HomeMy WebLinkAboutT15N R1W SEC 8 LT 186eri5-10 11(A)
SEC -8
s a •
Apr 33 21 F, F: ,:;ho _:tati Nell & Pump So: -
07='430142 P.1
MUNICIPALITY OF ANCHORAGE
Develop hent, —Services Department
�
� �IGIne: 907-343-7904
on -Site Water & V e ttlwater Sector,
5� ��x: 907-343-7997
Well Driffing Permit Number:
Rarcei Identlific ation Nuinber: 0-%- Y,31_
I.egalDescription� 1 Bio3:k Lnt
115 /V Sec e;
Mantrap IRS-tallation Dates
1. ate of Issue: -.___-
Property 0�,,rsi'er Name & Address-
-Al
Pump Intake Dept'a Below "Cep of Wttl Ca9iP_g:
Pump -M anul't:cturcr's Name: r:I.=~
Puntp Medei: 4
Pump Size:
Pitless AdapterBurial Depth--� �y _ feet
P.itless Adapter Manufacturer's Name,
Pidess Adatntc r Installer*
Weli Disinfected Upon, Cam On? Lei' Yes C No
Metbod. of Disinfection:
i
I
Comments:
Pump Instaaller Name:. ANCHORAGE WELL & PUMP SERVICE
7640 King Su=et
Company: any: __ Anchorage:, AK 99518
PH: (907) 243-07140
Mailing Address.
City:
State: _^zip:
Attentlow The pump installer sh li pro --j&, a pip i:nst<zitati.on loge to Can -sate within 30 days ofpwrp installation.
)MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE ~(NEW
.~"~'Y~ ~ ~ '-'FI...& L. L ~ ~'~::¢~ --~"~) [] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~ DISTANCE TO:IWell ~O/ I Ab'°rPt'°" ~"~/ D~.",.. ~ P~RM'~¢
~ Z Manufacturer ' Material No, of compart~ents~
Inside leng~ Width Liquid de~
' IF HOMEMADE: _~ .
~ ~ DISTANCE TO: Welt ~ Dwelling PERMIT NO.
~ Manufacturer~ ~ Material Liquid capacity in gallons
,F ndatio Nearest lot line PE
No. of lines Length of each li~e¢ /) ~1 length of lines ~ Trench width Distance betwe~ lines
--'~ inches
~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
~ inches
~ Lengthen/ Width /~ / D~thl ~ ~,~ O/~ Ple~ PERMITN~x~
~ Type of crib Crib diameter Total effective absorption area
~ _ Crib depth
~ - _ I ~o~
~ DISTANCE TO: Well /0~ /~__ Buildingf;und~ Nearestlotline ~
M Class ~ Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERI~S ¢
SOIL TEST RATING ~/~ F ri
INSTALLER
REMARKS i I r I
3 (Rev, 3/78)
PERMIT NO. (
['.'IL.Ilt"-.!I Z C: I: F'FllL_ Z -F"-r" C"F F-ti%IC:~'-t C"R F-t~-SE
DEPFIR. TMENT OF' HEFILTH FIN[:, ENVIRONMENTRL PROTECTION
E125 '"L'" STREET., FINCHORRGE, FIK.
264-4720
C, I"-.i --- ."S ][ -r E-: S E
83:06.72 )
RPPLICRNT
LOCRTION
LEGRL
JFIMES TLILLY
L186 SEC: 8 Tt5N RtH
L186 SEC8
5910 S TAHITI LP 99507
LOT SIZE
56g?'SB0
27000 SQURRE FEE]'
TYPE OF SOIL, F~BSORPTION SYSTEM IS: DRAINFIEL. D
MFt',:'::II'"IUH NUMBER OF BEDROOMS
SOIL RFI'¥ING (SQ FT/'BR)= 150
THE REQUIRED SIZE OF 7'HE SOIL RBSORPTION SYSTEM IS:
[:. E F" T It-I~ =:: !5 L.. E J'-4i ~3 T IH:~= 79 ~3 F.: F~ %-" E L. [:.EPTFJ=: i
THE LENGTI.-I DIMENSION IS THE LENGTN ,:lIN FEET]) OF THE TRENCH OR DRRINFIELD.
THE DEPTN OF Ft TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFRCE OF THE
GROUND FIND THE BOTTOH OF THE E',KCWCRTION (IN FEET).
THE GRRVEL [:,EPTN IS TNE HINIMLIM DEPTH i]F GRRVEL E:ETI4EEN THE C~UTFRL. L F'IPE
RND THE BOTTON 0F THE E',:.:;C:RVR"FION (IN FEET).
F'ERMIT F~PPLICRNT HRS THE RESPONSIBILITY TO INFORI"I THIS DEPRRTMENT DURING THE
INSTFILLRTION INSPECTIONS OF' FIN"¢ I.,.IELLS PID..'rRCENT TO THIS F'ROPERT"r' RND THE
NUMBER OF' RESIDENCES THRT 'THE WELL WILL SERVE.
........... TI.,JtC, .:: ;;':..:' :) I I%~'--z.P'EC:T I L--I~'-.~ S FIRE RE~-U ][
BI'-tC:I'.':]FILLING OF FIN'¢ SYSTEM WITHOUT FINFIL INSPECTION FIN[:' FIPPROVRL. B'¢ THIS
DEPFIRTMENT WILL BE"SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEI',I FI HELL RND RN'¢ ON-'SITE SEP.IFtGE £,ISF'OSRL SYS'f'E]'I IS
:1.00 FEET FOR t'~ PRIVRTE 14ELL OR "1.58 TO 200 FEET FROM R PUBLIC NELL DEF'ENDING
UPON THE T"r'PE OF PUBLIC WEL. L..
MINIMUM [)ISTRNC:E FROM R F'RIVRTE WELL TO FI PRIVFITE SEWER LINE IS 25 FEET FIND
'TO FI COMMUNIT"r' SEWER LINE IS 75 FEET.
OTHER REL=.!UIREHE:NTS 1"18"¢ FtF'PL."r'. SPECIFICFITIONS FIN[:, CONSTRUCTION DtRGRRMS RRE
BVFIILFIBLP- TO INSURE PROPER INS]"BLLFITION.
P E F-':~'""~ Z ]'" E.'..-::F" Z R E ~'~.. [:.EC:EtI"~IE':ER g :J.--.
I CERTIFY TI.-IFIT
:.L: i RI'd FFIMII_IFIR HITIq THE REQUIREMF'NTS FOR ON-SITE SEWERS RND !.4ELLS RS SET
FORTH BY 'THE MUi'.,IICIF'FtLIT'¢ OF' FINCHORF'IGE.
;2: I !4ILL INSTRLL THE SYSTEM IN RCCORDFtNCE WITH THE CODES.
3,: I UNDERSTFIND 'T'HFIT THE ON-SITE SEWER S"r'STEM HFI"," REQUIRE ENLFIRGEMENT IF THE
.' '- ' - P- '- INCLLI[:,E MORE THFlt",I ~' ~ "
F..E..~IDEN_.E t:, REI"IODELE[., TO _. BE[:,R:3MS.
SIGNED ._._..~..~.~:2-~'-":.~-,'-~.~-~ ....................... ' q ~..~:?(~ ~. ¢,.,'\-/ ' ' ' , '-
B,? "
- V4. lei
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
? ' [] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ,~.-.
PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE
or/~t~t C
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
12
13--
DATE PERFORMED: 4 ~'
SITE PLAN'
14
15
16
17
18,
19-
20-
, ~ Re@~i99 , Date Gross Net Depth to Net
/ /,s'- F;zoA- ---- ~<~" --
z ,,~;30 A /o ,~ /~"
~ ,,~;~ ~o :s3Tlr~
COMMENTS
PERFORMED BY:
72-oo8 (6/79)
SULLIVAN WATER WELLS
P. o, 90x 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS '~ ct /:
LEGAL DESCRIPTION Z Ir ~ [('b"~ ~" "e ' ~'
DATE - Started <; -~ ~' .~ ~' ;~ Ended --> ~. c ,> ~
PE~IT NUMBER ~ , ,
DEPTH OF WELL
ATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From .'9 Ft. to :) Ft. /) ;:~';~ /"'~L~ ,~
From '? Ft. to ,':,, Ft.. = " ' ' ' ~ ; ~'
From Ft. to Ft. ) ? :2; ',~ / From
From ii':, Ft. to · ' Ft. ~: , ¢ ~
From ~:' ,' Ft. to ) > Ft, ~ '
zSZ~(o,:,~<~ , ~ c:;~ ~ ,~rom'~
From Ft. to , Ft., ~:~': -~,'~l ~ From
From. ;, ,:: Ft. to /(:,/ Ft. t;:"~: :.?&%> ~ ;<- From
From Ft. to , /,; Ft. /: ' ':?/4' ~ ~' t~ ~, ~:::~,:'*:, From
From Ft. to Ft, (r.'.'.:-'"-' : ~,,.~ ~,t '~ From
From / ? ~ Ft. to ,,? ,$ Ft. ,~3',:,,,~o,~< From
From ' ~ Ft. to >il Ft. l'~'~/~"'~<,¢J/q"~t~e¢'<~ From_.
From Ft. to Ft. ,,,,; ~ ~ ~ FrOm
From ' q Ft. to ,? [t~ Ft. L?, oA' ro c_ ~*;. , From
From : ~ Ft. to > ;, Ft. ,~ ~, t' I ~ ~om.
'; <~,'~ From..
From .Ft. to.~Ft. ,~ c:,~, ~'~ ~ ,,~
From ': Ft. to ' ~ Ft. d~'~:: .:;.<~ ~,~ A
,"-' From
From Ft. to Ft. From~
Ft. to _Ft.
Ft. to_ Ft.
Ft. to___Ft.
__ Ft. to___Ft.
Ft, to_ Ft
Ft. to
Ft. to_~Ft.
- Ft. to Ft
Ft. to~.Ft.
Ft. to Ft
Ft. to_ Ft
. Ft. to Ft.
Ft. to.~Ft.
.Ft. to. ~t.
MISCL. INFORMATION:
DRILLER'S NAME _
( er fiei 3dllin Cog
DOC CO. dba
w wu
. O. BOX 272, CHUGr~AK,~a. LASKA 99567 · TELEPHONE 688-2759
~ '~ DE HOFWELL ~aO ~
OWNER OF LAND ~ ~ ~ ~ ~ ~
ADDRESS ~lO :~ ~t~/ ~ ~ ~q~ATIC~EVELOFWATERFT,
LEGAL D~CRI~ION ~ [ g~ ~ ~ ~ ~ ~t ~ ~ DRAW DOWN FT.
DATE- S~ed */~ '/F 2 Ended ~ -, ,GALS. P~p& /~
~ND OF FO~AT[ON. .- -, ~ , ~.~
From Ft. td Pt. ~-~/ ~Y '"":/;~Fr~m. -<;'Ft ~t0 ~,,' ' Ft
From /~ Ft.,to ~/ Ft. ~d~oc/< , ,~ ~'FkOm -' Ft~ Ft.
, to · Ft,~
From 7 a Ft. to~ I & t~ Ft.
From ~6- Ft.
From Ft.
_Ft. to
From ~ 70 Ft.
to__.Ft
to Ft.
From Ft. to ', L~t.
MISCL. INFORMATION:
DRILLER'S NAME ~-~--,'~* ~-'~'-'"'~-""-
PERMIT NO~
DEPBRTMENT HE8LTH AND ENYIRONMENTAL . ~:OTECTION
825 *L* STREET, ANCHORAGE~ AK. 9950±
264-4?20
I~ELL PERi~4 IT'
( 8~0±~0 )
F;PPLICANT JAMES M TULLY 5910 S TAHITI LOOP
LOCATION N BIRCHWOOD LOOP
LEGAL T'15N RiW SECT8 L±86 LOT SIZE
562 ?580
S~1..18 RE FEET
MINIMUM DISTANCE BETWEEN R WELL RND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR R PRIVATE WELL OR ±50 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED RND MUST BE RETURNED TO THE DEPBRTMENT WITHIN :~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS RRE
AVRILRBLE TO INSURE PROPER INSTALLATION.
F"ERI'-'I Z "T E."=-~P I RES ~"E£:Ei'"'IBEF?.
I CERTIFY THAT
i: I AM FAMILIBR WITH THE RE~UIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE COD, ES~
SI3~' "' '.-,,
iSSUED ...........
94. 0
,. 7
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date ~/~A~'~h
(a) Legal Desqription (include lot, block, sub~ision, section, township, range)
Locat~ipn .(address or directions)~
(b) Applicants Nam I ~b~ Telephone - Home
(c) Applicant_is (chec~on~) Lendi~ Institution ~ ; ~er/builder
Buyer ~ ; Other ~ (explain);
Address
(e) Real Estate Co. & Agent
Address
(f)
Telephone
~he HAA to the.following address:
2. Type of Residence
Number of Bedrooms
~, Water Supply
IndivSdual ~ell~
Multi-Family~
Other (describe)
Community~--~ Public~-~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite~ Public~-~ Community~-~ Holding Tank~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
Engineering Firm Providin~ Inspections; Tests, File Search~ Data and
Information
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 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
DHEP Approval
Approved
bedrooms
Disapproved
Terms of Conditional Approval
Telephone
'/ /
(ENGINEER SEAL)
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ?H AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY A~PROVAL CERTI! SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT -- ENGINEER REGISTERED
IN TILE STATE OF ALASKA. THE DHEP DOES THIS AS A C0I TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTI NS OR ANALYZE DATA BE~0RE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANC] IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
RR4/ej/DI8
[Page 2 of 2]
(DHEP SEAL)
ae
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AgTHORITY APPROVAL (HAA)
MUNICIPALITY OF ANCHORAGr'
DEPT.*OF HEALTH &
ENVIRONMENTAL PROTECTION
NOV 2" 1984
CHECKLIST - FEBRUARY 1984
Legal Descri. ptio~n: ~'~IV~ Ds
~A~/~J /CI L~J
Well Classificat~/(-y If A, B, c~ C, D.E.Cm Approved(Y/N).
Tota~ o.p~ 3 ~ o ' Card to 'f2 i l " $ ~ o~ptn cf ~outi~g
Casing Height Above Ground ~ ~ ~
Electzical Wiring in Conduit (Y~)
Separation Distances f~cm Well:
To Septic/Holding Tank c;n Lot ~C9 ; On Adjoining Lots
To Nearest Edge of Absc~tion Field oq Lot ~/O~ ~ ; On Adjoining Lots
To Nearest Public Sewer Line /aD//9- To Nearest Public Hewer
Cl. anout/~ole ~/,. ~ ~ ~.~est ~wer ~i~ Li~ on LOt
Water Sample Collected By S ~ 3' ~('//V~///V , Date
C~JJf=nts
Sanitary Seal on Casing
DeLm~ession A~ound Wellhead
Be
SEPTIC/HOLDING TANK DATA
Date Installed ~--¢ ~ Size /~_~.~,~ No. cf
Standgipes~/N) - Aid-tight Caps (~) Foundation Cleanout~Y')N)
Deg~ession~r Tank (¥~)3 Date Las~t ~umped //~k~ D-) ~ ,,
pumping/Maintenance Contatact on File (~/~ ; for ~ . .,/
Holding Tank High-Water Alarm (Y/N)/~Y'//~- TemporazuZ Holdimz3 Tank Permit (Y/N~//%
f~cm ' olding
Separation Distances ~
To Water-Supply Well
To P~operty Line /(D ~
To Water Main/Service Line d51) (~
Course
Cor~ents
Tank: ~¢
To Building Foundation
To Disposal Field d~- /
To Stream, Pond, Lake, c~ Major D~ainage
Receipt 9
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION. FIELD DATA
Soils Rating in Abso~l~tion St=ara
Date .Installed
Length of Field ~'- /
Width of Field Depth of Field ? /
· . ~'~0%~, Gravel Bed Thickness ~ ~
Depression over Field (Y~ Date of Lest Adequacy Test ,'~-~/ ..
Results of Last Adequacy Test /C/ /f'~
Separation Distance frcm A~sc~ption Field: ,
To Water-Supply Wall /~ Z ~ To P=operty Line /CD .~
To Building Foundation ~_"2~ ( To Existing or Abandoned System cn
Lot /u/~)~JT? ; On Adjoining Lots (~/~;~/~
To Wate~ 44m~/Ber. vice Line c~~ (~ To Cutbank(if .present) /tJO~J~'~
To Stream/Pond/Lake/or Major Drainage Course /JO ~J~ ..
To Driveway, Pa=king Prea, or Vehicle Storage A~ea ~ ~
Com~nts /J ~/~ ~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarl~ Level at
Tested for
Electrical Codes(Y/N)
Ccmments
Dimensions
,, ~nhole/Access (Y/N)
Pumping Cycles du=ing Adequacy
Test. Meets MOA
** Check Permitted Bedrocra Rating Against HAA Request
I certify that I have checked, verified, or conforrced to all MOA
on the date of this_inspection-
8 & ~ ENGI~F,~RIN{~
Signed
KB1/d5/s
[Page 2 of 2]
HAA Guidelines in effect
~/ T~J~"%._ ...-~'~'
2-15-84
ANCHORAGE/WESFERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
April 5, 1985
!
R#t.~ SHI. FFIF. LD~ GOVERNOR
274-2533
Mr. Robert Shafer
S & S Engineering
SRB 196X
Eagle River, Alaska 99577
SUBJECT:
Horizontal Separation Waiver i3etween Well and Septic Tank,
Lot 186, Section 8, T15N, RIW, Anchorage, Alaska
8521-WA.-128
Dear Mr. Shafer:
The Department ha'; reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic tank to 90 feet
on the subject property for a 3 bedroom single family residence only.
Si rlcerely,
SE/dd
~Steve Eng, P.E.~~
District En§~neer