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HomeMy WebLinkAboutKIJIK LT 5K ijik Lot 5 #017-092-21 Municipality ofAnchorage *'^"• Development Services Department Building Safety Division —� OnSile Water and Wastewater Program, 4700 S. Bragaw SL , P.O. Box 196650 Anchorage, AK 99519-6650 Page oI 3 www cl.anchorage.ek.us (907) 343.7904 ON-SITE WASTEWATERDISPOSALSYSTEM AND/OR WELL INSPECTION REPORT SI.Jg7O35/ Permit Number: PID Number: -iewe_ ZoSec, Wastewater System: w (7� Upgrade IIEE•n , ^ 3 , ,^(Quo ABSORPTION FIELD PM Ww aBFdeanr t(D..p rrwNl O SnFFow rn.ail O eM O MrFN O MMr LEGAL DESCRIPTION So'a'Fna I.a iaro•PmFmnNpWaMF I GPOFr PI. BIW Lot Sw Ao1 r /, r l bp"bO ham Wqa 7W D•pam &*F Nan Owrrn pim KI FI. FI. low p NFna• SOL44 H FNM Fea•F onamr i;F " Grrvr LWVM U FI. / FI. Well: ❑ New ❑ Upgrade C F* r Mh 3 NUrMN MMF D�FIFIIG DFWF•n MNF FI. CI.Fy41r lPmFb. S. 61 TOW D•Pl; -• W ^tt `LM,I( ioIr FOForyem r•F I / P"Wtr 1)3 /O l VolifC•' R. L/l- F� DrmrrLUJ -W r D•u D~ -5- 5'1 slaw Wrr l I e1 FL linv~ z r11 s Sfz�rne - Dr• MI M 0 z PINE a. . wT l Cu•^Y N•'aM APov. GrawMFL TANK GPM FL SEPARATION DISTANCES D(Septic ❑ Holding O S.T.E.P. ❑ Other: To Septic Absorption Llft Holding ubiwPovate Maf0 w'—p'1P1 From Tank[' Field Station Tank Sewer Lina l.a Q,.I/l. ot7UGr WN L 1:25 \ ;5 wlMr. S-fe ' Name« a crro.nm.nl. e(�5 ' f' ' ' LIFT STATION SLI.WrN L {„ L \ ,• wwu La lhw L •Pump an'IFrr FI vN Wan rFlr rrmN h ipaMFli0r1 I' yl I, Pump MFYFa AbEa EIMnW FNplaOanFpMamW bF. cPnrnDrain NO✓iG 110 "rr" sBENCH I v6 SWo MARK in t9'1r 10 OF•YO^ W D••urDaon -Fop of e40441'de hV .w iF.Fum. .5o 100 FI 0-VX e7 Engineer's Stamp 7 rn ; '1 •F '� Y `' � OJT' r t OIii Inspections performed by: 1(�S�L� Dales: 1t1 Development Services Department Approval •A• "d" T . ��•.1 14374 and approved by: � Date:flt_Z _O5' Reviewed fNF � q' •tip Pl r, o��fss= /t7 PERMIT NO. SW970357 PAGE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Ataska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5 KIJIK S/D P.I.D. NO. 017-092-21 - I ------------------------------ -----------------------------EAST EAST 140th AVENUE �i EXIStING TRENCH CO1 'MTI CO2 A ATH DRIVEWAY OO DELI & DBL2 ' ZOw EXISTING 1250 GALLON ST2 SEPTIC TANK Nwptn w0 ST1 Xmm w"' W FCO FC SHOP 1n W TBM Q B E—I 100' Wf(C RgpIuS W I� i SCALE'. 1' 40' Iry �� �'•' `i 6 LOT 4 •• .,.... a .;v PERMIT No. SW970357 PAGE 3 OF 3 Municipalit of Anchoro. e DEPARTMENT OF HEATH AND HUNAN 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 LOT 5, KIJIK S/D P.I.D. No. 017-092-21 ST1 ST2 97.4' FINAL GRADE 91.0' NEW 1250 90.8' GALLON SEPTIC TANK A B C01=94.6' FCO 51.5 14.5 CO2=94.0' ST1 78.0 75.0 ST2 74.0 77.5 DBL1 70 78.5 3. D_BL 2 72.0 79.5 C01 84.5 112.5 7 FINAL GRADE MT1 85.0 111.5 CO2 I 42.0 80.5 C01=89.8' SR CO2=89.8' N. T. S. E�LVV L'RT D/MP fid* I.N1.1• �'l 4,Y MT1=84.0'sM,•• e ~'•l%� r. f��1IMAX . NO WATER FOUND i 76.0' B.O.H. A. rJW y,• w. cava . p �n 0 /^' M -W DRILUNG, Inc. l P.O. Box 110378 a 10330 Old Seward Highway (907) 349.8535 ANCHORAGE. ALASKA Mit - — DRILUNG LOG Wall Owner i1. ofWeli DOMESTIC.... Location (address of: Township, Range, Section, if known; or distance main road LOT 5. KIJIK SUBDIVISION: SE CORNER 140TH & PICKETT Size of caring F" nepth of Ho1e100 feet Cased to 198.29 tett Static Water leve1112 ft � below) land surface. Finish of well (check one) open end (X Screen ( ): Perforated (p n . Describe screen orparlaat+oe} YN A 4r Well pumping test a* a-? n gaU42x pt} )x (minute) for 1 ~ours with— 100! k of drawdown from static Ievel. rr. Date of completi WUL loo Depth in feet from! f t . t : ! ground surface Divi d of Iormations penetrated, size of material, color and hardness Q,5TTr.K UP Aik l jz r 9; TO o e 9 4_TO 1 a t �- ,tl 141 TO 144 LPAMP told TO 1S6 .t. IrF; To a ... •. . I 7A • • H' • OCT • �. • 9•8 • T nicipalityot Anchorage • • • _ c.6PY: T� �o�Zalq� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L^ STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970357 DESIGN ENGINEER:JAMES SIZEMOORE S ASSOCIATES OWNER NAME:SNEED SCOTT T OWNER ADDRESS:908 W. 56TH AVE. ANCHORAGE, AK 99518 PARCEL ID:01709221 LEGAL DESCRIPTION: KIJIK LT 5 LOT SIZE: 39201 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1'.3o P r^ PAGE 1 OF 1 DATE ISSUED:10/08/97 EXPIRATION DATE:10/08/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PR^"TOT^"'C' RECEIVED B ISSUED BY: DATE: © / DATE: /O B Y 140 eh AVENUE - - - - - - - - - - - CLEAN OUT - - MONITORING TUBE — - - — - PROP06ED 3o'xll' DEEP (1' EFFECTIVE) 4155ORPTION FIELD ®� �� / y o TH"I REPLACEMENT FIELD PROP05ED 1250 GAL 53, / I {�.lOo' EXISTING/ WELL PROP05ED — - — I WELL LLI I I 0 i I I EXI5TING 1 I i I i I WELL � i ��``,tk OF 1 �4'- q � �� 00 e4"D,� �°°, No. 1517 E e" �� a Tom%°°°"°°°°°°°°°°°°°°° F� I`FrE: DRAWN BY: CCL LOT 5, KIJIK SUBDIVISION WELLSPLscAe AND SEPTIC SYSTEM SITE PLAN JAMES SIZEMORE & ASSOCIATES TEL (907)345-1572 FAX: (907)345-9629 Anchorage, Alaska CHECKED BY: 7JFSPROPOSED 7 5-KIJIK 1 WASTEWATER DISPOSAL SYSTEM LOT 5, KIRK SUBDIVISION 1.0 GENERAL 1.1 The scope of this project consists of installation of a 1250 gallon Septic Tank and a deep trench absorption field, 36 feet long, by 11 ft. deep, with an effective depth of 7 ft. 1.2 Construction shall be in accordance with: the approved site plan and design drawings and specifications, Municipality of Anchorage permit with any special provisions or conditions. Deviations from the approved design drawings shall be coordinated and approved by the engineer conducting the inspections. 1.3 All construction procedures and material used to construct the system shall comply with Municipal and State Regulations. 1.4 The homeowner shall be responsible for finish grading and seeding disturbed areas after the system is constructed and soil is compacted and mounded over the absorption trench and the Septic Tank. 2.0 SEPTIC TANK 2.1 The 1250 gallon septic tank shall have two compartments and shall comply with Municipality of Anchorage requirements. The tank shall include two 4" diameter cleanouts for pumping access. 2.2 The septic tank shall be set level and shall be bedded as necessary to prevent settling or shifting of the tank. 2.3 All pipe connections to the septic tank shall be made with waterproof mechanical couplings. A cleanout shall be installed upstream of the tank within 5 ft. of the house foundation. A double cleanout shall be installed downstream, within 10 feet of the septic tank. The first cleanout shall clean toward the drainfield, and the second shall clean toward the septic tank. 3.0 SUBSURFACE DISPOSAL FIELD 3.1 The subsurface disposal field shall consist of a deep trench, 36 feet long, one backhoe bucket width wide, by 11 feet deep, with 7.0 feet of sewer rock beneath the perforated pipe ( the effective depth of the trench). 3.2 A total of 7.5 ft. of sewer rock shall be placed after trench excavation. Seven feet of rock shall be beneath the drain pipe in the trench. A minimum of 2 inches of sewer rock shall be placed over the perforated pipe. 3.3 Sewer rock shall be 0.5 — 2,5" screened gravel with less than 3 % passing the #200 sieve. 3.4 Cleanout pipes and monitor tubes shall be 4" diameter and installed as shown of the plan. The portion of the monitor tube extending through the sewer rock shall be perforated. All monitor tubes and cleanout pipes shall have waterproof caps conforming to Municipality of Anchorage Specifications, 3.5 Filter fabric shall be placed over the sewer rock, and a minimum of 3 foot of backfill shall cover the rock. 4.0 ENGINEERING INSPECTIONS 4.1 A minimum of fourengineering inspections will be required during construction of the system. One after the septic tank is set prior to backfill, one after excavation of the trench prior to placement of sewer rock, one after placement of sewer rock and all distribution piping, cleanouts and monitoring tubes are in place. The final inspection shall be after the filter fabvric is placed, the trench backfilled and the final grading is complete. 4.2 The contractor shall coordinate with the engineer at least 24 hours prior to start of construction, PROBABLE IMPACTS TO ADJACENT PROPERTIES A) WELLS The proposed wastewater disposal system is designed in accordance with current Municipality of Anchorage Wastewater Disposal Regulations. The proposed drainfield will be constructed in accordance with these regulations. The separation distance from wells on adjacent properties is greater than 100 ft, Therefore no unacceptable impacts are expected on the wells located on adjacent properties. B) WASTEWATER SYSTEMS The new drainfield will be constructed with good separation distance from systems on adjacent lots. Soils tests have shown the soil where the system is to be constructed is acceptable for an on-site disposal system, therefore there should be no unacceptable impacts of adjacent wastewater disposal systems. C) RESERVED SPACE/SURFACE AND SUBSURFACE The lot on which this system will be constructed has ample space both surface and subsurface accommodate this deep absorption trench, and there is ample space for a replacement trench. The proposed drainfield should not affect adjacent properties. D) DRAINAGE The location of the drainfield will not interfere with any drainage. The area disturbed by construction of the field will be graded .and sloped so as to not pond water. Therefore this system should not adversely affect adjacent properties. �.A Municipality of Anchorage' �� X DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST a'c gar e� r• t� o�,e� o PERFORMED FOR: -ixk� 'V�. G (..�` DATE PERFORMED �e4-'11x ' LEGAL DESCRIPTION: � �� I Township, Range, Section: DEPTH rrny r� SLOPE SITE PLAN (FEET) 2 ► A-0 3 4 f 6- 7 7 8- 910 9- 10 11 M1 12 r- 13 14 15- 16- 17- 18 5161718 7 19- 20- COMMENTS 920COMMENTS WAS GROUND WATER �© ENCOUNTERED? IF YES, AT WHAT DEPTH? n rd)/C�y Depth to Water After„ r� /3 �iG =� / Monitoring? by Date. �l ';2� E)o+- .►6 r �1 PERCOLATION RATE`77— (minutes/incX/hh)`PERC HOLE DIAMETER TEST RUN BETWEEN —2— FT AND u FT Z�� �= / PERFORMED BY: � F � / ��.� CERTIFY T AT THIS VEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: , 72-008 (Rev. 4/85) —®----III PERCOLATION RATE`77— (minutes/incX/hh)`PERC HOLE DIAMETER TEST RUN BETWEEN —2— FT AND u FT Z�� �= / PERFORMED BY: � F � / ��.� CERTIFY T AT THIS VEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: , 72-008 (Rev. 4/85) I 4 t5 /� . Noas� s� c 1 Ra�;�� -- t• z -���, fs�- 4x deo Som p� 1-7, ". L = � = �K7 Uge De e f 1 fier?cb - 3r lor��.x 11"Dee� I,cl ► �h 7 ` SES. Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 8 Wastewater Program 4700 Bra aw Street P.O. Box 196650 Anchorage, AK 99519-6650 �r www.muni.org/onsite �I (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O / % — 92— 2-COSAft C'/ -7 0 Z/9 1. GENERAL INFORMATION Expiration Date: 7—;2— 6 �% Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KIJIK SUBDMSIOW LOT 5. 14033 PICKETT STREET • ANCHORAGE. AK 99516 JIM WHITE Day phone 14033 PICKETT STREET ' ANCHORAGE. AK 99516 Day phone 440-1947 CAROL BUTLER w/ REMAX Day phone 276-2761 110 W 38th SUITE 100 " ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality ofAnchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn C:�JUP, Ltd. Phone Address 701 E TURD; POAD SUITL "): • ANCHD2ACE, AV 99507 Engineer's Printed Name Engineer's Comments: IFP-1-REFY i,. lrah°.CSJ. P.E. In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational lite of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the solo benofil of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 4 bedrooms. Disapproved. 337-6179 Date qj_-7/04 Conditional approval for bedrooms, with the following stipulations: Attachments: / HAA Checklist l/ Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: `v��✓ Itl• Original Certificate Date: '2 L (Rev. 1)01) Municipality of Anchorage Development Services Department Building Safety Division On-SRe Water 6 Wastewater Program 4700 Sragaw Street P.O. Box 196050 Anchorage, AK 99519.6850 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: KUIK SUBDIVISION: LOT 5. Parcel ID: 01 -7 - DQ 2 - X / A. WELL DATA • WELL TEST PERFORMED BY S&S ENGINEERING Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (YIN) YES Date completed 12/15/1997 Sanitary seal (YIN) YES Wires property protected (YIN) YES Total depth 198 ft. Cased to 198 ft. FROM WELL LOG Data of test 12/15/1997 Static water level 112 ft. Casing height (above ground) 18+ in. AT INSPECTION •9/17/2005 108 ft. Well production 8-10 g.p.m. 3.2 g.p.m. WATER SAMPLE RESULTS: t� Coliform * oolonies/100 ml. Nitrate 2 "fig./L. Other bacteria —b—colonies/100 ml. Arsenic: ug./L. Date of sample: 4/10/2007 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 10/24/1997 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping `/r'f 3 -V i Pumper N&C 161OLnd I0MJx4Q,% J4 5cr ui ( cS C. ABSORPTION FIELD DATA Date installed 10/24/1997 Soil ratIng .p.d. or ftt/bdnn) 1_2 System type DEEP TRENCH Length 43 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 11 ft. Eff. absorption area 55166 ft' Monitoring tube YES Depression over field NO Date of adequacy test 9/17/2005 Results (Pass/Fail) 'PASS For 4 bedrooms Fluid depth in absorption field before test 8 in. Water added 66177 gal. New depth 39 in. Elapsed Time: 120 min. Final fluid depth 32 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date - * SEPTIC TEST PERFORMED BY S&S ENGINEERING '• DRAINFIELD DRY ON 4/10/2007, PER GEG INSPECTION D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on" level at —in. "Pump off lev High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM 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 N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manurelanimal 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'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION . 1 certify that 1 have determined through field inspections and t .. • review of Municipal records that the above systems are in "' "" '' ..• .... ' • ...... . conformance with MOA COSA guidelines in effect on this ... (i date. A. Go ass: Engineer's Printed Name JEFFREY A. GARNESS �Qa�y CE- Date 4�2f�o�ereyProf $aON COSA Fee s e7o;3 7 + 1 % 5 K LAS' \ Date of Payment / -,D 5 -07 Receipt Numbery� i (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number --CMS'_ SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 SGS Ref. M 1071472 All dates/times are Alaska Standard Time Client Name: Gamess Engineering Printed Date/Time: 04/25/07 12:30 Project Name: Kijik SD, L5 Collected Datefrime; 04/10/07 9:00 Client Sample ID: Kijik SD, L5 Received DatoMme: 04/10/07 1 :05 Matrix Drinking Water Technical _,S 6pphen EC* PWSID Nitrate 0.13 0.10 mg/L EPA 300.0 10.00 _Direr^tor. Releasedyp Sample Remarks: Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date Init Bacteria 0.00 9222B 04/10/07 04/10/07 dpt Nitrate 0.13 0.10 mg/L EPA 300.0 10.00 04/11107 04/11107 jds Mar 26 2007 12:57PM HP LASERJET FAX FROM :AS"TER-BLi;6,iNC. - I FAX M. :907-345-1621 1 T rte: p.2 Feb. 22 2007 12:23PM P2 . -AVE, _ �..56gg. :569'5 'S7"E...�M) .. '�..'r;;•�� '�.......:_ � '� � •.fit .... , er Tv uric s.R, t � , .. , � �.: • . _ 0 .�,.�' 8.. ••_: �`.ir. :a..y}.•� 1- �^]I �+,= , ' , Y ..• �r • 1. � Q¢ i , • �-: IV � •• cap •�1 : r ' - `. •r ' jgn , .� 1.07'4 REc Rr,FIED D I.a► - J`— Block S5 f' 0. Anchorage Recording Distrief, Aloska • ■°"'■'+' •! neere etA.r "� °'°"'•° ' Ht. eN! eI r«wa w eat ev.e s.e.oe e>� "' • aftemwe owed. ` p.L Wno. LnT Suwy CERTIFICATION EJB III I��y," ts:isl l r+.r w.tlff M.t lMw arwrea fed 7teV.rt7 swe.ew Wotlb.e (d Brass or "imm cwp*4: CantsnenT a •arae.. eed tr.n tae N*rewwee elfn.na a1..w ON Wind. n1. pwe- c Iron pipe WxVOr rotor lecoverel i `aos¢isue ' wq Ow. e.e w of e.«tq or cacao w wi«.n er•a.rtr ens net O Q t 2 nuO Q leek rtcwerW �'Z.i`l��o p rix w«rw• o wymw OreeMY e.atap w e.erped he tae premuaa • VV k � rsz-ar W. t:3s acrNfY w rt+e. a root wh.n a r nw.e7e. vnu+Y tWe or etnr vN�Nr .- 4 FBJCT 4D=A �- :.• /f/J��' awned M sold Mp.y e.rWw w lei.et.a WOO. Seale it �� Date Q� Prepared by: R. IL BUTTay dL"s- Ra�sraset�•,dslovgw (907fZT5.6YJ0 5/9tK£JDnMjkvtAtatwawNaetr9xfC F�61 . F.B. No. Properly of: - 3038 4; /-4.7 cbs B. mile Municipality of Anchorage .� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. ; 4 :CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-092-21 1. GENERAL INFORMATION HAA# 050tIM Expiration Date: I z - - O Complete legal description Lot 5• Killik Subdivision Location (site address or directions) 16077 Pirkntt St Anrhnrngp. AK 995115 Current Property owner(s) Steve Bales Day phone Mailing address same Lending agency Day phone Mailing address Real Estate Agent Adrian / Prudential J.W. Day phone 727-6989 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _1An 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site U Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S b S Engineering, Phone 694-2979 Address 17034 N. Ea Engineer's Printed Name 5. DSD SIGNATURE ✓ Approved for bedrooms. Disapproved. Eagle River, AK,99577 Date q/2D be" A- abs" raft iwa Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �!l �c Original Certificate Date: tA )R*, DIM2) Municipality of Anchorage ' Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT s KIJ 1K. SIN Parcel ID: 011-M7--Z- A. M7--Z A. WELL DATA Well type _F�I ✓NT& If A, B, or C provide PWSID # Date completed I7 15Ir(�7 Sanitary seal (PN) 2 `� Total depth ii ft. Cased to ILLAft. FROM WELL LOG Date of test 1 15 k Static water level Well Logal) �iES Wires properly protected �j J)y6s Casing height (above ground) l f5"f in. AT INSPECTION I DS IOQ, ft. Well production �3 - IO g.p.m. 3o Z g.p,m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0, I60mg./I. Other bacteria 0 colonies/100 ml. Arsenic: - mgA. Date of sample: 01//05 Collectedby: 54-S 'A9(y1K092'KX, B. SEPTIC/HOLDING TANK DATA Tank Type/Material SLcPTI e- / STEZet Date installed I V /2-q I4-4 Tank size 17,60 gal. Number of Compartments 2 Cieanouts&l) lES Foundation cleanouttl) J6 Depression over tank (Y/1VIlb High water alarm (Y(fD 1 Xx Date of pumping J3 1 °51 11 05 Pumper 75nAc.Sfy►nprK)& C. ABSORPTION FIELD DATA Date installed O Z ? Soil rating (g.p.d./ft2 or ftZ/bdrm) _L& System type Div TQJC-+�N Length f{3` ft. Width 31 ft. Gravel below pipe 6I ft. Totai depth 1 ft. Eft. absorption area SI to ft' Monitoring tube N � Depression over field _�aQ Date of adequacy test1 0G Results as ail) �WSS For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth -K3-1 in. Elapsed Time: [ min. Final fluid depth .LE in. Absorption rate >= 6GO 9- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) 1190 If yes, give date — D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. 'P vel at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO (YIN) High water alarm level at Meets alarm & circuit requirements? r Septic tank/lift station on lot I V0 '} On adjacent lots 1004 Absorption field on lot I M �4- On adjacent lots r ooI+ Public sewer main NYE Public sewer manholetcleanout Sewer /septic service line �ZS 't Holding tank N R SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 231 Property line 511 Absorption field !g 14 - Water main N A Water service line 10 r* Surface water I I+ Wells on adjacent lots 100 in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Property line 17- Building foundation (-I I Water main N 11 1 Water Service line 10 +- Surface water too 1+' Driveway, parking/vehicle storage I O I f Curtain drain &X -VC 14 -'CL* J Weiss on adjacent lots IbO l+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and review of Municipal records tha above systems are in ; «••"•""'i conformance with MOA HAA uide ' as' effect is da N r ..e it til■ir Engineer's Printed Name N.. 110/4 r Date210 HAA Fee $ 3D • a Waiver Fee $ Date of Payment9 ao aI' Date of Payment Receipt Number 7gxl Ktf Receipt Number (Rev. 12/01) Sep 16 2005 4:56PH HP LASERJET 3200 P.2 . ' :.. E. /qp 'AVE. _ S(5-9 55' 50,4E CR) .� :...589'5705730 CX)a I Ac'r/L1eC- 1 o 2 B volt &FPPC VA, v^ :..ro• r j. iv (5 55 M) 1-07'4 1 jAS-BUILT Lot 5 , Block I DI . Anchorage Recording Ois'trict, Aloska Eeaomweta of More Donor Mon Mew :M on Ma Nat or aataro we not "own M"Ox wig" LOT SURVEY CERTIFICATION atharwtoo Dater. LEGEND 1 Wray e.nh rwer snare S.rr.r•a the Mererrr wean and 4.erlbu Q Bross or Aliminum'CNpad monumDM ncowred hrraap, Me that the Imrraremweta 11t,"Ped en ssn we within the or". 0Iran plea and/or rebor raoowred. prof WOO one de Del overlap of aner"oe, w odlooW rrewty aad'tnat O 2 x 2. hub 6 tdA raoovwad we Srorewmenta s Sol~ prewar spider Sr onarosea, on the rrem:eas 0 . Wx We robot tat this survey . In *Aellon and that than ore.no roadways, WINtr WAS, or steer Mai►le easements an weld MwPartr "opt we IrAw.%d eerw :—Pf_77NCE LJNE(APPROX. LOG%l::)A4:.. Scale a r oats _25Preparedpy: R.4.BUTTON Ref. 3055 FB.No. 4�_¢7 PtYofs7`�1.v/% &�/es 09-09-06;12:29 ; ;907 561 6301 t 2/ 4 SCS ReLN Cheat Name Project Name/N Client SamPle ID Matrix Sample Remukr. 1035698001 S & S Engineering Lot S, n1k SO Lot 5,1ij ik S/D Drinking Water Ad Datcr/i;mes are Ahuka Standard Time Printed Date/Time 09/05/2005 16:35 Colkued Datafrone 08/31/2005 16:00 Reeeieed DatdTlme 09/01/2005 10:04 Technkal Director Stephen CEde Allowable Prep Analysis Pammetcr Raalu PQL lining Method Cotlmlra:rID Llmiu Dote Dam Init Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (b'10) 09/01105 DSH eoVI00mL SM20922213 A (col) 09101/05 TLF