HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 3 LT 50
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GR"" ANCHORAGE AREA BOROU`
DtrAHIMENT OF ENVIRONMENTAL QUALITIr .
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
T
DISTANCE FROM WEL !]/
MATERIALL-GCi NUMBER OF
COMPARTMENTS
LIQUID CAPACITY �d �-h GALLONS. INSIDE N�G�T/H JTFG Cf5170e-
SIDE WIDTH I
NFk�/��•
RE
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH , LENGTH A19 ,DEPTH
6 ��� y�`(
CE/FROM WEIL ^- , BUILDING FOUNDATION,
LINING MATERIAL-- % A �G QQ
� nn
NEAREST LOT LINE 710 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SO. FT.
TI IN FIELD:
DISTANCE FROM
NUMBER OF LINES DISTANCE BETWEEN LINES
ABSORPTION AREA SO. FT. LENGTH OF EACH
NEAREST LOT
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL �/ DISTANCE FROM WATER
TILE -
TY DEPTH , BUILDING FOUNDATION. �� SAMPLE �- , NEAREST
K/
NEARES �/ SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINE-, TANK , SYSTEM CESSPOOL ,SOURCES
DISTANCES:
Pala 4116
fNS7.9��<
xvw-
DATE 5-7- %Z
u,�afe
1 G.A.A.B.
• GREAsr-r< ANCHORAGE AREA B0R,L,.3H
DEPARTMENT OF ENVIRONMENTAL QUALITY
5500 TUDOR ROAD POUCH 6.650
ANCHORAGE. ALASKA 99502
TELEPHONE 279-8666
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
PERMITNO,QCL ZV7 .
NAME OF APPLICANT - `��/� 1;rJUV!� Jy"'//JQ� /Cl ����
MAILING ADDRESS PHONE
INSTALLATION LOCATION / ��/� !/�C �/ / Z" -
LEGAL DESCRIPTION - ` n/- .I//�'fC
INSTALLATION OF: SEPTIC TANK " SEEPAGE PIT 4— DRAIN FIELD OTHER
l / /7 n
TYPE AND SIZE OF FACILITY TO BE
FINANCED THROUGH TO 6E INSTALLED BY/
SOIL TEST RESULTS !/1GJ-r_%/'!-'ljlJ NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE SEEPAGE �< <�/ SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK .s'
zn�
'
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT S>h/
DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK �, SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK Xn ' SEEPAGE PIT --/z'�p /
DRAIN FIELD ,
J r/ �)
SEPTIC TANK. �_ SEEPAGE PIT ��IL, DRAIN FIELD
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIS CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS. I
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUT/IOAITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.58 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE
r 1L-1 r -d I C_ I F' P`t_ I T Y !_i F tr-i r -d Q F-I;Zw;t 1 r E
DEPARTMENT r ..EALTH ANC? ENVIRONt7iLNTAL ' _ ECTI rll
• 825 'L' STREET, ANCHORAGE, AK. 99501
264-4720
4•aELL F'ER't•1 I T
PERMIT NO. C 780311 )
APPLICANT TACK EASTERDA'' PO BOX 826 EAGLE RIVER 8.94 2567
LOCATION CHrt a ut FC
LEGAL L5 ELK 2 EAGLE RIVER HTS LOT SIZE 0 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPO=AL SYSTEM IS
100 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'EF= h1 I T E:{F' I F_E=03 E?ECEr•1E:EF? _:A; 1{+;-
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR Ott -=ITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED
ISSUED
V?. 2
by
A R L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 vy~ a6 6
OWNEROF LAND J,g</e r il.r7''4'5.o/v Y
ADDRESS f% MIX kaC, 15 fccE /JE4
LEGAL DESCRIPTION D JtdC<E eJOC*_
DATE -Started Ended /
PERMIT NUMBER 7 �-b 3(/
KIND OF FORMATION:
DEPTH OF WELL
STATIC LEVEL OF WATER FT. /6-15
bl6UfiAW DOWN FT. cE
GALS. PER HR `f'o 0
KIND OF CASING 6 7F,),4
FromFt. to--L—Fl.
0045 /4ue0E�
Ft.
From
Ft. to
Ft.
FromFt. to S Ft.
Ft. to
From
Ft. to
Ft.
From Ft. to 4 4F Ft.-
_ H 1'7 "r
Lao UGOS"er
From
Ft. to
Ft.
From 4 r Ft. to 6-7 Ft.
SAS 0
e 4 e ev6r%
Ft. to
Ft
From (- 7 Ft. to _M6Ft.
Clyt f 46.9
✓ F[ 71" POU<0'
,,From
"Prom
Ft. to
Ft
From -79 Ft. to'tL Ft.
SAVO
From
Ft. to
Ft.
From 't h FL to Q Ft.
C<"a Y ,
6 CAu �-c
From
Ft. to
Ft.
From422 Ft. to/-�l Ff.
S14 G!Q-fx
l- W1E
c From
Ft. to
Ft.
From 124 Ft. to/5-3 Ff,
—1 bl
A, oFcsFrom
Ft. to
Ft.
From 53 Ft. toC_Ft.
<< "*y t
�P9✓E<
From
Ft. to
Ft.
From--L—(-'LFt. to 171 Ft. SS f/ V Cta✓cez 1 "J-4rX C From Ft.
From Ft. to Ft. From Ft.
From
Fl. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
MISCL. INFORMATION:
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft
DRILLERS NAM E i2, S'�
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,eff,4fj H. 85/7
NAME
L
PRONE EW
V
¢� ❑ UPGRADE
MAILIN ADD12 RES
_
D
LEGAL DESCRIPTION
3
✓ f
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well
Abs poor ar Dwelling
NO.
csY
.
2
W
Manufacturer
Material
No. of mpartments
N
1 capacity in gallns
OMEMADE:
Insitle length Width
Liquid cpth
Y
J02
DISTANCE TO: Well
Dwelling
O
Manufacturer
Material
Liquid c. ,acity in gallons
G
W =
Well
DISTANCE T0:
Foundation Nearest lot line
PEHMI O,
J LL ZNo.
Z W
of lines Length of each line
Total length rench width
Distance etvueen lines
~ H
Top or the to finish ade
Material beneath tila inches
Total eft ctive absorption area
0
inches
W
Length
9
Width
Depth
PER NO.
U
is. d
Crib diameter
Crib depth ve
oral affecti absorption area
Type of Crib
W
H
DISTANCE TO:
Wall
Building foundation Nearest lot line
J
Class Depth / 7
Driller
Distance to line
PERMIT NO.
W
,�
VV
Building foundation
F [�} qp(�F T a�
Sewer line
Se
Septic tank
Absorption ar Is
•
V
�r- - •UTH
rijtEMATERIALS
a E ''F
SDIL-TEST R� •
is
4
eiALLER" ""' � Vvo
REMA'1�K.ti r �' tiw
w
r,
N
-41
S}rC
5
.V
i
APPROVED
DATE LEGAL
72.nia 1R•,. 9171%
Lf
S. LE-lapE$CRIITION
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
•
825 L Sun t • Anchonea, AWIn S9E01
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 2644720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all pans on page 1.
Incomplete requests will not be Proceed. Pleste allow ten (10) days for processing.
1. OPERTY OWNERIf Al A
O �N
(LING ADDRESS
0.
qq5 1
PROPE—, RE IDENJ (if different from
PA
rZ.—BU
)
1A
PH E
'ATTACH WELL LOG. A well log is required for all wells drilled
-10
Ag -
since June 1975. For wells drilled prior to that date, give well
ER
%.
M w G AQ
p/}
'cI2�ox
�M
ENDING � TIT IOy_
HONE—
�J
7 / 733
MAILING ��'1 AODREff ss
'ft, At
4. REALIC AGENT
MA NG ADDRESS
4
Lf
S. LE-lapE$CRIITION
,
/4t/✓3
ETRE .LOCOCATIONON
0. TYPE OF RESIDENCE V
NUMBER OF BEDRuUmb
SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ MULTIPLE FAMILY
❑ Two ❑ Five
Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL'
'ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE"
"If individual/on-site, give installation date
❑ PUBLIC UTILITY
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
7241013/7R1
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED -
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
❑Septic Tank or ❑Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic /Holding ank
Absorption Area
Sewer Line
rest Lot ine
Absorption Area to nearest Lot Line
5. COMMENTS
❑ APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
72-01417ns) \ I U
MUNICIPALITY OF ANCHORAGE
\
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION,'
y\
1
ENVIRONMENTAL ENGINEERING DIVISION ;
825 L Street • Anchorage, Alaska 99501 Telephone 2844720'
`
CERTIFICATE OF INSPECTION
SEWER AND WATER FACILITIES
1. PROPERTY OWNER
C /i 1%k- s 7'
MAILING ADDRESS
Z,/ r
6 ill, o O Qp 9- C'Jill
2. LEGAL DESCRIPTION
7- S" �� ht� ' r�
13-
3. TYPE DWELLING
Yk SINGLE FAMILY RESIDENCE O OTHER (Describe)
O MULTIPLE FAMILY RESIDENCE
4. WATER SUPPLY
N/ \ INDIVIDUAL
• O
COMMUNITY/PUBLIC
5. SEWAGE DISPOSAL
X
INDIVIDUAL/ON-SITE
O
PUBLIC UTILITY
O
HOLDING TANK (Maintenance Required)
�[ APPROVED FOR BEDROOMS
/
13
CONDITIONAL APPROVAL (See Attached)
O
DISAPPROVED
I
DATE
Jill7?
BV ITITLE1�ry�.Koe+iry�r„Ty SPit'Yr ('P flIj/%N/7
t•{�
�-
72-01417ns) \ I U
Date - - -7;,
ALASKA"" 'ARTMENT OF HEALTH AND SOCIAL S-0^ES f
DIVISION OF PUBLIC HEALTH
Lab. No. - .. t"^' ( ;
BACTERIOLOGICAL- WATER ANALYSIS Office
PLEASE MAIL RESULTS TO:
NAME
ADDRESS 1 ^
CITY "' '..t._ i , ZIPCODE t*�5`; -)-J
r
le collected by a =t n f , I— No.Collected i- ,f-- 7 Time �:—tl`�
ing Address R71,
Specific place of collection L ��
REASON FOR SAMPLE SUBMISSION:
❑ Illness suspected
❑ health Regulated Establishment
❑Other (-Jlir
WATER SAMPLE SOURCE
Well Type of casing
❑ Improved (Enclosed, Covered) Spring
❑ Surface (Reservoir, stream, lake)
❑ holding Tank
❑ Other
Analysis shows this WATER SAMPLE to be:
LJ Satlsfactory
❑ Unsatisfactory
❑ Questionable ❑ submit other sample
❑ Sample too long in transit to indicate reliable results.
Sample should not be over 48 hours old at time of
examination.
❑ Bottle broken or leaked in transit.
❑ Other
SANITARIAN'S REMARKS
Sanitarian's Signature:
06.1220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
1 J
Date collected— S�.""
Source
READ INSTRUCTIONS�/g <�/78 a'm
Date Retalved Time Received 9 p.m. Lab. No.
Presumptive I I .— _ _
48 Hours
BEFORE Confirmatory
48 Hours ' _
EMBBroth 24 hour: Broth 48 hours:
Multiple Tube Report:- (1
CO Oml Tubes Posltive/Total lOml Portions
TIN SAMPLE Membrane Filter: Dlr«t Count
Verification: LTB BGB Coliform/10omi
Final Membrane Filter Results Collform/100mi
Reported BY Dater /A
Time•- i
P.M.
11�