HomeMy WebLinkAboutLOMA ESTATES BLK 2 LT 5
~"-~UNICIPALITY OF ANCHORAGE/-~
He& .~ and Environmental Prote~ mon
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
INSPECTION REPORT ON'SITE SEWAGE DISPOSAL SYSTEM
NAME_~, ,~. BE_L~,RDF.
LOCATION
MAILING ADDRESS (¢ ~ ti
LEGAL DESCRIPTION /'"'
SEPTIC TANK:
DISTANCE
FROM WELL lO0 +" .
INSIDE LENGTH
MANUFACTURER.
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY ]~.o GALLONS.
DEPTI]:
TILE DRAIN FIELD:
/
DISTANCE FROM WELL 1OO ~ FOUNDATION ~/
.NEAREST LOT LINE. I0 '~ OF LINE
# of Lines I DISTANCE BETWEEN LII',IES ~I,],/A TRENCtt WIDTH 3~ IN. TOTAL EFFECTIVE
ABSORPTION AREA__ '~O SQ. FT. LENGTH OF EACH LINE
TOP OF TILE TO FINISH GRADE ~ ! DEPTH OF FILTER ,
N1ATERIAL BENEATH TILE ~ ~. ABOVE TILE ~ IN.
SEEPAGE PIT:
Log Crib Rings
BUILDING FOUNDATION__
DIAMETER .. OR WIDTH LENGTH DEPTH
Crib Size: DIAMETER .... DEPTH_ DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA)
SQ. FT.
Well
Class: IND. Depth: ~
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials:
~ of Bedrooms:
Installer:
Remarks:
DATE .~_~ .. APPROVED
1201 Ramona St. 99515 ANCHORAGE, .~t~LASKA
344- 714
SIX INCH WATER WELL DRILLED .......... OUT TO THE DEPTH OF'. 355 feet.
DRILLED AT THE RATE OF ........... PER FOOT. Steel casing seated out to 63' ·
PROPERTY OWNER Mr. John Belarde ~49-74~5
LOCATION OF WELL SITE Lt. 5
Bernie Claus of
DRILLER
WELL LOG:
0 - 23'
Blk. 2 Loma Estates Sub.
Rampart Drilling Works.
~ilty sandy fine gravel with 30% clay binder.
23 - 63' Hardoan. A cemented gravel material.
63 - 355' Bedrock. A very hard sedimentary rock, yielding water only ~n
the last' 45 ft. of drilling. Fissures & cracks in the bedrock allowed about
one to one & one half gore from 310 ft. to 35~ ft. From 351 to 353 ft. a
oorous rock materia~ yields about 2 1/2 ~pm. T.~t~l w~t~r ~d,~.f.~ .~h~ ~.
steady 3 Mom for lon~ duration pumping ?~, ebout 4 g0m after f~ll dr~wdown
during short duration oumoing. (About 45 minutes.) In dry seasons this Well
slows down to about 2 g?n. 120 gallons ?er hour. Water recovery comes back up
to within 55 ft. of surface. A 4~' plastic liner was installed to the bottom
of the Well & perforated the bottom 60'. This is a heavy wall (1/4 ~) liner
· .stallec by Mr. ~eo gawyer the same year the Well was drilled. (1978).
This Water Well was paid for in full by Mr. Chili B~larde.
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK pAyABLE TO RAMPART DRILLING WORKS FOR THE SUM OF
~ERNIE CLAUS OF~RAMPART DRILLING WORKS
DATE b~y 1; 1978
F'ERH I T 1'.IO
FI P [':' L I E: F:I N '1"
LF,:.:FIT t O1'.,1
LEGFIL
C. L"-;. E:ELFtRE:,E
L.5 E:2 LOHF-t ES'FFfTES
ENV ~ RONMEI'.4TFtL P ,'ECT I ON ~?~ Al
E:,EF'RRTMENT
Et:~LTH
FIND
E~2'.5 '" L" STREET., RNC:HORF!GE., FtI<:. 975k.,.~. I I; I~'L
,~,~
56 J.:J.. GREENHOOD 3:d.,4
LOT S I ZE 5]:7'S'~:t. 'E E:!LIFII:~:E FEET
T"r'PE OF SOIL FtE:':;Eff4:E:'I"ION S'¢STEM IS' "['I;::EZNCH
t"It::I::-:;IHLIH t'.,tLIHE:EI;:: OF E:EE:,F.':OOHS = -.3..':
THE F:ELT.!IJ I RE:E:, E; I ZE Eft::: THE SO I L FIE:SE~F:PT I ON S"r'STEM I S:
THE LENGTH DIMENSION IS ]'HE LENGTH (IN FEE:T) OF THE TRENCH OR [.',Fd'qlNFIEL. D.
THE DEPTH CIE R TRENCI4 OR PIT IS THE E:,ISTF¢,tCE BETHEEN THE SUF..'FF~C:E OF THIE
GROUNI) FIN[::' TFIE BOTTOH OF THE E',:.:',CFI',,,'RTION ,::IN FEE'T).
THERE IS NO SET HID'f'H FOr4'. TRENCHES.
THE GF..'I:I'v'EL B, EF'TH IS THE MII'.,I.T. MUH DEPTIq OF E'iF.:F¢,,,'EL BETHEEN "['HE OU"I'FI:~I_L F'IF'E
FIND THE [3OTTC~M OF THE EXE:Ia',,,'RTION ,::IN FEET).
Ft PFICb'::RGE PLFINT MFI"r' E:.:E .II'qSTRI"~LE[:' FiT THE PEF.'.MITTEE'"S OPTION SLIEL]'ECT TO THE
F:OLL. OI,J~ I NG COND I T IONS:
t. EITHER FI CLF¢.:SS I OR II NSF RF'PRO',,"E[:' PLFINT I"1F1'¢ BE IN?I"FILLEE:'.
2. Ft C:ONT]:NUOUS i"IFIINTENFINCE: FIGREEHENT IS REQUIRED. IF' fq i"IFIII",ITENFIt",ICE:
FIGREEHENT IS NOT KEPT CUF.'.F.:ENT '¢OU HFt'¢ BE: F.'.EL.qLIIRE[:' TO [.:'N[...F:II;:GE 'T'HE SEI]:L
FIBL::.;ORPTION SYSTEM FIND,.'"OF.' '¢OU Ml":t"r' BE SLIB.3'ECT "l'l"'l PROE::ECUTION.
MINIPlLtM DIS"FRNC:E E:ETI4EEN FI HELL lIND RN'¢ ON-SITE C;EHRGE DISF'O::.-';FIL S'.?E;TEH IS
:tL:"iE~ FEET FOR 1::] F'RIVFITE HELL OR ;7_-'EiE~ FEET FOR R PLIE:LIC 14ELL.
HELL LOGS FtF.:E REL.-.!UIREE:, RNB', MUST SE RETUF..'NED TO THE DEF'RR'FklENT 1.4ITHIN 2:F'i E:,R"r'S
OF THE klELL COMF'LETION.
OTHEI:;.: REqLIIF':'.EP1E:NTS MR'T' FIPF'L'T'. SPECIFICf:ITIONS FIN[:' CONSTF.'.LIC:TION DIFIGRRP1S RRE
FI',,,'RILFIBLE 1"O If',!SIJRE: PROPER INSTRLLFITION.
I CERT I F"¢ TIq'FIT
1: I lar,1 FFIHILIRR I.,.ltTl-i "['HE RE(.:.!LIIREMEN]"S FOR ON--L:iI'FE SEt.,IERS RND HELLS RS SET
FORTH E:'T' THE HUNICIF'RLIT"r' OF RNCFIORRGE.
2: I HILL. INSTRLL THE Sk"STEf'l IN F:tCCORDRNCE 1.4IT1'4 THE CODES.
3:: I LIN[:'ERSTRND THFIT THE ON-SITE $EI.qER SYSTEM MR'~' REQUIRE ENLI:~RGEHENT IF THE
RE'.SIDENCE IS REHODELED TO INCLLIDE MORE THRN ]: BE[:'ROOMS.
t~PPLIC:FINT C.S. BEL.RRDE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 8-~;50, Anchorage, Alaska 99502 ~76-922~
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGA~ DESCRIPTION:.
~t.~L~Sp
1
2
3
4
5
6
7
8
10
11
12
13
14
16
17
18
19
20-
COMMENTS
DATE PERFORMED: /~'
/'~= ICOt
SLOPE SITE PLAI~
//. ~-~---:-~ ............... ~ . ~ - .
i
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
/_
Gross Net Depth to ]lXle
Reading Date Time Time Wa~er~,L~,,,~, D~ rc
PERCOLATION RATE + (minutes/inch)
TEST RUN BETWEEN ~-- FT AND / '~¢ , FT
,/ ......
.:' '~;~ ~ ' '¢~:~;~.,~ ,'.;.'-~-,--.:~.._-. ~ ~'¥,',~ CERTIFICATE OF HEALTH AUTHORITY.
: ?~ii:i':i.;,i_"~: ~.:'~ ~:-: ~ ':."~P~Ro~A~'~FORAS'INGLE FAMILY
. '¥C~mpl~'fe legal descriptibn%:..._ ~, ~, .-~ ~o~
.,
- · ~.'"*' ' , ~,;',-:'-" ....... ~,"-:'-' % _ L-'-'. ':.-? . _ '.. . ..'--
' L0~atiOn :": .,.,...,. .~..7/¢0'
(site ad,res8 or directions)
2. ~ :'NUMBER OF BEDRO(
3 TYPE OF
....... NOTE:
4.--:TYPE oF WASTEWATER DISPOSAL:
,,,..'. AS' '~ ~ !::i" '~ '!-:' cert T ca'1""" ' ? "!'=; i ''L''''- oy m, y s ....... aa~'~'~"aff "~7%'~"'"': ~xed hereto" "' ~""' :,, and · as""' '?"of the ': validat ,,. ,, ~q ~ ·, f,,.,,r',.:,: .,. ?,,i~,~ :-;~ ~,;~,, ;.. ~.,.~ ..... 0n'~late.~: .., shown ,,~., ~=~ be.: ~'~
:.. inve~tigati0r{ of this Health A~{h~ri~'APpr0val ~pPliCati0n' shows that the~or
',' andlor wastewater disposal system is safe, functionaiand ad~l~u'a~''f~r'tl~e;'~ ,bet Of bedrooms
' arid type of structure ind cated herein. I further verify that based (~'~'ih'e inf~rm~ii~)r~ obtained f~om:''~:-
the Municipali~ of Anchorage files and from my invest~at'i0h ~and 'ins~eCtion;:'~h~.0n~site Water
supp y and/or wastewate~~d sP0~ s~stemis in'c'~plian~ith. ~11 .Muhicipal .'a~:~ St~tecodes;
' 'ordinances, and r~lati°ns ~n'eff~t on' the dateof th'is insp~ioh;.~':
· ,' ,.t~,', "~ ~,. .. '. · . '~&';~ . .:..~..'.~V ~'"" .
,, ~.. ~ ~'~,.[ .'-~ ~__~ ~., ~4~/~.G..~ ~honer.. ~....:~1
-" _.. Name of Firm ' ~ ~ ~ ~ ~'~
.~ /..., Addre~-
':~,':'~';::~-En~n~ssgnature""', "~~ ~ ..... ~ ..... Date
Z "' '~' ' ~=.,' - ' 2' ,,,. ;~ .............. ' ....... '~:
6: '''? DHHS SIGNATURE
a of AnChora e' DePar[ment Of Hea th 'and Human' Se'~i~'e$"!(r
Certificates based only.upon the representations gwen...,!.n,, L, rag?a~
;~;i'~m~l ~nn|n~r r~n ~.tere~l rf~he state of A aska The DHHS do'e$'i s asar~: }urchase~S of I~om~
their lending institutions in order to satisfy certain federal and state i u~r.e ,m~ 'r~no,.u~
' .:nS,~o~::an~ e ~s .......
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~:~r'~' ~COc. J(...Z, /--.Orv~A ~:::~'rAT~;5 Parcel I.D.
)
A. Well Data
Well type R~~'J/~-~'L~
Log present (Y/N) ~
Date completed
Cased to ~'-'~ / Casing height
Total depth .~ ~_.~, I
Sanitary seal (Y/N) ~
If A, B, or C, attach ADEC letter. ADEC water system number --~/I / '7 8 Driller
Date of test
Static water level
Well flow
Pump level1
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
h
_ S~~ _ S E~/
!
L)~J~ o ~3,J .~ ~oo
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~
Sewer service line
~ /DO t
~/DO ~
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform C)
Date of sample:
Nitrate
.ii) ~//.. Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 5//7 ~
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size
Foundation cleanout (Y/N)
gOO ~-IA-4. S. Compartments '"-7-'-~ O
'"'~ Depression (Y/N)
Alarm tested (Y/N) /V~/A
Pumper 0/4) /1/~C..?~0/JA,-L~'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot '>//2~2
To property line :>
Surface water/drainage
On adjacent lots
Absorption field
Foundation ~---
Water main/service line
'75'0 ~'
72-026 (3/93)* Front
. ~" b : ~ CONTINUED ON BAC~ PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
~~~~'~ Manufacturer '~J~ IA
,.~s(Y/N)
"Pump on" level at Man~es~ at
Cycles tested '~.~~
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed L.~L/7 ~
Length .~O ~ Width
Total absorption area f~L¢~ r'-~-, ~ Cleanout present (Y/N) "1/` Depression over field (Y/N)
Date of adequacy test ~:~/;~-~,-~O/~'~ Results(pass/fail) "~'~A'<~-S for .~
.:
Water level in absorption field before test After test
Peroxide treatment (past 12 months) (Y/N) /'4/. If yes, give date /"-//~
Soil rating (GPD/Ft2) /Z%~ Frr'~/~t~P~ System type i~6:~-P'"T~4 c/~
Gravel thickness ~ / /I ~.-/Z i
Total depth
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 7/00 / On adjacent lots ~./00 / Property line
To building foundation ~' 2'- -~ / To existing or abandoned system on lot
On adjacent lots '7/~ 0 ~ Cutbank -~ ~- ~ Water main/service line
Surface water '~/O ¢J /
Curtain drain
!
Driveway, parking/vehicle storage area > %*0 I
E. ENGINEER'S CERTIFICATION
I certify that I have chocked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
