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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
625 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
DISTANCES
~ ' ~..c:~.~.~ ~ - SEPTIC ABSORPTION WELL
~ddr TANK FIELD
J I r' - it No No ~ Bedrooms
Phone(s) 7 IPe~n ' I ' .~ WELL
LEGAL DESCRIPTION
Township, Range, Section AS-BUILT DIAGRAM (Show location ol well. septic system, property lines. [oundation,
TANKS N
Manufacturer Capacity in ~o~ ~
~ TRENCH ~ BED . DRAIN ~ OTHER ~
Fiji added above original grade Gravel depth beneath pipe /
Gravel length ~ FT
Totalabsorption area ~ ~, FT Distance between lines ~/~ ~ .,~ ~,~
FT
Number of lines Soil rating Pipe m,teria,~
WELLS ~~-
RIVATE ~ OTHER (Identifvl '~ '~ ....
InstallerDate Installed:
Scale: ENGINEER'S SEAL
~ ~ ~- ~~J~ ' Inspections Pe"ormed by:
cedily Ihat this inspe~ion was peflormed according to ag
Municipal ~m~l~cl o~% ? ' ~ ~' /~/
_ Date: ~ ~ C~.
Health Depa~ment Approval:
[]wner' I',lame'~ ,l~.dxC / O't ....
O~ner' A(::lclress~ ~ -:...?-c ¥,.~11FI.t.~..L. ~::l~l-.[ J
:'OR'['I....AND, 3R 9'?',~a :1.5
Oay F:'hone:
694 '"- 29 '79
Par'ce]. Id: 050-49 ].-0 :1.
I....o-L I....ega].~ ,Subd:i. visicn"t: C.)L.ACIER VIEW HG]'S, L.ol:.: 9 B].ocl.::~ A
Se:,c::tic:)n~ :[6 Township~ :[zj.N Range: :LW
L. ot Size '2175C) (sq., f'L, (::)r' acr'es)
Hax Bedr'ooms~ "['l]is'l:)ecmj.'Lx 2 To'Lal Capac:it.y~
~[[~!~[J:::'"J" I C TANK: M i n J. mum 'Lot ~ I sept :J. c 'L an I.:: c::ap ac: :L 'L y ~ J., 0()() g a i 1 a n s. Each sept J. (:::
· Lank mus'L have at ].eas'L :2 c:ompartments. Depth 'Lo 'Lop of' septic tank (s) < 4,,()
[]ONS]'RUCT PEI::~ ENGINEEERS AT"I'ACHED AF'PI::;:OV[ED DESZGN.
'FH]:S PE. FRMIT EXF:']:RES :t. 2/3:1./89 AND VALID FOR A S]NGI....E FAMZL. Y HOME~
THIS I'qOME 1'0 CONTAIN ;2 BEDRC]OMS ONLY AND MUST RECEIVE A~D~E,C.
AF:'F:'RC)VAL. F:'RIOIR TO ADDZNG BI[~:DR[]OMS :I:N THE FLJTLJF~E,
CEI::(F I I:::'Y THAT:
· . . , .. ~ , r"~ "~ ~" and ~.)i ].s as set
f'or'Lh by the I,turtic:LpaliCy of Anchorage (MOA) and 'Lhe Sta'Le of A].aska,
I will :Lns'La].l 'Lhe system in accor'dance w:i. th all MOA c:cJcJe~s al'~CJ r, eguta'Lions~,
and ~r'i compliar'Jce w:Lth the design cfi'Let:La of Cl"l:[s pePm:L'L,,
I t.~i].], adl"ter'ta .... c' at]. ~[]A arid S-:.ate (::~ Alaska Pec:lu~.r'ements Fop the set bac:k
dis'Lances fpom any e>(J.s'LJ, ri(:j (4e].l, was'Lewater~ c:li~t:jc:)sa]. system oP ptJ. blJ. c
sewer'age system on 'l:.h:L~ or any adjac::er'rL or near'by ].ot,
]: urider, s't. and 't:.ha'L r:)F.~H"filJ,~., is valid fop a
also und(ePs't, and c:apac::i, ty (:::,f 'Lhe 'Lo't. at system ]i.s ;2. bedr'cx:>ms ar'id
d]wner') N~
* : ~,-~... ~' ~ ~"°%cEN~Ih"~F, ER'S SEAL)
Municipality of Anchorage ~~ _~
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED:
LEGAL DESCRIPTION:~/ ~/~ ~/~hSffi0' I ge, Section: ~/
SLOPE SITE PLAN
1
6
7'
8-
9
WASGROUNDWATE"
IF YES, AT WHAT
DEPTH?
Deplh to Water A_tier.,,.?, /
1 3 - Monitoring? .Z,,,'/c"J,,," gate:
' Gross Net Depth to Net
Reading Date Time Time Water Drop
z 2o?,,"
15-
16
17'
18-
19-
20-
PERCOLATION RATE r~ (minutes/inch) PERC HOLE DIAMETER
· / TEST R'? BETWEEN ,'-~'~" FT AND ~ FT
Eagle River, Alaska 995~ ://~ ~ ? Z~ /~ ~
ACCORDANCE WITEALL STATE AND MUNICIPAL GUIDELI~FFECT ON THIS DATE. DATE: ~/~0 /
72-008 (Rev. 4/85)
GRE "ER ANCHORAGE AREA BO"
Department of Environmental Quality
3500 Tudor Road
Anchorage, Alaska 99507
UGH
/U~I~PECTION REPORT ON-SITE SEWAGE DISPOS~AL SYSTEM
LOCATION~,~/~ ?0~,~:~/, ./~,.~'~ LEGAL DESCRIPTION ~/¢
SEPTIC TANK:
DISTANCE ~ ' 4 ~ ~ NUMBER OF
FROM WELL ¢~'~ / MAN~JFACTURER~ MATERIAL~:~/)~--~ COMPARTMENTS /
INSIDE LENGTH ~ INSIDE WIDTH ~' LIQUID DEPTH ~ LIQUID CAPACITY ~'~-~ GALLONS.
SEEPAGE PIT:
. /
NUMBER OF PITS / ~JAMETER_~ OR WIDTHJ~, LENGTH/~,~,/ DEPTH
"I]INING MATERIA~-~'~.~'~',~i~;CRIB SIZE: DIAMETER ~ ZDEPTH DISTANCE FROM:
TOTAL EFFECTIVE
BUILDING FOUNDATION~_~ NEAREST LOT LINE.~-%~-) / .
WELL /,/~) /
ABSORPTION AREA (WALL AREA) .~:~'~' SQ. FT.
ADDITIONAL ABSO ~Tf~S,N .......... ·
WELL:
TYPE CONSTRUCTION
BUILDING .~,,~ NEAREST NEAREST SEPTIC
/
FOUNDATION ~..~¥ LOT LINE ~ SEWER LINE
CESSPOOL ~ OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM ,/z/~--~ /
DISTANC ES:,/~.~Z~ -:¢..~..~.,.~-,~ d_-//,~
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form PW-026
OF
SYSTEM
I
x~-'' -'--"-.-...//,~._..~__ \ llou~¢' \
DATE
APPROVED
GREATER ANCHORAGE AREA BOROLJGH
DEPARTMENT OF ENVIRONMENTAL DUALITY'
3500 TUDOR ROAD POUCH 6,650
ANCHORAGE. ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATaON AND PERMIT
PERMIT NO. -- -
NAME OF APPLICANT
,NSTALLA'r,o. LOCAT,ON
-,~ ..' " ,, ' I
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT__ / , DRAIN FIELD
TYPE AN,:, S,'"E OF FAO,L,TY TO BE SERVED ~D ,~.~c:/.z~'~ ~,i/,._.~/,.,,.-. ,-~-,~.--,....~_
SOiL TEST .ESULTS /~'~
COMPLETION DATE ANTICIPATED
NOTE; THI~ PERMIT t~. RIOT VALID WITHOUT
FINAL IN~,PECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEP'TIC TANK SIZE
MINIMUM DISTANCES, REQUIREMENTS;
FOUNDATION TO SEPTIC TANK 5~/v
/
FOUNDATION TO SEEPAGE Pit ~
SEPTIC TANK TO SEEPAGE PIT WALL / "~/
SEPTIC TANK ~/'c/~'~
TO NEAREST LOT LINE.
WELL TO ~E~IC TANK
DRAIN ~lELO
WATER MAIN TO SEPTIC TANK ~
DRAIN FIELD
DRAIN FIELD
SEEPAGE PIT , DRAIN FIELD
ALSO CONSIDER AREA WELLS.
/~) / . SEEPAGE PIt
SE"~'C TAN'<. ~0 r SEEPA'~E P,T r~o /
, , DRAIN FIELD
TO RIVER, LAKE, STREAM,
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION ~ FEET INTO UNDISTURBED SOil.
4 INCH DIAMETER CA~T IRON ~IPHON PtPES ON SEPTIC TA~K AND SEEPAGE Pit
F[T'~ED WITH AIRTIGHT REMOVABLE CAP~.
TYPE
DIAGRAM OF ~Y~.TEM
GRAVEL, BACKFILL
CONFORM TO BOROUGH REGULATIONS R~GAROING INSTALLATION1
I CERTIFY THAT I AM FAMILIAR WITH TI4E REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-88 AND THAT THE ABOVE
r}ESCRIBED SYSTEM IS IN ACCORDANCE WiTH SAID CODE
CASE #
IEATER ANCHORAGE AREA BOR~ iH'
D~/-ARTMENT OF ENVIRONHENTAL 4~¥<LITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
Performed For ~m~
Legal Description: Lo't q BJ_Q4;J~__
This ~orm Reoorts Soils Log.~
1
Date Performed ~-~~72
Subdivision ~lmm~,~ V~k~ /-/e~&~
,;~,~ Percolation Test
5--
6
7
8
Depth
Feet
Soil Characteristics
L/
s Ground Water Encountered?
If Yes, At what Depth?
Reading Date I Gross Time I, Net Time Depth to H20 I Net Dro~
I I I '
Percolation Rate HinUte
Proposed Installation: S.eeDage Pit Drain Field
Deoth of Inlet Depth To Bottom Of Pit Or Trench
Test Performed By
Data Certified By:
Date:
EXCAVATION
ROBERT A. SHAFER
WORK
February 24, 1983
CIVIL ENGINEER
694-2979
Jack White Realty
ATTENTION: Larry Mauldin
3201 C Street
Anchorage, Alaska 99503
Dear Larry,
Reference: Lot 9: Block A: GlacierView Heights Subdivision
The Tony Coelho property
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1000 gallons. The seepage
pit was charged with 1000 gallons of fresh water and after a period
of 24 hours all the water which had been added to the crib had percolated
out.
It can be concluded from this test that the waste water disposal
system serving the single family dwelling units located on this
property are currently functioning adequately. However, the system
cannot be guaranteed against subsequent failures.
It should be noted that there:is:a house and cottage located on
this property with two bedrooms in the m~in house and one bedroom
in the cottage. The combination of these two units was considered
a single family dwelling for the purpose of this test.
If we may be of further service, please do not hesitate to call.
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
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
(-'~._~ ~ ~ LtOt~ ~ [ HAA# ~/'~ "~r
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
/ //~//¢Xj/'&'/' 0 !~'~/U'/~4:~ =Telephone: (home) " Business
(b) Property owner- ,,---/ .
(c) Lending Institution Telephone
Mailing Address
(e) Mail the HAA to the following address: (or Check here,~if hold for pick;up.)
List contact person and day phone number below:.
S & S ENGINEER~t~tG
17034 E.~gle Ri~er Loop Road No. 204
Eagle River, Alaska 9957~
2, TYPE OF RESIDENCE
Single-Family I)~L/-_ Number of bedrooms
3. WATER SUPP,LY,
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. SEWAG. E/plSPOSAL
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 legailty and status.
72-025 (Rev. 7/8§} Page 1 of 2
Well Classification ~; ~L.-'AV~ ~_~.~
Well Log Present (Y~? r-& Date Completed
Total Depth ~'7.Jr~'¥"Cased to '¢f"c~J'~r'Depth of Grouting
I
¢ ~'~xO~ MUNICIPALITY OF ANCHORAGE (MOA)
'~ Ot ~) Health Authority Approval (HAA)
_,.,,~-~ ~5~ CHECKLIST - FEBRUARY 1984
,~ ~ ~ ~ 343-4744
~-O~' ~ Legal Description: ~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit ~)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot '¢¢~'~
If A, B, C, D.E.C. Approved (Y/N) '/'/~
Yield ~..¢.C> ~.¢'{'-"1 ~
Pump Set At
Sanitary Seal on Casingft2ZTN)
Depression Around Wellhead (Y~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~r/~
TO Nearest Sewer Service Line on Lot
Water Sample Collected by ~::~ IlO ~--~/d~ ;Date
Water Sample Test Results /~1~'-~'~:::~ ~= /~.P. /~
C o m m e n t s '"~/>~--/~-~-'-¢',~ ~::=,,"¢~ ---'~ I~ ~.- ~
; On Adjoining Lots
\ ~¢:~:::,1 ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed ~- 1~--'7¢-- Size
StandpipeS ~TN) y ·
Depression over Tank (Y~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
!
To Water-Supply Well
To Property Line
To Water Main/Service Line
Air-tight Caps.)
No. of Compartments
~/ Foundation Cleanout
Date Last Pumped I~- -¢-O
I~/¢~ ;for /~ "'~/~ '~ ~
,/
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
/..~....;:~.,,[~-..,.~ FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order ~ 11789
Date Report P~inted: FEB 20 89 ~ 13:25
Client Sample ID:L9, BA, GLACIER VIEW HTS
PWSID :UA
Collected @ h~s.
Received FEB 17 89 @ 16:30 hrs.
Preserved with :NONE
Client Name : S & S ENGR
Client Acct: SNSENGP
P.O.~ NONE REC'D
Req ~
Ordered By :
Analysis Completed :FEB 20 89 Send Reports to:
Laboratory Sup~y~so}_:$TEPHEN C. EDE 1)S & S ENGR
====================================================================================================================================
Special
~.Instruct:
Chemlab Rei ~: 4300 Lab Smpl ID: 1 Matrix: WATER
Allowable
Paramete~ Tested Result/Units Method Limits
NITRATE-N ND(O.IO) mg/1 EPA 353.2 10
Sample ' ROUTINE SAMPLE.
Remarks:
! Tests Performed ' See Special Instructions Above UA=Unavailable
fi~= None Detected ** See Sample Remarks Above
.~A= Not Analyzed LT=Less Than, GT=G~eate~ Than
CHEMICAL OLOGICAL LABORATORIES LASKA,
TELEPHONE (907) 562,2343 6633 B gtreet
Anchorage, Alask~ 99518
Drinking Water Analysis Report for Total Co iform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
APRIVATE WATER SYSTEM --
Name ' ' : Z ' , ~eNo.
City ~/ State Zip Code .
Mo. Day Year
SAMPLE TYPE:
~,,~C°utine
heck Sample (for routine sample
, with lab ref. no.
[] Special Purpose i
_) [] Treated Water
~/Untreated Water
SAMPLE
.o.
4 I
S I
Time Collected
Collected By
I
l
TO BE~COMPLETED BY LABORATORY
An,~lysis shows this Water SAMPLE to be:
~tisfactory . ~
[] 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 Received 9- / ?- ~"c:l
TimoReceived /(~ '.Z;x0
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
Analyst
~.~.
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter:. Direct Count ~
Verification: LTB BGB
Final Membrane Filter Results ~
Reported B~-~~Date
Time:
TNTC -- Too Numberous To Count
OB -- Other Bacteria
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