HomeMy WebLinkAboutT15N R1W SEC 4 LT 8B
MUNICIPALITY OF ANcHORAG~
~ /-"~ DF. PT OF L-ALTH &
/' ~ ,' 'i i:NViRONMENTAL FkCTECT ON
) MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION JAN 9 1980
*" 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTIOP~I~W E D
PHONE .[~EW
MAi L] N a-,~,D D~R ESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
DISTANCE TO: ~ 0
Manufacturer
Liq. capacity in gallons Inside length Width Liquid depth
~ .~ ~ IF HOME.DE:
, Z Well Dwelling PERMIT NO.
~OZ DISTANCE TO:
O ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
~ DISTANCE TO: I [0'
No. of lines Length of each line Total length of lines Trench width Distance between lines
~ ~i ~,¢' ~', :~' inches
~ -- ~ Top of tile to nlsh grade Mate~l ben ile Total effective absorption area
Length Width Depth PERMIT
~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:'
~ 31ass Depth Driller Distance to lot line PERMIT NO.
~ Build[nB foundation Sewer line Septic tank Absorption area{s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
APPROVED DATE LEGAL
72-013 (Rev,
j :: '~ IRONMENTAL ?~OTECTION
;'Unable ~:o: process wllxhoul:h by
legal doscr±pt±on eec co. ub,
SULLIVAN WATER WELLS
P.O. BOX272, CHUGIAK, ALASKA 99667 · TELEPHONE688-2759
FEB, 5 1980
RECEIVED:
OWNER OF LAND ,, } / ~/t .iQ r, c..~.:./ DEPTH OF WELL i ,"
ADD,ESS fl,
LEGAL DESCRI~ION ~~ ZOr'W~ *~ ~ff~ ~R~7~' ~., "`'~
DATE - Started
PERMIT NUMBER
Ended GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From. Ft. to
From; J Ft. to
From ;4:.' Ft. to
From ! ' Ft. to
From , " Ft. to
From L %? Ft. to ,
From / Ft. ta ,'
From__ Ft. to.__
From__.Ft. to
Erom__.Ft. to
From__Ft. to
From Ft. to,-
From Ft. to
From __ Ft. to--
From Ft. to
From Ft. to
From Ft. to
Ft,
Ft.
Ft._
Ft.
FL
. Ft.
__,Ft.
Ft.
Ft._
Ft._
Ft.
.Ft._
Ft.
.Ft.
Ft.__
Et.
Ft.__
From
From
From
From --
.. r From___
From _
From
From
From __
From __
From
From.__
From
From
From
From
Ft. to Ft.
Ft. to__.Ft.
Ft. to Ft._
Ft. to__.Ft.
__ Ft. Io__:FL
Ft. to__.Ft.
Ft. to__.Ft.
Ft. to__.Ft.
Ft. to Ft._
Ft. to Ft
Ft. to Ft
Ft. to ' Ft
Ft. to_
Ft. to___Ft
Ft. to Ft._
__Ft. to_ Ft.
Ft. to Ft.
MISCL. INFORMATION:
DRILLER'S NAME
FtF:'F'I... ;( i;)Fli",!'i~ .~t'!::!PlE:~!; I:I K ;( t',;~:~.;C:H
1.11!(i;i::i? ]' ()i"! GLF!C ;~ EF?. F;:D ..]'I':I'."--'.ON
T'"PE OF Si'3];! FIE;S(?.E~TZ(';ff',! S'?'STF;H
T 1~;i: E N E: H
Ti i!!~ ! ~i~f.,IC:iTH D ;i; !,'tEhiS ); C!t,,! ;1; ::.:; 'ifil;i; I.EN(,~i'TI.! ( ]; H F,r,'i!E I' ;:' (;;Ir::' 'r'HEi TF?.E;I',,!C;H OR D?.Fi .i' hF::' Z ~ii;i D.
THiE E:,Fi:ff::'Thi Oi:' R TI,i:ENCH OR F:';[T ;[:::~ TIdE D)'S"f'¢qNCE E~!._-TI,,!E;E;N TH!E SUF;i:FFIC:E
EiI:;:OIJND t::i!',ID 'I"I-IE~ !':~CF!"]'C)i,i CE:: '!-I~E E'?,CF'i',,,'FtTZEd',t (];i',,i Fi!ihr::'i').
THi::;RiE ]:':'~; i",lO Si'iH' P.!].E:Q'H FOF?. 'FRi.i:NE:HES.
'!'i Ii::; Cil;;'.F!',?~]L [.:,i-_'PTH ;[ ~i:; TI,.',E i','i ]; h! ): I,'ii.ti',i DEF:"I bi (:d:;' Gi:;d:i',,,'EL Eili~;"rl,!EE:i',,! TH_P; E!U'f FFiI !_ F'
!::ii'.,ii;:, THE; i3OT'!EI!¢I Eli::: i'HE ii;;,.O'3ff,,,'FIT ;!; Oi'.,.,' ,:: ;t~ ht i::'l,~;i;:;-i' ).
i'i;(N..';i"iUN D).S'!FtNCE ~.:ffi:;i'i,!P';IEN Fi HEi..i. Ri'.,ID Fi!"4'-r' Oi",i' -':5 ;[ Ti:: SE;P.!r:',EiE (:,);:ii;F:'()L;;i'::t[. S'./STEH
:i_Eit:.~ "l'();:¢(i(::.i FT;E;T F?.OH i:::i F'L!E;i .. ;i; ! ': ~,i(~;i .I.. C, EI:'E?,~D);I'.,il;~ UF'Oi'.,! T!..I~; T?F% ~;')F !:'I.E.:~!.;(C HELL..
i,.!~:-.L.L.i.OG::~; i:::iF:E ?.! ~;;:¢ J ); !;.'b?:, ?:fi-iD I','!!_iST !3i;;; ?.!:Ti'i. Ji;:N(:;D Ti) THE; D~?;F'FiRTHEi'-,Fi" P.!(TIqZi'..i ?i
Cd:' r'i i!~ i..fiEi .i. E:(?!I::'i_.F;'i ;i'
i?')[ i 1[;~: ?.i:!;l;:!i if ?.i !q[~?-,l i'::,, ?ii:'1'¢ ~;~::! :'! '.?. '.!::;!::'!::!].: i( F )1E:!:'!'[' ;il (,)f'-,!~:.:; l:ff, i!-:, i]::l:)~.,!:~?i-l;:l. IC-]' ]' Cil.4 ii:, )1 !::!(~iF~:Fii'.i~; !:::!l:?.i-~
?ceven A. Johnson
P.O. Box 76
Chugiak, AK 99567
Phone: 907-688-3085
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
DATEP RFO.M O:
I
LEGAL DESCRIPTfON:
1
2
3-
4-
6-
7
8
lO
I1
12
13
14
15
16-
17
18
19-~
20-
IF YES, AT WHAT
DEPTH?
ii
WAS OROU.O WATER
~.COUNT~R~O? ~1 C)
S
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
I i~3o 3o Il, o 6,0
3 Iq3~ I,Eo ~o '~,o
PERFORMED BY:
PERCOLATION RATE
TEST RUN BETWEEN
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 8B; S¢c. 4, TI5N, R/W, S.M.
Location (address or directions)
(b) Property owner ]'~mo__x ~./~x_ e~_
Mailing Address
Telephone: (home)
Business
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent AURORA PROPERTIES ATTN: Nancy Stahley
Address P.0.Box 671923 Chugiak. Alaska 99567
Telephone 688-4939
(e) Mail the HAA to the following address: (or check here [~)¢if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
Ea~le River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family B3~ Number of bedrooms t?~ ('~¢~ '~
3. WATER SUPPLY
Individual Well r~X. Community [] Public []
. Note: If community well system, must have written confirmation from the. State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~. 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.
72~)25 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is
Health 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 water supply and/or wastewater disposal system is in compliance with aH Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
5 & S A,r'IGINE-ERING
Address 17034 E¢,2ie River Loop Road No. 20~,
Telephone
Approved for ~ _bedrooms by ,-/~
Approved ~/'X'__ Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph $ above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The M u nicipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
?2-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY'1984
343-4744
Legal Description:
Total Depth q,~ ¢'t"
/.~,:.,~._.1:~.~ IfA, B, C, D.E.C. Approved (Y/N)
~ I ~l-ff '~ Yield "~-. 7
Casedto ~b~+ Depth of Grouting ~
Pump Set At t.)~,,
Sanitary Seal on Casingl~;~N) ~ --
Depression Around Wellhead (Y~ i~ --
; On Adjoining Lots
~ ~c~t ~' ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
~'~ ~'~ ~,,,t I,,~ ~ ~.- ~-R.-i ~,..~, L~;Date
Static Water Level ~'~- '
Casing Height Above Ground ~'~'~
Electrical Wiring in Conduit ~N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~,.Y1-"1'~ Size ~%~'c:> No. of Compartments --~
Standpipes ~N) ",/ ~' Air-tight Caps ~/N) ",/ -/' Foundation Cleanout (Y,~
Depression over Tank (Y~i) I~ Date Last Pumped
Pumping/Maintgnance Contact on File (Y/N)~, ~ I¢~- ; for --
I
Holding Tank High-Water Alarm (Y/N) f41 h,- Temporary Holding Tank Permit (Y/N). r,4 I,~.-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (YA~
Results of Last Adequacy Test
Type of System Design
Length of Field L~
Depth of Field
Gravel Bed Thickness
Statndpipes Present(~)'N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well \ c~ ~'~-
To Building Foundation \Ot ~
Lot ~--~ I Ix---
To Water Main/Service Line ~ C~ ~"
To Property Line \C
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Siz~
"Pump On" Level a~"-"~
High Water Alarm Level at
Tested for ~ /
Meets MOA Electrical Code.~-YT~
Comments /
Dimensions
Manhole/Access (Y/N) ~
"Pu~
~'-"--'~.-~ Vent (Y/N)
'"-~"--'~_~..~Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
Signed ::~ ,'.¢, S ~-.'N(~IN~I;t.~I[4G
Company ,! 703,¢. r;~rjle River Loop Roa~ ~. 2~d
)f this
Receipt No
Date of Payment
Amount: $
Receipt No
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE,ALASKA 99518 ° TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SAMPLE for Work Orde~ ~ 29433 Date Report Print~: OCT 22 90 @ 12:01
Client Sample ID:LSB SEC 4 T15N RLW SM
PWSlD :gA
Collected OCT 1? 90 @ 17:30
Received OCT 18 90 @ 14:45 hrs.
P~e~erved with :AS REQUIRED
Client Name : S & S ENGINEERING
Client Acct: SNSENGP
P.O.$ NONE RECEIVED
Req ~
Ordered By ; R. SNAFER
Analysis Completed :OCT 19 90 Send Reports to:
Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING
Re1 cas ed By ~ .~t'~_.~ ~__/'~. ?(_.~ 2)
Special
Chemlab Ref $: 904364 Lab Smpl ID: 3 Matrix: WATER
Allowable
Parameter Tested Result Units Method Limits
NITRATE-N 0.28 mE/1 EPA 353.2 10
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY RDJ.
1 Tests Performed * See Special Instructions Above UA=Unavailable
ND= None Detected "See Sample Remarks Above
NA~ Not Analyzed LT=Less Than, GT=Greatez Than