HomeMy WebLinkAboutEAGLE CREST #1 TR B LT 21Eagle Crest #1
Tract B
Lot 21
#050-292 04
Municipality of Anchorage Pa~ 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Pe~'nlt Numbs:. SW990416 PtD Number:. 050--292-04
BRUCE AND UNDA KUM Wastewater System: [] New · Upgrade
19025 SECOND STREET EAGLE RIVER, AK 99577 ABSORPTION FIELD
P~xx:(907) 522-1006/696-2522 I~, o~
LEGAL DESCRIPTION '" ~ 0.7 ~,o/~. ~ *.1.5-2.0
21 B EAGLE CREST #1 +1.72-2.22 ABOV~ CRADE ~ 0.72
- - - 4.7-5.6 ~. 45
15 r. 4 3
WELL: [] New [] Upgrade ~ ~. ~ ~
~ ~ ~ 675 ~ ~ ~ D-~34~-BlO/~H
~ ~GLE MTN. EXCAV. 12/2-5/99
SEPA~TION
DISTANCES
200'+ 200'+ 200'+ - 25'+ ~ ~ ~ ~
~,=~ ~oo'+ ~oo'+ ~oo'+ - - LI~ STATION
Une 5'+ *2' 5'+ - -I
~ln NE KNOW
~ln NCI
~emo~s: 'RE0U[~ A 2 F'OOT LOT UN[ W~ ~O~ ~E BENCH MARK
N~ D~NRE~ TO ~E WE~ PROPE~ UNE. ~R~L TOP OF MANHOLE LID
~P.OV~ c~. ~ .~ .om w/ D...H.S. ON ~2/2/~).
** ~DED 2 TO 3 ~ OF M.O~ ~PRO~D ~D BLUR 100.00
FOR L~UNC ~R~~--~~
Ins~ons m,o~ by: A~C. INC. Dates: 1st ,2/2/99 ' ~PJ/~ ~
3~ 12~7~99 L~e' fY~ I IA.~r~s;?'"~
DepaAaent of Health.fid Human Se~es .pproval ~%.~.~. c ~
PERMIT NUMBER: AS :BUILT DILATING PN~CEL ID NUMBER:
SW990416 - 050-292-04
10' U~I. RY EASEMENT
~EXISTING Mi )UNDED BED TO
-- ~K~PRox.BOX~. ~~ B C
ST1 1/.7 26.2 -
ST2 22.4 31.7 -
UH 24.1 32.9 -
SECOND STRE~ DV 53.3 59.3 -
OLD UT1 59.6 61.4 -
OLD UT2 59.4 64.5 -
UTi 52.0 76.2 73.9
~T2 61.6 82.5 84.3
MT5 50.5 112.5 96.5
EAGLE CREST SUBDIVISION ~1; LOT 21. TRACT B
BRUCE ANDLINDA KLIM (907) 522-I006/696-2522
SW9g0416 ' 050-292-04
~ - ~2 (A~)
- ~.22 - 94,22
N~: A VIXEN ~l~R W~ INSf~L~P ~P ~ ~ ~P,
INS?K~EP ~M~(?O
IN~A~ON W~ INS~EP
~1~ ~ A ~:1 ~
~lbL ~ W~P ~ ON ~ ~l~lNfi PR~,
~S~ WA~R & WAS~WA~R CONS~T~S, ~C.
EAGLE CREST SUBDIVISION ,1: LOT 21. TRACT B
~[ OF WORK:
PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ~.~:L"~ ....... :'"J~
J.LM. N.T.S.
'Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~Anchorage ~Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
December 15, 1999
Municipality of Anchorage
Department of Health and Human Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Lot Line Waiver for Lot 21, Block B, Eagle Crest Subdivision #1
To whom it may concern:
We request that your department issue a 2 foot lot line waiver from the west property line to the
new drainfield. On December 2, 1999, we contacted your department and received verbal
approval for the waiver prior to the installation of the new drainfield.
I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems.
s, please contact us at 337-6179. Thank you for your assistance.
-$effq}bla/~3arne~,-I'-eE, M.S.
Pre~dentg
kECEIV(,
EI~IROI~iENTAL $~RVICF.$ Dl¥l~loi~
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Wa'iver Review Worksheet
HA%
WR# WR000001 PID# 050-292-0&
Date Received: 1/10/00
Legal Description: Ea_~la C~.~t #I: T~rr ~; Thy 91
Engineer: Alaska Water & Wastewa~er Consultant~
6901 DeBarr Roadt Suit9 2B. Anehora~a. A~
Applicant: Bruce & Linda Klim
Permit % SW990&I6
Waiver Requested:
new drainfield.
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
Points:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: 5~ ~/~$ ~/~'~
Date: I--/4-00
Name of Reviewer
Rec ~: 05704 Amount: $ ~5_~0 Date Paid: Il?/00
Rick Mystrom.
Mayor
MtmicipaliD of Anchorage
Department of Health and Human Services
825 "L' Street
P.O. Box 196650 Anchorage. Alaska 99519-6650
hltp:l/www ci.anchorage.ak.us
January l7,2000
Jeffrey Garness
Alaska Water & Wastewater Consultants
6901 DeBarr Road, Suite 2B
Anchorage, AK 99504
Subject:
Waiver Request for Eagle Crest # 1, Tract B, Lot 21
Waiver Request #WRI
Parcel ID #050-292-04
SW990416
Dear Mr. Garness:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
2.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program.
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Sen, ices
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 23, 1999
Expiration Date: Nov 22, 2000
Permit Number: SW990416
Legal Description: EAGLE CREST#1 TR BLT 21
Design Engineer: 0041 AK Water & Wastewater Consultant
Owner Name: Bruce &Linda Klim
Owner Address: 19025 2nd St.
Eagle River, AK 99577-
Parcel ID: 050-292-04
Site Address: 019025 SECOND ST
Lot Size: 17820 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewatar Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspect[on. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: /('/'~0 .,,'t ]1 .,~ ,,,'7 (./-
Date:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504
{907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
November 11, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Proposed Septic Upgrade Design for Lot 21, Block B, Eagle Crest Subdivision gl
To whom it may concern:
The existing 3 bedroom house is served by public water system and a private septic system. The
existing septic system consists of a 1250 gallon S.T.E.P. tank that was installed on 5/12/94 and a
mounded bed type drainfield. The existing drainfield is surcharged and is at times surfacing. We
are proposing that a new drainfield be installed and the existing S.T.E.P. tank be used. Two test
holes were excavated on the property. The proposed septic system will be designed around the
30 foot radius of test hole #1. Comments regarding the proposed design are summarized as
follows:
1. SOILS: Attached are logs which shows the soil profile, and the percolation test results. In
both test holes, the soils below the organic layers are a GM/ML material to a depth of 7.5 feet in
TH#1 and to a depth of 8 feet in TH#2 (bottom of test holes). Groundwater was encountered
during the excavation of the test holes at 5.5 feet in TH#1 and at 6 feet in TH#2. After seven
days, the monitoring tubes were checked and found water to be at 4.25 feet in TH#1 and at 6.0
feet in TH#2. A percolation test performed in each test hole between the depth of 1.5 feet to 2.0
feet which had a percolation rate of 3.3 minute/inch in TH#1 and 5.3 minute/inch in TH#2.
2. TRENCII DESIGN:
a. Percolation Rate: 3.3 minutes/inch(TH#1)
b. Allowable Application Rate: 0.7 gallons/day/ft2 (application for sand filter)
c. NumberofBedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 643 ft2
f. Total Depth: !.5 feet (maximum - remove all organics)
g. M.O.A. Approved Sand Filter: 2+ feet
g. Effective Depth: 0.5 feet
h. Width: 15 feet
i. Minimum Length: 45 feet long
j Effective absorption area = 675 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPIIY: As can be seen on the design, the topography in the area of the proposed
upgrade is a I to 3 percent slope running from approximately south to north; in short, there are
no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
NOTE: Attached is a site plan drawing, a design drawing, a profile drawing, two soils logs and
a 4 page construction specification letter which are allpart of the design package for this septic
system.
LOT 7, TRACT B LOT 8, 'IRACT B LOT g, TRACT B LOT 10, 1RACT B LOT 11. 1RACT B
EAGLE CREST S/D EAGLE CREST $/D F..AGLE CREST S/D EAGLE CREST S/D EAGLE CREST S/D
THIRD STREET
LOT 17, 1RACT B LOT 16, ~ B LOT 15, TRACT B
EAGLE CREST $/D EAGLE CREST S/D EAGLE CR£ST $/D
SERVE{) BY PUBUC SERVED BY PUBUC SERVED BY PUBUC
LOT 18. 1RACT B WATER AND SEWER WATER AND SEWER WATER AND SEWER LOT 14, TRACT B
EAGLE CREST $/D EAGLE CRE~ST S/D
.... ,,Ec =:._. _=_o?__,x ...... L ---
~ f / /'-~ ~ WATER AND A lOT 23. TRACT e
LOT lg, TRACT B LOT 20, TRACT B ~ ~ I;'~ ~. PRIVATE SEP~C EAGLE CREST $/D
EAGLE CREST S/D [AC, LE CREST S/D
SECOND STREET
[AcLE CREST S/{) F.~CLE CRES'r S/{) D~LE CR~ST S/{) EN;LE CREST S/O E~LE CREST
ALASKA WATER. AND WASTEWATEK CONSULTANTS, INC.
EAGLE CREST SUBDIVISION ~1; LOT 21, BLOCK B .... :., ,'Il ~:~.~ .........
SITE PLAN FOR SEPTIC SYSTEM UPGRADE A~.:ss.:
LINDA KLIM (907) 522-1006/696-2522 -
BRUCE AND '~fl"A '.! ..-"
DATE,: IDRAWN By: SCALE: PAGE [~.~p , ~o\
11/11/99] J.L.M. 1 = 100' 1 OF 1 '~'~\\;rof'es,,o ~
$.T.E.P. TANK APPROX.
ON 5/12/94.
DRNNFIELD UPGRADr'
EXCAVAT~ A BED THAT IS 1,5 FE'Er
(MAXIMUM -- REMOVE N.J. ORGANICS)
~f' 15 FEET W~D£ 8Y 45 FEET LONG,
ADD 2+ FEET OF M.O,~. APPROVED SAND
FILTER AND THEN 0,$ FEET OF CLEAN,
WASHED ORAINROCK. THIS IS A PRE~S-
JRIZED SYSTEM. SEE PRORLE. PAGE .3 OF .3.
.OCAT]ON OF'
OLD TRENCH SYS'TEM.
10' U'flUTY EASEMENT
BEOROOM
HouSE
INSTAL
DN[R1
A INSULATED
VALVE BOX
APPROX, LOC.
NOTE: THE CONTRACTOR SHALL HAVE THE EAST J
PROPERTY UN[ FLAGGED BY A REGISTERED LAND
SURVEYOR PRIOR TO ANY CONSTRUCTION.
SECOND STREET
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 D£BARR ROAD. SUr~ 2B. ANCHORAGE, AK. 99504
PHONE: (907) .3'~7-6179/FAX: (907) .338-3248
EAGLE CREST SUBDIVISION ~I.'
rYPE OF WORK:
DESIGN OF SEPTIC SYSTEM UPGRADE
~REPARED FOR:
BRUCE AND UNDA KLIM
BY:
/11/99 J.L.M.
LOT 21, BLOCK B.
PHONE NUMBER:
(907) 522-1006/696-2522
PAGE:
1 = 50' 2 OF 5
-7953 ..'
I" ~0' LONG LATTd~ad~'
~['. F Om HO --I
I
L1--1/4" LATL-RALS ($CH, 40 PVC: PIPE)
W~TH
~.7 FELt1' ON CENTER (FAC'"'"'"ED DOWN).
IMP[RMEABI r
~AS~ WA~R ~ WAS~WA~R CONS~T~S,
PHOND (907) ~37-617g/F~: (907)
EAGLE CREST SUBDIVISION ~1; LOT 21, BLOCK B, ...................
PROFILE OF PROPOSED PRESSURIZED BED
LINDA KLIU (907) 522-1006/696-2522
AI.ASKA WATEI{ & WASTEWATEK CONSULTANTS, INC.
6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK. 99504
ISOIL LOG - PERCOLATION TESTI~"~'""';R?,,~)",~']~J_~ '..?,~
LEON_ DESCRIFTION: EAGLE CREST SUBDMSION l/Il: LOT 21, BLOCK B.j." ........ '. ~"'l~/~/k./~ .............
PERFORMED FOR: BRUCE AND UNDA KUM
'TESTI' . ,i...'"
k~ dpt ~ ~:~
o G ,cs
i ~ ~ITE
~-~,Y~'~ GW ~ ORG ,RO~'OSm l I' = I00' J
GP ML uP~P~
GH CL
SH OH
SC
DEPTH TO DATE
GROUNDWATEJq
5.s' 11/4/99
4.2s' 11/11/99
SECOND STREET
11 DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
TIP1E (FIINUTES) READING (INCHES)
12 11/4/99 1 ~:48 ~ 8'
2 -~:S8 10 MIN. 2-1/2' ~-1/2'
4 4:08 10 M~N. 2-7/B"
14 5 4:08 6"
6 4:18 10 MIN. 2-:~/4" $-1J4'
15 7 4:18 6'
16 8 4:28 10 MIN.
9 4:28 ~ 6"
17 10 4:58 10 MIN.
11 4:58 ~ 6"
18 12 4:48 10 MIN.
19 PERCOLATION RATE :~.3 (HIN./INCH) PERC. HOLE DIA. 6' (INCHES)
//'~
2
TEST RUN BETWEEN 1.5 FT. AND _, ,-.0 FT.
COHHENTS: PERC HOLE PRESON(ED FOR 4 HOURS p~"~
PERFORMED BY ALASKA WATER &: WASI'~'WATER I,( / J(~//~ , CERT1FY THAT
THIS WAS PERFORMED, IN ACCORDANCE WITH AIL
DATE. DAm~" ---- STA~T~P I~JNI.~I$~GUIDEUNES IN EFFECT ON THIS
DEPTH TO DATE
GROUNDWATE~
5.S' 11/4/99
4.25' 11/11/99
ALASKA WATER &: WASTEWATER. CONSULTANTS, INC. ,00.F.. A~.,~
6901 DEBARR ROAD. SUITE 2fl * ANCHORAGE. AK. 99504 ~- , ........ ~,
ISOIL LOG - PERCO~TION TESTI ~:¢~ ~l
~ DESCRI~ON: ~c~ CR~ SUBDMSION ~I~ LOT 21, BLOCK B, ~?~': .... ~'~ ~"~;'J .........
~/ ~l
PERFORMED FOR:, BRUCE ~0 UNDA KUa {~[ ..... ~.~ ........
I I "' '"'
~~ ORG~ICS TEST HOLE ~2 "~?"~:¢~,--. ".,.,. ........
~ SITE PLAN
~ GW ~ ORG PROP~EO "= O0
SE~C
GH CL .............
GM/ML GC T ~ OL
SW MH -----~ ........
~ sM OH
SC
DEPTH TO
GROUNDWATER DATE
~.o' ~ ~/~ ~/~*
SECOND ~RE~
11 DATE RE. lNG CLOCK NET TIME WATER LEVEL NET DROP
TIHE (HINGES) RE. lNG (INCHES)
2 ~:56 10 MIN. 4-3/4' 1-1/4'
13 3 3:56 ~ 6'
4 4:06 10 MIN. 4-1/8' 1-7/8'
14 5 4:06 I 6' I
6 4:16 10 UIN, 4-1/8' 1-7/8'
15 .... 7 4:16 I 6-
16 8 4:26 10 MIN. 4-1/8'
9 4:26 ~, 6' I
17 10 4:36 10 MIN. 4-1/8' 1-7/8'
11 4:36 I 6'
18 12 4:46 10 MIN. 4-1/8' 1-7/8'
19 PERCO~TION ~TE 5.3 (MIN./INCH) PERC. HOLE DIA. 6' (INCHES)
20 TEST R~ BETWEEN 1.5 FT. ~D 2.0 FT.
COMMENTS: P~C HO~ PR~ FOR 4 HOU~ PRIOT TO ~.
P~FORMED ~ ~ WA~R · W~A~R I, , CE~ ~T
~IS W~ PERFORMED ~ ACCORD~CE W~ ~ ~A~ ~D MUNICIP~ GUIDEUN~ IN E~ ON ~IS
DEPTH TO
GROUNDWATER DATE
6.0' 11/4/99
6.0' 11/11/99
Municipality Of AhChorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
.,~,: ~ ~~ Wastewater System: D New ~pgrade
A~,..:IqO~ '~ ~ ~' ABSORPTION FIELD
GPD~.
WELL: ~ New · ~ Upgrade ~ I
'1 SEPARATION DISTANCES aseptic a Holding ~S.T.E.P.
Sa',* LIFT STATION
'Water ~O~ [o~ t~ ~
Lot
Remarks: ~~ ~ ~ BENCH MARK
Reviewed and a~proved b~~~ Date: ~
Pe~mlt No~. ~,/ '~.,~o~:/~, Page '?- of
· Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN S.ERVlCES ;
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone:· 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report .
"j~ORTH pAc
· ~EL'E'CTRIC
LICF_HSED ' BONDED ' INSURED
Industrial - Commerclal - Residential
36.55 Ruth Drive
Wasllla, Alaska 99687-9201
(907) 373.4767
FAX 373.703~,
t-Hz='- · ..rpz/
,:.: -,., . ; .,
PAGE
1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940096
DESIGN ENGINEER:DAVID R. DAYTON, P.E.
OWNER NAME:WALLACE NATHAN E & ANATHEA J
OWNER ADDRESS:19025 2ND ST
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 4/26/94
EXPIRATION DATE: 4/26/95
PARCEL ID:05029204
LEGAL DESCRIPTION: EAGLE CREST TR BLT 21
LOT SIZE: 17820 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHOP, AGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
ISSUED BY: ~~
D. R. DAYTON, P.E., R.L.S.
~.~::B~f,:xl~6 Chugiak. Alaska 99567
20210 Ponalar
(907) 688x~4~
696-2417
April 26, 1994
Municipality of Anchorage
Dept of Health & Human Services
P.O. Box 99519 '
Anchorage, Alaska 99519-6650
Attn: Mr. John Smith
Re; Lot 21, Tract B, Eagle Crest Subd.
Dear Mr. Smith,
Please review the attached site plan and issue a permit
for a replacement STEP tank to replace a leaking septic tank
and lift station.
The existing mound has been tested and is functioning adequately
for the 3 bedroom home.
The new STEP tank installation will have no detrimental
affects on drainage or reserved space. The house is served
by the AWWU water system.
David R. DayEon
POUCH 6-650
ANCHORAGE. ALASKA 99502-0650
(907) 264-4111
~Permit ~: 821148
(Mou nd )
.January 31, 1983
TO: Permit Applicant
Subject: Lot 21 Eagle Crest Subdivision
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerel~
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
swp/057
,..,MUNICIPALITY OF ANCHORAGE,,-.,,
Department' ~ Health and Environmenta'. ?rotection
825 L Street, Anchorage, AK. 99501
264-4720
~ ~ ~ HANDWRITTEN PERMIT ~ + ~
W'E'L~AND/OR ON-SITE SEWER PERMIT
~-F~twW~4-~ Mailing Address:7~k
Phone Number:
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the.excavat%o~(in feet). There is no set width for ~r-e~ches.
The gravel depth is the minimum depth of gravel between the outfa~ pl~e and
the bottom of the excavation(in feet).
' ' REQUIRED SEPTIC(HOLDING) TANK SIZE = ..'-L'-~----. -- GALLONS~_.~
Permit applicant has the'responsibility to inform th~s department dur~g/the
installation inspections of any wells adjacent to this. property ardfh~ ~umber
of residences that the well will serve. '
· ' ' ' TWO(2) INSPECTIONS ARE REQUIRED #
will be sub]ect to prosecutzon.
Minimum distance between a well and any on site s~wage di~s~% ~s~% ystem is' 100 fe~
for a p~ivate well or.150 t? 200 feet from a.publlc well de e~. ~g upon the type
of'public well. Minimum d~stance from a private yell ~o prl ~te sewer line
is 25 feet and to a community sewer line is 75 fe~. W~i ~og ~are required
and must be returned to this department within 30~ays ~of ~e well completion.
Other requirements may apply.. Specifications. and~c'const:~uuc ~dq diagrams are
available to insure proper. Installation. ~
* * * PERMIT EXPIRES DECEMBER 31 ,t 918: ' * *
I certify that: ~.~
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3.bedrooms.
Applicant
Date: ·
SWP/024 (1/81)
Location:
Legal Description: a~ ] ~ ~ Lot Size: --
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed~ holding Tank:
Maximum Number of Bedrooms:_~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:'
DEPTH ~LENGTH . GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
" ENGINEERS, INC. t'", ANCHORAGE,71:>5 OLD SEWARDALASKA HWY.9950:5 ~ ~ $o,,s LOG
· . ,$*. ':~11' :549--6561 : ~i~' pI~RCOLATiO"
'- ~ . TEST .. ~ ]
· SOILS LOG-- PERcoLATION TEST ': -: '*:": :' '
PERFORMED FOR: ~---~:¢/~' '' ' :/~/~'~'~"'~"' "~ ' '-' ' DATE PERFORMED: /~,~/'~'~' ';'" '
' : ':'-': .'. '.:.:.~".' . .i".; :... ..... ""
... ..... . , .. .,:
LEGAL DESCRIPTION: ~ ' ~f~ ~. * * '
- .... sco. E - . S~E PeA. . *
10-
ENCOUNTERED? .~'~,.~' ~
WAS GROUND WATER S
P
:13t . ........ IFYES. ATWHAT:.. . ,. .' --' //._. E,
" '- "" 'G~E,.-' . Net ';.: Dap;hto :' Net
Re&d;e~g.. Date. · Tir~e..'~; :T~me :.:.. " Warm' ': '1 ' Drog, .
,
r
14-
15-
16-
17-
18' -
19-
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
NUMBER OF
MANUFACTURER ~'~"~ 5C'7' MATERIAL F/~15 ~"~ ~ COMPARTMENTS
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACIT~ ~:PGALLON$.
TILE DRAIN FIELD:
DISTANCE FROM WELL /~'~'"'~' FOUNDATION ~*~ ·
NUMBER OFLINES DISTANCE BETWEEN LINES
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE ~'/~::~ / TOTALoF LINEsLENGTH
.TRENCH WIDTH'~/[N. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE / ~'~ '~ '~ /
DEPTH OF FILTER ~
~/' MATERIAL BENEATH TILE~ IN. ABOVE TILE ~ IN.
WELL= {~,/]C//
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
SEPTIC SEEPAGE
TANK , SYSTEM
CONSTRUCTION DEPTH
NEAREST NEAREST
. LOT LINE , SEWER LINE
OTHER SOURCES
DISAPPROVED REMARKS
DISTANCE FROM=
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL: (?~'~"~
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
Form EQ-032
' >
GRe,. _R ANCHORAGE AREA bO ~JGH
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
~ / , .~
PHONE
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL SE SUBJECT TO PROSECUTION.
DRAIN FIELD /~ '~ /'
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
GREATER ANCIIORAGL I',RIZA UOROU6,,.
· Department of Environmenlal quality
3330 "C" Street
Anchorage, Alaska 99503
SOILS 1oO(; - I'EROI,^TION
Perforn~d for ~(~,r,~ '~',-~-~,-~- w Date Perfqn;,~d ~-Pq-~--
This fom reports: Spiis .lo9 y ' ~'jr,¢+- ~ -- Percol~tioh ~st ......
Depth
Feet
1-
2-
3-
4-
5-
6-
: 7 -
8-
9-
lO:-
ll-
1~-
13-
14- ~ t~._o
Was ground water encountered?
II I
Il I
~0~0
Y~. __ if yes. at what depth? /~/'/
Reading Date
Percolation rate
Gross Time
m)-nute.
-Proposed i ns tal 1 a~n.= ~ge Pi t
Depth of Inlet
COHIIEI'ITS:
Net Time
__Depth to Water
Drain Field
Depth to bottom of pit or trench __
Net Drop
Eq-040 (6/74) ~ "
· "0 E~ E GEOTECHNICAL ~r DEVELOPMENT CO.
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
r~usse/I Oyster
394-2774
;oils ~t Foundations
Earl Ellis
688-2280
Land Development
SOIL LOG,
Perfomed for: Hame: ~;~//1/~ ~'~/~ Z:~c/. Tel. Ho.
~JlJng Address: ~¢~ ¢~ . ~ ~r~,,
Depth (feet) Sql1 ~he~acterlst~cs
2
3
4
9
11
12
Ground Water Encountered: Yes Ho
,,Proposed Installation: Seepage Pit
Comments:
,'i
~,4//T~-///-/
Performed by:
/ If yes, what depth
Drain Field
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) I?Q Z-';,-' '~.~_~_~ ,~ ~,o,~_~ JP-~v~x~--
Property owner /J~'r~,~J
Mailing address ~ ~I o ~.~ ~ ,~.d ~_ ~'---A~.~
Lending agency
Day phone --'"-~-
Day phone.
Mailing address
Agent Day phone
Address
e
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER ,
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 application 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 furtherverify 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.
David R. Dayton P.E
Name of Firm 20210 Donalar St.
Chuglak, Alaska 99567
Address .,
6. DHHS SIGNATURE
Phone d.?G- ~'~/?
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 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 DHHS 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. '
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~.o-r ~ ! '"~'~=r [~, Pamel I.D. ~:,.~c:~ - ~?
~ ~r
A. ~ll O~t~
Well ~pe ~ ~A, B, or C, a~ach ADEC le~er. ADEC water system number
Log present ~) .Date completed Driller
Total depth
Sanitary seal (Y/N)
.Cased to
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Casing height
.Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On'adjacent lots
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
; On adjacent lots
.Public sewer manhole/cleanout
Petroleum tank
Coliform .Nitrate
Other bacteria
Date of sample:
.Collected by:
B. SEPTIC~ DATA
Date Installed -,~-/'~'7-.-7/'~'/4' Tank'size /7_ ~"Z> Compartments
Cleanouts (Y/N) ~' Foundation cleanout (Y/N) "// Depression (Y/N)
High water alarm (Y/N) ~ Alarm tested (Y/N) ~x
Date of pumping ' /[//~---&.~.) '7"'~r--V~__._ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO;
Well(s) on lot __
To property line .~
Surface water/drainage
On adjacent lots [ c> ~ Foundation
Absorption field ~'..~ .Water main/service line ~-..-~"~-
~2-02s (~3}. ~,x,t CONTINUED ON BACK PAGE
C. UFT STATION
Date installed
Size in gallons
Vent (Y/N) ,1/
High water alarm level
Meets MOA electrical codes (Y/N)
'Pump on' level at
Manufacturer
Manhole/Access (Y/N)
~ 2.- 'Pump off' Level at
Cycles tested 2.-
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot /g//~- On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
.-. Date installed
'-Length
- Total absorption area
~, Date of adequaqt test
IO/8'-/-.
Width
,./- ~"z-
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft~) ~:5 5'- System type
~ Gravel thickness ~' Total depth 52 t,,,~,,~-~,.
Cleanout present (Y/N) Y Depression over field (Y/N)
Results (pass/fail) / 2~ -c-~ for ,.~ Bedrooms
,c:) After test ~:~ ~
/'J .If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots ~o
Surface water I ~ ----.
Curtain drain J~o,u =~-
On adjacent lots I ~ Property line
~' To existing or abandoned system on lot
Cutbank ,,1,//',~ Water main/sen/ice line
Driveway, parking/vehicle storage area ~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, vedfied, ~r conformed to all MOA and HAA guidelin~s in effe_ct~g,r~__l~ o.f this inspect/on.
· ..tt.~ OF 4t..,'~-
' '~02! 0 Oenalar St. '
Signature ,,
Eng,neer's Name ~-..-.~1'-- ~--~'~ ~..
Date ...";4",-
HAA Fee $ ~,~ ~) ~ ~ Waiver Fee $
Date of Payment ~'"-' '~" ~ F Date of Payment
Receipt Number ~'-~ ! <~ L"//-~C/ Receipt Number.
~2-028 (3/93)' Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # &~._~_/0-- ~-'~.~
HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone
Mailing address
Agent ~' ~'~'~z~ ~"~$ ~,,-_ -' Day phone
Address /&.~.~:, ~L~.~..~;,.~'~.~' ,~.¢:. ~-d~-- .~',.4.r~,
........ ~ ~'~x~ ~,~"-. ..........
............... Unless otherwise requested, HAA Will be held for pickup.
2. NUMBER OF BEDROOMS: -~ '"'
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community On-site
Public sewer
NOTE: If community wastewater system, p~ovide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
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 application 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.
NameofFirm !,~,,~';m ~-. ~rD,,~ ~.~-, 'Phone
Address ~ ~~ IO~ ~~ : ~
Engineers signature ~~'~~~ Date
ApprovEd for ~.~
Disapproved.
Conditional approval for
bedrooms.
6. "DHHS SIGNATURE
bedrooms, with the following .stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 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 DHHS 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.
'Municipality of Anchorage .
'Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~.~OT' Z 7'P-A'~T, ~:~ Parcel I.D.
A. WELL DATA
Well type P~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
\/
If A, B, or C, attach ADEC letter.. ADEC water system number
Date completed I Z. / z-'7/? ~ Driller
Cased to Casing height. ~_.
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test
Staticwaterlevel ~'z..q ~, ~---,~.o ~,~- ~,~r ,~:~r..,~- 'r~
Well flow 2~. c;, g.p.m. -~ 7*- g.p.m.
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ I
Absorption field on lot I O ¢5>
Public sewer ~ain fJo NI~
Public sewer service line ~r.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS: ,
Coliform ~:~ d'//~.3,//gz.- Nitrate ~,10 A~.D ¢//o/'~Z- Otherbacterla -
Date of sampl,: 4~/'),/~Z ~/ ~I/z'z- Collected by: 'j~--{~¥yT~,~) '
B. SEPTIC/HOLDING TANK DATA
Date Installed '/Z./'7 ~'
Cleanouts (Y/N)
High water alarm (Y/N)
Date 0f pu~nping'
I
Tank size I o o c:~ Compartments
Foundation cleanout (Y/N) ~' ' Depression (Y/N)
Alarm tested {~/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot G I On adjacent lots /~:~ Foundation /F
To property line ~'~" Absorption field -,~ ~-- Water main/service line,
Surface water/drainage /[11~" '""~-~'P~'~) ~
~-~(~,.~n F~ ~o^~ CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed ,,
Size in gallons
Vent (Y/N)
High water alarm level ~_ .O
Meets MOA electrical codes (Y/N) Y
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot- ; 7 /
?-' · Manufacturer '
~ ~l~r~ c~ ~.~,..~ Manhole/Access (Y/N)
"Pump on"ie,~el at "Pump off" level at
Cycles tested
On adjacent lots
D. ABSORPTION FIELD DATA
Date Installed IO/
Length Z-~ ./ Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail) ' '/~'~
Peroxide treatment (past 12 months) (Y/N)
Surface water
Soil rating ES~'- System type
Gravel thickness
Cleanouts present (Y/N)
Date of a, dequacy test
for ~
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot '~oo OnadJacentlots i~ /Z~-~ Propertyllne ~r-'~"'
TO building foundation ~-'~) To ex~ abandoned system on lot
On adjacent lots .,.~O Cutbank /,7o ~ Water main/service line
Surface water /(~u ~ -~--~'*/~:) Driveway. parking/vehicle storage area ~-~ ~--
Curtain drain'- ~Jo~J~' '
,.. , .'' ., ~, ,\..',"~ , .
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In'effect on the date of this inspection.
Signature
Engineer,s Name '"'~d..3
HAA Fee $
Date of Payment
Receipt Number
Waive~' Fee: $
Date of Payment
Receipt Number
D. R. DAYTON, P.E., R.L.S.
HC 78 Box 1026 Chugiak, Alaska 99567
(907)
696-2417
April 9, 1992
ADEQUACY TEST
Legal Description: Lot 21, Tract B, Eaglecrest Subd.
Date of Test: April 7, 1992
Septic Tank: 1000 gallon, Sunset Plastics, 1 comp. (DHHS Records)
Absorbtion S~=em: Mound approximately 12' x 25'
Soils Rating: 85 sf/br
Design flow: 450 gallon per day
Test: 450 gallons of water was injected into the absorbtion system in
a 3 hour and 30 minute period.
Results: The system accepted a days design flow in 3% hours with a total
rise in the monitor tube liquid level of 0.25'. The liquid
level dropped to the original level in 8 minutes.
Conclusion: The septic system absorbtion bFd is currently functioning
adequately.
D. R. DAYTON, P.E., R.L.S.
HO 78 Box 1026 Chugiak, Alaska 99567
(907)
696-2417
April 9,1992
WELL FLOW TEST
Legal Description: Lot 21, Tract B, Eagle Crest Subd.
Date of Test: April 7, 1992
Depth of Well: 285' From well log
Static Water Level; 229' well log. Could not measure as probe caught
on wires or drop pipe.
Standards: The Municipality of Anchorage requires 450 gallons per day
for a 3 bedroom home.
Test: The well was run at an average rate of 2.3 gallons per minute
for 3 hours and 30 minutes.
Results: The well is adequate to meet the requirements of the Municipality
of Anchorage for a 3 bedroom home.
David R. Dayton, R. LS.
HC78 Box 10'~'6
Chugiak,Alaska 99567 Ph;(907) 696-2417
Easements of record, other than those shown
SUBDIVISION'' on the recorded plat ,ore nol shown hereon.
RECORDING DISTRICT, ALASKA
A'CtlEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562.2343 5633 B Street
Anchorage, Alaska 99518
Drlnklng Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D.#
~__ PRIVATE WATER ~Y~
Name ! Phone NO.
Mailing Address
City $1are
Mo. Day Year
?'7,:¢--,, 7
Zip Code
SAMPLE TYPE:
~,,Routlne~ ~
Check Sample (for routine sample ~
with lab ref. no. ; ) [] Treated Water
[] Special Purpose . ,~BC, Untreated Water
SAMPLE I Time * Collected
NO. LOCATION Collected By
' I
I
2
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
/l~Satisfactory
[] 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 mall,
Date Received L~/I I~ I~Z
Time Received I ~ 0"~
Analytical Method: Membrane Filter
No. of coloniesll00 mL
Lab Ref, No.
~2.147~
I I-FI
II-FI
I
Reael_t°I~q~' A.~st
R£AD INSTRUCTIONS
BEFORE
COLLECTING; SAMPLE
TNTC = Too Numberous
OB = Other Bacteria
BACTERIOLOGICAL WATER ANALYSTS RECORD
Membrane Filter:. Direct Count
Verification: LTB
Final Membrane Filte:..Reeults
To Count
~ CollformllOOml
PART ONE OF Tq~'O
REIIAIRDER TO FOLLO~ ·
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
/ ~/ /~,~ / /]///~ Anc~orage. Alaskag9518
.
Drinking W~,ter Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
CI PUBUC WATER SYSTEM I.D. #
/~PRIVATE WATER SYSTEM
Mo. Day Year
SAMPLE TYPE:
J~Routlne
CI Check Sample (for routine sample
with lab ref. no.
n Special Purpose
[] Treated Water
/~;t/~Untreated Water
SAMPLE
No. LOCATION
Time Collected
Collects! By
31 I
41 I
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Satisfacto~
n Unsatisfactory
I'1 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 delivm7 mail.
Date Received
Analyilcal Method: Membrane Filter
* No. of colonias/100 mi.
Lab Ref. No. Result*
I I-1-1
I I'-I'-I
I I-I-1
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct count
Verification: LS8
Focal Coliform confirmation
,Flnal Mem b rene/,~r ,' RelUttl ~
Reported By ~
Coliform/100 mi
TNTC = Too Numerous To Count
OB = Other Bacteria [
BGB
Time:
Collform/lO0 mi
Municipality of Anchorage Page of.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SZ~,~ PID Number:
"~ ~ ~~ Wastewater System: D New ~ Upgrad~
~ ~ ~ ~Ty ABSORPTION FIELD
~&' 7~o/ ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~Mound ~ Other
LEGAL DESCRIPTION SoilRating: ~ GPD/Sq F, ~ Total Depth lrom odginal grade:
WELL: D New ~pgrade ~ravel width: ~
Class¢~cat,on {P~,vate. A.B.C): To~al Depth: Cased To: ~olal absorption area: Pi~ material:
SEPARATION DISTANCES XSeptic ~ Holding ~ S.T.E.P,
SuHace
Lot Size in gallons: ~ Man
Foundation
Remarks: BENCH MARK
L~ation and Descriplion:
Inspections performed by: ~' Dates: 1st
Department of Health and Human Seffices approval
~eviewe~ ~nd ~pprove~ by: D~te:
,. APP/"~/~NT FILLS OUT UPPER H,"'~*.ONLY
Address · rm Zip Code
Phone
Type o! Residence
~ Single Family
[::] Multiple Family NO. of Bedrooms_ ~' ~_ /
I dlvldual Installed:
~'~ub~i¢ U~l~lty ~ {~onnected to Pubflc Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIALED.
Time Time Time Time
* MUNICIPALI~ OF AN~O~
{ ~) APPROVED BEDROOMS ~ ' U ~ 'CONDITIONS OF APPROVAL
Soils Rating Data ~wer Insl~ Well To ~sorptlon Araa Well LOg Recetved
Inhh~'~ .Milli-,. :..~leve'?: ;,!.,?," -:'l~etaified ['-. ::'" ~ .r'_x-e. rc.e-nt. '."'" ' "..:~:'Fe~cent'~.: J,
~,e{era'-' "?~egh":'>; ; ;' ' · ';' '- -: ' ~e~alnea . ~'" ~ ' liner"
· · . .- in Cra~s-.' , · ... .
'1.~ . ~ ',' · · ' ' ' ' ': ' ' :
- 1. O~ ...... 26~ 67-~ -~.'~-,- ' ............. ~- '~-:.'.,-~-..~ ............. ' ....... ~-~ ..............
"o:v~ '~S ......... ~:~; '"~ ...... ' "? :-'"' -" ..... ' .... ' ............ ' ...... - '-~,"'
. ; ; ,,', ... ..... ,. '.'<~' :.' .- ...-, .:., ~:-- ..'~,-.......-?- . .
' " " ' ..... '
~,.-....: ....... .~. ~ ..: ~.. ~ .- ,.
o.~ ~'~'"' ~"' ":' :' '~ ~/
- ' ..... ~'~: ~' "'" " -..-. '/-:~ '.0.....
0.371 9.423 " ...... ' ' ' ' ' ' ' : *:
0.~'., ', ~.6~.- ~e~-'. ,,~'-'~,~, .. : ..... .~ ~ ..~, ,,,... ~,- .,~.. - ', : ........
,'0~' 1~:'~ ....... "''.'4. 699 ;?~ :.~(~4 )f.~.~'~' ...... '~'~"~'" :': ~,.. ~'~" ...... '" ~?":'::' ;y." '~' ..... ...... "" ~ '. ~'?,..~/~......:"'" "~"-" :" i[':.~ ":~'~ ~/~'; "~',':'1~ ,,.~
093 '. ~.,. .,.~ . · ........
I'~; ' ";:fl)7 .'
' OiOt6". ~'.. , [ ,~i i~e. ::~' ": ...... '.:, -.' ,,:.."-. ~'` ",.. '.. '":.~." ....... .?.. '.... , ~. ..., ,.," ....... .,." ' . ". ....~' ' ::' :'?,. .... . "'.
. .' ..,? ~ "~' .;. ,. .,~,_.. ....... :. · . .,,....:.,,~.~.,.,:,.~,. ,....,,~ ....-,,-...
0 ~8: "0 ' :'~-.~.;~;% '~-..-'..' ',''~ ...... · ....... ... , ,' .- ., . ..... , .
6~32 ~ ~-[~ ..... .. ::.., :,.,.~.:.. · , ~... ........._ :, , . · ,~ ......'~:.: ,.-...
' 0.~9 ~ :: ~ ..:,'",,'c . ' .... '. ....
,' .... '~."~.,. ' ..... , ., ~ ""' , .... ~1 ,. .....
..... ' "' "" .... ' ..11 '-.'~''
'0. Cl16 ~' j[0.29 : ;'~,~"<' ;:U ~- :'" · '~;'~'~" "'"' ~' "' "' ' "' ' "' "" ...... : ....
..0.~ ,.- ,, 0.208 :. .-~,.::..; ' ' .' ~ .....................
:0.~ f; '': ........... ' ............
~O.~4~'.L ,:.. .... .: ...... . .~:.~' .-,'-'.- . :,, .... .~"''- ...... -. ,. ~",. '" :; ; '~'- ;'"" .'" :.' ...., '- .... ' '.-"., ""' u
'- .... ' ' '~ '." ~'"'~" :' '"" ' ',l" ;': ~;'~;~" .7;"~?-~":',';' 1' .;7}' :;'' '~ ' .~-I ,..-- . .,: '. ..., -...- ....
St EE. STREET ;.e ~EVA~$TC~
, './~- MUN,C,,AL,. O, ANC.ORAOE. .., ..,""" ~ :,, :;.' '.. ·
t ;/I ~ DIPAR~E~ OF H~LTH & E~IRONME~AL PROTECTION ' ~" ',. ;: , : .
~/ ENVIRONMENTAL ENGINEERING DIVISION
", r':" ,':~
REQUE~ FOR ~PROVAL OF INDIVIDUAL WATER ~D SEWER FA~IUTIES ....
DIRECTIONS: Complete a4l parts on [~ge 1. Irdtam~lem ~ will I~t be p~m:msed. IMe~e allow ten (10) abyi for pro~e~ing,
1. PROPERTY OWNER I PHONE
~obert Miller [ 443-5363
MAILING ADDRESS
Nome, Alaska
PRO~.RY¥ RESIDENT (IF different from above)
BUYER
Villiam H. & Mary Pomery
MAILING ADDRESS
2511 ~ake Otis Parkway, Anchorase, Alaska 99504
:~ ~ENDiNOIN~iku'i'ION
Alaska Mutual Savings Bank -- Attn: Smitty
'MAILING ADDRESS
P. O. Box 1068 Eagle River, Alaska
4. REALTOR/AGENT
S~mone A.J. Thomson ***
MAILING ADDRESS
Parkgate Building __ Area Relators
PHONE
PHONE
278-2489
PHONE
694-9572
PHONE
694-9555
k'Note please call the realtor for appointment date.)
LEGALpESCRiFTION
Lot 21, ~ract B Eagle Crest Sub~.
~[~ttl LOCATION
Kt~ 2nd Avenue
TYPE OF RESIDENCE
~ SINGLE FAMILY
r-I MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] Two i-'1. Five
~] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL·
[] COMMUNITY
[] PUBLIC UTI LITY
t SEWAGE Di~,~,~AL SYSTEM
I--~ INDIVIDUAL/ON-SITE**
f-] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is reqt;ired for all wells drilled
since June 1975. For wells drilled prior t,o that date, give well
depth (attach log if available.)
· * I f individual/on.site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3178)
~,ii THIS SIDE FOR OFFICIAL USE ONL
~"~ DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DtRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
r--I SINGLE FAMILY [] ONE [] THREE [] FIVE r-'[ OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR r-I six
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
DPVBLICUTlUTY I l-/-" '/5"
Connection Verified INSTALLER
[~'~ptic Tank or []HoldingTank
Size: IOoo If Tank is hornemede SOILS RATING
give dimensions: [ ~.~"~
TYPE OF TANK MANUFACTU~I~.....~..,
TOTAL A~ORPTION AREA MATERIAL
5. COMMENTS
~'"~APPflOVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must aceo/j~any certificate)
//
[] DISAPPROVED
DATE BY (T;tte) / /
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
' ALAS' ~'-~'~,ARTMENT OF HEALTH AND SOCIAL
~ ~ DIVISION OF PUBLIC HEALTH .. -'
BACTERIOLOGICAL WATER ANALYSIS
Office
PLEASE MAIL RESULTS TO:
NAME
ADDRESS
ZIP CODE
Sample collected by \:'"' ~'
Fnone No.
~.te Coll,~. ? - / / - ') ~
Time
Sampling Address
Specific place o f collection
REASON FOR SAMPLE SUBMISSION:
[] flln~ ~uspeeted
[] Health Regulated F~tsblishment
r'] Other ( ~ F, ~.~
WATER SAMPLE SOURCE
[] Well ~ype of casing
[] Improved (Enele~,d, CovemJ) Sir.'ing
[] Surface (Rt~ervoir, strewn, lake)
J--] Holding Tank
[] Other
Analysis shows this WATER sAMPLE to be:
[] Satisfactory
[] Unsatisfactory '
[] Questionable' ' [] submit other sample
[] Sample too long In transit to indicate reliable results.
Sample should not be over 48 hours old at time of
examination.
[] Bottle broken or leaked in transit.
[] Other
SANITARIAN'~ REMARKS
'SBnitirian's Si~re . f~ ('~)
A IN R TI N
O N M
04~-1220 (b}
BACTERIOLOGICAL WATER ANALYSIS RECORD
1Omi Tut)~s Positive/Total lOml Portions
LOG OF DR._,..,NG by A & 'L' DRILL..'~.~ COMPANY
ADDRESS .................................................................................................
WELL SITE ..~..~/:~.-~c.~.....~..r.J-~..~.T......~2~J ......................................
DATE---STARTED ... J...~.. Z.?...~... / .?...~. - .~.. .............................................
DAT~ENDED ....... ] ~...../?..~..../Z..~- .~.. ..............................................
DEPTH OF WELL c~'~"'' ~" ' '
DRAW DOWN FT.
CnLS. PER HR.
K~N,) OF c.,.-~N~ ...~..~'...~.~ ........................................
KIND OF FORMATION:
FROM ....... .~... ........... FT* TO......~... ............... FT*....~,.'~...L'.'..'~..~:~.*~..O..~/'''~ FROM .~...~.~.. ............ FT. TO...(.~[ ..'.'~... ........... ~r .,.~....~...O...T....~.~..N.....~.
FROM.....~'D.... ............ FT. TO..J~ .............. FT...,,[~R...~...~.~...~,,"~4, r~OM...J.~.'~..--........FT. TO....~..~....'~. ........... F .T'~.,...~.~...~...~.'.~,,~.?..~'~
lA FT .m ~- FT~"~ ~"'J (~'"¢~,,o~ i7o -"" To....~.:]. ....... FT.Jt'/..~....; .............
FROM ...................................................................... I ................. '~ .................. ~ ~'*
FROI',I.....'..~.......~".~ ........... FT. TO.....~,.~....~..7. .......... FT....~....~... ................ FROM...~#'~.~....'~. ........... FT. TO....~...~.?.. ..........FT..,,..~...?...~.....-.~'~..'~...?
FROM....~.S.--.. .......... ~. TO..J.~ ............ ,",...H.~......'"'/....~',"~'%OM...).....t..O. .......... FT. TO...~..L'.. ......... ~.....,[..,:c.r:.. ...........
FROM....J..o....O. .......... FT. TO.....~.,/.,,O.. .......... FT.....~....~,,.~..0. ............ FROM.....'.~....".~...O.. ....... FT. To....?.'....7..7. ........ rt...~..~. ................
FROM......I.L~ .......... FT. To...JZZ ........ FT ......... ~../.~.~. ....... ~'RO~..~.7.7. ......... FT..,o...~:..~.'Z........~....~.,'/.~.~. .........
rlIOM...J..'~.~'. ........ FT. TO I ~O FT.
......................................... TO ........................ FT .............................
MISCL. INFORMATION:
. . MUNICIPALITY OF ANCHORAGE
~ ' DEPARTMENT OF ENVIRONMENTAL QUALITY
&4UNICIPA[ITY OF ANC~RAGE · 3330 °'C" Street, Anchorage, Alaska 99503 - 274-4561
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIOi'~
JUN 3 01916
,. p.E EIVED
Inspection:
2. Property Owner:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
CMRO. VA.
FHA. CONV.
Mailing Address: . ~.A~le R{ver Loop Rd.
3. Name of Buyer:. Robert and Judy Hiller
Ea~l~ River Day Phone. 694-2222
.... Ma_i!i0g A_ddress:. Ceneeral Delf. ver,v Eagle River Day Phone 8~63-82,85
4. Name of Lending Institution:. A-l. aska Hutual Sav:[n~s Bank--Chris
Mailing Address: P.O. Box 1120
5. Name of Realtor or Agent:. None
Anchorage, Ak
Phone 274-3561
Mailing Address:
Phone _
6. Legal Description:. L 21 Tract B Eagle Crest S/D
Location:. NIIN 2nd Ave. Eagle RiPer, Ak
7. Type of Facility to be inspected: . S?
No. Bdrms. _ 2
8. Water Supply
Type of Supply: Public Utility . Individual
If Individual, number of dwellings presently served O:;E
If Individual, depth of well .
9, Sewage Disposal System
Type of System: . Public Utility
If Individual, date of ~nstallation .
37 (1/74) ' ' ' '
Individual (on-site) .
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
..'" L~ /
q.~. ',l., J~?~'~' .~t_.~ Date,Received J.~e ~,, 1976
.~JF ,4~.,,j 4f //~ F -(~ ) . Time of Inspect,on ~..~y~) ~,
~,~...,IA Dateof Inspection
~ . ~ REQUEST FOR APPROVAL OF "
,
~ ~ INDIVIDUAL SEWER & WATER FACILITIE~ ~
1. App~v,1 requested by: ,l?ska .gtual 5~,, qS Bane, Ch:zs
Mailing Address:, ?Qst Office Box 1120 Phone: 274-3561
Z. Proper:y ~er: Larry and ~na Person Phone: 694-2222
Ma~]}ng Address: Eaqle River Loop Road
3. Legal 0escr~ptton: Lot 21 Tract B Ea~le Crest S~division
4. Location: N~ 2nd Avenue
5. Type of facility to be ~nspected Single Family No. of bedro~s
6. Well Oa~: Individual
e
A. Type
C. Construction
Sewage Disposal System:
B. Depth
D. Bacterial Analysis
On-site system
A. Installed
B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
Be
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
Total length of lines
~// , Absorption area
, Other contamination
Sewer Lines
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2' of two'pages -IRe~'%st'for Approval of Individual ~'er & Water Facilities
'Legal Description T.ot 21 ?tact B I~agle Cre8t $~tbclivision
Co~ents
ApProval \Valid for one year from date signed /
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
06-122,010) I~ev. 1973
DATE
' ,A~A'~ D£PARTM£HT ,Ci HEALfH AND SOCIAL
· ' DIVISIOH OF PUBLIC HEALTH
INDMDUAL AND SEMI4~UBLIC
BACTERIOLOGICAL WATER AHALYSiS
OFFICE
INDIVIDUAL [] SEMI-PUBLIC [] CHLORINE RESIDUAL PPM .
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY '
READ INSTRUCTIONS
ON
REVERSE SIDE
SANtTARIAN'S REMARKS
I-1 No
BACTERIOLOGICAl. WATER ANALYSIS RECORD
BEFORE Loc.o.. S,o.h, 24 st,.
,COLLECTING ,SAMPLE
EMS AGAR