HomeMy WebLinkAboutDELBERT LT 42B*016 092, 60
n MUNICIPALITY OF ANCHORAGE ,—
CIL RTMENT OF HEALTH AND HUMAN SER ES
Environmental Health Division
• 825 •'L" Street, Anchorage, Alaska 99502. Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Lee V j jan tcaL-
DISTANCES
AddressTO
3404 jcl� (�rI're i}hc/j �i�( 99r,Q
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
WELL
,you i iii
/i 4r a.E
Phonelsl
•2 t)— 6 Lf S" 1
Permit No
A 3- C o s' "
No or bear s
LOT LINE
SS
S 5"
LEGAL DESCRIPTION
Lot i417
20
b�och Nn
Stoll,rsron
/} Ilei) n
FOUNDATION
n� d ,,
t
nU !n
Township. fiance. Section T
+-O 2 7 7- /L N Oat iLj'
AS-BUILT DIAGRAM (Snow luca:mn of well. x�ppC system. property lines. foundation.
or, way water bodies. etc 1
TANKS
CX SEPTIC ❑ HOLDING
wlanulac4n er
C; ce,
Gpacny in gallons
/z i-oma
Mmerrar
{ecr
N. of compartments
TYPE OF SYSTEM
[]TRENCH ❑ BED 49' W. DRAIN ❑ OTHER
Devin to Pipe DUttum IIOm
onqnal grand
-i4/ FT -
1Dial depth from original grade
6 FT
Im forced 'w a, original grade
IT Dai G FT
Glavin Depth benealn pipe
-Z 4 n FT
(never Icnga'
9 FT�;
Grarm wNln
. FT
I r
I oral aosmpnon area
3�%,2 ✓ SOFTI
I Distance between lines
Alei- FT
69
r4
2
Numt., lit ones
Suri idling
?s "'SO Fr
Pipe material
f 81 o CE, C 3 L 3 ya
G
4
d
ubldue'
/54101C %dam ll
Date Installed
9-7- QiY
sr
WELLS
❑ PRIVATE ❑ OTHER (Identify)
L
Lrasatie,.mon(A L1. C1lutatxNln
FT
ase" fa
FT
ms;euoi
Dale Installed
REMARKS:
Scale: NIS
Inspections PeAormed by
Oltr SrYs �Ey
ENGINEERS SEAL
Date
oerbly that this inspection was performed according to all
a Ido mos in ellen on this dale.
HIT Department Approval: - L'�"p wJ '`-e-L�-�-t Date.
72-0 13 (.voo)
r
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99541
264-4720
�I !—EZ; 3 _F E-= SE1•JJ=ri ar LwELL v-'E'r::! ! L -r
PERMIT No: e50055
VIA
DATE ISSUED: 02/08/85 �/(�«- 70 11
APPLICANT:
LEE V STANTON
L%J _ L7, FZ (-'5 T h!
DEPTH TO PIPE BOTTOM (FT. )
5.0
ADDRESS:
3404 LOIS DRIVE
0.5
2.0
,na M O
5.5
ANCHORAGE, A.; 99503
GRAVEL WIDTH (FT.)
,X38.
5.0
CONTACT PHONE:
272-6451
4C.0
L
e l�GC�
__/I�
`1J,
DJ&
LEGAL DESCRIP:
SUBDIVISION: ALLEN
LOT:
42E,
�
BLOCK: MA
85
SECTION: 27 TOWNSHIP: 12N
RANGE:
3(')
LOT SIZE:
49251 (SG.FT. OR ACRES)
LOT LOCATION:
MCDONELL ROAD OFF DEARMOUN
MAX BEDROOMS:
4
Listed below are the options available to you in designing your optic
System. Choose the option that,best'fits your site.
TANS; MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site scwars and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
1. I will adhere to all MOA and State of Alaska requirements for the set bacl.:
distances Erol any existing well, wastewater disposal nystcm or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enls.rgcment will require an additional permit.
IF A LIFT STATION IS INSTALLED IPJ AN AREA COVERED BY MOA.BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE ODTAINED, (2) AS-BUILTS
NIL.L. NOT DE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT, AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
£'SIGNED //--'
- /!) - DATE:
A^PLICANT: LEE ' UTA14TON
ISSUED BY ---_-.-.------.-.-_ PATE: 3
13 E n
L%J _ L7, FZ (-'5 T h!
DEPTH TO PIPE BOTTOM (FT. )
5.0
4.0
GRAVEL DEPTH (FT.)
0.5
2.0
TOTAL- DEPTH (FT.)
5.5
6.C,
GRAVEL WIDTH (FT.)
16.0
5.0
GR'011L LENGTH (FT.)
3" n
4C.0
JR.A,VEL VOLUME (CU. YDS.)
19.0
22. _
TANK. SIZE (GALE)
1,250.0
1,250.0 xr
SOIL RATING (SO.FT./BR)
85
O5
TANS; MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site scwars and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
1. I will adhere to all MOA and State of Alaska requirements for the set bacl.:
distances Erol any existing well, wastewater disposal nystcm or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms and
any enls.rgcment will require an additional permit.
IF A LIFT STATION IS INSTALLED IPJ AN AREA COVERED BY MOA.BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE ODTAINED, (2) AS-BUILTS
NIL.L. NOT DE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT, AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
£'SIGNED //--'
- /!) - DATE:
A^PLICANT: LEE ' UTA14TON
ISSUED BY ---_-.-.------.-.-_ PATE: 3
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEA! _TH AND ENVIENw.ENTAL PPOTECTICN
825 L STREET, AN.HCRASE, AC 99501
254-4720
ON—SITE SEWER & WELL PERMIT
PERMIT NO: 850055
DATE ISSOED: 02109/95
APPLICANT: LEE V STANTON
AODR:SS: 3404 LOIS DRIVE
ANCHORAGE, AK 99503
LCNTACT FHCNE: 272-6451
LE5.4L DESORIP: SUEDIVIS104: ALLEN LCT: 42B BLEK: NA
SECTION: 27 TOWNSHIP: 12.4 RASSE: 3W
LOT SIZE: 49251 (SD.FT. CR ACRES)
LOT LOCATION: MCDONELL ROAD CFF DEARMOn
Mal BEDROOMS: 3
Listed below are the options available to you in designing your septic
systea. Choose the optic^ that best fits your site.
as TA\K MUST HAVE AT LEAST TWO COMFARTI.ENTS
----------------------------------------
1 certify that:
1. 1 as familiar with the requirements far on-site sewers and wells as set
forth by the Municipality of Anchorage (MCA) and the State of Alaska.
2. 1 will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. 1 will adhere to all MOR and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system an this or any adjacent or nearby lot,
4. 1 understand that this permit is valid for a maxiacm of 3 bedrooms and
any enlargemant will require an additional permit,
IF A LIFT STATICN IS INSTALLED IN AV AREA COVERED BY MOA E'JILDIYS CCDES,
THEN (1) Al ELECTRICAL PERMIT AND INSPECTION MOST BE OBTAINED; Q) AS-BOILTS
klL' NOT BE APPROVED WITHOUT AN ELECTRICAL INSFECTICN F,EPCRT; AND (3) THE
rtcCT.iICAL WORK "JST BE DONE BY A LICENSED ELECTRICIAN.
SIDED OAT-:
APFLICANT: LEE V STANT:N
.csi"D BY ' ``` ` DATE:
" `�----_`--`-"-'---�-----------------------
BED
W.DRAIN
DEPTH T9 PIPE BOTTOM (FT.)
5.0
4.0
EFAVEL DEPTH (FT.)
0.5
2.0
TOTAL DEPTH (FT.)
5.5
6.0
"PAVE WIDTH (FT.)
14.0
5.0
ERA'1EL LENGTH (FT.)
29.0
36.0
GRA`.'EL V;LL''IE (C'J.YDS.)
14.5
15.7
TANK SIZE (EALS)
1,000.0 as
1,000.0 ++
SOIL SATINS (S9.FT.18F)
85
85
as TA\K MUST HAVE AT LEAST TWO COMFARTI.ENTS
----------------------------------------
1 certify that:
1. 1 as familiar with the requirements far on-site sewers and wells as set
forth by the Municipality of Anchorage (MCA) and the State of Alaska.
2. 1 will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. 1 will adhere to all MOR and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system an this or any adjacent or nearby lot,
4. 1 understand that this permit is valid for a maxiacm of 3 bedrooms and
any enlargemant will require an additional permit,
IF A LIFT STATICN IS INSTALLED IN AV AREA COVERED BY MOA E'JILDIYS CCDES,
THEN (1) Al ELECTRICAL PERMIT AND INSPECTION MOST BE OBTAINED; Q) AS-BOILTS
klL' NOT BE APPROVED WITHOUT AN ELECTRICAL INSFECTICN F,EPCRT; AND (3) THE
rtcCT.iICAL WORK "JST BE DONE BY A LICENSED ELECTRICIAN.
SIDED OAT-:
APFLICANT: LEE V STANT:N
.csi"D BY ' ``` ` DATE:
" `�----_`--`-"-'---�-----------------------
SOULS 6OG'
—�, MUMCIPALITY OF ANCHORAGE o s C U S J
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
�v 825 L Street, Anchorage, Alaska 99501 2644720 TEST
e.
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Sia 17' `^• DATE D .
LEGAL DESCRIPTION:" /-,-?A/ RTV, SeLI ;7�
0.9.
2. '
3
grai d
6 .�,
Q gra I
9 �#,?I, S76- A-
,. �rm
9 ` e
ai! .
10 iy9,Q.
11 l%1L� 1� dr�t
12 IJPr RPA�e
NA NA d'ORN) •`
13-
4
�-
15
17 -
V
18-
19-
20
6-1920
PERFORMED BY: l7✓�r �.JV 1 s `,
72.009 (6/79)
IOUNO WATER
VTERED7
AT WHAT
Reading
Data
Gross
Time
Net—�.`
Time
_Depthtn
- Water
Net
Drop
TRUIN
TWEE
�•F'1'.AND ��1 � F-6 - v
ITUE
II(( (J
1i7, -x117/LYJ7
. .� r �..
:a0a6,
_•
CERTIFIED BY:,TE:
J
. • 4<1, ' •' !t .
x p �•
•Ci
PERCOLATION RATE
•7'= : !, hjnuiss21rlch)
TRUIN
TWEE
�•F'1'.AND ��1 � F-6 - v
ITUE
II(( (J
1i7, -x117/LYJ7
. .� r �..
:a0a6,
_•
CERTIFIED BY:,TE:
J
. • 4<1, ' •' !t .
K"CIPALTTY
OF CEP OPAINVO"E
ErvlikoNMENTAL PR0TECTI011
BEC J
LOCATION OF WELL (Pieces Complete either lay ID o_lyif- r 1\1Fn
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological fi Geophysical Surveys
Drilling Permit No.
A_nl M..
lo� a-.
Subdivision
Lot
BIOCY
o—
ID
1/e
iClio n No.
Town Ship NO
Rpnpa E[]
Meridian
sr;rh.
Dr-11-'r,rt
'.?
—of_of_of_
S❑
w❑
17 DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
S. OWNER OF WELL:
c_ :'t.^stern
Address: Loir Dr.
Ile, GI`r.: C Ai(. 503
Street Address and Area of Well Location
2. WELL LOG
Fasteoel:w
4. WELL DEPTH: (Ilnal)
S. DATE OF COMPLETION
Material Type
Top
Bottom
111: ::rf'y' COa^f:CtG4 rend hI rd
6, ❑Cable tool ❑Ralary ❑Driven ❑Dug
❑Aug•, ❑Jet Nd ❑Bored [3 Other:
U V 4.'II9: i'r/''% r,.;1 cr In P r] 11,;1
t. .: trinI
?.USE: ❑ Domestic ❑ Public Supply ❑ Industry
❑ Irrigation ❑ Reehorge ❑Commerical
❑Testiest ❑Other:
.;,tJ:_.:1": ;'I'f•'r Cr`1"r, r.!cd i.Ua'. I,J GJ
is
e. CASING: ❑ Threaded ❑ Welded
1" rev end h::rd.
GO
80
diose. �> In. to '-L.1 it. [).pill weight 17 Ib../n,
diem. In to ft. Death Stickup It.
U Ur.: rrt V colorq 7cdiu^ 0 125
9. FINISH OF WELL: :7 or. (,,1:d.
Type: Diameter:
Stat/Moan Slse: La loth:
ed :rid h::rd. 125 14J
1L`V4.11: lIr'11'. b.^':v'❑ coloz', 1!t`) 145
'TT el .: i::: ri:rir9 E, zin C. 7i— or EF'.
----
I Set between fl. and fl.
BaCkHlllnp Orays pact
1L5 15t!
"lluvi•::^: lir"1]t br:�r;n r..�l.cr
i`.'^
17ci
10. STATIC WATER LEVEL' 1`)' ft.
❑ Above or 0 Below land surface Dale
broNn Calor 1'rL 162
T
;
Eauipmenl used: n tine
,-ri I ct•7 , i t t v I, —1t e `; r' -x:.
12 1 1 L 1 lla' : 1'I Cx 'Znd c ed: );&r( e
ih2
2�
<6 II,PUM PING LEVEL bola. land Surface and YIELD
' L
%(' fl. off*, 1i pumpinp�g.p.m.
_II al For _hrs. pumpinp_g.p.m.
^d ...:Ilei: f''r ::;j Colo.-, ":it7. CJL T71
is l; Cie
/'re- and h.srd.
12.O11OUTING Wel Grouted: ❑ Yes ❑ No
Malarial: C] Neat Cement ❑O1h1l:r';ItU1',`1.
:
llluVium: rr,J c- Ur, Get lura. c'11 ?1d
7;;: G.17 C• `, ti:7h 7. "•LO1' Cq'_UIY 4 ,!Uri
IS. PUMP: (II available) HP
l.lrviu!1: t-rFy c-, or, ed_uri
21�,
23t'
Length of Drop Pip. n. aapaoly g.p.m.
❑ Subm. ❑ Jet (3 Centriflcal ❑other
-n('.: 1ir'1:t b)" )%.:) , wit.' tr r;
{P
%!t1
14. REMARKS:
16 WATER WELL CONTRACTOR'S CERTIFICATION:
IS. Wazer Temperature .• ❑ F ❑ C
This well was drifted under my Jurisdiction and this repos It true to the beet of my knowledge and belief(
ors
AA
753
R.g.slered Business Name
Contract License Number
<d r.. 11. it: '„rco� 'Lr,t s'.
:, '1,
rr -)!")i
_ - I.
5.gn.a:r, I
_ y--
Dot.:
- Authorized Representative
/
Farm 02-WWP (11/81) COPY Distribution:
WHITE •Slot@ DGGS, PINK -Driller, CANARY •Customer