HomeMy WebLinkAboutKEMP LT 2
,,'.-- i.~ Municipality of Anchorage ... Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
" ENVIRONMENTAL SERVICES DIVISION .'
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'/o c~c~ -z~ PID Number:
Name:
~ ~ ~ ~ ~ ~ ~ ~ Wastewater System: D New ~Upgrade
Address:
~[~ ~ ~ ~ ABSORPTION'FIELD ..
Phone:
I No. of Bedrooms: ~Deep Trench D Shallow Trench D Bed D Mound D Other
Soil Rating: Total Depth from original grade:
Lot: Block: Subdiv~ion: Depth to pipe bo~om from original grade: Gravel depth beneath pipe
Township: J Range: ~ Section: ~ Fill added above original grade: ,~ Gravel length:
I
I
Ft.
WELL: D New D U~ Gravel widths, Number of lines: I Oistancebe~ee, lines:
Ft. t ~t.
Classification (Private, A,B,C): ~th: Cased To: Total absorpt on a~ea Pipe material:
Driller: ~~ Date Drilled: Static Water Level: Installer: Date installed:
~GPM II Pump Set at: Ft. Ic~ing Height Ab°ye Gr°und:Ft. TAN K'
SEPARATION DISTANCES ~eptic D Holding ~ S.T.E.P.
To Septic Absorption ~ Lift Holding Public/Private Manufacturer: Capaci~ in gallons:
From Tank Field Station Tank ~wer Lines ~ ~ ~
Material: Number of CompaAments:
Sudace
Water /~ ~* ~ z~* LIFT STATION
LOt ~- Size in gallons: I Manufacturer: __/
Foundation ~O, ~, -- -- __ "Pump on" level at: I '~~ I High water alarm at:
Cu~ain =ump Mak~ctrical InspeCtiOns pedormed by:
Drain
. Location and Description:
I Assumed Elevation:
Department of Heait~ and "~ ~O--'c~ ~..ro~;
Reviewed and approved by: < ~" ~1~ Date'
72~13 (Rev. 9/91) MOA 25 .
AS-BUILT
WASTEWATER ADSORPTION SYSTEM
Lot 2 Kemp Subdivision
Lo-t; 1
44,4'
45,Gi
200+ ¢eet to
neighboring syste~
49T~
~teven R.
No, CE 8149
Lot 3
(Undevetoped)
10'
100+ Feet
1:o
PREPARED~FORm
~100 To. Usm?,n ~x
Anchor~oe, A[~ 99516
(907) 276-4245 ~'~%%~
200+ ?ee~ ~o
existing s%re~ms
]TEl
verified
~t tl~e oF
Deslgnl InstaLt~on
Pert Rm~e o? 40 Nlm/ ~m~h
3 Be~poom House ~
1000 SF o¢ AbsocpUon Re~ui~ed
is. We% 8' EF?ec~lve Depth, ¢
,¢ ,, _ ................ U~e Deep Trench lO' TotM DepSh
/
/
STEVEN R. PANNO~, P.E. '
P. O. ]~OX 142085/
ANCHORAGE, ALASKA 99514
874-030B~, 878/8218 ,Fax ,
DATD 6-~3.9G ~
' iCALE, 1'=50'.../~ AS'BUILT
S[even R, Ponnon
No. CE 81~9
A -BUILT DETAILS
WASTEWATER ABSORPTION SYSTEN
Lo~; 2 Kemp Subdivision
J. igDNV3-1~]
Z
3EA£ aD£INDW
£
o
..J
~o
U
Ld
lnDN¥39D
PREPARED FrIRi
Mon%e Go~l%zke
BIO0 T,, tlsr~c~
(907>
STEVEN R, PANNDNE, P.E.
P. D BOX 142025
ANCHORAGE, ALASKA 99514I
274-030B~ 272-B21B FAX
ATE, 6-~3-9~ I '
~ AS-BUILT
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATI ON TEST
PERFORMED FOR: ~,t'T-~--- ~.~ tT~:~..~
LEGAL DESCRIPTION:
8
9
10
11
12
13
14
15
16
17
18
I
2
3
4
5
6-
7
DATE PERFORM
Township, Range, Section:
SLOPE
-/
WAS GROUND WATER
ENCOUNTERED?
IF YES AT WHAT
DEPTH?
Depth lo Water After
Monitoring? "'T~T~ "~ Date:
SITE PLAN
Reading
Date
Gross
Time
Net
Time
Depth to Net
Water Drop
COMMENTS
PERCOLATION RATE __
TEST RUN BETWEEN
,.OA~ ~ ~,~ ~
(m~nutes/mchj PERC HOLE DIAMETER __
~- FT AND ~-~ FT :-
PERFORMED BY: ~' ~ ~3~Jo~J ~. ~'~, ~., L~~_.~L CI=RTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~-~(~ ~
?2-008 (Rev, 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960033
DESIGN ENGINEER:STEVEN R. PANNONE
OWNER NAME:GONITZKE MONTE R
OWNER ADDRESS:8100 TALISMAN RD.
ANCHORAGE, ALASKA 99516
DATE ISSUED: 3/19/9'6
EXPIRATION DATE: 3/19/97
PARCEL ID:01701392
LEGAL DESCRIPTION:
KEMP LT 2
LOT SIZE: 59944 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WI~H:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
~ECOVER OR INSTALL FOUNDATION CLEANOUT AS REQUIRED.
RECEIVED By',.~_,2~? /7
DATE:
DATE:
Steven R. Pannone, P.E.
Consulting Engineer
(907) 272-8218
P.O. Box 142025
Anohorago, Alaska, 99514
(907)272-8218 Fax
March 18, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
RECEIVED
MAR 18 1996
Municipality of Anohorage
Dept. Health & Human 8ervioee
Subject:
Lot 2, Kemp Subdivision
Upgrade Permit and Conditional Health Authority Approval
Gentlemen:
In September of 1996 my fi~-m was requested by this owner to prepare an emergency replacement system for
his failed seepage pit. The original letter is attached. During the review period my client had his septic tank
and seepage pit pumped by Northland Pumping. His system has been operating without backing up since the
original pumping. The owner has indicated that at the time of the overflow there were six to seven people
living in his house.
I conducted a Health Authority Investigation on March 2, 1996. The system was operating normally. I was
able to put 450 gallons of water into the seepage pit without the fluid overflowing. The water level in the pit
was 135" at the start of the test and 65" after the water was added. Twenty four hours later the water level
was at 140 inches, or approximately 350 gallons per day. This system is absorbing water at a rate slower
than required by the Municipality.
I would like to request that a conditional approval be granted for this property. Attached is a design for a
replacement system that will be installed in the spring of 1996, when the ground becomes thawed enough to
excavate. I do not believe there is any eminent health danger by granting this approval. The new owners are
a young couple with one small girl. Since the average person produces 45 to 75 gallons of sewage a day, an
average of 200 gallon of sewage will be produced per day. The existing system will absorb that mount of
fluid with ease.
I feel that the system will operate adequately until a replacement system is installed. There will be no adverse
effects by granting this conditional approval. The original seepage pit was approved by the Municipality. A
Health Authority Approval conducted in 1994 showed the system met the MOA regulations atthe time the
system was installed. All work upgrading this system will be accomplished before June 1, 1996. The current
owner will escrow funds to cover the cost of replacing this system.
September 20, 1995
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Steven R. Pannone, P.E.
Consulting Engineer
P.O. Box 142025
Anohorage, Alaska, 99514
(907) 274-0308
(907)272-8218 Fax
RECEIVED
OOT 1 6 1995
Municipality o~ Anchorage
Dept. Health & Human Services
Subject:
Gentlemen:
Lot 2 Kemp Subdivision
Upgrade permit
My finn recently conducted a site visit and soil/percolation tests on the above property m preparation for an upgrade to
the existing system. A Health Authority was conducted two years ago which indicated the system was nearing the end of
its. l'.ffe, l The ~mm~l~existing system has gone into total failure. Currently the 1000 gallon Septic tank is being used as
a nolo, rog tank. A single test pit was dug; results are attached Based on the test pit results, we are requesting a permit
for a three bedroom upgrade.
The lot is approximately one and a half acres in size. It is generally flat; slopping to the south at a rate of approximately
3-5%. The well is located just north of the dwelling, approximately 100 to 120 feet away from the proposed system.
There is no evidence of any surface water, including ditch water, within 100' of the proposed installation. Existing wells
are located greater than 100 fec~ from the proposed system. Thc lot north of the proposed system is developed. It's well
is located greater than 200 feet away, and the soil absorption system is approximately 100 feet from the proposed system.
The existing septic tank is located 84 feet from the well. If during the course of the installation, the existing septic tank is
found to be failing, it will be replaced. If the tank is replaced it will located outside the well's protective radius.
The existing absorption field is in failure. Thc proposed field will be located 20 feet from the existing field. A soils test
and perculation test will be performed during construction to verify soils at the east end of the field. The existing seapage
pit will be abandoned in the construction.
If you have any questions about the proposed installation, please contact me at 274-0308.
Sincerely, ' ' ':
~e, P.E.
Dept. of Health & Human Services
March 18, 1996
Page 2
The lot is approximately an 1 ~4 acres in size. It slopes to the southeast at a rate of approximately three to five
percent. The proposed installation will be located greater than 100 feet away from the well and 25 feet from
the water service lines. The surrounding systems are located greater than 100 feet from the proposed
installation. Both neighboring wells are located greater than 100 feet from the proposed system. The
existing septic tank will inspected and if found competent, reused. A new tank will be installed if the existing
tank is not found competent. The existing seepage pit will be abandoned in place.
If you have any questions about the proposed installation, please contact me at 272-8218
Sincerely,
Steven R. Pannone, P.E.
C:\WORK~2-KEMP.LTR
Lot
200+
nei§hbo~'in§
49~
R, Ponno~e
DESIGN
WASTE¥/ATER ABSDRPTIDN SYSTEM
Lo~ 2 Kemp Subdivision
(Typ,)
/
/
\\
Exist,
3 ~edro
House
Exist
Exist.
(To be
Lot 3
(Umdeve[oped)
TH 1~--
'oposed
Deep Tremch~
800+ ?eet ~
to nelghborlng~.~\
PREPARED FDR~
Monte Gomt~zke
8100 Toilsmo. n
Anchorage, A[~sk~ 9951~
(907) 876-4245
Pert R~te oF 40 MIn/ Imch
3 ]Bedroom House
lOOO SF oF Absorption Required.
Use Deep Tremch ~:~' To~[
8 t~enches 85' Long
JSTEVEN R, P~N~DNE,
P, O, BOX 142~8~
ANCHORAGE, ALASKA 99514
874-0308, 878-8818
CALE~ ~'~50' I
DESIGN DETAILS
WASTEWATER AI~SaRPTIDN SYSTEM
Lot 8 Kemp SubdivisioK~
1~1N¥3'13
Z
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J. tlgN¥~I'13
NDI.I. VIINflD_-I
PREPARED FOR,
8100 Ta[Isma~n
(907) 276-4245
DATE, 3-8-96
NDT TD SCALEI
Ld
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
DATE PERFORM
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8-
9
10
11
12
13
14
15-
16
17
18
19
20-
;OMMENTS
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
S
IF YES, AT WHAT L
DEPTH? "~
E
Depth te Water Alter "r~ ~ ~'.~,
Monitoring? I 'Z2 Date: /0-~1~,-?$
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE -?r~ (m~nutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~ FT
PERFORMED BY: ~"~'~,~-J ~J.o},J P_%,~:~. ~.,. _L~ -'" CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; ¢~ ~ ~ -- ~,~-
72-008 (Rev. 4/85)
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-25! !
'N? 345
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL (/~z'-O",~'~,)
LIQUID CAPACITY ./,'~ ~O GALLONS.
MATERIAL
INSIDE LENGTH
_~.f-/~/_.~ MAILING
ADD RESS .~d~2"~/ '"'~Z~'~(' - ~'~:~ -~' PHONE__
LEGAL DESCRIPTION /~//Z-- .. ~//_.~-.(/~-.~ ~'~:'"~j.//.~ .
NUMBER OF
~--~ f~/~' ~:~ '/'~-- ' COMPARTMENTS
LIQUID
/-'~'"'~1 N SI D E WIDTH /DEPTH ~-'~'-
SEEPAGE SYSTEM:
NUMBER OF PITS.__
LINING MATERIAL
NEAREST LOT LINE ~O
SEEPAGE PIT:
/~.OUTSIDE DIAMETER / OR WIDTH ~ ~--- _, LENGTH /~ , DEPTH
...... DISTANCE FROM..:g~-, WELL ~'/'~2/~-~--~, _) , BUILDING FOUNDATION~d
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~/~/~-~ SQ. FT,
TILE DRAIN FIELD:
DISTANCE FROM WELL ~'~'~, FOU~N
NUMBER OF L,~ DISTANCE BETWEEN~I~NES
ABSO~N AREA SQ. FT. LENGTH O~ACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
NEAREST LOT LINE. OF LINES
TRENCH WIDTH IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: -~P~'~'/~'/'~"'~ "~'~'~'~'(~-~
TYPE ~z-j~,~ . DEPTH
_ NEAREST
LOT LINE / SEWER LINE ~
DISTANCES:
z.~, DISTANCE FROM
BUILDING FOUNDATION ~'~ SAMPLE , NEAREST
SEPTIC SEEPAGE OTHER
TANK / , SYSTEM
)IAGRAM OF SYSTEM
DATE
HEALTH AUTHORITY
No, /c5,/~--)
- HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS. LOCATION OF INSTALLATION/~(~ /'~~
APPLICATION TO INSTALL: SEPTIC TANK~, SEEPAGE PIT~, DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY ~ 7/'~"/4-o-~ ~
aY
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /"~ e~f,'~r''a~ ,PERMIT TO INSTALL A
AS DESCRIBEB BELOW. SIZE OF UNIT TO BE SERVEB
, SEPTIC TANK SIZE '7 ~'"0
DISTANCES:
TYPE ~ SEEPAGE AREA/~~ TYPE
2-~" n '
DIAGRAM OF SYSTEi
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE '~~ 2¢/~'/C'~' APPUCANTSS,G,ATUR 4/
O~t. 27. 1970
Mr. ~'l~nry Sd~roedor
Rt. A, Box 380P
Anchorage, Alaska 99502
SUBJECT: Sewer System, N 1/2, N.E. 1/4, S.E. 1/4,
N.~q. 1/4, Sec. 25, TI2N, R3~q, S.l~.
~ear Iqr. $chroeder:
Enclosed is your copy o£ tho approved on-site sewage disposal
system for the two bedroom single £omtly ~elltng located at
the subject location.
Un£ortuaatoly, approval cannot be given for the on*site s?age
dlsposal system for the three bedro~ Single family dwellt
also located on the subject propertg until an approved Bo~g
~ghAnchorage Borough.
bs~ptic t~nk is Installed. Groe~ se~ttc tanks a~ not app
ro¥~dthe
This system should not be covered or
utilized until such time as it has been. approved by this Depart-
If you have ail), questions r~garding this matter, ploase do not
hesitate to contact us.
Sincerely,
Carrol Su~ McKechnie
Sm~itation Aide
0 7.7
7
7
Municipality ®f Anchorage
On -Site Water and Wastewater Program a_ b C k,
(907) 343-7904
&� 0 ,
�
Certificate of On -Site Systems Approval zz 01 8 S 0'
Parcel I. D.017-013-92
1. GENERAL INFORMATION:
Complete legal description KEMP; LOT 2
Expiration Date:
Location (site address) 12851 PATRICK ROAD *ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Real Estate Agent
Day phone
ROY BRILEY Day phone 907-343-8857
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
F71 Duplex
F-1 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
.3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
z
Individual
z
Individual Water Storage
1:1
Holding Tank
0
Community Class Well
1771
Community
❑
Public Water System
R
Public Sewer
❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 15-6y
Date of Payment C2/1 q Ll q
Receipt Number
COSA #
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater. d isposa I system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road. Suite 101- Anchoraae. Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 1.4 r o q
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
....... ..
f A. Gorne s:'
C 953
Q4's �•. •� � c�G
�4ed pr o f e s sio�°oma
#AECC884
System #2 Approved for bedrooms`0F(rr(/,r/
Disapproved�i�
Conditional approval for bedrooms, with the winPs4i 5JT1aWions:
wATElk ANN)
By: Original Certificate Date:( 2.' -Z T
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist N Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other t - & �, 4CV; 0t^ j
Legal Description: KEMP; LOT 2
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1971(?)
Total depth UNK ft
Cased to UNK ft
FOR Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 12/2/19
Static water level at beginning of test 268.1 ft
Comments
B. TANK DATA
Age of tank(s) 23 years
Tank type/material SEPSTEEL
Measured operating fluid level in septic tank 51
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 2. — (!) 19
G -
►2-23-4
Parcel ID: 017-013-92
Structure served by this system 1
Well production at time of test 2.9+ gpm
Water storage tank volume NO gallons
Ltd Well disinfected for coliform test? ❑ Yes IN No
❑ Coliform bacteria is Negative
Nitrate 'Z •156? mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Ep�rsenic less than MRL (ND)
Collected by GEG
Date of Sample 12/3/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station - years
Lift station material -
Comments: N/A
D. ABSORPTION .FIELD DATA *AT MONITORING TUBE
Which system. tested (date installed) 6/22196
Adequacy test date 12/4/19
VALL standpipes present per record drawing
Results M Pass For 3 bedrooms
Total measured depth from grade *12 ft(max)
Fluid depth prior to test 7 in
Measured depth to pipe invert from grade **1.4 ft (min)
Water added 513 gal
❑ N/A — pressurized field
9
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
Elapsed time 135
depth into effective '7.91
p min
❑ Code -required soil cover over field
Final fluid depth 7 in
❑ System presoaked
Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NO
date of test)
Gallons introduced 2006 gallons
If yes, enter date N/A
Comments/Deficiencies: PRESOAK OERFORMED ON 1213119 **AT WEST SIDE OF TRENCH -2 INCHES OF ISULATION OVER THIS PORTION PER 1996 DESIGN DRAWING
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑✓
Yes
Community Sewer Manhole/Cleanout > 100'
[QYes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' 0✓ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No ft
Absorption Field on Lot > 100' 2rYes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption'Fields > 100'
❑✓ Yes if No ft
Water Main > 10'✓❑
Animal Containment > 50' ❑✓ Yes
if No ft
❑✓ Yes
if No
ft
❑✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
—❑✓
If septic tank is under driveway
Community Sewer Main > 75' ❑ Yes
if No
ft
Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑✓
Yes
if No
ft
Surface Water > 100'
❑✓ Yes if No ft
Property Line > 5'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Service Line > 10' ❑✓ Yes
Absorption Field > 5'
ft
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'✓❑
Yes
if No
ft
Community Wells > 200'
❑✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑✓ Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10' ❑✓ Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓❑ Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10' ❑✓ Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100' ✓❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
*ASSUMED
G. ENGINEER'S CERTIFICATION
1 certifythat / have determined through field inspections and review
9 p Q�P'� •••.'T ��
of Municipal records that the above systems are in conformance with Q * : ' 49 �O
MOA COSA guidelines in effect on this date. ...... .. ...... . .. . . • , • , . • . , ..
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COSA Checklist yellow sheet v0 ea /'rono �o
ofessAa
#AECcaa4
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC191596
Subdivision: Kemp lot 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 23 years old. Typical replacement costs range from $8,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Serwces
On-Site Services ~e~tlon
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone
Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be' held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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#21
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.,,
NameofFirm--~,,~r,~w~- ~.~-~. -%~,/c._ Phone
Address
Engineer's signature-~
q~.5-'/~
Date 3'-/.5---~6
6. DHHS SIGNATURE
Approved for
bedrooms.
Disapproved.
Conditional approval for ~ bedrooms, with the following stipulations:
Escrow monies to perform all work necessary to upgrade the
wastewater system per septic permit #SW960033. Ail work must
be completed by June 1, 1996.
AdditionalComments Monies shall remain in escrow until final approval
is
granted from this Department.
Byl ...`, .~ .I~..~~., ~.. / ~//c~ Date ~//~/~
'f;;'ll['ll
The"M~icipalit~/~'of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA ~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN IV E D
Environmental Services Division
825"L" Street. Room 502 · Anchorage. Alaska 99501 · (907~-~7~n]996
Municipality of Anchorage
Dept. Health & Human Services
Health Authority Approval Checklist
Legal Descripuon: ~.~,"F'
A. WELL DATA
Well type~l~r~ ~u ,a '7-~
Log present (Y/N) ~ a>
Total depth e,/oo t
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~ ~) ~
Date of samp!e ~ ~t
B, SEPTIC/HOLDING TANK DATA
Date installed oc~'x- 3 1 Tank size
Foundation cleanout fY/N) '5'
Date of Pumping ct'--
C. ABSORPTION FIELD DATA
Date installed c,c-r ~ t
Length ~ o Width
Effective absorption area
Date of adequacy test '~ -~
Parcel I.D.: 0['¢-
If A. B. or C. attach ADEC letter. ADEC water system number
FROM WELL LOG
Date completed / 9 6~ ~
Cased to ,~'~ '* Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
?-6,9,..<"
g.p.m. /. ~.g- g.p.m.
Nitrate
Collected by:
Other bacteria
· / o ~, c~ fl, Number of Compartments .J_ql~-P'Cleanouts (Y/N) ~_.
Depression (Y/N) ~ High water alarm fY/N) ~/t/~
Pumper vt o~z-r[t t,~a B
Soil rating [g.p.d./ft2 ~r ft2podrm)
Fluid depth in absorption field before test (in.);' 1~3~'
Fluid depth ! qo (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
d>- ~> System type
Gravel thickness below p~pe ~ Total depth l
Monitoring Tube present(Y/N) ~ Depression over field (Y/N)
Results (Pass/Fail) 'l='t~ t r_ For ~( bedrooms
hnmediately after qB> gal. water added (in.):.
Absorptiou rate = ~ ~ g.p.d.
If yes, give date ~
D. LIFT STATION
Date installed /k.// /~
Manhole/Access(Y/N) , ~7/~n'' level at*--
Highw~ ]/ A *Datum
~tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /~ ?4 r ~ ~ *--~ti>. On adjacent lots
Absorption field on lot ~ (. ~ ; On adjacent lots
~'Pump off' level at*
'/e, o
Public sewer main .o'/~ Public sewer manhole/cleanout
Sewer/septic service line ~ &.--t Lift station ,4/[ ~
SEPARATION DISTAlqlCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~ 0 ~ Property line I~?O ~ Absorption field
Water main/service line ~.tL Surface water/drainage /oo '~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation qO t Water main/service line ~ ~ t
Surface water ! ~0 °c
Curtain drain ~[~,
Driveway, parking/vehicle storage area ~ o
Wells on adjacent lots t' OO t Property. line
F. ENGINEER'S CERTIFICATION
in conformance with MOA HAA guidelines in effect on this datq.
HAA Fee $ ~00 ~ Waiver Fee $
Date of Payment ~ ~g ~ Dote of Paymem
Receipt Number 0~c~ /~ Receipt Number
Rev. 8/95 OSS: haa.wk.doc
LOT ~ BLOCK__
B,LM.
iron
i~1 llu~velt tlul~ & Tiuk. I~ _, P~Id. _ ~C~t ~]C~- IK~"'~"~ REC]OFIOINO PRIOINGT ALASKA
-- 'b.'~.' ~ ,,d · - s-" : ..... ~. ' -': .... ---'"~' = - o
~0/~0 'J
'ON XV~
~91I£ 1II, lAS ~D:80 AH£
CERTIFICATE of SURVEY
I Illl~Bby CIIllJf)~ Iliill llie folJl2winl~ cleeGrlblld pr01)elly lille bIKm euw4)yed by me or under my ;upgl~lilo~l,
N ~tM'~ ~' ~ .... - - .......--"- ....
!.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ~!~/c~o "-cA~go~,.~ ~:~G,
Property owner t-~t~r~-~ ~,,~,t-~-:z-~' ~
Mailing address ~c~~ ~e~, A~
Lending agency ~c~,c ~t~ ~~
Mailing address
Day phone '~-~,- c~ q5
Day phone '~
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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 #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm--'~u,uo,-u~ ~-~,
Address '-~.-
Engineer's sig natu re~~~,
DHHS SIGNATURE
Approved for
Disapproved.
Phone
Conditional approval for
Date ~-~P-~/~
bedrooms, with the following stipulations:
Additional Comments
By:
The Muni¢ipaliW of Anohor~ge Depar~mem of Health 8nd Human Services (DHH$) issues Health Authority
Approval Certificates based only upon ~he representations given in p~ragr~ph 5 above by an independen~
professional engineer registered in the $~ate of Alaska. The DHH$ does ~his 88 ~ ¢our~esy ~o purchasers of homes
8nd their lending institutions in order to satisfy oer~ain federal 8nd s~ate requirements. Employees of DHHSdo no~
¢onduot inspeo~Jons or ~n~lyze d~t8 before 8 ¢er~ifi¢8~e is issued. The Municipality of Anohorage is not
responsible for errors or omissions in ~he professional engineer's work.
72q325 (Rev. 1/91) Oac~ MOA ~21
RECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVI~i~ 1 1
....Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501· (%~7a~}a~b~4~f Anch_orag, e Dept. Health & Human
Legal Description:
A. WELL DATA
Well type ,.~
Log present (Y/N)
Total depth
Sanmy seal (Ynq)
Health Authority Approval Checklist
If A, B, or C. attach ADEC letter. ADEC water system number
,Date completed
Cased to
FROM WELL LOG
Casing height (above ground)
Date of test
Static water level.
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
SEFrIC/HOLDING TANK DATA
Date installed ~, -'~l - ~'~, Tank size
Pumper
Foundation cleanout (Y/N) ¥
Date of Pumping /x~ ~t.~
C. ABSORPTION FIELD DATA
Date installed 6 - ~'~- 76.
Length .F~,~c- ~ Width
Wires properly protected (Y/N)
AT INSPECTION
Nitrate Other bacteria
Collected by:
t'~> Number of Compartments ?. Cleanouts(Y/N)
Depression (Y/N) ~c~ High water alarm (Y/N)
Soil rating ~or ft%~lrm) a:,, q~- . System type -I3 ~'~
-~. Gravel thickness below pipe ~, 2_ Total depth / ! -/Z t
Effective absorption area /~,~, - Monitoring Tube present(Y/N) ¥ Depressiunoverfield(Y/N) Ac'
Date of adequacy test AP ~ ~'/Z ~_ Results (Pass/Fail) x~q ~c~ For ~ bedrooms
Immediately alter gal. water added (in.):
Absorption rate = g.p.d.
ffyes, gtve date
Fluid depth in absorption field before test (in.);
Fluid depth (ins.) Minutes later:
Peroxide treatment (past 12 months) (y/N)
D. LIVr STATION
Manhole/Access (Y/N) v -..../a~p on" level at*
E, SEP~TION DIST~CES
"Pump off' level at*
SEPARATION DISTANCES FROM Wl:l.l.I, ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
I~ station
/c~o '""
S. S~EEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation //O t Property line ~ ~ t Absorption field
Water main/service line ~ ¢ Surface water/drainage t~-e Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ONLOT TO:
Building foundation
Surface water
Curtain drain
Property Line / O Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
ENGINEER'S CERTIFICATION
I certify that I have determined thrufleld inspections and review of Municipal records
in conformance with MOA HAA guidelines in effect on this date.
Signature_ ~ --
Engineer's Name ~'v-~-xr ~ ~'~.g~:~0,.-ao, o~ t,~::~
ape
HAA Fee $
Date of Paymem
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk, doc
Parcel I.D. #
MUNICIPALITY bF ANCHORAGE.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Service~ Section
P.O. Box 196650 Anchorage,.'Alaska 99519-6650
. . 343-4744 - ·
CERTIFicATE OF ~EAL~':H AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA# ~=~Ot~'~ C~"~ /
1, GENERAL INFORMATION
Complete legal description L~ ~ ~
Location (site address or directions) 8~ ! co
A~,c~ Ar-`.
Property 'owner
Mailing address
Lending agency
Mailing address
Agent
Address
~,~-/~
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: '~
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State"ADEC atte§t-
lng to the legality and status of system. "
TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site-
Holding tank
Community on-site
Public sewer
If community wastewater system; p~'~)v'ide written confirmation from State ADEC
attesting to the legality ~nd status of system.
72-025 (Rev. 1/91) Front MOA#21
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 ~l~,,J,~a~ ~ ~.,~,~e,~.~ ~"~v~¢~-~ Phone --2 ~z4'-~ 3 o ~
Address '~P.(>.q'~o~ /~o'~- Ar~c~- A K. c~5~'lq
Engineer's signature--~~'~~ Date / - Z~¢'- ¢ ~
DHHS SIGNATURE
/~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrOoms, with the following stipulations:
Additional Comments
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. Em ployees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA ~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /,D"T-~-
A. Well Data
Well type
Log present (Y/N) '/,4 D
Total depth
Sanitary seal (Y/N)
Parcel I.D, (~l'~-C~t3-
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed /c~ &$?~_ Driller
Cased to ~'o~-~'T' Casing height
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~'~' ~
Absorption field on lot /C:~ ,5- / '~
Public sewer main ./~/! ~
Sewer service line /t,///~
Wires properly protected (Y/N) ~'~
.g.p.m. ['~' ' -gP~'
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank //~
WATER SAMPLE RESULTS:
Coliform C~
Date of sample: ! --- 7_0 ~ o~/4
Nitrate
,'7_ m E/~
Collected by:
Other bacteria O
B. SEPTIC/HOLDING TANK DATA
Date installed CPc'T
Cleanouts (Y/N)
High water alarm (Y/N)
.Tank size / o o c> ~ R L Compartments -7_.
Foundation cleanout (Y/N) ~ Depression (Y/N) /'~
Alarm tested (Y/N) ~,~ /A
Date of pumping l --~Z 1- 9 ~ Pumper ~,~c~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot r ~ ~
To property line c~ c~ ..~-'~ Absorption field
Surface water/drainage ,~ IA
On adjacent lots
/ c)c~'t-' .,0--r- Foundation
Water main/service line
72-026 (3/93)° Front CONTINUED ON BACK PAGE
Co LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
.Cycles tested
Surface water·
D. ABSORPTION FIELD DATA
Date inStalled C~ c.'-c' -~
Length '~_ c~ Width
Date ofadequacy test ~ -~-
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
,?~il rating (GPD/FF)
/ ~, Gravel thickness
Cleanout present (Y/N) "~
Results (pass/fail)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots ! ~'c> --c ~.-~
Surface water /v'[~,
Curtain drain ,~,
System type ~'pl "c-
Total depth /
Depression over field (Y/N)
for
After test / ~_ ~ '/.z"
If yes, give date
On adjacent lots ~'~>o "r' .~'~- Property line
To existing or abandoned system on lot
Cutbank ~ ! ~, Water main/service line
Driveway, parking/vehicle storage area
Bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA
Signatum~~b~~-
Engineer's Name ~. I~ .~:~::>,~,,~c~,~ "-~ ~--.
Date ~ ~ ,~.(~:>_c~/..(
CE-8149
HM Fee $
Date of Payment
Receipt Number
72-02e (3~g3)' Back
Waiver Fee $
Date of Payment
Receipt Number.
DATE DATE ~ DATE
INSPECTOR I NS P EC, T-Q R INSPECTOR
~t ~ RCPratt
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF H%~LTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL F,-,OTECTION
ENVIRONMENTAL SANITATION DIVISION cAN $ ~951
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S WE D
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
PHONE
1. PROPERTY OWNER
William/Jan Gehler 264~261
MAILING ADDRESS
Star Route A Box 380-H 99507
PR'OPERTY RESIDENT (If different from above) PHONE
'2, BUYER PHONE
Kenneth Fener 344-5434
MAILING ADDRESS
Post, Office Box 10-621 99511
3. LENDING INSTITUTION PHONE
National Bank of Alaska % Sue Benedetti 265-2882
MAILING ADDRESS
Pouch 7-025 99510
4. REALTOR/AGENT PHONE
April K0 Lee 279-2491
MAILING ADDRESS
411 East 45th Avenue 99503
5. LEGAL DESCRIPTION
Lot 2 Kemp Subdivision
STREET LOCATION
5th driveway on right on Patrick Road
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[~;]K One [] Four
:E~ SINGLE FAMILY I~ Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[~X INDI VIDUAL/ON-S [TE**
[] PUBLIC UTILITY
1970 YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
- THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED -
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTI LITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TAN K MANUFACTUR ER
TOTAL ABSORPTION AREA MATERIAL
4. DiSTANCESwELL TO: Sept,c,Ho,din0 Tenk IAb.orp. on Area [Sawer L,ne I Nearest .et L,ne
Absorption Area to nearest Lot Line
5. COMMENTS ·
~'"A~'FROVED FOR ___~ BED.OOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED /"~/
72-010 (Rev, 6/79)
MUNICIPALITY OF ANCHOP, AOE
.~ DEPT. ~F HEA~.TH &
ENVIRONMENTAL PROTEC,~ION
JUN 3`0 1976
RECEIVED
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 -- 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAl' SEWER and WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner: Smith, Diane K.
VA FHA
CONV X
Mailing Address:
Name of Buyer:
Mailing Address:
Box 380 H.S.R.H. Anchorase~ Ak.
Schleyer~ Raymond C. and Marie E.
Day Phone 344-8757
2403 W. Marston Anchorage, Ak. Day Phone 278-2541
4. Name of Lending Institution: First National Bank of Anchorage
Mailing Address: P.O. Box 720 Anchorage~ Ak. 99510 Phone
5. Name of Realtor or Agent: ......
Mailing Address: Phone
279-4481 x288
Legal Description: Lot 2 Kemp S/D
Location: NHN Jeanne Road - betwemn lTppor ~uffmmn mhd TT.n.n~r T)~Al-mc~111~
o
Type of'Facility to be inspected:
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well 400'
Sewage Disposal System ·
Type of System: Public Utility -
If Individual, date of installation
Singl~ Fnmily Pp~i2pnop No. Bdrms. 1
Individual w~ll Ann'
Individual (on-site)
EQ-037 (1/74)
Mary Ann Dqdge
Real Estate 6/28/76
1.
o
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received June 30, 1976
Time of Inspection
Date of Inspection~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by:
Mailing Address:
Property Owner:
Mailing Address:
Legal Description:
Conv.
First National Bank of Anchorage
post Office 720 99510 Phone:
Diane K. Smith Phone:
Box 380 HSRH~ Anchorage
Lot 2 Kemp Subdivision
279-4481 x 28~
344-8757
Location:
NHN Jeanne Road
Type of facility to be inspected
Well Data: Individual
A. Type
Single Family
B. Depth
NO. of bedrooms
400'
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
1. Size
1. Absorption Area
Total length of lines
/
'~ , Absorption area
, Other contamination
C. Absorption area to nearest lot line
D. Bacterial Analysis
On-site system.
B. Installer
2. Manufacturer
2. Material
Sewer Lines
, Absorption area
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - R~....jt for Approval of Individual
Legal Description Lot 2 Kem~ Subdivision
~.~r & Water Facilities
Comments
Date ~//, ,~ ~
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address:
CMRO VA
Z~ll~mm and J~n Geh]er
SRA Box ~gO-N C~ty g~O7
FHA CONV%
Day Phone ?~q/'-/'?61
3. Name of Buyer: Kenneth Fener
Mailing Address: P,O. Box 10-~21 City
4. Name of Lending Institution: National B~nk of
Mailing Address: Pouch &-025 City c)95~0
5. Name of Realtor or Agent: April K. Lee
Mailing Address: 411 E. 45th Ave. Anc. h.
Day Phone ? hm__~g-543~
Phone
Phone 9 7c~-?/, c~ 1
Legal Description: Lot 2 Kemp S/D
Location: 5th Dr{vew~:y mn r~ght
of" " & Patric Rd/ )
Type of Facility to be inspected:
Water Supply
Type of Supply: Public Utility ,
If Individual, number of dwellings presently served
HOuse is single story, yellow & s~
~ngl~ ~m~ly ~d~n~ No. Bdrms. 1
If Individual, depth of well 400'
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation Oct/70
IndividuJ] }{
Individual (on-site)
EQ-037 (I/74)
6771 Sherwood Ave.
Anchorage, AK 99504
18 Feb 81
Re: Adeouaey Test for am exist~ Wa. stew~ter disposal system
om Lot 2%. Kemp Subdivision.
Dear Mr. Oehler:
At your re.nest I hmve ~erfor~med An adequmey test on mn e~istin¢
"' ~
w~stew~ter *~t~.os~l system lock, ted ~ Lot 2, Kemp Subdl
om February 16 - 18, 1981. Department of H~ai~' and E~viro~mental
Protection (DHEP) records ind~e~a~e a 1000 ~alloD pre-cast co~crete
seDtte t~nk ~d a 2O~xl~'x9' deed concrete rln~see~a~· Dit with
a total effective absorption mres of 648 sq.
The seotic tank s~e~ was further confirmed by Dumnin~ the tank.
~. rec.ord of the pumotm~ is a~tsched and shows a.caoacity~of
The w, ter ].eVe] iR the seepage pit was abo~t 7 feet abOv~ the bot-
tom. This fact and recent
~ssumntto~ of ~ normal de~ree of soil saturmtio~.
Durin~ the test n~riod the septic tank overflowed interm:ittently.
There was no evidence of flow from the septic tank to the seepage
't
D1 . ~e n~ne eonRecti~ the two ma~ b~ block~,. Because the
wat~- level in the sentfc ta~k w~ ~e~e~' than'~ the w~teT leVel
the ~eena~e pit at ~ll C~,mes, the~e was no possibility of flow
from the ~ t to the ta~k. .~. -
~lSDos~! My~ rem tO
..... d ~ two
The Doo~l~t~n of dwellin~ units is ~..t~ma~e oe OhS
per bedroom. Since th~ daDartment will 'not anm~ove wastewater
systems~ rated at lems ~han ~e bedrooms, the-gastewater flow
your system must disnose of is 450 ~all~s oer day.
. . f
Th~ attached table of data zmdzemtes the oroeed~e and results o
~estin~..~h ~mmrv. an~. ~rbitrary~wat~r~ levet~' in the sgeDa~e
~lt was' selected a~ the reference' water level~']Water ~s add d
ger~odically to malnt~im~: th~s'~ Ieve% as closel~ as ~ss!ple.. The
~mount of w~ter mdded was the~' conszdered to e~sl the
of water percolated from the system. On day 2~ 80% of the max-
{mum da%iiy flow, or 560 ~allons, ~as added in as short a~time
momsib!~ to test the resoonme of the system to surKe lo~ds.
The fl~w rate from your well oumo was dete~ined to be 4~2 ~allons~
per minute.
Based on the results of two days of testing, your wastewater
seeDaqe nit disposed of anoro×imatet, y ~'3~ KalloRs of water Der
day, a figure ~reater than the required amount of 450 gallons
Der day. Your seeoa~e nit is therefore functionin~ adequately
at this
The ~De~ation bf soil absorntton wastewate~ diso~sal systems
~s~ affeated by ~a~y conditions. Groundwater conditions,
prior maintenance, moil tyoe, and household water use natterns
are but a few of the oargmeters which might ~ffect ooeration of
s~ch systems. The adenuaev test conducted here measured
nit performance usi~ stated test nr°cedures, Ram.ely surge lop, ding
a~d maxim%~ daily load conditions. This tyoe of testing can only
measure system ner~o~mance at a ~fve~ ooi~t in time. No deter-
mination of the condition ~f the seeoaKe Dit nor the deoth to
the water table was possible.
If you have a~y ~uesti0~s re~arding this test, olease contact
me ~t ~55~69~8.
· 1
Dam Crevensten, P.E~
Om-site Wastewater Disoosal System AdeouacY Test
Date of test: F~bruary 16-18, 1981
Location: Lot 2 Kemp SubdivisioR
OWner: William C~hler
System Comnonents: tO00 Kal. septic tank, 20'x16'xg' deed pit, constructed in 1972
Number of oqcun~ts: four--two adults,two childre~
Last time system oumped: February, 1981
Time
Feb. 16
10:0oam
11:10
11:5~
2:05
4:00
4:55
77:45
B8:50
Liouid Depth (below topl
of ~ ~l~mRout, i~ches) .
5?½
,, 58
- 561
,, ~'7~
,, ~7~
Feb. 17
7:10am "
P2~pm "
4:~0
8:00 "
9:20
Feb. ].8
8:50am
(10:00)
*calculated e~uivale~t
**calculated
56 1~8
1/8 >
59 5/8
Water Added
(gal)
56
106
109
2OO
C%~mulative
water ~dded
186
295
495
561
218
856
1074
1245'