HomeMy WebLinkAboutT12N R3W SEC 15 LT 77A
Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Bo:~-196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ._~:~'4;~-Z-~ ,~,_%ct,~?3~& \ RID Number: o/~o~l~ _
Na~":¢W/~ ~' Wastewater System: ~ew
Address: ABSORPTION FIELD
7~ ~W~/'~ ~,~. , ~ -
Phc.e: INa°IFdrOOm,: ~ Deep Trench ~ Shallow Trench ~ed ~Mound ~Other
Total Depth from original grade;
LEGAL DESCRIPTION so,..,..: ,? ~.o~s,.¢~ ¢-¢' _
Block: Subdivision: Depth to pipe botlom from odg{nal g¢~de: Gravel depth beneath pipe
Township:/~ I Range~ ¢ I Section: /~' Fill added above original~.¢~grade:~ Ft. Gravel length: ¢~ FI~
WE LL: ~ ew ~ U pg rade Oravet width: Number of ~ines: I Distance between lines:
Classification (Private. A.8.C): Total Deplh: Cased TO: Total absorption are~ Pipe matedal~¢~
,r ,(er: Date Drilled: Slatic Water Level: ,ns~5~ Date instal ed: ,'
Yield: Casing Helghl Above Ground:
SEPARATION DISTANCES ~p~io c~ Holding ~ S.T.E.P.
TO Septic Absorption Lill Holding ~Privale Manufacturer: Capacity in gallons:
¢. Material' ' Numbe( of Compartments:
Surface ' LIFT STATION
LhXg * ¢¢1 = ~7' / / % =7' Sizein gallons: J M.?nufaoturer: ¢/~- --
Foundation ~i ~ ¢,1 /. / / "Pump on" level at: ~~at:
~ ~ ~ PumpMa~Electricallnspectionspetformedby:
Curtain ~/~ ~ ~ -
Drain
Remarks: BENCH MARK
Location and Description:
Inspections performed by:~ ¢~/~ _ Dates: 1st _ /_ t~ .....
Department of Health a~ Human Services approval ,~ /~¢
Reviewed and approved by: Date: ~.- 2 7- ~¢
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:
~,3.5
40.00'
50.00'
Permit No. .~'0,~ 9z- O~47 Page '~ of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SEIWICEE; DIVISION
P.O. Box .196650 · Anchorage, Alaska 995'19-6650 ® Telephone: 848-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: /---'O'T~ 77~-/~ %a-cT~o/d /5' P~o No.
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
· ' M
ON-SITE WASTEWATER DISPOSAL SYSSE PERMIT
PERMIT NUMBER:SW930441
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP
OWNER NAME:BOCK JAMES E & JEANETTE E
OWNER ADDRESS:7060 CHAD STREET
ANCHORAGE, ALASKA 99518-2055
DATE ISSUED:10/20/93
EXPIRATION DATE:10/20/94
PARCEL ID:01505313
LEGAL DESCRIPTION: T12N R3W SEC 15 LT '77
LOT SIZE: 23941 (SQ. F'r.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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 (18AACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
' N
PRIOR TO EACH INSPECTIO . PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTLM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROV~/~S
RECEIVED BY:~Um'~ ~
ISSUED BY: /j~,~z~-~- ~
Tom Fink,
Mayor
Nlunicipality of Anchorage
Department of Health and Human Services
825 "L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
August 27, 1993
James E. & Jeanette E. Bock
7060 Chad Street
Anchorage, Alaska 99507
Subject: T12N R3W Section 15 Lot 77
Permit #SW920247, PID tt015=053-13
The subject permit, issued August 26, 1992 by this office for a
single family well and/or on-site wastewater system, has
expired as of August 26, 1993.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on--site wastewater system, the original
as-built inspection report; must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewat~'r and well permit.
If you have any questions, please call thls office at 343.-4744.
~ohn Smfth, P. E.
VP~rogr am Manager
On-site Services
enc:
Copy of Permit
cc: Arctic Slope Consulting Group
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAl, SYSTEM PERMIT
PERMIT NUMBER:SW920247
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP
OWNER NAME:BOCK JAMES E & JEANETTE E
OWNER ADDRESS:7060 CHAD STREET
ANCHORAGE, ALASKA 99507
DATE ISSUED: 8/26/92
EXPIRATION DATE: 8/26/93
PARCEL ID:01505313
LEGAL DESCRIPTION: T~2N R3W SEC 15 LT 77
LOT SIZE: 23941 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DNNS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS
SOi, L TEST ~4~/~STA. LL ~RDI~,~RIGINAL
RECEIVED
ISSUED BY:
IS AN AMENDED PERMIT; DESIGN REMAINS THE SAME USING NEW
DESIGN.
DATE:
DATE:
ARCTIC SLOPE CONSULTING GROUP, INC.
TRANSMITTAL
'lb
dUE g 0 1993
MunicTp~h~y of Anchorage
Dept, Health & Iquman Service!;
[] Enclosed
Approved as noted
Not apl)roved, revise nnd resubntit
[~ Other/l)escribe
301 Danncr Avenue * Suite '200 o Anchorage, Al( 99518-3035 * PHONE (907) 349-5148 · FAX (907) 349-d213
A sub~idittr{I of Arctic Slope liegiotlal Corporation
RECEI¥
MunicipahlY ot An(
Dept. Health & Huma
s 0 "06'00" E> 1t§,04'
D
hor~tge
~ Servioe8 u.J
o I',.~
EL.
N 0 ~05'22" W< t35.05'
$OH.S LOG - pE]L?.COLA. TIOH
Municipdity d Ar,chorage
Dept. Health & Human Services
F.~CO~? ~
IF Y~S, AT wHAT DF-2TH? -
DepO~ to Water Al~r
~' ~-- Ciwsa Net Depth to Net
Water
Reading Date ' Tim~ Time
· ~¢__ ~.x~.~ _ '- .
-~- "~ ~ 5 ~' '~ ~- '1:~-
-~ ~ ' ~ 7 tmlnut~ingh) pE~C HOLE D~
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519--6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920247
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP
OWNER NAME:BOCK JAMES E & JEANETTE E
OWNER ADDRESS:7060 CHAD ST.
ANCHORAGE, AK 99507
DATE ISSUED: 8/26/92
EXPIRATION DATE: 8/26/93
PARCEL ID:01505313
LEGAL DESCRIPTION: T12N R3W SEC 15 LT 77
LOT SIZE: 23941 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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 (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:__
DATE
DATE
SOILS LOG - PERCOLATION TEST
pERFORMED FOR: /~(. ic¢,t,/,~ ~ ' ; '
/ .~ 'r ¢,1.
SLOPE
DE~STH
[, /
WAS GROUND WATER S
ENCOUNTERED? I',J e3 n
I~ yE.S, AT WHAT DEPTH?
P
Deplh ~o Water After E
DATE PREFORMED:
SITE PLAN
RECI:'IVED
AU6 1 8 1992
Munic~pah~y ot Anch.orago
Dept, Health & Human Servico.,
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ __~4"r? o 7 /~¢. ~
~ / d,' 2 ,/ ~ ~,1 7 ~/~
7 (,-/. ~ '-( ~ ? ~/~ -
~ ~: ___ _~ ~. 3 ~ 7 3/~ '7 '/~
PERCOLATION RATE 0. e~ ,./
TEST RUN BEIAVEEN t f i
(minutes/inch) PERC HOLE DIAMETER
~v /~ID 9 ~ ?,,y"Fr
pERFORMED BY: (~7¢','C~ ~/(~.~/~ __ I ~ £1~'? ~/~',[/?'~/~ CERTIFY THAT 'PHIS TEST WAS PERFORMF. D IN
ACCORDANCE ~VITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATF.. DATE:
[~ARCTIC SLOPE CONSULTING GROUP. INC.
Engineers · Architects · Scientists · Su~eyors
SOILS LOG - PERCOLATION TEST
DATE
Townshlp~ Range~ SBctlon:
SLOPE
47--
SITE PLAN
WAS GROUND WATE~ S
RNCOUNTEI~D? /t/O__ L
I~ Y~S, AT ~/HAT DEPTH?
P
Depth lo Water After¢ E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
He~.
· ~/ ~ (minutes/inch) PERC HOLE DIAMETER
PERFORMED BY: ('7~v',F, (/5/'¢'(~{.i]'),' ~4,,t,/ /3)e,yt-~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE· DATE:
L__~_~) ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers · ArchRects · S¢ienUsts · Surveyors
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAl. DESCRIPTION:
DEPTH
CO~,~EN'rs I~ot6 {~c,oA~c~0 4
DATE
Township, Range, Section: ~-' I '~- I~'/ /~ ,'~v'J ~ I i~
SLOPE SITE PLAN
f
WAS GROUND WATER , ~ S
ENCOUNTERED? /~ ~r? L
I~ YES, AT WHAT DEPTH? ' ~ O
P
Depth to Water After E
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ 2~ ~,,,i ';7- i-3: ~5 ~S~
_3__ __.l"l: 07. - ,7 % -
7 ,'-I', I (- ~ '7% ,-
PERCOLATION RATE O, ~_.~____ (rainutes/ineh) PERC HOLE DIA3vlETER __
TEST RUN BETI%VEEN '~/ / _O,¢ FFAND ~4~-q/d'r~T
PERFOKMEDBY:_~p/C ~ro~p _l_ Ooe'~'/ /~'t,/C~'' .CERTIFY THAT THIS 'rEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
F ermit No.
Page I of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box ]96650 Anchorage, Alaska 99519-6650 Telephone:S43-4744
On-Site Wastewater Disposal System end/or Well Inspection Report
Legal Description LOT 77, JUPITER ROAD PID No:
RECEIVED
AUG 1 8 1992
LIST 75
PRDP[
FUTURE FIEI:
LET 83
Munioipahty of Anchorage
umaB Services
LElY E C_
/ FUTURE- V/EL
~ i -? ~/ LI]CATI[]N
J 5' MI~.--3----~--~~-~PI]SED l~50
~L,EANOU¥84~' Gh4_ SEPTIC TANI
SCALE
l'=]O0'
~ I'1
II
NOTE:
I) NO SURFACE WATER OR CURTAIN DRAIN WITHIN
100' OF THE PROPOSED SEPTIC SYSTEM.
2) NO EXISTING WELLS WITH 200'
OF THE PROPOSED SEPTIC SYSTEM.
3) LOTS 75, 76, 78, 8.5, AND 84 UNDEVELOPED
4) SEPTIC FROM HOUSE TO FIELD SHALL BE
6" PCV (MIN 3' COVER) S=1/4":1'
5) CONSTRUCT PER MOA DHH::; REQUIREMENTS
P.O. Box
On -Site
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
196650 Anchorage, Alaska 99519-6650 Telephone:345-474/~
Wasteweter Disposal System end/or Well inspect_ion Report
Legal Description
LOT 77, JUPITER ROAD
PID No:
AREA OF SEPTIC
MIN. OF 857 S.F.
48.0'
TO SEPTIC TANK
o
% MONITORING
TUBE
C~.£ANOUT
NOT fO SCALE
NOTES:
XISTING
RECEIVED
FILTER LAYER'
SECTION A-A
OF
, MONITORING TUBES ~
Zl!t SEPTIC ROCI</ Iii'
MANIFOLD ~
FILTER LAYER
SE'CT ON B-B
I CONTRACTOR re VERIFY MIN SO. FOOTAGE PRrOR re PLACING TOPSOIL.
AUG 1 8 1992
Municipality of Anch.?rage
Dept. Health & Human &erviees
August 10, 1992
Mr. Dan Roth
Municipality of Anchorage
Dept. of Health and Hmnan Services
825 L Street
Anchorage, Alaska 99501
Re:
Septic System Approval
Lot 77, Jupiter Road
Dear Mr. Roth:
Attach is the permit application for upgrading a septic system on the above referenced lot.
Below is a narrative of probable impacts to adjacent properties.
Adjacent Wells - There are no existing wells within 200 feet of the proposed new septic
system. The well for the lot will be designed next year. Ali surrounding lots are not
developed.
Adjacent Wastewater System - The proposed bed absorption system is the first system
on the lot. The lots surrounding are not developed and the proposed system will not
effect the future sites on the surrounding lots.
Reserved Space - The soil conditions on the lot are very good. There is enough room
for a future system to the west of the proposed system.
Drainag~ - The lot is flat (5-10%). Positive drainage away for the field will be
maintained. No concentrated surface water will be directed toward tile field anti no
existing streams are within 100 feet of tile proposed field.
The installation of this on-site system will have no probable impacts to adjacent well or septic
systems. The proposed system's separation distance radius will include parts of adjacent lots,
but will not interfere with the on-site systems on these lots.
V~ ~oHrs,
Carey St ~Meyer~.E.
Sr. CY~vil0Engind~
CSM:EG:MLT: 1 110-0026.029
Permit No.
Poqe I of 2
Municipality of Anchora9e
DEPARFMENT OF HEAL_IH AND HtJMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Ancholage, AIoska 99519 6650 Telephone:54.5 4744
On Si[e Wes[ewoter Disposal System and/or Well Inspection Report
Legol Descliption I.OT 77, JUPI'rER ROAD
PRBP(
kUTURE FIEL
L[3T 83
FUTURE WELl
ISLED HBUSE" t
/ 5' Mir'4:I'- ,~BP[3SED 1250
SEPTIC TANI
[BT 04
Q
NOI'E:
I) NQ bURFACE WATER OR CURTAIN DRAIN WITHIN
100' OF TH£ PROPOSED SEPTIC t,¥STEM.
2) NQ EXISTING WELL% WIYH 200'
OF THE PRQPOSED SEP'IIC ~WSTEIvi.
',} LUT% 75, 76, 78, $5, AND 84 UNDEVELOPED
4) SEPTIC FROM HOUSE I'0 FIELD %HALL BE
6" PCV (MIN 3' OOVER) S I/4":1'
5) (ON%IRUCT PER MO~ DHHS REQUIREMENTU
Municipality of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENFAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Aiesko 99519--6650 Telephone:S43 4744
On---Si~e Wastewa~er Disposal System and/or Well Inspection Repor'~
Legol Desc~ipUon LOT 77, JUPITER ROAD PID No:
AREA OF SEPTIC
MIN. OF 857 S.F
48.0'
ABSORPTION BED PlAN VIEW
TO SEP[LC lANK
lUBE
CLEANOU1
(r~p[CAL)
FILTER
EXISTING
GRTSUN~
SEC1 ION A-A
- · -- q2'
MITS OF
XCAVATION
~ CLEANQIJT
MONITORING TUBES
NATIVE FILL . / PERF£1RATEO pIPE
SEPTIC
MANIFOLD
FILTER LAYER
SE(}TION B. B
System Calculations for Lot 77. Jupiter Road
ASCG
Calculations
09-Aug-92
Page 1 of 1
'rank Size
4 Bedrooms := 1250 Gallons
Absorption Field Sizing
Using an acceptance rate of 0.7 gal/ft '" 2/day
and a daily load for 4 bedrooms of 600 gal/day.
A 2' sand filter layer will be used.
Req'd Absorption Area = 600 gpd / 0.7 gpd per SF = 857 SF ,
System Dimensions
48.0' X 18.0' = 864.0 SF ,ii
The laterals are to be spaced 6.0' apart and 3.0' from
edge of the bed.
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
0N-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW920377
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:BOCK JAMES E & JEANETTE E
OWNER ADDRESS:7060 CHAD
ANCHORAGE, AK 99518
DATE ISSUED:il/04/92
EXPIRATION DATE:il/04/93
PARCEL ID:01505313
LEGAL DESCRIPTION: T12N R3W SEC 15 LT 77
LOT SIZE: 23941 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALI, 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 (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROV I S/I 0~
RECEIVED BY: _~_~t~/~
Permit No.
Page I of
P.O.
Municipolity, of Anchorage
oERVI(.,E,~
EC£PARTMENT OF HEALTH AND HUMAN ':"' ~ ', c'
ENVIRONMEN'FAt. SERVICF~: DIVISION
Box 196650 Anchorage, Alaska 9951.9,-6650 Telephone:34.5-4744
On-Site Wostewater Disposal System and/or Well Inspection Report
PID' No:
Legal Description LOT 77, JUPITER ROAD ......
n._ L3 T 75
FUTURE FIEL
SCALE
FUTURE 'v/ELt4 '~-~'--~
NOTE:
l) NO SURFACE WATER OR CURTAIN DRAIN WITHIN
100' OF THE PROPOSED S[PTIC SYSTEM.
2) NO EXISIlNG WELLS WITH 200'
OF THE PROPOSED SEPTIC SYSTEM.
5) LOTS ~5. 78, 78. 83, AND 84 UNDEVCLOPED
,I) %EPIlC FROM HOLISE TO FIELD SHALL
6" PCV (MIN 5' COVER) S=~,/¢'.~'
5) CONSTRUCT PER M0~ OHHS RFQU~REMEN~5
(907) 243.2282
FAX: (907) 243.4852
KEN JOHNSON DRIILLING CO.
WATER WELL DRILLING
PUMP SALES AND SERVICE.
38 Years Alaska Drilling
KEN JOHNSON
3163 LINDEN DRrVE
ANCHORAGE, ALASKA 99502
JUNE 7, 1993
JAMES E. & JEANNETTE BOCK
7060 CHAD ST.
ANCHORAGE, ALASKA 99518-2055
344-9256
Dept. Health & Human ....
RE; LOT 77 T 12N R3W SEC. 15 LT.
OFF JUPITER AND ABB.OTT RD. SOUTH
WATER WELL LOG
0 FT TO 16 FT
16 FT TO 25 FT
25 FT TO 35FT
35 FT TO 49 FT
/-19 FT TO 70 FT
70 F"T TO 75 FT
75 FT TO 106 FT
106 FT TO I30 FT
130 FT TO 135 FT
i[35 FT TO 137 FT
i[37 FT TO 139 FT
COURSE GRAVEL AND BROWN SILT
COURSE GRAV & GRAY SILT
SAME WITH BROWN SILl' BINDER
MED. GRAV & BROWN SILT
COURSE GRAV & GRAY SILT ( TIGHT )
SAME WITH COBBLES
MED. GRAV &BROWN SILT DRILLS OPEN ..
COURSE GRAV WITH COBBLES..
CLEAN TIGHT WATER BEARING MED, GRAV.
8 FT HEAD..SAND PUMPS DRY
GLACIAl. TILL..DRY..
CLEAN TIGHT MED. SAND &GRAVEL..WATER
BEARING .. 30 FT HEAD
TEST BAILED 2 HRS. AT 7 GPM
l0 FT DRAWDOWN,.GOOD RECOVERY
BOTTOM STABLE
TOTAL CASING [3§ FT 0 IN.
STATIC WATER LEVEL 109 FT.
KEN JOHNSON CWD/PI
NWWA CERT~'~IED
(907) 243-2282
FAX: (907) 243.4852
KEN JOHNSON DRILLING CO.
WATER WELL DRILLING
PUMP SALES AND SERVICE,
38 Years Alaska Drillln~
KEN JOHNSON
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
JUNE 7, 1993
JAMES E. & JEANNETTE BOCK
7060 CHAD ST.
ANCHORAGE, ALASKA 99518-2055
344-9256
RE; LOT 77 T 124 R3W SEC. 15 LT.
OFF JUPITER AND ABB.OTT RD. SOUTH
WATER WELL LOG
0 FT TO 16 FT
16 F'r TO 25 FT
25 F'r TO 35FT
35 F'F TO 49 FT
49 FT TO 70 FT
70 FT TO75 FT
75 FT TO 106 FT
106 FT TO 130 FT
130 FT TO 135 FT
135 FT TO 137 FT
137 FT TO 139 FT
COURSE GRAVEL AND BROWN SILT
COURSE GRAV-& GRAY SILT
SAME WITH BROWN SILT BINDER
MED. GRAV & BROWN SILT
COURSE GRAV & GRAY SILT ( TIGHT
SAME WITH COBBLES
MED. GRAY &BROWN SILT DRILLS OPEN ..
COURSE GRAV WITH COBBLES..
CLEAN TIGHT WATER BEARING MED. GRAV,
8 FT HEAD..SAND PUMPS DRY
GLACIAL TILL..DRY..
CLEAN TIGHT MED. SAN[) &GRAVEL..WATER
BEARING .. 30 FT HEAI)
TEST BAILED 2 HRS. AT 7 GPM
10 FT' DRAWDOWN..GOOD RECOVERY
BOTTOM STABLE
TOTAL CASING 139 FT 0 IN.
STATIC WATER LEVEL. 109 FT.
JUt. '~ 1 1994
Cumc~pahtY o~ Anchorage
De'pt, Health & Human Services
Parcel I.D.
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL. INFORMATION
Complete legal description
Location (site address or directions
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone _
Day phone _
2, NUMBER OF BEDFIOOMS:
3, TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup,
NOTE:
Individual well ZX X
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site X X. Y.
Holding tank
Community on-site
Public sewer
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#2~
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.
Name of Firm /~ ¢"/J) c'/2-J~ 0 "J ~,,/(,, / ,.J ~"t~l ~J O Phone
Address ~:::~ O. J~o,'( Z~0'77~, t~,Jfc44o~'C't'(~C-
Engineer's signature ~ (~,' ~t~/,~ Date
DHHS SIGNATURE
Approved for ~¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
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 DH HS 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 ks 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:
A, Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Parcel I.D.
.If A, B, or C, attach ADEC letter. ADEC water system number
V' Date completed ~/'7/¢ ~ Driller //-~.'~J
/-~ J _Cased to / ~ ~ t _Casing height
"J/ Wires properly protected (Y/N)_
FROM WELL LOG
Date of test ~'/7/9* ~'
Static water level /~/~ I
Well flow '7
Pump level1 (-),'~J ~ O~J ~,~
AT INSPFCTION
.g.p.m. g.p.m.
; On adjacent lots
.; On adjacent lots
Public sewer manhole/cleanout
.Petroleum tank
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ~'/Z ~/~'/
/.~2~, Af}..qji. Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N).
High water alarm (Y/N)
Date of pumping
'rank size /, ~'0 ~':~f'cf,___:. Compartments
Founclation cleanout (Y/N) '~1/' Depression (Y/N)
~/~ Alarm tested (Y/N) ~
~'~lg~ Pumper ~ /~
SEPARATION DISTANCES FROM SEPTIC/FIOLDING 'rANK TO:
Well(s) on lot l/
To property line
Sudace water/drainage
On adjacent lots
Absorption field
), /5- 0'
/
> IOO
Foundation
Water main/service line
72-028 (3/98)' From 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)
· "Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Sudace water
D. ABSORPTION FIELD DATA
Date installed /J/'Z"/,
Length L/~, Width / ~ Gravel thickness
Total absorption area
System type ,~//./~ L,t,¢ ~.~
· .~'" Total depth
Depression over field (Y/N)
Date of adequacy test/~-uJ
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N).
_ Results (pass/fail) '~A, ~'J~ for ~ ~J ~ Bedrooms
/kJZ)/d -~ After test /~O~
/~ ~f yes, give date /~J/~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /~. ~ / On adjacent lots
To building foundation
On adjacent lots
Surface water
Cudain drain
'~/O0 / Property line
~ ~/ TO existing or abandoned system on lot
Cutbank J O ,',d &--- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certi that ~ ha~e checked~ verified~ ~r c~nf~rm~d t~ a~ M~A and HAA gu~de~nes ~n e~?ct~r~ ~`t~e ~t~;~[?h~s ~nspecti°n',,~ ~ .,: :~
Date ~ ~ ~." ~ '" ~ ~"":' "'-."'
HAA Fee $ ,~-¢'(~'
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Commercial Testing & Engineering Co.
Environmental Laboratory Services
LABORATORY ANALYSIS REPORT
CT&E Ref.# 94.3211-1
Client Sample ID LOT 77B, BLM SEC 15
Matrix WATER
ClientName ANDERSON ENGINEERING WORK Order 79867
Ordared By ALAN ANDERSON Prhtted l)ate 07/05/94 ~ 17:28 hrs.
ProjectName CollectedDate 06/28/94 @ 10:35 lu's.
Project// ReceivedDate 06/28/94 ~ 10:58 tuts.
PWS1D UA
Technical Director STEPHEN C. EDE
Sample Remarks: SAMPLE COLLECTED BY: AH.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Lhnits Date Date Init
Nitrate-N 1.03 mg/L EPA353.2/300.0 10 06/29/94 CMR
* See Special Instnmtions Above UA = Unavailable
** See Sample Remarks Ab ove NA = Not Analyzed
~ U = Undetected, Reported value is the practical quantification linfit' LT= Less ~han
~ D=Secondary dilution. GT= O'eaterTnan
~ 5633 B Street, Anchorage, AK 99518-1600 --Tel: {907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
COMMt::RCIALTESTING & EN('~INE~RI~G CO.
}.FJST BE CO.X.~LET-ED S%' V,'AiTR SU-'~PL~R
£.~'2,~LE DATE:
,_n Re,eat S~p[e (.:-or routine sample
' D Speci~
5 ~LE LOCA~ON
'
Yea:-
Tiz~e Coi[ec:ed
Co,i[ected B_~'
}..mo. ~u. Fitter Re~ul:~
Co!ifo:-~i 00 =l
. /,:5~ c3 ~:-,
PART ONE OF TWO:
REMAINDER TO FOLLOW