HomeMy WebLinkAboutT12N R3W SEC 33 LT 190
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Pump Installation Log
D~ta of Issue: __
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
En~mnmemal HeiUt Dlvt~on
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
L~t~-.~ ~L,~,~. DISTANCES
Lo, [ ~I 0 I"'~'' ~"~'"'"'"' '~ .
?t ~N,I / S~, $"~
~" ~ ~'J' TANKS ........
TYPE OF SYSTEM
'E~TRENCH [] nED [] W. =RA,N [] ml~ER
~-0~ 3rr_ "7 "~
~)0 SOFT U P~ ~T- ,~ ; I
~,u..,,..o,,,..~ '~";'~o so~ "'"""'"~¢~n'~o.,? ~q' - /"/ '
t - '
~PRIVATE [] O~ER
J~,o
REMARK~
.,,.
Ins~mns ~o;m~
I - r
Tom Fink,
Mayor
Municipality of Anchorage
Department of Health and Human Services
$25 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
January 10, 1991
Lyle Aune
4021 Rabbit Creek Road
Anchorage, Alaska 99507
Subject: T12N R3W Section 33 Lot 190
Permit #900162, PID #018-282-11
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1990o
A new permit must be obtained
on-site wastewater system not
from this office for a well and/or
installed by the expiration date.
If you have drilled the well, a wel'l log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation'.of the on-site
wastewater system, the original as-built inspection report
(three-part form) must be sent to this office for review,
approval and documentation. All inspection report~ must be
submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions,
Since~ge~y, / /
please call this office at
343-4744.
JW/ljm:200
enc:
Copy of Permit
~Kids Are Our Future
L" 45'-'¥E
Lcd'. l..,aga 1 ;: Sub c! :~_ v i ~ i c)n :: O(X)O00000 Lot: :1.90 1})].
S~,c:t.:~on: :~;:5 ]"c~nship: :[2N Range:
l...crL ~.~J.z~.~ 10(:}i900 (sq. {'L,, c)i"
:' OC)()Cx}
· t:.ariI( ,'ii..*-:¢' ,,v,,; ad' !.eas'L ?. compaPtmerr:. *, Depth.to 't. op of sep'L:i.c:
Each sep'L :i.c
'Lank (s) < 4,.()
DiEVZA'I]X:)N F:I:kOI'! 'il-liE AF'I:::'P,'OVi~;D Et',IGZNEEF,:'S ):}E:SZC",N DA'FE:O 06/:t. 4/90
'.:;'.EQLi]:Rh;S DHHS API:::'ROVAL F'R ]i,.']R TO CONSTF:;:UCT IO!'q,, NE} !':[F:Y DHHS F:'RIC)R
~(:) .,"il..[. :[NSF:iECf]:r.)I~iS,, :[NSTALLA'i :i:ON (IF; (;~ L]:F']' S'FA]"iON F;:E,r.;'!LJIF;'.ES 'rile
AI:::'F:'F;:I:iF:'F:; ].../".,'i t!.; f_-i;[ .i iX:; IR :I: C,/.:fi.. I NSF:'Iii.X?, T :[ ON ,, !'H ]: !.;~ PI!i]::~M :[ '[ I S F'.]il.:( A 3 BlED
F,:O[.)H Ei;];li(:)!..ii~ F~qt'l]:l.'¢ Ri_~:S]:i)ENCI~i ONLY, (~lq):) IEXP]U::,&::.~-~ C)N :t. 2i3:1./90.
)~, Li ( .... ti L(, '1, ),=, ¢'!:.'V C){' Anc:hc'~p,9. c],}? (P'ICiA) and the c, .....
and in c:esmpi:i, ance) *,~J'f,h IL[as:, desJ. c;.n iZF'J. LE-)I'i~:t C){' 'Lh:i.s
· .: .... i: ,~'i ]. ]. a(::!hei'(~ 'Lo a:l. J. I¢1(:)~.~ and c. ........ ',
distc, nc:(~*,s From any exi~:4, ting ,,,~{.*].;L,~.,a,:+ *,.,, ," ',',"',,.. ..,,,~ dJ. sp6sal system c:~r' p
away ~,[i l, atpq(~:;,[lx.;~,i]L ~J. ]. ], i'.[-z,~::~t..(:i.l",~¢ atn a'J('J:'[ ' Q a~ 1
JYssu~+~d )3y:: :)4"'
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPArtmENT
825 L Street, Anchorage, Alaska 99502-0650
SOLES LOG ~ ~ERCOEATIO~ TEST
5¢ £?f~ ~v~ ~_'~ ~"~ ) ~-' I c'~ (~ Township, Range, Section:
SLOPE
3
8-
9
10
13
14
15
16
17
18
19-
20-
ENCOUNTERED?
SITE PLAN
I
N
; r'ZJ
IF YES, AT WHAT
DEPTN?
Monitoring? I I ~ -) Dote:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN __ FTAND FT
)
PERFORMED BY: ~-~(Z~C ~'~) I ~/~'~ ~) CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~\~- ~-~--~- \ \ NAA # ~,~I~o~
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ~,~./ ~t~'~.'T ~-~.~ /~
Property owner
Mailing address
Lending agency
Day phone
Mailing address
Agent /'~,,,F/Z~, ~,~ /"~/'
Address
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well ~'
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev, l/91) Front MOA[t21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application 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 from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in.effect on th.e_date of this inspection.
Dawd R. Dayton
Name of Firm =0210 Donalar St. Phone
Chugia~, AIas/~¢567 ~
Address
Engineer's signature ' Date ~'~/,,
DHHS SIGNATURE
~' Approved for .,,~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
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 their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~)25 (ROY, 1/91) Bsck MOAlt21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
~ :~-~ Parcel I.D.
If A, B, or C, attach ADEC letter.
A. WELL DATA
Well type ~:)~Z.I O A"T'~
ADEC water system number
Log present (Y/N)
Total depth I ~.O -~-
Sanitary seal (Y/N)
Date completed ~¢/~J~:4J~ ,t.~ Driller
Cased to ~ '{"- Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
/oo '
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ,//'~
Absorption field on lot /_15'"Z~
Public sewer main /'J/,4'-
; On adjacent lots
; On adjacent lots
Sewerserviceline
Public sewer manhoie/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform E) Nitrate
Date of sample:
0 ¢/O Oth¢{ bac.tefia ~)
Collected by: ~/}/~ ./~"
B. SEPTIC/HOLDING TANK DATA
Date instal led
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size / O~:~ Compartments
Foundation cleanout (Y/N) Y . Dep~'essi0n (Y/N)
,~/./,/~'-- Alarm tested (Y/N) ~.
¢..~/.~'~-.~ Pumper, J.~7~.),¢¢~.¢ .¢, g='-~g'~¢¢
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot // 0 On adjacent lots
Foundation
To property line
Surface water/drainage
Abs(~rption field I I'7
Water main/service line "~J2'~
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer
Manhole/Access (Y/N)
Vent(Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed '/S'¢/¢0
Length · _~"~/)/~ Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating
Gravel thickness ~ /
Cleanouts present (Y/N)
Date of adequacy test
for ~
If yes, give date
$~,~,E-Syst e m type
Total depth
Y
bedrooms
SEPARATION DISTANCE FROM ADSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots /OO ¢'- Property line
/~/O To existing or abandoned system on lot
Cutbank }(,~ o ~..¢~ Water main/service line
I 6)~_p 1- Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
David R. Daytoa P.E. ~ '~'::
20210 Donalar St.
Signature Chu~a~ka~.
Engineer's Name .,-.-- '/ /-
Date
'//
HAA Fee $ ,/7E~)
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72 026 (Rev. 3/91) 8ack MOA 21
D. R. DAYTON, P.E., R.L.S.
~,~7~ Chugiak, Alaska 99567
20210 Donalar
(907) ~,~x~
696-2417
March 1, 1993
WELL FLOW TEST
Legal Description: Lot 190, Sec. 33, T12N, R3W, S.M.
Date of T~st: February 17, 1993
Well Depth: 120'+
Casing: 40'+
Static Water Level: 100.0 ft.
Requirements: 3 bedroom - 450 gallons per day
Test:
The well was pumped through theoutside hose bib with the bib
completely open.
The well produced 3.3 gallons per minute with a drawdown of 3.9'.
451 gallons were pumped in 2 hrs. 17 minutes.
Results:
The well is currently producing adequately for a 3 bedroom home.
D. R. DAYTON, P.E., R.L.S.
~~ Chugiak, Alaska 99567
20210 Donalar
696-2417
March 1, 1993
WELL FLOW TEST
Legal Description: Lot 190, Sec. 33, T12N, R3W, S.M.
Date of Test: February 25, 1993
Septic Tank: 1000 gallon, 2 compartment, steel tank
Absorbtion System: 50' x 5' effective depth trench
Soils Rating: 150 sf. per bedroom
Requirements: 3 bedroom - 450 gallons per day
(DHHS Records)
(DHHS Records)
(DHHS Records)
Test:
The absorbtion system was pre-soaked with 1000 gallons of water
for 24 hrs before testing.
At testing, 698 gallons of water were injected into the absorbtion
trench. There was no signif~icant rise in the liquid level in the trench.
The slight rise was gone within 30 minutes.
Results:
The absorbtion trench accepted 150% of the daily requirement
with no adverse effects. The system is currently functioning adequately
for a 3 bedroom home.
1802
DENALISEWER& DRAIN SERV[CE _-....' '. _ ' .
2900 Boniface Piety., #537 . v ·.
ANCHORAGE, ALASKA 99504 _ . .
- .' ._ '?; ::.' '!~ .'.:.¥L !~ ' '
' AME /'/'~/ .* ,! / ..Z:.------ ~'''' - ' ' "'"
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· , .....: · ,, : , . . .. .. ; . -... : ....... '...... . . .... .L..... .... ',, ....[ ;.. ', .r~-,~,r..~'.,
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: [907) 561-5301
Chemlab Ref.~ :93.0644-1
Client Sample ID :LigO SEC 33
WATER
REPORT =f ANALYSIS
Client Name :DAVID DAYTON
Ordered By :DAVID DAYTOE
ProJ eot Na~n~
PWSID :UA
Collected :02/17/93 ~ 13:30 hfs
Received :02/17/93 0 16:30 hfs
WORK Order 63290
Report Completed :02/19/93
Technical Director :STEPHEN C. EDE ~
Released By : ~ ~.~
Sample
Remarks:
ROIFIINE SAffPLE COLLECTED BT: D.R.D.
QC Allowable Extract Analysis
Parameter Results Qual, Units Method Limits Date Date Init
HITRATE-N 0.10 U ~/1 EPA 353,2/300.0 10 02/19/93 02/19/93 LLH
See Special Instructions Above
See Sample Re~ks Above
Undetected, Reported value is the practical quantlfxca~zon limit.
Seeondaxy dilution.
UA = Unavailable
NA = Not Analyzed
LT - Le~s Than
GT - Greater T}mn
~'~ ~'=~ -~ Member of the SGS GrOUD ¢Soci~t~ G6n~rale de Surveillance)
COMMERCIAL TESTING & ENGINEERING CO. AK DIV
CHEMICAL & GEOLOGICAL
LABoRArORr
' '' TELEPHONE(907)562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
/~. PRIVATE WATER SYSTEM
Mo. Day
SAMPLE TYPE:
~Routlne
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Year
) [] Treated Water
~ Untreated Water
SAMPLE 'lime Collected
No. LOCATION Collected By
i IL~-./~o S~-~3;T~I~-/J,£~°J I /2-~..'~ ~o
41 I
51 I
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
//~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to iridicate reliable results. Please send
neWsample ,~ia special delivery mail.
: ~/I'7
Date Received .
Time Received I ~ ~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
t
~' .~}'~ ~ C ?.~.---~:~ -'~ ~'"~'~--- BACTERIOLOGICAL WATER ANALYSlS RECORD
:~'l~l~Ab INSTRUCTIONS Membrane Filter: DirectCount
BEFORE
COLLECTING SAMPLE
Verification: LSB i BGB
Fecal Coliform Confirmation
TNTC = Too Numerous To Count
OB = Other Bacteria
SGS
Final Membrane Fl~s)~lts
Reported By ~' ~
coliform/lO0 mi
Coliform/100 mi
PART ONE OF TWO
REMAINDER TO FOLLOW