The URL can be used to link to this page

Home My WebLink AboutKNIK HEIGHTS BLK C LT 10 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 Name: %~¢ /a~,'~ Wastewater System: ~New ~ Upgrade Address: . ~2ox/ ~/eae/~' ~o/ ABSORPTION FIELD Phone: f'" ~¢~- ¢ F ~ ~ aDeepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION. SollRati.g: /. ~ GPD/Sq. Ft. Lot: Block: Subdivision: /O ~ Oep[h to pipe bottom from o~gmal grade: Gravel depth beneath pipe Ft /~O Ft. ~ WEL. L: ~ New ~ Upgrade Gravelwidth: / Number of lines: DislancebelweeMines: - , ~ ~,. Classification tPrivate, A.B,C): Total Depth: Cased To: To~al absorption are~: Pipe material: priller: Date Drilled: Stat,c Water Level: I.slaller:Ft. ¢~r ~G~¢~ GPM Ft Ft TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Sephc Absorpuon L,f[ Hold,n9 'ublic/Private Manufacturer~ / arom Tank Field Stat,on Tank S .... L .... ~R~ Well ~/~ ~/~ ~/~ .~/~ ~/~ Material: ~¢~ / Number . Water >2OD >~¢' //~ N/~ ff/~ LIFTS'rATION I Fo.ndation >/¢ ' >/~ ~ /V/~ ~/~ ~/~ "Pumpon'ievelat: "Purnp off" level a,: HJgh,vateralarmat: % Curtain / ' ' . Drain >ad %/~0' ,,,~/¢ ~y~ ~/~ *umo Make & Model Electrical I~spections performed by: Remarks: BENCH MARK Location aRd Description: ~{~ Assumed Elevation: /O~ ' ~[, ENGINEER'S SEAL ;;Inspections performed by: ~/~r~*~u)¢ Dates: 1st ~/9~ r~ -~. &~*,., ~* . ... 721013 (Rev 9/91) MOA 25 Permit No. 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 Disposa~ System and/or Well Inspection Report Legal Description: /~h/'~/ "~'/¢0/n'/5, ~/0~: C, /~1~ /~ PID NO.: Co , ¢07 72-013 A (Rev. 9/9!) MOA 25 /~7/'/~ J~l~0/~I [~0/~O I I BOREHOLE DATA: Depth Uate~iM T¥~ ad Color From To · ~, TE OF AId~EKA D~PARTM~'r'~P F~RT~JRAL flE~OUIIC~ DIVISION OF WATER WATER WEU. R~GORD ! ,[::3wl WELL OWNEP,~ DATE OF COMPLETi~ DEPTH TO E'AT|0 WATER LEVEL= M~D OF D~UN~ ~ a~ ~y ~ ~le ~ot ~ OF W~ ~ d~ ~ k~ati~ ~ m~ CONlllAOTOR INFORMATION; ~ I~P~ D;arrc Slot/Mesh 8i~: Length: . GRAVEl. PACK TYPE= ~ GROUT TYP~-' Volume: ft DEVELOPMB~iT MB'HOD: PUMPING LEVEl. AND YIELD; ft al'mr .. ~__ .... tvs pumph~n.. ~_. _ a_m'n i~dM.e INTAKE DEPTH: __ ft HorJ~pow~; Wla L DISINFEG~i'ED UPON COU.q~'TION1 [] Y~ ~] N0 PLEASE MAIL WHITE COPY OF L0¢3,~'0; o~aon~lS~Oa oF WAT~ .~ ~ BOX 772116 ~G~ RN~ ~ 99577~116 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:SW930244 DESIGN ENGINEER:POLARCONSULT OWNER NAME:PULLEN FAMILY LIVING TRUST OWNER ADDRESS:2204 CLEVELAND, #201 ANCHORAGE, AK 99517 PARCEL ID:01703428 LEGAL DESCRIPTION: KNIK HEIGHTS BLK C LT 10 LO~ SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 TH~S PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: o o DATE ISSUED: 7/23/93 EXPIRATION DATE: 7/23/94 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 343-4329 OR 343-4681 AFTER BUSINESS 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 AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: i,~.~_[~ ~j~,~,~z~..~..,.~,_~ DATE: ! //~/~,~ f!//~ DATE: ISSUED BY:'--7'--'' '''- ' ~ ....[ polarconsult alaska, inc. ENGINEERS · SURVEYORS ,, ENERGY CONSULTANTS MUNiCIPALiTY OF ANCHORAGE ENVIRONMENTAL SERVICt~$ DIVISION '~1.. 0 6 RECEIVED DHHS, Environmental Services, On--site Services P.O. Box 196650 Anchorage, Alaska 99519 July 6, 1993 Attn: Permit Review Officer Re: Design and Construction Approval for On-site Sewer System at Lot 10, Block C, Knik Heights S/D. Dear Sir or Madam: Please accept the following design for review and permitting. The proposed system does not affect the current use of the adjacent properties and will have minimum future impact. If you have any questions, please give me a call. David Ausman, CE Attachments: On-site Sewer/Well Permit Application Site Plan, Sheet 1 of 4 System Design Calculations, Section, Sheet 2 of 4 Percolation Test, Sheet 3 of 4 Percolation Test, Sheet 4 of 4 $200 Check for Permit Fee 1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 polarconsult alaska, inc. ENGINEERS ° SURVEYORS · ENERGY CONSULTANTS July 6, 1993 JOHN HAGMEYER 2204 Cleveland g201 Anchorage, Alaska 99517 Re: System Design for Lot 10, Blk C, Knik Heights S/D Dear Mr. Hagmeyer, In accordance with our proposal, Polarconsult has completed the system design at the subject property. Attached are the soils percolation logs, design drawings, and a letter of transmittal to the MOA. Based on the site investigation, the property appears suitable for the installation of an on-site waste water disposal system provided the subsurface conditions encountered are representative of the general area and the slope requirements can be met after f'mal grading. The total cost for this work is $600 as agreed to previously. Thank you for giving us the opportunity to be of service and if you have any questions, please~give me a call. David Ausman, CE POLARCONSULT 1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 polarconsult alaska, inc. ],503 West 33rd Avenue · Suite 3].0 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-24:19 SHEET NO. CALCULATED [3Y CHECKED sO^~E /"= ~0' DATE /~o~ 7 T polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 3:[0 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 CHECKED BY DATE / 0 0 2_.I ~" PV¢ p£RE PIPE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 ~ATE PE~O~ME~: ~~ Township, Range, Section: ~/~ /~)~ *~ ~IT~ PL~ 9 10 11 12 13 14- !5 16 17 19 20 COMMENTS WAS GROUND WATER }]1 ENCOUNTERED? /VO s IF YES, AT WHAT N/A oL DEPTR?. P E O°plh t° Waler ADer A //~- ~/~, ~/~ ~) Monilorino? _ /V//I Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE~"~ (minutes/tach) PERC HOLE DIAMETER ~' /'~ TEST RUN BETWEEN .q FT AND '~ FT PPRFORMED BY: .~J~f-~J I ~ /~)...~1-4.~. bJ I CERTIFY THAT THIS TEST WAS PERFORMED iN ~CCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: ~ ~ ~'- ~/~ ~ ~) 72-008 (Rev. 4/85) PERFORMED FOR:_ LEGAL DESCRIPTION: 2 3 4 :'.: 7 0'.0. -.~' 12 13 14 17 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Block 5~ c , AC-lo DATE P E R FORM E D~2~~~ Township, Range, Section: SLOPE SITE P LA"~r WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~///~ ~) DEPTH? p E Monitoring? . . Gross Net Depth to Net Reading Date Time Time Water Drop ~j ,-~-~/ ,__ ,, ~ ~ /¢~$7.~ ¢ ~,'~ 2 ~" t ~" PERCOLATION RATE q (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN q FT AND 5 FT COMMENTS P,"ERFORMED BY: "~)*~,'J I I'~ __/~m,.~.~2~.~.3 I CERTIFY THAT THIS TEST WAS PERFORMED IN ,~CCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7~-008 (Rev. 4/85l 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description /--°~L /0,, ¢/0-¢~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address ~"~-o/~3 /L/~.I~/'~'¢ ~P' Day phone ~ G Day phone 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 WASTEWATER 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny 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 furtherverifythatbasedontheinformationobtainedfrom 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 ~°/qrc-cn~c~/7L Phone Address /-¢'0¢ v,/, ,-~.~, Engineer's signature _ ~.¢'~ ~ /,~¢-4¢¢//'-'- Date DHHS SIGNATURE /~/ Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date .//- '~ z/. --¢.p~ The Municipality 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 independent professional engineer re§istered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-925 {Rev. 1/91) Back MOAIr21 e Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/3/¢'~ Driller/~/fl/A~/r/////l{~ Cased to ~-/~ / Casing height Wires properly protected (Y/N) Y A. Well Data Well type ~F-)'¥4,'~ Log present (Y/N) "7/ / Total depth ,~/~ Sanitary seal (Y/N) Y Date of test Static water level Well flow Pump level1 FROM WELL LOG 8 g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / ~--~-~ / Absorption field on lot l/~ t Public sewer main . /'[/'¢tL~ f'r~ Cu/~,~/v)2/}-r~ Sewer service line /'V}h.6. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout g.p.m. Petroleum tank WATER SAMPLE FIESULTS: Coliform Date of samp,e: Nitrate_ 0.~~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed g Cleanouts (Y/N) Higt~ water alarm (Y/N) ,A/////~f- Date of pumping_/'~/~ Foundation cleanout (Y/N) _ Y Alarm tested (Y/N) / Pumper SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO: Well(s) on lot /~- ~'~ On adjacent lots To property line ~ ¢''/' /~' Absorption field Surface water/drainage Compartments Depression (Y/N) Foundation 2 % Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed --- Size in gallons --' Vent (Y/N) -- High water alarm level --- Meets MOA electrical codes (Y/N) "Pump on" level at ~ Manufacturer -- Manhole/Access (Y/N) "Pump off" Level at Cycles tested ~- SEPARATION DISTANCE FROM LIFT STATION -I'O: Well on lot -- On adjacent lots -- Sudace water D. ABSORPTION FIELD DATA Date installed Length /0(~)/ Width Total absorption area 50~) /~-F Date of adequacy test /'~.p? '~/~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Cleanout present (Y/N) Results (pass/fail) Soil rating (GPD/FF) /' Gravel thickness Y System type J Total depth Depression over field (Y/N) __ /~/kcJ for After test ,.,'~ ¢ Bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot . /~0~ On adjacent lots /2_ .¢ '/ To building foundation /-/? / On adjacent lots Sur/ace water ,/[//CRC_- Curtain drain E. ENGINEER'S CERTIFICATION Property line To existing or abandoned system on lot Cutbank /~//¢'¢¢ Water main/service line Driveway, parking/vehicle storage area o¢ ~' ~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect or of this inspection. ; Signature Engineer's Name Date, FIAA Fee $ ~¢u/70 ' Date of Payment ,'~ Receipt Number Waiver Fee $ Date of Payment Receipt Number NORTHERN TESTING LABORA'DORIES, INC. 33:30 INDUSTRIAL AVENUE FAIRBANK§, Ab~,~KA 99701 907~56~116 2505 FAIRBANKS ~T. ANOHORAGE, ALASKA 99503 DRINKINO WA%~R ANALY.~I~ R~PORT FOR TOTAL COLIFOR}{ BhCTE~IA Polar COnsult 1503 W 33 Ave h~chorage, ~/~ 99503 , Routine Method of Analysist Membrane Flit=etlon Sample Location Date Lot 10 Knik Heights ~ubd. Public Wa~er System I.D.# 11/~6/93 Time Reeeived~ 17~00 1~/~7193 Time Analyze~ 11/18/93 Time R~po=ted= 12~39 C(~mant~: SA Old Sati~factoz7 Uneatis~&ctory None s~le Age >30 House But ~48 Hour~, ~aiysis No * # C~lonies/100 ml *' # Colonies/mi Sample Time Lab~ 16:00 AA14073 0 NT 0 [TI S NORTHERN TESTING LABORATORIES, INC. PMmLt A&ilke, I~c, Ff'alOM) i4~ t6 IMi'k EPA JOO,O iil~Mi~.~