' +
To Water Main/Service Line N/A To Cutbank(if present) stone Noted
To Stream/Pond/Lake/or Major, Drainage Course None Noted
To Driveway, Parking Area, or Vehicle Storage Area 10' +
Commlents Pumped 1000 gallons of water into trench which was completely absorbed in
approximately 10 minutes after pumping.
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
Dimensions
Manhole/Access (YM)
"Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes(Y/N)
I
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or, confortred to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed /�//,�.�;.r.,_, - /�._.Date 11 /2/84 F
Company Arctic Engineers, Inc. MOA NO. ST 84-001
KB1/d5/s
(Page 2 of 21
5-4 1r,
E.
7e, ' ... °o a..,. ,
��% E;SR 84
APP)LIC 'NT PILLS OUT UPPER HAP " ONLY
Time
Property Owner ; ��_.it �1 /C- ,/). /"f l/ 1, Il/ i _� fj /l) /- .
Phone
Mail -rig Addreps X17 O � /0 J-.�l f .... Zip Code
Buyer
Address �'-=--gip )� Zip Code
Lending Institution ` j} 1 ;% < /��.)�__ (- , J \ /,/ /i-
Phone
Date
Date
Address -/�% // i_- .`l. S� �l ,S' , 4 / fl 4, 14 4...� Zip Code
r• -
Really Co. & Agent /`;6 p,_;' -C-_,
Phone
Address ''------- Zip Code
Legal Description
Street Location K l 24 i 11 L
Type of esidence
Inspector
Ingle Family
Inspector
❑ Multiple Family No. of Bedrooms_��
'Inspector
❑ Other
Water Supply
GYrndividual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Field Notes:
Sewer Disposal
divldual Year Individual Installed:u.,-.�
❑ Public Utility When Connected to Public Utility: -
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
TimeTiime
_
Date
Date
Date
Date
Inspector
Inspector
Inspector
-
'Inspector
Field Notes:
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE _
b
Soils Rating
Date Sewer Installed
Well To Absorption Area . -
Well Log Received
;r t.
Well to Tank
Septic Tank Size
72023 131821
J c`8 3
CYj
;J'njive
Arl
Sll bj e (It. g Imin 4 Block 9 Kasilof k U Lin
Ap-,prowl.l. For inCIVARIBI MUM MY WSW:
uni-j-1'idle foll-Cmlilv) Alma Win well ColalAn NO.,
vaLur ;tnalysis Immort twedu iln hs 11--o L11i";
f im frua Hip Chnni QW, 5633 v jArrow , for rmy, mvinw.
0 tYpollod Alloily-Wal. w0m; W UlQ vmll howl are hl 0,11,11.011-1
of thon Municipality of \nchnrae Coote,', all"i oc
in confluit.
C, To c a -L. o the C11(mlyl rmltn rm Uyl MR.
0 lialve. i -.he fnqinoer col.Lj.iy l.WI 37izo of Uie rwptic tviM
Pleasle llo-PUTY this t,:(Jl: it Uw
nwkieO (li:9cw;jwmWw have ix-cni ili-e any
furthm. Cmestimm, pleme mll this offArie at- 266.1--,1'Q().
cha I:,,!
3.0-107A
NK .13 11
("c, Lot-, r" Block-, (1, ;i
c) ri (I l.j-olm-1 havi- hoon co "o.). 0 1- 'm
JqAt)j F 'M"13 r o tc-.0 OW
C
0 11 1 1 1
!�xfow;od -A,occr.'Lcal, to IAr� ('11"o J-11
;�tr! 17"Aw ,�Toao ou.
0 ilwye t -ho (n)(Jilleer 0 c i_, a,
-1. �1oal-'e no'LiFy
diif"croomicie,3 FMVC± jlr! tl _,orr, f: L rI !_Jwro caw
L
I t r 0, r. ue o n 17 i e c'. o 11, Al 7 '1) 0 .
I. -
V, 3
C e
c
2
i "���
�� �
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Q ,�-�.
,.
s.
, ,
��
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��
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�-
;,
�. -. r
EUGENE F. FISHER
P.E. - R.L.S.
f IVIL ENGINEERS /ALASKA
x BOX 888 WASILLA, ALASXAA 99667
PH0t1E 376- 2313
March 7, 1983
Municipality of Anchorage
Dept.' of Health and Environmenal
Protection
835 L. Street
Anchorage, Alaska 99501
Rq: Lot 4 Flock 9 Kasiloff S/D
Richard Lantz
To whom it may concern:
MUNICIPALITY OF ANCHORAGE
DEPT. Of' H°ALTII ?.
ENVIRONM'NTAL PROTECTION
CEI\i IED
There are two (2) clean—outs on the sewer tank for the
above referenced location.
If you have any other questions, please contact me.
Sincerely,
CIVIL ENGINEERS OF ALASKA
Eu/ene F. Fisher., P.E.
EFF; bks
EUGENE F. FISHER
sr
�IVIL ENGINEERS /ALASKA
Bo% Bea WASILLA, ALASKA f-1 99687
PHONE 376- 2313
February 10, 1983
Municipality of Anchorage
Department of Health & Environmental
Protection
825 L Street
Anchorage, Alaska 99501
RE: Sewer Permit Number 820119
Richard Lantz
To whom it may concern:
The tank installed on Lot 4 Block 9 Kasilof Hills Subdivision
for Richard Lantz, sewer permit number 820119 was a 1500 gallon
tank from Greer Tank.—�
If you have any further questions, please contact me.
Sincerely,
CIVIL ENGINEERS OF ALASKA
Eugene F. Fisher, P.E.