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HomeMy WebLinkAboutT12N R3W SEC 15 LT 114l~mmmmm MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl.TH & ENVIRONMENTAL PROTECTION 12NVlRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Tele0hone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ ' ~ . ..'- ' ~ UPGRADE DESCrIPTiON ~ ' LOCATION cit~ DIS FANCE IO: NO. OF BEDROOMS Total ----~_--- Driller Distance to lot line ~ DISTANCE]O'. lO¢"~g/ OTHER LEGAL DEPAR'I]vIENT OF HEAL. TH AND ENVIRONMENTAL PROTECTIOI',I 8R5 I.. STREET, ANCI"tORAGE, AK 99501 264-4720 PERMIT NC:I: 840f~85 DATE ISSUED." F~7 / 17/84 APF:'L.I CANT: SUNDAf4CE DELft GN ADDRESS." BOX 110:]!;67 ANCHORAGE, AK 99511 CGNTACT PHONE.' ::!;46-3799 L. IEGAL DESCFIIP: SLIBDIV:r. SION: NA LOT: BLM;L14. SECTION: 15 TOWNSHIP: 12N RANGE~ 3W LOT SIZE:' 46200 (!..~Q.F'T. OR ACRES) MAX BEDROOMS: 4 BLOCI.'.:: NA Listed belmw are '[,he opt,:i, on~ available {o yl:~u in de:~signing ymur sep'Lic system. Cheose the op'Lior~ that bes'L ¢it.s yeur site. DEPTH 'TI] F'IPE BEIT'TOM (Fl",,) 4.0 4.0 4,,() GRAVEl_ DEPTH (Fl" ,, ) :1",. 5 0.5 ZL",. 5 'I"[ITAL. DEF'TH (FT.) 7.5 4,, 5 7.5 GRAVEL. WIDTH (F:T.) 2.5 :[9.0 5.0 (~$RAVEL I_.ENGTI4 (FT.) 63,, 0 ~;5.0 48.0 GRAVEl_ VOLUHIE (CU.YDS.) 23.3 24.6 Z¢5.5 TANI< SIZE (GALS) 1,250.0 *'~' ~.~250.0 '~'~' 1,250.0 '~"~' · SOIL RATING (SQ. FT. /BIZ() 110 110 1:[0 .~,~ TAIxII< HUBT HAVE AT LEAST TWO COMF'AI~TMENTr3 cer.L~fy that: 1, I am Familiar, with 2. · Lh6.~ r'eqL~J.r~mei'~ts f~r c$1n-s:i, te SeW~P~ and wf~].ls a!~ ~ie~; f~)r"l:h by 'Lhe Municipality of Anchorage (MOA) arid the State cH' Alaska. I w~.].]. :i.l~sta].]. 'Line sys;tem in accoPdance wi'[.h all MOA ccldes and r'egula.t:L~l"~~ and irl compliance with the design cri'Le~ia ef 'Lt~is per'mi'L. I will adhel',e te all M(:',JA and 8ta'[,e ctf Alaska reqLt:i.i'e:fments rcm the set back distances ¢r'om any e~¢isting well., waste~a'Ler' dispBsal system or public sewerage system en i:,hJ.~ o1" arly adjacent ~bp near'by lot. I understand that 'Lhis per'mit is raj. id fer' a maximum ~]f 4 bedrooms and any enlargement wi].1 requiPe an addit.~c}nal per, mit. IF: A [..IF:']" S'TATION IS INSTALLED IN AN AREA CGVERED BY MOA BUILDING CODIES~ TFiEI',I (1) AN ELEC, TRICAL. I='ERMIT AND INSPECTION Mt]ST BE OBTAINED; (2) AS-GUILTS WILL NG'T BF_~r~OV~D WITHOLIT AN/ELECTRICAl_ INSPE(]TION REF'ORT; AND (.3) "FHE IEL.,ECTRIC~WORI'-.'~~ DONE ~ A LI~]E:IqSED EL. ECTF~I'.C',IAN. ~JE~:JG fi,lEE RS, INC. s 7125 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 {907) 349-6561 PEReORMED FOR SOIL LOG PERCOLATION TEST 4©40/ DATE PERFORMED LEGAL DESCRIPTION 2 3 4 5 6 7 SLOPE · qz SIFE PLAN 8 9 10 ~2 20~ Iho-II,~ IF YES AT WHAl DEPTH? W Reading Time (907) 243-2282 KEN JOHNSON SUNDANCE DESIGNS PAUL LETHENSTROM P.O. BOX 110367 ANCHORAGE, ALASKA 99511 I ;N'S COI IPANY WATER WELL DRILLING PUMP SALES & SERVICE 30 YEAFIS ALASKA DRILLIN6.} ( 346-3799 ) 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 SEPTEMBER 3, 1984 RE~ LOT 114 Sect. 15 T12E R3W SM (Pacer & 101st off Hanley) w___ LL LO_____q 0 ft to 8 ft 8 ft to 58 ft 58 ft to 64 ft 64 ft to 68 ft 68 ft to 69 ft 69 ft to 8i ft 81 ft to 95 ft 95 ft to 161 ft 161 ft to 203 ft 203 ft to 232 ft 232 ft to 23~.5 ft 234°5 to 244°5 ft 24z¢.5 ft to 250 ft 250 fi; Brown sandy silt with some medium gravel Brown silt with trace of fine gray Brn silt & fine gray Course gray & bron silt ( tight ) Same..weep in 20' bail dry ( poor ) Course gray & brn silt ( dry Brn silty sand ..some gray Course gray with grey silt & some cobbles Same with Brown silt Brown silty sand & gray Med. grav& brn silt weeps 6 ft H20 Course grav& 'brn silt ( tight )DRY,°. Course gravel & brown slit with small H20 Seame,.15 ft head bails dry at 3 GP~ Clean water bearing med. Gravel & sand 21 ft head Test bailed at 7.5 GPM for ! hr. 6 ft drawdown ( 2 min. recovery ) Clearing.. Total casing 250.00 ft. Bomtom stable.. Set perm~na~ pump i ft. off bottom.. MUhIICIPALII¥ OF DEPT. OF HEALTH & £NVIRONMENTAL PROTECTION' FEB o P, ECEIVED MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR I{EALTH AUTHORITY APPROVAL CERTIFICATE / (a) Legal Description (include lot, block, subdivision, section, to%mship, range) Location (address or directions) (b) Applicants Name-- /9~ ~. / ~ Telephone ~ Hpme 3~/~ 3 ~{:s~ness Applicants Address (c) Applicank is (check one) Lending Institution ~_---~ ; Owner/builder ~_~ ; (d) Lending Institution ~ ~!Z, r~'~j.~ ~', ,~, ~ r/ i./rbjjjj~ Telephone Z='~'~.i.f!:~" ...... ' ~ Address (e) Real Estate Co. & Agent __~-,. ~. ,,i x ,~ ¥ Telephone ,~-~ / ~ ~- .~- ~.-~.' < , (f) Mail the HAA to the following address: T_~vj~ 9~ f Residence Single-Family ~ Number of Bedrooms Multi-Family Other (describe) W,,~a~,~. Supply Individual Well ~ Community ~-~ Public E~ Nete: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. S__e ~_!g3 Di~al Onstte ~_~ Public ~ Community ~I Holding Tank E~ 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] 5. --Engineering Firm Providin__~__~spect..ions)_Te_~3_z File Search, Data and Infomnation As certified by my seal affixed hereto and as of thc! validation date sho~rn below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system ia 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 Mnnicipality of Anchorage files and from m', investigation and inspection, the on-site water supply and/or ~astewater disposal ' system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm___~r~___i~ z~-,.-,.~,~ ..~.?-/~./' (~, z-/xCl 3"u~ Telephone Address /'2o~ ~-~ (ENGINEER SEAL) D_HE__ A arov_ l./ Approved for ~f/~ Approved ~ Terms of Conditional Approval '--,-. 7' Disapproved-'~F ~ndi~z "tional C. Reid, Jr. j' .'~/ No. 2251-5 ~% CAUTION TI~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF t~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH A~HORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. """""~PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN T~ PROFESSIONAL ENGINEER'S WORK. (DIIEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 MUNICIPALI~"~ OF ANCHORAGE (MOA) HEAJLTH AUI~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL D~TA Well Classification _. ~v~ Well Log P~esent~) ,~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAl PROTECTION Date ComDleted ~S~¢t 3 {~_ Yield.~.5-~?_ ~Z' Total Dept/~ ~,r~o ~ Cased to ~ ~-O ~' Static Wate~ ~vel J~E~*~I~/~<~ Pump ~t At Casing ~ight ~ G~nd ~ /' ~ Elee~iea]:-Wi]~ing i~ Conduit ~) ~ ~D~ation Distan~s ~ ~11: To ~ptic~olding Ta~ ~ ~t 7o ~1 TO ~a~est ~ge of ~so~)tion Field on ~ To Nearest ~blic ~ Line ~ Clean~t~anhole Wate~ S~)le Colle~ed By Wate~ S~le Test ~sults Depth of G~,outin~ A/'~..~/~_ , 4f o Sanitary Seal on Casing ~_.N)~__ Dep~sssion A~ound Wellhead (Y~¢~_ .; On Adjoinzng Lots /~ O ~ ; On Adjoining Lots To Nearest Public Sewe~ To N~a~est Sewe~ Se~vic~ Line on Ix~t /o0 C~nts B. SEPTIC/HOI/)ING TANK £~TA Date I?stalled lo/Vga/ Size /~\~ , $~llNo. of C.c~. a~tmsnts ~ Stan~z~s~) ~ Ai=-tight Caps~) ~' Foun~tzon Cleanout~N)~ - ~ession o~ Ta~ (Y~. ~ ~te ~st P~d ~ P~ing~tintenan~ ~n~a~ ~ File (Y~) ~ _; fo~ ~ Holding Ta~ High-Wat;e~ ~a~m (~) ~ ~a~y Holdi~ Tank ~t (Y~) F~ SeD~ation Distan~s ~u ~ptic~olding Ta~: To Water-Supply ~11 % 0 ~ ~' To ~ilding F~ndation2~ ~ To P~ope=ty Line ~ To Water Main/Service Line Course , I,O 0 ~- TO Disposal Field /c[~ ~-- To St~ream, Pond, Lake, o~ Majo~ D~ainage Receipt: % Date. Paid: Amount: __ [Pag~ 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Itd~ ~ '/~- Type of System De, sign Date .Installed /~- ~-?~/~ ' Length of Field ~ ~ Width of Field ~ 0 ti Square Feet of Absorption A~ea Depression ove~ Field (Y~ Results of Last Adequacy Test Depth of Field '~ G~avel Bed Thickness ~ ~' Standpipes P~esent Date of Last Adequacy Test Separation Distance ~n Abso~Dt~on Field: To Wate~-SupDly Well /30/~ TO P~oDe~ty Line ~°/~ / ~, ~ ¢ To Existing or' Abandoned System cn To Building Foundation Lot ~;r To Wate~ Main/Service Line To St~eam/Pond/Lake/c~ Majo~ D~ainage Course To D~iveway, Parking A~ea, c~ Vehicle Sto~age Area Adjoining Lots ~O~)'e To Cutbank(if p~esent) ~ /~$~ D. LIFT STATION Date Installed Size in Gallons "Pump O~" Level at High Wate~ Alarm Level at Tested fo~ Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du=ing Adequacy Test. Meets MOA Cor~0ents ** Check Permitted Bedroom Rating Against HAA Raquest I certify that I have checked, verified, o~ confcl~m~d to all MOA HAA Guidelines in effect on the date of this i~sgection. Signed _./~//?/~/~ ~ Date Company ~ ~(3 ~. MOA No. KB1/d5/s [Page 2 of 2] 2-15-84