HomeMy WebLinkAboutT12N R3W SEC 27 (BLM LTS) LT 61A1Aug 03 22 10:20p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
Development Services DepartmentDZ
Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: Date of Issue:
Parcel Identification Number: 018-092 63
Legal DescriptionProperty Owner Name & Address:
W LOVDAHL JOHN D & PATRINA L
T72N R3SEC 27 (BLM LTS) 13957 MULLIGAN ROAD
7i�li
LT 61A1
ANCHORAGE, AK 99516
Pump Installation Date: 07 - 29 - 2022
Pump Intake Depth Below Top of Well Casing: 120 feet
Pump Manufacturer's Name: CENTERPRO/RED JACKET
Pump Model:
8512
Pump Size: '50 hp
Pitless Adapter Burial Depth: 10
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer -
feet
MARTINSON
Well Disinfected Upon Completion?p! Yes ❑ No
Method of Disinfection: PELLETS � 1
Comments:
Pump Installer Name:
Company -
Mailing Address: _
ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
ANCHORAGE, AK 99518
907-243-0740
State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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 WELL INSPECTION REPORT
NAME
MA'L'NG'XDDREBB O'
LEGAL DESCRIPTION
LOCATION
Well ~ Absorpti n area
DISTANCE TO- ~)(~
capacty nga ons ~... ] Inside ength
~ ~O I F H~w~v,~Dc:
PHONE
[~UPGRADE
Anckor%c. A K
Dwelling" ~ 7,5"~, ~
Width ~1'¢~/
NO. OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Manufacturer Liquid capacity in gallons
DISTANCE TO: Well
No. of lines // , Lengt ~ o .~)c~
Top of tile to finish grade
Material
Founda~E.~c~n ~! w~ ~ [Nearest lot line ,
Tota~ lengti~ of Hnes Trench wir~th , '
~ I ) ¢ ¢~.~ ~ inches
Material beneath tile ~ inches
PERMIT NOsL~ 0ILi
Distance between lines
.5-
Tota~ effective absorption are
Length Width Deptl~ PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Depth Driller Distance to lot line PERMIT NO,
Building foundation Sewer line f Septic tank Absorption area(si
DISTANCE
TO:
OTHER
PIPE MATERIALS
INSTALLER
APPROVED
72-013 (Rev. 3/78)
DATE LEGAL
PERMIT NO:
DFITE ISSUED:
84.0~48
04,.."06,,'84.
RPF'L. I CFINT:
ADDRESS:
CONTFICT PHONE:
COI'.,ISTR.
LEGRL [:,ESCR IP:
LOT SIZE:
LOT LOCRTION:
MBX BEDROOMS:
SUBDIVISION: NR LOT:
SECTION: 27. TOHNSHIF'; :'£2N RFINGE:
· . 25R (Si.:!. FT. OR ~CRES)
DERRNOUN BN[:, CURRIN
BLOCK: NR
LISTED E:ELON RRE THE OPTIONS RVBILBBLE TO VOU IN DESIGNING 'tOUR SEPTIC
S'¢STEH. CHOOSE THE OPTION "rHRT BEST FITS 'YOUR SITE.
DEPTH TO PIPE BOTTOM (FT.) 4. 0 4. 0 4. 0
GRRVEL DEPTt4 (FT.) 4. 0 0. 5 2:. 0
TOTRL DEPTH (FT.) F:. 0 ,1.. 5: 7. 0
GRRVEL NI[:,TM (FT.) 2. 5 ~('0 5. 0
GRRVEL LENGTH (FT.) 54. ¢ ~6. 0 52:. 0
GRRVEL VOLUME (CU. 'CBS. ) 22. 5 25. S~ 2:4. ~
TRNK '.SIZE (GFILS) %., 000. 0 ** t, 000. 0 ** i., 000. 0 **
SOIL R. RTING (~Q. FT. /BR) t42: t50 250
:~.:* TBNK MUST HRVE BT LERST TNCI COMPRRTMENTS
I CERTIF"r' THRT:
:t.. I BM FBMILIRR NITH
2.
4.
THE REQUIREMENTS FBR ON-SITE SEI4ERS RND HELLS RS SET
FORTH BV THE HLINICIPRLIT'¢ OF RNCHORRGE (NOR) RND ]'HE STRTE OF RLRSKB.
i i.4ILi_ INSTRLL TPIE S'¢STEM IN RCCORDRNCE HI'rH RLL MOB CODES RND REGULRTIONS.,
FIND IN COMPLIRNCE P.IITH THE DESIGN CRITERIR OF THIS PERMIT.
I NILL RDHERE TO RLL. MOB RND 5;TRTE OF RLRSKR REQUIREMENTS FOR ]"FIE SET BRCK
DISTRNCES FROM RN'¢ EXISTING HELL, 14RSTEHRTER DISPOSRL S~'5TEN OR PUBLIC
SEHERRGE SYSTEM ON TtiIS OR RN"r' RDJRCENT OR NERRB'T' LOT.
I UNDERSTRND THRT THIS PERMIT IS VRLID FOR R MRXINUM OF ]( BEDROOMS RND
RN'¢ ENLRRGEMENT NILL REQUIRE AN RDDITIONAL PERNIT.
Ft LIFT STRTION IS INSTRL. LED 'IN RN BRER COVERED' B"r' MOB BUILDING CODES.,
N (~) RN ELECTRICRL PERMIT RND INSPECTION MUST BE OBTRINED.~ '::2) RS-BUIL. TS
NOT BE FIF'PRGVED NITHOUT ~N E~ECTRIC. RL INSPECTION REPORT.; FIN[:' ';:~) THE
]TRIC. t~L HGRK i?JST BE [:(tME, BV ~LIC:ENSED ELECTRIC:IRN.
]]:thNT: t.,.IILLIfiM C HII]G~N~ NORTFI RI[:'GE C:ONSTE.
,:, *' ......................... ....
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
525 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
s, opE
3
5
6
7
8
9
~0
11
12
13
14
15
16
17
18
19-
20
SITE PLAN
WAS GROUND WATER ~, (~ S
P
E
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Readin9 Date Time 'Fime Water Drop
PERCOLATION RATE
(minutes/inch)
BETWE N
,RFORMED BY: G ~-~- ~ CERTIFIED BY: DATE:
008 (6/79)
MUNiCIPALiTY OF ANCHORAGE
Df. VISiON OF ENVIRONMENTAL IlEALTI{
DEPAt~.MEN'£ OF }0~ALT}{ ^ND ENqIRO[~,~NTAL PR()TEGTION
A£q?LIGA'£~O,N FOR I{I'[ALTIt ^UTIIORIT¥ APPROVAL CERTIFICATE
! · ¢,~.ueral Inf¢,l:ma~ou
Legal Description (include lot, l)lock~ subdivision, section, towsship, range)
,Loca~iou (address or directions)
(c) Applicaat is (check one)f,anding lhistitution ~'j~? ; O~,mer/builder ..... ;
Address
(e) Real Eat:ate Co. & Agent
Address
Te 1 epho ne
(f) ldaiI th~: i{AA to the following addreas:
Nulaber of Bedrooms :'~
Note: If community well systera~ must have written Col~J. rmal:J.o~ fro~ the State
])epartme~lt of Enviromnental Couservation attesting to the legality and status.
Note: %f community wall system~ must have writtan eonfirmation from the State
])epa)ztMent of F, llviro~lental ~onservation attest~E to the la~a],ity and
Engineering Firm Providing Inspectionsz_Yests File Search~ Data and Info
As certified by my seal affixed hereto and as of the validation date sho~,m belo~, I
verify that my investigation of this Health Authority Approval 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 f~om the Mm~icipality of Anchorage files and from my
investigation and inspection, the on-site wate[- supply and/or wastawater disposal
system is in compliaace ~lth al3 Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of ~ ~,~-~,~ ",~, J~.(~ /~' /z'c Z c '~ , ' T ~ '
Address / >~,~ ~ ', ~ ~ > ~ ( ~, ,. .
Date .... /c /1~: ;/,{ (~
DtlEP Aolgrova% ~7/~,~t i
Approved for ~ bedrooms
Approved .:~:_/f__. Disapp~'oved
Te]3as of Conditional Approval
(ENGINEER SEA1,)
Condition&l
2251,~
CAUTION
THE MUNICIPALITY OF ANCIIORACE DLPAR1MENf OF HEALTH AND ENVIRONMENTAL PROTECTIO~
(DtlEP) ISSUES IIEALTH AUTIIORITY APPROVAL CERTIFICATES BASED SOLELY UPON TIlE REPRESENT~
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONA~ ENGINEER REGISTERED
IN TIlE STATE OF ALASKA. THE DIIEP DOES THIS AS A COURTESY TO PURCIIASERS OF HOMES AND
THEIR ~J~NDING INSTITUTIONS IN ORDER TO SATISFY C
M' ' ,ER%AIN FEDERAL AND STATE REQUIRE-
ENTS. F&IPLOYEES 0}? I)HEP DO NOT CONDUCT I ' '
NSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. TIlE MUNICiPALI'£y OF ANCI{ORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS }iN THE PROFESSIO~L ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19--84
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
,OCT 1
RECEIVED
WELL DATA
Legal Description
Well Classification /3/~}L3/4 $
Well Log P~esent ~/N)
Total Depth //// Cased to
Static Water Level (~ ~
Casing Height Above Ground
Electrical Wiring in Conduit i!.~,/N)
Separation Distances from ~11:
To Septic/Holding Tank ~n Lot
To Nearest Edge of Absorption Field on Lot /j~)
To Neares~~public Sewer Line
If A, B, Or C, D.E.C. Approved(Y/N)
Date Completed ~-//$'~ Sf Yield
//// ~pth of G~outing
Pump ~t At ~o~ ~//
Sanitary ~al on Casing ]~)
~p~ession ~ound ~llhead (Y~))
; On Adjoining Lots
; On Adjoining Lots._3>/Do
TO Nearest Public Hewer
Cleanout/Manhole
Water Sample Collected By -'~[iJ(~ ; Date
Water Sample Test Results ~<~:L."IL~'~,~/C'ig~'~.-'
~zL)~A- TO Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed ~//~/~ ~/ _ Size 1~OC5 No. of Ccapartments
Sta,~dpip~s (~N) ' ' Air-tight Caps ~73~) Foundation Cleanout
Depression over Tank (Y~'~ Date Last Pumped
Pumping/Maintenance Contract on File (Y~)_~_~; for ~L3/.~.
Holding Tank High-Water Alarm (Y/N)~/~z~ Temporary Holding Tank Permit
Separation Distances f~cm Septic/Holding Tank:
To Water-Supply Well
To P~operty Line ~
To Water Main/Service Line
Course .
To Building Foundation ~ 7..C;
To Disposal Field ~}l
To Stream, Pond, Lake, ar Major Drainage
Receipt ~
Date Paid:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed _~ / I p/~
Width of Field ~ ~ t
Square Feet of Absorption A~ea
Depression over Field JY~
Results of Last Adequacy Test
Date of Last Adequacy Test
Type of System Design __~__~
Length o~ Field ~ ~
Depth of Field ~!__. ,
Gravel Bed Thickness ~ '~
Standpipes t~esent~N) __
Separation Distance from Absorption Field:
To Water-Supply Well ~;& ~ To t~ope~-Line 3 Z f
To Building Foundation ~,~ ..~-~/~ ~c~ff~/~ --
T~ Existing or Abandoned System on
Lot /{.)/F~ ; On Adjoining Lots ~30~
To Water Main/Service Line t~)/~ To Clltbank(if present) ~d/~
To Stream/Pond/Lake/or Major Drainage Course /0///4
To Driveway, Parking Area, Or Vehicle Storage Area ~) ~/+ ~
Date Installed ~ Din~ns lens
Sise in ,G, allons ~%%~. Manhol~ (Y~)
i'Pump On Level at ~p~Off" Level at
High Water Alarm Level at // ~ Vent (Y/N)
Tested ~or ~ing Cycles~ing Adequacy Test.
Meets MOA
** Check Permitted Bedroom RatinG AGainst HAA Request **
I c~rtify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on tho date of t~is~ inspection.
Signed [7~' ~-fl~_~q~- Date
KB1/d5/s
[Page 2 of 2]
2-15-84