Loading...
HomeMy WebLinkAboutHIGHLAND HILLS #3 BLK 2 LT 11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephon0 264-472]0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING LEGAL DESCRIPTION ~OCATION ~ ~WS' b F' __A~~ ;> . __-- ~ Z I Manufacturer ~ - Material w /Liq. capaGit~n ~Hons~ ~e length Width - ' /~ I IF HOMEMADE: I a,.~t DISTANCE TO: ~ ~ ~w~ ~-- ~ Manufacturer Material T I~ ~ o~{~~~~ j ~ ~ ~ No. of lines ~ Length~ e~h line Total I~gt~ of I~~th ~ p /Top of tile to finish grade ~ Material b~neath ti e a / ~ ~. inches - / bengt ,I -~ ..... ~h M / Well Building foundation Nearest lot line -. ICI~s Depth Driller Distance to lot li~ ~ I DISTANCE TO: -Building foundatior~ S0wer~ lin~ Septic tank PHONE NO. OF BEDROOMS ' PERMIT NO. Liquid clepth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absor ]tion area PERMIT NO. PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING INSTALLER REMARKS '.. L.EI't" 'Z-:, E:L.?::: 2 H]:CiHL..FIt'.,I[) H,T_L.L::!.:, L, OT 'THE !..%NGTH [)Z}','lEl'.,!!iJ;zr. ot'..J. .].':Fi; THE: THE: [::,EF'TFI OF' FI TF:ENCh. Eft;;: F']:T 1::5 THE: !)Z:BI"FINC:IE E',E-H,.II:~:E:N THE ~;I..J[;:!:cF:i[::[~; PF:' 'TI'"IF:: :21:~' ::' . NE, Fff.,ff::, THE; E~Eq~['Of',I OF' THE F:.:':. ;: FI ',,,' FI "." ~ Z H ,:: :[ N F'EE:T ::,. 'THE:RE ]::5 NO :SF2T' I.,.i :[ [::,TH F:(3F;:-r'fi:ENCHE:5. 'T'I...IIE GFi:F~'v'EI.. I';)IF;ZF'TH ]; ~i; T ...iF' f"l :): f.,I :[ r,'llJH [)EF'"I"H r"iF' f]~*4:!c!',,,'E][ .... '", {~:E,'.,. "I'I..'IIF~: F!h![::, THE !EK3TTCIPl ")F' THE F;:':. ~ .:::!',,,'FI".' [i:FI['::I<:I::':!:L.L.:[?-,t[3 CIF' F!~',~"r' :!!!;'T'!{;Tt~i]I'"I !,.!]:TH13UT F':[NFql '[F!:i'~F'Eii:::"r':(7:H I:::IN[) FPF:'-~'"",.,'::i (",'T' E:,EF:'!:::d:;i:THENT !.,.! ]: L.I.. E]E: ql. IE',.".ECT Tf" t'::'i:?CIii!;ECUT :[ ON. H]:l',llh11..l?,! !~:,:[:i!?]"FINC:[i[ [?[~:'T'i,.II!:_:;[EN I:::1 b![i:l..L. FIND l:::ll",!"r' :I.E!G FEET F'OF: FI F:q:~t:!:VFC!'Z F.!E:L.L. [3R :~.G(:!~ T'O ;2:Eni!l F'EET !:::'F4:OH I...II:::'ON THE T".!.'F'E OF' F:'UF3L.]:C I,.tEL..L. !"!:~N]:hll...IH E:,:[:~};'TfqI'.,ff::E F'I';;:OH Fi F'F;::[',,,'!:::ITE HEI....L. TO F:! F'i:;?IVF:I'T'E :E;EZI.,IEI:;: i...J:NE: 'TO F! C:Cff'IHI.JI",t:[T"r' :5Ei:HE,~;: L.:[NE ]::i:i; 7!5 O'['Hfi::!:;.: 5:E[;:!I...I Z F:Ef'IE:NT';5 !"'!FI"*" f:ff:'F'l..."/. %I::'EC: :[ F' F:I'v'F!;f:L!::IE',I...E T0 :!:?,!'ii;LtF;:E F'f;~:OF'[!i:l:;;: :[ i::::EF~:T Y. F""h" !'HFIT ::1.: ]: FIP! !::f:ff'!:[!...ZF!l:~i !.,.I:!:TH TH[ii: [;:I:D;:!LI:[?RE:H!ENT:i~; !::'Cd:;: ON'"':~;Z]'E :~;E!.,rlEi:~::~; FIND NI:~:U...:5 F:!Z ~:~E:I- F'OI:;?.-[H E:h.' TH[~:] [dUN ~ C: :1: F'F!L. :I: '['"r' OF' 2: Z H:[LL. :[!',I:~]?FFIL.L THE Zh"ZTEH Z~',I FiCCOI:~:[)I:~NC:E NZ'T'bl THE CODE:Z. :?: ]: I..II"~I:::,E~:F;::~;q"FIf',!E:, THF!T THE: [)H'-'~;~"FE: :~;[E['.!E:[;':: ~;'T':~kTq'EFI HFCr' R'.EX;R.I'!:FRE [~?',!L..Fff~'.C~E;PlEEFFF ]:¢::' 'THE: O E ENE..NEERING & DEVELO, Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 MENT CO. Russell Oyster 694-2774 Performed for: Legal Description: Depth (feet) 0__ SOIL LOG Name:_ Mailing Address: i / $oll ~hemcterlstles 10__ 11__ 12__ 13__ 14 Earl Elli~ 688-2280 Tel. No. PLOT PLAN 16__ PERC. TEST Ground Water Encountered: Yes_ Proposed Installation: Seepage Pit__ Comments: No ¢/ If yes, what depth Drain Field Performed by: ~--.,,~ t, ~-; ~ .~ by DOC Co, dba W&TER WELL P,O, BOX 272, CHUGIAK, ALASKA 99567 e TELEPHONE 688-2759 OWNER OF LAND../ot~_~L..._~ ]' .d /~_/.~ ADDRESS ['~o ~' ~.~~,~,'" ~ ~ _ /.~' , ,-~'~, LEGAl, DESCRWHON d, II ~.~ DATE- Starled (~f' z. Ended PERMIT NUMBER I)EPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER ItR KINI} OF CASING KIND OF FORMATION: ' ) From /) Ft, to_ c<', _Ft.__:~' cq:;'~':~{~'~d/~'~/-'''. 'J From From_~ Ft. to /.,.)5],',_Ft.~/ 4 /":~ ?' ~:~<q'~;:'.d, 5'~ ::: From From~ _Ft. to ~_Ft. /~, ~¥--f' From From /./~" Ft. to /4t,Q Ft. ~W~,~J /~ g~&~L,< ;~:' From From ..... Ft. to l~t.~~<: ~:- ' From Ft. to~ From~'~. Ft. to / /0 (' .Ft.___('t ,El ~' " '¢ ,:" ;- : ~ ~, ~. From Ft. to From ..... Ft. to_ FL /? 0 ~,~ o ,:::',~$ .F From Ft. to From~ '7 o~Ft. to_~Ft. ~J",q ~,~: ~ d~ q ~/,~:z~ ~ From Ft. to From Ft. to Ft. ~.~o <.-'~; ~:'~ ~" From F(. to From /'7'ff'- Ft. to~)'~'0 ~ '~' < ~ ' Ft,~ t,3./~ ~":' From . l;-, ~.. . From_: .) '}':!Ft. to_~Ft.~< ':~ A~?4L'>,:. A; 6 ~;'<,..~:d'>%~.; Frmn From Ft. to I:t .... )", _,.- ,w From From=~LC '~' Ft. to~g,~<Ft.~h'4o~.~:: 4' a ~,, ,<'; From_.~ From=.,").~ > "Ft. to~} Ft. ~2 ] ,~: .~:2~ ,:),:., ~ /)'z: r,A'Zc',,~-~ From From .... Ft. to Ft. ~"~-~'~/-'/ From ~_ From.~Ft. to '~0~ Ft._ /~ ~2~f~'.~. < g',}~.. <,':) From From Ft. to Ft Fromm_ Ft. to_ __Ft Ft. Irt. to .......... Itt Ft. to .... Ft. _Ft. to .... Ft. Ft. to__Ft. _.Ft. to_ Ft. Ft. to Ft. Ft. to Ft. Ft. to ..... Ft MISCL. INFORMATION: DRILLER'S NAME ~.:;~2 F'E[~ff'IIT I'.,IO. <: Ei:lOE;4:~: i:, F:IF'F:'L. l IS:F:II'.JT .J'I:.'iS:E:F'H [:. ..:rF:II'.,I~<:E: F' 3 E Z ',:-< Tgi?' ~ g. $- -'1 '~ I...E~2iFII._ I_OT :1.:l. EH_f<: ;2 HI 3: ~/JFIL. frtf',I[::' HIL. L.'.S :.E;,U L. 13T SI;..:~E :ii[';:' 0 0 0 :!i;E:!l..I FIF~'. E hl I I",{ :l: I"IUP1 [:, I :STFINI:::E E:E:'H,.IEEN la t.,J[~.L.L. FIN[:, Fff.,l't' Cff.,I-..E; I TE :SEI.,}RGE E:, .].' SF'O'.'SFIL. E;'T'IS"I"E:I'"I :[ ~; :1..OO F'E;ET F:'OF.: FI F'I::~:I'v'I::FT'E: I.,.IE:L.L. OF..". ::L~50 TCI ;?-::OO F'EEE:T F'ROI"I 19 F'I..IE!',L. IIS: I.,~E:L.L. [:,¢/.':F:'fZI'.,IE:,:[i",IEi I..JPOI'.,I TH[::.: 'F't'F:'[~': OF F'LIE.31._Ir': I.,.IEEL. L.. I"lZhl:[l'"lLIl"l [:,If~;TFINC:E: f:'F;:OI"I FI F'F~'.I',,,'Iq'f'E HE:L.L '1'O Fl F'F~!I',,,'FITE:.' ':~;F.~I.,.tEi:F:'. t~ZP,IE :[~; ;~'.!.'--'q FE~E:I" FIND TO FI C:Of"li'"lf..ll'-,lI'l'k' :~;[!:!.,.IE[:~: L. INE: I'_:; 7'.~ F[EE:'T. I.,JEL. L. L. CI~2J::;.': FIf2E: F,;:f.~EIZ!I...tIEE:IE;E:, FIND P'IUE;"I" E',E'_' E;i:E:'F'I..IEE:f.,IE:E:, TO TH[-Z [:,EPFIF?.TI"IEEf.,IT !.,.IITHIIq .:J:O E:,F:I'.r'E; OF "I'1..'t[~.: [,E;L.I... C:t3i"IF'[_[:ET 1131'-,I. 131"HEI:;~: F?.ED:;:!IJ I F?.E:i"IEN'T% ffll::ig.' FIF'F'L.'T'. !E;F'E.:C: :[ F :[ IN:la']' I IDN?'.; FINE:, C:I3F.IS'I"F4:I_IC:T I 1.3N [:, I F:H:3F.'.FIt'qtF.'; FlEE:I!: F:l'v'la :[ L.FIE~L.[~: TCI ! N£51_I,~:E~' F:'F..:I.~:IF'E:F'. I NE;TFI[...L.[:IT I CIN. I I:.'EI:~:T ]: [:'T' THFIT ::L: I FII'"I F'Fli'qtL. IFI[7. t. VITH 'THEE F:EC-:!I.J]:F4'.Ei"IE:NT'.'S FOF:: OhI'~'SIT[E SEI.'.tEfRE; FINE:' I,JE:L..L.:i.:; FI'E; F:O[~'.TH E?'/ 3'H[i: Pll_lhl I C:: l F'I::tL. I T'T' OF ;:;.': i ,.1]'..l,d[~.~ -'Zf'~;TIqLI._ TI-lIE '.'5'~'6;TE:1"1 l~',l F:IC:C:C~F.:[::'FIhlC:E: !qI'['H ']"FIE: C:OE:'E':'.-'.':. / , 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 11; Block 2; Hi~hland H~Z£s Subdivision Addition #3 Location (address or directions) Wild Mountain Drive (b) Property ownerAlaska Housinq Finance Corp. Telephone: (home) Mailing Address AHFC #58580 Business (c) Lending Institution Mailing Address Telephone (d) RealEstate Company and Agent JACK WHITE COMPANY/Lynda Banner Address 10928 Eagle River Road, Eagle River, Alaska 99577 Telephone 694-5500 (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 K S ENGINEERING/694-2979 17034 Eagle. Riv¢_r Loc]p Road~ Suite_ 204 Eagle_ Riv¢_~; A£~k~ 99377 21 TYPE OF RESIDENCE Number of bedrooms 3 Single-Family,~(. 3. WATER SUPPLY Individual Well B:X Ordered by Lynda Banner 72-025 (Rev 7/88) Page 1 of 2 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,E]( 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. ~ ,to ~ elSed '>IJOA~ s,JeeU!SUe leUO!SSejoJd eqi u! SUOlSSluJO JO s JO J J@ JOj elq!suodseJ ~ou si ebeJoqouv jo,~!led!o!unK4 eqJ_ 'penss! s! eleo!,t!),Jeo e eJojeq mep eZXleUe Jo suoi],oi)dsu! lonpuoo ),ou op SHHQ jo see~oldCUa 'slueweJ!nbeJ e],e~s pue leJepe,t u.e~Jeo/~,ts!],es oh JepJo u. 6u!puel J!eq~ pue SeLuoq JO sJeseqoJnd o~ Xse~Jnoo e se s!ql seop SHHQ eq.L 'e>lSelV ,to ele~S eq~ u! peJe~s!SeJ Jeeulbue leUO!SSe,toJd ~uepuedepu! ue/~q e^oqe S qdeJBeJed u! ue^!6 suo!],e~u@seJdeJ eql uodn ~lUO peseq pe~eoWJe3 le^oJ'dd¥ ~l!Joqlnv q),leeH senss! (SHHQ) seo!^Jes uecunH pue q~leeH jo ~uew),JedeQ ebeJoqouv jo lq!led!o!un~ eq/ leAoJddV leUOR!puoo Jo swJeJ_ leUORlpuo0 peAoJddes!O - Rq s~uoo~peq ~ peAoJddv ~ Jo,t pe^oJddv l~'AOl:ldcl~' SHHQ '9 euoqdelel w~!=l ,to ecueN A. WELL DATA Well Classification _  MUNICIPALITY OF ANCHORAGE (MOA) Heallh Aulhority Approval (HAA) ~-~J~7 ..... '~ o ,~.,~KLIST - FEBRUARY 1984 {!NVh,L~AL SE~'¢[C[:o D,VI~;ION 343-4744 LegaI,De.s, cr pt on: ~//,,/ ~/~ ~ If A, B, C, D,E.C. Approved (Y/N) /? / Pump Set At ,.~ ".Z ¢ Sanitary Seal on Casing(~N) z,~'/ Depression Around Wellhead (Y/~_~ Well Log Presen N) _ Date Completed , / Total Depth_ .~ Cased to ~0© Depth of Grouting Static Water Level _ ~.~-O Casing Height Above Ground Electrical Wiring in ConOuit (Y~) SEPARATION DISTANCES FROM WELL: To Septic/~ Tank on Lot /'~(D To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot 7L ; On Adjoining Lots /'C?© /~:::)O /- ; On Adjoining Lots /"~::~O To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ,~ ./.._~' ~'~,/'/y~,~,~..~ ¢ ; Date B. SEPTIC/~TANK DATA Date Installed _('~C ~- ~¥~// Size .,¢""~-~,~-~ No. of Compartments ~ Standpipes )__/ Air-tight Cap~) y Foundation Cleanout (~ Depression over Tadk (Y~ ~ Date Last Pumped _//~ Pumping/Maintenance Contact on File ( ~//~ ; for ~ Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit SEPARATION DISTANCES FROM SEPTIC/~ TANK: To Water-Supply Well To Property Line To Water Main/Service Line --~ ~' Y-- To Stream, Pond, Lake or Major Drainage Course Comments %/ ~'~ ~" TO Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (~C. -'~' ~¢ Width of Field '~'L9 Square Feet of Absortion Area Depression over Field Results of Last Adequacy Test Type of System Design Length of Field ~'~"- Depth of Field Gravel Bed Thickness StatndpipesPresen (Y~) DateT~t Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well //~.~ O //-- ~ To Property Line J¢2 ~ To Building Foundation ~[ /'-~" To Existing or Abandoned System on Lot ,,,t.J~ ~ ~ ; On Adjoining Lots ,,,4-'-o,¢~¢ ~- To Water Main/Service Line ~,~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /' r Comments To Cutback (if present) /Ur o /,j'/_-~' D. LIFT STATION Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions I~lanhole/Access (Y/N) "Pump Off" Level at ///} Vent(Y/N) / ,~-- Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** .. ~.:, ..... : I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect~C~'~;;a.f il~i'S*'". inspection. ,4 '~~~- " Company Eaele River, At,ska 995~ ~ ,~ ~~.~.~.,.-~ ~ MOA No. ~ O¢ ~ ¢"~ /'~ ~'-~ '~",* ~<~'¢' Receipt No. O~ '--~¢O 2 ~ % ~ ~ ¢ Receipt No. Date of Payment I ~--~- ~ ~ Waiver Fee: $ Date of Payment Amount: $ 72-026 (Rev. ~188) Back Page 2 of 2 O O e,S .OF FEDERAL TAX ID It 92-0040440 ANALYSIS REPORT BY SAMPLE foz Work Ozder # 10189 Date Report Printed: NOV 3 88 @ 18:44 Client Sample ID:LIt, BS, HIGHLAND HILLS PWSID :UA Collected OCT 31 88 @ 19:20 h~s, Received NOV 1 88 @ 13:00 hrs. Preserved with :4 DEG. C Client Name : S & S ENGINEERING Client Acer : SNSENGP P.O.# NONE REC'D Req # Ordered By : ROS Analysis Completed :NOV 2 88 Send Reports to: Laboratory Supe~i~TEPNEN C. EDE 1)S & S ENGINEERING Release~ By: ~ -~ C. ~ 2) Special Instruct: Chemlab Roi ~: 3276 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 1.8 mE/1 EPA 353.2 Sample ROUTINE SAMPLE Remarks: Tests Performed ' See Special Instructions Above UA-Unavailable None Detected "See Sample Remarks Above Not Analyzed LT-Less Than, GT*Greater Than Property Owher Realty Co. & Agen~ Address OUT UPPER HAL, _ NLY: Zip (;ode Phone Legal Description /,~_/// ~¢/ " Ty~ o>~den ce L¢ingle Family ~ Multiple Family No. of Bedrooms ~ Other Water S.u/pply L~.4f¢8 ivid ual [] Community [] Public Utility ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). L,k"ln dividual [] Public Utility [] Holding Tank Year Individual Inslalled: When Connected to Public Utility: NOTE: THE INSPEC'rION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BI:-' INITIATED. Time Time Time Date Date Date Inspector Inspector Inspector Field Notes: APPROVED BEDROOMS DISAPPROVED CONDITIONAL APPROVAL' 'CONDITIONS OF APPROVAL Date Sewer installed Well TO Absorption Area Well to Tank _ Well Log Received Septic Tank Size Soils Rating APPLIC NT FILLS OUT UPPER HAl. 'ONLY PropertyOvvner~_-j~O_~:{~.t_.:~) ~? [__~)~.}/j/,~ [~. ~.~'~i/~-~:~ Pho~e ,/~ , l" ,.~ ' (:"~'//? FL. ':~?~A Cod, , , Address Zip Code Lending Institutiom. '1.. I //'~.~ g~.. /2~ /.?/~ ~ Phone Address R%aI~ ~O. & Ag;n~' "~' {/' ~ Phone Address Zip Code Loo~li~ T~pe of ~si~noe ~ingle Family.~' ~ Multiple P~mily No. of Bedroo~ ~ '~ ~ O~her W~ter Supply ~ ~ i.~." ~'ndividual ~_~_ ~MX:, ~% A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community ~)~ /~ C/.~ For wells drilled prior to thai date, give well depth (~ttach Icg if available). ~ Public Utility Sewer Disposal /~'lndividual Year Individual Installed: ./ ~ ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date c,~_ Inspector Inspector Inspector Inspector b~ ~UN1CIPALITY OF ANCHORAGE ENVh ~ i >, RECEIVEP (~APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received 72-023 (3/82) Joser¢.'~ F. and ?b¥!t:Ln ]',. J~nke ?]agle River, AK 99577 Subject: Lot 11 Block 2 Higltland lI:[].].s Subdivision Approval for th,:,~ indivi~tual sewer and water 'facilities cannot be granted until the foil.owing items have been completed: A well log submitted to this office for our :files and review. ° Tho water analysis report needs to bo submit12ed to thJ. s office fromL'*ne Chem' ' · I,ab, 5633 B Street, for our Please not. ify this Department for a reinsuecl:ion wh~n the noted discrepancies have been correcte{1. !f there are any further questJ, or~s, please call. this offioe Sincerely, Robert;'_ C. Pratt Associate Environmental Speci. alls~'~