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HomeMy WebLinkAboutT12N R3W SEC 33 LT 100 MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HFALTH & ENVIRONMENTAL PROTECTION ) ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -- PHONE I [~NEW NAME ~'~ ~AIL~NGADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ]Well 'tAbs°rpti°narea Dwelling 'P'ERMIT NO. U~ DISTANCE TO: ~L ~'T /~ ~ j ,,v, oT //,,/ g~.3 o F~ ~ M~nuf~cturer Materi~l No. of compaltments ~ I- Liq. capacity in gallons /'OO ('~ IF HOMEMADE: "T~~.,.,.,..,..,..~, ~'~ ~ Well Dwelling PERMIT NO. 9~ DISTANCE TO: O ~: Manu~acture~ MQtaria~ Liquid capacity NeareSt lot I~ne PERMIT NO, t TO: Wall Foundation / DISTANCE ~ L~ Z No. of lines Length of each line Total length o~/lines Tronch width ~' ~ ,~ Top of tile ~o Enish §rad~ Material benead~ tile Total effecdYe absorption area Len§th Width Depth PERMIT NO, ~1~ Type of crib Crib diameter Crib depth Total effective ab~orpBon area u~ Well Building foundation Nearest lot llne ~ DISTANCE TO: j Class Depth Driller Distance to lot line PERMI I NO, ~u Building foundation Sower line ~epti¢ tank Absorption area(s) ~ DISTANCE TO: OTHER ~;~ ~- ~;-~ ~'/ -~PE MATERIALS -( ~ ~: ~ p,'v',c. __ SOIL TEST RATIN~ INSTALLER -- · /~ O i~_ SFW 'g - o 24 APPROVED DATE LEGAL 77-013 (Rev. 3/78) 'F'I ,. ]: C:I::tNT 17 :[ C:t-lf:ff;~:l::' 1) E:i",IN :[ '.E; ..O C.I:':IT I (:~N I jZu:::L. OI'II=IN I....E!:EiFII TJ.;L-TN I:;1:3.1,.I :BEC. :!i::]i. L.OT ::LEn:_:~ I,IFI',:.::II"IUI'I NLII,IE~EI:::: OF BE:DROC~HE; = :5 I]:!l_ll::l~:E: F'E:ET ':'"':":' OF THE z.._ .IL.. FiE::5OFi:F'-I*]:CII"¢I ....... I'E. I I "'::' -H-Ilk: I:;i:EE:!I.t:I:I::UEE:, ...,.I.,~E. ' : "::" THE I EHGTk E:, I I'"IENES): ON I E~; 'H4E: L.EF,I(:'i'FH ,' I N I=E:E'F ::' OFr 'I'HE: TF:ENCI'I OF: [::,B'.FI :I:I",IF' I E:LC,. .t .... THE:. D :[ Ei;TFII",ICE E~ETI.,.IIEE:hl TI.IE :,I.JF..F' H .L O1::' THE THE: I::,E:I:::'TH OF FI F.E.I,I..II -.3F' F']:T ':,f~:CILIHE:, FIND THE E:"J'f'TOI' OF' '1"HE IE::~:C:I:ZI'v'FI'[')"~N ,::IN I=EE:'I"" TI"IIC I:~f:]:l::l'v'[:[l_ L. [ .F I [ I ]: .'. THE H ]: I",t I I"'ll..ll"i B,E:I='TFI DF Ei[q:FI',,,'EI- DliETI.,.IEIEI",I THE I:)I..I"['F'I=II...I_. I=II",IE:, THEE E'~C)TTOH CIF' THE: [::. ", .... 'IIZ _1,1 ,' IBI ..... HI' b THE: I::~:E:~;I':'ONE; ]: B ]: L. :I: 'l'"r' TC) :£ I",lFOf:iff"l TH ]: :~, E:,EPFff:CH'"IEF,IT F:,IJI7 :I: NEi 'T'HE F'EF]:H I "F f:l~::~F'l '[ f::Fll",l'l" ': ':' - I.,.ILL.[ ...... :i: I'.,I'.=:,TFII....LFt'T' I Clhl :1: NE;PIEC:T I IDN~ OF: FIN"r' =' ':' FII~,,TI::I :: E:I",IT '1' '3 TH hllJHl!~:l!~:l::~'. Of= R:ILEE; :[ I)l?~l",lC:li~:!5 THFIT THE 141ZL. I~. 14 :[ I..[ .... E.[. E.. E!',F:I(:::I'(F' ILI... I 1',11:3 OF:' F:It',I'¥' .:, .:, ) L.H H I Ti4OI...IT F' I NFIL. I Iq['~;F'ECT I ON FIND FIF'F:'F:O","FIL. E, '~ I I'1.[-, I'I]:NIHI..IH E:,I!5'I'FII",IC:E BE"f'I.'.IEZE:N FI NELL. hill I=lt',l"r' "' I",I --' :.'E: ]: I' E :.:.;EI.,.IFICiE 'I ::",E~ FEET F'OI:;~: I=1 F'R:[',,"F:ITE; F!E:L.L OF' ::IJSC~ -I'O ;':::?F~ FE:ET F'F. UDH F:I FUB[...~. I,~IEL. L E:,EF'E:I",tE:"[I",IEi I..IF'Oi",t TI'IE': T'¥'F'IZ (:iF:' I I..II_L.] · I.,.IEI...I .... ". = "- FEET FII",II::' H I I",11HLIH E:' I E;TFINC:E FI:~:OH FI PF.: I ',,,'I=ITE HELL. L TO I:::1 F'B: I 'v'FITE :E;I'~:I.,.IEF~: I.. =,EJ. ILI:.. L.;[NE .[ ......'"'?, FEET. TO F:I 'j .'.1"11'11..li",I [ T"" - .... =": ' ': I.'.IEL. L I...T 3':5 FIF:E F:E:L=.&.I]ZlTIZI:::' FII",IC' I'"1 .':=;T 131i~. F:IE;TLII'71",IE:D '1'O ]'HE [::,'~EF'FiI:~:-rHE:IqT I-,.IITHIN OF THE: !,IEL. I.. C:OHF'I...E:T:f:EIF,L E:, ]: FIGF:F:IFI':'5 FIITE · '~ t IEF:. R:E(;!LI I REI',IENT$ PIF:I'¥' f:IPF'L'¥'. ~;F'EC I F I C. FiT I C)NE; FiI'.,II) F'FII',.I'=;Tfl' '- T I 31",1 FI',,,'FI :[ LFIBLE TO :t: I'.,i:==;LIFi:E: I:'BbDF'E;F~: :[ I'.,IE;TFtLLFIT :[ ON. ]: C:EI:;;:TIF'"r' TI:If:IT ~ ;' . ,~ ...... :. ::L: I Fli',l I:'FIHIL. iFIR: I.,~]:'r'H THE: [~:E):!I..IIFiE-.]'~IEF,I''I'L"':; F...[. uF,I--.::,.I. I[... E;E:I.,.IEF:E; FIF,I[:, I.,IE.].J..E~ FI:E; '.BET Fi:iF:TH =, THE 1,1UN I C :1: F'F:II..]: ]"'~.' C)F' FiNCHOI:;~:FIEiE. '7: ~: I,.1:1: L..L .[ 1,1:, I HIJ.. THE .=, ~ .: 1 E.I I ]: N FICC:CIF.:[::,FlhlE:E 14 Z TH THE u... B E .... .. I,I .... ]: TIE .... L.l. ff.J ...... ~' ... I El I I"lf::i'¥' R:EC.:!IJ :[ RE E'I'.[I I::IF' 3E ',lENT :[ F' THE :::i.: :[ I..li'.,l[:,[~:j:;i:STFff.,ll3, 1"Hr:IT ]"HE: - '= ':: ' : ":' '::'" ""-" F:E:E~IC, E:NC:E IE; F~:E:I,IO[::,~L.IZJ~-~--]!I",IE:IZI:.i[:iE f,IO[i~:EE _?HFIN :~: EtE[:IR:CuDH'-'5. ...... ......... ...................... Fl~,fi'~~ ]3::: I 'i I::ff;.'. C' [::' ~i[::il~'ii :i: "-'.. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~//'P E R CO LATI O N TEST 3 4 5 6 7 8 9 10 11 12 13- 14- 17 18 19 20 /:7,~'"~ COMMENTS ,z~/,~ -'~ L - ~-z4,¢ PERFORMED BY: '0C"~-,'X~ ~''~" 72-008 (6/79) SLOPE SITE PLAN /\ WAS GROUND WATER SL E~ODNTE~ED? ,Sh© .o IF YES, AT WHAT DEPTH? Gross Net Depth to Net Readin9Date Time Time Water Drop I. /~_~.~1 /2:2// ~ 1'20 :~ " ;'/1't iD I,dO , I0 RCOLATION RATE N~ " TEST RUN BETWEEN ~' '~" r~ AND ~-~ '~''~'' F.T (minutes/inch) N'S COMPANY VATER WELL DRILLING SALES & SERVICE ALASKA DRILLING MUNfCIPAUTY OF ANCHORAGE 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 SEPTE~4BER 29, 1.983 ANCHORAGE, ALASKA DENNIS CONSTRUCTION CO. I~.t2]CEIVED ( 337-3zp+8 ) T12N, SM ( Loc Loman $ Twighlight off Rabbit Crk. Rd~ Rel GOVT. LO':[' ].00 Sect° 33, h~TER c/ELL LOG 0 ft to ~ ft Or*~anies and .,Zray silt 1 ft to 6 ft f4ed. gravel and qPay silt 6 ft to ~8 ft Course gravel and ~,ray silt ( tiP;hr ) 18 ft to ~9 iI?t Bo~].de¢ 19 ft to 29 ft Course ~ravol and r;ray silt 29 ft to ~0 .Pt Ivied° ,-';ray. and ~;ray si~t &Oft to zl-3 fL Boulder, s & cobbles and gray silt 4-3 ft 'to 63 ft Course gravel & gray silt 63¢+ ~ ~ to 6/~ ..... Boulder 6& Ft to 69 ft Clean fine /';Pay ~ sa. nd with L,,ray silt binder ~qater bearing seams 20 ft head with 100¢ drawdown at 3 GPIVl ) 69 Z't ( TOC ) Clean med. gravel and sand ( loose ~/ater bearing 30 ft. head with ~5 £'t drawdown at bottom :;tatble with 1. L'to maberi;~l Very clean water ( pZu~ ) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ['"'1\~ .'c~lr~'C~ O-~ , . NAA # -- ¥~(~O~,t(~ ¢%~'-'~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner _ ,n'l t /~ ~ ~- O,4 T, N y ,~ , I / ~; : melePh~)r~e: ihome) -3~/5"62"~ .Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ,~if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESID.~.E Single-Family LS" Number of bedrooms -- ~ - 3. WATER SUPPLY individual Well [~-~ Community E] Public E] Note: f.community well system, must n ave written confirmation from Conser~ation at(esting to th legality ano status. the State Department of Enviro nmental On-site [~ ' .',Public [] Community [] Holding Tan k [] :: Note: if ~ommu*n(t,y well system, must have written confirmation f'~om the State,.DePartment of Environmental Cons6i'vation attesting to the legality and status. 72-025 (Rev. 7/88) Page I of 2 leUO!l!puoo lees s,Jeeuibu3 A. WELL DATA Well Classification , MUNICIPALITY OF ANCHORAGE (MOA) ,~UTY OF ~l~,~horily Approval (HAA) ' '-~'~L S~R~4~E~'~txz ' FEBRUARY 1984 ~N' ' 343-4744 /-~,.J(.~ 2/t 't990 Legal Description: TIZ~ RECEIVED Well Log Present (Y/N) __y Date Completed _-~/~F'?. Total Depth (~'~_ Casedto~r~ Depth of Grouting __j~/¢~ Static Water Level 2_ 7/ o Casing Height Above Ground / ~" Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot __ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ~/¢ Comments Od ~ L &. IS If A, B, C, D.E.C. Approved (Y/N) /~83 Yield *'/ ¢" ~P~ Pump Set At ,~T _ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /¢~ ; On Adjoining Lots /'~¢ To Nearest Public Sewer Cleanout/Manhole _ /~ · B. SEPTIC/HOLDING TANK DATA Date Installed $~:,oT:', 'B 5 Size Standpipes (Y/N) ___ ~' _ Air-tight Caps (Y/N) Depression over Tank (Y/N) _ ~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /V,,~z¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well //7 / To Building Foundation 3 '// To Disposal Field q O' IOOO No. of Compartments ,V Foundation Cleanout (Y/N) Date Last Pumped _ o¢,~Z,~¢ y ;for Temporary Holding Tank Permit (Y/N) To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (,Rev 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~P ~ Date Installed 15~'pT~m ~/~. /~ 83 Width of Field 2/ Square Feet of Absortion Area_ Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation 2/ Lot /./¢/¢z~' ~.,¢ To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness 7 ' Statndpipes Present (Y/N) Date of Last Adequacy Test Y To Property Line z~ ¢'/ To Existing or Abandoned System on ; On Adjoining Lots _ /¢¢ ' c- To Cutback (if present) ,~¢¢" To Stream, Pond, Lake, or M_~ajor Drai~nage Cour~se To Driveway, Parking Area, or Vehicle Storage Area Comments O f~' Iq.~..~ 1t4,~T,~LLATio~J. '~F.~TION Date 'Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request*' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~/¢ Company /'~ 0 ~'N.~O ~ ~'"','~ f, ~/J ~1 uhv' 6 , Date ~/Z..V/e~g Engineer's Seal MOA No. Receipt No. Date of Payment Amount: $ 72-028 (Rev. 7/88) Back / Receipt Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440: M'~M,¥8t~ R~I)OR'£ BY ,qM~PI,~ fo~ Work Order ~ 26M0 O4t~ Ro¢o~ Pzin~od: AUG 23 90 8 1.3;Sl 903164 Lab &,lp3 iD: 1, k'atrtx: I'tM~F,I\ [] iol~al)i6 APPLIC FILLS OUT UPPER HAL ONLY A- V, Address Zip Code Zip Code Zip Code Realty CO. & Agent Address Zip Code Phone Phone Phone ~/o ? Street Location ~- (o c /-, ,;z.~_A ~[ ~ ype of Residence ¢ Single Family .-.~ ~ Multiple Family NO. of Bedrooms _ Water Supply ~-'lndividual A~i'ACH WELL LOG, A well log is required for all wells drilled since June 1975. L3 Community For wells ddlled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ,~'-Individual Year individual Installed: ..... ~'~ { ] Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACN REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Tgne Time Date Date Date Inspector Inspector Inspector Field Notes: Time Date Inspector MUNICIPALITY OF ANCHORAGE PEP[ OF HF/.Llil $ ENVIRO~x;.3EJq I AL PC. OT~CrION RECEIVE[) APPROVED BEDROOMS DISAPPROVED CONDtTIQNAL APPROVAL' 'CONDITIONS OF APPROVAL Well To Absorption Area Well ~o Tank / O0 Well Log Received