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Home My WebLink AboutLot 08 MUNICIPALITY OF ANCHORAGE DEPARTMENT QF HEALTH & ENVIRONMENTAL PROTI=CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OF] WELL INSPECTION REPORT NAME / ~ MAILINGADDRE$S ' J ' ' "~ / (/f7 r D.//~/c. t-~ LEGAL DESCRIPTION . ) ~¢/ LOCATION ~ i ' -' ~ ~' / }We,Il , ~--~ Absorption area ~wellin~ I DSTA~CETO / ~/.~ ,. ~/~.? ~ t-~ Manufacturer ~' ¢ Material ~ Liq, ~apacity in gallons ~ '- ......... Inside length Width I - ~-~ IManufacturer ~ ~No, oflines ./ I Length of each hne~ ,~1/ Length Width ~ ~ tType of crib Crib diameter ~ DISTANCE TO: Well ~ ~ D ISTANC~ T O~ B uildin[~ f oundatio~ Septic tank _PHON E ~. NEW NO, OFBEDROOMS PERMIT NO. No, of compartments Liquid depth Dwelling PERMIT NO. -T Material Liquid capacity in gallons I. FCundaldon ~/-, I'N~[°tline / ,~ / PE/Rz2[V~ITNO~ , ~? /otal mng.~of lines f/ /Trench width. ' Distance between les __ - :~ ~: _1 ~' ::,~nches Material beneath tile /:7: ~/ Total e/f~jeo~ve, absolption area /.~.. Depth PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Absorption area(s) OTHER PIPE MATERIALS ~::,T._. , ,(? SOl L TEST R&~I N_~ / ~ . / :. ~;.- ':;' '~/,~ ~.~,7 ~ ~ R ~MAR'K~ ' APPROVED DATE LEGAL ~. 11., 72-013 (Rev, 3/78) ~' PERMIT NO. [:,EF'F~R'rMEI'.JT HERL"rH ~r.J[:, ENVIRONMENTRL . ~:OTE]:TIDN 825 "L." STREET, RNCt4ORRGE., RK. 9~591 264-4728 ,:; 821892 ) FIPPLICRNT I..,OCRTION LEGRL KORPI CONTRRCTING LOBLOCK K KNII< HTS 848t LITTLE DIF'F'ER 95~5¢,q. 279-76:1. zl. LOT SIZE 999999 SQIJRRE P"EET TYPE OF SOIL RBSORPTION SYSTEM IS: 'TRENCH MAXIMUM NOf'IBER OF' E:E[:,ROOMS = 2~ SOIL. F.'.ATING (SC! F'f',-."BR)= 125 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEEl') OF THE 'FRENCH OR DRRINFIEL[:,. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE E',ETNEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE E?.;CRVRTION (IN FEET.'.',. THERE IS NO SET 14IDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL E:ETWEEN THE OUTFRLL PIPE RND ]'HE BOTTOM OF THE EXCRVRTION (IN FEE"[). PERMIT RPPLICRNT HRS "FHE RESPONSIBILITY TO INFORM THIS I)EPRRTMENT DURING THE INSTRLLRTION INSF'ECTIONS OF RNY WELLS RDJRCENT TO THIS F'ROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. ......... TI.MICI ( 2 ::. I I%IS;F"EC:-T .'ll C~I'-.I_'S; RF...'. E F~: El].'~ LI I BRCKFILLING OF FINY SYSTEM WITHOUT FINFIL INSPECTION RND RF'F'ROVRL BY THIS DEPRRTMENT WILL BE StJBJEC:T TO PROSECUTION. MINIMLIM DISTRNCE BE'rWEEN R WELL. RND RNY ON-.SITE SEWRGE DISF:'OSRL SYSTEM IS ±00 FEET FOR R PRIYRTE WELL OR ±50 TO 200 FEET FROM R PUBLI, C WELL DEPENDING UPON THE TYPE OF PUBLIE: WELL MINIMUM DISTRNCE FROM Fi PRIVRTE WELL TO Ft PRIVRTE SEWER LINE IS; 25 FEET FIND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQIJIRED FIND MLIST BE RETURNED TO THE [:'EPRRTME:NT WITHIN Z-':O [:'R"r'S'] OF 'THE WELL COMPLETION. OTHER REQUIREMENTS MFIY RPPLY. SPECIFICRTIONS RND C:ONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. P E; F~: fl'"1 I T' ~-_Z ::..:: P .1.: F~: I.E L5 [:, EE C: E [Pl E: E R ~: t .. :1. ."S, :3 2~ I CERTIFY THRT t: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FtND WELLS RS SET FORTH BY THE MUNICIF'ALITY OF RNCHORRGE. 2.: I WILL INSTRLL THE SYSTEM IN RCCOR[:,RNCE WITH THE C:ODES. ]:: I UNDERSTRND THRT THE ON-SITE SEWER SVSTEM MRY REC,.!UIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ].' BEDROOMS. V4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMFNT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Al~chorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O 1 C/', COMMENTS SLOPE SITE PLAN E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ' (minut'es/inbh) TEST RUN BETWEEN FT AND~ ~ FT 72-008 (6/79} 0 0 >< 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 ~.Oc~ --'* ~¢,~ - ~,.~ NAA # GENERAL INFORMATION Complete legal description Location (site address or directions /.~ Property owner Mailing address _c[¢ Lending agency Mailing address. Day phone Day phone Agent Address ~-~ ~ 1,5'~ ,,P,~/ £~t1-¢ ~ ~ ,4acl~o~-~e., ~-1~ ~)'~5"~/ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: 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: If community wastewater system, provide written confirmation from State ADEC at, testing 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/orwastewater 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 on the date of this inspection. NameofFirm ~(~(-/-~f 7~c~ ;¢,~f -qec'~'~r,,-,' Phone Address I N.¢ ZO ~c 4o £/'. /4,~c~or-~¢~ ,,4.~ Engineer's signature ~"~ ,~. ~ Date DHHS SIGNATURE ~__~ ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. If A. B, or C, attach ADEC letter. Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) FROM WELL LOG /S /I.3 /0 ~ I -I,5- ADEC water system number Datecompleted l'z./ t$ /,~Z Driller Cased to ~- P-¢' Casing height __ Wires properly protected (Y/N) F'r:[~ 2 8 i992 R CEIVED Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 11<2' Absorption field on lot IIO ~ AT INSPECTION e/ zs-19e RECEIVED g~;~ 2 8 1992 IViunicipality of Anchorage Dept. Health & Human Services ;Onadjacentlots_~ foe,' ; On adjacent lots >' /(-,t2 ' Public sewer main N,4 Public sewer service line N, A., Public sewer manhole/cleanout /'4, A-, Petroleum tank ~Von¢ 5~¢0 WATER SAMPLE RESULTS: Coliform (2 co( I ~oo /~..~ Date of sample: '8. /P~3-/9 SEPTIC/HOLDING TANK DATA Date installed II /i /g~ Nitrate __ o~. ?_ mdc/~/_- Gollected by: Other bacteria Tank size IOOO ~,c~/ Compartments Cleanouts (Y/N) ~' Foundation cleanout (Y/N) High water alarm (Y/N) /N, A-. Date of pumping ~/'¢~'/9~: /~7 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I1~' On adjacent lots ~, (0o' To property line -¢' Absorption field Surface water/drainage >. Alarm tested (Y/N) Depression (Y/N) N,~-. Foundation 3 o Water main/service line_;> 72-026 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION I'~, Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed II { f /,¢P~ Length ~'/' Width Total absorption area cf ~0/ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating i¢-...¢ ~//B,¢fr~ System type ~'r¢,~ ¢_-4 Gravel thickness ,¢' Total depth ~&' Cleanouts present (Y/N) "¢ Date of adequacy test ~-/85- / ) ~ for ~ If yes, give date N, bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /10 To building foundation On adjacent lots Surface water --~ f Curtain drain I~f, Ar. Onadjacentlots '> 1oo' Propertyline ~ ' f*¢r' ~,,.~?. r~cVc¢,-f To existing or abandoned system on lot N, 4 · Cutbank N,4. Water main/service line "~ 5TM ' Driveway, parking/vehicle storage area ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature .'~~ Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number A DIWStON OF COMMERCIAL TESTIIVG & ENGINEERING CO. 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,# E:;J PRIVATE WATER SYSTEM Mailing Address SAMPLE DATE: SAMPLE TYPE: (~ Routine Mo. Day Year [] Check Sample (for routine sample with !ab ref. no. [] Special Purpose Zip Code ) [] Treated Water [] Untreated Water SAMPLE No, LOCATION 41 Time Collected TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /I~. Satisfactory [] Unsatisfactory (~ Sample too long in transit; sampie should not be over 30 hours old at examination to indicate reliable results. Please send ne','.' sample via special delivery mail. Date Received ~ /~' Analytical ~ethod: Membrane Filler Collected By t t No. of colonies/100 mi, Lab Ref. No. Result* Analy/st I 7-7-] READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC = Too Numerous To Count OB ..= Other Bacteria BACTERIOLOGICAL WATER ANALYSIS RECORD Membi'an~ Filter: Direct Count Coliform/100 mi Verification-', LSB BGB ~ Fecal Coliform Confirmation Final Membrane Filter Result~ /] ~ Reported By /ICL ~, J, ?~ Date PAET ONE DF TWO: J. :. REMAIEDER TO FOLLO~ Coliform/lO0 mi CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301 ANALYSIS RESULTS for INVOICE # 51411 Chemlab Ref.$ 92.0737 Sample ~ I Matrix: WATER Client Sample ID : L8 EK KNIK HTS S/D GARAGE LAUNDRY SINK PWSID : UA Collected : FEB 25 92 @ 14:55 hrs. Received : FEB 25 92 @ 17:05 hrs. Preserved with ; AS REQUIRED Analysis Completed : FEB 26 92 Labo~atozy Supe~lsgr :,~NEN C. EDE, Released By : ,,~~-~ < ~ Client Name :FLATTOP TECHNICAL SRV Client Acct :FLATTOT BPO~ : POS :NONE RECEIVED Ordered By :TED MOORE Send gepo~ts to: i)FLATTOP TECHNICAL SRV Pa~ametez Results Units Method Allowable Limits NITRATE-N 2.2 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: T.F. MOORE. Remarks: 1 Tests Periozmed ' See Special Instzuctions Above UA=Unavailable NI)= None Detected "See Sample Remarks Above NA= Not Analyzed nT=ness Than, GT-Greater Than ~SGS Member of the SGS Group <SociOtd G~nOrale de Surveillance) Pro; Address APPLIC ,IT FILLS OUT UPPER HAL ONLY ,er ~.,<),, .% ?. ~: / . Zip (;ode Zip Code > > ..? :, } Phone L':, '/ !, '":~ . / ',~'}/ / Address Realty Co. & Agent .~,,,:/./,/) Address Zip Code Zip Code Phone Phone _Street Locatio~ /'::./~¢///( .... // /~" Type of Residence t~ngle Family ~ Mulllple Family Ne. of Bedrooms ~ Other Water S.S/u p ply _~"l'ndividual [] Community [] Public Utility Sewer Disposal [~?b~d ividual [] Public Utility [~ Holding Tank ATTACH WELL LOG. A weli Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available). Year Individual Installed: __/:./~.';-~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Date Inspector Time Date Inspector Time Date Inspector Time Date I ns pect~'~ MUNICIPALITY OF ANCHORAGE DEPT. OF H=,".Li':I 7~ ENVIRONMEN iAL RECEIVED APPROVED BEDROOMS DISAPPROVED CO N DITI?D N A? APPR/~ *CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area / Well to 'rank ,. Well Log Received Septic Tank Size /' 4D ~ /-~ 72-023 (3/82) ACHEMICAL & GEolOGICAL LABORATORIES ¢.. ALASKA, INC~~~ TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: ? I,O, NO, Water System Name Phone No. Mailing Address Zip Code TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,E~] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at ,examination to indicate reli'bble results. Please send ....... new ~ampie[ '' City State Mo. Day Year SAMPLE TYPE: I~- ,,Routine [3 Cheek Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO, LOCATION 3[ I [ I Time Collected Collected . By. Date Received Time Received ' Analytical Method: [] Fermentation Tube E3',Membrane Filter Lab Ref. No, ~¢ Result* Analyst L J EZZ] J FTq I FT-1 L I ,FTq READINSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Data Collected Source a.m. Date Received ~ Time ReCeived -- p,m. Lab, No, Presumptive 10mi 10mt 10mi 10mi ~.0ml 1,0mi 0,1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 H ou r..__,_._,~ EMB. Broth 24 hours~ Multiple Tube Reporb Membrane FIIter~ Direct Count Verification= LTB Final Membrane Filter Results_ Reported By Broth 48 houri; 10mi Tubes Positive/Total ~.0ml Portlonl~ Collform/100ml BGB Collform/100ml 10- 6-04; 5x15PM; ;907 56x5301 # CT&E Ref. #: Client Name: Project Name: Client Sample ID: Matrix: PWSID Sample Remarks: 1046348001 KIND Engineering Knik Heights Knik Hts, Block K, Lot 8 Water n/a ME Environmental Services 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 All dates/times are Alaska Standard Time Printed Date/Time: 10/06/04 17:00 Collected Date/Time: 09/27/04 10:45 Received Date/Time: 09/27/04 11:05 Technical Director: Stephen Rde Released Allowable Prep Analysis Parameter Results PCL Units Method Limits Date Date Init Nitrate 5.09 1 mg/L EPA 6010B 09/28/04