HomeMy WebLinkAboutKNIK HEIGHTS BLK A LT 12
Municipality of Anchorage Page / of
' DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVlSIO'N
P.O. Box 1~6650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: -~..~(~ d'~./~, PID Number: ~.~ ~ ~
Name: - / /
~ ~~ Wastewater System: ~ew D Upgrade
~:7~/ ~/~-~ ~/~.~ ~ ~ ABSORPTION FIELD
Phone~___~ / IN°'°~drOOms: ~pTrench ~ Shallow Trench ~Bed ~Mound DOther
LEGAL DESCRIPTION so, Rating: . ~ GPD/So. Ft. Total Depth/~from, original grade:
LOt:/~ Block:~ ~/~' Sub~iv~ion:~.-- Depth to pipe ~,o. from odgin~ade:, ,,. Gravel depth beneath pip.~ / Fi.
~u~r of lin~; Dia~n~ ~u~ li~:
WELL: ~ew D Upgrade Gravelwid~h: ~'~ Ft. ! / / Ft.
Cla~ifiqation (~ivate. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material:~
Z~y~I~ ~' ~,. ~ ~' ~. ~ ~ ~ so.~. ~o~
Yield: /O GPU Pump Set =t:~//~ R. ~[C=ino Height ~ve~around:Ft. TA~K ~ /
SEPARATION DISTANCES ~i= a Holding ~ S.T.E.P.
To Septic Absomtlo~ Lift Holding =ukli~Pdvate Manufacture~ Capaci~in gallons:
From Tank Field Station Tank ,ewerLine, ~.~ X ~
Su~ace
Water. >/OO/ ,>/o¢' W~ ./ >/¢o' LIFT STATION
LOt , Size in gallons: I Manufacturer:
Line /7 /~ f j~ ~ ~ I
I
/ / '.em.o.",.,.,=
Cu~ain
Drai, ~l'~ ,~/~ ~/~ ,~ ~ PumpMake&M~el [Electricallnspectionspedorme, by:
Remarks: ~,.~ ~z?.~ ~¢~;, e~/~ ~,~¢/~ BENCH MARK
~' L~ation~d~dption:
A~umed /~ ~ Ft.
Elevation:
ENGINEER'8 ~EAE
Inspections performed by~~~ Dates: 1st ~/~ '" ' ~'z
, . 5~ ~'/~(~ --
Department of Health and ~ nar~ ~k~ces approval
/
72-013 (Rev. 9/91) MOA 25
'Permit No. ~vi/7,/~ ¢J'~, Page
Municipality of Anchorage
'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
Legal Description: ~--~' /'~f- /~'~ '~-/~//~ .~/.'~'.~PID NO':~/'70~'?'''°
Permit No. ~/~0~/~
Page of
Municipality of Anchorage
'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
ertifiei Drilling
by
SULLIVAN WATER WELLS
P.O. BOX 6~272, CHUG1AK, ALASt(A 99567 · TELEPHONE 696-2759
StaRed _.. Ended 7/~- GA~. PER HR
pE~IT NUMBER KI~I) OF CASING
KIND OF FORMATION:
From' 0 FI, to ~---~FI.
From ~ Ft.
From__~ Ft.
From._.L~ Ft.
l~rom ~'~ Ft.
From ~ Ft.
From ~,7 FI-
From//~' Ft.
From__Ft. to Ft. '
Fri)ro .... Ft. lo F~,
'}'rom FI,
From
From
From
, From
From~ Ft. to
From ,_ Ft. to__Ft.
From.__Ft. to ,Ft..
Froro FI.
From.__Ft. to ,,FI,
Fl, to~F!
FI. to Fl,
__FI. to... FI.
__FI. Ia_ Ft~
· FI. to--Ft.
Ft. to Ft.
Fi. to. Ft,~
FI. to__Ft.
to Ft.
to Ft._
to_ Ft.
to ....
· Ft, to~.F,
Ft. to..._,.-..--Ft
Fo, to__Ft.
Ft. to Ft.
Ft,
MISCL. INFORMATION:
Munioipalit~ Ot Anch?a~
DePt. Health & Ruman Serv,oes Dept. Health
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 WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960219
DESIGN ENGINEER:CONSTRUCTING ENGINEERS,
OWNER NAME:POWELL WILLIAM E &
OWNER ADDRESS:12601 RIDGEWOOD RD
ANCHORAGE, ALASKA 99516
INC.
DATE ISSUED: 7/30/96
EXPIRATION DATE: 7/30/97
PARCEL ID:01703230
LEGAL DESCRIPTION:
KNIK HEIGHTS BLK
ALT 12
LOT SIZE: 43500 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
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 (18AACS0) .
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 PROVI ~/~/~/
RECEIVED BY~//~'~ '~//~" '
ISSUED BY: ~? ',~~
DATE:
DATE:
J
SEPTIC
SEPTIC
~/ELL
J
iED 1250
TRENCH
HOLE
LOT AI~EA, 4,%~00 SF
NOUgE
nRIVF-.WAY
WELL RAI)iUS 2%500 SF
LADLE
PTI~N ~Y~TEH ~4,000 SF
SITE PLAN DETAILS
PI~OPO~ED WATEi~ AND WA~'f~¢/AT,V.~ ~B~OPd~TION ~TEk[
LOT 18 BLOCK A KNLK BEIGRTS ~UBDMSION ':'
PREPARED FOR: BILL MORAN 248-4780 "' '
8631 LORD BAP, ANOF DR, ":' .-
ANCHORAGE, AL4~SKA 99519-1~84
CONSTRUCTION ENGINEERS 348-8000
960! BUDDY WER,.N~R DR
ANCHORAGE, AK. 1~8510
3-12-95
^B$OEPTiON SYSTk'~t DE$1GN D~-FAIL$ -- ST^ND^ED TRENOH
CLE~NOUT TU~E /-CLEANOUT TUBE
~CL. EANOI IT
IF GRnUND CDVER
LESS THAN -5'
(ALL CnMP{3N£NTS~
1EDU GAL. I '
TWO-COHP,] FaOM WDU~E
~T£EL TAN~
i~ PRO,TROT: New eb.~orp!lon fi--!d 1~ d~'slgned for o four (&) bedraom
Lot im to bm mervermd by a prlvte wmlh 'chin m~em will be ~ m~andard
J2!IBOP-~llON ,~ltF~. C,iI.,CU/a&TiONBf
Minimum R~quimd: 4 8~droom: x 150 gpd/b~droom = 800 gpd ~apodty
iolli rating, propo~ =y~am, O.B gpd/~f
Minimum ~izing~ 600 ~pd - 0.8 gpd/~f - 750 ~f ~b~rp{i~n ~r~
Uae 3~W x B~L x 8~ D : 780 mf mlnlmum for ~.noh
Trenc~ depot Bo~t~m - 10' Below ~r~de, w/ 4' cover or 2' mln, ~oven ~n~ ~ HO
[n~u[o{ion ~r design drowing
~O~ O~ ADJAOR~ LOTS~ ~ere ore no privc{e wslls within 1001 and no publ[o
ha~ no [mpo~ upon ony odjocen{ ot~ o~ chown on o{~oohed si{e diogmm,
DESIGN DETAILS
PEOPOSED WASTEWATEE At~$ORPTION
LOT 18 BLOCK A KNIK HEIGHTS 8UBDMSION
PREPARED FORt BILL MORAN 24,B-&71BO
~§31 LORD BARANOF DR.
ANCH0t~A. GE, ALA~ KA
CONSTRUCTION ENGINEERS 346-8000
ge01 BUDDY I~ERNER DR
~NCHOBAGE, ,iX. 8801~
3-12-86
PERFORMED FOR:
Municipality o! Anchorage
DEPARTMENT OF HEALT~.~& HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
LEGAL DESCRIPT,ON: '/-/~' '~/'~f "~"~///~",~"-~' Township, Range, Section: ~'/Z ,/~//~-~ ~ ,-~-~'
SLOPE SiTE PLAN
(FEET)
1
2
3
4
5
6
7
9
10
11
12
13
14
15
16
17
18
19
20-
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? P
E
gap(h to Water Alter
Monitoring;' -- . Oaf~' '~ '/'
Gross Net Depth to Net
Reading Date Time Time Water Drop
3'2'75- -- - ,5# -
6,,,~ 6,.~ .~,5"" , .5-"
/ Z ,,~ ~. ,~ 54. o" . ,5'"
,/ 8 ,,~ ~.,,,., ~ 5-" . .-~ "
?_' ,-/.~ - ~ .,o '
PERCOLATION RATE // '~ (minutes/inch) PERC HOLE DIAMETER -;'
TEST RUN BETWEEN FT AND FT
72-008 (Rev, 4/85)
":,L ~.-'. - - MUNICIPALITY OF
' '"~;"' '~":" ' :'~ D TMENT OF HEALTH & HUMAN S VICE
.~ :, .:,: ,., · EPAR ER S
~ Divisi6n Of Env ronmentaiservi'cbs ' ·
_ ,.:...;_ _' · .~ _
,:; -,L;:: ::.. P.O. Box 196650 Anchorage; Alaska ~99519-6650
' '~- !, ,:;1.7 : ': !-, .,. -. '.
--' ="~'"-' ''.': :'-'"';=i" C'ER+ii~iCATE OF"HEA£YH AU'r:I~0RI:I'Y -
' --' · ..... APPROVAL FOR A SINGLE FAMILY
. 1. GENERAL'INFORMATION '.
' cOmPlete legal description 'Z/~'<~-
Location (site address or directions)
'F~rope~t¥ OwneF' ~'~,~¢, ~__~TZLf'~~.~' Day phohe
~i'Lending 'agency Day phone
Mailin~ address.
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF.BEDROOMS: ":/-", '"'
3. TYPE OF WATER SUPPLY: .~
Individual well t/' '
' ' CommUnity well ~' -i i . . -. ~ ~. , .' . :'~::
"-.. public water - · , . - . - .
NOTE: If community well system,'provide written confirmation. : from Sta~......~.,., ..::,'~%'
' ' ing 't~ the'legality and Sta~us of S~/stern. '- .' ...--. '- ..
,: NOTE: . If comm~mitY wa§t~w~ter'§Ybtem;:~pro~ide'Wriii~n fonfirmatibn from stat~ ADEC
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verlfy that my
.... !nvestigation of this Health Authority Approval application shows that the on-site water supply
~ ~.'and/or wastewat~r d sposal 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 ~-'rz-ro,J ~',/,-J~r~,~(., Phone
:. ,-...','.:-," .,,,.'-.- , .. , . ... ~/,/~
~nCf~e~s~i~n~t'u~a /~*'*~"-~' ':~'~~" D~te
DHHS SIGNATURE
f/~,. Approved for
Disapproved.
Conditional approval for
bedrooms.
be, drooms, with the following stipulations:
Additional Comments
': (Th,e Munic pality'of Anchorage Department of Health and Human serVices (DHHS) issUes Health Authority
'; ~,~¢3v~'l':~ertificates based only upon the representations given in paragraph 5 above by'an independent
pr(~fe'ssiona:ien'gineer registered in the State of Alaska. The DH HS 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 professiona! eng!neer's work.
72-025 (Rev. 1/91) Back MOA ~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division ~4~_~ ~ V E
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)
Health Authority Approval Checklist
Legal Description: '/ //~/, ~/~" %. ~-'/~///~. ,,'/¢/,¢~. ,/-~-Parcel I.D.'.
A. WELL DATA
Well t y p e,~/"" ~/,~¢,,~---
Log present (WN)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well prodt~ction
WATER SAM~SLE RESULTS:
If A, B, or C, attach ADEC letter. AD/~, water system nu, mber
Date completed 7/~'¢/~::~
· . / '/ , · .:
Cased to ~-~-:~ Casing height (above ground)
FROM WELL LOG
Wires properly pr~tecte.~l (Y/N)
/
AT INSPECTION "' '
/'~:> g.p.m, g.p.m.
Coliform o
Date of sample': ~'/~/~/~'~ . ! / /
B. SEPTIC/HOLDINGTANK DATA
Date installed ~/~//__~ ~i']~ank$ize~
Foundation cleanout (Y/N)
Date of Pumping A/~
C. ABSORPTION FIELD DATA
Nitrate ,/¢~' Other bacteria
Number of Compartments ~ Cleandu'ts (Y/N) .~-
Depression (Y/N)/V High water alarm (Y/N) ~,~
Pumper
Date installed~/-7,/~/- ~',/~,,'~.~' Soil rating (g.p.d./fF or fF/bdrm) _
Length ~'/" Width ~'~/ Gravel thickness below p, e
Effective absorption area//o c ,~, t~,~-. Monitoring Tube present (
/
Date of adequacy test /V/-/~- Results (Pass/Fail)
Fluid depth in absorption field before test (in.); ~
Fluid dept~ (ins) Minutes later: ~,~'
Peroxide treatment (past 12 months) (Y/N) ~
System type
~ / Total depth ~,'O /
· Depression over field (Y/N)
For ..~ bedrooms
Immediately after ~'"~gal. water added (in.):
Absorption rate = ~ g.p.d.
If yes, give date ./.~
72-026 (Rev. 3/96)*
LIFT STATION /~
Date installed
Manhole/Access (Y../~I)--~-'
High w/a~-a al~r~..,ley@l.at*- ,..
C~cles tested
Size in gallons
"Pump off" level at*
E. SEPARATION DISTANCES
"Pump on" level at*
· *Datum ....
SEPARATION DISTANCES FROM WELL ON.LOT, TO:
· Septic/betting_tank on lot ~ //7 /
Absorption fiel~l on lot ~///~" /
Public sewer main /v',~
-,On adjacent lots
On adjacent lots ~'//?---/"
Sewer/septic service line
Public sewer manhole/cleanout
Lift station, ' /~',*~ '
SEPARATION DISTANCES FROM SEPTIO/HOLDINGTANK ON LOTTO: ,..,
Foundation ~ ¢// Property line ~ / Absorption field /,.3 !
Water main/service line/v'/'~ Surface water/drainage ;>/O-O / Wells on adjacent lots
Property line
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON .I:.C~ TO:
~" /'~ / Building foundation ~_5 / '
"-' o- , Watermain/service. line
~/O,c> t Driveway, parking/vehicle storage area
F. ENGINEER'S, CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
HAA Fee $. ~2 ~ , (¢-)
Date of Payment "~/L//~"7
ReceiptNumbe, ~_~-.~L/D ~'~'-~/ ~)
/
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
CT&E Environmental Services Inc.
CT&E Rd.//
Client Name
Project Name///
Client Sample ID
Matrix
Ordered By
PWSID
970881001
Andemon lingineeriag
L12 Block A Koik HghtS, $/D
L12 Block A g.il~ Hghts, $1D
Watvr (Surface, Eft., 6round)
Sample Rauark~:
Client PO//
Printed Date/Time 02128197 13:47
Collected Date/Time 02124/97 00:00
Retelv~lDate/Tlme 02124/97 12:30
Technical Director: 8t~hen C. Ede
Para.tar
giLver
Atu~inu~
Arso~ic
~arlum
Chromi~
~o~r
Ha~nesi~
aangenese
Sodi~
Lead
Siticon
AtkaLinity as CocO3
Harness aa CaOO3
~itrate-~
Totat OiSSOiV~ So[fds
TOIeL Coifform
Reau[ts
0.0100 u
0.0500 U
o.0500 u
0.0221
38,9
0.0200 U
0.0250 u
0.306
0.0798
10.1
0.0816
3.56
0.0500 U
5.96
0.552
8.19
12&
139
0.100 U
105
0
PaL units ~ethod
0.0100 ~/L EPA 200.?
0.0500 alg/L EPA 200,?
0.0500 ~g/L EPA 200.7
0.0100 mg/L EPA 200.7
0,100 mg/L EPA 200.7
0.0200 lag/L EPA 200.7
0.0250 ~lg/L EPA 200.7
0.0250 mOlL EPA 200,7
0.0250 mg/L EPA 200.7
0,100 mOlL EPA 200,7
0.0100 mg/L EPA 200.7
0.250 a~l/L EPA 200,7
0.0500 mg/L EPA ZOO.7
0,250 ~19/L EPA 200,7
0,0250 mOlL EPA 200,7
pH units EPA 150.1
1.00 mg/L ~q18 2520B
5.00 mOlL SH17 2340B Cate
0.100 mg/L SH18 4500-NO]F
20.0 n~l/L SM 25&0C
cot/lOOrnL st418 9~a
ALtouabie Pr~
Limits Date
-- Date.~ Ini__t
0?,/25/97' 02/26197 £~
0?/25/97 02/26/97 E~
0~/25/97 02/26/9? e~
02/25/97 02/26/9r El~q
02/25/;? 02/26/97
07/25/97 02/~6/97E~
07/~5197 02/26/97 EHN
02/25197 02/26/9? EHH
02/~5/9~ 02/26/9?
02/25/97 02/26/9? EMIl
0~/25/97 02/26/97 E~
02/2~197 07/26/97 EI, I,I
02/25/97 02/26/97 EI4H
02/25/9r 02126197 ERN
02125/97 02/26197
02/2~I97FJ4B
02/24197
02/27~97 F~
02/24/97 Efta
02/26/97 EI4a
02/25/9? ~