HomeMy WebLinkAboutGLEN EAGLE BLK 3 LT 6
,,i~ ;:{'! '~k 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 IpFIONE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION [ ' NO. OF BEDROOMS
IPERMiT NO.
[~~-ufacturer ~ M,t,r~ No. of;~par[ .....
~ ~ L~q.~ in ~allons ............ Inside length Widlh ....... Liquid deptln
WoH Dwelling PERMIT NO.
DISTANCE
TO:
Z
~ ~ ~ Manufacturer -- 'Material Liuuid capacity in gallons
~ No. of ,ine~ of4ac~i~ Trem:h width
~ Topoftiletgnish .... graoL~g' Material bengh tl,e Total effect~,hsorp, i .......
Length Width Depth PERMIT NO.
~ Type of crib Crib diameter Crib depth Total ~ffective absorpl~on
]
w Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Clas~ Depth Driller Distance to lot line PERMIT
~ ~ Building foundation Sewer line Septic lank A[}sorpt~on area(s)
~ ISTANCE TO: -
OTHER
PIPE MATERIALS
SOl~ T[ST
I -
APPROVED DATE LEGAL
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GREATER ANCHORAGE: AREA BOROUGH
PERMIT NO.
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE:, ALASKA 99503
TELEPHONE 274-456!
SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT df~ '5:-/r~
INSTALLATION LOCATION
SEEPAGE PIT
DRAIN FIELD ' ' OTHER
TO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: Z4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
MINIMUM DISTANCES, REQUIREMENT5
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT ., DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ,SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK \~ DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
GRAVEL BACKFILL
SEEPAGE AREA SIZE
, DRAIN FIELD
SEEPAGE Pit ~OO
, ALSO CONSIDER AREA WELLS
SEEPAGE Pit
\~0 D.A,N P,ELO \C~O
TYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-6S AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE W)TH SAID CODE.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222'[
PERFORMED FOR: ~..:~' )
LEGAL DESCRIPTION: /~_'3 '7"'-- ~
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PERCO[ATION
TEST
SOILS LOG - PERCOLATION TEST
/'p .~ WAS GROUND WATER /L/o s
,-- :':J'~: .' .~ ~ E~COUNTEREO? . L
o
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Diop
~ ~ 'z L' ~,,~,~ ~ ~ ,~o
3.0 Z
PERCOLATION RATE ,~- (minutes/inch,)
TEST RUN BETWEEN ("~ FT ANO 7 .FT
h
72-008 (7/76)
DRILLING, INC.
DRILLING LOG
Well Owner Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing. Depth of Hole
Static water level ft. (above)
Screen ( ); Perforated (
feet Cased to feet
(below) land surface. Finish of well (check one) open end (
).
Describe screen or perforation ~: \
Well pumping test at__gallons per 0~Ot~r)
of drawdown from static level.
Date of completion .
(minute) for hours with
W~:LL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
TO -~
.TO
_TO
TO
_TO.
TO.
TO.
TO.
TO.
.TO.
TO_
__TO_
TO_
TO_
);
ft.
2 -- STATE
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
~'m,~ - L~(~_~-:},,~.) HAA# ~ I~~, ~°L f'~' ;m~,,(~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(home)~
~.x;;/- ~O~5~ u si n ess
(b) Property owner ---~'--¢-~'~-~'-'~/.-~/ Telephone:
MailingAddress
(c) Lending Institution Telephone
Mailing Address
(d)
(e)
Real Estate Company and Agent ( ,~'?-' ~
Address /¢//~,.¢z¢ (/('~¢~ _//~/~¢..~.~_~../~.4..¢~ _~c~ ~ ~ ~ ~
Telephone ' - / ~ ~ ~'- ~ /
Mail the HAA to the following address: (or cheok here~ if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEBING
Eaalo River, Alaska 995~
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 [] 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
8 to 8 eBed
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MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: b-~.l
A. WELL DATA
Well Classification _ ~¥'--~ [~;;'\~ ~ ~::~~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ~/N) "'f Date Completed ~ ~ ~-~- '~ ~:~ Yield
Total Depth \'~2'~~ ~
. Cased to ["~Depth of Grouting
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit
,-/
Pump Set At
Sanitary Seat on Casing(:~:2N)
Depression Around Wellhead (Y/~E;)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot _ _ __ \ ~:~(:::~ ; On Adjoining Lots
To Nearest Edge of Absorption Field_~n,/Lot ~, \ '~ ; On Adjoining Lots
To Nearest Public Sewer Line'-/¢~ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~-~ ~ [~ ; D?te
Water Sample Test Results ~'~-1 ~ ~-'~-I~
Comments ~/~,.-' ~.4:;~'~ '"~-75'~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~//~'~ Size _ [~,~2:2__ No. of Compartments
Standpipes ¢~N) "/ Air-tight Capsd~N)
Depression over Tank (Y/~) I'~
Pumping/Maintenance Contact on File (Y/N?\ ./
Holding Tank High-Water Alarm (Y/N)
Foundation Cleanout
i.~ate Last 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 Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev 7/88, Fronl Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/~ ~
Width of Field ~--'~' /
Square Feet of Absortion Area
Depression over Field (Y/d~
Results of Last Adequacy Test
/~""/¢~..--~ Type of System Design
Length of Field
Depth of Field '7
Gravel Bed Thickness
Statndpipes Present43~)
Date of Last Adequacy Test \ ~-~'~ --
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundatio~n/ ~---~ ~¢:'
Lot ~-!/~
To Water Main/Service Line \ .=. ~-4
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
· On Adjoining Lots
./
To Cutback (if present)
Comments
Da%nstalled
Size in ~
Level~
"Pump On"
at
High Water Alarm Level ~
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
uacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to alt MOA and HAA guidelines in effect on the date of this
inspection. .~'~'~
Signed ~..;.~.~
Company
Date
MOA No.
l?~J't4 Eea|e River Loop Road No, 204 /
Eagle River, Alaska 99577
"-
Receipt No, ~ ~ '//~... '.2 ? ///i~ ?/.., Receipt No.
Date of Payment / ~ k~2 / ~ Waiver Fee:$
Amount: $ / ~ ~ ~2~" Date of Payment
~2 o2, (~.v 7,'88) B,ck Page 2 of 2
C_HEMICAI. _&_ GEOLOGICAL LABORATORIES .OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order 8 11390
Date Report Printed: JAN 23 89 @ 12:09
Client Sample ID:L6, B3, GLEN EAGLE
PWSID :UA
Collected JAN 20 89 $ 14:00 hrs.
Received JAN 20 89 ~ 15:00 hrs.
Preserved with :4 DEG. C
Client Name : S ~ S RNGR
Client Acct : SNSENGP
P.O.! NONE REC'D
Req ~
0~de~ad By : RJS
Analysis Completed :JAN 20 89 Send Reports to:
Laboratory Supe~O~r .'_STEPHEN C. RDE 1)S & S ENGR
Special
Instruct:
Chemlab Ref ~: 4035 Lab Smpl ID: i Mat~lx: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 0.80 mcj/1 EPA 353.2 10
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY RJS.
1 Tests Performed * See Special Instructions Above UA-Unavailable
ND- None Detected *' See Sample Remarks Above
NA- Not Analyzed tT-Less Than, GT-Greatez Than
