Loading...
HomeMy WebLinkAboutT12N R3W SEC 33 LT 111B MUNICIPALITY OF ANCHORAGE Development Services Department 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: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?;;<HV No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 018 252 30 T12N R3W SEC 33 111B HOPE COTTAGES INC 540 W INT'S AIRPORT RD ANCHORAGE, AK 99518 1105 11 29 2023 145 BERKELEY B7P4JP05221 - 02 .50 12 MARTINSON PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 EI,WIRO; CIION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONblENTAI_ ENGINEERING DIVISION 825 I_ Street- Anchorage, Alaska 99501 -Feleplione 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WEI.L INSPECTIO[ NEW LOCATION ~ I- Absorption area Dwelli,~g 7~]' N0. __.__ ~oo _b,,,0~,~,~. / / _-- 2~ Z DISTANCE TO: jw.. j ~,,~li.~ PERMIT NO, ~% ; ' I o~ ~ Total &'TFT ~ ~ Dep~l~ OTI-IE R SOl L 'I-EST RATING REMARKS APPROVED 72 0~3 (lieu. 3/~1 LEGAL PERIl'lIT NO. [)EF:'II:~RTII'IEII'dT ,..,F I'-IERL-FH FIll,ID EN',/iROt",III"IISI",I-IF:IL , RO]"ECI'ION 8~5 "L" .'STREET., EINCHORI:IGI.S.., I::IK. ;2',S4-..4'72C~ ,:: 8±OEl:t8 ::, RF'PL I CRNT LCICFIT I ON LEC'iRI_. I",lORi'dElil4 CONS TRUE.:T I Oil',l NLJGGET LF:INE L. :~.::L.':LF.:,' SEC; 2C'.'-' T:t~:N R]:!4 '."~i'4 84C~D MEI'.,ITRR LOT '.SIZE: ]:49 2:I. 4q ,:I. SEE~E~ S~]:~L.II::h~:E FEET "r'~.'l::'E OF:' S;OiL. REr..'.:;Ot~:P]"ION S'T'STE]'"! :[E:: TRENCH MF:Ii:-,'IMLII'd II,ILJI'd[}ER OF E:EDROOMS = 5 fSOIL REITINI]i (S~]:! FT,.."E:R)= 85 ]'HE!: REE!I..IIRE[:, S;IZE CIF THE S;OIL RE:SORP]"IOII.~ S"r'STEM IS: II.:::~ EC F:" -r ~-..lI ===: :L-] L_ Ei~ II'-.!l ~Ei~ -11" II---~ == ~F, ,=:il.. ~:~ ~ 1I~-~ ',,-" I]'_:~ I!. .... lr]:, ~S:_- F" ~T- fi--il ....~ii.. THE LENI]TH DIMEII',IS;IIDN IS; THE L..EII4GTH (:IN FEET) OF THE TREIqCH OR DRRIIqFIEI...D. THE [)EP-FH OF FI 'TRENCH OR PIT I:S THE DIS;Tf:INCE [.::ET!.,.IEEII,I THE: S;URFFK3E OF THE GROUi'.,IE) FIII.,ID THE BOTTOM OF' THE E',:..',CEI',,,'F:ITII)I'.~ ,::Ii'.,I THE"R[:-' I!S I'.,10 STS'[' I-,.IZE:,TII.I FOR TREII.,ICHES';. THE' GRR',,,'EL DEF'TH IS; THE MINIIldt_lM DEF'TI-I OF EiRR',,,'F..L BETP.!EEN THE OUTFFILL. F:'iF'F F:IND T;-IE E:OTTOM ElF THE EXCFI'v'R'TIOII',I (IN FEET). NSTFILL. F:ITION INSPECTIONS:; OF Rlqkr' WELLS; F:I[)JIC]CEIlqT TI.') THIS F'ROPERT'T' FIN[:, THE NUME:ER OP' RE5SI[:,ENC'ES THFllr' THE I.,.IELL. I,IILL 5;ER"/E. DEPF:IRTi'dENT Iq ILL BE SLJB..)'ECT TO PRO'.'SECU"I'ION. MiNII'dLIM [:'I'.STFINCE E:E"I'I,.IEEII,I FI I,.IELL FiND Ri",IY CIII.,I-SITE SE!-qFIGE DISPOSFIL SYSTEM IS; ::i. Eu:3 FEET FOR I::1 PRIVFITE P.IELL OR :l. SCl -tO ;?lZiE:i FEE'T FROM FI F'USLIC HEL. L. DEF'ENDING tJPON THE T'~.~F'E OF PUBLIC HELL. II,'IIIqIMUM [:,ISTFiI'.,ICE' FROM [:1 PRI'v'FI'f'E NELL TO F/ PRIVEI]"[i[ SEI.,~ER I_If.!fS IS:; 25 FEET F::IF,I[:, TO la C:Oi','III,ILINIT'T' S[!:I.,.IER LINES I:S }"~i~ I::EET. OTHER REi]]I..IIF4ffr':MENTS MR'T' I::IE'PL.'T'. S:;PEi]:IFICI.:ITIONS RP,ID, C:ONS'I'RLICTIOI'.,I DIFICiRFIMS FIRE FP,,'EI I I_FIE~I_E TO I I'.,!SI..IRE I::'ROF'ER I NSNTFI[_LRT I ON. I CERTIFY THI::I'F :1.: I RM FRMILIFIR l,.llTIr-I THE REL::!L.IIE'.EMEII.,ITS FOR ON.....$I'FE S, EI.qERS RND IqELLS RS; SET FORTH B'-,.' THE I','IUN!CIPFILITN' OF' FiNCHORlal3E. 2: I WILL INSTFILL. THE S','S;TEM IN F'iCCI]RDRII.,ICE I.,.IIT'H THE CODES. ]~: I UN['.,ERSTFtN[> THFIT THE ON-S;I"FE SE,I. qEI:~: '.S'~.'STEM MFI'.r' REt~UIF'~tE ENLF:IRGEMENT IF' 'I"HE RE:SII.3, ENCE IS REII"ICI[)ELE[) ]"O INIZI... f"tORE THFIN 5 E]E[:,F.'.OOMS. I S S . EP ....... I}FITE SOILS LOG MUNICIPALITY OF ANCHORAGE , e'~r~ DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION [] PERCOLATION ~.~' 825 L. Street, Anchora§e, Alaska 99501 264-4720 TEST SOILS LOG -- PERCOLATION TEST PEREORMED POR: NO~ZHA~'~ CoNS'r~OCT~ON CO. DATE PE~EORMED: Z/VI SI LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- SLOPE SITE PLAN '~ AS GROUND WATER Ha~u~ N'4 ~NOOUNTE.ED? P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop L L9?i ' ' ~D LATION RATE (minutes/inch) TEST RUN BETWEEN FTAND FT Gl, ~ ~ I . / 72-008 (6/79) SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF ~20.00 PER FOOT. PROPERTY OWNER #~4., Bob ,DcW. 274~g171 LOCATION OF* WELL SITE DRILLER WELL LOG: ' 18 .... 44 ~ ~37--148' 145--14g~ To,t~LCo4~: ~3900.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING, WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF /J3900. O0 THANK YOU VERY MUCH· DATE_ BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF 1V~% PER MONTH WILL B~ ASSESSED ON PAST DUEACCOUNTS. Division of Environmental Se~ices On-Site Se~ices SectiOn P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # _O/_~_ 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # ~ BLM Lot I IIB; See $$;__ TI 2N__; RSW Location (site address or directions) 274& Property Owner Frederick & YoZand~ Owen4 Mailing address .__¢274~ N__~q.q6t~ Lan_6 Lending agency _ Mailing address_ Agent Address Day phone_ 345-1145 ~K 99516 ~Day phone_ Marcia WhZteomb,Marston R~al Estate-- Day phone_ 2804 W. Northern Lights Blvd. Anehorag6, AK 99517 244-4155 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ 5_ TYPE OF WATER SUPPLy: Individual well Commurdty well NOTE: XXX If community wastewater system, provide written attestin9 to the legality and status of system. . TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: 72-025 (Rev, 1/01) Front MOAW21 If Community well system, ~ ' ' ~ "" ' written confirmation from Stat · . ~\~ .~. provide lng to the legality and status of system. confirmation fi'om Stat,/ STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I veri~ that my Authority Approval application shows that the on-site water supply investigation of this Health adequate for the number of bedrooms and/or wastewater disposal system is safe, functional and and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water wastewater disposal system is in compliance with all Municipal and State codes, supply and/or ordinanceS, and regulations in effect on the date of this inspection. S & $ ENGINEERING Name of Firm ~ 17-~4 Eagle River Loop Road No. 204 Engineer's signature ~=¢~~~~ 880] DHHS SIGNATURE ~ bedroomS. ,~. Approved for ~ ~ ~ Disapproved. bedroomS, with the following stiputations: _ Conditional approval for -- -- - Additional CommentS The MunicipalitY of Anchorage Department of Health and Human Services (DHHS) issues Health AuthoritY Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes . . . and state requirements. Employees of DHHS do not ....... ,4 nn inst tutionsm ordert°satl.s~jcertalnJ..e,~d~rta~l .~ ssued. The Municipality of Anchorage is not conduct inspecbons u, ~,,,,, z- '- ' ' ' anotn~-,~,'"' ~ ..... ob,-,e data betore a cerum, responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Depar[ment of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: L.o?-III(~.,.CF--rL.~.~?'/~J,,~-~bq ParcelI.D. Cio© ~.~7__ 30 A, Well Data Well type Log present ~.~'/N) ~'~ Totaldepth If A, B, or C, attach ADEC letter. ADEC water system number -'/t/''/'~- Date completed ///d/~/ Driller/~fi/u'/,4.,~T~Z~,~/~-/~/tY~'~5' Cased to /~ / Casing height °¢ '/ cc- Wires properly protected Y~) '7¢~ Sanitary sea'N)Y~ FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level1 ; On adjacent lots /~)~ ; On adjacent lots //E.)~ '-7L Public sewer manhole/cleanout Petroleum tank ,/~O/'d~ SEPARATION DISTANCES FROM WELL 'FO: Septic/holding tank on lot Absorption field on lot // Public sewer main ~-~ /-~ Sewer service Line ~'~- 1'¥1 WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~/O Other bacteria Collected by: B, SEPTIC/HOEBtN6' TANK DATA Date insta,ed [/ / ?/ Cleanouts(~N) °~'~- 5 High water alarm (Y~ /('fO Date of pumping Tank size /¢~-/---Y.-~ (¢~(~ Compartments Foundation cleanou~N) ~//~'~ Depression (Y~ Alarm tested (Y/N) /99d Pumper .~+ ~O~ SEPARATION DISTANCES FROM SEPTIC/HOLDIN~i TANK TO: Well(s) on lot _/E~)('~ ('~ On adjacent lots ,'/~(~ /'-~ To property line /~) ('rz~ Absorption field Surface water/drainage /"OO Foundation Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93}' Front C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access ~ Vent (Y/N) "Pump on" level at ..~"Pump off" Level at High water alarm level _..---~Cycles tested Meets MOA electrical codes (Y/N)_..~...~'''''~ SEPARATION DIST~ROM LIFT STATION TO: ~eJ~t~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Z If¢fxf Length ,~Z~ ~¢g Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) ~'_~ ~//¢¢,~ System type Gravel thickness ~'/~ ~ / Total depth Depression over field for ~~) Bedrooms Results ~ail) ~//~ / % ~ After test /4 If yes, give date Cleanout present(~N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~ r To building foundation On adjacent lots ~-) f Surface water ,./~.) L~ Curtain drain ./~'¢,L,/~'~ E. ENGINEER'S CERTIFICATION On adjacent lots / ~.) O /'¢' Property line /O /','~/ To existing or abandoned system on lot ~/'/~ ~ Cutbank ~'-4:~ /'/--' Water main/service line / CD [7~- Driveway, parking/vehicle storage area ,~ r'7~- I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect Signature Engineer's Name Date this inspection. 0 F CE-8801 HAA Fee $ ~0¢ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number CT&E Ref.~ Client Sample II) Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.5622-1 LlllB SEC3t T12N R3W WATER Client Name S & S ENGINEERING WORK Order 10604 Ordered By R.J.S. Printed Date 11/07/94 ~ 16:02 hrs. Project Nalne Collected Date 11/01/94 ~ 15:37 hrs. Projectl~ Received Date 11/02/94 @ 17:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Relnarks: ROUTINE SAMPLE COLLECTED BY: S~S. QC Allowable Ext. ~lal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N O.10 U ~%g/L EPA 353.2/300.0 10 11/04/94 CMR See Special Instructions Above UA = Unavailable ~** See Sample Remarks Above NA = Not 7~nalyzed ~U = Undetected, Reported value is the practical quantification limit. LT = Less Than ¥~ = Secondary dilution. GT = Greater Than 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax; (907) 561-5301 -~-~ l~ E RECEIVED ' ' INSPECTION APPOINTMENTS TIME TIME - TIME DATE DATE DATE INSPECTOB INSPECTOR ~-- INSPECTOR ¢~-~ ¢.~.'~(- T~ MUNICIPALITY OF ANCHO~E ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street- Anchorage, A~as~a 99501 ~AR 2 6 1981 ENVIRONMENTAL SANITATION DIVISION RECEW ED Telephone 264-4720 .... REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete ag parts on page 1. Incomplete req~msts will not be processed, Please allow ten (10) davs for processing. 1. ~ERTY OWNER PHONE MA,~G&D~ESS ~ different from above, PHONE 2. flUYER PHONE MAILING ADDRESS 3, LENDING INSTITUT~O PRONE ~ L~A D 6R ~SS ~ REALTOR/AGENT ; { I PHONE MAILING A~D~ESS '. ~' ~ ..... - '- ~'. LEGAL DESCRIPTION ..... 6. TYPE OF RESIliENCE NUMBER OF,BEDROOMS ~ One ~ Four ~INGLE FAMILY ~ Two ~ MULTIPLE FAMILY ~ Three ~ Six [] Other WATER SUPPLY [~/" INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISP~OSAL SYSTEM E~~' NDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY ATTACH WELL LOG. A well Icg is reauired for aH wells drilled since June 1975. For wells drilled prior to that date, give well deoth (attach Icg if available.) ~/~ / YEAR ON-'SITE SYSTI_:M WAS INSTALLED. NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE P FJOCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF REDROOMS [~ SINGLE FAMILY [] ONE [] THREE [~ FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, ~ SUPPLY [~' INDIVIDUAL DEPTH OFWELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~'N DIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~eptic Tank or [] Holding Tank S ze ./'~b~'O If Tank is homemade SOILS RATING give dimensions: TYPE OF TAN. K ~,~, MANUFACTU~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY / 72-010 (Rev, 6/79)