HomeMy WebLinkAboutKNIK HEIGHTS BLK B LT 16Knik Heights
Block B
Lot 16
#017-033-36
~ MUNICIPALITY OF ANCHORAGE
DEI~TMENT OF HEALTH AND HUMAN SER~I~IS
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name ~[~o ~e¢--~ ~ '~ ~¢:~/[ ~ A/~ DISTANCES
TANK FIELD WELL
~ t~ ~ DW~ ~. z7. ~,~. dr~vew~y~As-B"iLTD~AGRAMtSh~w~~~at~~n~~we~''se~t~cs~stem'p~~p~~y~~~es~t~u~da~~~n~waterb~d~es'etc.)
TANKS
TYPE OFSYSTEM ~ ~ ~~
~faENCH ~ BED ~ W. DRAIN ~ OTHER ---~- L;~u~
Depth to pipe bottom lrom ~ T°iam depth fr°m °ngmnal grade ~
Total absorphon area ' ' Distance beLw~n mines ~
WELL~
~PRIVATE ~ OTHER (IdenUfv)
· Cased to
REMARKS;
Municipal and State guidelines in ~lecl off this date:
72-013 (3/85)
DERARTMENT ~HEALTH AND ENVIRONMENTAL t~.~O'¥ECTION
825 [ S'I"REET~ ANCHORAGE~ Ak: 99501
264-4720
PERMIT NO:
DATE ISSUED:
86t .. ].4
08/27/86
~3EWER ~_ WELL
F"EF,~M I T
AF'PL I CANT:
ADDRESS:
CONTACT RHONE:
ROBERT STEPHENS
PO BOX 113116
ANCHORAGE, AK 99511
243-7145
LEGAL DESCRIP: ~'OBD~V'!SION: KNIK HTS. LOT:
SECTION. 27 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 44022 (S(~.FT. [IR ACRES)
MAX BEDROOMS: 5'
BLOCK:,~B
Listed below are the options available to ~ou in designing your septic
s~stem. Choose the option thai. best fi~s your site-
-T'RE~4C~-~ BE][) W_ ORA I N
DEPTH TO PIPE BOTTOM (FT.) 6.0 ~.5 6.0
GRAVEL OEPTH (F'T.) 4.0 0.5 2'~0
TOTAL DEPTH (F'T.) 10.0 7.0 8.0
GRAVEL WIDTH (FT.) 2.5 21=0 5.0
GRAVEL LENGTH (FT.) 69.0 40.0 77.0 .~
GRAVEL VOLUME (CU. YDS.) 278.8 51.2 35.7
TANK SIZE (GALS) 1~000.0 ~ 1,000.0 *.* 1,000.(I ~*
SOIL RATING (SQ.F'I'. /BR) 183 183 183
GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NGT EXCEEDING 75 FT. EACH)
TANK MGST HAVE AT LEAST TWO COMPARTMENTS
I certiCy that:
1. I am ~amil~ar with the requirements for on-site sewers and wells as ses
~orth by the Municipality 0£ Anchorage (MOA) and the State o~ Alaska.
2. I will install the system in accordance w~th all MOA codes and regulations~
and tn compliance with the dessgn criteria o£ this permit.
3. I will adhere to all MOA and State o£ A~aska requirements ~or the set back
distances from any exisling well, wastewater disposal system or public
sewerage system on this o~ any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum o£ 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL. INSPECTION REPORT; AND (3) THE
ELECTRICAL WO~ MUST BE DONE BY A LICENSED ELECTRICIAN.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
1
2
3-
4-
5-
6
7
8
9
10
11
12
13
14
15-
SLOPE (,/ SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~O SL
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
4 ,, ~o ., ~o 7 ~ /~"
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264~1720
SOILS LOG - PERCOLATION TEST
2-0- z_
~ SOILS LOG
[] PERCOLATION
TEST
DATE PERFORMED:
SITE PLAN
WASGROU.DWATE.
ENCOUNTERED?
12-
IF YES, AT WHAT
DEPTH?
13-
15-
Reading Date Gross Net Depth to Net
Time Time Water Drop
TEST RUN BETWEEN FT AND FT
· uq ]
,,.~,
72-008 (6/79)
] ~00.00
Z
4
30
// I ~-
~WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicol ~ SeophysicolSurveys
Feel Below 4. WELL,D~PTH; (flnol} / 5. DATE OF~O~PLETI~
~ /P I~. PUMP: (if eve[leble) HP
[5. ~afer Temperoture ~o ~ F ~
Parcel I.D. 017-033-36
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 s, .{ ,
Certificate of On -Site Systems Approva FFR r ?nih
1. GENERAL INFORMATION
Expiration Date: 5_` / O _ / L
Complete legal description Knik Heights, Block B, Lot 16
Location (site address) 12431 Shelburne Rd.
Current Property owner(s) Robert Stephens
Mailing address
Real Estate Agent
12431 Shelburne Rd.
2. TYPE OF DWELLING:
FF1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Fx�
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for.
Distance:
Received by f
r
Date
COSA to be released to the engineer, unless otherwise
requested by the
engineer.
COSA Fee $ 5:p&• eJ
Date of Payment 91 t -01(4l
Receipt Number Ga a 9 C-7
COSA# (I'SeILf 1-6311T
Waiver Fee $ _
Date of Payment
Receipt Number
Waiver 4
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 Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
—System #1 Approved for 1-4' bedrooms
I
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Phone (907) 272-8218
Date 8/20/13
bedrooms, with the following stipulations:
By: -21�1��%– 1_ Original Certificate Date:
The Muni c0ali f 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
COSA blue sheet r 1, c
Other
If more than 1 septic system is on the lot:
COSA Checklist # _L_of
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Knik Heights, BIOCk B, Lot 16
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 8/19/86 Sanitary seal (Y/N) Y
Total depth 141 ft. Cased to 141 ft
FROM WELL LOG
Date of test 8/19/86
Static water level 89
Well production
20
ft.
Parcel ID: 017-033-36
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24 in.
AT INSPECTION
8/14/13
:•
7.5+
ft.
WATER SAMPLE RESULTS:
ColiformA/ colonies/100 mL Nitrate le �S mg/L
Arsenic ug/L Date of sample: 148110 I `I Collected by: ! �
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 10/14/86
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
�{//
Date of pumping %/ 0I Pumper / o
r �el"'l fc t t
C. ABSORPTION FIELD DATA
Date installed 10/14/86 Soil rating (g.p.d./f:2 or ftZ/bdrm) 180 SF/BR System type Deep Trench
Length 69 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth 9.7 ft. Eff. absorption area 828 ftZ Monitoring tubeY Depression over Feld N
Date of adequacy test 8/14/13 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 47 in.
Elapsed Time: 210 min. Final fluid depth 47
Water added 649 gal. New depth 67 in.
_ in. Absorption rate >= 600+ g p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons _
"Pump off' level at
Cycles tested
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that / 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 Steven R. Pannone
Date 8/20/13
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
in.
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—_-----_-----_—_--
-----__---__--_
b HUFFMAN
ROAD
I
300.00'
S89' 57' 15"E
I
10' UTIL ESMT
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495' 1 0'
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...'.'...... .-.-. EXISTING
.-
HOUSE
36,2'
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913.3' 120'
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WELLi
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— — — -
30'
10' UTIL ESMT
S89° 58' DD'W
300.00'
2
15
I
UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBUTY FOR THE INITIAL TRANSACTION ONLY
AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LJ LOT SURWY SURVEY TYPE -
SYMBOLS
❑ FOUNDATON AS-BUILT
:.
SEF REBAR 7m � DRAINAGE 0 ASPHALT
❑ FINAL STRUCTURE AS-BUILT
a ::::
---�
❑ PLOT PLAN ... ASit11LT ... LDi $URYEr ... TOPaT1AHty
O FOUND REBAR o—g,.g WOOD FENCE CONCRETE
AS—BUILT NO LYgNERS SET rERTFlC ON AS—BUILT. NO CORNER
00 ASSUMED ELEV.-H--X—X METAL FENCE ® W000 DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTIUTY CONNECTIONS AND TO DETERMINE
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
Prepared b
Robert E. Johns, Jr. & Assoc.
PLOT PLAN
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ANCHORAGE, ALASKA 99504
Scale: 1 „ _COI
Rac. Lot S.F.
Rec. Plat File No.
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FOUNDA71ON AS-BUILT:,.;;!r••
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Date Surveyed:
'� 11/26/13
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Date Drawn: 11/27/13
G"d: 2836
W'G' 13-614
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FINAL STRUCTURE AS-BUILT
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Le9al Description:
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KNIK HEIGHTS