HomeMy WebLinkAboutKNIK HEIGHTS BLK C LT 9 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 Wastewater Disposal System and/or Well Inspection Report Permit Number: 2W ~O,3~, PIDNumber: O ~m.: LARsoN L, ~ ~cE Wastewater System: ~w D Upgrade kddress: //~o ~/¢~ ~,~o~ ABSORPTION FIELD 3hone: No. of Bedrooms: ~ ~ DeepTrench~ ~hallowTrench ~ Bed ~ Mound ~Other i~, LEGALDESCRIPTION soi~..~.~: (,~ ~,~,0~1..,~; Total Depth from original grade:  ot: Block: Subdivision: Bepth to pipe bottom from original grade: Gravel depth beneath pipe [f'ownship: Range: Section: Pill added above original grade: Gravel length: .,, ~ Ft. ~? Ft. [WELL: ~ew D Upgrade Gravel ~ I~1 ~ ~ Number of lines: O~slance belween lines: ¢ Ft. / " FI. ~lassification (Private. A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: tiller: Date Drilled: SIslic Water Level: Installer: Date installed: ~ield: ..... Pump Set st: Casing Height Above Ground: r ~-I~GPM i~s' ¢,. z' TANK ~ SEPARATION DISTANCES ~eptic ~ ~o~i~g ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: Prom Tank Field Station Tank Sewer Lines ~ ~ ~ ~ ~ /~ Well /¢¢ ¢ Material: Number of Compadments: Surface w~t~ >/oo' >/co' - ~ -- LIFT STATION Lot Size in gallons: Manufacturer: Foundation ~ i /1~ ~ ~ ~ "Pump on" level at;~; level at: High water alarm al: Curtain ~ ~ ~ Pump MaC Electrical Inspections performed by: .... Drain ~OM~ ¢,J ~EEA ..... ~emarks: BENCH MARK :[ Location and Description: I ~ Assumed Elevation: : . -~I~EE~'S SEAL Inspections performed by: ~, ~ F~q Dates: 1st/z/2¢/¢~? .~~;,¢.~~:-. .... . ....... : ...... ~~. ~' t,/,,},co[ F Anderson Department of Heal Hu ~ces approyal ~:' Reviewed and approved b Date: ...... .013 (1/91) MOA 25 PermitNo. ~;(N ~Z0388 Page .of. Municipality Of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ¢. ~ ,¢',~d I~NI/~ PID No.: o/7o$Y27 72-013 A (2/91) MOA 25 t'S SEAL · .~:k.~ ~, W PermitNo. ~ c~Z./~G Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On,Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L©T~ ? t~L©C/~ ~, K~II< ~t~I~I-fTG PIDNo.:_ 01705L/Z''] . 5 oj ,SEAL 72-013 A (2J91) MOA 25 Munic~pali~f of 0EPARTMENT OF HE. AL, TH & HUMAN SERVICES SQILS LOG ~ PERCQLATIQN TEST 0ATE LE(~AL nF_SCmp-noN:_L._~.._.~~.~T~ Townsni0, Range, SeC~on: ~ ~) I~A u, t C.~ SLOPE 7 8 9 10 11 12 13 14 15 17 18 19 20 WA8 G~OUNO WATE]:I ENCOUNTER EO? I~ ~ IF YES. AT WHAT TTm. __ I, I PFJ::ICOLATION RATE __ TF~ RUN Wa'fez I I (mmu[~m4:~l P~-~C HOLE DIAMETF.~ FT ANO , ,cT ACCOROANCE WiTH ALL..~TATE ANO MUN,CIPAL GUIOFJ..JN~.~ IN EFFECT ON THI~ DATE. OAT1=. -- IN from . HK/MUW-WbLL PHONE No. ; 907 ~45 4417 Mar. 29 199~ 10;00RM P01 Well Log ,.._._ Ale~ka Now-Well/Vero'~ Drltlllnll 12241 Avlon (907] ~4~-4417 Materiel T~p~, Top Bottom ~aPb~rdon,. ]r,dyi;lrace ~r'avel e 17' i seep har. d p~n w/cobbies, oc¢o¢lon~l ?own ~:Jltx UII hard u~n, dump ~ 55', heavy~ ~rd p~n w/cobbles cernel'~ud gr'uvel~ ~u uu y se~ bottom ¢' purr p about 1 ,~:~' boulder 22 eep ~ 65'-73' dB 98 ~~ 98 ............ 125 130 r~rj~p of Well DepLh (fL) Date of CompleLIoh i .......... : .... i~4 Ii.,~,o~ brlllln~I Method Uso Ca~InQ 'typo LO ' Fl.luh or Typo Diameter Pumping, Level B~}ow T 0¢ (: (fL,) A(L~r [hrs~ Pumping I ] I ............ l ........ :.::'.:.:'.'.:....,l Yos~ Malorlal Pump Jsubmersible "~ ~e~Uno ~emark~ ~ w~lll w.~ dr'lll.d ur.dur' my jur'l~dlcllon and LI.I~ roporl la Lr'uo to the bosl of my knowledge ~nd belief'. 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 WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920388 DESIGN ENGINEER:ANDERSON F. NGINEERING OWNER NAME:LARSON L ROYCE OWNER ADDRESS:il300 SNOWSHOE ANCHORAGF. 99516 PARCEL ID: 01703427 i LEGAL DESCRIPTION: KNIK HEIGHTS BLK C LT 9 DATE ISSUED:il/17/92 EXPIRATION DATE:il/17/93 LOT SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIiS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE I.N ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AN[) THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). THE FOLLOWING SPECIAL PROVISIONS. SPEEIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST/2 HOURS PRIOR TO EACH INSPEC%ION. // ~ / ISS[JED BY: ~O~q ~['R¢ DATE: ON SITE SYSTEM IMPACT L 9 Block C Knik Heights Subd. Installation of an on-site wastewater system for this lot should have little, if any, impact on surrounding properties since: 1. The lot has sufficient reserve area for the wastewater drainfield systems and still maintain the required 100 foot well separation. 2. Installation of the on-site systems will not effect surface or sub-surface drainage in the general area or on the lot due to the size of the lot, vacant land to the north and roadways to the west and south. If you have any questions please contact me at 344-4551. Yours Truly, Michael E. Anderson, P.E. NO.L~IH.J.V '~ 0 CHKD. BY DESCRIP'rlON __~___G'__,~__~__(~'_.___:~_~__/L~___///,:, /_6~_/_~T'.:, JOB NO* $ PERFORMED FOR: Munic~0ality of Anci'~orage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" SD'eeL Anct~orage, Alaska 99502-0650 SOILS LOG -- PERCQLATIQN TEST LEGAL DESCRIPTION: 5 9 10 13 14 16 18 19 20- ,'~'////~ //(/Altz2~' Township, Range, Section: SLOPE 7'>// SITE PLAN I I WAS; GROUNO WATER ENCOUNTER ECl? IF YES, ATWHAT DEPTH? s I PERCOLATION RATE -~ TEST RUN aETW~EN _~' D' ~ (mtnutes. qnc, n! PERC HOLE. DIAMETER FTANG ~/, ~"~ ,cT COMMENTS ACCOROANCE WITH ALL STATE ANO MUNICIPAL GUIOELINES IN ¢~cFECT ON THIS OATE DATE; Municipality o! Ancttorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street AncP, orage. Alaska 99502-0650 SC)ILS LOG -- PERCOLATION TEST OATE 2 4 7 12 Townsl~ip, Range. Section: SLOPE El WAS GROUNO WATER ENCOUNTERED? IF YES. ATWHAT DEPTH? 16 17 lg 2O COMMENTS SITE PLAN '~me 'l~n'~ W~er _.I //~,,/,q~ ....... i ~', z ,, .~, '; .~. p' I ~" /" .,~r ,, x, f:; ,t ~ .m" /" ,ff ,, //xr ...... ,/ I -//" /" -f~' _.,' /,% :5 z/ I / ~-" /" I I I I ! PERCOLATION RATE /'/ [mmut~.~,r~..at PF. RC HOLE DIAMETER ~"~" TEST RUN BETWEEN ', '~ P"T ANO _ FT Parcel I.D. # 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMA,rION Complete legal description Location (site address or directions) Property owner Mailing address //3oo Day phone_ Lending agency Mailing address Day phone_ Agent Day phone_ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWA'rER DISPOSAL: Individual on-site Holding tank Community on-site 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~21 STATEMENT OF iNSPFCTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I 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 ,~z,~:7~('~ ~-~J(~iN ,=~¥C~,u L, Phone Ad dress '/~ 0, ']~©,~. Engineer's signature Date DHHS SIGNATURE /~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, With the following stipulations:, Additional Comments By: Date 4;~//~'~ _ The MunicipaJity of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an i~.~ependent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHb 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. Legal Description: /- c/ Municipality-of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~ L. C /~,U l /c' /-/EI ~ ,,-/ ,~5 Parcel I.D. A, WELL DATA Well type /~/~/~ 7--,~- Log present (Y/N) ~/ Total depth /30 Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to /5'¢> ADEC water system number Casing height_ Wires properly protected (Y/N) FROM WELL LOG Date of test /' ~-, ~.3 __ Static water level ~' ~' Well flow ~ - / ?~ Pump level /~/~' g.p.m. AT INSPECT~:~iC,OA,.iTY r~l: ~, ~ E~/ti.~DNMENTf,L SER\ k..-'S OWlS/ON ~3 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot // Public sewer main /¢7/~ ~F~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ) /~ WATER SAMPLE RESULTS: Coliform ~ Date of ample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed /Z/2 (//~Z. Tank size /Z'~O Cleanouts (Y/N) y Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping X/E'W Compartments y Depression (Y/N) Alarm tested (Y/N) ~,//¢ ~CCupA~qcy__ Pumper ~',X/oE'CT'E~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: : Well(s) on lot /~D©' On adjacent lots >/om' To property line I~' .Absorption field Surface water/drainage 2_ Foundatio. ~' Water main/service Ii ~e 72-026 (Rev 7/91) Front CONTINUED ON BACK PAGF Vent (Y/N) Manufacturer Manhole/Access (Y/N) "Pump on~ .... Pump off" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Cycles tested D. ABSORPTION FIELD DATA Date installed Length 57' Width ~"' Total absorption area ~/~Z',/.~ f:_~z_. (j. Z.) Depression over field (Y/N) Soil rating 1, Z. System type Gravel thickness Total depth Cleanouts present (Y/N) Date of adequacy test Results (pass/fail) PA S,.S for ¢ bedrooms Peroxide treatment (past 12 months) (Y/N) t,J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //5' On adjacent lots /OO/ Property line To building foundation /L/I TO existing or abandoned system on lot On adjacent lots /om' Cutbank /~o / Water main/service line Surface water ~ % ~)' Driveway, parking/vehicle storage area Curtain drain /JO/./F~ IM AFt. CA E. ENGINEER'S CERTIFICATION Signature Engineer's Name Date I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the.date pf this inspection. HAA Fee $ /*~0 Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Chmslab Ref.~ :93.1252-1 Client Sample ID :WELL WATER L9 B C KNIK Matrix : WATER Client Name :MCFADDEN, WAYNE Ordered By :WAYNE MCFADDEN PrOject Name : Pr~jeet~ PWMID :UA REPORT of ANALYSIS Collected :03/27/93 @ hrs. Received :03/29/93 ~ 08:00 hrs. WORK Order :64362 Report Completed :03/29/93 ~ecbnical Director :STEPNEN,~C. EDE Released Sample ROUTINE SAMPLE COLLECTED BY: MCFADDEN. Re~azks: QC Allowable Extract Analysis Parameter Results Qual. Units Method Limits Date Date Init NITRATE-N O.lO U ~/1 EPA 353.2/300.0 10 03/29/93 LLH · See Special Instructions Above UA - Unavailable " See Sample Remarks Above NA ~ Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT - Less Than D ~ Secondary dilution. GT ~ Greater Than COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER R BUC WATER SYSTEM I'D' # F-I I r I I I IVATE WATER SYSTEM Name Phone No. Mailing Address city State Zip Code MO. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref, no. /~-- Special Purpose .) [] Treated Water [] Untreated Water TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: //~Sat[sfacto ry [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail Date Received ~:c~'~- -~ ~ Time Received [ ~ Analytical Method: Membrane Filter * No. of colonies/lO0 mi. i SAMPLE No. LOCATION 5l J Time Collected Collected By READ INSTRUCTIONS Membrane Filter: Direct Count Lab Ref. No, Result* l J Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD Coli[orm/lO0 mi BEFORE COLLECTING SAMPLE TNTC OB = Verification: LS B BG8 Fecal Coliform Confirmation Final Membrane Filter Results Too Numerous To Count Other Bacteria Date Time: PART ONE OF T~0 RFMAINDER TO FOLLOW Coliform/100 mi