HomeMy WebLinkAboutDONALD C SCHROEDER #3 UNIT 1 BLK 1 LT 2
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
IN,~PECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~ MATERIAL
LIQUID DEPTH_
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY / ~GALLONS.
SEPTIC TANK:
DISTANCE
FROM WELL /~-----) MANUFACTURER
INSIDE LENGTH ~ INSIDE WIDTH
NUMBER OF~I:H'~ / DIAMETER __ OR WIDTH__
LINING MATERIAL
BUILDING FOUNDATION__
CRIB SIZE: DIAMETER
/
NEAREST LOT LINE /~'
LENGTH3~, Ij;)E PTH
~" ~DIS~I' WELL /,/O' )
DEPTH ANCE FROM: ...
TOTAL EFFECTIVE
ABSORPTION AREA WALL AREA Q.
ADDITIONAL ABSORPTION
WELL:
TYPE
BU I LDI NG NEA REST NEA REST
FOUNDATION __, LOT LINE , SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
, TANK __ , SYSTEM
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
LOT SLOPE:
REMARKS: __
Form No. EQ-031
DIAGRAM OF SYSTEM
!
DATE
"~,//~--~ ,/~/'- APPROVED
PERM I T I'.,I0.
HPF'L.I CRNT I'"I'~'°RNA JOHNSTON
LOCRTION HAMMOND RVE
LEGRL L2 BiASCHROEDER _,U6D
Tg'PE OF :.OIL FIB_.ORB~ION Dbz. TErl IS' TRENCH
r,ll_ll,-,I I C: I F'AL I 1-%~" ,3JF Rf-IC:HOE:RGE.::
"" .....
DEF'RRTMENT OF HERLTH AND ENVIRONMENTAL FR. UTEbT]._N
· ]"., , ';
~.5:~.~il E. TUDOR RD.., ANCHORAGE.,
.~' r ~-. ~1
LOT
DI~.E
~.JL~3~Z~ _,L,!LIHRE FEET
MRX IMIJM NLME, EF.. OF BEDROOMS
SOIL RFITI NG
'- OF THE ~,UIL RB~ORFTION S'~STEM IS'
THE REQLI I RE[:, .-., I ZE ~ ~ ~" '"
E:, E] F"F H = 12 LE~Im3TH= ..:.~-='-~- 4 m3RA %.'EL E:, EP l" H =.:. '-'
'THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E×CAVRTION (IN FEET)·
THERE IS NO SET WIDTH FOR TRENCHES.
'THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OLITFALL PIPE
AND THE BOTTOM OF THE E×CAVRTION (IN FEET).
t(.'.E,]~lJ I E:E[:" SEF'T I C: TR~P..::--.~ I ZE= 1£'~£'~L~ GRL_L. CI~-~=::..~-
E,H~2.KFILLINI2i OF RN'~' :,Y=,TEi'I WITHOUT FINRL INSPECTION AND AFFF..C~RL E,Y THIS
DEPFIRTr'IENT WILL BE :,UBJECT TO PRO:,EL. LIT IC, I',I.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTAL. LATION.
PERt-1 :I. 'T '-..'RLI [:, FOR C,I'-.IE 'T'ERR FR,-,r~ I
I CERTIFY THRT
1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH B~' THE MUNICIPBLIT'Y' OF ANCHORAGE.
2: I WILL INSTALL THE S~'STEM IN ACCORDANCE WITH THE CODES.
3:: I UNDERSTAND THAT THE ON-SITE SEWER SD'STEM MFI'Y' REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN _~: BEDROOMS.
c;I GNE[:''
2204 Cleveland Ancho. rage, Alaska 99503
Lenal Qescr~Dtlon:/ [ot~Block / Subdivis,on Jc~~r ~
Th~s ~o~m Re~o~ts So, Is Lo~ ...... Pe~'C°]atio. Test
~e,th
Feet ..... Soil Characteristics
8--
14--
16--
20~
Was Ground Water Encountered?_.~) d'/~oe
I~ Yes, At what Denth?
J Readinq Da'to Gross Time Net Time Depth to H20 Net Dron
i .,'.1 ......... ~,~
~ m m ~/V~ ....... I' Im m i,, ~mm+/~ ' 0 ' m I
., ........... ,, ... o, ...... ~'~1,.I. .
' " .., ~ c:) y./~ ~'/+""~/,i "
" .... ~0 # . , ~a "
I ..... . f~ ', "~ %4" '
Percolation Rate /.q'//~/Hinute~
Proposed Instal la't-idn: Seenaae Pit Drain Field
Den. th of ..... Inlet Denth To Bottom Of Pit 0~' Trench
CAU~'ENTS: ~ --
Test Performed
Bye_ Data
Certified BY:~ . Date
Well Owner.
Location
~vl-W DRILLING, Inc.
P. O. Box 4-1224 · 1310C International Airport Road
(907) 274-461!
ANCHORAGE, ALASKA 99509
DRILLING, LOG
};,ob i~rn
Use of Well
(address of: Township, Range, Section, if known; or distance main road
L2, glk 1, ,.c rocker Subdiv. No..3
Size of casing. 6 Depth of Hole
Static water level 20 ft. (~l~'~)
Screen ( ); Perforated (
150 feet Cased to 23.5 feet
Describe screen or perforation,
Well pumping test at ~ gallons per of drawdown from static level;
Date of completion
Depth in feet from
ground surface
.TO 21
.TO 150
.TO
.TO
.TO
.TO
TO
~TO.
.TO.
.TO.
.TO.
.TO.
__.TO.
.TO
.TO.
(below) land surface.
).
None
Finish of well (check one)
open end ( ;:~ );
(minute) for 1 hours with
WELL LOG
Give~elails of formations penetrated, size of material, color and hardness
)Ie Gravel~ silty
Med~ock~ gray, common quartz strinoers, water
common fractures
2 -- STATE
tV1-W DRILLING, Inc.
P. O. Box 4-1224 · 1310C International Airport Road
(907) 274-461 ]
ANCHORAGE, ALASKA 99509
Well Owner
Bob Horn
DRILLING LOG
Use of Well
Dom
Location
(address of: Township, Range, Section, if known; or distance main road
L2, Blk 1, Schroeder Subdiv. No. 3
Size of casing 6
Static water level
Screen ( ); Perforated ( · ,).
Describe screen or perforation .
Well pumping test at 3 gallons per (~)
of drawdown from static level.
Date of completion 16 J.l_v 1975,~ ;:"
Depth of H01eL 150 . feet Cased to 23.5 ~eet
20 ft. (~) (below) land surface. Finish of well (check one)
None
(minute) for ] hours with
open end (
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
21 Cobble 'Gravel: silty
x );
0 TO,
21 ,TO 150
TO
TO
TO,
TO
TO
TO
TO
____TO
.... TO
TO
TO
~O
,TO
Bedrock:'
gray, common quartz stringers~ water
common fractures
seaps
lq;%%VA,,Certified Con~mctor
. Cer~i£ica~,e No's. 814 ~ 973
1 - CUSTOMER
MUNICIPALITY OF ANCHORAGE·
DEPARTMENT OF HEAl'TH & HUMAN SERVICES_
. .~' .~ Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage,Alaska 99519-6650
343-4744
Parcel I.D. # ~)~)-"/-Jr~ ~_O~,
1. GENERAL INFORMATION
complete legal description
.... CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Lot ~; ~ZoCb.:r~l'? ~)rfi*'~d e~ ~_~e_o~_~e~_ ~,,~,,~;,,;.;,, #$
Location (site address or directions)
Property owner
Mailing address
'HC$8
NHN Hammond
~ Sh~r/lyn Ka~kow~/zi
Box I 610 Eagle. River, AK
Lending agency
,Mailing address
Agent Bob ~ombold, t/ REMAX OF EAGLE RZ[/ER
Address 16600 C~i~d
Unless othe~ise requested, H~ will be held for pickup.
AK
Day phone
99577
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well XY, X
CommUnity well
PbbliCWater
NOTE:
Day phone
Day phone
'AK
99~77
If comm~u'n~'weii SYstem, provide Wri~ten co-nfirmati°n from Sta'~"~bEc ~ttest-
.................. lng to the legality and status of system. : .........
-~ .. <- - :<... .... ..~ ....
4. '~.TYPE OF WAsTEWATER DISPOSAL: .........................:'":
· -;' Individual on-site
.~:..~,~:-~ ~.~.,- ,;i~'.'. .~,::.:::~;?Public sewer~
STATEMENT ,OF INSPECTION BY ENGINEER
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 apPlication shows that the 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. ! 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 S & $ EN~.~,!..,., ....... Phone ~ ~/'/' - ~.c./7 ~
17034 Et,' ,. '
6. DHHS SIGNATURE ~
X ....... Approved fOr~ '~ ..... bedrooms.' '' ·
Disapproved.
Conditional approval for
I~adrooms, with the following stipulations:
Additional Comments
Department of Health and Human Services (DHHS) issues Health Authority
,based only upon the rePresentations given in paragraph 5 above by an independent
in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
~ns in order to satisfy certain federal and state requirements. Employees of DHHS do not
before a certificate is )ssued.~',The MtJnicipalitY:'of Ancha~ge is not
._. inthe professional engi~i~i;'s'work:~%~q~:~::~ ~.,7:'!:~.i, "i".:'-'-!~':;'. :."
for errors oromissions
· '<.:,(~,:~,'~.~,.'~¢a~'~._'.~ ' *:?:'~:. ?~ ':, ..' .~ ~;~4" ¢...' , . ~-*¥74;,'¢".{;h'-, . .. :- :,',.~:?.'C~'~e. ?:.. ,. * - ~.%..t<.'~t~.: , ' :'; ?"~,~C-' ~.:.~. ;',U;'.~ -..
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:~-~-~
A. Well Data
Well type
Log presenl~)
If A, B, or C, attach ADEC letter. ADEC water system number.
Date completed -'/- t ~-..~..."/=5. Driller ~
Total depth
Sanitary seal ~N) ,,-/
Date of test
Static water level
Well flow
Pump level1
Cased to
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
'7-'5 ,%-. F-~.C-_ '
Wires properly protected ~1)
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots
Casing height
Z
Public sewer manhole/cleanout
Petroleum tank
Coliform ~
Date of sample: \o..-~-~'
Nitrate
~ ,~,~ Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
Cieanouts (~N) ,,./
High water alarm ('~l~
Date of pumping
,Tank size J~ ~ ~ Compartments
Foundation cleanout (Y~ ~ Depression ,(Y~
Alarm tested (Y/N) ~ [*
~"~ -"~ ~ Pumper ~"~F--. ~r--S,st~o
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~' ~ ~ ' On adjacent lots ~,~c~ t'~ Foundation
To property line \o~ ~' Absorption field. (~ ~ Water main/service line
Surface water/drainage ~ ~ o
72-026 (3/93)° Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer
Vent (Y/N) "Pump on" level at
High water alarm level .~'"'"~,~'~ycles tested
Meets MOA electrical codes (Y/N) ~
SEPARATION-'PARA~D E FROM LIFT STATION TO:
We [-'t~-~ ~t On adjacent lots
Manhole/Access (Y/N)
Su dace water
O. ABSORPTION FIELD DATA
Date installed '7 "1 ~
Length '~ L~'
Total absorption ama
Date of adequacy test
Soil rating (GPD/FF)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
System type -T"t.-~,-L ~-~
Width '5~ Gravel thickness
5' ?L~ ~; Cleanout present(~/N)
\ ~-~ ~' -' ct ~( Results~il)
,9, ~ Total depth
Depression over field
for
After test -~ L~
If yes, give date
Bedrooms
Well on lot
To building foundation
On adjacent lots
Sudace water
Curtain drain
On adjacent lots I, ,--~ ~ Property line
To existing or abandoned system on lot
Cutbank ~1 ~-. Water main/service line
Driveway, parking/Vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspec¢on.
Signature
Engineer's Name
Date II
HM Fee $ ~.~00, OO
Date of Payment (( ...~_. ~ c~
Receipt Number
f~
ik.cO
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
SINCE
CT&E Ref. #
Client Sample ID
Matrix
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~'~'~',4,~,~'~'~'~'J~'~',~'~'f~-~'~-~J~JJ~JfJJ~JJ~
94.53s3-~ LABORATORY ANALYSIS REPORT
L2 BLK1 DONALD C. SCHROEDER S/D #3
WATER
Client Name S & S ENGINEERING WORK Order 10208
Ordered By BOB Printed Date 10/21/94 @ 11:41 hrs.
Project Name Collected Date 10/18/94 @ 12:00 hrs.
Project# Received Date 10/19/94 @ 09:00 hrs.
PWSID UA
Technical Director
STEPHEN C. EDE
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 10/19/94 MCE
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
'.U = Undetected, Rep0~ted value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
5633 S Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
COMMERCIAL TESTING & ENGINEER[NGCO.
ENVIRONMENTAL LABORATORY SERVICES
Drinking Water 'Analysis Report for Total Coliform Bacteria ~xv ZNSrRvCrZONS ON RS~S Sn>S Bsroe~ cozr.~crma
MUST BE COMPLEFED BY WATER SUPPLIER TO BE COMPLBTED BY LABORATORY
PUBLIC WATER SYSTEM LD. it
PRIVATE WATER SYSTEM
Ul Send Re~ub.s [] Send Invoice
Company N~m¢ ~n~ct
Year
[] Treated Water
[] Untreated Water
SAN(PLE DATE:
Month Da)'
SAMPLE TYPE:
.t5" Routine
'~d_N Repeat Sample (for_, r, utble,sa~mvle
with tab reft no. °/ ¢. g- ~0 d' 3~
n Special Purpose
Time Collected
Sga'v~ LE LOCATION Collected By
5633 B STREET
ANCHORAGE, AK .%a518
TEL: (907) 562.23,~3
FAX: (.a07) 55~.5301
Analysis shows tY, is Water SAMPLE to be:
/d~ Satisfacto .ry
[3 Unsatisfactory
[] Sample Over 30 hours old, results may
be unreliable
[3 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.
!
D ate Received t,e/'7,,6
Time Received
Analysis Began
Analytical Method: ,12-"Membrane Filter
* Number of colonies/100 ml.
/
Lab Ref. No. Result* AnaJ~yst
/
Sent to .4~lJ. r,.~..
Fbks
Jun
CHent notified o£ unsafisfacto~' results:
Phoned Spoke ~ith
Date: Time:
Faxed
Faxed
BACTERIOLOGICAL WATER ANALYSIS RECOI:tD
Comments;
N~MO-MUG Result: Total Coliform
Membrane Filter: Direct Count
Verification: LTB
Fecal Coliform Confirmation
Final Membrane Filter Results A
E. Coli
BGB COL[FII~M
Colonies/100 ml
Coliforaff100 ml
r~ate ..... f o . ~-?- ~ ~ Time
TATC ~ Too A'ume. rous To Count
.. -'OB = Oth~ B~eda
ENVIRONMENTAL SERVICES IN ALASKA. COLORADO. UTAH. ILLINOIS. OHIO. MARYLAND. WEST VIRGINIA, NEW JERSEY. SOUTH CAROLINA
Rick Mystrom,
Mayor
Mtmi ipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
November 29, 1994
Mr. Robert W. Cowan
S & S Engineering
17034 Eagle River Loop Road, Suite 204
Eagle River, AK 99577
Subject: Waiver Request for: Lot 2, Block 1, Donald C. Schroeder Subdivision #3
Waiver Approval: # WR940062
Dear Mr. Cowan:
Your request for waiver(s) of the required 100 foot horizontal separation of a
septic system to a private well has been approved. The approved separation
distance(s) are:
Well to Septic Tank 91 feet
This waiver approval applies to the existing septic system to well separation
only. Any future upgrades to either will require all separation distances be met
or another approval be obtained from this department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Services
kb
MUNICIPALITY OF ANCHORAG~
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR9 WR940062 PID~ 050-481-06 HA9 HA940594 Permit #
Date Received: 11-02-94
Legal Description: Lt 2, Blk 1, Donald C. Schroeder Subdivision #3
Engineer: S & S Engineering
17034 Eagle River Loop, Suite #204
Eaqle River, AK 99577
Mel Kalkowski
Applicant:
Waiver Requested:
Well to septic tank - 91 feet
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: ~£~ ~~6~
Date: //- ~9- q~ By: p~/~ ~ 0r/~
Name of Reviewer
Rec #: Fee Waived Amount: $ Date Paid:
x' =.1~-'/' 2
Z~
October 28, 1994
Municipality of Anchorage
.EALTHAUTHORI~ DEPARTMENT OF HEALTH AND HUMAN SERVICES
APPROVALS 825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERT SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
A risk analysis was performed using the State of Alaska,
Department of Environmental Conservation's Separation
Distance Waiver Guidelines. Our results are as follows:
A. WATER TABLE:
From the well log, we can see that the well depth is
150 ft. From the well flow test performed on January 21,
1994, we see the static water level to be at 56 ft. Using 56
ft as the aquifer water table:
= 5.4 pts.
B. SOIL SORPTION:
From the soils log used in the design of the septic
system the receiving soils for the septic system are silty
sandy gravel. From the well log there appears to silty
gravel to 21 ft. with bedrock extending down to the bottom
of the well.
= 2.7 pts.
C. PERMEABILITY:
With the soils as described above use "silty gravel
with bedrock"
= 1.5 pts.
D. WATER TABLE GRADIENT:
With the static water level in the well to be 56
ft. and with the well to be approximately 20 ft. up hill from
the septic tank, the hydraulic gradient is approximately 0% to
-5%.
E. HORIZONTAL SEPARATION:
The horizontal separation
septic tank and the well is at 91 ft.
distance
TOTAL POINTS = 15.1 PTS.
= 2.9 pts.
between the
= 2.6 pts.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Request you issue a Health Authority Approval on the
referenced property and grant a waiver for the horizontal
separation distance between the septic tank and the well
serving this property at 91 ft.
REFERENCE: Lot 2 Block 1 Donald C Schroeder Subdivision #3
Page 2
October 28, 1994
Lot 2 Block 1 Donald C Schroeder Subdivision #3
Since the septic tank does not normally allow effluent to
reach the soils prior to reaching the absorption area, the
probability of contaminating the soils at less than 100 ft.
to the well is mitigated by the steel tank.
Nitrate levels measured at 0.10 mg/1 and satisfactory
bacteriological water analysis show no indication of
contamination even after 18 years of septic system and well
use.
In going from the well to the septic tank the ground slopes
away from the well.
The house is located between the septic tank and well. This
would alleviate any surface overflow from the septic tank
from reaching the well.
In our opinion, the separation distance requirement
prescribed by iSAAC.021 is not necessary in this case.
If we may be of further service please contact us.
Sincerely,
~ S-hafe~
~g~~n~~ian
Robert C. Cowan, P.E.
I
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HEALTH AUTHORITY
APPROVALS
8EWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
~:)IL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESK~N
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
Ti'RL[, FLOW TBBT I)A~A
CIVIL ENGINEERS
(9O7) 694-2W0
FAX 694-12~ 1
CASINO DEPTHs '~.,"~,~'~-, TESTED BY, ....
DATE DRILLING COMPLETEDs T-It,-' '~ DRZL/~ERt J'~ - ~
TRBT DATAt
CLOCK DEPTH %~0 DRAWDOWN I~U~I~ZNG ~
TXHE WATHR ,.RA'~ (GL:'M) ........, ,
'A " ,
,1~ ~' ~' ~ .......
,m~o~ ..~g~ .... ~' ~-.o ~ OF ~, ,
_~ ~ ~ ~ ~ ¥ ~% ROBERT C. COWAN ~ ~ ~
. ' ",%'t ............. '
~,~.,
MISC. DATAz CASING HEIGHT~_%~t~'' SANITARY SEAL?I ~
WIRES IN CONDUXT?~__~.___ GRADING O.K.?s _
BACTERIA & NITRATE ~M~PLES COLLECTED~ / '
~SOLTS~ t~ELL COIkRENTLY PRODOCES ~,O OPM WXTH.A ~ ~
DRA~
PLOW RATE HOT GUARANTERD--SOBSEQOENT VARIATIONS ~N OCCURI
17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99571
~ ~ .... ' ' DATE RECEIVED
· ~ ~ INSPECTION APPOINTMENTS
TIME .~'"' TIME TIME(~,_~ ~'J~~ ~~'
OATE ' DATE DATE
"INSPECTOR INSPECTOR "~
INSPECTOR
MUNICIPALITY OF ANCHORAGE
i DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
826 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
'1. PROPERTY OWNER ....~ PHONE
Wayne T. and Carolyn K. Gaylq,r , , , I 694-9637
MAILING ADDRESS
~ In Transit
PROPERTY RESIDENT (If different from ,;bove) PHONEr
NHN Hammond - Hasle River Road~ Mile 5
' PHONE
2. BUYER
Melvin P. Kalkowski and Sharilyn T. Mumaw 243-6615
MAILING ADDRESS '
3511 Tanglewood Place, Anchorage, Alaska 99505
3.' LENDING INSTITUTION [ PHONE
First ~National Bank of Anchorage [ 276-6300
I~IAII' I'NG ADDRESS -
, Box 4-8 Anchorage, Alaska 99509 Attn: Cathy G,ust
4. REALTOR/AGENT
PHONE'
Dynamic Rea.lty, .Inc,. Susan Gallion [ 694-4160
MAI LING ADDRESS .'-
P.O. Box 681, Eagle River, Alaska. 99577 ,
5. LEGAL DE~I~RIPTION ~ ' ~
Lot 2 Block 1 Donald C. Schroeder Subdivision #3 Unit #1
STREET LOCATION
Eagle River Road, Mile 5 (Hammond Avenue)
6. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
[] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8.' SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
[] Three -FI Six
[] Other
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
· YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-01D (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: J~::X~ If Tank is homemade
give dimensions:
[] ONE
[] TWO
PERMIT NUMBER
NUMBER OF BEDROOMS
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
[] THREE [] FIVE
[] FOUR [] SiX
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
MATERIAL
Septic/Holding Tank IAbsorption Area
[] OTHER
Sewer Line
INearest Lot Line
5. COMMENTS
~. APPROVED FOR ~-~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
BY
72-010 (Rev. 6/79)
EXCAVATION
ROBERT A. SHAFER
WORK
August 15, 1982
CIVIL ENGINEER
694-2979
Thomas Gaylor
c/o Dynamic Realty
ATTENTION: Sue Gallion
Eagle River, Alaska 99577
Dear Mr. Gaylor,
MUNICIPALITY OF ANCHORAGE
ENVIK ,,l,L ~,A. '. ,O ~ ;;..4
1982
RECEIVED
Reference:
Lot 2: Block il Donald C Schroeder No. 3~
Unit %1
A sewer system adequacy test was performed on the system
located on the referenced property as you requested. The
septic tank was pumped and verified~ have a capacity of
1000 gallons. The absorption trench was tested by a continuous
flow of water over a period of 72 hours without any adverse
effect on the system.
It can be concluded from this test that the waste wa%er
disposal ~ystem serving the three bedroom residence located
on this property is currently functioning adequately. However
the system cannot be guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to
call.
Ms/ss
cc: First National Bank of Anchorage
Northern Lights Branch
Municipality of Anchorage
Department of Health and Environmental ProtectJDn
SRB 196X EAGLE RIVER, ALASKA
CHEMICAL & G1
LOGICAL LABORATORIES
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
TELEPHONE (907)-279.4014
274-3364
ALASKA, INC.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D, NO.
Water System Name ~ ~ Phone No,
Mailing Address
City ~ State
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no..
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1
3 I
. I
I
LOCATION
I
I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[:~a~isfactory
[] U:nsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sampe
Date Received
Time Reoeived /' ,~
Analytical Method:
Fermentation Tube
[~Membrane Filter
lab Ref. No. Result* Analyst
/ I,/ . ~ ...'/'~,
I//,/ . F'-]7]: '"'
FT-I
,,,~ I-T-1
, I I-]-]
06-1220
Rev. 197e
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date Collected Source.
Date Received Time Recelve(I __ D.m. Lab. No.
Presumptive 1Omi 10mi 1Omi !0mi 10,mi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
,48 Hours
EMB
Multiple Tube Report:
Membrane Filter: DireCt Count
Verification: I.TB
Final Membrane Filter ResUltr~
Reported By
Broth 24 hours:
Broth 48 hours:
10mi Tubes Positive/Total 10mi Portions
Collform/100ml
BGB
Date
Collform/100ml
, Time:, a.m.
p,m,
July 28, 1982
Wayne T. and Carolyn K. Gaylor
c/o Dynamic Realty, Inc. ~
Susan Gallion
P.O. Box 68].
Eagle River, AK 99577
Subject: Lot 2 Block 1
~3 Unit $1
Donald C. Schroeder Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
~~iO~--" Exposed electrical wires to the well head are in violation
~-- of~ the ~4unici.. pality of Anchorage. _.. codes and must be encased
~-~~. n~~ conduit. '
%~~~water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for o]r review.
o The septic tank pumped with a receipt submitted to this
O~J department.
An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system is
~adecuate, . .~ accordinq, to ~ational Standards. A listing of
private firms performing the test is enclosed. This report
meeds to be submitted, to this office for our review.
Please notify -this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Robert C. Pratt
Associate Environmental Specialist
RP174/D/EH
Enclosure
POST OF'I~IC£ BOX 433
EAGLE: RIVER, ALASKA 99577
~~PHONE 694-9202
N°_ 5687
CUSTOMER'S O~DER NO. LOCATION PREVIOUS BALANCE
RENTAL OF- .CHEMICAL TOILET UNITS
MONTH OF. ., I
Carry4ng Char~ Past Due Accounts
~ ' THIS SIDE.. FOR OFFICIAL USE ONLY'.
' INSPECTION APPOINTMENTS '- , ' ~ ~ ' . ' .
'DATE '" " - DATE ' · '- -' DATE
NSPECTOR - .- - ~; ~, f ~". I NSP~TOR INSPECTOR
DIRECTIONS: ,
' ~"' ~.1 F . " I ~ ~ , ~ ,~ ,,, , .... ~ ~ ~ , ,, , ,,,
'1. T~E oF-RESIDENcE ' ~ ' -. ' NUMBER OFBEDROOMS
~ 'SlNGLEFAMILY ' ~ ONE ' ~ 'THREE . '. ~ FiVE ._~- OTHBR-';,
~ . MULTIPLE FAMILY ~ TWO ~ FOUR ~ SIX
2
.~ INDIVIDUAL - DEPTH OF WELL - .- . _ ~ 2"
~ 'COMMUNITY ' ' .
- - : DATE DRILLED ', .~
~ PUBLIC UTILITY
Connection Verified ~ . LOG RECEIVED i ~ ' '
3~ S~E DISPOSAL SYSTEM PERMIT_NUMaER -
~ INDIVIDUAL/ON -SITE DATE INSTALLED
· Pu uc UT -UTV
Connection Verified ~ , INSTALLER '__ ' '
Size: ~ If Tank ishomemade SOiLS RATiNG ~' ' - ,
g ve dim~ns ohs'
.,- ...... . , ,
TYPE OF TANK ........ , MANU'FACTURER ~. '
TOTAL ABsoRPTION AREA ' ' MATERIAL '
4 DISTAN S ~ Septic/Holding,~ank- Ab~rption Area Sewer Line' Ne~r~st Lot Line
'-~'~'' 'WELLTO: ' ' I I ' I ' -': - ~
Absorpti6n- Araa to ~eacelt Lot Line - ·
I r , ~ r
~ CONDITIONAL APPROVAL {letter must accompany certificate) - ' -
~ DISAPPROVED~ ~ ~~~
LEGAL DESCRIPTION. -' ~' '
'\
'.
_ 72-010 (Rev. 3/78) ,.
c..EmC & .EOLOe CA L,.dOK, a'ORF.8 OF mCr.
P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE~OMPLETED BY WATER SUPPLIER
Zip Code
PUBLIC WATER SYSTEM:
Public Witer System Nnmo
M~ll~ddr~$~
City (~j~ ~ ~' State
Mo. Day, Year
[] Treated Water
[] Untreated Water
Time Collected
Collected By
TELEPHONE
(~07) 279-4014
TO BE COMPLETED BY LABOR~TORy'
LABORATORY:
NAME /
CITY
Date Received
Time Received
Analytical Method:
A~t
[] Fermentation Tube
~, Membrane Filter
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
SAMPLE
NO.
4
5
Lab Ref. No. Result*
* No. of colonies 1100 mi. or No. of Poalflve portions.
06-1220 (b)
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18-310 (3-78)
Date Collected Source
Date Recelve(~ Time Received. p.m. Lab. No.
Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.3mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours ~
EMB Broth 24 hours:
Multiple Tube Report:
Membrane Filter: Direct Count
Verlflcat Ion: LTB
Final Mom bra n~__~er~_as~t s ,,~
Reported By ~'-~'"'"~"~"
.Broth 48 hours:
10mi Tubes Positive/Total 10mi Portions
Collform/100ml
BBB
Collform/lO0ml
T,me: / 5'0-O , ,.~.
Page 2 of two pages - Req,~ ,t for Approval of Individual S
Legal Description Lot 2 Block 1 Schroeder $3
Water Facilities
Comments
Approve~. ~.~'~~Disapproved, Date~-.2~~
/)
Approval ~a~id for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I 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)
'1.
Municipality of Anchorage
Environmental Protection
825 L S~reet
Anchorage, Alaska 99501
'REQUEST FOR APP2OVAL OF
'INDIVIDUAL SEWER & WATE, R' FACILITIES
Type of InSpection: .CHRO'
VA FHA
Prope'rty Owner:
Nailing Address:
February 9, 1977
MUNICIPALITY OF ANCHOR.AIDE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION'
FEI ' 0 1977
RE_CEIVED.
CONV x
William E. and Myrna E. Johnston
P. O. Box 334
Eagle River, A~aska ~9577 Da.y Phone 694-9766
.l
Name of Buyer: Frank J..and Evelyn M. MacHovec
Mai ] ing Address: None Da j/ Phone
~lame of Lending 'Institution:
South Center Branch Attn: Jayme Smith .'
Mailing Address: P. o. Box 4-2090' Phone 274-1521
Anchorage, Alaska 99509
Name of Rea]t0r 'or Agent: .MyrnaJohnston, AREA, Inc. Realtors
P..0..Box 334
Mailing' Address: Eagle River, Alaska 995.7~hone 694-9555
The First National Bank of Anchorage
6;. Legal Description:'
Donald C. Schroeder ~3.,. UDit ~1 B 1, L 2
Location: ...Mile 5.1,~'Eagle River,Road
Hammond. AvenUe, Green Ranch.. on left.
(Agent. has key,
Contact fOr access.!
e
.Type of Facility to be inspect'ed:
~later Supply'.· ,
Type Of SUpply: PuSli'c Utility'
Sinqle Famil~.y N0. Bdfms. 3
IndiVidual x
If' Individual,'number of dwelli'ngs, pre'~ently .served
If Individual, depth of well 150,
Sewage Disposal'SYstem
Type .of S~st'em: Public Utility.
Individual (on-site) x
................. I.f. Indiv'idual., date of installation
June 1976
.gle River Area
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received February 10, 1977
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by:
Office Bez 4-20q0
Mailing Address: Pest
Time of Inspection
Date of Inspection
Conv.
9q~09
Phone: 274-1521
2. Property Owner: William E/Myrna E. Johnston
Phone: 694-9766
Mailing Address: Post Office Box 334, 99577
3. Legal Description: Lot 2 Block 1 Schroeder Subdivision #3
4. Location: Mile 5.1 Eagle River Road, Hammond Avenue, green ranch
' on l~tt
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data:
A. Type Individual B. Depth 150'
C. Construction
D. Bacterial Analysis
7. Sewage Disposal System: On-site system, Permit 76347
A. Installed 1976 B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8, Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines .. ,
Nearest lot line
, Other contamination
B. Foundation to septic tank
., Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
06-1220(a) Rev. 1973
DATE
ALAS~,.. DEPARTMENT OF HEALTH AND SOCIAL. S~ ~.ES. -~
DIVISION OF PUBLIC HEALTH Lab No,
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS or ,cE
INDIVIDUAL []
NAME
ADDRESS
SEMI-PUBLIC [] CHLORINE, RESIDUAL PPM
REPORT RESULTS TO
CITY ZiP CODE
ADDRESS
OF SOURCE
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
Sample Collected From ~Kitchen Tap [] Bathroom Tap [] Basement Tap
[] Other (Ust) ..~
Well-- [] Dug [] Driven [] Drilled
SOURCE: [] Spring [] Cistern [] Other
Dug Well or Cistern Construction:
Walls-- [] Wood[] Concrete ~
Top -- [] Wood [] ]
Concrete BMetaIMetal
LOCATION:
[] In Basement ,?1-1 Basement Offset
I--lin Yard [] Other
Building Sewer
DISTANCE TO: or Other Drainage Pipe
Tile Seepage Cess-
Field Feet~ Pit_ Feet. Pool
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- [] Cast Iron [] Woad [] Tile
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored?
[] Bored
~, .~p,eTile Brick or
n :TOP [] Concrete
[] Under House
Septic
Feet. Tank Feet,
Feet. Privy. F e'e~:
[] Fibre [] Asbestos
Cement
[] Yes [] No
When?
Diameter of Well Depth
Well Casing
Material Diameter . D e p~t.?
Length of Water Depth .~
Drop Pipe From Bottom
Offset in
PUMP LOCATION: [] In Wel [] B~sement [] In Basement
On Top
[] Of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected? [] Yes
New Source of Supply? [] Yes [] No Repairs to System?
Feet.
Feet.
In Utility
[] Room ~
[] No
[] Yes [] No~ Signature __
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
Analysis shows this Water SAMPLE to be:
[~'~Satisfactory
~ Unsatisfactory
[] Questionable
r-i~Sample toe long in transit; sample should not be over 48
hours old at examination to indicate reliable results. Please
send new sample.
[] Bottle broken !in transit, please send new sample.
SANITARIAN'S REMARKS
o6-I~'~o (bi BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973~ -.~
Date Received -.' ~~~/~': ? Time Recelved pm Lab. No.
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc
24 Hours '.
48 Hours
Brilliant Green " ~.~.
24 Hours
48 Hours
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs. Gram's stain
Coliform Density (Most probable No. per 100cc)
MF Results
Reported by
This analysis indicates Coliform Organisms to be:
'~bsent --~?
Present
~ / . · .,,' DATE ANSWER
TO: DEPARTMENT: ~~? REQUESTED:
REQUESTED ACTION SCHEDULE
:~ PREPARE BACK-UP ~FOR~AT~O~
FOR IMMEDIATE ACTION ~ CALL ME BEFORE YOU ANSWER
FOR YOUR CONSIDERATION ~ NEED YOUR RECOMMENDATION
OTHER
FROM:
GREATER ANCHORAGE AREA
BOROUGH
TO:
! DATE ANSWER
DEPARTMENT: ~.. ~./~.,~ REQUESTED:
REQUESTED ACTION SCHEDULE
FOR IMMEDIATE ACTION ~ CALL ME BEFORE YOU ANSWER
~ NEED YOUR RECOMMENDATION
FOR YOUR CONSIDERATION
OTHER
SIGNATURE
H~,~.~ .~
GRE RANCHORAGE AREA BOROUG _
INITIATED BY: ~.
~ / _ DATE ANSWER
TO: DEPARTMENT: ..... ~.~..~~/..,,~ ........ : ....................................................... REQUESTED:
REQUESTED ACTION SCHEDULE
FOR I~EDIATE ACTION ~ CALL ~E BEFORE YO.U ANSWER
FOR YOUR CONSIDERATION ~ NEED YOUR RECOmmENDATION
.
~ . .
SIGNATURE
SIGNATURE