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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 ., _ kf''. f �,-;•, i'�•.1�f t-.11 {f� moi•}#.,{.%� i•{7'1!' r'-%,F'?'fir; it;.sf'�!'£:::.i•���1), ��'�`•`t=f I_-i"i!'1�¢ :"i =-C_' '� {j•c`€?:°-= #.• �#1'!f"f'tt i �{'tf.7%' . }-1�... 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I {fi'iEW.w,a{{11's?y* {vai3- mv 411r `,[y'. .t �i� ..r n� ..' #7;s ?} 111,{I- ).1 ,;'k (;- ;•r e, - �,,t. �i:5t`.#�+i� (:. i c:.{'}t_?Z�- �-. =.�'! F'lt Y'?1'i �,?(1'y Y•li .��`1-: ,��'is•t •t t;:ir{ifs{tt 4i'Y^. .... � �'t __,_ ��.•� rlt�ll J�mlc ',, x,4•1 �T5 ;'' _ .. _{ -"sr F`l ;f f_ ,,.lE, l f . _ ..._ ..1 2F-} 7 i - __3k�1` t { 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 50' WRVEY ,� AI M LOTLAN FUD" ASB4T FASCTE A&LT O T rMY /.r1Y.r.l•w.T w1nt�. iSU �N.. . ).ANEr ... WyeoNNwr Robert E. Johns, Jr. & Assoc. Professional Land Surveyors V. =501 Lot 4 B1OCk 9 Kasilof Fills LOt S.F. 'Ree. Mt nx of:J Ia'. 4d by. J 2514 a.. F pm* SET PEBAR t � �♦ DRAINAGE O FOUMt P.f6AP � WOOD FENCE r P1 A�^JUEO E [v. MET.L [[NCE ASPHALT CONLYtETE e. �rvC - N UI G p9awagammm NS t LOT SLW&-YS ONLY T10SE tMPROVEmENTS ABOVE GROUND AND VISIBLE Y W Bt R I-gNt)V/N [ENCES. WELLS. $E9 RC EyEANOUTS. SI!)EWALKS' GN<VEWAY$ESPONSIBILITY OF TME BUI pER OR,UCpADE RELOATIVE ARE $HOMt IN TntEtR APPROxIMATE tACwnoN, ONLY, gNOyION, TO VEP.IFY PrtOPOSE' wy n%J TO OE TEHNINE EIC..D GRADE ANU UTILITY GONNEG770NS %' RESTFICTIONS MAr vFEVENT SOME INPROVEME'TS FROM BEING SEEN AND LOCANCE OF ANY EASEMENTS, GDYENAN TS'ON P AT. ♦ I"r � cnI H[»v151 �ARY OR FENCE LNES.NOY APPEAR CIN THE AECORD�p_ S.�UNDER 110 t71tLUU5TANCES SHOULL• AN ASY &IMT BC USED FOP CClISTRJCiICw OP [OR ESTABLISHMCewmlrntw uAr GAJSE ERRORS M SCMLI AL TPI.NSACTION ONLY ANO ASSUME$ FMANCIAL UABNTY ONLY fOR SNE COST OF THE SURIRVEYOR TAKC$ RESPp+51BLATY FON THE, W Tl �„ ,,.... ,,�, _ _ _ Mtuiicipaliiy, of A,nehorage CO. IAox 1!NiG;0 • :\nchomgc, .\luau) !Y.6i19•66i0.47(NI lihuarc Riad = O lim (!N)7) 313 KM • 19n: (!N)7) 333kC'(X) h!ryr.//�r�ar.muntnrg 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 0' . . . . . . . . . . . . . Do 0 0 c; o Lu 66 IN rj) O z < z z a: LU I > 0 ui w W -j LU Ul ul -i -i w ui 0 . . CL ca u (1) LL . . . . . . . . . . . . . Lu z z a: LU I > m LU I < > uj ui w W -j LU Ul ul -i -i w ui w m -j ui (1) a: F. 0 IL ca u (1) 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 I I I I I I 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 "��� �� � ���. Q ,�-�. ,. s. , , �� ,. �� �� �- ;, �. -. 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.