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
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.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~