HomeMy WebLinkAboutKNIK HEIGHTS BLK I LT 155 1 2
,sun 5 21 02:22p An.,1h(-1i-age,P!M & Pump Saf-
90-172430742 p.1
MUNICIPALITYNCHORAGE
Development Services Department Phone: 907-343-7904
011 -Site Water &' NasteWater Section Fax- 907-343-79977
Pump Installation Log
Well Drilting Permit Number: Date of ls&ue.-
Parcel Identiffeation NuRlber: --X3-1- 0
Legal Descriptjon —
5- Tv
Block I Lot Property Owner Name & Address:
5 C sea
Plimp I=wgtallaCon Date:-
?urn!) Intake Depth Roiow Top of AA,eh Casing:
fc
P"'!mP Mallufacturer's Name: A V
Pilrapmwaci. -9-30-75V31-3
Fu,rnp ,Size:
Pitless Adapter Burial Depth. -- feet
P'tless Adapter MOTILIfacturor's Name,
Pitless -kdapter lnstrdler-,
Well Disinfected Upon Completigu? M yes 0 NO
Metbpd of Disinfection.,
Comment -q -
PUMP Installer Na
GF "JELL a. put'.
K;nc S -re -pt P Skj?Vl
COMP28Y., .4nCijC,,a, CE
Mailing Address
City- -.-__State-
Attention: "l c "'ArIT i z;,;4ia lie, shall I io % da a pure jilAall, - - _ -e within `0 daYs Of Pun -it.) installation.
L.wT, i09 �o On-sk I j
Flattop Technfcal Servfces
14530 Echo Slreet
Anchorage,
/
DATF RECEIVED
INSPECTION APPOINTMENTS ~,~C~:~k~(~¢__~:
DATE DATE DATE
INSPECTOR INSPECTOR I NSPECTOR~
~UNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S I
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
MAI LING AD~HESS' ' '
PROPERTY RESIDENT (If diffe~nt frm~above) ~ PHONE
2. BUYER PHONE
MAILING ADDRESS
3. I. ENDING INSTITUTION I PHONE
I
4, ~EAL~OR/A~BNT PHONE
MAILING ADD~S
5. LEGAL DESCRIPTION
/.. .'-r'.
STREET LOCATION 'k~'
6. 'FYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE! FAMILY
7. WATER SUPPLY
INDIVIDUAL~
[] coMMUNITY
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
[] One [~1 Four
[] Two [] Five
[] Three [] Six
[] Other
ATTACH WELL LOG A weil log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depm (attach Icg if available.)
S. SEWAGE DISPOSAL SYSTEM
I~ INDIVIDUAL/ON-SITE** !(]~c~' _¢~¢~¢1:AR ON-SITE SYSTEM WAS NSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [~] Holding Tank ~',
Size: 1 ;:~--~--~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[~/APPROV ED FOR 4 BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
I~] DISAPPROVED
DATE BY
RETURN TO:
Division of Geological and ¢
]OOI Porcupine Drive (Tel~.
Anchorage, Alaska 9~50J
,yslcal Surveys (DGDS~
ne: E77-6615)
WATER WELL RECORD
Drilling Company Nam~
t~.~0~ATION OF WELL J Please complete either la, lb, or 1¢,
la. Borough TSubdi¥ision ~F-~[oqHlock lb. Fract o Sectlon No.
I I I
],=~c~ Olstance and Oire~ion ~rom Road Intersections
Strb~t Add~e's's'ah~ Area Of Well Location
WELL LOG
Material Type
Feet Bel~
Surface
Top Bottom
U,S.G,S. Lo¢~l No.
Drilling Permit No,
STATE OF ALASJO~
DEPARTMENT OF NATURAL RESOURCES
l~owns~lp N/S J Range E/W Meridian
3, OWHER OF WELL: : , ' , : ~
4. WELL DEPTH: (completed)
Date of
Completion
Surface Elevation
5. [~]Cable tool E')Rotary E]Drlven [~Oug
E~ Auger ~] Jatted ~] 8ored [~ Other:__
6. USE: [~]Domesttc [~]Public Supply [] Industry
[~ Irrigat Ion [~ Recharge ~-I Commerc iai
[]]Test Well ~0ther:
7. EASING: [~Threaded [~Welded
in. to ~ ft, Depth Weight
in. to ft. Depth
Ibs/ft.
8. FINISH OF WELL:
Type:_ ,~'
Slot/Mesh Size:
Set bet~en
Fittings:
Length:
ft, and
ft.
STATIC WATER LEVEL: ft,
[~Above [-'~Below land surface
Type of Measurement:
10. PUMPING LEVEL below land surface
., .} ,_ft. after hfs, pumping ~- g.p,m.
ft. after hrs. pumping g.p,m.
11. WELL Hf~O COMPLETION: [] In Approved Pit
[~Pltless Adapter _~- inches above grade
GROUTING: Well Grouted: ~.~ Yes [~No
Material: [~]Neat Cement [3 Other:
PUMP: (If available) HP : .
Length of Drop Pipe .,__ ft, capacity
Type: [~Submerslble [~ReciProcating
[~]Jet [--]Other:
14, REMARKS:
15. WATER WELL CONTRACTOR'S CERTIFICATION:
Thls well was drilled under my jurisdiction and this report ls true ~o the best of my knowledge and belief:
Regi~:~r~d Busin~ss flame ~ Co~tract Llc~e Number
Address: /
Signed: ': : :: ~
Authorized Representative
t~--%,~ MUNICIPALITY OF ANCHORAGE
DEPARTMEN'r OF HEALTH & ENVlRONIVtENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
'825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT
NAME ]
~-AI LING ADDRESS
~GAL DESCRIPTION
ocx ,o.
_
Well Absorption area Dwelling PERMIT NO. - ....
~ ~ DISTANCE TO: ~p~ ~
~Z Manufacturer~ Materia~ ~)~ No, of compartments
Liq, capacity in g~llons Inside length Width Liquid depth
[ ~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~_~O ~ ~ Manufacturer -- Material Liquid capacity in gal]ohs
~ ~ DISTANCE TO: ~ ~ ~ /O 7~
~ ~ ~ No, of lines L~ngth of eacl~ liDe Total length of li~es Tronch width Distance between
; ~ ~ T opoftiletofin,shgrade , M aterialbeneathtile ~ T ot~l~ffective~ie~area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total eff~tive absorption area
e ~Well Building foundation Nearest lot line
DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT ~,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER ...............
~OIL TEST RATING
INSTALLER
REMARKS
APPROVED_ / DATE LEGAL
,"u:"", i,', ,ti'il I'" i".!!.lt"'lii:i:!:!;;: !]::il:::' I]q:i:!::,l;?.[!Ol"l:i:; ':::
! i'll:!:: .iii]",![ f'! I [::' ' t'"tF]'4'::i :: IL'lf,] I 'iiL i l"!l:: ! i::]",!r:i'?'j ':: 17 i",! i:::I::]: !" '"
I'i.IF' I?FI:::']!i Of: t::1 ']::".:'f',l(' II::!l:il l.::'l I I':::: ]'i'll:!: [:' :i: ii!; l'i::tJ",]l::l]: ~:::,,::
G!:::[)I.II",!I) I::!N[:' l'hIt!i: I::OITO!"!OF: FI'i!:: !:i:':i!::I:::F,"I::IT:i:01"4
I!"II!::Fi:I:i: :lC :i; ?'40 :i;l::T !4 :[ !::"! I'! ~: OK.: I'
.... :fl':.' ','l::.!. I:,~::l:::' t"1 ..... r,::' 'l'l..i,::',, J'l"i',I I !'11 I"J [:'!i:!::' I'J! riF:
F:!N[:, !N.'!:' r:!',O'. "[ ."t JiF 'li"!!:Z F.:::.::~]::I',.,'I:::T: i: i-,! (). N F:Ei]::T
::! ~::!I!:!i ::!::[i:T F:I]Fi I::! i.:'?;i:/!:',,,'l::l]'lii: I,IFi].! :
::I!:::i~i:!! iii ;:::!?F:i I:::'!:!]:i:l' !:'1;i:[11,! I:::! F'l!lSri ):[: HI:Ii I::,:i]::'li!]'.,ll)):N(:i I.I1::'[))'.,! !Jill. T'r'i::'i:Z OF: ?:'I.l~:',l :I:(:
!.'I!:].l I..r]l]:i; i'1!:;i:!:: FilJ:l:::!I..I?F;:lii!,r::, i:::IN[:, I"!I.!:i;T l:i~iii: I:;ii!!:i:"! I.IIii:J",IF:D I!] !'HF:' i::,Fii:'F:ll::ij"ll:i'..!l' !,.i?'[Jl]:!",! :::I!
I:!!:.: i'!.II: l,.Jl:'] !. C()HF'I.t::I":!.
O?Nl:i!]:ii: ?.i:1::!1 ! :i:I::F]'"!I!ZN"! :i; !'IF:Ih.' !:::!F:'F:'L "r'. ::?::'Ei:l:;.( I::' :l: [:1:::1 I :!: [Ih,l?; !::IN!) [:ON!:::!F?!.!I::: j !: ON J::' :? !:::ll:!F?:!!"i'::;
f:?,,,'! ! !' i...?:tlii~l .1_:: '! 0 :1: !"4:!!it II'dii ::::::::::::::::::::::::::: :i: N:i"I'I::II. i I:::iT :): O1",1.
:!: ] !'::I~'"! i::"!:::!H)I ]]!:::I?R J.'!)]
FOFi!!]'I l:',"~' ]'JIF!:
· .? !: !'I]:I.I ]:I",!:;T(::!I .I. T','I!:
]:: :! L!l',j[)l: :!';?:ii;Tl:::ll",!i::, Ti'IF:II
MATERIAI_S TESTING ~ ('~UAI.rfY COH1'ROL
SOIUi ENGINEERING
2204 Cleveland Ave, / P.O. Box 10-1126 / A ~cho~age, AK 99510 / 277-0321
710 3roi Ave. / P,O, Box 2540 / Fairbanks, AK 99706 / 452-126'/~ 456-5155
October 18, 1979
Mr. Bob Runkel
% Nova Real Estate
2207 Spenard Road
Anchorage, Alaska
Re:
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT J, 8 1979
RECEIVIng.
99503
Lot 15, Block 1, Knik Heights Subdivision
Dear Mr. Runkel:
We inspected the open trench for the septic system
currently under construction on Lot 15, Block t,
Knik Heights Subdivision. Upon our inspection on
the morning of October 18, 1979, we noted a small
pocket of trapped seepage, which was no longer
seeping but only moist. This was on a small portion
on one side of the trench where a small slump had
occurred. No water table or potential water problems
were observed. We recommend continuing construction
of the system per the permit.
If we can be of further assistance please let me know.
Sincerely,
CONSTRUCTION TEST LAB, INC.
Managing Engineer
RJP/td
"ProfAs'siouals working lo desi,?n and huild a better'/1 lask~"
DNSTRUCTION TEST LAB
"One Test is worth a Thousand Opinions"
2204 Cleveland Anchorage, Alaska 99503 27'7-0231
rfoznned for Steve Hawkins Nova Real Estate
gal Description: L_ot 15 ·:Block 1
~is Form reports: SOILS TEST Yes
Date Performed 5/24/79
Subdivision Knik Heiqhts
PERCOLATION TEST
lepth
'eet
Soil Characteristics
Organics
Brown Silt with organics
Light Brown Sandy Silt with
Trace of'Gravel ~f~.
_ Medium Grey Sandy Gravel
Meduim Grey Gravel GW
5'
-- Medium Grey Sandy Gravel
-5' with Trace of Silt SW ~ ~-~
Gravelly Sand SP \
Bottom of Test Hole
~s Ground Water Encountered
= YES, What depth?
No
~ading
Date
Gross TLme
.Net TLme Depth to H20 Net Drainage
]rcolation Rate Minute
Proposed Installation: SEEPAGE PIT D_~,AIN FIELD
Depth of Inlet ~ Depth to Bottom of Pit or Trench
...... trench re u red edroo. ' -
~st Performed by R.P. & L.B. ~
Data Certified By: Qe~st~ion Te~L~
Date :
MUNICIPALITY OF ANCHORAGE ~ ~'~'~
DEPARTMENT OF HEALTH AND ENVIRONMENTAl PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL [c-\~D / ~[~,L~
OF ON-SITE SEWER AND WATER FACILITY
264-4'/20
Application Date tO / '8~ /
GENERAl. INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name ~h~f
Applicant Address ~ ~¢'~¢
Applicant is (check one): Lending Institution ~; Owner/builder B; Buyer B; Other B (explain);
Telephone: Home 3 q.~- t.~,~ Business
(d) Lending Institution
Address .-J- '~; it
(e) Real Estate Company and Agent
Address 300 f2
Telephone
Telephone _ ~'O/_.,)_ ,¢~,~ VS~·
~,~/~1~'~ ~ ~tOl
~ . Abet 7~om~J
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 z2-025 (1%8,1)
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 coFnpliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ~.(~,4~.~ 7~¢:.~'~-¢¢¢ ,~e~'~-¢.~'/ Telephone
Address Iq~ ~C4o ~ ~ ~o~ 2 ~
Date lO/ &~ / ~
Engineer's Seal
DHEP APPROVAE~ d¢..~ ~,, //~)~ ~.
Approved for P~D~T/~ bedrool'nsby~'¢~-~c.~',-~4~_~'~ie
Approved ~ Disapprov~ 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:
WELL DATA
Well Classification I~ c~'u~{'~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~ Date Completed ~'/¥,/ ~O Yield
Total Depth i ~ ~ Cased to I ~ ' Depth of Grouting ~,~
Static Water Level 1~' Pump Set At _~ ~ ~¢'
~O" Sanitary Seal on Casing (Y/N)
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Depression Around Wellhead (Y/N) N
I 0¢~ ¢'~ c,o · ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~ IO~' ' ; On Adjoining Lots
To Nearest Public Sewer Line t~,4, To Nearest Public Sewer
Cleanout/Manhole N, h. To Nearest Sewer Service Line on Lot ~,/~.
Water Sample Collected by T"~--¢"~ ; Date ~o! ~_? / ,¢g'
Water Sample Test Results ~"~¢~e~ - ~o coh~ o~ o~ G~ ~
Comments ~'~,/ ~m~}~ ~ ~, ~ ~ c~ ~~ ~ ~
B, SEPTIC/HOLDING TANK DATA
Date Installed tO / l~ /
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size 1~.¢'~ ~¢rl No. of Compartments
Air-tight Caps (Y/N) ~" Foundation Cleanout (Y/N)
Date Last Pumped
N,A. ; for
N,~.. Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line ;;::-
To Water Main/Service Line
Course ~ (OO
To Building Foundation ~' ' :~r¢~ ~ ~..
To Disposal Field ~" '
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 291988
RECEIVED
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~o ! f ¢ / 7'9_
Width of Field .~K"
Square Feet of Absorption Area 70 8
Depression over Field (Y/N) N
Results of Last'Adequacy Test _
Separation Distance from Absorption Field:
To Water-Supply Well ~- fo~
To Building Foundation ¢~.~_~K
Lot N. ~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
/B,:~r,~ Type of System Design
Length of Field ,~_~, t
Depth of Field I~¢ '
Gravel Bed Thickness ~' '
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line __ ~
To Existing or Abandoned System on
; On Adjoining Lots ;:,' ;~,'~
To Cutbank (if present)
To Driveway, Parking Area, or Vehicle Storage Area
Comments As' ~,tf C~.~,~'~ ~
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.
Signed ~ ~. '~¢0,~_ Date
Company ¢~-~'/'~'f' ~ ~¢~ MOA No.
Date
of
PaymenL
Amount:$ ~-- ~ ·
~/~..' ~ %9'" ~. Engineer's Seal
Page 2 of 2
72-026 (11/84)