HomeMy WebLinkAboutKIMBERLY MANOR BLK 1 LT 6Onsite File
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Feb 03 22 08:06p Anchorage Well & Pump Ser 9072430742 p.1
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MUNICIPALITY OF ANCHORAGE
..,E
Development Services Department jls, J Phone: 907-343-7904
On -Site Water & Wastewater Section / Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 017 _07414
Legal Description I Block I Lot
KIMBERLY MANOR 1 1 1 6
Pump Installation Date: 02 - 02 - 2022
Date of Issue• -
Property Owner Name & Address:
MAGDA WITHERS
7701 COX DRIVE
ANCHORAGE, AK 99516
Pump Intake Depth Below Top of Well Casing: 215 feet
Pump Manufacturer's Name: A.Y. MCDONALD
Pump Model: 24075V2
Pump Size: j/4 hp
Pitless Adapter Burial Depth: 12 _ feet
Pitless Adapter Manufacturer's Name: MART I N SO N
Pitless Adapter Installer:
Well Disinfected Upon Completion?Yes ❑ No
Method of Disinfection: PELLETS
Comments:
Pump Installer Name:
Company:
Mailing Address:
ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
ANCHORAGE, AK 99518
907-243-0740
State: Zip:
Attention: The pump installer shall provide a pump installation tog to On-site within 30 days of pump installation.
MUnicipality of Anchorage Page
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 I.~p~ction Report
Permit Number: ~[4/ %(b O I ~c( PID Number: ~
Nme: Wastewater System: D New ~ Upgrade
Address: ABSORPTION FIELD
Phone: No. of Be~ooms: ~ Deep Trench O Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so, Rating: Z~ 5¢/~GPD/Sq. Ft. Total Depth from[ [°riginal' grade:
Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath p~pe
Township: I Range; ~ ~eotion: Fill added above original grade: Gravel length:
~ O ~ Ft. ~ ~ Ft.
I
I
'~~ ~ New ~ ' ~ Gravel width: Number of lines: Distancebe~eenlin~:
2 ~Ft. ~ ~o~ Ft.
Classification (Privy,C): ~Depth: Cased To: Total absorption area: Pipe material:
~ Ft. Ft. ~ 9~G SQ. Ft.
Driller:~~ ~ ~Date Drilled: Static Water Level:Ft. Installer:~{~~ Date installed:
~ .u~.S.,a~: ~*~ove ~,ou..: TANK
SEPARATION DISTANCES Cseptic ~ Ho~di.g U S:T.E.P.
TO ~ Septic Absorption Lift Holding 3ublic/Pdvate Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Linea ~ ~
Material: Number of Co~adments:
we~ //o ~¢ ~/~ w/~ ~o~ ~ L
s.,.o~ LIFT STATION
Water ( oo ~ i ~ ~/~ ~¢A [ ~ ¢
Lot Size in gallons: Manufacturer:
Line ~ ( l ~' ~J~ ~/~ ~o ~
Cu~ain ~/~ ~ ~ ~ Electrical Inspections pe~ormed by:
Drain
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
Inspections performed by: ~,~,~o~,%~- Dates:lst &-~-~
Department of Health an~ Human Seduces approval
Reviewed and approved by: Date: d- 2~-Y~
72~13 (Rev. g/gl) MOA 25
AS-BUIET
~/ASTE~/ATER ABSORPTION SYSTEM
Lo~ 6, B~ock 1 Klmberly M~nor
Lot 10
No we(( or
septic within
200' o¢ p~op~d9
system
Lot 8
-- 17.
0
TH i
BR Lot 7
house
Ne~ lO00 g sep ic ~onk
I
)posed Syst~
~ I septic
I ! F tocc~ed om
~ / I ecst side oF
~ lot,
.!
/
Cox Drive
3 Bedroom House
750 SF Rqd
DESiGN~ 8' E??ective
1i' Toro( Depth
~' ~/ide, '~j~'"'~ng
Tot¢~ Ab~orp¢io~
PREPARED FOR'
John Peterson
7701 Cox Ro~ol
Anchorage, AK 99516
4987)345-1813
/Pommone E~§,. Svc,: '
Pi 0, BOX 142025
ANCHDRAGE'~;' ALAS,KA 99514
878-8218~ 278~88'18 FAX
ATD 6'88-98
~CALE, ~'=SO' ~ ASzBUILT
AS-3UILT DETAILS
VAS~F-E-WATER ABsnRPTION SYSTEM
Lot 6, 3lock 1 Klmber[y Manor
.I. flON¥3"i3
Z
W
£f'lON¥393
W
PREPARED FOR'
John Pete~$on
7701 Cox Road
Anchor~oe, AK 99516
(907)345-1813
/fl~3N¥,3"lO
..LflnNV3'13 '
.I. nrlN~3"13 ::.
_--~'~ 8." ~'q: ...
I Po, nnone Eno, sVC, -
P. B. BOX 142025/
ANCHORAGE, ALASKA 99514
274-0308, 872~8818 FAX
DATD 6-22-96
NOT TO SCALE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960119
DESIGN ENGINEER:STEVEN R. PANNONE
OWNER NAME:PETERSON JOHN M &
OWNER ADDRESS:7701 COX DR
ANCHORAGE, AK 99516
DATE ISSUED: 6/13/96
EXPIRATION DATE: 6/13/97
PARCEL ID:01707319
LEGAL DESCRIPTION:
KIMBERLY MANOR BLK
1 LT 6
LOT SIZE: 34500 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION 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 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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.
SPECIAL PROVISIONS:
ENSURE TRENCH MEETS THE REQUIRED SEPARATION
DISTANCE(S) TO ADJACENT DISPOSAL FIELDS
AS DESCRIBED BY AMC15.65.060.A1D.
RECEIVED
DATE
Steven R. Pannone, P.E.
Consulting Engineer
(907) 272-8218
June 6, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On~Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
P.O. Box 142025
Anohorage, Alaska, 99514
(907)272-8218 Fax
Subject:
Lot 6, Block 1 Kimberly Manor Subdivision
Upgrade Permit
Gentlemen:
My firm conducted a Health Authority Approval investigation at the above referenced property in August of
last year. The existing trench type system failed the adequacy test. The system was operable, but would not
take the required 150 gallons per bedrooms. It would take approximately 100 gallons then the water would
start to rise in the lateral. After 30 minutes the water would drop below the lateral. Furthermore the existing
system was located completely inside the 100 foot well radius. I was requested to investigate the possibility
of installing a new system. One test hole was excavated in August of 1995. The soils reports and
percolation test results are attached. No ground water was encountered.
I would like to request that a pernfit to replace the septic system be granted for this property. Attached is a
design for a replacement system that will be installed this summer.
The lot is approximately an 0.79 acres in size. It slopes to the south at a rate of approximately two to three
percent. The proposed installation will be located greater than 100 feet away from the well and 25 feet from
the water service lines. The surrounding systems to the north and east are located greater than 100 feet from
the proposed installation. The system to the west is located along the property line, and even crosses onto
Lot 6. The new system will be installed greater than 20 feet from this existing system. Both neighboring
wells are located greater than 100 feet from the proposed system. The existing septic tank abandoned. A
new tank will be installed outside of the 100 feet well radius. The existing soil absorption field will be
abandoned in place.
If you have any questions about the proposed installation, Please contact me at 272-8218
Sincerely,
Steven R. Pannone, P.E.
C:\WORK\6.1KIMLY. LTR
DESIGN
V//~STEV/ATER A]iSBRPTIBN SYSTEM
Lo~. 10
Septic
(To be
~bcmdoned)
No welL on
sep+Jc w'%him
200' o¢ pPop~5~d9
system
F ix
Lot 8
'v/ell located
om wes$ edse
o¢ [05 5,
Lo~. 5
Neibops
sep'Wc ~
sy~ ue'm -%.
.~-4;~
LO,. 7
New 1000 g sep ic tank
0 ~ep
TH i ? Located on
~ ! e ~s+,, side
r-3X t
Cox Drive
47'
PREPARED FFIRI
John Petemson
7701 Cox Roc~d
Ancho~'age, AK 99516
(907)345-1813
Sol(s= 250sF/bp
3 }~edpoom House
750 SF Rqd
DESIGN~ 8' EP£ec$ive
II' Tot~( IC.'ep~h
~' kCic~e, 47' Lon~
Toto. t Absorption = 752 sC
6Pmnmone EnB, 2vc,
P. 0, ~OX 142025
~NCHBRAGE, ~L~SKA 995~4
878-8~t8, ~7~-88~B FAX
-6-% J ~ESZGN
~ /
DESIGN DETAILS
~/ASTE~/ATER ABSF1RPTIBN SYSTEM
Lo~ G, BLock 1 KlmberLy
.U10N~393
Z
E]
49~__ ........~
R. Ponnone
CE 8149
PREPARE]] FOR,
John Pe~erson
7701 Cox Rood
Anchorage, AK 99516
(907)345 -1813
i~90NV"490
Panmome Eng, Svc,
P, B, BBX 142025
ANCHBRAGE, ALASKA 9951~
274-0308. 272-8218 FAX
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Ataska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:_
LEGAL DESCRIPTION:
6
7
8,
9
10
11
12
13
14,
15
16
17,
18--
19
20,
1
2
3
4
5
_ DATE PERFORi
Township, Range, Section: SLOPE ~
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh Io Water After
Maflitorino? --. ~ __
Readin! Date Gross Ne
Time
SITE P L A-~'--'~
PERCOLATION RATE ~--._._..~ - (minutes/inch) PERC HOLE DIAMETER
TEST RUN ~ETWEEN _____G __ FT AND ~ PT
PERFORMED aY: ~._~ ~ ~~ '4;ERTJFy THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICJPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ._~_.~__~t6
72-008 (Rev. 4/85)
-. _JMUNICIPALITYOF ANCHORAGE ,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
NAME
DISTANCE TO:
Manufacturer
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
DISTANCE TO:
Dwelling
area
IF HOMEMADE:
NO. OF BEDROOMS
No. of compart~ts --
depth
PERMIT NO,
DISTANCE TO:
No. of lines --
Type of crib
DISTANCE TO:
Length of each line
grade
Crib diameter
Well
length of lines --
leath tile
Crib depth
Building founda
line
inches
ef fective~abs°rpd °~,~r
Nearest lot line ~
y in
on
DISTANCE TO: Building foundation
OTHER
Sewer line
to lot line
Septic tank
Absorption area(s)
DATE LEGAL
F' E: R M I T ."l 'A
LE '3F~L
C 'iii:.:: [:,Fi:
L.6 [::,:-,- ...!.11,-': :M-'~ MFti'.,!OR
THE '[:,EF'TH 3F Fl "i"RIEHC:H .....
NLII'4E:EI~ "3F F,.ESN:)IENCES 'T'HRT THE HEI_L l,l'[L.i .............
DE:PFI?.TMEHT I,IT Li_
RES I DENCE ~ '.E; P. EMODEI_ED TO I N i:_ Ji'~,E MOF?.E THFIi'.,! 3 E Z[',P: i P' S
Anchorage
POUCH 6-65O
ANCHORAGE, ALASKA 99502
(907) 279-2511
GEORGE M. SULLIVAN,
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(825 "L' Street)
November 22, 1977
976900
Frank D. Swanson
3701 Eureka - Space 4lA
Anchorage, Alaska 99503
Subject: Permit Expiration
Dear Mr. Swanson:
'A permit issued by this department for well and/or on-site
sewer installation on Lot 6 Block 1 Kimberly Manor Subdivision
has expired since the issue date exceeds one (1) year.
In the event you still plan to install the well and/or on-
site sewer system, a new permit is required. The original
soil test may be used to obtain a current permit.
If the well has been drilled, a well log should be sent
to this department to document the installation date.
If you have any questions regarding the above matter, please
do not hesitate to contact this office immediately at 264-
4720.
Sincerely,
BUc hholz, R.S.
Sanitarian ~
LNB/ljh
I:1F:' F' L ]I C l::ilq T
I~. [3 C FIT ~ 0 Iq
HI::i;:.:; :[ HUH HI I"llii!:l!E:l;~: L")F E:EE:,F4:O(:)HS *."- Z
'FHE IE:IEL::flJ :[ RIEl) ':E; :1: ;::":E OF THE :!};1~1 ]: I_ FIE:SOF.:F'T ]: [73N ':_:;'¢:E;TIEH :[ S '
THE: L.ENGTH E:, I HENS ]: ON :I:S THE I_ENGTH (]:1'-,t F'IEIE;'F::, Eft:' HIE TRENE:I40F~: E:,FE:FI :[ Ni::' ]: EM:::,.
THE I:::,EEF'"H4 OF FI "FREt'.,II::::H 13R F:']ZT ]:S THE I:::,ZSTFIN] E',E'T [EEi",t THIE SURFI::ICE OF' THE
GROUND FIN[::, THE: E:EYf'TOH OF "FHE E',q(:Z:t::B,,'FtTION
THERE ~5 I",10 SET i4IE:,TH FOI:E'. TRENE:HES.
THE: G[~:FI'i,,'EI.... I)IEZI::'TH ]: S THE H I N Z I',llJt',t OF: E:ETt,]EEN ']"HE i:)i...tTFi::~L.L. F' :[ PE
FIi",ID THIE E:CITTEII'"I I:: ] [;:l "I"HE: E',:.:',I:Z:I'v'FIT Z ON ( ]: tq ~
E:ZTHEI:::'. F:I (]:I_FI'.:.:.,:Ei Z I]:1[~: :[)~ NSF F'~ F:'I::;:O'v'I.EI
T HF'i"r' BE: :[ NS'T'F:IL. LE:I:::'.
:;i:E:D. :[ I::' I::1 I'"iFt :1: i'.,ITE:NF:tN(:::E
.EJE: I:;]:E(;:!U]:F::E[) q"O E:l'.,lL.F:lF;::l:~iiEi: TIdE :E;O:i:I ....
IJ E:..:rlE C'I" T O I::'F.'. E E;[:Z ::: _tT :1: O N.
CH ]:S LISED
i~;"rEl','l ]: E; L'ISIEI
'H ]:'."!; 40. 0 FEIET.
!iTH ]:E; !~:':.~::'1... 0 FrEE'T'.
H :[ N ]: HUH [):[ :E;TFtNCE [![E
:LOO FEET FOR ~
L:.';F~EC ]: F' ]: E:RT ]: ONS FIND
]: N :!~; ']" 1:;:1L L.. I::1 'T' :[ I[I 1",!.
FI
[,.!IE L.I.... 0
]: CERT :[ I::'"r' THI::IT
:L.: I t:~1"'t FI::Illlll]:I....]:FII:~: ['-! :l: 'l"H "FHE I:;i:EX;!UtF~:EHECNT:Ei F::OF~: Ot",t-S]:TE SEZI.,.IE~:F::'::i I::t1",Ii::' i.'.IEi....I....:i5 FIS :
F'E~F. fr'H B'T' THE HLJI"4]:C].F "Lilt OF FII',IfL':H(Tff;.':FIGE.
2: :[ 1.'.1 :!: M.... ]: NS'T'F&..L. THE' :5'T'STECH :1:1"4 F~CE:O[4:E:'F~NCE I.'.t:[ TH THE E:Ed)IE:~;.
:Z:: :[ LINDEF.'.E;TFtI',II:::' THI::IT THE F?'I-':ii!;:[TtE :i;Et.,.tER :iii;"r'~!;TIEH Hl:~"r' I:~:IEQU:[I:~:E: ENI....I::iE:GEHECNT '.(F' THE!:
I:;~:E::"~ ]: DEi',IE:IE ]: :E; I:;:'.EHE~DEI_E[:' TO ]: NCI_Uf-':'E: I"IO.~::E: -t"I'4F:It",i 2i:
R & M [~ON~'~ULTANTS, INC.
November 11, 1976
R & M Mo. 656322
C.B. Duke and Son Excavating
3701 Eurika, Space 4lA
Anchorage, Alaska 99503
RE: Test Hole and Soil Log Report for Sanitary System
Lot 6, Block 1, Kimberly Manor
Dear Mr. Duke:
We are submitting herewith the test borin~ ~esults and our comments
regarding soil conditions encountered at the subject site~ This in-
vestigation was performed in accordance with your request of November
9, 1976 and those procedures outlined in a letter dated 0~ly 15, 1975~
by Mr. Roll Strickland of the Municipality of Anchorage, Department
of Environmental _~Ouality.
A single test hole was put do~ within the subject site area for the
purpose of defining general subsurface soil. conditions for the proposed
sanitary system. Excavation was accomplished with a tractor-mounted
backhoe and the test hole was extended to a total depth of !2-5 feet
below ground surface. The final log prepared for the test hole has
been included in Drawing A-01.
Ground water was not encountered in the test hole while drilling.
We appreciate being given this opportunity ~o be of service to you.
Should you have any questions wi~h regard to the above, please do not
hesitate to contact USo
Very truly yours,
R & M CONSULTANTS~ INC.
James Wo Rooney
Vice President
~WR/pe
xc: Municipality of Anchorage
TH-1
- Existinq
Crib
COX DRIVE
·
TH-1
11-10-76
ORGA~]IC SILTY SAND
Dark Brown
SANDY SILT W/TPJ~CE
GR3tVEL (ML)
Lt. Brown
4..0'
SAND W/SOME GR3n3fEL (SW)
Brown
_6.0'
FINE SAND W/SOHE SILT (SI4)
Lt. Brown
7.0'
SANDY SILT (~L)
9.5'
SILTY SAND (SM)
12.5
No Water Table
This lo9 represents subsurface
soil conditions within Kimberly
Manor Subdivision
WN: DZ$
K D:~ JMA
nYE: 11~11-76
SANITARY SE?~ER TEST HOLE lrF-8, '
CHET DUKE /~GRID:
£uWCHORAGE, A!i~SKA / ~0
... j[owo.~o.
656322
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. # C'/l'~'
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone -~ ~/,S--/~ i.~
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well '~-
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 [Rev 1/91) Fronl MOA tt21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage flies and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm '-~r'~,.J ~,~,,J~ E'-.',--(.~ E~,',~ (_ Phone '2 .?'2'-~-
Address ""~ ¢"."~'-'~c,~ /q-z~.',_',~ /.:~..~_.(tic..m~.~,\,t.,~z._ ~:~
Engineer's sig n at u re.~--~'-.-~-.--x*¢'~--'
Date ~'- -
DHHS SIGNATURE
Approved for -~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with ti-re following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 [Rev 1/91) Back MOA ~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 5020 Anchorage, Alaska 995010 (907~(~,4[ V E D
Legal Description:
A. WELL DATA
Health Authority Approval Checklist
[~-~_M"l~Lz~gc-d t-,l~q~,c~.. Parcel I.D.:
Well type
Log present (Y/N) _ ~F~ ~
Total depth 2 t ~
Sanitary seal (Y/N)
dU l 2.4 1996
Municipality of Anchorage
Deist. Health & Human Sa~lces
~3~ xu~T~. If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to Z t ~,
Casing height (above 8round)
Wires properly protected (Y/N)
AT INSPECTION
(¢- 2'2-
g.p.m. '~. ~ g.p.m.
Date of test
Static water level
Well production .~- · ~c>
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample; __~-- I ~'- c//~
B. SEPTIC/HOLDING TANK DATA
FROM WELL LOG
[, t..[ /~ Other bacteria
Collected by: ~ -'~'2 ,--'~.,~,..,.9o r~,~--
Date installed ~'- 22~r?bTanksize I
Foundation cleanout (Y/N) ~' Depression (Y/N) id,
Date of Pumping /L2 ~..M) Pumper
C. ABSORPTION FIELD DATA
Date installed b'~ ~ -- q{~ Soilrating (g.p.d./fi2orfi2fodrm)
Length ~$ ~. Width
Effective absorption area :3¢-~
Date of adequacy test ~41~C~
Fluid depth in absorption field before test (in.);
Fluid depth ~ (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Number of Compartments ~L Cleanouts (Y/N) ~
High water alarm (Y/N) ~t/(oa.
System type '~ T-
~_~ t Gravel thickness below pipe ~, Total depth / {
Monitoring Tube present(Y/N) ~ Depression over field (Y/N)
Results (Pass/Fail) ~DrA~ For ,,~ bedrooms
~ Immediately after ~-- gal. water added (in.):
-- Absorption rate = g.p.d.
~ If yes, give date
D. LI~T STATION
Date installed Size in gallons
Manhole/Access (Y/N) /%// ~ "Pump off" level at*
High water alarm level at* *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
.; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~_~ _z Property line '/~ Absorption field
Water main/service line /vt-,t' Surface water/drainage t oo'f Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~ q ~
Surface water i Cvo'c-
Curtain drain ~4/[,A
Property Line
Driveway, parking/vehicle storage area i[O
Wells on adjacent lots [
Fe
ENGINEER'S CERTWICATION
I certify that I have determined thrufield inspections and review of Municipal reco~?~l[Jaf~l~e ab-ov¢,sy~te~,.s are
tn conformance wtth MOA ~ gutdehnes m effect on thts date.
Engineer's Name ~;~c~ ~ ~A~ ~o~
Date ~ '-' ~ e--- 't ~
I-IAA Fee
Date of Payment
Receipt Number
Rev. 8/95
Waiver Fee $
Date of Payment
Receipt Number
/~. Approval 'requested by:
R TER ANCHORAGE ARE ,
De~ment of Environmental Qu~ity /
0 "C" St,~_t,_Anchorage, Alaska 99503 274-4561
~0' '*~ ~' 'Date Received October 29, 1976
~..0~,~,~, O,~f~O@ %'~'~ ~''0 Time of Inspection .q,'~]) prT[
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
First National Bnk of Anchorage
Mai 1 i ng Address ~ Pos~/~Office Box 720 Ph0ne:
2. Property,Owner:.i: Frank,iD. Swanson Phone: 265-4676
Mailing Address: Star Route A Bo× 404
279-4481 x 483
3. Legal Description: Lot 6 Block 1 Kimberly Manor
4. Location: ~ '
o
Type of facility to be inspected sfngle Family
Well Data: ~ I nd iv-id~a~
A. Type --~~ (~ 7
C. Construction ~/~/}~2~-~ ~(?~,
Sewage Disposal System: O~site s~8tem
A. Installed
C. Septic Tank: 1. Size
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
No. of bedrooms 3
I
B. Depth ~/~
D. Bacterial Analysis
1. Absorption Area
B. Installer
2. Manufacturer
Total length of lines
2. Material
, Sewer Lines ,
, Absorption area
, Other contamination
C. Absorption area to nearest lot line
, Absorption area
EQ-034 (1/74) Page 1 of two pages
k~'MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274 4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 2, 91976
RECEIVED
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
CMRO VA FHA
:Prank D..qwan~on
SPA Box 404 Ancho'r'ag¢_; AT4 99507 Day Phone _
None
CONV .
265-4676
Mailing Address:
4. Name of Lending Institution:
Mailing Address: P,O. Bo~ 720
5. Name of Realtor or Agent: None
Mailing Address:
Day Phone
First National Bank ofAnchoraqe
Anchoraqe, AK 99510 Phone
Phone
279-4481 ext. 483
6. Legal Description:
Locat ion:
Lot 6, Block 1, K/mberly Manor S/D
Anchorage: NI.A.r Ala,~ka
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
No. Bdrms. 3
Public Utility
Individual X
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
if individual, date of installation
Individual (on-site)
X
Marie Iiams
October 26, 1976
ECL037 (1174)
~age 2' of two pages - Re~
st for Approval of Individual
Legal [escripti0n Lot 6 Block i Kimberly Manor
Comments
~r & Water Facilities
Approved
Disapproved Y/~yx~, .~/j~ Date
Approval Valid for one y~ar from date sig~
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF S YSTEM~__~_-;---~ ~://~
certify that the ]~ation contained in this request for approval to be a true and
accurate representation of th9 subject sewer and wa~er facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
REQUEST FOR APPROVAL OF
INDIVIDUAL E~AGE AND WATER FACILITIES
(Fill out in Triplicate)
6, Well data:
b. Depth_
c. Casing Size
dj
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tanR
3. Seepage Ar,ea
4. Cesspool'_
5. Property Line
6. Other sources of p sszble contaminatlon~ i.e.~ creeks, lakes,
O ~
houses~ barn~ drainage dltch~ etc.
Sewage disposal system.
a. Age of system.,
b. Septic tank capacity in gai]ons
e. Name of septic tank manufac*u~er
1. If "home made" show diagram on ~everse side of this form.
d. Disposal field or seepage pit size and type
1, Distance to property llne .... to house foundation
e. Percolation Test results
f. Percolation Test performed by
Use the reverse side of this form to show diagram, Diagram should include
the following information: p~op.-~.rty line s~ .well location, house location,
septic tank location~ disposal area location, location of percolation test~
and direction of ground slope.
The information on this~g~/m ~s/rue and~ct to the best of myynow~dge.
~ignature 'of App'Tfcant ' Dat~ signed
TO BE FILLED OUT BY HEALTH DEpART~.~ENT PERSONNEL
'~T~e above described sanitary facili~ are hereby approved, subject to the
.......... ~{~'llowing cond~f~ons: .
The above described sanitary facflitlss a~ disepp~oved fo~ the followin6
Approval i~ valid for one year following the date of approval·
CPJ:cw
BloCk 1,
Subdivision.
~to ~vo uo i~t~or~atlon on the sawm~e d~npo~a.1 ~ystm'o.
CPJ/ee