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Home My WebLink AboutFISCHER BLK 2 LT 1B ~'~ '~O~ ~--'! MUNICIPALITY OF ANCHORAGE ~- ~'! · {{~"~J~\\' DEPAR'TMENT 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 P,ONE ~'~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDffiOOMS I Well Absorption area DISTANCE TO: l I ~00 IF HOMEmDE: ~o ~ Well Dwelling PERMIT NO. DISTANCE TO: Material beneath tile Total eff~ti~ J[~rptio~ area ~ ~ ~ T~ Of ,lie ,o finish grade 5 ~ Ty~ of c~ib ~db diameter Crib depth Total eff~ti~ absorption area ~ DI~TAN:E TO: m Building foundation S~r line ~epfic ~ank Absorption area(s) ~ DISTANCE TO: OTHER APPSOVEO O TE LEGAL 72-013 IRev, 31781 PERMIT NO. · ~'IUN I C I PAL I TY Of F:ir-ICHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 LqELL RI-ID ON--S I TE :~E~-IER PEAr'11 T ( e1041S > APPLICANT ROBERT J GLEASON LOCATION FISHER SUB ~/'-x LEGAL LIB~ts~J¢ TYPE OF SOIL ABSORPTION SYSTEM IS: PO BOX 1897 TRENCH LOT SIZE 349 1203 45000 SQUARE FEET MRXIr'IUM NUMBER OF BEDROOMS = 5 SOIL RRTING (SQ FT?BR>= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ~ DEPTH= ~_ LEt-lOTH= ~ GRR'-,"EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET>, THERE IS NO SET HIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUm1 DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION <IN FEET>. REQ..I_t I RED SEPT I C TRNa.-. 5 I ::~E= :L500 GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER 0~ RESIDENCES THAT THE WELL WILL SERVE. THO ( 2 > I I'~ISPECT I 01'-,15 ARE REI~U I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS I00 FEET FOR A PRIVATE HELL OR 150 TO ~00 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC HELL, 'MINIMUM DISTRNCE FROM R PRIVATE WELL TO R PRIVATE 5EWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LIHE I5 75 PEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE HELL COMPLETION, OTHER REQUIREMENT5 MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, PEAr'lIT E×PII~:E5 DECEMBER .~'! ~ ~i_~S'1 I CERTIFY THAT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I HILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. -?.: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE.~I-,~ REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. APPLICANT RpI~ERT J GLEA-~ON · "CONST ,F JCTION TEST LAB i PERFORMED FOR: I LEGAL DESCRIPTION: THIS FORM REPORTS: Robert Gleason Ld lB Block B Visual Soils Examination 180('"'W. 48TH AVE. STE. 'C' .ANCHORAGE, ALASKA 9950:5 248-1333 .,- /~ ~9 Subdiv;sion C~ Percolation DATE PERFORMED: 5123/8] Fisher Subdivision Test 81-1557 DEPTH SOIL NOTES FEET DESCRIPTION '--- ~, Silty Gravel (GM) Gravel GW 4' Sand (SW) 17,' Gravel (GW) , 16' BOTTOM OF HOLE ¥,'-~S GROUND WATER ENCOUNTERED No IF YES, WHAT DEPTH LEGEND .: -- Parc zone · , S - Sample token ~,-- Frozen zone 'I- I- O Z READING DATE GROSS TIME NET TI~'~'~''~''~ DEPTH TO H20 NEi' DRAINAGE PERCOLATION RATE: DRAINAGE REQUIREMENTS: 85 sf/bedroom PROPOSED INSTALLATION: [3 SEEPAGE PiT ~1 DRAIN FIELD E] OTHER COMMENTS: TEST PERFORMED BY: K~.B.._._ DATA CERTIFIED BY:_Kinney_R~Baxter DAT E:. _.5Y_23/.81 .ti{Il. IS VIELL DRILLll~G DRILLER'S ~/ELL L'OG SIZE 6" DEP~ ~ ~S[tIG DEP~ 1~ GRO~ZNG DE~ ~/~ Y]E~ 5-6 ~ STATIC ~'~ATER L~EL ~5~ ~,~ TEST~ J~ FO~,~TIQ~S ~COU~ ~ APPROPRIATE DEP~S 1 .04 87 TO TO__ TO__ TO~ __ TO /V umcipahty of Anchorage MEMORANDUM DATE: October 19, 1981 TO: FROM:. SUBJECT: Laura Crow Senior Office Assistant Sewer and Water Program Request for Refund - Account fl2460 Please make arrangements for the following refund, a private engineer did the inspections on the installation of the on-site sewer system instead of this office. Thank you. Receipt #146300 Permit ~ 810418 Amount $30.00 Lot lB Block 3(s/b Block 2 Fischer Subdivision Robert J. Gleason Post Office Box 1897 Anchorage, Alaska 99510 Laura J. Ward Senior Office Assistant LJW/ljw attachments 914)10 (5/78~ MUNICIPALITY OF ANCHORAGE "'-" DEPARTMEN OF HEAfTH & HUMAN SERVI ES . .... P.O. ~ox 196650 ~Anchorage. Alaska 99519-6650 · . · -,' '~ .,' ": .... ',:343-4744 , ~, CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '-' Parcel I.D.# ('~.'~- ~)c~..~. ["',jo 1. GENERAL INFORMATION . ' Complete legal description ~::~'- Location (site address or directions) .Prope~ty'owne;" i,i: '~ Address ? '"' ' - '.2. NUMBER OF BEDROOMS: *. 3...T~PE OF WATER SUPPLY: Individual well · ... ~"z.c)l ~ leo~' Dayphone ~"q I'- (~<~' Day phone Day. phone · Public water .... NOTE: If commumty well system, prowde written confirmation from State ADEC attest-, "' DISPOSAL: -: ~-- !~* 4. TYPE OF WASTEWATERT,----- ~* *' · Public sewer ., ~ NOTE: ~ If community waste'water sysiem,~,,,.vide written c~nfirmatlon fro'ii~ State ADEC' . .*' .. attesting to the legality and status of system.' '~' ', 5. STATEMENT OF INSPECTION BY i ENGINEER ..... ..-**:,, ' '' '. · As cert~hed by my seal affixed hereto and as of the vahdabon date shown be ow, I ver fy that mv · ' '~.i%___.h'A',;; ~';~. ............ ~ ...... : ........ '"'-'. '-- :' Ihvest,gabon of th s i-lea/{ ho ,t~ ~p~/~ ~hc~t,onshows that the"on-s,te water supply " 9 "''safe; '" ';~' ' ' ' ': ' '= and/or wastewater d~spo~l s stem is funct~6nal and ad u~ite for.the number of bodrooms . andtypeofstructure nd~catedhere~n, furtherverlfythatbasedonthelnformationobtainedfrom the Municipality of Anchorage flJ~s ahd from my invesi~gat~ori"and Jnsl~t~on the on-s~te wa{er · .':. · .supplyand/orwaste.,waterd~sp.osalsystem*is'n.comp ancewtha Muncpa and State codes · ':~ .:: ~: ,... 0rdmances, and regulat~ons i,n effect on the date of this inspection. , ~ '. .. ~.. · .' ...; · .' . ' .Name of Firm. D ~%'JLT~ ~-v~C~t~¢~¢--~-'¢'' ,': Ph6he ~3~-~'-I%~' ~'!' ' ,: . . .:",-",~ '.,,,~. ,,'- ~'~.,.;;. !. -*, ;.... .,,.. ~. . · , ,, :.*' ~* ,* . :, '~' $.',. DHHS SIGNATURE: ":'"... .... ~' . ~ Approved'for · ~ . t~drooms. ~' '- ...... Disa~oroved. - ' ': .... ' Conditional appr6val fo~ ..... ~ '"'"~'"%~" "'" .... = ' ' ' · .-De, rooms, with th~ foll0v~ing · ' stipulations: · . · . - ~ , :'-'.' ~: ';,,,, ~.- : ~i-,' · '~',,The M,uhlclpaliht of Anchorage Department of Hea th and Human Serv ces (DHHS) ssues Health Author ty :, ~ ;, '. ~.',:-,~ ;,Approval Cerbflcates based only upon the representations given.in paragraph 5 above by an Independent ' ~: · '"'~ ' .:"'-': ~r~fessi~na~engineerregistered~n{he~ta~e~fA~aska~TheDHHSd~esth~sasac~urtesyt~purchasem~fh6m~s ' ;~ .- andthe~r endng nsttutons nordertosatsfycertanfedem andstaterequ rements EmpoyeesofDHHSdonot .,?, ,,..~ .'~,conduct mspecbons or, analyze.data before a certificate is issued. The Mumcipahty of Anchorage is not '. ~.i'- ':~ . .' ..,. r~pons~ble for errors or om~ss~ons in the pro~'~onal engineer's work. ' Municipality of Anchorage Department of Health and Human Services HEALTH AUTHdRiTY :A'ppROVAL CHECKLIST Legal Description: L. 'IE, I I~ '~. A. Well Data Well lype I~D~,~tDo~,---(~) If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y'~%(~) Date completed IO-,4-~ I(~) Driller ,~.~S ~fiLt- O~,II..L-I~,~~ Total depth I ~:O' ~) Cased to · I~,~© Casing height. 1,4' (~) Sanitary seal (Y/N) Y~-~' (~ Wires properly protected (Y/N) Yfi % (~ FROM WELL LOG Date0itest IO-4-~ t © v/ Static water level '~ Well flow Pump level1 g.p.m. Septic/holding tank on lot Absorption field on lot ~. tto~ (D Public sewer main id/~,. ,"'"' ATINSPEC~ON ~..C~_,~ 4. (::D ~ I&¥, ~ ! {~ ' v'~ MUNICIPA~.IIY OF ANCHOI<~G[: ~.~ 1~ V~'~ ENVIRONMENTAL $ERVICEs DI¥IslON g.p.m. U~v,~,,,~' ./"~' .',PR ~ 3 1994 SEPARATION DISTANCES FROM WELL TO: '~ IlOI (~) ~"" ; On adjacent lots ~ ; On adjacent lots Public sewer manhole/cleanout Sewer service line ~J/~', ~' Petroleum tank WATER SAMPLE RESULTS: /' Date of sample: z~.l~,- ct4- (D RECEIVED Nitrate I.'"1'7_ ("c~'~A.'t'w,<-.~-J3'~ Otherbacterla C:> ('%~:~_ ~.'rr~c~-~'~ Collected by: Bo SEPTIC/HOLDING TANK DATA Date Installed Cleanouts (Y/N) ~ % CD High water alarm (Y/N) Date of pumping Tank stze t ~'-'-'-'-'-'-'-'-'~C) ~.t (~) ~ Compartments '"'Foundation cleanout (Y/N) ~%~ ~ Depression Alarm tested (WN) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ,t...-"' Well(s)onlol ~' tiC)~ 0::) c'/ On adjacent lots "7 t?-.OI ~ .Foundation I~-.~ To property line 44 ' (~) Absorption lield '7: '~' (~ Water main/service line Surface water/drainag(~ 0 ~ ! ' 72.026(,&~3)OFm~l {~ ~ Dgl~~ p[~, . ;..,.... CONTINUED ON RACK PAGE C. UFT sTATION Date Installed. Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes (Y/N) Manufacturer 'Pump on'levelat ~ at..' . ~"~'-'/ Cycles tested ~. Well on lot SEPARATION DISTANCE FROM LIFT STATION TO: ; . .' ' -'"-" On adjacent lots ~ Sudace water D. ABSORPTION FIELD DATA Date installed ~- ~ ~,1 (~) Length 4~ ' ~;) WMth ~'~-~ Total absorptiOn area .,~.'z.~;>' +- (~. Date of adequacy test z~....~-~l ~- (D . Results (pas~a~) Water level in abso~3~ion lield before test ~c,~ ~_.- (3;) Soil_rating (GPD/FF) ·Gravel thickness .Cleanouf present (Y/N) YE )Jter test System type T Total depth <~ ' ~ Depression over field (Y/N) t,-3o .for ~ Bedrooms Per~cide treatment (past.12 months) (Y/N) o,,~¢vz- i,.~o, (-,,..r~q "c~cCDIf yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: : We[Ionlot '> tlc)',(~ On adjacent icts '~- IJ.~' ([~) .Pmpertyline II ' · To building foundation I~. ~.~ ! (3~) To existing or abandoned system on lot IJ/~. On adjacent lots~Cutbank F.~o~ (D Water main/service line Surface water k3(:~c..- Driveway, parking/vehicle storage area ~(.~ ~ Curtain drain ~ E. ENGINEER'S CERTIFICATION I cer~'[y that I have checked, vedfied, or conformed to all MOA and HAA Engineer's Na~e"'~.~(E ~/,~'~ Date ./'~"/ /-J' ~/ ..,.. date of this inspecO'on. HAA Fee $ * ',~Oo ~ o_.._ ' ' Waiver Fee $ Daie Of Payment 4,/-/,,~-- ' ~ -" Date of Payment Receip~ Number. 72-02~ (3/93)' Bacl( 10:~ GI&E ENUIRUI't;J'H~ Lg~B f~_l~Jl~:5 -, 9g! ..M~ ~i~I~_~..~ONMEI'ITAL LABORATORY SERVICES Drinking Water Analysis Report for Total Colifo.ii Bactcria,~o~..'"' '..""~, .. · ~ INS'rRIICTIOA~S Ot¥ ~2~SE SIDE,BEFORE COLLECTING SAMP£E .,x: pan ~t.~ SAMPLE DATE: SAMPLE 0 Routine Month . Day Year 0 Treated Water O Repea~ Sample (for fonitne lampIe O with lab r~f. no. ,,-1 " SAMPLE LOCATION Untreated Waler Collected ]By TO BE COMt'L~II:D BY L3J]ORATORY A~yals thaws ~s Water 5~LE to k: 0 ~ple ~ 30 ho~ ol~ te~ ~y be ~llsblc 0 S~ple ~ long in ~t~ ~ple sh~d ant ~ ~ 48 ~rs ~d st cxa~na~on to I~ate reliable rcnlt~ P]~ ~d ne~v ~mple ~a s~nl deli~ m~l. An~ic~Mcthod: ~ Mcmbra~. Fil~r o ~b Ret. N~ . Re. It* An~?'st BACTERIOLOGICAL WATER ANALYSIS RECORD I& Cotl ~I,~,iO.FIUG Remit: Total Coliform ..... (~ Colo~les/l O0 mt L-~lff~nt~l! eo ~nl Et~/IRON%t~NTAL [(RV~C~S IN ~U,.~ .?~k%~.O~A~O. UIAH. ILLINO~ PART ONE OF TWO: REMAINDER TO FOLLOW Commercial Testing & Engineering Co. Env~ronme~te! Laboratory Bewice. LABORATORY ANALYSIS REPORT CI'&E Eel.# 94.14~-I Climt 8~,ml~le ID LIB BI Mt~l~ WATER 8m~lc Ramnrk~: ROtrJllq~ 8AMPLECOLI~ECTEDB BY: M.U. QC Allowable Ext. Aaa] I~a'~metet Rc~nlts ~ Units Md.ho~ Limits ~tc ~ In~t ~Hitra¢~-H 1.72 m~1. EPA 353.2/300.0 lO ~ CMR