HomeMy WebLinkAboutT12N R3W SEC 27 NW4 NW4 NW4 NE4
~ , ~'-'~! MUNICIPALITY OF ANCHORAGE
DE RTMENT OF HEALTH AND HUMAN SER ES
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N .... DISTANCES
^ddre~ TANK FIELD WELL
Phone(st~ -- ~ Pe~5~ ~E~ ~ no. o~ ~o~oo~/ WELL /
- LOT L,nE
A~-BUILT DIAGRAM (Show IocatlOa ct well, septic system, property hnes, Ioundat~on,
TANKS ~ ~ 'N
~EPTIC ~ HOLDING X,~,p~iy
TYPE OF SYSTEM ~ :o~
~TRENCH ~ BED ~ W. DRAIN ~OTHER.j
Dept~ to pipe bottom from Total depth lrom original grade d j
o,,g,.~, ,,~e~ ~ FT / ~ F~ ~
Ora%~['l~'nglh GravelTdth /
Total absorphon area ~--/SO FTjDistance between~/A lines F1J, ~T
/ ~/~ SQ ET ~5~ ~3~ ~ ~
WELLS ~ff/,,,t. ~/~ S ~L
~RIVATE ~71~ ~ OTHER Ildentifv) ~ ~ ~ ~Jl
Classn,cat,o. (A.B.C) Total Depth Cased ~o ~- ~ t /~, J
FT
REMARKS: CO ~ ~S~
Scale: ~5
InspectionsP~ormed by: ENGINEE,'SSE L :
J~
,/_ ..... . .... ,
5 & S ENGINEErinG ~ ' '
I ..... ~ ~.. o~ ,~ cedily)hal Ihis inspection was pedormed according id all
17034 ~agle R,w, -~-r ............
72-013 (3/85)
S & S ENGINEERING
:L 7054 lie. R ,, I._.00f':'
,~ii. AGI,.iL RI VER ~ AK 995'77
PI-.K]NE 'l~694-.-2979
DA II~i:: 8/:d 7/87
APPI I CANI ~" DOb:(:) [FlY [:;:AY
AO01:;:I:[SS: .I. 2:]}0:L JOHONS ROAD
AN(]'I. AK b'9',g() 2
CCINTAC f P; K:)NI:~:: 522--8522
t, . ~.,. 'i)F'~:(!R:tF:'] i~!~.l: NWI/4 NW:L/4 NWl/4 __14
SEC 27 ~ Y12N~R3W
[01' SIZi~:: :2,,~::~ (~ (3R ACRES)
SOil. RAT]:NG: 2:1.2 S(? F'I-/BF~
SOIl.. TEST DEI::']H: 16 F:'[
NO WA IER PI:~:ESI~]q]' :iN fEST HOLE,,
il.liS IS [4h.I UPbI:-d4DE OF 4 BEDRC)OM '10 i'HE. EX!S-liNG SI:iI;::'I~C SYSIEM
SCALE
J
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: %/~J7~"~ /~.A~f DATEPERFORMED:
LEeALDESCRIPTIO.:~.I~ ~JM~¢I k~/.~'/~/! ~..~/¢ Township, Range, Secti°n:"~.,k~ /
1
2,
3-
4
5-
6-
7
8
9
10
11
12
13
14
17
18
19
20
SLOPE
SITE PLAN
ENCOUNTERED? O
S
Depth to Water Alle,,~,,O
Moniloring? ~ Dal:
- /
/ Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE / ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'- FTAND {~ F~
le River, Alaska
ACCORDANCE WIT~ STATE AND MUNICIPAL GUIDEL~CT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED IN
/ '/ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
.,V.SlO. OF E.VIRONME.TA' HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~i g-~ - ~)~/~/~'~
OF ON-SITE SEWER AND WATER FACILITY
264-4726
Application Date
GENERAL INFORMATION . ,.
(a) Legal Description (include lot, block, subdivision, section, townshi p, range)
NW~, NW~, NW~, NE~, Section 27, TI~, RI~, SM.
November 9, 1987
Location (address or directions)
Corner of Huffman and Balnb~dg~ -
(b) Applicant Name Re§eft & Dorothy Ray Telephone: Home 522-8522 Business 345-6584
Applicant Address 12301 Johns Rd. #22 Anchorage, Alaska 99502
(c) Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain);
(d) Lending Institution ' Telephone
Address
(e)
RealEstate Company and Agent Virgi~a Joh~.~on-- H~,~tage
Address 207 East Northern Lights Anchoraqe, Alaska 99503
Telephone 216-1533
(f) I~a~'the HAA to the following address:
S & S ENGINEERING
Ea~jle River, Alaska
TYPE OF RESIDENCE
Single-Familyx[~ Multi-Family [] Other
Number of Bedrooms 4
WATER SUPPLY :: ::'
Individual Well~ Community [] Public []
Note: if community well system, must have written bonfirmation from the State Department of Environmental Conservation
attesting to the legality and status. . ~ i'~
4. SEWAGE DISPOSAL
Onsite,[~[ Public [] Community [] Holding Tank [] ~,~. : .-. i ' ' ~ i~. ,.~. -,,' ' ' ~ ·
,~ ~tote: it community well system, must have written confirmation from the State Department of Environme, ntal Conserv,ation
~.;' attesting to the lega ity and status ' : ' .' ·' : i :' ,:-
ENGINEERING FIRM PROVIDll INSPECTIONS, TESTS, FILE SEARCH, D~ ,~ AND INFORMATION -' :'
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
Authority Approval shows that the on-site water supply and/or wastewater dis0osat system is safe, functional and adequat"e
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 su
wastewater disposal system is in compliance with all Municipal and State codes, ordinances,?nd regL
the date of this inspection, ~ ~, ~ ...':
S & S ENGINEERING
17034 Eagle River Loop Road
........ &ladca 99577
Name of Firm
Address
Date
DHEP APPROVAL
Approved for /~'z:~c~rZ-/-.~/)bedrooms by
Approved ~'~ Disapproved
Terms of Conditional Approval
Conditional
Date
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA,
INC.
"~;~'~1 FEDERAL TAX ID # 92-0040440 ""
~A CHEMICAL & GEOLOGICAL LABORATORIES OF ~ASKA, INC.
h084 ~AOL~ ~iVE~ LO0? ~D., ~204
NeieaseO ~v ?d/~: ~:
CABO~ATO~Y SUPERVISOr: $£~P~N 6.
i'fes~s Pec~ormed ~ See ~peciaJ instructions Above
2U= ~une ~etectea ~, See $~J}ple ~emar~s Above
NA: iiot Aoai?zeO 5'?=[,ess ?~an, G?=Greatec Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
G~IVATE WA~.ER SYSTEM
Name Phone No,
Mailing Address
City State
Mo. Day
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no. )
[] Special Purpose
LOCATION
1
2
[] Treated Water
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~-Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method:
Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
I
I F-F1
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct Count
Verification: LTB
INIC = Too Numberous To Count
BEFORE
COLLECTING SAMPLE
BGB
Date
Time:
Coilformll00ml
Coilform/100ml
a.m.
OB = Other Bacteria
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MO,-,j
~UNICIpAL!TY OFHAE~THORITY APPROVAL (HAA)
E~IRONMENTAL PROT~O" 264-4720
Legal Description:
NOV 9 987
RECEIVED
Well Classification
Well Log Present (Y/~
Total Depth /'~0.,~1'/' Cased to
Static Water Level / ~'6¢
Casing Height Above Ground
Electrical Wiring in Conduit ~)'N)
Separation Distances from Well:
To Septic/~g .Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
If A, B, C, D.E.C. Approved (Y/N) /,4'/¢:~
Date Completed ~4-,¢/Z~x ./9~-b
z/o/4' Depth of Grouting
Yield
Pump Set At (.,~'/~
Sanitary Seal on Casing (~;~N)
Depression Around Wellhead (Y,d~
Z.o,~,"-.t. ; On Adjoining Lots
,/¢~)/_~ ; On Adjoining Lots
To Nearest Public Sewer
CleanouVManhole
Water Sample Collected by
Water Sample Test Results
Comments ~,~/~---~/_ ~ ~,-%
B. SEPTIC/I-I~dc~'~...~ TANK DATA
Date Installed
Standpipes~/N) Air-tight Caps~N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
//-- ~' -~:~ Size / ~ ~L~ No. of Compartments
Foundation Cleanout (Y~
Date Last Pumped ~.,z-~ ..............
/W'//2s, ;for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation ,¢;~e//
To Disposal Field ~ ,~ /
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~-,-,
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 Foundation
Lot /¢ I n~'
To Water Main/Service Line
2-/~_ ¢¢/'/3¢-- .J~_.%. Type of System Design
Length of Field ~'~'¢ !
Depth of Field / 7~/
Gravel Bed Thickness (.~ r
Standpipes Present ~/N)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Date of Last Adequacy Test
To Property Line /
To Existing or Abandoned System on
; On Adjoining Lots ~ Lb
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/NJ
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
' g n e~'0:;I 4 Eagfe~Rt:vef-L~r170:;I, ~e=~ Ne. A~ate
Com~ Klver, Alaska 995~ MOA NO. ~ ~
ecei t .o. /
Amount: * ~ ~
~UN[CIPAL[TY OF ANCHORAGfi
ENVIRONMENTAL SERVICES DIVISION
Page 2 of 2
NOV 0 8 1987
72-026 (11184)
RECEIVED