HomeMy WebLinkAboutTANAINA HILLS LT 18 ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE EW
LOCATION NO. OF BEDROOMS
--~ ~ DISTANCE TO: IWell /OO ' I Abs°rpti~7~a ~ Dwellin9 % PERMIT NO.~le:~ ~) ~ ''~ ----
, ~ Well ~// DweJling PERMIT NO,
Trenc~ wid~/~inches Distallce between lines,
~O Top of tile to~inish ~g inches
cra Material beneath tile Total eff~ct~ absor~n area
~ Length Widtb // Depth PERMIT NO.
~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ 21ass Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO:
SOIL TEST RATING
RE~AR~S'
72-01 ev. 3/78)
-r
C
F'EF:M I T NO.
:A: Cl.': %, d::=l~E._. :E "1F'%-' nTZ)F" Ftli]'-,~C:fl'...-, JF;.~_"IF";:IIn]i;.IE~Z
DE:F'FIRTHENT (.]F HEFIL.TH FIhlD ENVIF:OI'qMENTF'IL F'F:OTEC:TION
825 '"L'" s'rREET, taNCHOFdaGE[., FIK. 9~50J.
264-..4.720
16:It t"*,,i] IE:,, Cn ["-.1t ---. :'~%; :E -F' lEE :'..E¢ E~: I],...lt EE ~: F" EZ: f:~." I]".1t ]E ""IF'
::,
FIPF'L. I F:FINT
LOC::FIT I ON
L. EGRL
I'( Fl"r' L.I NDFIHL
L:t. 8 TFII",IRII"~IFt FIILLS
22t0 BELMONT
LOT SIZE
5,5,9999 :-~;I~:!IJFIRE FEET
'T'¢F:'E OF SOIL I::IBSORPTION SYSTEM IS: TRENIZ:H
I'"IR',:-::IMUM NUMBER OF BEDROOMS
SOIL. RFITII'.,IG ,::SE! FT,."BR)TM t25
]'FIE REQUIRE[) SIZE OF TNE SOIL F:IE:SORPTIOI",I S'¢S"['[""I'"I 15;:
[]:, E~. F' ]F FII == ;.-1.i]: L_ E I]',..~l ~]~i 1'- FI] == '7' ":~" n]ii [;~: FII %-" ~:E L [:) E F' T' I]4 := "::il.
T["IE L. ENGT['I D I MENS 1 ON I S TNE L.E:i",IGTH ( 119 FE:ET ) OF THE TRENCH OR DF:FII I",IF I E:L.D.
TNE [:,EPTH OF- FI TRENCFI OF: F'IT IS; THE DI:BTFfiNCE E',ETI4EEN ]'HE SIJFtFFICE 01:': THE
GROUND f:IND T['IE: BOTTOH OF T['-IE E::.::C:R',,,'RTION ,:lIN FEET).
]"HERE: IS NO SET HIDTH FOE;.: TRENCHES.
TFIE GRFI'v'EL [:,EPTH IS THE MINIHIJM [:,EPTH OF GRRVEL BET!-,~IEEN THE OUTFFI~I..L. PIF'E
RND ]"FIE BOTTOH OF' THE EXCFI',,,'RTIOI',I (Ii'.,I FEET).
PERHIT RPF'LIC:RNT HI:IS THE RESPONIStE:IL. IT'T' TO IiqF'OI:;.:M 'THIS [:,EPRRTHENT [:,URING THE
INSTFIL..LFFI'ZOI",I II',ISF'ECTIOI'.,IS OF RN'T' !4ELL. S FIDJRCEI",IT TO THIS PROF'ERT'T' FIND THE
NUMBER OF 17::ESIDENCES TNFIT THE HEL.L WILL SEI;.'.',,,'E.
.............. ]- ~..-*i] C~ ,:'.' ;;:.:' }:. ~ I'.,.[ 2:"; F" E: ¢_Z: ]- I C~ I',.,~ :5 Fu F-.u EE
E,'FICKFILL. IiqG OF RN'T' S'¢STEH 1.4ITNOUT FINRL INSPECTION
DEPRRTHENT I-4IL. L BE SUE:..TECT TO PROSECUTION.
IF;;.: E 6;.., fi_il :I f.~: F£ If:_::, ................
RF'PRO'v'RL BM THIS
1,1INII',IUH D]::STRi'.~ICE BETHEEi'.,t FI I.,.IELL FIND RN"¢ ON-SITE SE!.qFIGE DISPOSAL SYSTEH IS
:1.00 FEET [:'OF'. R PRIVFtTE HELL OF: 150 TO 200 FEET FROM FI PUBL. IC': WEI..L. DEPE:NDII'.~IG
UF'ON 1'HE TYPE OF F'UBLIC HELL.
HINIHUH DISTFINCE: FROM FI PRIVRTE WELL 9'0 FI PRtVRTE C;.EI4ER LINE IS ;25 FEET FIND
TO R COHHUNIT'¢ SEWEF: LINE IS ?'.5 FEET.
WEL. L. [...065 FIF:E REQUIRED FIND HUST BE RETURNED TO THE DEF'FIRTMENT 1,4ITIJIN ]:0 [:'FI'T'S
OF ]"I'4E HELL C:OHF'LETION.
OTHER REQUIREMENTS PIFI'¢ FtF'F'L'¢. SF'ECIFIC:FITIONS FIN]:, CF~NSTRUC'I'IOi'4 DIRC'iF:FIf'IS FIRE
R',,,'RIL. RBLE TO )]"~ISURE F'ROPER INSTRL. L. FITIOI'4.
I C:ERTIF'T' TNFIT
J.: I RI','I FI::tI,1IL. IFIR !.,IITI4 '['FIE REQL.IIRENENTS FOR ON-SITE SEHERS FIND I.,IE[...I...S ]:IS SET
FORI"H BY THE HUNICIPRLIT'¢ OF FINC[..IORFIGE.
2: I WILL IN'.:~;TFILL THE S'-r'STIEH IN RCCOF?.DFINCE HITH THE CODES.
]:: I UI'.,IDERSTFIND THRT ]'PIE ON-S):TE SEI.qER S"r'STEH MR'[ I:;.:EC!UIRE ENLFIF:GE:HENT IF THE
RES;ZDENCE IS I~:EIdODEL. ED TO II"~ICLUDE ['"lORE TNFIN 5 BEDF.:OOMS.
S I GNED:
FIPPL I CFINT KR'¢ L I NDFINL
I
I~4 EL t...
KRY LINDRHt.
L:LG TRNR i: NFl
;~,£'L0 8ELHONI'
f'YP[C OF FOIL RB~0RPTION SY:~TEH ~S: 'FREfIQH
HAX,U-'JIJI'I I'iUI'IBER ~:~? BEOROOI'IS ~ .~ '~O[L I~.t'~]'j[NI] (St~ FF/EIR)= i~5
THE DEPTH OF R TREHCH r3~ P[~ [~ THE OD~FRNCE 8ETI4EEN THE ~URFFICE OF THE
KHE~E IS N0 SE~ NIDI'H FO~ 'FRENCHE'~.
[N~TRLLI~TIOt~ [N~¢EL. TIOND OF RF't't ),IEL,L,¢ ~-lO.ffl¢~Ni Ft) I'HIL5 PROPERTY AND THE '
DEPRRTI'IENf fl TEL 8E .~USJE~F TO
PI TN [I'IUH ~ [ 1~ f~NL:E
HELL COHPLE r [OH. i'
~ CEf~T[F'¢ TItFtT
ffORTH ~Y THE HUNIC[PI:tL[TY OF RNCHOERGE.
:Z' [ HtLI.-[N. FRLL TIlE s','srE~l IN R,.uORDRN~5 [.l~l'H THE CODES..
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
13-
14-
15-
16-
17-
18-
19-
20-
LoT la WAh/AINA
SLOPE
o~-~A~t C C~lLq-
2225-E
JN£ 25, 197[
DATE PERFO.MED:
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
,(minutes/inch)
PERFORMED BY: /: ~ Y~ tal4~
CERTIFIED BY:
FT AND FT
72-008 (6/79)
DATE:
MUNICIPALITY 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 lot, block, subdivision, section, township, range)
LOT 18; TANAINA HILLS SUBDIVISION
Location (address or directions)
7020 Kit~isa Drive
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
Jim & Kay Lindahl Telephone : (home)
7020 Kit~isa Drive, Anchorage, Alaska
Telephone
24 8- 7773Business
(d)
(e)
Real Estate Company and Agent
Address 3201 C Street
Telephone 565-5500
JACK WHITE COMPANY ATTN: Ka~ England
Suite #100 Aneh~r~g~ Ah. 99503
Mail the HAA to the following address: (or check here F~Xif hold for pick up.)
List contact person and day phone number below:
$ & S ENGINEERING
17034 Eagte~i~m- Loa,r~.
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family EX Number of bedrooms __5'
3. WATER SUPPLY
Individual Well BI,'(
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 EX Public [] Community [] Holding Tank []
Nole: 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
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A. WELL DATA
Well Classification
Well Log Present (Y/N)
c MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
ipALt1'f OF ~JCECKL[ST - FEFtRUARY 1984
APR 1 6 '¢9O
_ Date Gompleted
Legal Description: ,/--~"~' /
,/.
If A, B, C, D.E,C, Approved (Y/N)
[~-[~ -~ Yield
Total Depth t ~z_L~_oased to_~_~O Depth of Grouting
Static Water Level _ I,~ /¢
Casing Height Above Ground / .~ ~': ¥",
Electrical Wiring in Conduit (Y/N) L~
CH: =-
Pump Set At b) ('~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (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
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots I co
; On Adjoining Lots [ (20
To Nearest Public Sewer Cleanout/Manhole /'0///4
B. SEPTIC/HOLDING TANK DATA
Date Installed _~ -I ~ '~._~Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) /,J/~
! ~-00 No. of Compartments
Air-tight Caps (Y/N) C~ Foundation Cleanout (Y/N)
hO Date Last Pumped ~/~ 5"'- ~ O
/~/¢1 ;for M /~ ,
Temporary Holding Tank Permit (Y/N) /,.)//4
SEPARATION DISTANCES FROM SEPTIC/H~ TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments ..~e c :/)0t¢¢. e u
To Building Foundation /-/0 ' '~
To Disposal Field / O
72-028 (Rev. 7/88)Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
~(~//¢~1"~ Type of System Design '/'~o~.
Length of Field
Depth of Field
Gravel Bed Thickness
~' ~ Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Water-Supply Well
To Building Foundation
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
SEPARATION DISTANCE FROM ABSORPTION FIELD:
/'~.~O / ~ ~
To Property Line "~ ~ --
To Existing or Abandoned System on
' -/1
l, On Adjoining Lots
[O ¢- To Cutback (if present)
/ co
/ ~
Comments
D. 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 ~ ,t. ~
17034 Eagle River Loop Road No.
Company ~agle Rlv~ A~a~ka ~9577 --
Receipt NO. ~/¢~ ~'~ ¢ Receipt No.
Dateof Payment-- --~/~ ~'~¢ Waiver Fee:$
Amount: $ ~ ~.~ Date of Payment
Page 2 of 2
721026 (Rev 7188) 8¢ck
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
f:EDERALTAX ID # 92-0040440
ANALYSIS BE?ONT BI 8A~PLg fox Wozk Ozdox ! 20877
Date Nepo~t P:inted: APR 9 90 ~ 10=29
Client Sample ID:LOT 13; TANAINA HILL8
PWSID :UA
Colleoted APR 4 90 ~ 16:20 hue.
RoeelYed AP~ 5 90 ~ 12~30 hrs.
Preserved with :A3 R~QUI~[D
Client Name
Client Acat
P.O.$ NONR ~ECEIYSD
Roq $
O~dered By
Anelyeie Co~pleted :APR 6 90 Send Reporte to:
Special
Instruct:
Chemlab Ref 1:900752 Lab S~pl ID: 5 Natrlx= WATBN
Allowable
?ore,ate: Teated ~eeult Unite Method Limits
NIT~ATE-N SD(O.IO) I~/1 EPA 353.2 10
1 Teats Peffoz~d ' See 3pocial In~truotione Above UA=Unavailable
ND- Hone Detected '* 3aa Sample Red,rko Above
SA- Not Analr~ed LT-Leea Than, OT-G~eate~ Than
APPLIC IT FILLS OUT UPPER HAL 3N~.Y
PropertyOwr,er J//~'/~/Z:~ Z'~~ //.~//.z~//~, ~//~1~ /</(/?~l/y/Z,[~/ ~. /~/A/~/~f///~/-~-.---~, Phone
Street Locati~ ~¢~ O 47~2--~1~/ ~ ~
~ndlvldual Year Individual installed:
Time Time Time Time
Date Date Date Date
Inspector Inspeclor Inspector In s p ec~ ~)_
Field Notes:
( ) CONDITIONAL APPROVAL*
So,lsR~ln~ Dato~werlnsta,loO Well To Absorptlon Area / ~ Well Log Recelved
~-7~ 3 Well to Tank ~ ~ Septic T~k Size