HomeMy WebLinkAboutHIGHLAND HILLS #3 BLK 2 LT 17i.gh I d
D
050
MUNICIPALITY OF ANCHORAGE
DEPARI'MENT OF HEAl_TH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264.-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILINGADDRESS~
_
LEGAL DESCRIPTION
NO~EDROOMS
~ DISTANCE TO: - ~ ( ~ Dwelling~ PERMIT NO.
~ ~ Manufacturer ~ ~ Ma~ . No. o~compartments
Liq. c~allons IF HOMEMADE: Inside length Width Liquid depth
~ ~ Well Dwelling PERMIT NO,
8=~ DISTANCE TO:
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ ~ DISTANCE TO: We /~ Foundation~
I~ f t Nearest lot line ZO ~ PERMIT NO,
2~ No, of I~es Lengt
H-~ Top ~fl[le to finis~rado h~¢l,no Total~t~l,~es Trench~t~ inches Di,tancoB~t~.enline,
~ Material~neath tile TolaLe~f~ive absorption area
~ ~ ~ inches
Length Width Depth PER~I% NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
~IPEMATERIALS~. _
~0 L~ ST~ATIN~
IN~TALLER
'
'~P DAtE - LEGAL
72-013 ( ~v. 3~78)
MUNICIPALITY OF ANCHORAGE
DEPARIMENT OF HEALTI-I & ENVIRONMEN'rAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 LStreet-Aochorage, Ataska 99501 Telephone 264-4720
ON-SITF- SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
IF HOMEMADE:
Well
Manufacturer wT'~-~ell ~-~ ~,~ ~
I Well [! --~--
L~ngthu~[ ~h line
sh grade
Length
Type of crib
DISTANCE 1'O:
Class
DISTANCE 1'O:
Crib diarne[er
Well
Depth
Building foundation
OTIIER
Inside length
/
/OO
idth
Dwelling
Foundatio,~ -~-~'"~
'Fetal le~gth oJ lines 'l~ench
Depth
NO. O~.F BEDROOMS
PERMIT NO.
Liquid depth
PERMI-r NO,
Liquid capacity in gallons
PERMIT NO.
area
Crib depth
Building foundation
Driller
Sewer line
Total e(,fe&tive absorption
PErd~J-¥
Nearest lot lille
I
Department
825 ~ Street, Anchorage, AK. .9501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: ~ '~ ' '
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
: DEPTH LENGTH .~ ' GRAVEL DEPTH ~ WIDTH
MUNICIPALITY OF ANCHORAGE ~, 6,0 ~..~'
~ Health and Environmenta? ~rotection~~ Y~/~/z/~/~
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SiZE = ~:: ~[?~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmeni
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee~
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the resi~ence~i~ remodeled to include more that 3 bedrooms.
a~iican~
Date: ,'
SWP,/024 (1/81)
:>
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRQNMFNTAL PROTECTION
825 L, Street., Anchorage, A!aska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
5
6
7
8
10
11
12
13
14
15
16
17
18
19
2O
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
,
PERCOLATION RATE
TEST RUN BETWEEN
72-008 (6/79)
Jminutes/inch)
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O, BOX272, CHUGiAK, ALASKA 99567 ~. TELEPHONE 688-2759
OWNER OF LAND
LEGAL DESCRIPTION
DATE- Started ' -~ : ..... ~ Ended
PERMIT NUMBER
DEPTH OF WELL
' : ,~ STATIC LEVEL OF WATER FT.
///d' :; ./~) .;'/:' !~ DRAW DOWN FT.
:~ /, / ' " GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From = ) Ft. to Ft
From Ft. to / [ , Ft.
From__Ft. to Ft.
From ? Ft. to
From ' ~ Ft. to
From____ Ft. to
From ' Ft. to ,:
From__ Ft. to
From ~: Ft. to (. ~
From: Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From__Ft. to__
From__Ft. to__
From Ft. to
/ i . ,';* t)~: ~:: ' ' '; From __Ft. to_ _Ft.
f
~ ~ :y..~ d.; ,q, "~>',/~f.f :~ -'" From Ft. to_ Ft.
' -' :" ~ ~-~ ' ~;., ~, := f From__Ft. to_~Ft.
Ft. ~: '/ :~ ~ ~ '; , `~ From~Ft. to Ft
. Ft ' ~ ~ ]; ' : '~' ; From_ _Ft. to ~Ft
,Ft. ' ~.'~.'~" ' - From Ft. to Ft
Ft. ~ '"'~ ' ") ~,; :.' 4:" c From _Ft. to Ft.
Ft. " ', 7 ~ From~Ft. to _Ft.
~Ft '~ · '; , t~ ...... ,:", From~ Ft. to Ft.
Ft. ~ ;:: '~ ' :;~:' ~,-: ,: ~' From Ft. to Ft.
Ft, ,': ~,:j'/,~,L:'/ From~Ft. to_~Ft
Ft. From Ft. to _Ft
Ft. From Ft. to_ Ft
Ft. From ~ Ft. to Ft
Ft. From~Ft. to Ft
Ft. From~Ft. to Ft.
Ft From Ft. to__~Ft
MISCL. INFORMATION:
DRILLER'S NAME
August 3~ 1977
?16394
J~.~ k Hag~3erty
,~tar Rout~ A Box 9355
Eagle Riw~r~ Alaska 99577
A peri, it :l. ssue(l by this depart~a~nt for ~-~ell and/or on-site
sewer installation on Lot 17 Block 2 ~i~hland, Hills
Subdivision ha~ ~pired since the issue dar(% exceeds one
the ev(mt you s~;il], f~lan to inst~.~ll the well and/or on~-
~f l;h~ woll has been (L~:ll].c..,d, a well lo9'
to i~.his department to d¢)cu~:,]ent tha installa~.ion data°
~f you have ~my qulestlon9 regarding %he above ma.tter~ }?laase~
d,o not hesitate to contac'E tl~is offi(3(~ irm'~e~lJ, ately at 279~
251!~ (-~xtension 224 Or 225.
Les No l'luchholz.
~an ii:arian
i:ll-';'i-:'i., i (.:F;!N I
i~Cii,]:l'l i 1
i .t:;). :ii"!L.,
i 'i t. iii::' E;ILI]L. FI[~:':'~;EIF?.I3'T'];Oi"~ S"/'.SqE}"I .[E;:
i--iE I...IEi'.,l(i 't'1..1 [:, :!: HENS ]: ON ]: ~ii; THE; t...ENG'I'~
t
'1 I...11:::: £:,EI.:;"IH LIl-:: F:t I'I::::EI'.,tE:H
(iii;,:.:(.ilJNI) I:-It'.,IL:, 't'HE~ E~O'fTOH OF' q"HE:~
it. lEi;d-!:; ;r:~.:; t'.,tO SE(1 P.IZt)'fH F:Ok.'.
i i"i~: IJibi:H'v'i:i:.t.,. E:'EF;"T Fi 1 S TF'IIE
k:tNL.) IF.tk: EI()'i"t'I;)I"I CIF THE
[i:l:':lC;h::l'; ): l.J_.. J; 1",I(5i I. F: l::li",l"r' ..: = I El I
L.:,E.i..'I.:[I-~.:'I r'IEN l' H I L..L E;E '.:SL.II~;J EE;T 'to
,!, (.:k,I;:~ i 1 I':'"? 'f HI'I I'
::k: J iql"l F"I':II"tIl..:t:FIFi: l.,l:l.'ikl THE I'~:E)i:.!I.J]:I:;:tEHE:;I"EI:S I":'OR Ot",!"-SI'l'l::i: :~!;l:E!.,]l::~t';.t'.:~:; FIND t.,ItEI..L..S FI:E;
F: UF:: t i-'1 k:'¢ TIDE: i"ILIN :1: C :1: F:'f:IL..[ 'l'"r' OF: FII",ICHOI'~'.I::IGE.
;.:::: I t~,.i.I:L.t.~ tI"4'.:.:.,'TI::IM.. THE( 'F.;'¥".E;TEH ~1",1 F,Z:C(:)I~:'.E:'FIt',ICE !4:I:TH 'l"Hk~ COl)ES.
::~:: I t...INL:,E':I'~:::,'I"FIND THFI'F 'IHt.E OI",I'-'S:!:TE :~;E~I.'.IE':f":. E;'¢STF::H HFt"r' Fi:IE6!IJ]~I':4:E ENI..FII"~:GEI"I!EI",H' IF':' TI'lIE
t,i:I/.'.;',~;:I;I::,I-i.:.NLL:E :[.S I:,~'.P:HEil)IEI_.EI;) 1'Li ];NE:IJJI.:,E HOI.,i:E "I-HFIN '.':~:
:f::, i k~i'.di.fi:L:,: ..: .. '
· 'i .... ' ' ..... I' "f-¢,7. , .~¢
MUNICIPALITY OF AMCHO~AGE
Departl_ nt of Health and Environmental cotection
SOILS LOG
PERCOlaTION TEST
Performed for Jack. Haggerty
'Date Performed 6/17/76
Legal Description
Lot 17, Block 2, Unit 3, Tract 2A, Highland Hills Subdivision
(See attached sheet for test hole location)
~nics
Red-brown, silty, fine sand (SM)
Perc rate = 250 ft.2/bdrm.
Frozen, gray, silty, sandy gravel (GM) with c~bbles to
lb inches
Perc rate = 225 ft.2/bdrm.
Non-frozen, gray, silty, sanQy gravel (GM) with cobbles
to 10 inches
Perc rate ~ 225 ft.2/bdrm.
Moist, clean, sandy gravel (~W) with cobbles to 6 inches
Perc rate = 85 ft.2/bdrm.
No water table encountered.
AVERAGE PERC RATE FROM SOILS LOG = 149 ft.2/bd~a.
Date
Net Time
Depth
Net Drop
Percolation Rate
).
minute
MUNICIPALITY OF f=NCHORAGE
DIVISION OF
DE]?~{I~E~.~ OF ~L~4 AND ~IR~lbIENTAL PRO_~C%ION1'~'"
APPLIC~:I'U~I ~R [{~L~}I ~JTHORITY ~PROVAL
i {~eral Inforn~vtion
· ~pl lca~.~oh Oate
(a) LeGal ~sc~iption (inclg~ lotr btQck~ aubdLvision, sec:t]on, f'ownshJo, :anae)
Loc~l:ion (ad.ess or directions)
~nding
Institution
Ad~:ess
(e) Real Estate Coo a Agent /
Te lephcn~
Note: If c~murunity vel.'[ system, must have , ,"
~pa~mt of ~nvizon~ntal Conservation attesting t:o t1~ ]egaJ. k~ and
Is 'd~e ¢~I.L adequate_, fo~z the hunter of ~,<k~c~ss .s~r'[fiad~ .... in this ~AA } ............
~v~aq~ Ois osa]
Is the v~stewater disposal system adecuate cop the r~un~r:' of ~drocms
[Page 3. of 2]
5. Enqineerinq Firm P~'ovidin.q !n.sj2~_~ctions, ~sts, Data and Infornmt]cn
Address
( ENGINEER SEAL)
6. DHEP ~prova].
· /
Approved for , ,,"
[mdr ce~r~
Disap,.o~o~d [211'[
Condl ,.lol~a ,. Approval
1he Municipality off Anchorage Departrm. Tnt of ~a].th and Environrmntal Prctecticn d
not guarantee the continued satisfactouy ~rfo~mmn~ of ttm water supply and/ct t
wastewater d].s[~sal system. ~his approval indicates that, as o[[ the vali. dat].c?, d
sh,lw~ above, hased on the ~ta and information furnist~ed ~ an m~ginaer register'e
the State of ~[aska, iiqe water supply and wastewater disposal system is safe and
tiona! fort the nun~lxer of ~(k'~ls ~d ty!~ of structure indicated.
(DHEP S~iAL )
7. ~i. 1 the t'~kA to the follc~ing aclck'ess:
KB2/d5/s
[Page 2 of '~
WELL DATA
MUNICIPALITY O? ANCHORAG5
DEPT, OF HI!AL'rH &
MUNICIPALITY. OF ANCHORAGE (MOA)ENVIRONMENTAL PROTECTION
HEALTH ALri'HORITY. APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:g~
Well Classiftcat~
Well Log P~esen~Y
Total Depth
Static Water Level
Cased to
If A, B, c~ C, D.E.C. ,App~oved~/N) -
Date Completed
~ ~- ~p~h ~f G~outing
Pump Setat
Casing Height Above Ground
Electrical Wi~ing in Conduit ~
Separation Distano~$ f~cm Well:
To Septic/~ Tank o~ Lot
Sanitary Seal on Casing((Y~z~__
DepressionAround Wellhead
; On Adjoining Lots /d)O
To Nearest Edge of Absorption Field on Lot/z~) dP ,/- ; On Adjoining Lots.../~DD
To Nearest Public Sew~ Line /~ /~ To Nearest Public Sewer
Cleancut/MapJ~ole. /Q //~ To Nearest Sewer Service Lithe on Lot
Wate~ Sample Collected By ~_~ ' ~'~%-~-~~\ ; Date ~'-/~/~/./~f' "
Water Sample Test Results .-~ ~/~/~/~ C ~'~Z ~7 '' '/
CQt~t~ts
Bw
SEPTIC/P/~gL~G TANK DATA
Date Install~d ?/~/~.3. .Size /~ No. of Cc~,~3a~tm~.nts
Standpipe~/(Y~) / ~2.,~Air-tight Cap~i~)/N) Foundation Cleanou~)
~ession o~? ~ Ta~ ~ ~te ~s~P/t~d~/ ~~. ~'
P~ing~aintenan~ Con~a~ ~ Fi~9 (Y~//~; fo~.,
Holding Ta~ High-Wate~ ~a~ (Y~/~ ~a~y Holdi~ Tank ~t
Sep~ation Distance ~ ~ptic~ding Tank:
TO ~O~ty Li,~ ~ ¢ TO Dis~sal Field f~ /
To ~ter~rvi~ Li~ /¢~Q '~ To S~e~, ~nd, ~e, ~ Major ~aina~
Cour se
Comments
[Page 1 of 2] ~
:~ 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed F/~/~
Width of Field ' ' '~ ~ z~
Squa~'e Feet of Absorption~ea
Depression over Field
Results of Last Adequacy Test
Type of System Design
Length of Field ~ ~ !
Depth of Field ~ /
/~ravel Bed Thickness ~ O
~3~-~ Standpipes P~esen~) '
Date of Last Adequacy Test ,~j~
Separation Distanos frcm Absorption Field:
To te=-Su ly To operty Line /O /
TO Building Foun~tion /~ ¢ To Existing or ~ndo~d System
Lot ~ / ~ ; ~ Adjoining ~ts ~~ ~
To Water~/~rvi~ Line /'O~ .~ To ~t~(if pre~nt) ~ /~
To St~e~ond~ke/~ Majo~ ~aina~ C~ ~ / t~
To ~i~way, Pa=ki~ ~ea, ~ Vehicle St~a~ ~ea ~/~
Conm~nts
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
"~A ~f"~_at
//~ /~n~ ~¥/N)
Pumping Cycles duging Adequacy ~st.'
Meets MOA
Conm~nts
** Check ~n~ Bedroom Rating Against HAA Request **
I certif .~h~at, Iz~.~v~ checked, verified, or confcatmed to all MOA HAA Guidelines in effect
on the/~ate/o~//f~/~6tion. / / [-'--~ ----'
2-15-84
HEMICAL & GEOLOGICAL LABORATORIES OF ..ALASKA, INC.
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CE~ITER
5633 B Street
Drinking Water Analysis Report fdr Total Coliform Bacteria
WATER SYSTEM:
Water System Name
TO BE COMPLETED BY'WATER SUPPLIER
_ .~.~/ ' I.D. NO.
Phone No.
Mailing Address
Ci~ State
Zip Code
SAMPLE
NO,
1
2
3
4
5
SAMPLE DATE: [~ ~ ~]-~
Mo, Yesr
[] Routine
[] Check Sample (for routine sampli
with lab reft no. .) [] Treated Water
¢;~'...~_peclal Purpose i ,J~Untreated Water ~'--
Time Collected
..LO/CATION Collected
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TO BE COMPLETED BY LABORATORY
Apalysis shows this Water SAMPLE to be:
Satisfactory
Unsalisfactory
[] Sample too long in transit; sample shou}d
not be over 30 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail.
Da,e . ce,ved S'z t- ¢
Analytical Method:
[] Fermentation Tube
J~'Membrane Filter
Lab Ref. No. Result*
I ~ J IF']
I ~ I I-FI
Analyst
%.,%.
8.1220 (b)
,er. 1983
BACTERIOLOGICAL WATER ANALYSIS RECORD
embrane Filter: Direct Count
'erlflcatlon: LTB
rinal Membrane Filter Results
BGB
Collformll00ml
Collformll00ml
Date_
Time: _
T, NTC = Too Numerous To Count