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Home My WebLink AboutKNIK HEIGHTS BLK I LT 8 ~ Municipality of Anchorage Page / of ~z~ DEPART,MENT 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 Inspect'ion Report Permit Number: ~\)~'/q~ O0~¢'1 PID Number: %me: ~¢-~5'., '~A-~/~'-¢ Wastewater System: [] New [] Upgrade Pl~one: No. of Bedrooms: /..{ [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other DESCRIPTION so, Rating: Total Depth from original grade: LEGAL GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bollom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: Ft. FL WELL: [] New [] Upgrade Gravel width: Number of lines: Distance between lines: Ft. Ft. '~laseilication (Private, A,B,C): Total Depth: ' Cased To: Total absorption area: Pipe material: Ft. Ft. SQ. Ft. '~ri[ler: Date Drilled: Static Water Level: Installer: ,/ Date installed: ~Z /¢,~ (¢2 Yield: GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~Soptic [] Holding [] S.T.E.P. TO Septic Absorption Lifl Holding Public/Private Manufacturer: Capacityin gallons: WeiF /0~' Material: <5~ ,~. ,~ ,~ / N u m be r o f C~,~.,pa rt m o n ts: Surface Water I~0~E LIFT STATION LineL°t ~5 f Size in gallons:II Manufacturer: .¢~ I "Pump on" level at: "Pump off" level at: High water alarm at: Foundation CurtainDrain P~O ~ ~ump Make & Model Electrical Inepectione performed by: Remarks: BENCH MARK OLb TANK. BdP-. IEb L°cati°n and Descripti°n:'~'~o ~~'~1''¢~ ~'"~ ~' ¢~///df ~ _ OrH ~ ~Ti~ Assumed Elevation: ~.~, ENGINEER'S SEAL 2nd Department of Hen th and m~l~'i/Services approval' " Reviewed and approved by("' X?}t~t," ~t~ ?L~C~ N / ~> tffell / 'x LET 17 TOI3BEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 =(907/ 279-5916 \, LOT 8 YI, OCK I IiNII( IIEIGIITS BERNADETTE HESS 15151 SHELBOURNE ROAD LZT? ?A / ~Er,~ ..' ',1o, EE 2225 SEPTIC SYSTEM AS BUILT DATE: JULY 7, 1996 SHEET: 1/5 6RID: 2856 Airtight Cap WoleHight cover ~ ?~,~ 1250 GAL~ SEPTIC TANK AID $£ALE 205 W 15TH. AVENUE ANCH. AK. 99501 (g07) 279-$71 ~ LOT 8 ]7LOCI( / IfNIIf [I£[GII7'S BERNADETTE HESS 15151 SHELBOURNE ROAD I I SEPTIC SYSTEM AS BUILT DATE: JULY 7, 1996 SHEET: 2/5 GRID: 2856 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Jim Williams Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: PID 017-372-28 Lot 8, Block I Knik Heights July 23, 1996 3. heavy water usage prior to observation. Gentlemen, In response to your "Pink Sheet" dated 7/17/96 Installer and installation date have been added to the inspection report. Sheet 2/3 has been corrected to show the correct configuration of the tank Observed water in cleanout may indicate that trench is or was surcharged due to Approval of trench is not requested. Yours MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960081 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:HESS JAMES S & BERNADINE A OWNER ADDRESS:13151 SHELBURNE RD ANCHORAGE,ALASKA 99516 DATE ISSUED: 5/21/96 EXPIRATION DATE: 5/21/97 PARCEL ID:01737228 LEGAL DESCRIPTION: KNIK HEIGHTS BLK I LT 8 LOT SIZE: 27750 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHH8 AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: _' '// ' ~ ISSUED BY: :~/~ I/t /~f~,~ DATE: DATE: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 RECEIVED MAY 2 0 1996 D Municipality oi A,,Cl~pr ept, Health & Human James Williams Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: "Pink Sheet" Lot 8, Block I Knik Heights May 15, 1996 2. 3. 4. The existing tank will be replaced with a 1250 gal. tank. The locations of the well and septic system for lot 4 have been added to the siteplan. A profile drawing of the proposed septic tank has been added to the submittal. A formal request for septic system repair as been added to the submittal. Yours Lxc,L Tobben Sl~urkland P.E. T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Se~wices 820 1 Street Anchorage, Alaska 99501 Subject: PID 017-372-28 Lot 8, Block I ICdfik Heights May16,1996 Gentlemen, The septic tank for this property is partly collapsed and must be replaced. required paperwork to obtain a installation permit. We are snbmitting the Yours T. S~urllJland P.E. _/ N, ~ J'Fell / LIJT 4 25 O \ L~T 17 50 75 lO0 SCALE; 1" 50 FL TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 \ x, SEPTIC SYSTEM DESIGN DATE: AP£1~ I1, i996 SHEET: 1/I GRID: 2856 4 FEET N]NIPiUN CE]VEI~ Airligh] Cap Wo}erHghf cover J Caulder Coupling 1250 GAL~ SEPTIC T NK /,/[7 £,CALE ~'~2 ~x). ................ '~/.7~ '* LO7' 8 BLOCT( I ENII( flEI6'lt~ I SEPTIC SYSTEM DESIGN BERNADETfE NESS [ DATE: MAY 15, 1996 1J151 SHELBOURRE ROAD SHEET: 2/J GRID: 2836 TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 .{'~07~ 279-5916 NAME MAILING ADDRESS Sgt LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF FIEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ __ IPHONE E~ ~RADE LOCATION I ~ "~--~ ~/ Dwelling ~, IDISTANCE TO: ~'" /~ Absorption area ( Mater.. ~~ ~ [Liq. capacity in ga onsl ' ~ ' ~ ~AN~E TO: Iwell ~ I Man~*rer ..... /, Material ~ ~ No. of lines Length of "~4"Y ~7 ~ I ~ inches i% of.,,T /~/¢ Totamlengt~p~in¢. ITrenchwid¢~ ~, I ~n,th Width~ ~ I Well I DISTANCE TO: ~ Cm~ O _ ~ ] DISTANCE TO: Bumldmng foundatmon Inside length CDwelling 4 NO. OFBEDROOMS ~ PERMIT NO. No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Material beneath tile Total effective, absorp i[~'..n area r7~ inches ~-¢2(~)~~') ~ D0pth PERMIT NO. 3rib depth Total effective absorption area Building foundation Nearest lot line )tiller Distance to lot line PERMIT NO. ;ewer line Septic tank Absorpt on area(s) PERMIT Distance between OTHER PIPE MATERIALS INSTALLER REMARKS E. xo A~,,,a¢7' 7,,~"¢~' [)I!31F'f::Ii;i2'FHI}i[",tT 0!:::' I~h!i}iH[.. ~ F' FIN[) '::"; .... I,... :::i:'T'I:ii:IEI:JT'I',, FIJ",ICHORFI(]itE., I'::IIC ;~'. 6'::t-'"" 4. 17.:Oi",!TF:IE:T I:::'HOI",I,Ei: ' !...,tZGF!L. D!j!!?.i!i;E:t;?. ;11 I:::': L,.O'T :!ii: i[ ',i!'.Ei: HFI;:.:', E:I~i:I:;i:'T' ;[ l;::'"r' 'T'HF:IT: ::i...:1: F:iI'I I:::'F::II'q;I:I....il;F:iI:;;: I.,.I]:'1"1'I T'HE I;i:IE(;!UZI:;i:E:HEI",IT'.E; FOR Ed",I"-':5 :I; TIE 5EI.,.IEFi:'.iB FII',tI?' I.,.tEEL. I...::'i; RS; F=OFi:TH E:"¢ '!'T'I!E HUN ;[ E: ;I: F'Fit._ ;[ 'T'"r' OF:' FINE:I'"IOP:F:IGE ':: I"101::t ::' FII",tD THE 5TFf'I"E O1:::' FII....I:::I:SKFI. ;:ii:.:[ I.,.I:[L.I... ;[i",I:i:VT'F:II...L.. "FHl!ii; :i5;"r%'l"El"l ;I;l',t F:ICCORI:;:'F:INE:IE i'.I]:TH FIL..L. I"'IC)I:::I E:O[)E;:i:J; F:II',I[::' F~::Ei;GL.II.~.FIT];ONSi;.' I:::II",E:' :1: t",! COHF:'I.... :i: F::Ii',tE:E I.'.! ;I: TH 'T'I'"IIE DE:E; :1; GI',I E:R :t; "FEI:;i: :1: FI OF:' 'f'H :[ 5; F:'IEI;;'::I4 :[ T. ;;~:. ;I; H]iI...L..I::II;::'HE!:FR[i!: 'T'O F:II...L.. HOF::I F:IND 5TF:ITE OF:' FI I... FI :!51'::: FI f;?.EX;!LI:r.P::EHE;I'.,ITS FEd;?. THE :.51E'T' I:;:, ]: 5;TFINE:E:5 i::i;i:OH t:::IN'.¢ lEX ~ '.!!;T ]; t'.,IG i,.ItEI...I .... I.,.tFIS!;TE:I.,.IFI"FI!i!iI:R D ]: 5F:'O:SF:IL. :;5't'S"I'E:.H O1:;1: F'I..IE&.. Z C 5El.,.![5;Fi:F'l(:!ii'.Si: 5?'r'!i!;TEl'i Oi",l TI'"I;[:50F;: t:::lN"d I:::ID..)'i:::Ili]:Iiil;NT C)I:;;'. I",IEEFIB:E:"d L..OT. 4. ;t; I...ll'.,!l)lSi:!:;i::!STF::ll',!l;::, THI:::!'T' 'T'H ;f. :5 I:::']EI;;:I'I ;I; 'T' :i; '.:5 'vq::ll... ;[ [];~ F'Of;?. I:::1 I'IF::t;:':; ;1: I"ILIH OF:' ,q. E:[~%,I;i:OOI"'I:E; F:I[",II:) I:::lt",l"r' t?i%it....F::tFi:(L!il!!i;l"ll!~;N'F I,.I:[L..L.. };?.liii%!L.l :I; F;:[!( FIN I:::II:)B'];T];Oi"41:::II.. F:'}'_"i:l:;;:l"l;l:'l". ;IF:' F:t I..i:l:l::r'l'' '.:B"l'l::lTZi:Lqbl ]::ii; ;[N:E;'TFIL..I....E:D :l:t',i FIN I:::II¥::E;FI C:EWE!:F~::F_"I)l!i!?¢ I"lOf:t E&.I:I:I..J)]:I"4G E:OI)ES-";., "FHE;N (::!. ;:' FIN EL.E:I:TH:;i: :i: (;:FIL. F:'IEJ?.H ;!: "!" FrlN[.':' :[ h,15;F:'ECT :[ ESI I'"IL.I:B'I" E~E OE',TFt ;1: NE:I:;:'; ,:: ;7}: ) l:~'.:.i;--t!id..I ;I; [...T:~!; i.4 Z I....[. NOT !!?,E FII:'F'F;;:OVED 1.4:1: THC:tUT FIN EiL..E;C'TF4: :t.' CFIL. :1: i",l:BF:'lii:E:'f' Z ON F;?.EF'OF,:T.~ FIND ':: X: ;:' THE; [!~[..I}%;T~: ;[ E.l::ii.. 14OJ:~:K l"iI.JST I!?,E B'ONE E','T' I'::t L :( E:EI",i:!i;Ei:D EL.'EC:"I'Fi: :[ C:: :( FIN. FIF' PL i C F~i",t T 1.,.. O C t:;I ]" ,'[ I]i I",! i,..EGFIL. [:;,EPFtR"t'HI!:]",FI" ,_,r' HI':~:I::ILTH F:II",ID EN',,,' I RONHEi",ITFIL r ,-J3-FECT I ON 825 "L." '.BTRIEET., Fli'.,tCt40RFIGE., F-IK. 264-4720 LJ3T SIZE .:r. t'.,!E ROB I I'.,ISOi'.,i LOT 8 E;LK I I<I'.,IIK HTS. TY'F:'E OF' SOIL HB_~,ijRF t Iul,I:,~::'""' "- .... FEll IS '1F4ENJI :~:BS'~ :!F 'S SL.'::!I..IF:IF.:E FEET HF~;:.:;iHi...IH NUi,'IEEtR OF BEE:,ROOMS .... 4 SOIL F.:F-I"FII'.,tG ,"~]) F-'F,.-"E:F.:)= THE RE(;:!L.IIREI} SIZE OF THE SOIL. F-tESZ[~'F:'TION S'¢S'T'EM THE L.ENGTH DIi,iENSION IS THE L. Et'.,!GTH <IN FEET:., OF THE TREhtCH OR [:,RFIINFIEL£). THE DEF'TH OF R TF.:ENCH OR F'IT IL:; ]"HE [:,ISTF:INCE BET!.,.IEEN THE SURFFICE OF THE (~ROt...IND FIND THE BE~T"FOH OF' THE EXCR',,,'FITIOi",I ,:;ii'.,l FEET). ]'HERE iS NO SET t4I[;,TH FOR TRENCHES. THE GRFI',,,'IEL. I}EF'TH I:5 ]'HE MINIMIJH I'!,EF'TH OF GFRR',,,'EL. BETI.,.IEEi'.,I THE OL.ITFI=tLL.. PIF:'E FIN[:, THE BOT]'OM OF' THIE EXCR',,,'FITION <IN FEIET). PIERI'IIT RPF'LtCFiI'-4T HFIS THE I~:tESPE, I'-,i'.SIE~ILIT'T' TO INFORM THIS [;,EPFIRTMEI'.,I]" [;,I...IRii'.,IG THE I NSTFtLL. FtT Z ON I NSF'ECT I Obis Of: FIN"r' ~,.IELL. S FIDJFICENT TO TH I ';5 F'F-:F'~F'EF::T'¢ FIND THE i".!ItHFER_ ~ OF RESI[.,Et",tCiES THI=IT "FHE !41L::LL I.,.IILL =,EF..,' ..... E. BF::I(]:KFII_I_ING OF RI",I'¢ SY'STEM NITHOIjT ICli'.~FIL II,t:.f E...FtON RI",![:, FIPPRO',,,'RL E','¢ THIS [:'EF'FIR]"HENT I.'.IILI_ E:E SLIBJECT TO PRO:BEC:UTI01'4, i"IIiqIHLIM DISTRI",IC:E E:ETF.IEE?',I Fl [4ELI_ I::IND FIN'¢ OI",I-'SITE: SE:[qRGE [:,ISpOSFIL S"r'STEM I$ :t00 FEET FOR Ft PRIVFITE I.,.IELL 01:;?. :1.563 TO 200 FEET FROM FI F'UE:LIC WELL DEF:'EI",II}ING LIF'ON THE TYF'E OF PUBLIC t.,.IEL.I ..... I'"IINIMLtM [:'ISTFIhlCE FROM FI F'R]:VFITE !-,.IELL TO FI F'RIVFiTE SEI.,.IER LINE IS 25 FEET TO FI COMMUNIT'¢ .SEI.,.IER LII'.,IE IS '?'5 F'EET. [,.IELL. LOGS FIRE RE(..]UII'~:Et} FIND I'It...IST BE tRETLiRI',IED TO THE E:'EPRI:;..'Tt'IEt",I]" I.'.IITHIN ];0 [:'FI"r'S.; OF THE 14ELL COMF'LETtOI",I. OTHER REI;!LI I REHEt",FFS I"tR'¢ FIF'F'L'¢. SF'EC I F i CWT IONS FIN[:, CONS]"I;::UCT101'.,I [:,.t.' FtGRt":IM5 FIF..'E FIYFI]]LFIBL. E TO IN?7, URE PROPER It',I:E;]'RI_I_FITION. ~ CEF.".T i F:'"r' THFIT ;.L: I FIM FF:II"IILtFIR I.,.I~TH THE RE6!LIIREMIEI'.,ITS FOF.: ON-SITE :¢EP.IERS FII'.,II} I,,.IEL.I_S FIS SET FC)F,".TH B'Y' THE MUNI C I PFIL Z T'Y' OF I:H'.,ICPIOF.]FIGE. 2: I I.,,IILI,,,. tt'.,IL:';TFII.,,.L. THE '..~;Y'STEM II'-,I FIC:COF,:[.,Rt'.,ICE 14ITH THE CODES. 3.; I L.INDERSTFH'.,ID THRT THE Ot",I-'.':!;ITE SEI,,.tEF.': '.::;¥STEH t"IFW I;:E(;!LIZF::E ENLf~RGEHI~:'NT IF THE RESIi}ENCE I'.5 REI'IODEI_E:[:, TO I I'.,IE;I..JJDE 1'IOI:~:E "FHFIN 4 BEE:,ROOMS. S I Gi'.~E[:~: FIF'~ ,t. :,SUE[;' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ©L 2 3 4 7 8 ~0 ~2 ~3 ~4 17 18 2O kni k I-le~,~hf.3 LO+s,_oPE8 SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE COMMENTB V~SUO/ 0-~ PERFORMED BY: 72-008 (6/79) {minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: DATE: . A~.,. ,.~..A.~:r E R. WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURE$ Division of Geological ~ GeophyslcolSurveys Drilling Permit No. . LOCATION OF WELL (Plooee complete Dither la, b or lc,) A.O.L. No. · I~..JSorough Subdtvioion Lot Block Ib~..~J.. I/4qtra. Section No.[TownehlPNE] Range EEl Meridian OWNER OF WELL: Street_ Addr,,t and Area o~ Well Location ' :' ~3. W~LL .. · .~ ~ - Feat Below . . ' .' -,'. :" ' ' - . :- - ' ' ~urfo~e 4. WELL DEPTB; (final) ~. DATE OF COMPLETION Muterl.l TT,~ ' ' Top Bottom ~O9 ft. ~ --3~- ~' ~ Type: Diameter: (J~- MUNICIPALI~ '-(:)F ANL.~,-E/,OE ~ Above or ~ ~elow land ~urface Date .......L~'~ .. ft. after hrl, pumping _g.p.m. · Material: U] Neat Cement U Other: I~, PUMP: (if available) HP Length of Drop Pipe ft. oapecity g.p.m. ~ Subm. D del ~ Centriffcal ~ Other 14, REMARKS: · O, WATER WELL CONTRACTOR'S CERTIFICATION: 15. Woler Temperefure .o ~ F ~ C This wail ~1 d~illed under my juHsdlcllon end this report I~ true lo lhe best of my knowledge end belief; Registered Business Nome Conlroct License Number Address 'WW~ (11/81) COpy Oisfribulion; WHITE-S~ofe DGGS~ PINK'Oriller, CANARY-Customer 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 Lot 8, Block I, Knik Heiqhts Location (site address or directions) 1 31 51 Shelburne Road Property owner Mailing address Lending agency Mailing address Agent Address Bernardine Hess 13151 She!burne Road Larry Zamber Day phone_345-3180 Day phone Day phone 689-6482 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Fnur (4) TYPE OF WATER SUPPLY: Individual well XXX 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: 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 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 Anderson Enqineerinq Phone 563-7155 Address p c~ Rc~w 246~77'g Anchorage: AK 99524 Engineer'ssigr ature Date 5/97 DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. 1/911 Back MOA ~1 Legal Description: A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. ADEC water system number Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESD E Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 AUG 18 1997 Health Authority Approval Checklist Municipality of Anchorage Dept. Health & Human Services Lot: 8, B'look T, Kn±k He±qhts Parcel I.D.: Log present (Y/N) Y Date completed June / 1 984 Total depth 507 ' Cased to 1 93 ' Casing height (above ground) ;2 ' Sanitary seal (Y/N) y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test 6/84 8/7/9? Static water level 1 961 ' 1 98 ' Well production 1 g.p.m. ,45 g.p.m. Nitrate 1.09 mg/L Other bacteria 0 Collected by: ,7 6/96 Tank size 1 , 250 Number of Compartments 2 Cleanouts (Y/N) ¥ Depression (Y/N) N High water alarm (Y/N) N _Pumper Northland Pumping WATER SAMPLE RESULTS: Coliform 0 Date of sample: 8 / 8 / 97 B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Y Date of Pumping 8 / 1 5 / 9 ? C. ABSORPTION FIELD DATA Date installed ~ / 84 Length 47 ' Width Effective absorption area 611 Soil rating (g.p.d./fF or fF/bdrm) 1 50 SF_ System type Trench 2. ~ ' Gravel thickness below pipe 6.5 ' Total depth 11 . 5 ' SF Monitoring Tube present (Y/N). Y Depression over field (Y/N) N Date of adequacy test_ 8/7/77 Fluid depth in absorption field before test (in.); 8" Fluid depth 8" (ins) Minutes later: 1 ¢44n Peroxide treatment (past 12 months) (Y/N) N 72-026 (Rev. 3/96)* Results (Pass/Fail) Pa s s For 4 bedrooms Immediately after 658gal water added (in.): 1 6" Absorption rate =. 6 D 0 g.p.d. If yes, give date 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: Septic/holding tank on lot > 1 D0 ' Absorption field on lot > 100' Public sewer main H± 1 es Sewer/septic service line > 25 ' Size in gallons "Pump on" level at* *Datum On adjacent lots > 100 ' On adjacent lots > 1 00 ' Public sewer manhole/cleanout IVH 1~.~ Lift station N/A HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Property line Surface water Curtain drain f4r~n~ (3h.qRrvRr] (~n ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Muntc~pal recor~¢,;t~iat;_Jh~beve systems are m conformance with MOA HAA guidelines in effect on this date. ,~,,,~.;,:,,..., ~,.,. .,,~ ,:.., .. . Signature Engineer's Name Mi "Pump off" level at* Absorption field > 5 ' Wells on adjacent lots > 100 ~ Water main/service line > 25 ' Driveway, parking/vehicle storage area > ~ O ' Wells on adjacent lots > 1 ¢Jf'l ' Waiver Fee $ Date of Payment Receipt Number SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > 5 ~ Property line > 5 ~ Water main/service line > 2, ~, ' Surface water/drainage ~ 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation > 10 ' MEMORANDUM DATE: August 15, 1997 TO: FROM: Onsite Services Engineer Mike Anderson, P.E. ,/l/~. SUBJECT: Lot 8, Block I, Knik Heights Subdivision Well Flow Test/Water System On August 7, 1997, a flow test was performed on the well located on Lot 8, Block I, Knik Heights Subdivision. The static water level was measured at approximately 198' below the surface. Water was then discharged into the septic system at a rate averaging 7 gallons per minute. After one and one half hours the pump in the well quit after more than 630 gallons of water had been discharged. The well was then allowed to recover for two hours. Flow was then continued and nearly 55 gallons of water was discharged. This process was repeated again with almost identical results. The well appears to be producing between .45 and .5 gallons of water per minute. This production rate marginally meets the Municipal requirements for a four bedroom home. The water system for the house includes a 3' diameter X 5.2' high storage tank which flows into a WX 203 X-Trol pressure tank via a 1/2 HP General Electric transfer pump. The water then flows into the water system in the house. Total water storage is in excess of 325 gallons. The combination of water storage and well production provides sufficient water to serve the four bedroom home. MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. H.~qg.(}~.9~ During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot ~ Block l~ of K~ H~IQ~& Subdivision, the well's g productivity was determined to be ~.~$ gallons per minute. The minimum well productivity required by this Department (AMC ].5~55) for a ~ bedroom residence is 0,~ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. MUNICIPALITY O1" ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Application Date Legal Description (include lot, block, subdivision, section, township, range) L.-,~-r B az.-,,<'. / _K,w'~K Location (address or directions) t ~/5- / ,-5~,¢d,c_,,,J~ ~, Applicant Name',~-/£ ~--~/¢/,,d 5o/,J Telephone: Home Applicant Address /~.d):~'~,~ ~' ! (,?_~, /'~-,,H', Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); ~'~ ~'~ Business (d) Lending Institution (..,//,-] Address '"~/.¢:' "~'~ fCc (e) Real Estale Company and Agent Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING SR B 196X EAGLE RIVER, AK 99512' TYPE OF RESIDENCE Single-Family,S-. Multi-Family [] Number of Bedrooms ~-k Other WATER SUPPLY Individual Well ~C Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL. Onsite ~ Public [] Community [] Holding Tank [] Note: If cummunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN ,ISPECTIONS, TESTS, FILE SEARCH, DA 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. Name of Firm S & S ENGINEERING Telephone ~) ~"~/-'/- ~'~:~' ~ ~' SRB 196X Address EAGLE RIVER, AK 99577 JUJ'~ 2 6 IgU6 Date DHEP APPROVAL App~°ved fo,' Approved bedrooms by ..~:-z'-,~.~ /.) - '"~7~*'~'''~'~ Date -'~ Disapproved __ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: J~UNICIPALI'[Y OF ANCHOP, AG;~ DEPT. OF kIEALTH J~NVIRONMENTAL PROTECTIOIki: IV ED WELL DATA Well Classification Well Log Present~:~/N) Total Depth ~o'"1 "' Cased to J ~) ~ Static Water Level / 90' Casing Height Above Ground ~,/.¢ t, Electrical Wiring in Conduit ~/N) Separation Distances from Well: To Septic/Me~lff~ Tank on Lot / ~ ¢ ''M To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by "~ ~ ,¢ ~(t/,'J~"~"~-~'~ Water Sa ,mple Test Results C0'mments If A, B, C, D.E.C~Approved (Y/N) Date Completed :;~u,~E- ~,¢ Yield Depth of Grouting '~ Pump Set At 'S'"-~ Sanitary Seal on Casing ~/N) Depression Around Wellhead (Y/~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/J4~ED/I~G TANK DATA Date Installed ~-~-/7'~/ Size I¢..-,5'~:2 No. of Compallments '7.- Standpipes C/N) Air-tight Caps (~}'N) Foundation Cleanout td~N) Depression over Tank (Y/,~ Date Last Pumped ~, - /~) ~ ~& Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/fffuldiHg Tank: To Water-Supply Well /' _¢O To Property Line To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /-¢'-¢ ~/~ Date Installed ~"-/~'7 - ~/ Width of Field .~.~ 6, Square Feet of Absorption Area Depression over Field (Y/~[)_ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Presentd~/N) Date of Last Adequacy Test To Building Foundation Lot ~/~ To Water Main/Service Line ~7/o To stream/Pond/Lake/or Major Drainage course To Driveway, Parking Area, or Vehicle Storage Area comments '~ /~ ~/¢--'~ -'~-'o O~--,¢--- o/~ ,¢.-r~ ¢-~/ To Property Line // To Existing or Abandoned System on ; On Adjoining Lots '~0 I./~ To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. JUN 2 6 1986 Signed c ~, Date ., . $ ,NGINr-E iNG Company SRI::! ~.96.v. MOA No. Receipt No.EA(~II I= RIVER, AK 99577 Date of Payment ~-;~-~ Amount: $ (o~ ~ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON~'NTAL HEALTH DEPAR~F, NT OF !IEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~U~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General infotqnation (a) Application Date Legal Descrip, tion (include lot, bloc~.~ subdivision, section, township~ range) I.oca~:io~ (add,tess or~birectio.mf) (~) app~i~nt :~s (check one) ~ndtng (d) Lending Inst~utlon /;~ //:~? Telephone (e) (~) Address Rea]. Estate Co, & Agent Address Telephone M=~gJ:" E~m tIAA t:o the following address: 3. Water Sup)]] Individual Well Note: If community well systam, must have ~.rritten coufirmation f~:om the State Depa?:tment of Envit"onmental Conservation attesting to the legality and status. 4. Sewage Dis~>osal Onsite ~ Public [:=_.~.j Community l~ Holding Tank ~5 Note: If community well system, must have x~itten conf:l, rmaPion from the State Department of Environmental Coresew:ration attestJng to thc~ legality and status. [Page 1 ,.of 2] Engineerin. g2 Firm Providin~_~I~n. fipections, Tests~. File Search, Data and Informatiou "i: As certified by my seal affixed hereto and as of the validation date shown belew, I verify that my investigation of this llealth Authority Approval shows that t:he 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 Manicipality of Anchorage f£1es and from my investigation and inspection, the on-site, water supply and/er wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and reguia- tions in effect on the date of this inspection. Address Date DHEP Alp rov a~l!.' Approved for ..... _/-~__ bedrooms Approved /./..~ .... Disapproved Terms of Conditional Approval CAUTION THE NUNICIt',5,LITY 0F ANCHOi~AGE DEPARTMENT OF HEALTII ~l) ENV [RO~LENTAL I RO (DIIEP) ISSUES HEALTH AUTIt0R!TY ~I?ROVM~ CERTIFICATES BASED SOLELY UPON THE L~.I kE,~" ~':"E.~I.- ATIONS GIVEN IN PARAGRAPlt 5 ABOVE BY AN INDEPI}'.NDENT PROFESSIONAL ENGINEER R~{GISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF ltOMES THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CEWI~IN FEDERM., AND STATE REQUIRE-' MENTS. F~[PLOYEES OF DIIEP DO NOT CONDUCT INSPECTIONS OR ~ALYZE DATA BEFORE CERTIFICATE IS ISSUED. TIlE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DI1EP SEAL) RR4/ej/D18 [Page 2 of 2] '?-19-84 ae WELL DATA Well Classification/~.~ Well Log Present ~_(~) Total Depth r~_Ok~/ .~ t Cased to Static Water Level /~ Casing Height Above Ground Electrical Wiring in Conduit((~/~') Separation Distances from Well: To Septic/Holding Tank on Lot ,qlCIPALll'Y OF ANCHORAOE OEP]', OF H~AL'I'H pROIFCTION MUNICIPALITY OF ~CHO~GE (MO~~vm°NM[~NTAL H~ AU~ORIT~ ~PROV~ (~) 0~I ! J- ~eg~Z Desaz~p~:Lon; If A, B, or C, D.E.C. Appr0ved(Y~) /~n ~pth of Grouting Pu~ ~t At ~ / Sanitary ~al on ~predsion ~ound ~l~ead To Nearest Edge of Absorption Field on Lot/agQ ...... , Sewer Line /-b£//~k-- To Nearest =~'~ ~'~ Cleancut/Manhole /J~/~~ To Nearest Sewer Service Line on Lot Wate~ Sample Collected By~,-!,~ ~.~7~//7~f~_.//~_%; Date Water Sample Test Results ~ )<~,~3-"F'//}/~w~:d' '7"r-~ Comments ; On Adjoining Lots /~ ; (hn Adjoining Lots..../(9~) To Nearest Public Sewer SEPTIC/HOLDING TANK DATA Date Installze~ ~w~7/~ ~ Size /~,~ No. of Ccn~3a~tments -- 1 ' ' r- Cleanout (~) · Standpipes4Y'~ ~ Air-tight Cap~ Foundation Depression over Tank (gi~) Date Last ~umped Pumping/Maintenance Contract on File (Y/N~/~ ; for Holding Ta~k High-Water Alarm (Y/N~/~- Temporary Holding Tank Permit (Y/N)/~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line /O 7 To Water Main/Service Line Course Com~nts To Building Foundation To Disposal Field ~ / TO Stream, Pond, Lake, or Major Drainage Receipt 9 Date Paid: Amount:t [Page 1 of 2] 2-~5-s~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Str~ata Date Installed Width of Field 30 z, Square Feet of Absorption Area Depression over Field (~/.~ Results of Last Adequacy Test 7/~ Type of System D~sign Length of Field Depth of Field / Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~O ~ To Property Line /O To Building Foundation ~--~ ~ To Existing or Abandoned System on Lot /J ~f~ ; On Adjoining Lots ~C).~ Tc Water~-~rvice Line ~O ~ To Cutbank(if present) To Stream/Pond/La'e/or Major Drainage Course AJ To Driveway, Parking Area, or Vehicle Storage Area ~ ~ Comments .,'/k~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dinmnsions JManhole/Access (Y/N) 4~ Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. ~ets MOA Co~nents Check Permitted Bedroom Rating Against HAA Request certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. ~.g ,e ,- ~,.: SRB "lg~X . ~o~any~ .- pH, ~94-~979 KB1/dL/s Date MOA No. [Page 2 of 2] /6-7.3 ~ /~7. m7 F/w}