HomeMy WebLinkAboutKENO HILLS #5 BLK 6 LT 3Keno Hills #5
Block 6
Lot 3
#020-171-33
ra
Municipality of Anchorage Page 1
of 3
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 South Bragaw Street
P.O. Boz 196650 Anchorage, AK 99519-6650
www.cianchorage.ak.us (907)347-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW040308 PID Number. 020-171-33
William Hiatt
Wastewater System: Tank Only
Ad .
17715 Ashland Drive Anch. AK ggs16
ABSORPTION FIELD
r., a. aewoo•.
345-7602 Four 4
Existing Trench
LEGAL DESCRIPTION
5"Rav
TOIWD•Obkenmgy R•a•
GPD/FeFI.
111 A Lm alb ry .06
D•Petbpq Edtvrthgn argrW V•O•
GravN OepN C�reN P9•
6 3 Keno Hills
Ft.
FL
To.rrlrp Nares
FA.ao.aabo ;WWgr w
•.w Lrptn.
Ft.
Ft.
Well: Existing Well
wMw
NunOar Yn•e
O•ha•n 1~
FI.
Fl
clnaLr�oan (Prteat•. A a. C)'
TOW Dean
CassO b:
r•a
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DM•DrWW
sm. Water L•.•1
Ft
Acreage Systems
8/4/2004
rWe
PurVSMaI
rata �o Gand
rJ05-DF51 TANK
G A L/
GPLI
FI
Ft
SEPARATION DISTANCES
® Septic ❑ Hoeing ❑ S.T.E.P. ❑ Other:
TO
Septic
Absorption
Lift
Holding
uwPdvate
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250
wa1
100'
>100'
N/A
N/A
>25'
Steel
Two (2)
&,%wwa
1001
>1001
N/A
N/A
LIFT STATION — NONE ON LOT
La LM
>51
>101
N/A
N/A
GW
F•urtlYan
>5'
>101
N/A
N/A
urV an .
utvw
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in.
culaetor•e
None
oted
•a o maO Dy
Ror"Its
Tank Only Replaced Under This
BENCH MARK
Permit. Existing Se tic Tank
Door Stoop. Northwest Corner of
House.
Pumvied,Crushed and Buried On Site.
AaautrO ENvalbrc
100.0 FL
Engineers Stamp
y
or49th
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Inspections performed by: NZA Dates: 1" 8/4/2004
--' -:
MICHAEL •E .
rA ANDLR5 j
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2nd 8/4/2004
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Department of Health and Human Services approval
Reviewed and approved
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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. SW040308
PID No. 020-171-33
ting Trench
NEI Septic Tank Only Placed Under This Permit.
Existing Septic Tank Pumped, Crushed and Burled On Site.
3 49th t'e
PROFILE AS -BUILT '•, No.aH�
Scale: 1' • tm
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SWO40308
Legal Description `KENO HILLS #5 BLK "6 LT ' 37
Design Engineer: 0014 Anderson Engineering
Owner Name: WILLIAM HIATT
Owner Address: 17715 ASHLAND DRIVE
ANCHORAGE. AK 99516 -
Ely iqa
Date Issued: Jul 30, 2004
Expiration Date: Jul 30, 2005
Parcel ID: 020-171-33
Site Address: 017715 ASHLAND DR
Lot Size: 108464 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
R] 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 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 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
Issued By.
Date: a 'G)- (Y4
Date: 713-010 y
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.ek.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020.171.33 Permit Number SW
Property owner(s) William Hiatt Day phone 345.7602
Mailing address (1)17715 Ashland Drive Anchorage, AK 99516
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 3. Block 6. Keno Hills Subdivision No. 5
Legal description (Section, Township & Range)
Lot Size 101, QU!A Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms _Four (4)
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ED
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
Waiver Fees:
Date of Payment:
Receipt Number. FJ )C Jp Receipt Number.
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
July 27, 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 6, Keno Hills Subdivision No. 5
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The septic tank on Lot 3, Block 6, Keno Hills Subdivision No. 5 is failing and must be
replaced. We are proposing to replace the tank with a new 1,250 -gallon tank to serve
the four-bedroom home on the lot. We are therefore requesting a permit be issued for
the construction of a new septic tank to serve the home. The attached Site Plan and
backup documentation identify the location and configuration of the existing septic
system and the location of the new tank. Also identified on the plans is the existing well
on the lot. The new tank will be placed in the same location as the existing tank with
the exception that it will be 7' to 8' from the foundation. The existing tank will be
properly disposed on the property or removed from site. The drainage patterns will be
maintained after construction.
The ground surface on the lot slopes at varying grades. The new septic tank will be
constructed near the location of the existing tank and as parallel with the slope of the
land as possible in conformance with Municipal requirements. The new septic tank will
be constructed a minimum of 10' from the existing water service on the lot and those on
the adjacent lots and will not conflict with other facilities 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
Lot 3, Block 6, Keno Hills No. 5
July 27, 2004
Page 2 of 2
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,
Michael E. Anderson, P.E.
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Lot 3, Block 6,
July 27, 2004
Page 3 of 3
Keno Hills No. 5
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.
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.
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.
Lot 3, Block 6, Keno Hills No. 5
July 27, 2004
Page 2 of 3
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: - NOT REQUIRED
The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench 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.
ONSITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 6, KENO HILLS SUBDIVISION NO.5
GENERAL:
1. The scope of this project includes the pumping, crushing and
abandonment of the existing septic tank on the lot and the
procurement and placement of a new 1,250 -gallon septic tank at the
location shown on the site plan. Work also includes the placement of
2 post tank cleanouts and a new foundation cleanout if one does not
currently exist. The existing septic tank must be disposed in
accordance with Municipal and ADEC requirements. The new septic
tank must be constructed a minimum of 100' from any surface water
and 100' from the existing well on this and adjacent lots. A minimum
of 4' of cover is required over the septic tank. In lieu of cover 2" of
direct bury insulation and 2' of cover may be placed.
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
1. A new 1,250 -gallon septic tank must be procured from a certified
septic tank manufacturer if the existing tank is found to be defective.
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.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
^'S�I
EW
❑ UPGRADE
MAILING D ESS
LEGAL DESCRIPTION
Cr
LOCATIOW
NO. OF BEDROOM
Uy
DISTANCE TO:
WAell
Absorption area !
Dwelling
PERMIT NO.
Q
1- z
y
Manufacturer
Gt� r
t�
Material
f�.
No. of compartments Z_
Liq. capacity in gallons
IF HOMEMADE:
Inside length �-
Width
Liquid depth
_jaZ
DISTANCE TO:
Well
Dwelling
PERMIT NO.
= Z F
Manufacturer
Material
Liquid capacity in gallons
w =
DISTANCE TO:
Well
Foundation i
Z 5•
Nearest lot line -
PERM�,I+T NO
?Y9 7 :
Ju. Z
Zw
F — �
No. of lines
j
Length of each a
Total length of lies
Trench widt
inches
Distance bet een lines
;.
<
D
Top of tile to finis grade
t�
Material beneath the
1 "2 inches
Total _ fective absorption area
'
W
a
Length
Width
Depth
PERMIT NO.
i F
Wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
LU
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT N0.
W
:2:
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL�TTESTRA/TING
U� U Z 0
INSTALLER to
}
/ oh ` �. v �, U✓V�/.
/K ,
REMARKS
a
n J�rn ��
`"5�
APPROVED DATE LEGAL
2-u13 IHev. S//6)
u
00502
344=7714
.. y,.!
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH O 2'U Teei
DRILLED AT THE RATE OF MOOPER FOOT.
PROPERTY OWNER AIU Midd ias M44tt 6SQ¢--�. 16th Rj B _99504 333-5051
LOCATION OF WELL SITE Lt. 3 44A2 6 Xeno (j
DRILLER _ Be"Ze Ciau4 ale Rampatt Atttt L" Glotko.
WELL LOG:
0-17' Snait bou.tdete & 4an4 gtoa►"
17---36' Coatae quwat w4th 35% clay. bLulet. Steed afar inch ca44ru4 dktuen. to
&e%at at 39 .deet, three Aet 4mo bed tock. ULGGil!g moe ,therL cant4mLed ung a
B,taaond d Ut. TU4 each Ae4 ha rd bedtack. 44 the Cao.ing a ihat�o tett an.
36**"225' Bedtock.. R aediaeeataty, .tack. Ito motet ptodurtdan 4how4aq ure,t,LG 16$
Aa
1/2 VM Uptaudnq..to 1 1/2 WE by 200 ./.t.. Thin. ate" 4 po,toa4 type •tock.
Uoa. 210 to 2254 4hot64 an tn Aeaee of two WN 4a a gtalull ,t. & po4ou4
Total. water V444d 4how4 a good 3 .to 3 1/2 &sM & 4hou d 4aaptove to 4 �;1'M e4th u4e.
200 gaUon4 pet hour ptoduc ioa & 4houdd 4spaouc. Water. a Ao Caae44 back wttAJA 25
®1, 4"A" ove t nLght. 200 A 04 wat44 4twuUng at 1.6 �N
3/4 h&ue 4utweA44ble pineµ 4houtd ire tr&4ta ted 10 ,to 15 botio&.
The ove t alt depth alt the ecet.L 14 230 �.t.
Thank YOU 17"* AMA B"
AlaU pa6d JA &U by. R,t. Btu 16iat t
Dates Oct. 16th, 1983 Be,tnde CLaw4 of. lamps" 11tat4 e4 trrott o r`�
Department f Health and Environments Protection
825 Street, Anchorage, AK. �J9501
264-4720
Permit #�'�� # # # HANDWRITTEN PERMIT # # #
WELL AND/OR ON-SITE SEWER PERMIT rSv
Applicant: 2yi%1-An-7 0/� 1010 2iuA_ //A7� Mailing Address: Geo( cc_'/4f'` h4c)L jg4t,6
Location: L07` 3 6(r_(, kl_(�,yyo H; ((S Phone Number: 33 3-51 . 1
Legal Description: TJI N f2 Lot Size: —
Type of Soil Absorption System Is:
Trench: Drainfield: i/ _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) Rs-
The
S
The Required Size of the Soil Absorption System Is:
DEPTH �� LENGTH 3 7 GRAVEL DEPTH 3.%� WIDTH S
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ /2S`0 GALLONS # #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* # * TWO(2) INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 'feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper_ installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # # #
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signed: Issued by: �n--G---
Applicant / / U
Date:
SWP/024(1/81)
06J— sUi LS LOG
`MUNICIPALITY OF ANCHORAGE
-. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264.4720 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: & iI H; ptI" DATE PERFORMED:Ayj 3 1953 - -
LEGAL DESCRIPTION:_ Keno Hills RIK 6 Let 3 TlIWR3i, moR STB30z�
p pT SLOPE SITE PLAN
10
WAS GROUND WATER S
11 e
.ENCOUNTERED? N� L
s . O
12 P
IF YES, AT WHAT s E
13 Cia1�0S dove DEPTH? _
14
16-
17—
gas
6 17
rC.Raid, J
19 �tJ'•. No. 2251•E
F'9 'h•••wNw�ww''
�p4110FESS0
Reading
OF E
Co L�o go ;c Sol
Net
Depth to
Net
.�
S{Iee t
1
i
Water
Drop
"
CGk) tilt Sil� S,n.l� gra✓!'
2
-
i Q.'
a.b.,eei.nt �66ICS
3
4-
6
6-
7
8
6S aLovt_ -
10
WAS GROUND WATER S
11 e
.ENCOUNTERED? N� L
s . O
12 P
IF YES, AT WHAT s E
13 Cia1�0S dove DEPTH? _
14
16-
17—
gas
6 17
rC.Raid, J
19 �tJ'•. No. 2251•E
F'9 'h•••wNw�ww''
�p4110FESS0
Reading
Date
Gross
Net
Depth to
Net
.�
S{Iee t
Time
Time
Water
Drop
i Q.'
20 �'��ea�te+`�
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT /
COMMENTS Se -Porn c3 ' -jo 8' and -Gm 9V2' 'Fe I Z a i V �sva 11!4 rn-1ed tZ 8S t7 �44
PERFORMED BY: D Art
CERTIFIED BY: DATE:
72-008 (6/79)
S{Iee t
/
og a2 SiteC �.S
SOILS LOG
MUNICIPALITY OF ANCHORAGE
I� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: V�I� �la DATE PERFORMED:_2 1193
LEGAL DESCRIPTION: Keno thin B10.tc 6 pct 3 TIItJ�-3�J MMA TT 953 o-zy
- SLOPE SITE PLAN
F E (p L.) Organ+C SeG)
(GTA) 6D n �r t sravell'\ vl }
"Vlar ICAWIS a -A SaAd
(ML) ve,y dense ': rRy 9raverlc� d.t sc�}
*!4911.4W *14
WAS GROUND WATERS
N
ENCOUNTERED? O L
O
P
IF YES, AT WHAT E
DEPTH?
le kr
FT
-Reading
Date
-
Gross
Time
Net -
Time
Depth to
Water
Net
- Drop
JPERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: Carlo.g Co"Aw- CERTIFIED BY: DATE: 4
s ,
AV AT AT FILLS
OUT UPPER HEAL ;ONLY
Property Odvner I F.
Time
Phone
fy0-,/
Mailing Address.- :. y, .'-� l�� , �_ �
Zip Code _-)) tr
3?
Buyer A
Date
Address
- Zip Code
Lending Institution I_ )I I%- A
Phone
Address
Zip Code
Realty Co. & Agentlj
Phone
Address
Zip Code
Legal Description uT _� 7,L cc /._ iv G
I-) 3 L{, S Sv 1'; j) %� n pr%
Street Location -7 —11 t -} (, , t n! 1]
e-.5/.✓(� �E a
WU4111-�'
Type of Residence .
Dingle Family
'CONDITIONS OF APPROVAL
❑ Multiple Family No. of Bedrooms— LL�- /inti
-'- �Y- [ !=v vrr r
❑ Other //
( ) CONDITIONAL APPROVAL -
Water Supply
ndividual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Sewer
14
P-Iff-dividual
Year Individual Installed: Q
❑ Public Utility
When Connected to Public Utility N1 14
❑ Holding Tank
.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
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(�3) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL -
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area / (�(j i
Well Log Received
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Septic Tank Size
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Parcel I.D. 020-171-33
Certificate of On -Site Systems Approval
Expiration Date: 8/19/2025
Legal description KENO HILLS#5 BLK 6 LT 3
Site address 17715 ASHLAND DR Anchorage AK 99516
Current property owner(s) HIATT
X_ The On -site system(s) is/are approved for bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
nitrate concentration in well water is 4.03 mg/L
Original Certificate Date: 9/25/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPAI-ITY 02FANCHORAGE
Develloorneint Servilces Depari'm
ar 1 t
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Pho -4
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907"-43-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 020-171-33
Complete legal description KENO HILLS #5; BLOCK 6, LOT 3
Location (site address) 17715 ASHLAND DRIVE, ANCHORAGE, AK
current property owner(s) BILL & PATRICIA HIATT Day phone 907-345-7602
2, ON -SITE SYSTEMS SIZED FOR 4 __BEDROOMS
3. TYPE OF WATER SUPPLY: F* Private Well F-1 Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units 0 Community Well or Public
F-1 Water Storage
4. TYPE OF WASTEWATER DISPOSAL: Fk Private Septic ❑ Private Septic serving 2 dwelling units
0 Holding Tank D Community Septic or Publir, Sewer
5. SEPTIC TANK: F* Steel F-1 Plastic F-1 Concrete D Fiberglass
Age 20 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: Fj AWWTS 0 Bed ❑ Deep Trench JZ Wide Trench F-1 Seepage Pit
Waiver request for:
Expedited review requested: Fj
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee$ Waiver Fee $
Date of Payment kh'
Date of Payment
COSA # 0_5 C Z'-I, I 'S C, Waiver 4
COSA Application —June 2022
Legal Description: KENO HILLS #5; BLOCK 6, LOT 3
Parcel ID: 020-171-33
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
Al Well log is filed with Onsite (or attached)
Date drilled 10/16/83 Total depth 230 ft
Cased to
X Sanitary seal is functioning correctly f
R Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 8/19/2024
Static water level at beginning of test 23.5 ft
Comments
B. TANK DATA
Measured operating fluid level in septic tank *49"
Date of pumping �j�► 1 >-'4
❑ Required maintenance completed, if AWWTS
Comments: *IN ST1 / 49.75 IN ST2
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/4/1983
W ALL standpipes present per record drawing
Total measured depth from grade 8.5 ft (max)
Measured depth to pipe invert from grade 3•2 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced - gallons date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Well production at time of test 3.0+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? Yes ` No
Coliform bacteria is Negative
Nitrate `" "> mg/L = I'Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG, LTD. r"
Date 8/19/2024 1 4 � _ d
Adequacy test date 8/19/2024
Results W Pass
Fluid depth prior to test 0 in
Water added 728 gal
New fluid depth 0 in
Elapsed time 0 min
Final fluid depth 0 in
Absorption rate 600+ god
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 42 in
Effective depth used 0 in
Effective depth remaining 42+ in
dt
Comments/Deficiencies: *DISTRIBUTION LINE IN DRAINFIELD APPEARS TO BE OUT OF LEVEL BY APPROXIMATELY
SEE ATTTACHED EMAIL FROM OWNER REGARDING NO FREEZING (TANK APPEARS TO HAVE 2.5' OF COVER)
COSA Checklist June 2022
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
❑n Yes
if No
ft
❑0 Yes
if No ft
Neighboring Tank > 100' Q Yes
if No
ft
Private Sewer/Septic Line > 25' Q Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' QYes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' QYes
if No ft
a Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' QYes
if No
ft
Yes
if No ft
❑ NIA — Served by Community Well (not on lot) or Public Water
From Septic/Bolding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' [E Yes if No ft Surface Water > 100' rC Yes if No ft
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
❑■ Yes if No ft
7 Yes if No ft
® Yes if No ft
7 Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100' E Yes if No ft
Community Wells > 200' 9 Yes if No ft
If tank or field is under driveway comment below
G. CERTIFICATION & 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, indicates that the on -site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Garness Engineering Group, LTD, (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Gayness Date
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 systemis. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the systemis; 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 Worm
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.
COSA Checklist —June 2022 VL [
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MUNICIPALITY OF ANCHORAGE
0EVELOPMENT SERVICES DEPARTMENT � 907-343-7904
On -Site Water and Wastewater Section �= � Fax: 343-70 7
www.rnuni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241362
Subdivision: KENO HILLS #5 Block:6, Lot: 3
The septic tank for this property is 20 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
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 30 year old steel tank MAY look like.
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EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON FB 22-1, 71-72
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AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 3. BLOCK 6,
KENO HILLS ADDITION No. 5
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage Alaska
this 7th day of September, 2022,
FRED WALATKA & ASSOCIATES, L.L.C.
907-248-1666 Engineers and Surveyors
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original
client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered,
the liability extent of the preparer Is limited to the amount of fees collected for services in Preparation of this product.