HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK A LT 12 REMGRE,.fER ANCHORAGE AREA B0,.. UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~1~ ' ~.~ ~Jr MATERIAL
FROM WELL MANUFACTURER
INSIDE LENGTH INSIDE WIDTH / LIQUID DEPTH
NUMBER OF
~", (~.~- e~';' .3 ~'-%~ COMPARTMENTS
LIQUID CAPACITY iF')ODGALLONs-
~ DRAIN FIELD: .L.k,.~,~ t TOTAL LENGTH /
DISTANCE FROM WELL _~,O' P~OUNDATION ~-~' NEAREST LOT LINE ~0 I+ OF LINES_ '~ I
NUMBER OF LINES I DISTANCE BETWEEN LINES '~jJ~ TRENCH WIDTH~ IN. TOTAL EFFECTIVE
ABSORPTION AREA- ~ ~ SQ. FT. LENGTH OF EACH LINE ~ j i
I DEPTH OF FILTER ~
DEPTH: TOP OF TILE TO FINISH GRADE ~ MATERIAL BENEATH TILE~ IN. ABOVE TILE ~ IN.
WELL:
TYPE __
CONSTRUCTION
BUILDING NEAREST
FOUNDATION , LOT LINE--,
CESSPOOL OTHER SOURCES
APPROVED- .. DISAPPROVED
NEAREST
SEWER LINE--
DEPTH
SEPTIC SEEPAGE
TANK__, SYSTEM
· DISTANCE FROM:
_REMARKS
DISTANCES: /
INSTALLED BY: ~1~~ ·
SEWER LINE DEPTH:
PIPE MATERIAL:
DIAGRAM OF SYSTEM
DATE_ APPROVED
G.A.A.B.
FI F' F'L. :1; E:FIN 'f'
L O E: FI T i O I",1
LEGFIL
.3'Ftl]::I'::: EJREEN E:O::':: :::'7':1. EFIGLE F;:IYER Ell'::;
F. ]., E.R F~:l.".'lRE:'
i'"t~'L.E': '::1.. ;:-::'."E EFIGLE ...... '
L..:'I..;;:.:' E:I:;:I GL.F:ICZEF:: "]:E:I.4 HEIGHTS; '51..I I....L3T .:,:[~E.
T'¢F'E Ii'IF '.:~;t]1II... RE::E;Ofd:EFf'ION --..~ -= 1EJ'I I'-:,: TRENCH
,~,'lF~;:.::iI','ll..tl"l 1'.dLIhlBE[~'. OF E:EE:,R:OL3HL:, =
':-.':';:J'~:.¢3::~ E~;q-II=IR'F FEET
THE I-~:Er:.:!LI ]: F.:E[:, S'; ]: ZE: OF THE S50 ]: L FiE:E;OF.:F:'TI ON "E;'¢E;TEH I '_2;:
..=%
'I"HE LENG"I'H [::,fI"IENE;~ON ~E; THE LENGTH ,::IN FEET::, OF THE ]REN..H OF?. E:,~:R~NF~ELD.
OF THE
THE t::,EF'TH OE' FI TRENCH 12IR: F'~T ~'"" THE [:,~STFINE:E E:ETHEEN TIDE: ':;URFFICE
1"3~:OLI?.~[:, RN[:, THE: E'ZTTOH OF THE E::-::E:R',,,'RT~I:IN ,'ZN FEET::,.
r RENI...HE:,.
THERE ~:E; NO E;E"I" H]:D"I"H FOR .... ' ....
THE GRR',,,'EL [Z:,EF'"t"H ~:E; THE H~NZHUhl DEF'TH OF aR.h EL. E:E'TP~EEN THE OLITFRLL.. F'ZF'E
FINC, THE E:OT'f'EIr"l OF THE E::~;CFd',,,'FI"f'~EIN ,::~N FEET::,.
E:I:IC~:::F ZI-L:[ NG OF ¢~N'¢ :,~ :~ EH H I THOU'~ F Z NRL Z N:E;PEE:T ~ ON RNE:' RF'F'ROVRL.
E:,EF'FIR"f'FIENT ~'~]:LL E:E '~IJEh~ECT TO F'ROSECUT~ON.
MZNZFilJH I::,I~;TFINCE BETI.dEEN FI HELL. RND RN'¢ ON'--E;ZTE SEHRGE
:Lt239 FEET FOR R F'RZ',,,'I~TE HELL OR 2E~8 FEE]" F"3F' R F'IJE:LZC I.dELL.
HEL..L LOG:~; RRE REQIJZF:E[:' RN[:' h'IUST BE RETU~:NED TO THE [::,EF'FIRTHENT P.IZTH:[N
OF THE HEL. L COHPL. ET]:Ed"4.
:SF'EC :[ I= ~ CFIT :t: ONS FINE;' CONSTRUCT ]: ON [- Z H .~rd. Hfl:, RF'.E; R',.,'FI Z L_¢~BLE TO Z [4:~'I_IRE F'REtF'ER
]: N2;TFIL. LFI'f' Z ON.
I _.EF.I ].1- · THFIT
1: ] I:~P1 I=I::Ii"tILJ:FIFi: !.,.lI'l'H 'I"HE RE¢.:!i.J:[REf"EN"2; FEIF: EiN.-':_;;ITE E;EF.IEF..::~ I:l[*,l[::~ I.,.IELL. LF.; FIL'5, L:C.,E'I"
F:'E t~'"I"H E:¥ THE MUN ]: C I F'FIL :[ T'¢ OF FINC:HOF.:FIGE.
2' Z 1.4]~LL. Zi'-,IE;'T'Ft[..[.. THE f.~;'~.'2;"I"E:I"I :1:1'.,t FICCORE:,RNCE Lq:[TI"*t THE CF~E:,ES.
::.'::: ~ LINE:,E:F.:E;TFfl",IF:' THFIT THE F'IN~...;~ZTE ~.;EFI(-EF.: :5'¢S;TE]'"I I'"IFI'¢, Fi:Eg!LITRE ENLFII*q'.GEI"IENT IF' THE
[4'.ESIE:,EN':::fF:~//', -, ./~ /~ ~ :[L'*~;~:,I::,EL. EE:, 'I~::LUDE i"lO1E; THF:IN ~: E:E:E:RE, OH~;.
'=,:t: ~ ~f,tE [_ · _ ..: -::::.H~ b:~*<~.br',~' ................. '"' ' " ......................
Z ~:;SUEE:, E:"r*. ...... ._....E: Ft'f'E .........................
Depar~,~.~nt of Health and Envirommenta~k~L~rotection
SOILS LOG
Performed for
Legal Descriphion
0
Jack Beam Date Performed
¥,o~ ]2 Glacier View Heights
6/30/76
Red-brown, sandy ~ilt with organics (ML)
' Perc rate = 27 ft.2/bdrm.
Red-brown, sandy gravel (GW)
Perc rate = 85 ft. 2/bdrm.
Red-brown, gravelly sand (SW)
perc rate = 125 ft.2/bdrm.
I0
14
16
Frost zone from -5 to -7 feet.
Red-brown, gravelly sand with some silt (SW)
material is low density.
Perc rate = 125 ft.2/bdrm.
\
No water tabl~ encountered.
AVERAGE PERC RATE FROM SOILSLOG~rm.
Date Net Time ,Dept~h'~----' Net Drop
Percolation Rate minute
Performed BV ~ .... NORTHWEST EXPLORATION .q~l~X~'TC'~Tq TJ~T~'~
GAAB-HD-2
ROUGH
GREATER..ANCHORAGE AREA I
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
sEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Case No.~
NAME OF APPLICANT
RESIDENCE ADDRESS
I~_ oJ ¼lc~ LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
, MAILING ADDRESS
LOCAIION OF INSTALLATION
· SEEPAGE PIT , DRAIN FIELD
TO REINSTALLED BY [~~
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
, SEPTIC TANK SIZE .TYPE SEEPAGE AREA
DIAGRAM OF SYSTEM
TYPE
DISTANCES:
Health Authority
I certJ£y that ! am £amJ]Jar with the requirements o£ Greater Anchorase Area Retouch Ordinance No. 28-68 and that the
above described system Js J~ accordance with said code.
DATE APPLICANTS SIGNATURE
J ~?REATER ANCHORAGE AREA BOROUGH
~ '~ IiEALTH DEPARTMENT ~-~ CASE
, ~ · 3~7 EAGLE STREET
ANCHORAGE, ALAoKA 99501
" ~m~a For~n Const. Co, Date Performed ~¢~y
Legal Descr~p~ ¢~'s~'°n~~
This Form Reports a: S~Log.~ .... ~
0!
~0,0'
Depth
Feet
Soil Characteristics
D~rk Brown Silt S].i
Organic, USCS CLASS
"]~,~L"
Si].ty grave] vr~th sma]_]
s~nd fraction
nven~%e maxJmumo 'IISCS
Cf,ASS
Samdy s~].t grave], poor].'
graded~ ]" ma¥~mum
si~e v,rith bou].da~s 6"
to f~" IJSCS Cf. AS2
Co-~tin~e~ to at ]_.e~st
]2' depth
Was Ground Water Encountered?~NO
If Yes, At.What Depth .......
Reading Date
.~rcolatlon ]ate 1"/
Gross Time
Net 'rime
Location Sketch
Depth To HsO Net Drop
Proposed Instal~Seepage Pit Drain Field
Depth Of Inlet l)ep%h To 'B'o~tom Of Pit Or Trenc~-"-~ ........
COMMENTS: ~?q~er4,~[[ belay? s~]t, ~burden _iS ~a]_etive]y .].oosq ~ d
neE~ob]¢ Re~eome~d ~qO ~e. f*, ~9or bedrnOp~
Data CeP,ifled ,,~ ~~~~
Date :~~k '
A & L DRILLING COMPANY s
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 · ' '
· , .: ,, ~,,.: /~::/::' ~ 1 DEPTH OF WELL
OWNER OF LAND " ' ~- · '
STATIC LEVEL OF WATER FT.
ADDRESS
LEGAL DESCRIPTION-/--
DATE-Started
PE~IT NUMBER _
KIND OF FORMATION:
From Ft. to- ' :' Ft.- ~ ~. ~'~'' / :'~ (:'/'~ ~,q~./c~ From Ft. to--Ft.
From_ .Ft. to ', Ft._ ':-, ~,4...>~ q q:, ~f~,;/~ .... From_ Ft. to Ft.
, ./ :~ ~,/ {./, .~i ,,.:./ :/ :~:,,;~:dtFrom Ft. to Ft.
From_ .Ft. to ' ~ .Ft. ~ ,-"' ~ ..... -
· ;.' ' ' ; . 4,~/,.;t c. From Ft. to Ft,
From / _Ft. to / Ft._ ~"; :":~ : --
From Ft. to" Ft.~ ~ ..:L: ~') From_~Ft. to.~Ft-
.'( ,: ~i, ,/~ L. From Ft. to Ft.
From' ,Ft. to } Ft. (" /:"~ ' ~ "~ ........
From .Ft. to /: .'f Ft. ,.f~'~ ?'P~"~,7'd~? hh.4~; /~3~''J From Ft. to Ft.
From. .Ft. to / y '~ Ft. ~ :? ''~'~0 / .... ~'~ ~ ~ ' ~ ::' "'¢ ~ Ft.
. ~, ,e: ,,/,/,qe~ - -~.,,; ~;,,. From. .Ft. to
From .Ft. to Ft, Fromm. Ft. to_~Ft.
From Ft. to .Ft. From .Ft to Ft._
From _Ft. to_ .Ft. From Ft. to_ Ft.
From Ft. to_ .Ft. From_ Ft. to Ft.
From Ft. to Ft.- From_ Ft, to Ft.
From. .Ft. to Ft. From Ft. to Ft.
From_ _Ft. to_ Ft. From ~Ft. to .Ft._
From~Ft. to Ft. From_ Ft. to ~Ft.
From .Ft. to _Ft From Ft. to_~.Ft~
MISCL. INFORMATION:
DRILLER'S NAME.
MUNICI~SALITY 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
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (.include 10t, block, subdivision, section, township, range)
Lot 12; Block "A" Gla~i6r View Heights ·
(b)
Location (address or directions)
Mile 4.5 Eagle River Road
Property owner ~ny
Telephone: (home)
Business
Mailing Address
(c) Lending Institution
Mailing Address
Telephone
(d)
Real Estate Company and Agent RE/MAX OF EAGLE RIVER ATTN: I(nCa ~aeone
Address 16600 Cen~e~f~e6d D~ve S~e 20! Eagle R~ve%Ak. 99577
694-4200
Telephone
(e) Mail the HAA to the following address: (or check here{~,Xif hold for pick up:)
List contact person and day phone number below:
S & S ENGINEERING
17034 E~Ela R~ve~' Loop
Eagle River, Alaska
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms
3. WATER SUPPLY
Individual Well [2!3X 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
5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my sea[ affixed hereto and as of the validation date shown below, Iverifythatmyinvestigation 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,
ad No. 204
Date
Telephone
Approved for ~ bedrooms '
Approved ~approved ' Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspect!ohs
or analyze data before a certificate is issued. TheMunicipality°fAnch°rageis not responsible for errors orom~smons
in the professional eng'neer s work.
72-025 (Rev. 7/88) Back Page 2 of 2
~ MUNICIPALITY OF ANCHORAGE (MOA)
(,*'~j~,~ Health Authority Approval (HAA)
, ,k~: ."~_~L;_ ~/ CHECKLIST - FEBRUARY 1984
M~:~IT¥ OF ANCHORAGE 343-4744
ENVIRONMENTAL SERVICES DIVISION
Legal Description: ~-e-['"l
Well Classification _; ,
Well Log Present (Y/N)
Total Depth I -~FI ' Cased to z-JO '-/- Depth of Grouting '
Static Water Level ,~' ~2_ Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
TO Nearest Public Sewer Line i~I/1%
To Nearest Sewer service Line on Lot
Water Sample Collected by
Water Sample Test Results
If A, B, C, D.E.C. Approved (Y/N)
Yield
o1<
Sanitary Seal on Casing (Y/N) ~'/
Depression Around Wellhead (Y/N) t~J
{oo ~
; On Adjoining Lots
; On Adjoining Lots
To NeareSt Public Sewer Cleanout/Manhole
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-22-70Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
( 00o
Air-tight Caps (Y/N)
No. of Compartments
I~ Foundation Cleanout (Y/N)
Date Last Pumped
',for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well I Oo ~ To Building Foundation
' To Property Line [ o -f-
To Water Main/Service Line [ 0 fi-
To Disposal Field
/
To Stream Pond, Lake or Major Drainage Course
Comments ht'C~e,~oo 1L' (oc~'~ol~¢d%.iq~e
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ira(toe' ~c _
Width of Field -~
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
¢ / "¢'~ Type of System Design
Length of Field
Depth of Field /
Gravel Bed Thickness
/._/ ~ L/ ~U Statndpipes Present (Y/N)
~ Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ~-.._Co
To Existing or Abandoned System on
; On Adjoining Lots ~_~ o -/-
To Cutback (if present)
Comments
LIFT STATION
Date Installed ~.~
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company
Date
17034 Eagle River Loop Road No. 204
F. agle Ri~t~r/~ ~7¢ 7 7
MOA No.
Receipt No.
Date of Payment
Amount: $
72-026 IRev 7/88) Back
/ ?¢, o (-)
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 ° TELEPHONE (907) 562-23zl3
FEDERAL TAX I.D. #92-0040440
ANALTSIS REPORT BY SAMPLE for Work Order ~ 26176
Date Report Printed: AUG 14 90 @ 12:52
Client Sample ID:LI2 B'A" GLACIER VIEW HTS
PWSID :UA
Collected AUG 6 90 @ 15:00 hrs.
Received AUG ? 90 @ 14:00 hrs.
Preserved with :AS REQUIRED
Client Name : S & S ENGINEERING
Client Acot : SNSENGP
P.O.# NONE RECEIVED
Req ~
Ordered By : R. SIL~FER
Analysis Completed :AUG 10 90 Send Reports to:
Laboratory Superv[sgr.d~PHEN C. EDE 1)$ & S ENGINEERING
Released E, : .~~~. ~ 2)
Special
Instruct:
Chemlab Ref {: 902884 Lab Smpl IDi I Matrix: WATER
Allowable
Paxamete~ Tested Result Units Method Limits
NITRATE-N ND(O.ID) mE/1 EPA 353.l , LO
Sample ROUTINg SAMPLE. SAMPLE COLLECTED BY RAY.
Remarks:
1 Tests Performed * See Special Instructions Abeve UA=Unavailable
ND= None Detected *' See Sample Remarks Above
NA= Not. Analyzed LT=Less Than, GT=Greater Than
(-
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking WaterAnalysis Report for. Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
~ PRIVATE WATER SYSTEM
Name Phone No.
Mailing Address
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
~--Routine
[] Check Sample (for routine sample
with lab ref, no.
[] Special Purpose
.) [] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
~ I ~ ~ ~ ~h~'
3 I
4 I
51
Time Collected
Collected By
Date Received
Time Received
Analytical Method:
TO BE COMPLETED BY LABORATORY
5nal. al~shows this Water SAMPLE to be:
~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
no~ be over 30 hours old at examination
to indicate reliable results. Please send
n~w sample via special delivery mail.
~ _-~ _c~
Membrane Filter
BACTERIOLOGICAL
No. of colonies/100 mi.
Lab Ret. No. Result* Analyst
90.2884
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter:. Direct Count
Verification: LTB
Final Mem~~..
Colltorm/10Oml
BGB ~ Collform/100ml
Date
TNTC = Too Numberous To Count
OB = Other Bacteria
pART ONE OF TWO
REI~,INDER TO FOI. LOW