HomeMy WebLinkAboutFOX HILL BLK 3 LT 5o' 3
NAME -
LEGAL DESCRIPTION
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
LOCATION NO. OF BEDROOMS.,~
WeP, /~1~13 /' Ab$orpt'on ar I Dwelling ~ //?L. PERMIT NO.
~ DISTANCE TO: I~~ . ~- ~'~
~-~ Manufactur~ , M ~' ~
v, Liq.¢~it~ ~n gallons ......... I Inside length
I /~/~/~ I .......... ADE: Liquid depth
~(9~ I DISTANCE TO' Iwell [ IDwelling PERMIT NO.
~ I - ]~ell ¢ Foundation
~ I DISTANCE TO: / __ I Nearest lot line PERMIT NO.
~ J No. oflines / L~t~¢~ Total length of lines Trench widthinches Distance between lines
~~rade / Material beneath tile Total effective absorptioa area
inches
Eeng~h ~ ~ Widtl~ ~ --~ I Demth/ / /F /'
~ ~1 ~ ~ ]~ ~. ~//;~ ~F~L,.~ PERMITNO.
<~k~/. I Typeof crib Cribdia,~ ~ribdepth Total effectiveab~/~i~ear~
'
~ Well /-, /:~ / '~ Buildi~undat~
X DISTANCE TO: /Z- ~ ' /~ .-- Nearest Io, line~
- '~ Class ~ De~th [ IDr ~r
~ I ~ ~ ~ ,~ '~ / V~ ~ I Distance to lot Pine PERMIT NO.
~ DISTANCE TO Building foundation ~ Sewer line Septic tank Absorption area(s)
/
OTHER
PIPE MATERIALS
SOl L TEST RAT~G_G._ ~.~. /
REMARKS ~ ~ ,
ROBERT A. SHAFER
January 5, 1984
CIVIL ENGINEER
694-2979
ADEQUACY TEST
WATER AND SEWER INSPECTION
WELL INSPECTIONS AND
FLOW TEST
SITE PLANS
ROAD DESIGH
SOIL TEST
ON SITE WASTE WATER
DISPOSAL SYSTE~,4 DESIGN
EXCAVATION WORK
Ralph Schuchman
127 Chickaloon
Eagle River, Alaska
99577
MUN[CIPALITY OF ANCHORAGE
9
Dear Hro Schuchman,
REFERENCE: Lot 5: Foxhill Subdivision
A water and well inspection was performed on the referenced property,
as you requested. The well. was examined and found to be equipped with
an adequate sanitary seal and all wires were in conduit as required
by Municipal code. The ground around the well casing was adequately
sloped away from the well. At the same time this inspection was performed
a water sample was taken from the hose bib Qn the front of the house
and submitted to Chemical and Geological Laboratories of Alaska for
coliform bacterial analysis. The results of this test were satisfactory.
If we may be of further service to you, please do not hesitate to
/cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE
~ Health and Environmenta' ~rotection
Department
825 ~ Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT
Permit ~ /~.~//~/ ~-~E~L AN~/OR ON-SITE SEWER PERMIT
Applicant: ~2~ 7f~?CttL~I~'~f Mailing Address: /2 '7
]Location: ~)~'r '/~d'~ Phone Number:
5egal Description: L ,~--~ ? /~'~ /~¢~// Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed:/~ Holding Tank:
Maximum Number of Bedrooms: <~'~ Soil Rating(sq.ft/br)
DEPTH
/ The Required Size of the Soil Absorption System Is:
LENGTH . ~ . GRAVEL DEPTH ~c'~¢'~-J' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE =/~/~/~C2 GALLONS ' *
Permi~ applicant has the responsibility to infor~ this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 $ 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set fo~t~ by the ~unicipality of Anchorage.
(2) I w~l ~tall t~ system in accordance with codes.
(3) I~nde/-~ t~t the on-site sewer system may require enlargement if
/~~/~/is~//// remodeled to include more that 3 b~drooms.
plic t'
~ Date:
SWP/024(1/81)
SOILS LOG
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
SLOPE
ENCOUNTERED? / O
IF YES, AT WHAT :,,,~ E
DEPTH?
15-
17-
18-
19-
2O
SITE PLAN
Gross Net Depth to Net
Reading Date
Time -Fime Water Drop
//
PERCOLATION RATE
(minutes/inch)
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
®~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
~~/'~ J~?~F./,/'/:/~'Sq_:ILS' ~'LOG .-P E RCO~ LATI ON TEST
PEREORMED EOR:... DATE PEREORMED:
by
DC, C Co. dba
SULLIVAN WATER WELLS
P.O. BOX279, CHUGIAK, ALASKA 99567 · TELEPHONE 688-27,59
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
PERMIT NUMBER
DEPT. OF WELi.
ST,TiC LEVEL or
DRAW DOWN FT.
G,~. e~ ~R
KIND OF CASING
KIND OF FORMATION:
From. ~ Ft. to , {~' Ft.
From. ~ Ft. to gl Ft.
'
From Ft. to t1{o Ft.
From //~__Ft, to._~Ft.
Ft. to / Ft
/
Fmm,~Ft. to _ . FL
IF~m. . Ft. to ,,, ~._
Frm Ft. to , : ~ Ft._
From. FL ~.~Ft~,
From Ft. to ,, Ft.
From Ft. to Ft.
Frm. , Ft. t~Ft ......
From ~ Ft. to , Ft
~mm Ft, to , Ft
F~om Ft. t~Ft._
F~om.~FL to .... Ft ....
From Ft. to,~Ft
From___Ft. to Ft.
From Ft, to Ft.
From__Ft. to__Ft
From__FL to Ft,
From Ft, to__Ft.
From Ft. to Ft.
From__Ft. to__Ft.
From__Ft. to__Ft.
From__.Ft. to Ft.
From__.Ft. to Ft
From, Ft. to__Ft
From Ft. to__Ft
From Ft. to Ft
From Ft. to._~__Ft.
From__Ft, to Ft,
From__Ft. to____Ft.
From Ft, to Ft
MISCL. INFORMATION:
~ //
/~o ~'
To ?,4~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
(b)
Location (address or directions)
Telephone: Home Business
(c) ~ending Institution'" Telephone
'M~iling-Address .... "
(d) RealEstate.ComF~anyand..Ag. ent ~//'"~/¢"~ ~ '~J~Z~'I''~''/~' ~'~I'~.~'~"---~'~
(e) Mail the HAA to the followina address: or: Check here~ if hold for pick up.
List contact person and day phone number below.
$ & 5 ENGINEERING
Eagle River, Alaska 9~577
TYPE OF RESIDENCE
Single:Family.s-
Number of Bedrooms
WATER SUPPLY '-
Individual Welling.. Community [] Public []
Note: If,community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite,J~L- Public [] Community [] Holding Tank []
Note: If community 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 fRev 8/861 Fronl
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'g
WELL DATA
Well Classification 1 t.._.~ k./ \ ~._"1,¢'~'~..~ If A, B, C, D,E,C, Approved (Y/N)
Well Log Present ~N) y Date Completed ~.*¢:~' -"~-~ -- ¢tr¢~"'2~ Yield
~,.~¢¢f ~.~,L-t Depth of Grouting
Pump Set At _ t,.~--.
Sanitary Seal on Casing(~'.TN) ~-/
O.,,O ,.~ C~IPALITY OF ANCHORAGE (MOA)
r~ I'"¢~$~I~I~ALTH AUTHORITY APPROVAL (HAA)
.~.~.\'~' ,~'5%%''1\'~ CHECKLIST- FEBRUARY 1984
~k~C~~v ~ 264-4744
,- OVW'
%~ ,,¢~ &0 ~ Legal DescriBeR:
Total Depth _~-- .,¢~'~ ~'~ Cased t~
Static Water Level ~'~ ~'l
Casing Height Above Ground
Electrical Wiring in Conduit ~,~N)
Separation Distances from Well:
To Septic/~Tank on Lot
To Nearest Edge of Absorption Field on Lot \,.~.~:~ I
To Nearest Public Sewer Line t.-~ /~_
Cleanout/Manhole
T Depression Around Wellhead (Y/~J~
I
\ \~-~ ; On Adjoining Lots _
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Water Sample Collected by C~'~ ~¢;;2~ [I~'~:~C-~,}~.~ _; Date ~'
Water Sample Test Results ~_.'..~l~/~_.~.~_~...¢..~>..~ ~(' ~.,~.~!¢~.~.¢~L.~t~,~6.~_~
Comments ~'~'~¢~-.-L- '~"'~L.~C~I_/-) '¢'"~¢~f~'"' ~'~¢~-~'~]0/?---~'~.~-~-~ '~
B. SEPTIC/I't~L--B~NG.-TANK DATA
Date Installed
Standpipes <L-'~.~N) x./,' Air-tight Caps ¢-~N)
Depression over Tank (Yd~::'
Pumping/Maintenance Contract on File (Y/Nt,,~ /~.
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Hbtd~Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
No. of Compartments "~'~
y Foundation C I e a n_~._o u t~--('~4 ) V
/~ Date Last Pumped ~'? ~ ~ ' ~
¢ I~ ;for ~
Temporary Holding Tank Permit (Y/N) f~/~
Comments
t
To Building Foundation ~
To Disposal Field
To Stream, Pond, Lake, or Major' Drainage
Page 1 of 2
72-026 fRev 8861 Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design
Length of Field ~ ~D !
Depth of Field ,¢~
/
Gravel Bed Thickness ~--~" ~'
6''~ ¢~' '''¢* Standpipes Present~) "--~/ Date of Last Adequacy Test
Square Feet of Absorption Area
Depression over Field (Y/~_
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundati%
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line \
To Existinglor Abandoned System on
; On Adjoining Lots '"~'~Jk_"-~
To Cutbank ~if present)
Comments
,~8.~e Installed
Size Ga o~n in
"Pump On" Level at ~
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
est Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and H. AA guidelines in effect on the date of this inspection.
Signed ............ Date
CompaT~034 Eagle Rid'or Loop Roa¢ l~. ~A No,
Eagle River, Alaska 99~77
Receipt ~o.
Date of Payment ~ ¢~ -~f/
Amount: $ /~ ~
Page 2 of 2
7~026fRev 8'86~ Rack
CHEMICAI, & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
AHALYSIS REPORT R¥ SAMPLE ior Work Order ~ 6710
Date Report Printed: MAY 19 88 @ 07:56
Client Sample ID:LS, B3, FOX HILL
PWSID :UA
Collected MAY 16 SB @ 16:50 hrs.
Received MAY 17 B8 @ 16:00 hrs.
Preserved with :4 dog C
Client Name : S & S EMGINEERING
Client Acct: SNSENGP
P.O,~ HONE REC'D
Req i
Ordered By : RJS
Analysis Completed :MAY 18 88 Send Reports to:
Laboratory Sup..e~,~_ :STEPHEH C. EDE 1)S & S ENGINEERING
Released By :~~-. ~ 2)
Special
Instruct:
Chemlab Roi #: lO?O Lab Smpl ID: 1 Matrix: Water
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 0.66 m~/1 EPA 353.2 LO
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY RJS.
1 Tests Performed ' See Special Instructions Above UA=Unavailable
ND~ Hone Detected "See Sample Remarks Above
NA= Not Analyzed LT=Lees Than, GT-Greater Than
Property Owner
Mailing Address
Buyer
APPLI¢' NT FILLS OUT UPPER HAt ONLY
.,-.;_,.;.? ,:., x.,,: ,,¢ zip Code
=.. z"'z'~.'-, ,r:,, / ..",. -,, , , , , .,, .~ :.. /, ,,.x-,~:
Phone
." ,? .. d ,~,
Address Zip Code
Lending Institution
Address
Realty Co. & Agent
Address
/7' ,47//.:P zip Code
Legal Description
Street Localion
Zip Code
Phone
Phone
Type of Residence
I~ Single Family
[] Multiple Family No. of Bedrooms
~ Other
Wat e~' Supply
,~ Igdividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
C'~mmenity For wells drilled prior to that date, give well depth (attach log if available).
[] Pu~blic Utility
Sewer Disposal
~ Individual
' ~ Public Utility
[] Holding Tank
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
( ' ) APPROVED BEDROOMS
) DISAPPROVED
( ,/%" ) CONDITIONAL APPROVAL'
*CONDITIONS OF APPROVAL
Date Sewer Installed Well To Absorption Area
z/ Cd-- ~ 1 ~ ~ .~ Well to Tank ('
Well Log Received
Septic Ta,qk Size
Soils Rating
72-023