HomeMy WebLinkAboutGREENLAND BLK 2 LT 1Lo+l
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF IlEAl. TH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street .. Anchorage, Alaska 99501 Telepho,e264-4720
ON-,SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
bN E ~] ~L~J NEW
ILOCATION .¢~% ,/-~ ~
I ~Well I Absorpiion area
DISTANCE TO:
Manufacturer
~y in gallons I~HOMEMADE:
CS TO: Well Dwelling
...... Well ~ --
Ne. of lines / ILengfl~ of each line / Totalle~th of Pines
Top of tile to finish grade~ t Material beneath ti~e
J ~ngth Width Oepth -
Type of~i~ ~ ~ Crib depth -
ic, Depth
I ~.~C~TO: B uildh,~ fou,,~atio,~
Dwelling
Lerial
ial
"~'~'o t line
I ,9 o/
jTrench wid~ //
k,.2 U inches
NO. OF B~OOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
P E R M I T~.cO.y
_
[Pis,ance b~:,~li,,es
J Total effecti~'e ar:)~)rption area
L_ c Oo
OTHER
INSTALLER -'h ~,
REMARKS
tTotal effective absorption area
'j ~7.~%7t lot ,ne
IPERMIT NO.
Absorption area(s)
Distance to lot line
Septic tank
DA-rE LEGAL
£:,Ef:'FiI:;i:Tr,IENT r",~' FIE:FILTH FtI'.,tD EN',,,']: I:~:CH'.4r,tEI'.,I"FFtl... ' 'x'.OTF: T ]: O1'.,! - (7~ ' ;' '
HFINE:,FI E. ff,?¥RN SRR Et.J;:-:: :I.?;.:::E;E',
CtI...I[;?. RD ::L,.."4 r,'l]: E;O. OFZ'F or,IFILLE'.~'
L..OT ::t. DLI-::: 2 GF. tEENL. FII'-,ID :5,.."[::,
r~F[. Cfi::' SO]:L FIE:SOF;'.F'T]:L-~I'.,I S'T'STEI','I ZS: TREI'.,IC:H
I.J'" T ':"; I ZE
SOIL RFI'T"[N:3 ,:: L"-~; (:! F'T,."!31:~: ', =:
THE..: E:E:E:IUIF.:E:D './:2;]:ZE OF' THE SOIL FIE:SOF.:F"r'If_"&~ .i:';"~'::2;'FErl ]:'.:2;:
THE L..E:NGTH D l HE:NS I EiN ]: S THE LENGTH ,.'.' I I'-,1 FE:ET ::, OF THE TF..tEI'.,Ii::::H OR [:, I;'. F117 HF ]: E:LD.
"F'FIE DE:F'TH OF I::1 TF4'.ENL-:H F~E: F']:T IS THE DISTFINC:E E~ETHEEN THE SU[~:FFIC:E OF THE
(3Fi:I:)UNE:, FII'.,tE:, THE: DCITTOH OF THE E::-:;CFI',,,'FIT I ON ,:: II",l FEETT' ::,.
THERE: I:-2; t'.,1(:) SET H:I:E:,TH FOR
THE (:~i[~'.I:::I',,,'EEL DEF'TH ].'L::: THE H]:IqTHUr,1 DEF'TH 13F GF.:FI'v'EL DE:THE:Et'.,t "FHE CIUTFF:iL.L. F':[F'E
FIND TFIE E',OTTOH OF THE: Ei:-::CFIb'FIT I ON ,.'.' I N FEET ::,.
F'EF;ff,1 :[ -f ..... , '!
HFFL ....... I'i'.,11 HFIS THE I:;4:EE;F'F:IN':2;]:E]:I~.T.T¥ TO ZblFOF?H "I"HJfS DEF'FIF::THENT [::,LIFi~I!'.,IG THE:
]:N'::;TF:IL.I I::tT]:ZN ZI'.,I=,FE .'] ]:_I'U_., L-iF F:IN¥ .H[CL.L'.B F:IF:,.'rFIC:EI'.,IT TO TH]:::; F'P. OF'EI:;:T"r' Fff',t[::' THE
NI..HE:EI:~: O1:: I:iIEE;]:DE'H'"EiE 'H'"IFrT THE HELL H]:L.L SEP.'v'E.
..................... 'T B...~I 'C::~ ":. ;;;Z: .':" J: ~"~ EET,, F" E::" "2.:: 'T' Z: ~-". ...... D-ti "=; ~:::~ IF~:~ E: 1"~ Ex, ........ ,'7, n ~ :X: IF":..~" EZ .... i[E' .....................
E',F:ICb::F:[LI...]:NLT'i f]F f::tl",l'T' ~" "-'""F:'' . ' - ,'" E["r'
:,'r.':,~. H.T. THOUT FZNI::IL ]:NE;PECT:[CI',t FINE:' I"ff'FF. ,-IL. TH]:S
I)EF::'FIFE:THENT H ]: I....L. BE SIJE:J'EC:T TO F'P F ':2 E 'J _ T ]:
t"l]: N ]: r'll..Ir,1 E:,]: STFINC:E DETHEEN FI HEL. L FIND FIN'.r' ON-.-S ]: TE SE:HFIGE I":,Z SF:'OSFIL. S¥S'I"EH Z'.:2;
:1. OO i:::EE.'.'-t' F(3F~: FI F'F:.T.',,,'FITE HELL OF..: :tSO TO ;.:.'~OO FEE'[' FROH I::I F'LIE:L ]: C: HELL. DEPENE:,:I:NG
LIPON THE: T"r'F'E: OF F'LIE~L]:C HELL.
H]:NZr,tlJr,1 D:I:STI::iI'.,ICE FF:'.OI',I F1 F'F::]:VFi'f'E HELL TO FI F'F.:]:'v'FiTE SEI.,.IEFi: L..:[I'.,tE :['.2:; ;25 FEET FINE:,
TCi Fi COI',]HUi'.,I:I:T't' L:;EHER LINE ]:::2; '.,:"'~S F'EET.
Cq'HE:F: REL.':!UIREr,IEi'.,ITS h'IFi'T' FIF'F'I...."r'. SPEC:IFII]:FITIONL:; FIND C:ONE;"['RI..IC:T:[ON DIFIE'iI~.:Fff'IS
FI'v'FI ]: LFIE',LE TO ]: NSUF:'.E F'F:OF'ER Z NSTFILLFIT ]: ON.
]: CE:F~:r' I FY 't'HFIT
::L: ]: FII',I FI..':.ff'IILIFII';~: HITH THE RE~L.:!LI]:f~:Er,IENTS F'OFi ON--~SITE SEHEF::S F:II'.,I[) HELL. S FI'.:2; :SE:T
FORTH E~'-r' THE: HUN I C: I F'FII.~ ]: T't' OF' FII'.,IC:HOF..tFIGE.
;'.?: I HILL II'.,IE;TFIL. L THE S"r'STEr'I IN FICCOF.'.DFIiqCE HI]"H THE: C:OE:,E':5.
:i:: I UNE:,E:F:.'E;TFIN[:, THFIT THE: OIq--S]:TE SEHE[? 'Z,'t'STE':I"I HFt"r' I:,::E~]:!IJ:[[~'.E EI",ILFIF?.C'iEHEi'.,FI" ]:F' "I"HE
I:~:ESI[:,ENCE: IE; REHODE:LE[:, TO INCLUDE HOF.'E THFIN 2.:: E:E[:,F.".OOHS.
FIF F'L ]: C:F:INT HFII'.,IE:,FI [iilFE:'T'i::II",~
Performed For
Legal ~escrintion:
This Form Reoorts Soils Loq
nenth
Feet Soil Characteristics
Lot__l. Block '2-- Subdivision__~/:~L~.9]?~tq~c{~ ^. ~, ,.
Percolation Test
L:oe~.e~ZoN []7~ _flab'
"One test is worth a thousand opinions"
~5[~ ~5' Date Performed
Was Ground
Ie Yes, At
Water Encountered?_~
what Depth?
Read i ng
Date
Gross Time
Net Time Depth to H20
Net Drop
Percolation Rate Hinute
Proposed Installation: SeeDaae Pit Drain Field
De!)th of inl,et __./~,_~_._~~_~./.~_.~_~¢/j__~_/. Den~'~--]=o--~-~-i?'onl, Of Pit. Or.Trench
cnHf'~ENTS: - -~:' - - :'-'F .... - - _ ~~
__~..~_~_.~_.~:'.-. ..................... ........ ,
oGRE'"'ER ANCHORAGE AREA BO'
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
'UGH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
FROM WEL~--~¢7 -MANUFACTURER
' COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH ,LIQUID CAPACITY_//L/')(~ (-/ GALLONS.
SEEPAGE PIT:
J4/'t; '
/
NUMBER OF PITS ~ DIAMEtTER OR WIDTH__
LINING MATERIAL.([~ ~V~ ~P~/]'(~'._/~/~.EIB SIZE: DIAMETER
, ¢4pCgCx,
BUILDING FOUNDATION~-2)(~ NEAREST LOT LINE ~-(~ _j_
ADDITIONAL ABSORPTION
LENGTH DEPTH
DEPTH '7 ~- !
· DISTANCE FROM:
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
WELL:
TYPE
BUILDING
FOUNDATION
C ESSPO0 L
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
. DISAPPROVED
NEAREST
SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
REMARKS
Form NO, EQ-031
DIAGRAM OF SYSTEM
N
DATE// .-, _
// G,A.A,B.
GREATER ANCHORAGE AREA BOROUGH/ P~RM~TNO,
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM .... APPLICATION AND P~:RMIT
TO BE INSTALLED BY
NOTE~ THIS PE:I~MIT IS NOT VALID WITHOUT SOIL TEST
FINAl. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITI'IOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONIVIE:NTAL QUALITY AUTHORITY Will BE SUBJECT TO PROSECUTION.
TYPE
MINIMUM ~ISTAN~$, R~CtUIREME.'NTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT /~._~r./ DRAIN FIELD
SEPTIC TAN~ TO SEEPAG~ ~lT WALL
SEPTIC TANK ,SEEPAGE PIT
LINE.
WELt. TO SEPTIC TANK
DRAIN PIELD
., DRAIN FIELD
SEEPAGE PIT t
ALSO CONSIDER AREA WELLS,
WATER MAIN TO SEPTIC TANK ., SEEPAGE PIT
DRAIN FIELD __
TD RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 PEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC 'rANK AND SEEPAGE PIT
PITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BAE:KFILL
CONFORM TO ~3OROUGN REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF~R ANCHORAGE AREA ~OROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE
Well Owner
M-W DRILLING, Inc.
P. O, Box 4-1728 · 2811 Dawson
A C 907-279-1741
ANCHORAGE, ALASKA 99509
Location (address of: Township,~ Range, Section, if knoWn; or distance main road
Our Road~ Anch '"' -. -:.:"
DRILLING LOG
.Use of Well Dom
Size of casing f Depth of Hole
Static water level PI: ft. (a..bp.v_.e)
Screen ( ); Perforated (
Describe screen or perforation
WeE pmrnping test at ~ gallons per (.h.~_u.r)
of drawdown from static level.
Date of completion
feet Cased to lp.~
(below) land surface. Finish of well (check one) open end ( X
). ,
hqmm with ~ ~'~'
(minute) for'
WELL LOG
,' ~eet ..
);.
Depth in feet from · . _ :: ,
ground surface Give details of formations penetrated, siz~ of m~terial, color and hardness -
O S~r~ace Or~nie" ]' ' "
7
TO 1
__.TO 7
TO
.TO.
TO.
.TO
.TO
__ _TO
_TO
.TO
.TO
TO
TO
S~ndy 01ay
Sandy Clay~
undifferentiated, oocstsional cobbles & ~11
gravel se~ms~ fe~ boulders-mall
}~edium Oravell elt~htly ~endy~ ~cod w~terbearim~
DEPT. OF HEALTH & ..
~JVIRONMEN~AL 'PROTE~ION :
"~'~ayne~ E. Westber~y
3--, Contractor
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL, , ,~,~P'~(~'~- ~c~,l~~
OF ON-SITE SEWER AND WATER FAGILITY
264-4720
Application Date .,-cop'. /.¢,/~
GENERAL INFOR~/IATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lo~n 1 : Rlc~lc 2 C.~o~nl~nrl~.~/D .~. 22: rp 12 ~: R 3 W
LocatJon (address or directions)
13000 Our Rd.
(b) Applicant Name Tom Coqhill Telephone: Home 346-2434 Business 561-8191
Applicant Address 13000 Our Rd., Anchoraqe, AK 99516
(-) Applicant is (check one): Lending Institution []: Owner/builder []; Buyer []; Other [] (explain); ~
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
/.¢/.'/" -
TYPE OF RESI~..E'f~CE
Single-Fami't~;/?¢ Multi-F,m?~'~ Other
WA'rER SUPPLY
Individual Well
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 1 of 2 72-025 (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 Approval 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 Quadra ~ng;Lneering, Inc. Telephone 276-3770
Address .ir w ed Lan ~ Anchorage, AK 99503
Date August 19 ~_~1986
Engineer's ,¢ .~al
DHEP APPROVAL
Approved for bedrooms W
Approved ¢"'~-~ Disapproved Conditional
Terms of Conditional Approval
Date
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 (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: T,nf 1
WELL DATA
Well Classification Individual
Well Log Present (Y/N). Y _
Total Depth 124' Casedto 124'
Static Water L.evel ?1 ' - 0"
Casing Height Above Ground 2' - 0"
Electrical Wiring in Conduit (Y/N) Y
Separation Distances from Well:
To Septic/Holding Tank on Lot 102'+
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line N/A
Cleanout/Manhole
Water Sample Collected by A. Harala
Water Sample Test Results Attached
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Depth of Grouting None
Pump Set At .~L.~5 ' +
Sanitary Seal on Casing (Y/N) ¥
Depression Around Wellhead (Y/N)
; On Adjoining Lots 300'+
115' + ; On Adjoining Lots ~300'4-
To Nearest Public Sewer
To Nearest Sewer Service/.ine on Lot
;Date 8/3_4/86
8+ qallons /min,
N
Comments
B, SEPTIC/HOLDING TANK DATA
6/73
Size 1000 qat.
Date Installed
Standpipes (Y/N) ¥
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well 102 ' +
To Property Line 30'
To Water Main/Service/.ine N/A
Course 300'+
Air-tight Caps (Y/N)
No. of Compartments 1
Y Foundation Cleanout (Y/N) Y ~,F~
Date Last Pumped '~,,~
; for
_ Temporary Holdin9 Tank Permit (Y/N) N/A
To Building Foundation 15~
To Disposal Field ? '
___ To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 5/81
Width of Field 36"
188
S.F./B.R. Type of System Design Deep trench
Length of Field: 51
Depth of Field ?2"
Gravel Bed Thickness
Standpipes Present (Y/N) _~
Date of Last Adequacy Test 8/14-15, 1986
Square Feet of Absorption Area 636 S.F.
Depression over Field (Y/N) N
Results of Last Adequacy Test Satisfactory
Separation Distance from Absorption Field:
To Water-Supply Well 115 '
To Building Foundation 20'
Lot N/A
To Water Main/Service Line N/A
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
_ 5/81.
To Property Line 10'
To Existing or Abandoned System on
; On Adjoining Lots N/A
To Cutbank (if present) N/A
N/A
25'+
Seepage pit installed 6/73, deep trench absorption field upqrade added
System is currently adequate.
D. LIFT STATION
Date Installed N/A
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
'rested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that._,,;/ ,,; ~--/n ,I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'/'/4,C/L,Ct.(,.J~c~~'Date Nov. 19, 1986
MOA No.
Company Quadra Engineering
Receipt No. _/~_.,~O ~'~JO ~/
Amount: $
Page 2 of 2
72-026 (11;84)
401 EAST FIREWEED LANE
ANCHORAGE, ALASKA 99503-2197
(907) 276-3770
DATAFAX NO. (907) 279-5092
ANCHORAGE ~' JUNEAU ~ BETHEL o FAIRBANKS
August 21, 1986
Tom Coghill
13000 Our Road
Anchorage, Alaska
99516
Subject: Lot 1, Block 2 Greenland Subd.
Job No. 6-42.11
Dear Tom,
Attached is the completed paperwork necessary to acquire
Health Authority Approval on your well and septic system.
Total cost of our services is $250.00. Please submit this
amount at your convenience.
Sincerely yours,
Michael E. Anderson, P.E.
MEA/rr
DATE RECEIVED
INSPECTION APPOINTMENTS
INSPECTOR INSPECTOR INSPECTOR._
MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ~NVIRONMENTAL PLO'[ECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWJ~A~ ~l~l~J
DIRECTIONS: Complete all parts on page 1. Incomplete requesls will oat be processed. Please allow ten (10) days for processing.
1, PRO~TY OWNER , PHONE
MAILIN~ ADDRESS ' ' / ' - --
PROPERTY RESIDENT~diffffrent from above) PHONE
2, BUYER PHONE
MAILING ADDRESS
MAILING ADDRESS /
4, REALTOR/AGEN~ ~7' ~ONE'
5. LEGAL DESCRIPTION
STREET LOCATION ;
6, TYPE OF RESIDENCE
E~'SING LE FAMILY
[] MULTIPLE FAMILY
I
NUMBER OF~B~DROOMS
One ~ Four ~ Other
Two ~ Five
Three ~ Six
7, WATER SUPPLY
E~ INDIVIDUAL~
[] 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.)
8, SEWAGE D/ISPOSAL 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.
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
[] INDIVIDUAL DEPTH OF WELL
[] 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 'rank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[~./~PPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (latter m~u~)accompany certificate)
~-~-DISAPPROV ED
72-O10 (Rev. 6/79)
