HomeMy WebLinkAboutKIMBERLY MANOR #2 BLK 3 LT 100/7 o73 Department ' ' Health and Environmenta' Protection 825 L~. Street, Anchorage, AK. '~'~.~(~501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit # ~3~ O~2-~-- ~'-; ......... -- WELL .... ~:--.-OP, ,~,, [}:72 '.,u ..... PERMIT Location: /2~-Phone Number: ~0 Legal Description: ~- ~$~ ~-/~3--~3~k] ~w~ Lot Size: /~/ Type of Soil Absorption System Is: ~/~-~ Trench: Drainfield: Seepage Bed: Holding Tank Maximum Number of Bedrooms: ~ Soil Rating (sq. ft/br) DEPTH The Required Size of the Soil Absorption System Is: /t3~ LENGTH AJ,/~ GRAVEL DEPTH ,d~2~ WIDTH "~Y"~ The length dimension is the length(in feet) 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 = /l~"a'- 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 department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum d'istance 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 * * * I 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 re~ire enlargement if the residence ,is r~modeled~,__~ to include more that~edrooms.~. Signe Issued by: ~,~ Date: SWP/024 (1/81) ~-~ 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 NAME E~UPGRADE MAILING ADDRESS LOCATION ] DISTANCE TO: ~ ~ ] Manufacturer ~ Eiq. ca~ ~allo~s IF HOMEMADE: ~ I lWell ~= IDISTANCE TO: I ~ ~ ~ No. of lines ~ Length of eac~ line ~ ~ ~ Top of tile to finish grade  Length Wid~ ~ ~ ~ Type of crib Crib diameter ~ Well ~ DISTANCE TO: ~ lClass Depth ~ DISTANCE TO: Building foundation NO. OF BEDROOMS Absorption area inside length Material Width Dwelling Foundation,~.(~ / Total length~2es Material beneath tile Depth Crib depth PERMIT NOel0 No, of compartme_nts Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line~/~) / inches inch es PERMIT N O.jl~/ Distance between lines Total e f fective absorptj ort.are¢. PERMIT NO.~~ Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tan k Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTAELER LEGAL F'ERM I'T NO. L.~P'PIP: I I'IPJ"¢. I LJ~ ~"I~H.L I M HNL) ~:'J",D,,' I h:LINI-']~:.N I P'IL P I [ b.l..: I 1 UI",t 82D "L.',,-~STREET., FINCHOF.:FIGE., laK. 995,_ .~. 264-4?20 ( 8:1. E~4Et7 ) APPLICANT LOCATION LEGRL ROGER ELSHOL..Z 2408 W 6?TH. OUR LANE ROR[> LOT i0 BLK 2: KIMBERLY NRNOR StJ LOT SIZE ;F:,4. E:-i477 22000 SQUARE FEET TYPE OF SOIL. I=IBSORPTION SYSTEH IS: PIT MR',:.::IN ...... li',i .NUMBEF.: OF EE[:,F."InI-IM'~ = ?.~. SOIL -'hAl .... INa' '" THE REC!LIIRED SIZE OF THE SOIL laBSORPTION '--;YSTEM IS: THE LENGTN DIMENSION IS THE LENGTH '-'.'IN FEET.'." OF EFICH SIDE FOR A SEEF'RGE PIT. TNE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN TIdE SURFACE OF THE GROUND RND THE BOTTOM OF THE ENCR'-',"RTION '-'.'IN FEET.'-". 'THE GRA","EL DEPTH IS THE MINIMUM DEPTH OF GRW',"EL BETWEEN THE OUTFlaLL PIPE AND THE BOTTOM OF THE EXCA"/ATION '.'.'IN FEET.'.". PERMIT APPLICANT HAS TIDE: RESPONSIBILITY TO INFORM ]"HIS DEPRRTMEN]" DURING THE INSTRLL. ATION INSPECTIONS OF FINY WEL. LS RDJlaCENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPRO',,,'AL BY THIS DEPARTMENT WILL SE SIJBJEE:T TO PROSECUTION. MINIMUM DIS'TRNCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS iOEI FEET FOR A PRI",,'ATE WELL OF.: '1_.5~ TO 2¢"IE~ FEET FROM A PUBLIC WELL [:,EPEND!NG UPON THE TYPE OF PUBLIC HELL MINIMUN DISTANCE FROM B PRI',,,'R'f.'E WELL TO R PRIVATE SEW. ER LINE Ibm :.'.:'5 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRE[." Ah,ID MLIST SE RETURNED TO THE [:,EPRRTMENT WITHIN ]:l:.] DRYS OF THE WELL COMPL. ETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE A',,,'RILRBLE TO INSURE F'ROPER INSTALLATION. I CERTIFY THAT :L: I AM FRMILIFtR HITH THE REQUIREMENTS FOR ON-SITE SEWERS'] AND IdELLS las SET -'ORTH BY ]"HE MUNICIF'FIL. ITY OF ANCHORAGE. ': I WILL INSTRL. L. THE SYSTEM IN ACCORDANCE WITH THE CODES. : I UNDERSTFIND THFIT THE ON--SITE SEWER SYSTEM MFIY REQUIRE ENLARGEMENT IF THE ]SIE:,ENC:F IS F.:E~]3[:,EL.E[:, TO IN. CLUE:,E MOF.'.E THlaN 3: E:EDROOHS. PERFORMED FOR: LEGAL DESCRIPTION: 1¸_ 5 6 7 8 9 10 11 12 13 14- 15 16 17 18 19 20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION 825 L. Street, ~r~chorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST .~,. 06~ ~f'~' ,~ l,'~h 0 I '~' DATE PERFORMED: [] SOILS LOG PERCOLATION TEST SLOPE '-/ SITE PLAN !/ ENCOUNTERED? O P IF YES, AT WHAT ~/, E DEPT.: //~ '£/, ReadingDate Gross Net Depth to Net Time Time Water Drop / /~/~ /,¢., ~,¢¢, ~/ o / ~ /o,:~,~~ i.~.' /~ ~ ¢ ~ PERCOLATION RATE /J (minutes/inch) TEST RUN BETWEEN 3' FT AND '~ FT COMMENTS ~-~,.,,, -/¢¢.~../ tX;. ~.// B~, ~ w~/6 n,~.4.&,~¢ ,~ ~'.g~. ~ ~.,~,,~ PERFORMED BY:.~g,.~_. ~~+ CERTI Fl ED BY: _ ~~__~/~AT E:/~, .~/ 72-008 (6/79) > MUNICIPALITY OF ANCHORAGE ~ DIVISION OF ENVIRDNMEN~DtL HEALTH , DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1. General Information Application Date (a) Legal Description (include lot, block~ subdivision, section, township, range) (e) Applicant is (che~ o~) ~nding Institution ~; ~r~~~; Burr ~; ~er ~ (e~lain); (d) ~nding' Institution Telepho~ Address (e) Peal Estate Co. & Agent Address Telephone 2. _T~rpe of Pesidence Single-Family Number of Bedrocms 32 Water Supply e Multi-Family O~er (~s~i~) Individual Well ~ C~',munity ~-~ Public ~ Note: If c~nity ~ell system, must have written confirmation f~cm the State Department of Enviror~rental Conservation attesting to th~ legality and status. the nun~er of bedrcc~s specified in this M3~ Is the ~11 adequate for Sewage Disposal Is the wastewater disposal system adequate for the r~mber of kedroa~s ~i~, ~[?d~<? [Page 1 of 2] 2-15-84 Se Engineening Firm Providin Ins ctions, Tests, Dsta and Information ~ ~ I certify ~t I have chocked, ~'~2ified, o~' ~nfom~d to all [~DA HAA Guid~lims ~in effect on the date of this inspection° Signed ' ~ ~ ,'>~4] r- Date , Nan~ of Firm ~-_~_~.> Telephone Signed by Date 6. DHEP ApDroval. Ap~oved for App~oved~ ( ENGINEER SEAL) Terms of Conditional Approval The Municipality of Anchorage Department of Health and EnviroP~n~ntal P~otection dces not guarantee the continued satisfactory performance of the wate~ supply and/o~ the wastewate~ disposal system. This approval indicates that, as of the validation date shcwn above, based on the data and information furnished by an engineer ~egistered in the State of Alaska, the wate~ supply and wastewate~ disposal system is safe and func- tional for the p~mbe~ of bedrccm~ and type of structure indicated. (DHEP SEAL) 7. Ma'~l the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 Well Classification Well LOg esent Total Depth Static Water Level ~ q.~.~ ~,, Pump Set At Casing He ight Above Ground Elect~icaI Wiring in Conduit (Y~) Separation Distances f~m ~.~11: To Septic/Holdin~ Tank on Lot Wate_~ Sample Collected By Wate~ Sample Test Results Cor~rents ~ ~(~ ,, Depth of G~outing Sanitary Seal on Casing ~N) Depression Around Wellhead (Y,~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ,/(~O<./f-©.,, ~ On Adjoining Lots To Nearest Public Sewe~ Line /~f~/~ To Nearest Public Sewer Cleanout/Manhole ~J/~ To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed ~-~/!~ ~,~ i Size _ l~0 No. of Cc~,t0a~tments Standpi~s ~) ~'~i~-tiGht Caps ~) Foundation Cleanout P~ing~intenan~ ~n~a~ ~ File (Y,~) ~ ; for '- Holding Ta~ High-Wate~ ~a~ (Y~) ~/~., Te~y Holdi~ Tank Pe~t JY~) Separation Distan~s ~ ~ptic~Hol~ing Tank: To Water-Supply ~11 (~ ( ~ To ~ilding F~ndati~ ~{~ C. ABSORPTION FIELD ~TA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption A~ea Depression ove~ Field (Y~ Results of last Adequacy Test ~.~t Type of System Design Length of Field ._~/~ Depth of Field G~avel Bed Thickness _. ~Tz~~/~t~-~ ~'~g~'~ Standpipes P~esent ~N) Date of last Adequacy Test . Separation Distance from Absorption Field: ~ To kt~ter-Supply Well l~/g) To P~ope~ty Line '~ ~ To Building Foundation ~,~/ 0 TO Existing Or Abandoned System on Lot ~ / ~ ; On Adjoining Lots (~ ~C~p.~f ~7 TO Water Main/Service Line ~/~--- To Cutbank(if present) To Stream/Pond/Lake/c~ MajoF D~ainage Course l~.~/ To D~ivew)~, Parkin~ A~ea, o~ ,Vehicle Storage Area .~/t~ ~ De Date Installed "~---.~ Dimensions Size in Gallons ~ Manhole/Acce~s~.2-YTN$ "Pump On" Level at ~.~ "Pump Ojf~f"~Levei at High Water Alarm Level at ~.~-.~ Vent (Y/N) Tested for Electrical Codes(Y/N) Coran~nts .... Cycles g cy Test. Meets MOA Check Pc=mitred Bedroom RatinD A~ainst HAA Rmquest I certify that I have checked~ verified~ o= conformed to all MOA HAA Oaidelines in effect on the date of this inspection. Signed ~///~ ~/~-t ~/'~'~, Date co. any KB1/d5/s [Page 2 of 2] 2-15-84 ~~ E (907) 562-2343 ANCHORAGE INDUSTRIAL CENT~ER - '- ."a , ~ i ' ' ;" ':i~;;' :' ' 5633 B Street" ! . ' . · ' g W~ter Analysis Report for Total C°lifor~Bacteria TO BE COMPLETED WATER SYSTEM: I I Water System Name Mailing Address cry WATER SUPPLIER I,D. NO, Phone No, State ' Zip Code TO BE ~30MPLETED BY LABORATORY lysis shows this Water SAMPLE to be: /~J~atisfactory [] Unsatisfactory [] Sample too long in transit; sample should not'be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. ? Mo. Day SAMPLE TYPE: -I~l~l~ut Ina n" Check Sample (for routine sam with lab ref, no,. n Special Purpose SAMPLE NO. ' LOCATION ~'i: -~?. · ~ ~/Treat ed Water' Untreated,Water Time Collected Collected By Date Received . i' Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst READ INSTRUCTIONS i0~1220 ~) BACTERIOLOGICAL WATER ANALYSIS RECORD BEFORE COLLECTING SAMPLE Membrane Filler:. Direct Count Verification: LTB BGB Final Membrane Filler Results ~ Repoded By. TNTC= Too Numerous To Count Collformll00ml Collformll00ml Da,e ?-/?- _. Time: ./,~-'-'~;~ a.m.