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HomeMy WebLinkAboutFAIRMOUNT LT 12 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,~/,~-C~)"~OO PID Number: Name: ~~L ~ ~0~~ Wastewater System: ~New ~ Upgrade Address: ~,~ //~S ~/~, ~// ABSORPTION FIELD LEGAL DESCRIPTION ~o,, Rating: Total Depth from ~1 grade: Lot: /2 Block:~¢~ ~/~n~ Depth to pipe bottom from ;r~g,~, grade: Gravel depth beneath pipe Township: Range: Section: Fill added above sr;~mc, grade: Gravel length: O, ~'~/N. ~t. ~ ~t. &O~ U rade~ / Gravel width: Number of lines: Distance betweenlines: WELL: Pg ~ /,~ ~, ~ 5 ~t, CJassification~~~(Private. A.B.C):~~-~ F ~al P~'~t Cased To: Ft. Total absorption~area: SQ. Ft. Pipe material: Driller:'.~~ Date Drilled: S~atic Water Level: Installer: ~/ ~0~ _~ Date installed: Ft. ~f ,~( ,~ ~ .-_-: Y~~ Pump Set at: Casing Height Above Ground: GPM Ft ~0'~ "', TANK SEPARATION DISTANCES u Septic ~ Holding ~S.T.E.P. TO Septic Absorption Lift Holding Public/Pdvale Manufacturer: , Capacity in gallons: Well /~ /~3 /~ ~ ~' Material: ~ Number °f C°mpartments: Surface / Water //5 /~0 /2~' ~¢ ¢~' LIFT STATION Lot Size in gallons: ~ Manufacturer: ~ "Pump on" level at: "Pump off" level at: High water alarm at: Foundation 44 5~* 53' ~ ID' PRESEt F¢ESgT Curtain Drain ~ ~. ~ ~ ~ Pump Ma,e, Model O~O J Electrical Inspections~r~O by: Remarks: ~& ~/~ ~¢ ~ED/~ BENCH MARK Location and Description: ~ I Assumed Elevalion: /~ ~ ~-/¢ ¢]] /¢~ ~ ~. Department of Health and Human Services approval Reviewed and approved by: ~ ~'~ Date:~//~/~ 72 013 (Rev 9/91) MOA 25 Permit No. 5~/~.0~00 Page ~ of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT t2_ F,~ r~ ~4~uT PID No.: OI71 ~oU,~- L~I'rTL,~. 72.013 A (1/g3)' Permit No. ~ Page ,~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lcrr ~7_. FAIRMc~U. UT PID No.: Oi-J !lIO~. 72-013 A (1/93)* STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELL BOROUGH SUBDIVISION LOT BLOCK SECTION QTRS SECTION TOWNSHIP RANGE MERIDIAN []N DE LOCATION/SKETCH: WELL OWNER: DEPTHS~MEASURED FROM:l-lcasing top r-]ground surface ~/WELL DE~*~: DATE OF COMPLETION Depth of hole: ~ Z./7 ft BOREHOLE DATA: Depth Depth of casing: Material Type and Color From To ' I DEPT:~ TO C, TAT:C WATEP. LEVEL: ~ ft below [~ top of casing I--I ground surface ~- % · ' Date: ~'-' / ;/~- METHOD OF DRILLING: '~ air rotary [] cable tool [] other USE OF WELL: p domestic [] irrigation [] monitor '"? -/ ....... ~ ") fY '7 [] public supply [] other CASING STICK-UP: 7~_____ft. Diam: ~,:L/~ in. to,.... ~.ft / ~ ft ~./~ Casing type: c,~-7'. in. to WELL INTAKE OPENING TYPE: [] open end [] screened [] perforated [~open hole Depths of openings: to ft SCREEN TYPE: Diam: in. Slot/Mesh Size:" Length: ft C~L.\~ GRAVEL PACK TYPE.~ O ~' Vo!ume u~ed: x D.%-.th to too: .,,~,t ,~ % ~ )'0" GROUT TYPE: Volume: ~,~,(~ Depth: from ft to ft · o~p~\W o~ ~,'- ., ~,n~;~.~ ~.Y~: ~ 5°~ DEVELOPMENT METHOD: Duration: -. ' PUMPING LEVEL AND/~ELD: _~, _~z:~- ft after ~rS pumping, gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? [] YES [] NO CONTRACTOR iNFORMATION: REMARKS: · ~ ,.,' ,: ~ ,! ,?-",~ Regist~i'ed Business / J - ~ / PLEASE MAIL WHITE COPY OF LOG TO: OF WATER Signature of Auth0H~ed Respr~d~ti~e. PO BOX 772116 ~GLE RIVERAK 99577-2116 i PAGE 1 OF 1 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920200 DESIGN ENGINEER:SKLH CONSULTANTS OWNER NAME:JOHNSTON DARRYL R OWNER ADDRESS:BOX 110463 ANCHORAGE AK 99511 DATE ISSUED: 7/28/92 EXPIRATION DATE: 7/28/93 PARCEL ID:01711104 LEGAL DESCRIPTION: FAIRMOUNT LT 12 LOT SIZE: 22400 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. DHHS MUST BE PRESENT AT FIRST INSPECTION. MAXIMUM DEPTH OF SYSTEM,~S 2 FEET BELOW ORIGINAL GRADE. SYSTEM IS DES~ED AS A/PR~SURIZED MOUND. iSSUED DATE: DATE: RECEIVED SKLH Consultants F:'. Ill). E~ o >', J ] ~Zt ?~ C.:, 1 ~,:llqc:~hO'r%;l!i:ll+':,~~ I';~1/, 9"')',',,:;J ( '?~Z~'7 ) 3zt.',':.~....(i:~gz~ 7 JUL 1 41992 Municipality of Anchorage Dept. Health & Human Services ON-SITE APPLICATION REVISION I...,::;,'t J. ii!i'. I:::','~:/:i. ~.~r,'h:::, ur, t ',ii~ u b(::l :i. v ii. !~ :i. o','[ :1. 4 J' u ] v :i. 9¢:i);i:]: v..~ :i. 't'; h t he ¢:':d'; t ,'~u:::h(c.!d ¥"c.:.v :i. sed des :i. [ll"~ shee't s (Sheet :1./~ili: ~':'~"~(::1 !i~hc.?et ;iii:/;i:i: ) <:.h:¢ct; c.:,(::l '?. :1. q. '..)iiii: I:;~(.:.:.~v ,, :1. ,, 'Tit e 'r'ev :L sed des :i. !;H"~ c:h:::,¥'~s :i. st s ,:::,'f 't: h e 'fo :i. ]. ,:::,~¢ :i. n !;;I (:::l"~ an !;;le~ :~ f;;;~ ¥'1 :J. i"l C? Y' (.;-:! ¢::~. !i~; (¢:2 :i. 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Hemlee 7604 LOT 2.2. LOT ~3,, UNDEV ELOFED RSVISION5: I. INCRUSt.SE SEPTIC TANK TO I.r-~-SAL, W,/i/1-1 LIFT 5TATIo~. IqO. DF BEJ)P. OoM5 FROlfl 3 TB 4. P~GE ~ o~ z LOT IZ F,a, IRMOIJNT SUB.- ~1jI1,,I. DI,5"rRI- TIDkl LlUE CLEAkIOIJT$~ ~'F(ir(r__~ TYP. G LIIdF.. ,/~ NEW 15-FTx 40 Fl' 5OILAg_50~PT)0N BED. AFPLI r..Al'lO~a 3'~(P, G kAgCRAL~ FDR DI$~ LI~. ,~'1;~ .50LI~ PlS~.. .Y.5 FI' LI'I~ E ' T~P. GIN. J~3T'~; 0~.IFICE 5~IEL~ ~ MONITOE ~B~ TYP &. WEL011,JG 3EFTIC TAMK, WITH I LIFT 5T,~,'TIOH. 5Y.~'[EH '~oBE 1~5t'ALLED I:'~ CI4AgTE'~ I~; .G~ SECTIOIO ~.' WITH CAI). PEFJ:'O ~-AT l okJ.S 5EP13C R0ClC. PLAN. NTS C LEANOUT AT F..~ C H I. ATE.~A,~ I~. IN. i3~LOW GF,.OUIJ P E~-..~, I IN, IdOTE: ADDITIOMAL. i3ACI~I::ILL w~u.. ~E ~£[D£D 3'o I'RowtPrr. ~.1. INC½F_S OF CoVeR.. ~4 IHCHE3 F~LI'E£$AkID ,.,SIDE 40 fT MIr, l SEED. GE~ F£F. II~IF_TEI~ TO PREVEkrr Fo/u011,I~, o~ 5U RFAC~ WATER. I$ FT MAy, END P~G£ .?- o.~ z SKLH Consultants P. ll]. Bo>< ll~Z~ii:61 ( 9g.'.F? ) 345-694'7 MEMORANDUM L..c,t l. iE: Fair'mc, rtl Subdivis:i. July 'T'c,: I:::i].e? I¥1ur~ic::ipa].ity c,'P' Ar~(:::hopar~]e The put'pc, se c:,f 'this paper' is to prov:i, de acld:i, tic, r~al in'Fc, r'r,'tat:i, or~ to be c~,:::,r~s:i, der'ed dttt-:i.¥'~[] the i.-ev:LeN ,::,'F the attached appl:tc~at:i, or~ 'For' 'the :i.r, stallati,::,r~ of a r~ew orr..s:i, te wastewatep disp,::,sal system 'For' the above r'ef:eY'eric'ed i::tr'opept y. Due to the e~ist:i.r~Ei E~pc:,t.md [:,c.,rrtc, ut-s,~ l:i. rn:i. ts c,f pr'otec~tive pad:i, us ..... es~ arid ~]Y. ollrld~a'ber. (.:e].eva~ :i. orls :J.~ was Y'lec2essaY'y to, (::),::)Y'di~idep a¥'l Liric2cq"l ..... v~rrbio¥'~a], c,p:k~rrba~:i, or~ 'Fc, r' the ¥'~e~ sc,~l absc, r'pti,:::,r~ bed ir~ r'elati,::,r~ lc, the e'f'Fluer~t lir, e ].eadir~[] 'Fr'c, rn the sept:kc~ tarot. "f'he r~ew ,:::,¥-:i. erd;ati,:::,r~ would [)l"':i.l"~[~I the ef'fluerrt ]. :i. lq~? 'f'P,:]h't the r~ew sept :i.(:~ ta¥'~R at a¥'~ arf[]:l.e 'to the loT~[]:i, tud~rsal a)4is o'F the syst~rn. Af~ep sc, me 'bhc, u[~ht~ I believe that dist~--:kbutic, r, of~ e'F'F:l, uerrb to the 'Field will be ac~c~,:)rrlplished as e'F ..... 'Fec:ybively as with tl"~ mope tpaclitior~al ,::,pierd;a~ior~. Cor~sequerd;ly,~ 'the subm:i, tted de~$[~lr~ use~ the r'evised c,r':L~ntatior~. Hc, pefq.~].ly~ tl"l:ks c,r'iel", ..... 'tat :i.,:::,r, ~:i. ]. 1 r~ot del. ay [lpard; :i.v's[] ,:::,'F the orr-..s:Lte (:2c, rrs'br'Lu::~ J.c,r~ apppova:l. ,, :[¥'~ :1.986, a 'test hole was exci'avated (:,n the subjec.'t ppc, pe.r'ty as par't of a des:i[]r~ fq:::,p ar~ c,r~-site wastewater' disposal system wh:i. c2h was r~evep ir, stalled. This test I"~c, le has been :i. der, ti'Fied ,:::,r~ the site i:):l, ar~ as 'l"ld ~I. awed has I::)eer~ used as pan.-'t c)f' this desi[]r~ to ver'i'fy the pe .... sepve apea as L~seab:L~ f"c,Y' ar~ owr-s:[te clispc, sa]. systeh'l. (~ {::~,::,py ,:::,f: t h:[ s 'tes~ hc, le has beer~ J.r~c~].uded 'for' r'e'Feper, c~e. Fllthc, tl[~h r~c:, per.c:~,:::,latic, r, test was per'fc, pmed~ th:ks test hc, le was visually [IPac:led at the time to, iderrb:kfied iw'~ ~he ~)4c'avat:i.,:::,r~. "l"h~s p~A¥"a].lel~ the P~;))sL~lts (:)'F ~::~ peY'c~(:)la ..... tic, r~ t~st pep'For'meal ~r, r~{:~iDl"~bor':i.r, EI TI..~ ~[}~'. e)~:~ava~ed c:,r~ ;~3 June 1.99;~iL, The per'(:~c, la'tior~ pa~e ~r~ 'TH :[~;~? ~as rrleasm."ed 'to be 'Faster' thar~ 1 m:i.r~ute per' ir~(Dh,~ thL~s (:?,::)~"~'~iprflJ. r,!~ the F~d 'l:c,Y' ~:i ~,~'AI'~(:J 1 il"~ep. As a r'esult of' the appar'ent un:i.f"c, pm sLtbsLtr"f"'ac::e I:)etweer~ TH '~1 arid 'T'H ~*;F.'~ it was dec:ided that a per'(:~c, latic, r~ test :i.n the des:i. !:]nat ed r'eser've apea would b{.): ped ur~darrt pr'c, vi(::l iv',g] ru:, rffz.)w i¥'FF(::,prfla .... 't i,:::,v'~ I:)Lct c,r~:l.y {:~,::,rcFipr~l:i. rql] 'the l,*~et:.]{::l 'for' a sal,'~d ]. inet.. C,:::,r~sequerrt :l.y., I r'eSl:)ec'.tively ask that the attac:hed appli{::~,'~'b:i.,:::,r~ be appp,:::,ved despite 'the abser~c:e c,'F a pepc)c, lat:i, or~ test fop TH ~1. :If' yc, u should have any questi,::,ns~ please dc, r~c:,t hes:i, ta'te lc, c:,:::(r~ ..... ta(::?t rfl(~:? at the: 'tele.,l::)hor~e ]"ll.~[l'lb(~'~' C'~"' addPess [live. r, al:.~,:::,ve,, ~) gJ R,.,.. 9 f:?. 0 6 9] 7. a SKLH Consultants Ar~c:~h c,r~a !i~ e,~ ( 90'7 ) MEMORANDUM L,:::,t :l.~!it F;'ai¥-mc.,rvt Subd:~v:i.s:i.c,r, 6 J u 1 y 199;iii'. "1"(::,: l:::':i. ;I.e~ fflur~:i.c:± pal ity o'f "['l"l:i.s papeY' is I:.)e:i. rhr..J subm:i, tted ir~ aoc.'or'dar~c:e wi'th Ivl[]A Clnapter' :I. 5.65.1ZK3~'z] D. :l.e a¥'~d )D.4 to descr'ibe the site tc, l::~,::,El¥'aphy~ ar. ea!.'..'; c,f' esoessive slc, pes~ ar;d dr'air~aEle patter'r,s wi'l]h:iy'~ J.f/'.llZl f'.12; ,::,'F th~:-) syst em and p¥'obal:) le :i. mpaot s t o r~ei Eib bc, r'i r,!;I pr'ol::)er't :i. es. ,Si'be tc, pc, gr. aphy !;;lerner'ally c'.c, rdsists ,::,'F slc',p:i, rq;] EIr',::,ur, d f"r',:::,m r.:,r'theast to sc, uthwest ~ith lc,(::'alized ar'eas c,'F r. elative].y level []~.'our~cl. "['l"~er'e a~.-e r~,::) ar'eas of exc:e:s[.~ive slc, pe cn.'~ the pr'c, per'ty. Sl.l¥-'Fac:e c,f' 'the pr',::,per'ty tel.-r¢~ir',at:[rhr..;I ir:to tl"le L:i. ttle Ral::)bit (::h.-eel.~. whic:h bc, r. der. s the pp,::,l:)ept¥ tc, the south. Ir~stallatic, r~ ,.'::,'F the i:)r'c:,posed c,r,-site waste~ater' dispc, sal system al~l:)eaps t,::, have r.::, impaot to, r~eighb,:::,pir~[;i pr.c, per't:[es as it r'e].ates tc, · f'utur'e ar~d/c,r' e~ifii;tJ.Y/[:I orr....s:i, te potable water' we:l.:l.s,~ c, rr'"'site wastewate~" d i sposa 1 syst erris,¢ i'-esel~ve ar'eas 'f%::,r' r'ep].~(::)e:.~r,'l(~,l"~t orr....si t e d i spt, sa ]. s~ysterrls~ arid exist:i.r',D d¥-ail"~a~e. ~Z, e] 21: ..... 9 ;iii: E~ 6 e~ '7 00Z-52 No~: There :re no ~bhc - ~P~o~o~D ~ELL wells ~l~t~ god of ~e ~ra~d LITTLE ~BB~T CREEK s~em lac~oq. PLAN PAGE ~ ot z //~4 IN. PERFORATED PIPE' LAID LEVEL,TYP Z.. / NE'V,./ 15-FTx 40 FT 5OILAI3.SoRPTION / BED. _ _-C-.....-P-....-S.. --, ,-77, 7_ ;, .-'..~ '-1-- ~,..,,,.~--- 4 IN ..50LIP LAID LF..V E.k. /,,2~'J"~C ROCl~, IrC IN. l$ FT MII, I END PAGE. ,.z_ o,~ ,,~ Municlpalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ A ~') -'~.?~ LEGAL DESCRIPTION: L.O '~"'[ Z.~ ;~bl4 ~J ~ 'F o ~ 8 9 10 11 12 13 14 15- 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? , S IF YES, AT WHAT '7 ! oL DEP'I-tt? p I]eplh to Waler Alt~',,,y I Monilorlng? / Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minulestmch) PERC HOLE DIAMETER __ 1EST RUN BETWEEN __ FTAND FT '-/"']L~r ~r~..s'¢¢ t~ yzC_._-('o~- n, lo~'/-o~',~© 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS 5'-1,5' 1.5'-3,0' ~)7" /,,~c, ,,L~,L:' '//.,'D//~ . ~¥W'/.T°wnship, Range, Section: ?,5 Fac~, SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? ~//C'~, P E Depth to Water Alter ~. / Monitoring? Dale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop Z DTzO Z ,~ /~" ¥;~ PERCOLATION RATE ~,,(~ _-F' (m,nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND /-J FT PERFORMED BY: ~%'. /-//~,£)~.,/C,~. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: SLOPE WASGROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? 4 FL. E' Deplh to Waler Alter~ 5 '-" Monitoring? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE /d~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN -- FT AND -- FT PERFORMED BY: "~ //7/~'/)'~, I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) SKLH Cor~sul t ar~t s F.'. CI. i3o x ii. 11Z~ii!~;~ 1 MOA 7-22-92 Additional Information Request for 0 N- S I T E A P P L I CAT I ON I... o t 1 2 I:::' a i r rd,::;, u ~"~ t S u I.;) d i v i s i c, ¥'~ SKLI. I N(),, : 002"92 Ivh.,,, !3rd :i. t h At t achec:l :i. ~:~ 'b he :i. ¥'~ F,:::,r'rnat :i,:::,¥'~ you ~"e(::f ue%t I::):l. ar~ (::h'-aw:i.¥d;;Is,., pump curvl.:e,~ arid c.a:l, culat:i.c,r~ 'Fc, r I"~:.'xa(::l:l.c, ss cl ~?~i;; :i. ~;~1 I'i Nc, ]. (::-) (:1 :[ al'fll~?'b (.:.~:'r ¢:/i"tcI !ii~ pair(:2 i I"~ :!: h ave ~..~i~,e¢::l a 1 /8 :i. ¥'~c.l-i d :i. an'~e'l:: ~::n.~ ,:::,'r i f" :i. (::~(~', vE~. a 1/.,] :i. r~ch c,r. :i. f i cc.? t I::)r',:::,v i de bet '1'; ~er d :i. st r. :i. but :i. ,:::,v'~ c,f e'Pf I uent ,:::,ver t he ¥'~t::a..~ bed ~%,'st em ,, r'he sma 1 ]. ~i?r ,:::,l.". i f" :i. c.e a I ]. ,:::,~..us t h 1:.!:, u.~is~':.~ (::,'F Gl:..}, ,:::,r'. :i. 'F :i. i;::.e~.; a'l; iii?. ,, ',5 'Feet ,:::n"~ cen'L ,~:.:.n.'.,, Tin ~-:.'..., us(-:? ,:::, f a ;1. / 4 :i. i"s(:::l"i (':,r' J. f" :i. ex.? w,::)u 1 d a 1:1. ,:::,w a s pat:-i ~"r !;ii ,::)f a p i::)r,:::, x :i. mat ~i:? ]. :,,,,' 'Feet witl"i 'l;he u!!se ,:::,f ,:::,r~ly ;?;0 c,r:i.f":i, ces 'for 'l';he staYx::lar'.d 32 gl::m'l pump systerd pr-c,v:i, ded w:i. th the gl"lc:)hc, ra~;~l.;.:-;, "l'ard< av'~d W~.:.;)ldil,'q;;I l:i'Ft ~!i )~' ~i t i~]l'ft ,, cx:)rl'~;&'lc!'l'; i'fl(.?? ,'::k'~'; the JOB SHEET NO. CALCULATEO BY CHECKED BY Lo'j' 1'/. r'off'n'iourrE.' ,Jot~r~3'l-c~$. 6x-J4-3~ I of Z 6.1-1, OA~E7-Z40Z DATE - ....... SKeTCh: B=~ ~ js'~sr' .rEG. 4,77F~ SHEET NO CALCULATED BY CHECKED BY ~ OF ~'~° HI DATE L. of~ l?_ Fairmoum~-;YohnM.mns £ DATE- COI1PUTATI~k,15 COM. TI~dUED; - ' (4.7ZT)(ZZ. 5) {' Z9 'SI' 8 g _/../,; o. o/,/z (~?)' --l~./a'. usz..../4.~ LOT 12_ F~IRMOU~T SUB.-szu4¢~ult~at~ ooz-~z El P~rcol~t~o-n f_e~c bcciflon No~: There ~.re no pubhc wells Lu{~m ~oo' of the propo~cl s~-em ~ ~. ~ ". ~ - 7404 i.z ' R~VlSJON5: LOT 15 EXIST. ~JELL LIT'TLF PUxBB~T CREEK PLAN Lot la FmLtmo~tS~bdivts{o~ ~',= ,:,h' 'r ~ LOT 2.~. , LOT ab UNDEUE~PED :-~-,~ PAGE. LOT II LJNDEVELOP~D LOT IZ F~IRHOdNT 5UB.-s~m~wt~ biD/,/ IB-FT~5'FFT .SO~LAI3,.SoRPTIOa ~- ~ ........................ ~ . I J J PVC T~R~ED BED. AI'PLI CATIO~ M. TUI~ WITH CA~. .sEPrc ROck. PLAN_ NT.5 C LEANOUT AT F-~CH LAT£RAu I~.IN. I~,LOW I MOTE: AI~ITIOI~AL BAcK~&LL ~.~ INCP, L:..S OF CoVeR.. ~.4 INCHI~5 SIDE · ~T FT MIN END PAGE _z os 2. /IIIIIIIIIIIIII~IIIIIIIIIIIIIUI ~ // ILUr[lllllllllllllllllllll ~ /ll~rlllllllllllllllllllllllllllll ~ .t unic p .i'tyo Anchorage P,O. 1X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONYKNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 9, 1987 Randy Johnston Box 110463 Anchorage, Alaska 99511 Subject: Lot 12 Fairmont Subdivision On-site Sewer & Well Permit ~860229 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Sincerely, R W Robinson Program Manager On-site Services RWR/ljw enc: copy of permit ir.. 2 .Ic::,r't..!'i I::iy' !'f"m? MLu"l:i.l::::i.l:)a].:i.'l:y I::)[' ~:~r'l(::h(::)pag~:.:,, (I"t[]P~) and '~:l"~(:i, EH'..at..E, (::)f' :1: ~.,,J:i :1. ] :il',~:H.a] ]. 't..l"~E~ ~y~d'.em :i.n ac:c:c)r'c:h':ar"~c:(.:, t.~:i.'t..l'~ ~a]. 1 I*1(::}~.'~ c:c~(::r(.:a~:~ amd and :i r'l c::,::::,mp]. :i al'lC:(:, ~.lj.~:.h '[t"iE) c]~:.~g)") c:r' J.t..er' :ia c:)f t..l"/:[~ per. m:i.L,~ :[ ~.~:i.] :1 ac:lher'.e 'Lc) a].]. HI:3[-~ and E~'La'Le (:~' ~:~:la~M.,:a pec:lu:i.P(.::.~mE, r':LE~ fc:)r' 'l:..l"m:, E~.e?'k'~('El" T:~:.:IC:') E~¥E~V['.E:')[i) C)f'/ 'Lb :i E~ C)l'" (:d'l'? E~CI,.~ ~C:(.'2~F~'L (::)1~ I"t(.:.:.~:'~1" [::)'~ ]. C)'[, ,, Municipalily o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: CO 8 9 10 11 12 13 14 15 16 17 18 19 20 · a-'b~q~s To ~J Township, Range, Section: SLOPE WAS GROUND WATER ~,,/~'-('" ENCOUNTERED? . S IF YES, AT WHAT -7 I °L DEPTH? p E Depth to Water Afte,~,~ I Monitoring? / Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER ]EST RUN BETWEEN __ FTAND __ FT co,~,~EN~S q"'~"~' ?'r"- .s~¢ ~ ~L _¢'o¥. ~,1o,~'./-o,/,,~_5 .5" ,~ ACCORDANCEW(THAL~)~TATEA~MUNICIPALGUIDELINESIN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 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 1. GENERAL INFORMATION Complete legal description LOT I~..F'cL{£/7/£'~IJJ'f~ ~d~5~l'¥1~oD~l Location (site address or directions) [k/lit~ HI Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 4 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 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 inves~i~gation 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. Nameof Firm ~c~L~ Address D.~, ~()X//'!IOZ(~'( /~¥',~JC(.).~'~./Ak Engineer's signature Phone 3 '5-G 47 DHHS SIGNATURE Approved for Disapproved, Conditional approval for bedrooms. 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 and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: b~'L I~. F,/J('J~/'][Ln~ ~C~U.['"X~iU. Parcel I.D. A. Well Data Well type FrLl'~' Log present (Y/N) ~ Total depth 347 Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well flow Pump level1 FROM WELL LOG 5-Z5 -~ 3 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~'~0' Absorption field on lot J 3,~' Public sewer main Sewer service line 60/ 5 -7__~ -~3 WATER SAMPLE RESULTS: Coliform Date of sample: 30" Date completed Driller Cased to [~JE~ cor,_k - I'~-' Casing height Wires properly protected (Y/N) ~ AT INSPECTION ~_~ g.p.m. .... \ g.p.m. ~. ; On adjacent lots I~oY~[' oJi{'~'l;~l 200' ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ -[4-'~e~ Cleanouts (Y/N) ~ High water alarm (Y/N) Tank size i.C'~O Foundation cleanout (Y/N) Date of pumping N(~LU ~qg~eldA i~,d¢,- LL,.S~J~ ~1,,~ Pumper ~f' 1:5i~ 'd~ ~ ,'(~ -Lo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot !Z[3' On adjacent lots To property line ,~(~ Absorption field Sudace water/drainage [ t 5~ ([5, 'ir. E. P_~ Compartments Depression (Y/N) Alarm tested (Y/N) ~ Water main/service line ~' 72-028 (w93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) f2_5o m L~', T E, ~.'~ I,,..~2rJ/np (~,1~I ~x?-'~Manhole/Access (Y/N) (¢ "Pump on" level at ~..-c~.'t' ~U ~'~ "Pump off" Level at Cycles tested ~ · Manufacturer SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot i ~,r~ ~ On adjacent lots ~ O'/~C Wd:J~in ~/~J~Surface water D, ABSORPTION FIELD DATA Date installed ~ '-~,4 -~ 2 Soil rating (GPD/F¢) O, ~' System type Length 57' m Jrt Width I,..~~ Gravel thickness ~ Total depth Total absorption area ~ ~,~ ~'[- Cleanout present (Y/N) ~ Depression over field (Y/N) Date of adequacy test {'~'~ L~' ~'uS~c&v'r~Results (pass/fail) N/t~ for ~'/~, Water level in absorption field before test NA- After test Peroxide treatment (past 12 months) (Y/N) ~, If yes. give date ~ ~/-~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot i 3 .,3 ~ On adjacent lots N ~¢_ v~ I.~i.'~ ~)0' Property line To building foundation ,c2~ ~ To existing or abandoned system on lot __ On adjacent lots ~ O,'A~ w i'~nin Z/~' Cutbank ~, Water main/service line Sudace water I,~' Driveway, parking/vehicle storage area Curtain drain ~ 40' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature / / Engineers Name ~"~ ~ Date HAA Fee $ / ~ DO Date of Payment Receipt Number ' of this inspection. Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back t COMMERCIALTESTING & ENGINEERING CO. NTAL LABORATORY S~RVICES .......... REPORT of ANALYSIS Chemlab Ref.# :93.2953-1 Client Sample ID :L12 FAIRMOUNT SUBDIV. Matrix :WATER 5633 B STREET ANCHORAGE, AK99518 TEL:(907) 562-2343 FAX:(907) 561-5301 Client Name :S K L H CONSULTANTS WORK Order :67478 Ordered By :S. HENSLEE Report Completed :06/24/93 Project Name : Collected :06/22/93 @ 18:00 hrs. Project# : Received :06/23/93 @ 09:25 hrs. PWSID :UA Released By Technical Director:STEPHE~,C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.H. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.14 mg/L EPA 353.2/300.0 10 06/23 LLH RECEIVED JUN 5 0 1995 Munic~pahty ot Anchorage Dept, Health & Human Services * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ~SGS Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA