HomeMy WebLinkAboutT11N R3W SEC 14 SE4NE4SE4NE4
MUNICIPALITY OF ANCHORAGE
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 ~ iPHONE i []NEW
/¢~ ~ IF NOME ......
Manufacturer
'rd~f tile to fla~sh g~ade
Dwelling
Width
Foundation ! Nearest lot line
Total ~ength of lines Trench width
MaterJa~ beneath ti~e
Depth
PERMIT NO,
No, of compaltments
Liquid dapth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
inches ,~ ~:~
Crib diameter Crib depth Total effective absolption area
OTHER
PIPE MATERIALS
SOl L TE~T RATI1~
INSTALLER
REMARKS
APPROVED
LEGAL
DATE
72-013 (Rev, 3/78)
~Permit #: 820764
January 31, 1983
TO: Permit Applicant
Subject: '?]lN R3W Section 1.4 SEN NE% SE¼ NE¼
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely
Robert C. Pratt, R.S.
Acting Pregram Manager
Sewer and Water Program
RCP/ljw
eric: Copy of Permit
SWP/057
!.!.!:H(3i'H DIH!Ei'.,!SIO!',I )2!; T!tE t...E:i'..I(31'!..I (::(i".f FEE'r;,
i)[.;F:'TH ElF' Fi !'I:;i:ENIZH Ot'~: !::'I'! 1;% THE D;I.%-I'FII',E:!~; ~?,EI'NE;~?..! THE St..I~:FF:IE:E; O?: THE:
(:ii;~:F:¢,/E:;L i;:,iE~::"i'~.l );'.:;; FILE; J'I];N;[ML~H DEFq"il OF G~:;~:ff,,,'EI.. E',IETP!EE!'! '['llE~: OUTFFd..L.
Il.liE E:(]! FTO!,I O1:: TI...E{ i~X:-:;I]:FI',?F!'f'i ON ( Z~.,! FLEET
LiF:'OH THE 'T'T'F:'E O!::' PUBLIC
H ! N ! PtUi'! D I :i; ! F::ii'4E:[!; l:::'?;~:()!'! F:I i::'R I 'v'!:]'i iii] l'-i!E! .L. FEi f::i F'R i ',,,'FFFE SE!,iEi:;i: L. i J',!!:; I S ~;~:~;:~ FEE T Fff',ID
0 FI'iiZR ~;:i:~:!;:~l..i I i;;:Ei'IENT':~; H!::Y'¢ F:If:'F'L "/ r::~;J:::'EE: I !::'
i:::!',.,'FI);LF!I31_.¢~: TO ~NE;Ui:;;'E; I::'~;;:OF'E;!:;;;
! E:L:Z!:;.'"!' ! F:' h" I' ~!F:! '!'
:;i: ]; F:I!'! F::F!I'!ZLZ(FIi;: i,ii'FH 'r'HE i:CtE(;!U!!:Ri;:i]','!IEI',!i'S FCd4;: ON...~:; ]; TIE SE;I,.IER'_:i; I:::!Ni) HEI_..L.';:: i:::r:~; SIR:'!
F:OI:~'TH i?,"/ FIlE HLtHZiX3iFq:::II..:!:i'.? OF F!!".ICHOfii:F:I(3E
;2: t: !,i];!.J. !N:i~:i-F:!i..i_ IHE :?',-"!!;TE!"! .i.!:.4 FIE;E:O~;?Df:IHCE~ I,.I;t:TH 'FHa:; E:ODES
~;; :!: t.1t",1[:)~:I;:::!::!*!::!1".![:;, THF!T I'HE Of",I'-.:!:;IT'iE SI.~!,!ER ?ii?Si'E!"! MI::t? F;:E-(;:&.IiRE Ei'qL!:::!I:;?X3I:~:i,!!Et',t'r' iF t'!.!E
i:;~:¢i:'~i;].!.)iii:NE:E iS i:;UEHODE!..E!:)"10 II'..!E:I.LIE:,E HOI:~:E T,~.IF:Ii'..! ;:ii;
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 I., Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
LEGAL DESCRIPTION: .~_. l/,~. ~j,~_ I./~ .~E ll/~ N ~ I'llg '-~ECJ !l.~ '"'i" II .i~ ~ ~ ~ ~ ,['"),
SLOPE SITE PLAN
1
2
3
4
-5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTN?
Gross Net Depth [o Net
r, Reading Date Time Time Ware, Drop
· ,4~,~
~ ~;~ ............
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN BETWEEN FT AND Fl'
PERFORMED BY:
CERTIFIED BY:
DATE: ,;~?~.~,~
72-008 (6/79)
:ii:;75 'i iii:i F!::?EET Fli":K)!'!(3~ff:I(!i~i!i.. F:d-~ ?ii~ J
::::' :!!;,::t ,::. ;::~.?. i:!
~-(Ei ]i TIi F' {'"1 ] t.:
t','!]i]i'.,i;[HI...II','! D;I]S;-iFtt',!(;:i;i; E:!ii]'!"I,.tE!EH R I,.iE! L. FIHD I:::tl'..k.? (])i'..!..-St"FE-'; '::;EI,.!FIG!E
:;!.li!lG i::[i:]iiii' F:()!;it ~::i F'!;;ti[',,,~I:::!I[~J t.,.!ELi.. Oil: ;:L~[~il~j "i'O ;~:l;~tp3 FLEET I:::ROH I::t
tJl::'Cff-,! FF!E 't'.,"F:'~E Cd:::' F:'tJI~',I...tC: t,ilELt
i'I;I]H;[HtlM D];SI'*'::IHC:E I::F:CII"I FI F:'[~:;[',,,'I::tI'[]; t,IEL.!._. 1'O I::1 PI:~'.;[',,,'I::ITE :E;EI,~EI:;i: I._.]]HE ]IZS ;2F.~i F'IEEF !:::tt"4[)
t'O !::i COIdt"iUI'-,!;!;Th': SEt,.tf}]:;;: t...]Z!".!~; ;IS ZS.i FEET.
i,.tF:;Li. LOGS; F:tI';~:E] !:;?.I~](~:~IJ];I~:Ei) 1::!!'..113, 1,1t.15;'1 l~iE i:;'.t~;"!'I..II:;;~HG;!]) TO TI.tE t]:,E?t::!t:;~'r'HI}]t'.,tT !,l;tZ r'bl;[t'.,t ~i:~! Dl'::l'.r'~;
(3i::: THE !.,tE;LI.. C:Cff,tPL[?r ;~ON.
O'T!-Ii~:~I:;~: i:;~:EI;:~I..i;I;I:;~:Ei,iENT;i}; Hl:l'.? FiF'F:'t..',' SF:'i[~;C:;!;F';[CI::If';[ONS Rhi[;, C;C~t'..t'.~;I'i?.LIC:T~CIN
P.I ZlZ 'I'H 'THIS'
~VI-W DRILLING, Inc.
P.O. Box 10-378 * 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
KEITH ivDBLEY AM~2xlDED LOG Use of WeI1D°mestic
Well Owner.
Location (address of: Township, Range, Section, if known; or distance main road SF~. NFJx SF~. NF~. Section 14 TllN R3W S,M,
Size of easing _Depth of Hole 450 feet Cased to 218 feet
Static water level 270 ft. ~:t~) (below) land surface. Finish of well (check one)
Screen ( ); Perforated ( ).
Describe screen or perforation ]>]one
Well pumping test at_ "~ gallons per ~
of drawdown from static level.
(minute) for 1. _hours with
open end ( xxx );
Date of completion
July 5, 1983
WELL LOG
100% x~.
Depth in feet from
ground surface
MUNICIPALITY OF AbICHOP, AO~
DEPT. OF HEALTH
~:_NvlRONMENiAL pROTECI]O~
Give details of formations penetrated, size of material, cc~(~'~t ~J~J~'ess
_ 0 .TO 2
2 TO_. 4
4 .TO 16
16 TO 42
42_TO_ 47
47 TO ]
108 .TO 118
118 TO 218
218 TO
TO
TO
_TO
_TO
.... TO
TO_
_ Organ] c
%.1.1
Silty_ clay
_ Silty gravel
S~ndy ~avel
f~av'ol ly hnra p~m ;_occaaion~l r'ntlz,b..'Les
Sand
MUNICIPALfTy Of: ANGHORAO[~
OEPT. OF HEALTH &
.......... ,~,~ P~OTECIiON~
Gravelly hm:doan, occasional cobbles
Bedrock
NWwA Certified
C~4~lca~fe NO'S. 814 & 9731 CUSTOMER
MUNICIPALITY OF ANCHORAGTJ
DIVISION OF ENVIRON~DSNT. AL HEALTH
DEPARTMENT OF I '~LALTH AND ENVIRONbCENTAL PROTECTION
APPLICATION FOR HEALTH AUTtiORiTY APPROVAL CERTIFICA%%]
1o General Information
AppIication Date
(a) Legal Description (includ~ Lot~ block, subdivision~ section~ township~ ra~ge)
, I ~ / ~ dec. -L~ i]..h,~ hi,, o.:~
(~)
Location (address er directions)
Applicants Name i(eJ.~i icL-i,.~;/ Telephone ~
Applicants Address .... ~ -
(c) Applica~nt~..is (cheek one) Lending Institution
Address
(e) Ileal· Estate Co, & Agent N/ii
Address
Telephoae ......................................................................
(f) Mail the HA~% to the follswiug ~ldress:
2o T pa of Residence
Singie~Family l.~; Mnlti-.Fami].y [~SZ~
Number o~ Bedrooms i tC, rie)
3 ~ Water ~ ~ ~
Other (describe)
Note: If communi%y well. system~ must bare written cortfirmation from the State
Department of Environmental Conser.~ation attesting to the legality and statu~:i~
4~ S ewag a ~J~J~
Note: If community weli system, must have ~itten cot~irmation from the State
Department of Enviromnental Conservation attesting to the legality a~l status~
[Page 1 of 2]
5o Engineering ~.t~ra Providing Ins~]ecl'Jons. Tests__F~Ile Search~ Uata and Infozvaation
As certified by my seal affixed hereto and as of the validation date shown below~
verify that my investigation of this Health Authority Approval shows that the
wa~er supply and/or ~.)z~s~ewa~;er disposal system is safe~ functional and ~lequate fo~~
the number of bedrooms and type of structure indicated herein~, i further versify that~
based on the information obtain~ from the M~nicipality of Anchorage files and fr ,m ~y
investigation snd inspection~ t~= on~-site water supply and/or .... ='
system is in compliance with ~1 M~icipal a~td ~ .... codes~ o~'dinances: anJ ~;egu].a~
tions iu effect on the date of ghts inspection.
~ame of
6. p~E~ Appffo~Z~[~ /'X - /'-'~'---', ,~t '>; ',' . /
' ~-'% - t ...... "~'..' : -' " ~ !'~ f~ ~-
A ~oved ' Disapproved Cott~iEiotlal
T~IE ~YNICIPALITY OF ANCHOtlAGE DEPARTME~ OF HEALTH AND E~¥VIRONMENTAL PROTECTION
(DHEP) ISSUES tDI~i_LTH AUTHORITY APPROV&L CERTIFICATES BASFJO ~I~i~L~Y. U!:ON TIB>i ?£PRZSEblT'
ATIONS GIVEN IN PAD~8.GRAPH 5 ABOVE BY AN INDEPF, NDEh?~ PROFESSIONAL ENGINEER REGiSTER~'~D
IN %UJE STATE OF ~LASI[to TILE DHEP DOES THIS AS A COUltTESY TO PU[[CthiSERS OF HOMES ~;s]D
THEIR LE~DING INSTITUTIONS IN OP~DER TO SATISFY CERTAIN I,~.DERAL AND STATE REQUIRE~'
MENTSo gMPLOYEES OF ])HEP DO NOT CONDUCT INSPECTION~ OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSi[EDo THE MONICIPALITY OF ANCHOiIAGE IS NOT RESPONSiBLPi FOR EI~RORS
OR OMISSIONS IN Tq~'~ PROFESSIONAl, ENGINEER'S WORK°
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7~].9-84
ao
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUS~ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification Individual
Well Log P~esent (Y/N) Y
Total Depth 450 ft (Well lc~sed to
Static Water Level 275 ft.
Casing Height Above Ground 2.5 ft.
Electrical Wiring in Conduit (Y/N) Y
Seps~ation Distances from Well:
To Septic/Holding Tank on Lot 145 ft.
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line lo0+ ft.
If A, B, c~ C, D.E.C. Approved(Y/N)
Date Completed 7-5--83 Yield0.5 gpm (Well
-- log~
218 ft . Depth of Grouting N/M __
Pump Set At 420 ft
Sanitary Seal on Casing (_Y/N) Y__
Depression A~ound Wellhead (Y/N) N
; On Adjoining Lots 100+ ft.
146 ft... ; On Adjoining Lots 100+ f't.
To Nearest Public Sewer 100+ ft.
Cleanout/Manhole lO0+ ft. To Nearest Sewer Service Line on Lot
Water Sample Collected ByMark I{olum, P.E. ; Date 2/22/89
Water Sample Test Results Satisfactory
Cc~1~nts Well yield reconfirmed at lpO+ gal/day on 2/2!/89
85 ft~
B. SEPTIC/HOLDING TANK DATA
Date Installed 8/10/82 Size 1000 gal (Ins].. P~) of Cu~a~tments 2
Standpipes (Y/N) Y Aid-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) N Date Last Pumped S~e commen'ts.
Pumping/Maintenance Contract on File (Y/N) N/A ; for
Holding Tank High-Water Alarm (Y/N) N/A~ Temporary Holding Tank Permit (Y/N)N/A
Separation Distances f~c~ Septic/Holding Tank:
To Water-Supply Well 145 ft.
To P~operty Line lO+ ft.
To Water Main/Service Line 85 ft.
COtL~Se 100+ ft.
To Building Foundation 55 ft.
To Disposal Field 5 ft.
To Stream, Pond, Lake, c~ Major D~,ainage
Conm~nts Funds to be placed in escrow for tank pumping. Winter roa~ conditions
prevent pumping at the present time.
Receipt $ ~?~ '-~ cD / ,
Date Paid: _ 91~t~!~
Amount: A~~-~
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils RatinG in Absorption Strata85 ft2/bdrm(Inst. ~ of System Design Drainfield
Date ~Installed 2-10-85 Length of Field 63 ft.
Width of Field 60 Inches (Instl. Rpt.) Depth of Field 5.5 ft.
Gravel Bed Thickness 24 Inches
Square Feet of Absorption Amea .900 (I, nst. Rpt. ) Standpipes P~esent (Y/N) Y
~O W/ sidewalls
Depression over Field (Y/N) N Date of Last Adequacy Test 2-21-8~
Results of Last Adequacy Test Approx'. lO00 gal/day , Sa%isfactory
Separation Distance f=om Absorption Field:
To Water-Supply Well 146 ft. To P~operty Line 10+ ft.
To Building Foundation 48 ft. To Existing or Abandoned System cn
Lot N/Al ; On Adjoining Lots 100+ ft.
To Wate~ Main/Service Line ?5 ft. TO Cutbank(if present)
To Stream/Pond/Lake/o~ Major D~ainage Course 100+ ft.
To D~iveway, Parking Area, or Vehicle Stc~age Area 18 ft.
Corarents
LIFT STATION..
Date Installed N/AL
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
TeJted fo~
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA
on the date of this inspection.
Signed Date 2-25-85
Cor~pany Alaska Soil Testing and gngineeM~No' ST85-260
KB1/d5/s
,~s in effect
[Page 2 of 2]
2-15-84
HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 ANCHORAGE iNDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
~,4~'~/~ S-o/~ ?~S?
-~"-~- ~ (') See h on back
WATER SYSTEM:
I.D. NO.
Water System Name Phone No,
City
MO. Day
State Zip Cc~e
Year
SAMPLE TYPE:
'~- Routine
~E3 Check Sample (for routine sample
with lab ret. no, )
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
1
2
3
4
5
LOCATION
J
I
I
Time Collected
Collected By
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 Reoe,va
T,me Race,veal /
Analytical Method:
[] Fermentation Tube
[~ Membrane Filter
Lab Ret. No. Result' Analyst
I FT-]
I
I FTq
06,1220 (b)
Rev, 1983
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter. Direct Count
Verification: LTB
Final Membrane Filter Results _,_ ~__.~
Reported By/ ~/~'/~'>/! - --
Collform/100ml
BGB
Coilformll00ml
TNTC= Too Numerous To Count
APPLIC' 'IT FILLS OUT UPPER HAL 5NLY
Property Owner /,]//~/ ?/./ /'/~',.;,5/- '. 7' Phone
Buyer
Address
Zip Code
Lending Institution
Realty Co. & Agent
Address
Zip Code
Phone
Phone
Legal Description
Street Location
Type o Residence
~ngle Family
(~ Multiple Family
EJ Other
No. of Bedrooms
Water pply
I~ Community
E~ 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).
Sewer isposal
[] Public Utility
L3 Holding Tank
Year Individual Installed: ./¢
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time
Date
Time Time
Date Date
Inspector
Field Notes:
) APPROVED BEDROOMS
) DISAPPROVED
) CONDITIONAL APPROVAL*
DATE
BY:
Inspector
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
ALASI SOIL TESTING AND ENGINEERING
6100 A Street, Anchorage, Alaska 99502
(907) 561-7453
Location:
TyDe:
Address:
Client:
Adequacy Test
SE 1/4 NE 1/4 SE 1/4 NE 1/4 Sec. 14, TllN, R3W S.M.
Septic Tank and Drianfield, (See Installation Rpt., Attached)
Upper Potter Valley
Keith Mobley, Box 111882, Anchorage, AK 99511
Date Time
Quantity of
Water Added to
Drainfield
(Gallons)
Depth Below
Grade of Water
Level in
Drainfield
(Inches)
Depth Below
Grade of Water
Level in
Septic Ta~k
(Inches)
2-21-85 12:53 pm 0 63 66
12:57 4 60.25 "
l:15 95 56.5 "
1:22 120 55.5 "
1:43 243 52.75 "
1:50 255 53. "
2:18 " 54.5 "
3:11 " 57.
4:16 " 58.9
4:49 " 60.
2-22-85 9:31 am " 63. "
Comment:
Conclusion:
The house is currently under construction and is
occupied intermittently. Ground surface above the septic
tank is approximately 1.5 feet above the ground surface
in %he drainfield area.
The absorption rate rate of the drainfield exceeds the minimum
rate of 150 gal/day for the one bedroom single
family dwelling. The absorption rate is
approximately 1000 gal/day at a water level
of 60 inches below grade.
Performed by: Mark Holum, P.E.
ST85-260