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HomeMy WebLinkAboutKASILOF HILLS BLK 7 LT 18 oGR r :R ANCHORAGE AREA BO'- IGH Department of Environmental qualily 3330 C Streel Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME _ PHONE LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE _, NUMBER OF FROM WELL/~/~ ~-~/F MANUFACTURER .,(,4 ,,~-¢/%~ ~ ¢ ./ MATERIAL ~ ,'~'"'- / COMPARTMENTS / INSIDE LENGTH INSIDE WIDTH -- LIQUID DEPTH -- LIQUID CAPACITY ~/¢~¢'~'g' - . ,, GALLONS. .SEEPAGE PIT: NUMBER OF PITS I DIAMETER OR WIDTH /-~',- LENGTH2-"~,"' DEPTH ~:) ' LINING MATERIAL /~//¢'~',~ CRIB SIZE: DIAMETER__DEPTH ? / DISTANCE FROM: WELL /)~'/ ,¢/_ / ~ / TOTAL EFFECTIVE BUILDING FOUNDAT ON~-~" , NEAREST LOT LINE ¢- ~ . ABSORPTION AREA (WALL AREA) '"~-;?~'~ SQ. FT. ADDITIONAL ABSORPTION ,/1'///~- WELL: TYPE _~'~ t/~ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION __ LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK__ SYSTEM DISTANCES: INSTAl_LED BY: / LOT SLOPE: /~'.-/~/ REMARKS: ~.~'~¢&/_./¢ i¢ / Form No, LQ-031 DATE AP P R OV E D ;,~Z,';:z /;') ~'_ ~:d'~ ~/~: - :;: G.A.A.B. GREATER ANCHORAGE: AREA BOROUGH~P~ DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456 ~ ],' SEWAGE DISPOSAL SYSTEM --- APPLICATION AND PERMIT INSTALLATION F~~p~ ~~~-~{~ . OF: SEPTIC TANK ......... SEEPAGE PIT . DRAIN FIELD OTHER O OMPLET'O" DATE A,TI('IPATED -~~ /Y~] WELL. ]O SEPTIC TANK /'d~ ~ /' SEEPAGE PIT ~ / DRAIN FIELD ALSO CONSIDER AREA WELLS. ~ATER MAIN TO SEPTIC TANK __ / ~¢ /2 .... SEEPAGE PIT / ~ ~' TG RIVER, LAKE, STREA~4, CASA IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. GRAVEL. ~A~KFILL CONPORM i'O BOROUGH REGULATIONS REGARDING INSTALLATION, GREATI]R ANCHORING[ AREA BOROUGtt DEPARTMENT OF ENVIRONHFql'AL QUSLITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For Leo Sawyer Dated Performed Ma~ 31, 1974 Legal Description: Lot 18 Block 7 Subdivision Kiso[iffkz~A~-ea~s//~//~ This Form Reports Soils Log X Percolation Test - Soil Test I,lust Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 2-- 4 .8--- 9-- le- i 3-: Light brown silty clay ML Gravel; coarse-to-m'edium wit~ha~/ trace of sandy silt ~ SP-S'vV Coarse gravel with sandy silt Was Ground Water Encountered? No If Yes, At What Depth? __[_ ~Reading Date Gross Time Net Time Depth to H20 Net Dro Percolation Rate Minute Proposed Installation: Seepage Pit X Drain Field Depth of Inlet Dept 16' h to Bottom of Pit or ~T~nch / COMMENTS: Based on Borough requiremen~s and regulations, we recommend(172~q, ft. per bedroom, ____ Test Performed BY Joh_n_jameson Date Certifie'd BY: Da te: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-47'44 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A S N LE FAM 'V DWELUN6 GENERAL INFORMATION compi'ete legal description Lot 18; Block 7; Kasilof Hills Subdivision; Location (site address or directions) 10141 Stroqanof~ D~cive Property owner Mailing address _ Lending agency Mailing add~ess' V~rn & Marion Burkholder Day phone 346-2630 ~.O. Box. 100266 Anchorage. Alaska 99510 Day phone Agent Carol Pope CENTURY 21/PACIFIC NORTH Day phone 345-1444 Address 1120 Hurdman Rc~a.d Anchorage.; Alaska. 9951,5 Unless otherwise requested, HAA will be held for pickup ; '. . NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: - Individual well , XX ' ,' Community well Public water NOTE: If community well system, provide written confirmation from. State ADEC. attest- ' ',~', ing to the. legality and status of system. TYPE OF WASTEWATER DISPOSAL: :- -';"' -:'.';:"~'; '""';i? Individual on-site ,' ','; ; ':Z".',-?; - ,.,-/~ :' :, ', Holding tank Community on-site Public sewer ~ NOTE: If community wastewater syste.m. ¢~provide written confirmation from State ADEC attesting to the legahty and status of system. 72-025 (Rev. 1/91) Front MOA #?.1 s~,ue~oo i~uo!~.!ppv -- :suoj~elnd.~s I~U!MOiiO~t eq~, q;~!M 's~ooJpeq 'swooJpeq Joe le^oJdde leUOp, jpuoo 'pe^OJddes!c] Jo, peAoJddv ~ '=lid rlJ..'VN ~)18 SHHCl eJm, euB!s sAeeu!Sust Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKI..IST Legal Description: / !~)Z'2~;..~.~-&'/~)¢~///fi, %.~. ParcelI.D. A. WELL DATA Well type_~lf A, B, or C, attach ADEC letter. ADEC water system number _ Log present (Y/N) /%,J Date completed ,,X- ~- -""~d _ Driller. / ~ ~ Cased to '¢(' ~---~ Casing height ! Total depth Sanitary seal (Y/N) c1 Wires properly protected (Y/N) L1 FROM WELL LOG AT INSPECTION Date of test "% '~ - I 2 -~ Static water level ~ Well flow g.p.m. ~. ~ Pump level I 2 Zr Z ? Absorption field on lot Public sewer main Public sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot [ 062 ; On adjacent lots ; On adjacent tots Public sewer manhole/cleanout _ , Petroleum tank, lOC+ WATER SAMPLE RESULTS: Coliform ;,:~l/~'.~'l~c-2/-or~ __ Nitrate ~4~,ff'~C~/)¢~ ~ 2, A,~ Date of sample: --:/ - O ~- - ~ / Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed /~ - ,~. (¢ - "¢ ,Z,/. Tank size / ~ 5--0 ~/,~ I Compartments Cleanouts (Y/N) t~ Foundation cleanout (Y/N) ~ Depression (Y/N) High water alarm (Y/N) /',J/~A Alarm tested (Y/N) ~,~/~ Date of pumping ~[;;~-c~-~O ~-'-~Fl ¢1¢ ~ (See ~'¢~¢~c/~ect ¢'~c~p'/') SEPARATION DISTANCES I--ROM SEPTIC/HOLDING TANK TO: / Well(s) on lot ! F)O On adjacent lots To property Pine / 0 Absorption field Surface water/drainage [ ©(2 fi- Foundation Water main/service line ! [off- 72-026 (Rev. 8/91)Frol]t MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM LIFT STATION~O: Well on lot On adjacent Iots~ D. ABSORPTION FIELD DATA (_~ - 2- (..o - '~' Z[[ Soil rating Width ~ '~ ' Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water Date installed Length ! Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) [ "7 ~- ~/~2~ System type Gravel thickness ~ Total depth Cleanouts present (Y/N) Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot l O(-~ To building foundation On adjacent lots Surface water Curtain drain ?{/ On adjacent lots ! CO ~ Propertyline., To existing or abandoned system on,lot Cutbank /'J ~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature .............. ] '70~-'~ '~ ..... '~:~':;, '~ i ¢.iV~-:;" Luup ~ Engineer's Nam~ Eagl~/i,li../;r, Alas};a 99527 Date HAA Fee $ Date of Payment Receipt Number the ~0], this inspection. "7" ~',~. ~" ~ Waiver Fee: $ Date of Payment Receipt Number 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 I.D.# ~ PRIVATE WATER SYSTEM Name Phone No, S & S ENGINEERING Mailing Address ii034 F. agie Rivet" Loop Road ~ ~ Ea~jle River, Alaska 9957'~, City State Mo. Day Year SAMPLE TYPE: J~ Routine Check ,Sample (for routine sample with lab ref. no. [] Special Purpose Zip Code Treated Water Untreated Water SAMPLE NO, LOCATION Time Collected Collected( .(,:, CQ(~) _~ TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: [~2}~'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* Analyst J BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB Final Membrane4~llter Result~ Reported ,~/~/~/ TNTC -- Too Numerous To Count OB - Other Bacteria BGB Coliform/100 mi .Coliform/lO0 mi Date '-~ ~ --¢/ Time: /,~-~ O CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING &ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ,0, ! .... f;?,?,fL~; CT i: ~ BG-~ Member of the SGS Group (Soci6t6 G~n6rale de Surveillance) ISAACS PUMPING SERVICE (Norm Tlbbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 I I I TOTAL 2320 a .... penled by ,~,~ b,,,. c.]~hanl~CYou