HomeMy WebLinkAboutT11N R3W SEC 2 NE4NW4NW4NW4020-0 -/5
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 PHONE ~NEW
M^ILING ESpO ~ /o ~ ~n J ~.
LEGAL DESCRIPTION
LOCA
TIO
DISTANCE TO: I Welled ¢~___ IAbs°rpti°n area Dwelllng. f
~ ' ?~ ~ No. of compartme~
CS' ~ inches Distancebetw~/~es
OTHER
REMARKS -~ ~ /
72-013 (Rev. 3/78)
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i1:i~
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]:-~;':':.:,U!-i::[::, [3"r . :l.~~--.-~'~'~:e~. CF'ITl:':} .......................... .~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222~
SOILS LOG - PERCOLATION TEST
J~ SOILS LOG
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
~--- 8
9
10-
11
14-
15-
16-
17-
18-
19-
20-
Z
SLOPE
(Nv~WAS GROUND WATER
ENCOUNTERED? '
DEPTH? IF YES, AT WHAT
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
PERFORMEDBY:~~z~'-f ~ CERTIFIED BY: ~,.~f.~2~.,~. DATE: ~/~,/~ ~
72-008 (7/76)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
3-
4-
5-
6-
7-
8-
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 9950:2 276-222~
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
SOILS LOG
[] PERCOLATION
TEST
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
. TEST RUN BETWEEN FT AND ~ FT
PERFORME.."~ ~"~% ~ .G~X"' CERT,FIEDB .ATE:
72 008 (7/76)
g~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
1. GENERAL INFORMATION fMUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
. ,Locati'on (address or directions) .
Mailing Address
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the followina address: or: Check here~, if hold for pick up.
List contact person and day phone number below.
cu.
TYPE OF RESIDENCE
Single-Family..
Number of Bedrooms
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,
SEWAGE DISPOSAL
Onsite~ 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.
Page I of 2 72-025 fRev 8/861 Fronl
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NOI~V~aOaNI ON~ v~va 'HOUVaS ~qlJ 'S~S~ 'SNOI~O~dSNI 9NlalAOad ~MI~ 9NlBaaNIgNa
.g
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
MUN~CIPALI~¥ OFI~,E~I~'UTHORITY APPROVAL (HAA)
ENviRONMENtAL S~W;cE~H~IST - FEBRUARY 1984 264-4744
~ :' ~ (~ ~ ~':~'~ Legal~//~ - ~ ~ ~,Descripti°n: ~T~,~, ~'~/N~/j~
R CE VE¢
Total Depth 7 / ~' Cased to
Static Water Level ,~(...~/ z
Well Classification ._~--A,/O/~/[~ ~. ~--../ If A, B, C, D.E,C, Approved (Y/N)
Well Log Present (Y/N) ~v'~....~ Date Completed ~/~--~'/'7~ Yield ~¢~
'~/t Depth of Grouting
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Casing Height Above Ground 3 /
Electrical Wiring in Conduit (Y/N) ~"'~-~'~
Separation Distances from Well:
To Septic/Holding Tank on Lot '7~'/~'~ 5~+;~-~ o~; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot f/'~ / ; On Adjoining Lots
~D ~ To Nearest Public Sewer
~ To Nearest Sewer Se~ice Line on Lot 7
[~¢ ~~~ ;Date
Pump Set At /4.,,z~¢4 r" "-~O !
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
B. SEPTIC/HOLDING TANK DATA
Size
Date Installed
Standpipes (Y/N) Y'~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) /~o
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well '7
TO Property Line ~"~) / "~
TO Water Main/Service Line
Course
Comments ~.4:'~ z¢,~,4'~,,',~' ,"-
NO. of Compartments
'~-'~ Foundation Cleanout (Y/N) .
Date Last Pumped
/q-///"~ ;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation '~ /
To Disposal Field / ~) ~
,/LZ~2/'~'Z..----' To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026 (Rev 8/861 Front
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
Separation Distance from Absorption Field::
~'~ Type of System Design
~/z"' ~/'~7¢ Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
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
To Property Line ~¢,'.-/~'~.~-~ )/-¢¢: d
To Existing or Abandoned System on
; On Adjoining Lots (' ¢-.)O /-,,~
,,~Jol~TO Cutbank (if present)
Comments
LIFT STATION ~., ~, ~-,-~'~ X
Datelnstalled ¢ Dimensions ~~
Size in Gallons ~o ~ ~ Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at / ~ '~ Vent (Y/N)
¢
Tested for ~ ~ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I hav~hecked, vedfle~r conformed to all MOA and H~ guidelines in effect on the date of this inspection
Oo ..n, 7'
Receipt No. ~- O ~)/~) ~)~ ~
Date of Payment ~ '- ~ ~
Amou t:$ _ /?O-
Page 2 of 2 ~,~
~ W. Benson Blvd.
Sutt~ g06
PENINSULA ENGINEERING
(007) ~ol-SlO7
Adequacy Test and Well Flow Analysis
Legal: NE1/4, ~W1/4, NWl/4, ~l/g, Section 2, TllN, R3W, Seward Meridian
System: 35' x 3' x 5' deep trench with 1250 gallon septic tank and 500
gallon lift station set in 5' diameter Metal CMP Culvert Manhole.
Performed by: Wayne Henderson P.E.
2-3-88
Time
0
13
23
3o
5o
7o
9o
2-4-88 0
Septic Lift Trench Rate ~antJty
Tank I Station I C.O. I (gpm) I I Added
0.4' I 0.5'1 3.1' I 0 I 0 I
I 0.5' I ~.6' I 5 I 20 I
I 0.5' I 4.0' I 5 I 65 I
I 0.5' I 4.7' I 5 I il5 t
t o.5' t ~,.9' ! 5 I 15o I
I o.5' I 5.o' I 5 t 25o I
-- I 0.5' I 5.0' I 5 I 35O I
0.4' I 0.5' I 5.0' I 5 I ZOO I
I - I 2.1'l o I o I
Absorption field was tested first by adding water directly from the well at
5gpm into the trench and monitoring the levels. 7~e lift station was then
tested by adding water directly into the lift station and monitoring the
cycles and measuring the high and low pumping levels.
A high level alarm float system t~th alarm mounted inside the home areas
installed for safety. Absorption system funct5 oned adequately for 3
bedro~ns at this time.
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
,/~:.~~ 5633 FEDERAL TAX ID #92-0040440
A CHEMICAL &'~EOLOGICAL LABORATORIES OF ALASKA, INC. :
TELEPHONE (907) 562-2343 5633 B Street
I Anchorage, Alaska 99518
Drinking V~tter Analysis Report for Total Coliforml Bacteria
TO BE COMPLETED BY WATER SUPPLIER
PRIVATE WATER SYSTEM
City ~ State Zip Code
Mo, Day' Year
SAMPLE TYPE: :
~.~ Routine
Check Sample (for routine sample
with lab ref. no.. ~ _)
[] Special Purpose j
SAMPLE I
NO, LOCATION
[] Treated Water
[] Untreated Water
Time Collected
Collected By
TO BE coMPLETED BY LABORATORY
Analysis~shows this Water SAMPLE to be:
[~¢ Satisfaciory
[] 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 mai].
Date Received '~ ~ --~
Time Received / '~'*~ ~
Analytical Method: Membrane Filter
* No. of c~lonies/100 mi.
LalJ Ref. No. Result*
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TNTC = Too Numberou/
OB -- Other Bacteria
Membrane Filter: Direct Count
Verification: LTB BGB
Final Membrane Filter J~ult~ d //,ffffr
Reported By ~.-']-~ ~.,~,-~ Date
Time:
PART t OF 2 REMAIN~£R TO FOLLOW
Coilformll00ml
(~) _ ~oilformll00rnl
/ ~"Zoa.m.
Tom Fink,
Mayor
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
February 17, 1988
Wayne B. Henderson, P.E.
Peninsula Engineering
440 West Benson Blvd., Suite 206
Anchorage, Alaska 99503
Subject: Waiver Request for NE1/4, NWl/4, NWl/4,
Section 2 TllN R3W Seward Meridian
Waiver Request Number WR88-008
NWl/4,
Dear Mr. Henderson:
Your request for waiver of the required 100 foot separation
from a residential well to a septic tank/lift station has been
approved. This distance has been waived to 75 feet.
Laboratory test results show that nitrate levels are
undetectable in the well water, thus indicating the well casing
is functioning properly. Also, because the ground level
elevation at the well is approximately 30 feet higher than the
septic tank/lift station, any effluent that may potentially
surface would travel away from the well.
This waiver approval applies to this existing well to septic
tank/lift station separation only. Any future upgrade to
either will require all separation distances be met or another
approval from this department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Services
cc: Gus Andress, P.E., Manager
On-Site Services/Water Quality Programs
TO
PENINSULA ENGINEE ~IG
440 WEST BENSON BLVD., SUITE 206
ANCHORAGE, ALASKA 99503
(907) 561-5107
GENTLEMEN:
WE ARE SENDING YOU ,~,ttached E] Under separate cover via
[] Shop drawings [] Prints [] Plans
[] Copy of letter [] Change order []
[] Samples
the following items:
[] Specifications
COPIES DATE NO. DESCRIPTION
THESE ARE TRANSMITFED as checked below:
[] For approval
[] For your use
~As requested
[] For review and comment
[] FOR BIDS DUE
REMARKS
[] Approved as submitted
[] Approved as noted
[] Returned for corrections
[]
[] Resubmit.__
0 Submit
[] Return__
19
copies for approval
copies for distribution
corrected prints
__. [] PRINTS RETURNED AFTER LOAN TO US
o UlVl$1~b,~
1988
' LEIV£D
COPY TO
MUNICIPALITY of ANCHORAGE
MEMOI~ND~
DATE:
TO:
FROM:
SUBJECT:
February 29, 1988
File of TllN R3W Section 2 NE1/4 NWl/4 NWl/4 NWl/4
Daniel J. Roth, Civil Engineer, On-Site Services~_
Site Visit To Verify Engineers Work
On February 16, 1988 the subject site was visited and the
topography map submitted to me by Wayne Henderson, P.E. of
Peninsula Engineers appeared to be accurate.
Waiver granted.
co:
Wayne B. Henderson, P.E.
Peninsula Engineers
440 West Benson Blvd., Suite 206
Anchorage, Alaska 99503
::~, .. · ' / . ":- -~Z?
· v v ............................ :.,~--..-:-.;:::'~--__~.?'
~ ,' COVENANTS AND,R~R ~
~1~. . · , · .,..
~.~ ~ I ~ NOT 'A~R.~,,~HE:: .... '
": ...... ~'m -.~' ' v
DED UBD~ON-~TA~tQ ~. -
LOT .SMRVE~:: CERTi~ICATIgN~'
Pjot Fil~.'~o;= =Zoning DISTRICT
~nchorag~. Recording District, Alaska
LEGEND:
Brass Cop Monument ~-
IrC Pipe
St~el Pin
Survey Hub & Took
'' . REVISIONS DATE
)'V,/hLCH' Residence of: / ,~'7_~.'.' .._,,--,-,.'z ~'~' ,'~'
~o,,..~. ~:~ __ ~'~:¢~
DAT~E RECEIVED
· INSPECTION APPOINTMENTS (g,X.,~,~,~¢?~
TIME , TIME TIME
DATE DATE DATE
INBPEOTOR INSPEDTOR
/VIUNICIPALiTY OF ANCHORAGE
MUNICIPALITY OF A~OHORA6E DEPT. OF IFALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~ RONMENTA_
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION jViJ~Y 1 9 1980
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~'-~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proceed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION PHONE
MAI LiNG ADDRESS
4, REALTOR/AGENT PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
J[~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
~' INDIVIDUAL* * ATTACH WELL LOG. A well tog is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** //¢',¢~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[~3 COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED ~,/~,,~_
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] iNDIVIDUAL/ON -SITE DATE INSTALLED
[~ PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size; ~. (;'~-'~ .If Tank is homemade SOILS RATING
give dimensions: .~
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must a~ertificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79}
CHEMICAL & G~-~,OGICAL LABORATORIES
TELEPHONE (907}-279,4014
274-3364
ALASKA, INC.
ANCHORAGE INDUSTRIAL CENTER
5633 B Street,
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water Sys~ern Name ~ P~tone No.
Mailing Adaress
Zip Code
State
City
SAM.'E ATE:
MO. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
2 "Tt ~,',,f
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analys~.< snows th~s Water SAMPLE to be:
[:~'Satisf act ory
[] Unsatisfactory
[] Sampetoo~ong ntrans~t; sample should
no[ De over 48 hours old al exammanon
to n(~cate reliable results. Please send
new sample.
Da~e Received '-"-, ,'~" ''> · i ,,'i' ,~'
Time Received / ~,'/'-' '~
Analytical Method:
[] Fermentation Tube
· .E] Membrane Filter
Lab Ref. No. Result* Analyst
I FT']
I r-'c1
I
I FT~
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
06-~.220 {b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. ~.978
Date Collect e~ Source
ab. NO.
Presumpt lye /Omi /Omi 1Omi ]Omi lOml 1.0mi O,lml
./J Time. /,- ,://,:? ~.1 a.m.