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HomeMy WebLinkAboutKENO HILLS #5 BLK 6 LT 7 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: ___________ PID Number: ___________ Dwelling: Single Family (SF) with ADU Duplex (D) Two Single Family Project: New Upgrade Name ABSORPTION FIELD Site Address Deep Trench Wide Trench Bed Mound Other Phone Number of Bedrooms Soil Rating Total depth from original grade GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft.Ft. Fill added above original grade Gravel length Township Range Section Ft.Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. From To Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Number of trenches Dist. between trenches Ft2 Ft. Well TANK Septic S.T.E.P. Holding Other Manufacturer Capacity Surface Water NA Gal. Material Number of compartments Lot Line Foundation LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to drainfield Drainfield CO/MT Inspector BENCH MARK (Assumed elevation)ft Inspection dates:1st 2nd Location and description 3rd 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer’s Stamp Conditional Approval: Date Septic System Approved ____________________________ Date Note: this approval does not include well permit requirements. (Rev 05/02/18) 2023.03.29 PROFILESCALE: NTSPANNONE ENG SVC, LLC (C.I. 1088)NSEWSCALE:1"=50' d" Y +r A ft d" MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231021 Work Type: SepticTank Upgrade Tax Code Number: 02017129000 Site Legal Address: KENO HILLS#5 BLK 6 LT 7 G:3438 Site Mailing Address: 17800 ASHLAND DR, Anchorage Owner: HARRISON PATRICK & TERESA Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: p�cnt Department 2/27/2023 2/27/2024 100624 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: `55 Issued By: Date: Date: Z Z 20 2 4 MV U1HMG°'aUTY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-171-29 Property owner(s) Patrick & Teresa Harrison Mailing address 17800 Ashland Drive Anchorage, AK Site address Same Day phone Legal description (Sub'd., Block & Lot) Keno Hills #5 136 L7 Legal description (Township, Range & Section) Lot Size 100,624 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) . Septic Tank 19Upgrade ❑X Duplex (D) ❑ Holding Tank ElRenewal F1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. AArcrw Par dig - (Signature of property owner or authorized agent) Permit/Rush Fees: X4 s Date of Payment: Receipt Number: Permit No. (35P1113 10V Permit App__- : . '-.,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 21 February 2023 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Keno Hills #5 B6 L7 17800 Ashland Drive Septic Tank Replacement Design Narrative This is a design narrative for a permit to install an upgrade 1,250-gallon septic tank to replace an existing 1,250- gallon septic tank to be issued for this property. The existing tank is 32 years old and will be replaced per Municipality of Anchorage requirements for steel tanks of this age. Currently the lot is developed, this lot and surrounding lots are served by private wells. Currently there are no wells within 100 feet of the proposed installation. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 10’+ from building foundation. 10’+ from any water line. 100’+ from any surface water. 100’+ from any private wells. 200’+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, JRL Joseph Lawendowski, PE Civil Engineer Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231021, Curtis Townsend, 02/27/23 r,r u �-1 U) pv-p = C>0 I mNN Dz W Q CD -U �m z�� m A � '_0'X ;U � r7l fn p 7 p C fit U1 p N< 7 c>��zZ� y �� Do N mW N Z �pU) z _ —I vyi £ zJ -0 m p p m -. � U -0 O p mz I o cNn nD mm�z CIOD r�70 m mD D O^ CSD �J w Z Z r Mp a O -0(n ip O it _ O M D r O p O 0 m i Z 0 cm C m a U) D �0 (n W ZZ O n o c�2n - - 'U" zt - - n Z 0o p p a \ O— rQ V _ IcoN.41 _ — -- —— — -{}----- �_---_02` — —— — — imZ I ------------,ASHLAND DRIVE�� NOTES: pANNONE ENG SVC LLC (C.1. IO8S) P.O. BOX 1807 PAL ER, AK 99645 ���\\\ =OF A qs\t; REVISIONS DATE 2/21/2023 For construction PHONE 907) 745-8200 FAX 907) 745-8201 %�P•' �9+� SCALE KENO HILLS B6 L7 TH s' *'.4..... ""*I% 1:9 0 DRAWN ACP #5 PATRICK & TERESA ASHLAND 178ANCHORAGE HARRISON•J.R.L',7EI4D0WSKIJR- 9ore�iti'l�' Cawenc%wr(v. % -�.'. 2023.02.21 .';"�j ti`i P.I.D. 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(y >....LAlyf�. > 0 •�!.R.IAWEh;DO'vvSi;IJk,� � Ldp+`�j:^GE-3H7?''<<,'`� ooevAoe�-� REVISIONS DATE 2/21/2023 For Co;nstruff�iionLY For Construction SCALE NTS KENO HILLS 5 B6 L7 PATRICK & TERESA HARRISON 17800 ASHLAND DRIVE ANCHORAGE, AK DRAWN P.I.D. NO 1-2s CHECKED JRL SOIL LOG/NOTES PERMIT PERMIT NO. N osPxxxxxx SHEET 2 OF 2 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~ ~ ~::~:~4:~ PID Number: N~JlP~i~ '~ ~1 ~ ~~ Wastewater System: ~New ~ Upgrade ~:l ~ ~ ~ ~q~l~ ABSORPTION FIELD Phone: ~ [~ ~ No. of B~ooms: ~Deep Trench ~Shallow Trench ~ed ~Mound ~Other LEGAL DESCRIPTION So~,.,~in~: ~,~GPD/Sq. Ft. Tota, Depth from origi~grade: BIock:~---- Suh~ion:~~ Fill added above original glade: , Depth to pipe botlom ~om orig~r~,_~ Ft. ' Gravel depth beneath pipe ~' ~Ft' Gravel length: WELL: ~New ~ Upgrade Gravel~ ~ Ft. Numbe~ines: Distance between lines: Cl~tion (~rivate, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: StaticWater Level: Insta~ ~ Date installed: ~.u ~t. [~. TAN K SEPARATION DISTANCES ~s~,t,o ~Holding~ S.T.E.P. Surface w~te~ ~Y [~ '~ ~ ~, LIFT STATION Remarks: BENCH MARK Location~ Description: ENGI~E~AL Inspections performed by: , .~.]s~ -z - ~ -~ ~"~ 17034 Eagle Ewer L~p Roa~ N~.~ , ~.~ _ ~ Eagle River, Alaska ~5~ - zna -; ~ ~i Department of Health and Human Services approval ~eviowod and approved by: Dato:./ .... 72-013 (1/91) MOA 25 : · Permit No. of ~-- ~'J ~ld:~ ~-;=z~ Page ~ Municipality of Anchora9e DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Y.~kJO t,t I!,1~-~ ~'5 ~L,K- ~ ~ "t' PID No.: EAL 72-013 A (2/91) MOA 25 E X FU'. RAT.T. CiN i"W2~ 'i" F:' [ February 28, 1991 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOIL TEST Municipality of Anchorage DEPARTMENT OF HEALTHAND HUMAN SERVICES 825 L Stre~ P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 7; Block 6; Keno Hills Subdivision; PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON S~TE WASTE WATER DISPOSALSYSTEM DESIGN PER~IT REQUEST NARRATIVE Request you issue a permit to drill a well and i~tall a 4 bedroom septic system an the referenced prope~y. The so~l test~ were perfarmd by Corwin & Associates, Inc. in 1988. At present this lot and all surrounding lot~ are vacant. The top of the lot near Ashland Drive is r~lativ~ly flat, however, the lot slopes at abou~ 10% toward the west. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Although the proposed location of the well partially shadows the property to the north, due to the large lot size, we foresee no negative impacts on the adjacent properties. SCALE t DATE PERFORMED: SITE PLAN ~r7' 15 - 16- 17- 18 19 20 PERCOLATION RATE TEST RUN BETWEEN ~ FT AND, ~ FT COMMENTS Reading Date Gross Net Depth to ~ 'Net Time Time Water Drop 1''~ ~ ./~~. I ~ O. ~ / / PERFORMED BY:' "-~H~:~V~ ~.'J~'[-~CH~--"~. I. ~A'-~~ CERTIFY THAT THIS ~EST WAS PERFORMED IN ACC0RDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNESIN EFFECT ON THIS OAT6 DATE: 72~8 (Rev. 4/~) """' ' · " ' . · Consulting Engin~rs 12001 Industry Way · 81dg. B - Suite Eleven - Anchorage, Alaska 99515 · (907) 345-4440 LEGAL DESCRIPTION: ~ ~ ~L~ ~ ~ Township, Range, Section: " SLOP~ S~T~ CLA~ 10 ~-"I:~,l~U~ WAS GROUND WATER NC), ~:~Dt~r' r' ENCOUNTERED? ~ Reading Date Gross Net D~th to ' Net Time Time Water Drop 20 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72~ {Rev, STATE OF ALASKA OEPAI~TMENT OF NATURAL RE$OURE$ O~vl$1on of Geologicol 8~ Geophy$!co~ Surveys A,D.L TowAmh~.~ NE~ Ra~9~ £[]1 cltQm. D. F!NI~H OF W£LL: .// . 8 Io~/Mq~h St~e; ~e~gth ;. , I~[,~ROLITIhlG weu ~eouted: ~_~ Yea E~ No ~tlrt~l; ~ Neet Gemini ~ Ofherl I~.PU~P~ (If gvOIllble} HP -- Length of Drop Pipe lt. copooily ~9,P,m. 14. R~MARK~: /~ Y ft. oiler _~ hr,, pvmpln~ ~ g,p.m, MUNICIPALITY OF ANCHORAGE Development Services Department ^ ` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-171-29 Legal description KENO HILLS #5 BLK 6 LT 7 Site address 17800 Ashland Dr Current property owner(s) Teresa Harrison Expiration Date: 2 3 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: L Ci BYQ_Original Certificate Date: 3/29/2023 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 Arsenic Advisory Other COSA Approval_June 2022 MUMCPAU T OF LSH CHORAWE u " 4 Development Services Department T Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-171-29 Complete legal description Keno Hills #5 Block 6 Lot 7 Location (site address) 17800 Ashland Drive Current property owner(s) Teresa Harrison 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑B Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ®❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: [ I Steel © Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS X Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑M 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 $ 8d Waiver Fee $ Date of Payment COSA # L")S C 2-_2_J07/ Date of Payment Waiver # COSA Application_ June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. 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) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: E. SEPARATION DISTANCES 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' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' 9 Yes if No ft Holding Tank > 100' Fm -]Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No ft n Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No Tank to Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft Private Wells > 100' 0 Yes if No Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No _ Water Service Line > 10' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ** The drain field is approximately 50%-60% used. Based on level of biomat in the drain field ft ft ft 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 Pannone Engineering Services Phone 907-745-8200 Engineer's Printed Name Steven R Pannone P. E., F. ASCE Date COSA Checklist June 2022 �61 g 9 10 77 • • aE o0 •F 7 Municipality of Anch d : ��`.4.:,w l ,� On-Site Water and Wastewater -r.00ra4•1` 11,iJ (907) 343-7904 m JUL rA 201 5 ?F E.Y a N, Certificate of On-Site System •royal Acv Parcel I.D. 020-171-29 Expiration0l Date 9 1 J, 2_l y 1. GENERAL INFORMATION Complete legal description Keno Hills #5 B6 L7 Location (site address) 17800 Ashland Dr Current Property owner(s) Bradley & Kay Underwood Day phone 519-2932 Mailing address 17800 Ashland Dr., Anchorage AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: El 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 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: 4� Date: ell'-4 71 7 COSA to be released to a engineer,unless otherwise requested by the engineer. COSA Fee $ '571e Waiver Fee $ Date of Payment q125-ite Date of Payment Receipt Number 03512A Receipt Number COSA# 6SCIt 13(43 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 Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 7/23/18 �,c OF AL,k‘>l s*.49TH •;*'l 6. DSD SIGNATURE r"C. System#1 Approved for Cif bedrooms / . Beniamia/Schiller : �' •. CE12592 •• `�/ System#2 Approved for bedrooms •+k��sl .• 7/23/18 ••• Disapproved Conditional approval for bedrooms, with the following stipulations: A-ankk ;s 21 cavic DL7 P t G S S eft 1-'S 2 ö 1Qcvc c W Y or,i r. ON-SITE c� WATER ANU WASTEWATER / 4 PROGRAM By: \ vIA Original Certificate Date: Artc --e_-,-74_ 1� The Municipality of Anchorage Development Services Division(DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: tr��:; COSA Checklist X Nitrate A visory •. Septic System Advisory Arsenic Advi or ' Well Flow Advisory Oth@-, • /AAA.. 2.7 COSA blue sheet_f . 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 Hills #5 Lot 7 Block 6 Parcel ID: 020-171-29 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 3/23/91 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 167 ft. Cased to 13 ft Casing height (above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test 3/24/91 5/29/18 Static water level 23 ft. 22 ft. Well production 6 g.p.m. 2.8 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 4.12 mg/L Arsenic Neg ug/L Date of sample: 7/16/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5-20-91 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 5/17/18 Pumper Isaacs Pumping C. ABSORPTION FIELD DATA Date installed 5-20-91 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.5 System type Bed Length 55 ft. Width 24 ft. Gravel below pipe 0.5 ft. Total depth 3.25 ft. Eff. absorption area 1 320 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/29/18 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 709 gal. New depth 0 in. Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 600 g p d None Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas _>50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >1 Property line >5 Absorption field >5 >10' >10' >100' Water main Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >1Building foundation >1 Water main > 10' > Water Service line > Surface water >1�� Driveway, parking/vehicle storage Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION ��� .\\\` I certify that I have determined through field inspections and ��P ,��0 review of Municipal records that the above systems are in d . `�� .-. T conformance with MOA COSA guidelines in effect on this date. 0*:'49TH i\ ••* r/ Engineer's Printed Name Benjamin Schiller, PE "•• '�' " 0 8/2/18 % .. •- . . . .` . . ... . .. Date �yy Benja chiller fO �'F�,•.• CE '1259c2 •t� � �1i> 8/2/18 •.•�v�„r ik%PROFESSION+"� COSA brown sheet 10-10-12.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 1 s .4". l 907-343-7904 On-Site Water and Wastewater Section %! Fax: 343-7997 www.muni.org/onsite - Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181363 Subdivision: Keno Hills #5 Block:6, Lot: 7 The septic tank for this property is 26 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. 46 ‘at-:: :::..mi-Z., '' ly, '''''''' -, ' _ ...„ ; , . ....,, , rts,,,. e, ,,,c- ,...,,.. , - . , . ,..s,„ .., , f....,,,,...... ,. •. ---. ,,,, ,, )40, 1 tox,,,,, ; - . r.,`.. . : --/ . ,ga - --. - .,,,,,,,...:.e4,-.-• , ' .4- -4, • ort-5.t If 6,-, -IN--- e�.yy,;�w .a •d' CCK. 'a 9 2, fija. t v J tµ .. 40 ;',,,,,,0,7* J' " `Y •� \ AA`s". s;� 1 • tY „,� 4-� ` „ .,-;,,S..- {s.,,= ,ya 0. :., bl '`i , ,,, tfo • ry a .J; 4,,,,,,y Ar ' •, : 4 Y 1 ,,,:.). ..‘. _ 26:-*It ,c,-6,. .22 1%01 y •., . .,00 • "y .,:t. L 4 J S..1 ,.. -ig Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site add'tess or directions) /7~ Property owner Mailing addres; ,~'~, /~4"1v' Lending ag e ncy,~,~%7- Mailing address ~-~,/~¢,')(" Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system.. NOTE: 72-025 (Rev, 1/91) Front MOA #21 ~rA¥1::MI;;:N¥ (21~ INSPECTION BY ENGINEER AS certified by my seal affixed hereto and as of thevalidatioh date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply ~.nd/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~-/~'Y~',~ ,/¢',///¢¢.~/',/' ./-///¢ ~/~-~ ,//d/~, Phone Engineer's signature D~S SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments *f*'Xql['Ji The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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. 72K)25 (Rev. 1/91) 8ack MOA  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:,~,7'F Z~:~"~//~',~.~/V'~ /-///~..~' Parcel I.D. A. WELL DATA //~',~f/ '//~/'~--~'~-//~.~ ~' ,/V'~' z~:::::~".~'~'/v/~' Well type /~?,~/~//~'/~"~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed 6~/-~/¢// Driller Cased to /3' ~/~Eg~-O¢/'(1 Casing height /' ~.'~'/~" Wires properly protected (Y/N) ,~'~ Log present (Y/N) Total depth Sanitary seal (Y/N) /~--~ FROM WELL LOG Date of test 03/,Z~/// Static water level ~.,.~ Well flow /(2_' Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main/~/'~,/~-~' Sewer service line AT INSPECTION WATER SAMPLE RESULTS: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank //1//,,'~' Coliform c.~/~B~Fd~T"O~/ Nitrate ~/~/¢2~,/// Other bacteria/¢/'O/~ Date of sample: ~ ~ ~ Collected by: ~~ ~~~ B. SEPTIC/HOLDING TANK DATA-~ ~~-' ~~ ~/~¢~ Date installed ~~ ~/ Tank size /~ ~~ Compartments Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression High water alaEm (Y/N) ~ Alarm tested (Y/N) ~/~ Date of pumping ' ~/~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~ ¢~ On adjacent lots ~¢~ Foundation /~, To property line //~ ~ Absorption field ~,~ Water main/service line Surface water/drainage ~ ~ ~~N ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION /'V///~ Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO'. Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ,~'/2~)/¢2// Length ,,~'~' ~' T' Width Soil rating ~.L~Z~/~'F System type Gravel thickness ~, ,~'~'~7- Total depth Total absorption area Depression over field Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Cleanouts present (Y/N) Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot /.,~-/,~../Z-~'~"- Onadjacentlots ~:::~)TZ/K'7'~ Propertyline To building foundation 2,~,~,~' To existing or abandoned system on lot On adjacent lots ~:~)~7/'~~'7- Cutbank/~/~,/~' Water main/service line Surface water Curtain drain .//~/~/Y'~--~: Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~~ ~f ,~~ _~,,~.. ~.~",'~,~ Engineers Name ~~ ~ ~~ ~-.~ ...... ,,,~.~ Date U(JNE ,9o f I ~,~, ROBRRT W. W~IGHT NAA Fee $ / ~ ~ Waiver Fee: $ Receipt Number ~ ~ ~ O ~ ~ ~¢~ Receipt Number 72-028 (Rev. 3/91) Back MOA 21 TRYCK NYMAN HAY6$, INC. ENGINEERS/SURVEYORS/LANDSCAPE ARCHITECTS TRANSPORTATION and COMMUNITY PLANNrNG 5173.0 June 26, 1992 Municipality of Anchorage Dept. of Health & Human Services Div. of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, AK 99519-6650 Attn: Ms. Susan Oswalt Re: Health Authority Approval Lot 7, Block 6 Keno Hills Subd. Dear Ms. Oswalt, Attached please find a Health Authority Approval form for the above noted lot. Per our telephone conversation of June 25, we have taken all required measurements related to separation distances, and a water quality sample. The results of the water quality sample are attached. It is our understanding that a well flow test and septic adequacy test are not required in this case. Our research of DHHS files showed that a well log is not present. We have therefore left that portion of the yellow Health Authority Approval Checklist blank. Should you have any questions, or require additional information, please contact us. Very truly yours, TRYCK NYMAN HAYES, INC. Robert W. Wright, P.E. Project Engineer 911 West E}ghth Avenue · Anchorage, Alaska 99501-3497 · (907) 279-0543/FAX (907) 276-7679