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HomeMy WebLinkAboutSAND LAKE #2 BLK 3 LT 21( Lo'.1'L 3 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L. Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME II r PHONE NEW !Ll l �i %� ° , LjC/C� ❑ UPGRADE MAILING ADDRESS ch LEGAL DESCRIPTION 2 1f LOCATION n1 i / NO. OF BEDROOMS U Y DISTANCE T0: Well 7R' Absorption area D r Dwelling 3 , C� PERMIT N0. LI , az < Manufacturer r, MaterialPe� No. of compartments LU _ Liq. caps it in gallons IF HOMEMADE: Inside length Width Liquid depth 6 Y DISTANCE TO: Well Dwelling PERMIT NO. z SZ h Manufacturer Material Liquid capacity in gallons w= LU DISTANCE TO: Well- D +s�! Foundation j ,� { Nearest lot line f / -(� PERMIT N0. 02O_ 02 LL. z p z No. of lines Length of each line 1 Total length of lines Trench width 96inches Distance between lines F.. Top of tile to finish grade Material beneath tile e inches Total eff cove bsorption area �' -'. w Length Width Depth PERMIT NO. a F- wa Type of crib Crib diameter Crib depth Total effective absorption area w co DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to In line PERMIT NO. J LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS I/ PU SOIL TEST RATINGi INSTALLER 6 - REMARKS09 + f /- r, -1 5 P, t 6' Ire cZ APPROVED DATE LEGAL --Y-,7 115atkdLq 2 61,,,k 3 �,t z c-�io Incv. o/iol � 'M RIB �m������ HND HN9 OpoSITE SEWAGE DISPOSHL ��� A�� �1���� � , DEPH��TMENT/~� HEH�TH HND ENV` ONME�7H^/~�`)TE�l�--�� �� 825 '� STREET/ �HNCHORHGE. ' , 25 FEET AND 264�4720 FEET. �� �� `� W 1-0 FEE F� F::-:����.�-r- f.; P����T' N[\ ( 820202 ) DIHGRHMS HRE HYHILHBL.E TO INSURE PROPER INSTALL.ATION. ~ APPLICANT HULTQUIST CONST, INC 4761 MARS DRIYE 99507 LOCHTICAN LEGAL L21 B] SAND LHKE #2 LOT SIZE 6500 SQUARE FEET '1"1-/PEOF SOIL HBS8RPTION SYSTEM I -S: TRENCH MAXIMUM N8M�ER OF BEDROOMS = ] SOIL RIMING (SQ 2 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: Q FEE F=:" -I- 1A =as -1. 12" U FEE,: T�8���---- -4� F-5 F-­� V Ez". L_ ����U-i� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DIRAINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE . GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TREN(.:HES. THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. 8ET14EEN THE OUTFHU PIPE AND THE BOTTOM OF THE EXC8YHTI0N (IN FEET). �FEE 1m. 'I K-1 W so 241 Ft. A; I W FEE �151�ICE) lC_-r VJ S, PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. '7 W W �low W FEE 00 T I �D r.4 7E_� ?i u FF_ r.-:--�������� ~ BHCKFILLING OF ANY SYSTEM WITHOUT FVNHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTIOKi MINIMUM DYSTHNCE BETI-JEEN H WELL HND HN9 OpoSITE SEWAGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H pUBLIC WELL DEP�NDING UPON THE TYPE OF PUBLIC WELL MINIMUM DI' -STANCE FROM H PRIYHTE NEL!.- TO H PRIVHTE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MHY APPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HYHILHBL.E TO INSURE PROPER INSTALL.ATION. ��FRP-1 1 Kyw4F=w :1 Fv..EH_'E:� [ON W W K to! [Hy E=r Fit �ft. � ��r"r�� I CERTIFY THAT 1: I HM FHMILIHR 1 -11TH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF H�jCHORHGE. 2� I WILL INSTHLL THE �YSTEM IN HCCORDHNCE WITH THE CODES. UNDERSTHND THAT THE SEWER SYSTEM MFT-;' REQUIRE ENLARGEMENT IF THE RESIDEN�E 1.:":; REMO['jE�ED TO INCLUDE MORE THAN ] BEDROOMS, ISSUED BY ~__' I L., - Al l I M ". ell t: T. E 7 8 9 10 11 ."�2 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) .silt (ML) CMI) x23 a/ WAS GROUND WATER I�O ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date _- Gross Time SOILS LOG Depth to Water MUNICIPALITY OF ANCHORAGE rt z� -Z DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION %I Q, 87-5 L. Street, Anchorage, Alaska 99501 264-4720 TEST l0 O.tf'3 LOG - PERCOLATION TEST z PERFORMED FOR: j� "' ` p'SOILS u-^�12�ie r/.5e DATE PERFORMED: 1--z—oz LEGAL DESCRIPTION --✓ is 2O Z 810, An61 L,54e 5W 1®,OS��I SLOPE SITE PLAN C�t) --_ F lil 11 E 7 8 9 10 11 ."�2 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) .silt (ML) CMI) x23 a/ WAS GROUND WATER I�O ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date _- Gross Time Net Time Depth to Water Net Drop rt z� -Z "0 9 0.55 G l S l0 O.tf'3 x,12 z .5"15 42 0.55 .5:35 /t%�7in 1 0,07 S: S lO M /'A ss /o A *H7 0 S; rs -9- 0.51 U 6 /D 9S PERCOLATION RATE _(minutes/i 1 TEST RUN BETWEEN 2�Z- FT AND FT °°o°oo ooa0°o°0000 ell oo. nUlu, Jr. eop°p°000000®°O\, P' 14% ��® 1 _ A�FtC3Vh�t,TO-CONSTRUCT �?1�ns fo :the constructlon to i by r�ir ryt: 3 _ ❑ conditfon�l[yapproued�ee; x p � Sume>r Alas{<a,�s C -45- 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # QLA HAA # WM_)C)_1 3c1 1. GENERAL INFORMATION Complete legal description Lot 21; Btoch 3; Sand Lake Subd.iv.iz ion #2 Location (site address or directions) 8038 Seay.iew Street Anchohage AK Property owner Joe and Jackie Mo6zakowshi. Day phone 258-596 5 261-3111 (w) Mailing address __ 3200 Wentiuon..th Sticeet Anchorage, AK 99508 561-7065 (w) Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \\f 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev.1/91) Front MOA #21 Municipality of Anchorage O Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: [,U -i �- %/ �41CC tZ Parcel I. D. A. Well Data * ScE r 7TAC +€ CoNS-TQfAC-z ton, � Oi efZ=7IaN ae.?�-rI;.,c,vT6-- r- Rr t,/,4-y69--Sys771, Well type O�OAAII"IV17�4 If A, B, oG attach ADEC letter. ADEC water system number _eoLz i - FA-- loS Log present (Y/N)yVIA- Date completed SIA Driller 41M Total depth /USA Cased to AJ A Casing height IK If Sanitary seal d5�?N) Y/eg Wires properly protected Y/N) hF Date of test Static water level Well flow Pump levell FROM WELL LOG AT INSPECTION 00 CU HI/FNL I I 1 IR ii 5 tt g.p.m. L -z SEPARATION DISTANCES FROM WELL TO: (,,f r-3 K Septic/holding tank on lot I() C,' �4- ; On adjacent lots t Absorption field on lot .16 S 14- ; On adjacent lots N/A - Public sewer main 01A Public sewer manhole/cleanout N��1 / Sewer service line (2 �- Petroleum tank O/V �ndrvv WATER SAMPLE RESULTS: Coliform C / Nitrate Aro� 4721v�6% Other bacteriay Date of sample: 1 I I j 193 Collected by: S � S I� rVGi nt C�FZt rJG B. SEPTIC/HOLDING TANK DATA Date installed 2 Tank size M06 &6565 Compartments , I Cleanouts ON) Foundation cleanoutON) (Yo/ Depression (Y 6 High water alarm (Y/ID) � Alarm tested (Y/N) n 1�1a Date of pumping Pumper L-�-TC - SEPARATION DISTANCES FROM SEPTIC/FSG TANK TO: Well(s) on lot n%/A- On adjacent lots /OS I F To property line I Q 14- Absorption field �S Surface water/drainage /()() t-/- / _Foundation Water main/service line 72-026(3/93)• Front CONTINUED ON BACK PAGE M g o z I M > Zt g•p• s `a,, C < i V; G 6 `r' Z Absorption field on lot .16 S 14- ; On adjacent lots N/A - Public sewer main 01A Public sewer manhole/cleanout N��1 / Sewer service line (2 �- Petroleum tank O/V �ndrvv WATER SAMPLE RESULTS: Coliform C / Nitrate Aro� 4721v�6% Other bacteriay Date of sample: 1 I I j 193 Collected by: S � S I� rVGi nt C�FZt rJG B. SEPTIC/HOLDING TANK DATA Date installed 2 Tank size M06 &6565 Compartments , I Cleanouts ON) Foundation cleanoutON) (Yo/ Depression (Y 6 High water alarm (Y/ID) � Alarm tested (Y/N) n 1�1a Date of pumping Pumper L-�-TC - SEPARATION DISTANCES FROM SEPTIC/FSG TANK TO: Well(s) on lot n%/A- On adjacent lots /OS I F To property line I Q 14- Absorption field �S Surface water/drainage /()() t-/- / _Foundation Water main/service line 72-026(3/93)• Front CONTINUED ON BACK PAGE COMMERCIAL TESTING & ENGINEERING CO. cRtilm, ENVIRONMENTAL LABORATORY SERVICES Drinking Water Analysis Report for Total Coliform Bacteria 5633 8 STREET ANCHORAGE, AK 99518 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE TEL: (907) 562-2353 FAX: (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM I.D. # !/❑`PRIVATE WATER SYSTEM ❑ Send Results ❑ Send Invoice Waco sysim Name'company NG c Contact rune Phone Number laxi um r MuLrigAddress City Staff Zip .. ❑ Send Results ❑ s S �1N Send Invoice Company Name Contact nam 1 City State Zp - SAMPLE DATE: � ( © Ll1�J 13 Month Day Year SAMPLE TYPE: Routine ❑ Repeat Sample (for routine sample with lab ref. no. ) ❑ Special Purpose SAMPLE LOCATION ❑ Treated Water ❑ Untreated Water Time Collected Collected By 06fw /n1t ?Ic c Print TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received 7 Analysis Began 11 7 l 0 0 Analytical Method Membrane Filter ❑ MMO-MUG * Number of colonies/100 ml. Lab Ref. No. Result* Analyst Y3.6?6 ^Ell 6r Sent to A.D.E.C.(A neh Fbks Jun Date: "12 21R a Tim--: Client notified of unsatisfactory results: El Phoned Spoke viith Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-DTUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB E. Coli 6 Colonies/100 ml El Faxed El Faxed TTTC = Too Numvous To Count BGB COLIFIRM oB=OthQBaCevla Fecal Coliform Confirmation Final Membrane Filter Results / Coliform/100 ml Reported By Date l "-� 3 Time �00 hrs Comments: PART ONE OF TWO: ��%SGS Member of the SGS Group (Societe REMAINDER TO FOLLOW ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS. OHIO. MARYLF COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES R SINCE 1909 P ' ' - f ANyr b SA ! Ol •, _. Sample COLLECTED BY: QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date In.it Nitrate -"N 0.10 U mg/1, EPA 353,2/300.0 10 1:1./2.2 LLH * See Special "Instructions Above UA = Unavailable *"* See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification :limit. LT = Less Than D = Secondary dil.uti.on.��±±GT'= Greater Than 1116?S S Member of the SGS Group (Societ6 Generale cle Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA E ORI. v 5633 B STREET Chemlab Ref . # :93.6276.-3 ANCHORAGE, AK 99518 Client Sample ID :1.21 B3 SAND LAKE S/D #2 TEL: (907) 562-2343 Matrix 1-x _ _ :WATER - _ FAX: (907) 561-5301 I Client. Name :S & S ENGINEERING WORK Order :73448 Ordered By :R. SHAFER Report; Completed :11./7.4/93 'roject. Name Collected :11/19/93 @ 13:00 hrs. '. Project# Received :11/1.9/93 @ 14:50 hrs. PWSID :UA `technical. Director:Sl 'P EN C. EDE Released By � � vat _. Sample COLLECTED BY: QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date In.it Nitrate -"N 0.10 U mg/1, EPA 353,2/300.0 10 1:1./2.2 LLH * See Special "Instructions Above UA = Unavailable *"* See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification :limit. LT = Less Than D = Secondary dil.uti.on.��±±GT'= Greater Than 1116?S S Member of the SGS Group (Societ6 Generale cle Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA Time Time ie Date Date Date Inspector Inspector Inspector Comments Conditional Approval Fco) pprova� I gate V' QT Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner a T' c3;+;', Phone Mailing Address /1705 I 33 Buyer Address Lending Institution Phone Address Realty Co. & Agent �� (e,lpg I('f;rl;i:;,, , ;jr i,:; Phone Address .,1{y ;' P AI-4;' Dti Legal Descriptiona; t ;�4.vt late J Street Location f Type of Residence f9 Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply q Individual ATTACH WELL LOG. A well log is required for all wells drilled since June t�7 Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewage Disposal 2_ /M Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. C. LIFT STATION Date installed ll Size in gallons Vent (Y/N) "Pump on" High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCF FPROM LIFT STATION TO: Well on On adjacent lots Manufacturer Manhole/Access off" Level at Surface water D. ABSORPTION FIELD DATA )SS &F Date installed �— Z� `8� Soil rating (GPD/Ft2)o23i`�— Pte`System type ('/ice Length 0 Width �$ Gravel thickness r Total depth Total absorption area 6ci St` Cleanout present �1 Depression over field (Y/dA �I c Date of adequacy test I 16 Results Oaa s/fail) Ns : for Bedrooms Water level in absorption field before test m 0 " /)/'/ After test Z Peroxide treatment (past 12 months) (Y/HCl Y "d'r 6000" If yes, give date )nj/* SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot AA On adjacent lots Property line To building foundation -t To existing or abandoned system on lot %U %( On adiar•.Pnt lots j� �-� Cutbank /Ii/A Water main/service line `J Surface water I )AA vW Driveway, parking/vehicle storage area Curtain drain / 614E- )mot-,-) E. ENGINEER'S CERTIFICATION I certify that 1 have checked, Signature Engineer's Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back to all MOA and HAA guidelines in effect on the date of this inspection. Waiver Fee Date of Payment Receipt Number