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Home My WebLink AboutLELAND STANFORD LT 1P 11 dak allolk. ��5-ani-3l Deve ioym.^t Services Department BuiiGing sarety Division On-S,ite Water ' Wastewater Program 4700 �ragaw Street Mark Begich :��;c��arage. AK 99519-6650 Mayor:'+'Surra/onsst,. ,(07) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description y fit.} L �a ` /Y J /%n%lfDR /j Property Owner Name & Address: Pt�Di, 5ivhP57(\1 IL`'�b0 �V'F.�l."A'1Ct2Tl7ST>�'Z=1�T Pump Installation Date: 1-2- ,2Pump PumpIntake Depth Below Top of Well Casing: j q feet Pump Manufacturer's Name:+2Kk� Pump Model: 67 py,M 50-5231 Pump Size 1/2 hp Pitless Adapter Burial Depth:0I feet Pitless Adapter Manufacturer's Name: ryil�d7�i>L Pitless Adapter Installer: N i q Well Disinfected Upon Completion?fzYes ❑ No Method of Disinfection: el- I- Comments: Pump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMFNIAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet - Anchorage, Alaska 99501 Telepholephnnn 2.64-4720 ON-SITE; SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPEC-I-ION REPORT NAME /1� }��---xL_.'_,.A..___�.-__.�.._.�...__..__ iA--�-_ -�� r� i �N!`Il✓ - -- -- PH%O%NE 7� 'y NEW /l.j / /r ❑UPGRADE MAII"NG DDRESS (40 ---— LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS We Absorptio area Dwell PE I' NO. UY DISTANCE TO: `b�� 7 �k --j'9 — N Z Manufacture a Q /s Mat�ial UJ No. of�C; mpartments Liq, ca �ity in gallons IF HOMEMFlDE: Inside length Width Liquid depth Z Z DISTANCE TO: Dwelling PERMIT NO. O R T -Manufacturer aterial Liquid ca pacity in gallons w x W U DISTANCE TO: �iIC� ( `` Foundatio Neatest to line c�t-�`'' PERMIT Nl� a l� z ¢ No. of lines Len th /(. eacl line —� g Total leng t f ies Trench wJ th`� �4 �`-� inches_ Distance be}p+ye�.n lines /(L/ 9 . Q P tt Top of tile to fii isf de J._ y _ Material beneath tile - ( -L-/ -- Total effec�t)ive absorption area w Length Width ry Depth cy PERMIT NO. C7Crib a H wa Type of crib di Crib ameter depth _ Total effective absorption area w W DISTANCE TO: Well Building foundation Newest lot line .a a w Class Depth Driller — Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS - SOILTEST TING INST LERt I - - REMARKSt —i - Ab A OVE DATE LEGAL c-vi� �nev. olio) NATER WELL RECORD STATE OF ALASKA DEPARTMENTOF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or Ic.) A.D.L. No. la. Borough ppSubdivision Lot Ib. 1 1/4 gIrs. Section No. Township N ❑ Range E ❑ Meridian ,Block /� `7t -C srf qt L -i —of -01 I S❑ W❑ Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WEL f Address: f Street Address and Area of Well Location i 4-1101 (.��1%�-r 1� �t/LG./ �r;��C)•'� 2. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Material Type Top Bottom f%, _ r-_, b 6.❑4, 'Coble tool ❑ Rotary ❑ Driven ❑ Dug ❑ Auger ❑Jelled ❑ Bored ❑ Other: f � e,�,,,•„-;.,'.rrJn..�• • ✓ , �j;a 7. USE: ❑ Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑Other: TY/!�• J rl - • � > - - /,rte/t.,�. 6. CASING: ❑ Threaded ❑Welded diem. �_ In. to %'/I ft. Depth Weight ! `'r Iba.�fI. .%�-r....-r:;• (j <_.f�. ' y �, d„r.>1�7. fa `�'y/ diem. In. to ft. Depth Slickup ft. 9. FINISH OF WELL: Type: �?�!''"r= .i�(i C. Diameter Slot/Mesh Size: ^--"" Length: Set between ft. and ft. Backflliinq Gravel pack _ 10. STATIC WATER LEVEL: ,-/;) ft. ❑ Above or ❑ Bolow loud surface Dote Equipment used: l`--r.r.-' I I . PgU,jrIPING LEVEL below land surface and YIELD ft. after -"R hrs. pumping../•SI- g.p.m. ff. of ler hrs. pumping g. p.m. 12. GROUTING Well Grouted: ❑ Yee �❑ No Material: ❑ Neat Cement ❑ Other: 13, PUMP: (If available) 11 Length of Drop Pipe l,�,.�. ft. capacity 9 -P.M. y = Subm. ❑ Jet ❑ Centrif Teal ❑ Other 14.REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature —0 ❑ F ❑ C This well/was drilled/6-4delfmy )urisdiicclion and this report is true to the best of my knowledge and belief; P. 47egiste}}re``d Business Al Contract License Number CNo ( Address: /"/ G�^,aC:v�l'- f-�'• li��,.,.a� / Signed : n/(J�,..._: k.. , `;:. ! l-/•`4.... P-.- Authorized Reef sentolive —' Form 02-WWR (11/61) Copy Distribution: WHITE -Stole DGGS, PINK -Driller, CANARY-Cuslomer r.1 U r4 1. c: I F=, n #_ I DEPARTMENT ( HEALTH AND ENVIRONMENTAL OTECTION 825 `L- STREET, ANCHORAGE, AK. 99b JI 264-4720 W FEE L_ L_ rx gal I -r F -E :E; F= L-A EF_ FZ F=* F-7 R -C rq 3E _lF PERMIT NO. 821_718ES9 APPLICANT RUSSELL L ANDEWAY 35605 ARCTIC #119-7 99503 LOCATION LEGAL Ll LELAND STANFORD LOT S12E 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS =: 3 SOIL RATING (SO FT,,BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS.: 1>E:F=:`l-"== :�:R -1 CF. :3lF;ZFlVUlL_ E=' THE LENGTH DIMENSION IS THE LENGTH :IN FEET) OF THE I-RENCH 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 < I N FEET). F;;?E-rf--NLJXFP'E:L--'- -r"1-=ijr-4lK_" ::Lc -loo C3ni PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTION'-=.' OF ANY WELLS ADJACENT TO 'THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. MINIMUM DISTANCE BETWEEN A I -JELL AND ANY ON--'-=*,Il'E SEWAGE DISPOSAL SYSTEM IS 1.00 FEET FOR A PRIVATE 14ELL 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. 41ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. Cll-=�F=lr-lE3*EElFR.* =< :IL , __lL � I CERTIFY THAT 1: 1 AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND I -JELLS AS SET FORTH BY THE MUNICIPALITY (IF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SE14ER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ASIGNED:- A APPLICANT RUSSELL L ANDEWFlY TcZ,:ZHrr,. QV il , - .4, - - - � - - - - - . . - - . _ . . .. . . - Grl I r, j - - V-4. el n F; a F-4 I-= 0_ L-1 I F; EE r --d BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A I -JELL AND ANY ON--'-=*,Il'E SEWAGE DISPOSAL SYSTEM IS 1.00 FEET FOR A PRIVATE 14ELL 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. 41ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. Cll-=�F=lr-lE3*EElFR.* =< :IL , __lL � I CERTIFY THAT 1: 1 AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND I -JELLS AS SET FORTH BY THE MUNICIPALITY (IF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SE14ER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ASIGNED:- A APPLICANT RUSSELL L ANDEWFlY TcZ,:ZHrr,. QV il , - .4, - - - � - - - - - . . - - . _ . . .. . . - Grl I r, j - - V-4. el Began C% CIS /�d G - ` Hole No.:'.... �.. �.^ .. .. Ic Comp/a/zd /00WLING-JOHNS sneer of Na / Engineers — SurVe/OrS o oject Na Anchorage, Alaska ojeL ame P�/1� d sY�Li/Zi CIDP / G -thod Used /d Port y Geologlsl LCL�1j Ground Water roble Oeplh in Fl. rim e DESCRlPrION Sol/ /ype, co/or, lexlure, Dole ' olhe� �— • ?ompllnqR DESCRlPrION Sol/ /ype, co/or, lexlure, Locolioo Na/es E Dicgrcm: L:o-.o. esl/moled porlicle site, c : •,' a t m �- •C $ sampler drlv/ag noles, •L lost .. 100.;... r�.O .. ....., .. ,,:., ,•., LL• � c n dep/hs cireulolion F � , ,; • , noles on dr!l//ng ease, b/ls- used, e10. oo oAli/;;'. .`i , 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015-291-311, HAA # 1. GENERAL INFORMATION Complete legal description Leland Stanford Subdivision Lot 1 Location (site address or directions) Property owner -Mailing_ address Lending agency Mailing address. Agent Address _ 10360 Evergreen Street Anchorage, AK Russ Andeway 10360 Evergreen Street Day phone 562-2244 Anchorage, AK 99516 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 31 ) 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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(Rw.1/81) Front MOAU21 5. 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 files 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 Address Engineer's signature Alaska Water 8 Wastewater Consult an Shall be PAID or prior to, closing for the Engineering Services Prov 6. DHHS/SIGNATURE Disapproved. Conditional approval for Approved for 1 SEE bedrooms. Additional Comments By: — r Phone 33 7– 6 /7c, i bedrooms, with the following stipulations: Date 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-M (Rev. 1R1) Back MOA 021 RECEIVED APR 15 1999 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC�VICIPALITY of ANCH(0 Environmental Services Division ENVIRONMENTAL SERVICES DI 325 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LagNo S74AIFOKD , Z07 ( Parcel I.D.: A. WELL DATA Well type ��111P, C _ If A, 8, or C, attach ADEC letter. ADEC water system number Log present ON) �CS Date completed _ '�" 2 3 N% Total depth 741 Cased to Casing height (above ground) (off _ Sanitary sea(((Y)N) LS Wires properly protected (Y/N) FROM WELL LOG Date of test _ r/ " 2 � , 9 ;)L— Static water level q1 Well production d5 g.p.m, AT INSPECTION VIA /79 33c`> r w g'/v14.YC1 ,a g.p.m. WATER SAMPLE RESULTS: Coliform / % � Nitrate+�� (J R ' Otherbaccteria ��qy Date of sample: q5 -�(�� I�7 Collected by: i - W. e B. SEPTIC/HOLDING TANK DATA Date installed 13 ($ 2 Tank size 1600 Number of Compartments v2 Cleanouts ON)_ ,L_ _ Foundation cleanout (YA!P0_ Depression (YI& `fib _ High water alarm (Y/W> LJ A Date of Pumping O Pumper IVORfi+LPd•�D Cun.a W6 C. ABSORPTION FIELD DATA Date installed 2 Soil rating (g.p.d./ftz or it2/bd " �S System type 'IEP (2� it PEA+r FIELD Length (, Width Gravel thickness below pipe . Total depth A4 FA Effective absorption area ASS SF Monitoring Tube present &Y N) (/E5 Depression over field (Y/ l � Date of adequacy test- 2 °i Results (Pass/Fall) � S For �T4lR. t bedrooms Fluid depth in absorption field before test (in.); DKA_ Immediately afters` 6 gal. water added (in.): 68 Fluid depth DKY (ins) Minutes later: a) ij Mi Absorption rate = _ * a.p.d. Peroxide treatment (past 12 months) (Y/Qy t*202 LLE!;,? If yes, give date 72-026 (Rev. 3/96)' Mi FOLI N ✓D To E- X 7E" 0 ONLy 6' fnj'ZD SEwpt 2ucrc fe; 6acLo(r• ZNU, �-} ((V1rt F �i 112E0 ZiSc2 13)/ A* Home SEkWceT) D. LIFT STATION � l� Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES in gallons "Pump on" level at* "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LO TO: Septic/Ig tank on lot /DQ / On adjacent lots Absorption field on lot F1 eld rnQASuse iv6� t _51,04 On adjacent lots l 1 �•Seeatfachec/rtSba,'GFSurvu,d�ecG`f-� -99 Public sewer main Public sewer manhole/cleanout Sewer /septic service line o1S a- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r� r Foundation rO Property line 10 � Absorption field T pea- Water eeWater main/service line Surface water/drainage /00 ? �_ Wells on adjacent lots (UU SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain 0 ti Building foundation ( d 4 Water main/service line Oo 4 Driveway, parking/vehicle storage area PON ")i )i Wells on adjacent lots F. ENGINEER'S CERTIFICATION �.,•� *°�"b P PA SOF A 1 certify that I t rm' field inspections and review of Municipal r in conforman e itO g 'delines in effect on this date. / /p1 00 ems are Signature Engineer's Na a WJ E_ l + Jnr,/LJt) y X � • GE 7453 `` cf'�, o• Date �/� a'��1 1 `�� ,o. M.�'.401 yws l HAA Fee $ y 0-0 1 M Waiver Fee $ Date of Payment 1 / s-% Date of Payment Receipt Number. C Receipt Number 72-026 (Rev. 3/96)* �MEJ� �i mcny �roQN w m C H 9Fm CC9z9zYY r— .Agacl -a rl r- A N z tj --I tj g3a PI �0 ''-I '0 00 o 30.0' r, /rri 7 EVERGREEN N 0001'18" F_ 4-14 FT W 135,34 FT o 171 co I� V� N 0601'17" E T e . • A r-- rTl F11 A w � � m b � � A W 135,34 FT o 171 co I� V� —2F r i m r- e r a F11 f'1 � —2F r i m r- ---� r a F11 o 0 t`j CDC) a -Tl � � A C A�TAF r- 35.21 F I G —2F r i m r- ---� r a o 0 t`j CDC) -Tl nF- 1 � A C r- 35.21 F I a APR -09-99 10:02 FROM -VE ENVIRONMENTAL 5615301 /t ME Environmental Services Inc, CT&V Aef.# 991386001 Client Name AK Water & Wastewater Consultants Inc Praject Name/N Leeland Stanford S/A Lot 1 Client Sample IA Leeland Stanford S/0 Lot 1 Matrix DrWang Water Ordered By MID 0 1-9!7 P.02/Ul F-597 Client FM Printed Date/Time 04/09/99 10:26 Collected Date/Time 04/05/99 14:00 6teceired DAWThne 04/05/99 15:00 Technical Director, Stephen C. lade Relmed By SM92223 - aacterielsample invalidated due to laboratory error. Resample requested. Allowable Prep Analysis Parameter Results ARL units Merhod L 1111 IS Oate Dole inir Nitrat e -N 2.43 0.500 Rig/, EPA 300.0 10 man 04/06/99 04/06/99 Wi. .n /D N 1) C , N _ LTJ L w CL "pro : a, : zr � cz m CJ Time APPL' 'ANT FILLS OUT UPPER H/ 7 ONLY Time Properly Owner ) 5 I .i o(-JSLO'Cc a Date Mailing Address J % ��`; / l-«_ `� (I `I J �„ Zip Code Date f Buyer Inspector Inspector Address Zip Code Lending Institution OF ANCHORAGE 91 Field Notes:"' --01 Phone Address l.c.-) Zip Code r �, .- j 0o Realty Co. & Agent < Phone Address h:i Zip Code Legal Description �.- .w_ � r� .. I 'CONDITIONS OF APPROVAL Street Location (; �t-- ,,� 1 _, p _ C Type of Residence 13 I, Single Family Date Sewer Installed Well To Absorption Area Well Log Received ❑ Multiple Family No. of Bedrooms Well to Tank Septic Tank Size ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Individual Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time `� o(-JSLO'Cc a Date Date Date Date Inspector Inspector Inspector Inspector MQNIpjpALITY OF ANCHORAGE 91 Field Notes:"' --01 kNVIRoi did .f „ A . .v i -(-TION rrp ))`.), < � h� HIM ,_r h:i - ( N) APPROVED BEDROOMS �) 'CONDITIONS OF APPROVAL ( DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE�"- 13 Soils Ratir G_, Date Sewer Installed Well To Absorption Area Well Log Received ;". Well to Tank Septic Tank Size 72 923 (3182)