HomeMy WebLinkAboutT12N R3W SEC 15 LT 88
ENVIRONMENI'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTIC)N REPORT
MA~LINGADDRESS
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
' PERMIT NO.
Material No, of compartments
p ~ Manufacturer
~ Liq. capacity in gallons Inside length Width Liquid depth
Well Dwelling PERMIT NO.
9~ DISTANCE TO:
O ~ Manu~scturer Material Liquid capBcity in gallons
Foundation Nearest lot line
~ ~ ~ No, of lines Length of each line Total length of lines Trench width Distance between lines
~ ~ ~ Top of tile to finish grade¢ ~ Materi~l beneath tile Total effective absorption area
~' Lengd~ Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well , Building foundation Nearest lot line
¢ DISTANCE TO;
~ Distance oLotline PERMIT NO.
OTHER
~NSTALLER f~ ~ ~2
//
72 013 (Rev, 3/78)
rv~-w DRILLI: '.,, Inc.
P.O. BOX 10-378 * 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner_ JetTy F. ,!atf ~o .Use of Well
Location (address of: Township, Range. SecLion, if known; or distance main road_ I~t ~8 Sec~i~ 1.5 ?17.! 17.~ ~;eward ~'%ridim
Domestic,_
Size of casing_ C," Depth of Hole
Static water level__ ] 67 ft. (iib-6~
Screen ( ); Perforated (
,%'~ feet
= ,, feet Cased to_2Ll.A
(below) land surface. Finish of well (check one) open end ( xXX ); - :
).
Describe screen or perforation__ %'ay.~L, '>~' 19TL
Well pumping test at o.~__gallons per (h'611;~/- (minute) for__
of drawdown from static level.
[)ate of completion ,'hr "'? ~o ~ ~
].__.hours with _ J~l()~ ;~
WELL LOG
Depth in feet from
7round surface Give details of formations penetrated, size of material, color and hardness
" ~V1 'W DRILl. I:'.'.,, Inc.
P.O. BOX 10-37~ · 10300 Old Seward Highway
· (907)
ANCHORAGE. ALASKA 99511
DRILLING LOG
Well Owner Jerry F..7~zo ,Use of Well
Location (address of: Township, Range, Section~ if known; or distance main road Lot 88 Section 15 ".12".! P_~-: F,e,,urd Ilcridiam
She Of casing f"' Depth of Hole ~47 feet Cased to 21,1;~ feet
Static water level 167 ft. ('a~ (below) land surface. _Finish of well (check one)
Screen ( ); Perforated ( ).
open end ( xxx );'
Describe screen or perforation }'ay. 2F,. 19.t3 _
Well pumping test at ?_5 gallons per (hl:aX~ (minute) for
of drawdown Irom static level.
]. hours with
Date of completion
· WELL LOG
Depth in feet from
ground surface Give details of forma:ions penetrated, size of material, color and hardness
0 TO
.~ TO
32 TO
(~3 To
l/~-, TO 179
179 TO
_ ~_135._:ro
__
TO
.TO
,TO
TO_
TO.
,TO
Silty n :',.-~dv
Silt%, £rmml
Silt-y
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta' ?rotection
825 ~ Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~__~L~ICt~I__ WELL AND~ ON-SITE SEWER PERMIT
Applicant:
Location:
Legal Description: -T'l~ A.3 ~5C~
Type of Soil Absorption System Is:
Trench: ~ Drainfield:
Maximum Number of Bedrooms: ~ _
Mailing Address: 17~ (
Phone Nu~ber: ~U ~-~
~. /S L ~? Lot Size:
Seepage Bed~ Holding Tank:
soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH / ~L~ LENGTH 3~,, GRAVEL DEPTH g 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. Minimtun distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well legs 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 ~ 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
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 system may re.quire enlargement if
the residence is remodeled to include more that ~ bedrooms.
Signe~: Issued by: ~_~c~917 _
Applicant ~ ~
Date: -- ~ ~,_
SWP/024(1/81)
NU,3 !C ~ F'Ai ! I'Y OF ANCHOP, AgE
264 ~4 ?20
',t:' ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION "rEST
SOILS LOG
PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6-
7-
8
9
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
ENCOUNTERED? ~N/~ .
IF YES, AT WHAT
DEPTH?
Gross Not Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
__J TEST RUN BETWEEN __~,,-' FT AND r F'T
72-008 (6/79)
(minutes/inch)
MUNICIPALITY OF ANCHOP3%GE
' DIVISI£~ OF ~IRO~NT~ ~AL~
DEP~'ME~~ OF ~{ ~D ~MENT~ ~ECTiON
APPLICATI~ I'OR [~{ ~O~[~ ~PROV~ CE~3IFI~ITE
1. ~ral Infor~tion ~plication ~te ~' ~ ~'~
(a) ~gal ~s~iption (inclu~ lot~ block, su~livision~ r~ction, t~ship, range)
Ix)cation (adck~sss or directions)
(c) Applicant is (che~ ~) ~ndinq Institution
(d) rx~nding Institution
Te lephorm
Address
(e) I~,~al Estate Co. & Agent
Address
Telephor. e
Multi--F~nily [_~.' '[ '/ Other
(descz~ibe)
CoN~.uni ty _~--_j Public
Note: If cc~Yunity w~;l], system, must hays vg~,itten ¢~nfirn~tion frcm the State
Depa~lnr~nt of Enviro~m~ntal Conservation attesting to the legality ~%d status.
$ewaqe
Is the 'wastewater disposal system adequate for tJ~e number of ~dr~ ~.~ ...........
[Page 1 of 2]
~ 4
2--1~-8
5. ~eri____n~ Fimu P~-ovidij]g_I_ns_~_ctions ~ %%sts: ~ta and Infor~tion
I ~tify ~at I have c~cked, v~ified, ~ ~nfo~d to all ~A ~ (~i~li~s in
effect on t~ ~t~ of this ins~ction.
. /I ,~<' ~" .
S igrmd by
Date
( ENGINEER SEAL)
The Municipality of Anchorage Department of Health and Enviror~antal Protection does
not guarantee the continued satisfactory Derformance of the wate[~ supply and/or the
wastewatez, disposal system. ']]ais approval indicates that~ as of the w~lidation date
shown above, ]mased on the data and information :furnished by an ePx~ineer registered in
the State of Alaska, the water, supply and wastewater disposal system is safe and func-
tional for the number of kedroc~s and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the follc~ing adclress:
KB2/d5/s
[Page 2 of 2]
2-].5-84
MUNICIPAL{TY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
MUNICIPALrW OF ANCHORA(~E
DEPT, OF Hf:ALTH &
ENVIRONMENTAL PROTECTIO~
rJIJl_ 9
Total ~p~ ~ / ~d to _ ~F~ ~ ~ptn o~ G~outing ~,/~ __
Static Wate~ ~1 /~-/ t~ ~t At /~~
Casing ~ight ~ G~nd ~,// Sanit~i ~al on Casing
Elec~ieal wi~ing in ~nduit ~) ~p~ession ~nd ~i~ead (~
~p~ation Distan~s f~ ~11:
· o ~pti~olain~ ~a~ ~ r~%__
To ~a~est ~e of ~so~ption ~ield on ~t ~M~z~.; On Adjoining ~ts ~/~
To Nearest ~b].ie ~ Line _ ~/~. _ To ~est ~blic
Clean~t~a~ole ~/~ . . _ To ~a~eSt
Wate~ S~le Test ~sults ,,
I
~te Installed ~/~ Si~
~p~a~on D~s~an~ ~ ~p~/~o~d~g Tank~,
TO Wate~-SupDl~ ~11 _~~~To ~ldin~ Foundation ~'
TO ~o~ty Li~ ~/-~ TO D~sposal Field .
To ~te~ Main/Se~vi~ Li~ __~/~ To S~e~, ~nd, ~e, ~ ~jo~ ~aina~
[Paga 1 of :2] 2-15-84
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/~/~
Width of Field ~/
Square Feet of Absorption A~ea
Depression over Field (Y~_))
Results of Last Adequacy Test
/~ Type of System Design
Length of Field ~ /
Depth of Field /~9 (
Gravel Bed Thickness ~ ~
Date of Last Adequacy Test ,/~/;~
Separation Distanc~ f~omAbsorption Field:
To ~i~ter-Supply Well
To Building Foundation
Lot,,,
To Water Main/Service Line
//~z~ TO l~operty Line _'-3'~/
~z To Existing or Abandoned System cn
; On Adjoining Lots ..~-~9 /
To Cutbank(if present)
To Stream/Pond/Lake/c~ Major D~ainage Course ~/~D /
To D~iveway, Parking A~ea, o~ Vehicle Storage A~ea .~/~/ .
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manh~9~Y/N)
"Pump On" Level at ~t~ Off" Level at
High Water Alarm Level at ../ Vent (Y/N)
Tested for / l:Mmping Cycles du~ing ~dequacy Test.
Electrical
~ets MOA
** Check Permitted Bedroc~ Rating Against HAA Request **
I certify that I have checked, verified, o~ conformed to all MOA HAA C4~id~lines in effect
on t~he dat~f
si ed
Company
KB1/d5/s
MOA NO.
[Pa~e 2 of 2]
2-15-84
BILL SHEFFIELD, GOVERNOR
DE~T. OF ENVIRONMENTAL CONSERVATION
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
Telephone: (907)
Address:
274-2533
July 5, 1984
Alaska Environmental Control
Services, Inc.
1200 W. 33rd Avenue, Suite B
Anchorage, Alaska 99503
Dear Sir:
Subject: Horizontal Well to Septic Separation Waiver
Lot 88, Section 15, TI2N, R3W Anchorage, Alaska (8521-WA-001)
The Department has reviewed the subject waiver request and hereby waives
the horizontal well to septic tank separation to 95 feet for 'tile existing
syst~n .onl,v.
Sinc,erely,
Bruce E. Erickson
Environmental Engineer
B E E/m sm
cc: Robbie Robinson (MOA)