The URL can be used to link to this page

Home My WebLink AboutJEM LT 1 U e (,, '2Cj n 8 11 1 : (2, C, a MorA Begich ka-vor A rlChC rage & --�;-ripber 61012430f42 Services bepartment Building Safety bivi'sion Cm -Site Water & Wastewater Program 4700" Eimore Road P.0, Sx 196650 Anchxoqe, AK 99507 —r-,/Lt-IL,t—e (S07) ?43-7904 Punip Installation Log Well Drilling 111tr SNy Parcel Idelitification Z It Z - 6,11 Date of Issue: Attentlan: The p '09 to zhc DSD wli',.-hin 10movys ofpurn-;� installation. e k_,~ 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 PHONE ~] NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption are DwelHng PERMIT NO. ~ ~ No. of~mpartments Material ~ ~ Inside length Width Liquid depth Liq. car~it~allons IF HOMEMADE: ,-- -- Well Dwellin9 PERMIT NO. ~ ~ DISTANCE TO~ ~ Foundation ~ Nearest lot line ( PERMIT NO. Nell ~ DISTANCE TO: i ~OO ~ ~ ~ ~ ~ No, of lines Length of each Ii Total length of nes TFench width Distance~etween lines to finish ~rade ~ ~ Material beneath tile ~ ~ Total effective a Ct' depth T~pe of c~ 'Crib ~ effective a rption area r / ~ Nearest iot line ~ ~ ~ ~TANCE TO: ~1 B ion ~ ~~s Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATIN6~ ' ' ~ INSTAELER APPROVED DATE LEGAL 72-013 (R~ 3/78) PERMIT NO. ~;--.,-.---'~:' EFIST 22ND RVE.., RPF'L I L:RNT EL:, HEF.:ZOG '- ~='"':"' : . E. IL.I. ..... LOT .:,I~E LOCFIT 'f FiN ., .... .c ?,TF.:EET ,- ...-, - LEGRL LOT :.t JEM '.SUE: T'-r'F'E OF SOIL RBSORPTION SYSTEM IS: TRENr:H = SOIL RFITIf",IO ,::SQ FT,."'BR)= '150 MH,,.:,IflLli'l NUMBER OF E:E[:,ROOMS 4. c ~ ,-":rill RBSOF.:F'TION ST",TE['I IS: THE RE6!U I F:E[:, .=, I ~:.E OF THE - - DEF'RRTMENT'"oF HERLTH RN[:, EN"/IF'ZNMEF'TRL'''-''~'¢RUTECTION ,-,.-:,~ STREET., RNL-:HORRGE., RI-:::. '_~'.~50:t. ,: ..... '" L '" ;26AL-4720 F'ERf"I ]E T ...... _ ,~2:56R 5;QURRE FEET THE LENGTH DIMENE-;ION IS THE LENGTH (:IN FEET) OF THE TRENCH OR [:,RFIINFIELD. OF THE ) , TREN..H NF.' PIT THE [:,ISTFINCE BETNEEN ]'HE ,=,IIF.'FFICE THE [EPTH OF R - · GF.:OUND AND THE BOTTNM FIF THE E::-'.:F:R',,,'FITION ,::tN FEET::'. THERE IS NO SET NIE:,TH FOR TRENCHES. OUTFRLL PIPE MIF ' THE GRFIVEL DEPTH IS THE 4IHIIM DEPTH OF 6F.:RVEL BETNEEN THE RND THE BOTTOM OF THE E:.-.:',CFIVRTION (IN FEET). F'EF.:MIT FIF'PLICRNT HRS THE RESPONSIBILITY TO INFNF.'M THIS [:,EPRRTMEN. T DURING THE !NSTFILLFITION INSPECTIONS OF RN'¢ HELLS R[,JFICENT TO THIq pF'.FjPEF.:TY FIN[:' THE NUMBER OF RESIDENCES THRT THE HELL. HILL SERVE. BFIr:KFILLING OF FINN.' S'¢STEM NITH-jIJT FINFIL INSF'ECTION FIND ..... - ...... ' DEPFIRTMENT HILL BE SUB3'ECT TO PROSECUTION. MINIMUM DZSTFINC:E BETHEEN Ft NELL RNB, RN'~ ON-SITE SEHFIGE DISF'OSFIL S'¢STEM IS ~FIO FEET FOF.'. Fi PF.'.IVFITE HELL NF.' t50 TO ~' ."4 FF'ZM FI FqIBLIC HELL F:,EF'ENDING FIJBL ]. L. HELL IS MINIMUM DISTFINI-:E FRL-IM R PRI',,,'RTE 1.4ELL TO R PRIVRTE SEHER LINE ,=._ FEET RN[:, TO R COMMUI'.,IIT'T' SEHER I_INE IS ,--"5 FEET. 'R'- REL.-.,._IRE[:' RNC, MUST BE RETURNEC, TL'i THE DEPFIF.'.TMENT HITHIN 3:0 [:,FI'.r'S OF THE NELL F:OMF'LETION. _ ..... ,_- . ,--. RF'F'L'-r'. '-,F'EL. IFIL. HTIUN-, RND Ci'iNSTRLICTION [ IHbF. Hrl-, RRE OTHER REQI..I ! REMEt'~T-, RVRILRBLE TO INSURE PROPER INSTRLLRTION. I uEF..T I F THAT .:.,ET !: I Rid FRMILIFtR HITH THE REgglIF.'EMENTS FOR ON-SITE SEHERS FIND HELLS FIS '= FORTH BV THE MUNIF:IF'FILIT",? OF FINCHOF.:FIGE. RESIDENCE IS FEMO[:,ELE[:' TLI Ir.,!L. LUL.'"' H'-'rs':- ..... ' i -J C~IPALITY F N E MUNICIPAL T 0 A CHORAG 25 L Stre", An~hor~; Al~ka ~501 2~720 SOILS LOG - PERCOLATION TEST 17 18 NO. 1732-E COMMENTS SLOPE SITE PLAN WASG.OUNDW,TE. /'JO' t ENCOUNTEREO? O E IF YE$.'~T WH~T DEPTH? Readin9 Dat~ Gross Time 'r;M Net Depth Water to. Drop NetJ I PERCOLATION RATE (minutes/inch) BETWEEN FT AND ,. FT ~ I~ - - CERTIFIEi 72-008 (6/79) Well Log ~0~...E~. .... ~~.. ~~ ................................ ........................... i ......... Location L..~.t.' ! U[.~. ~oSo Date completed., i~: ?: ~ - ~[ Depth of well ....... [..~.[.! ..................... S~ze of casing ~ Distance to water ~'~OU, .~d[~:~ ~0I~ DiStance to water while pumping... [00! ' · ..... at rate of ........... ~.~i.0..! ...... : ..................... gallons per hour. FOrmation [ from to 13 23 Driller DELTA DRILLING COMPANY SRA BOX2~. 94 b ANCHORAGE, ALASKA 99507 -3~I~-~ ~70 T 0 D A T E suBJEcT MESSAGE .~ X.;: ? SEND PARTS 1 AND 3 WITH CARBON INTACT - P~Y**K (~ SE;S)¢ ~7~ ~edi~rm~ 4S 471 PART 3 WILL BE RETURNED WITH REPLY. 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Day phone - Mailing address Lending agency Day phone Mailing address Agent /(-% ,-¢ ~ / k, ~, ~ C .o ~r~'Cl./ Day phone Address ~/2 ¢¢~ ~'/ ~ Unless othe~ise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: ~ ~ , t ~.~ Individual well Community well z o Public water If community well system, provide written confirmation from State ADEC~ttest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site o Holding tank Community on-site Public sewer If community wastewater system, provide wri~en confirmation from State ADEC attesting to the legality and status of system. NOTE: 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. NameofFirm '? ~;~'j';-'c~', %3~,'~,C.~~:~vLc-(7''~-~-- Phone ~'0'?-,.%'7(~-~- Address ,~C' }~ u / Engineers signature ~~ ~-~ Date 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 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth ~ q~,/ Sanitary, seal (Y/N)' Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~2( Date of sample;" Health Authority Approval Checklist 3 [~' &L{ Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~ FROM WELL LOG lo[ Nitrate Collected by: Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Z F.L: Other bacteria B.SEPTIC/HOLDING TANK DATA _..., / ~ Dateinstalled 'O/q/Bi Tai k size Co Foundation cleanout (Y/N) Date of Pumping ABSORPTION FIELD DATA Date installed ""~/q/ Leugth J~J~ ' Width /O~-~ Number of Compartments o~ Cleanouts (Y/N) y Depression (Y/N) N High water alarm (Y/N) N Pumper Soil rating (g.p.d./ft~ or ft2/bdrm) ]2'~'~/~ System Lvpe / Gravel thickness below pipe ~' ! Total depth Effective absorption area Date of adequacy test Fluid depth in absorption field before test Finial depth ~ (ius.) ~er: Peroxide treatment (past 12 months) (Y~) Monitoring Tube present(Y/N) INk'Depression over field (Y/N) I"~ Results (Pass/Fail) ~ For ~ bedrooms hnmediately after~OOgal, water added (in.): Absorption rate = ~> ~/~'tS? g.p.d. If yes, give date LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* Cycles tested "Pump o11" level at* *Dattlm "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot'1~ ~--Dt : On adjacent lots .~/~ ~ Absorption field on lot Public scxver main }~///~ : On adjacent lots Public sewer nlanhole/cleanout Scxver/septic sen, ice line ~ (~.~ I~ Lift station SEPARATION DISTAl'ICES FROM SEPTIC/HOLDING TANK ON LOT TO: Btfilding foandation 'ql ~ Property line >],~.,> I Absorption field Water main/selMce line ~t~,~/Surface water/drainage N ] 12) Wells on adjacent lots 1 Driveway, parking/vehicle storage area ] ~ Wells on adjacent lots ~//3-O Property line F. ENGINEER'S CERTIFICATION .;::, ,,,., ,. I certify that I have detemnined thru field inspections and review of Municipal rocor, ds,. theft the.above S~st~ff~s are in coq/brmance with MOA ~ guidelines in efJkct on this date. ,': ' : ' " S D' ,., ,;, ./~,,:. . ,.::,,; z HAA Fee $ ~ O~ Waiver Fee $ Date of Paylllent //-/-- ? ff Date of Payment Receipt Number ~3 ~/[ O ~ L[~ Receipt Number Rev. 8/95 OSS: haa.wk,doc SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ / Water mai~Vservice line Cu~ain drain ~! ~ 0 T.SPURKLAND P.E. WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: Lot 1, JEM S/D 12041 Galena Circle David Calvin TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET: Yes WAIVERS GRANTED: None Required WELL YIELD FROM WELL LOG: 2.5 Gallons per Minute PUMP YIELD FROM TEST: 1 Gallons per Minute DATE OF INSPECTION: October 25, 1995 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 36 feet below top of casing. At a pumping rate of 5.75 gallons per minute the water level dropped to 142 feet, the intake of the pump. Water was then shut off. 250 gallons had been pumped. The well rested for 3.5 hours and the water level rose to 61 feet. The pump was started again and 150 gallons were drawn before water level returned to pump intake. A total orS00 gallons were pumped. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on October 25, 1995 E.Coli 0. Other Bacteria 0 Total Nitrogen 2.51 mg/l. Max. allowable Total Nitrogen 10 mg/I. No Bacteria Allowed TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. DATE RECEIVED ~, INSPECTION APPOINTMENTS ~.j.~ L_ ?/~2') 4 ~r~.~ .~' TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PFCOTECTION i ENVIRONMENTAL SANITATION DIVISION MAY 9, ' 1981 Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEV~IJl-VIt~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILINGADDRESS~ ~ ~ PROPERTY REagENT (If (]ifferent from abbve) PHONE 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ,,'~/~ ,.5' f~-~°~ /5 ~ '~I PHONE MAILING ADDRESS 4. REALTOR/AGENT ~ I PHONE MAILING ADDRESS STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS ,J~,~l N G L E [] One [] Four FAMI LY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six [] Other 7. WATER SUPPLY '~"~'DIVI DUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY [] PUBLIC UTILITY since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PI~CESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE E~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL. DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~//APP ROY ED FOR ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79)