Loading...
HomeMy WebLinkAboutTURNAGAIN BLK 4 LT 1 GRI' 'ER ANCHORAGE AREA BORO 01~'Jm;~TMENT OF ENVIRONMENTAL QUALI'r~.-~" 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL. SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY /.~. ~ .GALLONS. MATERIAL '~)77~' NUMBER OF ~ - COMPARTMENTS LIQUID INSIDE LENGTH_ __INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF FITS / OUTSIDE DIAMETER L N NO MATER AL.~'~ NEAREST LOT LINE__/'~ . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) OR WIDTH DISTANCE FROM WELL ,/ LENGTH /~ , DEPTH BUILDING FOUNDATION. SQ. FT. ~T'IL-E.~[~ RA[ N FIELD: DISTANCE FROM WELt NUMBER OF LINES_ ABSORPTION AREA , FOUNDATION , NEAREST LOT LINE DISTANCE BET~EE~I~E~ .... TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN, TOTAL EFFECTIVE IN. ABOVE TILE WELL: LOT LINE TYPE .~./~/Z-Z-Z~/') DEPTH NEAREST _, SEWER LiNE DISTANCE FROM WATER · BUILDING FOUNDATION _SAMPLE SEPTIC SEEPAGE TANK . SYSTEM_ . CESSPOOL NEAREST OTHER · SOURCES DISTANCES: DIAGRAM OF SYSTEM 7XZ~.//L/.h' - '! DATE G.A,A.B, grE/~?'ER ANCHORAGE AREA BOR~OGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND P£RMIT TYPE AND SIZE OF FACILITY TO ~3E SERVED PHONE OTHER SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TES~ COMPLE¥1ON DATE ANTICIPATE~//~- FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL ]NEPEGTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK seepage Pit WEll TO SEPTIC TANK ~, SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER, LAKE, STREAM. , SEEPAGE PIT EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON ~EPTIC: TANK AND SEEPAGE PIT F~TT~D WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, LICENSED DESIGNE~ AREA SIZE TYPE DIAGRAM OF SYSTEM I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ~c~ AIN~:HORAGE AREA BOROUgN DE",.'RTMENT OF ENVIRONMENTAL QU~.~ITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 ': , ~ Pe'rformed Por Robert Coulter Date Performed CASE Legal Description: -,This Form Reports 6/16/72 Lot 1 Block 4 SubdiviSion Turnagain Soils Log X Pe"rcolation Test Depth Feet Soil Characteristics Brown silt and mix (ML) Gray sand (SW) with sandy gravel seam 5 to-6.5' Was Ground Water Encountered., If Yes, At What Depth? Date Grdss )Depth to H20 Net Dr6~ P'e~6~lation Rate Minute Proposed InstaT~-J~lon: Seepage Pit x Drain Field Depth O~ Inlet Depth To Bottom Of Pit COMMENTS: .ll5 sq. ft. of drainage area is required per bedroom. ., Test Perfbrmed.By Carli~' ' 'DJ-fa Certifi~])y:National Testin~ '--?/~'?" MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# (-"~. ,~::. -/.~ C~2.1 HAA# ~ O<.D~.~ ~,.~ ~, 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution  .r~..~__.4,~e p,h. o F e: (home) Telephone Business Mailing Address (d) Real Estate Company and Agent Address ~ ~ 0 ~ Telephone Pc../ ld, bo.~ (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms Single-Family {~ 3. WATER SUPPLY Individual Well [] 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 [] 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. 72-025 (Rev. 7/88) Page 1 of 2 ;B J.o ~ ae~d '~lJO~ s,Jeeu!bue leUO!SSejoJd aql u! suo!ss!~o Jo sJoJJa Jo,t elq!suodsaJ ~ou s! al~eJoqouV jo ,qlledlo!u nv~ aqJ_ 'panss! si aleo!J!~Jeo e eJojaq e),ep az/qeue Jo suo!loedsu! ~anpuoo iou op SHHQ ~o saMolduu3 'siua~ueJ!nbaJ eleis pue leJepat u!elJeO ,~js!~es oi JepJo u! suop, nl!lsu] bu!puel J!eLl~ pu~ sat.uoq jo sJeseqoJnd o~ /,salJnoa e se s!qi seep SHHQ eq.L 'mtSel¥ jo e~e~S aqi u! peJe~s!6aJ Jaeu!bue leUO!SSejoJd ~uepuadapu! ue,~q e^oqe ~ qdeJ~e,ed u! ua^lb suo!~eiueseJdaJ eql uodn ,~lUO peseq peieo!j!Jeo ]e^oJdd¥,q!Joqln¥ q~leaH sanss! (SHHQ) saa!^JeS ueLunH pue q~leeH ~o luatulJedeQ eaeJoqou¥ jo,q!led!o!unlAI aq/ leUO!~,!puoo le^oJddv leUO!~!puoo Jo swJeJ. pa^oJddes!O --' ~ pe^oJddv / iq SLUOoJpeq ~ Joe pe^oJddv IYAOI4ddV SHHO '9 RECEIVED MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /...o-r' A. WELL DATA Well Classification ~' t ~.J"~ Well Log Present ~Y/N) h/_ Date Completed Total Depth I~ ~ Cased to ~_ ¥~' t Dep!.h of Grouting Static Water Level q~ ~ , Casing Height Above Ground __ Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: If A, B, C, D,E.C, Approved (Y/N) /~, Pump Set At . ;> 7~'' Sanitary Seal on Casing (-Y/N) Depression ArOund Wellhead (Y/N) N To Septic/Holding Tank on Lot ~'~' 3~' ~, 0. ; On Adjoiniqg Lots To Nearest Edge of Absorptiofi Field ori Lot ~* ~ ¢, ~. ; On ,~.djoining Lots To Nearest Public Sewer Line N.~. To Nearest Public Sewer Cleanout/Manh~ie To Nearest Sewer Service Line on Lot ;:> ~,.¢' ~ Water Sample Collected by 7- F/'~ ; Date WaterSampleTestResults Z;~J~ ~-~¢Jo~-)/ - 0 e~ h*[~o,, /Io o ,.~ j Comments Du.¢;n.~' ~.,,¢11 J~[oc~ /'~t"~ ~n ~/~/~'~ B. SEPTIC/HOLDING TANK DATA Date Installed ~(~o/78 Size. V Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contact on File (Y/N) _ No. of Compartments '~- Y' Foundation Cleanout (Y/N) N Date Last Pumped ~/~/~'~ ; for Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~/e~ .~r..~ ¢,O. To Property Line '~'~ ' To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Temporary Holding Tank Permit (Y/N) To Building Foundation ~ 1.7.° To Disposal Field I~ ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7/10 / ? ~ Width of Field I~~ J~5' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area /,/O'O ?¢~' ~,4'- &u', It DePression over Field (Y/N) /~1 Results of Last Adequacy Test ~'~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~¢'~ ~,~ C,o'. To Building Foundation To Water Main/Service Line ~ Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line I~ ¢ To Existing or Abandoned System on ; On Adjoining Lots ;~ -~ ~ To Cutback (if present) N¢ ~, To Stream, Pond, Lake, or Major Drainage Course To Driveway, Pa~king Area, or Vehicle Storage Area Comments f,,~u¢~' ¢'~'~'~',~f' ..-~' ~..~11 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 Manhole/Access (Y/N) '"Pump Off" Level ~t Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA ~.fi4t~'~[r~effect on the date of this inspection ? ~.¢~ ¢ ~ .ng,neers ~ea, Date ~ MOA No. _ Receipt No. Date of Payment Date of Payment Page 2 of 2 Torn Fink, Mayor uni pality of Anch Or ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 31, 1989 Ted Moore, P.E. Flattop Technical 14530 Echo Street Anchorage, Alaska Services 99516 Subject: Dear Mr. Waiver Request for Lot 1 Block 4. Turna~ain Subdivision Waiver RequeSt' ~WR890007, HA890064 Moore: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 85 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. S~cerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljw~6 . ,, ,~I~E~~ :..:? -,:'~. .;.~ ~ .'..-~ ~ P TECHNICAl, S T~ODORE F. MOORE, P.E. '" y%~ruar"~.~, 1989 14530 ECHO ST. PH: 007) 345-1355 ~CHORAGE, ~KA 99516 M.O.A. Dep't. of Health and Human Services P.O. Box 6-650 Anchorage, AK 99519 Dear Sirs: By means of this letter I am requesting a waiver down to 85 feet from the required 100 foot separation distance between the well and the closest portion of the seepage pit on Lot 1, Block 4, of Turnagain S/D, located at 1209 East Klatt Road. To assist you in your review, I am enclosing a site plan as well as other relevant backup material. No well log is available, however the septic system as-built indicates the well existed in 1972. A:~:973 Health Authot~ity Approval:doCUmentihdicates that th~ total-depthof:the:we!!:~s/l~22:f~?t. On February 8 of this year I conducted a yield t~t of ~he well The ~ni{~ai s~a_tic:wa~t~.?:l~evel in:the:well on :~a~_48:fee~:below the ,toP?f the casiffg.> Steady pumping of 487 gallons of water from the well at the maximum pump output of 5.0 gpm caused the water level in the well to be drawn down to 76 feet, but no further, and it returned to it's original level within a half hour of cessation of pumping. Based on this test, I concluded that the sustainable yield of the well is in excess of 5 gpm, which is more than adequate for any single family residence. Water samples taken that day were satisfactory, showing 0 coliform bacteria/100 mi., and 0.24 mg/l of nitrate-N. The wastewater disposal system was installed in July, 1972, and according to the as-built drawing consists of a 1250 gallon, two compartment septic tank followed by an 18' by 24' seepage pit containing 6 feet of gravel. While the seepage pit cleanout pipe is approximately 95 feet from the well, the underground extent of the pit should bring it to within almost 85 feet of the well. The 69 foot separation between the weld and the septic tank cleanout was legal at the time of installation, and thus has grandfather rights. To test the system's adequacy, on February 8 I had a pump truck add 1800 gallon of water directly into the empty seepage pit, plus I added another 487 gallons from the well, creating a total fluid depth of 44 inches. The fluid then receded at a rate which was more than adequate for a 4 bedroom residence. The June 1972 soils log indicates the soil in the absorption strata to be predominantly gray sand with a soil rating of 115 square feet per bedroom. No water table was noted to a depth of 14 feet. This sand can be expected to provide optimal treatment of the septic tank effluent. While no well log is available, the fact that the total depth is 122 feet and the static water level is at 48 enables one to conclude that there is a vertical separation of at least 38 feet between the bottom of the soil absorption system and the top of the aquifer. It is more probable that the aquifer is located at a depth of around 120 feet beneath a confining strata, for a total vertical separation of 110 feet. Certainly, the water samples give no indication of fecal contamination of this aquifer. The lot ~s essentially level, with the house being situated between the wel and the septic System. Thus, should the system fail C~ausing effluent to surface, there would be no particular tendency for the effluent to flow towards the well, and any possible surface route is greater than 100 feet. Based on the surface topography, one could surmise that the water table gradient is relatively flat. In consideration of the above facts, it is my professional opinion that the requested waiver can safely be issued without concern over compromising public health. Please give me a call if you have any questions on this analysis. Sincerer, Ted Moore, P.E. '~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /~,'\= 5-'~33 ~T"~-~ ~A"~"~A 99-'~'~ ~~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY 3A~LE for Work Ord~ ~ 11631 Date Report Pzlnted: FEB i3 89 ~ !5:13 Client Salaple ID:LI. Bd, TURNAGAIN PW$ID :UA Collected FEB $ 89 ~ 14:00 Ars. Received FEB $ 89 ~ 14:30 hrs. Preserved with :AS REQUILED Client Wame : FLATTOP TECHNICAL Client Aced : EDAYTOI P.O.~ NON~ Req ~ Ordezed By : T.F. Analysis Completed :FEE 13 09 Send Reports to: Laboratory Supelvisoz :STEPHEN C. EDE i)FLATTOP TECIINICAL URV Che.n~ab Re£ ~: 4196 Lab Smpl ID: 1 ~t~ix: WATER lllowabl~ Pazamete~ ~ested Result/Unit~ Method Limit~ NITRATE-Il 0.24 mE/1 EPA 353.2 10 Sa~plo ROUTINE Eomark~: SAIdPLE COLLECTED 1 Tests To,formed ' See Special Instzuction~ Above UA=Unavailable DD~ None Detected "See Sample Remarks Above Nh= Not Analyzed LT=Less ?hah, GT-Gzeate~ Than ACHEMICAL & 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 [] PRIVATE WATER SYSTEM Name Phone NO. Mailing Address City SAMPLE DATE: State Mo. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 31 4 I 5 I Time Collected Collected By TO BE COMPLETED BY LABORATORY / ;Fj'~is shows this Water SAMPLE to be: atisfactory nsatisfactory [] 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. Time Rece,ved Analytical Method: Membrane Filter * No:of colonies/100 mi. Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATERiANALYSIS RECORD Membrane Filter:. Direct Count _ ('~) Verification: LTB BGB Final Membrane Filter Resulted// ...,,/~? C oilform/100ml Time: ,.,~c~.~ (~,-~ a.m. TNTC = Too Numberous To Count OB = Other Bacteria Coilformll00ml ~.atto~ Technical Services 14530 Echo Street Anchorage, A aska 99518 1.07' I~ Grilling Ce. Alaska Now-Well-Vern's Drilling Driller Vern Type of rig rotary wel~ o. ner Wayne Britton ~o~::::(',8dd[p~s~7~ legal description) ~_~ .].~8'-: ft. Cooing: depth 38 ft. diem._6 Static water I~y~i; ?~ ~-, fl. (above, below) I~nd outface. Oate Finish of well: ;(open'end, screen, perforated, open-hole, ether), USGS no. Date well completed Nearest community Describe Intervals end SiZe:. Well yield tested by (pumpin;, bellini, eir) at 9 for 48 bents with 4© ft. of drewdown from static level. gal/mtn, §RILLER'G MATERIAL LOG Dec. 4, 1986 Anchorage Location sketch or remarks Use of well: Class C Water cleared over night, but was pumped over 84 hrs. continou~ Depth below land eurfeee in feat 0 tc 13 13. 43. tO 43 94 to 94 130 to 130. tc 134 134 fp 136 136 t0138 ta .Give description of strata penetrated (size of material, color, hardness of drilling, end water content) --tO sandy till hard pan gray silty clay-lenses siltys~ndudii cemented gravel and silt silty sandy gravel with some H20 tight gravel with sand-H20 tO V , SON VELL DRILLIN,', 1305 W. 45TH STREET ANCHORAGE, ALASKA 99503 PHONE 272'9343 DRILl. lNG LOG Well Owner__ Use of WeD Location (address of: Township, Range, S, eetion, if known; or distance main road~ Depth of Hole eJ_Om_. ~{ feet Casedto I~)C, ~ feet Size OJ[ Static water level i,. ~ ft. (above) (below) land surface. Finish of well (cheek one) open end Screen ( ); Perforated ( ). - ); Describe screen or perforation Well pumping test at "~ gallons per (hour) of drawdown from static level. Date of completion 3 ~ (%~) (['i" ]~ ] '? for hours with~ r '3 ft. WELL LOG Depth in feet from ground surface TO TO TO TO _TO Give details of formatior~s, penetrated, size 9f material, color and hardness - ~ ..- ~,.,,- ,...~, . !. ', -TO. .TO. SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF ~7~ Fect. DRILLED AT THE RATE OF PROPERTY OWNER M1~, LOCATION OF WELL SITE DRILLER ~ni~ fllaus V/ELL LOG: ~-~26' S~y 37--121 ' Ha~p~. FOOT. ~.126--13~5V Sandy_u~___silty water bearing material. Very poor qualmt2water.~. / .~_~ 135-178'_ Silty~wet olay. ..... J, ' _ Drill&d out to 200 fe6t. Blue ~lay from 179 to 200 fee~ /~/- Drillers deei$ion to perforate water at 121 to ~26 fee~ ~ ~J AD ;alled at a later time if needed. After pumping several hours well is ready for permanent pump. ~ump should be installed at 1~15~_ Zeet~-"Wett':~ou~d._produce 15 GPM at il5 feet. ma~ pump sand if s~bmersible p3m~. ~f~ in~A~lled much lowe~ th~ il5 feet. This wel~ COST INCLUDES ALL LABOR ANI~')'M~ERI;~E'~OR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABle TO RAMPART DRILLING WORKS POR THE SUm OF THANK YOU VERY MUCH. BERNIE CL~_U.~ OF RAMPART DRILLING WORKS SERVICE GHARgE O F IF~% PER MONTH WILL BE ASSESSED ON 'PAST D~' E, ACCOUN~S;~,.~ WATER WELL DR~.¥1W, RS L~G DO NOT FT[J, , Drilling Co. Ve,r~' s Drilling. , & ,.EnterDris,es- . ., ., US~ No. DriVer.. ~non Nowell Ar~ ' We~ o~er Steve Ford Use of we~ house Location (address of: T6~s~p, ~nge~'& sect~'~n~ ~if ~ or dis~ce 6-12-75 ~in r~d~ Lot 12, Bloc~.:~rnigan Sub~ Size ~f cmsing .: ~. 6 D~D~h of' hole ~P~"-~ feet ~sed to 1~5' ' f~et Sbatl~[~ter i~el~,6~ 3m~e~(~)(~elow) land s~face. Finish of wen x (Check one) ~[~~~)~ Screen ( ); Perforated ( ). : screen or ~rforatlons We~g~test ~t 7 ganons ~r (~)'('~dte)' ?o~[~ ~0~ ~ ~{,~O~:~"~ fe~ ~o~ from s~tic level ~e~ :: ........ .............. ~,Z ho~ ........... Depth in"feet from Glve'd~tails'of fomtidns penetrated~ size of mterlal~ gro~d s~face ,, q~.~oE~' an~ ~dn~ss.. ...... Q, to 3' . ~r~vm t%!~ ........... ~' ~o 11, sandy & gravely~ gray brown till ~/~ ...... , .......... 14~6"to122' gray sloppy silt-heaving '- :~il~y sand & grave~. It20 , ,., ~ .... /, to /~Z -/'z-7 to to WATER WELLS 665 W. 87th Avenue Anchorage, Alaska 99502 HOWARD TEAL 344-0498 MUNICIPALITY OP ANCHORAOE ENVh~ j,j.. :i . .! ZLFIGN WELL CONSTRUCTION LOG D,,,,,n, De. ,~'~ ,'.Z' DS,S ,o. RECE! Vr.D Driller ~-~'~,"~.--~ /~'~'~?~"~ Date well completed Static water level J~ ft. (~bov~, below) land surface. Date Finis~ of well: (o~an-snd. screen, perforated, open-hale, other) Describe intervals and size: ·. . / ~ ./~'. C ' ~ell yield tested by (pumping, bailing, air) at /~ gal/min. ,~' for. hours with /~,~ ft. of drawdown frdm static level. DRILLER'S MATERIAL LOG Depth below lang Dive description of strata penetrated surface in teet (size of material, color, hardness of drilling, and wa~er content) ~ to_ ~,~? tc to __to __to --to to¸ 4. WELL OEPTH: {completed) [ Surface Elevation ft. Date of. Completion E~Test Well E~Other: 7. CASING: [] Threaded ~Welded in. to ft. Depth Weight in. to ft. Oepth '~AbOve ~--~Selow land surface 13, PUMP: (If available) ~P .~q., Type: ~Submer$ible E~ReciProcatin§ ~Je~ []Other: 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 10t, block, subdivision, section, township, range) Location (address or directions) (b) Propertyowner ,AHFC 17 /1>, d' n r' Mailing Address ~E~O /¢~¢'/'z.¢// R,¢~'~, (c) Lending Institution ~'t Mailing Address ~o 5' (d) Real Estate Company and Agent Address CyO0 /-/-~c~"z-t t'/ /~o(. Tel.ephone .~ qq- 0~"0 / Telephone: (home) Business Telephone J-~'3 -o 7o0 (e) Mail the HAA to the following address: (or check here Bi, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3, WATER SUPPLY Individual Well [] 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 [] Public I~ Community [] Holding Tank [] Note: If community well system, must have written confirmatior~ from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. ?/85) Page 1 of 2 ~ ~o ~ eaed '~]JOM s.JeeU!l~u9 jeuo!ss@joJd ertl u! suo!ss!~uo Jo sJoJJe JoJ elq!suodseJ lou s! ebeJoqouv ~o,~!led!o!un~ eH1 'penss! s! eleo!jBJeo e eJojeq e],ep ez,~leUe JO suop, oedsu! lonpuoo lou op SHHQ jo see,~oldUJ3 'slueu~eJ!nbeJ e~],s pue I~JepeJ u!elJeo ,~JsBes oi Jap Jo u] suoBniBsu! 6u!puel J!eq], pue setuoq Jo sJeseqoJnd o1 Xse],Jnoo e se s!q~ seop SHHQ eqJ. 'e~SelV ~o elelS eql u! peJe],s!eeJ Jeeu!bue leUO]SsajoJd ],uepuadepu! ue ,~q eAoqe ~; qdeJI],Jed u! UaA!6 suoBelu~)seJdeJ eq], uodn,~lUO peseq peleo!j!Jeo leAoJddv X~,!Joq],nv qlleeH senss! (SHHQ) seo!AJeS uemnH pue qlleeH jo lueLu1JedeQ e6eJoqouv jo ,~],!led!o!u nvq eqJ. leUOB!puoo le^oJddv leUOB!puo0 jo swJe/ pe^oJddes!Q j( pe^mddv Xq su. looJpoq ~'~r~ot po^oJddV 'IYAOHddV SHHa '9 ~ __ AI~u.r~..QI.[:'.ALITY OF ANCHORAGE (MOA) MU~°~EALT~'I&~1T[11 Authority Approval (HAA) EN'v~TAL PROT~C~I::I!IiCKLIST - FEBRUARY 1984 343-4744 ~V 1 ? tg~Ct Legal Description: RECEIVED A. WELL DATA Well Classification Well Log Present (Y/N) N_ Date Completed ~ e,~ hl~nl TotalDepth 18~ Casedto'~¥o' DePth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield "> ~.. E, ~lCm Static Water Level Casing Height Above Ground '~d' Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: Pump Set At ~- ?o/ ¢ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Al To Septic/Holding Tank on Lot N.h. (?¢~t,c..c~,,.,~,-) ; On Adjoining Lots > fcc To Nearest Edge of Absorption Field on Lot ,~.,~. ( ?,,.~/,< ~'-~.,.~,.-); On Adjoining Lots To Nearest Public Sewer Line ~ To Nearest Sewer Service Line on Lot ~ ~' Water Sample Collected by Fl~f WaterSampleTestResults ~,~c~v - Comments D~(~ ~(t ~(~ SEPTIC/HOLDING TANK DATA Date Installed Size. Standpipes (Y/N) Depression over Tank (Y/N) No. of Compartments Air:tight CaPs (Y/N) Foundation Cleanout (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Date Las~ Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~c'l-J2'¢~ 4'.c,~'~c/zc~ ~ To Building Foundation To Disposal Field 72-026 (Rev, 7~88) Front Page 1 of 2 C. ABSORPTION FIELD DATA t,l.,4. Soils Rating in Absorption Strata Date Installed Width of Field (._ P~.b Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test 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 I/4rt~,~ ~o.o,o ,,~ /~,~ ~ .4- ~'~'¢.4 Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line . To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) D. LIFT STATION /~1, A. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/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 I have checked, verified, or conformed to all MOA and HAA guid,e,~nes in effect on inspection. ,~.-~,'e'~ ~ ~/7~ b k. ~ C~~ , ,~{~ · <-~ ~ Date h(ou /~ /~8~ ~ ......................~'"'¢ MOA No. the date of this Date of Payment Engineer's Seal "¢.,%.~ CE-.~589 , ,m ~ Rece pt No. a~.~ Waiver Fee: $ Date of Payment 72 026 (Rev. 7/88) Back Page 2 of 2 RECEIVED ACHEMICAL & 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 [] PRIVATE WATER SYSTEM Name Phone No. Mailing Address City State MO. Day Year Zip Code SAMPLE TYPE: [~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose _) [] Treated Water ~ Untreated Water SAMPLE NO. LOCATION t I /- ~, /~P,' ~, T',~,,',~,~-c/z) I (/ I 31 I . I I Time Collecled Collected By "~ :~.~t>pt -l-F/'7 TO BE COMPLETED BY LABORATORY 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. Date Received _ Time Received Analytical Method: Membrane Filter * No. of colonies/lO0 mi. Result* J BACTERfOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB BGB Final M ambran il~esut~ Reported ~ly ~_~~ Date Time: TNTC -- Too Numberous To Count OB = Other Bacteria Collform/lO0rnl CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ANALYSIS REPORT BY SABLE fo~ Work Ordex ~ 18252 Date Repoxt Printed: NOV 16 89 8 1~:59 Client Sample ID:LI B4 - TURNAGAIN PWSID :UA Collected NOV 14 89 @ 15:55 h~s. Received NOV 14 89 @ 16:50 hrs. Preserved with :AS REQUIRED Client Name : FLATTOP TECHNICAL SRV Client Acet : ELATTOT P.O.$ NONE RECEIVED Req ~ Ordered By : T.F.M. Analysis Completed :NOV 15 89 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE I)ELATTOP TECHNICAL SRV Released By , ~ C.~ 2) Special Instruct: Chemlab Re£ ~: 8521 Lab Smpl ID: i Matrix: WATER Allowable Parameter Te~ted Result Units ~ethod Limits NITEATE-N 0.19 mg/l EPA 353.2 10 8ample ROUTINE SAMPLE. SAMPLE COLLECTED BT T.F,M. Remarks: 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Rema~k~ Above NA= Not Analyzed LT=Less Than, GT~Greater Than GREATER ANCHORAGE AREA BOROUGH Department of Environment~l Quality Tudor Road, Anchorage, Alaska 99507 279-8686__ Date Received ,~./~t//~., Time of Insoection Date of Insoection REQUEST FOR APPROVAL OF INDIVIDUAI, SEWER & WAIER FACILITIES Aoproval Requested By: Address~ ,~ ~. Prooertv Owner: Legal Oescription:._L/--~-~- / Location: FOR Phone: Phonet Number of Bedrooms: Well Data: ~ A. Type ~ B. Depth C. Construction D. Bacterial Sewage Dtsoosal.System: ~, A. Installed 8. Installer Analysis C. Septic Tank: 1, Size 2. Manufacturer O. Seepage Pit: 1. Size 2. Material E. Disposal Field: Total Length of Lines B. Distances: A. Well To: Septic Tank , Absorption Area , Sewer Lines · Nearest Lot Line Foundation to Septic Tank , Other Contamination Absorption Area C. Absorotion Area to Nearest Lot Line DIAGRAM OF SYSTEM I certify that the information contained in this request for appreval to be a true and accurate representation of the subiect sewer and water facilities located at: Signed Date 5' CERTIFICATE OF SURVEY I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY.' AS RECO~ED IN THE ANCHORAGE RECORDING PRECINCT, ALASKA~ AND THAT THE IMPROVEMENTS SITUATED THERE~ ARE LOCATED ~ SH~N ON THIS ~T,AND T~T THERE ARE NO ROADWAYS,TRANSItION LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPTAS INDICATED HEREON. DATED AT ANCH~E,ALASKA, ~IS BARNARD ~ ASSOCIATES ERNEST A MARTH ~ LS REGISTERED LAND SURVEYOR REG. NO. IE, 14-S ADpRESS: 999 TUDOR ROAD ANCHORAGE,ALASKA 99502 PHONE: 2?2-0470 S~URVEY TITLE SCALE~ BOOK NO 7~ /~ ~AWN BY::~ ~CHECKED BY: ~ ~ JOB NO. ,~1~ GRID NO. ~