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
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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
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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,~,
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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)