HomeMy WebLinkAboutKNIK HEIGHTS BLK A LT 5
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kildinq t)fvi. -an
or-spl*e Water & Wastewiater- Foro.gram
4700 Elmore Raccl
1.
A'Mch,rage, AK 99507
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Parcel IdentifIcati., Nun,ber: L,) -0.32-05
Date of issue:
Legal
Pro—
Knik 1411 - wlue'r N:Imp dd SR:
-1
JPun'P Intake Depth nr;low TkT 'If WE11 Casing. l�*Zf-ot
PU-11UP NIL, nufhcmrer's Name:A J
41K
pump model;
PUMP size
-Pitless Adapter Burial Depth: /V feet
Pifless AdapterNla""factlurerss Name: A( ew7,
Pitle,,RsAdapter justailer:
WeR Disinfected U
pnn (-,'Omp1etjOQ?! YES rio
Of Dij';nfV.4CVJVJJ;
Comments. t11-4- �/'- le- �7,r
1"nP Mqallar
1-`U ri-17
U Nom"""" ttentlon. �Tb�' u r"P shat! pt is P mllmp):n
10E, 10 th2 DSD ;within M days rpumo
7-•G zti 0 09- s d �.- 70 6i. (j� c8 j'
~ DEl. _.{TMENT OF HEALTH AND HUMAN SER~ "S
~- Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name. DISTANCES
~4~rlN 3~ ¢¢~1 ~0 SEPTIC ' ABSO,PTION
Add .... 9& '7~-0 ~ TANK FIELD WELL
BlOCk I 8ubdiwsio~
AS-BUILT DIAGRAM (Show location ol well. septic system, property lines, foundation.
'Tt AN; ~ * ~/ ¢~ A7 Or,veway. water bodies, etc)
· TANKS
I~--
Fdl added above original grade Gravel depth beneath p~pe
~ FT ~ ~ FT
Jo/y S0 FT ~ FT
WELLS
~ PRIVATE ~ OTHER (Identify) ~A[N~R[~GE ROAD
Classfficallon (A,~.C} ]oral Depth ET Casedto ~T ~
Installe~ Date lnslalied: CDNTDUR ACRES SUgD[V[S[DN
REMARKS: TD~EN SPURKLnN~ P.E. j j LOT 5, 9LDCK
~907) ~79-3916 [~ MARTIN JACKSBN
Scale:
ENGINEER'S SEAL
Inspections Pedormed by:
' codify that lhis inapection was pedormed according to all
72-013 (3/85)
LOT 5
LDT 4
3-Bedroom Housl ~
Exlstln§ ~elt
BAINBRI]]GE ROAD
CONTOUR
ACRES SUBDIVISION
TDBBEN SPURKLANB P.E, LOT 5, BLOCK A, KNIK HEIGHTS SEPTIC SYSTEM
203 W, I5TH. AVENUE SEC 87, Ti2N, R3V,/
ANCHORAGE, ALASKA AS BUILT
(907) 279-3916 MARTIN JACKSON I/ SEPTEMBER 8, 1987
.l
39'
4*perF, pipe, $ runs
4x4x4 Tee
Cap e~ch end
~ ' Nonltor
Clean
INFILTRATION BE]]
PLAN VIEW
-- C~ean
500 Gat, Tank
Moni%or tube / m Flna~ grade, stope t;o dr¢in
I
........................................................ ~-~- 5' Cover
~ T~?~r Si~tbarrler
INFILTRATION BED
~ECTIDN
TOBBEN SPURKLAND P.E. I LOT 5, BLOCK A, KNIK HEIGHTS
203 W. 15TH. AVENUE I SEC 27, T12N, R3W
ANCHDRAGE, ALASKA
(907) 879-3916 MARTIN JACKSON
SEPTIC SYgTEM AS BUILT
SEPTEMBER 2, 1987
SHEET 8/2
J In$~c~l[ 30x32 bed
See de~;<zlt$ shee~: 2
9AINSRISGE RDA9
CDNTDUR ACRES SU33IV~SIDN
TD93EN SPURKLAN3 P.E. LDT 5, 3LDCK A, KNIK HEIGHTS SEPT]C SYSTEM
eo3 w. ZSTH. AVENUE SEO 87, T~SN, RSW
ANCHDRAGE, ALASKA SHEET
(907> ~79-39~6 MARTIN dACKSDN ~UGUST lO, 1987
3-J
4'per'C, pipe, 5 runs
4x4.x4 Tee J : 4' tine F~'op~ exls'tln9
30 ~,w-- I tog
Co, p eo, ch end
4' Nonlto tube
6 -Il ~ ~ITO/~ ~4~ i C~p both ends
~ ~ One ~u~e
INFILTRATION BED
RLAN ~IE~
Monitor ~ube ~ Fln~t grade, ~tope ~o drain
~lt~barrler, Typ~r or equ~t
INFILTRATION BED m' Screened ~ock
SECTIUN
I D3BEN SPURKLAN9 P.E. LOT 5, BLOCK A, KNIK HEIGHTS SE~ SYSTEM DESIGN
803 W. I5TH. AVENUE SEC E7, T1EN, R3~ SHEET ~/~
ANCHORAGE, ALASKA
(907) E79-3916 HARTIN JACKSON AUbUST 10, ~987
4'pete. pipe, 5 runs
4x4x4
Tee
/ 4' Line ?~'om
1
30 f - - ~
[o9
C6p e~h end ~
Bne ~ube I~
CONSULTING ENGINEER
..203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: {907) 279-3916
-,',',5,2 =
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LECA, DESCR,PT,ON: L0 ~-- ,~,/~A, /(N///~/~,
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18-
19-
20-
COMMENTS
,~.% :'"":i~ ~ ih~ E~S~ SEAL)
~,..; ,..~'i,~, ¢..~,1'
" ~"'~'~°. "~ '2%
i~ .... N~f/ 2225-[: ~ ~'~
DATE PERFORMED:' '
'rov, nsh~., R~.ge, Sec.on: 'nA~/t~
SLOPE SITE PLAN
WAS GROUND WATER
O
ENCOUNTERED? , ~
S
L
IF YES, AT WHAT O
DEPTH? p
E
I]~plh lo Water After
Monitoring? Dote:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN __ FT AND __ FT
^COORO^NCE W.H A'~STA.EAND M~.,C,.A~..DE~,.ES,N EFEEOT ON T.IS OA.E. °ATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:~, ' ~ ~::;~.~A ~--'~t~:' 14,
9
10
11
12
13
14
15
16
17
18,
19-
20-
O/
Township, Range, Section:
SLOPE SITE PLAN
WASGROUNDWATER
ENCOUNTERED?
S
IF YES, AT WHAT ! OL
DEPTH? /o~ p
E
Depth '0 Walor ADer j~ '12, ~/I//~' 7
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
~- ~- i~, ~,~, ~/,~
PERCOLATION RATE /~'~ (minutes/inch) PERC HOLE DIAMETER .~i/
,
COMMENTS
PERFORMED BY: '~ ~ I ~' '~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ 7! ~/~ d~ 7 '~
72-088 ~Rev. 4/85)
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N? 984
SEPTIC TANK:
D STANCE FROM WEL'
LIQUID CAPACITY
MAILING .~"~,,'2 ~( ~'~.~-'~' /~/6~/C,/~ PHONE
ADDRES~ ~ ~
LEGAL DESCRIPTION ~:~'~~ /~/~
NUMBER OF /
MATERIAl ~"-~ COMPARTMENTS
/.~r,~ -~'~/~-)~'~ "¢7'~'~--~-~ LIQUID
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
~ OR WIDTH /'~ ~ , LENGTH '~'~ ~ . DEPTH
DISTANCE FROM WELl ~ BUILDING FOUNDATIOIx~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~c~ SQ. FT.
TILE DRAIN FIELD:
..jz~g, JdNDATi,EN~ NEAREST LOT LINE
DISTANCE FROM WELL // N~''~ES ~
NUMBER OF LINES /~ DISTANCE BETWEEN LI , TRENCH WIDTH ~.~-~
ABSORPTION ARE SQ. FT. LENGTH OF
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. T~T-AL. EF F E CTI V E
IN. ABOVE TILE
WELL: TYPE/--~-/'~/~Z~ DEPTH /~' / DISTANCE FROM
, BU LDING FOUNDATION.
NEAREST SEPTIC SEEPAGE
LOT LINE ., SEWER LINE , TANK SYSTEM
WATER .,~,~,~,>...~ NEAREST
SAMPLE ,
OTHER
, CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
HEALTH DEPARTMENT "~='~ ~/~V~LI ~t)//~d~
327 Eagle St. Anchorage, ~as~ 99501 279-2511 PY'./]~ ~:-;~ ~"
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT(~?_~7-O~d¢-
,. ~ ./
NAME OF APPLICANT O/D~ '-) ,9~.}0~/__~) MAILING ADDRESS g~":/¢ 'A,.:'d¢ PHONE
LOCATION OF INSTALLATION ~l~ ~1~
1/~ ,, SEEPAGE PIT. ~- DRAIN FIELD
T0 BE INSTALLED BY : ~
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINAN .~. ~THROUGH
~TEST RESULTS ~ 'S ~--
.~T~ICIPATED DATE OF COMPLETION'~4 /~'~ /VCP~?~:~--
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS [~' ":~k [~1 ~0 &~ , PERMIT TO INSTALL A :)2~ t"UY( ~ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~-
lox ·
. SEPTIC TANK SIZE ~5~ TYPE ~~SEEPAGEAREA/~)~
DIAGRAM OF SYSTEM
DISTANCES:
dCA) F' Og~m
AUTHORITY
LICENSED DESIGNER 15~ ' ' '~ Ir
I certify that I am familiar with the requkements of Greater Anchorage ~rea Borough Or~ance No. ~-68 and that the
above described system zs ]n accordance wzth sa,d code. j,~)~>~ ,1
- ':' ..--'~ l~ ,,- /
BATE /~/2- 7~ APPLIgANTS 816NATURE
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # (~./7-~._:J'~ --d,..~~' HAA # ~.~ - ~'~'~\'-~
1. GENERAL INFORMATION (Must be completed .prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ~ Telephone: (home) ~;~"' ~O~'_usiness~
(c) Lending Institution ~ .... ~* ";~; ~ ''Telephone" '
(d) Real Estate Company and Agent ~ ~ ~e .~
Telephone '~1 /
(e) Mail the HAA to the following address: (or check here ~if hold for pick up.)
List contact person and day phone number below:
i
2. TYPE OF RESIDENCE
Single-Family~i~ Number of bedrooms ~=~
3. WATER SUPPLY
Individual Well ~l~ Community
Public
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site,S, Public [] Community [] Holding Tank []
/
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. 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, Iverifythat myinvestigatio~'.ofthis
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system ~s 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.
NameofFirm ~-'~ ~'~'~'~ ~r~-ToIophOne
Address
Date
,'~7 z "~ ·° ~. '°;' :' I
Engineers
'.. . I,u, ¢-~ --.. )
~ '.'. lJU;;E 2~, ;;'-~ ' '-¢
· ', ~.:, .', ;;,.,' ..,
Seal
6. DHHS APPROVAL
Approved for ~ bedrooms by
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph $ 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, 7/88) Back Page 2 of 2
A. WELL DATA
Well ClassifiCation
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authp_rity Approval (HAA)
pALFfY i~fi'CL~:' FEBRUARy i984
ENViRONMeNtAL SERVICES DIVI~.4744
~P 2 ~ 1988 Legal Description: ~O%
RECEIVED
Well Log Present (y/N) ~
Total Depth 17/~Cased to
Static Water Level 1 ,'~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
IfA, B, C, D.E.C. Approved (Y/N)
. UateCompleted 'P,,t~ Iq'Ii Yield ,'~ -I~1~"/
Depth of Grouting ~ o V/,.~
Pump Set At >
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
~,~
To Septic/Holding Tank on Lot ~O,.
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results ¢ ~ ~-"~//~,,
Comments -~- ~l,T¢ ~
; On Adjoining Lots
Il _~, ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date ~/~'//~
B. SEPTIC/H~TANK DATA
Date Installed ~ ~?/f ~o Size 7,~0 f,,~O No. of Compartments
Standpipes (Y/N) / 'P! Air-tight Caps (Y/N) ~
DepresSion over Tank (Y/N) ~
Pumping/Maintenance Contact on File (Y/N) ~/~'
Foundation Cleanout (Y/N)
Date Last Pumped
Holding Tank High-Water Alarm (Y/N) I~//~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well _/~ 0
To Property Line ~
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
; for 'N/~,..
Temporary Holding Tank Permit (Y/N)
TO Buiiding Foundation
To Disposal Field
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
c. ^.so. PT ON . ELD DAT^
Soils Rating in Absorption Strata,,
Date Installed~;~/~
Width of Field ~
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot
Statndpipes Present (Y/N) -'r"¢~ o
Date of Last Adequacy Test %//~ ~
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line / '~'
To Existing or Abandoned System on
; On Adjoining Lots ~ / ~
To Cutback (if present) ~//¢4~_
Comments
D. LIFT STATION ~,
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
D. imensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**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._
Company
Date
MOA No.
Receipt No. ~)-~'
Date of Payment
Amount: $
72-026 (Rev, 7/88) Bac~
Receipt ~o. ·
Waiver Fee:
Date of Payment
Page 2 of 2
Engineer's Seal