HomeMy WebLinkAboutKNIK HEIGHTS BLK D LT 5 Onsite File
Knik Heights
Block D
Lot 5
#017 - 035 - 05
Municipality of Anchorage
On -Site Water and Wastewater Program - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181232
PID Number: 017-035-05
Dwelling: W Single Family (SF) E] Duplex (D) 1771 Multiple (SF and/or D) Project: F_J New FEW] Upgrade
Name:
Donald Endres & Laura Koenig
ABSORPTION FIELD
Address
7 Deep Trench 7 Shallow Trench 7 Bed F-1 Mound
12600 Atherton Rd, Anchorage, AK 99516
0 Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
229-5657
4
GPD/SF1
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot
Ft. Ft.
Knik Heights D 5
Fill added above original grade Gravel length
Township Range Section
Ft. Ft,
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES
Ft. Ft.
To! Septic 1 AbsorptionHolding sewer
Lift Station
Total absorption area
Number of trenches
Dist. between trenches
From Tank Held Tank 1 Line
2
Ft
Ft.
>
Well 1 N/A N/A N/A >25'
TANK Septic ❑[] S.T,E.P� ❑r_1 Holding E] Other
Manufacturer Capacity
Surface Water >100'1 N/A N/A N/A 1
Anchorage Tank 11250 Gal,
Material Number of compartments
Lot Line >10' N/A i N/A N/A
Steel 2
NA
Foundation >10, N/A N/A N/A
LIFT STATION
Manufacturer Capacity
Curtain Drain None' Noted
Gal.
Remarks No insulation was used.
Pump on level at Pump off level at High water alarm at
Tank only permit
----------- ------
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to drainfield D3034
Installer
A+ Home Services
Drainfield CO/MT
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspectes:tion 1" d
10/9/18
Location and description
da2
3rd4th
Bottom of siding on SW corner of house.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
0
Conditional Approval:
Date
Are 4
I �Xv
4-9 TH
E
lao /19
CE 12592
.�11/20/18
ApprovedXQP,�
Date
Inspection Report-9-1-12.doc
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PLOT PLAN AS BUILT —2L SCALE —!L= GRID —SW— 2836 Project No. 18-577/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, in c . (907) 522-6476 Phone 00000pp0
(907) 522-4625 Fax oo
Professional Land Surveyors kenOlongsurvey.com c OF A.7k
jonothanOlongsurvey.com_ a��•.• .•S QO
I hereby certify that I have surveyed the following described property:
LOT 5, BLOCK D, KNIK HEIGHTS SUBDIVISION (PLAT No. P -452A)
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on sold property except as Indicated hereon.
Dated this the m:x' Day of 7`' 25 , at Anchorage, Alaska
49TH *(
.................. J............
. KENNETH G. �
4�A .�S-5202.-*'
0
Q�� �SSIONA� o
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
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PLOT PLAN AS BUILT —2L SCALE —!L= GRID —SW— 2836 Project No. 18-577/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, in c . (907) 522-6476 Phone 00000pp0
(907) 522-4625 Fax oo
Professional Land Surveyors kenOlongsurvey.com c OF A.7k
jonothanOlongsurvey.com_ a��•.• .•S QO
I hereby certify that I have surveyed the following described property:
LOT 5, BLOCK D, KNIK HEIGHTS SUBDIVISION (PLAT No. P -452A)
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on sold property except as Indicated hereon.
Dated this the m:x' Day of 7`' 25 , at Anchorage, Alaska
49TH *(
.................. J............
. KENNETH G. �
4�A .�S-5202.-*'
0
Q�� �SSIONA� o
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
MUNICIPALITY OF ANCHORAGE oent
On-Site Water&Wastewater Program No Sc„
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
_ Department
4h<HORP'�
On-Site Wastewater Disposal System Permit
Permit Number: OSP181232 Effective Date: 8/1/2018
Work Type: SepticTank Upgrade Expiration Date: 8/1/2019
Tax Code Number: 01703505000
Site Legal Address: KNIK HEIGHTS BLK D LT 5 G:2836
Site Mailing Address: 12600 ATHERTON RD, Anchorage
Owner: ENDRES DONALD R& Lot Size in Sq Ft: 43500
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. 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)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: e/ OW.r L'�l t Date:
Issued By: �; . / / Date: . 118
eeLl/AS
MUNICIPALITY OF ANCHORAGE
Community Development Department ;,.. ir Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-035-05
Property owner(s) Donald Endres & Laura Koenig Day phone 229-5657
Mailing address 12600 Atherton Rd, Anchorage, AK 99516
Site address 12600 Atherton Rd
Legal description (Sub'd., Block & Lot) Knik Heights Block D Lot 5
Legal description (Township, Range & Section)
Lot Size
43,500 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field n Initial I I Single Family (SF) X
(w/wo ADU)
Septic Tank U Upgrade
Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings
Privy LJ (SF and/or D)
Private Well U
Water Storage Ill
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
WL-"r•
(Signature of property owner or authorized agent)
Permit/Rush Fees: g15 Waiver Fees:
Date of Payment: '7"/A7/r2 Date of Payment:
Receipt Number: Q8(iog0 Receipt Number:
Permit No. 3SP/ 'L23e).. Waiver No.
Permit App__-.• ::..,c
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
July 26, 2018
MOA Development Services Dept- On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Knik Heights Block D Lot 5 – Septic tank replacement
Dear On-Site Services Engineer:
The septic tank has failed on the above property, so we are submitting this application for a new
tank. The attached site plan identifies the location of the home, well, and existing septic system.
The new tank will be placed in the same location as the old tank. No conflicts exist between this
proposed system and any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot slopes moderately from the east to the west, but not enough to cause
any difficulties in the new tank location. Drainage arrows are shown on the site plan showing the
grade and direction of flow.
Wells on this and adjacent lots are shown. The new tank will be more than 100’ away from all
wells, and more than 5’ from the existing field.
Please refer to the attached plan. If this design is followed, there will be no adverse impacts to
adjacent properties.
Sincerely,
Benjamin Schiller, PE
7/26/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181232, Rebecca Carroll, 08/01/18
// // // // // // // // // // // // // //6' CHAIN LINK FENCE
2CO
4-BDRM HOMENOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH
WELLS OR SEPTIC SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
MT
ATHERTON ROADKNIK HEIGHTS BLOCK D LOT 5
Jul 26, 2018
1"=50'
FEET
0 50 100
GRAVEL DRIVEWAY
TO LOT 4
10' UTILITY EASEMENT
EXISTING SEPTIC TANK
REMOVE AND DISPOSE
OF OFF-SITE
INSTALL NEW 1250-GAL
SEPTIC TANK
CO
CO
MAINTAIN 5' SEPARATION
FROM EXISTING FIELD
AND 100' FROM WELL
PROVIDE DOUBLE
CLEANOUT BEFORE AND
AFTER TANK
EXISTING WELLWELL >100' FROM PROPERTY LINE2CO
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181232, Rebecca Carroll, 08/01/18
tMAILING ADDRESS
EGAL DESCRIPTION
ILOCATION - ~- . . .~_., .
[-'--
I I
/ ~ I Manufactu~r ~
[ ~ i Liq. capacity in gallons
~ j ~ IF HOMEMADE:
OZ< I~ -
MUNICIPAI_I'FY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DlVlglON
825 1.. Street - Anchorage, Alaska D9501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
-J' -7~,~-- I [] UPGRADE
Length
~: F-- Type of crib
DISTANCE TO:
~ lclass
~ ~ DISTANCE TO:
·
DISTANCE TO: Well
No. of lines Lenglh of each line
I
Top of tile to finish grade
Width
Crib diameter
Well
Absorption area
Inside length
Dwelling
Foundation
Total length of lines
Material beneath tile
Depth
Depth
Crib deptb
IDwell~,~ ~
Material
Width
Materia]
Nearest lot line<
Trench wild t I~'"~
.'~/,~'-" inches
inches
NO. OF BEDROOMS
-- ~'-E R M-~I~T N O.
Nc). of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Total effective absorption area
PERMI~ NO.
Building fouadation
Driller
Building foundation Sewer line
PIPE MATERIALS OTHER -r--
/
SOIL TEST RATING
Total effective absorption area
Nearest lot line
PERMIT NO.
Absorption area (s
Distance to lot line
Septic tank
INSTALLER
REMARKS
-- ,~- ~:~ .,- ~.,p~
..... ~TR ;.;, .... ', t ',:,
APPROVED
DATE
LEGAL
72-013 (Rev. 3/78)
Static Water Lew]l __~__ .... feet
Draw Dowrl____~~_ ..... 'feet
WELt. LOG
MUNICIPALITY OF ANCHORAGE
DEP[. ()i: ; !.i:~ &
I~NVIRONMLt~i,',z.,, i [CTION
L.~,:.,, 2 2 t~00
RECEI'VED
Gallons Per Minute
Total Feet of Casing]//~,'
0 feet to ~:~' ' ~ / %
.'.d s'
F'ERMI T NO,
[:,EF'RRTMEt'.,tT 0r HERLTH FII'.,!D EN',/II;::ONMEN'rRL P'~"O'T'EC:TION
825 "L :E;TREET., RNCHORIRGE., RK. 9'.9L .,
2.E;4.-4720
I..,.llEEL_L. ~::'~ ~'-4 £;:, C~IPd.--.?ZE:] X qf~E :B',EE t-,.~ E ~:a". F' E]II;,.].: ~',"l ]'It'. ']-
,:; 800.542~ )
11PPL I CRI'.,IT
LOCRT 101'.4
I...EGRL
R 0 E: E R T ',,,'FI U G Id1'4
L5 BLOCK D KNIK HEIGHTS
440:1. E. 6TH
LOT SIZE
4:...].':500 SQLIF:IRE FEET
'I"¥F'E OF SOIL RBSORP'T'ION S'¢S'rEM IS: TRENC:H
MRF,',IMIJM NUMBER OF BEDROOb'IS = 4
SOIL RFIT'I1'dG (S(.:.! F"T/BR)= :1.50
THE REQUIRED SIZE OF THIS SOIL FIBSCIRPTI01'.4 S"r'STEM IS:
E::" E; F" 'T Ifil := :~:~ b. EE !".4 (::'~ "iF I~-al == ";""=' -~;; C~ ~": ii-'BI '...' EZ If ..... E:> E"F- F' qr" IH =::
THE L. ENGTH [.',II','IENSIC~N IS THE LENGTH ,::IN FEE]") OF 'I"HE TRENCH OR [:,R11INFIEI..[:,.
TIdE [.',EI:::'TH OF FI 'FRENCH OR PI]" IS THE [:,ISTFINCE BETI. qEEN THE SLIRF11CE OF THE
GROUND 111'4[.'.', ]'HE BOTTOM OF THE EXCF~',,,'RTION (IN FEET).
THERE IS 1'.,10 SET !.dI[:,TI4 FOR T'RENCHES.
THE GRFIVEL. [:,EF'TH IS; THE MINIMUM DEPTH OF GRR',,,'EL.. BETHEEN THE OUTF11LL F'IPE
11ND THE E:OTTOM OF TH[-:.:' EXC11VRTION (IN FEET.':,.
PERt','I I T 11PPL I CRNT HRS TIdE RESPONS I B I L I 1"¥ TO I NF'ORFI 'T'H I S I)EP11RTME1'.,IT DUR I NG 'l"l-,.l[.~]
Ii'.,IS]'F-ILLFITION INSPECTIONS CiF RNa" HELLS 111)J11CENT TO THIS F'ROF:'ERT'¢ 111'4[:, THE
NUMBER OF RE:E:I[:,ENCE'..E; TH11T THE HELL HILL SERVE.
........... "iF I,.ql C} ,:: ;;:.~ ::, :[ I".ql :~5; F' E: C: 'T ]: ~_-],, t'-.I :S; f---.~ ~;~;: E: F~: E,.:] 6;~ L.I I ~-': E If::: ..............
BRCKFILLING CiF FIN'¢ S'¢s'rEM HITHr.)t.IT FINRL INSPECTION RN[:, I=IPF'RO',,,'FIL [¢'¢ THIS
[)EPFtRTMEI'.,IT I.,.IIL. L BE SUBJECT TO PROSECUTI01'4.
i',tINIMIJM DIST111'.,IC:E BETHEEN F:I HELL. RN[:, FIN'¢ ON-SITE SEHRGE [.',ISF*OS11L S'¢STEM IS
:I. EiEi FEET FOR FI PRIVRTE HELL OR :1.50 TO 200 FEET FROi'd R PUBLIC HEL. L DEPEI'.,ID:I:NG
UPON THE T"r'F'E CIF PUBLIC 1.4EI..L.
MINIMUM [:,IE;l'11NCE FROi"I la PRI',,,'RTE HELL TO 11 PRI'¢11'fE SEHER LINE IS 25 FEET 111",1D
'l"l..]l El CCIMI'dUNIT'¢ SEI.,.IER LINE ]:S 75 FEET.
HELL LOGS RE:[:' RE6!UIRED R1",I[:' MUST BE RETUF.:NE[:' TEl THE [:,EF'FIRTI'dE'NT P.IITHIN S':IZ~ DR'CS
OF THE 1.4ELL COMF'LETION.
O]"HE~F.': RE6!UIREME'.NTS M11'¢ RF:'PL.'~". S;PECIFICflTIONS RN[." CONS, TRUCTION [:,IFIGRRME; RRE
F:I',,,'RILR8LE 'FO INSURE PROF'ER INSTFILL11TION.
I CERTIF:"¢ TId11T
:L: J: F¢'1 FFtMILI11R I.,IITH 'FIDE F'~:E~]:.!UIF.:EMENTS FOR CN-:,I rE' "' ..... ':_,El. lEk..=,", ""'"' 111'.4[:, WELLS FIS SET
FORTF.I [.:Y¢ THE MUNICIF'11LIT'.r' OF R1'.,ICHORRGE.
2: I I.,.I):LL I1'.,IST11L[. ]'HE S'¢STEM 11'.,t RCCOF.'.D11NCE .WITH 'THE CO[.',ES.
]:: I UI'qDERST11N[:, THaT THE ON-SITE SEb. IER S"r'STEt'd M11¥ REIP. UIRE ENLFIRGEMENT IF' ]'fiE:
RES:;I[:,EI",ICE IS REMODELED TO INCLUDE MORE TH11N 4 BEDROOMS.
Contracting Engineers & Associates
212 Fast International Airport Rd,
Suite 204
ANCHORAGE, ALASKA 99502
(907) 278-3773
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION: ~ '~' /'~ d~) /"{' "~ / /~' /"~ ~'''~''
171
18
19
20
NO. 1
SLOPE
WAS GROUND WATER
ENCOUNTERED?
'"/"J ~
'/ F YES, AT WHAT
DEPTH?
SiTE PLAN
- I
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DI--'PARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
UNICIPALITY OF ANCHORAGE
ONMENTAL SERVICES DIVISION
JUL 22 1997
RECEIVED
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions) I~0 ~r~-/~ert~,~ ~ ~
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
D~,n ~ D~:~r~, /9~ ¢:4'~¢..ro,~ Day phone
12 ¢~,o /)-~¢~-,~o,~ RTZ). /'¢-,~cA~,~¢, .~
~ e f .y ~/" ...¢~ ¢¢~ Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well ~
Community well
Public wa[er
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.
724)25 (Rev, 1/91) Front MOA ~21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of theval[dation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the informat[on obtained from
the Municipality of Anchorage flies 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
Address
Engineer's signature
DHHS SIGNATURE
~ Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
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 registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. -i'he Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~025 (Rev. 1/91) Back MOA ¢t21
Municipality of Anchorage ~,bhq~ffqT^~s~Rv~cus o~WStO~q
DEPARTMENT OF HEALTH & HUMAN SEi:~/~'tw oi: ^NCHO~U
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-474.42
JUL 2. 1997
Legal Description:
A. WELL DATA
Well type f' c~
Log present (Y/N)
Total depth _ .
Sanitary seal (Y/N)
Health Authority Approval Checklist
RECEIVED
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to I / ~ '
Date of test _
Static water level ~9 '
Well production t I
WATER SAMPLE RESULTS:
Coliform 0 ~c,l, / too ra-~ Nitrate
Date of sample: ,-7 / !t / ? 7
B. SEPTIC/HOLDING TANK DATA
FROM WELL LOG
lo/ t9
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
7/ ti / 97
g.p.m. 5; 9 ~ g.p.m.
;~. ¢' 3 r~,ff/~' Other bacteria
Collectedby: ~[c~ /-t~/o 7-~ c/~
Date installed 9/3o/~)0 Tank size I ~C0¢~ Number of Compartments __
Foundation cleanout (Y/N) __
Date of Pumping 7 {~/? 7
C. ABSORPTION FIELD DATA
Date installed 9 / 3 o / ego
Length '75-' Width
Effective absorption area ~'~o
Date of adequacy test _~ / I t [
Depression (Y/N)
2 Cleanouts (Y/N)_.y'
Pumper
Soil rating (g.p,d./~
~ t Gravel t~ckness below pipe
Monitoring Tube present(Y/lq). Y' Depression over field (Y/iq)
Results (Pass/Fail) I>oJx For ¥ bedrooms
Fluid depth in absorption field before test (in.); .5 '/ Iramediately after '/O/gal. water added (in.):
Fluid depth "l,oc I/z (ins.) Minutes later: 7 7 Absorption rate = '~ ~'oo g.p.d.
Peroxide treatment (past 12 months) (Y, qq) ^1o,~ l~,no~,~ If yes, give date /V. A-.
D. LIFt STATION b/. ~..
Date installed Size in gallons
Manhole/Access (Y/lq) "Pump on" level at*
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot I r~ t ' -t~ ~. c~,
Absorption field on lot ~: I Ig '
Public sewer main ~. A.
Sewer/septic service line ~ '?~oc'
; On adjacent lots > too '
; Oa adjacent lots _ > too '
Public sewer manhole/cleanout
Lift station /v'. A,
"Pump ofF' level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation I ~ ' Property line ~ 5~0' Absorption field
Water main/service tine ~> to' Surface water/drainage ;> /Oo' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~ ~ O ' Property Line~ ~' Water main/service line
Surface water ~ t 0o' Driveway, pm'king/vehicle storage area_ >
Curtain draiu ~o o ~ $ ¢~t~ Wells on adjacent lots / oo '
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal record~{~.IJ".a)~th¥!~bogb~<~b)n~
in conformance with MOA HAA guidelines in effect on this date. ~'?~,.~;~'~'
HAA Fee $ ~00~-~
Receipt Number _
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
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 INFORMATION
Complete legal description Lo-F .-~¢ [~Lk< b
Location (site address or directions) I:Z Goo ATrl¢=~'rO~ F,~b
Property owner S~w~l 4-Su~AN J~c~/ Day phone
Mailing address 12232 I. ILAC C~CLE ~NCi~ ,' ~k g~5~/~
Lending agency Day phone
Mailing address
Agent_ bAa W~L¢ E~..~Ax P~-op¢rh~
Address ?g'O0 ~r ~/o ,*~ ~"/./ ~n ~o~ ~/
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: L~
TYPE OF WATER SUPPLY:
Individual well ~
Community well
NOTE:
Day phone
9
Public water
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) Fror, I MOA It21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL OHEOKLIST
Legal Description: L,,,- s, s~-~ % ~:,4~ ~4'r~.
Parcel I.D.
A. Well Data
If A, B, or C, attach ADEC letter. ADEC water system number ~.A.
Date completed Io/I°l/~° Driller [-/£ F'r'-/ D~ILL~N~
Cased to I I 2_ Casing height Iff"
Wires properly protected (Y/N) "/'
Well type
Log present (Y/N). "/
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot I ~ 5' 'To C.o.
Public sewer main "~ /oo'
Sewer service line
FROM WELL LOG AT INSPECTION
~0 7 ~
II g.p,m. > G
; On adjacent lots -~ loc'
; On adjacent lots '-~/oo '
Public sewer manhole/cleanout
'~l oO '
Petroleum tank
WATER SAMPLE RESULTS:
Coliform (:7 col /~oo ,.-~.( Nitrate
Dateofsample: -lJs/°l~-I- ? 7//9
/,~ ~'.-¢- Other bacteria
Collected by: Fl-ATToP
B. SEPTIC/HOLDING TANK DATA
Date installed ~13o [ go
Tank size
12 5'0 ~,4L Compartments
Cleanouts (Y/N) "/
High water alarm (Y/N)
Date of pumping
Foundation cleanout (Y/N)
N Depression (Y/N)
Alarm tested (Y/N) N.A,
Pumper A +
N
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
t
Well(s) onlot Icl F,eo~ ¢,o. Onadjacentlots
To property line 5'0 Absorption field
Surface water/drainage > too'
Foundation Is' l:~o,, ~.o.
Water main/service line
72-026 (3/g3)' 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 TO:
Well on lot
On adjacent lots
Surface water
D, ABSORPTION FIELD DATA
Date installed fi' [3 o/~ o
Length '75' / 3
Total absorption area ~;:(:-~
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) I, o
Width Gravel thickness
Goo Cleanout present (Y/N) '/
System type Tr~,,.ICH
Total depth
Depression over field (Y/N)
for /'/ Bedrooms
After test 5' /"
If yes, give date ~.~,
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot II~ F~oM C,o,
To building foundation 3 o
On adjacent lots > 2o
Surface water -~/o o '
On adjacent lots ;>/oo Propertyline
To existing or abandoned system on lot
Cutbank N,,~. Water main/service line
Driveway, parking/vehicle storage area ~o '
Curtain drain ~Lo,tc
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~,~i,~date of this inspect/on.
Signature
Date ~ l y
HAA Fee $ ..¢0~
Date of Payment
Receipt Number
Waiver Fee $ _.
Date of Payment
Receipt Number
Tom Fi~k,
Mayor
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4?44
August 5, 1994
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 5 Block D Knik Heights Subd.
Waiver Request #WR940043, P.I.D. 017-035-05
DearMr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 6 feet from the north property line.
The
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
/ Robert ~ Robinson
Civil Engineer
On-site Services
ljw#7
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR~ L~j~PID# ~~_~]~p__ HA# i~q~,~ Permit
Date Received: July 25, 1994
Legal Description: Lot 5 Block D Knik Heiqhts Subdivision
Engineer: Ted Moore, P.E., Flattop Technical Services
14530 Echo Street, Anchoraqe, Alaska 99516
Applicant: Steven/Susan Jayich
Waiver Requested: Lot line waiver of 6 feet from north property line.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
2 o
3. Other:
Waiver is Granted: / Waiver is NOT Granted:
List Conditions or Reasons for above:
Date:
Name of Regiewer
Rec ~: 00138/5787 Amount: $ 115.00 Date Paid: 7-25-94
CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
July 25, 1994
M.O.A. DHHS
P.O. Box 196650
Anchorage, AK 99519
Dem' Sirs:
By means of this letter we m'e requesting issuance of a lot line waiver allowing the cleanout
at the end of the existing soil absorption trench serving the residence on Lot 5, Block D, Knik
Heights S/D to be 6 feet from the north property line, instead of 10 feet as specified in the
wastewater ordinance. The inspection report submitted at the time of installation indicates that the
trench is 10 feet from the lot line, however according to the enclosed as-built survey, the cleanout
is actually approximately 10 feet from the lot line.
Tliere should be no problems with granting the requested waiver because the soil
absorption system serving the adjacent lot is approximately 50 feet away, and there appears to be
ample room for replacement of that system without being impacted by the location of the system on
the subject lot.
In the course of out' adequacy test we mTanged for A+ to install a new perforated monitor
tube in the trench approximately 10 feet from the downsn'eam end. Please give me a call if you
have any questions on this waiver request.
Sincerely,
Ted Moore, P. E.
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
JUL 2 5 1994
RECEIVED
P. 02
DIRECTIONS: Complete all carts on page 1, Incomplete requests will not be precessed, Please allow ten (10) days for processing,
1, PROPERTY OWNER PHONE
R~h~¥t F, V~ughn _ 248-4440
MAILING ADDRESS
2401 Bentzen Circle
~ROPERTY RESIDENT (If different from ebove) PHONE
~, BUYER PHONE
George M. Williams 272-3571
MAILING ADDRESS
5140 Spruce Creek
3, LENDING INSTITUTION
Alaska Statebank
MAILING ADDRESS
310 E. Northern Lights Boulevard Anchorage, AK 99503
4, REALTOR/AGENT I PHONE
I
N/A
MAI LING ADDRESS
N/A
PHONE
279-7637
5, LEGAL DESCRIPTION
. . Lot 5, Block "D" Knik Heights
STREET LOCATION
NHN Ather ton
6, TYPE OF RESIDENCE
[~ SINGLE FAMILY
IZ: MULTIPLE FAMILY
7. WATER SUPPLY
[] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC U'FI LITY
8, SBWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE"
[] PUBLIC UTILITY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
[] Three [] Six
[] Other
* ATTACH WELL LOG. A well icg is required for al wells drilled
s ncc June 1975. For wells drilled prior to that date, give well
depth (attach log if available,)
**If individual/on-site, give installation date )F~' ¢0.
If system is over two (2) ~/e~ rs old an ader~uac~/t6st is required
oy this Department,
NOTE: THE INSPECTIDN FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
7~-~)10(3/78]
/'/..? o
THIS SIDE FOR OFFICI/~,t. USE ONLY
DATE R ECEIVE'D
INSPECTION APPOINTMENTS
-~IME T~ME TIME
-~AT E DATE D/~TE
I N~ P-E~3'~(~R /~.~) INSPECTOR INSPECTOR
~-~IRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2, WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL.
[] COMMUNITY DATE DRILLED '-
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[O I NDIVI DUAL/ON -SITE DATE INSTALLED
E~ PUBLIC UTILITY
Connection Verified INSTALLER
[~Septic Tank or [] Holding Tank
Size: I ')'~'-') . If Tank is homemade SOILS RATING
(.live dimensions:
-TYPE OF TANK
MANUFACTURER
--TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Lin,, I Nearest Lot Line
WELL 'FO:
I
I
Absorption Area to nearest Lot Line
Ii. COMMENTS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
-LEGAl_ DESCRIPTION
72-010 (Rev, 3/78)
APPLI¢' 'NT FILLS OUT UPPER HAP' ONLY
PIoperty Owner George aT'tH Ann Wi].l'[aiDs Phone
WM~,iingAddress C~/O Jack White Co. 3201 "c" Zip Code(~35f3q
St.
Buyer
Steven A. And Susan M. Jayich
Address 26215 Murad Ave. Lomita, ACA. Zip Code 90717
Lending institution Phone
Address Zip Code
Realty Co. & Agent Phone
Address Cold,fell Banker, Jack White Co. Lew Weeks ZipCod~)9503 277-1553
Legal Description Lot 5 B,lock D. K~,flk Heights
Street Locatiod Attached Plan
Type of Residence
Single Family
Multiple Family No. of Bedroonqs 4
~ Other
Water Supply
~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
[] Community For wells drilled prior to that date. give well depth (attach log if available).
[] Public Utility
Sewer Disposal
'J~ Individual Year Individual Installed: 1981
[] Public Utility When Connected to Public Utility:
~J Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time ~.
Date Date Date Date
Inspector Inspeclor Inspector Inspector
Field Notes: ;'J ~'~'~' ....... MUNICIPALITY OF ANCHORAGE
<~r'~¢' DEPT. OF IfE/',,LTH
'~-'~,J~3'~f %'"'~ { ENVIRONM[NTAL PRO1-ECTION
APR S 1981¢
RECEIVED
-
i( ) APPROVED BEDROOMS 'CONDmONS OF APPROVAL
( ) DISAPPROYEB
( ) CONDITIONAL
Soils Paling Date Sewer Installed Well To Absorption Area Well Log Received
~ ~'~O ~(~k~'~ Well to Tank Septic Tank Size t ~,,~.~.~..~"~
72-023 (3/82]
3201
;~; ].nco r'ely,