Loading...
HomeMy WebLinkAboutKNIK HEIGHTS BLK I LT 17Knik Heights Block I Lot 17 #018-232-02 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: ~ ~ ~)O0 tf,~ er PID Number: N,~,: WastewaterSystem: ~ New ~Upgrade ~°"":1~3~ ~o,~< ~ ABSORPTION FIELD Phone: INo'ofB~r~m': ~eepTrench O Shallow Trench ~Bed OMound ~Othe~ LEGAL DESCRIPTION WELL: D New ~ Upgrade ~.v,~ '"'~: F,. ~ ,~. TANK ~ GPM ~ PumD Sel at: ~mg Hegel A~ SEPARATION DISTANCES su,,~, N Jo ~ LIFT STATION Wate~ Line -Pump on-le.,.t: I'Pum~eve'.': I H'gh w'te'''''m't: Foundation ~ q o~,,. / BENCH MARK Remarks: ~atlonand ~scrlgtfofl: · . Inspect OhS performed by' ~ ' ~ ', Da ': t;..,.;, Department of Healt man Se~ices approval c~ ,.:,. ,,., ... Reviewed and approved by: Date:/- 2~/ -". ' - '"' $2 ~ J 12 FY ~ F · 8 G ~ECTIV~ R~K I 14.5 ~0 35 ~ ~ BO 63.5 A~ 54.5 ~ 74.5 AF Br 8~/.~ I I~Oe~E~ SPUR~LA~D ~E. 20~ · ~STH. AVENUE A~C~. A~ 9950! (9oz) 279-s9~6 PERMIT # 2W000459 $0 7§ 100 SCALE: 1' = 50 FT. SPURKLAND No. C£-EE25 LOT 17 BK I KNIK flIz76'HTS DAVID P/RIGHT 12J2J6 SH£1BOURNE ROAD PID # 018-£32-0c? BENCH I~ARK: BOTTO~,I SIDING ASSUI4ED £L£¥M'ION: 100.00 DATE: NOV. 6, 2OOO SHEET: 1/3 GRID: 2936 KNHOII 72.flVG Ia Q Stondord Trench~ 2' Wide 32' Long 12' Beep 8.0' Sewer rock 4' Cover OC)-O 0 0t 1250 gol Sept;c b, nk · 0 NO SCALE -- Cleanout Silt £orrler $2.9 B,O ft oF Septic Rock / Monitor Effective lYE 95.55 NO SCALE 1250 poi. sept;c ~onk IIBBBEN SPURKLAND P.E. 203 WJ5th Ave Anchorage Ak 9950[ PERMIT ~ SPI000459 II LOT 17 BI{ I KNIK IIEICtlT£ S/D DAVID WRIGHT 1222~ SHELBOORNE ROAD PARCEL ID ~1 018-232-02 SEPTIC SYSTEM SCHEMATIC ~ATE,, flOY. 6, 2000 SHEET 3/3 oRI0:2936 KIVHOII ?$.BWG MUNICIPALITY OF ANCHORAGE Department of Health and Human Sen/ices On-Site Sen/ices Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 27, 2000 Expiration Date: Oct 27, 2001 Permit Number: SW000459 Legal Description: KNIK HEIGHTS BLK I LT 17 Design Engineer: 0019 Flattop Technical Services Owner Name: David Wright Owner Address: 13236 Shelbume Rd. Anchorage, AK 99516- Parcel ID: 018-232-02 Site Address: 013236 SHELBOURNE RD Lot Size: 33600 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: CIVIL & ENVIRONMENTAL ENGI~NEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PiI: (907) 345-1355 ANCHORAGE, ALASKA 99516 October 23, 2000 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities to 4-bedroom capacity, on Lot 17, Block 'T' Knik Heights S/D located at 13236 Shelburne Road. The present wastewater disposal system is no longer able to accept the wastewater load generated in the residence. Soils logs, per¢ test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity oftest hole # 1. As can be seen from the soil log, the native material below 4' is a very sandy gravel with a measured perc rate of less than one minute per inch. Despite the rapid pete rate, the high sand content ofthe native material should eliminate the need for an imported sand filter. Using the soil application rate of 1.2 gpd/sq, ft. specified in the wastewater ordinance, this 4-bedroom residence requires a total absorption area of(4 x 150)/i .2 = 500 square feet. The proposed 32-foot long trench design with an effective gravel depth of 8 feet has a total absorption area of 512 square feet. The topography of the lot in the area of proposed construction is generally level. There is ample room for another replacement trench to be constructed in the vicinity of the same test hole. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. ' , MONITOR TUBES / X X ~ LOT11 ~ , , KNIK HEIGHTS SID ',,, ' ', .... : ~TTOP TECI~C~ SER~C~ I INCH = 50 FEET ~ OST~ET D~WNBYTFM~. . · ~ ,. ', ~ ~ ALL LOCATIONS SHOWN ~E APPROXIMATE. INSTALL 1250 GALLON SEPTIC TANK ~4" DI~ D-3034 FROM FDN. C.O.  4" DI~ F-810 ~ PERF. PIPE I / U~ CONSTRUCT 32' LONG SOIL ABS. TRENCH W, 8.0' EFF. GRAVEL BE'BN. 4.0' & 12,0' PLAN VIEW SCALE: 1" = 10' MONITOR TUBE CLEANOUT 3ACKFILL GINAL GROUND -- FILTER FABRIC -- 4" DI~. F-810 PERF. DIST. PIPE -- lrZ' - 2 l/Z* SEWER GRAVEL BOttOM OF EXCAVATION SECTION "A" - "A" SCALE: 1" = 5' LOT 17, BLOCK "I", KNIK HEIGHTS S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECI [~CAL SERVICES SCALE: AS SI IOWN 14530 EClIO STREET DRAWN BY: TFM ANCIIORAGE, AK~ 99516 OCTOBER, 2000 q:fattop rl'ecfmica£Services 14530 ~c[io Street, ~lnc[iorage, .P1~ 99516 c~f~one (907) 345-I355 Lot 17, Block "I" Knik lleights S/D 13236 Shelburne Road Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope ofthe project consists ofabandonment of an existing 1000 gallon steel septic tank and concrete ring seepage pit and installation ora new 1250-gallon septic tank which discharges effluent into a 32-foot long soil absorption trench containing a total of 8.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. Ail separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement oftopsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removin.g the top and backfilling with soil. The top of the existing seepage pit shall be exposed, and if the cover ~s no longer structurally sound the pit shall be pumped and backfilled with soil. 2.2 The new 1250 gallon, 2-compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 AII pipe connections to the tank shall be equipped with waterpr°°fmechanical c°uplings' The waste line from the residence to the septic tank shall have a minimum slope of I/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 32-foot long trench to a depth of 12 feet below original ground level in the approximate location shown on the site plan. 3.2 The bottom ofthe excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. Sand for leveling or serving as filter material shall comply with Municipal specifications. 3.3 A total of 8.5 feet ofapproved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 8.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the//200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4' diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface ofthe sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 Aminimumof4 engineering inspections will he required during the course ofthe projecr (I) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any ofthe above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer su~ciently far in advance to ensure the availability of the engineer. ITEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH ~ (feet) -- FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 17, Block "r', Knik Heights S/D October 12, 2000 David Wfighl; Pt SM Reddish sandy loam ML/SM Gray sandy silt GP/SP SlighW silty sandy gravel Lenses of gravelly sand SLOPE EXISTING 11- 12- 13- 19- 20- BH Depth to Groundwater Date No_~Groundwater 10/12/00 '-M(~ mt~Ft~b~-d ry 10/20/00 Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) ,10/2_ ._..1Z.L~e~Qak 12:40:30 27_l/4 #1 12~41~30 I 23_3/~ 3 718 ~ 12:42:30 19 4~J/8- #3 12~3~'10 4~)" 17~dry) 2 Resoak 12~5~0 27__3~8 #1 12~6~0 1 24~3/8 ~t2 12~7~40 1 201/4 4 #3 12:_48:_40 I 17 1/2 2 12:48:50 10" 17 1/2 PERCOLATION RATE <<1 (minutes/inch) PERC HOLE DIAMETER 12 TEST RUN BETWEEN {~.75 FT AND._..~..5__ FT COMMENTS: The r~ative materiaLb, elow 4 feet bas a~sand content of almost 50%. so a separate ~and filter should l~oLbe neces_~ary... PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,,,~..4.~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I o/ ~ /' O ~ oGRE' cR ANCHORAGE AREA B0 Department of Environmental Quality 3330 C Street Anchorage, Alaska ,99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM NAME .~/,/~//,2 ,:' :,/"/,~,- //1 LOCATION ,,) /4,~{*//.'.,~/,,/,~,,., i,~?,'~ MAILING ADDRESS /-'~ ,"/ ..../f;/~/d',d'/'( LEGAL DESCRIPTION /~- /'''i SEPTIC TANK: DISTANCE //?/,///"///'/ iNSIDE LENGTH INSIDE WIDTH MATERIAL ~.~' NUMBER OF COMPARTMENTS / LIQUID DEPTH -- LIQUID CAPACITY_ /~¢~" GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER . OR WIDTH_/' LENGTH ,-~'- , DEPTH ,~','~ ~ * '// ' * '"' DEPTH 4' / LINING MATER ALb~'-,~XZz~//2/~_"'CR g SIZE: DIAMETER ~(~(' / - DISTANCE FROM: WELL f¢~///A¢/~////' _, ,4¢/~/,z-~?...,.' TOTAL EFFECTIVE BUILDING FOUNDATION j,,.' , NEAREST LOT LINE ~/,/¢ . ABSORPTION AREA (WALL AREA)/~ //f~/'~ SQ. FT. ADDITIONAL ABSORPTION ~'~ WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SI_OPE: REMARKS: DIAGRAM OF SYSTEM Form No, EQ~031 NAME OF APPLICANT GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'CI' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ,,''- - ' , - ~ Lc': , : ;: PHONE ,5// / ' ;/4: !¢ ? PERMIT NO LEgal DESCRIPTION . }'/ I . INSTALLATION OF: SEPtiC TANK ~'~' seePAge PIT ., DRAIN FIELD , OTHER TYPE AND SIZE OF FACILITY TO BE ser ~ / . FINANCED THROUGH TO be INSTALLED BY SOil TEST RESULTS ~-~? NOTE: THi~ PERMIT I~ NOT VALID WITHOUT ~OIL COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF: SYSTEM ~OUNDATION TO SEPTIC TANK /~ ~ FOUNDATION TO SEEPAGE PIT ~ , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIt WALL / ~' SEPTIC TANK TO NEAREST LOT LINE, WELL. TO SEPTIC TANK , sEePAGE PIT ., DRAIN FIELD SEEPAGE PIT DRAIN FIELD ALSO CONS]DER AREA WELLS. WATER MAIN TO SEPTIC TANK ., SEEPAGE PIT DRAIN FIELD SEPTIC TANK, ./~ , SEEPAGE PIT //~> , DRAIN FIELD //C~ TO RIVER, LAKE, STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIBcrossING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETer CAST IRON SIPHON PIPES ON SEPTIC "rANK AND SEEPAGe Pit FITTED WITH AIRTIGHT ReMOVABLe caPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. (: :/ : - OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCr[SED SYSTEM IS IN ACCORDANCE WITH SAID CODE. GREATkR ANCHORAG[ AREA BOROUGH DEPARTMENT OF ENVTRONMFNTAI_ QLIAt, ITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case Legal Descripti~ F~-_~i_~[~'~F_~__...=-i~____.Subdi' '.' )c/~-~.~]J~ ~-~ This Form Reports Soils Log ~ Percolation Test Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet Soil Characteristics Was Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depi;h to H20 Net Drop Percolation Rate Minute Proposed Insi]allation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of 'Pit or Trenc'~ COMMENTS: Test Performed BY_._z~[~_.~_Z,~E.,~.~ Date Certified BY: Date: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUA[.'[TY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For i_)(xoi~ Zj_)F~Z[-1t- Dated Per~fermed /o-~-)~ Lega 1 Des c rip ~-~-~2'--~- o'~- __~] -~1-~ __~___ ___S u b d i'vis i on~_~d~_~l~J]i~L~]___~ This Form Reports Soils Log__}< ..................... Percolation Test Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet 4~ \ 7 .... 8-~ ll~, 12-- Soil Characteristics ~-~as Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depth to tl20 Net Drop Percolation Rate Minute Proposed Insl:all'~'~: Seepage Pit Drain Field Depth of Inlet Depth COMMENTS: Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WA'I'ER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L~catiq~ '(~dd~s~ er directions) (~), Appl,cant Nama~¢/ ~J~,[~.~ Telephone:Home ~ '-~¢ Bus,ness ~':.':', Applicant Address ['~ ¢~2 ~/~"~'~// ~¢K~ 4' ~ ~c,), ~plicant is (C~ee,k,q~e): CenOinO Institution ~; Owner/builder~; Buyer ~: Other ~ (explain); (d) ~ Eending Institution~2 ¢' (e) Real Estate Company and Agej 47~/" Address Telephone (f) TYPE OF RESIDENCE Single-Family,~ Mult~ [] Other Number of Bedrooms .~k,~/_ ~ _ WATER SUPPLY Individual Well~ Community El Public [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAl. Onsite,..~ Public [] Community [] Nolding Tank [] r Note: If com m unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA, A AN)D 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 tile 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 compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, Name of Firm / { --.~ Address ~. ¢E2 6(/. Approved for ~/.,-¢9 bedrooms by~//.//// 7---¢--¢-_-<..,~Z.~_,,¢,_..6. ~-~/~.Date Approved ,/" Disapproved ConditJon¢_~ Terms of GondJtional 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 72-025 (11/84) "~r~tA~ P~0~£310N RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 If A, B, C, D.E.C. Approved (Y/N} Date Completed j'/fc~.¢dce./c.,~ ' Yield q2Depth of Grouting .... Pump Set At Sanitary Seal on Casing N) Depression Around Wellhead (Y/~'~ Well Classification Well Log Present (Y~-~. Total Depth I(~¢'-'..~( ~ CaSed to '~ Static Water Level t¢6, ~ Casing Height Above Ground ~ / Electrical Wiring in Conduit0/N) Separation Distances from Well: To Septic/Holding Tank on Lot //3 /¢~-.~ '-*~,fr __ ; On Adjoining Lots ( To Nearest Edge of Absorption Field on Lot ~¢f"~f'fl¢'-"¢'-"- L_, ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole 4//-Ir To Nearest Public Sewer "~/4 . To Nearest Sewer Service Line on Lot · ~ ~,.o'-6. __ ; Date ~'- Water Sample Collected by Water Sample Test Results Comments ~ //4 B. SEPTIC/HOLDING TANK DA'rA Date .Installed Standpipes~N) Air-tight Caps rN) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ ,'//.z~4~=__ _ Separation Distances from Septic/Holding Tank: To Water-Supply Well //~' ./o r To Property Line ~? To Water Main/Service Line Course ~/~ Comments Size //~(~ NO. of COmpartments _ / Foundation Cleanout (~?N) Date Last Pumped /(./-4 ;for Temporary Holding Tank Permit (Y/N) /~/4 To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (~:;~ ~. ?c¢ Width of Field ! Square Feet of Absorption Area Depression over Field (Yi'N~ V Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ,,~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments (9 Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~ Presentl~N) (./ Standpipes Date of Last. Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Manh. CeY'Access (Y/N) r~.,-'~"Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify th~ I have che~:k~d, v.,..e~ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ ~//" ~""~--- Date ~-,_,~.y~.~7~ Company AE'''''''¢''~-¢ ~¢~C.. MOA No. Receipt No.~ ~ ~ / ~ ~ Amount: * ~, ~ ~ Page 2 of 2 72-026 (11/84) A ASKI 8,1101ROFImBFITAL COBTROL $8 ulC $, IFIC. ~nqinm'inq $ {nuir~nmcnlaJ $1udics ANCHORAGE ALLASKA 995 ~ 6 SE[,LER 9,2d ' 86 L~GAL:Y,N]~( IU:~(3HTS DI.OC}( ~ i.OT i!ff ADEQUACY TE%T FOR SEWER SYSTEM Ai)EQUACY T!ST OAT}{ 9/! 2/86 THE TVPE OF ABSORPT}ON SYSTE?,! TS A CRiB ?!TTH AX UNKXOWix' ARI{A, THE SVSTEY iS CAPABLE OV ACCI?TING 300 G,M.LOXS 0[' biATKR PER DAY. Tile SURGE CAPACITV Oi THE SYSTEM IS 300 GAT, EONS, BASED IZPOX ",'HE 'Fi:.ST D6TA 'I'HE SYSTE~ rS ACCI~I"J'AIIJT,I~ F0!t A 2 BEI}ROO~i S!q~T~.C TAYK ADEQUACY THE EXtST[X(i SEPTIC IAN. K VO!,USIE OF 3000 IS Al)EQUATE FOR THIS 2 BEDR~OX 14OUSE. TIlE SEPTIC TAXI(/PACtiA(;}; P~ANT I?AI~ PU?4PEI) ON 9/]6/86 . SUPPEr OR NASTEWA'I'Ei~ SYS'I't:.Ni. .,BATE 9'!9/86 A FLOW TEST WAS P[qlI~ORSIED ()X '?lie WEi.i,. 300 {]Ai.J,ONS OF [(Al'ER WAS PUMPE[] AT A RATE OF fi OPS~ OVER A DURATiOX Of 2.5 HOURS. TIlE i)RAWDOIt~N WAS 1200 ~esl 33rd Auenue. Suile B. Anchoroqe. Alasko 99503,(907) 561-5080 :'8S$1 · _ mok ,cmY Z.D.# _ BACll~RXOLOGXCAL MATER ANALYSIS TO BE, COMPLETED BY MATER SUPPLIER BATE COLLECTED TII~ COLLECTED I~NTH DAY YEAR X.D. NO. (PUBLXC'SYSTEMS) L I I J t I. I NAME OF ;YSTEM SYSTEM ADDRESS f.LOCATION WHERE SAMPLE WAS COLLECTED / 7 , ;.?: :{YPE dF SAMPLE ' (CH~CK O"LY ONE THIS COLUMN) [~] P~W SOURCE WATER [] NEW CONSTRUCTION OR REPAIRS [] OTHER(Specify) TYPE OF SYSTEM '- AM [] PUBLICC~ll~DIVIDUAL PM CTRCLE CLASS A B C llELEPHONE NUMBER zip CODE [:]CHLORINATED ~'IFILTERED ~]~dTfrREATED OR OTHER IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE? I"IYES ~ PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO:(~R~NT FU~L NAME,ADDRESS AND ZIP CODE ADDRESS CITY STATE ZIP FOR USE r=) RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE [] Sample too long in transit. Sample should not be over 30 hours. [] Sample received too late in week []Not in proper container [] Leaked out [-') Insufficient information provided. Please read instructions on form. [] Other (Specify) DATE %//,~/~ TIM~ /,'/.~-'" -- ~MBRANE FILTER ~ FERMENTATION TUBE Date & Time Started _._ LABORATORY RESULTS [] Other Bacteria ~ Test unsuitable because: [] Confluent Growth [] TNTC ~UN- S~TtSFACTORV SATXSFACTO~Y [] BACllERIOLOGICAL MATER ANALYSIS RECORD FOR LAB USE ONL. Y TOTAL COLIFORI~ FECAL COLIFOI~J4S OTHER Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By BGB Date Coliform/lOOml Coliform/lOOml Time A.M. P.M. READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received November 4, 1976 Time of Inspection /~ ~_ Date o mF Inspection //F~-~/~ ~ REQUEST FOR APPROVAL OF ~cJh~ INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: 4. 5. 6. COllV. First National Bank of Anchorage Post Office Box 720 David W. Wright Star Route A Box 1590-R 99507 Phone: 276-6300 x 483 Phone: 277-0581 Mailing Address: Property Owner: Mailing Address: Legal Description: Location: Type of facility to be inspected . Lot 17 Block I Knik Heights Subdivision NHN ShelbournRoad~ ~_~/ c~y _6y_~y_~_c.%/~3 ~LY'/- /~ Single Family _ No.~ of bedrooms 2 Well Data: A. Type Individual C. Construction Sewage Disposal System: On-site system B. Depth D. Bacterial Analysis A. Installed C. Septic Tank: D. Seepage Pit: 1. Absorption Area ~-~ E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank__~''O!~ , Absorption area~ Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area B. Installer Size ,/~ 2. Manufacturer 1. 2. Material , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page I of two pages MUNICIPAMTY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY Ol= ANCHORAGE DEPT, OF HEALTH & I~NVIRONMENTAL PROTECTION NOV 0 4 g76 RECEIVED 1. Type of Inspection: 2. Property Owner: Mailing Address: CMRO David W. Wriqht SRABox 1590-R VA Anchorage FHA 99507 Day Phone CONV X __ 277-0581 3, Name o[ Buyer: __none Mailing Address: 4. Name of Lending Institution: Mailing A(Idress: t?,O, :Box 720 5. Name of Realto~ or Agent: none Mailing Address: Day Phone First National Bank ofAnchora_ge Anchorage, AK 99510 Phone Phone 276-6300 ezz~_~83 EO.OS? Legal Description: __ Location: Type of Facility to be inspected: Water Supply Type or Supply: Public Udlity If Individual, number of dwellings presently served Lot 17¢ Block_Id Knik Height~ NHN Shelbourn Road Ancho~rage¢ Alaska 9950_7 sin~]a fam~]y No. Bdrrns. 2 .. Indiviclual X If Individual, ctel)[l'~ of well Sewage Disposal System Type 'o[ SysLcnl: If Individual, (late of installation Public Utility Individual (on-site) X Marie Iiams 11/3/76 Page 2 of two pages - Re~ st for Approval of Individual' er & Water Facilities Legal Description Lot 17 Block I Knik Heights Comments Approved "~- '$ Disapproved Date App~l~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH ~ !~.,7,,~..~,~.~.,,._~, /' ~i ' ]~,' · . .z' , Department of Enwronmental Quality ~+~,~-, "C" Street, Anchorage, Alaska 99503 274-4561 Date Received / Time of nspection Date of Inspection REQUEST FOR APPROVAL OF Mailing Address: ~/~ ~~~ Phone: Property Owner: ~~ ~ ~~ Phone: ~x~- z~/x Mailing Address: ~'.~. ~ /~o ~ TypeWell Data:°f facility to be inspected/~/~_. _No, of bedrooms / A, Type ~2~. B, Depth . 2 C. Construction -'/~-~(/~4C?.~[~ ~_, D. Bacterial Analysis Sewage Disposal System:~~ A, Installe~~~ B, Installer ~~ C, Septic Tank: 1, Size ./~y~)~/ 2. Manufacturer D, Seepage Pit: 1, Absorption Area~~ 2, Material ~~. E, Disposal Field: Total length of lines Distances: A. Well to: Septic tank } :2~/~- Absorption area / ~--~ Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank~ ~, Absorption area ~~m~q~, ~.~ C. Absorption area to nearest lot line ~/.~/~ ~/ e 4. 5. 6. EQ-034 (1/74) Page 1 of two pages 'GREATER ANCHORAGE ARE/\ BOROUGH Department of Environmental Quality 3330 "C" St,, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: .~mo~d ~, ~ Nailing Address: ~£/q gM 3. Name of Buyer: .q~.~ ~.~ VA FHA CONV r /~q-I ©/~ ..D~7 Phone Hailing Address: Day Phone 4. [qame of Lending Institution: Hailing Address: ~¢/F] ~. A/o, X_,'~,~,-~.<-~/¢~/Phone 5, Name of Realtor or Agent: Hail in(. Address: ,/ Legal Description: }.. /-ff ~ Location: ~.S~L~//~O~FF~ ~])~ Phone 7. TYi)e of Facility to be inspected: 8. ~ater Supply Type of Supply: Public Utility ~t~,/~_~ No. Bdrms. / Individual v/// If Individual, num'ber of dwellings presently served If Individual, depth of well Sewage Disposal-System · Type ,o'F S~stem: Public Utility Individual (on-site) If Individual, date of installation ~.~~ /~-¥.~ Page 2 of two pages - Re st for Approval of Individual ~ 'er & Water Facilities Legal Description Comments t / /~ /'} Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)