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HomeMy WebLinkAboutT15N R1W SEC 4 LT 37B Municipality of Anchorage Page ~ of ~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report PermJt Number: '~l~ ~J '~'~ / PID Number: ~)~ ~ ~:)~1'~'~ I ~ ~ ~~ ~ ~ ~ Waslewater System: ~ New ~Upgrade Address: ~1~ ~o~c~.~ ABSORPTION FIEL~ Phone:~_~ No. of Be~oms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from ordinal gr~: LEGAL DESCRIPTION soi,~t~.~: ~.~/s~.~. I - I ~ Lot: ~ Block: Subdivision: Depth to pipe bottom from original gra~e: Gravel depth beneath pipe ~1.~ Ft. ~'~ ~. FHladdedabovooriginal_graOe:~, ~' Ft. Gravel,ongt,: ~/ Ft. Number of lines: D~s~ance betwee lines: WELL: U New Q Upgrade Grave~ ~ ']~/Ft. [ ~ ~ Ft. '~(Private'A'B'C): Total Depth: Ft. CasedTo: Ft. Totalabsorptio. area:~ SO. Ft.~--~,1 ,~ Drifter: DateDdlled: StaticWaterLevel: ~[~~ Date installed: a/ /~ Yield: GPM ] Pump Set at: Ft. ICasing Height AbOve GrO"nd:Ft. TANK SEPARATION DISTANCES ~ s~,~c a HoU~.~ TO ~ Absorption Lift Holding ~ublic/Prlvate Manufacturer: Capacityin gallons: Fro~ Tank Field Station Tank Sewer Lines A~~ ~ Well ~, ~, jj~, ~ ~ M~~ .umberof~padments: Surface Water I~t~ ~'+ ~'+ ~ LIFT STATION Line ~ ~ ]~ ~ CudainDra~n ~ ~ ~ ~ ~ ~ ,~ / ~[~umP Make~& Mode]~ Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description:  Assumed Elevation: ~ ~t, ENGIneS SEAL Inspections performed Department of Health and Huma~Services approval Reviewed and approved by: _. ~ ..~ ~ Date: /~ 72-013 (1/91)MOA25 Pe?m, it No,. '~-J ~"~:~:~/ Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~ 72-013 A (2/91) MOA 25 Sep, 11 '92 11:~6 1992 SOUTH FORK CONST ]'EL 907-694-1122 ED'S ELECTRIC NC. $'J;3~1 ~O~,IM~RC:IAL DIHVI~ ANCHOfiAG~, ALASKA ~50i F'. 3 VALDET-- $o[~=hfork Construction ~2~30 Springbrook Drive Ea~:~e I{ivor, Alaska 99577 ~e~erence E3.e~trica3. I~]s]hect~c.r] on r.h~ ~* Stat]<~) ~t ~ William Mille? }~egidence j~ HC ~0 Box 51~2 ODer9 [~oad ,~ Chugiak, Alaska .,3u67 Th~ inspections took place Soptember ~C;, 2992~ ar..c t:}'.q~re code violations observer.[ at; %k~iS tin'.s. Th~nk you, }.aS Electric ,. t ~out MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920081 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MILLER WILLIAM F & OWNER ADDRESS:22314 YARNOT AVE CHUGIAK, ALASKA 99567 DATE ISSUED: 5/13/92 EXPIRATION DATE: PARCEL ID:05107261 LEGAL DESCRIPTION: T15N R1W SEC 4 LT 37B 5/13/93 LOT SIZE: 40207 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: BED INSTALLATION MUST BE 5 FEET. ? INSTALL CLEANOUT BETWEEN SEPTIC TANK AND LIFT STATION. MINIMUM SEPARATION BETWEEN WATER MONITORING HOLE AND DATE: DATE: May 9, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL ~NSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 37-B, SE 1/4, SW 1/4, SEC 4, T15N, R1W Request you issue a permit to upgrade the septic system serving the referenced property. The existing system is backing into the house due to groundwater levels. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. During excavation groundwater was encountered at 3.5' and groundwater monitoring within the test hole found water at 3.5'. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. We would appreciate you expediting this request due to the unsanitary conditions. If you have any questions or require additional information for your review, please contact us. Sincerely, RJS/lsu ON SITE WASTE WATER DISPOSAL SYSTIEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I"= 40' SCALE UPGRADE YARNOT AVE. PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4- 5 8 ~.o.q4. 9 10 11 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST -~-.~%...~ -~1'- ~ ~_..y.~t~-~wnship, Range, Section: ~--~,~ SLOPE SITE PLAN IF YES, AT WHAT /.~ .~.~' DEPTH? 13- 14- 15- 16- 17- 19- 20- [3epth to Water A~e.~./._ ~ ,~/~ J~_~' Monilorin§? r/..~.~ Dsle: Gross Net Depth to Net Reading Date Time Time Water Drop ,, PERCOLATION RATE TEST RUN BETWEEN (minutes/inch} PERC HOLE DIAMETER -- _ FT AND _~ FT $ & $ ENGINEERING 17034 EagJe River Loop Road No. 204 4"~ ¢~ /~. ACCORDANCE WITH ALL S~ATE AND MUNICIPAL GUIDELINES IN EFF HIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTNIENT 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 NAME PHONE , [] NEW D/~ zZb/~'/~/~/~ / C/'~ ~ ~/~ ~o~o¢ - ,~/~' [~] UPGRADE MAILING ADDRESS B. ~. Box LEGAL DESCRIPTION LOT ~ 7 LOCATION Well i Absorption area DISTANCE TO: Well Dwelhng Manufacturer DISTANCE TO: ~ //~ ~ Well i Foundation No, of lines Length of each line Total length of li~es Type of crib Crib diameter Crib depth WelJ Building foundation DISTANCE TO: Class Depth Driller OTHER PiPE MATERIALS SOl L TEST RATING INSTALLER REMARKS Nearestlotline Trench w~_~ inches inches NO. OF BEDROOMS PERMIT NO. '7Z~ o ~ '7~ No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. "7 ~ 0 o Distance between Ii es Total effective ab~orptio¢~ PERMIT NO. Total effective absorption area Nearest lot line Septic tank Distance to lot line LEGAL ,5, F'EI;?.M I T I.,I _. DET:'FII:;~TFIEI'-CF OF I.iEFILTI! Fit',II:, ENVIF~ONHENTFIL. F'ROTECT'IOI'.,I ,'.325 '" L.. "' STF?.EET., FINC:HC/F?.FIGE., FIl<. '9%~50t 2E;4...4.7.':."0 .... '. ' E,O;.; ]:~:J- CHUG I Iii [ l..] .. I~f ~_::.'SOI'L,L L...: FI T ): 0 I",1 '-' H_ 31 I:ll-;' LtEGFIL 'l":1..SN F;'.:tl...! SEC 4 L :2:7 ,::EC:, '~ ~,~,~' ~E~z~/L,] LOT T'-r'F'E '."il::' 'E;OZL FIE:SOF?.BTZOI"4 S~'r"-:.?'I'EM I~N~ELD MFIi:4ZI"IlJM 1"41...IME:EF;: Eft:' [..,E.C[;.....,t.- = TIlE F~%QI..II[:::E[:, SIZE: O[:' THE 'r:;I-~IL. E ....... [ FI_M .::,r_,TEM I.:,: Ri:" ~:~: F:' -]f- .II..-""1t === ~:::. ~___ EE'Z t~"~ .:.', Il fl'-l! =- I .... :l.(O(1ZlO '~l';d.ll:ll;i:E FEET TI'IE L..EI'.~GTlt I> ]: MEI',I'.:~; I ON IS ]"tiE I...EI'-~GTI...I (!N FEET> OF THE "FRENCH OFt THE DEPTH OF: R TRENCH OR PIT IS THE DISTRtqCE BETI.,.IEEN THE ':TURFFICE OF TIlE GF?.OUI'.4[> FllqD THE BOTTOM Elf THE E::.;',CFI'v'RTION ,.'.IN FEET>. THE TRENCH WIDTH FOR DRFIINFIELDS IS ,~ FEET. THE' GF?.R',/EL DEPTH IS T'HE MINIMUM DEPTH OF' GF~Ft',,,'EL BETWEEN THE OUTFI:::IL.L PIPE FIIqD THE E~OTTOM OF THE E',qL-:R',/FITtON (tN F'EET). _ :,: ...... I[1I.:- [:,EF'FI~:TPIENT [:,l_ll:;~:!l"dl3 "File F'IZI;?.MIT FIF'r:'LIE:FINT I11-_, THE .E.::,I LI,!.:,IE, ILI1 r T]3 It'-,t1::'O1;;:i"1 IhlL:~i'['FILLI:::ITtl.}N Iii-, E-.FI-,N-, CIF I::iN'r' [~EL.L::, FID.I'FIC":ENT TO TI-II'::'-, F'F;-FEF r~ FIND THE N..I ~.E.F. OF LE.:,t~.EN-.E.::, TI'ii:IT THE HELL WILL SEt;:","E. []:[::iE:[:::FILL!I",II]i C]F' I::llq"r' =~_.I'Efl 14tTHEIIJT FtI'-4FIL Ii",ISPEF::TICII",I F:II'-,ID Ill II; tL E, Fill_, [:,EI:r:'I:'tl;;:'TI"IEI"~"I- 14ILL E,E. =,U[,JL_.'I TO I'~[;?.OSE(-:UTION. M:I:NIFII..Ihl D]:S'FFINCE BETI.,.IEEIq R I.,.IEL. L RIqD Ri"4"¢ ON'-SITE SEI-'.IFIGE DISF'OSRL S'T'STE:hl IS 1OO l::qi!ET F'CI[;?. I':l f:'r~:I',,,'FITE 14EL. L.; O[:?. :l. 50 "FO 200 FEET FI701-,1 R PUE:LIC I.,.IEL.L DEEF'ENDTNG UPOI'-,I THE TYPE OF' PUE:LIC P.IIZL. L.. !.4EL. L L. OGE; I'::IF?.E: REQUIF:'.ED FIl'-4[:, i',ILIS, T BE RETLIRNED TO THE DEI::'RF;:ThIENT 14ITHIN ~:O DF:f"r'S OF THE WEI_L COHF'L[E'FIOI'C OTHER I'q:EQUtI?.Ei"IEIqTS HF'I'¢ FIF'[:'L.",". SPEC:[F'ICR-FIOIqS AND CONSTI;?.UCT!CIN DIFIG[:?.FIt"IS Ftf;?.E FI',,"FIILAI3L. E TO lt",ISU[;:rE F'ROF'ER INSTRLLRTION. I C:E[;'.T I F'¢ 'I'I"II::IT 1: I RI"I FAMILIFIi';?. 14ITII THE: RIZQUIF:[ZMI.'ZNTE; FOR ON'"-SIT[i 5E:I.'.IERS FIND' WELL. S I::IS SET FOI;?.TH B"r' THE I"IljI"4ICII:'I::II_IT"/ O1::: FINCI'iO[i:FII3E. 2: I I.,.IIL_[. ]:N:'":';TFIL. L. TtiE S"*"E;'FEM I?',1 FICC:OF;'.DFII",IOE WITH TI-IE CO[:'E~3. 2: t U,NE:,E[;]?:STRN[> T[IFIT TIlE C',N'"'::;ITE ,r::%SII],[EI'-,IC:E IS REi"ICd.;:,EL.L-D TO INCLUD,rZ I"IO[;~:E T[IFIN Z: E:EDI:?.OOHS,. [:IF'PLiCFiNT DI::IL.E I'IENDR: 1 ..:,::,dl:.[ El"r' , . OSE Russe# Oyster 694-2774 Soils 8 Foundations GE£~-%,ECHNICAL 8' DEVE~-'~PMENT Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 Performed for: Name: ~ ' ,,,, SOIL LOnG CO. Earl Ellis 688-2280 Land Development Mailing Address: Tel. Legal Description: D_~p t h ~fee~ 2 6 8 lo__ 11__ 13 16 Ground Water Encountered: Proposed Installation: Commen~s: Yes No ...... If yes, what depth__ Seepage Pit__Drain Field~ Performed by: Date: Well Owner -W DRILLING, INC. Dale Hendrlckson DRILLI~IG LOG Location (address of: Township, Range, Section. if known; or distance ~nain roa(i Lot 37B T15N RiW Sec /' S.M., Chuglak Size of casing 6" Depth of Hole Static water level 135 ft. Screen ( ); Perforated ( Describe screen or perforation N/A Well pumping test at 15 gallons per of drawdown from static level. Date of completion 9 J 15 / 78 162 feet Casedto 160.9 feet (below) land surface, Finish of well (check one) open end ( xx ). (minute) for 1 hours witb 100% WELL LOG Depth in feet from ground surface Give' details of formations penetrated, size of material, color and hardness 0 TO 2 Casing stickup 2 TO 40 40 TO 65 65 _TO 130 130 _TO. 135 135 _TO. 162 _TO. _TO. _TO. .TO. .TO. .TO_ .TO_ ~TO TO ); Silty gravel: cobbly Silty gravel Cobbly hard pan Gravel Water gravel GAAB*HD.J TER ANCHORAGE AREA BOROt '4 D~rAI~TMENT OF ENVlFIONMEBITAL nUALh .' 3{]00 TUDOFI ROAD ANCHORAGE, ALASKA ggB0? 275-8888 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: DISTANCE FROM WELL /~')~ ! LIQUID CAPACITY /c~'~//) (~Y,~'~-, GALLONS. MAILING ,-~ ADDRESS /('~/J' LEGAL DESCRIPTION ZOr MATERIAL IN=SIDE LENGTH NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH____ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH . DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH //~ / , . DEPTH BUILDING FOUNDATION~J ~":~ /~'~ SQ. FT. TILE DRAIN FIELD: ~ /, EOUNDAT,ON DISTANCE FROM WELL NUMBER OF DNES ~ ABsORPTION A~ DEPTH: TOP OF TILE TO FINISH GRADE  . N AREST LOT LINE DISTANCE BETWEEN LINES ~,~ENCH WIDTH SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH; , OF LINES / IN. ABOVE TILE DISTANCE FROM ~.~, WATER WELL: TYPE C'JK'i J J~cJ DEPTH , BUILDING FOUNDATION. SAMPLE NEAREST LOT LINE ~C,I ! NEAREST SEPTIC SEEPAGE OTHER SEWER LINE , TANK ~ ~ , SYSTEM I,~_ ~ , CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE ~/~/~ ~)~- APPROVED GREA~ER ANCHORAGE ArEA BONoUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT I -' INSTALLATION LOCATION SEEPAGE PIT J// - , DRAIN FIELD , OTHER SEPTIC TANK SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK~- FOUNDATION TO seEPaGE Pit SEPTIC TANK TO SEEPAGE PIT WALt SEPTIC TANK ., SEEPAGE PIT TON~ARESTLOTL~NE. J? WELL TO SEPTIC TANK [)RAIN FIELD SEEPAGE AREA SIZE · SEEPAGE .IT /~(:2 x , , ALSO CONSIDER AREA WELLS. DIAGRAM Of SYSTEM WATER MAIN TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. A~IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOil. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHOR[TY OR LICENSED DESIGNER I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-~8 AND THAT THE ABOVE Ii"DRILLING ...~,z~,*~; :~- -~.. .... ~ ::, ... -:-x ..... -¢ ,q,:a~HORIZATION TO DaILL "- ~ F ~ ['[.Xt F ~ -.;. ~, :' - ':---~ ..... ~? ~ h~eby autho~e 101 D~i~ Co. ~ proceed ~th the above de~ribed ~ork. Pa~ent ~U be mad; ' ":' ~; f --.' -':~m the foHo~g ~nner ~.- ~?~:z~-~.' .... '-'~-~:- _ ~ ' _~.~t/: : -: · .. · ~ ~, .' -,'- :~ - ~' ~?);' ~z- :~ ,:~/:~In~ the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional sum of not to exceed ten percent (10%) of the contract price as attorney's ::~:'fees, plus costs, for legal oroceedings. ~--\ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ~ t- '3 -? z~ 7'1s"/,/ ,,~/~.~' :~-~_- .¢ 5, (b) (c) (d) (e) Location (address or directions) Applicant Name ~"~ ~-~::~-"7,¢/¢:~' Telephone: Home ~;~ Business Applicant is (check one):~nding Institution ~ ;Qwner/builder ~; Buyer Lending Institution /~/J~YZ2w ¢' ~O~/~/M Telephone Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (f) TYPE OF RESIDENCE Single-Family j~ Vlulti-Familyr-I Number of Bedrooms ~ O[her WATER SUPPLY Individual Well~ Community[] 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 OnsiteJ~ 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 (11/84) ENGINEERING FIRM PROVIDIN~ 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 m~ investigation of thi~ ~lealth' 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 all Municipa! and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~?/-'"~ "z'-J~7~'d~"-/:://~/z'-X;' Telephone Address /~"~ /~'"~ ~ -// '¢: '7,~ ~- /~--L,,'(:,, /?-/-,~ .?-~,.~-' ,)ate ineer's Seal DHEP APPROVAL' for "~'"'~J-/ bedrooms by Approved Approvea ~ Disapproved~'/ Conditional Terms of Conditional Approval 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 72-025 (11/84) · ·· M~/~IICIPALITY OF ANCHORAGE (MOA) _ I~'¢,C,'¢O,~k~ALTH AUTHORITY APPROVAL (HAA) ~g¢. ~ ~ ?~ 264 4720 ~ , ~ ~ ~) ~ Legal Description: ~ -~ ~ WELL DATA ' Well Classification ~~/~ ff A, B, C, D.E.C. Approved (Y/N) Well LOG Present (Y/N) ~ Date Completed ~/~Yield Total Depth /~ ~' Cased to ~'~'~'.~ Static Water Level /'~¢¢. Casing Height Above Ground Electrical Wiring in Conduit (Y/N) · Separation Distances from Well: To Septic/Holding Tank on Lot Depth of Grouting ,"¢'/J"'¢ Pump Set At ///¢ ~- Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ,:~ / ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /'~z¢; / ; On Adjoining Lots To Nearest Public Sewer Line ./1//?~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments To Nearest Sewer Service Line on Lot ~'- / · , Date B. SEPTIC/HOLDING TANK DATA Date Installed ¢/~,/7~¢¢ Standpipes (Y/N) ,/~ Air-tight Caps (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/H9lding Tank: To Water-Supply Well ~;2~" / To Property Line ~0 / TO Water Main/Service Line · Course Size /OO ¢ ¢~Z/No' of Compartments Foundation Cleanout (Y/N) .~T'~_~ Date Last Pumped /¢/~ .~ ; for Temporary Holding Tank Permit (Y/N) 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 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 /E)O / 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 Comments LIFT STATION /'~,///'~'"~ Cype of System Design ~-"'~-~"?¢:~/' -- / I-' ~,~.~. j Lengt~ofFieldjt ~ .... 2, _.. Depth of Field ~) Gravel Bed Thickness ~ /~ Standpipes Present (Y/N) Ad qu c To Properly Line ~ To Existing or Abandoned System on ; On Adjoining Lots TO Cutbank (if present) Date Installed Size in Gallons "Pump On'i Level at High Water Alarm Level at Tested for ~/~/~''~'~Z '~? Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Bating Against HAA Request ** I cerli fy..t ha, t I have checked, verified, or conformed to all M-CA and HAA g uidelines in effect on the date of this inspection. C,~y ~/¢~-~-¢~'5~CZ*"/~ MOA NO. Receipt No. ~ O O / ~ O c':':':':':':':':'~- o Date of Payment '"~/7//~' Amount: $ ( (¢ ~"' ~ ~ ~ ineer's Seal Page 2 of 2 72-026 (11/84) ¼unicipality P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264~4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES September 30, 1986 John R. Chambers, P.E. CTS Associates P.O. Box 671478 Chugiak, Alaska 99567 Subject: T15N R1W Section 4 Lot 37B Waiver Request, WR86-t41 Dear Mr. Chambers: Your request for a waiver of the 100 foot separation required between the septic tank and well on the subject lot has been granted° This distance has been waived to 85 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Civil Engineer On-site Services SSM/ljw CTS ASSOCIATES P.O. Box 671478 Chugiak, Alaska 99567 (907) 688-4442 September 12, 1986 Municipality of Anchorage Department of Health and Environmental Protection Bth and L Street Anchorage, Alaska 99501 Attn: Mr. Dan Bowls Re: Lot 37B, Section 4, Township 15 North, Range On-sits Septic and Well ~sparation Waiver Request - Bill and Wanda Miller West, S.M. Gentlemen: As a follow up to the telephone conversation between Mr. Dan Bowls of the D.H.E.P. and myself last week, this letter requests a waiver to the 100 foot separation distance required between the on-site well and septic tank for the sub3ect property. Durin9 an on-sits inspection, including at an adequacy test and water sampling and testing of the subosct systems, it was determined that the previous recorded measurements indicating a greater separation between the septic tank and the well were inaccurate. The measurement determined during this on-site visit was 85 feet between the septic tank and the existing well. The separation between the leach field and the well is i00 feet plus. The system has been in use since 1978 with no reoordsd or apparent contamination or sickness resulting. Certainly, the well water tested satisfactorily as indicated from the test results by Alaska them Lab. The topography and soil conditions are such that the drainage from the tank, toward the well will not be likely and lead to contamination of the well. J~r. Dan Bowls Page Two I request, on behalf of the present owners Bill and Wanda Miller that a waiver of the required separation distance of lO0 feet be granted and that the existing 85 feet be accepted as adequate. If there are any further questions regarding this issue, please contact me at the above phone number or Mr. Gene Skyles. ~incerel¥, CTS A~OCIATBS John R. CE 6922 JRC/kls MAT-SU TEST LAB, IN C. Soils - Concrete - Water Field m~d Laboratory Testing Services P.O. Box 871868 · Wasflla, Alaska 99687 · (907) 376-3005 DRINKING WATER ANALYSIS FOR TOTAL COLIFORM BACTERIA ~,Pp/ICA MT INFORMATION~ S~le Inf~ma/ion: 9a~e Collect.d: ,~?~-fl~ Time Collected: ~yO ~Coll~cc~d ny: ~ample Type: ~AouCine ~Check SampLe '~Trea:ed ~UnErea~ed Tills SECTION TO BE COMPLETED BY LAB ANALYSIS RESULTS ?2J~ Satisfactory [-~ Unsatisfactory -.. ~ Sample Rejected:i--lOver 30 Hours I~ Trensit~-r~TNTC'.Cclonies Too Numerous To I-~]Confluent Gr/~ RECOMMEND' RESAMPLE Final Membrane Filter Results:~ '{_.7' Colonies/10~ml No. of Positive Tubes f~.om 'fiVe 10 ml Por~io~iJ;~MPN:~___/~__ pep~ lOJ3 ml Date Anatysis Co~rpleted: ~'~c/i~O~Reported"Bg': '.2 (/ '.~..,~Z~ MICROBIOLOGY LABORATORY RECORD-COLIFORM ANALYSIS Date Received: ~~ Ti~e Received: ~\1~ ~ Lab Number: Date Test Started:~-~2~'-~-~~ .Time Test Started: /~z~) Analyst: TEST METHOD - TEp~.RESULTS-~ -- ~ATE/I;IME/ANALYST Membrane Filter Direct Count:F~)Colonies/1OO mi (NF) Verification: LTD ,BGB Presumptive Tube # (LTB) 24 Hr. . 48 Hr. Confirmatory Tube ~ ' (BGB) 24 Itt. Completed Plate # Tested EMB 24 lit.,, ,~ Tube # LTB 48 }Ir. REFER TO BACK SIDE FOR INSTRUCTIONS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO~I~i~IOI~ALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPT, ©~ H~ALTH & ENVIRONMEN1'AL F;;OYECTION, ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 /~Pi~ ~ 1980 REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANDSit~{~ I._ _ _~J~ET~S PROPERTY RESIDENT (If different from above) MAILING ADDRESS PHONE PHONE MA UNO AODRES 5. LEGAL DESCRIPTION TYPE OF RESIDENCE NUMBE'/~OF BEDROOMS [] One [] Four [] ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY '~] Three [] Six Other 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled BI COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM "1~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date ..... If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEI).