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HomeMy WebLinkAboutKNIK HEIGHTS BLK I LT 16 69/17/z 6 z.- Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241289 PID Number: 018-232-03 Dwelling: A-1 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑N Upgrade Name Shay & Annette Foster ABSORPTION FIELD ❑ Deep Trench El Wide Trench ❑Bed ❑Mound Site Address 13300 Shelburne Road ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Knik Heights 1 16 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ NA NA NA 25'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer (Deep Bury) Capacity 1250 Gal. Surface water 100'+ NA NA NA Material HDPE Number of compartments 2 Lot Line 5'+ NA NA NA NA Foundation 10'+ NA NA NA LIFT STATION Manufacturer Capacity Gal. Remarks Tank replacement only Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer Beeks Contracting Inc Drainfield existing CO/MT D3034 Inspector Pannone Engineering Services, LLC BENCH MARK (Assumed elevation) 100.0 ft Inspectio1s` 10/17/24 2nd 10/23/24 Location and description MH Lid 3'd 4" ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Ak qkk� Conditional Approval: Date OF law low f -9 49 ......�.... -- —— — — ----- --—--------- ---------� n R. Pann Steve.one Septic System Approved Date 5�a" CE 149 .% ¢��sTF�Fa�/�2a����� 19'OFESSO\ Note: this approval does not include well permit requirements. (Rev 05/02/18) asp N O n?? Z (�;i c) C r'7���� Oc� O n E ZC���r'1~ O rTl h N O N N N O Ul O Cy rz D o z� a?: m r \�~� ~ zzE 2 p ti =tea U) n 5 m -n 6 Z m m� O z�mm�zAmm� mo o O Z< c o o z 51 n n, m* O o D o m � m z m m oaN�oDNco� ON NO WELLS WITHIN 20OFT OF PROPOSED SEPTIC TANK LOCATION r D- O z D o z mm z�Om�Z�ZDn z mmcmzmmzz z D' m m' < -<O c�mm�NDomom _ _ =oc= ov=m z m;Q zfr" ZO Z(n;u a * m O Z 0=,>C, 0➢oJ0�7m0a) r rtrj p �zm�D�7Om' o<mnn*cm m m o�� O=z n� z-n �U �Q) p z OmOA=ten zl mT Z'm �o a_ �7mNomo ODm KC)-r Fpx' c 0 pco C)f� `ry `names :un� FOUNDATION �� r oNmmnomm0 CLEAN OUT(E) �Z of =vpOJa0000 � N O � n p oz- Las. -<m>,00O zLn m=on���= oD MAN HOLE _mOOm-m omz�NmAo� -�m�r7 oo D 30 r z7 K- N AArnDZ A� Drm .ZT.m \ _ \\mZ \ >rmm=�moo� INmn➢mz m CLEAN OUT M- -� b \ oo=mmmDo t=! DOUBLE \ A� m�n�Nmom� CLEAN OUT mmmr-room ,cm,pzN (° —t— O� 0 v�=mmo �m Op v oOz�m-a�'iOn �= D m m 5 m I lJ -n Ozm D➢m zmmD�mr� n = m m m `� £ �� IN c N am>cm, 3 m60N0 z 0 p cc_D mr�iro -{ cn ;u m I J\ 3 -u > �i�z� m0<�o m \ I 1 Nor-- m NOTES: PANNONE ENG S1/C LLC (C.1. 1088) R.O. BOX 1807 PAL��ER, AK 99645 PHOH (907) 745-8200 � AX (90 7z5-8201 �P' '• . *.4AM ak ••.. ......• "C}am anna,a CE 8149 Zio<izo2; REVISIONS DATE 12/04/2024 RECORD DRAWING SCALE 1 - 50' KNIK HEIGHTS BI L16 SHAY FOSTER 13300 SHELBURNE ROAD DRAWN ACP P.I.D. NO 018-232-03 CHECKED SRP PERMIT N0. OSP241289 SITE PLAN ANCHORAGE, AK SHEET 1 OF 1 S H E L B U R N E R O A D N SREE ANHORAE A RYAN E. SORENSEN No. 13006 - S MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241289 Work Type: SepticTank Upgrade Tax Code Number: 01823203000 Site Legal Address: KNIK HEIGHTS BLK I LT 16 G:2936 Site Mailing Address: 13300 SHELBURNE RD, Anchorage Owner: FOSTER SHAY H & ANNETTE Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 9/17/2024 9/17/2025 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 3 Received By: � - D f - Date: Issued By: Date: ) -2-E �- 7 MUNICIPALITY OF ANCHORAGE 4 fi A�X� Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-232-03 Property owner(s) Shay & Annette Foster Mailing address 13300 Shelburne Road Anchorage, AK Site address same Day phone Legal description (Sub'd., Block & Lot) Knik Heights BI L16 Legal description (Township, Range & Section) Lot Size 36,800 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank FAI Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 22 Waiver Fees: Date of Payment: J9 Z � O 'Z Date of Payment: Receipt Number: Receipt Number: Permit No. as Waiver No. Permit App__- : , _.,:c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Knik Heights BI L16 Septic Tank Upgrade Permit Request This is a design narrative for a permit to install a 1000-gallon minimum capacity MOA approved septic tank to replace an existing 1250-gallon septic tank currently serving this property. The existing tank will be decommissioned per MOA code. Currently the lot is developed. The proposed replacement will be connected to the existing drain field. This lot and the surrounding lots are served by private wells. There are currently no wells within 100’ of this upgrade. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 10’+ from building foundation. 10’+ from any water line. 100’+ from any surface water. 100’+ from any private wells. 200’+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer 27 August 2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241289, Curtis Townsend, 09/17/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241289, Curtis Townsend, 09/17/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241289, Curtis Townsend, 09/17/24 Municipality of Anchorage Page 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 Permit Number: ~J~J ~ o,:, ~ ~., PID Number: O~ ~ Name: ~A~ ~ ~~ ~ Wastewater System: ~ ~ Upgrade Address: Phone: ~-- ~t~ No. of B~ooms: ~DeepTrench USharlowTrench DEed ~Mound DOther LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: Subdivbion: Deplh to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ Range: Section: Fill added above original grade: Gravel length: Ft. Ft, WELL: ~ B Upgrade Gravelwidth: ~ I Number of lines: Oistance between lines: Ft. I ~ Ft. ~lsssification (Private, A.B,C): Total Depth: Cased To; Total absorption area% Pipe material: ~riller: Date Drilled: Static Water Level: Installer: Date in,tailed: ~ield: Pump Set at: Casing Height Above Grou~d: SEPARATION DISTANCES ~ ~ Holding U S.T.~.~. TO Septic Absorption Lift Holding Public/Private Manufacturer: Cap~city in gallons: From Tank Field Station Tank Sewer Lines ~ ~ Material: Number of C~partments: Sudace Water ~oo% ~J¢ -- ~ ~ LIFT STATION LOt Size in g~~: Foundation Cu~ain ~ ON~ ~ ~¢~ ~ Pump~l Electrical Inspections pedormed by: Drain Remarks: BENCH MARK Location and Description: I Assumed Elevation: Inspections performed by: u&s~e~ c.~% Dates: 1st ?/~/~e _ ,, Department of Heath and Huma~ Services approval~ ~ .~, ,,~, ...... 72-013 (Rev. 9/91) MOA 25 PERM,TSW98001. UM.ER:2 AS ' BUILT DP'U~WlNG P^~0EL01 ~--~--0~'D ~: C02 FIN~ GRADE ~ ~ 5~ =: 9~ 36~ X H H / r-ORIGI~L GRADE 7320 E. CHEWER NEIOHm CIRC~, ~CHO~OE, AK 99504 ~.' ........ .".~. PHONE: (gO7) 337-6179/F~: (907) 338-3246 · ' ~'.~u LO1' 16, BLOCK I, KNIK HEIGHTS SUBBIVISION ~ .... : ....... ~2 ............ : .... ~PE OF WORK: PREPARED FOR: PHONE NUMBER: SHAY FOSTER 273-2166 11/6/98 J.L.M. 1 = 40' 2 or 2 ~'r,:,m : ALP i NE DR: L.L '3L~-~ ;~45 02E~2 'ION OF WI~LL : 'i L;0oATIoN/$KETc H; STATE OF ALASKA 'DEPARTI~,4~-NT OF NATURAl, RE~IOUROfi~ DIVI@ION OF MINING & WATEr{ MGM¥ · WATEI~ 'W~LL RECORD ~U~DIVI~ION ~EO¥1OPI OTR6 TOWN~:HIp ~E~DIAN ,' DEPT!HS MEASURED FROM:[~oa~i~g top ~gtOund surlac¢ ~flEHOLE DATA: Deptt~ · ~Matedal Type end Color From To WELL DATE OF COMPLI[T, ION: Deplh 01 hol~:,~_ . ft Depth of coding: ~.~'_~' 'ft DEPTH TO $~ATIC WATER LEVEL; METHOD OF DRILLINO; .¢'r~air rotary ~ csble torsi E] other USE OF WELL; --~,domestic ~] irrlgatio~ ~ fnoal~[or ~ pubhc supply ['~ type: It. Diam: WELL INTAKE OPENI~t TYPE: [~] perferat~d ~ opm~ hole D,pth~ c.f [~penings: to .... l't SCREEN TYPE~ Diem: ....... in," Slot/M~sh S i~e.. Len ~,t ' GRAVEl. PAC~ TYP~: NOV GROUT TYPE', D~pth: ft to Dept, Heaith &Hum~ ,E~/EL AND YIELD: ft efter .~ ..... hr~ ~umpin PUMP INTAKE DEPTH; ...... it Horsepower: WELL DISINFECTED UPON OOrVIPLETiON? CONTRACTOR INFORMATION: REMARKS; ~~ " ' ' ~ .... ~)' DNR/FJIVISION OF MININ~ ~ WATER MO~T ~0nature ct Authotlze~ fle~p~ento~v~'- Da~e 3601 C St, 3ulte 800 ANCHORAGE AK 99~03,59~[~ Phone (~07)269.86,3¢J, Fe~ 19071t~62.13t14 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALAS[CA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980012 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:FOSTER SHAY H & ANNETTE OWNER ADDRESS:13000 SHELBOURNE RD DATE ISSUED: 2/02/98 EXPIRATION DATE: 2/02/99 PARCEL ID:01823203 LEGAL DESCRIPTION: KNIK HEIGHTS BLK I LT 16 LOT SIZE: 36800 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / 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 ENGINEER MUST NOTIFY DHHS 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: THE ENGINEER SHALL VERIFY CON$ISTANCY OF THE SOILS DURIN~ ~iNS~ALLATi0N. A~y DESIGN ~N~ES R~KE p~OR~PR0VAL FROM /, ISSUED BY: T~ ~' '7~ DATE: January l8, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 7320 East Chester Heights Circle - Anchorage - Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers ~W~/ Ref: Well & Septic System for Lot 17, Bk I, Knik Heights S/D. To whom it may concern: The subject property is currently undeveloped. The owner is proposing to build a 3 bedroom home on the site, which will require the installation of a well and a septic system. Comments regarding the proposed systems are summarized as follows: 1. SOILS: Attached is a copy of the soils logs. Three test holes were dug, however, suitable soils were only found in test holes #2 & #3. Starting at a depth of 8.0 feet (TH #2) and 9.5 feet (TH #3), the soil was a well graded sand, or a gravely sand. This soil profile perked at less than 1 minute per inch in both holes, however, since the soil is primarily a sand, an imported sand filter should not be required. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch. b. Allowable Application Rate: 1.2 gallons/day/122 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. Total depth: 11.5 feet max. g. Effective Depth: 2 feet h. Reduction Factor = .7 i. Width: 5 feet minimum j Minimum Length: 52.5 feet k Effective absorption area = 375 122 3. SURFACE WATERS: There are no surface waters witlfin 100 feet of the proposed septic system. 4. TOPOGRAPHY: Attached is a map (4' comours) which shows the topography of the subject lot. Except for a localized slope of 38% adjacent to the proposed trenches, the lot slopes vm3' from 10-22%. The 38% slope near the trenches is not a legitimate concern due to the fact that the total depth of the trenches will be 11.5 feet deep (effective depth of only 2 feet) which will place the bottom of the trench sidewalls below the toe of the 38% slope. In short, there are no slope concerns associated with this installation. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244~9612. Thank you for your assistance. Sincerely,, ~arness, P.E., M.S. LOT 6, McCABE S/I). PVT. WELL AND SEPTIC PER M.[LA. REGULATIDN~:. SEPTIC AREA '? \ /r~XISTING HTS. S/I1 PVT, ~ELI RE ERVE NEW 1000 GALLI]N SEPTIC TANK LX AREA LOT 15. ~BK I, KNIK FITS PRUPUSE)] ATTENTION: WELL DRILLER AND SEPTIC SYSTEM INSTALLER NnTE~ THIS IS NDT A SURVEY, THE LDGA'rION I]F ALL STRUGTURES~ WELLS, AND SEPTIC SYSTENS IS APPRDXII4ATE, THE CDNTRACTBR SHALL ~E RESPI]N~I}~LE FUR F'IELI) VERIFYING THE SEPARATIDN ])ISTANCE FRDM THE PRDPDSED SEPTIC SYSTEM TD THE PRnposEI) ~/ELL ANI) THE EXISTING ~ELI_S: ON AI)JACENT PRDPERTIES, THE ~WELL I~RILLER SHALL ENSURE THAT THE PRDPDSE:D WELL IS GREATER THAN Io0 F'EET FRDM ALL SEPTIC SYSTEMS, ~/ELL & SEPTIC SYSTEM' LOT 16, BI< I~ KNIK HEIGHTS S/I) PREPARED FOR: tPREPARED BY' DATE, 1/17/98 SHAY FnSTFR ALASKA WATER & ~/ASTE~/ATER DRA~/N, GARNESS I SCALE, 1* 100' I LDT 17, BK I, KNIK HTr, i / ~'"~X~T~Nr, ~L~ ~L~  LOT 15~ ~K I, KNIK HTS, 8ID, PREPARED ~Y, ALASKA ~4ATE:R & WASTEWATER, ~h~'~/CE~7~B~ .'"~ DATE~ 1/16/98 DRA~VN~ GARNESS SCALE: 1' = 40' THE TRENCH SHALL HAVE A MINIMUM LENGTH OF 52.5 FEE?', AND A TOTAL EFFECTIVE ABSORPTION AREA OF ,375 SQUARE PEET. BACKFILL WITH NATIVE SOIL AND MOUND. TOPSOIL & RESEEDING SHALL BE RESPONSIBILITY OF HOMEOWNER. MONITORING TUBE (TYP.) - ~ PERFORATED IN DRAINROOK. [ DRAINROOK SHALL SCREENED PER M.O.A SPEOIFICA TIONS. TOTAL DEPTH OF TRENCH SHALL NOT EXCEED 11.5 FEET. NO TE: 1, 2, ~5 FEET WIDE ............. ~.~ TRENOH SHALL RUN PARALLEL TO THE SLOPE CONTOURS. FOR LOOATION OF CLEAN-OUTS AND MONITORING TUBE SEE THE SITE PLAN. CONSTUCTION PRACTICES, AND MATERIAL SPECIFICATIONS SHALL COMPLY WITH ANCHORAGE MUNICIPAL CODE 15.65, "WASTEWA TER DISPOSAL REGULATIONS". INSTALLATION SHALL COMPLY WITH SPECIAL PROVISIONS NOTED ON THE SEWER PERMIT. SMEARED BOTTOM AND SIDEWALLS SHALL BE RAKED, BOTTOM OF TRENCH SHALL BE LEVEL. 2 INCH MAXIMUM VARIATION BETWEEN HIGH AND LOW SPOTS. DETAIL FOR 5 FOOT WIDE SHALLOW TRENCH: PREPARED FOR: ,.?,HA Y FOSTER ALASKA WATER & WASTEWA TER SERVICES DATE: 1/18/98 DWN: GARNESS SCALE: NTS FILTER FABRIC SILT BARRIER 4 INCH DIA., ASTM F810 PERFORATED PIPE. HOLES DOWN. PLACE .....E INCHES OF DRAINROCK OVER TOP OF PIPE, AND ACROSS ENTIRE WIDTH OF TRENCH. PIPE SHALL BE INSTALLED LEVEL (WITHIN .01 FEET). i ( PERFORMED FOR: Municipality cf Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'TEST 1 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER r~ ENCOUNTERED? DEPTH? -- Monitoring? ~"Y []ate: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ Immutes/,nch) PERC HOLE DIAMETER L TEST RUN BETWEEN ~.) _ FT AND L~,~' _ FT PERFORMEDBA~ ¢ ~ 1%/~ CERTIFY THAT THIS TEST WAS 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST lO 11 12 '~/,~,~k ~G ~7 20 WAS GROUND WATER ENCOUNTERED? Township, Range, Section: SLOPE SITE PLAN geplh lO Water Alter Monitoring? Reading Date Gross Net Depth to Net Time Time Water Drop TEST RUN BETWEEN__((~ FTAND 2'S FT COMMENTS ~~ I~ / //~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE ~; ;LL STATE AND MUNICIPAL GUIDEUN~N EFFECT ;N ,;IS DA,E. 72-008 (Rev, 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'iL" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST LEGAL DESORIPTION:_~II(~ ~'~% / (~o7 //~! /,.~../~,.~ Township, Range, Section: C~I~A ~ ~c~ SLOPE SITE PLAN 10 11 12 13 14 15 16 ':R'S SEAL) 17 ~.0~1~ ' 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~onitorino7 Reading Data Gross Net Depth to Nat Time Time Water Drop i, S ~Co.~ (mmutesfmch) PERC HOI.E DIAMETER __ FT AND [O ,'~ -. FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) ANCH, MUNrl DEAR ~IRS. DUE TO COST AND type- VERY SMALl. BUILDIN0 BUDGET, I NEED TO INSTALL MY OWN SE_PI'lC SYSTEM. I'VE CO~'rSULTI~D WITH ruFF GABNESS I~ROM ALASKA WATER AND WASTEWATER TO DI~$IGN TI-lIS SYSTEM. 1 IqAVE CONTI1ACTF.,D JEFF TO OVERSEE A~ND iNSP. ECT MY SYSTEM IN ALL PHASES OF INSTALLATIOIN. I I-lAVE EVERY CONFIDENCE TI-LAT BETWEEN JE, FT AND MYSELF WE WILL I)48TALL A VERY FUNCTIONAL SYSTEM. PLEASE CALL OR FAX ME iF YOU IfAVE ANY QL~STIONS rN THIS PROCE$$ THANKS FOR YOUR CONSIDERATION SHAY FOSTI~R FX 273.2112 PI-1273-2166 J / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Enviror~mental 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 01 8-232'-03`4 HAA # 1. GENERAL INFORMATION Complete legal description Lot 16; Block I; Knik Heights Location (site address or directions) Shay Property owner Mailing address C/O Alaska Pipe Lend i ng_.g~~--, ~., ,, ,.~n.g address 13000 Shelbourne Rd. Anchoraqe, AK & Annette Foster Day phone 2300 East 63rd Avenue Day phone 273-2166 Anchorage, AK 9950' Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: ×x Individual well 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: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev, 1/91) Fronl 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 furtherverifythat 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 onthe dar A aska Wa er & Name of Firm ~!.~f,~s~ [~ Address ;'.~ ':;,.~ 07/ j~ ~* ~ EngineeYs signature ~~ ~ DHHS SIGNATURE '/" Approved for ~'~'~e Disapproved. Conditional approval for bedrooms. of, this inspection. Phone rcle ~ 0 ','~ Date 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. 72-025 (Rev. 1/91 ) BeCk MOA #21 Municipality of Anchorage ~,...,, ,~ C ~ ?I V ~ ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~.~Y44 1998 Municipality of Anchorage Health Authority Approval Checklist .,- ~ ~ea!th & Human Services Legal Description: ~ltF. ~c.H~-~ ~/D ~ Lo-r [6~ &Ll~ ~ Parcel I.D.: A, WELL DATA Well type ~F., i~t A'rE If A, B, or C, attach ADEC letter. ADEC water.system number / / Log present(~) "/e~ Date completed ~/-t?/ Total depth ~ ~:~ ~ Sanitary seal (Y/N) Cased to / ~) ~ Casing height (above ground) / "~' Wires properly protected (Y/N) _ '~/~' FROM WELL LOG Date of test -~/'~"// Static water level /' ~ ~ Well production WATER SAMPLE RESULTS: AT INSPECTION g.p.m. 0,~"/~ m~ /L- Other bacteria Collected by: ,~ , L~J. L,.3. ~ Coliform Date of sample: B. S('~EP~ TANK DATA Date installed '7/5/~/~' Tanksize Nitrate g.p.m. I'Z..~ o Number of Compartments '7-- Cleanouts (~N) Foundation cteanout (~N) Ye-~ Depression (Y/~ ~ o High water alarm (Y~) ~ o Date of Pumping ~J ~- ~,J Pumper C. ABSORPTION FIELD DATA Date installed \ I/E,'/¢I 8 Soil rating (~or fF/bdrm) I,Z~ Length ~© Width -~ Gravel thickness below pipe Effective absorption area ~'Z~ "~ System type '7'"~ ~.~ Total depth Monitoring Tube present (~/N) ¥~ Depression over field (Y/~ Date of adequacy test ~6-~-~' Results (Pass/Fail) For -~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after ---gal. water added (in.): Fluid depth ~ (ins) Minutes later:. Absorption rate = ~---~ g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons M a n h o-~T, tc~'ee s-(~U~ Cy%fl~tested E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot I~l~ ~--- On adjacent lots On adjacent lots Public sewer main Sewer/septic service line Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FRO~TI~~ TANK ON LOTTO: I Foundation ~ ~ Property line %-5~ Absorption field Watermain/serviceline loI 'f Surfacewater/drainage I oo~ 'f' Wellsonadjacentlots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain I001+ Building foundation Z2 ~ +' Water main/service line I o~ -f- Driveway, parking/vehicle storage area ~c)l ~- IL.,J~ ~ Wells on adjacent lots I co~ 'Y ENGINEER'S CERTIFICATION/ I certify that I h..a.v~det~ine/~ru in conformande with MC/A NA,N/~uid Signature. l-~ ~'/~//~~ Engineer's Name Date ~ld inspections and review .lines in effect on this date. are HAAFee $. ~'~" Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number