HomeMy WebLinkAboutBARCLAY CITY LT 6
Name
/
_ MUNICIPALITY OF ANCHORAGE /
DE[ TMENT OF HEALTH AND HUMAN SERV - 'S
/
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 P ~0/~ ~IL '/
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
Phone(s) I I-'e m~t No. iNd. of Bedrooms
LEGAL DESCRIPTION
KS
~_ SEPTIC [] HOLDING
ManuTactu~er Capacdy m gallons
Mateual No. of Comparlments
TYPE OF SYSTEM
[] TRENCH ,~BED [] W. DRAIN [] OTHER
Depth to p~pe bottom from Total depth from onglnal grade
original
grade
Fdl added above ongmal grade Gravel depth beneath p~pe
0 FT O, ~ FT
Gravel length Gravel w~ath
"~1~ FT ~'~'")-~" F1
Total absorption area
Number dj hr/es Sod rating
D~stance between lines
Pipe material
F1
DISTANCES
SEPTIC ABSORPTION
TANK FIELD WELL
WELL
LOT LINE '"~'J"7 /
FOUNDATION
AS-BUILT DIAGRAM (Snow Iocabon of weft, septic system, property hnes, foundahon,
~way, water bod~es, etc)
Installer Date Installed
WELLS
~-PRIVATE [] OTHER (Identifv)
Installel J DaT~-e Installed
FT
I
S & S ENGINEERING
17034 Eagle Kiver Loop Roa~i
m u n i c illjkjj~eSlJJ,/I¢¢ qlklml~lik:allJit~l,~[JJs date:
Health Department Approval:
72-013 (3/85)
Inspectio d by:
ce~;pry tha~is inspection was pedormed
according to all
DEPARTMENT OF HEALTH & HUMAN SERVICES '",¢~ 825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL OESCR,PT,ON: ~ ~ ~~ ~¢Township, Range, Section: ~l~
SLOPE SITE
f/
L--
/
10 WAS GROUND WATER
ENCOUNTERED?
11 s
L
IF YES, AT WHAT O
12 DEPTH? p
E
13 Depth to Water Alter
Monitoring? ~ Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
5L ' '5:'50 / o/--/,,,J, 5'"" '
15
16
17
18
19
20
PERCOLATION RATE 7 (minutes/inch) PERC HOLE DIAMETER Iz~ ·
TEST RUN BETWEEN ~ FTAND ~ FT
COMMENTS .. ...... /
S & $ ENGINEERING '
17034 E~I. RiYer Loop Rom:l No. 20~~~-~~ ~,~FORMED IN
PERFORMED BYI~_~.I-_ ?_.t~.., .a.!~_~._ 99~.37 ~ ;/ / ~ / CERTIFY THAT THIS TEST WAS
ACCORDANCE WITHALLSTATEANDMUNICIPALGUIDEL~ONTHISDATE. DATE: ./~..~/~'~ /t~ '
72-008 (Rev. 4/~) / /
.... ,:.'-:::i ..... : ........... : .... ,,-;..,-:... ...... -:,,. . ........
· ' _. ' "', - '~- .-" '.-' '" ' """' - 6oc'cg.~:~,, ' .,:. ".',':"~ i~. '.".:.'..'.' . -
"::: ' ' "'"-;?'"-"' ".SULLIVAN WATER 'WELLS
· -.,:.._~: ," :,,.' . ._ ~., ...... ,ii :.,.,;.'"': ',-,' '"". ;..':' '-'::,,'..'
sk ~ '" '"'
..... - P,O, BOX 670272, CHUGIAK, ALA A 9567 · TELEPHONE 688-2759 ' "' '-' i' '~-.,' '"~'"
· · ."..'.' .: 'i'J_~ .'7'~. '.:''.~' . . . . ......~- ,.-'-.:~'~-'~-i-'~:~-! .... ."~.'*'
,.. .._ *. .. , ._ . ... ;- '~ ~ ~ . ' ','.- ;~.. ~.. ,.- . ~
..... -*:. . ~',,' ~ .~- .. ~ '. . . .- .,~-, . ~ , ~ ~,., ... _ . -...-.:,..?:..:~.. .,,'. ... :'~ :,.~.. ,~ ,_
' o~. o~ ~ ~ ~ ~' ~ ': '" ~ '"'~'"'~ ~'".:,'~%~,~,...... _ o~ ~'~ ' -__~ 0 ..... ~"-' "
: .- ~ - . .. ...*" ~ .,'*.: 7,* .,.
ADDRESS ' STATIC LEVEL OF ~ATER FT.
'' . ...... . ~ . , . . ..~. ,. 'h... .
DATE'-started '''~'/~/~ ' ' ~nded"~'~ :' .... '"'' ':GA~'.P[R "' '~' 'HR '.7/~
- .. ~
. . .... . . -.. _ . . . . ....... .,;~'~:~,~. ~ -..,. . . , .,. ,...:,~. . . . ..... .
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From ' Ft, to Ft, Z ~*g~ '"" ': '- :."-"- '~rom" ..... ."Ft, io "' '- Ft, ~/
From l~ 'Et. to I~OFt ~'~Y ~ '. From ~- Ft. lo Ft,
~ ...... ' ' ' ' " ...... ~2 ~ -" '-
., . -' I .... . ~v.., ~ . ..: ..,~. ~/ .,-2.. r -' .,~," ~ '.. _ · · ......- . .. - '..~,: ~.' 2~'.-
..,-- ~
. }..':'From '-' .... '"'~'~'-Ft.' ':~'to x~ : ...... Ft. :"'"' O ~ ~ ' "' ' ........ ~ ":'.':':',::'FrOm' "+~'~"~- ~t. ~o ....... FL. ' ':
'. ~, _ . . . ... . , - . . . . . . ,..~'." '.~.. ~. ~_ ..;~.~ ........ :..~ .:. ,' . : ~. . ~ . .,.' ~- ~ ?':., , ~ ~ . * · ... ,
...'-:-'~o~,., "~'..~ ~,: ~o~~,.'"" '"~,."'~".~: ~' .... ,.." "'~1 :-.. "..~,o~" :'?":"~,. ,. ':" ~: ~,. "
~'~ From ' :: ::~' Ft. ~o -. Ft. ' ~ ~ ~'~ '~ ':'"~?" '''''~ '-[::--'From ...... FL ~o ' '- . - . ...... '.
'....' -'-~. - -' · ~ , - ,. ......... ~. ,,~ .~ ' _ ~:Z - .'.~? ' ;?~z~?~'~%'m~-~':Z'_ . ~:z ~.: :~-'?:~Z'","~z-'~z~z~-Z~.~.
,, · ~ . ,, ,:,. . ~.~_-~:~. , ......... .-:~ ..... ~ ..... .,, :~--,~ .?-., .......... ~ .,~:,-,'~,-,.,T~,~' ...... ~ ~.~--- .~.~
'-. ':': From '"2~° '~t. to--Ft. ' t~c~ ~ '~'" ~O'~rom ' ¢- Ft. to .... .Ft.
' ,'..~." . , '.~" .. '~;-%.',,L"~ _.'. ', .--; _ .~" ~ '-' ~ . · ".~..'~_".'"' '% · ': ' '' -'..7~'-'~75~':L~.~'",%?:.~':''' ' '~7;~.: ':~'~:.~ .."',
...::".'~.From'~ :~?:'~."Ft~'to :,M:'Ft.'~,E~~ "'~ 3~ ~/~ ..~:~&.:From': ..... "~-.Ft. to "'' Ft.' .......
.:From 3~Ft. to ~1 Ft. ~ff~ ~ <~g~rom Ft. t0' '~:'-:::',,Ft.'~(
"-' '"-'.From' ~i 'Ft.'~0' ~Ft.' ~dffo~ ":'~ ~W;~From '~'"~':'f-.:,.Ft. to ..... · Ft ......
::::"'' ':'* ~ Ft ~o "-':"Ft~t ~ ~~ ~o~ ~From Ft. to .Ft.
From ' :- ·
,c',::'. i...?:c.?c~:::~i:z ~Subdivision: BARCLAY L:ITY Lot: 6 Block:: NA
Municip _. y
Anckor ge
P.O. "'""~( 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES.
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 9, 1987
Greg Ross
1203 Boston Street
Anchorage, Alska
99504
Subject:
Lot 6 Barclay City Subdivision
On-site Sewer & Well Permit ~860190
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1986.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system the original as-built inspection report (three part
form) must be sent to this office for review and approval, and
for documentation.
If there are any further questions, please call this office
at 264-4744.
Sincerely,
· . 013.
Program Manager
On-site Services
RWR/ljw
enc: copy of permit
L'Ei;F'AF;:THE:NT HEi:AL'T't'4 AND ENV I RONHENTAI .... :i:UTE:CT I OFJ
)DATE: I .:.,.:::, Jb .t..., ::
AF:'F'L t C)AI"'J] =
A D .!} f :.;'. E ,.:.::; S ,".
C; D 1"4'1" A C'F F'I'"I 0 N E:
H Al', L W R I T TIE !',1
GRE'G ROSS
.... :.,J,..::, BO:B-I-ON
ANCH[]F:;:AGE, Al<
L.. O'1 S t Z lei: ::
SUBDIVISION: BARCLAY CI'TY
SECT'ION: t. 5 T'OWNSHIP: :[3N
,:,-'.. :SA ~, c:A.. F'I" C)[;: (--1C;F,:E:S)
L [")'1":
RANGE
B [... O C K: N A
i cerl. ify that:
J.,, ii: am familiar, wi't.h 'Lhe requirements for' c)n--site sewers and wel:l.~i as sei.
fc)r'L!-'! by the MLtn:Lc:ipaJ. ltV of Anchopage (MOA) and the State of Alaska,
?,, i wi].l :i.r"~si. ali tlqe system in ac:c:opdar'[ce ~Jt.h all IdOA c::od~ and p~gu].at.:i.c)ns~
and J.r'~ (:::omp].iance wit. h Cl"le des:i, gn cr'iLer~a o[ Cl'~&s p~l"mit,,
:S,, ]: ~.~i:l.~ adhere to a:l.t MOA and State of A].a~ka r'equir'ements {or the s~t back:
d:i.s'f..ances Frc:)m any existing wE:,l]., wasCewater disposal system or public:
sE:,~er'a(]e:~ systeffi cn"i this (::ir" ar~y aclj ac:~nt or'. near'by ].c)'L,
IF A L..IF:T Sf'FI'f'ION iS INS"I'AL.L. ED 1:lq AN AI;:dE(4 E;[)VE:F;:EJD BY FIO¢:~ BUIL..DIIqG [:ODES,
!"HEN ¢}~ .:-':::'ff,.I E:L.E:C]'R.t:CAt .... PERM]:'I" AND INSPI.'.z.':C"I"ILJlq I~IUS'T' BE OB]"AIIqED; (2) ":.q---.q~['~: "~":::
N.[ ~ hlf!i ]31:ii: ~.-d'"r-f,.LvEL~ Wi'I'HOU'T AN EL..EC~[RIC:AI .... II',ISF:'IE':CI'IdN Fd.<F:'C)RT',I AND ('"'~ THE;
E::L..E!X:: I ,, Z ,.,(..-,1 t,',IC)F;:K MUST i3Ei DC!NE B'/ A L.
AF:'F'L. I CANT ~
ENG'INEE G GEOLOGY
P.O. Bo:: 11018~, Anchorage, .4la,ica ~511
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
~PERCO LATION
TEST
PERFORMED FOR:
LEGAL
1
3
7
20,
SITE PLAN ·
Reading Date Gross Net Depth to Net
Time Time Water Drop
I'
PERCOLATION RATE < '~ VJ~/~ ~- / {minutes/inch,
TEST RUn BETWEEN z/' ,- FT AND ~ FT
I - . .
ENGINEERING GEOLOGY
Consulting and Services, Arctic-Subarctic
P.O. Box 110186, Anchorage, Alaska 99511 o. (907) 349-4942
· Foundation Investigations * Sit· Exploration * Inspections * Percolation Tbsts * Soil Reports * Drilling Supervision
ENGINEERING GEOLOGy
Consulting and Services, Arctic-Subarctic
P.O. Box 110186, Anchorage, Alaska 99511
e (907)
//
· Foundation Investigations · Site Exploration · Inspections · Percolation Tests · Soft Reports · I)r~lNng Super~slon
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
GENERAL INFORMATION
Complete legal description
Lot 6; Barclay City Subdivision
Location (site address or directions)
Property owner
Mailing address
Gregory Ross
Day phone · 349-6572
Lending agency
Mailing address
Day phone
Agent Paul Baker
TOTEM REALTY, INC.
East 15th Avenue
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Anchorage~
Add ress 724
Unless otherwise requested, HAA will be held for pickup.
$
Day phone
Alaska 99501,.
272-0571
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.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72-025 (Rev. 1/91) Front MOA #21
5. 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.
Name of Firm Phone
Address
Engineer's signature
S & $ ENGINEERING
17034 Eaqle River Loop Road No. 21~t~
Eagle River, Alaska 99577'
DHHS SIGNATURE
,~,._ Approved for ~"'~.,~/<~_~) bedrooms.
Disapproved.
Conditional approval for
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.
72-025 (Rev. 1/91) Back MOA #21
( Municipality of Anchorage ~i~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: ~P'1" I_~ ~::>/~.-4~1..-~,~ ~l-'~$1~rcell.D.
A. WELL DATA
Well type
Log present~N)
Totaldepth
Sanitary seal {~N)
If A. B, or C, attach ADEC letter. ADEC water system number
Date completed ~-~-'~ ~ Driller
Cased to '~z:;~ Casing height
Wires properly protected (~'N)
Date of test
Static water level
Well flow
Pump level
FROM W/ELL LOG
!
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~c'C2 ~¥
Absorption field on lot ~ o o
Public sewer main
Sewer service line
g.p.m.
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
g.p.m r,o ~ 0_,,
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed I C) ~ - ~1
Cleanouts (~N) ~./-
High water alarm (Y~
Date of pumping
Collected by:
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Tank size tc:~4::, ~ Compartments ~
Foundation cleanout~/N) ~ -- Depression (Y~.I~ ~
/~- Alarm tested (Y/N) ~J ~/A.
~ Pumper ,..;~..~-'. ~-~$5 ~'~oz._ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /Z~O I ~
To property line Jo / +'
Surface water/drainage
On adjacent lots /~ ~ ~' Foundation
Absorption field 5' / ~ Water main/service line
72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
"Pump on" level at
Manhole/Access (Y/N)
High water alarm level
Meets MOA electrical codes~
We13 on lot On adjacent lots
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed [ 4> -'5
Length '~o ' Width
Total absorption area ~ L,O
Depression over field (Y/~;)
Results .~fa il) i~$
Peroxide treatment (past 12 months) (Y,~
Soil rating ~z~'5 ~/6~
Gravel thickness ~,~ '
Cleanouts present (~N)
Date of adequacy test
for T't~ ¢-,f~ E tf'~--~
~o~ ~o ~ If yes, give date
System type
Total depth
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ldo ~4~
To building foundation
On adjacent lots ~'o I 4-
Surface water [~O ~'
Curtain drain ~J~A'
On adjacent lots )oo ~' Propertyline ] o ~/-
To existing or abandoned system on lot
Cutbank ""~A- Water main/service line /o //'
Driveway, parking/vehicle storage area
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.
S & S ENGINEERING ..... "~ ..... ~ ~:'~ '~
Signature 17034 Eagle River Loop Road No'. 204
Eagle River, Alaska 99577
Engineer's Name
HAA Fee $
Date of Payment ~-" ZT-~__
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
ANALYSIS RESULTS £or II~0ICE ! 53781
Che~ab Ref.t 92.2140 Sample ! I llitrl[:
FAX:(907) 561-5301
Client Sample ID : L6 BARCLAY CITY
PWSID : UA
Collected : MAY 15 92 e 10:00 hrs.
Received : I~Y 15 92 ! 14:45 hrs.
Preserved with : AS REQUIRED
Client Name :S ~ S ENGINEERING
Client Acer :SNSE#GP
BPOt :
Reqt :
Ordered By :ROGER SHAVER
Analysis Comploted : ~A! 18 92 Send Reports to:
Laboratory Supervisor~: STEPHEN C. EDE 1)$ ~ S ENGINEERING
Released By : (f.~~ 2)
Parameter Results Units Method Allowable Limits
NITRATE-N 0.37 ~/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarks:
1 Tests Performad * See Special Instructions Above UA-Unavailable
ltl)- None Detected "See Sample Remarks Above
NA- Not Analyzed LT-Less Than, GTuGreate~ Than
Member of the SGS Group (Socibt~ Gbnbrale de Surveillance)