HomeMy WebLinkAboutT12N R3W SEC 22 LT 17A
~,--'~ MUNICIPALITY OF ANCHORAGE
DEl. ,TMENT OF HEALTH AND HUMAN SER~ oS
Environmental Heallh Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
, ) ...... ~TO SEPTIC ABSORPTIO~
TANK FIELD WELL
~/~. · . .~.~ ~ .. ' .~ 22 dnveway.AS'BUJLT DIAGRAM ,Show ,bcation of well. se~Uc ,,s,em. prope,, hnes. foundahOn.water bodies, elc.,
TANKS N
~ SEPTIC g HOLDING
TYPE OF SYSTEM
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ ] /
orlginaIDeptht°plpeb°H°mfr°m ~ ~grade FI ToJaldepth from originalgrade ~ FT ~'l ~ ~ ~.
Fill added 8bore original gred~' Gravel depth beneath pipe ~ ~0~ ~ /~ ~ ~ -
~00 SO FT O FT
WELLS / ' '/
~ PRIVATE : OTHER (Identilv)
ClaSSlnCeJlO~ (A.B.CJ Total Depth ~ased to '
Municipal and State guidelines in effect on this date: ~/fT/~w ',
25.
1971
/
HealthDepaHmentApprovaJ: ~ ~ ~ Dale: ¢--~
72-013 (3/85)
-)03 W. 15th AVE 'C" SUITE 203
ANCHORAGE, ALASKA 995Q1
TELEPHONE: ¢907) 279~3916
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 6-6650
ANCHORAGE, ALASKA 99501
AUGUST 14, 1986
SUBJECT: REQUEST FOR WAIVER FOR MAXIMUM LENGTH OF TRENCH
ON-SITE SEWER SYSTEM
LOT 17A, BLM LOT, SEC 22, T12N, R3W
J. RINDALL
Gentleman:
We request a waiver from maximum sinqle segment disposal field
lengths as stated in Anchorage Municipal Code Chapter 15.65 to
permit a length of 100 feet for the subject property..
We verified during construction the line maintains a slope of
approximately 3 inches in 100 feet, and tested the system after
completion to confirm it ran water throughout its entire length.
If you concur with this request, please sign as indicated below.
Yours
Tob~b~Spurk~lnd,
P.Eo
Date
K.'IJ.I IlO.
APPL. ]: CAN'I' ~
ADDR!ES,S:
CONTAC[' ~I,OlftE=
L.E{:AL. :OESCF",' I }':' [ ,SUBD I V I. S I ON ,~ }3L.N L.O'I LO'l'~ 17~ I?:~L. OCK = N lA
SIE[TI ! liN: ~2 'f'O~INSH I P: :}.2N RAND)E::
L.O i S.i.z.E',: :377OC) (SQ. F:]. JIF;: ACRES)
J: c:¢~vti~y 'Lhat:.~
~c:)v~.h by thE. Mt.tnicipalJ. ky of Anchovag~e (FIOA) and Cf'm, StaLe oF h].a~ka.
:::~ :[ t~J.J.:l. :in~iLall 't. hez~ sy~:f:.em J.n acc:opdanc::e t,*i'Lh a].l FIOA c:odtas~ and pegu].a'L:i, onSh
:.:!.:, i v,~J.J.]. ~5~dh~z.)i'e '1:.(] a].] ["IOA arid St.a'Le of Aiasl<a p[~.qt.tipen~[erl't,s fop the ~;et. bacl.::
dJs'kanc:~s frc:)m any exJ. sk:h~g well:, wa~'Lawate:,v dJ.~po~ial ~y~r~tem or public:
S[A'I :ION IS ]:NS[ALJ..ED iN AN AREA C[]VERED BY MOA BLJ]:L_DINL3 CODES~
AFl ILLECIR:[CAL. F'ERF[tI' RND iNSF'ECTICIN MUS'T BE: OBTAINED; (2) AS-BLIIL..TS
L{E AF'F'F~L}VED W]:'IHOU[ AN ELECTRICAL.. INSF'EC]'I[tN RECF'OR-F~; AND (:3) TIqE
E:.L..ECIIR.[CAL kJORK NUSI' ~E: DJ]NE BY A LICE:NSED ELIZCTR]:CZAN~
.......................................................................................
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
~-~,
WAS GROUND WATER
SI~OPE
SITE PLAN
IF YES, AT WHAT
DEPTH?
S
No
Gross Net Depth to Net
Reading Date Time Time Water Drop
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
18
17
18
19
20
COMMENTS
DATE PERFORMED:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH7
0
E
[] PERCOLATION
TEST
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN ET AND FT
CERTIFIED BY: ~-~
72-008 (6/79)
~-% MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF H A TH AND ENV RO,MENTA' PROTECTION
DIVISION OF ENViRONmENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a) Legal Description (include lot block, subdivision, section, township, range)
Location (address or directions)
(b) Applica.t Na~e A.~
Applicant Address
Telephone: Home ~'"~¢~;~-- Business --
(c)
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lendinglnstitution-~/~'v~"/~ ~-~-~"~
'Address
Telephone
(e) Real Estate Company and Agent ~"~g,~
Address ¢.~ ~' ~ L ~_~ k'~'_S
Telephone ~'~ ~' ~ J '~ '~
(f) Mail the HAA to the following address: '
TYPE OF RESIDENg~ ,,.,
SinCe-Fami%[A' Mult¢ a i y [] Oth
~umberof. Bed'rooms'";'~ '~ ~'¢,
WATER SUPPLY"
Individual Well~ Cbh~munity [] ' Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note:Ill corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72.025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'IA AND INFORMATION =~- ~
As cer[ified by thy seal affixed hereto and es of the validation date shown below, I verifythat myinvestigation of this~ealth ·
Authority Approval 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. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site wate.r 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 ~ Tetepho.e Tq- zL.
Address '~ ~ ~, ~ /" ~
Date
DHEP APPROVAL
Approved fo,' . -~" "~'"~¢'(--¢~bedroomsby '/~¢''~'~ /'~'
Approved ~ Disapproved Conditional
Terms of Conditional Approval
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
'uNi~i?ALiT,, MUNICIPALITY OF ANCHORAGE (MOA)
D ~ OF ·
ENv,~ £PE O? ~,~ A";'Ci,' ,HEALTH AUTHORITY APPROVAL (HAA)
c. c us -
' ' ~ , ~/~ 264-4720
WELL DATA
Well Classification ~_ If A. B. C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) N Date Completed UI~ Jl~,,~.~.,,~l Yield
Total Depth ~' Cased to ~,O~:~ Depth of Grouting
Static Water Level i' ./~r"~ Pump Set At
Casing Height Abov~ee Ground ~"~;14~I,Z~ ~;¢ Sanitary Seal on Casing(Y/N)
Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N)
Separation Distances from Well: ~' ~
To Septic/Holding Tank on Lot hO -'- /O ~' ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~ ~ ,~"'"' ; On Adjoining Lots
To Nearest Public Sewer Line ~ O ~ J.~. To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~ - Date
Water Sample Test Results
Comments /K ~:~e"l~O~/'~ -~"'~ .,..~ :~ "-'~/
SEPTIC/HOLDING TANK DATA
Date installed ~/'./'~/~'(" Size ..~'~ No. of Compartments / "~/
Standpipes (Y/N) ~ Air-tight Caps (Y/N)~/ Foundation Cleanout (Y/N)
~)~ Date Last Pumped
/ Y__/A ;for
Temporary Holding Tank Permit (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~¢ "'" /"~ ,.~
TO Property Line
To Water Main/Service Line
Course
TO Building Foundation
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 ~/! ~///o~
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N) ~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot ,~
TO Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Comments
D. L,FT STAT, O.
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/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Page 2 of 2
72-026 (11/84)
I certify that I have checked, verified, or~onformed to ail MOA and HAA guidelines in effect on the date of this inspection.
Signed _~~ Date ~"/~' ~/~' ~:~
Company/ ~ MOA NO. _ ~
Date of Payment ~/ ~ /~~ ~c~,' ~ ' '.;," '?
Amount: $ ~' b~ ~W~'4~:)2 ;," Engineer's Seal
:'
APPLIG' ',tT FILLS OUT UPPER HAL ONLY
Pr°pertyO~'ner''' ~CL~t~..~(~,_~_i ~~ ~__~,(~ ~). f.~'~ (\/'~ ~h~n~/
~.yer
Address Zip Code
Phone
Realty Co. · Agent
Address Zip Code
~ividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST.SEFORE ~OCESSING CAN BE ~N[TIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspsctor Inspector Insp6ctor
Field NPtes: MUNICIPALITY OF ANCHORAOI~
:~ DEPT. OF HEALTH
ENVJRONM2NTAL PROTECHON
OCT 1
gECE! ED
( ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) CONDITIONAL APPROVAL'
DATE
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
ARCTIC ENGINEERS, INC.
October 11, 1983
AEI# 83-013-29
Pamela Gotham
SRA 1737-C
Anchorage, Alaska
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
001' 'I 1983
Re: Lot 17A, S22, T12N, R3W, SM
Dear Mrs. Gotham:
RECE!EE
On October 10, 1983 an inspection of the private well on the above referenced lot was
performed by our firm. The Municipality of Anchorage requirements for individual wells
are:
1) Casing extends 12" above ground
2) Ground surface sloped away from the well.
3) Well cap is tightly sealed.
4) Wiring is enclosed in cohduit.
5) Total Coliform analysis is satisfactory.
6) Adequate clearance from septic systems is maintained.
The well is a modified pit type well, with a vertical culvert?~i~ndd;~n:;:&ns~&~d,
waterprodf lid.
The well casing 8xtends 12" above ground surface level.
The well is in compliance with all requirements, except for only 60 foot clearance
between well and septic tank. Adequate clearance is maintained between well and
absorption system.
The present owner stated that well depth is approximately 300 ft.'[
A copy of the water quality test report is attached. We conclude that the well is
satisfactory. If we can be of further assistance, please contact us.
ARCTIC ENGINEERS, INC.
October 11, 1983
AEI~ 83-013-29
Pamela Gotham
SRA 1737-C
Anchorage, Alaska
99507
SEPTIC SYSTEM ADEQUACY TEST
L~GAL:
Lot 17A, Re-Plat BLM Lot 17, S22, T12N, R3W, SM
OWNER:
Pamela Gotham
HOUSE TYPE:
3-Bedroom, 2-Story, Single Family
WATER:
On-Site Well
SEPTIC
SYSTEM:
F~om On-Site Determination
Tank:
Absorption
System:
Absorption
Area:
1,000 gallon
Possible Tr.ench with Seepage pit
Unknown
TEST DATE:
October 10, 1983
PROCEDURE
House water use was kept at a minimum for 1 day prior to the adequacy
test, which was started at 10:30 am. Water from a tank truck was
dumped into the pit in 100 gallon increments with liquid rise in the
pit measured after each increment.
When 600 gallons had been added, the pit became full. At that time,
addition of water was halted and the septic tank was pumped.
The calculated rate of rise in the pit was 122 gallons per foot.
Pamela Gotham
83-013-29
PROCEDURE:
(Cont'd)
RESULTS:
~bsorption monitoring was carried out for 90 minutes after pumping
the septic tank. The resultant plot of absorption vs. time, with
the extrapolated dail~ absorption capacity, is included.
The plot of absorption vs. time yielded a daily absorption capacity
of 550 gallons per day. The required abso3~ption capacity f~r a
3-Bedroom house is 450 gallons per day. The soil absorption system
meets Municipality of Anchorage requirements.
(SNO"I-IV~D) NOIJ. dblOSGV