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HomeMy WebLinkAboutT12N R3W SEC 33 LT 215C MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~,~'¢ ~ Vr ?~£~ ~ ~ SEPTIC ABSORPTION ~ ~(~ ~r. ~ ~CA~ ~ TANK FIELD WELL Phone(s)~7~.-- ~7 Permit~ No. oo~ No of Be~oo ms WELL I I ~ ' f ~6- ' LEGAL DESCRiPTiON LOT LINE ~ ~ Lot J BlOCk__ ~1~ C FOUNDATION ~O' 7~' ' ~-, ~eC ~3 t T ~j R ~ ;' ~' drlveway, walerbodleS, elG) TANKS ~ N ~ SEPTIC ~ HOLDING ! Material No. of Comps~ments ~ TYPE OF SYSTEM °nO'hal grade ~.g FT ~ FT ~: F,H.d.eOaboveor,g,nalgr.de Gravel.ep/hbenemhp,pe 'r~ I ~ '~ 0 FT ~. C FT Numberoll,nes Soilrahng ~ JPJpematerJal ~-~10 P¢~ 7et ~c ~ ~' ~AP~ . ~ ~ ~r~ ~¢~ Inspections Pe~ormed by: , I _ ~ ~00 ~ cedify that this inspection WaS Oeflormefl accorging Io all -, Municipal ~nd State guidelines in effect on this date' ~/~ j ~ 72-013 (3/85) ZOa t. ~ "~ ...... ~ · [)ay Phctr'l~, ~ Par' c: ~:)1 :[ (::I :~ () J. EI...:)';::i!; :I, ...-2;~:~ i...i::xL ! .(~ga :I ~ElL.d:x;:l ;i. v ~. s~ J, c)n: Cx)O00 Lot.: ;?. :LSC, )31 cie:: I.:: ~: Plax }:~c,x::i r' (:)om!~, x ]'h :i, ~s F'~i"m J. t. ~ 4. 'F o'L a I C}apa(: ~. 'L y ~ z~ 000()0 ....... _ t .<~ [., , c; al::)a(::: :i. 'L y ~ :l, ~ s-::~" cia ]. 1 c)n s~ ,, " !~;eJ::) 'L i (:: D(~t:;tl'~ t,c~ ~:-<:~i:~ c:!i s~ei:rLJ, c: tank (~) <: d,,O ...... " ' ........ t. 6 ....... ;~ ..... t..,.¢.~(.~t..L. , ~.~ ¢.... ~ ~ .... ... . ~ ,¢ 7, / [.a~-~_~.~_ ~.d~ ..):,.O ...~..:.~:~ 2.2 ~ S~¢(::'[. :i. en ~ :3:3 'rc~,,,,n~h :i. p :~ ;[ 2hi I~nq~> ~ ~' (,:¢ C~)'(', i' ~) (::~t,,( ~. l' E.~ ~;~ :i I-1 ~t..t ,I. a '~L ;i. (3 i'1 '(. ~:%d"i ~.:: ( ~ ) . DiEE~:[GN RI~EC;~t.J:I:f';:E!:S DHI'-IS APPFd3V S. I:::,, RIES:t::,'.)ENE;Ei: E~I\ii...Y!, ¢.iND f-qqY> ~'~[i!:IEF~,/~GEi: F-":[T Ivt!JST ie l%~n:i_c:::i.l:)a] c::,~ Arlc:;hc:)ra~.C]6:-' (FIE)A) arid 'Ebro:, S~.:.a't:.e c:)F A:laska,, .~:I.) 'th(.~) ~' :i~'~~cc:c~r'dar'~c:6) ~:i'f:.l"l ~J.:[ PIC]¢~ ~:::c~(::l~;)~i and (:~r~ '( h :i ~il c)[ ;~(::l.j atc:e)i'l'l:. (::ir' rlE¢~ll'l::iy ICi'(. ,, '~vJ.].]. f'(~)c]~.~:[!*6.:,ari add~.'(.J.c~na:[ ~.~ I.. [ .. I~: I~'~ ...I .I. I t · . :- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" St,:eet, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: g- 12- 13 14 20- SLOPE s L o P E TOP TECHNICAL:SE .... ..... ~ r~uFECT/ON CIVIL & ENVIRONMENTAL ENCINEERINC * ENERCY CONSERVATION & ANA~ x~o~o~ ~. ~oo~, e.~. March 16, 1990 PH: (907> 345-1355 ~~1 ~flA 9,5]6 John Smith M.O.A. Dep't. of Health and Human Services P.O. Box 19-6650 Anchorage, AK 99619 Dear Mr. Smith: At the request of Mike Livingston, the potential purchaser of BLM Lot 215C, Section 33, T12N, R3W, S.M., on March 15 I inspected the proposed wastewater disposal site on this lot and reviewed the design documents submitted to your office for issuance of a permit. The soils log indicates that there is a relatively steep topographic feature a short distance downslope of the test hole which has a downwards slope of something less than 18%. Based on measurements I was able to make using a hand held inclinometer, I found the maximum slope in this area to be approximately 33%. I would estimate that the total vertical drop of this feature is in the vicinity of 12 feet, with the topography above and below this feature having an average slope of approximately 10%. Mr. Livingston is concerned that the discrepancy between these measurements and the information submitted in support of the permit application could jeopardize the validity of the permit, in light of the separation distance required by the wastewater ordinance between a subsurface disposal system and any slope in excess of 25%. It is my opinion that the relatively small vertical extent of the feature where the slope exceeds 25% will effectively preclude the possibility of effluent surfacing from a soil absorption bed constructed as designed at a depth of 6 feet.below ground surface. Assuming you agree with this rationale, perhaps you could allay Mr. Livingston's concern by indicating on the permit that it's validity will not be compromised by the presence of the conditions described in this letter. Please give me a call if you have any questions on this matter. Sincerely, Ted Moore, P.E. cc: Mike Livingston, 4650 Reka Dr. #20, Anchorage, AK 99508 Bob Kniefel, 8441 Miles Ct., Anchorage, AK 99504 ( erlifie rilling by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759 OWNER OF LAND ?'}/7 / ~'E ADDRESS '~, 5© ~' / ' ' LEGAL DESCRI~ION a ~ ~ ¢~ ~ ~ ~ DATE - Started Ended PERMIT NUMBER YO-- ~ ~ DEPTH OF WELL ST>.TIc LEVEL OF WATER FT. c~5'" DRAW DOWN FT. GALS. PER HR c~ ~' O KIND OF CASING (~'?~ '~ O~ KIND OF FORMATION: From O Ft. to c~) Ft. (f/t.~l~ ~.~7'tc-~'L ~J/0 From.~Ft. to__ Ft. ~ ~ (~) O ~ ~ ~30,e.O ~.'C" ~J From Ft. to Ft. From c?:~ Ft. to . Ft. -- From L~ Ft. to'V~ Ft. ,f't'-/ /" ,~/~,,~/(}.~; (~d,~[,/,~<.Fro,n__Ft. to Ft. From__.Ft. to Ft. ~ / C.,~'?/~-/o/E~'~ Fro,, Ft. to Fh From ~ Ft. to / ~-- F,~ /~'/~,~'% F~om ~t.,o F, From/,~ Ft. to d~? Ft. .~-/<.T'~' ,.f.~^ID.$ From__Ft. to Ft. From Ft. to Ft. ~d~¢~<Z- From Ft. to Ft. From.~'~! Ft. to d']4] Et. ,~/<'~'~'~' ~¥,~-,,O~ (~/(,floc{P~om Ft. to__Ft._ From Ft. to Ft. ~ t_ad F°f ~' ~ t'~ 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. t9 Ft . From Ft. to Ft, From___.Ft. to_ Ft From__ Ft. to Ft. From Ft. to __Ft From Ft. to.___Ft. From Fi. to Ft. From Ft. to Ft. From Ft. t~UNIC PAU~ OF A_..NCI~IRA~E '-- -- DEPT, OF Ht:O,~4~ m From Ft. to Ft. From_ Ft. t~NV!RONN~i~.~TAL PROTECTION MISCL. INFORMATION: ~,JUN g 7 ~9~ RECEIVED DRILLER'S NAME . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 .. '- Parcel I.D. # ~)\~ - ~::~-~ - ~-~)- 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING - HAA# ~i'~-q~/~O--~ Location (site address or directiops) ~ 3 6'"/5..... Por'~_ /4~,~,~,4 ~. Prope~y owner ~,H~ ~;~¢~ ................ Day phone ~ ~q - ~7 Lending agency ~t~+ ~q~'~ I '' ''~}:~--~' Day phone Mailing address 7Jo/ '~" ~' "~ ;~"' ' .. . __ ..,~ - - , ,. ',~.~ ~ ... Address 4. TYPE OF WASTEWATER DISPOSAL: Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ ........... ......... : ,.-...': ,';: :.. 3. TYPE OF WATER SUPPLY: nd v dua we v"_ . - ~-'.~.' .: ' _.'~': .................... . -~-' Community well ~ Public water NOTE: If community well system, provide, written confirmation from State ADEC attest- mg to the legality and status of syste~n,. ~ _ ._., ,.~.,,.~-,..-...... ,..,*,.~., ...... ~ ....... ,~.,, - ,~ '; '{';" ":'~:~'"'"L'" ';' ~'"" ' ' ': '"~': " '"-" Holding tank Community on-site · Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) :rent MOA #21 ')~JOM s~eau!6ue I~UO!SSe~oJd eql u! suoJss!mo Jo sJoJJe .loci elq!suodseJ lou B! eDEJOLIouv ,Lo Xl!lBd!o!un~l eqJ. 'penss! si e~oij!peo e e]o~eq ~I~P eZ/~l~U~ Jo suol~oedsu! 1onpuoo lou op SHHQ jo eeeXoid ~U::l 'siuemeJ!nbeJ ele~,s pu~ I~epeJ ulsPeo/gs!]~s ol JepJo u! euo!inl!]euj I~u!puel Jleq] pus samoq Jo sJes~qoJ nd ol Ase~ noo ~ s~ s!ql seop SHH C] eq.L 'mis~lV ~o e~lS eqj u! peJejs!l~eJ Jeeu!§ue 18uo!ssejoJd luepuedepu! u~ Xq eAoqe g .qdeJl~J~d u! ue^!l~ euo!~]ueseJdeJ eqi uodn 41uo pesBq se~uo!l!pe0 I~^oJddv 41poqinv qil~eH s@nss! (SHHC]) seg!~eS u~LunH pu~ qil~eH Jo ]ue~p~dec] eB~Joqouv ~o Xi!l~d!o!unlAl eq/ Municipality of Anchorage Department of Health & Human Services ~ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,L.o~ 2/5-(/ ~¢c ~.~ T/2-1~., ,r{.~f,c, Parcel I.D. A, WELL DATA Well type r~ ~'/' Log present (Y/N) Total depth L~ ~ w Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number N. 'i" Date completed t¢/'~ 7'/'~O Driller Cased to ~/~ ~ ~- Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION ' On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank SEPARATION DISTANCES FRO M WELL TO: Septic/holding tank on lot I! o ' Absorption field on lot I ~J~' ~ Public sewer main N, At. Sewer service line WATER SAMPLE RESULTS: Coliform ~ col {~o0 mC_ Date of sam pie: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Nitrate /, '~ ,n~ q'/,~. Other bacteria G/SZ/~. Collected by: ~',/~/'~'.P T Tank size I ~ ~'¢/ Compartments Foundation cleanout (Y/N) Y' Depression [Y/N) A, Alarm tested (Y/N) N, ,¢. (¢y..r,c~.,',', n~,.'~r ,h~,.~ ~.,~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot · I~o' . ~nadjacentlots To proper~yline 5*0 ' ~- Absorption field Surface water/drainage '~ ~oo' Foundation 0"¢ / Water main/service line ?o ' 72-026 (Rev. 7/91) Front ~. ~'" CONTINUED ON BACK PAGE C. LIFT STATION /11, ~. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D, ABSORPTION FIELD DATA Date installed Length ~(~ ' Width Total absorption area Depression over field (Y/N) Results (pass/fail) I~h /~, On adjacent lots Soil rating Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water ~'/' ~'//~'~-'¢"~ System type Gravel thickness /,~' ' Cleanouts present (Y/N) Date of adequacy test for ~- Peroxide treatment (past 12 months) (Y/N) NC'~ ¢ SEPARATIQN DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ~" To building foundation Onadjacentlots :~ .?~" Surface water Curtain drain If yes. give date Total depth Y bedrooms 1'4.4,, On adjacent lots ~" f ~"¢--" ' Property line ,5'o' To existing or abandoned system on lot hi,/¢, Cutbank /"/. ~-, Water main/service line Driveway, parking/vehicle storage area lo ' r 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 inspection. Signature Engineer's Name Date HAA Fees /TD Date of Payment ~' Receipt Number 2 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE ~ 54717 CherAab Ref ~ 92.2749 Sample t t ~fatzlx: WATER Client Sample ID : L215C SEC 39 TI2N R3W 3645 DORA AVE PWMID UA Colle~ked ' JUN 12 92 ~ 1D:O0 h~s ReceJYed 3UN 12 92 8 10;30 hrs. ?resezved with - AS REQUIRED Client Name :FLAYYOP TEC~IICAL SRV Client Acer :FLAT~O~ BPO} . ?08 :NONE RECEIVED ReqH Ordered By : An~lwis Completed . SU}{ iS 92 Send Repozts to: [)FLATTOP TECHNICAL Laboratory Supe~vl~o~ : STEPHEN C. EDE Parameter Results Units ~ethod Allowable Limits ........................................................................................................................................... NITRATE-N 1.7 ~/1 EPA 353.2 10 Sampl~ ROUTINE SA}dP~E COLLECTED BY: T.F MOORE. Renmrk~: 1 Tests Performad 3ee Special InstYuctzons Above UA~Unavallablo ND= Hone Detected "See Sample Re~arks Above NA~ Nol Analyzed LT-Less Than GT~zeate~ Than ~S~S Member of the SGS Group (Soci~,t6 Gdndrale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D. # '~ PRIVATE WATER SYSTEM FLAT~o? 'T~c~ ~[/C5 Phone No. Mo. Day SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) [] Special Purpose Year [] Treated Water *~ Untreated Water SAMPLE No. LOCATION 31 41 Time Collected Collected By 2:20 . Cl~e~.~ T0 BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /~atisfactory [] Unsatisfactory [] Sample tee 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. Analytloal Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* [-[-1 F-I-] Analyst A .D jE,C./.,-//3~~.~'~/~'~'-~ ,- BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count ~ Coliform/100 mi Verification: LSB BGB BEFORE COLLECTING SAMPLE Fecal Coliform Confirmation Final Membrane FIIt~_l~sults Reported By --,./ ~' TNTC = Too Numerous To Count OB = Other Bacteria / ...~ Coliform/100 mi PART ONE OF REMAINDER TO FOLLOW