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HomeMy WebLinkAboutKENO HILLS BLK 1 LT 3Keno Hills Block 1 Lot 3 #020-171-10 A C. Municipality of Anchorage Page 1 of 3 Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW040309 PID Number: 020.171.10 Do rominic and Mildred S ezial Wastewater System: Upgrade M&m: 8400 Gordon Street Anch., AK 99507 ABSORPTION FIELD Rtae: Nt A,Vaaearooma: Shallow Bed 344-2905 Three 3 Snl Rasp: TON Deem Iran wvirtat gene: LEGAL DESCRIPTION .5 GPDTI' 2.5 Ft. eect: La: S.W,ovat: Deptn at Mpe eaten can mquw yrsae'. Cravat dean teneam It": 1 3 Keno Hills 2 Fr. .5 Ft. Tewrnlep: Range: sect a,: Fu eaaea prove apna Wade. Gavel Lnpm: 1.3 Ft. 85 Ft. Well: Existing Gravel vnam: 15 3 I DMwceeet !,es: 5 Ft. Ft. Ctesydnaten (Pante. A S. C): Taal Dapm:Caaen e: Tar at swt ten area: Ape Mnann: fl. FI. 975 Fr ASTM 3034 PVC Oder Data D,,aae: $Ma: Weta Lava: h,nalw: mee Data aW: FI. Acreage Systems 88'1012004 TeW: Panpsb„: I Caen, ntAeoveGwe: TANK GPM Ft. Ft t - SEPARATION DISTANCES Septic ToSeptic Absorption LIR Holding ubtic/Prlvate re xtua. pealyn wns. From Tank Field Station Tank Se (Llro Anchorage Tank 1,000 wen >100, >100, NIA NIA >25'MataW. Steel Munger acanwrtmene: I Two (2) sd.w.l« >100' >100' NIA NIA LIFT STATION. Lace >10, >10, NIA NIA Gr . Founnalen >5' >10' >$' NIA •pa” tp w,-10vet at 'Pamp ar evat at: Hpn wets wrm n: m. „ m. None Noted Aanp Mate A Mona Eeancat mspemorts Waman by: car. dap R'm"" BENCH MARK insulation Placed Over I ank and bed. Existing I an 1Sa0onaMDeeam— Bottom Step From Upper Deck North Side of House. Assumae Ebvslen: Trench Excavated and Replaced with Clean Sand. 100.0 FL Engineer's Stamp 11 r .aws\11\1t10F A 1 114 r !# a 4gtn Inspections performed by: MEA Dates: 1M 817104 rb 0 n % 2 8110104 � IlMICHAEL E. ANDERSON W= Department of Health and Human Services approval, . •C`- No. CE -41381 t . Reviewed and approved by:ht•. 6. m,D, Oo Date: ,. , y s�aw�ss w�.mn r CD NCN 0 I % C I i j♦ TG N� 116:,• o = . a a IES //aq o4� �'...; •�. a v m C rl o c> y �o ZwU wroa cwtzF m o n r 00.O N Lp4 ` N O oNnwm Q op ai E w oY +nm j o dCU Luz �° suto L+ W U CO I t aF-wn I W J o2 z C w m " Q Lu wE" •� :i „e. .. p m to I w ;,•: N N O C I?Y= •R a � 0 0 7 Q Y s U CD wte3 Renin o: — — — — —g 3 ao o>z p U) U) m a —j E _ F— m 0 ania(l M@IAUapIoE) w Y . Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SWO40309 N CUM y N UU Gallon .1 PID No. 020-171-10 _ Xu Geotextile and 2' Insulation O O Dralnfield Rock 85.0' 1 2.5' 5' 5' 2.5' DUMN PROFILE AS -BUILT 0. -% ""`" 39t ' 1� f'•. No. CE-Oe� � Spee: V- 10' MUNICIPALITY OFANCHORAGE VIII I76b Development Services Department 180 On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 30, 2004 Expiration Date: Jul 30, 2005 Permit Number: SWO40309 Parcel ID: 020-171-10 Legal Descriptionf KENO HILLS BLK ='1 LT -:3 - 7 Design Engineer: 0014 Anderson Engineering Site Address: 005801 BLUEBELL DR Owner Name: DOMINIC & MILDRED SPEZIALY Lot Size: 92783 SO. FT. Owner Address: 5801 BLUEBELL DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-5706 This permit is for the construction of., ❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By- Issued y Issued By. Date: 1/70/11f Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-171.10 Permit Number SW Property owner(s) Dominic and Mildred Saezialy Day phone 3442905 Mailing address (1) 8400 Gordon Street Anchorage, AK 99507 5e Mg address (2) 5%01 '9ktu-be-tl , U"'q_ Zip Code 4lg5l(, Legal description (Lot, Block & Sub'd.) Lot 3. Block 1. Keno Hills Subdivision Legal description (Section, Township & Range) Lot Size Otg.105 AcreIED Number of Bedrooms Three (3) THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 11 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool . ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Date of Payment aa C )l Receipt Number.l X (Rev. 12100) Waiver Fees: Date of Payment Receipt Number. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX July 26, 2004 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 3, Block 1, Keno Hills Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer. The existing septic system on the subject lot has failed and must be upgraded to serve the existing three-bedroom home on the property. We are therefore requesting a permit be issued for the construction of a new septic system. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic systems. Also identified on the plans are the locations of the existing well. No conflicts exist between the proposed septic system and existing well and those on adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The existing septic tank will be pumped, crushed, backfilled and abandoned in place. In addition, the existing absorption trench will be removed and disposed on site a minimum of 100' from the well. All contaminated material will be removed to virgin ground and replaced with coarse sand. The new absorption bed will then be constructed in the same area. The test hole placed on the lot indicated silty gravel with varying amounts of sand in the area of the new absorption bed. The percolation rate for this material is between 6 and 15 minutes per inch. No groundwater was found during placement of the test hole, but was noted at 7.5' below the surface during the monitoring period. We are therefore proposing to place a new 1,000 -gallon septic tank and a 60' long by 15' wide absorption bed to treat the effluent generated in the house. The elevation of the distribution line in the absorption bed will be 2' below the surface and the total depth will be 2.5'. Coarse sand will be placed to a minimum depth of 1' below the bed to replace organic material and provide additional separation from the groundwater table. Sufficient fill will be placed over the bed and septic tank to prevent frost penetration and possible freezing. Lot 3, Block 1, Keno Hills Subdivision July 26, 2004 Page Two The ground surface on the lot slopes at shallow grades from east to west and north to south. The bed will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 100' from the existing well and any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, a'j, Michael E. Anderson, P.E. Attachments c+; ._.. --r-t!" .* MICHAEL E. ANDERSON %. No. CE -4381 i Wm I. Henn N 00'O>Z L0/ aniaa ME)IAUapIoE) C C 10 4) CO� 2 La X O pFL z I U 03x �g O U) I X r �m w� 2�ZC m m U o T Eaci°n my 2 mw UU)UQ CO0 -CO j m T \'J O bl Y SN — � Wwuesa3 A!IOf1 Al 00'O>Z L0/ aniaa ME)IAUapIoE) LOT 3, BLOCK 1, KENO HILLS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom House Shallow Bed System Perc. Rate: 8.9 Min./Inch 1,000 Gallon Septic Tank Application Rate: .5 GPD/SF 1' Coarse Sand 3 Bedrooms X 150 GPD/.5 GPD = 900 SF Absorption Area 900 SF/15 SF (Width) = 60 LF Bed Length THEREFORE: Construct a 60' Long x 15' Wide Shallow Bed as Shown Below. Place Distribution Piping at 2' Below Original Ground Surface. Provide 2" of Insulation and 2' of Cover Over Bed or Mound Over Bed Minimum of 3'. Maintain 100' Separation From All Wells in the Area. Ground Natural Backfill 1.5' 1 2' Insulation & 2' Cover 5'� I O O O Drainfield Rock 1.0' M 11 1 Coarse Sand (See Specification) 2.5' 5' 5' 2.5' TYPICAL BED SECTION (NO SCALE) NOTE: Grade Area Surrounding Bed to Drain Away. Minimum 6' Separation From Bedrock Minimum 4' Separation From Groundwater. Minimum 1 00'Separation From Wells in the Area. Minimum 1 00'Separation From Surface Water or Streams. Minimum 10' Separation From Water Service Line. 4 � \I1 Existing Ground PVC 1 2 4 5 6 7 8 9 10 11 12 13 14 15 IE 17 18 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM 4700 SOUTH BRAGAW ANCHORAGE, AK 99519 PROJECT: SOILS LOG -PERCOLATION TEST PERFORMED FOR: Dom Soezially DATE PERFORMED: 7/13/04 LEGAL DESCRIPTION: Lot 3. Block 1. Keno Hills Subdivision TEST HOLE # 4 SLOPE SITE PLAN Organic Fill Roots, Etc. Silty Gravel GM Some Sand d a y q. SM 5% WAS GROUNDWATER ENCOUNTERED? NO IF YES, WHAT DEPTH? DEPTH OF WATER 7.5' AFTER MONITORING: DATE: 7/22/04 S L P E 4% READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 7/13/03 5:15 12.0" 1 5:4S 30 8.25" 3.75" Recharge 5:46 12.0" 2 6:16 30 8.5" 3.5" Recharge 1 6:17 12.0- 3 6:47 30 B.S- PERC RATE: . 86 MIN./INCH PERC. HOLE DIAMETER: 6" TEST RUN BETWEEN--l—FT. AND 6 T. COMMENTS: Test Hole Pre Soaked Prior to Percolation Test. TEST PERFORMED BY: AH 1, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 7/26/2004 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 3, BLOCK 1, KENO HILLS SUBDIVISION GENERAL: The scope of this project includes the total demolition of the existing absorption trench. All contaminated material must be removed to virgin ground and replaced with clean coarse sand. Contaminated material must be buried on site a minimum of 100' from the existing well and 4' above the groundwater table. The existing septic tank must be pumped, crushed and backfilled on site. New work will include the procurement and placement of a new 1,000 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new absorption bed 60' long X 15' wide also at the location also shown on the Site Plan and at the configuration .shown. The distribution line in the bed will be placed at 2' below the existing ground surface. A minimum of 1' of clean coarse sand must be placed below the bed to replace organic material removed. The new tank and absorption bed must be placed outside the 100' protective radius of the well on the lot. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must'be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,000 -gallon septic tank must be procured from an approved source and installed at the location shown if the existing septic tank is found to be defective. Lot 3, Block 1, Keno Hills Subdivision July 26, 2004 Page 2 of 4 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: The drainfield shall be constructed to the dimensions shown on the design. The bottom of the bed shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for -a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. Lot 3, Block 1, Keno Hills Subdivision July 26, 2004 Page 3 of 4 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. COARSE SAND: 1. Coarse Sand must be graded as follows: 50% Passing No. 4 Sieve 3% Passing No. 100 Sieve 1% Passing No. 200 Sieve INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. Lot 3, Block 1, Keno Hills Subdivision July 26, 2004 Page 4 of 4 The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. GRER ANCHORAGE AREA BORGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON—SITE SEWAGE DISPOSAL SYSTEM NAME `Tm $ /Yi. �OU��/4S MAILING ADDRESS -/- 3 O PHONE S/��-a/�4 LOCATION LEGAL DESCRIPTION 4�T'-i I�LOe.�/ e_e=- D A14z-ts SEPTIC TANK: DISTANCE FROM WELL— INSIDE ELL_ INSIDE LENGTH TILE DRAIN 6Xi'Z 7-7 NUMBER OF MANUFACTURER ESp"�dZgMATERIAL ��%G2�� COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/_a-1_7) GALLONS. TOTAL LENGTH DISTANCE FROM WELL ��, FOUNDATION `L� /� NEAREST LOT LINE '/J^� OF LINES Z/ t NUMBER OF LINES 1D��AN E BETWEEN LINES TRENCH WIDTH 3_6IN. TOTAL EFFECTIVE ABSORPTION AREA ^aJIM SQ. FT. LENGTH OF EACH LINE Q a DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE Z MATERIAL BENEATH TILE_ . ABOVE TILE IN. WELL: TYPE CA1010 CONSTRUCTION BUILDING NEAREST FOUNDATION , LOT LINE CESSPOOL OTHER SOURCES APPROVED—DISAPPROVED DISTANCES: 1 0 `c INSTALLED BY: A'apt- f SEWER LINE DEPTH:'' O I� PIPE MATERIAL: `'4497- Z20� ©2iJ �1/GEA�t�C . LOT SLOPE: REMARKS: KEPLACE'iSn�E/ O i T -TD c) G t4% ,5 7V toe-zi- . Form EQ -032 ,'/ 9),274LE1J NEAREST SEWER LINE REMARKS DATE DEPTH 57'r DISTANCE FROM: SEPTIC 5-01f SEEPAGE TANK , SYSTEM_ DIAGRAM OF SYSTEM 'ti »,p LZ APPROVED G.A.A.B I, SA 0 J D kAt 4UJQa-/3 o,;,t �24, , 14;g� 0� M -P -M / �'�11 f y Z wee 4 Cir/ �,feq o�4& a," f .o f' rn O J to N � C rn r tA C 19 C rn Y;rt.^•.' t,`( rFY < � `r' �: *.A` \ Ada »I � '( 1 �..�•. ;`L.r✓I 7��,tn, : n.s w�.a. ".,� � . ,�'" .�' F ': �.a4�' ( 1 � I w_' ( � I l 6N � uyn M1�J a� 1 N I a� 31 1•. 4 IS: w_' ( t l 6N 1 N a� 4 IS: 4 G ( r`v n a � ( t LD(� > ee�/- �) — /oCo 2T/u4_ /_S 41>sO 9- ��77' r4-Tf�F 71 dgle ,t�r:% Irk//� Z r" --L!L L/ WT; a rofAx-N l�Yto- GRMENCRA�AREA BORt UGHA44, v / 9`} - DEPARTMENT OF ENVIRONME TAL QUALITY q 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT NAME OF APPLICANT.� 1L9 .INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK PERMIT pro. MAILING ADDRESS ` 0 ' .l PHONE SEEPAGE PIT DRAIN FIELD � , OTHER ��^ / / TYPE AND SIZE OF FACILITY TO BE SERVED ,, FINANCED THROUGH —_ TO BE INSTA IED BY (,/ 4�>?.a,'- .0, SOIL TEST RESULTS —� Z✓ 7® �vw NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE T PE MINIMUM DISTANCES, REQUIREMENTS e✓ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT , DRAIN FIELD TO NEAR L/'OjT LjIjIE�W P� ? pyt ��C� WELL TO 5 IC TANK &o „SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT '�74Sa "" pry y��' tr��• %� l�"'t�'a�'-✓' %fir % E AREA SIZE TYPE SEPTIC TANK,. SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL.. 4INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGgSLATIONS REGARDING INSTALLATION. G.A.A.B. OR i LICENSED DESIGNER u�Maarcwm yr aia�am I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIB SYSTEM IS IN ACCORDANC�U`CANT'S ITH SAID CODE. DAT' SIGNATURE M NO. EQ -Of 6 - . HEALTH DEPfTJNT tECASE Il 327 EAGLE STREET ANCHORAGE, ALASKA" 99501 f Date Perfor.�.ed�uN � 2101 a Performed For Nj$ � " h^ D�r�l-` L• A S LeF;al Description: Lot 3 Block, /� Subdl �v s;.on/�i�0 i'ercolation esti This Form Reports a: Soils Lo Depth Location Sketch Feet Soil Characteristics _....� .� ` To SOIL., 1" 6 4>2t46 16 1 `` /6 "rest kG�Ia•veyiftQS s,It ova Cut 6av�te. p +. _J �Y 0 o: cis ' Was. Ground rater Encountered? aa ! If Yes, At 4;':at. Depth Reading i Dae :ire Net Time Depth To H2O Net Drop .Gross Y..wwM1w.+r.eN v.•I.pRw..HwNro`1ww_. - s .•r.�..YMWr.. I.\wY•M\ 4PJ'M t�N}.r.MM1f.VJOYV�w._.M�nw.n..rMlwiw�.MY�..I.� Ltf( TIP ej wl- 10 P E D 'Y'�I^r•._r•.y\•. F MM•M..l.- \ ..�YYl.V..-.1./.�.ww...v ..gMMfNe�1N_�` ww• r.r.•..r�..r....Yr'..rd.��Mrr 1w.n,� •!i .Wu. �.N• f u.sv..-+wruwrY.yw.rr.erv.a� ww.w.M• ..MWrvw4Mrrw/ �Y 0 o: cis ' Was. Ground rater Encountered? aa ! If Yes, At 4;':at. 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Of I*.?,r�'t a d2erh- r, o� Depth To Bottom Of Pit Cr Trench COMMEN i S : I '. i jF'.&Z.4�.a/.'.S -- -tG4 .s?. LL ....-i.� ,. {'�. � Si r bad v-0 Test Performed By:_LAJ � ! Data.Certified By:�, :4 r7e,9 5 A7 -7 No. 3 Date. Name. SOLD BY CASH C. O. D. CHARGE ON ACCT. 1, MDSE. PAID OUT I ' / RE D! CLAN. DESCRIPTION PRICE AMOUNT 'PIS -7, 71 pz m 4a s.A 4 151 61 7 irA -S 9 12 13 14 15 16 17 18 Customer's Order No. FR, d By KEEP THIS SLIP FOR REFERENCE $H 28 Rediffrm BOX 10( ^SOLD BY CASR��. CQ 0�fs f,, C ARG J DL 'PIS -7, 71 pz m 4a s.A irA -S TOTAL COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Keno Hills, Block 1, Lot 3 020-171-10 11 1 2.4 1972 None 95* 30+* 4.12 12 FORGE ENGINEERING 8/06/20 0 8/06/20 *Information from Municipal files. 16 Septic/Steel 50" N/A 8/28/19 - Isaac's Pumping Service Septic System is gravity flow. Shallow Bed 5/23/05 8/06/20 3 3.0 0 2.5 477 0 150 0 >450 No NA ✔ 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 if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’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 Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS 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. 8/21/20 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Property owner s--�� t, L Day phone g7 M H;iddr ess a-7a� C 41-�—(� �AY C, lig ai ng a Lending agency W /IA Day phone Mailing addro�� Agent S t Address Unless otherwise requested, HAA will beheld for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Day phone P-17 2-- zz1 As certified by myseal affixed hereto and as' of the validation date shown below, l verify that v' y4ay. i X { .;6 ".•`, ^ a N e iY -. t a: investigation of this Health Authonty Approval appllcatlon 'shows that theon site water supply , and/or wastewater disposal.systerri'issa,e, functional and adequate for the number of bedrooms and type of structure indicated herein. l furtherverify_that based on 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 th_e�da�'te of this inspection. Name of Firm Phone 2Z-61 � 4 Address Engineer's signature —!��--- Date—i`t"�� 4�000Op� 0 OF kN AC 6. DHHS SIGNATURE _-/,— Approved for Disapproved. Conditional approval for Additional Comments bedrooms. bedrooms, with the following stipulations: Date 8 -2 S - 9B 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 orderto 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 EIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICEMUG 2 1 1998 Environmental Services Division MUNICIPALITY OF ANCHORA 825 L Street, Room 502 *Anchorage, Alaska 99501 • (�Q7%W- A�f? 6ices Dlvlsin Health Authority Approval Checklist Legal Description: ^�� 2✓r V,4Z6V-j- IC.E5O 44 A-S Parcel LD,: A. WELL DATA Well type- 1 If A, B, or C, attach ADEC letter. ADE(C water system number /k Log present (Y/N) 1 Date completed hi f K Total depth I �✓/ Cased to Casing height (above ground) �^1'Zf l Sanitary seal (Y/N) 49? Wires properly protected (Y/N) `amu kr lt. nt*4 1 WML AqA- WMA -FReM WELL Lea ffDate of test *98 - gI X3198 Static water level TDP G/E5t►�GT Qalod"-"i Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate' 2� Other bacteria .Date of sample: �8r<5%8 'g�1�9� Collected by:z✓t.�-ria'Tatl B. SEPTIC/HOLDING TANK DATA t,IfJ�swt/w Date installed Eg7a Tank size Number of Compartments Cleanouts (Y/N)� Foundation cleanout (Y/N),jk2_ Depression (Y/N) 0 High water alarm (Y/N) IJQ Date of Pumping Pumper f�r.D M"D�1�Lfi�5 C. ABSORPTION FIELD DATA Date installed I't"1'S Soil rating (g.p.d./ft2 0 #t2/bdrm « System type 'IJ Length Width 3 Gravel thickness below pipe ID Total depth Effective absorption, area Monitoring Tube present (Y/N)A�?Depression over field (Y/N) Date of adequacy test Results (Pass/Fail) For bedrooms FT. 56:157A- Fluid depth in absorption field before test �'r � Immediately after_ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) KIV> If yes, give datetjIA 72-026 (Rev. 3/96)" - 50Me tZU`i v�BP�' iEfilih` � FP-Jvt,l ��L � � sC►.C�e �e jL � 11.4�C-� �, D. LIFT STATION N� Date installed Manhole/Access (Y/N) — High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on'.' level at* "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 78 On adjacent lots r � Absorption field on lot ' + On adjacent lots 2 (— Public sewer main 1A Public sewer manhole/cleanout Nl Sewer /septic service line Lift station t,41A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r r / Foundation (o Property line Absorption field "fes / / / Water main/service line ti Surface water/drainage Wells on adjacent lots't- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: ti 'T" �/ 1 "t— &/ Property line Building foundation �t'(o Water main/service line Surface.water ✓o -f– Driveway, parking/vehicle storage,area lc�ln Curtain drain Wells on adjacent lots �a / F. ENGINEER'S CERTIFICATION I certify that I have d termineoLthru field inspections and review of Municipal r in conforman hMg de/ines in effect on this date. Signature Engineer's Name _Gr QIZ P E Date 10115196 HAA Fee $ 300,00 Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Wo . ��..6z .cis•: t -9 6 ........... are v%f�/l�'(, l vr, '-7 LT -U,' l Poo app (S"A C, 0- (s 8 -7 -� g 8- / 8.n cyo r C) q, r C5 1 v "' 0-F -t-(L-F ... q l f C-c) `C):O o v%f�/l�'(, l vr, '-7 LT -U,'