HomeMy WebLinkAboutKENO HILLS #5 BLK 6 LT 5Keno H ills
#5
Block 6
Lot 5
#020-171-31
Jun 18 22 12:49a Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section _: Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 020 171 -31
Date of Issue•
Legal Description
KENO HILLS#5
Block
6
Lot
5
Property Owner Name & Address:
CUTLER MICHAEL TIMOTHY & LAKEY MICHELE E
17901 ASHLAND DRIVE
ANCHORAGE, AK 99516
Pump Installation Date: os - 15 - 222
210
Pump Intake Depth Below Top of Well Casing:
feet
MYERS
Pump Manufacturer's Name:
3 N FL72-8-P4-02
Pump Model:
Pump Size: .75 hp
Pitless Adapter Burial Depth: 12 feet
MARTINSEN
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection: PELLETS
Comments:
Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
Company: ANCHORAGE, AK 99518
907-243-0740
Mailing Address:
City: State Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ONSITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131132 PID Number: 020-171-31
Dwelling: W Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade
Name:
TRAVIS PURVIS
ABSORPTION FIELD
❑ Deep Trench 07 Shallow Trench ❑ Bed ❑ Mound
Address
17901 ASHLAND DR., ANCHORAGE, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
3.7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.2 Ft.
Gravel depth beneath pipe
1.5 Ft.
Subdivision Block Lot
KENO HILLS # 5 6 5
Fill added above original grade
1-2 Ft
Gravel length
2 X 40 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
NA
Distance between lines
NA Ft.
SEPARATION DISTANCES
Te
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
512 Fe
2
10 Ft.
Well
>100'
>100'
NA
NA
>25'
TANK ■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE
Capacity
1250 Gal.
Surface Water
>100'
>100'NA
NA
Material
STEEL
Number of compartments
2
Lot Line
>5'
>10
NA
NA
NA
Foundation
>5'
>10'
NA
NA
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
>50'
>50'
NA
NA
Pump on level at
Pump off level at
High water alarm at
Remarks EXISTING DRAIN FIELD ABANDONED
in.
in.
in.
PER UPC REQUIREMENTS
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer
DEAN CONST.
Drainfietd F810 CO/MT F81
Inspector ANSON MOXNESS & LARS SPURKLAND
BENCH MARK (Assumed elevation)100 ft
Inspection1a 6/25/13 6/25/13
Location and description
2w
P 6/26/13 06/28/13
BOTTOM DECK DOOR JAM
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
n tamp
�ti.�F A<q�ll
Conditional Approval: Date
i
•, SPURKLAND.
T, 11550
0F�UrSSiONA���
A rovedall Date �/ j
PP
tit
Inspection Report9-1-lx.do6l
CA Till AWWTS.• MAX. APPLICATION RA Tr. 6 GDP/SO.FT.
FL L S
KENO
SLOE - IV
� f2
m O
a /3
All
3 FI SLOPE _ LOY.
BLOCK 6S / D
NOTE: SLOPES EXCEEDING 25X WERE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED
ABSORPTION nELD LOCATION.
NOTE. THIS IS NOT A SURVEYED PLAT. WELL #SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCAIM SHOWN ARE
APPROXIMATE.
25 0 25 50 75 100 125 150
SCALE, 1' = 50 FT
LOT 4
SLOPE - 85Z
INSTALLED 4 -BEDROOM SEPTIC SYSTEM
1250 GAL SEPTIC TANK
TRENCH LENGTH 80 FEET (2 x 40)
MAX EXCAVATION DEPTH 4 FEET
TRENCH WIDTH 5 FEET
SEWER ROCK 1.5 FEET
COVER 3 FEET (MIN)
0
SPURKLAND
ISPURKLANDAK. 9ENGINEERING I I ]VENO HILLS 15 BLK 6 LOT 5 (I SEPTIC SYSTEM ASBUILT
ANC W K 11 99501 AVENUE
ANCH. TRAVIS PURVIS BA F6, JULY 3, 2013
(907) 279-3916 17901 ASHLAND BR. ANCHORAGE, AK 99516 SHEET, 2/3 01B+ 3439
PERMIT If 17SPI31132 PIB # 020-171-31 KENL7HOLLS#5B6L5SC50-ASB.BW6
TH /I
El
Flow Splitter
Double Clean outs
O
O O
Replace Existing 1000 Gallon
O Septic Tank
2 x Wide TrenchES,
5' Wide
40' Long
4' Max. Depth NO SCALE
L5' Sewer Rock
Trench Elevation (TyP)
Cten nouts —
/Double Clean outs
Ns0 aEv-,KP
ELOW2I'
1.5 Ft of Septic Rock 1250 GALLON SEPTIC TANK
RENCN MARK DECK DOOR FRAME
ASSUMED ELEVATION 100 FEET
ISPURKLAND ENGINEERINGI ( KENO HILLS 15 BLK 6 LOT 5 (I SEPTIC SYSTEM ASBUILT
203 W 15TH. AVENUE
ANCJ� AK. 99501 TRAVIS PURVIS DATE, JULY 3, 2013
(907) 279-3916 17901 ASHLAND DR. ANCHURAGE, AK SHEEP 3/3 GRID, 3438
P£R141T # 17SPi31132 PID # 020-171-31 K£NUHILLS#5B6L5B3-ASB.BV6
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP131132
Tax Code Number:
02017131000
Work Type:
Septic
Permit Effective Dates: June 20, 2013 to June 20, 2014
Design Engineer:
SPURKLAND ENGINEERING
Subdivision:
KENO HILLS #5
Site Legal Address: KENO HILLS #5 BILK 6 LT 5 G:3438
Owner/Address: PURVIS TRAVIS J & REBECCA L
17901 ASHLAND DR ANCHORAGE AK 995165726
Site Mailing Address: 17901 ASHLAND DR, Anchorage
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy
All construction must be in accordance with:
r'/Z513 9a.n
Lot Size in Sq Ft: 111949
Total Bedrooms: 4
N Private Well N Water Storage
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 must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By:
Date: Gr
Date:
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWERAIVELL PERMIT APPLICATION
Parcel I.D. 020-17116'
Property owner(s) TRAVIS PURVIS
Mailing address
Day phone
Site address 17901 ASHLAND DR. ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) KENO HILLS #5 BLK 6 LOT 5
Legal description (Township, Range & Section)
Lot Size
APPLICATION IS FOR:
(M all that apply)
Absorption Field E]
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Ft. Number of Bedrooms 4
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) E
(w/wo ADU)
Upgrade ElDuplex (D)
El
❑ Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
NONE
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
of property owner or authorized agent)
Permit/Rush Fees:J`% 0) Waiver Fees:
Date of Payment: &&& Date of Payment:
Receipt Number: OS 43 Receipt Number:
Permit No. (3SA/3Ila a Waiver No.
Permit App_9-1-12.doc
J*'_Aj_ SPUTUalmd Finuhnsen1mg
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
Municipality of Anchorage June 10, 2013
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Septic System Installation Permit
17901 Ashland Drive
Ladies and Gentlemen:
I am writing to request a septic system installation permit for the above referenced property. The
existing septic system did not meet COSA operational Requirements. The proposed system will
serve a 4 -bedroom single-family residence. Soil logs, design calculations, a site plan, design
drawings and construction specifications are enclosed for your review.
Design Cates: Groundwater observed to a depth of 8 feet below ground surface
(6/7//2013).
Soil Rating. From Testhole 5/31/13
1.2 min/in = 1.2 gal per sq.ft/day
3.Omin/in = 1.2 gal per sq.$/day
No. of Bedrooms 4
Required Area per Bedroom: 150/ 1.2=125.ft.
Total area required: 125 x 4 = 500 sgft
Use a shallow trench with 18 inches of effective depth
Minimum trench length 500/5*0.78= 78 feet
System: We are proposing a 1250 gallon septic tank followed by a shallow trench absorption
field. The absorption field will be 80 feet long and 5 feet wide and contain 1.5 feet (512 sq.ft.
effective) of sewer rock. .
Soils: Test holes were excavated on May 315`, 2013. See the attached soil logs. Groundwater
was observed at a depth of 8 feet below ground surface on June 7t", 2013.Ground water
Monitoring will continue through construction of the septic system.
Surface Water: There are no surface waters within one hundred feet of the proposed septic
system upgrade.
203 West 15t" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
SPUMand L ngmMee ong
Environmental Consulting and Design
Topography: The ground level slopes down towards the west at approximately 10% grade
Waivers: None
The installation of this septic system will not prevent wells and septic systems from being
installed on the adjacent lots. The proposed septic system will not change the general slope of
the area. Ponding and/or concentration of surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
l� U�
Lars S kland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
I I I
I I okZ!>
LOT 7
5
--- N I L S BLOCK 6
�;�!CakZ-.). K E N 0rot
— — —
\
LOT 6
LOT 5 I I LOT 10
i
/ P A R ADI S E VA L L E Y S I D
BLOCK 6 I I
I I
I I
lY
NOTE.• ARS lS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTAAOM ALL LOCAAONS SHOWN ARE
APPROXLMAT£.
50 0 50 100 150 200 250 300
SCALE 1` = 100 FL
I I
III
III
I I
I I
LOT 4
LOT 5
I I /
I I
I
III
III G�
III
I I
I I
III
III
III
I
10' Uru EASE I
® I
LOT 11
I�
ISPURKLAND ENGINEERINGI I KENO HILLS 15 BLK 6 LT 5 I (SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE TRAVIS PUR VIE DA 7E.- JUNE 10TH, 2013
M0, IMM) 17901 ASHLAND DR SHEET) 1/3 GRID• SW3438
PERMIT # USP131OXX PID # 020-171-31 KENDHILLS5B5L5SC100DW6
CATIII AWWTS. MAX, APPLICATION RATE. 6 GDP/SQ.f7.
4=f00 SO.FT USE STANDARD SHALLOW TRENCH DEPTH J
L L S
ENS
" -I' /rm\
stay - I'M
BOCK 6S
5
SLOPE - 1OX
NOTE.• SLOPES EXCEEDNG 25X WERE NOT OBSERVED
WARN 50 FEET DOWN GRADIENT OF THE PROPOSED
ABSORPRON RaD lOrABON.
NOTE.• THIS IS NOT A SURVEYED PLAT. WELL & SEP71C
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE,
r1w5of5mmommiM -
25 0 25 50 75 im 125 150
SCALE, I' = 50 FT.
LOT 4
SLOPE - 25Z
INSTALL 4 -BEDROOM SEPTIC SYSTEM
1250 GAL SEPTIC TANK
TRENCH LENGTH 80 FEET
MAX EXCAVATION DEPTH 4 FEET
TRENCH WIDTH 5 FEET
SEWER ROCK 1.5 FEET
COVER 3 FEET (MIN)
49
SLOPE - 25x
ISPURKIAND ENGINEERING HNO HILLS #5 BM 6 LOT 5 SEPTIC SYSTEM DESIGN
203 V 15771 AVENUE DATE, JUNE 10, 2013
ANCH. AK 99501 TRAVIS PURVIS
(907) 279-3916 11 17901 ASHLAND AR. WCW?AZ AK 99516 MEET, 213 RIB, 3439
I PERMIT # L7SPI31OXX PID # 020-171-31 REACHILLSM61.5EMM I
Fl.. 5P0Sof 5o
.Double Clean outs
2 x Wide TrenchES.,
5' Wide
40' Long
4' Max, Depth NO SCALE
L5' Sewer Rock
3' Cover Min,
Trench Elevation (TyP)
/ Cleanouts
Replace Existing 1000 Gallon
Septic Tank
/Double Clean outs \
1.5 Ft of Septic Rock 1250 GALLON SEPTIC TANK
ISPURKLAND ENGINEERING(I KENO HILLS 15 BLK 6 LOT 5 I I SEPTIC SYSTEM SCHEMATIC
203 V 15TH, AVENUE TRAVIS PURVIS BATE, JUNE 10, 2013
ANCH. AK. 99501
1907) 279-3916 17901 ASHLAND BR. ANCHORAGE, AK SHEET, 3/3 DRIB, 3438
PERMIT # OSP1310XX PID # 020-171-31 KENOHILLS#5B6L5D3DW6
Municipality of Anchorage SNI
Development Services Department �Q�"
Building Safety Division
y� On -Site Water and Wastewater Program �'O,
4700 Elmore Road / `�
P.O. Box 196650 Anchorage, AK 99507 10
www.ci.anchoraae.ak.us I
(907) 343-7904 �� p, ; E
Soils Log - Percolation Test
Performed For: TRAVIS PURVIS Date Performed: 5/ V
Legal Description: KENO HILLS #5 BLK 6 LOT 5 Township, Range, Section:
1
7
10
11
12
13
IV3
Depth
101
I D
I � Sowle gCaJLI
p I
I I I
Silt V1
t,,
Sown, 914.1 3
�T'f4.Jb`
DAL)
WAS GROUND WATER
Date
ENCOUNTERED? YES
Net Time
Depth to Water
S
IF YES, AT WHAT DEPTH? 5.5'*
L
Depthto Water After
P
P
Monitoring? DRY
E
Date: 6/7/13
-
•, 't�
Fant
SAURKLAND,'
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
5/31/13
11:33 AM
0 MIN
11.500"
8.438"
-
11:43 AM
10 MIN
11.938"
3.063"
8.875"
11:53 AM
10 MIN
11.938"
3.063"
8.875"
12:03 PM
10M
12.000"
3.063"
8.750"
12:13 PM
10 MIN
12.625"
3.250"
9.313"
12:23 PM
10 MIN
11.500"
3.313"
9.188"
12:33 PM
10 MIN
3.313"
PERCOLATION RATE 3.0 (mhWesfinch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN 2 FT AND 3 FT
COMMENTS PRE-SOAKED. *SEEPS
PERFORMED BY: ANSON MOXNESS I���--�U�1A1-(I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPA'L--GUIDELI ES IN EFFECT ON THIS DATE. DATE: 6/10/13
Municipality of Anchorage
Development Services Department
Building Safety Division
yir On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci. a nchorace.ak.us
(907) 343-7904
Soils Log - Percolation Test
Performed For: TRAVIS PURVIS Date Perk
Legal Description: KENO HILLS #5 BLK 6 LOT 5 Township, Range, Section:
#2
7
1c
11
12
13
14
15
a -.
@0 Rock
WAS GROUNDWATER
ENCOUNTERED? NO
S
IF YES, AT WHAT DEPTH? —
L
Depth to Water After
D
P
Monitoring? DRY
E
Date: 617/13
m . LARS E. jSP�UpRKLANO;
Site Plan
Reading I Date I Gross Time I Net Time I Depth to Water I Net Drop
PERCOLATION RATE
TEST RUN BETWEEN
(mhn stench) PERC HOLE DIAMETER
FT AND FT
PERFORMED BY: ANSON MOXNESS I µjl {�,U�/,>"/fit . CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL INES IN EFFECT ON THIS DATE. DATE: 6110/13
4
Municipality of Anchorage/' . GINEER'
Development Services Department i �ij rZa �r
Building Safety Division ; 49 TH
On -Site Water and Wastewater Program t
4 196 Elmore Road ,. �.
P.O. Box 196650 Anchorage, 99507 D; /
www. ci. a n ch o ra a e. a k. .0 u s LAR SPURKLA,N
(907) 343.7904
10
Soils Log -Percolation Test II1iF�4IFEso��'`���.
Performed For: TRAVIS PURVIS Date Performed: 513113
Legal Description: KENO HILLS #5 BLK 6 LOT 5 Township, Range, Section:
7
10
11
12
13
4l
Depth
1
' D
to
I t
vm1.r
l Vlaf�lC
Ool
SaVI 'JI
Op° '
l
Sovnb 9lwJOl
5/31113
Q
Pb leets aY
1
5;1�
a10
6. A
1 1
t
Monitoring?
COMMENTS A
8•o•p.
Site Plan
WAS GROUND WATER
Date
Gross Time
ENCOUNTERED?
YES
Net Drop
5/31113
S
IF YES, AT WHAT DEPTH?
9'
L
Depth to Water After
6. A
0
E
Monitoring?
6.000"
6.000"
Date: 6/7/13
IS L1100.
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
5/31113
11:30 AM
0 MIN
6.000"
0.000"
11:36 AM
6 MIN
6.000"
6.000"
0.000"
11:43 AM
7 MIN
6.000"
6.000"
0.000"
11:50 AM
7MIN
6.000"
6.000"
0.000"
11:57 AM
7MIN
6.000"
6.000"
0.000
12:04 PM
PERCOLATION RATE 1.2
TEST RUN BETWEEN 3
(minute>Jnch) PERC HOLE DIAMETER 6"
FT AND4 FT
PERFORMEDBY: ANSONMOXNESS I / fin'1r WVIO-A(j`- CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL NES IN EFFECT ON THIS DATE. DATE: 6/10/13
72-013
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
0*
ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 264.4720
ON-SITE
SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION REPORT
NAME
♦ .)J
L
/
�C�h / 1 N / �"i
PHONE /
�� 5 ��(�� 2
E]d UPGRADE
MAI LING ADDRESS
.5-a4
-
& 3ay-_0 99jb
LEGAL DESCRIPTIO- I`(—!� iJ
✓✓
5 •.+
���o IV
LOCATION -
NO. OF BEDROOMS
Well 4�
Absorption area
Dwelling
P T O_ .
�
Uy
DISTANCE TO:
p,S
�.�
w2
Manufacturer p
C
Y e�
Material s,
No. of comparZents
y F
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
p o O
6 (7 z
DISTANCE TO:
Well
Dwelling
P 4U.P �
�1p
O Z Q
�
Manufacturer
Material
Liquid capacity in gallons
x
D
w=
DISTANCE TO:
Well/Oa {
Foundation
Nearest lot line
PERMIT NO.
JL)
Z
Z wS
No. of lines
Lengih of each line.
Total length of lines
S
Trench width
inches
Distance between lines
~ a F
Top of rile to finish grade
Material beneath tileTotal
effective absorption area
inches
l`' d
Length
Width
Depth
PERMIT NO.
w
C7
Q F-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w °
Lu
w
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
L'l 41,4ILS-c
SOIL TEST RATING
d,
4r Id
INST
De-N t'
REMARKS
/
erc� I�1
o
bb
OR
E
�i
MUNICIPATITO �Hc�l
H &
CTI
VA
ENvIRONMRN
f
�r
If
APPROVED
D,Q�q` ED
^
9KK� 1. /_ 16-
72-013 (Rev. 3/78)
n'xk_vo��������_lLn'r 80 r- ���" - r--- " V_3 8 -
DEPARTMENT C HEALTH AND ENVIRONMENTAL TECTION
` 825 `L"STREET/ ANCHORAGE, HK' 99501
264-4720
F=� " E -a Cv I -r E- E7 W 1= F=�' -1
PERMIT NO. ( 8Z0276 )
�
`
APPLICANT MARK I SCHIINDLER SRH ]24-D HNCH. 8K. 265-6122
�
LOCATION
|
�
LEGAL LOT 5 BLK 6 KENO HILLS SUB. LOT SIZE 99999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
|
|
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 180
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
I
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELC\
THE DEPTH OF H 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 13R8YEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
��1=4711- I C- -rF=iNK I #DVIR I CH"E=.
�
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
i
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
|
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
!���� ��� ���� ��������������� ����� ������IEE Ca ---�
�
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WB_L AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS '
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO H COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 2-:0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MHYY SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
.�E=F-'N I -r EEXF�3 I FRE"OH. r_E=lC-IEEME?aF.' 2:1 _. -1L�E-1 2�
I CERTIFY THAT
1: I HM 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 THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS RENODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED:~ ��������8�<��_--- 5�����---
HPPLIC-NT [,ARK J. SCHIINDLER �
ISSUED B
3/i
V4.0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
f� SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: Ph A 1. 1 C JI11 C f DATE PERFORMED: 5. 0.85
I 1a � /
LEGAL DESCRIPTION: 1411 tS Blt-S to �Qf 5
I dL nee SLOPE SITE PLAN
1� 1
1
2
3
amu..., 4
5
6
7
8
9
..x--10
11
12
13.
14
15
16
17
18
19
20
COMMENTS
GM
-51 IA -y s (_YiLj gr<)WJ
Ml.
Very hard , drry qr� I I I � I I �►
occe rston3i qmw
WAS GROUND WATER S
ENCOUNTERED? L
O
P
IF YES, AT WHAT E
ML
DEPTH?
mci-e- rotd
dtcve, l-16v�-I pn
e
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
10
14C) In In
d 37
Iv. (1
•33
1 CQ
/)In/n
tom
30
3
(3 35.`34
IUfI9r/�
. .D>t
,_
T zv
Fa: 35
a. 3k
to: -45,
10 m/n
✓v
—.06
+ tiz 0
j a i HW
j, d/d
1011:1(�
/,oMIt)
./,-:r
r 1 (1 Lv
PEF&LATION RATE
TEST RUN BETWEEN
sY'��•'
i/ /0
PERFORMED BY:Ci�_ I I.AIYre—ir _CERTIFIED BY:
72-008 (6/79)
/!i /if iii y•
(minuCes 7in)
FT AND FT
DATE:
any
m
�1
I
3
1 W/ ljev
l
BOX 13690 STAR KOtiTE A AA'CHORAGov ALASHA 99502
344=7714
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF M' 00 PER FOOT
PROPERTY OWNER
LOCATION OF WELL SITE %eV.a killy S 4 IJIV,
ne ^.hiL,C C%C'.1,� 17 P )�`!'?.`nn $.1 :.),�% ��.%n.^ � •�cl1.1/.,.
DRILLER
WELL LOG:
n/-p---7Pt
C�!?. �•r'.�'!'^r /7.{7JJt." AJ1.i �.
r+ Ccn�f l?'•n�4 _'r•
� fr,5 ,-: l,n-, l-n:.'y��,
J.
nim..,
rJ •;u 1.; n.ln �•
o
.., ..n.
.P_e. C:
�'• .� �'=•
(11i 1✓... t' CF rzr.,.y 17.'7'
Pr.a.� 77 frt 7nr Fn 'r(7.1,l.^rn !^ 1-n I
n, I n-ChC ^4 ` /7 Oi ,'?^• . ;{ i^h._.6:+' CC.f J n n 7 7 1 n n l / ry t n !; ' 17 r r C<^° I' j P. P f> 6. n
(."!Iif C�%✓ft^..� 0,�lir- 7?O },s X177 On C'.�"• Thies: �rt1�i7�: nl�.'^CJ': iif.61',. 41�f5i'. IIS li^/' i :.'1 C/��1L'vf;
7•- az blonn pGt 300 nn1 on-,) oj' ib, lLC/P>LUE.
3�l �tOn/JC. "LA^C'iuVr„L TLf�n 4!16111.e AC WnJ 6 CiV•r! 7n-1! i rp
c ; .ems
., a;, a a.:..
N a�io33z .�
; 3 VY. ISM
n: 00 PeA ;,oa. „ ��� �r� 1: "57 S n� MUNICIPALITY OF ANCHORAGE
�o o�� % 1✓_1.. - 7, DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION,
cC : EGGS
'AUG 191985
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF St II. nlia I�I(eD
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF C 571 % 7P . n!;
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
DATE 212,e. 30 r:.,
SERVICE CHARGE 0 F 1 %s% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
o
.., ..n.
.P_e. C:
�'• .� �'=•
7•- az blonn pGt 300 nn1 on-,) oj' ib, lLC/P>LUE.
3�l �tOn/JC. "LA^C'iuVr„L TLf�n 4!16111.e AC WnJ 6 CiV•r! 7n-1! i rp
c ; .ems
., a;, a a.:..
N a�io33z .�
; 3 VY. ISM
n: 00 PeA ;,oa. „ ��� �r� 1: "57 S n� MUNICIPALITY OF ANCHORAGE
�o o�� % 1✓_1.. - 7, DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION,
cC : EGGS
'AUG 191985
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF St II. nlia I�I(eD
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF C 571 % 7P . n!;
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
DATE 212,e. 30 r:.,
SERVICE CHARGE 0 F 1 %s% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
• u Municipality of Anchorage,,,,, °
On -Site Water and Wastewater Program
(907) 343-7904 ;^ s ^ F E r
a l� l
Certificate of On -Site Systems Approval X010
020-171-31-000\`\-
Parcel I.D. Expiration Date: 12
1. GENERAL INFORMATION
Complete legal description Keno Hills #5 Block 6 Lot 5
Location (site address) 17901 Ashland Drive
Current Property owner(s) Janette England Day phone 832-703-8176
Mailing address 17901 Ashland Drive
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
F
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:.
Received by: ��/1/Nl/✓�YLQJ Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 521x-00 Waiver Fee $
Date of Payment 1012,7 ) 1 ZOl (P Date of Payment
Receipt Number O,59Lq Receipt Number
COSA# OSOU1509 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater 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 Phone
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P
6. DSD SIGNATURE
4 System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
522-7773
E. Date 10/24/2016
®®®a®o®®®a
OF
49THP
®
'.MICHAEL, E: ANDERSON
®® �-. CE - 4381
#44%%
... •�,v®
®B%eFE �e0®0
with the following stipulations.
By: ` w1 I—F✓ft Original Certificate Date: 3
I
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet ! c
If more than 1 septic system is on the lot:
COSA Checklist # _of
Structure served by this system*
Certificate of On -Site Systems Approval Checklist
Legal Description: Keno Hill's #5 Block 6 Lot 5
A. WELL DATA
Well type Private If A, B, or C provide PWS ID #
S)W119/30/83Y
Date completed Sanitary seal (Y/N)
Total depth 225 ft. Cased to 225 ft.
Parcel ID: 020-171-31
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
FROM WELL LOG AT INSPECTION
Date of test MMM5 &/go gs 10-20-16
Static water level 20 ft. 38.2 ft.
Well production 1.0 9-13 m. 2.44 9 -P.M.
WATER SAMPLE RESULTS
Coliform 0 colonies/100 mL Nitrate 7.14 mg/L
Arsenic ND ug/L Date of sample: 10/13/16 Collected by: And. Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size '" 4 1g V. Number of Compartments 2
Date installed 6/28/13
Cleanouts(Y/N)
Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) NHigh water alarm (Y/N) N
Date of pumping .. d 2 Pumper d 1 a Q' 442
C. ABSORPTION FIELD DATA
Date installed 6/25/13. Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type 5' Wide
Length 2 @ 40 ft. Width 5 ft., Gravel below pipe/'5 * ft.
Total depth 3.7 ft. Eff. absorption area 512 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 10/20/16 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 5 in.
Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 600 9 p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
in. "Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
> 100'
Manhole/Access(Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot On adjacent lots >100'
Absorption field on lot >1 00' On adjacent lots >1 00'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer /septic service line > Holding tank >75
Animal containment areas > Manure/animal excrete storage areas >
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >51 Property line >51
Water main Water service line >10
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
r ,
Property line Building foundation >10
Water Service line >10' Surface water >100
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 10-25-2016
COSA brown sheet 10-10-12.doc
Absorption field >51
Surface water >100'
Water main >10'
Driveway, parking/vehicle storage > 10'
of
49
t0 MICFI AEE. ANDERSON
�0 CE -4381
�d�89®®a 0uQ oma®
in.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC161509
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 6, Lot 5 of
Keno Hills #5 subdivision. This inspection revealed a nitrate concentration
of 7.14 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
Parcel I.D. 020-171-31
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: % U — 17 " 13
Complete legal description KENO HILLS #5 BLOCK 6 LOT 5
Location (site address) 17901 ASHLAND DR., ANCHORAGE, AK 99516
Current Property owner(s) TRAVIS PURVIS
Mailing address
Real Estate Agent
PEGGY FRENCH
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone 242-6121
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
n
Individual 0
Individual Water Storage
❑
Holding Tank ❑
Community Class Well
❑
Community ❑
Public Water System
❑
Public Sewer ❑
WaiverNariancerequest for.. NONE
---
Received by:
rrDistance:
Date: 7 6
COSA to be released to the engineer, unless otherwise requested by
the engineer.
COSA Fee $ 1 5b
Waiver Fee $
Date of Payment
I It t -J
Date of Payment
Receipt Numbertit{ 1`�G
Receipt Number
COSA # CY6 C l31'J 1'i
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater 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 SPURKLAND ENGINEERING Phone 279-3916
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND Date 7/8/13
6. DSD SI NATURE i
1. ...PFJ..
System #1 Approved for bedrooms /� ; gp��;{gyp„tip• /�
S
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: �� A' Original Certificate Date: 7- ! /. J�
oo
Th nici �bfnchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheet ( c
Nitrate Advisory_
Arsenic Advisory
Other
If more than I septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: KENO HILLS #5 BLOCK 6 LOT 5
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #
Date completed 8119/85 Sanitary seal (YIN) Y
Total depth 225 ft. Cased to 18 ft.
FROM WELL LOG
Date of test 8/19/85
Static water level 20
Well production 1.0
WATER SAMPLE RESULTS:
ft.
g.p.m.
Coliform NEG colonies/100 mL Nitrate 7.29 mg/L
Arsenic ND ug/L Date of sample: 5/21/13
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments
Foundation cleanout (YIN) Y Depression over tank (YIN) N
Date of pumping NEW Pumper
Parcel ID: 020-171-31
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) >12 -in.
AT INSPECTION
6/4/13
•24 ft.
5.6
g.p.m.
Collected by: ANSON MOXNESS
Date installed 6/25/13
Cleanouts (YIN) Y
High water alarm (YIN) N
C. ABSORPTION FIELD DATA
Date installed 6/25/13 Soil rating (g.p.d./fe or ftz/bdrm) 1.2 System type 5 -WIDE
Length 2 X40 ft. Width 5 ft. Gravel below pipe 1.5 ft.
Total depth 5 ft. Eff. absorption area 512 ftz Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test in. Water added ---gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) _ If yes, give date
D. LIFT STATION
Date installed _ Size in gallons
"Pump on" level at _ in. "Pump off' level at
Datum _ Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot '100'
Absorption field on lot '100'
Public sewer main NA
Sewer /septic service line '25
Manhole/Access (Y/N)
in. High water alarm level at
Meets alarm 8 circuit requirements?
On adjacent lots '100'
On adjacent lots '100'
Public sewer manhole/cleanout NA
Holding tank NA
Animal containment areas 'J0 Manure/animal excrete storage areas '100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 'S Property line >51 Absorption field >5
Water main NA Water service line '10 Surface water '100'
Wells on adjacent lots '100'
ABSORPTION FIELD ON LOT TO:
Property line '10 Building foundation >10
Water Service line >10'
Curtain drain '50'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water '100'
Wells on adjacent lots >100,
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKAND
Date 7/8/13
COSA brown sheet 10-10-12.doc
Water main NA
Driveway, parking/vehicle storage '100'
OF A4
`; LA RS E. SFURKLAND.-,-
in.
D.-,
in.
Municipality of Anchorage
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 131317
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 6, Lot 5 of
Keno Hills #5 subdivision. This inspection revealed a nitrate concentration
of 7.29 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
lel (YY `J4 1-4
4- -..
3 54, 75
4o.5, Z 6
30821
Rr_c_r-eT1rzcv 5 -o4 -o4- � hl. 2�`�3 �L' V
5 G 0. Ie; I =50'
AS-BUILT NO CORNERS SET THIS DATE
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. RC D
A_
of A
C'�ff^^4{,Ax�CiI4tiKBS � 'x'x` !
NO 32.,9-S < ��
FW
I hereby certify that I have performed a Mortagee's in-
spection of the following described property: L o
Floc 6. keno Hil/s Sw6d Adao 5
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do
¢not overlap or encroach on the property lying adjacent there-
to, that no improvements on 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 A- A- d day ofJ/ f C g h, 6 e M 19_ 88
FRED
8FRED WALATKA & ASSOCIATES
Engineers and Surveyors
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS
FOR A SINGLE FAMILY DWELLING
Parcel I.D. J4 COSA# 6701 L4 -I-
1. GENERAL INFORMATION Expiration Date: CJ — a 3—!EZ
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KENO HILLS SUBDIVISION #5. LOT 5, BLOCK 6.
17901 ASHLAND DRIVE ' ANCHORAGE. AK 99516
JEANINE KAZACOS Day phone 928-2951
17901 ASHLAND DRIVE • ANCHORAGE. AK 99516
Day phone
FSBO Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
a
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
a
Individual Holding tank
❑
Community On-site
❑
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 On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's 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 riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. Tho operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole bonofit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
337-6179
Date S/1. 0
Conditional approval for bedrooms, with the flowing stipulations:
Attachments:
COSA Checklist !/
Septic System Advisory
Well Flow Advisory
Nitrate Advisory !/
Arsenic Advisory
Maintenance Agreements
Supplenienfal Engineer's Reort
Other
ttXZY OFfgN��
,QPM.•,,..., cy%
ON-SITE ,
WATER AND
WASTEWATER
PROGRAM c
p•
)I1
By: Original Certificate Date: 7 - 3 ' d %
(R". I IM)
Municipality of Anchorage , .
• Development Services Department
Building Safety Division ` .. "
On-Ske Water 3 Wastewater Program
4700 Bregaw Street
P.O. Box 196650
Anchorage, AK 995196650
www.muni.orglonske
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: KENO HILLS SUBDIVISION #5, LOT 5. BLOCK 6, Parcel ID: 0.-,',' O —171-31
A WELL DATA *TO BEDROCK **GP420/2004 WELL TEST INDICATED 3
M, PR DUCTION MAY BE SEASONAL
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 6/30/1983 Sanitary seal (YIN) YES
Total depth 225 ft. Cased to *18 ft.
FROM WELL LOG
Date of test 6/30/1983
Static water level 20 ft.
Well production 1 9•P•m•
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 6.18 mgJL.
Wires Property protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
4/25/2007
23 ft.
*•2.59 g.p.m.
Other bacteria 0 colonies/100 mi.
Arsenic: ND ug./L. Date of sample: 4/26/2007 Collected by: GEG Ltd.
B. SEPTICMOLDING TANK DATA
TankType/Material STEEL Date installed 7/15/1983
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation deanout (YM) YES Depression over tank (YIN) NO High water alarm (YM) N/A
Date of pumping 7/26/2006 Pumper DENALI EXCAVATION AND PUMPING
C. ABSORPTION FIELD DATA *BELOW EX=NG GRADE TO BOrroN of Mr
Date installed 7/13/1933 Soil rating (g.p.d./ftror([� 180 System type TRENCH
Length 57 ft. Width 3 ft. Gravel below pipe 4 ft.
Total depth *9.41 ft. Eft. absorption area 456 fe Monitoring tube **YES Depression over field NO
Data of adequacy test 4/25/2007 Results (PasslFail) PASS For 3 bedrooms
Fluid depth to absorption field before test 19 in. Water added 490 gal. New depth 25.5 in.
Elapsed Time: 150 min. Final fluid depth 23 in. Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date
** PHYSICALLY SAW INVERT OF DRAINPIPE IN SUMP. MT EXTENDS 47" BELOW INVERT
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N
'Pump otP level } High water alarm level at
Cycles tested Meets alarm 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/Ilft station on lot
*81,
Absorption field on lot
100'+
Public sewer main
N/A
Sewer /septic service line
25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 109+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
'WRBS-073
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date - '4V/&A-;P-
COSA Fee S -1130-00
Date of payment e v / 1
Receipt Number 5 (V �9 O Y �IW
(Rev. 11ft)
Waiver Fee $
Date of Payment
Receipt Number
14
SCS Ref.N
1071720001
Client Name
Garness Engineering Group, Ltd.
Project Name/N
Keno hills 5 L5 66
Client Sample ID
Krno hills 5 L5 66
Matrix
Drinking Watcr
PWSID
0
Samplc Remarks:
All Dates/Times are Alaska Standard Time
PrintedDate/Iime 05/09/2007 15:51
Collected Date/rime 04/26/2007 11:00
Received Date/time 04/262007 12:05
Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Inil
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/08/07 05/09/07 TK
Waters Department
Total Nitratc/Niuitc-N 6.18 0.100
mg/L SM204500NO3-F 0 (<10)
05/05/07 JDS
Microbiology Laboratory
Total Coliform 0 coUl00mL S\120 92226 A (<I) 0426/07 DLC
Municipality of Anchorage
2 •'• f ,t0
• '� Development Services Department <:
Building Safety Division
- On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 070147
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 6, Lot 5 of
Keno Hills #5 subdivision. This inspection revealed a nitrate concentration
of 6.18 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality p y o f Anchorage
' Development Services Department
4
Building Safety Division' ` 5 . T T
On -Site Water & Wastewater Program
4700 South Bragaw St. `
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-171-31 HAA# L4 Q I �o
1.. GENERAL INFORMATION Expiration Date:
Complete legal description KENO HILLS SUBDIVISION #5; LOT 5, BLOCK 6,
Location (site address or directions) 1790' ASHLAND bRIVE * ANCHORAGE, AK. 99516
Current Property owner(s) MEREDITH DOMURAT Day phone 345-7134
Mailing address 17901' ASHLAND DRIVE * AN .HORAGF_ AK 99,516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
1-Faiviclual Welln ivi ua un -site
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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
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 Health Authority 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date ±12:1,/04 -
Engineer's
O
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, o4oF
conscientious engineering analysis of the system in accordance with ADEC and MOA o! Q
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and a :;' 4
septic systems depend on the local soils condition, groundwater levels that may • • • • • • •
fluctuate during the year, and the water usage of the family being served by the system. 0
These conditions are outside the control of the evaluator of the system. Satisfactory test Q...
results do not guarantee future performance of the system, nor do they guarantee that f ey .Gar ss.
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide QQ��� C oo`�
any warranty or future estimate of how long the system will continue to meet the ......operational ....
this report is for
the ole benefit of the owner wner listed above. s of the ADEC Any DD ce upon or use nt t of this s report by any �DO00 fesslo'cl
otherperson or party is not authorized, nor will It confer any legal right whatsoever. O000
5. DSD SIG'NATURE
�/IGApproved for _3— bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
OF
Attachments:
HAA Checklisty
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
�.
WATER AND
'. PROGRAM
By: Original Certificate Date:
(Rev. 12/01)
Municipality_ of Anchorage
Develont Services Department '
r° . . c
rA i
Building Safety Division
' On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
i . www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL ;CHECKLIST
.. ... , . I ',. .. .... .. a
Le9al Descri tion: KENO HILLS S/D t#5; LOT 5, BLOCK 6,
Parcel ID: 020171-31
, P ,k
A. WELL DATA I I *TO BEDROCK
Well type i PRWATE If A, B, or C provide PWSID# 'N A Well Log (YIN) YES
Datecompleted6/30/83 .Sanitary seal (YIN) YES Wiresproperly.protected (YM) YES
Total de': 225' ft. Caed to a *18 ft : Casing height (above ground) 12+ in.
c
FROM WELL LOGS AT INSPECTION
r
Date of test:6/30/83 F 4/26/04
!
l
Static water level 20 1 ft j., 40 ft
W!
it
production g .m - .
p
II i
1
•j g.p.m.
E
WATER' SAMPLE RESULTS: ;,
Coiifolrm i, 0 colonies/100 ml. -. Nit�atet 2.381° mg./L.
;Other bacteria ` 0 colonies/100 ml.
Arsenic mg /L:. Date of sample: 4/19/04 Collected by: GEG, LtD.
B. SEPTIC/HOLDING TANK DATA I'
Tank Typ a/Material STEEL 1
Date installed 7/15/1983
Tank size !1000 gal. Number of Compartments 2
Cleanouts P(YIN); ; YES
II:; ka.
Foundation cleanout (YIN. YES Depression over tank (Y/N) NO
High water alarm (Y/N) - N/A
Date i� f pumping 9/30/03 ' � . Pump r '
DENALI !'PUMPING
i F { OW RUNG GRAD
C. ABSORPTION FIELD DATA I'
t
!
Date Installed 7/16/1983 Soil rating (g:p d /ft2or bdrm 180.._
System type TRENCH
Length; '' 57 ft Width ` 1 ft.
Gravel below pipe 4 ft.
***9.9 456
**YES
Total depth ft. Eff absorption alrea ft Monitoring
tube Depression over field NO
Date lof adequacy test 4/20/2004, l j l' r Results (Pass/Fail) PASS j For 3 bedrooms
i
Fluid depth in absorption field before test DRY 'In Water added 504 gal.' New depth 19 in.
Elaps, 6 Time: 1020 min. Final fluid depth' -1 i`�' in.
Absorption,rate'>= 450 g.p.d.
Any rejuvenation treatment (past 12 mo) (YIN & type) . NONE
KNOWN 1 11 t' If yes, give date —
,�
y **MT ONLY EXTENDS, 21 BELOW : INVERT
I ***TO ;;;BOTTOM OF MT.
.I
,
- IIS. t li, M•'
I �I �
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in.
C
E. SEPARATION DISTANCES
"Pump off' in. High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *81'
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank ' N/A
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 LOTTO:
9
Property line Building foundation' 10'+ Water main N/A
� 10
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*REQUEST THAT EXISTING WAIVER BE AMENDED.
SHOT FROM EDGE OF WELL TO EDGE OF ST1 ® 84.21'. aoaoo
a OF oa .
G. ENGINEER'S CERTIFICATION
Sr4ppo
Y g9 �r
review of Municipal records that the above systems are in
1 certify that 1 have determined through field inspections and
conformance with MOA HAA guidelines in effect on this date.
QO Je a A. ess: X
Engineer's Printed Name JEFFREY A. GARNESS OQm C-7953�p
O
Date 4- L4- ���44dPr .....jo�o;�oo�
of es a
�400000�'
�aSL
HAA Fee $ �"_10 Waiver Fee $
Date of Payment 1C��oA Date of Payment
Receipt Number r-) IC6 Receipt Number '
(Rev. 12/01) ..
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Health Authority Approval # 040168
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 6, Lot 5 of Keno Hills #5 subdivision,
the well's productivity was determined to be 0.63 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
3 -bedroom residence is 0.31 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
05/10/2004
1
V•
10:06 9072432081
/u 6 9
FRED WALATKA & ASSO
s
I Q -5-, Z B
1
5 c a Ie
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
'LAT ARE NOT SHOWN HEREON. RC_D
A. Gj ;Ai
00
Fred V� ,
urky
Azar
d� •••..•'�c w
e� 90Fr•:siorv...
FW
AS43UILT NO CORNERS SET THIS DATE
PAGE 02
8x82 r
I hereby certify that I have performed a Mortagee's in.
specti022 of the following described property: L o -
I Anchorage Recording ,precinct, Alaska, and that the improve
re -
01nents situated thereon awithin the property linea and do
snot overlap or encroach on the property lying adjacent them_
to, that no improvements on property lying adjacent thereto
encroach on the premises in Question and that there are no
roadways, transnLlesion lines or other visible easements on
said property except as indicated hereon.
Dated int Anchorage, Alaska
n d
ay
FRED WALATKA & ASSOCIATES
Engineers and Survevors
' 1:..:;
4-23-04; 3:18PM; ;907 5615301 to 3/ 9
SGS
IGS ReE# 1041882002
:tient Name Garness Engineering Group, Ltd.
Project Name/# Various Ch
:tient Sample 1D 17901 Ashland Keno Hills ,L
datrix Drinking Water
IWSID 0
ample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 04/23/2004 12:18
Collected Date/Time 04/20/2004 17:30
Received Date/Time 04/21/2004 12:20
Technical Director `tep� .Ede
Released y /�
'arameter Results PQL UnitsMethod Container ID Allowable Prep Analysis
Limits Date Date Init
Caters Department
A'itratc N 2.38 0.100
iicrob.iology Laboratory
Total Coliform 0
mg/L. EPA 300.0 B (<-10)
col/IOOmL SM18 9222E A (<=])
0421/04 JJB
0421/04 DPT
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. # ��n— 1� i- 1 HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lr i3{� 4tt�rc' 14rj�
�
Location (address or directions)
(b) Property owner V r`
Mailing Address
(c) Lending Institution
Mailing Address
Sch�s�dlov g/
Telephone: (home) -44,21 Business
Telephone P06— 5013
(d) Real Estate Company and Agent i" >L << r �'^ �� t' jra'k^ /QA"-` �"'
f
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
3. WATER SUPPLY
Number of bedrooms 5
Individual Well I� 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-site ❑ Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) 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.
� Telephone A7q 39/6
Name of Firm �obbcv! 9pUv'k10.�
Address on21� 3 (,rte / Sip
Date l l 4
>Engineer's Seal
6. DHHS APPROVAL
Approved for 3 bedrooms by&�49 �%Gv `�` Date/2 —Z3�
Approved _>C 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88; Back Page 2 of 2
G d MUNICIPALITY OF ANCHORAGE (MOA)
=1 Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984 i
343-4744
`s Legal Description: Loy 5 RLQ to
FFlLL_s Isar
A. WELL DATA
Well Classification If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) _ Date Completed S3 Yield 'Y �� ✓yi
Total Depth -2:29 to ��"epth of Grouting — ''//
Static Water Level .2 % Pump Set At �� %��M
N
Casing Height Above Ground 2 y Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) x Depression Around Wellhead (Y/N) N
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 46G ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ! !o t ; On Adjoining Lots > /00-0
To Nearest Public Sewer Line H To Nearest Public Sewer Cleanout/Manhole N/A
To Nearest Sewer Service Line on Lot 71 C)
Water Sample Collected by �/ m'
; Date
Water Sample Test Results
/ 7
Comments � � rw✓► �r!vui tS
N
B. SEPTIC/HOLDING TANK DATA
Date Installed -7/8-5 Size 1&-8b No. of Compartments 10410
Standpipes (Y/N) T%e/o Air -tight Caps (Y/N)
Depression over Tank (Y/N)
M
Last Pumped X1011. 1211, l9F 8 t y,
Pumping/Maintenance Contact on File (Y/N) --_ — for
Holding Tank High -Water Alarm (Y/N) ty��c Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well ab To Building Foundation
To Property Line 7 In To Disposal Field
To Water Main/Service Line -> /0
To Stream, Pond, Lake or Major Drainage Course VA
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
/_01F)Z
)
_
Soils Rating in Absorption Str/ata os Type of System Design ; eczisC—Y
Date Installed �/ t�3 Length of Field `� 7
Width of Field ��o Depth of Field 9
Gravel Bed Thickness
Square Feet of Absortion Area JB 6 Statndpipes Present (Y/N) y
Depression over Field (Y/N) Date of Last Adequacy Test f yli%laP
Results of Last Adequacy Test 14:0 v-
SEPARATION DISTANCE FROM ABSORPTION FIELD
To Water -Supply Well o-0 To Property Line > /O
To Building Foundation 410 ¢ To Existing or Abandoned System on
Lot �% ; On Adjoining Lots > /fes
To Water Main/Service Line %/tom To Cutback (if present) NIAW
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
NoNi5�
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
**Check Permitted Bedroom Rating Against HAA Request**
"Pump Off" Level at
Vent(Y/N)
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
Y
Com an I e(D�0evt �pu�a VCIX rc �,
Company-
Engineer's Seal
Date
MOA No.
Receipt No. � O Jy�2 rZZ,1,rz)
Date of Payment /�2 / o
ao
Amount: $ Z 2LD
Receipt No.�
Waiver Fee: $�����
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
Municipality of Anchorage } j
Department of Health and Human Services df'lh5
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
December 13, 1988
Tobben Spurkland, P.E.
203 West 15th Avenue "C" Suite 203
Anchorage, Alaska 99501
Subject: Waiver Request for Lot 5 Block 6 Keno Hills Subdivision��
Waiver Request #WR88-073, #H88-0535
Dear Mr. Spurkland:
Your request for waiver of the required 100 foot separation of
a septic system to a private well has been approved. The
approved separation distance is 85 feet.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
S' erely,
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljw#6
203
TE
ANCHO AGE:AL'AS AI 99501
CONSULTING ENGINEER "TELEPHONE (907) 279-3916
Municipality of Anchorage December 6, 1988
Division of Environmental Health
Department of Health and Social Services
820 L Street
Anchorage, Alaska 99501
Subject: REQUEST FOR WAIVER OF SEPARATION DISTANC S FOR
iITT±/1H Fi E -f La.
PRIVATE WELL TO liB"Sn-*t-z—�-a�-«��� 1
LOT 5, BLOCK 6, KENO HILLS 'L*6 SZ>
MARK SCHIJNDLER t.
Gentlemen;
We are submitting a request for waivers from the separation
distances stated in Title 18, Alaska Administrative Code,
Chapter 80.020.
During an Health Authority Inspection on November 17, 1988 is
was discovered that the distance between the well on Lot 5 and
the septic tank was 85 feet, fifteen feet less than the
required 100 ft.
The well and the septic system were installed in 1983 and was
inspected and approved at that time. The As Built report shows
the distance between the tank and the well as 85 feet. The well
is located up hill from the septic system. According to the
well log the well is 225 feet deep with bedrock at 18 feet.
By going through the DEC's procedure of analyzing the potential
for contamination I arrive at the following points:
Bedrock at 18 feet
Soil Sorbtion ( Sand/
Permeability ( Sand/
Gradient ( 5-100
Separation ( 85)
Total
Conclusion: Chemical contamination possible but unlikely.
Please issue an waiver for this well.
Yours
Tobben Spurkland P.E.
2.00
Gravel/Silt)
3.00
Gravel/Silt)
2.00
away from well)
5.25
2.50
14.75
Conclusion: Chemical contamination possible but unlikely.
Please issue an waiver for this well.
Yours
Tobben Spurkland P.E.
a --
Lo+ q
\ �\ op
"�•-
!(9
56 e 44o Vie'
s / A
er•ti• 22e25—L
' JUYV:SE ?.a, 1971 s
N
s
/°//GtiG
I" 8
v'm
V --r-I 1 0 14 e //_s
Time
APPLIC NT FILLS OUT UPPER HAI, ONLY
Pro e., ty Owrier
G Phone
Mailing Address
Zip Code -
Buyer `
Address
O Y. C\ L- (} )/ Zip Code
Lending Institution
F
{. /
ckA_'t V\� r� T e� tw 1Ut�y)r 64 V1
Phone
Address
J Yip Code
GL2nce7gn�,p MUNICIPALITY OF ANCHORAGE
Realty Co. & Agent1
y� �h�
Phone
Address -•
Zip Code
}�� ��� (�,i �;('C`1�-
NOV 28
Legal Description
yyl
PIGc �V�b
Street Location
Type of Residence
_
R Single Family
J -
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
M Individual
-
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
Septic Tank Size fid_ D p
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Well to Tank
S `T
Sewer Disposal
Individual
Year Individual Installed:
Public Utility
When Connected to Public Utility:
❑ 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: C _:-: i?�� //� %� �i� . �-'t/�G-O �i�i22/ ��r�C�•� . '" �<�i�—[T •�/
�L '�� �G
GL2nce7gn�,p MUNICIPALITY OF ANCHORAGE
y�<ir�v
DEPT. OF Hc/`1TH <:
ENVIRONMENTAL PROTECTION
NOV 28
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL E
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL-
-
DATE Q
-
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area % SL _ f
Well Log Received - .S
Septic Tank Size fid_ D p
O >
/ � 1
Well to Tank
S `T
72023 (3182) //
ALASKA 0-01ROWWAL COnTROL SWIM, InC.
Engineerinq & Enuironmental Studies
November 14, 1983
Municipality of Anchorage
Department of Health & Environmental Protection
825 L. Street
Anchorage, Ak. 99501
Re: Health Authority
On November 10, 1983 our company collected a water sample from the house
located on Lot 5 Block 6 Keno Hills Subdivision. The property owner is
Mark Schindler" The water analysis was satisfactory. A copy of the
report is attached.
The well is located 86 feet
from the septic tank and is approved and
over 102 feet from the leach
field" The electrical wires are encased in
conduit. All the standpipes
are capped" The well casing stands 1 feet
above ground has a sanitary
seal.
®and
OF Al �®bhpp
9
fi' a fzRi✓e - 'JR4 0" ^i�
�q
• ae oo• ea••o. �
%jo esu
oy C. Reid,
No. 2251E'1e`'
MUNICIPALITY OF ANCHORAGE
rq`•,...e..«.e"+`�� °'�
X41 �PPOFF`',S0'', v
PEPT. OF I:SiLTii-.
ENVIRON,'YISN AL PROILCTION
E�LIVE
1200 fest 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 276-1361
