HomeMy WebLinkAboutDENALI HEIGHTS LT 2Ocuy&LA 4i/L Ms
(RA A
4oA-a3k ---C.) a.
Mark Begich
Mayor
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650 ,
www mum mrtVonsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW_
Parcel Identification Number:I Jjft—d3(—Ck2
Date of Issue: _
Legal Description
kftviscii 141-s
Cor 9 -
Property Owner Name & Address:
Ai- L/o yg
)113 cries ccre-os e12.9
Pump Installation Date:
Viz/07
Pump Intake Depth Below Top of Well Casing: feet // f
Pump Manufacturer's Name: �U ac (�'+
Cl‘r/z'3
Pump Model:
Pump Size hp �Z
Pitless Adapter Burial Depth: feet
/0
Pitless Adapter Manufacturer's Name: I) A
Pitless Adapter Installer: p /a
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection: :7091 v..`
Comments:
Pump Installer Nan
ANCHORAGE WELL & PUMP SERVICE, INC
:30 EAST 76TH AVE. ANCHORAGE, ALASKA 99518
(907)243-0740 - FAX:(907)243-0742
E-MAIL: pumpmanjim@att.net
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
— MUNICIPALITY OF ANCHORAGE ---
Dl 2TMENT OF HEALTH AND HUMAN SER cS
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Address
Phones)
`:; ?91
Permit No.
At 9.(J,--(1
No of Bedrooms
FROM
WELL
DISTANCES
TO SEPTIC
TANK
ABSORPTION
FIELD
WELL
ia)' 4 -
R6- (-51
LEGAL DESCRIPTION
Lot
Block
LOT LINE
Z
Subdivision 1
Township, Range, Section
I'H'J o.t W S
TANKS
FOUNDATION
F
AS-BUILT DIAGRAM (Show
driveway, water bodies, etc
location of well, septic system, property lines, foundation,
X SEPTIC ❑ HOLDING
Manufacturer
ct
Capacity in gallons
oc 0
Material
No. of CCpartments
TYPE OF SYSTEM
TRENCH ❑ BED
Depth to pipe bottom from
original grade
4
FT
❑ W. DRAIN ❑ OTHER
Total depth from original grade
j0
Fill added above original grade
Gravellength
v
FT
FT
Gravel depth beneath pipe
Gravel width
FT
FT
,
Total absorption area
FT
Distance between lines
SQ FT lV
Number or lines
Soil rating
SQ FT
Pipe material
FT
Installer
4C)USI., tt?1 G-,-4-
Date Installed
WELLS
I9 t
t
PRIVATE ❑ OTHER (Identify)
Total Depth Cased to
FT FT
Classification (A,B.C)
Installer
Date installed:
REMARKS:
Co
4
fAr
I eck (el
('�2�tI++t
(_L)'-"4 �111 e �<•
Municipal and State guidelines in eltect on this date:
Scale: iT'j
I pectiotns Perfprmed by:
y3 TYVL»14--N1 GV (1 /IN-( .*d
tie C.2
Date
certify that this inspection was performed according to all
' l;)\94'
Health Department Approval: �tL
Date /�' >/a
72-013 (3/85) ' A4-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
ON—SITE SEWER & WELL PERMIT
PERMIT NO: 860181
DATE ISSUED: 06/18/86
APPLICANT: CARL DISOTEL
ADDRESS: SR 192 A MYRTLE DR.
EAGLE RIVER, AK 99577
CONTACT PHONE: 694-5797
1� reG Tr by!
LEGAL DESCRIP: SUBDIVISION: DENALI HTS. LOT: 2
SECTION: 33 TOWNSHIP: 14N RANGE: 1W
LOT SIZE: 2.2A (SQ.FT. OR ACRES)
MAY BEDROOMS: 3
BLOCK: N/A
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
TRENCH W. DRAIN
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0
GRAVEL DEPTH (FT.) 6.0 3.5
TOTAL DEPTH (FT.) 10.0 7.5
GRAVEL WIDTH (FT.) 2.5 5.0
GRAVEL LENGTH (FT.) 38.0 49.0
GRAVEL VOLUME (CU.YDS.) 22.9 36.3
TANK SIZE (GALS) 1,000.0 ** 1,000.0 **
SOIL RATING (SQ.FT./BR) 150 150
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers 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.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REf;0RT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED Ej.FCT,
G
SIGNED C;,/ 14/ DATE:
APPLICANT: CARL DISOTEL
ISSUED BY
DATE: ‘74,
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
CQr! 1?iSotel
";'LEGAL DESCRIPTION: L 2 Den a L
DEPTH)
(FEET)
2-
3-
6H
8-
9-
10-
11 -
12
13-
14-
15-
16-
17-
18-
19-
20-
Org )14-
»WE% all}
(-1-6
• •, N... •._.......i..:. N
x10.217322 -E1968
kid
lune ••; ����
DATE PERFORMEsE),` ��MaA "VP
Township, Range, Section:
SLOPE
5 P - poo - (`1 9 r zdedl
Szr‘oksome,
9 rzeeA 4 -,rice oPs;f
COMMENTS
Ts‘ 4-N C' 1 W S 33
SITE PLAN
N
1-
N
3
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
NO
S
L
0
P
E
Depth to Water After fv% LUATele-
Date- 6-II-8se
i
ti
PERCOLATION RATE
TEST RUN BETWEEN
So1�3 24t4 47‘ 1Sa 34": (beareom
(minutesilnch) PERC HOLE DIAMETER
FT AND
EL
PERFORMED BY' COnS4ltit*` 65) It‘ I ' apre: r 1 lAaprSe
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
CERTIFY THAT THIS TEST WAS PERFORMED IN
��.nna
b(41 86
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
So1�3 24t4 47‘ 1Sa 34": (beareom
(minutesilnch) PERC HOLE DIAMETER
FT AND
EL
PERFORMED BY' COnS4ltit*` 65) It‘ I ' apre: r 1 lAaprSe
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
CERTIFY THAT THIS TEST WAS PERFORMED IN
��.nna
b(41 86
\
t
r
�c40
.•R•N .••MO
NO. 1732-E ;,
June 22, 1968 ; l�,r
•
ktsOk4AL :'.`
P.i` 0 - -Z3w 00
r^
Lc, (_
1 rt ItiT11“.-
1
LEGEND:
41) Brass Cap Monument
O Iron Pip.
• 5/8" x 30" Rebar
CI Survey Hub & Tack
E , ry rSTrNC
_u /
r, e
N 89- S9- £3
w
- a-
1. 1 L Cj -7? ? .) 1
, P (1 11 3 1)
3►
ir.
e1 Iik
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:..t? it/'
I hereby certify that I have surveyed Lot , Block
Subdivision, Anchorage Recording Precinct, Alaska,
and have replaced all lost corners with 5/8" x 30" rebar. It is the
responsibility of the owner, prior to construction, to verify proposed
building location on lot, grade, and utility connections, also to
determine the existence of any covenants or restrictions which doG� not
appear on the recorded plat. Dated at Anchorage, Alaska this
day of ciu - ,19
CONSTRUCTING ENGINEERS, INC.
9801 Buddy Werner Dr.
Anchorage, Alaska
348.2000 894.9098
PLOT PLAN
f SCALE 1" = IOo '
440,
USGS Local No.
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MUNICIPALITY OF ANCHORAGE J Vr
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY fi) S40 - f l ?}
264-4720
Application Date Sep} 27 )-9B
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
L Z Der,21 i S.Ab S33 -r 14-1\1
Location (address or directions)
N H N co4--k,r, LzrP
(b) Applicant Name Case\ ii)lsd€'' Telephone: Home 694S-7\479Business Sa`'ie
Applicant Address Po 30-A E 995 7
(c) Applicant is (check one): Lending Institution rif; Owner/builder 0 ; Buyer 0 ; Other 0 (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following address:
No l l ;w Ccr s4vuc 5 1 nc-
2. TYPE OF RESIDENCE
Single -Family Multi -Family 0 Other
\3
Number of Bedrooms
3. WATER SUPPLY
Individual Well Community 0 Public 0
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 lad Public 0 Community 0 Holding Tank 0
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
72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DMA 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 regulations in effect on
the date of this inspection.
Name of Firm Co -ns '` 1.?1 ��'t ��' 1.'4- Telephone 344,7-0009Coo1 tt,,c1dy Wev �/ Ar�hAr�� Ak
Address
Date
,}24- 1984
99516'
6. DHEP APPROVA L)
Approved for L%Q_.Q. 7 bedrooms by
Approved Disapproved
1EI
Date e/CJ/�C�
Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this 'as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-02e (11/84)
AtINICIPAtrr ' w
DEPT. ;_„
ENNIRONMENM
MCT 6 99n,..
,RECEI,
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description. LZ Denali 1s
5 33 114N 1tti.J
Well Classification ? WA -Te If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) y Date Completed 7-Z9-86 Yield
Total Depth 94' Cased to 94' Depth of Grouting
12 c prn
Static Water Level 45' -1).3.
Casing Height Above Ground I5"
Pump Set At
74'
Sanitary Seal on Casing (Y/N) "(
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) IJ
Separation Distances from Well:
To Septic/Holding Tank on Lot loo f ; On Adjoining Lots loot .1-
To Nearest Edge of Absorption Field on Lot loo 4-; On Adjoining Lots (oO't
To Nearest Public Sewer Line N To Nearest Public Sewer
Cleanout/Manhole N To Nearest Sewer Service Line on Lot t05'}
Water Sample Collected by C'""5- oGin^4 6,c,(heta", )"L ; Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Ave( 1986 Size 1CCO No. of Compartments Z
Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) 1J Date Last Pumped New ths4.z11r v.;,,,
Pumping/Maintenance Contract on File (Y/N) N A ; for
Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (Y/N) N A
Separation Distances from Septic/Holding Tank:
To Water -Supply Wel liTo Building Foundation 13'
To Property Line )001-1- To Disposal Field S
To Water Main/Service Line So r 9- To Stream, Pond, Lake, or Major Drainage
Course !V•18
Comments Nlw SYS+Gr., incl-a11ed Ati-i 1986 - Pin,.,►- » $6-016,
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Ajol 1986
Width of Field
Date Installed
ISo
(ittar'o^' Type of System Design
Length of Field
Depth of Field ie Id
9zl
IYehci-1
Square Feet of Absorption Area
Depression over Field (Y/N) Date of Last Adequacy Test re.A,o Cuis4e^`
Results of Last Adequacy Test
594 sf
Gravel Bed Thickness
Standpipes Present (Y/N)
Y
r,u SHiae
Separation Distance from Absorption Field:
10o 4 -
To Water -Supply Well
To Building Foundation
Lot N A
To Water Main/Service Line 7S a -
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments Now S9'ls .. ii��ll ea (jride�
To Property Line
To Existing or Abandoned System on
loo/f- `>
; On Adjoining Lots
To Cutbank (if present)
NA
NA
2.5'
pP/vm‘i C36-01$ ►
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** 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 Date
Company MOA No.
40Q/v2C�
Receipt No
Date of Payment
Amount: $
Page 2 of 2
72-026 (11,84)
OFA, 14
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of
*�
0*LAN
� , ate arty
Gam• /LL
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99701 907-479-3115
6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99502 909-349.8623
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
❑ PUBLIC WATER SYSTEM I.D. #
)1/PRIVATE WATER SYSTEM
Ca?--/ DIsaz el l/
NAME
L.ZDin.,lI Ai-fsSab
Mailing Address
- (24z -o-,
City
State
Zip Code
PL
SAMPLE DATE: 9 4 Phone
Mo. Day Year
Purchase Order No.
SAMPLE TYPE:
'Routine ❑ Treated Water
❑ Special Purpose Untreated Water
❑ Check Sample (for original contaminated
sample with lab reference no.
Sample
0 No. Location
2
3
4
5
6
7
8
Time
Collected
Collect
9
10
Signature of Representative
/Laboratory Ref. No.
,9,4171 Z -
1y1
CASH
CHARGE
PREPAID
TRANSMITTAL
SPECIAL INSTRUCTIONS
MAIL
HOLD FOR
PICKUP
TO BE COMPkETED BY LABORATORY
Received at: Anch?ihVi0
.❑ Fbks.
Date Received / Time Received /3 3 0
Next Sample Due
COMMENTS:
SATISFACTORY
UNSATISFACTORY
RESAMPLE
OTHER BACTERIA
TOO NUMEROUS
TO COUNT
oaI
TNTC
Direct Verification Final
Count LSB BGB Result•
0
Comments
*No. f Total Coliform Colonies per 100 mis.
7717Mg°
Date
/4lS
Time