HomeMy WebLinkAboutSUSITNA VIEW ESTATES BLK 1 LT 8 i! ~d MUNICIPALITY OF ANCHORAGE i
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
I 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE
MAILING ADDRESS
LOCATION NO. OF BEDlaMS
Dwelling
m~ ~ ~u~acturer ~ ' ~o. of com~tm0nts
Liq. capacity in gallons Inside length
~ ~ (~ IF HOME~DE: ~ Width klqui~ dept~
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
m -- ~ ~er ~ ~r Liqui~ma~ty
~ · Well ~ - Foundation · . Nearest lot line ~ PERMrT NO.~
~ DISTANCE TO:
~ ~ Top of tile to finish grade Material beneath tile Total effecti absor ion area
Well
OTHER
REMARKS
U-W DRILLING, Inc.
BOX 10-378 * 10300 Old Seward Highway .-
(907) ~9-~35
ANCHORAGE, ALASKA 99511
Well Owner
DRILLING LOG
Use of Well Domestic
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing 6" Depth of Hole
Static water level 31 ft.
Screen ( ); Perforated (
Describe screen or perforation
Well pumping test at 5 gallons per of drawdown .from static level.
Date of completion '~y 22, 1983
180 feet Cased to 27.6 feet
(below) land surface. Finish of well (check one) open end (
(minute) for 1 hours with 100%
Depth' in feet from
ground surface
WELL LOG
Give details of formations penetrated, size of material, color and hardness
0 TO_ 5
Casin? sticku~
5 TO 10
Brown clay and g~avel (damo)
10 TO. 25
Brown silty grax~l (wet)
25 TO
B b L ock
$~ TO 180
TO
~TO
.:
.TO
To-
TO
__TO
__TO
_TO
,.v 973
~ (L : ~)~-~ ~ 3--CONTRACTOR
Permit ~ q,~C)Lo~)~
Applicant
D~epartment~ ~. Health and Environmenta3 ~rotection
825 <~ Street, Anchorage, AK. '~501
WELL AND/~ ON-SITE SEWER PERMIT
Location: ~$,/,~
Legal Description .~ ¢
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed:
Maximum Number of Bedrooms:
Phone Number: O'&,~ °
Lot Size:
Holding Tank:
Soil Rating (sq. ft/br) /~
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH ~' GRAVEL DEPTH ~ '~ '
WIDTN /~
The length dimension is the length(in fee~) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and apProval by this departmen~
will be subject to prosecution.
Minimum distance between a well and anY on-site sewage disposal system is 100 fee~
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
Z certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that~bedrooms~
Signe~: ~b---~e~-n~-. C,-",~,~ Issued by:
Applicant Date:
SWP/024(1/81)
.u.,c,.AqTv A.C.O.A E
OEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~E L, $trIet, A~chefege. Allske 9950S 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
lEGAL DESCRIPTION:
ELOPE
, DATE PERFORMED:
l'1 PERCOLATION
TEET
S
6
7
8
9
10
11
· 12
13-
14-
15-
6-
17-
18
19
20-
IF YEE. AT WHAT
DEPTH?
Gross Net Depth to Net I
PEROOLATION RATE / (~ Imin~t~/inch)
TEST RUN EETWEEN ,~ , FT AND ~ , FT
p._~LiVl-~u~z-y ~,-~'Ai'd &E~5~ ~<~l',~PV.~ ~u6&6sT-' 2. b ~/A///~~/'/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
e2E L Stteeto AKhot~. Aletkl 9950t 264-4720
SOILS LOG - PERCOLATION TEST
~OIIJ LOG
PERCOLATION
TEST
~'~.."ORMED FOR:
LEGAL DESCRIPTION:
2
-3
4,
5-
6-
7-
8-
Nichols
No. 4113-E
COMMENTS
DATE PERFORmD: 6 --"q 7-- ¥ 3
SLOPE SITE PLAN
,,AS GROU.O W,~TE.
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
~" ~ ~ 6"
~', I~1 d
/0
~.~ /3 ~6 J3 ~ ~,, ;.5"
· PERCOLATION RATE / (~ Iminuleslinch)
TEST RUN BETWEEN ','~ FT AND ~ FT
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Des.cription (include lot, block, subdivision, section, t~wnship, range)
Location (address or directions)
(b) Applicants Nar~ TORA~A~3
Applicants Ad~ess
(c) Applicant is (che~ o~) ~nding Institution ~; ~r~il~r~;
Buyer ~; ~her ~ (e~lain); '
(d) ~nding Institution [~;_~ ~A ~D~ ~/r~epho~
(e) ~al gs~ate
Address -- ~o~
Telephone--
2. Type of ~sidenoe
Single-Family
Numke~ of Bedrocms
Multi-Family ~--~
Other (describe)
3. Water Supply
Individual Wall ~;~[ Coamunity ~--~ Public ~-~
Note: If cc~u~dnity well system, must have written confirmation f-r~u the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the number of bedrocks specified in this HAA (~/N)' y~
4. Sewage Disposal
Onsite~ Public F--~ Core,unity ~-~ Holding Tank r-~
Is the wastewater disposal system adequate fc~ the rxa~ber of bedrooms ~/N) y~'_~
[Page 1 of 2]
2-15-84
5. Engineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, c~ conformed to all MOA H~A Guid~lirms in
effect on the date of this inspection.
N ar~
~;;?oooo~.oo~o.o,. .... Q. ~
~% CE-1411 j' ,/~' ~
Te~ of ~nditio~l AD. oval
The Municipality of Anchorage Department of Health and Environmental Protection dces
not guarantee the continued satisfactory gerfczmance of the water supply and/c~ the
wastewater disposal system. This approval indicates that, as of the validation date
shown abo~, based on the data and information furnished bi; an enginser registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of baclrcom~ and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
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2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification
MUNICIPALITY OF
r~Pr. OF HEALTH
~NVIRONMEN3'AL
l'4OV 16
RECEIVED
Legal Description: S~['+n~
Well Log P~esent (~/N) ~'/~
Total Depth /~/O ~r Cased ~
Static wate~ ~1 ~/ ' ~1~ ~t$~ ~t at
Casing ~ight ~ G~nd ~ ~~
~p~ation Dis~n~s ~ ~11:
To Septic/Holding Tank on Lot / / O .?-~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~O ~; On Adjoining
To Nearest Public Sewe~ Line /~/O~ /~/~5I~x3'~ To Nearest Public Sewe~
Cleancut/Manhole ~7' ~/~KA=A/7- To Nearest Se~ Service Line on
Wate~ Sample Collected By ~_~ 'L/;
Wate~ Sample Test Results --~/I~/~C~ >z /__~-- ~/~'"'-,/'/,,~--23
Cotkt~nts
B. SEPTIC/HOLDING TANK DATA
Date Installed-~-'~%
Stan~i~s ~) ~
~ession o~ Ta~ (Y~ ~te ~st P~d N
P~ing~inte~n~ ~n~a~
Holding Ta~ High-Wate~ ~a~
~a~y Holdi~ Ta~ ~t
~p~ation Distan~s ~ ~ptic~olding Ta~:
To Wate=-Supply ~11
To ~o~ty Li~
~ S~e~, ~nd, ~e, ~ Major
To ~ter Mai~vi~ ni~ ~ To'
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
De
Soils Rating in Absorption Strata /~ ~_~,~/~' ~ype of System Design
Date Installed '~'~4~ ~ )'~ ~ ~ng~ of Field ~ ~ .~
Width of Field / ~ .~ ~p~ of Field ~
~ It 'o,~ -
S~e Feet of ~s~ption ~ea ~ ~,~. Stan~ims ~esent ~) ~
~p~ession ove~ Field (Y~ ~'of ~st A~a~ ~sh ~]~ ~.
Results of ~s% ~equa~ ~st ~/~~ ~ -~ ~
Sep~ation Distan~ f~ ~s~pti~ Field: ~ ~ ~. ~ ~ ~ b~ /c:~~'
To Building Foundation ~ .~ To Ex~sting or ~ndo~d System ~ .
not~o~. ~&¢~ ; ~ ~]oini~ ..... ng ~ts k%o~ ~Y~sC~
To Wate~ Main/~vi~ Line ~e~ To ~t~(if p~e~t) ~r
To St~e~,~ond~ke/~ Majo~ ~aina~ ~ ~Q'~
To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea ~-
Size in Gallons~-~ Manhol/e~ccess (Y/N)
iE~i;~Al~l aLvel a~ ~/~' "~~ii~u)acy Test.
Electrical ~~ ~'~.
Con~nents
Meets MOA
** Check Permitted Bect~ocm Rating Against HAA Request
I oertify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
,m~o. OENGI~.R~ '.W 9.
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