HomeMy WebLinkAboutKNIK HEIGHTS BLK H LT 9
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water & VVaStewater Section Phone: 907-343-7904
Fax, 907-343-7997
Pump Installation Loth .
Well Drilling Permit Number:
Parcel Identification Number: Date of Issue:.,
Legal Descriptloa Block
1� n i k Frei kr5
91k, if Nq
Pump Installation Date: -7
Lot Fra Owner Names:
Pomp Intake Depth Below Top Of Well Casing: o 2- 2-D
feet
PIImp Manufacturer's Name: A i �G�NIGc �l
Pump Model: � �3`� 7V Lc—
Pump Size: 3 h
p
Pitless Adapter Burial Depth: feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Com letio�t? X'Yes
Method of Disinfection: ❑ No
Comments:
'umP Installer T- -
ANCHORAGE WELL & PUMP SERVICE
:olupany: 7640 King Street
Anchorage, AK 99518
failing Address PH: (907) 243-0740 --
Ity: State: — -�ZiP
itention: The pump installer sha.I1 provide apump installation log to On-site within 30 days ofgumP installation.
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SEF:IVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
~~ ~. ~~ Wastewater System:~~ew D Upgrade
Address: ~ ~ ~O ~
~[ ~. ~ ~E~X~ ¢~ 4~ ABSORPTION FIELD
Phone: No of 0~ms: ~DeepTrench ~ Shallow Trench E]Bed ~Mound ~Other
Total Depth from original g~e~
LEGAL DESCRIPTION so, Rating: ~'~GPD/Sq. Ft~.__
Subdiws~on: Deplh to pipe boltom Irom original gra~e: Gravel depth benealh pipe
]ownship: Range: '~Section: ' ' " i~illaddedaboveoriginalgra~l Gravel length:
WELL: ~New ~ Upgrade Grave, width:~/ Ft. Number of lines: [ Distance ~e~,,,een lines:~[~,,_ ~FI'
Cla~lcation (Private, A.8.C): ~ Total Depth: Cased TO: Total absorption area: ~ :ipe material:
Driller: Date Drilled: ;relic Water Lev¢: Installer:
Date installed %%%
Yield: Pump Set at: Casing ~,~,*~o,~ o,ou.~: TAN K
SEPARATION DISTANCES ~eptic ~ Holding ~ ~ S.T.E~P
TO Septic Absorpbon Ldt HoMing Public. Private~~Manufacturer:~ I. Capacily in gallons:
Well 1~ 1~ / ~ ~ ~ I& Material:~~ ~~Number°fC°mpartments:
Surface LIFT S'rATION
Foundation ~ till ~g¢ / / ~ "Pump on" level at: fF' level at: High water alarm at:
CurtainDrain ~ ~ ~ ~ --~ Pump Make & t~del.[ ~c~n;~e~ions ~erforme~ by:
Remarks: ~~ ~0 ~ _ BENCH MARK
Location and Description:
Assumed E~evation:
Inspections performed by:Eagl~r, AI~ 9~77
Department of Health and Human Services approval ,,¢"~', ~,,,.~,., ~,,,
72-0~3 (Rev 9/91) MOA 25
PermitNo. ~..~'~ID'~--~ 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: ~,-~/~/_.~ t~-~L-n~\~.x~'T~ ,'I;:~~..---~ ~,~:q~fiPIO NO.:
72-013A (Rev 9/911 MOA 25
[DOC CO. ODa
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND j~/~.~y 3E.t.. H,4[ ,~.,,'I, o~-,,~.,.b
LEGALDESCRI~ION ~ ~3CE_ ~_K,"4~ M6?*J'" I)RX~ DOWN
DATE-Started Ended ~ (,XI.S. PERHR ~
PERMIT NUMBER
KIND OF FORMATION:
From ~ Ft.,o~ Ft. YJbdCr ~;'~'r ~'Z Ero,n FLto
'From~Ft. to Fi. 6~C~ ~ From
From t~ Ft. to~ .Ft. ,~tL :r .6t~C_.~/' Fro,,,~l-L h,~Et
From~__Ft. to Ft .... ~'~r?~ ~(' . Fr,,m I:t lo Ft.
V6* '"'""
From~Ft. to Ft.~~ 6~ ~" From~ Ft. to_~ FI.
From I~ Ft. to Ft.~~_~ ~,(~;O From _~Ft. h>_ FI
From Ft. to .FI.~:}[T~ ~'~C' From FI.h, _FI.
From Ft. to Vt.fffft+C T¢CEO ~-(//~ From Ft. to _ Ft
From~ Ft. to~q~ Ft. ~C'~t~__._~['~g~ From ~Ft. to _ Ft
From~Ft to__Ft. ~/~" From__ Et. to __ Ft .....
From__ Ft. to
From ..... Ft. to~Ft
From__Ft. to Ft.
From Ft. to Ft.
MISCL INFORMATION:
RECEIVED
DEO 1,5 1992
Municq~ali~y of Anchorage
Dept. Health & Iquman Services
DRILLER'S NAME
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
PAGE 1 OF 1
PERMIT NUMBER:SW920102
DESIGN ENG~NEER:S & S ENGINEERING
OWNER NAME:BRANDT HERBERT R &
OWNER ADDRESS:3741 W. SEVETYNINTH AVE.
ANCHORAGE, AK 99502
DATE ISSUED: 5/26/92
EXPIRATION DATE: 5/26/93
PARCEL ID:01737209
LEGAL DESCRIPTION: KNIK HEIGHTS BLK H LT 9
LOT SIZE: 43500 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST 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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
May 18, 1992
ROBERTSHAFER. P E
ROGERSHAFER, P.E
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE: Knik Heights Subdivision, Block H, Lot 9
We request you issue a permit to drill a well and install a
septic system to serve the proposed 3 bedroom house on the
referenced property.
Two test holes were excavated and percolation tests performed
on the above referenced property. The approximate location of
the test holes are located on the attached site plan. There
was no water encountered during excavation of the first test
hole and after seven day water monitoring the monitoring tube
was found to be dry. There was no water encountered during
excavation of the second test hole, .a~though water was found
after seven day water monitoring at~3 , -, ~
This property has enough area for future seCtic upgrades,
which can be seen on the attached site plan. We do not
anticipate any adverse effects on neighboring properties by
the installation of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
Sincerely,
~7~S~h ~af~~~'~
RJS/lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVL--R. ALASKA 99577
I'=
SCALE
~ I0' UTIL. ESMT. ~
BAINBRIDGE ROAD
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEG^'. OESOR,PT,ON: t.fl
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Bepth t0 Waler
~onilori.,? ~'"ff D~le: ~'-¢
SITE PLAN
Reading Date Gross Net Depth to Net
Time Tirne Water Drop
PERCOLATION RATE ~¢~ (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN__("¢' FT AND '~ __ FT
PERFORMED BY: $ & $ F-'NGINEERIN6 i "~/'~//'~ CERTIFY THAT THIS TEST WAS PERFORMED IN
¥7~~op Road No. 204
ACCOR DANCE WIT N A~0~eA~V/~LDA~E~-~UI DELIN ES IN EFFECT ON ITHIS DATE. DATE:
72-008 (Rev. 4i85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
8
9
10
11
12
13
14
15
16
17
18
19
20-
COMMENTS "'"~---~'~ ~ ~--~'~
DATE PERFORMED:
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER ~. I
ENCOUNTERED?
S
L
IF YES, AT WFIAT O
DEPTH? p
E
Depth Io Water Afler.
Monitoring?
Reading Date Gross Net Depth to Net
Time Time Water Drop
\ ~-¢.-~.'~'~ ~-'./~/ .~- 'b ~ 1~' ' '
PERCOLATION RATE ,~O (m~nutes/mchl PERC HOLE DIAMETER
TEST RUN BETWEEN (42 FT AND__? -- FT
PERFORMED BY: S & S ENGINEERING , '~'?,/~
17034 Eagle River Loop Road No, 2~
ACCORDANCE WITH A~f~p/~~IDELINE~ ~ EFFECT ON THI~ DATE.
72-008 (Rev. 4/85}
CERTIFY THAT THiS TEST WAS PERFORMED IN
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICFS
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
Parcel I.D. # ~ -~q¢_~- i(")¢~_ ~
1. GENERAL INFORMATION
Complete legal description Lot 9;
Block H~
Knik Heights
Location (site address or directions)
Property owner .
Mailing address
M~',c~¢y ~ Kathy 3cZ. AcC Day phone 229-6929
3741 W. 79th Anchorage, AK 99502
Lending agency
Mailing address
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2, NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
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.
STATEMENT OF INSPECTION BY ENGINEER
As certified by myseal 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 furtherver fy that based on the information obtained from
the Municipa ty of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater dJsposaJ system is in complia-nce with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ~.& S EN~NEE~ ~
Engineer's signature _~~ Date _/O~/,/~ --
bedrooms.
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
AdditionaJ Comments
Date //- ¢~/~,9~
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~)25 (Rev. 1/91) Back MOA ~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~c;r¢~ ~.~..¢- ~ ~--~, ~Z_ F~1'5. Parcel I.D.
A. Well Data
Well type '~¢-v4
Log present ~"'JN)
Total depth
Sanitary seal ~N)
Date of test
Static water level
Well flow
Pump level1
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed C~ -~ ¢~ ?~. Driller ~
Cased to ~%' ~'* Casing height
~ Wires properly protected ¢~N)
FROM WELL LOG AT INSPECTIONL~
~ .c> g,p.m. / g,p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot \
Absorption field on lot \ \
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate ~, ~'% Other bacteria
Date of sample: \~o ¢ ,~ ~ ¢ ~ ~. Collected by: 5 & $ ~;,,',;:4;,.~'JEf, H~'4G
B. SEPTIC/HOLDING TANK DATA
Date installed
Tank size
Cleanouts t~N) "¢ Foundation cleanout~'~/N)
High water alarm (Y/~
99577
~ c,c~ O Compartments
V Depression (Y/~P
Alarm tested (Y/N)
!
Date of pumping ~1 ~ ~.e.--~ ¢,¢~'--~-o~..~'~ Pumper
SEPARATION DISTANCES FROM SEPTiC/HOLDiNG TANK TO:"'""---~_~
Well(s) on Jot ~, O 0 On adjacent lots \ 0 ~ Foundation
To property line ~, p Absorption field -~ Water main/service line
Surface water/drainage \ ~_¢~
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N) ~
Vent (Y/N) "Pump on" level at ~ff" Level at
High water alarm level ~~-/'""-'~ycles tested
Meets MOA electrical codes (Y/N~
SE~M LIFT STATION TO:
WEll on lot Surface water
On adjacent lots
D. ABSORPTION FIELD DATA
Date installed ~, _.-~, _c~ ~._ Soil rating (GPD/Ft2) O.
Length ~/-~ Width -2_~' Gravel thickness
Total absorption area \ c~c~ ~ ~ Cleanout present~/N)
Date of adequacy test ~/k,' - I~¢'--¢, Results (pass/fail)
Water level in absorption field before test ~
Peroxide treatment (past 12 months) (Y/N)
System type
~-~ Total depth
Depression over field (Y/~b
for -' -
After test
tf yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot \ ~ ~' ~
To building foundation \ ~
On adjacent lots "'~
Surface water \ ~ ~ \~-
Curtain drain
On adjacent lots \ ~ ¢' ~ 4-- Property line
~ '~ To existing or abandoned system on lot
Cutbank ~'~ ~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have ch~~MOA and HAA
Signature ~/~/',~,, ~ ,~, E
Engineers Name ...... ./. _. .
' ' u'~'* ~g'e ":.'ver Loop Road No. ,2,.(~4/~
Date Eag!~v;r, Alaska ~577 //
HAA Fee $ ,F
Date of Payment
Receipt Number
guidelines in effect on the date of this inspection.
¢ .... ;' ~ ' .
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Bedrooms
(ger,ifie rilling
OOC Co.
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
LEGAL DESCRI~ION ~ Zt ~_ ~. g~:'42~ M ~ ?'J" I)R X~, DOWN rl.
DATE - Started Ended ~ ~ .... (; ~IS. P[R HR
PERMIT NUMBER ...... KIND 01' ('AS[N(;
KIND OF FORMATION:
From 0 Ft. to '-~ Ft. (~,t'0~'~tm~'(.:' -~"i"'~C-~,~O~~ From.__ Ft.
From__~ Et. to ~ ._Ft._~,~Z<~/d Frmn~l-,
From
I
From Ft. to .... Ft. ~e { ~ ~ Frmn J'l
From tO'Ft, to j O~Ft.~_.T I 6~ ~6 E 1 Fr,,,n F,.
From Ft. to Ft. .~$ ~ ~'' From~
From ~gg Ft. to~'~Ft.__~C~ e3~/~ From
From~Ft. to a~ I Ft.__~?_~4~(-l&
From~,l Ft. to~~ Ft. l~C~;~
From Ft. to Et. (~:~
From FI. to__Ft.
From Ft. to Ft.
NED
Ft. to
Dq~.tt ~lealth &l~.~uman Serwces
[:l.
From_ Ft. to____ Fl
Front Ft. to._ Ft.
From ...... Ft. to Ft
From FLto ~__ Ft
From ____FI, to .Ft.
From __Ft. to .FI
MISCL. INFORMATION:
/
COMMERCIAl. TESTING & ENGINI:;ERING CO.
ENVIRONMENTAL LABORATORY SERVICES
......... REPORT of ANALYSIS
Chemlab Ref.~ :93.5819-1
Client Sample ID :L9 B H KNIK HEIGHTS S/D
Matrix :WAT~
5633 8 STREET
ANCHORAGE, AK 99518
TEL: (907) 562-2343
FAX: (907) 561-5301
Client Name :S & S ENGINEERING WORK Order :72674
Ordered By :R. SHAFER Report Completed :11/01/93
Project Name : Collected :10/28/93 @ 13:00 hrs.
ProJect~ : Received :10/28/93 @ 16:45 hrs.
:UA Released By
PWSID Technical Director: ST~E~H_~ C.
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.S.
,¢ .- QC Allowable Ext. Anal
Parameter Res}~lts~QualUnit~ Method L~mits Date Date Init
..... ...................... .....
See Special Instructions Above UA = Unavailable
See Sample Remarks Above NA = Not Analyzed
Undetected, Reported value is the practical quantification limit. LT = Less Than
Secondary dilution. GT = Greater Than
Member of the SGS Group (Soci~,~ G~nCrale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROI..INA
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
[] PUBLIC WATER SYSTEM I.D. # I I[llll
~¢-PRIVATE WATER SYSTEM
Name Phone No.
Mailing Address
Cily Stale Z¥ Code
Mo. Day Year
SAMPLE TYPE:
~//~Chutlne
eck Sample (for routine sample
with lab ref. no.
Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
No. LOCATION
21
Time
Collected
1
Collected
By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
rl~Satisf actory
[] Unsatisfactory
E] Sample too long in transit; sample should
not be over 3O hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received /
Time Flecelved
Analytical Method: Membrane Filter
No. of colonies/100 mi.
Lab Ref. No.
I
I
Result*
st
READ INSTRUCTIONS
BEFORE Verlficallon: LSB
COLLECTING SAMPLE
Reported By
TNTC = Too Numerous To Count
OB = Other Bacteria
~'~,~SGS Member of ,h,
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count d Coliform/100 mi
BGB
Fecal Coliform Confirmation
Final Membrane Filter Results
Date
Time',
Coliform/100 mi
PART ONE OF TWO:
REr!.A!NDER TO FOLLOW
p.m.
PX4174A
FACSIMIC~
TO:
£XT: DEPT: N/S
~RI FICATIOIt NO:
NO. OF PA~E$ INCLUDING COVER
Xo~ f