HomeMy WebLinkAboutHILLSIDE NORTH #3 BLK 3 LT 3Mayor
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
wmmuni.oro/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Parcel Identification Number:
Date of Issue: _
Legal Description Property Owner Name & Address:
G /V 6 R 7 sco 4+ cA "'ja rrd.a-
%0151 / I19±,QPj-*Rock
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing:tl0 feet
Pump Manufacturer's Name: -r;zap �c...r�
Pump Model: (? S / C,
Pump Size :k hp
Pitless Adapter Burial Depth: / O feet
Pitless Adapter Manufacturer's Name: 1"04R7-jra Jo ^f
Pitless Adapter Installer: to /+
Well Disinfected Upon Completion? 9Yes j No
C/u
Method of Disinfection: V✓L-+ op Q�
Comments:
Pump Installer Name: din (� �
333o 7&
Alc-Aorc.y, Ak- ggSlp,
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
0 3�5'
K C t. C IV C V Municipality of Anchorage Page of Z
r OCT 2 2 1993 DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
MuniciPali ty,q t ,%ragg
ept. Health &Int a Qrv1 50 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: I i I -)I� 12-, C) J..,
0 L 1 —
PID Number:
Name:
Scoff Caere,
Wastewater System: New ❑ Upgrade
Address: Z35 —47 9"1 -#-203 995
ABSORPTION FIELD
Phone: /
276-2$63
No. of Bedrooms:
y
gDeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
/.2--GPD/Sq. Ft.
Total Depth from original grade:
/ P7'
Lot: Block: Subdivi ion:
- 3 illsie� N3
Depth to pipe bottom from original grade:
�f. 5
Gravel depth beneath pi
5
Ft.
• Ft.
Township:
Range:
Section:
Fill addedaboveoriginal rade:
Gravel length: _5q,- %
WELL: New ❑ Upgrade
Gravel width:
Z•
Number of lines:
'
Distant=between lines:
Ft.
Ft.
Classification (Private, A,B,C):
fIV
Total Depth:
ZZ
Cased To:
IZO
Total absorption area:
Pipe material:
PVC
Ft.
Ft.
Soo SD. Ft.
Driller:
'Al ine, Drillin
Date Drilled:
G/16/9Z
Static Water Level:
//Z
Installer:
Date installed:
/O�y193
5
Ft.
Yield:Pubrnp
AlefZns ►led
Set at:
Nor 1
Casing Height Above Ground:
Z S
Juurf%�ro�/�C *"TANK
GPM
1r6Qjfd Ft.
• Ft.
SEPARATION
DISTANCES
gSeptic ❑ Holding ❑ S.T.E.P.
To
From
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer: �f
AMM
Capacity in gallons: .y C
12 0
Tank
Field
Station
Tank
Sewer Lines
(mak
Well
I�+
�'^lnf
V, //w
IN1A
N/A
(VIA
Material: slim/
7T
Number of Compartments: 2
Surfac
Watere
Nov
141./.
Y/
AA
LIFT STATION
Lot/
Line
.J
50
I
/ p
IVI,+
VI,
IV/A
/VIA
Size in gallons:
Manufacturer:
Foundation
5 I
CN/^
•i!•r/
/'(
"Pump on" level at:
"Pump off" level at:
High water alarm at:
Curtain
Drain
Nov.
��
IVIA
/►,
/�I
AI
Pump Make & Model
Electrical Inspections performed by:
—
Remarks:
BENCH MARK
Location and Description
Assumed Elevation:
ENGINEER'S SEAL
IF VS
Inspections performed by. o{a�fcans�t `` Dates: 1st
2nd
000*
Department of Healt d Hum S ices approval
Reviewed and approved b Date: 14"�►a�.��.�►s
�� }: �' :v �a9a : °°"Ar
72-013 (Rev. 9/91) MOA 25
Permit No. Page 2 of 2—
Municipality
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: L-'+ 3, hill5ic% Ay4h #3 s1D
co co con �r
n
Sur�act: RR n A=1 one
16.4 Fm doh- I
40g,> L
83.7' $4
DRWE
cos
SK
PID No.:
W
No4x :
No 4i4asf Wells or scflc
Sy4ev'r w1��n
ZCO o� 5154,-m,
G"A,er
sE!'
79 _ _ o �' No wa+u
— — ! l6�
Cxis�t'nq we II �o� L;r� AtQrox. !pp' —
/oo` EIN .
ce.M., I
L0+ L�ne
A(I"' $p'
�Ro4�S£D
� BDRM
1oo'R
_4 56 4 af.e col A61
W1ZE
Z °
Co
C.02. o
� o
Sfl
M1 1250 G.I. -A k ENGINEER'S SEAL
col 5', $0'i Luf Line �
5T7'!z ?�' l3d, 400
Agtrex. 150' �'•�3F` A(�#
Got 7L' t3o'
C3 '3; 3n
Cosi 0v 1 t), RECEIVEDAlwl
e(+"'•,. ...... a,
`r's !2*. 135 OCT 2 21993 r IlAR18 ti A �°;
`•.° C,E -1393 �•'
I
=3D Municipality of Anchorage .•
Dept. Health & Human Services 4®' �`"" 0
72-013 A (2/91) MOA 25 �+ �Q (�
BOROUGH 1SjgBS BD VIS xNi
> LOT BLOCK
fl�
a.
'�
DIRECTIONS:
MEASURING POINT: ® top of casing
E]ground surface E]other:
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF GEOLOGICAL AND GEOPHYSICAL SURVEYS
WATER WELL RECORD
SECTION QTRS
TOWNSHIP RANGE MERIDIAN
E]N 1:1 E
Ms I F1
WELL OWNER:
WELL DEPTH: ,� DATE OF COMPLETION:
Depth of hole : � c+� y ft
Depth of casing:/,;RC) ft�-
BOREHOLE DATA: Depth
STATIC WATER LEVEL: / f ft. Date e O
Material type and color
From
To
METHOD OF DRILLING: ;Llair rotary
❑cable tool ❑other:
11
e
USE OF WELL: �° domestic []irrigation []monitor
❑ public supply other:
E
`
CASING: Stick-up .__. ft. Diam: h;;(� in
q
WELL INTAKE: 'Q open end ❑ screened
perforated ]open hole
Depths of openings: . to - ft
f
2(0.
SCREEN TYPE::" Diam• in
Slot/Mesh Size: "-, .Length: ft
Set Between and ft' "
GRAVEL PACK TYPE:
Volume used: ''-,..- Depth to top:
GROUT TYPE "-- Volume:
Depth: from ft-rto--i _. ft
r r
DEVELOPMENT METHOD: e'G�t-
Duration:F. ef��R q ca
REMARKS:
PUMPING LEVEL AND YIELD:
t? ft after �hrs pumping gpm
PUMP INTAKE DEPTH: ft Horsepower:
Date Pump Installed - -
CONTRACTOR INFORMATION: WATER CHEMISTRY SAMPLE TAKEN? ❑ yes Q no
F I /I ;t� " . • Well disinfected upon completion? es no
RegiAered Business Name PLEASE. MAIL WHITE COPY OF LOG WITHIN 45
DAYS TO:
Signature of Authorized Representative
Date
DGGS
PO BOX 77-2116
EAGLE RIVER, AK. 99577
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650`
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930373 DATE ISSUED: 9/17/93
DESIGN-ENGINEER:POLARCONSULT EXPIRATION DATE: 9/17/94
OWNER NAME:CAMERON SCOTT & DEBORAH A
OWNER ADDRESS:235 E. 9TH AVE., SUITE 203
ANCHORAGE, AK 99501
PARCEL ID:04103185
LEGAL DESCRIPTION: HILLSIDE NORTH 43 BLK 3 LT
3
LOT SIZE: 93202 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
RECEIVED B
ISSUED BY:
DATE: 411 13
DATE: /
polar'consult alaska, inc.
ENGINEERS • SURVEYORS • ENERGY CONSULTANTS
September 14, 1993
DHHS, Environmental Services, On-site Services
P.O. Box 196650
Anchorage, Alaska 99519
Attn: Permit Review Officer
Re: Design and Construction Approval for On-site
Sewer System at Lot 3, Hillside North Addn #3 S/D.
Dear Sir or Madam:
Please accept the following design for review and permitting. The proposed system
does not affect the current use of the adjacent properties and will have minimum future
impact.
Based on the site investigation, the property appears suitable for the installation of the
on-site waste water disposal system provided MOA grading requirement can be met.
Due to the unfortunate location of the on-site well, the proposed septic system location
is near a slope which averages close to 25%. As shown on the attahed approximate
topographic survey, some fill will be needed to cut the slope below 25% for a
minimum distance of 50 feet from the absorption trench.
1f you have any questions, please give me a call.
POLARCONSULT
Attachments:
On-site Sewer/Well Permit Application
Site Plan, Sheet 1 of 6
Topographic Survey (Approximate), Sheet 2 of 6
System Design Calculations, Section, Sheet 3 of 6
Percolation Test, Sheet 4 of 6
Percolation Test, Sheet 5 of 6
Sieve Analysis Results for TH1, Sheet 6 of 6
$320 Check for Permit Fee
1503 WEST 33RD AVENUE • SUITE 310 • ANCHORAGE, ALASKA 99503
PHONE (907) 258-2420 0 TELEFAX (907) 258-2419
polarconsult alaska, Inc.
a 1503 West 33rd Avenue - Suite 310
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258.2419
JOB LoT 901 /1kxvf 4`3 %s�/D
SHEET NO. I OF "� l
CALCULATED BYE/"/� DATE
CHECKED BY DATE
v �
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fi 1577 NL -I
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NOTE: PROMIED StTfl WILL N07 AGF c
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PR�Pfri�5 hr✓D w1tL F{AvE H�N�MvM
LFG£Nf
,.... _
GtiT R� 17��fr'c'f
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Well
PRODUCT204I ISingb SAems) 2051(Padded) (�7® Inc.. Groton. Nass. 01471 To Order PHONE TOLLIHEE 144225-M
polarconsult alaska, inc.
1503 West 33rd Avenue - Suite 310
ANCHORAGE, ALASKA 99503
(907) 258.2420 Fax (907) 258-2419
,OS 40-r S. /VoA -ff-3 15/V
SHEETNO.- OF 3
CALCULATED BY MK DATE
CHECKED BY DATE
SCALE 1-0
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.......... ....... .... . ......... ...........
6
polarconsult alaska, inc.
1503 West 33rd Avenue • Suite 310
ANCHORAGE, ALASKA 99503
(907) 258.2420 Fax (907) 258-2419
JOB Z-0-/ 5 f//lS%a2 //oy4
SHEET NO. 3 OF
CALCULATED BY J - DATE q� 3 i93
CHECKED BY DATE
VF -IV—I` 1IM. muwn. We Uirn.ioUmerrnancrvurncciw4—
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: SCO-ff CGm2fn't
DATE PERFORMED:
LEGAL
16
17
18
19
20
COMMENTS) 6J2 gr0JV5l S
43 Township, Range, Section:
SLOPE
SITE PLAN
9TH
tutuutE v AUMAN
CE - 1393 4
WAS GROUND WATER /
ENCOUNTERED? 0
PERCOLATION RATE U' f (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5 FT AND —�2_FT
1i`41"t'S SoiA sarc
PERFORMED BY: �� 1Q fcr7i r tI�T I y' r -'
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. q/�f/% 3
72-008 (Rev. 4/85)
(FEET)
1
D
2
4
'
5-
- �T
6
"
7
r
J�
8�
9
J
10
°
G �
11
- o
12
` o
13
n
14
15
16
17
18
19
20
COMMENTS) 6J2 gr0JV5l S
43 Township, Range, Section:
SLOPE
SITE PLAN
9TH
tutuutE v AUMAN
CE - 1393 4
WAS GROUND WATER /
ENCOUNTERED? 0
PERCOLATION RATE U' f (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5 FT AND —�2_FT
1i`41"t'S SoiA sarc
PERFORMED BY: �� 1Q fcr7i r tI�T I y' r -'
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. q/�f/% 3
72-008 (Rev. 4/85)
�'� , &SEAtt9i1#*
e +- Municipality of Anchorage*�'•9�0*
DEPARTMENT OF HEALTH & HUMAN SERVICES • • •••• ••••••N
825 ••L•• Street, Anchorage, Alaska 99502-0650 rr " •...••.'Z/�.i
SOILS LOG — PERCOLATION TEST : ItAlt� Al93 '
� ••, a- 1843 ,.•,
PERFORMED FOR: SCoe CgwVro-yt �►�
// II oL 2 DATE PERFORMED:
Zd 3
LEGAL DESCRIPTION: , % �/S 4(�,tt - Township, Range, Section:
1 i (FEET) I O
2
3
4 L�
57
6
6 =
7
8
9- i
10
11 O
12
13
14
J
15
16
17
18
19
20
COMMENTS
7/y AZ
SLOPE
WAS GROUND WATER n/
ENCOUNTERED? NO
mom
mm
■■■mum®■■■
■■■■■■■■■■
■■■■■■ME
■■■■
■■■■■■■■■■
PERCOLATION RATE (' (O 1,C (Minutes/inch) PERC HOLE DIAMETER
10
TEST RUN BETWEEN FT AND 6 FT
PERFORMED BY: PC) A(6MSu/7 ^
`�f^3 CERTIFY THAT THISTESTWAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9�4i/j 3
72-008 (Rev. 4/85)
roro.rnmo-�nwnm mn..1e n.�iemmewnn.mn-e...Gf_.>n— ... ...,...,,,.,,.0 .... .... ....... .
31V0 Asa3M03H0 61VZ-BSZ Q06) XBj OUT -89Z Q06)
31v0 As a31VinOltlO £0566 WSVIV '3JV80HONV
OTE apnS . anuanV pa££ }SaM £09T
maul `e4sele jInsuowelod
F GRAIN SIZE ANALYSIS (ASTM D422)
PROJECT NAME:
NOT AVAILABLE
PROJECT NO.:
5072
CLIENT:
POLARCONSULT
BOREHOLEILOCATION:
100
SAMPLE NO.:
93-S-3
DEPTH:
0.37
DATE TESTED: 9/11/93
TESTED BY: RJPC
REVIEWED BY:
DESCRIPTION: Well graded sand with gravel
EBA Engineering Inc.
Phone (907) 561-4085 907 East Dowiing Road Suite 27 Anchorage, Alaska 995}8 Fax: (907) 56f-707}
01CUC AIJAI YSiC TEST
SIEVE
SIZE
DIAMETER
mm)
TOTAL%
PASSING
6'
152.4
2.6
4'
100
D30.
3'
762
0.37
2'
50.8
100
1'
25.4
96
3/4'
19
92
1/Y
12.7
80
3/8"
9.5
72
# 4
4.75
52
#10
2
35
02D
0.85
19
#40
0.425
11
#60
025
8
#100
0.15
5
#200
0.075
2.6
100.0
90.0
80.0
70.0
60.0
%RNER BY 50.0
wmtfr
40.0
30.0
20.0
10.0
0.0
100
DATE PRINTED 9/11193
•.vwe��uGTG� TCCT
ELAPSED DIAMETER TOTAL %
TIME mm PASSING
0
0.5
1
2
4
8
15
30
60
250
1440
GRAIN SIZE DISTRIBUTION
U.S. STANDARD SIEVE OPENINGS
.. ... #29 un un #100 #200
%GRAVEL:
47.9
% SAND:
49.5
% SILT/CLAY:
2.6
D60-
6.61
D30.
1.66
D10.
0.37
Cu.
17.9
Co-
1.1
M.C.= 5.7%
USC: SW
FC:
%.02 mm
10 1 0.1 0.01 0.001
GRAIN SIZE IN MILLIMETERS
GRAVEL Ig&un I SILT AND CLAY
REVS)93 /