HomeMy WebLinkAboutMCCABE WEST LT 7
MUNICIPALITY OF ANCHORAGE
~ DEPARTMENT 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 ~.~H ON E ! ~NEW
~0. OF
~ DISTANOETO: I Wel~ /~0; I AbsorptionareaT/ Dwelling /V' PER~.
Width
Liquid
depth
PERMIT NO.
~Z~ ~ DISTANCE TO: ~ Well ~ng ~ ~ ~ ~y in gallons
OZ~ ~
Q DISTANCE TO: Wel ~B ~ Founda~
~ No. oflines / LengtP¢.. · /O0 T°tal ~tTi~s Trench wn~ inches DistancebepT~s
ff~ Top of tile to finish g~ ~'
Material beneath tile Total ~av~bsorption area
Q ?~ inches
Width
~ ~E TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
REMARKS O .~
~' ~ t
AP~ DATE LEGAL
79-gl~Rm~ 3/7R) ~ J
F!F'F'L. ! E:FtNTGE:NE ..~RN I GO PO
LOCF:tTION P~C:CFIBE C:IR [4EST
L.EC~FtL. L7 HCCFIBE 1.4EST S,,'D LOT SIZE
T'¢PE OF' SOIL F~E~SORPTZON S'¢STEPI :CS: TRENCH
P'IF¢,:.::IHI...tH NUFt[3E:R: OF BE[::,ROOHS = *~. SOIL RFiTZI",IG ,::St;:! F]",zBR:)=: :'.LOO
THE REG:~UiRED SIZE: [)F' THE SOIL RBSORF'TZON S'¢STEH
5 a00E't :::2 C~URRE: FEET
THE LENGTH DIHENSION IS THE LENGTH ,.'.'IN FEET) OF'-' THE TRE':I",!CH OR DR:FIINF'IELD.
THE DEF'TH OF' i::t TF~:ENCH OR PIT tS ']'HE DISTRNCE BET!.,.IEEN THE SURF'FICE OF' THE:
GROL!.N[.':, RNt:::, THE E',OTTOhl OF THE'.' EXCRVR'T'ION ,.'.'IN FEET).
71'..IEF~:E IS i'.,IO SET ktIDTH FOR TF.:ENC:HES.
THE GRWCEL. [:,EF"TH iS THC:: FIINIPtUH [>EPTH OF GRF:IVEL 8ET~,.IEEN THE OLr!"FRL. L. F'!PE
F:IN£.':, TP!E 80TTOi'"t OF THE EXC:F¢,,,'RT!ON ,::IN FEET).
PE!:;Uq t 1"RPPL I CFif.,tT HFtS THE RESPO.I'-,IS ;[ B I L I 'T'¢ TO ;[ I'.,IFORI',I TH :[ S E:,EF'¢::I. RTP1ENT [)UR I NEi THE
INSTRLL. F:ITION INSPECT.IONS OF' FIN'¢ .L!EI....LS RD..:rRCENT TO THIS F'ROPERT? FINE:, THE
i'.,IUi','!BER Ot::' RESI.F.:,ENCES THFIT THE .[4EL. L HILL SEtTVE.
BFiC:iCF.T. LLING OF R!~',t'~'' S?S"FEH !4tTHOU'f' FtNFiL INSPEC!"iOf'.,t RND f:tF'P.[;;~O',,,'FIL B"¢ THIS
DEF'[:::tRT!"!ENT i4IL. L BE: SUE;.J'ECT TO PROSECUTION.
HI,NIFIUI',t DIS'TI:~t",IE:E BE"f'!.,.tEEN R HELL RND RN'.r' ON-.-SiTE SEI.,.IFtGE [:,ISPOSF:tL S'-r'STEt"I IS
±CCi FEET FOR R PRtVRTE IaEL. L ON: :250 TO 200 FEET FF.'COl"1 R F'UDLIC [,.IELL. [:,EPEND:[NG
UPON THE T'¢PE Cfi:' F'UBL. IE: t.4ELL..
HINIHUi'4 D:[STFtF,!CE FF:'.Oi"! FI F'RIVRTE .~4[.:.::LL. TO R F'R!',,,'FH*E: SEI.,.IER: LINE I~; 25 FEET FIND
TO R C:OIq!"IUN;[TY SEI.,.!E.:.I:~'. L:[f.~!E IS 75 FEET.
1.4E:LL LOGS RRE F.:Ei(PUIRE[::' RN[;.', HLIST BE RE-t"UR,~",!ED TO ']"HE DEPRR'THENT N:["f'HIN 3:0 DR'.r'S
OF THE t.,.iELL COi"IPLE:"f'ION.
OTHER RE(;!U:[R':E!'flEi'4TS NR"r' FIPF't..."¢. SPEClFICFiTIONS FIF,Ir_'.', CONSTRLICTION E:, ]: RGRFff'1':5 FIRE
RVfllLRBLE TO INSURE F'ROF'ER INS]"RLLFtI"ION.
I CERTIFY THRT
±: t RH FRMILIRR !-4:[TH THE t~:EQLIIFi'.EHENTS FOR ON...-SITE SEI.,.IERS AND 1.4ELLS F~S SET
FORTH B'~.' THE HUNIC:IF'¢~LIT'¢ OF RNCHORRGE.
2: I !.41L..L tNSTRLL THE ?¢STEP1 IN 8CCOR'.DFINCE P.!ZTH 'r'HE CODES.
]~:: Z UNt:::,ERSTRND THR'I" THE ON--S:[TE SEWER S'.¢STEH HF:I'¢ RE(;4UII:~'.E ENLRRGEHE:NT IF' THE
RESIE:,ENCE IS REHO[::,EL.E[:, 'TO INCL.UDE FIORE THFIN 4 BEDROOPIS.
LEGAL DESCRIPTION:
C'! ,~'~,j~ SO~LS LO~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82§ L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~"'//~j~-~ / ~'~ O ,, DATE PERFORMED:
[] PERCOLATION
TEST
1
2
3
4-
5
6
7
8
10-
11
12
13
14
15
16
17
18
19
2O
SLOPE SITE PLAN
NO, 1732-E
June 22, t968
WAS GROUND WATER /~J (') SL
ENGOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
minutes/inch)
COMMENTS
TEST RUN BETWEEN
FT AND
.,z /~,41//I
FT
CERTIFIED
72-008 (6/79)
SIX INCh WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
dRILLED AT THE rATE OF ~723.00 PEr FOOT.
PROPERTY OWNER
90 7'e.eZo
LOCATION OF WELL SITE.
DRILLER
WELL LOG:
0 .... 78'
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOrTHE SUM OF(.(,?,O. Yi:O..~. ,~--- ,,
THANK YOU VErY MUCH.
Date
BERNIE CLAUS OF RAMPART DRILLING WORKS
~ERVICE CHARGEOF 1~% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
IVlUNICIPALITY 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 ~ r/~
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b)
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ulti'-Family []
Number of Bedrooms __~
Other
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
Onsite ~/'~pUblic [] Community [] Holding Tank []
Note: If community wetl 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 PROVIDING .~SpECTIONS, TESTS, FILE SEARCH, DAis-, AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this 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 Jn compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. __ ^ , /
NameofFirm L//~,Or~"q ¢(~'¢ Q,,~._~,~'(~(/R.~t 4/~j~.. Telep?one ,~
L~ ;:~ ' / - -- /-
Engineer's Seal
Approved ~ O}saop~oved2. Coudi~iona~ i_
Terms of Condi~ioRal 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
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal~e.~.c~.Ption:
~UNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
1986'
A. WELL DATA
Well Classification ~J/~f'~._ I~LG..~_ If A, B, C, D.E¥C. Approved {Y/N)
Well Log Present (Y/N) 1£7 Date Completed '7 /(~. ,,r Yield
Total Depth (~O~ Cased to C(o '
Static Water Level /'J~J
Casing Height Above Ground J I
Electrical Wiring in Conduit (Y/N) I ~5
Separation Distances from Well:
Depth of Grouting /~/~A
Pump Set At ~)O ~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
: On Adjoining Lots
I I O ; On Adjoining Lots
To Nearest Public Sewer
100
Cleanout/Manhole /~Ji~ To Nearest Sewer Service Line on Lot
Water Sample Collected Dy L.,0QQ.¢" ;Date ~ ~5~,.
Water Sample Test Results ~
Comments
U
B. SEPTIC/HOLDING TANK DATA
Date Installed ~P/~'~'/~--'~
Standpipes (Y/N) ¥ ~ ~'
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N) /~/J~
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well J ~)c)l
To Property Line
To Water Main/Service Line
Course
Size /Z.~"O ?ll~or) No. of Compartments
Air-tight Caps (Y/N) ~4 ~ Foundation Cleanout (Y/N) U. £.5
'
Date Last Pumped
for
Tern porary Holding Tank Permit (Y/N)
To Building Foundation J ~ !
To Disposal Field ~ I
To Stream, Pond, Lake, or Major Drainage
Comments
Page I 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/N)
Results of Last Adequacy Test
/ ~Jp¢'~ ~- Type of System Design
I I,,' '
Length of Field
Depth of Field
Gravel Bed Thickness ~
Standpipes Present (Y/N)
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
Comments
Date of Last Adequacy Test /-~t~'~; lq~.
To Prope~y Line JO ~ ~
To Existing or Abandoned System on
; On Adjoining Lots ~-
To Cutbank (if present) ~/~
1oo
LIFT STATION
Date Installed~k,
Size in Gallons ~
"Pump On" Level at~
High Water Alarm Level at'~"'"~
Tested for ~
Electrical Codes (Y/N) J ~
Comments ~
Dimensions ~ ~
Manho~ "~
Pumping Cycles during Ad~,qu~Test. Meets MOA
/
** Check P~fr~ted Bedro~__..~Rating Against HAA Request **
I certify th~ ~ j~h~ecJ~i.~rified, (~r conformed to alLMO~and ~AA guidelines in effect on the date of this inspection.
Signed ////~/~ ~ ~ate ~
Oompa:yU~~~t~ MOA No. ~
Receipt No.~ ~ ~ ~ - 0~
Date of Payment ~ - ~-~ ~
Amount: $ ~ ~ ~ [ngineer's Seal
Page 2 of 2
72-026 (11/84)
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
[] PUBLIC WATER SYSTEM 1.D,#
[] PRIVATE WATER SYSTEM
Name
Mailing Address
City State
Mo. Day ' Year
Phone No.
Zip Code
SAMPLE TYPE:
[~outine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
SAMPLE
NO. LOCATION
31 I
4 I
) [] Tr0ated Water
B;~A~treated Water
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Date Received
Time Received
Analytical Method:
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.
Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
I ST/?-a/.l I-]-'Q
I
I F-F1
I
BACTERIOLOGICAL WATER ANALYSIS RECORD
'Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count
Verification: LTB. BGB
Final Membran~t~s ~
Reported~.~-~' ~ ~ate
Time:
TNTC = Too Numberous To Count
OB -- Other Bacteria
Coilformll00ml
AppLICaNT FILLS OUT UPPER HAL'~h~ONLY
Property Ow, per ,,,--~,,~/t. 2/:~/~ d_2~ ~'/~ ~:~ ,/~ Phone
Mailing Addre~ ~> ~ /~ _ /~ 2.~~ / ~//~/~. .,~ Zip Code ~/~--'// ~ ~-~
Buyer /~ ,
Address Zip Code
Realty Co. & A~nt Phone
Address -~.~,~ Zip Code
Street Locati~
Type of Resi~nce
~Single Family -
~ Multiplo Family ~o. o[ Bodroo~ ~;~
~ Other
Water~ IndividualSUpply
~=/~ 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
S.we~ o,,~os~,
~ Individual ~-~LJ~.~ ~ ~2~' Year Indiv~ual Installed:
~ Public ~ility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Tim& [ ~ ~'i0
Date Date Date Date
Inspector Inspector Inspector Inspector
C__~,- g- ~ B~C 1 7 t982
RECEIVED
(2 ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( > DO~mTIONAL APPROVAL'
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received ~ (3
(~:~-- ~ ~ Well to Tank Septic Tank Size I .~-.~'~
72-023 (3182)
GEOLOGICAL LABORATORIES Or' ALASKA, INC.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL ITER m274-3364
Drinking Water Analysis I
TO BE CC
WATER SYSTEM:
Water System Name
I.D. NO.
Mailing Address
City
SAMPLE DATE: ~
~0.
SAMPLE TYPE:
[3 Routine
[3 Check Sample (for routine
with lab ref.
[3 Special Purpose
State Zip Code
Day Year
Analysis shows this Water SAMPLE to be:
[~,/Sat i sfactory
[] Unsatisfactory
I~. Sample too long in transit: sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
,new sample.
Date Reoeived ~ / ' ~
time Received ; ~ ~ -7')
Method:
Filter
SAMPLE
NO.
1
2
3
4
5
LOCATION
ReBult* Analyst
06-1220 {b)
Ray. 1978
BACTERIOLOGICAL WA~i~ ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Data Collected · Source
PresumPtive r 1Omi 10mi [Omi 10mi 10mi ' 1.0mi 0.1mi
24 Hours
48 H~urs
Conf rmatory · '
24 Hours ' .
48 Hours
EMB Broth 24 hours:. .Broth 48 hours:
Multiple Tube Report= [Omi Tubes Positive/Total /0mi pol'tlonl
Membrane Filter: Direct Count Collform/100ml
verification: LTB BGB
Fna Membrane F ter-Results - ,~ . / Coll,form/100ml
Reported By~~*'' :~:-" :: '~:~'~ ....... ·'. 4 Data / 'C ",/ *"'~ / '~:J :~;
' ' ~ ....... Time* ' , ~..~' '¢1::~7'-?"h a.m.
December 27, 1982
Janigo, Gene R.
Box 10-1223
Anchorage, AK 99511
Subject~ Lot 7 McCabe West Subd.
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
A well log submitted to this office for our files and
review.
~ The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
" A four (4) inch cleanout needs to be installed to the sep-
tic tank.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this offic~ at 264-4720.
Sincerel?~)
Robert C. Pratt
Associate Environmental Spacialist
RP255I IE