HomeMy WebLinkAboutT12N R3W SEC 15 LT 113
Tom Fink,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
May 12, 1994
Gene B & Jacque~Line Lettis
4910 East 101st Avenue
Anchorage, Alaska 99516 6307
Subject: T12N R3W Section 15 Lot 113
Permit ttSW930093, PID #015=484-07
The subject permit, issued May 12, 1993 by this office for a
single family well and/or on-site wastewater system, has
expired as of May 12, 1994.
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,
this office for documentation
close the permit.
a well log must be sent to
of the installation and to
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 wastewater and well permit.
If you have any questions, please call this office at 343-4744.
~r~,z y tSinc ely, ~/~ ~
Robert W. Robinson
Acting Program Manager
On-site Services
Copy of Permit
cc: Steven Pannone, P.E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-66!50
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930093 DATE ISSUED: 5/12/93
ENGiNEER:U~KH--RRCq4~T-E~pS~-EN~E~-Rg~~ EXPIRATION DATE: 5/12/94
DESIGN
OWNER NAME:LETTS JACQUELINE KAY
OWNER ADDRESS:4910 101ST AVE
ANCHORAGE, ALASKA 99516
PARCEL ID:01548407
LEGAL DESCRIPTION: T12N R3W SEC 15 LT 113
LOT SIZE: 46200 (SQ. FT.)
NUMBER OF BEDROOMS: 6 THIS PERMIT: 6
THIS PERMIT IS FOR THE CONTRHCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQU·[REMEN S 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 DHHS 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:
1. ORIGINAL SYSTEM BASED ON OLD SOIL TEST. ENGINEER MUST
VERIFY PERCOLATION TEST DURING INSTALLATION.
2. NEW PORTION OF SYSTEM DESIGNED FOR 6 BEDROOMS BUT WILL
BE CONNECTED TO EXISTING 3 BEDROOM SYSTEM.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
3. INSTALL DOUBLE CLEA,3~O~,UTS AFTER SEPTIC TANK.
RECEIVED BY: ~..~-~3%°<J- c~
DATE:
DATE'.
PAGE 2 OF 2
April 26, 1992
Department of Health and Human Services
Anchorage, Alasks
Re: Onsite Sewer system design for the Gene Letts residence
Lot 113, Section 15 Township12 N Range 3W
Dear DHHS,
This is $ request for an onsite sewer permit for a existing residence
located at the above address. The owner is adding on to his house and
needs the septic system upgraded. Due to the good soils, a whole new
system will be added and the ()Ed system abandoned. The new system is
designed as a six bedroorn system, therefore the existing tank will be
reused (pending inspection) and a new tank will be added to get the
required capacity.
No impacts to the surrounding properties are foreseen. All have
onsite systems already and appear to be performing adequately. The
required set-backs and reserve areas are easily obtained due to the large
lot size and good soils. No problems with any of the surrounding systems
have occurred.
The topography of the area is approx, flat with the ground just
outside the lot area sloping appro)(. 30% on the West and North sides. The
lot footprint is rectangular shaped~ in the North-South direction.
The general area has excellent soils (thick sand layers} therefore the
drainage above and below ground is good.
Sincerely
Steven R. Pannone P.E.
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6-
7
8
9-
10-
11
13-
14-
15-
16-
18-
19-
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG --, PERCOLATION TEST
(
DATE PERFC
/..~.~L [[~ ~,,/5- T"I Z..N (~.5~Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? /~ O
S
L
IF YES, ATWHAT O
DEPTH? p
E
Deplh to Walet AII, r ./
SITE PLAN
I 11''''
Gross Net Dopth to Net
Reading Date
Time Time Water Drop
~'11¢¢~ ~lr..-~-,,*~. - ~'~.n;~ ~-.~'.._. n ~
PERCOLATION RATE ~' (m~nutes,mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ,~'-:,C)_ FT AND ~ ~'' FT
PERFORMED BY: ~~&ff~Ud I ~'¢~'~ ~e-* .... ~ . CER~IFYTHATTHISTESTWASPERFORMEDIN
ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: ~ ¢ ~ ¢ ~
72 008 IRev. 4~85)
IOl 5%,
hi
,,.
0
~o
~I~,'![ERS - PLANNERS - SURV, ]RS
1610 DIMOND DRIVE
ANCHORAGE~ ALAS~4A c~t~507
SOILS LOG -- PERCOLATION TRST
PERC~.JLATION
TEST
LEGAL DESCRIPTION:
1
2
3
4
7
8
O
10
11
12
13
14
18-
18-
20
SLOPE S~TE PLAN
ENCOUNTERED? ....
tF YES, AT WHAT
[.NVtRONMEN1ALENGIN£{H~NG
ON SITE S[WAO~ DI~(3SAL SYSTEM AND/OR WELL IN~ECTION REPORT
D~?A~Cf ~0
OTHER
RATING
INSTALLER
REMARKg
;.....~.......... ....... ,...~
LEGAL
l'f, Rr,l.I (."1 blt Ill .'
VAI lit', r I
lmxl'w2oo ....................
CElT*FI
This do~um
............ ~c)~' bt ti~"'~
orruP. ' ......... ~O~pJl~O0'
~ , ~El~OOg rooU
ON-;-iSITE
PERMIT N0~ -'
DATE ISSUED:
,..: RPPLICRNI':~
i, ,I
ii' ADDRESS:.
'~' CONTACT PHONE
"~ LEORL DESCRIP:
~Ei.-IEZt~
047047~
OLENW S & JEF:ItlIE CRLE¥
SRFt BOX l?4OC 10200 OUR ROAD
ANCHORAGE, AK 99507
346-1874
& IqELL
LOT ~IZE;
LOT LOCRTION:
MRX BEDROOMS:
F' E R I~l I 'r
GRAVEL DEPTH (Fl'. > ?. 0 0,
TOTAL DEPTH (PT,) ii. 0 4.
~RRVEL WIDTH (Fl', > 2. 5 17.
'GRAVEL'LENGTH (PT,) 27. 0 34.
GRAVEL VOLUHE (Cfi YD~. ) ' 18. 7 21.
TANK SIZE (GALS) , ' l~ 0~0. 0 ** l, 000.
SOIL RATING <$Q. FT, /DR> t25 125
LISTED BELOW ARE THE OPTIOHS R',,,'FtILAE:LE TO YOU IN DESIGNING VOUR SEPTIC
StCSTEt'I. CHOOSE THE OPTION THAT BEST FITS YOUR ~ITE.
Tr~Et-,IC H 19ED N. DER
DEPTH TO PIPE BOTTOM (FT. > 4. 0 4. 0 4, e
7.
4i.
:30.
i, 000.
12=j
** TANK MUST HAVE RT LEAST TWO COPIF'RRTMENTS ·
i' 'I CERT:IFV TFIRT:
l, !'AM FAMILIAR WITH THE REQUIREMENTS FOR ON-S~TE SEWERS RHI], WELLS RS SET
FORTH B~,' THE ~IUNICIF'RLIT~ OF ANCHORAGE (FLOR) AND THE STATE OF ALASKA.
2. I W~LL INSTALL THE S'¢S, TEM IN ACCORDANCE WITH ALL NOR CODES AND REGULATIONS,
'~RND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3, I 14I[.L FIDHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE ~ET BACK
D~STRNCES FROM ANY EXISTINO WELL, WRSTEI48TER DISPOSAL 5YS'rEM OR PUBLIC
SEWERROE SN'STEH ON TI4IS OR FtNY ADJACENT OR NEARBY LOT,
4, I UNDERE;TRND THAT THIS FERtlI r IS VALID FOR R MRXINLIM OF 3 BEDROOHS AND
RNV ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
ZF R.LIFT ST¢ITION IS INSTALLED IN RH RRER COVERED BM NOR BU[LD~NO COD~S~
THEH (l> AN E:LECTRICRL PERMIT At.iD INSPECTION HUST BE OBTRINE[u ~2> RS-BUILTS
I,IIt. L NOT BE APPROVED WITHOUT AN ELECTRICAL ZHSPECTZON REPORT~ AND (3) THE
ELECTRICAL WORK MUST Be: [.,OUF B',' ¢1 LICENSE[* ELECTPI¢.~RN
-4
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~ ~' ~'- -~-~/~L~-~----- Type of System Design -..
Date Installed ~1~_~; ~/_ c~_~. .................. Length of Field
Width of Field - ~'"
Square Feet o! Absorption Area
Depression over Field (Y/N) ---~
Results of Last Adequacy Test .
Separation Distance from Absorption Field.
To Water-Supply Well .~(~.~"
3'0 Building Foundabon ~ 5'
Lot -....~,
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, o;' Vehicle Storage Area
Comments ~ ~l,,,Sj ~_~,__~t _ __
Depth of Field "~ ~° ~"
o/~..~l, ~-.
Gravel Bed Thmkness
Standpipes Present (Y/N) - ~
Date ol Last Adequacy Test .--~t'--~
._ TO Property Line __2,~'--~--
To Existing or Abandoned System on
; On Adjoining Lots -.:;~----~- ' ......
To Cutbank (if present) -~"
D. LIF¥ STATION
Date Installed
Size In Galtons
"Pump On" Level at
High Water Alarm Level at
Tetaed for
Electrical Co, es (Y/N)
Dimensions
Manhole/Access (Y/N) -. ~--
~ "Pump Off" Level at ........
Ve~t {Y/Iq) .....
Pumping Cycles during Adequacy Test. Meets MOA
Commenta
'° Check Permitted Bedroom Ratm(J Against ! fAA Re~luest **
I certify that I have checked, ve~'dmd, or conformed to afl MOA end HAA gu~dehnes in ell°ct on the date of this
Palp! 2 Of ?
DEP[, OF H~A. LIH &
2 1
RECEIVED
A, WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 19~4
2~1,-4720
Well Ciassdicahon .__~_~i~*Y_~_~_ ............... If A, B, C, r)EC. Approved (Y/N)
Well Log Pre~nt (Y/N) _._~ ..... Dale Completed _~~ Yield _..~ ~ ..~P~ .~P~
TotAl Deptt~ .__~ .... Ca~ to _.. ~.~_~. Depth of Grouting _~,~...
Slahc Waiur L~el ~_~__. Pump ~t At ~.
Casing Hmght A~ve Ground .... [ ~ ~ ~mtary Seal on Casing (Y/N)
El~tricml Wiring in Condu~t fY, N) ..... ~_ ........... Depress,on Around Wellhead (Y/N) .~
~)paration Distances from Well
To ~ptic/Holdmo Tank on Lot .... ~(.~ /' ; On Adioinlng Lots ~~ ..........
To Nearer Edge of Absorption Fmid on Lot __~_~) ~ ~-; On Adjmning Lots
To Nearest Public Se~r Lme ._~_~ · . _~_ To Nearest Public Sewm
Cleanou~Manhole ._~ ~ To Nearest ~wer ~ice Line on Lot .~_ ....
Water ~ample Collected by -~ ~' ; Date .... ~/~ /~' '~ . --
~mments ......
B. {;EI:~ICIHOLDIN~, TA[~,IK DATA
Date Installed..lj,/_.~j'~___ size ..~C[~'afl - No. of Compa.ment8 ~-
StaHdpl~ (Y/N) .:. ~ ..... Atr-h~ht.Cnps (Y/N) ~ Foundation Cleanout (Y/N) ~ ~
Depression over Tank (~N) ~-~-~' Date Last Pumped _~, ~ : -
Pumping/Maintenance Contract on File (Y/N) ~ ...... ~ ; for ........
Holdtng Tank High-Water Alarm (Y/N) ~~ Temporary Holding Tank Permit (Y/N) L~
~paralton Distances from ~ptic/Holdtng Tank:
To Water-.qupply Well
To Property Line
To Water Mein/,gervlce Line
Course
To Building Foundation ~O ~ ~~
To DIspotla{ Field ..... ~,,,r. ....
To Stream, Pond. Lake, or Major Drainage
Pegp 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TE.'.STS, FILE SEARCH, DATA AND INFORMATION
As Cerhfied by my seal affixed herolo .~nd as of the vahdat~on date shown below. I verify Ihaf my mvesbgatlon of th~s ~[th
Authorlly Approval shows that the on-rote water supply end/or wastewater disposal system ;s ~e. funcb~l and ad~uate
for the RumOr Of ~drooms and type el sh ucture intimated herein. I further verify that ba~d on t~ reformation ~
from the Municipalily el Anchorage hies and from my mvesbgation and trisection, the On-s~te wafer supply an(Eot
wastewater disposal system ~s m comphance with all Municipal and State codes, ordinances, and r~u~ti~s in efl~ on
the (late of this ins~tion.
Name of Firm _~ ~,~c~!~;~ ~ Telepho~ _ ~,'1~ ' 13~'.5' ~
ndiflonel
CAUTION
The Munc:lp#ltty of Anchorag# Departmenl of Heatlh end Environmental Prot~ctiott (DHEP)
MUNICIPALrl Y OF ANCHORAGE
DEPARTME~4'! OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTI~-tCATE OF iNSPECTION FOR HI~ALTH AUTHORITY APPROVAL
OF ON-SITE St'WElt AND WATER I'AC. ILI1Y
264-4720
Application Date
GENERAL INFORMATION
Letlal Description {in~lude lol, block, subdw~s~on, soctJon, town~hip, lango) ~
L~stion (addre~ or d~rectiom,)
(b) App C ..... -~- ......
(C) Applicant is (check one). Lending Instdulion g , Owner/builder ~; Buyer ~; Other ~ (~xplaln);
Lending Institution
Address
__~'relephono
(e)
Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following addfe~.s:
2. T~PE OF RESIDENCE
~ngle. Famlly J~ Multi-Family ri Other
.Numbar of Bedrooms. .v'~. .....
3. WATI[R SUPPLY :.
I,'~dlvidual Well ~ Community ['"J Public ri
' Note; If community well system, must have written confirmation from the State Department o; Environmental Conservation ·
attainting to the legality and status.
4. BEWAQE DI6POSAL
Onelte J~ Public ri Community ri Holding Tank J~
' Note'. If community well syalem, must h~ve written confirmation from the State Department of Environmental
attainting to the legality and
Page t el 2
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & I:NVIRONMENTAL PROTECTION
ENVIF~ONMEN'I'AL ENGINEERING DIVISIDN
825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
' P-Fie N E
£ '3 '/6
~]UPGRADE
~(enn
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
I F ~OOMEMA Dr I-I I iside I~n.~gth Widt ~
Well IDwellin§
NO. OF BEDROOMS
PERMIT
Liquid depth
PERMIT NO.
DISTANCE TO:
Manufacturer Material Liquid capacity in §aliens
Nearest lot llne
Well
DISTANCE TO:
f:oundation
Total leah of lines
Trench width
~ o~ inches
PERMIT NO.
Distance between lines
No. of lines
Top of tile to finish grade Material ben0ath tile Total effective absorption area
~'0 II ~¢ inch0s ~¢ ~
Length Width Depth PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
W61l Building foundation
DISTANCE TO:
Class Depth [Driller
Building foundation Sewer line
DISTANCE TO:
OTHER
PiPE MATERIALS
SOIL TEST RATING
Nearest lot line
Distance to lot line PERMIT NO.
Septic tank Absorption area(s}
v/e/e,/,
DATE
LEGAL
E:,EF'FIF~:TlrlENT OF:' I.I:EI::II.."FH FIN[::, IEI',I',/]:I:~:EINI'IIEN.1"FIL PIq:O'I"ECTZON
825 L. :iiFIFI:;:IEE:.1'., I::INCHOF:FIGE., F:IK
I,. ;[ .':S"FE:E:, liJ~E£1,,.Ol,I I::IF4:II:; "I'I'IE: I::I:F:'T:I:Cd'.I::E; I:::i',?IFI]:LI::I[I:',LE "FO '¢OU ;[hi DE:I::;]:EiN:[NG h"OUR 'JI:;E:PTZC
':S"75;.1'.1E1'1. CI'IOO5;E THE: OIF"I" I:: C)l",! 'l"Hl:a.1' E',[ECST F:' :[ 'I"~E; '¢OIJl:;?. 5; Z TE.
FI.'S SET
I:::OI:;I:TH 1:3'.r' '1'.1.1E HI.JI'-,I :I: C ;[ F:'FIL ]: T"? OF:' I::I:I"I:C:I:'IE[I:;.::FIGE (I"'tOIF[) FINE) THE STRTE O1::' FI:L.I::IS;I::::I::L
;:IF Z I.,.I)~L.L. ]:N':'2;-I:'FIL.L. 'FHIE 5;"r':il:;'l:.1EH :[h,I FI:C:COF?.I:)FINCIE I,.I]:TH I::I:L.L. MOFI E:ODE'.'S FIND
I::II",[D ): H COI"IF'I... ]: IFINC[I:: I.,.I ]: TH THE [::,EE; ]: C'iN E:I:R Z TE;R :[ F:I OF:' TH 1' ~ F'EF'.M :[ T.
.'i::. I:: 1.4]:I_.L. I:I[)HE~FI:E .1"O FII:..L. I'iOFI I::ll",lJ3, :S'IF[:'~TE l:3F FIL..IFt:~i;I':::FI F~'.ELT.!I:JZ[;?.Ei"I:[i~I"4T';-::; F'OI;~: THE SIE.1' E:FICI:'.::
E., :[ :I:i;TFii:.,ICt!~:E; I::-I;?.i::)l'1 F:I:N"r' I:i::i:':: ]: ~!;"1~ ]; IqG HII:.'L.L., I,I:FI'."STEI.qI::ITEI:~: B', ]: 'IF;F'OS;.,FIL '.I:?'r'5;TEM OIq: F'UI31.. :i: C
Fi!;II::I.,.I[EI::;:I::~G[!i :ii;"r':!2;TEFI CIN TI"I:I:'.I:i; O1:?. F:I:Iq~T~ F:ID..'rI::IC[I::I'.,IT (::iF='. I",IEI::II:;;:E?'r' LCI.1".
]; UI"I:[:)[!i:I:;'.:B.1h31",II:) .1']IIF'IT 'Fl'l:[:~i; I::'lE:l:,d"l];T ]:'S '¢FI[.. ]: E:' I::'C_II:;?. I::1 I'dFI:X:[I'*IUM {:IF' ::~: B[E[::'F~:OOI:dS.; FIND
FI:N"r' E;t%ILI::II:;~:GI!'"-"I'IE':I",FI" t.'.[I::L.L. I:;?.E(J:!U:[FI:E: I:::l[",i IFIDE)].'T:[OiqI::IL
NEF_']RS - PLANNERS - SURV, ]RS
1610 DIMOND DRIVF
ANCI'~ORAGE, ALAF3KA 99507
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
6-
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
SLOPE SITE PLAN
/
WAS
GROUND WATER ~/n S
ENCOUN'rERED? /V[z L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net DepH1 to Net
Reading Date Time
Time .-. L-,. 4N ~ ~,-,~' t, Drop
, : c '~ ,' ~:,~:...!~
'" """ /S~ ,::,~,;'
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND
FT
72-008 (6/79)
0
(907) 243-2282
KEN JOHNSON
GLENN Ci~LEY (
SR~t
ttNCHOR~tGE, ALAbKA
RE~ Lot ].13 Sect.
0 ft to 5 ft
5 ft to 10 ft
]0 :Ct to 12 ft
12 ft to 2]. ft
21 ft to 23 ft
23 ft to 31 ft
31 ft to 4-3 ft
43 ft dj 55 ft
55 ft to 62 ft
62 ft ~o 71 ft
?1 ft to75 ft
?~ ft 'to 82 ft
82 ft to 8~ ft
8~ ft to 90 ft
90 ft to 99 ft
99 ft to 116 ft
116 ft to t28 ft
128 ft to 1~9 ft
1~9 ft to 170 ft
170 ft to 185 ft
185 ft to 191 ft
~91 ft to 195 ft
195 ft to 201 ft
201 ft to 20~-6
201-6 to 211 ft
2].1 ft to 213 ft
2t3 ~t to218 ft
218 ft to 228 ~t
228 ft to 232 ft
232 ft to236 ft
236 ft to ~5 ft
2~5 ft to 252 ft
252 ft to 25~ ft
2~ ft to257 ft
257 ft to 258-6
258~6 to 260 ft
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
30 YEARS ALASKA DRILL. lNG
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
Jeany )
99507 ( 346-18?4
15 TN12 N R3W S~I
WATER WELL LOG
Fill
Brown silt & fine gravel
Silty sand & fine gray
Si] ty sand
Med, gray & gray silt
Course grav& gray silt
I~;led. gray & brn silt
Brn silt & fine ~rav
Brn silt & med gray
Same with 2 ft open hole
Course gray & brn silt
Same with courser gray ( -tight )
IVied grav& sandy silt ( wet )
Course gray & it brn silt ( tight
Cours gray & gray silt "
JYJed gray & gray slt ( i~- open )
Cours grav& gray silt ( tight )
Courser grav
Same with cobbles
course ~rav & brn silt
Cobbles ( conglomerate ) very
[¥~ed gray & brn slt ( 2' open )
Course grav& brn slt
Weeps
Cours gray & cobbles..Brn
Cours gray & brn sand
ivied, brown sand
Cobbles
Weeps..small seams..tight,.3 ft.
Dirty brown sand weeps..
~led. sand & brown silt
Med gray & brn silt..some cobbles
~ater bearing Med. & fine sand 9'
Course grav& brn silt dry
~Teeps
Clean Med~ Sand & gravel., tight..
16 ft head
Test bailed ].~ hours at 7 GP[v[
one ft drawdown., bottom stable..
Total casing 260-8~
tight
slt.. dry..
head, o
head..
very clean..
MUNICIPALI'IY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAl. HEALTH
E;E,:]-I IFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWE_R AND WATEFt FACILITY
264-4720
GENEHAL INFORMATION
(a)
Application Cate
Legal Descriptio~n (include lot, block, subdivision, section, township, range)
Location (address or directions)
(c)
Applicant is (check ()ne): Lending Institution [];Owner/builder ~2.~; 13uyer [] ;Other [] (explain);
(d) Lending Institution .........................
Address
__ Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms -'~
Other
WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have writton confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite I~ Public El Community [] Holding Tank []
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 72025(11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'fA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, J verify that my investigation of th~s Health
Authority Approval shows that the on-site water supply and/or westewater disposal system is safe, funcbonal 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 tiles and from my investigation and inspection, Jhe on-site water supply and;or
wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Appreved for-~-~'-L--bedrooms by
Approved ..... ~ .... Disapproved
Terms of Conditional Approval
nditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based aolely 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 eourtesy 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 ia not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCttORAQ~
DEPT, OF HI:ALTH &
ENVIRONMENTAL PROTECTION
AU6 '1 5
RECEIVED
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: _ ~.,O~' /'13
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth. ~'O Cased
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
If A, B, C, D.E,C, Approved (Y/N)
Date Completed ,.~/1~ {¢~'~ Yield
Depth of Grouting
Pump Set At _
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N}
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ___~ ~,-2 ~ ~' ; On Adjoining Lots '~. loc '
To Nearest Public Sewer Line I~h/l- . To Nearest Public Sewer
Claanout/Manhole ~!~/~ To Nearest Sewer Service Line on Lot N,/I .
Water Sample Collected by
Water Sample Test Results
Comments
[3, SEPTIC/HOLDING TANK DATA
Date Installed ~ {~/'~
Standpipes (Y/N) t ___ Air-tight,Caps (Y/N)
Depression over Tank (t~¢N)
Pumping/Meintenance Contract on File (Y/N) ~J-
Holding Tank High-Water Alarm (WN) ~¢/J',
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line .'~5'-~ '
To Water Main/Service Line ~(~,
Course ~,,',,',,',,',,',,'~-- .~-'~
Foundation Cleanout (Y/N)
Date Last Pumped N,A, ~
; for
__ Temporary Holding Tank Permit (Y/N)
To Building Foundation '~.O '
To Disposal Field _ tO'"
To Stream, Pond, Lake, or Major Dra nage
Page 1 of 2
72-026(1~/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ///~/~y
Width of Field ~ocr~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I~'
To Building Foundation ~
To Water Main/Service Line Nr~t¢,
To Stream/Pond/Lake/or Major Drainage Course
To Driveway. Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field '~¢ ¢ "¢¢
Depth of Field ,x,x,x,x,x,x,x,x,x,~
Gravel Bed Thickness '?
Standpipes Present (Y/N)
Date of Last Adequacy Test _ I~/¢ .~.
'To e,~ ch
To Property Line 5%'s
To Existing or Abandoned System on
; On Adjoining Lots '~ ~¢~ ¢
To Cutbank (if present) i'k/,~.
D. LIFT STATION Cf, ,/4-,
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" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
Signed ~J-4¢~.~._
Company F¢~ ¢'~/~,~
Receipt No.
Date of Payment
Amount: $
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA g uidelines in effect on the date of this inspection.
Page 2 of 2
72-O26 (11/84)
Date:
WATERWELL - TEST PUMP REPORT
Well Information: Ttl. Depth ~2._Depth of Casing ~Screen From~ To
Fiemarks ~ --~
Pump Information: Intake Depth 2~Pump Size ~//~ ~ Air Line Depth
Drawdown ~
PumpOn: Time ~,~,¢ ~__Dat .e/.;~r_PumpOff: TIme/.~h _Data
WATER PIEZO- FLOW W
TIME LEVEL TUBE GPM REMARKS . REMARKS