HomeMy WebLinkAboutKENO HILLS BLK 2 LT 22f%\C.)
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax_ (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241156
Work Type: SepticTank Upgrade
Tax Code Number: 02017108000
Site Legal Address: KENO HILLS BLK 2 LT 2 G:3438
Site Mailing Address: 5900 BLUEBELL DR, Anchorage
Owner: TURVEY JANA M & RICHARD P
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
7/2/2024
7/2/2025
95832
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
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 (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
/! _.
Received By: '' t= Date:
2__Issued By: Date: 2' `"
4
MUNICIPALITY OF
. . . ..... . . p,
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON -SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 020-171-08
Property owner(s) Jana Turvey
Mailing address 5900 Bluebell Drive, Anchorage, AK 99516
Site address 5900 Bluebell Drive, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Keno Hills Block 2 Lot 2
Day phone
Legal description (Township, Range & Section)
Lot Size 95,832 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(S all that apply)
Absorption Field
❑
Initial El
Single Family (SF)
19
(w/wo AD U)
Septic Tank
R
RX❑Upgrade
Duplex
El
(D)
Holding Tank
El
Renewal ❑
Multiple Dwellings
❑
Privy
0
(SF and/or D)
Private Well
0
Water Storage
0
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
�4_ Z_
Receipt Number: _Q5zlo7D
Permit No. 05 P 9, (-111 �6
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_-'- : - :'_.,:c -,
June 11, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Keno Hills Block 2 Lot 2, 5900 Bluebell Drive
Septic Tank Replacement
Dear On-Site Services Engineer:
The owner of the above lot has a septic tank that has reached its end of useful life, so we are
submitting this permit application for its replacement. The attached site plan identifies the location
of the home as well as the wells and septic location. No conflicts exist between this proposed
system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing
the septic tank with the same size designed for 4 bedrooms.
The new septic tank will be a minimum of 100’ from all we lls and surface water. Please refer to
the attached plan for the septic design. If this design is followed, there will be no adverse impacts
to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241156, Curtis Townsend, 07/02/24
Benjamin Schiller
CE 12592R
E
GISTEREDPROFE S S I O N A L E N GINEER
1"=50'
24' WIDE, 50' LONG SEPTIC
MOUND TO REMAIN IN SERVICE
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
NEW 2CO
KENO HILLS, BLOCK 2 LOT 2
FEET
0 50 100
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SEPTIC PLAN
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EXISTING 1500-GAL TANK
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NEW 1500 GAL SEPTIC TANK
CREEK
CREEK
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WATER SETBACK
ppOdlL'T71Y.1�0w.,&OWL Mm 0147L To Oro*PMMETOLLFREE 140bil0-0.9B0
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MLN apAtm of AMCM
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DEPT. OF HEALTH &
Se A40"4Q¢ �k 3 7, S
ENVIRONMENTAL ?ROTEOTItDN
NOTE C C (1
All Dimens � / at ons Must
Be Field Verified Prior To Construction
:SEWER SYSTEM -LOCATION-PLAN
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LOT BLOCKSUBDIVISION
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/ SO The Proposed pro Of Location Of Exiells. and And
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DRAWN BYin Systms. indicated Is Not exact. Dimensions
:pli C,
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Indicated Slave Been Determined By Use OC Cloth
Tape and/or Municipal Records, And Not By -
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Municipality, of Anchorage`s
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DEPARTMENT OF HEALTH &HUMAN 4
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825"L" Street, Anchorage; Alaska 995
SOILS LOG - PERCOLATIO
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Township, Range S tion. xxj>� e-/
LEGAL DESCRIPTION:./
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11 IF YES, AT WHATa��0
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DEPTH
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ALITY'OF ANCHORAGE
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PT. OF HEALTH &
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11 IF YES, AT WHATa��0
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MUNICI
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PT. OF HEALTH &
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19
20
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PERCOLATION RATE �� 33 (minutevinchl PERC HOLE DIAMETER
TEST RUN BE EN/ ANO FT
j COMMENTS a
PERFORMED BY:
RTIFY THAT TH?1,TEST AS PERFORMED IN
ACCORDANCE WITH ALL STAT$ AND,MUNICIPAL GUIOELI N EFFEC O THIS DATE. DATE: a
72-008 (Rev. 4MI
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PERCOLATION RATE �� 33 (minutevinchl PERC HOLE DIAMETER
TEST RUN BE EN/ ANO FT
j COMMENTS a
PERFORMED BY:
RTIFY THAT TH?1,TEST AS PERFORMED IN
ACCORDANCE WITH ALL STAT$ AND,MUNICIPAL GUIOELI N EFFEC O THIS DATE. DATE: a
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D. IIOBSON CA NTERPRISC, S
���/ 10881 STROGANOF DRIVE
►i„_ _d , / L?CHORAGE, ALASKA 99516
xl?jal 33 �F-aek
SkQ PHONE: 346.1807
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BUILDER/OWNER
INVOICE
1672
DATE: Z ��
P. O. No./�J`Y-
'MAILING ADDRESS
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SIGNATURE X ", :, ;: 1 r.iJ'':• `'
Signature of this invoice will be considered your notice of our intent to lien this project, if necessary.
Terms: Net upon receipt of invoice. 1 %x% surcharge 30 days past date of invoice.
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ilIllClpallty Of Ai1C' .P°4� 703: 799
.r RECEIPT FQ., - T(; QED MAIL
Department of Health and Human NUINSURANCE'COVERAGEPROVIDED
825 "L" Street NOT FOR INTERNATIONAL MAIL
Tom Fink,ee Reverse)
Mayor P.O. Box 196650 Anchorage, Alaska 99! r,,
Sentizo
Bruce Corwin _
i0ottviyi1Mo•& Associates
August 3, 1990; CERTIFIED `' PA°rriorage 99523-06 $
Bruce J. Corwin, P.E.
Corwin & Associates, Inc.
P.O. Box 230608
Anchorage, Alaska 99523-0608
Re: NOTICE OF VIOLATION - AMC 15.65.040
Lot 2, Block 2, Keno Hills
Postage $ -
certified Fee r _
S eciel Delivery Fee
P
Aestricted Delivery Fee,
�eturn Pecei
Fpt ShoWinp
Dear Mr. Corwin' Y,pT-A 1,P;MgaandFeea"
p„ P_astfnark or Date
Please be advised that this letter will se d�
violation of AMC 15.65.040(A). Procedures M
violation are specified in the compliance
0
w
After careful review of your design and as a
based on our field inspections of the subjec " ot, this office
believes that you are responsible for the following violations
pertaining to the design and construction of the on-site
wastewater disposal system serving the subject lot.
VIOLATIONS
1. Submission of inaccurate design information. The design
submittal indicated that a mound type system was to be
installed on the subject lot in an area with an existing
slope of less than 5 Our field inspections indicate that
the slope where the mound was constructed ranges between 13
and 17%.
2. Submission of inaccurate and false as -built documents. The
as -built documents which you first submitted on 7/16/90
indicated that the bottom of the mound system was installed
at a depth which provides only 3.5 feet of vertical
separation to seasonally high groundwater. Municipal code
and state statute require a minimum 4 feet of vertical
separation. Your as -built documents further indicated that
the system was installed in accordance with the permitted
design and that the down slope edge of the mound consisted
of 4 feet of sand, l foot of washed rock and 3 feet of
cover. This would yield a total system thickness of 8 feet
on the down slope side. Based on our field measurements,
the mound is only 4 feet, 10 inches thick on the down slope
side.
Kids Are Our Future
Bruce J. Corwin, P.E.
August 3, 1990
Page Two
After meeting with you at the construction site on 7/31/90,
to resolve these elevation and cross section discrepancies,
you agreed that the existing constructed mound was not
accurately reflected in your as -built submittal and that you
would provide this office with a revised submittal. On
8/1/90 you submitted a revised as -built drawing indicating
that instead of the 3 feet of cover, the contractor had
placed 2 inches of insulation followed by 18 inches of cover
material over the washed rock.
Upon receipt of your revised drawing, this office made
another field inspection at which time two small test holes
were excavated on top of the mound. Those test holes
indicated that the depth of cover material over the washed
rock ranged between 6 and 12 inches and that there was no
insulation in place between the cover material and the
washed rock.
COMPLIANCE ORDER
As a result of these documented violations and engineering
inaccuracies, the following items must be completed:
1. Within three working days from receipt of this compliance
order you must provide this office with a revised design and
permit application for the installation of a new system on
the subject lot. The revised design must specify that the
contractor will remove the existingsystem to a level equal
to original grade. As an,alternative to complete removal of
the system, the contractor may excavate four test holes, one
at each corner of the mound, to verify depth to original
grade and the relative depth and quantity of sand in place.
Each test hole must be inspected by this office to confirm
its depth with respect to original grade and the documented
3.5 ft. depth between original grade and seasonally high
groundwater.
2. The contractor (Acreage Systems) will be required to
complete construction of the new system within 5 working
days after issuance of the revised permit.
3. You must prepare and submit as -built documents to this
office within 3 working days of construction completion.
Bruce J. Corwin, P.E.
August 2, 1990
Page Three
This office will not approve use of the subject system until all
conditions of the compliance order have been satisfied.
If you have any questions regarding this notice of violation or
the requirements of the compliance order, please contact our
office at 343-4744.
Sincerely,
kn Smith, P.E.
rogram Manager, On-site Services
cc: Lee Browning, P.E., Manager, Environmental Services
Dan Roth, On-site Services
Susan Oswalt, On-site Services
John & Cindy Minier
Ed Sanderson, Acreage Systems
Dave Brennen, Code Enforcement Manager
I
Municipality of An
P 49 703 =80QA :..
Department of Health and Hum r> ,EiQr FORied MAi
825 "L" Street NO INSOANOETO.VERAGE PROVIQED
Tom Fink, NOT FOR INTERNATIONAL MAIL
Mayor P.O. Box 196650 Anchorage, Alaska 1
(ISee IfeverseJ ,
August 3, 1990 CERTIFIED ;,tta.
Ed Sanderson:
"spiiatpe Systems
P: Ll IT, an-l2,CCd e B
Mr. Ed Sanderson :nc or ge,Acreage Systems, Inc.
601 E. N. Lights Blvd, Suite 343 ed Fee
Anchorage, Alaska 99503
l -Delivery FeeRe: NOTICE OF VIOLATION - AMC 15.65.040
Lot 2, Block 2, Keno Hills cted Delivery Feit ShowingDear Mr. Sanderson' olnand'.Date Del ivered• nor int Chnwina towho'm
Date nd Address'of Delivery -
Please be advised that this letter will �, 'aY. $
violation of AMC 15.65.040(A), 15. 65 060;'—
Procedures for correcting these violatio v, Postfnarkot Date'''
compliance order.
0
M =
After careful inspection and review of t:.9
respect to the engineered design and -as -:,V'
office believes that you are responsible a
violations pertaining to the construction of the on-site
wastewater disposal system serving the subject lot.
VIOLATIONS
1. Improper construction of a wastewater disposal system. The
as -built documents submitted by the engineer on 7/16/90
indicated that the bottom of the mound system was installed
at a depth which provides only 3.5 feet of vertical
separation to seasonally high groundwater. Municipal code
and state statute require a minimum 4 feet of vertical
separation. In addition, the system was not installed in
accordance with the permitted design. The permitted design
required that the mound consist of 4 feet of sand, 1 foot of
washed rock and 3 feet of cover. This would yield a total
system thickness of 8 feet on the down slope side. Based on
our field measurements, the existing constructed mound is
only 4 feet, 10 inches thick on the down slope side.
After meeting with the engineer at the construction site on
7/31/90, to resolve these elevation and cross section
discrepancies, it was agreed that the existing mound had not
been constructed in accordance with the permitted design or
with municiapal code.
Kids Are Our Future
P
Ed Sanderson
August 3, 1990
Page two
2. Inadequate cover material placed over system. On 8/1/90
this office conducted a field inspection at which time two
small test holes were excavated on top of the mound. One
hole was placed on the south side of the mound,
approximately 3-4 feet from the cleanout; the second hole
was placed at approximately the center of the bed. Those
test holes indicated that the depth of cover material over
the washed rock ranged between 6 and 12 inches and that
there was no insulation in place between the cover material
and the washed rock.
AMC 15.65.060(K) requires that all systems have a minimum of
24 inches of final cover material placed over the entire
surface of the mound. AMC 15.65.060(L) requires that any
system which has less than 36" of cover material must have
insulation installed between the gravel and the cover
material. Our field inspections indicate that neither of
these requirements are reflected in the completed
construction of this system. This is a violation of AMC
15.65.040(A).
COMPLIANCE ORDER
As a result of these documented violations, the following items
must be completed:
1. The engineer. (Corwin & Associates) will prepare a revised
design and permit application for the installation of a new
system on the subject lot. The revised design will require
removal of the existing system to a level equal to'original
grade. As an alternative to complete removal.of the system,
you may choose to excavate -four test holes, one at each
corner of the mound, to verify depth to original grade and
therelativedepth and quantity of sand in place. Each test
hole must be inspected by this office to confirm its depth
with respect to original grade and the documented 3.5 ft.
depth between original grade and seasonally high groundwater.
2. You will be required to complete construction of the new
system within 5 working days after issuance of the revised
permit.
This office will not approve use of the subject system until all
conditions of the compliance order have been satisfied.
Ed Sanderson
August 3, 1990
Page Three
If you have any questions regarding this notice of violation or
the requirements of the compliance order, please contact our
office at 343-4744.
Sincerely,
J n Smith, A.E.
Program Manager, On-site Services
cc: Lee Browning, P.E., Manager, Environmental Services
Dan Roth, On-site Services
Susan Oswalt, On-site Services
John & Cindy Minier
Corwin & Associates, Inc.
Dave Brennen, Code Enforcement Manager
DRAFT
A u 9 u s -1. 24 '199(D (`EF,'rr!F1EI::) MAIL
Mr.. Ed Sanderson
Ac.r.eage Systerrisi lrii::.
601 E. N. Lights FAWS Suite 343
A ri c 1--i (:) r- a g e I Al a s 99503
SLIt'i NO 1 On—Si t e Sewer- WHO I at ioin (.in Lot B1 k. 2
K., e r, o s S
Dear Mr. Sander,sorift,
The staff of the On—Site Sermices Section has r,ecently masa to
sever -a inspections at the above louati,-)n. I in it i 'I y a i e 1 d
inspection was made to ver,ify :eptain aspeNs of the repor-t
SLaMlitted by the inspec-ting F.-,n,;.J.neer%, Bruce Clorwin. When
discr-epancies were found, an additional inspei:tion was made with
Mr. Orwirin Dan Roth, and John Smith. [)ur-ing Ji.n.....'pection,
Mr- . Nimbi cmitacted YOU hi y' r-adio -And confirmed that ther-e was .-I
minivium of 18" of i:over- over- the systell'i �.*Ar'!O , that the sy-.-.Jerfil was
also insulated. Mr-. C�or-wiri attested to this in kor-i-ting.
YesterWay Dan Roth and .1. made a subsellu* nt visit to the sit -est
;and dug two small holes to vei-ify the installation of
insulation. One hole was placed on the sf-.iuth side of the tied
a -.a 'I y 3-4 f net t f r- out t he 1.-. 1 o u t tic? `.:i4 c on d In! I e was
p p r o x j. mat �
at appr-axii-riately the caner of the be In the; f ir-st
In a I e , w F. f o u n d e n g i r, e p r- J. in g f a b r. i c at. 6 b e 1 o w t In is f a b r i were
roc:ks and a 'I at er-al distr1but i on p, ipta, . Thee s e .: o ri d In o I e was
e-xcavattad to 1.3", wher-e toe found engineerino fabr-ic over i-ocYs.
AMC! 15.615.060 section K r-enju.ires that an), system have a i-ninimun-,
of :24" of final imver- over. it. AMC0 15.65.060 sel:tiori L. requir,ess
tInat any system which has less than 236" of ::ovei*,, must have.
insulation over, it. Witter, of these Pmovisions wv.--.re met during
YOUr installation. Additionally, this installation was riot
installed according to the design submitted by the engineer. an,i
am-oved by this; section, whi-S is a violation of
AMC',' 1.5.65.0-140A. At this Point the system is disapp-rovedn And
may not be i..ised.
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CORWIN & ASSOCIATES, INC.
1000 E. Dimond Blvd. Suite 205
ANCHORAGE, ALASKA 99515
(907) 522.1311 FAX (907) 349-2236
JOB � • /11 r-..c..-rc.: w... I'
SHEET NO.-
CALCULATED
O. CALCULATED BY og DATE
CHECKED BY DATE
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MUNIG I FALlTY UF ANCHOHAGE
Departme�t
Of Hcullth & lduV}an
8215 L Street, Anchorage, Alaska 99501 343-4720
ON - SITE SEWER & WELL PERMIT
�
Permit Number: 900025
Date Issued� 02/01/90 Engineer Designed
Dwner, Name: JOHN AND CINDY MINTER Day Phone:
Qwner Address: 9071 CATHEDRAL PLACE 276 22
ANCHORAGE, AK 9q507
Parcel Id: 020~171-,08
L.K. Legal: Gubdivisicon: KENO HJLLS Lot: 2 Block: 2
Section: 11 Township: 11N R-ange: 3W
SITE: 59(::) BLUEBELL ^.
Lct Sizo.i 95832 or acres)
Max, Bedrooms: This Permit: 4 Total Capacityx 4
'
SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons.
Each septic,
tank must have
at least 12 c:oilpartmcants°
Depth to' t�p of'
Beptic tank(s) < 4"0
[eet requires
insulatiOn over tank(s).
WELL: Lug must
be submitted to Municipality
of Anchorage
Departfnent of' Health
and Human
within 30 days ch' well
/
completion"
PERMIT EXPIRES
199O"
OPEN AND CLOSE
' CAVATION ON SAME DAY OR
HEAT EXCAVATION"
NOTIFY DHHS OF
INSPECTIONS AT 343-4744 OR
343-46B1"
I CERTIFY THAT:
1, I all -I J'amiliaP sewers and wells
Fcorth by theo Municipality OF Anchorage (MOA> and the State of Alaska,
2" I will install the system in with all MOA codeg and'regulations,
and in c:ompliance with design criteria of' this permit.
3" I will adhenre to all MDA and State of' Alaska requirements hor the set back
distances {rom any existing well, wastewater dispIsal systeM or public
sewerag� system on this or any adjacewt or nearby lot"
4^ I understPnd that this permit is valid fOr, a maximu0 Of' 4 bedrooms. I
also understand that the capacity o{ the total system is 4 bedrooms and
any will requirc: an additicJnal pearmit^
- ~ .
Signed:
(Own��> JOHN A�u CINDY MINIER
IsSued By:
~___���__�
'
DATF::
..��~�4_.���..... ..... �.....
DATE: k_1 --Fd
�~���___~..... .~___
`
�
`
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1990
Robert & Roberta Pond
7411 Blackberry
Anchorage, Alaska 99507
Subject: Lot 2 Block 2 Keno Hills Subdivision
Permit #890253, PID #020-171-08
A
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for review,
approval and documentation.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
On-site Services
JW/1jm:200
enc: Copy of Permit
"Kids Are Our Future"
�-. .
MUNICIPALITY OF ANCIII ORA8E
' Department of HeaIth & Human Gervitsms
825 L Street, Anchorage, Alaska 99501 343-4720
�
ON�SITE SEWER sk WELL PERMIT
Permit Numbep: 890253 Is
Date Issued: 10/30/89 Engineer Designed
Owner Name:
ROBERT 8i ROBERTA POND
/
Day
Phone:
Owner Address:
7411 BLACKBERRY .
522-1311
AN�HORAGE, AK 99507
Parcel Id:
02(-171--O8
Lot Legal:
Gubdivision:
Amtion11 Township: 11N Range:
3W
Lot Size
95832 (sq"ft" or acres>
Max Bedrooms:
This per(Tit:' 4 Tc)tal
Capacity:
4
SEPTIC TANK: 11ini.mum
total septic hank
capacity"
1p250 allor t o,
Ea(.::h septic:
tank must h�ve
at least 2 compapt0ents.
Depth to
top of septic
tank(s) < 4.0
Feet requires
insulation over tAmk(s)"
WELL: Log must be submitted to Municipality of Anchorage Department of Health
and Human Services Within 30 clays of well c�mpletion"
PERMIT EXPIRES .989" '
NOTIFY DHHS OF INSPECTIONS AT 343~4744 OR 4681.
OPEN AND CLOSE EXCAVATION ON SAME DAY OR HEAT EXCAVATION"
I CJ;JRTIFY 1"I1HAT:
1" I am Familiar with the for on—site sewprs and wells as �et
forth by the Municipality of AnchoPI (MOA) and the State oJ Alaska
2. I will install the system in accordance with all MQA codes and �egulations,
ancl in compliance with the design criteria of this permit"
3" I will adhere to all MOA and State of Alaska requirement,s for the �et back
distances from anyexisting well, wastewater disposal sy$teno or public
sewerage system on this or any adjacent or nearby lot"
4" I understand that thispermit is valid for a maXimum of 4 bedrooms" I
also understand that the capacity of the total system is 4 bedroom� and
,'any enlarOement will re�uire an additional �ermit"
' ~ � -
^/
�
Signed:
(Owner} ROBERT
Issoued By:
.... ..... ..... . _.... ..... ..... .... ..~
DATE:
....... 1.-____...1._ ......... .... __�
QATE
: /m.~��6
_����_..........���_���
PPri/yuN� O
�j SeP.ly,. 2
/21 e00 pre rye fj
Ste/
o
® Z07- .3
GOT 2
Bc% X 150k 1,!5 = goo
Glse /1/lGuv� 24'x37.5'
= 9o0sq.
NOTE:
All Dimensions And Locations Must Be Field Verified Prior To Construction
SEWER SYSTEM LOCATION PLAN
LOT BLOCK SUBDIVISION
�lAeAJO H/LLS
nno'°`a x
SECTION/TOWNSHIP/RANGE
T k
_.r , SCALE, •I NOTE.
/0 The Accuracy Of Location Of Exisiting And
DRAWN BY0
Proposed Property Corners, wells, and. Septic.
ria , .� n�. , n Systems Indicated Is Not Exact. Dimensions
NORTH `� G Indicated Ilave seen Determined By use Of Cloth
Tape and/or Municipal Records, And Not By
Surveying Techniques
re J Cp,�kl ,:r yi 'fl M
rY s
cI. .E-u2$v �`i 3 PREPARED FOR,
�. ... .. 1.. OATEN �D//1,. /�t� SHEET / OF
.0
From 5er0 frc Tam .�
1 311 & , i to t
pi A /,/
r
0/0 / a"j
3t_ 6u
/ 131
�b f'l�ce sa�t�
.Ge° dv, 7`z�j o 1L
NOTE: �! illl l Pi% $EGTwAl J/
All Dimensions And Locations Must Be Field Verified Prior To Construction
SEWER SYSTEMLOCATION PLAN
BLOCK
sueowlsloN
2 2 �E� Jo ff/GLS
SECTION/TOWNSHIP/RANGE
SCALE% / NOTE -
7
T, IAJ
T n /� /
1. 1 / = /00 The Accuracy Of Location Of Exisi ting And
AProposed Property Corners, Wells, and septic
DRAWN BY- syste s Indicated Is Not Exact. Di�nsions
+ -io NORTH Indicated Rave Seen Deter=ined By use Of Cloth
iC+n Tape and/or Municipal Records, Md Not By
-^^"•"' Surveying Techniques
PREPARED FOR-
OW
OR-
4 es, �Ek TUI2,t/L��
• „� t ineers C�
SHEET 2 0F 2
Municipality. of Anchora�
DEPARTMENT OF HEALTH & HUM.
825-L" Street, Anchorage, Alaska
SOILS LOG — PERCOLATI
PERFORMED FOR: / _ `� 7-641,1pl
LEGAL DESCRIPTION: Z,/ T 2, 6?4,0ii& Z Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20 -
DEPTH
(FEETI
COMMENTS
a 11
/IAG IAII
Cobb/e
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH?' P
E
Depth to Water Atter
Maniwrinp7 Date: 4
SITE PLAN
r
PERCOLATION RATE 81 33/p 61
(minutesiinchl PERC HOLE DIAMETER
TEST RUN BETIyEEN / ET AND :2? FT
PERFORMED 8Y: t/Le SL Cf " t- I �- CERTIFY THAT YHIS T T WAS PERFORMED IN
ACCORDANCE WQFH ALL STATE AND MUNICIPAL GUIOEU S N EFFE N THISDATE. DATE:��
72.006 (Rev. 41651 ..
PERCOLATION RATE 81 33/p 61
(minutesiinchl PERC HOLE DIAMETER
TEST RUN BETIyEEN / ET AND :2? FT
PERFORMED 8Y: t/Le SL Cf " t- I �- CERTIFY THAT YHIS T T WAS PERFORMED IN
ACCORDANCE WQFH ALL STATE AND MUNICIPAL GUIOEU S N EFFE N THISDATE. DATE:��
72.006 (Rev. 41651 ..
OEPTH ��/� I
2-
3-
4—-
5-
6
3 45 s�
7-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
191 910111213141516171s1s
20 Q it
PERCOLATION RATE —42'V 2 (minutes/inch; PERC HOLE DIAMETER
TEST RUN BETWEEN 3 ANO 4—FT
__7_ ! it- . .Y. .
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depthtri Water A
monit rier
�P
Mollitorkiq? i
i� i
own MEN
COMMENTS
PERFORMED BY: ! ff Aft C% f !11f IVVIV i
ACCOROANCE WITH ALL STATE AND MUNICIPAL G
72.008 (Rev. 4/85)
I IFY THAAT7 T TE§T WAS PERFORMED IN
EFFEYqN THIS DATE. DATE:
.7
_
w
�l^hl'i
• .
Municipality of Anchorage
� u .: rF2 is ijmr$
+v P
F° 1,'e'
DEPARTMENT OF HEALTH & HUMAN SER,
„," v r
825 "L" Street, Anchorage, Alaska 99502-0
:" b a `3 ,
MM•' °"
SOILS LOG — PERCOLATION TE'
<•,, .
N. _ i,
"DPcFRFORMEf�,."��
PERFORMED FOR:
-`''-✓��1�,'Li/�ti
/
LEGAL DESCRIPTION:
Township, mange, Section "
(.�1 G� �Gp� g
,.
C40
OEPTH ��/� I
2-
3-
4—-
5-
6
3 45 s�
7-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
191 910111213141516171s1s
20 Q it
PERCOLATION RATE —42'V 2 (minutes/inch; PERC HOLE DIAMETER
TEST RUN BETWEEN 3 ANO 4—FT
__7_ ! it- . .Y. .
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depthtri Water A
monit rier
�P
Mollitorkiq? i
i� i
own MEN
COMMENTS
PERFORMED BY: ! ff Aft C% f !11f IVVIV i
ACCOROANCE WITH ALL STATE AND MUNICIPAL G
72.008 (Rev. 4/85)
I IFY THAAT7 T TE§T WAS PERFORMED IN
EFFEYqN THIS DATE. DATE:
.7
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE: August 14, 1990
TO: File for Keno Hills Block 2 Lot 2
FROM: Daniel J. Roth, Civil Engineer, On -Site Services
SUBJECT: Comments On Construction Of The Wastewater System On
Keno Hills Block 2 Lot 2
On the week of July 20, 1990 I was assigned the subject as -built
to review. The permit application reflected that a mound system
was to be constructed on top of a GM layer after 1 foot of peat
was excavated from the top of the GM layer and replaced with 4
feet of sand according to the design drawing submitted by the
engineer. This was to generate a minimum of a 4 feet separation
to the seasonally high ground water table.
The as -built submitted to the office appeared to indicate that
the mound was constructed by removing 1 foot of peat from the
surface of the GM layer and installing a sand layer 6 inches
thick at the uphill side of the mound and four foot of sand at
the downhill side of the mound. Since this did not reflect what
should have been done according to the engineers drawings in the
permit application, it prompted a field visit by myself and Susan
Oswalt on July 25, 1990.
While at the site, we discovered that the terrain described by
the engineer in the permit application to be "5% +/-" was
actually ranging from 14% to 17%. This explains 6 inches of sand
at one side of the mound and 4 feet of sand at the other side.
The height at the highest point on the mound was approximately 4
1/2 feet from original grade. We determined that this was not
near high enough to account for 4 feet of sand + 1 foot of sewer
rock + 3 feet of soil cover = 8 feet. On August 1, 1990, John
Smith and I met with the engineer on-site in attempts to solve
the discrepancies between the as -built and the actual field
measurements. The engineer said he would give us a revised
as -built to reflect the true constructed mound after our meeting
with him on-site.
The revised as -built was submitted to this office on August 1,
1990. The revised as -built indicated that the up -hill side of
the mound was placed on 6 inches of sand excavated 6 inches into
the ground which placed the bottom of the sewer rock at original
ground surface. This again pointed out as the original as -built
did that the bottom of the sewer rock at the uphill side of the
mound was 3.5 feet from the water table. The engineers
explanation for this is at the time of construction of the mound
on July 11, 1990, he dug a test hole 6 feet deep at the uphill
side of the mound to verify no water. I told the engineer that
in July this would not count since this is a low water table
period of the year. The new as -built also indicated that there
was not 3 feet of cover on the mound but 2 inches of insulation
and 18 inches of cover.
Memo To File
Page 2
After the submittal of this new as -built, Susan Oswalt and myself
again went to the site and dug some test holes on top to the
mound to verify depth of fill on top of the mound and verify
insulation. We found the cover to be in the range of 6 inches to
10 inches with no insulation.' This was at one corner of the bed
and in the middle of the mound.
On August 3, 1990, John Smith wrote a compliance letter to the
engineer telling him to submit a new permit application to
construct a new drainfield and upgrade this apparent illegal
system. Or, dig a test hole on all four corners of the mound to
original grade to prove the separation to ground water.
A meeting was held with the engineer, the excavator, and the
property owner during the week of August 6, 1990. In this
meeting, what I heard was the test holes would be dug as the
letter of August 3, 1990 indicated.
On August 10, 1990 this office received a new as -built in which
all the numbers were correct. Separation to the ground water was
4 feet as required by code according to the new as -built. All
that was left was to get proof that the mound was indeed
constructed the way the new as -built indicated.
On August 13, 1990, John Smith told me to go to the site because
the excavator had dug a single test hole on the uphill side of
the mound to show burial depths. When I arrived at the site, I
observed the test hole, took pictures and the excavator showed me
some holes on top of the mound proving there was insulation.
When I returned to the office I told John Smith that I could not
tell very much from the test hole and told him that I felt that
the four test holes on each corner of the mound would help
determine what was actually constructed. John said that the
excavator/engineer talked to him and said this would ruin the
entire mound and a new one would have to be constructed if they
tried to dig these test holes, so this would not be happening.
Seeing and believing that nothing was going to be resolved with
this project any further, I removed the "Approval" from the
statement at the bottom of the as -built form that states, "Health
Department Approval", and signed it.
WATER WELL RECORD
- STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological 9 Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either to, Ib or la.) A.D.L. No.
la. Borough Subdivision Lot Block Ib. 1/4 qt re. Section No. Township N ❑ Range E ❑ Meridian
_of_of—of — 3❑ v, W❑
Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL:: '
Address:
Street Address and Area of Well Location
FeetBelof oc*w
2. WELL LOB
4. WELL DEPTH: (final)
— --ff.
4!2r
5. DATE OF COMPLETION
11
�
Material Type Top Bottom.
r
B, ❑Cable tool Rotary ❑Driven ❑Dog
O'A*#or 9Jetted [3 Bared ❑ Other:
+
^
T. USE: Domestic ❑ Public Supply ❑ Industry
- ❑ Irritation ❑ Reaherge Q Commerical
^
❑.. Test Well ❑ Other:
S. CASINO: ' t
. ❑•Threaded [ Weldod
dlele.,4_in: t44tt. 64th Weight -J-'Z lbs./ft.
diem. In. to ft. Depth Stickup-2� ft.
- 9. FINISH OF WELL:
Type: „`f....�.Dt
- -
Slot/Me Len Size: Length:
Set b4tween ft. and ft.
Backfilting - Gravel pack
RECEIVED
10. STATIC WATER LEVEL: ft.
MAR 1
Oats
❑Above or Pelow land surface
Equipment used:
Dept. I uman Services
ft. PUMPING LEVEL below land .surface and YIELD
ft.. of.Nr hire. pumping-,&QQ g.p.m.
ft. offer - Mr. Pumping a. P. M.
17; SROUTINO✓ Well Orautetl: 0 Ye No
Material c ❑ meet cement ❑ Otb r:
13, PUMP: Cif avail able) HP -"��-
Length of Drop Pipe.- ft. capacity g.p.m.
-❑Subm. ❑ Jet ❑ Centrifical ❑ Other
' 14. REMARKS:
16. WATER WELL CONTRACTORS CERTIFICATION:- -
I5. Water Temperature _° ❑ F ❑ C
This well was drilled and my jurlsojction and this re art is true to the best of my knowledge and belief,
egiafere Bus, aces ams 'Contract Iriconpe Number
Address: PJA ez
n
Signed: . Date: 7— ea-- V[l
—�
hor etl'Rapr • atl
Form 02-WWR (11/811 Copy Distribution: WHITE - State OGGS, PINK - Driller, CANARY- Customer
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
020.171-06
1. GENERAL INFORMATION
Complete legal description Lot 2, Block 2, Keno Hills Subdivision
Location (site address) 5900 Bluebell Drive Anchorage, AK 99516
COSA # D O a 7:7
Expiration Date: i — a / — O Q
Current Property owner(s) John and Cynthia Minier
Day phone 229-6107
Mailing address 1424 N. Overlook Drive Port Clinton, OH 43452
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well❑
Individual On-site
IZI
Individual Water Storage ❑
Individual Holding Tank
❑
Community Class Well ❑
Community On-site
❑
Public Water System ❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes,
ordinances, and regulations In effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage. AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
.G Approved for bedrooms.
Disapproved.
Phone 522-7773
Date 8/1912009
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: iW, / Original Certificate Date:
(RM 11.05)
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/onshe
(907) 343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 2, Block 2. Kano Huls subdivision Parcel ID: 020.171.09
A. WELL DATA
Well type Pdvate If A. 8, or C provide PWSID # _ Well Log (YIN) Y
Date completed 7110190 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 4s ft. Cased to 48 ft. Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 7110190 6112/09
Static water level 30 ft. 26.5 ft,
Well production 20 g.p.m. 3.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies1100 mL Nitrate 3.71 mg/L Other bacteria 0 colonies/100 mL
Arsenic: WD mg/l Date of sample: /6&12/00 Collected by: A. Haraia
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Sepuclsteet Date installed 7/11190
Tank size 1.500 gal. Number of Compartments TWO Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) _A/
Date of pumping 811109 Pumper Denali sewer and Draln
C. ABSORPTION FIELD DATA
Date installed 7111/90 Soil rating (g.p.d./(t2 or ft2/bdrm)150 SFIBDRM System type Raised Bed
Length so R Width 24 ft. Gravel below pipe •5 ft.
Total depth 13 ft. Eff. absorption area 1.200 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6112109 Results (Pass/Fall) Pass For Four bedrooms
Fluid depth in absorption field before test 0 in. Water added 612 gal. New depth 2 In.
Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date
D. LIFTSTATION
Date installed Size in gallons
Manhole/Access (Y/N)
'Pump on' level at_ in. 'Pump off Ievei at _in.
High water alarm level at in.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100'
Public sewer main NIA
Public sewer manhole/cleanout N/A
Sewer /septic service line >25'
Holding tank N/A
Animal containment areas None
Manure/animal excrete storage areas None
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 >t0• Water main >10'
Water Service line >10' Surface water >100'
Driveway, parkingtvehicle storage >25'
Curtain drain None Noted Welts on adjacent lots
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I certify that I have dgtermined 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 Name Michael E. Anderson, P.E.
Date 8/1912008
COSA Fee $ % 0
Date of Payment C7 ''a R
Receipt Number 1 ,0 17
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
49IH 1 *
Vol MXXAR-L-'ANMSON
i
"CE -4381
SCS Reta
Client Name
Project Name/X
Client Sample ID
Matrix
Sample Remarks:
1094159001
Anderson Engineering
Keno Ifills L2,Q2
Keno Hills L2,Q2
Drinking Water
Printed DateMme
Collected DateMme
Received Date/Time
Technical Director
08/19/2009 15:18
08/122009 13:31
08/132009 8:45
Stephen C. Ede
Allowable Prep Analysis
Paramacr Results PQL Units Method Container ID Limits Date Date Ing
Microbiology Laboratory
Colony Comt
Total Coliform
Fecal Coliform
0 col/100m]. S%120 92220
A
(<200)
08/13/09
DLC
0 coV100mL S%1209222D
A
(<I)
08/13/09
DLC
0 COVl00mL SN1209222D
A
(<I)
08/13/09
DLC
SCS Rct.a
1094055001
Client lame
Anderson Engineering
Project'Name/N
Water Samples
Client Sample ID
Keno }fills SubD, L2,B2
Matrix
Drinking Water
Printed Datelfime 08/19/2009 16:23
Collected Date/Tlme 08/06/2009 13:20
Received Date/Time 08/072009 13:00
Technical Director Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results POL
Units Method Container ID
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
ND 5.00
ug/L EP200.8
C
(<10)
08/11/09 08/14/09
NRB
Waters Department
Total Nitmte/Nitritc-N
3.71 0.100
mg/L SM204500NO3-F
B
(<10)
08'07/09
LCE
'crobiology Laboratory
Colony Count
NTC
col/100mL SM20 92228
A
(<200)
08.'07/09
DLC
Total Coliform
Invalid
col/IOOmL SM209222I3
A
(<I)
0807/09
DLC
Fecal Coliform
Invalid
col/100mL SM2092228
A
(<I)
08107109
DLC
Dt7TA1 t.
7u�n: V—Zo'
PLOT PLAN _ AS
BUILT' SCALE GRID *,41^ . Project No. '07"14-[e
11500 Daryl Avenue, Anchorage, Alaska 99515
Lang do As80CiG1e0* nc. 907 522-6476 Phone
Registered Land Surveyors9073 522-4625 Fax
1 hereby certify that I have surveyed the following described prop*�y
L.oT.2 &LO- Zm _{G Jo l}u.vS-SUPi,__LC'u+T lo:bl�---
Anchorogi Recording Dljtrlot, Alaska, and that the Improvements situated
thereon are within the property lines and do not encroach onto the property
adjacent thereto, that no Improvements on the property lying adjacent thereto
encroach on the surveyed premises and that then are no roadways, transmission
lines or other visible easements on said property except as Indicated hereon.
Dated this the 1' 40 Day of AU6n51 . 7401), at Anchorage,Alaska
It Is the responsibility of the owner to determine the existence of any
easements, covenants, or restrictions which do not appear on the recorded
subdivision plat.
.KENNETH G. I.
L11 -7j2
�O��seroNN-�
~ MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # fl aQ - Ch- �g HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
L,oTlj2p gee. ti, 71.2 N 112 3 Le
Location (address or directions)
59 rso B L L A- to -o -a
(b) Property owner &LM I H i--e-r — Telephone: (home) 3'45- 77046 Business 9_b 3- Y233
Mailing Address
.(c) Lending Institution k Telephone
Mailing Address —� � s
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single -Family X Number of bedrooms V
3. WATER SUPPLY
Individual Well V Community ❑ Public ❑
Note: If community,well system, must have.;written confirmation from the State Department of Environmental
Conservation attesting to th legality and "status:
4. SEWAGE DISPOSAL
On-siteV -. Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State. Department of Environmental
Conservation attesting to the legalityand status.
72-025 (Rev. vas) Page 1 of 2 .
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 regulations in effect on the date of this inspection.
Name of Firm
I o bb{"
SPu v-1
1xK.QCh I7-- Telephone
Address
G7y
t440K
Date F",_ b as-, t R g f
;<✓_ �:�//-">\d�c': ', :,:",..:_, Engineer's Seal
1
6. DHHS APPROVAL
Approved for bedrooms by V42 spate
Approved X Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back Page 2 of 2
t' MUNICIPALITY OF ANCHORAGE (MOA)
ZPti s�� I� Health Authority Approval (HAA)
ENVtR��MeA 19 CHECKLISt1ARY 1984
343-4744
��ig 'D LegalDescription:
1
p'tion: _ LOT a Q_
A. WELL DATA
Well Classification
iZ £ s If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed T /0 90 Yield ao
Total Depth Y8 to 44 Depth of Grouting t1e He
Static.Water Level 30 Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)-
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ' ° ISO ; On Adjoining Lots _?/0-0
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots ') icrt�
To Nearest Public Sewer Line NSA To Nearest Public Sewer Cleanout/Manhole 1NA
To Nearest Sewer Service Line on Lot ? 0 -
Water Sample Collected by �• L I ; Date 0
2 •C;2g_ a�
Water Sample Test Results G= t'_'ol i i3 ru 1 /Z
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed _11/840 Side 150-' No. of Compartments t W o -
Standpipes (Y/N) Air -tight Caps (Y/N) y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contact on File (Y/N)for NSA
Holding Tank High -Water Alarm (Y/N) r'(/A Temporary Holding Tank Permit (Y/N) NSA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
0
To Water -Supply Well ! 5 ° To Building Foundation C5
To Property Line 'fq', To Disposal Field �5
To Water Main/Service Line >
To Stream, Pond, Lake or Major Drainage Course V41A
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ISO Type of System Design ht00Np
Date Installed 7/14Q0 Length of Field 5 0 rl ,
Width of Field '24, Depth of Field �y°" 36
bn'
Gravel Bed Thickness
Square Feet of Absortion Area 1,200 Statndpipes Present (Y/N) Y
Depression over Field (Y/N) r/ Date of Last Adequacy Test ff/A
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well > / S, D To Property Line o76
To Building Foundation
Lot K�A ; On Adjoining Lots
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
To Existing or Abandoned System on
To Cutback (if present)
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent (Y/N)
K
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed c%��n
Company ! bb H SPprV_6-Koc 1.0 `Fi
Date �`-c-b oL5 lqa �` Engineer's Seal
ez . ,
MOA No.
�J �� � �0�, VI✓i''S�Qe� uc ry '��
Receipt No. Receipt No.
Date of Payment Waiver Fee: $ \
Amount: $ Date of Payment
72-026 (Rev. 7iee) Beck Page 2 of 2
a
V
NORTHERN TESTING LABORATORIES, INC.
FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125
3330 INDUSTRIAL WAY ANCHORAGE. ALASKA 99503 (907) 277-8378 • FAX 274-9645
2505 FAIRBANKS STREET
John Minier
5900 Blue Bell Drive
Anchorage AK 99516
Attn: -
Our Lab #: A108505
Location/Project: Keno Hills
Your Sample ID. Lot 2, Blk 2
Sample Matrix: Water
Comments:
Method Parameter
EPA 300.0 Nitrate -N
Reported By: William E. Buchan
i Anchorage Operations Manager
Report Date: 02/26/91
Date Arrived: 02/22/91
Date Sampled: 02/22/91
Time Sampled: 1130
collected By: RL
Flag Definitions
U = Below Detection Limit
DL Stated in Result
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Units Result Flag Analyzed
-------- 1.8 -------
mg/l ------ 02/22/91
