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HomeMy WebLinkAboutT15N R1W SEC 4 LT 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONNIENTAL PROTECTIOI~MUNIClPALITY OF AN~ ENVIRONMENTAL ENGINEERING DIVISION DEPT. OF HEALTH & 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ENVIRONMENTAL PP, OTECTI~!~ NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION We ~ ~ ~bsorption area Dwelling L ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REP(~I~ I 9 1qR.A. PHONE ..... 1' [~N ~:W DISTANCE TO: Dwelling NO. OF BEDROOMS Liquid depth PERMIT NO. Material Liquid capacity in gallons Well I Fou,~_~.~o.n~/ .~ Ne~tl~ / DmTANOE TO: Tre ch width / istance between lines No. of lines Length~c~line J Total I:ngth of lines J J~ X '~ ~ Length Width Depth PERMIT NO. Crib diameter Well DISTANCE TO: Crib depth Total effective absorption area Building foundation Nearest lot llne Class "~,NJ ~ lief DISTANCE TO: Building foundation Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED 72-013 (Rev. 3/78) DATE Distance to I( t line Septic tank/ PERMIT NO. LEGAL 11' C, EPFIRTMENT OF I-.IERLTH FiND ENS,,'IRONMENTRL PROTECTION 825 L STREET.. RNCHORFIGE, RK 9950t 264-4720 F'ERM I ]- NO: DFiTE ' I :,c, LIED: 84 El El 5' 6; 0? '"29,.'"84 FIPPL. ICRNT: KIT CFILLFtHRI`4 FtDE:,RESS: F' 0 FIO;d 299Z EFIGLE RIVER., ~K ~9~57'7 CONTACT PHONE: ~9~-5i02 LEGF~L. DESCRIP: SUBDI',,,'ISIOI`'4] ~',IF~ SECTION: 4 TOWNSHIP: LOT' SIZE: 2. 5R (SQ. FT. OR FICRES> i`'lR:,.,: BEDROOHS: ~: LOT: 9 E, LUL. t .... NR kin JE: ±~4 _,E.F T t _. _ISTEIZ:, E, EL._kl FIRE THE:LF ..... I ILi`,= .... FI'v"RILFIFILE TO ~r'FIII IN [,E'::;IGI",tING 'T'OUR ':-' .... _,T_,FE!i. CHOOSE.THE OF'TION THFFF E,E_,T FIT.., 'T"]ItR SITE. DEF'TH TO F'!PE BOTTOM ,::F'I". ) GP'.:FI'v'EL DEPTH <FT. > ' TOTFIL [:,EPTH ,::F'T. ) GRFt'v'EL NIDTH ,::FF. ::, GRFI'v'EL L..EI`.4GTH (F'T.) GRFI'v'EL ',/OLUHE ,::CU. 'T'[:'S. ::' TFtNI<: SIZE ,:: GFILS ::, SOIL RFITII`.,K:;i ,::SQ. FT. /FIR). 4.0 4.0 4.0 5. 5 0. 5 2. 5 9.5 4.5 6.5 2. 5 t7. 0 5.0 ]:]:~. 0 2:4. O 48. 8 20. 5 , 2:t. 4 9. O l., 000. 0 .:+::+: i, 000. 0 :+::+: ' it., 000. 0 t~:4 j..;~'.5 ' t.25' ::.::4.: TFII'.,!K I'IU.:,~ i.-!FIVE FIT LEFIST TI.d'" uuHFHKFI`1EI`I... I CERTIF'T' THFIT: :!.. I FIH F:'FfHI[_IFIR WI'/-H THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS RS SET FORTH B'T' TFIE hlUI`ilCIPRL. IT'¥' OF FINE:HORFIGE <MOFI) FIND, ]"HE STFITE OF FILFISKR. 2. i klILL iNSTRLL THE S'T'STEM IN RCCORDFti`iCE ldlTH FILL MOR CODES RND REGULRTIONS, Ri`4[:, IN CCII`'IF'LIFII`qCE 1.4iTH THE DESIGN CRITERIR OF THIS PERi"IIT. 3. i I.,.IILL RDFIERE -FO FIL. L. HOFI I::1i`4[> STFtTE OF RI._Fr-:;I-(FI RELT.!UIREMENTS FFIR THE SEq" FIFICK DISTRNCES FROM Fti`4'¢ E',:.,:IF_.;TING WELL, I,.tFISTEWRTER DISPOSFIL S'T'STE.M oF.: PUFILIC SEWERRGE S'T%TEH ON THIS OR FIN"r' FIDJFtCE:NT OR NEFIRE:'¢ LOT. 4. Z UI`',![:,ERS]'FIi"~[:, THRT THIS PERI`dIT IS 'v'FILID FOR Ft MFI:,4II`4UM OF Z; FIEDROOHS RND RN"? ENLRR(3EMEI`,IT WILL REQUIRE FIN RD[:,!TIONFIL PERMIT. IF' FI !_IFT STFITIZH IS INSTFtLLE[:, !N Ri".! FIRER CO'v'ERE[:, Fi"r' MOR FILIILDING CO[.Eb';., THEN ':::L> RN EL. ECTRICFIL. F'ERHIT FiND tI,L-,FE, uF_LN MUST FIE ClE, THiI!E[. C::":, H_, E, UILT_, WILL NOT FIE FIF:'F'RO'v'ED WITHEdJT FIN ELECTRICRL INSPECTION F,.EF_RT. RN[:, ,'~') ]"HE FI FF'TRI'"Fi[ WORI.::: MOST FIE DONE E,T FI LICE]",ESED ..... ' HFFLll..Hhlf: K!T CFIL. LFIHFIN. {~] SOILS LOG PERFORMED FOR:_ John Parker LEGAL DESCRIPTION: -Lot 9(-A~ T15N. R1W. Sec. ~ S.M. AK SLOPE MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L, Street, Anchorage, Alaska 99501 2644720 SOILS LOG -- PERCOLATION TEST S' J~?'~~ DATE PERFORMED:. 3/21Zg2 roz~n 2 3 4 5 6 7 9 BROWN GRAY SILT (ML-OL) LIGHT BROWN SILT (ML) moist, medium stiff BROWN GRAY SANDY GPJ~VEL (GP) moist, medium dense subrounded to rounded /~RAY SAND (SP) moist, medium dense iRAVEL (GM) 10 11 12 dry, dense WAS GROUND WATER NO S L ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? SITE PLAN 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-00B [6/79) Bottom of pit at 16.0' John R. TEST RUN BETWEEN Chambers CERTIFIED BY: ~6~ ]=~, ;,t. ~'9~.~.~ ~.~:. 4/6/82 Gross Net Depth to Net Reading Date Time Time Water Drop NOT APPL: CABLE I. MUNICIPALITY OF £ DEPARTMENT OF HEALTH AND ENV 825 L. Street, Aiichora[l~, Alask~ SOILS LOG - PERCO PERFORMED FOR: John Parker ,~.~,~ ~.-,~-r' '3~ LEGAL DESCRIPTION: ~F~',TI~ R1W, SOILS LOG PERCOLATION TEST 4 5 6 7 8 9 GRAY-BROWN SILTY PEAT (Pt) S, M, __A l_as~k a SLOPE LIGHT BROWN SILT (ML) moist, medium stiff LIGHT BROWN-GRAY SANDY SILT (ML) dry, medium stiff GRAY SANDY GRAVEL (GP) moist, medium dense sobrounded to rounded -- GRAY GRAVELLY SAND (SP) moist, medium dense 10- 12- 13- GRAY SANDY SILTY GRAVEL (GM) moist,, dense WAS GROUNDWATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? 14- 16 17- Reading I Date I Time Gross Net 18- 19- 20- COMMENT PERFORMED BY: 72-008 ~/ ~\ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geop.hysical Surveys Drilling Permit No. lc.) A,O.L, NO. I~-~.JDIsTANCE ANO DIRECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELL: Nrc ~t Ca~.~.&.~_~. Street Addres~ and Area of Well Location Si[ts gravel sand, 8 14 ~Au$er small boulders 7. us~om,,~l~ ~ Public SupHy ~ In$u*tr~ Silt~ sand, gravel 14 3~ ~ Irrigation ~ Recharge ~Commerleal Sand~ sravelt brown si[~ 38 58 ~ z**,w,. Sand and gravel, water 58 62 8. CASlN~ , ~ Threa~e~X~ Welde~ I0, STATIC WATER LEVEL~ ft. ~ Above o~ ~ Below land surface MaleHal: ~Neat Cement ~ Other: ~o~uc~o~ This well~O~a~ drilted under~my Jurisdiction on6 this repo~l Is true to ~.A ~ MUNICIPALITY OF ANCHORAGE (~9,.,,~"/ ~) '7 ~- ~__ DEPARTMENT OF HEALTH & HUMAN SERVICES D,V,S,O. OF ENV,.O.ME.TAL SERV, OES OF ON-SiTE SEWER AND WATER FACILITY 264-4744 Application Date ~'-~ fO" ~' GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ProportyOwne]~/'~.~0 ~t4.~-~-~'~L¢'',~. Telephone:Home ,~ Mailing Address , Business (b} (c) Lending institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (% Mail the HAA to the followina address: or; Check herek if hold for pick up. List contact person and day phone number below. O 2. TYPE OF RESIDENCE ;'~ gini: ;Fr aor~ ' 'BYe d~r o o m s WATER SUPPLY Individual Well Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note:/ ~t'r community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 IRev 8/861 Fronl NOIJ. nvo le^oJdd¥ ITUO!~!puoc) jo eW~el leuoi~!puoo peAoJddTafC] paAoJddv JoJ paAoJdd¥ l~AO~dd~f SHHO '9 'uo!loe~u! a!ql jo elTp aN1 ua ]oaJja u! suo!~Tin6eJ put 'saouTu!pJo 'sapoo a~elS pub led!o]unR lie q~!M eoUe!ldUJoO u! s! LUele/[s leeode!p Ja~TMe~STM Jo/puB ,qddns Je~eM alfa-ua aq] 'uo!~oadsu! put uo!~TJ~!lsa^u! AuJ LUO]I pub aal!~ aaeJoqouv peu!elqo UOI]TLUJO~U! aql ua paseq ]Tq]/[J!Je^ Jaq~Jn~ I 'u!aJaq pelTo!pu! eJn]onqe Jo ad/4 put sLuooJpaq elTnbape pub leuo!iaunj 'BiTs s! uJele,~s iTsods!p JeJTMalSeM Jo/puT/[Iddns JejTM Bi!e-ua eqj iTql SMOqe ITAoJddv,~jpOqlnv qllTeH s!LIl 1o uo!jTaJlse^u! ,~Lu ~Tql ,~jpe^ I 'MOlaq UMOqS alep uo!lTp!lT^ sql jo sT pub OleJeq p@X!JIT ITaS,~uu ,~q Pall!Pea sv NOIJ.~flNblOJNI aNY ¥.L~a 'MOthY=IS :~11=1 '$.LB~.L 'SNOI.L::)~dSNI ~NlalAOt~d INBI-t 9Nli~NI!gN~ .g WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) /vlUNtC~PAUTy oI~FA~o~I-A- UTHORITY APPROVAL (HAA) ~NVI~ONMENT~ P~OTECTION 264-4744 Well Classification AUG 1 1 t988 RECEIVED If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Cased to 4¢O Date Completed 7//¢0 Y Yield Depth of Grouting f)/o,¢/ Pump Set At Sanitary Seal on Ca~(N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots I ¢-~ "~" /'~O., ~z' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot '~""7~ ~. ; Date B. SEPTIC/HOLDING TANK DATA Date Installed E'¢]/~ ~/~ t'¢/ Size /O'~ C:) NO. of Compadments T~'O Standpipes (Y/N) 'T~-/O Air-tight Caps (Y/N) Y Foundation Clea. nout (Y/N) ,~' Depression over Tank (Y/N) ~k~ / Date. Last Pumped ?~/~_¢~ ~ ~ ;for ~/A Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~///~ Separation Distances from Septic/Holding Tank: To Water-Supply Well / ! ~ To Property Line ! ~ i~ To Water Main/Service Line Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~O Course To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72 026 fRev 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test "7'~ Separation Distance from Absorption Field: To Water-Supply Well J ~)~ To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots TO Cutbank (if present) ~'~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or ¢pnformed to .a, II MOA and HAA guidelines in effect on the date of this inspection. Signed Company MOA No. Receipt No. e"~-~ 7~-)~ ~ Date of Payment '~" ,//- ~¢)/~ Amount: $ /~.',~) ~) Page 2 of 2 72 026 /Rev 8/861 Back Engineer's Seal MUNICIPALITY OF ANCHORAGE ' DMSION OF ENVIRONMEN~IAL HEALTH DEPAKTMENT OF HEALTH AND E~qVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHOP.%TY APPROVAL CERTIFICATE I. General Information Application Date e (a) Legal D~scription (include lot, b. lock, s. ubd~vision,.se~¢tion, tcwnship, range) Lo~ation (addffess o~ directions) Applicants , da ess (c) Applicant is (check one) Lending Institution Su r ~; Other [~] (explain); (d) Le nd in~ ' I nst itu t io~/~.,///~;~ ~.~} .~-~~ (e, .al Estate Co. & A~ent ~ o~ ~s~n~ ~-~; Owner/builder ~; Numbe~ of Bedrooms Wate= Supply Individual Well ~ Cormnunity t----~ Public ~--] Note: If ccrmunity ~11 system, must have written confirmation from the State Depa~h~ent of Environmental Conservation attesting to th~ legality and status. Is the w~ll adequate fo~ the number of bedrocks specified in this HAA (Y/N) y~ e Se w~ge Dispcsal Onsite ~ Public ~ Corr~unity .~--] Holding Tank ~ Is the wastewater disposal system adequate for the numbe~ of kedrocras (Y/N) [Pa~e 1 of 2] 2-15-84 Engineering Firm P~ovidin~ Inspections, Tests, Data and Information I certify that I have checked, verified, o~ confOrmed to all MOA HAA Guidelines in effect on the date of this inspection. Nam~ of Firm ! Address Signed by Date (ENGINEER SEAL) g~ ~,ce :1, Corwln 1o~ CE-5283 6. DHEP Approval Approve d for Approved ~ bedrocks Disapproved ~ Conditional~ Date Te~ms of Conditional Approval The Municipality of Anchorage Depa~tn~nt of Health and Environmental P~otection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date sho~ above, based on the data and infc~mation ftn~nished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of badroors and type of structure indicated. (~PS~) 7. ~il the HAA to the foll~ing ~dress: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHQRAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION A. WELL DATA Well Classification ~ Well Log P~esent (Y/N) Total Depth ~ ' ~ Cased to Static Water Level J~J~I~L~]~ Casing Height Above Ground ~.~' Electrical Wiring in Conduit (Y/N) Separation Distances f-~om Well: To Septic/Holding Tank c~n Lot //3 To Nearest Edge of Absoz~ption Field on Lot To Nearest Public Sewer Line MUNICIPALITY OF ANCHORAGE (MOA) JUI_ J. HEALTH AUTHORITY APPROVAL (HAA) - R E C E l V E g Legal Description: ~/~f C~/; If A, B, C~ C, D.E.C. Approved(Y/N) Id/~4 Date Completed ~7~ ~ Yield /~/~ Depth of G~outing J.,(,~$~7'~ Pump Set At ~7 ~ Sanitary Seal on Casing (Y/N)~g~ Dap~ession A~ound Wellhead (Y/N) Il&' ; On Adjoining Lots ~ ; On Adjoining Lots N/A To Nearest Public Sewer Cleanout/Manhole /~//J To Nearest Sewe= Service Line on Lot Water Sample Collected By ~/~ ; Date ~ ~ ~+ Wate~ Sample Test Hesul? ~j~i~ /' B. SEPTIC/HOLDING TANK DATA Date Installed ~-~J)"~~A~ Size /~)/3~).~, ~/~ NO. of Ca~a~tm~nts Standpipes (Y/N) y~ Air-tight Caps (Y/N) ~. Foundation Cleanout (Y/N) Depression overt Tank (Y/N) ~0 Date Last Pumped /~) Pumping/Maintenance Contract on File (Y/N)~/~ ; for ~//~ ' Holding Tank High-Water Alarm (Y/N) N/~ Temporary Holding Tank Permit (Y/N) Seps~a~tion Distances f~om Septic/Holding Tank: To Water-Supgly W~ll J I.~ ' . Tc ~o~,ty Li~ ~ ~ I To ~ter Main/~vi~ Li~ ~Oi To Building Foundation ;?~ To Disposal Field ~ ! ;~ TO' Stream, Pond, Lake, c~ Major D~ainage [Page 1 of 2] C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Squalze Feet of Absorption A~ea Depression ove~ Field (Y/N) NO /.~.~/'37~'/',~f~'3'~Z'Type of System D~sign Length of Field ~ ' '~ G~avel Bed Thickness 0. ~; ~ ~-~'.v~ Standpipes P~esent (Y/N) Date of Last Adequac~ Test Results of Last Adequacy Test ;~/~ Separation Distance f~om Absorption Field: TO Water-Supply Well I wo ope=ty Line TO Building Foundation ~ To Existing or Abandoned System cn Lot ~/~ ; On Adjoining Lots To Wate~ Main/Se~vice Line ~! To Cutbank(if p~esent) /~/~ To St~eam/Pond/Lake/c~ Majo~ Drainage Course To Driveway, Pa~king A~ea, o~ Vehicle Sto~age Area ~0 ! De r.z r S TION Date Installed Size in Gallons "Pump On" Level at High Wate~ Alarm Level at Tested fo~ Electrical Codes(Y/N) Din~nsions Manhole/Aacess (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Ccaments ** ** Cheek Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, ozr confc~mmd to all.MOA H~A~. Guidelines in effect on the date of this inspection. ~' ' Signed~/z~/.~ ~, ~f.r~f Date KB1/d5/s [Page 2 of 2] 2-15-84 -/. MUNICIPALITY OF ANCHORAGE DEPAF~TMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 826 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: John Parker LEGAL DESCRIPTION: Lot 9~ B).T15N, RI~, Sec_. 4, T ~ GRAY-BROWN SILTY PEAT (Pt) LIGHT BROWN SILT (ML) moist, medium stiff 4 5 6 7 8' 9- S.M, Ala] SLOPE LIGHT BROWN-GRAY SANDY SILT (ML) dry, medium stiff GRAY SANDY GRAVEL (GP) moist, medium dense sobrounded to rounded GRAY GRAVELLY SAND (SP) moist, medium dense 10 - GRAY SANDY SILTY ~t GRAVEL (GM) . moist, dense 12 13 14 15 Bottom of pit 16- at 16.0' WAS OROUND WATER S ENCOUNTERED? 'No , ~ IF YES, AT WHAT DEPTH? P E Reading Depth To Net Water Drop Dale Time Time NOT APPL CABLE 17 18 19 20 COMMENTS PEREORMEO BY: 72-008 (6/79} PERCOLATION RATE ,,~,~-~ F';''~"-"'~''~-- ,a ' ' ch John R. Cl~amber~ ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street~ Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: John Parker DATE PERFORMED: 3/21 /82 LEGAL DESCRIPTION: Lot 9(A) T15N, RIW. Sec. 4, S.M. AK SLOPE BROWN GRAY SILT (ML-OL) 2 3 4 5 6 7- 8- 9 10 11 12 13 14 15 16 17 18 19 20 LIGHT BROWN SILT (ML) moist, medium stiff BROWN GRAY SANDY GRAVEL moist, medium dense subrounded to rounded (GP) (GM) COMMENTS PERFORMED BY: 72-008 (6/79) SAND (SP) moist, medium dense dry, dense Bottom of pit at 16.0' WAS GROUND WATER ENCOUNTERED? NO IF YES. AT WHAT DEPTH? Reading Date SITE PLAN S ~-~[S<' S[al~ 20' J 5' . I 1 Gross I Net Time Time NOT APPL CABLE Depth to Net Water Drop John R. Chambers~