HomeMy WebLinkAboutKENO HILLS #6 BLK 2 LT 8~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/o PHONE ZNEW
MAILING ADDRESS i Il
LEGAL DESCRIPTION , A~ 6
LOCATION ] NO. OF BEDROOMS
Well [ Absorption area Dwelling PERMIT NO.
~ Z Manufacturer Material _ No. of compartments
~ Liq. capacity in gallons Inside length Width Liquid depth
~ ~O IF HOMEMADE: ~
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
O Z ~ Manufacturer Material Liquid capacity in gallons
Q Well Founda~on Nearest lot line ~MIT NO,
Distance between lines
No. of lines ~ Length of each line Total length of lines Trench wi~h
~ Q~ ~ TOp of tile to finish grade ~ ~ ~ / Material 'beneath tile ~ inch.es Total~effective~ ~abs°rpti°n~ area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot Jine
~ DISTANCE TO:
~ Class Depth Driller Distance to lot llne PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS ,
INSTALLER
APPROVED DATE LEGAL
72-013 (Rev, 3/78)
PERMIT NO.
HF F L I _.HNT NORSCO ::,EF, ~ I L.E CENTER
LOC RTI ON
L_EGRL LSB2 KENO HILLS ~6
[.,EF HR TttEN] HERLTH FIN[.) bM',/t NUNfqb. N ! ML.~ ~:UI bL-~ [ ur'~
o.:,,~ STREET, MNCHURRbE., FIK.
:2~4-4720
( 820460 >
E, Lt.., .-_,': J. ~:0
LOT SIZE
¢.f,=,=.,=.,=..:,.-,.x, os,,:, SQl JAPE FEE7'
TYPE L-IF' ¢',FtIL HB':,CRFTIU.,I .:,T:=,TEM IS: DRRINF!ELD
MRX!MLIM NIJMBER OF EECF. LLfl_, =
SOIL ~HTiNJ r.:22 FT,..BF .... 85
=,I~.E OF THE =,JIL RBSORF'TtON .=,.rz, TEM IS'
THE REQUIR. E[:, c...-~- '-F '-'"-
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE 'TRENCH OR [:,RRINFtELD.
'THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE
GROUND RN[:, THE BOTTOM OF THE EXCFIVF4TION (IN FEET).
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRFI'v'EL BETWEEN THE OUTFFtLL PIPE
BND THE BOTTOM OF THE EXCF¢,,,'BTION (IN FEET).
F'ERMIT RPPLIC:RNT HRS ]"HE F..E.=,FON_,IE, ILI] T TO INFORM 1HI_ uEFRRTMENT DURING 'THE
!NSTRLLRTION INSF'ECTIONS OF RNY WELLS R[:,JRF:ENT TO THIS rm_rr~~. ~ RND THE
NLIfIBER OF RESIDENCES THRT THE WELL WILL _,EF..,E.
....... . : · ,._, t'-.! .::, I;:: E Lq LI I: F,,." F_: [:., .........
T [-..! C) ,,.. Z '::, [ P-4t_ F ~-2 C: 'l I -- "--' R F." E
~.'~ ~,, ""' ' -' -I - '" "' 'I-','-
BRCKFILLING OF RNY z,~_TEM 14ITHC,JT FINAL IN_-,FEL. TILN RND NFFF.._,,HL BY THIF-;
DEF'SRTMENT WILL BE :,UE, JE-.~ TO PF.U:,EU..TION.
MINIMUM DISTRNCE BETWEEN R WELL AND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS
~00 FEE]' FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBL. IC WELL DEPENDING
UPON THE T~PE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIVRTE WELL 'TO R PRIVRTE SEWER LINE IS 25 FEET BND
TO R COMMUNIT9 SEWER LINE IS 75 FEE]'.
WELL LOGS PRE REQUIRED RND MUST 8E RETURNED TO THE DEP8RTMENT WITHIN 30 D~YS
.OF THE NELL COMPLETION,
OTHER REQUIREMENTS MRM RPPL9. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS PRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F"E F~.: f"l ][ 'T E:=-~F' ][ RE.: [. EF_'-~Z~"IE. EF-': 3:1 ........ :
I CERTIF9 THRT
1: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND NELL. S RS SET
FORTH BY THE MUNtCIPBLIT9 OF RNCHORRGE.
2: I WILL INSTRLL THE SSSTEM IN 8CCORDBNCE WITH THE CODES.
~: I UNDERST8ND THRT THE ON-SITE SEWER SSSTEM MR9 REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS.
S I GNED: ..................................................
RPF'LICRNT NORS::: _,EF..,,,IL.E C:ENTER
ISSLIED BY___~C'flTE--~--~-~----~- -
V4. 0
T.H. 5
10/5/76
GRAVEL W/SOME SAk~
AND. SOME SILT
Organic, Dark Brown
0.0
2.0
SANDY GRAVEL W/TRACE
;ILT 3.0
SAND W/SOME GRAVEL
4.0
T.B. 6
/76 0.0
ORGANIC SILTY SAND 0.5
SAND W/SOME GRAVEL AND
TRACE SILT
2.0
GRAVELLY SAND W/TRACE
SILT (SW)
GRAVEL W/SOME SAND (GW)
Many Cobbles
Brown
-- 7.0
SANDY GRAVEL W/TRACE
SILT
Brown
9.5
SAND w/SOME GRAVEL AND
TRACE SILT (SW)
Occasional Cobbles
Brown
6.0
SAND w/SOME GRAVEL AND
SOME SILT (SM)
7.5
SAND w/SOME GRAVEL (SP)
Fine, Very Moist
---- 9.0
GRAVELLY SAND w/TRACE
SILT (SW)
10.5
SAND W/SOME GRAVEL (SP)
Very wet
13.5
SAND w/SOME GRAVEL AND
SOME SILT
Moist
No Water Table
18' T.D.
--'18' T.D.
LSC~L£~ 1"=3 '
TEST HOLE LOGS
HOWARD MOEN
ANC~tORAGE, ALASKA
.NO 656309 J
NO. A-03 ,J
December 14, 1976
, (3/(- ??-, ,., ,o.
Star Route A,. Box 472 W
Anchorage., Alaska 99507
Re:
Soil Profile for Sanitary Sewer Systems, Lots 4, 5, 6, 7, 8, 9, and.
10, Block 2, and Lots 12 and 13, Block 6, Addition 6, Keno Hills-
Subdivision, Anchorage, Alaska.
Dear Mr. Moen:
We are submitting herewith ~he Soil Profile Diagram concerning soil
conditions at the subjec6 site. This report was prepared in accordance
with your request of November 30, 1976. The purpose of this report was
to correlate soil conditions between existing test holes to determine
soil suitability for Sanitary Sewer Systems in areas where tesu holes
have not been drilled.
On October 5 and 6, 1976, eight test holes were drilled on the subject
site for the purpose of defining general subsdrface soil conditions for
the proposed sanitary systems. The final logs prepared for the test
holes have been included in Drawings A-01 thru A-04. The location
diagram for all the test holes has been included in Drawing B-03.
As illustrated by the soil profile', Drawings B-04 and B-05, and ~e test
hole logs, the site is generally overlain by an organic, silty-sandy
overburden up to two feet in thickness. Beneath the surficlal Over-
burden, relatively clean sands (predominately SW-to SP) are encountere~
with thicknesses ranging from 16 feet in Test Hole 3 t6 one foot in Test
Hole 5. In Test Hole 7, well-graded gravels are predominate from the
surface to 13 feet. .
The enclosed soil profile illustrates the expected so~l conditions along
the profile section lines. It is felt that the soil conditions depicted
in the soil profile are reasonably accurate; however, this does not
preclude the possibility of differing soil and, or, groundwater conditions
within the subject area.
December 14, 19~
Page 2 ~
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & J CONSULTANTS, INC.
Jeffrey M. Ayres
Staff Geologist
sc: Municipality of Anchorage
I
S 89° 54' 17" E(Nr)
1502.08
'~-I0 Util Esmt
' ~ //
//
/
[.1wnel~ Name: TOM MARONIi:~Y
.]wner Address: :.:]',,"!:'i () F[.i:I:~N STREET
ANCHI]I:~AGE., AK 99504
P E R M I T
Day F'hone:
· :.48-' ?.-: .) 1
I:::'a~'ce], Id: 020- 1'71.-:38
l._ot Legal: Subdivision." I<ENO HILL,,~ G6 L. ot~ 8 Block~ :2
Sect. ien~ 11 7ownship~ 11N Range~ 3W
Lot. Size [2.5A (sq.l't.. of ac:pBs)
Max Bedraoms~ This Permit,: 3 'T'oCal Capacity: :2;
WEL.I_: l_og must be submit, ted to Munic:ipalit. v of Anchorage Department o~' Health
and Humal] Services wit. hil'l 30 days o[ well c:ompletion.
PERM I T EXF:' .1: RE,S DECEMBER...:,'"~ .1. ~ 1989 ,,
I CERTIFY 'I"HA'T',~
1. I am J'am:L]ia~' w:i, th th~) p(,,.:,,'quipe-~m~:?nts J'op on-~;~t,e sewEel"s af]d we] 'is a~ set.
[ept. h by t. he Ml,.u]:J.c::J.l:JaZit. y oJ' Anc:hopage (MOA) and t. he State a[ A].aska.
2. I will il"Hst, a].] the system in accopdance wi'[.h a],l MC)A codes arH:J pegu].atior)s~,
and in complianc:e wit, h t. he des:i, gn criter~:La c)[' this permit,,
3. I will adhere t.o a].]. MOA and St. ate c)J' Alaska requir'ements Cop t. he set. back
cJiBtanc::es i'pom any exist:Lng well., wast. ewat. ep dispos~ system ap public
sJ~.~w~Dpage By~t.c~lll an t. his op al'ly ad,jac:erJt, op neapby lat.
4,,, Z L,u'ldePst.~nd t, hat, this pepmit, is valid Fop a max:Lmum
a~so unde~tand Lh~t. t. he capacity of the total system 'ii 3 bedr. ooms arid
~;:, - . ..... ~ D A T [,.:]:
([)wne~') 'TOM k~O~:~
]:ssued
By~
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D.#
1. GENERAL INFORMATION (Must be corn pleted prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
/7 7oo Or:'.
(b) Property owner -T'o~
Mailing Address ~' .~"O
(C) Lending Institution
MailingAdCress ~O~ ~. ~ ~.~
(d) Rea Estate Company and Agent
Telephone: (home) ~q,~"-~JSg Business
Telephone ~(g- ffgly
Address
Telephone
(e) Mail the HAA to the following address: (or check here R1, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family I~. Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community [] Public []
~,~, Note:,lf commun ty.~well system .must have:written confirm~t on,from t~eStateDepartment:of,Environmental,.'
Conservation attesfl'ng to th le~ahty and ~tatu~.
4. SEWAGE DISPOSAL
:, On-site~] ~..PublicD Communityl~-::. Holding Tank •
· Note~ If COrflmu'~' t~ we system must h~v~:'written conf(~mat on fror~ the State'Department of,Envirbnmontal
C6nservat on attest ng to the legaflty and status. ' -
72-025 (Rev. 7/88) Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and~a$ of the validation date shown below, I verify'that my investigation of this
Hea th"Authority App['~al.,shows' that the on-site Water supply and/or wastewater disposal system is safe,
functiona and adequate f0~"the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Mun c pa ity of Anchorage f es and from my invest gation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm j~.~'~.~ '7-¢c~,'~Cqf -C~*~'''~ '~J Telephone 3' ¥,5-'- t3,-~',>'''' .-
Address
Date ..-~'-~
6. DHHS APPROVAL
Approved for ,./~ bedrooms by
"' ' '"" '
Appro~,ed ",','.Disapproved
Terms of Conditional ApProva
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88)Back Page 2 of 2
A. WELL DATA
Well Classificati6~
Well Log Present (Y/N) 'r' Date Completed
Total Depth 1~,7 Cased to
Static Water Level
Casing Height Above Grou nd /8"
Electrical Wiring in Condu t (Y/N) Y'
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot IO~' ' ¢u ¢.o.
To Nearest Edge of Absorption Field on Lot ~ i 15'"
MUNICIPALITY OF ANCHORAGE (MOA) .,~,
Health Authority Approval~(HAA)
CHECKLIST ~ FEBRUARY 1984
343-4744
Legal Description: /--~ ~ ~
If A, B, C, D.E.C. Approved (Y/N)
Depth of Grouting
Pump Set At
· Sanitary Seal on Casing (Y/N)
Depression AroundWellhead (Y/N)
N
; on Adjoining Lots ~ ~'oo '
; On Adjoining Lots ;:> ,'oo '
'To Nearest Public Sewer Line ~/!, To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water SampleCollectedby ~'/o.,z(o/o /~c~
Water Sample Test Results ~'~z~3 ~.~r ~r'~ o
Ccmments pi/C- flh~," ,~.¢]-~ifeM '~
Date
SEPTIC/HOLDING TANK DATA
Date Installed 7/8 ~ Size
Standpipes (Y/N) Y'
Depression over Tank (Y/N) N
Pum ping/Mai.ntenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
I Z$"~,~/ No. of Compartments
Air-tight Caps (Y/N) I"
Foundation Cleanout (Y/N)
Date Last Pumped N./I. t~
; for /~/,/3.
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well I 08 ' .,-~*'~ ¢.o,
To Property Line I'i~-' ~2ro~ C.o.
To Water Main/Service Line ~ ff 7
To Stream, Pond, Lake or Major Drainage Course ~ ~oo '
Comments ~ ~' ;~ ~ ~ ~ ~ ~
72~26 {Rev. 7/88) FronJ .Page J o~iz .
To Building Foundation ';2',~' .3Cro~ c.o.
To Disposal Field S '
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7 / ~ ~
Width of Field ,,C' '. ?~
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field ~' 2, S '
Depth of Field ~', 5' '
Gravel Bed Thickness 'Y- ~"
Sta~'ndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot N,/L
To Water Main/Service Line 70'
To Property Line 70
To Existing or Abandoned System on
; On Adjoining Lots ;> .~0 '
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course ~ too
To Driveway, Parking Area, or Vehicle Storage Area ~'$"'
Comments Thc C:~c'~a,~C~e(v~' L' S~'zec-/' ~f ~ ~
D. LIFT STATION~,~~ ~)~'
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and _H~-Z~.~l~ti~lin effect on the date of this
inspection.
.......
Signed ~~ ~ ~ ~ ~ -- " "
Company F[~
Date ~.n~ ~ I CYO ~~ ~~~:'~~ Engineer's Seal
MOA No.
Receipt No,
Date of Payment ~ '~-~ Waiver Fee: $
Amount: $ I~,~ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
CHEMICAL & GEOLOGICAL O ATORIES OF ALASKA, INC.
Client Sample ID:L8 B2 KENO HILLS #6 NORTHSlDE HOSE BIB
PWSID :UA
Collected JUN 21 90 ~ lO:O0 h~s.
Presexved with :AS REQUIRED
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I,D. #92-0040440
ANALYSIS ~EPOgT BY SAMPLE io~ Wo~k O:de: ~ 22625
Date gepo:t P:lnted: JUN 26 90 e 08:53
Client Name : ELATTOP TECHNICAL SRV
Client Acct : ~LAITOT
?.0.) ~ONE RECEIVED
Ozde:ed By : TED MOORE
knalysls Completed :JUN 22 90
Send gepo:ts to:
Labo:ato:y Supervisor :3T.F,P]{EN C.~EDE 1)ELATTO? TECHNICAL
Chemlab Rei {: 901992 Lab Smpl ID: 3 ~atzlx: WATER
Allowable
?azamete: Te~ted Result Dnite Method Lln~i~s
Sample ROUTINE SAMPLE.
Eenmxka: SAMPLE COLLECTED BY CHI{IS.
Teats ?e:£o:med ' See Special Inst:uc~ons Above UA-Un~vaxlable
None Detected "See Sampla Roma:ks Above
Not Analyzed LT-Less Than, GT=O~eate: Than