HomeMy WebLinkAboutKNIK HEIGHTS BLK G LT 16Knik Heights
Block G
Lot 16
#017-372-36
Jul 152208:10p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
Development Services Department (.` Phone: 907-343-7904
On -Site Water & Wastewater Section \
Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 017 372-36
Date of Issue: _
Legal Description Block Lot Property Owner Name & Address:
KAAS RODNEY & HEATHER M
KNIK HEIGHTS G 16 12901 SHELBURNE RD
11 11 ANCHORAGE, AK 99516
Pump Installation Date: os - 21 - 2022
Pump Intake Depth Below Top of Well Casing: 155
Pump Manufacturer's Name:
Pump Model:
50M311
MYERS
Pump Size: '50 hp
Pitless Adapter Burial Depth: 12
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
feet
feet
MARTINSON
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection: PELLETS J
Comments:
Pump Installer Name:
ANCHORAGE WELL &PUMP SERVICE
Company: 7640 KING STREET
ANCHORAGE, AK 99518
Mailing Address: 907-243-0740
City: State: _ Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
NAME
C r:R ANCHORAGE AREA BOP" )H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS
LOCATION S,\ Wri*TA\v LEGAL DESCRIPTION
SEPTIC TANK:
PHONE 3Z -A - �'S
G- k m', k N e'ic\:
DISTANCE(� -� NUMBER OF
FROM WELL 9..—MANUFACTURER MATERIAL S� E f I COMPARTMENTS I
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH 1 IQUID CAPACITYL�IS)GALLONS.
SEEPAGE PIT:
NUMBER OF PITS. DIAMETER OR WIDTHLL, LENGTHLC/ DEPTH nr0�• I A
LINING MATERIAL CRIB SIZE: DIAMETER ZILDEPTH G DISTANCE FROM: WELL
= �v
("� IE _ TOTAL EFFECTIVE L A.
BUILDING FOUNDATION , NEAREST LOT LIN . ABSORPTION AREA (WALL AREA) O SQ. FT.
ADDITIONAL ABSORPTION - h N -
WELL:
TYPE
�r
r ONSTRUCTION `b CC'S+I N�
DEPTH
DISTANCE FROM:
BUILDING
L
FOUNDATION 5�1,
NEAREST
LOT LINE �0 + EWERS INE
o
I
OI
, ,
TANKC
SYSTEMS
CESSPOOL N"J N(.
OTHER SOURCES NoNt-
Now K)
,
N: owt')
APPROVED
DISAPPROVED REMARKS
,
DISTANCES:
DIAGRAM OF SYSTEM
W
INSTALLED BY:
PIPE MATERIAL: 61C_ASi-
LOT SLOPE: SKI'
REMARKS: SJ/�•(/O�j�!'�t/y-
" C,C1,0 /9f
I
\ Se C.QFjC
P"i
DATE 5 -IA:
Da+cll;n,, �i ••
•
u
�SC�FIcr C-krwOut
APPROVED
G.A.A.B.
Form No. ED -071
//....TER ANCHORAGE AREA BOROUG
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
7700 TUDOR ROAD POUCH 6.630 '
t ANCHORAGE. ALASKA 99302
• T911PMONt 279.6686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT C C ✓• M/AILING ADDRESS. / C,�� `' P ��•l ✓% �/ PNONcs
INSTALLATION LOCATION -e 1t�-� \ /% , /� i n L `LtV� .r(�J7/./J!!L•'7' LI(✓L' �[�L�f s' a
LEGAL DESCRIPTION ' ��. 0/k < //, ' g ) � / 7
INSTALLATION OF: SEPTIC TANK v 6EEPAGE PIT v DRAIN FIELD-7OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED - �/ NI Si, 11, /e --
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS IZS NOTE, THIS PERMIT 13 NOT VALID WITHOUT BOIL TEST
COMPLETION DAT[ ANTICIPATED
FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE O n0 TYPE.` 'r4y J� f"e bI EPAGE AREA SIZE
MINIMUM DISTANCES.REOUIREMENTB
FOUNDATION TO SEPTIC TANK J7 I
FOUNDATION TO SEEPAGE PIT 2cTt DRAIN FIELD
/�
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE IT_ Z O DRAIN FIELD
TO NEAREST LOT LINE.I+V-'fvy'
i n
WELL TO SEPTIC TANK /SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD !
SEPTIC TANK, SEEPAGE PIT ..• 19 DRAIN FIELD
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING OAP OF
EXCAVATION 6 FEET INTO UNDISTURBED SOIL.
A INCH DIAMETER CAS TIC-TANS{-AMD-6EEPAGE PIT
F17TUD WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKPILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE
OESCRIBY SYSTEM IS IN ACCORDANCE WITH SAID CODE.
C/7APPLICANT'S SIGNATURE
TYPE
DIAGRAM OF SYSTEM
ORDINANCE NO. 28-68 AND THAT THE ABOVE
l/ r, S�� x/73
�r:['
DEPARIM.ili Or L. Ql:,i_;!i CASE i
• 3500 TODOP ROAD
A'ICHORArE, ALASKA 99502
Performed For Crewier Excava-f;n, Co. Date Performed 9-23-73
Leaal Descrintion: Lot /6 Block G Subdivision Kn;k /-lc;e,l,fs
This Form Reports Soils Loq K Percolation est
Oenth
Feet Soil CI
1 / TePseiL (0-1 "%-)
2 L:.:
clravelly ,o1vcl (II/L-0
A5a.xly 5;It (4-9'/.)
5I
�gvtly C.S�i)
6
7
M
In
eristir.s
5W 1 i z.
,� Ols Ground Water Encountered? N O
i'%
If Yes, At what Denth?
A
M
1 �J
N
Reading
Date Gross Time
Net Time Denth to 1120 Net Dronl
i
rul
MAWOMM
C
Reading
Date Gross Time
Net Time Denth to 1120 Net Dronl
i
1
vercoiation Kate "liar-
Prorosed Instaliatior: �ornone Pit K Prair rir:ld
Cn 1,+ Death of Inlet wlt...w. !' _ _ Nenth Tri Ro -t-om Of Pit Or- Trench u~'k—._-_
�
".ENTS:
Inn all Faces �F
• Test Performed Rv ['a ;.a ern er! * 1 •,:
---- f — —
Municipality of Anchorage
-� Development Services Department
rc Building Safety Division
On -Site Water and Wastewater Program •, ; r,
T'==F' • 4700 Elmore Road
"' LI P.O. Box 196650
Anchorage, AK 99507
6'r www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING (�
Parcel I.D. ���� �o?'� rP COSA# Ca O M O
Expiration Date: 9 -.P- &— 09
1. GENERAL INFORMATION
Complete legal description Lot 1e; Block G; Mk Heights Subdvision
Location (site address) 12901 sheroume Rd. Anctwrage, AK 995te
Current Property owner(s) Kane Peterson Day phone 345-M3
Mailing address same
Lending agency Day phone
Mailing address
Real Estate Agent _ Payphone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
El
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
El
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION SY 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.
Name of Firm S a, s Engineering Phone 694-2979
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineer's Printed Name Roberta Shafer DateZ-3 a
n)
5. DSD SIGNATURE
_Ld:f'*0 Approved for .3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
tllll((fuuii�
nN SII€ •�_
WATERAND • m=
_ PRllraee,r
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory, Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By &' f Original Certificate Date:
(R« 11M)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
,a ` (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: 1- 0 } I E, 13 1 I( f kr, i L Uf ia%-S Parcel ID: d 17 - 3 72 -,;'Co
A. WELL DATA!
Well type _1� tUuV, If A, B, or C provide PWSID #= Well Log(R/N) y p 5
Date completed ��- Sanitary seal (4�N) RFs Wires properly protected 8N) „1,0 s
i
Total depth % 6S ft. Cased to 165 ft. Casing height (above ground) / F3 fn.
FROM WELL LOG
Date of test 7 �-
Static water level
Well production b g.p.m.
WATER SAMPLE RESULTS:
Coliform � colonies/100 mL Nitrate d 6%�ng/L
Arsenic: 01b� ug/L date of sample: - 40 m
AT INSPECTION r
Z/0
1-2q ft.
g.pF
Other bacteria colonies/100 mL
Collected by: 'Sg 3 E�Li'�/�ffL'14�G
B. SEPTICIHOLDING TANK DATA t
Tank Type/Material S epTl CDate installed S 2-7-
7 3
Tank size1000 gal. Number of Compartments 2 Cleanouts Ql N) " V40 5
Foundation cleanout &/N) *6- Depression over tank (Y/6' r� High water alarm (Y!& X110
Date of pumping i�- 17
Pumper A 4- 0&12 Se_",(.'es /r)c-.
C. ABSORPTION FIELD DATA
Date installed 2 )3 Soil rating (g.p.d./ft2 ft=/bdr �Z System type ' Cri %
Length r; ft. Width 15 ft. Gravel, below pipe ft.
Total depth ft. Eff. absorption area �20 ft2 Monitoring tube _Je.Depression over field Na
Date of adequacy test 12 O Results (Pass/Fail) SSS For 3 bedrooms
Fluid depth in absorption field before test 11 in. Water addedgala New depth2j- in.
Elapsed Time:i20 min. Final fluid depth in. Absorption rate, >= L14D g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on' level at _
E. SEPARATION DISTANCES
.,
level at _ in. High water alarm level at ' in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
r a=(
Septic tank lift station on lot Ct 3
Absorption field on lot f
Publicsewermain ►lane. k -0,0t v\
Sewer /septic service line 2Z914
Animal containment areas 1s;-0
0 of
On adjacent lots
On adjacent lots lCC) �y'
Public sewer manhole/cleanout
Holding tank /vin
Manure/animal excrete storage areas 1 0 O It
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I r f
Building foundation s t Property line f Absorption field -t
r
Water main Water service line 10 it Surface water AYO-y
Wells on adjacent lots IDo'f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /0 �F Building foundation 10 r* Water main /O 4
r
Water Service line Surface water 100 , -1ir Driveway, parking/vehicle storage L O �f
Curtain drain nort•e- /<na.1n Wells on adjacent lots /00 14
F. COMMENTS
*Qo1-' r4t, rJ CQ
Tiollto—
G. ENGINEER'S CERTIFICATION S 7L1
13
1 certify that I have determined through field inspections and
review of Municipal recordgoui
a above systems are in
conformance with MOA
.OS
nin ec on firs date.
Engineer's Printed Name \1 fll
Date I0
COSA Fee $ �JCj n Waiver Fee $ _
Date of Payment ���°9 Date of Payment
Receipt Number Off) JA u1 L Receipt Number.
(Rev. 11/05)
cNllr�tnn
Na
4L
3
ilrr PMOI
naR MRHR ar
i.R•I. OIt
IF
w
aur.790kwj p.2
17
L------- 10 ulLE9:T
.m
o.. I
1
1s
Vasn+c
HOUSE
I
•au I
I
I
I
10• um Esrr
s Wv1^r cERnFICATaN I M I Prepared by
Tf PLM,�D�m! - Robert E.. Johns, Jr. &Assoc.
As wALr
41 r
a..ra b—LS—ErJ
ar . •,I RF.T
caum.• b)x
oa• O o.: — —
o •A 2836
r.o 9II6/911
wr•.
:.:�..�
�•F•••YRA�"" •
Lot 16 G1ock C
•••• •r ••�
knik Heights
wrRRMY SURVEY TYPE SY11BOlS
101•OATOM A&-"? . SET REHAR
r•IIL xwtc w w-raT ORARIACE ASPHALT
mar" ... UWAY... 7OOYIYNT O FOUND R®M �y..� VOW iBK[ CONCRETE
ASS IMED ELEY. .N--w--R. VITALF! %OaD DECK
PLOT PLANS &LOT SURVEYS NOTE
IT IS TIE RESPON91RIUTY Or THC BIRDER OR OMNER. PRIOR TO ONLY THOSE 16IPROV110[NTS ABOYC OROjNV AND VMMLE TAIL BC
CONSTRUCTION. TO V MrY P'ROP'OOED BUADINO GRADE RE3.ATK SHOIRI. FSNC[S. IIELLL Sl>•llc OISANONTS. l0aWAAXS, D"'ETrAYA
TO FW6N[D GRADE AND UTRITY OONNECTONS MC TO DE7ERWNE [TC.. ARE SNOMN M ?NCR AP•ROIOMATE LOCATION. ONLY. SNOW
THC OOSTENOE Or ANY EASEMENTS. COVENANTS CR RESTRICTIONS WAY PREVENT SOME NAPRO%,EWENTS FROM BOZO SEEN AND LOCATED.
-"-MCH DO NOT APPEAR ON THE RECORDED SUBOMSION PLAT. I ALL DISTANCES ARE RECOFID UNLESS OTNERWSE NOTED.
UOOl1 NO CIROWWANCLS 940LID AN A3-9MT BE USED FOR CONSTPKXIION OR FOR ESTASLOWNO BOL&AWY OR FENCE LINES
THE SURVEYOR TAKES RESVISWUry FOR INE WTIAL TRANSACTjON ONLY AMD ASSUMES RNANDAL UABIITY OILY FDR THE COST Or TE SURVEY.
US1ED DISTANCES PREVAIL OVER SCAUNG REI+ROOUCTCN WAY CAUSE VMtS 04 SCALE
SGS RtU
1092565001
Client Name
S $ S Engineering
Project Namelm
L16 BG Knik Fights
Client Sample ID
L16: BG: Knik Hghts
111atris
Drinking Water
PWSID 0
Sample Remarks:
Printed DateMme
Collected Date?ime
Received Daterrime
Technical Director
06/19/2009 16:27
06/102009 15:40
06/102009 15:55
Stephen C. Ede
Pawctcr AllowaNe Prep Analysis
Rdolts PQL Units Method Contains ID Limits Date Date Init
Metals by ICP/HS
Arsenic
Waters Department
Tote) Nitrate/Nitrite-N
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
ND
5.00
Ug/L
EP200.8
C
(<10)
06/15/09 06/18/09
NRB
0.675
0.100
mg/L
SM204500NO3-F
B
(<IO)
06/15/09
LCE
0 coU100mL SM20 92228
A
(-COO)
06/10/09
SDP
0 coUIOOmL SM209222B
A
(<1)
06/10/09
SDP
0 col/IOOmL SM2092220
A
(<I)
06/10/09
SDP
Jun 10 09 12:47p
L
John $ Katherine Peterson
907-345.0993
Certified Well.
•` For_.aTPk1n.P.eatez'so;l.:.. � ::;.'�
Location
Date won leted.. 1
P Ausust..3r 1972:: o-
i'
Depth we11:.:::IbS Feet
. Sias of casing7nCh:...
.. .._
r....
Distance to wer
at....723..eeb.:...:.....
...........................
Distance to mater while pumping.::::: a$5...reet.-,...:........._...af rete
:... all '
:.:......: ..jaUQ ,, � ns, er hoar.
scri
ptioa of Fora�ptioa:.
trom .
to
4lmdra
ravei d 6andy ti=
20
' - -
Graver taWdreard"20
LP
avely rs d' and : c7ey ;...: -..' • ".
:rg
8
Sdnd'2n$
2
Sand ::
Hard='
11
1 4
Yell clay• .f,— *.
154
164
Slater sand ani3. avel': ``
5
15