HomeMy WebLinkAboutSHENANDOAH HILLS LT 4henandoah
Hills
Lot 4
#015-212-41
""JNICIPALITX OF ANCHORAGE
Heals and Environmental Protect
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
----- INSPECTION REPORT ON-SITE SEWAGE DI POSAL SYSTEM
__
NAME���'��- MAILING ADDRESS %Ldp`. 1. PHONE
s
LOCATION
SEPTIC TANK:
LEGAL DESCRIPTION
DISTANCEn NUMBER OF
FROM WILL_�U __ MANUFACTURER �� MATERIAL -�!j-/- COMPARTMENTS_ _
-�-- -
INSIDE LENGTH___— - INSIDE WIDTH-.__ LIQUID DEPTH _ LIQUID CAPACITY - �"d GALLONS.
TILE DRAIN FIELD:
J / TOTAL LENGTH �/ /
DISTANCE FROM WELL -52
FOUNDATION!��T/ W NEAREST LOT LINES _-OF LINE
Of Lines ._ DISTANCE BETWEEN LINES//9--.-TRENCH WIDTH 3�e IN. TOTAL EFFECTIVE
i x^/
ABSORPTION AREA V— __ SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER }p/(� ,� �/
DEPTH: TOP OF TILE TO FINISH GRADE - /Y OATERIAL BENEATH TILE�sTq. ABOVE TILE _./ IN,
SEEPAGL PIT:
DIAMETER --OR WIDTH _-, LENGTH_, DEPTH
Log Crib Rings Crib Size: DIAMETER____UEPTH-_DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDINC FOUNDATION-__, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
well
Class :�n Depth:
Well. Distance To: Lot Line ,
I31dg: Sewer_ Line: i- --r
Pipe Materials: ,
4 of Bedrooms: i
Installer:
Remarks: I i
I
- I I
I
J
DATE -Z2 APPROVED
�r
10-
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11IIY
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J-11-
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1-4-1
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DATE -Z2 APPROVED
.III Ir. -III fl� A: W owl 0 J: I Up0- VI So R 11 1 UJX���vh� �.
DEPMH|MENl Ut- 4EHL|H RND ENV]kUNMEIII THL P| r
/ 825 'L' ,TREET. HNCHORHGE/ HK995�^
/J}4
HPPLlCHNT DHVE DEHN/S CyNSlRUCTlO BUX 115 CHICKHLOUN ST EHGLWE R b94~9]87
LOCn[1UN ��ENHNDOHH PLHCE ^
LEGHL L4 E 62916 SQUHRE F�ET
(YPE OF SOIL H8SUkBTIUN SYSTEM IS� TRENCH
MHXlMUM NUMBEH OF 8EDROOMS � ] SOIL RHTlNG (SQ PT/BR)� 175
I1Im REQUIHk.D SIZE OF THE SOIL H8SORPT1ON SYSTEM IS:
ILD fr. b" -0'-I- �� NWIZ ��� �R �_' P_.. �::;- 11 "'" H.�� �
|HE LENG[H DlMENSlON IS THE LENGTH (IN FEET) UF THE TRENCH UR DkHINFlELD
THE DEP1H OF H TRENCH OR PIT IS THE DISTHNCE 8ETWEEN THE SUHFHCE OF THE
bHOUND HND THE 8OTTOM OF THE EXCHVHTlON (IN FEE[).
THERE lS NU SET WIDTH FOR T1-..!EN13HE5.
lHE GRHVEL DEPTH lS THE MINIMUM DEPTH OF GRHVEL OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTlON (1:N FEE[).
���K_J A. R�:! 0_-- KE.": 11-:-:"~N * J: U~K-1 P4 ����A If It I�
~.... .... .... �~~~^������������1: C-4 VA ~~�~�������
H PHCKHGE Fl. HNl MHY BE INSTHLLE1) HT THE PERMITlEE'S OPTIUN SU8JEC[ TU lHE
FULLOW1NG CUNDITlUNS:
1_ F%ITHE'i! H CLHSS I UR II NSF HPPR(II VED PLHNT MHY BE INSTHLLED
2H CUNTlNUOUS MHINTENHNCE HGREEMENT IS REQUlRED. IF H MHINTENRNCE
HGREEMENl IS NOT 110.90 IF CURREN[ YOU MHY 82 REQUIRED TU ENLHRGE THE SUIL
H8SORPTlO11-4 SYSTEM HND/OR YOU MH -F' B-:: SU8JEClTO PROSECUTIUN
�....... .... ... .... �������������.... .... ...... ��.... .... �������������......... ......... ........ ..........
�
���.No tin ����" K W 0 " _V V-4 P� V"�" OE�: �������H K.":E: ---- --
(Ill-" HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPkOVHL BY [HIS
D�PHRTMENT WILL BE SU8JECT TO PROS2CUTION
M1NlMUM
V14 Ca.- WEEN H WELL HND HNY ON--SlTE SEWRGE DISPUSHL SYSTEM IS
100 FEE| FUH H PRIVHTE WELL UR 200 FEE[ FOR H PU8L1C WELL
OlHER REQUIREMENTS 11 Y HPPLSPEC1FlCIA FIONS HND CONS; lRUCTlON DIHGRHMS HHE
HVHILH8LE TO 1NSURE PROPER IEAS THLLHl]Ohl.
1"Phs"ANVII X 1- X OVIVIS �Q Q LEI owl oil LEI� ��� WY4
I CI �.RTIFY lHH|
1� l HM FHMlL1Hk WlTH lFIRE FUH UN -SITE SEWERS HND HS SET
FUR|H BY THE MUNICIPHLlTY OF HNCHORHGE.
2� l WlLL INSTHLL THE SYSTbM IN HCCORDHNCE WITH l+4E CODES
�� l UND�HSTHND THHT THE ONSI[E SEWER SYSTEM MAY REQUlRE ENLHHGEMENl IF THE
RESIDENCE IS HEMODELED TO INCLUDE THHN � 8EDRUOMS
SIGNED
MPPLlCMNT DHVE DEHN'S CONSTRUCT1ON
'J
Test Hole ##1 Table A WO d#A18217
Lot 4 Date: 9-8-77
Logged By: T. Barber
ll 2th in Feet
From To
0.0' - 2.0'
2.0' - 2.5'
2. 5' - 7. 5'
Soil Description
F-4, brown Gravelly Sandy Silt, ML, wet, soft,
backfill.
F-4, brown Topsoil, with undecayed vegetative
material.
F-4, brown Gravelly Sandy Silt, ML, damp, stiff
to hard.
7.5' - 15.0' F-4, brown Sandy Silt, ML, damp, stiff.
15.0' - 16.0' F-4, brown Gravelly Sandy Silt, ML, damp, stiff
to hard, occasional. cobbles.
16.0' - 21.0' NFS, brown Sand, SP, damp.
Bottom of Test Hole: 21.0'
Frost Line: None Observed
Free Water Level: None Observed while drilling
Test Hole 1p2 Table A WO JfA18217
Lot 7 Date: 9-8-77
Logged By: T. Barber
Depth in Feet
From To
Soil Description
0.0'
- 0.2'
F-4, brown
T2s0il.
0.2'
- 15.0'
F-4, brown
Gravelly Sandy Silt, SM, damp, stiff
to hard, occasional,
cobbles.
15.0'
- 20.0'
F-4, brown
Sandy Silt, ML, damp, stiff.
Bottom
of Test Hole:
20.0'
Frost
Line:
None
Observed
Free
Water Level:
None
Observed while drilling
ALA LAS
Dave Deans Construction
Box 115
Chickaloon Street
Eagle R.i.ver, Anchorage, 99577
4040 "B" STREET,
ANCHORAGE, ALASKA 99503
PHONE: 907-279-2581
September. 13, 1977
W.O. 4A18217
Grid 42736
Subject: Subsurface Investigation for Suitability of
On -Site Sewer, Lots 4 and 7,
Shariendoh Hills Subdivision
Gentlemen:
Transmitted herein in accordance with your instructions are
the results of the above referenced investi.gati.on as performed
by us on scotembe.r_ 8, 1977. The scope of this project
is the investigation for suitability of an on-site sewerage
system.
Included in this transmittal are:
Test Hole Location Sketch Figure 1
Test_ Hole Logs Table A
Explanatory information Sheets 1--3
The exploration was conducted using a continuous flight
solid stem auger. The rig is owned and operated by Denal:�.
Drilling was super_vi.sed, the test hole
logged and percolation test performed by Mr. Terry Barber,
geologist xor Alaska Testlab.
The .Logs of the test holes are included as Table A of this
report. Inin ter. pret_ng t.1re logs, it would be helpful In-
utilize the explanatory information contained in Sheets 1-3
of the report.
When drilling was completed a 3/4." slotted PVC pipe was
inserted in the hole to aid in determining the f-r.ce water.
level. For: the percolation test, the test hole was filled
with water and left overnight to saturate. On returning the
next day, the hole was refilled with water and the drop in
the water level- c<1.refu:Ll} mol i.to.red over the next 60 minui.c.:
This procedure is i:ot a sL-andardized p^r.colation test,
howevex, we understand that. the municipality of Anchorage,
Depart;ile ,t of: Pub7. _C; Heaa.+, h and L,nvir<:mrnenl.al Protect.:i_on
p]"C j:erg tEi: LSm.'I ]" i.0 Cval.uat-.e a site
for a proposed O7.'i -S i_tC' 7ewerJC?e system.
Dave Dean Constr. tion
September 13, 19"1%
Page 2
Using the above test, the observed minimum percolation rate
for test hole #1 (Lot 4) was 5.7 minutes/inch. This requires
a seepage pit absorptive area of 135 square feet/bedroom.
The observed minimum percolation rate for test hole #2 (Lot
7) was 5.0 minutes/inch. This requires a seepage pit absorp-
tive area of 125 square feet/bedroom.
The percolation rates obtained are higher than would normally
be expected for the soil types encountered. These fine
grain soils, though they may percolate, have a tendency to
plug. It may, therefore, be prudent to use a more conserva-
tive design value of about 175 square feet per bedroom for
both lots.
No water table was observed during drilling on either test
hole. It should be noted though, that the free water level
normally fluctuates seasonally and with precipitation.
We hope this report meets your present needs. I£ we can be
of further service, please feel free to contact us.
Very sincerely,
ALASKA TESTLAB
P -j 'JvV
>
John R. Schur.zng,
jJr(
JRS:rb
Enclosures
AP . f OVED `
ce'vin R. Nichols, P.E.
Laboratory Manager
0-10 —A two X U; A ozy So K -- 1: 1 �A 11 oil 104 C; 0 —1 L I Fit UZI U is-
DEPHRlMEN[ [ HEHLlH HND ENVIRUNMEN[*L | |TECTION
825 'LSTREElG HNCHORHGE, HK. 995�1
279~2511
PEHMIT NO ( 77771 )
HPPLICHNT DHyE8�EHNS 8OX 115 CHICKHLU0N STHEET LE.R 6949]87
LOCHTION SHEN|i NDOHH STREB
L�GHL LU[ 4 SHENHNDOHH HILLS SU8 LOI SIZE 52272 SQUHRE PEEl
MlNIMUM DISTHNCE 8ETWEEN H WELL HND HNY ON~SlTE SEWHGE DlSPO�FU SYSTEM IS
100 FEET FOR H PRIVHT11 WELL OR 200 FEE[ FQR H PU8LlC WELL
W�LL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT W1l+IN I0 DHY�
OF lHE WELL CUMPLETION.
0 1S MHY HPPLY. SPECIFlCHTlONS HND CONSlRUCTION DIHGRHMS HRE
HVHILH�LE TU INSURE PROPER lNSTHLLHTIUN.
��� �������� ��
1 C�R[IFY THHT
1 l HM FHMlLIFOR 14 11+4 THE REQUIREMENTS FOR HND WELLS HS SE[
FOK|H BY lHE 1*11 1NIC1PHLITY OF HNCHORHGE
2� l WlLL INSTFII- L THE SYSTIN ACCORDHNCE WIll1 THE CODES
~~~�~_�~�~~�~
HPPLlCHN[ DFIVE DEHNS
W~II Owner_,__
· l.~atlon
Size of c.lng- (~ __.Depth Gl' Hole~teet C.~ to~/~, f~et
Stntlcwnterleve) ~ It, (a~ve) ~J~) land zurface, Flnllh of well (ch~kone) o~nend ( t
.Screen ( )1 Perforated (
Describe ,crecn or p~r~oratiom
of drawdo~ from s~at{c level
Dat~ of eompletlo)~ ,~ , .....
WELl, tOO
Depth in Jea[ ~rom
~ound surface
L
Clive details of formatlonz penetrated, size of material, color and hardnesS
�,_( (1�1
Well Owner--
W oLSON WELL DRILHI
1305 W. 45TH STREET
ANCHORAGE, ALASKA 99503
PHONE 272-9343
DRILLING LOG
location (address of: Townshi�,, Range, Section, if known; or dist
of Well-
ance main �oacl�
p
Size of casing-_ Depth of flole.__�Lc C_ -feet Cased to -r-"
Static water (above) (below) land surface. F inish of well (check one) open end
Screen Perforated
Describe screen or
Well Pumping test at gallons per (hour) minute) with_______
of drawdown from static level.
Date of complction.__L_
WELL LOG
Depth in feet from
ground surface
Give details of formations
penetrated,
size of material, color and hardness
J
k _TO---
A
To-
C,
C
C_ %C(
----TO.--. k)
V
Parcel I.D. 015-212-41
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
Expiration Date: Z 0 —,-2-5— -
Shenandoah
.2—_--
Shenandoah Hills, Lot 4
Location (site address) 12001 Shenandoah Road Anchorage, AK 99516
Current Property owrier(s) Aileen M. SwartS Day phone
Mailing address
Real Estate Agent
5833 Tweedsmuir Drive Rocklin, CA 95677
2. TYPE OF DWELLING:
0 Single Family (w/wc ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
F1
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public lhlater system
Public Sewer
❑
WaiverNariance request for:
Distance:
Received by:
Date:
7-Z-4`fS
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ G 61
Date of Payment
Receipt Number
COSA# QcSGt3/7Na
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.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD S1GfJATURE
`1// System #1 Approved for :3 bedrooms
System #2 Approved for bedrooms
Disapproved
Date 7/1
Conditional approval for bedrooms, with the following
a �e®e..O ,r•®,
o
49-TH
CE • 6381
�ROFESSVONa ®®�
By Original Certificate Date: —7
T unic�i ality✓ f Ay Drage 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 blue sheet E ., 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: Shenandoah Hills, Lot 4
A. WELL DATA
Well type Private If A, B. or C provide PWSID # _
Date completed 9/77 Sanitary seal (Y/N) Y
Total depth 80.8 ft. Cased to 80.8 ft.
FROM WELL LOG
Date of test 9/77
Static water level 55 ft.
Well production 20 9.p -m.
WATER SAMPLE RESULTS:
Coliform 0�colonies/100 mL Nitrate '"CTJi
mg/L
Arsenic Q// / V ug/L Date of sample: 7/11/13
Parcel ID: 015-212-41
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
7/9/13
35.4 ft
6.4
9-P M.
Collected by: Anderson Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/77
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N)
Date of pumping 711/13 Pumper Isaac's Pumping
C. ABSORPTION FIELD DATA
Y
M
Date installed 9/77 Soil ratingz 175 SF/BDRM Deep Trench
(g.p.d./ft or ftz/bdrm) System type
Length 42 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth 11-12 ft. Eff. absorption area 528 ft2 Monitoring tube 2 Depression over field N
Date of adequacy test 7/9/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption Feld before test 27 in. Water added 450 gal. New depth 40 in.
Elapsed Time: 1,440 min. Final fluid depth 27 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & 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
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
ln[��SiP►�SijiC�71
Septic tank/lift station on lot
> 100'
On adjacent lots >1 00'
Absorption field on lot
>1 00
On adjacent lots >1 00'
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'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >51 Property line >5
Water main N/A Water service line >10
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10 Building foundation >10'
Water Service line >25' Surface water >100'
Curtain drain None Noted Wells on adjacent lots X100'
F. COMMENTS
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 Michael E. Anderson, P.E.
Date 7/18/2013
COSA brown sheet 10-10-12.doc
Absorption field >5
Surface water >100'
Water main N/A
Driveway, parking/vehicle storage >10
Municipality of Anchorage
Development Services Department 4SA
Building Safety Division
On -Site Water and Wastewater Program `0120
4700 Elmore Street T
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. DrS —2t 2 --IL/ 1 COSA # fq' D /,6741
Expiration Date: 9 — - 0 Cl
1. GENERAL INFORMATION
Complete legal description 55hr.jainci.ee6 f-1-114 S!10 L -v4` -f
Location (site address)
Current Property owner(s) Ornnrs Osb x.., Day phone 3s7—q q i-2
Mailing address 14-00 C 151"rmo., dra ti 2d .
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:_
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
El
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage 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 NlLrhari /� /�nct �rs�n E
Address q(1GIA(a4(a..A. AS .L,AA 99s/(v
Engineer's Printed Name/fllt�L,a / /� /�na t�ce n AIG!,
5. DSD SIGNATURE
Approved for .3 bedrooms.
Phone 3q,5' -3399 -
Date G t•
• �f
*:49
A, MICHAEL N. ANDERSON :e /E
9
Disapproved. `
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(R. 11105)
Original Certificate Date: 6; " ✓-' 0 9
Municipality of Anchorage
• Development Services Department
Building Safety Division
-� On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: 4 tirn an t o a 11 4, I is I-" 1 4 Parcel ID: o/ S -i( 2-4 (
A. WELL DATA
Well type
Date completed
Total depth 14 to "fl.
If A, B, or C provide PWSID # _�_ Well Log (YIN) X
Sanitary seat (YIN) -Y
Cased to
FROM WELL LOG
Date of test 7Zt 9 -? 9 -
Static water level SS ft.
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 17_mg/L
Arsenic: t4 0 ug/L date of sample: s lslc 9
B. SEPTICIHOLDING TANK DATA
Wires properly protected (YIN)
Casing height (above ground) Z g in.
AT INSPECTION
4 iH o
5'Cv ft.
S'O + g.p.m. L,",4eL
tiJLv slE�e.
Other bacteria _46-- colonies/100 mL
Collected by: N M 1. -
Tank Type/Matedal -5� tc- Date installed 7h 11-A;z
Tank size „L000 gal. Number of Compartments z- Cleanouts (Y/N) Y
Foundation cleanout (Y/N) ,Y, Depression over tank (Y/N) High water alarm (Y/N)
Date of pumping IS C Pumper �..anL Fw< C'wrLfi —�hdn,
C. ABSORPT16N FIELD DATA
Date installed 9 2� Soil rating P'P-d. x/ r ) / 25 System type Qrcp +Tn'{,.
Length ' Alrl1'IZ ft. Width 1.0 zk>a�e�+yC-S Gravel below pipe O ft.
Total depth / ft. Eff. absorption area 22P ftZ Monitoring tube �_ Depression over field
Date of adequacy test H +tdoq Results (Pass/Fail) Poe -5` For 3 bedrooms
Fluid depth in absorption field before test in. Water added *Vcvgal. New depth y in.
Elapsed Time: /4110 min. Final fluid depth S"q- in. Absorption rate >= 41;0 +- g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Dale installed Size in gallons
'Pump on' level at in. PM—Do—tr level at _ in.
Datu Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tan�ljtE station on lot /oo
Absorption field on lot / 06 14
Public sewer main tir IX .
Sewer/septic service line -79;' f -
Animal containment areas c9o'-t-
(YIN)
High water alarm level at In.
Meets alarm & circuit requirements?:
On adjacent lots too `t
On adjacent lots toyrt
Public sewer manhole/cleanout If
Holding tank )V/ .
Manure/animal excrete storage areas /bJ tF
Building foundation /o '+ Property line 70'i Absorption field i o' �-
SEPARATION DISTANCES FROM SEPTIC/HUEERNG TANK ON LOT TO:
Water main r/ IA. Water service line 5.0 i Surface water /va'ti
Wells on adjacent lots loot
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 20 1f, Building foundation 20 L� Water main w
Water Service line So `� Surface water /e D e + Driveway. parkingfvehicle storage '/ I
Curtain drain uh knout n Wells on adjacent lots ion' f -
F. COMMENTS rj e� S%«( MT e. pt cL4cLcd L,,
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 RIP,
Date Of r/o y
COSA Fee $ {
Date of Payment
Receipt Number �2oQ0 72
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
•r � v. ry
*: 49TH*
MICHA00
EL N. ANDERSON
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10' UTILITY EASEMENT
m O I \ N00°04'00"W 326.82
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m #
SCS ReE#
1092038001
Client Name
Mike N. Anderson, P.E.
Project Name/N
Shcnondoah Hills Lot 4
Client Sample ID
Shcnondoah Ilills Lot 4
Matrix
Drinking Water
Printed Date/Time
05/29/2009 11:41
Collected Date/Time
05/15/2009 7:15
Received Date/Time
05/15/2009 8:20
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Rewits PQL Units Method Container ID Limits Date Date [nit
Metals by ICP/MS
EP200.8
Arsenic
ND 5.00
Waters Department
NRB
Total Nitrate/Nitrite-N
1.79 0.100
Microbiology Laboratory
(<I0)
Colony Count
0
Total Coliform
0
Fecal Coliform
0
ug/L
EP200.8
C
(<10)
05/21/09 05/22/09
NRB
mg(L
SM20 4500NO3-F
B
(<I0)
0527/09
1DZ
coV100mL
SM209222B
A
(<200)
co11100ml.
SN1209222B
A
(<I)
coUl00mL
SN120 92228
A
(<I)
05/15/09 DLC
05/15/09 DLC
05/15/09 DLC
MUNICIPALITY OF ANCHORAGE
�0 DEPARTME. OF HEALTH AND ENVIRONMEN _ PROTECTION
825 L Street, AnchoraQP, Alaska 99501 I;b
- _� �� f 264-.4720 �"
�j Date Received: Marc, x, 1978
#1: Time 1:30 p.m. #2: Time #3: Time
Date 3-28-78 Tuesday Date Date _
Insp Pratt Insp Insp
57X' X _o l r
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIIES
1. Lending Institution Request: First National Bank of Anchorage
Mailing Address: Post Office Box 4--2090 99509 _ Phone: _
2. Property Owner: Lowell Thomas
Mailing Address: % Dave Deans
Phone: 349-2294
3. Legal Description: Lot 4 Shenandoah Hills Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
5. Well System:
Permit #
Construction
Number of Bedrooms:
Number of Bedrooms:
Individual Well (x)
Depth of Well
Three
Community/Public System ( )
80' Well Log on File (x)
Bacterial Analysis
6. Sewage
Disposal
System: On-site
System (x) Public Utility ( )
Permit
#
installed
1977 Installer
Septic
Tank Size
Ud
Manufacturer __
Absorption Area Soils Rate Material b��_"4
7. Distances: Well to Septic Tank to Absorption Area _
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 4 Shenandoah Hills Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved: Date:
Disapproved: Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGL-
��\ Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
7 �i
4
264-4720
iii_/ /
'�-i�equest for Approval of Individual Sewer and Water Facilities
1. Property Owner: LOW&u J omUM 5 —
Mailing Address: _Phone:
2 Name of Buyer: SY✓�� —
Mailing Address: — Phone: !_
3. Lending Institution:
(n ITt+ d�
Mailing Address: S1, �_ Phone: —
���
4. Realtor/Agent: NoNtG —
Mailing Address: Phone:
5. Legal Description:
Street Location:
6. Single Family Residence: (tom Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply:,_ *Individual Well (Public/Coimnunity System ( )
I
If Individual Well, well depth 80
If Community System, name of system _
8. Sewage Disposal System: **On-site System (lam Public System ( )
If On-site System, date of installation: _�Q_(_���
*NOTE: A well log is required on ALL wells drilled since 6/75.
**If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each .request before processing
can be initiated.
3/77