HomeMy WebLinkAboutUS SURVEY 3201 LT 6 T10N R1W SEC 9/10
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
Ike Kelly 653-7311 [~ UPGRADE
MAltING ADDRESS
SR Box 8503 Bird Creek, Alaska 99540
LEGAL DESCRIPTION
Lot 6 US Survey ~3201 Sec 9/10 T10N R1W S.M.
LOCATION NO, OF BEDROOMS
~ mile north of Bird Creek Tesoro Station 3
IWel] I AbsorpBon area Dwelling PERMIT NO.
DISTANCE TO: 105 ' 115 ' 51 ' 850284
I-- 2 Manufacturer Material No. of compartments
~< Anchorage Tank Steel 2
~) F- hiq. capacity in gallons Inside length Width Liquid depth
I 1000 q'al IF HOMEMADE: NA
,4, ~ DISTANCE TO: Well Dwelling PERMIT NO.
u~z NA
O Z <~ Manufacturer Material Liquid capacity in gallons
13 Well Foundation Nearest lot line PERMIT NO,
~I DISTANCE TO: 116' 64~ 100'+ 850284
~ ND. of lines 1 Length°feachline73' T°tallength°flines 73' Trenchwidt~0 Distance between lines
¢¢ Top of tile to finish grade Material beneath tile Total effective absorption area
~ 4'-6' (fill added) drain rock (q'} 48" inches ~ 584sqft
Length I Width Depth PERMIT NO.
~ F- Type of crib Crib diameter Crib depth Total effective absorption area
~u Well Building foundation Nearest lot line
~ DISTANCE TO:
-I~ Class Individ~--__~D~pth Driller Distance to lot line PERMIT NO.
Lu Building foundation Sewer llne Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS Cast Iron from house to
tank. D3034 to field&standpipes.
SOILTESTRAT~NGD2729 in drainfield. ' /~-~
194sqft/BR
/
HR Redmond Girdwood, Alaska
silt barrier. Tank insulated wit
APPROVED DATE LEGAL ~'~/,~ ~ i ~'
72-013 (Rev. 3/78)
,?%
..... ; , 'it,,.....~.'~'"'" % , , ¢i]iI F:::u "" ...... ' ....
i ]l'q T Off'Y] ', "1 ~.Oi'ql .Z;4 4.
~ AN~CHORAGE, AK99502 (907) 344-80421
3
SOIL LOG
PERCOLATION TEST
[] SOIL LOG
PERCOLATION
TEST
~_BEDROOMS
JOB NUMBER:
7'
SLOP~ SITE PLAN
5
6
10-
11-
8
J
was ~ROUND W^TE.
ENCOUNTERED?
12-
14-
DEPTH
(FEE~
W E
IF YES, AT WHAT
DEPTH?
Gross Net Depth I~ Net
Reading Dale Time Time Waist Drop
· ~ ~1,./~ ~:~? o ~,,, o"
PERCOLATION RATE ..... _~J"~ _ (mlnute$11nch)
TEST RUN BETWEEN ~'/ FT AND ~/, O !
........... 3 .... .:'~ ...........
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
PERCOLATION
TEST
~2
3
4
~ 5
7
8
9
10
11
12
13
SLOPE
n : ·
DATE PERFORMED: / v ~- ~" ' ·
/ i t
,..' .a k,
SITE PLAN /
,L/he/
14
15
16
17
18
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ 5'J~ I0 O,~S' d~.,d~ 7
PERCOLATION RATE ~ .~7 ~ ~*'~.i '~ ' ~ * ' · ,(m~u.te,s/inch)
TEST RUN BE~EEN ..... ,~T~ND' ~ ,k?~
, ~ /~ /~ >x', ',..
or''
72-008 (6/79)
CERTIFIED BY:
Drilling Co. ~ ~a~~
L~cation (address of;
Size of Casing ~ t/
Static water level
one) Open end
%~ATER WELL DFgLLERS LOG
DO NoT FILL IN
USGS No,
Area .
Use of Well
Township, Range, & Section, if known; or distance from main road:
.Depth of Hole ~/ feet. Cased to ~/ feet.
feet (above)(be~lo~) land surface. Finish of well (check
Screen ( ); Perforated ( ).
Describe screen or perforations
Well pumping test at /O gallons per (hour) (~inute). for
feet of drawdown from static level.
hours with
Remarks
WELL LOG
Depth in feet from Give details of formations penetrated, size of material, color, and
ground surface hardness.
to
to
to
to
to
ENVIRONMENTAL pROTEC~ JOJ~
to
R[C iVED
to
to
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application Date June 20~ 1985
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
L 6 U.S. Survey 3201
Location (address or directions)
Mile 101 Seward H~/~ ¼ mile behind Tesoro Station
Applicant Name Ike Kelly Telephone: Home 653-7311
Applicant Address S,E, Box 8503 Bird Creek AE 99540
Business 653-7311
(b)
(c) Applicant is (check one): Lending institution []; Owner/builder []; Buyer []; Other][]] (explain);
twenty (20) years old and I am applyin~ for a Home Improvement Loan.
(d) Lending ~nstitution AMB-Minnesota/Benson Branch Telephone 338-7890
Address Pouch 4-9003 Anchorage, Alaska 99509
(e) Real Estate Company and Agent N/A
Address
Telephone
(f) Mailthe HAAtothefollowing address:
S. R. Box 8503
Bird Creek Alaska 99540
TYPE OF RESIDENCE
Single-C:amilyl~ Mql. ti-Family [] Other
Number of Bedroo~ns, Three(3)
WATER SU~PPLY '
Individual Well [~ Community [] Public []
Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
4. SEWAGE DisPOSAL
Onsite ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72025(11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approva~ shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Telephone
Address
Date
Engineer's Seal
This office has received written confirmation from the engineer ( Geolab ) that
the conditions for July 30, 1985 have been met. Therefore, this property meets MOA
requirements.
DHEP APPROVAL/
Approved for /~£~'"c".~b~droomsby('")-~' ,.~ .~Z~Date\/
Approved ×/'~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
: . MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONIVIENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application Date (¢/~'/ ~ ~--
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name~-~( e- ~-~- \~' \/ Telephone:Home
Applicant Address _%,
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer E]; Other [~ (explain);
!
(d) Lending Institution /~ ~. ~:~
Address ~:) ¢, ~,_ ¢~t~. ~. - ~ 0 0.'~ ~. ~ ~. \~,. ~ ~'.
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address: ,
TYPE OF RESIDENCE
Single-Family,,,~ Multi-Family []
Number of Bedrooms '~)
Other
WATER SUPPLY
Individual WellJ~ Community I-I Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attestin9 to the legality and status,
4. SEWAGE DISPOSAL
Onsite ¢~ Public [] Community [] Holding Tank [] ~ ~/~7-~
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status,
Page I of 2 72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona~ and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
NameofFirm /t}'7/c~oJ-~-,~-~,-~ '~ J~ Telephone ~'~1/
Address __ ~ 1,2~ ~
Date
Approve~ ~or ~.~L,&~,.z~ bedrooms by Date ~--/4) - [~¢
~pro~d' '- ~~ Conditional ~
Terms of ~onditio~l Approval~ ~-~ ~ ~ .~~ ~ ~' ~
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a cou~esy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a cedificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
PaRe 2 of 2
GEOLAB
11:~1 EAST 76TH AVENUE
SUITE t ! 01
ANCHORAGE. ALASKA 99502
Junelq, 1985
907- 344-8042
Municipality of Anchorage
Department of Health and Environmental Protection
825 "L" ,Street
Anchorage, Alaska 99501
Reference: US Survey Lot 6, Indian, Alaska $~c. 9/10 11 ON R 1W
Owner: Ike Kelly
Oentlemen:
'[hie letter is to inform you that the requirements for the conditional Health Authority Approval
for the subject property have been met.
The following work has been done sin~ the conditional approval was submitted on April 10,
1985.
1. The well casing has been extended to 2' above ground level, a sanitary seal has been
placed on the top of the casing, and the wiring has been placed inside conduit. The surface has
been graded to slope away from the casing.
2. A percolation test was performed east of the septic tank which has been used as a
temporary holding tank. The percolation test passed and a permit was issued on June 11 to
install a new septic system.
3. The system was installed and inspected on June 12. The inspection report is attached.
All final grading has been completed satisfactorily, and the well and septic system meet
Municipality of Anchorage requirements.
,Should you have any questions regarding this matter, please do not hesitate to contact us at
344-8042.
Oeoloyical Consultiny p Testfny Laboratory p /~ualltll Control · Septic System Pesiyn & Inspection
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
ae
Be
WELL DATA
Well Classification
Well Log P~esent (Y/N)
Total Depth 9/ / Cased to
Legal Description:
If A, B, C~ C, D.E.C. Approved(Y/N) /~/~
Date Completed 9- ~ Yield
9/ / ~pth of ~outing ~'
Static Water Level ~ ' Pump Set At
Casing Height Abo%~ Ground /_~_~m~3_ ,~A~W~ Sanitary Seal on Casing (Y/N)~_~
Electrical Wiring in Conduit (Y/N) W/~ Depression Around Wellhead (Y/N)
Separation Distances f~cm Well:
To Septic/Holding Tank on Lot /~-/ ; On ~joining Lots /6~'
To 'Nearest Edge of Absorption Field on Lot /V./~ ; On Adjoining Lots /~'~"
To Nearest Public Sewe~ Line /~/~ To Nearest Public Sewer
Cleanout/Manhole /V/A~ To Nearest Sewer Service Line on Lot ~2~' !
Wate_~ Sample Collected By
Water Sample Test Results
Date Installed ~-.~'-F~'- Size /~9~J~ ,~/;~ No. of Compartments
Standpipes (Y/N) y'~_~ Air-tight Caps (Y/N) V~_~; Foundation Cleanout (Y/N) y~.
Depression over Tank (Y/N) N/~ Date Last Pumped
P~mping/Maintenance Contueaot on File (Y/N) A/ ; for
Holding Tank High-Water Alarm (Y/N) A/ Temporary Holding Tank Permit (Y/N)~R?t,
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /6~'
To P~operty Li.~e /~' '~
To Wete~ Main/SerPice Line
Course ////~
To Building Foundation
To Disposal Field
To' Strea~, Pond~ L~e, or Major D~ainage
De
ABSORPTION FIELD DATA
Soils Rating in ~so~ption S~ata ~t~, ft¢~/F~P T~ of System ~sign
Date Installed
Width of Field
Square Feet of AbsorptionA~ea
Depression ove~ Field (Y/N)
Results of Last Adequacy Test
Length of Field
Depth of Field ._ &//~
Gravel Bed Thickness
Standpipes P~esent (Y/N)
Date of Last Adequacy Test
Separation Distance f~om Absorption Field:
To Water-Supply Well ~./ior To P~operty Line
To Building Foundation /~//g ~ To Existing or Abandoned System on
Lot ~/,/~ ; On Adjoining Lots ~
To Wate~ Main/Service Line ~//~ To Cutbank(if p~esent)
To St~eam/Pond/Lake/c~ Majo~ D~ainage Course
To D~iveway, Pa~king A~ea, c~ Vehicle Storage A~ea
Meets MOA
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Ala~mLevel at
Tested fo~
Elect=ical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Con~ents
** Check Pe=mitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or confo=rced to all MOA
on the da~?~/~.A~.
Signed "'/~f'~'-.~ ~,..,~P:,3~ Date
Company ./~ ~/~_ MOa No.
KB1/d5/s
[Page 2 of 2]
2-15-84