HomeMy WebLinkAboutWEST ADDITION KNIK HEIGHTS BLK 2 LT 4We
t Addition
Knik H
ight
lock 2
Lot 4
0 7-37!
-32
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191270 PID Number: 017-371-32
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade
Name:
Michael & Ann Gravier
ABSORPTION FIELD
❑■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
12945 Elmore Rd. Anchorage, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(907) 903-6574
4
0.8 GPD/SF
8.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.0 Ft.
Gravel depth beneath pipe
7.0 Ft.
Subdivision Block Lot
West Addition Knik Heights 2 4
Fill added above original grade
2.8 Ft.
Gravel length
57 Ft.
Township Range Section
Gravel width
3.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
798 Ft2
1
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK � Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1250 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
*Steel
2
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks *Septic tank is epoxy coated.
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
A+ Home Services
Drainfield D3034 CO/MT
Inspector J. Williams
BENCH MARK (Assumed elevation) 100 ft
Inspection151 8/6/19 8/7/19
Location and description
dates: 2ntl
3r 4'h
Bottom of siding @ point'A'
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
1
may 49th1001
04 ....................
F„
%A_11 MICHAEL E. ANDERSON
i.0
No. CE-4331
9/18/19 ,.•����
Approved i�('S( Date 5 J
�o••
F •'' nuup0•6
inspection Repon_a--i--iz.aoc
WEST ADDITION KNIK HEIGHTS, BLOCK 2 LOT 4
PERMIT # OSP191270
I �
I
rLOT 3
I II EXISTING WELL
I/
I EXISTING WELL
I
ED
�I
m --_
; I� /SHEED'_� LOT 4
OmZIN�ORNE ALONL
GGN LINE ALONG
ESF PROPERTY.
/ (SEE NOTE ON PLAT NO. 76-189)
EXISTING WELL
PID # 017-371-32
I
I
L,
I I
1 00'WELL RADII
I
NEW 1,250 GALLON
SEPTIC TANK w/ 20"
MANWAY.
v ( MT1 b
\ co
TH1
Q5
PT2
U
D
m
K
m
z
57' LONG pct'(WIDE x 7'
EFFECT'VE DEPTH
ABSORPTION TRENCH
(45 DEG. I).EG ON
NORTH EI D OF
TRENCH 10' -LONG)
ALTERNATE SITE
MH
44.4
33.7
SV
51.1
41
2CO
53.5
4.4
MT1
97.2
64.5
Co1
98.9
65.1
MTS
94.6
1.1
02
-� 9Z/5-
89.3
PLAN AS -BUILT
0 50 100
FEET
1 "=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
PT - PERCOLATION TEST
WEST ADDITION KNIK HEIGHTS, BLOCK 2 LOT 4
PERMIT # OSP191270
94.0
P I D # 017-371-32
vu.V
97.8 FINISH GRADE
95.0 ORIGINAL GRADE
DRAINFIELD ROCK
87.0
57'
79.0
NO GROUNDWATER 6/24/19
PROFILE AS -BUILT
(NO SCALE)
87.0
INSULATION
94.0
DEPTH
(feet)
1
2
3
4
5
6
7
10
11
12
13
14
15
16
17
18
1
k��
SOILS LOG AND PERCOLATION TEST
E N G
LEGAL DESCRIPTION: WEST ADDITION KNIK HEIGHTS 132 L4
PERFORMEDFOR: MICHAEL GRAVIER
DATE: 6/4/19 PROJECT No.:
PARCEL ID#: 017-371-32 TECHNICIAN: L. T I D W E L L
TEST HOLE 1
SLOPE
(SILTY SAND) SM
(SILTY GRAVEL) GM
WAS GROUND WATER ENCOUNTERED? N O
SI I L FLAN
SEE SITE PLAN
IF YES @ WHAT DEPTH? -
L
GROSS TIME
(MINUTES)
DEPTH OF WATER AFTER MONITORING: NONE
0
NET DROP
(INCHES)
DATE OF MONITORING: 6/24/19
P
1
1:45 /1:54
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
9/17/19
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1:45 /1:54
9:02
6-1/12-1 / 12 16
6 16
2
1:54/2:04
10
616/1116
513
16
3
2:12/2:22
10
616/1116
516
4
2:23/2:33
10
616/1116
516
5
2:37/2:47
10
616/1116
516
6
2:49/2:59
10
616/1116
516
PERCOLATION RATE: 1.95 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 1 FT. and 2 FT.
COMMENTS: *PERCOLATION TEST DONE IN SM LAYER. THE 3'013 LAYER ON THE TEST HOLE LOG ATTACHED
TO THE PERMIT WAS NOT FOUND DURING INSTALLATION OF THE TRENCH.
DEPTH
(feet)
1
2
3
4
5
6
7
10
11
12
13
14
15
16
17
18
1
k��
SOILS LOG AND PERCOLATION TEST
E N G
LEGAL DESCRIPTION: WEST ADDITION KNIK HEIGHTS 132 L4
PERFORMED FOR: CLIENT
DATE: 6/4/19 PROJECT No.:
PARCEL ID#: 017-371-32 TECHNICIAN
TEST HOLE 1
(SILTY SAND) SM
(SILTY GRAVEL) GM
L. TIDWELL
SLOPE
WAS GROUND WATER ENCOUNTERED? N O
SI I L FLAN
SEE SITE PLAN
IF YES @ WHAT DEPTH? -
L
GROSS TIME
(MINUTES)
DEPTH OF WATER AFTER MONITORING: NONE
0
NET DROP
(INCHES)
DATE OF MONITORING: 6/24/19
P
1
10:06
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
6/19
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
10:06
111
10:36
30
11316
216
2
10:37
111
11:07
30
113,6
216
3
11:09
111
11:39
30
11316
216
PERCOLATION RATE: 14.1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: *PERCOLATION TEST DONE IN GM LAYER. THE TOB LAYER ON THE TEST HOLE LOG ATTACHED
TO THE PERMIT WAS NOT FOUND DURING INSTALLATION OF THE TRENCH.
c: 49 T_H `9
h'Ae�—
0
s SHANE A. HOLT �� G
LS -6914 y��4�
,\,°fessiona� �-Qo
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
AS-BUILTSURVEY 111 =301
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT4, BLOCK2, KNIKHEIGHTSWESTADD'N.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE, ALASKA THIS 997H DAY OF
SEPTEMBER , 2019
7990, FB 199-35
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
345-5513
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: OSP191270
Work Type: Septic Upgrade
Effective Date:
Expiration Date:
Tax Code Number: 01737132000
Site Legal Address: WEST ADDITION KNIK HEIGHTS BLK 2 LT 4 G:2836
Site Mailing Address: 12945 ELMORE RD, Anchorage
Owner: GRAVIER MICHAEL E & ANN Y
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
2 Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy
�Lg1C'F)j.
f
V f�
n
V•
llepartinent
7/5/2019
7/4/2020
Lot Size in Sq Ft: 46080
Total Bedrooms: 4
❑ 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: / /� Date:
Issued By: Date: 7 _ _
P)G9ZG1`
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-371-32
Property owner(s) Michael and Ann Gravier
Mailing address 12945 Elmore Road Anchorage, AK 99516
Site address Same
Day phone
Legal description (Sub'd., Block & Lot) West Addition Knik Heights, Block 2, Lot 4
Legal description (Township, Range & Section)
Lot Size 46,880 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank
❑X
Upgrade
pg �
Duplex (D)
El
Holding Tank
El
Renewal EJ
Multiple 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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 95,
Waiver Fees: _
Date of Payment: & /A'SJII Date of Payment:
Receipt Number: o53IaD Receipt Number:
Permit No. 05PI91,�t Waiver No.
Permit App_:;- : -
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
July 1, 2019
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: West Addition Knik Heights, Block 2, Lot 4 – 12945 Elmore Road
Septic System Design
Dear On-Site Services Engineer:
The owner of the above lot intends to upgrade his septic system to accomodate a 4-bedroom home.
We are submitting this permit application for the construction of a new septic system. The attached
site plan identifies the location of the home and the existing well and septic system and the
proposed septic system and alternate site. No conflicts exist between this proposed system and any
other well or septic system on this lot or adjacent lots.
The ground surface on the lot slopes gently to the southwest at shallow grades. There are no slopes
greater than 25% within 50 feet downslope of the absorption trenches. Ground surface contours
are shown on the site plan indicating the grade and direction of flow. Storm water drainage will
not impact this septic system. The new trenches will be constructed parallel to the slope as much
as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank.
Please refer to the attached test hole log and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, PE
7/1/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191270, Rebecca Carroll, 07/05/19
// // // // // // // // // // // //41
5
42
0
EXISTING WELL
CO
10050 0
FEET
1"=50'
54' LONG x 3' WIDE x 7'
EFFECTIVE DEPTH
ABSORPTION TRENCH
4
-BDRM HOMENOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
WEST ADDITION KNIK HEIGHTS, BLOCK 2 LOT 4
ELMORE ROAD7/1/19
SHED
SHED
5' UTILITY EASEMENT 10' UTILITY EASEMENT40' SETBACK LINE FOR NATURAL
GAS TRANSMISSION LINE ALONG
WESTERN EDGE OF PROPERTY.
(SEE NOTE ON PLAT NO. 76-189)
ALTERNATE SITE
CO MT
2CO
SV MH
DECOMMISSION EXISTING
SEPTIC TANK PER MOA CODE.
1,250 GALLON SEPTIC
TANK w/20" MANWAY.
ABANDON EXISTING
ABSORPTIN TRENCH.
TH1
EXISTING WELL
EXISTING WELL
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191270, Rebecca Carroll, 07/05/19
WEST ADDITION KNIK HEIGHTS, BLOCK 2, LOT 4
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 14.1 MIN/IN
APPLICATION RATE: .8 GPD/SF
7' EFFECTIVE DEEP TRENCH SYSTEM
1,250-GALLON SEPTIC TANK
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
6"
2.5'
7'
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 10' BELOW GRADE
FLOW LINE ELEVATION: 3' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
600 GPD / .8 GPD/SF /7' DEEP * 2 SIDES = 53.6 LF TRENCH REQUIRED (54 LF SPECIFIED)
7/1/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191270, Rebecca Carroll, 07/05/19
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
WEST ADDITION KNIK HEIGHTS B2 L4
6/4/19
L. TIDWELL
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
NO
-
NONE
14.1 6
3 4
017-371-32
CLIENT
10:06
6/19
1
2
3
30
30
30
111
113 3
16 2 3
1610:36
10:37
11:07
11:09
11:39
OB
SILTY GRAVEL
6/24/19
Professional Engineers Stamp:
7/1/19
111
113 3
16 2 3
16
111
113 2
16 2 2
16
GM
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191270, Rebecca Carroll, 07/05/19
HUNI(ilPALITY OF ANCHORAGE
and Environmenha] Prohoc
]:*our{~h Floor West
825 I, SLroeL
Anchorage, Alaska 99501
219'-2511, x 224, 225
TII.E DRAIN F:I['iLD:
L)I.', r/'.,f,l(R F R(Wv \'VEl_t_ {//~/, ~ OU,N!)£',~ ION ;,~i A~H % T L C,
I)EPllt: *for' ()f IlL! ]O I I'qlStt ¢;~/Al)[ ~ / i;,r. Prll o~ i ;; rEu. ,x~.,.,,~ ¢
· .MAILi~;a! Hl NI l'.llt TILl. . .f""'~.,,,--~f-~OVt{ TIlE ~ . .l":
SEEPAGFi PIT:
I.)I;',ME'II R ........ OR v/iD'ri4 ., {.I;;..~(;iI i I->l: P '!~ .............................
Log Ct: b ..... Rings ....
Crib Size: (';I/\MI;.'I[ tt .L)LPItt .- 1i)IS'I,%NCIi FI:OL~.:
ior~t ill FEE fIVE
NI:i/XRES1 t.or t ]NiL . /,F':;O ~ItON ~N[ fl (WALt.
Well
Cia. ~: _
' s~ Depth:
Well l}isbance To: Lob Line
Bld%: Sower I~ine:
Pipe Materia]_s: .~_.~S~'_ e
~ of Bedrooms: ~
I
Remarks:
fi,' {J:;? 'j i 'J'
lYF '::i
!;:*iii:()l..iJ",i[.' F:li~q[) i i'l[~; Ein];) J'"l'()i'i I::lj:::' 'J'!!l~:: I!{::'::L-:i:::?,,,*F!T ]: OJ",J ]: i',! ]::'!!:iJ:i' }
'! i Ji:::[~!{ :!: :i:i; J"di':~ :::;ii!': i 14 :I: fi:'Ti J F(:!P
'-iH!i::: (:iFi:F:iV[}i i':q!i'k:'l'i'! ]:'!i; "!J-il!!: !'! '! !"l :!: !'ii. tH [:'ii:::P'tl'! ()J:: I;[ij:i:F'dv'J{i i"!'d::' j'l,?:'i:!j',:i 'ii'iii ()i.!'!!::i:~i. ! !':'i:(:::'~'
i::!J'.,ji, '! j'l!::: I?,()'F'i'JZIj"[ (;!F -J'l'l!~{ J~:~'::(::F'?',"!:':! )' :!Z !?J",! ':: ): i",J J::: E;!~Z'!' )
May 12, 1977 R & M No. 751147
Kirk Allen
5419 E. 4th Avenue
Anchorage, Alaska 99504
Subject: Soils Investigation for Sanitary Sewer System, Lot 4,
Block 2, Knik Heights Subdivision, Anchorage, Alaska
Dear Mr. Allen:
At your request of May 5, 1977, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the
subject lot. The investigation complied with those procedures required
by the Municipality of Anchorage, Department of Health and Environmental
Protection.
This investigation, which was accomplished on May 10, 1977, consisted of
a test hole drilled to a ~ of 20 feet below the existing ground
surface. The location of the ~~shown in attached Drawing A-01.
Drilling took place with rotary drill rig using continuous flight solid-
stem auger with an outside diameter of 6 inches. A sample was taken at
the depth shown on the soils log in attached Drawing A-01. The sample
will be held in storage at our lab for approximately six months. In
addition, all material brought to the surface by the augers was continuously
monitored by an experienced engineering geologist.
The topography at the drilling site is generally gently-sloping to the
East. At the time of the investigation the site had original vegetation
and ground cover. The top of the test hole was located at original
ground surface.
The soils encountered in the bore hole are shown in the test hole log in
Drawing A-01. Groundwater was not encountered in the test hole while
drilling. BedrOCk w~s-no~t~nc~ntered~---~-~ocon'ditions may
vary in oth~"~-~-~-~---~-
We appreciate this opportunity to be of service to you. Please contact
us if you have any questions concerning this letter.
Very truly yours,
Jeffrey M. Ayres
Staff Geologist
Jim McCasiin Brown, Ph.D.
Head, Earth Science Department
JMA/RLS: bb
Attachments: Drawings A-01, B-01,
XC: Department of Health & Environmental Protection
WA~ILLA
LOCATION SKETCH
60'
t100 ',
Knik Heights Subdivision
Lot 4, Block 2
A
TEST HOLE LOG
Scale:.'["-3'-
0.0~
ORGanIC SILTY SAND,
Brown
SILTY SAND, (SM),
Brown
2.0'
GRAVELLY SAND W/SOME
SILT (SM), ~0
Brown, Wet, Medium Dense
--6.5"
SAND W/sOME GRAVEL,
TRACE SILT (SP~SW)
Brown, Slightly Moist,
Meditun Dense
.13.0'
SAND W/SOME GRAVEL, SOME
SILT (SM),
Brown, Slightly Moist,
Medium] Dense
Boulder @ 15'
Not To Scale
Distances shown are approximate
and have not been measured by
surveying methods.
SANDY SILT (ML),
Brown, Dry,
Medium Dense
--17.0'
20.0'T.D.
Groundwater was not encountered.
This log depicts subsurface soils
observed within the test hole at the
location shown.
See Drawings B-01 and B-02 for
explanation of symbols.
CKD: JMA
[)ATE: 5-11-77
SCALL:see above
CONSULTANTS,
LOCATION SKETCH AND
TEST HOLE LOG
KIRK ALLEN
PROd. NO 751147
~o-~, ~67 A-Ol
INVOICE N° 2248
M-W DRILLING INC, °ATE
UNIT
ANCHORAGE, ALASKA 99511 QTY. MATERIALS PRICE AMOUNT
PHONE 349-8535
:i '~ :~ /',.-~ /'
ADpRESq
~. ] "! } ,. { ~., ;>c I '-~1\)I '~ _:,
LEGAL DESCRIPTION
TOTAL MATERIALS
WELLNUMBER DIAMETER DEPTH_ I ~T~TIC L~VEL ..//~ ,") . /''(' GPM ~ DRAWDOWN
DESCRIPTION OF WORK
DATES
//'.. ~ ,''
> rt.--' / ./ .' -/ .'?/ /,/ .-, _'. /
::7 :" ' 5!'"
All charges shall be paid in full with/n ten
days unless other arrangefnents are made
prior to drilling. The customer shall pay in-
terest at the rate of 1~ % per month on any
amount not paid within ten days. Failure to
pay may result in a lien aga/Hst the property,
WORKMAN
DATE
CUSTOMER SIGNATURE
OUT
LABOR ; ' -
MATERIALS IFROM ABOVE}
OTHER CHARGES
PAY THIS AMOUNT
]i [i:::l:~.~t;i'.'rt'' :[ F'"r' THFFI"
:t..: ]: FII'"I t:::'i:::ll"i]:L...:l:l:tf;~ H:I:"I"H "ll'UEi!: F::'.E:QIJ]:Fi'.l;~.:l"ll!it'.,l"l':iii; F:'OF~: Ol'.,I.....::ii;:l:'Fl~: ~i;EHI~!:I:~'.'.!~; FIN[:) HEI..I.:~; F:I:~;
F'OF~'."I"H E:'?' THE h'ILII'-,IZE:]:F:'FtI...]:T'.~.' OF FIt'.,ICHOI~'.FIGE.
2: :1: I.,.t:l:IJ... :[I'.,IS"I"FIL. L. THE ~5'~.'~;TEI"'I 3:1'.,I I:::IE:E:p:::~F~'.[::,FII'.JI::::{~: I.,.l:['l"l.I TF.IE~: E::O[::,E'.~5.
~; :l: GI'.,IE:I:::, ' ......... ~.....~._....~~~ .....................................................
I::t F' F'I.~ E:I::I N "l" ~::; ]: F~'}:::
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 017-371-32
Certificate of On -Site Systems Approval
Expiration Date: I' 4— 2(9 Zo
1. GENERAL INFORMATION
Complete legal description West Addition Knik Heights Block 2 Lot 4
Location (site address) 12945 Elmore Road, Anchorage, AK
Current property owner(s) Michael & Ann Gravier Day phone (907) 903-6574
Mailing address 12945 Elmore Road, Anchorage, AK 99516
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distan
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 296-
!Z3
Date of Payment 1/�frt
Receipt Number 6T1 & ?b
COSA # .`)c !91 qq9
Waiver Fee $
Date of Payment
Receipt Number
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 9/20/19
ur A�q 4
° 49th '
6_ DSD SIGNATURE
p....4-Cst+a.J� C ....sy„a7•i..
....................................
System #1 Approved for bedrooms °off, ; PdICHAEL E. ANDERSON
—4—
System #2 Approved for bedrooms �4�'s No. CE -4381 •'
Y pp 00000FoP...2oi�s..���®®c�
Disapproved ®®o oa®®S�S� �®
Conditional approval for bedrooms, with the following stipulations:
llll(((i
r—, /A 1 L ll A A t r.
O
'/llatr... %,%W I
By:L—L6Original Certificate Date: d - /--/
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:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: West Addition Knik Heights Block 2 Lot 4
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled Unknown
Total depth '75 ft
Cased to >40* ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 9/17/19
Parcel ID: 017-371-32
Structure served by this system
Well production at time of test 3.8 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 8.30 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 9/17/19
Static water level at beginning of test 79.4 ft.
Comments *See Aarow Pump & Well Service inspection report in MOA public records.
B. TANK DATA
Age of tank(s) 816119 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New Construction
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 8/7/19
❑ ALL standpipes present per record drawing
Total measured depth from grade 10.8 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date New Construction
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0✓ Yes
if No
Community Sewer Manhole/Cleanout > 100'
✓7v Yes
if No
ft
0 Yes
if No
Neighboring Tank > 100' [71 Yes
if No
ft
Private Sewer/Septic Line > 25'✓0 Yes
if No
Absorption Field on Lot > 100' F/ Yes
if No
ft
Holding Tank > 100' 0✓ Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' 0✓ Yes
if No
✓0 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' F71 Yes
if No
ft
0 Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
0✓ Yes if No ft
Property Line > 5'
0✓ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
[Z] Yes
if No
ft
Private Wells > 100' 0 Yes if No .
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200' Q Yes if No _
Water Service Line > 10'
0✓ Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
✓0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' ®✓ Yes if No
Water Service Line > 10'✓0
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No
Surface Water > 100'
✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
Septic tank and absorption trench constructed 8/6-7/2019.
G. ENGINEER'S CERTIFICATION
l 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.
COSA Checklist yellow sheet
f� *.
49th.
MICHAEL E. ANDERSONe
No. CE -4381 ,•w� 0
• 9/20/19
ft
M
ft
ft
----------------------------------------- — — ---
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Nitrate Advisory
Certificate of On -Site Systems Approval # osc191449
Subdivision: West Addition Knik Heights, Block: 2, Lot: 4
A water sample revealed a nitrate concentration of 8.3 milligrams per liter (mg/Q.
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.
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.
��� � � �1 gAd"dre���O $ox�,55650<� Ante, etas at�99519 6650 �wu���ittun� orgy � ������;
"~-.-'i ..... 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 u/ ~
www.rnuni.org/onsite /'~ {] ~"~
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE'~:'AHILY DWELLING
Parcel I.D. 017-.571-32
1. GENERAL INFORMATION
COSA / //')_'5
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KNIK HEIGHTS WEST S/D; BLOCK 2, LOT 4
12945 ELMORE ROAD * ANCHORAGE~ AK * 99516
DAN PERRY Day phone
12945 ELMORE ROAD * ANCHORAGE~ AK * 99516
Day phone
830-0380
Day phone
Un/ess otherwise r~quested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site 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 ca~fied by my seal a~xed hereto and as of the validation date shown below, I vedfy 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 vedfy 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 b'me of installation.
Name of Firm CARNESS ENGINEERING CROUP, Ltd. Phone
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORACE, AK 99507
Engineer's Printed Name JEFFREY A. CARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conducb~g 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. The operational life of alt wells and
septic aystems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage cf 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, horde 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 benefit 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
I/'"'" Approved for, ~ bedrooms.
Disapproved.
Conditional approval for __
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ "~ O -/O .
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Prog~arn
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS ~,PpROvAL CHECKLIST
Legal Description:
KNIK HEIGHTS WEST S/D; BLOCK 2, LOT 4
Parcel ID: ~ 1 7 ' ,3 ? I" ~..?..
A. WELL DATA
Well type pRIVATE~ IfA, B, orC provide PWSID# N/A
Date completed UNKNOWN Sanitary seal(Y/N) YES
T0taldepth '81+ ff.
*PER INSPECTION BY ARROW PUMP AND WELL SERVICES.
Well Log (Y/N), NO
Wires properly protected (Y/N) YES
Casing height (above ground). 12+ .in.
Cased to *45+ ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform i 0 coloniesll00 mi.
Jif.
g.p[m.
AT INSPECTION
5/24/2010
88 ft.
Other bacteda 0 colonies/100 mi.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1 lOOO gal. Number of Compartments
Foundation cleanout (Y/N) YES
Date of pimping 3/17/2010
C. ABSORPTION FIELD DATA
Date installed 9/29/1977
Soil rating (g.p.d./ft~oQ 135
Date installed 9/29/1977
2 cleanouts (Y/N) YES
Depression over tank (Y/N) NO High water alarm (Y/N) N/A ~
Pumper A+ HOME SERVICES
Length 38 ft. Width 3 .ft.
Totaldepth *.13.5 ff. Eft. absorption area 494 ,fi2 Monitoring tube YES
' Results (Pass/Fail) PASS
Date of adequacy test 5/24/2010
Fluid dep!h in absorption field before test **66 In.;. Water added ,4'50, gal.
Elapsed Time: 140 minl Final fluid depth **68 In. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - __
*'NOTE: 'MONITORING TUBE ONLY EXTENDS 1.5 FEET INTO DRAINFIELD. TOTAL DEPTH IS CALCULATED PER 1977
INSPECTION REPORT AND GEG LTD, INSPECTIONS. UQUID LEVEL WAS 12' BELOW THE INVERT AT START OF TEST.
System type TRENCH
Gravel below pipe 6.5 .ft.
D~Pression over field NO
For ,3 bedrocms
New depth **72 in.
450+ g.[3.d.
Arsenic: ND ug.lL.
Nitrate 6.69 rog.IL.
Date of sample: 5/24/2010 Collected by:
4.,3,3 i g.p.m.
CEG Ltd.
D. LIFT STATION
Date Installed Size in gallons ~ ~
'Pump o~~ High water alarm .level at : in.
Datum ~ C~ts alarm &circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldlift station on lot *95' On adjacent lots. 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N,/A
Sewer/septic service line 25'+ Holding tank N,/A ~
Animal containment areas 50'+ 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 10'+ Surface water. 100'+ '
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ 10'+
Water service line 10'+ 100'+
Curtain drain . NONE KNOWN Wells on adjacent lots 100'+
Building foundation.
Surface water
Water main N,/A
Driveway, parking/vehicle storage
: 10'+
F. COMMENTS
*PER EXISTING WANER #WR000051
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. (;ARNESS
COSA Fee $ '7 ~'/,,
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number.
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
12945 Elmore Road
Well was inspected by camera down to 45'. No perforations were noted above 45'.
Brian R. Wille
Aarow Pump 8: Well Service
S_G -S
SGS Ref.# 1102305001
Cllent Name Gamess Engincerlng Group, Ltd printed Date/Time 05/28/2010 15:21
Project Name/# Knlk I Its 9,'cst B2,L4 Collated Date/Time 05/24~010 I 1:30
Client Sample ID Knik I its West B2,L4 Received Date[l~lme 05/24/2010 12:10
Marlex Drinking Water Technical Director Stephen C. Ede
PWSID 0
Sarapl¢ Remarks:
4500NO3 - NitratedNitrite - MS did not meet QC criteria,biased low. LCS mee~s QC criteria.
Allo~'able P~p Analysis
Metals b~ ICP/MS
Arsenic
ND 500
ug/L EP200.8 C (<101 05/25/10 05/26/10 NRB
Waters Department
Total Nitratc/Nitrit¢-N
6.69 0.100 mg/L SM204500NO3-F B (<101 05,'24110 AYC
~Li crob~ology Laboratory
Colony Count 0
Fecal Coliform 0
Total Colt fom'~ 0
col/100mL SM20 9222B A (<200)
col/100mL SM20 9222B A (<D
col/100mL SM20 9222B A (<1)
05/24II 0 DLC
05/24/I 0 DLC
05/24/10 DLC
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elraore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 101103
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 4 of
Knik Heights West subdivision. This inspection revealed a nitrate
concentration of 6.69 milligrams per liter (rog/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 OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services - ' ·
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
; .". ,':-' '?' ' ~::' ! i - :'~'~ 'CERTIFICATE OF:HEALTH AUTHORITY
:~;~,:?. ~:?r-..,'. !'? ,., ,-' !":':'?APPROVAL FOR A SINGLE FA~IELY DWEL:LING -.
Pardi I.D. ~ ' 017-371-32' : "' ~ ]
........ :~ :.. . . ;,~ ,... ~' .., _ ;- ;.,.,:¥ . .:
': '/ "'% ' n"':- ; ; S~D.';LOT:~:';¢ -;2
-. .......... letet ....... . - . ,.-~. .
· Location (siteaddress,or,d~mctlo.ns)12945 ELM0RE- ROAD· ANCpQI~ApI~.: AK 9951
"'~t. Pr0pertYowner 'JAMES ARMSTRONG 7 --, .... ~ Day phone*,(907) 227-0726
':'~ IglA no ~ddf~' '-~ P : BOX 2935' VALD~ AK 99686
"': ~:: .,L~h:ainga~:~;;~ 'z ' - :"_'-'--~:':' : _ ' ~- :Day phone' · -:
.... Mailing'address '
.Agent :".~--: ..-
'Address
Day phone
3. TYPE OF WATER SUPPLY:.
-Un/ess 'bt"h'~se requested, HAA will be held forPick'up.
· ' XXX
IndiVidual Well . .
'"" -' ~0mmUni~".'well" 't~ "
Public water
NOTE"If community well system, provide wdtten confirmation from State ADEC
lng to the legality and status of system.,~.'<-;"
4, TYP~O. F-WASTEWATER DIS POSAL:
Individual on-site xXX
Holding Tank
Community on-site
Public sewer
If community wastewater system, provide wdtten confirmation from State ADEC
lng to the legality and status of system.
NOTE:
72-025 (Rev. 1/91 ) Front MOA #21 Computer Version
'Note: Alaska Water and Wastewater Consultants, Inc. shaft be paid $1000.00 at,
. orprior to, closing for the engineering services providec~.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vad~ that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastawatar disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I furl.her.verify that.based on the information obtained from the Municipality of
Anchorage filesand from my investigatipn ~nd insp /(ion;.the bn-site water Supply and/o~' waste',~atar
disposal system is in compliance With all Municipal ~d State ~odes, ordinances; and regulations in effect
. 0nthed~te.ofthisinsP~ction- ' ~;;'
"a'm'~ of Firm'-:ALAsKA ~ ~&~ ¢~,~'~/~; R CONSULTANTs,' INC. Phone (go?)337-6179
system in a~rdan~ m'th ~EC and ~( ~ 'D~J fS Guidelines'&. R~ula~q~S. ~he ,r~ ~esults des.cd, the ':
peffo~an~ of the system' under th~ ~ndiCo~ en~unter~ at the ~me.of the test, and separation distends
measur~ tO?eadily identifiabl~' ~eatbres: ~eto~tlonbl life of-~ll ~lls add S~btic S~Stems db~h~ ~
on the I~18oils ~ndi~io~, ground wateY I~1~ 'that may flucfuate during the Y~ac anb the ~ter ' -' .~ : //
usage of the'fable being Se~ed b~ the :~tfm. These' ~,ditions' a~e o~Slde the.~tml Of., ' ~
the e~/UatO~ of the s~tem. Satisfacto~ test results do nbt guamntee f~ure pe~Srman~ ~-" ~,
of the system, nor do they gu~rafitee that there am ho.hidden clefts or encroachments... ~ ~' ;
A~C, inc; ~fi therefore not proffde anY waffan~for~ure eSt/mate of ho~ lon~ the . : ~;;.~ ~
system ~/I ~ntinue to m~t the o~rational r~uirements of the ~EC 5r MOA DHHS. . ~~~ ....
The~ntentof~hisrePo~lsforthesole~n~fitoftheo~er~lsted~ve.~y ' ~
nor ~11 it ~ner any legal dght ~atsoever. . ~ ' ..' '~ffr~/A..
~ Approved for ~ bedrooms.. :.. .
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date
3;he ~unicipality of'~,~chorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Cedificates 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 requirementsr Employees of
DHHS do not conduct inspections or analyze data before a certificate is IsSued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Sock MOA #21 Computer Version
( CEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907)
Health Authority Approval Checklist
LOT 4, BLOCK 2 Parcel I.D,:
Legal Description: KNIK HEIGHTS WEST S/D;
If A, B, or C, attach ADEC letter. ADEC water system number
NO Date completed
Cased to
017-371-32
YES
N/A
40'+ Casing height (above ground) 18"
Wires propedy protected (Y/N) YES
AT INSPECTION
6/20/2000
A. WELL DATA
Well Type PRIVATE
Log present (Y/N)
Total depth 81 +
Sanitary seal (Y/N)
FROM WELL LOG
Date of test ,
Static water level
Well production ~g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 Nitrate
Date of sample: 7/3/2000
B. SEPTIC/HOLDING TANK DATA
Date installed 9/29/77 Tank size
Foundation cleanout (y/N) YES
Date of Pumping 6/20/2000
C. ABSORPTION FIELD DATA
Date installed 9/29/77
Length 38'
Effective absorption area
Date of adequacy test
Fluid depth in absorpiion field before test (in,);
Fluid depth. DRY (ins) Minutes later:
Peroxide treatment (past 12 months) (y/N)
724)26 (Rev. 3/g6)* Computer Veto Jori
74'
18"
4.27 m~l/L Other bacteria
Collected by: A.W.W.C., INC.
g.p.m,
1000 Numberof Compartments 2 Cleanouts (Y/N) YES
Depression (Y/N) NO · High water alarm (Y/N) N/A
PumperA+ HOME SERVICES
Soil rating (g.p.d./ff2. or ff2/bdrm~. 135 .System type TRENCH
Width 3' Gravel thickness below pipe 6.5' Total depth 12.5'+/-
494 SQ FT Monitoring Tube present (y/N) YES Depression over field (Y/N). NO
6/20/2000 Results (Pass/Fail) PASS For 3 Bedrooms
DRY Immediately after 1012 gal. water added (in;): 12"
720 Absorption rate = 450+
NONE KNOWN If yes, give date
D. LIFT STATION
Date installed_ Size in
Manhole/Access (Y/N) ~at* "Pump
tevel
at*
High wa~ ~.t~~ *Datum
E. SEPARATION DISTANCES I *WAIVER REQUESTED 7/11/20001
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/hoIding tank on lot *95'
Absorption field on lot 100%
Public sewer main
Sewer/septic service line 25%
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
I.iff station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10% Surface water/drainage 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Absorption field
Wells on adjacent lots
5'+
100'+
Property line
Surface water
Curtain drain
F. ENGINEER'S C.~
I certify that I ~l'ave
of Municipal tbcor(
with MOA H~A gu~
Signature
Engineer's Natty
Date '
10'+ Building foundation
10'+ Water main/service line
100'+
Driveway, parking/vehicle storage area 10%
NO~ KNOWN
iqb~l,t,~r~ tleld inspections and review.
ge ~/)Sov systems are in conformance
n
this date.
JEFFREY A. GARNESS
Wells on adjacent lots
HAA Fee $ ~
Date of Payment
Receipt Number
72.020 (Rev. 8/90)' Computer
Waiver Fee $
Date of Payment __
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Services
Waiver Review Worksheet
WR#: WR000051 PID#: 0t7-371-32 HA#: HA000 Permit#:
Date Received: July t0, 2000
Legal Description: Kntk Hei~lhts West, Lot 4, Block 2
Engineer: Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, suite 2-B, Anchorage, AK 99504
Applicant: James Armstron~
Waiver Requested: 95 foot separation distance waiver from the well to the septic tank on the
subject property
Criteria: 1.
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
Total:
2. Special Conditions:
3. Other:
Waiver is Granted:
List Conditions or Reasons for above:
Waiver is not Granted:
Date:
Rec~: 0669'1 Amount: $625.00
By:
Name of Reviewer
Date Paid: 7/10/00
®
vR~V~R R£q~$r fp~ rH~
'7'7'7
2.7
2.0
6-Rnk~
ALASI WATER & WASTEWATER
July 11, 2000
Municipality of Anchorage
Department of Health & Human Services
Attn: Dan Roth
P.O. Box 196650
Anchorage, Alaska 99519-6650
CEIVED
dOL 1 1 000
MUNICIPALITY OF ANCHORAGE
"me~!MENTAL SERVICES DIVIo''
Subject: Knik Heights West; Lot 4 Block 2; Waiver of Separation Distance from Septic
Tank to Well
0 17- Z7/
Dear Mr. Roth,
Recently our firm tested the well and septic system on the subject property for purposes of
obtaining a Health Authority Approval. During our field evaluation we found the septic tank to
be only 95 feet from the well.
We are requesting that your department waive the subject separation distance to 95 feet.
Justification for the waiver is summarized as follows:
1) There is no well log for the subject property. The static water level was at 74 feet prior to
starting our well flow test. Neighboring well logs (see attached) show depths from 99' to
117' and static water levels between 77 feet and 88 feet. All of the logs indicated confining
layers of hardpan or clay / sand / gravel.
2) The topography of the land is such that the well & septic tank lie generally along the same
contour line. If the tank was to ever leak or overflow, it would flow toward the north property
line (see topography map attached) and not towards the well.
3) The existing encroachment has existed for 23 years with no major impact to the aquifer.
4) Recent water samples taken 7/3/00 indicate no bacteria and nitrate levels of 4.27 mg/L (see
attached water analysis). Although the nitrate level is slightly elevated, it is probably not
related to the septic tank encroachment. Attached are copies of nitrate samples for lots 2 & 3
of Bk. 2 which showed nitrate levels of 2.04 mg. & 3.9 mgL respectively.
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * email: info~akwwc.com
Page Two
Knik Hts West Lot 4 Block 2 Waiver Request
It is our opinion that the required 100 ft. separation distance bom the private well to the tank
could be waived to a 95 feet without adversely impacting the subject aquifer. If you have any
questions, please c~ntact me at 337-6179. Thank you for your consideration regarding this
matter. // ,q
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * email: info~akwwc, com
/
/
/
LOT 5, BLOCK 2
KNIK HEIGHTS WEST
WELL -
/
~-TRENCH
LOT 5, BLOCK 2
KNIK HEIGHTS WEST
ALASKA WATER & ~VASTEWATER
CONSULTANTS, INC.
PREPAREO FOR: PHONE NUMBER:
JAMES ARMSTRONG (907) 227-0726
LEGAL DESCRIPTION:
KNIK HEIGHTS WEST S/D; LOT 4, BLOCK 2
DATE:
7/11/2000
DRAWN BY:
K.D.W.
1" = 40'
NUMBER:
1 OF1
OF WORK:
WAIVER: WELL TO SEPTIC TANK
LOT 3, BLO K 2
LOT 7, BLOCK E
~7-0726 I~F 1
,O0'§9L 3,,OL,~OoO S
,O0'g9~ ~,,00,~0.0 N
ELHORE ROAD
07-05-00 20:58 FROM-CTE ENVIRONMENTAL
zt~__- CT&E Environmenlal Services Inc.
5615301
T-O?8 P.02/05 F-405
CT&£ Ref,~
Client Name
Project Name~
Clieal Sample ID
Matrix
Ordered By
PW$1D
1003567001
AK Water & Wastcwater Consultants Inc.
Kni~ Hts W Lot 4 BIk 2
Kink Ht$ W Lot 4 Blk 2
Drinking Wa~er
Sample Remarks:
Clieu~ PO#
Printed Date/Time 07/05/2000 13 44
Collected Date/Time 07/03/2-000 13 00
Received Date/Time 07/03/2000 14 05
Technical Director Stephen C. Ede
b.27 0,500 ~/L EPA 300.0 10 man 07/flSl00 $Cg
COMMERCIAL TESTING & ENGINEERING CO;
Ghemlab Ref.# :93.2551-i
Client Sample ID :i2845 SOUTH BRAGAW TAP WA'£~
Hatrix
Client Name
O~dered By :3~'F GARN~SS
P~oJect Name
PrOject#
I~SID
:AK WA'I%~R & WASTEWAT~ SERVICES
5633 B STREET
~,NCHORAGE. AK 99518
TEL: (907).~62-2343
FAX: (907)'561-5301
WORK Order :66790
Report Completed ~06/07/93
Collected -. ~06/03/9~"@ 15~15 ~r.s.
Received :06/03/93 ~ 15i40 hrs.
Technical Dtrector~S'l~C. EDE
ReleasedB¥
Sample Remarks: ROUTINE SAMPLE COr.r.W~gT~iO BY: GARNESS.
QC Allowable Ext. Anal
Parameter Results Oual Units Method Limits Date ~, Date. Init
Nitrate-N 2.04 ~/L EPA 353.2/300.0 l0 0,6/04 LLH
* See Special Instructions Above
** See Sample Remarks A~ove
U = Undetected, Reported value is the practical quantification limit.
D = Secondary dilution.
UA.= Unavailable
· NA.= Not Am~l~Zed
LT = Less'~fl~ '
GT = Greater Tha~
Member of the SGS Group (Soci~t~ G~n~rale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND. WEST VIRGINIA. NEW JERSEY, SOUTH CAROLINA
EPORT;~
' ' ,, 6633 B STreet. ,f~ge. AK 99S18.16~ -- Tel: (~fl 662-2343 Fax ~ 561.5301
WATER WELL LOG
FOSS DRILLING
1336 Ingra Street
A~chorage, A~aska 9950!
WELL OW~ , ....
LOCATION
to
to
to
to
to ,
___to
to
to
to
to
,,to
to ,
to
to
to
SIZE OF CA~ING~" DEPTH OF HOLE//~T. CASED TO //D PT.
PEET OF DRAWDOWN.
REMUS
DATE COMPLETED,, ~/~./?~ PUMP TO BE SET AT_~.
/~to/_Z~ ~ .
/~o~ " w ~ ~
/ ~to~ ,~ ~. w/~~
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# (')f'~- ~:~l ~L. HAA# ¥~6'~CI
1. GENERAL INFORMATION
Complete legal description L 4 ¢ ~ E'r~"~\(. ¢t'l~ UJ~F
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent ~h
Address
Day phone
Day phone
Day phone
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Unless otherwise requested, HAA will be held for pickup.
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
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.
72-025 (Rev 1/91) Fronl MOA~21
')]JO/~ S,J@@u!BuG leuo!sse~oJd @ql u! suo!ss!uJo Jo sJoJJe JOj 91q]suodsGJ
lOU si @beJoqouv ~o Al!l~d!o!un~ eq.L 'penss! s! a],eo!j!peo ~ eJo~eq e~ep eZAleUe Jo suo!~oadsu! lonpuoo
~ou op SHHC] jo saaAold~u:E] 'sluauJ@J!nbaJ e~e],s pue leJapaj u!e]Jeo/gs!les ol J@pJo u! suo!lnl!lSU! bu!pu@l J!eq], pue
. seLuoq ~o sJeseqoJnd o~/,s@]Jnoo e se s!q~ seop SHHQ aq.L '8)~SBlV-Jo e181S @ql u! peJ@lS!69J J9eu!Ou9 I~UO!SS@joJd ....
~uapuedapu! ue ~q a^oqe ~ qdeJbeJed uj ue^!b suo!le~u@saJdeJ eq~ uodn ~lUO p~seq sG~Bo!j!]J@0 le^oJddV
/q!Joq]nV qlleaH sanss! (SHHQ) saoFueS ueu~nH pue qlleaH ~o lueLupedac] e68Joqouv Jo Al!led!o!unl/~ eq.L
S~u@wwo0 leUO!~!PPV
:suo!jelnd!ls 8U!MOII0t eql q]!M 'SLUOOJpeq
'suJooJpeq
Joj leAoJdde leUO!llpuoo
'peAoJddes!Q
JOt paAoJddv ~
~fll~N~lS SHH~
'9
,g
Legal Description:
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A, WELL DATA
Well type
Log present (Y/N)
Totaldepth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
Cased to -P-"7 ~'~
't
ADEC water system number
Driller
Casing height
Wires properly protected (Y/N) ~'
Date of test
Static water level "7'~
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot log'
Public sewer main + '7_.~o '
IoOt
; On adjacent lots
; On adjacent lots
__ Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform /~
Date of sample:
Nitrate
Collected by:
Other bacteria
B. SFPTIC/HOLDING TANK DATA
Date installed ~ f-z_oj/~.~. Tank size I OOC)
Cleanouts (Y/N) ~Y' ('/~_ Foundation cleanout (Y/N)
Compartments
High water alarm (Y/N)
Date of pumping
¥ Depression (Y/N) ~'d
Alarm tested (Y/N)
To property line '-70'
Surface water/drainage
SEPARATION DISTANCES FROM SEPTIC/14OLDING TANK TO:
Well(s) on lot l oo~ On adjacent lots
Absorption field
Foundation
Water main/service line
72 026 (Rev. 7/95) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Manufacturer
Manhole/Access (~Y_/N) .'~
"Pump on" level at,~ ~--'-'~ "Pump off" level at
hl~_~----~'~''-~j/'' Cycles tested
Meets MOA electrical codes (Y/N).~, .......
SEPARATION DISTANCE FROM LIFT STATION TO:
Well or~ lot On adjacent lots
D. ABSORPTION FIELD DATA
Surface water
Date installed ~®
Length "~' :'-' Width '~
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating ~%~ System type
,,~.ravel thickness ~' %~' -- Total depth I~..o
~'~?~; Cleanouts present (Y/N)
Date of adequacy test ' ?~ .~
for ~
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots t' ~' Property line ¢o'
To existing or abandoned system on lot ¢J ¢5
Cutbank +-I °(-) ~ Water main/service line +' ~
Driveway, parking/vehicle storage area 4-- ~ ~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ~.h_is inspection.
Signature ~ , ~ "A ~
Engineer's Name /~7~ ~¢~' /~ l~:3':~
Date
effect or&t4.e.~
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES INC.
3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456-3116 · FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 (907) 277-8378 · FAX 274 9645
Constructing Engineers
9601 Buddy Werner Drive
Anchorage AK 99516
Attn: C. Landers
Report Date:
01/04/93
Date Arrived: 12/31/92
Date Sampled: 12/31/92
Time Sampled: 1150
Collected By: CL
Our Lab ~: A121898
Location/Project: Knik Heights West
Your Sample ID: L4, B2
Sample Matrix: Water
Comments:
Lab
Number Method Parameter
* Definitions *
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Estimated Value
M = Matrix Interference
D = Lost to Dilution
MDL = Method Detection Limit
Date Date
Units Result * MDL Prepared Analyzed
A121898 EPA 353.3 Nitrate-N mg/1 3.0 2.5 12/31/92
Reported By: Sus
Microbiology Supervisor
Property Owner
APPLIC- NT FILLS OUT UPPER HAl. '" ONLY
Buyer
Address Zip Code
Phone
Phone
Legal Description ,/. ~, ,~.~
Street Locatio~ I'',~' ~-\, t ~
Type of Residence [~ Single Family
[] Multiple Family
[] Other
No. of Bedrooms. '~:
Water Supply
; {ndiyidual -i ATTACH WELL LOG. A we~l log is required for all wells drilled since .June t97§.
Community ~ ' ': For wells drilled prior to that date, give well depth (attach log if available),
[] Public Utility
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.
0
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field
Noles:
DEPT.
OF
H~ALTH
ENVIRONMFNfAL PROTEC liON
RECEIVED
( ~,~ APPBOVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITI(~NAL AJ~P. RO.~'AL"
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received /V'
;'~ "" "7 '? Well to Tank Septic Tank Size
72-023 {3~82]
ARCTIC ENGINEERS, iNC,,
July 6, 1983
83-013-15
Kirk Allen
SRA Box 1561 Y
Anchorage, Alaska
LEGAL:
OWNER:
HOUSE TYPE:
WATER SYSTEM:
SEPTIC SYSTEM:
TEST DATE:
PROCEDURE:
SEPTIC SYSTEM ADEQUACY TEST
Lot 4, Block 2, Knik Heights-West Addition
Kirk Allen
3-Bedroom, Single Family
Individual On-Site Well
From MOA Records
Tank:
Absorption Sys;
Absorption Area:
Soil Rating:
Approval Date:
June 30, 1983
Water was dumped into the absorption system through a 4"
cleanout in 100 gallon increments. A total of 1000 gallons
was input to system without causing backing up or significant
liquid level rise in the system.
1000 gal. Greer, 2 compartments
Trenchf 6.5'D x 3'W x 38'L
416 sq. ft.
135
9/29/77
Kirk Allen
Adequacy Test
83-013-15
-2-
RESULTS:
The system absorbed 1.5 times the daily design capacity
for a 4 bedroom house. It is adequate for a 4 bedroom
house by the M~icipality of Anchorage requirements.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PR~F~I~Ty OF ANCHORAGE
825 L Gtreet - Anchoraga. Alaska 99501 DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 0CT~:~ 1978
^...ow,_
DI REOTIONS: Complete all parts on page 1. incomplete requests will not be processed. Please allow ten (10) days for processing.
1, PROPERTY OWNER PHONE
MAILING ADDRESS
'2, BUYER
PHONE
PHONE
MAILING ADDRESS
MAILING ADDRESS ~.)/ ~'~
4, REALTOR/AGENT
PHONE
MAILING ADDRESS
PHONE
5. LEGAL DESCRIPTION
Lob
;TREET LOCATION ~
6. TYPE OF RESIDENCE
SINGLE FAMILY
M~kTI~kE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] -wo [] Five
~' Three [] Six
[] Other
7, WATER SUPPLY
[ '~C" INDIVIDUAL*
[] COMMUN 'FY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAl. SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC U'I"I LITY
ATTACH WELL LOG. A wel log's required for all wells drilled
since June lg75, For wells drilled prior to that date, give wel
(attach Icg if available.)('/Tf-/7
depth
**If individual/on-sit~ give installation date ~-/.r~
If system is over two [2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION F. EE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED '
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF REsiDENCE NUMBER OF BEDROOMS
E~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~ ~ ~7
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank ~ ~-k/t/'7-O ~
Size: [Oc~KD If Tank is homemade SOILS'RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
PPROVED FOR BEDROOMS
{~ I~ CONDITIONAL APPROVAL {letter must accompany certificate)
[] DISAPPROVED //~
DATE BY {T~) / .~~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
October 13~ 1978
Kirk Go Allen
Star Route A Box 1561Y
Anchora~¢e ~ Alask~ 99507
Subjec't; Lot 4 Block 2 Knik tleiqhts Wc, st Subdivision
9~'his depar'[:~-~:ent can nolx process your requ~,~st fo): approval
on the on-si-to s~wer an~'{ well until a well log has been
submitted to this office.
Also~ the water ~naly~]J.~ report mus'~ b~: brout~ht into this
office°
If there are any furth(~r <BTestions, please contac't this
office, at 264~4720.
Sincerely~
Rob(~rt Co Pratt~ R.~3.
Associate Specialist