HomeMy WebLinkAboutTIMBER RIDGE #1 BLK 3 LT 8 ~t"~ ~UN,C,P^.,TY oF ^NC,ORAGE .r",
DEPARtmENT OF .EALTH & ENWRONMENTAt.ROT~CT,O.
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
LEGAL DESCRIPTION
-LOCATION
PHONE
DISTANCE TO: Well
Manufacturer
Length of each line.
Top of tile to finish grade 3 /
Length Width
Type of crib CribWell diameter
DISTANCE TO:
Oassp,~t V,~7'& Depth ,,,?
DISTANCE TO: Building foundation
DISTANCE TO: I-we" /OZ~/-/- IAbs°rpt'°nare~'!
Inside length
Dwe lng
F°undati°~o ~1"
Total length of lines
Material beneath tile
Depth
Crib depth
· Building foundation
Driller
Sewer line
Dwe,,i.g /~/
Width
Material
Nearest lot Iine~O ~,~
Trench width
~ ~:) inches
"O. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT N O~b,,3~~
Distance between lines~/~.
PERMIT
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
OTHER
PIPE MATERIALS p/~,,¢~/~ ~
C.e,~/~,/a~ ,,Wv,,)
SOIL TEST RATING
iNSTALLER
REMARKS
72-013 (Rev. 3/78)
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
DEPTH OF WELL ¢-~ ? ,.~""
STATIC LEVEL OF WATER FT.
OWNER OF LAND ~'/
ADDRESS ? ~:)
DATE-S~ed ~/:,~fC 2 :Ended ~/) '-fig 3 GA~.PERHR
PE~IT NUMBER ' KIND OF CASING
KIND OF FORMATION:
From f½ Ft. to c~ Ft. ~ O[~,e'~. ,~tl.~','/~/d From~Ft. to
From ,~) Ft. to .? ~ Ft. ~ ~~ From Ft. to
From Ft. to Ft. /~,~ Y ~ ~ ~ ~ From~Ft. to
From/ ~ Ft. to WO Ft. ~Tr ~ ~ ~/ f~ From Ft. to~
Fmm.~Ft. to Ft. /~ ~ '~ ~f From~Ft. to
From ~/', Ft. to /~'~ ~Ft. ~/~ ~ From~Ft. to
From .'¢~'~ Ft. to /~ Ft. · ~/~,,~e~ ~ ~4'o~ From Ft. to~
From Ft. to~Ft. I ~ ~ ~r~ , ~, Fromm. Ft. to
From /~'/~ Ft. to ~ Ft. /~/,'~ : From Ft. to
From~'~? Ft. to ~ll Ft. ~'~ ~C ~ ~/' ~,J~7~From~.Ft. to
From Ft. to Ft. ,~,'~1~ ~ ~ ~'~ From Ft. to
From ')~.~ Ft. to ~7~Ft. /~r )C From Ft. to
From ~ 77Ft. to '~ 7q Ft. /~ oc ~ ff,'?e, t'~From Ft. to
Fr~ Ft. to Ft. C~ o ~,:, ,~, '/ (~, ~'~ From__Ft. to
From 37 ~ Ft. to ),~C~Ft. ,',3~,:',.:~. ~-' From Ft. to
MISCL. INFORMATION:
i ~, (, /,
Ft.
MUNICIPALITY OF ANCHORAGE
FtD[pT, OF
ENVIRONMENTAL PROTECTION
Ft.
Ft. MAY 3
, FtRECEIVED
Ft.
Ft.
Ft.
Ft.
Ft.
Ft:
Ft.
Ft.
Ft.
Ft.
Ft.
Ft
DRILLER'S NAME ":'' ' / L .......
PERMIT NO.
I~llJl'~l T ~_.~ T ~--~i::ll _ T TY O,,F, FIr~IC:I--.I~*~;~.FIGE
DEPARTMENT i '~ HEALTH AND ENVIRONMENTAL 'I ..~TECT I ON
8:>5 "L' STREET, FlHCHORFIGE, ilK. .<:)_~.50::[
264-4?20
NELl fll'~iD Ot'-.I--S I TE SEI..IER PERF'I '1i T
APPLICANT SYDNEY fl. HUFFNAGLE P.O.
LOCAT I OH
;-LEGAL' LOT 8 BLK 3 TIHAERIDGE' SUB #1 '
TYPE OF SOIL ABSORPTION SYSTEM IS: TREHCH
MFlXIHUH NUMBER OF BEDROOHS = 4 SOIL RFlTIHG (SQ FT/BR)=
BOX 102 EAGLE RIVER 694-974~
LOT SIZE 999999 SQUARE FEET
'i
220
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
/
DEPTH= ::g2 ,/"LENGTH= 55 G RFI'...'E L DEPTH=
//
THE LENGTH'DIMENSION IS THE LEHGTH <IH FEET) OF THE TRENCH OR DRFllNFIELD.
THE DEPTH OF,8 TREHCH OR PIT I~ THE DISTRNCE BETMEEN THE SURFACE OF THE
GROUND 8ND,,T~E BOTTOM OF THE EXCAVBTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVE~' DEPTH IS THE HINIMUH DEPTH OF GRAVEL BETHEEH THE OUTF8LL PIPE
. 8ND 'THE BOTTOH OF THE EXC~VBTION (IH FEET).
RFI~gI I RED SEPT I ~ TRt~K S I ZE= 1250 GSLLO~S
PERHIT ~PPLICRNT HRS, THE RESPONSIBILITY TO INFORM THIS DEPSRTMENT DURING
THE
INST~LLRTION INSPECTIOHS OF SHY NELLS 8DJSCENT TO THIS PROPERTY 8ND THE
HUMBER OF RESIDENCES THaT THE HELL HILL SERVE. ·
T~O ( 2 ) I ~SPECT I E~S 8RE REQL: I BED
BSCKFILLING OF 8NY SYSTEM HITHOUT FINSL IHSPECTION ~ND ~PPROV~L BY THIS
DEPBRTHEHT HILL BE SUBJECT TO PROSECUTION.
MIHIMUH DISTANCE BETNEEN fl HELL FIND tiNY ON-SITE SEHFlGE DISPOSAL SYSTEM
100 FEET FOR R PRIVATE HELL Or 150 TO 200 FEET FROM fl PUBLIC WELL DEPENDING
UPON THE TYPE OF,PUBLIC NELL
MINIMUH.DISTANCE FROM 8 PRIVATE NELL TO 8 PRIVATE SENER LIHE IS 25 FEET ~ND
TO fl COMMUNITY SEHER LIHE IS ~ FEET.
HELL LOGS FIRE REQUIRED AND HUST BE RETURHED TO THE' DEPflRTMEHT NITHIN 30.DAYS
OF THE WELL COHPLETION.
OTHER REQUIREMENTS MR~ RPPL~, SPECIFICATIONS AND CONSTRUCTION DIRGRRHS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERI"11 T E×P I E:FS DFCEI-'IBER __?--::L., '1 96:
I CERTIFY THAT
l: I fill FAMILIAR WITH THE REQUIREMEHTS FOR ON-SITE SEHERS AND HELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN ACCORDANCE HITH THE CODES.
~. ll.~ R~ fl-~ T H ON- ITE SEHER SYSTEM
SIGNED:
APPLICANT SYDNEY F~." HLrFFNRGLE
ISSUED B '..DHTE __ V4. 0
PERFORMED FOR:
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 Lo Street, Anchorage, Alaska 99501 264-4720 ~ ~: ,
SOILS LOG --PERCOLATION TEST
LEGAL DESCRIPTI'ON:
7-
SLOPE
E%%L~uRN%C~I~ D5ATER
IF YES, AT WHAT
DEPTH?
SOILS LOG
PERCOLATION
TEST
DATE PERFORMED: 'g~'"'""~-~' --~2
SITE PLAN
s
Gross Net Depth to Net
Date Time Time Water Drop
:.~;/~ /o,. i/~/r~
,,~ ;~o ,~ ,. ii ~" _~,
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. # ~',.~C',-
1. GENERAl. INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
Day phone 6'~'fz'-~',~'~
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
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.
72'025 {Rev. 1/91) F.ont MOA ~21
SlUeLUUJO0 leUO!l!Pp¥
:suo!lelnd!ls §u!~OllOI eql ql!~ 'sLuoo~paq
JoJ le^oJdde leUOll!puoo
· suJooJpaq 7~
'paAoJddes!o
Jo; paAoJddv
~I'11YN~DIS SHHO
'9
Municipality of Anchorage
Department of Health & Human Servia:es
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Y Date completed ~/'/Z.~'/Z~ .~ Driller
c~--~,~' Cased to ~ ,~/i~(.~,.
Casing height
FROM WELL LOG
Date of test
Static water level
Wel~ flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/l'~tank on lot /"~'~'
Absorption field on lot
Public sewer ~aln ,x_~,,.,
Sewer service line
Wires properly protected (Y/N) Y
g.p.m.
,.. AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Colifcrm Nitrate
Date of sample: ~/z,/5r~''' Collected by:
B. SEPTIC/H~'~lIG TANK DATA
Date Ir~sialled'
Cleanouts (Y/N) ¥
High water alarm (Y/N)
Date of pumping
Other bacteria
Tank size /~-~o¢.~ .Compartme,nts .
Foundation cleanout (Y/N) ~/ ' '~ ' '" ....
.~Depress on (Y/N)
~,,~ ~ ,
~/~ Alarm tested (Y/N) ~
SEPARATION DISTANCES FROM SEPTIC/I IOLDINC TANK TO:
Well(s) on lot ~AL~ On adjacent lots ~ ~ %4- Foundation
' Topropertyline ~o ~-I-- Absorption field ' I~'
Surface water/drainage ~ o,0 +-
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION /
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
~.,Manufacturer ' ,
Manhole/Access (Y/N)
· "Pump off",le,~el at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot "' On adjacent I°ts
Surface water
D. ABSORPTION FIELD DATA
Eength ~ ~ Width ~ '~ Gravel thickness
Total absorption area ~ ~ ~ Cleanouts present (Y/N)
Depression over field (Y/N) ~ - Date of adequacy test
' Results (pass/fail) ~ for ~ ~
Peroxide treatment (past 12months) (Y/N) ~¢ /~/ ' ' ~
~ If yes, give date
System type /'""""""""'~""'/
Total depth ///
Y
bedrooms
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e'ffect on the date of this inspection.
David R. Da)ton P.E.
20210 i:)m~lar St.
Chu/~k, Almskm 99567.
HAA Fee $ ['~") ' ~'
Date of Payment ~,__.~,~c~. ~___
Receipt Number '~'Z~O ~ ~-Z~
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/9l) Back MOA 21
E, ENGINEER'S CERTIFICATION
SEPARATION DISTANCE FROM ABsORpTION FIELD TO:
On adjacent lots Ioo' 'l-- Propertyline
To building foundation ~ ~' ~
To existing or abandoned system on lot
On adjacent lots J~'~/'~-' Cutbank /(-/o ~ ~- Water main/service line
Surface water I o~ +-- Driveway, parking/vehicle storage area
D. R. DAYTON, P.E., R.L.S.
~'~1~1~t~t~ Chugiak, Alaska 99567
20210 Donalar Street
(907)
696-2417
September 10, 1992
WELL FLOW TEST
~~, 4S 468 ~ NO REPLY NECESSARY ~ REPLY REQUESTED-USE REVERSE SIDE
POLY PAK (50 SETS) 4P468
D. R. DAYTON, P.E., R.L.S.
]8~j~]~]~7~ Chugiak, Alaska 99567
20210 Donalar Street
(907] ~~::
696-2417
September 10, 1992
ADEQUACY TEST
Legal Description:'Lot 8, Blk 3, Timber Ridge Subd. ~1
Date of Test: Sept. 8, 1992
Septic Tank: 1500 gallon, 2 compartment, steel t~nk
Absorbtion System: 8' effective depth x 55~ trench
Soils Rateing: 220 sq. ft. per bedroom
Daily Design FLow: 4 Bedroom - 600 gallons per day
(DHHS Records)
(DHHS Records)
Test:
Metered water was injected into the the absorbtion trench until
the water level rose 1.37 ft.. Measurements of the water level
.~'¢,were taken as the water seeped out. The results were plotted
~ a graph of gallons absorbed'versus time and the line extended on
to 24 hrs.
Results:
The absorbtion system is currently functioning adequately
for a 4'bedroom home.
CHEMIC;L & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
A.~ALI~I$ I~ESULT$ fox INVOIC[ ! 57845
Chemlab lei.{ 92.4661 5ample ! I Eat~lx: WATE~
Client Sample ID : L8 B3 TIt~ER EIDOE {1
P~SID : UA
Collected : SEP 2 92 t 16:30 I~e.
Recel~e~ : SE? 3 92 ! 09:00 hrs.
P~ese~¥e~ ultk ; AS
Analysts Completed : S~P 4 92
Laho=atory Supe=vtlo[: ~EPHEN C. EDE
Client Name :DAVID DAITOH, P.E.
Clie~ l¢ct :DAVIDDA
~eqt :
O~e=ed ~7 :DAVID DAITO~
SeM ~epozte to:
[)DA¥ID DATTON. ~.[.
~)
~IT~ATE-N 1.2 m~/! [PA 353.2 10
Sample ~OUTIN] SABLE COLLECTED BI: D.[.D.
I Tests ?e~fo=me~ ' Soo Special Instructions Above OA-Ur~vallable
~D- None Detected "See Sample Reaarke Above
~A- Not Analyzed ET-Less THan. GT-G~eater Than
~SGS Member of the SGS Group (Soci~t~ G~nOrale de Surveillance)
APPLIC 'NT FILLs OUT UPPER HAt '.',ONLY
Pr~pertyowne. r.,.~x/d~.~ e..,,/ 1-~, /-./~ f:+ ~c~.~
Buyer ~.~
Address Zip Code
Lendinglnstitution j/~/6~ HC- /~ C~.'C/-- ct"'~'-'l pO, )30~ /O&~
Realty Co. & A~nt
Phone
Phone
Phone
Address
Legal Descript~n
Street Locath:~
Type of Residence
~' ~(..Sin gle Family
I-'1 Multiple Family No. of Bedrooms
[] Other
Water Supply
'~Condividual
mmunity
I"1 Public Utility
Sewer Disposal
~'~:3nd ivid ual
ublic Utility
[] Holding Tank
Zip Code
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available),
Year Individual Installed: / ? ~" -.~
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time ~ Time
Time Time
Date Date Date
Inspector Inspector Inspector
Field Notes: ~'~11~ C. 0.
Date
Inspector
MUNICIPALITY OF ANCHORAGE
DEPT. OF H-C^LTI-I ~',
ENVIRONM':NTAL PROTECTION
OCT ,S
APPROVED BEDROOMS
DISAPPROVED
CONDITIONAL APPROVAL'
RECEIVED
*CONDITIONS OF APPROVAL
BOilS Rating I Date Sewer Installed
JWell To Absorption Area
Well to Tank l~ O ~C) ~
I0O .,/.
J Well Log Received ~
Septic Tank Size J ~" O O