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HomeMy WebLinkAboutKNIK HEIGHTS BLK I LT 7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SF. WAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT Address LEGAL DESCRIPTION TANKS ~S~TI C [] HOLDING TYPE OF SYSTEM ,,~TRENCH ~ [tED [] W. DRAIN [] OTHER ~)~J~ to pipe hotJom horn ~olaJ depth JrOl'q orl(.]lnal grado DISTANCES WEL tOo +- 1OO% LOT LINE ~0i 20 / FOUNDATION ~, ~ ! ~ ~ f AS-BUiLT DIAGRAM (Show IoCaJlOlJ oJ well. sephc syslem, ploperW hne5, toundabon, F'r FT F'F 2,, ~ FT FT WFLLS ~]~PRIVATE [] OTHEFI (Identify) FT REMARKS: Health Deparlment Approval: Date. 72-013 [3/851 Performed for /~'~ This 'Form reports :-' GREATER ANCHORAGE AREA BOROUP'' Department of Environmental Qu, ty 3330 "C" Street Anchorage, Alaska 99503 SOILS I.,OG - PEROI,ATION TI';ST Date Performed IJepti~ Feet Percolation test 10 ~ 2 lop~ 1'1 .- t2 ~ 13~ Was ground water encountered? .~)_c_', .........If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Proposed installation: .>eepage Pit Drain Field :)cp~h of Inle[ .................. . Depth to hot[om of pit or [rench ~OMDIEHTS: / ................. ~ ....... c ] ........ _tS .......... .-~ ..... ...................................... ]' ~,~ - Performed By :_ =J_tS_z . :SZ~Z_~ I ~a L~. ___ E(~-040 (6/74) WELL LOG: go~, 'wa,c¢ 30 COST INCLUDF;S ALI._ LA13OR AND MATERIAL FOR COMF'LTI'ION O,-'¢~' SAID DF~ILL, ING. '~RITE CHECK PAYABL,tE TO RAMPAFiT DRILLIF,IG kVONKS FOR TI-lIE SUM OF: .... ~j~'iB{},~(}0_ ........... THAN}( YOU \fEIRY MUCH, lOT 7 PROPOSED DWELLING LOCATION NOR~: It is the eontrae;or's rcsponsibillty (o chec~ Toil of li'oufldadon in relatlonsblp [o Filflsb Grade, 'fop o~ l;ounda.Hon a,~ indicated is one ¢o,n'.~e o[ block above Finish Grade, I hereby certify that I have' surveyed the following described property:~__. ,'C';??.' //,/f /~;?// Z'.9' Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on prop- erty lying adjacent thereto encroach on the premises in ~uestion and that there are no Toadways, transmission nes or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska 7.5' t 's~oay of. , --~ FRED WALATKA & ASSOCIATES Engineers and Surveyor~ 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 .... ' HAA # 1. GENERAL INFORMATION ~. Complete legal description Lot 7, Block~ Knik Heights Subdivision Location (site address or directions) 4600 Shelburne Place Property owner Bob & Mailing address ._46~ Lending agency Mailing address Agent -3udith Ann Criffin .qh~]burne Place Address Dayphone 345-0900 Anchorage, AK 99516 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Four (4) Individual well Community well 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: XXX 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 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 Anderson Enqineerinq Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 EngineeYs signature ~1/J¢c<'/*¢0-~ ~--~ U/'-(~4'~--~ Date ~./~n./98 DHHS SIGNATURE · ///' Approved for ~-O (,"/~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ./ fc~r Date 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 ~21 Environmental Services Division 825 L Street, [:loom 502 · Anchorage, Alaska 99501 · (907) ~-q~,~^~ Legal Description: A. WELL DATA Well type Private Log present (Y/N) Total depth 475 ' Sanitary seal (WN) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Health Authority Approval Checklist Lot 7, Block 1, Knik HeightsParcelI.D.: 017-872-29 IfA, B, or c, attach ADEC letter. ADEC water system number Y Date completed. 2 / 27 / 76 Cased to 289 ' Y FROM WELL LOG 2!27/76 150' Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample: 9/24/90 B. SEPTIC/HOLDING TANK DATA Casing height (above ground) Wires properly protected (Y/N) _ AT INSPECTION 9/24/98 Undetermined >2' Y 1.5 g.p,m. 1.8 g.p.m, 1 . 06 mg/L Other bacteria 0 Collected by: T. Kimbrough Date installed 1975 Tank size 1,250 Foundation cleanout (Y/N) Y Depression (Y/N) Date of Pumping ._~_~'L/_..9.~ ~ _ Pumper Isaac. ' s C, ABSORPTION FIELD DATA Date installed 1 9 7 5 Length 41 ' Width 2.5 ' Effective absorption area A~c, .q~ Date of adequacy test _ ~ / 2 '~ / c) R Fluid depth in absorption field before test (in,); 0 Fluid depth 0 (ins) Minutes later:, 0 Peroxide treatment (past 12 months) (Y/N) N 72-026 (Rev, 3/96)* Soil rating (g,p.d./fF or fF/bdrm) Gravel thickness below pipe Monitoring Tube present (Y/N) ¥ Results (Pass/Fail) _P a s s Nitrate 1.50 SF_ System type_ D~ep TreD. ch ~ ' _ Total depth 1 4 ' Depression over field (Y/N) R [:or _ 4 bedrooms Immediately after 600gal. water added (in,): 0 Absorption rate = > 600 g.p.d. If yes, give date Number of Compartments 2 Cleanouts (Y/N) ~ N High water alarm (Y/N). N D. LIFT STATION - None on Lot Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump on" level at* *Datum Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line "Pump off" level at* F. On adjacent lots > 1 O0 ' On adjacent lots > 100 Public sewer manhole/cleanout Lift station N / A Absorption field > 5 ' Wells on adjacent lots > 1 0 0 ' Water main/service line Driveway, parking/vehicle storage area > 5 ' Wells on adjacent lots > 100 ' >10' are SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > .5 ' Property line :> .5 ' Water main/service line > 1 0 ' Surface water/drainage > 1 0 0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 1 0 ' Building foundation > 1 0 ' Surface water > 100 ' Curtain drain None on ~,ot ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and revie~ in conformance with MOA HAA guidelines in effect on this date. Signature ~,c(~t,~,~,- ~' ~,~'~/,------~ Engineer's Name Michael E, Anderson: P.E. Date 9/30/98 HAA Fee $ Date of Payment /(~,/OCz /~' ~'~ Receipt Number ~/'~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number $EP-30-98 09:34 FROM-CTE ENVIRONMENTAL 561530] T-600 P.O1/OZ F-673 CT&E Environmental Services Inc, Laboratory Division 200 W. Potter Dr~ve Anchorage, AK 99518 Tel: (907} 562-2,343 Fax: (907) 561-5301 ChemLab Ret. ~ Client Name: Project Name: Cllen[ Sample ID; Matrix- 98.5552 Anclerson Eng~neenng LT/B1 Knil( Outsiae Spigot Drinl~ing Water PWSID n/a Sample Remarks: Client PO~: Pnnted Da[e/Time: Collected Date/Time: Race,yeti Date/T~lle: Technical D~rec[or: n/a 9/30/88 09:25 8/24/98 14:30 9/24/98 15:30 Stephen Ede Released By~~,_ Parameter Results PQL umts Allowable Prep Analysis Method Limits Date Date Init Total Coliform (MF) Nitrate 0 col/100 mi 1.06 0.1 mg/L SM9222t3 9/24/98 ;'(,AP EPA 300 10,0 9/24/98 GCP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) Property Owner ~V~P ~__lCA~ro-~ ~o.,L~ Telephone: Home Mailing Address_ ~00 ~ ~ Lending Institution 6***X.__ Telephone Mailing Address Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followinq address: or: Check here'~if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~(. Number ol Bedrooms WATER SUPPLY Individual Well (~' Community [] Public [] Note: if community well systern, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL ~ Public [] Community [] Holding Tank [] Onsite Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and slatus. Page 1 of 2 72-025 (Rev 8/861 Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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. Address / C"?C~x::~) ~ Cate s/:h,¢ DHHS APPROVAL Approved for /~,~.Z//~,} bedrooms by Approved ~ -~ Disapproved Terms of Conditional Approval Conditional Date CAUTION 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. Page 2 of 2 72-025 IRev 8'86) Back ~, ~,UCIPALITY OF ANC~I¢;~,~ FP~ OF H~ALTH & ~ I,~ v, i ~O!.~d~¢: lxl [ AL r :4oTECTIO~ k[:CE VF.D. A, WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: ~.o T MUNICIPALi'[Y OF ANCHORAGE ENVIRONMENTAL SERVtCES DIVISION AUG 1 6 !988 Well Classification F3¢..~ ~/,~'T~- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed i cf-7~' Yield ~)- '7.:'~ fl ¢~., Total Depth ~: 7.5~' Cased to 4 7;f'' Depth of Grouting Static Water Level ~C) / Pump Set At ~CC; I Casing Height Above Ground ~ ~/¢ ~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~' Depression Around Wellhead (Y/N) _~ Separation Distances from Well: To Septic/Holding Tank on Lot ~(~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~ ' ; On Adjoining Lots ~[~%-; To Nearest Public Sewer Line ~//4 To Nearest Public Sewer Cleanout/Manhole ~//q To Nearest Sewer Service Line on Lot Water Sample Collected by .~:~ ~¢ ~'~ %' . ;Date ~ Water Sample Test Results ~ ~,:' ~ ..... / Comments ~?*~ [~ ~'z- / ~.< 0 B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Y Air-tight Caps (Y/N) ~/_ ' Depression over Tank (Y/N) ~,l. Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) &J /,4-1.- Separation Distances from Septic/Holding Tank: To Water-Supply Well //(,2 t To Property Line cf..'~~'' To Water Main/Service Line 40' d- Course Size /(')C_;O~,,~ / No. of Compartments ~-~ Foundation Cleanout (Y/N) Y Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) J~ To Building Foundation To Disposal Field ~'" ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 fRev 8861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /'~ Width of Field ~/,~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~© To Building Foundation /~-- / Lot IV/,,~ To Water Main/Service Line -~-C'~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,4~/'p¢:~, ¢/~/'ct/,¢~,'~.,,*,¢,,~,,,,,'¢~' .4.~.~ /g',;i,u,' l.~- t,~ .44,0.4. /,r~o~£,-~, Type of System Design Length of Field ¢,*; Depth of Field ]_~.' Gravel Bed Thickness [/4 Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~-~-¢- To Existing or Abandoned System on ; On Adjoining Lots ~.5~) ' To Cutbank (if present) /©' LIFT STATION \ Date Installed Size in Gallons~ "Pump On" Level at High Water Alarm Lever~ __ Tested for ECI~ Cmt rimCeal t~ ° d es ( Y/N )~ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Pe/mltted 8edro/~ Rating Against HAA Request ** I certify tha/~,~,~beck¢,~ve-~ied, or conformed to all M/OA a, pd HAA guidelines in effect on the date of this inspection. Signed //////~/_/' // ~/' '- Date d~,,/~/,~ Date of Payment (~Z ~ L__ Amount: $ //'~/.~. 0~) igineer's Seal I. Coffin Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA INC. ' FEDEFtAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLZ for Work Order $ 8435 Date Report Printed: AUG Il. 88 @ 09:42 Client Sample ID:L7, B1 KNIK HTS PWSID :UA Collected AUG 9 88 ~ 14:30 hrs. Received AUG 9 88 @ 16:00 hrs. Preserved with :4 DEG C Client Name : CORWIN & ASSOC Client Acer : CORWINP P.O.$ NONE REC'D Roq # Ordered By : KRESS Analysis Completed :AUG 10 88 Send Reports to: Laboratory Supervisor,:STgPNEN C. EDE I)CORWI}t & ASSOC Released By : .o~""~ ~-~J"~"~ 2) Special Instruct: Chemlab Ref ~: 2149 Lab Smpl II): 3 Matrix: WATER M. lowable Parameter Tested Result/Units Method Limits NITRATE-N 0.29 ms/1 ..... EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY KRESS. i Tests Performed See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA~ Not Analyzed LT~Loss Than, GT~Greater Than June 30, 1983 © ARCTIC ENGINEERS, INC. SEPTIC SYSTEM ADEQUACY TEST Lot 7, Block 1, Knik Heights Barbara Headley 4-Bedroom, single family On-Site Well SXST~: TEST DATE RESULTSz From On-Site determination Tank: 1250 gallon Absorption System: Absorption Area: Soil~ 150 Approval Date= Trench, Unknown% dimensions June 30, 1983 1,000 gallons of water was dun%ued into the absorption system SU~o Liquid level rise was monitored at the absorption system su~. No backing up into the septic tank was observed, and the t~ench absorbed all the water input within 5 minutes. The system accepted 1.5 tim~s the daily design flow for a four bedroom house. The absorption system is adequate by ~micipality of Anchorage requirements. The 4" standpipe at the tank and the 4" cleanout both offset. They should be repaired. ApPLIC .kiT FILLS OUT UPPER HA! ONLY Pioperty Owner .... i'i'~' .. ~ '~= ~-=,(_'\'\ Phone Mailing AdLce~ ~' ~ ,'-~'~ i ~,.., ¥ =? ~, '~. ~"-, Zip Code ~ ..., (.~ .;,<~ '~': Buyer Address Zip Code Lending Institution Phone Address Zip Code Phone Type of Residence I~-'"§J~ Die Family [] Multiple Family No. of Bedrooms [] Other Water S.u pply E;J/J~ndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior lo that date, give well deplh (attach log if available). [] Public Utility Sewer Disposal [~'l~dividual Year Individual Installed: __~L~ ".~ L~ Public Utility When Connected to Public Utility: [] Holding 'rank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~/ MUNICIPALITY OF ANCHORAGE ~ DEPT. OF HS/\LTH ~ ENVIRONMENTAL PROTECTION RECEIVED ) APPROVED BEDROOMS ) DISAPPROVE[) L~'~'CONDITIONAL APPROVAL' 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Seplic TaJ]k Size 72 023 { 3/8~.) June 30, 1983 ARCTIC ENGINEERS, INC, LEGAL: OWNER: HOUSE TYPE : WATER: SEPTIC SYSTEM: TEST DATE: PROCEDURE: RESULTS: COMMENTS: SEPTIC SYSTEM ADEQUACY TEST Lot 7, Block 1, Knik Heights Barbara Headley 4-Bedroom, single family On-Site Well From On-Site determination Tank: 1250 gallon Absorption System: Absorption Area: Soil: 150 Approval Date: June 30, 1983 Trench, Unknown dimensions 1,000 gallons of water was dumped into the absorption system sump. Liquid level rise was monitored at the absorption system sump. No backing up into the septic tank was observed, and the trench absorbed all the water input within 5 minutes. The system accepted 1.5 times the daily design flow for a four bedroom house. The absorption system is adequate by Municipality of Anchorage requirements. The 4" standpipe at the tank and the 4" cleanout both offset. They should be repaired.