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HomeMy WebLinkAboutKNIK HEIGHTS BLK C LT 7KnI*k Heights Block C Lot 7 #017-034-07 Municipality of Anchorage On-Site Water and Wastewater Program - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191432 PID Number: 017-034-07 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: TEDD & AMANDA WILLIAMS ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 11300 JOHNS ROAD, ANCH., AK 99515 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/S F Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. KNIK HEIGHTS C 7 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft -- -- Ft. Well 100'+ NA NA NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ other Manufacturer GREER Capacity 1 1250 Gal. Surface water 100'+ NA NA NA Material HDPE Number of compartments 2 Lot Line 5'+ NA NA NA NA Foundation 101+ NA NA NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA NA NA NA Remarks Existing septic tank decommissioned Pump on level at in. Pump off level at in. High water alarm at in. per code, new tank installed 5' from & connected to original 1979 field w/ diverter to 1994 bed. New FCO Installed. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer MIKE N. ANDERSON Drainfield CO/MT 3034 Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft Inspection fisc 10/7/19 10/8/2019 Location and description 2�d dates: 3`d 10/11/19 4`" TOP OF MANHOLE COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL i AZ \ Conditional Approval: DateAV �* � ,#(* *� .49THA61i e kIPA4 p MICHAEL N. ANDERSON- No. CE 9469 )0( r Approved ( Date % 10/11/19. cs� t PftPEssto-'s0 s' inspection rteport_9-1-12.doc z 0 CD C CD Fur— O O f m D L7 4�` m Ul Z C:) Z A -C=17.0' B -C=19.7' A -D=18.7' B -D=24.0' KNIK HEIGHTS BLOCK C, LOT 7 PID: 017-034-07 PERMIT: OSP191432 -------------- - 10' UTILITY EASEMENT N89°518'00'W 3C S E -- r�-1 GRAVEL � / 1994 BED FOUND 40.7 BURIED <1' TWO STORY BELOW GRD. 4 -BR HOME , 41 SUMP DCO 199 D4 rReNC D C N CO DIV WELL, I INSTALLED NEW 1250 -GAL MH SEPTIC TANK PER CODE. CO / SCALE: V = 50 SEPTIC SECTION SCALE: NTS PREPARED FOR: SUPPORTCSERVICES: TEDD & AMANDA WILLIAMS ��� OF AL,4'S�� IIII KNIK HEIGHTS BLOCK C LOT 7 F .5 �W-L-112700 SHELBURNE RD., ANCH., AK 99516 C 111111l' A-4 ®r * 4�TIi �* Michael N. Anderson P. E.MICHAEL N. ANDERSON a DATE: 10/11/2019 �� No. CE 9469 4� 4661 Natrona Ave. `' 3 Af DRAWN: FWCS 10/11/19 v Anchorage, Alaska 99516 �4A PN, (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' *OFESSIO� DESIGN CRITERIA: Minicipality of Anchorage REVIEWED FOR CODE C LJAN( OSPI91432, Rebecca Carta 09/301 DECOMMISSI❑N EXISTING SEPTIC TANK & INSTALL NEW 1250 GAL, SEPTIC TANK MAINTAIN 10'+ FROM FOUNDATION, 5'+ TO FIELD & 100' TO WELL WITH 4' ❑F COVER OR INSULAITON, INSTALL NEW FCO & DIVERTER TO ORIGINAL TRENCH, IF ELEVATIONS CAN'T BE MET TO CONNECT TO TRENCH, ADD PUMP BASIN AFTER S.T. I I L 10' UTILITY EASEMENT rr I N89 58 00 W 300,0 --- 2C ---------- w---- -----� GRAVEL I I I j 1 1994 40.7 ro I BED TWO STORY I z I 4 -BR `0 dp`t°,y I o C I HOME 15,9 j1zN1 ° --- I w qr l CD I R) F- I ICD I 24.8 F9 I FCO WELL. 1 I SUMP DCO o INSTALL NEW 1250 -GAL I I u 3 I 19 9 DIV CO MH SEPTIC TANK PER CODE, I CD I �RENCy C STAKE WELL RADIUS CD z I 1WELLS W I I 100 0' OF PROPOSED S.T. I I I I I I I I 10' UTILITY EASEMEN N89058'00"W 300,00 i I \i I I 1 PREPARED FOR: SUPPORT@SERVICES: AMt AW' 1k TEDD & AMANDA WILLIAMS ���, OF 4,LNk 1q�, KNIK HEIGHTS BLOCK C, LOT 7 1H 12700 12700 SHELBURNE RD., ANCH., AK 99516 * 49— Michael N. Anderson RE . � MICHAEL N. ANDERSON DATE: 9/27/2019 c f No. CE 9469 4661 Natrona Ave.DRAWN: FWCS 9/27/19�'oAf Anchorage, Alaska 99516 �?OFESSIOTiP1 (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' 9/30/19 E PMIfs MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-034-07 Property owner(s) TEDD & AMANDA WILLIAMS Day phone 9072290413 Mailinq address 12700 SHELBURNE ROAD, ANCHORAGE, AK 99516 Site address 12700 SHELBURNE ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) KNIK HEIGHTS BLOCK C, LOT 7 Legal description (Township, Range & Section) Lot Size 43,500 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ® Upgrade ® Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FTG (Signature of property owner or authorized agent) Permit/Rush Fees: 02.125- Waiver Fees: Date of Payment: 12&/ Iq Date of Payment: Receipt Number: Qo�a�(Or3ii Receipt Number: Permit No. QS P i U3.q Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 September 27, 2019 On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: KNIK HEIGHTS BLOCK C, LOT 7 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 4- bedroom house. The lot and area are served by private water. The proposed design will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191432, Rebecca Carroll, 09/30/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191432, Rebecca Carroll, 09/30/19 Municipality of Anchorage Page of_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewaler Disposal Syslem and/or Well Inspection Report Permil Number: SW940372 PIg Number: _ 01703407 .a,,,e: Wastewater System: I~ New [] Upgrade Scott & Catherine Blo~mt ,,ddre,s: ABSORPTION FIELD 12700 Shelburne Road Phone: NO ol [~ed~'ooms: (9071 345--9559 4 [] Deep Trench [] Shallow Trench ~ Bed [] Mound [] Other Soil Raling: T~)lal Depth Irom original grade: LEGAL DESCRIPTION 1 GPD/Sq. Ft. 12.5 + / - LoI: Block: Subdivision: Deplh Io pipe hollom t~oln original grade: Gravel depth beneath pipe 7 C Knik Heiqhts 12 + / - R. 0.5 FL Township: ~anga: Section: Fill added above original grade: Gravel lengU~: 1 2N 3 W . 27 0 F~. 51 FL WELL: E] New [] Upgrade GraYe~ widgl: Number Gl lines: Dislsnce belweenlines: 1 7 Ft. 3 5 Fi. :Jasslficalion (Private. A.B.C): [dial Dap/b: Cased To: rotal absorption area: Pipe malarial: Private 1 26 FL 12 6 FL 867SQ, Ft. Plastic Driller: [)ale Drilled: Slalic Warm Level Inslaller: Dale inslslled: Foss Drillin~ Assoc. 06/22/79 '70.25'FO Acre~q~ Systems 10/06/94 3.7 * GPM! 125 F,. 1,5 **~,. TANK SEPARATION DISTANCES ~:~ Seplic I.J Holding [] S.T.E.P. From h*,,* field Stalio. lank Sewer Iii,es ~mchorage Tank 1250 we. 100+ 100+ N/A N/A 100+ Steel 2 S,,~,.~e LIFT STATION Water 100 + 100+ N/A N/A 100 + Lol 9 ' Line 50 + N/A N/A 50+ N / A I -- I High waler alarm al: Foundalion 6 ' 29 ' N/A N/A 0 I Curtain P*~mp Make & Model J Eleclrical inspections pa,lo.ned by: Drain N/ A N /,.A.,. N / A N/A N/A .... I Remarks: * Static water level and yield BENCH MARK per inspection 7/28/94 by DHI. All S.E. Corner Garaqe Slab other well data per DHHS records · * New Seal installed and casing raised 100.0' [I, E N G) J N.,,,.,,~F~t],~. SEAL one foot by MW Drilling 10/20/94. All measurements adjusted ~7¢'-~¢.,.-,~ by one foot. ~ ~ ~, %,~'¢;:;: '-~, ............. ~. ~.~¢, ~:~ '<?' '~ Inspections performed by: Imur:Le Kozisek, P.E. Dates: lsl 10/04/94 ~%~-~%,k~,,~/f'~;-.!:, 2nd 10/05/94 ,-- 3rd 10/06/94 r~,,,. % ~:~.', ~'~'~7-',~1' ,' Health and Human Services approval .~.,-~, Department of~ . ,,~ ...., ,. .~:~..,~;~,,~;~.. ~"~ ........ . ,. . Reviewed and approved by' Date://~/¢ - ~4 ~*'>"~-'~-:,~'":"'~'""'-:"'"" ~' .... ~,~""'~ Permif No.Sw 940572 Municipality of Anchorage Department of Health and IIuman Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650' Tel: 343-4744 On-Site Wastewater Disposal System Legal Descripfion: Page 1 of 3 W.O. 941 47 Date 10- 1 4-94 LOT ? BLOCK C KNIK HEIGHTS SUBDIVISION PID No. 01703407 C.O.~5 NV. 88.4 M.W. ,W_~87_6 C.0.~3 ,o5 ~ ~ -~P 1 '~WINO TIES TO HOUSE DST. TO CORNE C,O, ~4 _0~ A B C 17' 97 '[H~,-$8.4 SP //1 I~ 1~-~[-~0' *:~ SP //2 I - 18, / 28, ~o'~ .~REMOVE TREE _ c,o. //31 53'145'l- c.o. //41 56'172'|- C,O, //5 45'177' ~- MW //1 / 49'I59't- IMW //2 135' 171' |- EMOVE TREE¢5.o, lA ' ,~ 3DRM SINGLE FAMLY HOUSE ~.9' ~...~.~T P 2 .B %' ~--~ '~, 95.2 NV. / PI=AN V!EW ON DECK '~>'" TBM SE 'COR '' - GARAGE SLAB  ELEV.- 100.0_ (ASSUMED) KEY MONITOR WELL ~ : OR STAND PIPE, CLEAN OUT ~-- EXISTING 1250 GAL SEPTIC TANK CRUSHED AND ABANDONED IN PLACE ~ . ~' -PLAY HOUSE A SWINGS RECORD . DRAWING ~ eeeeee ., DAlE SCALE: 1' = 2~)' Permit No. SW 940372 Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, AK 99519-6650 ° Tel: 343-4744 On-Site Wastewater I)isposal System/Well Inspection Legal Description: LOT 7 BLOCK C KNIK HEIGHTS SUBD. PID No. Page 2 of 3 W.O. 94147 Dale 10-12-94 Report 01703407 ELEV.=99.0 ELEV,=88.4 SEED ALL DISTURBED AREAS FABRIC 12" SEWER ROCK 6" TOPSOIL MOUND TO - FILL, NO ORGANICS TYPICAL SECTION 93.5 MONITORING TUBE THfi 1 9~ ORGANICS & ORGANIC SILT SANDY GRAVEL W/ SOME SILT GCC. COBBLE SIET AND SANDY SILT WITH COBBLE 88-- SAND 87 SAND & GRAVEL LAYERS 85 SILT WlIIt GRAVEL DESIGN CALCULATIONS STRUCTURE: - 4 BEDROOM SINGLE FAMILY RESIDENCE .. , DESIGN WASTEWATER FLOW RATE -- 150 GAL/DAY AVG. DAILY WASTEWATER LOAD = 600 GAL/DAY SOILS: PERCOLATION RATE = 2,4 MIN./IN, APPLICATION RATE (BED) = 0.8 GPD/SF (TABLF' 1L, A090-48) APPLICATION AREA NEEDED= 750 SF = 15' X 50' /' ACTUAL ABSORPTION FIELD SIZE 17' X 51'= 86'7"S'F' ::: ,.., :" ':5','( ACTUAL ABSORPTION FIELD SLIGHTLY OVEREXCAVATE'D: RECORD DRAWING Permit No. Page 3 of 3 Legal Description: LOT 7 BLOCK C KNIK HEIGHTS SUBDIVISION W.O. 94147 1 Date 10-12-94 RECORD DRAWING NOTES: 1 ALL CONSTRUCTION DONE IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS OF THE MUNICIPAL CODE : MOA STANDARD SPECIFICATION FOR STREET, UTILITIES & PARKS— 1994 EDITION. 2 CONTRACTOR EXPOSED EXISTING 1250 GALLON SEPTIC TANK FOR ENGINEER'S INSPECTION. TANK WAS LEAKING AND WAS REPLACED WITH NEW STEEL 1250 GALLON TANK. 3 SITE TOPOGRAPHIC SURVEY CONDUCTED BY DHI ON 8-25-94. 4 CONTRACTOR LOCATED ALL UNDERGROUND UTILITIES. LOCATION OF EXISTING UTILITIES ON THE PLAN ARE APPROXIMATE ONLY. ACTUAL LOCATION WILL VARY FROM WHAT IS SHOWN. CONTRACTOR VERIFIED THE EXACT LOCATION OF ALL UTILITIES PRIOR TO COMMENCING WITH CONSTRUCTION. 5 CONTRACTOR NOTIFIED THE ENGINEER AND DHHS 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF THREE SITE VISITS WERE REQUIRED. THE FIRST VISIT WAS TO VIEW THE SUBGRADE PRIOR TO PLACING THE SEWER ROCK. THE SECOND VISIT WAS AFTER THE PLACEMENT OF SEWER ROCK, DISTRIBUTION PIPING, STANDPIPES, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD VISIT WAS AFTER THE WORK WAS COMPLETED. 6 CONTRACTOR DELIVERED TO THE ENGINEER A SET OF RED—LINED, AS—BUILT DRAWINGS SHOWING ALL DATA AS SPECIFIED IN SEC. 15.65.F.2, 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF THE FINAL INSPECTION. INVERTS AND SWING TIE LOCATES WERE TO THE NEAREST TENTH OF A FOOT. THESE AS—BUILTS WERE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWINGS TO DHHS. 7 CONTRACTOR STAKED LOCATION OF ABSORPTION FIELD PRIOR TO COMMENCING WITH CONSTRUCTION. 8 FLOOR OF BED EXCAVATED TO APPROXIMATELY 12' BELOW GROUND LEVEL, TO THE TOP OF THE SAND LAYER, AND SCARIFIED. ELEVATIONS RECORDED AT CORNERS AND MIDDLE OF THE BED BOTTOM. CONSTRUCTION EQUIPMENT DID NOT OPERATE ON THE FLOOR OF THE EXCAVATION, 9 SEWER ROCK PLACED TO THE SPECIFIED DEPTHS. SEWER ROCK WAS NOT CONTAMINATED WITH NATIVE MATERIAL, OR SPOILS FROM EXCAVATION. ROCK SURFACE LEVELED TO t 1" PRIOR TO INSTALLING THE PERFORATED PIPE. 10 ALL PIPE IS PVC CONFORMING TO ASTM D3034. ALL JOINTS WERE CONSTRUCTED TO BE WATER TIGHT. 11 DISTRIBUTION PIPE COVERED WITH 2" (MIN) OF SEWER ROCK, AND COVERED WITH GEOTEXTILE FABRIC BEFORE PLACING FILL AND TOPSOIL. 12 MATERIAL USED AS FILL WAS CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 13 ALL FILL MATERIAL SLOPED TO DRAIN IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD WILL NOT OCCUR. THE FILL WAS LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. 6" OF TOPSOIL WAS SPREAD OVER ALL DISTURBED AREAS. SURFACE WILL BE REGRADED TO DRAIN, RETOPSOILED WHERE DISTURBED, AND SEEDED PRIOR TO JUNE 30, 1995 AS PER MUNICIPAL SPECS, SECTION 75. 1 e t 72-013 A (2/91) MOA 25 C. File: 147C593R DEPARTMENT OF HEALTH & HUMAN SERVICES ~.'" ~,~. 825 "L' STREET_ , ANCHORAGE, ALASKA 99502-0650 ~'~: SOIL8 L~-PERCO~TION TEST~l~ TEST HOLE 1 ~ ' C~: 8-19--94, ~N~ PERFORMED FOR: BRAD GALE ~-~' ' '*~ ~ ' _ ~ ~ DATE PERFORMED: 10-5-94 _ ~.~: ~,:- "L,',;:: LEGAL DESCRIPTION: LOT 7 BLOCK C KNIK HEIGHTS TOWNSHIP,RANGE,SECTION:__ ORGANICS *ROOT MAT omzY ROWN OmO*N,C S,LT ~o ~ W/ OCC. COBBLES TO 4" SLOPE SITE PLAN ~'~'~ i DENSE GRAVEL W/SAND, W/mACE [ ' -J · ~. SILT, LOOSE, DRY 5 -~ ~_ SANDY GRAVEL W/TRACE SILT, ~ ~ ......... ~ ! -- ':.00 OCC. BOULDER TO 8" LOOSE DRY .... .%L ~0 56 6 ~// GREY SANDY SILT ~/ROCK 1/8", OCC. COBBLE DENSE ~ ///~/ ] /~/ / / ~ 9 ~ OREY S~LT W/OCC. gOBBLE, BEN% ~, ~ 10 ~&~ VERY DENSE, MOIST SILT ENCOUNTERED ? NO L W/GRAVEL TO 2" 0 --- 11 ~.~¢~. IF YES, AT WHAT p -~}~$t~.I FINE DRY SAND W/SOME DEPTH ¢ ~s~,j SILT BALLS A GRAVEL I 12 ....... DEPTH OF WATER ~X-~/' i COARSE SAND W/ LENSES AFTER MONITORING ? NONE FOUND DATE: 9/25/94,10-5-94 15 ~ SILT, SOME GRAVEL, DRY '~:~$~1 DENSE DRY SANDY, SILTY GRAVEL "~"~ OCC. SILT BALLS, OCC. COBBLES , lo-5-94 3:19 51/16" 1 ~ ~ 2 10-5-94 5:29 10 MiN. 9 1/2" 4 7/16' .. VERY DENSE, MOIST SILT 15 p//// SILT, MOIST W/OCC. %1~/: BOULDER TO 6" 5 ,o-5-94 ,:4o:,o ~ 6;/4" ~ ~ ~.O.H ~ 10-5-~4 3:50:30 10 UlU. 10 17 8 10-5-94 , 4.01 --~ 10 MIN. 8 3/4" 4" , ~ 8 - 10 10-5-94 4:12 ~ MIN, 8 3/4" , 3 5/8" 19 PERCOLATION RATE: 2,8 (MINUTES/INCH.) PERCHOLE DIAMETER: 6" 20 TES~ RUN BETWEEN: 11 FT..~ND 1'1.5 FT. COMMENTs:PERC -rEST PREFORMED ON SYSTEM BE~ AP~OX 15' NORTH OF TH//1, SOILS UNIFORM THROUGHOUT BED PERFORMED BY: L. KOZISEK ~J~, ~. TIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF~N THIS DATE. DATE: 8-19-94 A 10-5-94 147CSBA~ 2 10-5-94 5:29 10 M~N, 9 1/2" 4 7/16" 4 10-5-94 3:40 I 10 MIN. 10 5/8" 5 1/8" 5 10-5-94 3:40:30 J 6 3/4" 6 10-5-94 3:50:30 10 MIN. 10 3/4" 4" 7 10-5-94 3:51 4 3/4" 8 10-5-94 4'01 --J 10 MIN. 8 3/4" 4" 10 10-5-94 4:12 ~00 MIN, 8 3/4" 3 5/8" MUNICIPALITY OF AHCA'IORA~E DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" STREET, ANCHORAGE, ALASKA gg502-0850 $01L8 LOG-PERCOLATION TEST TEST HOLE 2 PERFORMED FOR: BRAD GALE __DATE PERFORMED: 8--19--94 LEGAL DESCRIPTION: LOT 7 BLOCK C KNIK HEIGHTS TOWNSHIP,RANGE,SECTION: LOOSE ORGANICS BROWN & GREY SILTY SAND W/GRAVEL LOOSE BRIGHT ORANGE SILT & ORGANICS DENSE SANDY GRAVEL W/SOME SILT, SILl' LENSES, OCC. COBBLES TO 4" COARSE SANDY GRAVEL W/5-10% SILT, ROCK TO 1/2", W/OCC. COBBLES TO GREY SILT W/OCC. BOULDERS TO 8", SOME GRAVEL, VERY DENSE, MOIST, QUICK WAS GROUND WATER ENCOUNTERED ? IF YES, A-F WHAT DEPTH ? DEPTH OF WATER AFTER MONITORING ? SLOPE S NO L 0 P E SITE PLAN NOT MONITORED DATE: 9-2,3-94 1 8-1g-g4 t 10 MIN. 10 1/4" 5 1/4" 6 8-19-94. 1:40/1:50 I 10 MIN. I 9 1/4' 4 1/4" 7 8-1g~g4: 1:50,5/2:0C 5 10 MIN. 9 1/8" ~- 1/8" 8 8-19-g4 2:01/2:11:1 ' 10 MIN, 9 1/8' 4 1/8' PERCOLATION RATE:'-2.,~: (MINUTES/INCH.) PERCHOLE DIAMETER: 6" TEST RUN BETWEEN: 4 _FT. AND '~.5 FT. COMMENTS: MONITORING TUBE NOT ~ THIS PI~7-BE,GC(~JSE OF PROXIMITY TO TEST PIT 1, NO WATER NOTED. t / // PERFORMED BY: L. KOZISEK --, '~~ICERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL_ STATE AND MUNICIPAL ~UIDELINES IN ~FFEC~"'¢ THIS DATE. DATE: 8-19-94 147CSBAD PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGP~ADE) PERMIT PERMIT BK]MBER:SW940372 DESIGN ENGINEER:DHI ENGINEERING OWNER NAME:BLOUNT SCOTT B & CATHERINE 0 OWNER ADDRESS:12700 SHELBURNE RD ANCHORAGE, ALASKA 99516 DATE ISSUED: 9/30/94 EXPIRATION DATE: 9/30/95 PARCEL ID:01703407 LEGAL DESCRIPTION: KNIK HEIGHTS BLK C LT LOT SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THiS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: o 4 o THE ATTACHED APPROVED DESIGN. 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). THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 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 A_N]D HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: INT IT%O XI IN TH~ TIME OF ~4qRUC~ION. RECEIVED ISSUED BY: / ' SEPTIC TANK AT DATE: DATE: Rermit No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ' Anchorage, AK 99519-6650 ° Tel: 843-4744 0n-Site Wastewater Disposal System Legal Description: LOT 7 BLOCK C KNIK HEIGHTS SUBDIVISION Page 1 of 5 W.O. 94147 Date 9-01--94 PID No. NSTALL INSTALL BED SYSTEM SEE SHEET 2 OF zoo 105 --~- ..... . .-~=TOE OF SLOPE , I 2" TO~ 4" -/$UNICIPALITY OI- ANCHO 'k~ SEE NOTE 7~ O~P 0 ~ 1994 RECEIYED PLAN VIEW YU~EoE~ 2~TYP I~,1 TP 1 ~EMOVE TREE,.1.O,'~q J-= WEST ~XLL' O~ 6WRA6~' ]"" ~ 4 BDRM I~1 SINOLE FAMLY HOUSE .:'.'"." :' ."," ~" ': ', ~1 ~ ~ ~ :-'-.. :..,-..... I ~ / ~ / I t'-'ELEV.= 100.0 ~ ~¢.~TP 2 ~' .. ~1 FLATTEN SLOPERS" ~//~ LJUD~-~i~-H~. ~ t ROUTE WIRES THRU INSTAL LIFT / sEESTATIONNoTE 16 / ~ PLAY HOUSE & SWINGS No On-Site Legal Descripfion: LOT 7 BLOCK C KNIK HEIGHTS SUBD. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ° Anchorage, AK 99619-6650 ° Tel: 343-4744 Wastewater Disposal System/Well Inspection PID No. Page 2 of 5 W.O. 94147 Dale 8-31-94 Report /~SEED ALL DISTURBED MONITOR TUBE ~. AND FILLED AREAS SEE PLAN-. .5' 1 C.O. FILL, NO ORGANICS 12" SEWER O.G. ROCK INSULATION REMOVE 2'± ORGANIC SILT REPLACE W/ FILTER MATERIAL REMOVE ORGANIC MAT TYPICAL SECTION MONITORING TUBE OIL 3:1 98.0 ORGANICS & ORGANIC SANDY GRAVEL W/ SOME SILT OCC. COBBLE SANDY GRAVEL W/ TRACE SILT OtC. COBBLE TO 99 92,5 DESIGN CALCULATIONS STRUCTURE; - 4 BEDROOM - SINGLE FAMILY RESIDENCE DESIGN WASTEWATER FLOW RATE : 150 GAL/DAY AVG. DAILY WASTEWATER LOAD --- 600 GAL/DAY SOILS; PERCOLATION RATE = 2.4 MIN./IN. APPLICATION RAT[: (BED) -- 0.8 GPD/SF (TABLE 1, A090-48) APPLICATION AREA -- 750 SF ABSORPTION FIELD SIZE -- 15'X50' 87I WITF COBBLE RECEIVED SEP 2 8 1994 Dept, Health & Human 8er~tcee MUNICIPAkflY OF ANCHO 'k~(5~' ENVIRONMENTAL SERVICES DIVISION SEP 0 7 /994 RECEIVED c. rile: 1476SBBD ermit No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION Page 3 of 5 W.O. 94147 Dale 9-01-94 P.O. Box 196650 * Anchorage, AK 99519-6650 · Tel: 343-4744 On-Site Wastewater Disposal System Legal Descripfion: LOT 7 BLOCK C KNIK HEIGHTS SUBD. PID No. MONITORING TUBE ,.~ SEE PLAN VIEW ADD RINGS TO ADJUST ............... / FOR LOCATION . C 0 (5 TYP ) L /SLOPE OF HILL ~-i;1 ~ ~ [ 101~ ON 100.0 L Z ~ ~ ~ / EAST SlOE , 500 GALLON / / ...... ~ 15' X 50' OF 2" INSU~TION =~ ADD ON LIFT - ~1~ / 6~LF ~¢ ~ STATION / SOLID PIPE / SLOPE PIPE TO DRAI~ TO LIFT STATION RECEIVED SEP 2 8 1994 Municlpah~y Gl A, ~crla: age Dept. He,~lth & Human Se, v,cee MUNICIPALH'¥ OF ANCHo,k~,~b ENVIRONMENTAL SERVICES DIVISION RECEIVED I~ermit No. Page 4 of 5 W.O. 94147 Legal Description: LOT 7 BLOCK C KNIK HEIGHTS SUBDIVISION Date 9-1-94 NOTES: ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITN CHAPTER 15.65. WASTEWATER DISPOSAL. REGULATIONS OF THE MUNICIPAL CODE : MOA STANDARD SPECIFICATION FOR STREET, UTILITIES & PARKS- 1994 EDITION. 2 CONTRACTOR TO VERIFY INVERT ELEVATION OF SEPTIC TANK OUTLET & EXPOSE EXISTING 1250 GALLON SEPTIC TANK FOR ENGINEER'S INSPECTION PRIOR TO BEGINNING WORK ON TFIE ABSORPTION FIELD. 5 SITE TOPOGRAPHIC SURVEY CONDUCTED BY CHI ON 8 25 94-. 4 ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION INTO THE SYS'[EM 5 CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES. LOCATION OF EXISTING UTILITIES ON THE PLAN ARE APPROXIMATE ONLY. ACTUAL LOCATION WILL VARY FROM WHAT IS SHOWN. CONFRACTOR SHALL VERIFY THE EXACT LOCATION OF ALL UTILITIES PRIOR TO COMMENCING WITH ANY CONSTRUCTION. NOTIFY TIlE ENGINEER OF ANY OBSERVED CONFLICTS PRIOR TO CONSTRUCTION. 6 CONTRACTOR TO NOTIFY THE ENGINEER AND DHHS 24- HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF THREE INSPECFIONS ARE REQUIRED. TNE FIRST INSPECTION SHALL BE OF THE SUBGRADE PRIOR TO PLACING THE SEWER ROCK. THE SECOND INSPECTION SHALL BE AFTER THE PLACEMENT OF SEWER ROCK, DISTRIBUTION P~PINO, STANDPIPES, AND OTHER COMPONENTS AB SPECIFIED. THE THIRD INSPECTION SHALL BE AFTER THE WORK IS COMPLETED. 7 CONTRACTOR SHALL DELVER TO THE ENGINEER A SET OF RED-LINED, AS BUILT DRAWINGS SHOWING ALL DATA AS SPECIFIED iN SEC. 15.65.F.2, .3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF THE FINAL iNSPECTION. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT. THESE AS-BUILTS SHALL BE USED BY FHE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWINGS TO DHHS. 8 CONTRACTOR SHALL STAKE LOCATION OF ABSORPTION FIELD PRIOR TO COMMENCING WITH CONSTRUCTION. g EXCAVATE THE ABSORPTION FIELD DOWN APPROXIMATELY 2' TO THE BOTTOM OF ORGANIC SILl. BOTTOM OF EXCAVATION SHALL BE SCARIFIED. RECORD ELEVATIONS AT CORNERS AND MIDDLE OF THE BED BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FI_OCR OF THE EXCAVATION. ANY MAI-ERIAL COMPACTED BY THE OPERATION OF 1HE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITII UNCOMPACTED MATERIAL. REFILL ABSORPTION FIELD TO EL. 98.0 WITH FILTER MATERIAL AS PER SEC 15.65.O60.D. 10 PLACE THE SEWER ROCK TO 'THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL, FILTER MATERIAL, OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO ± /" PRIOR TO INSTALLING THE PERFORATED PIPE. 11 AIL PIPE SHALl BE PVC CONF'ORMING I'D ASTM D3034 OR ENGINEER-APPROVED EQUAL. ALL JOINTS SHALL BE WATERTIGHT. FIELD TEST WATERTIGHTNESS OF FORCE MAIN PiPE BETWEEN PDMP & FIELD BEFORE COVERING. MINIMUM SOIL COVER SHALL BE 2' OVER THE PIPE IN THE FIELD AND 4' OVER THE PIPE FROM THE FIELD TO THE PUMP. ALL INSULATION BOARD SHALL BE 2" THICK DOW H1-35 INSULBOARD OR ENGINEER-APPROVED EQUAL. 12 COVER THE DISTRIBUTION PIPE[ WITH 2" (MIN) OF SEWER ROCK, AND COVER WITH GEOTEXTILE FABRIC BEFORE PLACING INSULATION, FILl_, AND TOPSOIl. 13 MATERIAL USED AS FILL SNALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 1,1 SLOPE ALL FILL MATERIAL I'D DRAIN A~ 2% MIN. SLOPE, AND .3:1 MAX SLOPE, AND IN SUCH A MANNER THAT PONDING AT OR NEAR TIlE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLfMENT. THE TOP 6" OF FILL SHALL BE TOPSOIL. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MUNICIPAL SPECS, SECTION 75. 15 RECORD THE FINISH GROUND ELEVATION OVER THE CORNERS AND CENTER OF BED AND SUBMIT THIS INFORMATION ALONG WITH THE RED LINES TO THE PROJECT ENGINEER. 16 LIFT STATION SttALt. CONSIST OF A SINGLE 1/2 H.P./lIS VAC U.L. LISTED EFFLUENT PUMP, ORENCO OR EQUAL, IN A 500 GALl_ON TANK, WiTH ALARM, CONTROL PANEL, AND ALL ELECTRICAL AND MECHANICAL APPURTENANCES CONFORMING TO MUNICIPAL WASTEWATER DISPOSAL CODE SECT. 15.65.080. CONTRACTOR SHALL SUBMIT SNOP DRAWINGS FOR APPROVAL PRIOR TO PURCHASING MATERIALS. Permit No, begol Description: LOT ? BLOCK C KNIK HEIGHTS SUBDIVISION NOTES: Page 5 of 5 W.O. 94147 Date 9-1-94 17 CONTRACTOR SHALL VERIFY PLANNED METHOD OF WIRING THE CIRCUIT BREAKER, MOUNTING ALARM, AND REPAIRS OF WALL DAMAGE, IF ANY, WlTB THE ENGINEER PRIOR TO COMMENCING WORK. 18 CONTRACTOR TO OBTAIN ALL REQUIRED STATE AND MUNICIPAL PERMIT AND COMPLY WITH ALL APPLICABLE CODES. CONTRACTOR SHALL NOT DAMAGE ROOTS OR BARK OF TREES, EXCEPT THOSE MARKED ON DRAWINGS FOR REMOVAL. RECEIVED S E P 2 ~ ~,994 , MLINIOIPAL[i"Y OF ANO~IORAG~ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 ~L" SI~EET. ANCHORAOE, ALASKA 99502-0850 801L8 LO(iI-PEROOLATION TEST TEST HOLE 1 PERFORMED FOR: BRAD GALE DATE PERFORMED: 8-19--94 LEGAL DESCRIPTION: LOT 7 BLOCK C KNIK HEIGHTS TOWNSHIP,RANGE,SECTION: ORGANICS *ROOT MAT GREY-BROWN ORGANIC SILT W/ CCC. COBBLES TO 4" DENSE GRAVEL W/SAND, W/TRACE SILT, LOOSE, DRY * SEE NOTE SANDY GRAVEL W/TRACE SILT, CCC. BOULDER TO 8" LOOSE DRY GREY SANDY SILT W/ROCK 1/8", CCC. COBBLE DENSE GREY SILT W/CCC. COBBLE, DENSE VERY DENSE, MOIST SILT W/GRAVEL TO 2" FINE DRY SAND W/SOME SILT BALLS & GRAVEL COARSE SAND W/ LENSES SILT, SOME GRAVEL, DRY DENSE DRY SANDY, SILTY GRAVEL CCC. SILT BALLS, CCC. COBBLES VERY DENSE, MOISq SILT W/ GRAVEL TO 1" SILT, MOIST W/CCC. BOULDER TO 6" RECEIVED SLOPE WAS GROUND WATER S ENCOUNTERED ? NO L IF YES, AF WHAT DEPTH ? DEPTH OF WATER AFTER MONITORING ? NONE FOUND SITE PLAN DATE: 9/23/94 1 8-19-94 11:25/11:33 10 MIN. 9 I/2" 4 1/4" 3 8-19-94, 11:¢3/11:53 10 MIN. 9 1/2" 4 1/4" SEP 2 8 1994 MUlllO,pcll~,;~ ,¢. ,., ~.,i,.~ ~.~8 Depb Health & Huma~ S,-,-PEBP-_~)LATION RATE: 2.4 (MINUTES/INCH.) PERCHOLE DIAMETER: TEST RUN BETWEEN: 4 FT. AND 4.5 FT. COMMENTS:* ELEVATION OF TOP OF LIQUIDS ON SEPTIC TANK IS SAME ELEVATION AS 4' DOWN THIS HOLE (SHOT WITH LEVEL) PRESOAK STARTED AT IO:50-VERY FAST. PERFORMED BY: L. KOZISEK CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8-19-94 147CS8AD DEPARTMENT OF HEALTH & HUMAN SERVICES TEST HOLE 2 PERFORMED FOR: BRAD GALE DATE PERFORMED- 8-19-94 LEOAL aESCRIP-nON: LOT 7 BLOCK C KNIK HEIGHTS TOWNSHIP,RANOE,SECTIO~: //// B.O.H I_OOSE ORGANICS BROWN & GREY SILTY SAND W/GRAVEL LOOSE BRIGHT ORANGE SILT & ORGANICS DENSE SANDY GRAVEL. W/SOME SILT, SILT LENSES, OCC. COBBLES TO 4" COARSE SANDY GRAVEL W/5-10% SILT, ROCK TO 1/2", W/OCC. COBBLES TO 4" GREY SILT W/OCC. BOULDERS TO 8", SOME GRAVEL, VERY DENSE, MOIST, QUICK MUNtCIPALt/Y OF ANCM~Dt~'~b ENVIRONMENTAL SERVICES DIVISION ' E ~ I ~ST RUN BETWEEN: COMMENTS: ~.// ~-/~¢,~/~ ~ ~F~ ~ ~'~ ~. 7' WAS GROUND WATER ENCOUNTERED ? IF YES, AT WHAT DEPTH ? DEPTH OF WATER AFTER MONITORING ? REcr v-rr) MUnic SLOPE SITE PLAN i I NO P E 5 8-19-94 h29/1:39 10 MIN. g 1/4' _ (MINUTES/INCH.) PERCHOLE DIAMETER: 6" SEP 0 7 19D~RCOLATION RATE: 2.4 FT. AND 4.B FT. '~"~T ,~,7~ ~' rc ~ PERFORMED BY: L. KOZISEK CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8-19-94 147CSBAD 10-03-1994 12:05PM FROM D HI ONSULTING TO 3436?40 P. 01 LTING ENGINEERS Surveying Planning FAX MEMORANDUM FAX NO .... ~q%"~ 7 qO ..... W.O. NO. SUBJE~: 1. o~ ~ b[oo~ ~ . ~n/l~ &~ NO OF PAGES ~:t O~luding ~ FOR YOUR I~ORM~TIOS: Origi~ Di~ition: ~ Mail~ ~ C~I tot Pickup ~ FiI~ PO Box 111349 Anchorage, Alaska 99511-1349 · (907) 345-1385/Fax 3454386 TOTAL P, 01  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVlSIQN ~' 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 i ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT '~EGAL DESCRIPTION LOCATION_ , N~.OF BEDROOMS :~:~ Manufacturer & ~~. Materi~'T~C No. of co~ments Liq. c:.~-~"~allons., S IF HOmEmADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~:~Manu[acturer ---./q/~ Materia] Eiquidcapacityingallo,s -- ~~ ~ DISTANCE TO: Well '11;:~ NO. Of lines / [.e,g,~c~,. line Total ,ength~Zes, Trenc~th inches Dist a:,c~ ~7~' ?nos -- ~ - Total. el f~ct[va~bsorption ~N Top of tile to fieish grade ~/ Material beneathtileQ~ '/ ken,th ~id~b De~tb P~R~IT ~O. m :~ ~ Type of crib Crib diameter Crib depth Total effective absorption area :~ Well Building foundation Nearest lot line ~ DISTANCE TO: Class De~ ...... Driller Distan~ to lot line ~ PERMIT NO. i[ ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ......... IPE MATERIALS ~NSTALLER ~ (Rev. 3/78) WELL OWNER WATER WELL LOG FOSS DRILl, lNG ASSOCIATED 909 CHUGACH DR. #5? ANCHORAGE, ALASKA 99503 Frank O, Bethard WELL LOCATION Lot ? BlkoC Knik Hts. Subdiv. MUrmCIPANTY Of' ANCHORAGE DEPT. Ci ::; L'[i~ & E NVIRON;v' Eix, L'~.L [:i 0 i'ECTION USE OF WELL Domestic RECIziV'ED SIZE OF CASING 6" DEPTH OF HOLE 125 FT. CASED TO 12~ FT. STATIC WATER LEVEL~7~__FT. G, P, M, 20 WITH 40 FT. OF DRAWDOWN. REMARKS DATE COMPLETED 6/22/79 .... PUMP TO BE SET AT.__I~4! ._~ tol~0 j_q_t o3 _ 3_~_t o$~ t~t o~.~_ .70. to 120 120toj2~ to Alluvium; brown co-or~ medium hardness Till; gr~X...color and very hard Alluvium; grey color~ medium ~ardness Alluvium; dark grey colo~.~, medium hardness with water: Till; ~rey color, and hard Sand and~ravel; grey .color with water 1 G.P.M. to to to to to to to to to to to~ to HF:t::':i).HI.IH h,!!,ff'!l!'4:? [)F: Edi![:'F~:ll)()l'ilil :: ':I TFiF L.!i:];':!(!i't"H F:'}HF:'I"J':; H ~ '::;" I F:Hf':i'liq Ii',! ' . OF' r ' ..................... · !.t. ':, , 'd:: ' 'F' ::'t'.": rd:z, DF:F:!"' ~' ' '"1" !'Hi:( i)F!]:'TH OF' FI iF;:Ei',!Ci~ ()R F>];'! ..... " ................ (:}i~':l;')lr.iF',![:' F:iILJ[) 'ii" · -,. t:-x,.... ;11 :}!; NFl, (:;F;:FI'v'!;i !;:1!:!;!:"i'll *iiI$::: Fi;f; TT '. i'". I'll::' F:'E'i;;:H;!i" i:::!1.:'i:'! ;iL [:Fir,FI' Fli::: <:: 'Fl-.l[:; J;i:j:!;'}};It:'l]l~.,j!.:;;[ I~.l;J . ]; T"? ill) "*l,!t-I..I.:.J',! J'I.iT. ':::; [)!i!]::'l'::l~,};Ti,!i;{]k! f' ~"'.... 'Z'.' ';",~ d:: ,.,~., ;"! ?.U...' .( .'!::: .-f:L..i _f::l l' _( !;;Ii'-,! i; N:!ii;I'::'F!X3T :[ (;ff'.ir:i; OF:' f::lN'./ ri,l::-Ii % !::![:,.;J'l::l(;:Fi:h!T FO FH J; ::::; ! l,:.!..l~. ~- ,: T Fii'.E:* ;..i ::. SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99B02 276-222~ SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST ;PERFORMED FOR: 2 3 SLOPE SITE PLAN 9 10 7 b-O 15 16 17 18 19- 20- ./ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: 72-008 (7/76) MUNICIPALITY OF ANCHORAGE Development Services Department \ = / Phone: 907-343-7904 On -Site Water & Wastewater Section \ - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-034-07 Expiration Date:_1 — 11-1— 2—Oa 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS BLOCK C, LOT 7 Location (site address) 12700 SHELBURNE, ANCHORAGE, AK 99516 Current property owner(s) TEDD & AMANDA WILLIAMS Mailing address Real estate agent ELBURNE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® 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: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $J�� Date of Payment to 'Mq Receipt Number NpNq D COSA # OS C I I ! L115 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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 10/7/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic „40074 applies only to the conditions as of the day tested. The flow and absorption rates may change AW OF AZZ due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, levels that may fluctuate during the of .> groundwater year, quality construction (workmanship & materials), the water usage of the family being served by the+ 1 system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the 10, * , TH well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by FUf5 and Anderson Construction & Engineering. -woun f3. J13IDY,tAIi,. No, Cc fi 4 of DSD SIGNATURE '--:10/7/19 ..• System #1 Approved for bedrooms b"W System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: 1 /As T EATER - p J j)1J)))i1111� l ^, By. Original Certificate Date: C'�� 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other Legal Description: KNIK HEIGHTS BLOCK C LOT 7 Parcel ID: 017-034-07 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 6/22/1979 Total depth 12T_ft Cased to 125 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/27/2019 Static water level at beginning of test 88 ft. Well production at time of test 5+ gpm Comments B. TANK DATA — 10/7/2019 - 1250 GAL Age oftank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate L` 4 (_ mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) WES Collected by` Date of Sample 9/25/2019 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA — 32'L x 3'W x 8'ED — 114 SF/BR = 512 SF Which system tested (date installed) 6/5/1979 Adequacy test date 7/23/2019 ® ALL standpipes present per record drawing Results N Pass For 4 bedrooms Total measured depth from grade 13.4 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 8.4 ft (min) Water added 1010 gal ❑ N/A — pressurized field New depth "55.5 in (Below Invert) ® Monitor tubes go to bottom of effective. If not, state dElapsed time 1120 min depth into effective 5 ® Code -required soil cover over field Final fluid depth 0 in ® System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced 1740 gallons If yes, enter date Comments/Deficiencies: Fluid levels during presoak and test were 55.5 — 57" below invert consistantly. F�-�p� ;- %�_'-__ COSA Checklist copy 4.docx 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' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® 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 ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® 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' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S 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. 10/8/19 COSA Checklist copy 4.docx ft ft > CO > II CO '2 trJ C: 0 co 0 0 ri .gym ca C." CD 0 1 arq m cjl X, CA 0 r CO CA CD 0 -.1 g�b000 -S m K- D m I'- 0 0 H .0 to m coo ct ca m 0 OP 00 -Cy 0 C, :Hr -1 CD O 0 0 co Rb CD CD PYO p0 W m m (D (D 0 w CD 0 CD Cc" c000�a e.. o =fb CD 0,4 I I 00'9-b L M,,OO,ZO.00N :-`� 00*9tL M,,OO,ZO.00N -40 C-4 0 ,GVMJ� 3NOM3HS dw 00 6� LO 0 p O O 00'9-b L M,,OO,ZO.00N :-`� 00*9tL M,,OO,ZO.00N -40 C-4 0 ,GVMJ� 3NOM3HS dw 0 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 94147 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING j� Parcel I.D. # 01703407 HAA # 1. GENERAL INFORMATION Complete legal description Lot 7 Block C Knik Heights Subdivision Location (site address or directions) 12700 Shelburne Road, off Huffman �_,fI[ ,:F Property owner Scott & Catherine Blount Day phone (907) 345-955. Mailing address 12700 Shelburne Road, Anchorage, Alaska 99516 Lending agency Fenton Young Mortgage Day phone (907) 345-3442 Mailing address 16300 Christensen Road, Suite 106, Seattle, Washington 98188 Agent N 1 A Day phone Address Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water 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: _.Individual on-site X Holding tank`' L , 1 w Community on-site t4 ., .. .;�.�. public sewer.... NOTE: `" If community wastewater system, provide written confirmation from State ADEC attesting to the legality 'and status of system. 72-025 (Rev. 1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm PHI Consulting Engineers Phone (907) 345-1385 Address 2820 'Q -'-Mw 111349 ', Ancharaqef Alaska -'-99511-1349 l�, _�AZZ' Z Engineer's signatureDate Dee High, P E. Note: Seeding will be completed bj June 30, 1995. 6. DHHS SIGNATURE ._. Approved for bedrooms." Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments BY: Date lT The Municipality of,"AiZ chorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates `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 iending institutions in orderto 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. 1/91) Beck MOA #21 `(4147 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:L 7 B C Knik Heights subdivision Parcel I.D. 01703407 A. Well Data Well type Individual If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) Y Date completed 06/22/79 Driller Foss Drilling Association Total depth 126' Cased to 126' Casing height 1.51 Sanitary seal (Y/N) Y * Wires properly protected (Y/N) Y * * New Seal installed and one foot added to casing by MW DRILLING / inspected by DHI 10/20/9 FROM WELL LOG AT INSPECTION r., Date of test 06/22/79 07/28/94 z rrna o Static water level 75' 69.25' Well flow 20 g.p.m. 3.7 g.p.m. n, r m O Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot _ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform 0 Date of sample: 07/27/94 B. SEPTIC/HOLDING TANK DATA 100' + 100' + c Z Ifsrn_ o 2� �c On adjacent lots 100' + o ; On adjacent lots 100' + Public sewer manhole/cleanout N/A N/A Petroleum tank N/A Nitrate 0.21 Other bacteria 0 Collected by: Mark Erikson Data installed 10/04/94 Tank size 1250 Gallon Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping New N Y Depression (Y/N) Y _Alarm tested (Y/N) N/A Pumper N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 100' + On adjacent lots To property line 50 + Absorption field_ Surface water/drainage 100' + 100' + Foundation 6' 35' Water main/service line N/A 72-026 (3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed N/A Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot N/A On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at _Cycles tested Surface water Date installed 10/06/94 Soil rating (GPD/Ft2) 0.8 System type bed Length 51 ' Width 17' Gravel thickness 1 ' Total depth 12' Total absorption area 867 S F Cleanout present (Y/N) Y Depression over field (Y/N) Date of adequacy test New system Results (pass/fail) N/A for N/A Water level in absorption field before test N/A After test N/A Peroxide treatment (past 12 months) (Y/N) N/A If yes, give date N/A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100'+ On adjacent lots 1001+ Property line _ To building foundation 29' To existing or abandoned system on lot On adjacent lots 501+ Cutbank N/A Water main/service line Surface water _100'+ _ Driveway, parking/vehicle storage area 70' Curtain drain N/A E. ENGINEER'S CERTIFICATION rs N/A N Bedrooms I certify that I have checked, verified, or conformed to all MOA and NAA nuidelines in effPnt nn tha datA of th;s ;ncnor/;nn Date of Payment l Receipt Number -- Lf R! Date of Payment Receipt Number \IA it ---- — -------- s>` > 0 1 >1. H. :j , I U) m Co > m :K -0 (6 M uo C-1 1115,00 P ir , s>` > 0 1 >1. H. :j , I U) m > m :K -0 (6 M 0 � 0 -,<O O0 CD L ol o (D z -n 2 :D3 =0 " 0 c =O x M GQ --j < 0, ;5 r 0 Z C) 9 "A " D, o 0:� -5 0 > C, Z DO " 0 ri In I (D O'Q �d w (D cn L m 0 (D Di m m 0 �o 0,0 0 C-) m (D 0 (D 0 ;D 10 O 0 (D ro (D m > 0 z (D 0 0 to n CD 0 cn 5 o o 0 T C-1 1115,00 P ir , H. :j -0 (6 � CD L ol o (D 2 :D3 =0 " 0 GQ --j < 0, ;5 r 9 "A " D, o 0:� > C, It " 0 ri In I (D O'Q �d w (D cn (D (D 0 �o 0,0 m> (D 0 (D 0 ;D 10 > 0 (D (D CD (D 0 0 to n CD 0 cn 5 o o 0 T C-1 1115,00 P ir , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) ApplJcant Name~ I~V~ ~lbL/~ Telephone: Home Applicant Address ~OJ [,L), kJr)~.ml-I~ L.q-% A~CFI. (c) Business ~. '-?' c~ ApplJcant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institutiot) Telephone Address (e) Real EstateCompanyandAgent-b"./~,.,)Al~(.'., _'?, CA L-I~// / Sq-~U~ Address ~OI ~. ~TI-I~I~ I,-T~, A~Ci~ · A-~. Telephone P~ fl_ - 7 6 II (f) Mail the HAA to the following address: 5107 TYPE OF RESIDENCE Single-Family ~ulti-Family [] Other Number of Bedrooms ~¢¥ (J"~O L) I°~ )_ WATER SUPPLY Individual Well B~ Community [] Public [] Note: If communily well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [.~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDI[ NSPECTIONS, TESTS, FILE SEARCH, D, AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thi~ HeaR,h. Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 lhe Municipality of Anchorage files and from my investigation 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. NameofFirm_'~)t£~,A.//,'t-')% i)L~A..~p-~blbE'f~l~//O~q~ Telephone ~--b Address ~'6 I,~.~ , ~%~F~(~ ~b~ ~ AL}dLF( . ~. ~qS~-g DHEP APPROVAL Approved for '~'~"' Approved Engineer's Seal ._ . .,. , ~ bedrooms by ~~ ~' %¢~ Date ~- "- / ~ ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72 o25 (u/84) MUNICIPALITY OF ANCHORAGE (MOA~iUNiCiPALi-iY OF ANCHORAGr- HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 J~NVIRONMENTAL PI~OTECTION 264-4720 .RE EI V E WELL DATA Well Classification Well Log Present ~N) Total Depth /~--~' / _ Cased to Static Water Level '7'~"" t Casing Height Above Ground /,~ ~ Electrical Wiring in Conduit~-~)N) Separation Distances from Well: To Septic/Holding Tank on Lot __ If A, B, C, D.E.C. Approved (Y/N) Date Completed [¢ ]2&2_~]7~ Yield ,/,¢,.~ '~ Depth of Grouting Pump Set At Sanitary Seal on Casing~(Y~N) Depression Around Wellhead (y/(~i ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _/~ ~' ! ; On Adjoining Lots To Nearest Public Sewer Line /tJ ]/~ To Nearest Public Sawer Cleanout/Manhole Water Sample Collected by Water Sample 'rest Results /00 Comments f SEPTIC/HOLDING TANK DATA Date Installed ~--/"~ J / I Size /'¢2~'4) . No. of Compartments .~* __ Air-tight CapsC~N) Standpipes(~N)_ ~ Depression over Tank (Y4~ Pumping/Maintenance Contract on File (Y~'~ Holding Tank High-Water Alarm (Y~-~ Separation Distances from Septic/Holding Tank: To Water-Supply Well __ ~ O~' To Property Line 5~_~ To Water Main/Service Line ' ~ Course /k) 0 y Foundation Cleanout~N) Date Last Pumped _ 5 ; for Temporary Holding Tank Permit (Y~) To Building Foundation ~7 t To Disposal Field '~ ~-~ t To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11t84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~o [ ~' ]~ q Width of Field '3/~ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well i ;'~ / ''~ To Building Foundation ~. :,~¢ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ,.~ ;;:;:2_ I Depth of Field ~ Gravel Bed Thickness '~ j Standpipes Present~/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoining Lots ~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at .." Tested for Dimerf~i-ons M~nhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments /' ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed.~~'~ _-'~',-~- Date ~ 12--~ I ~ Company~J~l~' ~ ~..~t~l~' A ~. MOA No. Receipt No. ~..~ '~ '~/ Date of Payment ~/~' ~/¢ ~ Amount: $ //~ ?~ Page 2 of 2 72-026 (11/84) ° CE-4488 o,,° ,5' z; ~O W, Benson Blvd. S,dte 20~ PENINSULA EN GINEFAHNG (007) 561-5107 March 28, 1986 Dynamic Realty 501W. Northern Lights Blvd. Anchorage, Alaska 99503 Attn: Steve Smith RE~ Lot 7 Block C Knik Heights Subdivision Sewer & Water Health Authority Approval Dear Steve: Per your request we have performed the adequacy test of the septic system as required for health authority approval on the above referenced property. ~ The test was performed by adding water from the well at 6 g.p.m, to the end of the absorption trench and monitoring the levels in the trench and septic tank at regular intervals. This procedure was repeated on two con- secutive days and the test results are tabulated below: Well Qnty Date Time Tank C.O. Rate Gals 3/25/86 0 17.5" 1" 0 gpm 0 10 17.5 11 6 60 25 17.5 12 6 150 cap chkd 6 qpm 45 17.5 12.5 6 280 60 17.5 12 6 360 80 17.5 15 6 480 95 17.5 19 6 570 6 gpm 110 17.5 20 6 650 3/26/86 0 18" 3 6 0 15 18 12 6 90 35 18 12 6 210 55 18 14.5 6 330 70 18 15 6 420 85 18 20 6 510 6 gpm chkd 110 18 25 6 650 3/27/86 0 18.5 6 6 0 The test results indicate that the sewer absorption system is performing ade- quately for a 4 (four) bedroom home. The well as tested found to deliver a steady flow of 6 g.p.m.. If we can be of further assistance please do not hesitate to call. Sincerely, Wayne Henderson, P.E. WH:js MUNICIPALITY OF ANCHORAGE DIVISION OF EN"qlRONMENTAL HEALTH DEPARTMEN OF H~:.AL%I{ AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~ + :: '~' ~-'- (a) Legal Description (include lot:, block, subdivision, section, to%reship, range) Location (address or directions).~ ?': '?¥~::'> ~h'~ ( (~. ~,'~.< I<:,:,~ ~ (d) Lending Institution ~Tg~/~ Telephone 1 (f) Telephone Mai]. the HAA to the following address: -;/., : . ,,,.',:.: ._ 2. ~pe of Residence Single-Family,S. Number of Bedrooms Multi-Family ~ Other ~(.~dese r:tbe) Water _S Uj~_p ]~.~ Note: if community well system, must have written confirmation from the Sta~e Department of Environmental Conse~ation attesting to the legality and status. ~Sewage Disposal 0nsite ~ Public I:--[ Community ~ Holding Tank ~Z Note: lJ community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] i[As certified by my seal affixed hereto and as of the validation dats shown below, iverify that my investigation of' this HeaLth Authority Approval shows that the on-site iwater supply and/or wastewater disposal system is safe, f~ctional and ~equate for ~ the number of bedrooms a~[ type of structure indicated herein.. I further verify that~ based on the i~o~ation obtain~ from the ~nicipality of Anchorage files and from my ~ i~vestigation ~d inspection, the on-site w~ter supply and/or ~stewater disposal ~8ys~em is in compliance ~.th ~1 Municipal and Stage codes, ordinances, a~ regula- ~ tions in effect on the date of this inspection. ~Na~ Of Fi Telephone Approved J/ Disapproved __~__,L/ ' Co~ition~/ ~ Terms of Condition~ Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HY~ALTR /~[) ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOIJELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRhkPR 5 ABOVE BY AN LNDEPENDENT PROFESSIONAL ENGINEER REGISTERED %N THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~YD STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE 18 ISSUE]). THE MIRqICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TtIE tRIOFESSIONAL ENGINEER'S WORK. RR4/ej/OlS 2 of 21 (DHEP SEAL) 7-19-84 WELL DATA Well Classification Well Log Present~/N) MuNICIPALI'fY OF ANCHORAGE DFPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIR°NMENTAL pRO'rEC'fION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 ~)~ Total Depth Static Water Level Casing Height Above Ground /' / '~- z Electrical Wiring in Conduit/.~Y.)N) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) /t//"'-'7"./., Date Completed ~;~/~ z ,/-7~' Yield J Z~' / _ Cased to / '~ ~ / Depth of Grouting Pump Set At ~/~-~ ~'~ Sanitary Seal on CasingS) Depression Around Wellhead (Y~) Cleanout/Manhole _ Water Sample Collected by Water Sample Test Results To Septic/Holding Tank on Lot __ To Nearest Edge of Absorption Field on Lot _ ; On Adjoining Lots To Nearest Public Sewer Line ~'~' To Nearest Public Sewer ~/~.' .... To Nearest Sewer Service Line on B. SEPTIC/HOLDING TANK DATA Date Installed ~/eZ-_cL_ Size //~ ~"~ -'" No. ofCompartrnents ~-'" Standpipe~/~) Air-tight Cap~Y)-~N, Foundation Cleano,~ *.. Depression over Tank (y~/~ Date Last Pumped g//~/~ ~ ....... ;for Pumping/Maintenance.Contract on File (Y/N) Holding Tank High~Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Property Line ~'i To Water Main/Service Line _ ,///,//v~'~:emporary Holding Tank Permit (Y/N) '~,~" To Building Foundation ,-0 To Disposal Field _ /~.2 ~ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata~ Date Installed Width of Field Type of System Design Length of Field Depth of Field / '~ Square Feet of Absorption Area Depression over Field (Y~_~! Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //"~-~' / ~ To Building Foundation _ .r---~.~2/")(~ Gravel Bed Thickness /~"%-"~ Standpipes Present)N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on / Lot -/~-g~" On Adjoining Lots 'TL-r.?2z¢2 To Water Main/Service Line "~'~'~) *~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course _/-/~/_2 / To Driveway, Parking Area; or Vehicle Storag~ Area ~,.2~ ~ . D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (yiN)`~ i~'m'-e n siOn s ......... ' ........ "Pd'i~i~' ~ff'' Level at Pumping Cycles during Adequacy Test. Meets MOA Comments/// ,J ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha~have chec,~ed, verifie.,~._or conformed to all MpA an, d HA~ guidelines in effect on the date of this inspection. Signed &/~'/~' k,~ ~ Date ____/~ ~ . ~oF A~ Receipt No.~ :~L[ C?_ 5 ~' ' Date of Payment ~ ': i ? "~ ~ " '0 Amount: $ /~ r~ ~ /eroy C, ReM, Jr, Page 2 of 2 ~ ~?~,~ o,~, ........ ; 'f', .~-~_.. 4L;~-,:,'~/"i~" (// ......... I?A:.:T',' O;' ,dqC,~Ol;.AG2' ' ' , MUN CIPALITVOFANOHORAGE DEPT. OF i: .:".in ~ 825 L Street- Anchorage, Alaska 99501 ~) ~ LO~- ENVIRONMENTAL ENGINEERING DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) clays for processing. 1. PROPERTY OWNER PHONE PROPERTY RESIDENT (If different from above) ' PHONE 2, BUYER .... PNONE MAILING ADDRESS 3. LENDING INSTITUTION , MAILING ADDRESS 4. REALTOR/AGENT [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One F-Z2~our [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPJ.I.LY I~P~ N DIVI DUAL- [] COMMUNITY PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975 For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM L~L~IN DI VI DUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date ~ If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS .SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPFCTION APPOINTMENTS TIME - TIME -TIME DATE DATE [)ATE I NSPECTO R INSPECTOR INSPECTOR DIR ECTI~)NS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [~ FIVE [] OTHER [] MUL. TIPLE FAMILY [] TWO [] FOUR [-3 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 [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~ '-~') ? Connection Verified INSTALLER _ . []Septic Tank or []Holding Tank Size; ~'.,Z~"~ If Tank ishomemade SOILS RATING give dimensions: ! / ~ ~-YPEOFTANK MANUFACTURER 2~,~ ~ TOTAL ASSORPTION AREA MATERIAL ,i_h _ . ~. 4, DISTANCES Septic/Holding Tank 1Absorption Area ~wer Line Nearest Lot Line WELL TO: ..... '~'bsorption Area to nearest Lot Line 5. C'OMMENTS ~-~-APPROVED FOR d~-- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED LEGAl. DESCRIPTION 72-010 [Rev. 3/78)