HomeMy WebLinkAboutKNIK HEIGHTS BLK E LT 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/
[~NEW
UPGRADE
NAME
"^'L'N° ADD78~
EGAL DESCRIPTION
£o'r 2_
LOCATION
DISTANCE TO:
Manufacturer
DISTANCE TO:
Manufacturer
Well
I2 O/
DISTANCE TO:
No. of lines // Length of ~,~l~/n..g
Top of tile to finish grade ~, ~/
Length
Width
Type of crib Crib diameter
Well
DISTANCE TO:
Class Depth
DISTANCE TO: Building foundation
/-/E i ~(-/
ti, A,//-f
Material
Foundation.,9 ~'
ITotal Ion f ~jnes
a~/ial beneat ~ tile
)opth
Building foundation
Driller
Sewer line
NO. OF BEDRO0,~,
P E R N~,~- NO,
~,3o4~1
No. of compartments
liquid depth
PERMIT NO.
Liquid capacitv in gallons
PERMIT ~ 304
Distance be t,~/~i n es
Total effecti~a~gt~rea
PERMIT N~;
Total effective absorption area
Nearest lot line
PERMIT NO,
i nce to lot line
c tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
i z.
Ovd-K
INSTALLER
REMARKS
2" or' g" d.'~. k/4Cd GUL-
APPROVED
72-013 (Rev. 3/78)
DATE LEGAL
...... ¢..¢ _ ,r r,----,', --
DEF'FIF::TNEI',IT I. I.tEI::ILTH I::ll',lE:, Ei'.,I',,/I I:;.:OI'.,IHEI'.,ITF:IL OTEC'T' :[ FIhl ..,,//5
':"":":; '" L. :, I I~.EE'I., FINCHEff;:tFtL3E., FII<:. ,: q :'= F !1
264-4720
11-4t E L L FH lb4 iE;::, C_'fl [r,.,,H ......... E~:i; :r T E S E IMt E F.i: F" E ~:~: IMI ][ T
,:: :B::!:Od-;?:l. ::,
FIF'F'L. I I::FI~',I'I"
LOCFIT101",1
I...EGFIL.
BE-i"HFiF;,,D C:OI'.L'.:.N-.
LOT 2 E:L.I< E I-::.'I'.,tlI< HTS,
SUE:
SF. tR i698t.:{,
-F'./F'E OF SOIl_ I)E:SOI';.:F'TION Sh.'STEH IS: TF.:ENCH
HFIXIMUM NIJI"IE:EF~: OF BE[:,F.:OOMS = 4
FtNCHORBGE., FIL. FISKFI 34,5.-2..6±5
LOT SIZE 99999 SQI_IF:IF..'E FEET
SOIL. RR'I'II'4G (91! FT,.."BF.:::,= ±62
TFtE Rli.:.:6!l...l]: F.:E[:, S I ZE OF 'T'HE SO I L FIE,'SORF'T I ON S'.r'tSTEI'"I I S:
~E::. EEl F' 3- E-~ == ~,_ Ea L_. EE ~-,~ ii~ 3F ~.-~ .... :z~ 7 ~L3~ E~: F:~ %." LEE L_ E:. bEE F" -'E" I-] ..... ;?
'T'HE L.E:NGTH [:,IMIEI'qSION I:E; "FFIE LE:NGTH (IN FEET:.', OF THE TRENCH OR [::,RFIIhlFIEI_[:,.
TFIE [:,EF'TH FiF Ft TRENCH OF..' F'~T iS THE [:,ISTI:~NCE BETI.4EEN THE SURFRCE OF 'TFIE
GF.:OI...IN[:, F:IN[:, TFIE BOTTOH OF TI4E EHCFfv'RTZOIq ,:: IN FEET::,.
'THEI:;:E ZS NO SET H:I:DTH FOR TRENCHES.
THE GF::Ft',/EI_ [:,EF'TFI tS THE I',tII'4IHLtH [:,EPTH OF GF:'.FI'v'EL BETHEEN THt:.i ou'rFFtL. L P ZPE
RN[:, "t"t-.IE BOTTOM 0t:: THE: E:::-:;E:R',,,'FIT I ON ,:: I N FEET .':,.
PERMIT RI::'F'LICFINT HI::IS THE F.':ESPONS I BI L I T'¢ TO Ilql::ORl"l TFII S [:,EF'FIF..'TME:NT [:d. JR:[ NI3 'THE
:[NSTI::tLLJ:ITZON ZNSI::'ECTIOI'-4S OF Rl'.4h.' HELLS RD.]'RCENT TO TFIZS PF.:OF'ERT"r' FIND 'THIE
NUMBEF.: OF RES ZDENCES THFIT THE HEL. L 14ZL. L SEF.:',,,'E.
EIFICKF ]:LL Z NG OF RN"r' Sh"STEH I,.IZ THOLIT F Z NRL Z NSPECT Z CiN FIND RF'F'RO',,,'I~L. Bh" THIS
t)EF'FtF4:TMEI",IT t.,.I:[L.L. BE SLIB.]'EC¥ lO F'ROSECLITZOI',I.
i'lIl'4It'"liJl'"l [:'IS'I'F~t",tE:E BETHEEI',I Fl HE:L.L FIND' FIN"? ON-SITE SEt,.IFtGE [:'ILr:,F'IiISFIL S"r'STEM IS
i00 F'EET FOR FI F'F.'.I',,,'FtTF.: 14ELI~ OF..' ±50 TO ;2'00 FE:ET FF..'OM FI F'UtBLIC 14ELL [:,EF'EN[:,ING
I.]F'ON TFIE T"r'F'E OF pI_IIE:I...IE: HELL
MINIHIJH IX:'ZSTFINCE FROM R F'F.:Z',,,'RTE 14ELL TO R PF.:I',,,'FITE SE£1.,.I[:.R LZh,IE ZS 25 FLEET FIND
]~1_-I F:~ COHHLIN~T"/ S[:.:HER L. INE IS 75 FEET.
HELl_ I_(:~GS FIF.:E REX;!IJIRE[)FtNI:::, I"IlJST E',E F::ETLIF..ff.,IE[:, TO TFIE [:,EPFIF;:THEI',IT 14ITHTN 2:.::0 [:,Ft"r'S
OF THE HELL. CEd"'IPL. ET 1' 01",t.
OTHE'F.: I;?EL::!LIIF?.EMENTL-i, I"'IFt'¢ F'IF'F'L."/. ':;PECII::ICFITIOI",IS FIND CONLSTF.'.UCTION DIFIGRFIMS F:IF:'.E
F:I'v'FI ]: LF:IE~LE TO ]: N'_:;IJRE F:'F.:OF'ER I NSTFILLFfT'.T. Oi",l.
]: Clii:':F;:"l"~ F:"r' 'T'HI::IT
:i..: ]: FIi'"I I:::'I::IM :I: I_ ]: FIF: HI'TH THE F.'.EQLIIF:EMEt"4TS FOf~: Ot',I-':i:,ITE SE:HE:F.:S RN[:' HELLS FIS SET
FOI:;.:TH E:"r' THE i"IUt',IICIF'F:ILIT"r' OF F'IIqE:HEIRFIGE.
2: I I.,.tILL. Zi",ISTFILL. TIqE S'¢STEM iN FIE:E:OF.:[:'FIi',ICE I.,.IITH THE CO[:'ES.
3: ): I..II',t[:,EI;.:STFIN[:' THFFF THE ON-SiTE SE:HER S"/::.;'I'EH MFIh" REQUIF.'E ENLFtI:(:GEHEhlT IF 'THE
r,.':E::S I [:,ENCE T S REI"IOE:,E:LE[:, TO INCLUDE t"IOF::E "FI"-IRN ,4.
S I G t'.,1 E [:, ·
I::tF'F'I.... I Ii:l}ht{r' E',ETHF:IF~'![:' CIiII",tST.
& ENGINEERS, lng.
s
tNCHORAGE, ALASKA 9950:3
.349 - 6561
S()ILS LOG PERC()I. A11()N IES;I
I
6
7
8
9
10
12
15
18
19
2O
~-7t
SITE PLAN
_ I
OF AL/.
JOHN E. SWANSON
1834-E ..'
DROFESSIO~
~ead,ng
/
PE F~ CO L A 110 t,,/ f.~ AT E
TEST f~ut,t OETVCEEN
2'
2.:~-5
/
,¢--- / ,
Drop
/~2v
FIF'F:'I_ I CFIi'-,IT Efli~.Tr'HFll::::[:, COi~.,IST
L. 0 C FI "1" I 01,.,1
LO'T SIZE ':9:!~'Z:~'~':9::~ SQt..IFIFi% F'EET
THE L. ENGT'H [:, I I"iE?',l'.:.'i; I Oi",l I ."-;; 'THE LENGTH ,:: ]: N FEET > OF 'THE TRENCH OR [:,RI:'] ].'t'.,IF t ELI).
THE DEF'TFI OF I::] TF?.EI'..ICFI OR PIT' I'S THE I::,ISTRNCE E:ETI.,JEEN THE 'SUF:'.FFICE OF' THE
GF.':OL.i1,..ID F:I1,.,I[:, THE BOTTOM OF THE E::-:',CFi',,,'Frl" 1 O1,.,1 ,:: 11,.,I FEET ::,.
ql'"' tFqt ~Z-IF' F~." LE P-JJ C:: ~-"~ ~..,,Jt lIE liE:, T' ~-.~ :Z "--~;; ~:.:.5 .. ~EE~ ~D~ ~i':.:~ ii:::'-" E: E: 'T' ..
THIE GRI:r¢,,,'EL.DEF'TH I2'; THE MIN:[HLIH DEPTH OF GRR',,,'EL. E',ETNEEN THE OUTFRLL F']:F'E
FINC, THE BOTTOH OF THE EXCI~',,,'FITI01,',1 ,:: IN FEET::,.
F'EF.':H i T FtF'F'L. I E:FI1,.,IT HFIS "FFtE M__,F .. hi_, I E., I L I T"r' TO 11,.,tFOF.:I',t TH t L:.: DEF'FIi~:"FHE1,.4T [:,I_IF.: I JqG THE
T I'.I':E TFILL FIT 1: "N :[ NSF'ECT I O1,.4:~5 OF:' RN'¢ NEI_L.S Ft[:,..TRCE1,.,IT TO "r141 s F'F.:OF'EF..:T'.¢ I::IND THE
NUHBEP. OF F:ES]:r::,E1,.,K::ES 'T'HFIT THE I.,.IlZLL_ N IL.L SEF.':',,,'E.
E:FtCI<FILL. ING OF' F-tl'.,l't' S'¢S'FEH P.IITHOIJT F'INFIL. INL=,F'ECTIEd'.J AN[:, HFFF._ L _ 'THIS
DEF'Fff,;:TMEI'.,I"r' I.,.tlL. L Fi:E SI.E:.~TEE:T T3 F'r4'"'SE'Z ."I"~':N
I"111'.,ti1'"11..11'"1 DIS"FFII'qC:E E:ETNEE1,,I FI I.,.IEI_I_ F:IND F:IN"r' O1,'.I-.SI"FE L:.:,E!.4RGE E:,IL:.;F'CJSI:tL S'¢STEM
:LE~R FEE'T F:OI:4: FI F' Fi: :[ ',,,' R q" E: 1.41EL. L OF,'. ::LSL..3 TO ;:Z"E,-Z~ FEET FF.'.'OM FI F'LIE',LIC 1.4EL. L. DEPENDING
LIF'ON THE T"r'F'E OF I::'LIE~L. IC I.,.IELL.
HII",IIMIJM E:'ISTFINE:E FIT:OM FI F'F=:Z',,,'FrT'E NELL TO FI F'F.'.I',,,'FiTE ';T, ENEI-~: LINE :IS 25 FEET FINE:,
]'O I:1 (::IZIMI'flLIN:[T"r' SENER: LINE IS '75 FEET.
kiEl_L.. LOGS FtP::E:_' F:EQLIIF.:ED FII",I[:, MLI'S"I' BEE P. ETUI:'4.:I'.4E[:, TEl THE C, EF'FtF::THEI"4T .NI'I"HI1,'~ /j:EI [:'F¢'r'.'.:;
OF 'THE .NELL.. C:OMPL. ETtOI",I.
OTHER i'4:EQIJ ]: REMEi",FI":E; MFI'¥' I:::IPF'I_"r'. SF'EE: Z F I CFIT 1 OI'42; FtI",ID CONSTRIJCT I ON £:, I FIGRRM2; FtRIE
FIVFI:[L.FIE',LE TO INSURE F'ROF'ER II",ISTI:-'ILI...RTION.
t E:EF::T' :l:l::'"r' THFt"f'
i: I Fff,1 FRMIL. IFII.;.: I.,.IITH THE I::::EQLIIREMENTS F'OF;: ON-SITE SEI.,.IERS FIND I.,.IELI_S 1:11!~; SET
F:OI:;.':TH E?¥' THE MUI'-,tI E: I I..':'FtI_ I 'l"',r' OF FiNCHOF.:FIGE.
2: t NtLL. II'.,t'S"I"F~LL THE S'¢S'T'EM IN FiCCOF:E:,FINCE NITH THE COl)ES.
]i:: I UN[::,EP. STF-IND THFIT THE ON-SITE SENEF.: S'.¢9I"EM Ml:'"'l"r' I;:EQLtlI~tE E1,-,tLFIF..'GEMEI"4T IF' THE
RESIDENCE IS F.:EMO[::,E:L.ED TO tNCI_UDE MOP. E TFIFIN 4. E:EDI~:F~Of"IS.
S ! G1,',IEI): .............................................................................................................. '"~D %
FtF'F::'L. I CFI1,',!T BE:THFIRD C:ONST ~-:r']) ~_ ~
I :~:E;I..IEE:,
s
& fNGINEERS, I~G.
712:3 OLD SEWARD HWY.
ANCHORAGE, ALASKA 99503
349 - 6561
S(}ILS LOG PEf]COI_A]I()N I'ESI
5
6
7
8
9
I0
12
14
15
'17
19
2O
SITE PLAN
WAS GROUND WATEI:I
lfi34-E M°
PEI~COLATION ~ATE _ ~/~N~ ~ / [m;r,uIe$/Jnchl
TEST RUN O£1WEEN --7 FT AND /~) FT
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
1. GENERAl. INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
4.
Lending agency
Mailing address
Agent '.~ ~.1'~.
Address b~t~//_/~/
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
Day phone
Day phone
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 i~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 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 l~'kll-~
20441 Ptarmiga~ Bird,
Address Eagle
Engineer's signature_
Phone ~:~ -,'~,//.//
DHHS SIGNATURE
.X
Approved for 4
Disapproved.
Conditional approval for
bedrooms.
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. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA
A. WELL DATA
Well type /,.~/
Log present (Y/N) Y
Total depth
Sanitary seal (Y/N)
RECEIV
Municipality
of
Anchorage
DFPARTMENT OF HEALTH & HUMAN SERVICES APR 2 2 199
Environmental serVices Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)h3.A~ff~ZL4f~ OF ^NCHo~ACE
ENVIP, ONMENTAL $1~RVICI~8 DIVISION
Health Authority Approval Checklist
/'~/,~'~,~ //~/'.~- Parcel I.D.: ~/'~-,~7/-,¢~
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform /'
B. SEPTIC/HOLDING TANK DATA
Date installed ~'~ ~.- ~-~ _ Tank size
Foundation cleanout (Y/N) Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to /~Z/
Casing height (above ground) ~ ~?, ~'
Wires properly protected (Y/N) Y
FROM WELL LOG
AT INSPECTION
Nitrate ,,¢, ,~- Other bacteria
Collected by:
/~.¢~;) Number of Compartments .~- Cleanouts (Y/N)_ /
Depression (Y/N) / High water alarm (Y/N) /L.//¢ _
Date of Pumping. z//~/,~ ..~.~ _ Pumper
C. ABSORPTION FIELD DATA
Date installed
Length ¢~ / Width ¢/ Gravel thickness below pipe
Effective absorption area .¢~'&3 ~.~. Monitoring Tube present (Y/N) Y
Date of adequacy test ~/--/.5 "~),,~ Results (Pass/Fail)
Soil rating (g.p.d./ft~ ofl~//_¢,~ System type ~'
//
~ (~) ' Total depth J~, 5
Depression over field (Y/N) /
For ¢ bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth /¢, ~6' (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Immediately after'?¢)~ gal. water added (in.):
Absorption rate = ~E)~ '/'' g.p.d.
If yes, give date
72-026 (Rev. 3/96)*
LIFT STATION ~/
Date installed J Size in gallons
Manhole/Access (Y/N) /"Pump on" level at* ,.~ "Pump off" 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 /0~.2 /~
Absorption field on lot ///)~ /-,/'
On adjacent lots /~) /'
On adjacent lots /~) //'
Public sewer main //,,//~
Sewer/septic service line ~,~' ~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ,/~ ~ Property line /g) /
--/ Absorption field
/ /
Water main/service line ~ 4' Surtace wateddrainage ?Z~ -P
Public sewer manhole/cleanout
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line .//_)/¢' Building foundation .~-~- /
Water main/service line
Surface water //~ -/- Driveway, parking/vehicle storage area
Curtain drain //.¢_~¢.¢~.../¢~/)¢~J/) Wells on adjacent lots _
ENGINEER'S CERTIFICATION
!,
I certify that I have determined thru field inspections and review of Municipal records
in conformance with MOA HAA guidelines in effect on this date.
Signature ~/'~
/
Engineer's Name
Date
HAA Fee $
Date of Payment
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Property Owner -(7 7 ..-, '-
Mailing Address -
APPLI(: 'NT FILLS OUT UPPER HAl ONLY
~ ~. i. [ Zip Code '~ /
Phone
Buyer
Address
Zip Code
Lending Institution
Address
Zip Code
Realty Co. & Agent
Address
Legal Description
Zip Code
Phone
Phone
Street Locati~
Type of Residence '~ Single Family
E) Multiple Family
~ Other
No. of Bedrooms
Water Supply \
?]: Individual /- ¢~ -
~ C°mmunity t,~(~
Public Utility
ATTACH WEI_L LOG. A well log is required for all wells drilled since June 1975.
For wolls drilled prior Io that date, give well depth (attach log if available).
Sewer Disposal ~' Individual
[3 Public Utility
[] Holding Tank
Year individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Date
Inspector
Time Time
Date
hlspecter
TitT~9
Date
Inspector
Date
Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
f;EP'¢. OF I¢!/',LiIt ~:
[~NVIRONMENI'AL PRO'faCTION
RECEIVE])
- APPROVED BEDROOMS
) DISAPPROVE[:)
COND, O,A _ A PROVA.'
DATE ~- ~/ ~f ~' ~
'CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Inslalled
Well 'Fo Absorption Area //O
Well to Tank / ')..- ~
Well Log Received
Septic Tank Size
