HomeMy WebLinkAboutT12N R3W SEC 15 LT 80
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 wr:iLL INSPFCTION REPORT
NAME ~HONE ! ~EW --
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
~ ~ Manufacturer No. of ~qmpartments
Liq.c~pac pacity in gallons Insid~ length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ < Manufacturer Material Liquid capacity in gallons
~ ~inches Distant etween lines
~ N°' of lines/ Lengtl~ac)~ line 'Total le~W~lines Trench ~idth - ~,
lop of tile to f~io -~ade ~aterial bonea~ tile ~ Total effectwe abs tlon aroa
< ~ Type of crib Crib diameter Crib ~epth Total effective absorption area
~ Well -- Building fotmdation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: 9uilding foundation Sewer line Septic tank Absorption area(s)
OTHER .....
PIR MATERIALS
~EMAR~
72-013 (Rev, 3/78)
DE:F'FFF;'.THENT E,
EOT.':5 "'il..'
F:'E]E'.HtT NO. ( :3].':ii~87!2 )
Fff:'F:'l.. I CFFF,IT'
LOC)gT I ON
L.E:E~EIL
H"?F~'.'TL..E: Fi: F~:EIS, HLIL:;;SEN
RENEII,.IEiL. Ili:8 21~C]. E;;Z
TL[,;;~:I'.JRFJ:N S :J..L9 I..E~lilil
TYF'E: OF SO ):1_. FiE:SOI:~:I::'T I EIl",l S"r'S-FEH I S:
HFIII.IIIHUH i',II..Ii,'IE/ER OF: E~EE:,ROOHS .... I.
LEFT SIZE 999999 SL:IlURFIlE F:EET
E;,RF:Iii"mlF Z ELF:, Il :~/') ~
:.:.:;OIL. IE'.FI-'I-iI'.IG ,(Si.::! f::'T,."E:E:,=
'THE RIIEQLIII~:ED SIZE OF THE SOIL FIE:SOI;?.F']"IOhl ':.E;'¢S'f'EI'I IS:
THE LEI',IdfI"H D]:I'"I[~I'.,IS]:CII'.,I IS TFII~ L..IEi'.41]TFI ,:::IN FEE"F) Il3E THEFE. EH..tl-' FjR,' ERI'.Ii',IF.[E. LI.¢.)," '
"ii'Hil'Z DE:F'TH EIE E~ TREI",ICt. I OF;it PIT IEi; TFIE [)ISTEINCE BETHEEN "I,HE ':E;URFFIE:E OF THE:
GEE:Oil:il,IF::, FIND THE E:OTTOH OF' THE Ei:':;CFFv'RT:[OI'.II ,::IN FEET).
THE GRFI'v'EL DEE'TH IS THE FIINIHUH E:,EPT'H OF GRFI'v'EL. 'BIETklEEI'.,I THE OUTFFIL.L E'IF'E
Elhll) THE DEIT'TOH OF '1"FIE: EXIZ:Flil,m'FITION (:[1",1 I:'EET).
E'EF~:I'II T FIPPL.. ]: CF:II',,IT HFIS THE RE:SE'I:)NS Z E~ Z Il.. I"rv TO ;[I',IFORH TH i 5 II)E:PI:IRTHENT DUR I NEi THE
:il NSTF]L. LEIT I Ol'.,I I I'.,tSPIF:C:T 7[ O1'4S OF Eli'.flY I,.IELI....S IRII::,J'I:iCEN"I- TO TH Z S I::'IE:OF'EII;?.T9.~ FIN[) THE
NLIHBEF'. OF RES:IIDENC:ES 'T'HEiT TIdE 1.4ELL. II,.lILL SEF;:',,,'E.
E',I::IC:I':::E'I LI... :[ II',lG OF RI',I'T' S'¢STEf"I Il,il I 'II-HOUT E' :Il NEll... ]: I',IE;F'E:C:T :[ ON FINE:, EIPF'F:.'O'v'FIL B"? TH :1: S
L":'E:F:'EIRTHEI',IT II,.IIL. L. [3E SUBJ'EE:T 'T'O PF:OSECUTIEU"II.
IqlNIMLIH DISTFII'.,ICIE BE:TI.,.IIEEII.,I R II,.IEIIL. L. F:ll'.,l[) F:lil,19.' I:)I'.,I-:-];ITIE SE:HFIGE [::,ISF:'II::IS, EII_ S'¢SI"EI"I iFS
:.l..ii~lZ~ FEET F'il:ilF: R I':'I~:;[VFITE I,.IELII_ OR ::I.SE~ 'TO 2C~O F'IEET FREH"I FI PI..IE:L. IE: I.,.IE:LL.. DEF'E:NDIi'.,IG
UPOII4 THE T'¢PE OF' PUBL. IC I,.IELL.
I'IIIqlHUH [::,ZSTRI',IC:E FI;il. OH I.':1 PF?.]:'v'FITE I.,.IELL TO F:l F'RI'v'RTE :II];,ElqER L. II'.,IE IS ;-25 I:'EET FIND
'TO FI IZ:OI"II"ILINIT'¢ SEI,.IEI:;:t LII",IE IS 7'5 F:'EET.
.hiiE:L.L LOGS F:IIRE': F:E(;!I..I]:F%I::, Elil',lE:, I'"IUE';T 13E II;?.E:TUFE'.NED 'i-O THE E:,IEF'FIF~ff'P'IEI",I-I- 1.4ITHZI',! 3:El DEWS
OF: THE: I.,.IE:L.L CCIHF'II..ETION.
II3THEIR f-il:EQIJ :[ REFqEI'.,ITS I'lffT' laF'F:'L."r'. SPEC I I-- I CFI"I- I O?',lL:ii FII",ID E:OI"JS]"I;~:I...IIZ:T i CII",I E:' I RGII:.II'EIP1S laF;:E:
Fl'v'F:l I M:IBL.E: Til:) i II'ISUF':E E$~:OPER Z I",ISTFi[.LFIT i ON.
I C[:.:F4:TIF"/ ]-HRT
:1.: ]: Flil'l FFIl'lIIl...IFIF~: I.,I:["Fl"l THE I;Il. EQUIREiqENTE'i; I::OF'. ON-SITE SEII'.IERS FIN[::' 14ELI..S FIS SET
FORTH B"J" THE HI...INIC;]:F'FIII...IT'¢ OF EINCI'IIORI:III]iE.
2: I 14IL.L.. II'.,ISTlaLL. THIE :E;'./STEH IN RCCOIRI]:,IaI',IC:E I.,IITH "[HE
]i:: I UNDEF:S'TFIND THEIT THE: ON-SITE SEIlqlEF: Sg-'STEH h'lFl'¢ RE6~UIRE ENLEI¢;:GEr,E:NT IF THE
II~:ESIE:,E;NCE IS REHODEL. IE[:, TO INCL. LIE:,E I,'IOI:~:E THEIN ,I. BE:DROOIldS.
~~ --¢~F'L, :il C~llq"I II'l'~. RI%E I;'. IRFISHIJ'.:SEI'.,I
]'SSJE'II2' E',9". ......... t)FITE .............. ;,ilq.. t3
,PermJ_t t~: 820363
January 31, 1983
TO: Permi L Applicant
Subject: T]2N R3W Section 15 Lot 80
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982~
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department fer documentatien ef the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerel,~
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
eric: Copy of Permit
SWP/057
i ti ~ J,. I E:F:II",I 'r'
i [" r":F1T I'"
I...Ei;G F:IL.
'.{;E:J:':'J. NEL. CH ;I; J",!l:::l ?~;E!iE1
t..O"f' S I
SOIL F~'. F:FT ]: I",! G .........
· ,~ F'~J ,.'"E',F~):;: "1 :Z 2.
i'FIF:'_, t';~:l~]l~-:jI.J ]: I::;:E;D S ;t; ZE O1::: THE: ~i;O I L F:IE:rE;ORF"f ]' Olr',! ." ................. *.: Il:dj .[.,
-I'F'IL:] LENGT!-I E:, I hlEEI'-.I'_::~; I OH )~ S THE] LEiqGTH ,:: Z I",! FIE;ET ;:, (::iF:' FHE; '!'B'.ti!;i~,!OFl Eft;;: [)F;:I:::t I f",!I':: ;1: Et....!%
THE: [)EF:'"i-H Eft: FI TF~:ENC:H 01:;~: PIT I'J:!; FILE; DISTI::II',IE:E EIETHEtZI",! 'll'lIZ !i;I..IR:i:::'I~::ICE; OF: T'HE
GF~:EIUf.,tD F::lh!t;)'!'!'Il!ii; E',O'T'TOH 01::' THE E?;;CF!',,,'!:;I-t'ION ,:;Zi",l
q"HEF'.!iE :t;S t",10 ~:.;ET t.4IL":,TH FOR
-FHIE (31';:!::!'v'E;L OEI::'TH );S T'HE t"III".II['ILIt"I E:,E:;t':'TH OF:' Gf;'.I':I',,"IEt.. li3EZT!,IEEN 'THE; EIU'T'F'FIL.L.
I:::ff',ll) 'THE 13E~T'I"OF't OF:' THE; Ei::4Cl::l'vh:::lT'IOl",l ,:; [t".1
F'.EF;~I"I I T' F:lf:'l::q.. Z[ E:I::INT Ht::I% -[FIEf: F';%SI::'ON:iii; i F~: ]: L_ ! T"r' "l'O I !",IF'L)Rh'I 'T'I'I I S E:,EF:'FIRTI"tEI'.,! '1" F, F' L' t"t ': I'HE
:[ NS;'FI:::IL.L.!::Yi' I ON I I",I:E;F'E:E:T~ Of",P~; OF: I::ll",l'~" I II .L.L.:, FI[).J'FIIZ:EF,J'I' T 3 'l"f-I I ~; '- ;
l-f I J:.f.I . FiND THE
i",!l..lt"lJL~',~b~l:;: OF::' [;;:I~;E; I CdEI",IE:E~; 't'Ht:::IT 'THE 1,1E:!..I... t.,.!:[ t...L .... :' E.F.'"; E.'
............... ' ' :' ' "'
i',!INrr, I ......... I" .].:,!- ,,..!:. I!!:E'I'HE;E:I'.,! I:::1 I,IFt Fli'.,!E:, FtI'.,I'./ OI'.,!.-..:~;]:-J'E 'E;EI-,IF:tGE [..,[:.f ..._:,ILL
::LEuZt F'EE:'"I... f::'t;;:l¢~t f::) F'~:]] v.f') .... IE. HIEt.L OFt ~F ::r 'FO ?;]i¢:1 F:'E;F"r. ........ F-I:;?r;'d',l FI F' RI ]'- HELl.._ [::,tEPENE:,IF.IG
:::'ZN THE[ 'FVF'E; -il:: F'JP. LJ'E: i,IEL.!
H ]; I'.,! I hlUhl E:, ;[ S'f'F:II'.,IE:E FROH FI t:::'t;~: ]: 'v'F:t"i'E HEL. I.. 'J"O t::!~ t. [ - 1 ~. SIEHER I .... T NE I t~; "-"::,:~.._., F'EIE 1 F:ll"~E:,
IU Fl ..... ltltli,IL ! SEI,.!EF: [_:(NE IS ":
._ F:'EE I".
HE[I..L. I_OGrE; fit .... FU)3;:II.J;[RE[) FtB![:, t"IUE;] E~E; I?IFT ~'t"iE'[', 1 .... [HE DEF:'F~I;~:'II"!E[I",I'! I..i.t. il'II. ,I
OF:' TIdE HELL E:OHF'L. ET]:
13 T'HEF~: f;:~E;Qt_I I RIEHEZI",ITrE; I"lFl"r' F F L.r. S~;tz'E(;T: )' F; 't' I';:lXl'l'' ;[ - I"t':: tXlNE:, I;[:Ol",lS;-i I::?.IJ[S:T ;[ Ell".! [:,
.I. LP~,I.~I:. TO II",I%LII:;~:E F'P"~PKt:;'
;i; CE;RT.(F"/
~L: I I::lh! F:'Fd'!i~I.~;[!::IR HI'FH '1"I"'~E; f';':E;QIJ~Fi:_rEh16[N!"'.{i; f:::OF: OJ",h"%iTE; 'E;EHE;E:S Fl?',ti) t'!EL.L.!ii; FIE:;
F'O~;:t"I'! 13"¢ 'IHE I'"tUhK[E:IF:'F:&.iT'¢ Eft::
2: I I'E[I.L. II',ISfRL.L. 1'Idle S"r'STEId II',t f::ICE:OR[)F:II",!CE H];'i"H THE
;!i:: Z UI",!DEFi:S'iFiHD THFI'T THE OI'.F"'S}:TIE :~i;E;I,.IE;Fi: :BY'-:?f'E;h! hlFl'¢ F~E;g!U];F:E Ei",!LFIf:;~:GEI'IENF IF' T'IqE
F:E!::;:[DIE;hlCE ZS F:Ei"IOE:'EI..EI:' 'T'O INE:L.I..IDE f"l~Z~l';i:fi'; '/-F'IFiI",! 4
IUNICIWALI IY Ur AN~HUMAbm
Department ~ Health and Environmenta' ~rotection
825 ~ Street, Anchorage, AK. ~501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~C~.(_>.~,~'~ ~ELL AND/OR ON-SITE SEWER PERMIT ~
Location: ~~li~/ ~ ~ Phone Nul~er ~ ~ ~--0C/~¢
Legal Description:? /~p ~h~ /~-~'C'~COt Size: ~
Type of Soil ~sorption System ~s:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Max~ N~ber of Bedrooms: ~ soil Rating(sq.ft/br) /~
The Required Size of the Soil Absorption System Is:
,P _.LENGTH GRAVEL DEPTH '~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /'-/)'"~--~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 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
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer
the residence is remodeled
Signe~:
Applicant
and wells as
system may require enlargement if
to include more that~bedrooms.
Issued by:
Da ts:
SWP/024(1/81)
iUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta. ~rotection
~ _,,,~ 825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL ANDj~!~ ON-SITE SEWER PERMIT
Applicant :'~ot/,~d //~,5!
Legal Description: L3'i)
Type of Soil Absorption System Is:
Trench: .... Drainfield: Seepage Bed
Maximum Number of Bedrooms: . f~_
Phone Nul~ber:
~ Lot Size
Holding Tank:
Soil Rating(sq.ft/br)
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH 5~Y GRAVEL DEPTH ~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = / ~'$ ~* GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between-a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a pqblic 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
and must be returned to this department within 30 days of the well completion,
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER i 9 8 i * * *
certify that:
(1) I ami familiar with the requirements for on-site sewers
set forth by the Municipality of Anchorage.
(2) I wJ. ll install the system in accordance with codes.
(3) I understand that the on-site sewer system may require
the residence
Signe~:
Applicant
and wells as
enlargement if
is remodeled to include more that 3 bedrooms.
( -'~ .~/,.
Issued
by
· .. _7:~-~,~-,.,~' -~' ,,~.-,
Date: If~' ~-)~ ,- ~' / .- ,.S'
SWP/024(1/81)
January 4, 1982
John R. Rasmussen
934 Nelchina
Anchorage, AK 99504
Permit
Subject:
810816
T12N R3W SEC 15 LOT 80
A permit issued by this department for a well and/or sewer
system has expired as o£ December 31, 198]..
Permits are issued on a calendar year basis, as stated on
the permit, by authority of }]unicipa]. Ordinance.
If you have drilled the well, a well log should be sent to
this department to document {~he installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264.-4720.
Sincerely,
Sewer and Water Program
Enclosure: Copy of Permit
F'ERMZT NCL
[:,EF'FIRTr"IENT (..,, HEFILTH FtN[;, EN',/ZRONM[ENTFIL PI4:OTEC-f'ION
~..-IJ ~Ei L. ~ ....FIt th.~ IE:, {Z, lf'..,,l) -.- :'~i:T, iE ]- EE .':Z~;; E'i B..II E¥-' tF~'~: F" Eil !F~.' iJ~dt :fl
,:: 8:1.0 8:L 6
.I- FL [..HP, I
LI3CFIT I ON
I E' 3FIL.
.f" HN R.
S;h:~'4::L FIE[E~OTT LOOP I;'.OF:IC,
T±2N RZ.':!4 --',E_. J.5 LOT o0
LOT E; I Z-.':E
i:i. 50~ ii~;(;:!I. JFIF?.E F::EET
I"'¢PE OF' SOIL F:IE:SCIF~:F:'TIOI",! -:,r ,1Ei'l IS: TRENC:H
MFI::'::IMLIM NI. JME:ER OF E=EC'RCtOiVlL'4; = 4
SOIL F:FITII',P3 ':;SQ F'T,.'"E:F'.)= :1. O2
THE PE) '[F';'D :,I,¢.E OF 'THE L':;"Ill ltE,:.,URI J].ul,l ._,~'._,1Etl :
El::" ~_TE ;~:" 5?' ~-It ...... ¢:~;. Ef.~; IL. E.']; !1'-4l C~i -"11'- ~"-!t ...... 'E~ RZE~ FT:: IF:':I! %." E:JE I1. .....
THE LI. ENGTH [:'IMENSION IS ]"HE L. ENGI"H (IN FE:ET) OF THE 'TRE]",ICN OR D'RFIII"JF]:E]._[:,.
THE DEPTN OF FI TF,'.E]",IE:I'4 OR F'IT IS THE t]:,:rSTRNCE E~E]'!4E:EEN THE' .SIJI;?FF:tCI~i: OF THE;
GROUND, FIND, THE BOTTOM OF THE E',,.,:CFCv'I:::ITICIN ,:] J;N FEE'I").
THEFflE ]iS; NO SET WI[:,]"I4 FOR TRENCHES;.
THE GRFI',,,'EL I:)EP-FH IS 'FHE H:rN!MUM DEP'f'I4 OF: GF:d:I'v'EL. BE-FHEEI'.~! T'HE Ot..ITF:FiL.t... F'IPE
RND THE BOT-I-OM OF THE E'XC:F¢,/FIT Z 01'.4 ,:: I N FEE"I" ).
F'ERMIT HFI L..[LHNf HI::I_"~; 'T'NIE F..E...I ~['I:.[EIL..I.I r "l*r' INFCrIq:N ]"F.IIS [:,EF'FIf{.:TMEI'.,IT E:,LIF::iNG
ZNSTF!L.I..I::I]'I (IN .I.N::,F[:_ 1 .[ ..14.:, FF FIN"/ 14EL..L.S FII}JFIE:ENT TO TH:I:5 [ ~. _ FE.F. [ r FIN[:' THE
i",IIJHE~EF: OF [.E-1[EN...L:: TFIFll" THE: I.'-!EL..L. HILL. EE'R'"E.
.................. T' tl.,,!~ C3 c] '"":" Z:, % l -.,~ ~. tt E::_ _.. ~ ][ L, !; -,~1 ..=. F~. F;': Ei ~::;: EEC;:!! IL.it 31 1t:;,7: E{E
8RCKFZ LL I I",IG OF' FIN"r' c, ~ _,"1 EM 141THOLIT F [ NFIL I NE;PECT ! ] N FIND FIPF'F-~:CI',,,'FIL. 8'¢ TH I E;
E)EF'FIFYTP~IEP,!I' PI ). L.L. [3E '.'-~lJE'. ]'ECT TO PiE: ': %[E ':. l" r ] ['4
MINIHUH .D',IE;TFINCE 8E!"HEEN R I.,.IE:LL FIND,
&00 FEET F:'OR R F'F';tI',,,'I:::ITE: I,.IEL. I._ OR ±50 "FEi ;;?00 f:'EET FRI)M FI PUBLIC I.,.IEI...i_ DEPEN[)IF.IG
UPON 'THE: T","F'E OF' F'U[%..IC I.,.IEL.L.
MII'.,IIHIJI'"I DI:J_<TFINC:E FROM FI PRZVFF['E WELL 'T'O FI PRI'v'F]TE SEWEI:,~: I..INE :t:S 25 FEET FIND,
TO R COHHIJI',IIT'¢ SE!-,.IEF:;~ LINE ZE; 75 F:EET.
!.4ELL. LOG~5 FIRE RIZQUIRED FIND, MUE;]"
OF THE I,.!ELL. C:OHF'LFJ]"ION.
OTHER REI::!U i REI"IEN'T:E; MR"r' t:'IPF'L"r'. E;PEC I F I C:FIT I OiqS FIND, COI",ISTFdJCT I ON [:, I FIGRFIFI:iT IqRE:
FI'v'FII LF:IBL. E TO INL'-]I_IRE PROPER INE:I"FILLFI]'I ON.
I CERTIF"¥' THFFF
i: ! RM F'FIMILIRR FILTH THE r.~:EQUIREMEN"rE5 F'OR ON---SII'E SEWERS
FORTH E',¥ T'H[E MLIN I C: ! F'FIL I 'l""r' OF:' FINCHOF~tFIGE.
:;~:: I I.,.tILL.. INtSTFILL THE E;"r'STEM It",l RCCOR[:,FINC:E WITH THE COD, ES.
::~:: i UNDER. ST'FIND ]'HFIT
RES I DENC:E I S IRE'MODELED TO ! [",!C:LIJ[':,E r,IOF::'.E 'THFtN 4 E',iE[:,ROOME;.
FINE:' [.JELL..:, FI:E; E;E'['
ENLFIRGEMEN'I- IF 'THE
E; i GNE[:,:
FIPPI... Z CFINT JOHN R. F;'.F1E;P'ILISSEI"~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
(;;~"~' SO ILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER S
ENCOUNTERED? ~)0 L
O
P
E
IF YES, AT WHAT
DEPTH?
Cross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
COMMENTS
CERTIFIED BY:
FT AND . FT
72-008 (6/79)
M-W DRILLING, Inc.
P.O. Ilox 10-370 · 10300 Old 8award Highway
(907) 049-8535
ANCHORAGE, ALASKA 90511
DRILLING LOG
Well Owner .~11)~tl ~n.'~t,!tt!zf!tSlt ~.(/itt' ~lU~¢~l Use of Well
Location (address of: Township, Range, Section, If known; or distance main road
Size of casing Depth of Hole feet Cased to feet
Static water level ft. (above) (below) land surface. Finish of well (check one) open end (
Screen ( ); Perforated ( ).
);
Describe screen or perforation
Well pumping test at gallons per (hour)
of drawdown from static level.
(minute) for hours with
ft.
Date of completion
Depth in feet from
ground surface
164 .'1'0 170
170 TO 177
WELL LOG ..
Give details of formations penetrated, size ~f material, color and hardness
8:mdy ~ravel (d.la~O
tJlay, hard ~rnvcJ.
177 TO 21(i
Cl ay
210 TO 21;t
Bou].dor
;q~ TO ;90
230 TO
TO
TO
TO.
TO.
.TO.
.TO
.TO
TO
TO
3--CONTRACTOR
rv1 ..W DRILLING, In,:.
P.O. Box 10-378 * 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner John ~',/~]lil[~,¢~(~tl (](),[Ll;:im~ed Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing Depth of Hole_
Static water level .ft. (above)
Screen ( ); Perforated (
~eet Cased ~o .feet
(below) land surface. Finish o~ well (check one)
).
Describe screen or perforation
Well pumping test at gallons per (hour)
of drawdown from static level.
Date of completion_
open end (
);
(minute) for
_hours with
ft.
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
164 .TO. I'10 S:mdy &ravel (damp)
t 70_TO. )77
177 .TO 2 ! 0 __C].a,~
2 ! (2 .TO 2 / ;! Boulder
2212 TO_ 230
23(I TO_ ? 15
TO
TO
TO
TO
_TO
_TO
__.TO
.TO
.TO.
Cla¥~ l~,l;ave], imrdj)an
WaLnrl,ea I~ Jrt:; ~ rave!
973
3 -- CONTRACTOR
MUNICIPALITY OF ANCHORAGE
DIVISION OF EN~..RONMENTAL HEAL~
DEPA[iTMENT OF HEAL'I~I AND [~VI~DNMF. NTAL PR(IrECTION
APPLICAT£ON FOR ~kL%~I ~ORITY APPROV~, CE~IFIOTE
1. t,~ n~a., ~ ,~al Infor~tion Application Date ; ?
(a) l~gal~ Description (inclu(~ lot, block, Dubdivision, ~cticn, t~%ship, range)
/ ~- %" ~e~ /~.,-f/2A~,A~:~c,'. 51~3
Location (ad~ess or dir99tions) . ,n r
(c)
Applicants Address /
Applicant i.~ (check o~) I~ndin~ Institution
Lending Institution /~ /,' /',. ~ /, Telephone ' ', '
Address " '
(e) P~alE~,,,ate Co. & Agent
Address
Mu 1 t i.-Fami ly t~----~- -
Other (descrite)
Note: if cc~nity w].l system, must have wi, itt-mn ccnfir~mticn fntcm the State
Depa~t]ue, nt of Eaviron(~ental Conservation attesting to the legality and status.
Is the ~,~,11 adequate for the number of bedroc~s s~cified in this UJ%A ~_)~_' ~
Onsite ~t Public ~-~1 Community ~_.~_,j[
Is the wastewate~ disposal system adequate for
Holding Tank
[Pac~ 1 of 2]
2-15-84
5. _ED.~qineer~.n.q F]~[f, Pr_ov_~d!r4t l__'n~pecticns, 1%sts, Data and Infcrnmtion
I c~31ttify that I have c~cked, verl~.ied~ or conf¢~cn~K~ to all ~A [~A ~i~li~s in
~ . ~. ~ . / ..
( ENGINEER SEAL)
'fl~e Municipality of ;uncho~age Depa~?tT~nt of H~alth and Enviror~r~ntal P_wotection dces
not guarantee the continued satisfactory perfommnnce of the water: supply and/or the
wast~ate~, disDosa], system. 'ibis approval indicates that, as cf tl~e validation dab~
sho~n above, l~nsed on the data and info~mation furnished by an eng].~.er registered in
the State of. Alaska, the wate~ supply and wastewater disposal system is safe and fur. c=
tional for the numkmr of bedrcc~.q and type of structure indicated.
( ~EP SEAL)
7. Mail the HAA to the fol].c~ing address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH Atrl~ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
ENyt~ON~
WELL DATA
LEGAL: Lot 80, Sec 15, T12N, R3W, SW
Well Classification Individual
Well Log P~.esent (Y/N) Y
Total Depth 235, Cased to
Static Water Level 187,
Casing Height Above Ground 12"+
Electrical Wiring in C~nduit (Y/N) Y
Separation Distances f~cmWell:
To Septie~olding Tank on Lot~ 98'
To Nearest Edge of Absorption Field on Lot
To Nearest PublicS ewer Li~ none
If A, B, O~ C, D. EoC. Approved(Y/N)
Date Completed
235,
Pump Set At
N/A
10/3/83 Yield__iQ
Depth of Grouting unknown
unknwon
___ Sanitary Seal on Casing (y/N) y
Depression A~ound Wellhead (Y/N) N
108,
; On Adjoining Lots 100'
; On Adjoining Lots__~oo,
To Nearest Public Sewer
Cleancut/Manhole none TO Nearest Sewer Service Line on Lot
Water Sample Collected By D. Maney ; Date 4/18/84
Water Sample T~st P~sults Satisfactory for Total Coliform
Cc~r~nts
25' +
B. SEPTIC/HOLDING TANK DATA
Date Installed 10/83
Standpipes (y/N) y
Depression over Tank .~Y/N) .N Dat? ~ast Pump~!d _ New Syste~
P~ping/Maintenance Contract on File (Y/N)N/A .; for__N_~
Holding Tank Hig~-Water Ala~m(Y_~/N) _N~A Ten~ora~y Holdir~ Tank Permit (Y/N)
Separation Distances f~om Septic/Holding Tank:
TO Water-Supply Wel~%~ 98, To Building Foundation 48'
To P~operty Line~.~ 5' + To Disposal Field 10'
To Weter Main/Service Line 10' +
Size .____~_g~__No. of Ccre~a~wnts__2
Air-tight Caps (__Y~_~_y_~____Foundation Cleanout (Y/N)
To Stream, Pond, I~nke, c~ Major D~ainage
Comments
[Pa~ 1 of 2] 2~15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 10/83
Width of Field 36" +
Square Feet of Absorption .A~ea
Depression over Field (Y/N)
408
102
Date of Last Adequacy Test
Type of System Design Trench
~ngth of Field 50,
Depth of Field 6.6'
Gravel Bed Thickness 3.6'
Standpipes P~esent (Y/N) y
N/A
Results of Last Adequacy Test System Installed 10-83
Separation Distance frc~ Absorption Field:
To Water-SupplyWell
To Building Foundation
Lot none
TO Water Main/Service Line
108' To P~operty Line 10' +
48' To Existing or Abandoned System on
; On Adjoining Lots N/A
TO Cutbar~k(if present) N/A
To Stream/Pond/Lake/o~ Major Drainage Course None Noted
TO Driveway, Parking A~ea, or Vehicle Storage A~ea
Core,ts Adequacy Test not performed because system was installed within the
past two years.
D. LIFt STATION N/A.
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
.,Pump Off" L~vel at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Cor~ments
** 'Check Permitted Bedr. OomRatingAgainst HAA Request **
I certify that I have checked, verified, o~ conforn~d to all MOA HAA Guidelines in effect
on the date of/~this inspection.
/
Date
MOA NO.
KB1/d5/s
[Page 2 of 2]
DEPT. OF ENVIRONMENTAL CONISERVATION
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
May 14, 198l}
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
MUNICIPALITY OF ANCHORA(DE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION,
MAY 1 4 1984
blt. ,John Rasmussen
934 Nelchina
Anchorage, Alaska
99501
RECEIVED
Subject: Waiver Horizontal Well to Septic Tank Separation,
Lot 80, Section 1!5, T12N, R3W, S.M.
The ])apartment has reviewed the subject waiver request and hereby waives
the horizontal well to sept:Lc tank separation from 100 ft to 98 ft for
a private water system only.
Sincerely,
Environmental Engineer
BEE:msm
cc: Arctic Engineers [[nc.
1506 W. 36th Avenue
Anchorage, AK 99503
SURVEY TYPEc-].--~;. e _
[] PLOT PLAN
[] LOT SURVEY
[] RECERTIFICATION AS-BUILT
Lot Survey Certificotion
,m~o~.~n~s on odjoo~
LEGEND hub I~ tock- found ~ set
· iron rebor -found 0 set
iron pipe -found 0 set
brass cgp -found (~ sel
alum cop -found ~ set
~~- ~ ~el)or~ by
~' oF.~Lg'~
~ ~ ...... .%~ ~ENCH M~H ~NC
' Professl~ol Land Surveyors
2436
~.-~' .. .. ,~ ~ Legal~cripti~'
~'~/~ ~ Lot 80 Sec.[5, T]2N R3S, SH