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HomeMy WebLinkAboutROLLING HILLS ESTATES BLK D LT 18Rolling Hi*11s Estates Block D Lot 18 #011-072-42 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? XX Yes 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. On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141241 Tax Code Number: 01107242000 Work Type: SepticTank Upgrade Permit Effective Dates: July 31, 2014 to July 31, 2015 Design Engineer: NORTHERN GEOTECHNICAL ENGINEERING Subdivision: ROLLING HILLS ESTATES Site Legal Address: ROLLING HILLS ESTATES BLK D LT 18 G:2124 OwnerlAddress: MARTIN NORMAN B & DEBORAH A 5433 WANDERING ANCHORAGE AK 995021929 Site Mailing Address: 5433 WANDERING DR, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 35350 Total Bedrooms: 4 N Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: _' L Issued By: MUNICIPALITY OF ANCHORAGE d Community Development Department M Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. © R—c;IZ -(42- BreAf, Property owner(s) /Vc)AAj.A-,✓,i 11f A" h Day phone 9� 7_yvi- 57io Mailing address Sy 33 Site address SY3 (_ ,A- ,,d,eA,: _, A,4-'ue Legal description (Sub'd., Block & Lot) X'o ( Legal description (Township, Range & Section) Lot Size Sq. Ft. APPLICATION IS FOR: (0 all that apply) Number of Bedrooms APPLICATION IS AN: TYPE OF DWELLING: Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank Upgrade ElDuplex (D) ElHolding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ SUBA41TT44 THIS APPLICATION INCLUDES A VARIAKCq tWfiyf-R IQUEST FOR: /VU f K a ✓ y%A1z r Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Ck—k71 41YI Permit No. 0510 1417Jgl Permit App_-1-12.doc Waiver Fees: W'7 _ ate of Payment: Receipt Number: Waiver No. LU `a JEA 1 d• LLJ S � >aw 0 r� v F a _jxm Q Q LLJ D u > > a 0 Z 0 r LLI wo aaL a 3 q N r ❑ W --. V) d U A Y U yW d a � r Z a r o � z 9'92 Ln Q W J U 09 > 0'02 O Y > C3 O u W W W J 3�¢ w a \J CLJ oY Wlx Li, LL) CL a1P90. N ^ r 0 U r Cl r r QW W..Y Z0 Q Z - Z :� z> mwrW Wo Z Coo) o W W' a¢�� 0 7rC3 r a No J. X W WA D r, f W F- (4 } r z U a U W' F- J F -w d d U W WQ C4 N 0.. W I -- Q' Y Z �o r Developmer, t Services Depart men t Buiidira Safety Division Or -Sire Weer & We to oi_- Prov _ -� Si N i�:� i r'!iii 47700 Src9ew Street ".O Eo;:. 195050 MarkBegich Arldno•rage, ,AK 99519-6050 - - Mayor s•unv.muni. orn/on5,Te (907}343-7404 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: Legal Description RoG%�,�y j-/ Its S�"a fes Property Owner Namj & Address: 66RrPOV MAWTlr) 13 ` p L _ / 5133 wr►isalhy �z dnCh ilk Pump Installation Date: 8- �.�, tL! Pump Intake Depth Below Top of Well Casing: 97 feet Pump Manufacturer's Name: Ay Y"1rbo pNLD Pump Model: o1 3j " fS// * /O Pump Size 3/d hp Pitless Adapter Burial Depth: 16 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? Ves ❑ No Method of Disinfection: j pLr►9� / —'— Comments: RnchOrace PUMP & WWI Service Pump Installer Name: 330 East 76th Avenue Anchorage, Alaska 99516 Phone: 907-243-0740 7711 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [] UPGRADE !MAILING'ADDRESS LEGAL DESCRIPTION LOCATION Well~ _ _ , Absorpt~narea ~ Liq. capacity in gallons ............ Inside length ~ Manufacturer / V Q We ~ , ~ Foundation ~ I D~STANC~TO:I ~ /~ ' ~ ~ Z ~ No. of hnesl ~ Length of each li~ Total le~h of line~ ~ I Top o, ti,~ ~o,i~i.h g~d... Materia, beZth tile ~ Length Wi~th Depth < ~ I Type of crib ~ ~ ~ ~ ~earest lot line ~ ICl~s Depth Driller Distance to lot line ~ ] ~ Build,ng foundat,o~ Sewe~ I,n~ Septic tank Dwelling Mat e r./a~-~.. Width Material N ea rest I ot~j~, ~"/-.~.. Trench ~dt~ ~;.~ (~' inches inches NO. OF BEDROOMS No. of compartm~L Liquid depth PERMIT NO. Liquid capacity in gallons ,PERM,T NO..TB¢ D ist a n c e b et w~/7,,,~. Total effectiv~.aJSsorption area PERMIT NO. Total effective absorption area PERMIT NO. Absorption area(s) OTHER PIPE MATERIAL(~_~ ~'~ ~-~ 0 ~ SOl L TEST RATING C~ ~) ~,~~ I NSTA E LER REMARKS DATE LEGAL DRILLING LOG Well Owner __ H & H Painting Use o£We]] Dom. Location (address of: Township, Range, Section. if known; or distance mazn road_ Lot 18 Block D Rolling Hills Estates ,,~4~ _~ 6" l'ept~ of Ho?c J. 27_ fc,~ Screen ( ); Perforated ( ). Describe screen or perforation N/A Date ff con-pletion__._~O/2}/78 Ca ~ to_ - .... fi.et kind surface. : illisi oI well tc}mck ollc~ (~pen ell ,, inut:,, for I hours WELL LOG Depl h in fe~t from ~r'ou~ 4 u~r'ace Giv,~ details of formations penclrated, siz~ of material, color and hardness Casing s kickup 0 TO 2 2 TO 8 _ S__TO 20 20_ TO 60 .00_~_TO 8 7 ._ 8~7_ TO_ 96 96_TO 100 100__TO_ _iR5__TO__LLS_ 118 TO ]27 127 TO ........ TO _TO _TO , Sandy clay Silty _~)pd ~sravel __Si~!Y~Y_sm~d ......... Sandy_c%ay_ Gravelly h~xd_~pan Wet gravel _Silty wet sand ~~_~ sandy gravel ~W~ar sand & gravel Water gravel _ _TO THE E',O'T'T Oh1 :!:!; Ii!.:: T !.,.! ]: [::,TH [::,EF'TI."! :!:~]; 'T'HEi: i:~CFI"TC!I"I (::~f:::' THE iE!i~:: ~::::), :!ii!!,; iE~i::: !F:::~ '"E'" I:::iF:'t::'LZC:IaNT HFt::i!; Tl-.-!tli!: :I:Iq:!i!;F'iZC:'T']'[::ff.,!:~:i; OF: F:tI",!Y H[!i:L.L..:!~; F!!:::,,.:[i:P::::[!3',I'F "I"0 "l"H:[!i~; F:'I:;i:CL~::!~i:I:;i:'T"-? FI!'.,II::, t:;i: E!: :!!!; ]: [::, [i~: N C:[ii::(; THFIT !C:::~ ~:::: ;~?: :::)* ::t!:: OF:' FIW'¥' :!~;~.~-':iil;"f'[!!:!'"i I,.t]:THCCY'I I.,.i]:L.L. Ii:Ii: :~:!;tJEi'~..?Ii~:C:'T' :!.:.';T!:::II",IC:[!!: Ei[E:THE:E!:N FI F!E:I....L FIN[:, I:::IF,?.? CI?.,I.....~.~; :[ "['E: :E:!:i::l,.!l:::IEi!!::: I:::, :[ :ili;l:::'O'.!!i;F:t!.. FI ?F: iIi ',,,'!:::ITE i.,.l!i!:".!..L..~ F:'[!!:[!!:"I' I::I:~:O1'"! !:::~ ,I:::'LII.:~IL. :I: I]::: i.,.!E:i...I.. E:,E:I:::'E:i'.,ID:!:I'-,!G I...t.i::'CI?.,i TI...I!!:~: "F'~,?F:'I~!i: Of:: F:'I...I[3L.. :[ C: Fi: [!!: Q 1...i ]: !:;~:li!: [/, !:tI'.,tD Fi'.iiii?'i[i:?.,l"i":i~; !"tF:I'.~" i:::II:::'!:::'L."~". ]: I'.,l :!i!; LI I:;:: !!i~: !:::'l:q:O F:' E: Fi] .... lliiiii:: }:~..::; I!::::::~ ::E: F;;[;': i.: :I: l:::ff"i I::F:II'"I :t: !... :[ I:::!I:;i: i.,I:[TH 'THE F:O!:;i:TH Eli'./ TH[ii: ;;Z: :[ [,.! :i: L..L. Z !'-,P.~:;Ti:::tL..L. 'T'k.ll:.::: i:!i:: :!: i. ji'.,![::,!!.{Fi::i!~;TI"::If'.,I[::, THI:::I"t" T!'.'tE: i:;i:Ei::Jli;:[i]:,[!~:?.,IC:Ei: :!::!!!; I::i:E.:I'fiO[],EL.[~][::, "I"C~ PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6- 7 8 9 10 11 12 13 14 15 16 17, 18- 19- 20- COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6650, Anchorage, Alaska 99502 276-2221I SOILS LOG - PERCOLATION TEST DATE PERFORMED: [] SOILS LOG ~ PERCOLATION TEST SLOPE ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop q-? ?-~ ~h -- ~-~" f .- ~' Z ¢~ l~ I~ ~ ~ 4~ " /,, PERCOLATION RATE /~ (minutes/inch) TEST RUN BETWEEN ~0 FT AND '"~,~ FT PERFORMED BY: D~TE: 72-008 (7/76} DATE RECEIVED "1 ' '~' INSPECTION APPOINTMENTS ~/4~-~O~.~7 ' '¥1ME TIME TIME DATER DATE MUNICIPALITY OF ANCHORAGE 'NV/DEPT'R OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~ ONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 NOV 2 i 1979 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. 1. P~OPERTYOWNER ~].. J PHONE MAI k~G A~DB ESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3~ LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS / / 5. LEGAL DESCRIPTION , Zz STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS /~ SINGLE FAMILY [] One [] Four I~ Two [] Five MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS .~, [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTIL TY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE ~NSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: ~ D..~- ;~ If Tank is homemade SOILS RATING give dimensions: ~-~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption AreaISawerLine I Nearest Lot Line WELL TO: I I Absorption Area to nearest Lot Line 5. COMMENTS ~_.,/~I~ROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompa~rtificate) [] DISAPPROVEDi~ DATE BY