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HomeMy WebLinkAboutT15N R1W SEC 8 LT 3 SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE ~.2759 OWNER OF LAND LEGAL DESCRIPTION '~'"/~"~'J ~ I ~ DATE - Started. Ended PERMIT NUMBER I lop DEPItl OF s, VELL ~, / ('" ,, STATIC LEVEL OF WATER F'r. DRAW DOWN FT. GALS. PER HR 7c~ ~ KIND OF CASING < 7tr~ ~ KIND OF FORMATION: From Z) rt. to ~ Ft. From ~ Fi. to ~' Ft. ~ From ~ rt. to--Ft. Fmm__.Ft. to Ft. From Ft. to~Ft From Ft. to.~Ft. From __ Ft. to Ft. From __ Ft. Io.__Ft, From Ft. to FI. From __ Ft. to Ft. From __ Ft. to Ft. From __ FI. Io.__FI. From FI. lo FI. From Ft. to FI. From Ft. to Ft. From__FI. lo · From Ft..to--~Ft. From Ft. to Ft. Fro,m ': Fl. to: · ' 'Ft. From Ft. to Ft. From , Ft. to Ft From Ft. to Ft. From Ft. to Ft. From__Fi. to Ft. From__Ft. to Ft. From__.FL to Ft. From__Ft. to Ft. From__Ft.. to~ JUL 9 1997 Munlcipa lb/o! AnchOrage Dept. Health & Human ~e~v MISCL. INFORMATION: DRILLER'S NAME /~, / ~ 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 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960110 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:ANTON BILLY J & MARGIE L OWNER ADDRESS:21332 BLAIR AVE CHUGIAK, ALASKA 99567 DATE ISSUED: 6/10/96 EXPIRATION DATE: 6/10/97 PARCEL ID:05109118 LEGAL DESCRIPTION: T15N RlW SEC 8 LT 3 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL 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. 1 SPECIAL PROVISIONS: RECEIVED  iMUNICIPALITY OF ANCHORAGE ~ DEPARTMENTiOF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street i Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DIspOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~EGA~ESCRIPTION ,.~ -- ( - LOCATION ' N~, OF BEDROOMS ~Z~ Manufacture~c~ ~ ~ J' M~e.~.~" /' No. of compartments ~ Liq.~gRacit~ allons ~ Inside lengt~ Width Liquid depth , ~ Well ~ Dwelling PERMIT NO, , Total le~bines Trench,> ,1 Well Building foundation Nearest lot line MU~LII'Y __ DEPI'. OF HEALTH & ~ C~ ~ ~ ~epth~- ,~ Driller Distance to lot Hne ENVII~I~fND.PRC)TEC'flON ~ Buildil~g fo,ndation S e~O~' ;"~ Septic tank OTHER ~ .? · SOILTESTRATIN~ ~ ~ . ~ ~ ~'-.~..~. ~* ~ 72-013 (Rev, 3/78) DEl- A~ f I lId 11 OF:' U L. tIE:AL. TH AND IE:I',IVIRONMEI',ITAL. S'T'I::~I!~ET, AI',ICHEff:~AGE, Al'::: 99',50 1 2 6.4.'"' 4.7,SX) F:'[EFIM I'F DATE AF:'PL~ I []ANT ADDRESS: CONTACT F:'H[)NE .: 84 () '757 09/06/84 BILL. AND I"IAIRGIE !317 :1. BOX CHLJbtAI.., AK 99567 :!L:D. EE II/dl IE: I....E(!~AL. DE[iCRIF':J SUBDIVIE;ION,~ iNA Lo"r:: 3 BLE)['_'.I<: 'NA SE[~TIOIq: 8 TOWIxlSHIF:': :LSN RANGE: :t.W I,..OT SIZE: ....... A (EiQ. F'] . [)1:~ ~CR[:SI ..... IflAX BIZDROOME~ ~ 4 I_i~vLed I:~(~]].o[,~ ape the C)l:)Cions; availab].e 'Lo you in desigrl:i, ng your' system. Choose '/.l'le op'Licm tha'L best f'J. ts yOLH- ]~: E~E ~:) IL,~ .,, ]3, F;','. ~:~, ]1:I1",,11 DEI:::'TH "FO F:'IF'E BCJTTOM (I::'T.) GRAVEL. DE:P1]'"I (1:-1".) TOTAls. DEF:'TH (F:'T.) L:~R(:~VE:L WIDTH (F:]".) GF,:AVEL, LENGTH (FT,,) GRAVEL. VOl_LIME (CU. YDS. ) TANI< SIZE: (GALS) EH]II,.. RATIIxlG (!E~G!. F:T. /BIR) · }~.'~. DEF:'TI4 "1'[) F'IF'E BOT'T'OM < Z;.5 FT. F~E:QLJIFIES ]:NSLJL.ATION · ~'~ DEP'I'I4 TI] F'IF'E~ BEI"I"'T'[IM '::: /I.,,O F:]'. MAY I:~E~:6E.I J: IRE: A LIF:T EF/"AT:[ON, · ~,x.'T'AIqK MUST HAVE A'T' L. IZAST 'TWO COIqF'AR]"MI~EN'rS c: (.~ 2. :3,, I alii '~'~l~.'J.].J.E~l' I.,.~:['Lh 'LJ'I~.~ f't:g~cJl.(:J.l"(~l[l(:~'l"l']:.~[[ {'c:}P Ol]"'"!i~li'L(.~:~ ~5({&~,~(-H'E~ al]d ~/~(.E~I.].~; ]'on'Lb by 'Lhe tvlunic::Lp~lJ'~.y of' Alac:hcH aqe (MO~) arid the .~L,:~i.(:. cH' Alasl::a. I w:i.].]. :i. ns'Lall 'Lhe Eiyi~i~'.,~ITI ifi &~C:C:I31"(:JalF)C::(~~ v,ItL'Lh ~,~],], MOA c:ocles al-Icj cd]d il"l c:c)fhp],ial]l:e ~Ni'Lh 'Lh(~ cJE:~s:i, gl"l c::r':i.'L(~H'ia c:)f' th:LEi I u~i].l adl"iel-e to all MOA ancl EH'..aCe cH' ~l,'~.~d::a r'cc, quipem?rrLs Fop the set back (Jis'L<~IrlC:('~; f'r'om any ~B~.~i~$t~l'lg we].l~, wastewa'Le[' disj::)c)E;al sys'Lem cH' public EHE}WE~P~:Ig~ ~sy!~'LE~[I CJI] 'LI-iJ.~ or' arly ad.jjac:fz~r~t OP l]0~al'by ].o'L, I L,u'lder's'Larld that 'Llqif~ per'mi'L is val:Ld for' a fllaxi~nt.uII oJ' q. I::)Odl'OCfills; al'id any enlar'gemgz)rrt will I'eqt,Hi.r'~:~ an add:L't, ior'lal I::)(::~Plil:i.L,, IF: A I..IF"F S]'A'I"ION IS INE;]"ALI.,ED IN AN AREA [;OVE]::,:IZD BY MOA BLIILDING TI"Ili~N (1) AI',I ELECTRICAl.. F:'ERMIT AND ]]xI,fl~PI~'~E:TtL]N MUST BE'] OBTAII',IE][); (Et) AS-BU]:LTS WIL..L. NI]T BE AF'F:'ROVE]O I,',II'I"I'-IOLJTI Alxl EI...ECTRI(]AI,. INSF:'E!:C;TIOIxt REPORT; AND (3) 'II'Ilia: IEIn. I!i[[]'FF,::[[',AL. WORK MUST BE: D[)NEi BY A I...]:CE:IxlE~ED EL. EC'I'F;:IE;]:AN. Ai::'I:~L..]:C~NT." B]:LL AND M~RGIE AN'I"Olxl MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street. Anchorage. Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST ~- SOl LS~-~O~ Yq OT s [] PERCOLATION TEST PERFORMED FOR: 'EGA"DESC",PT'ON= DATE PERFORMED: 1 2 3 4 5 6- -7 SLOPE SITE PLAN IIIIIIIIII III1[ 1,11 11 10- WAS GROUND WATER ENCOUNTSREO~ IF YES, AT WHAT DEPTH? 13- 14- 15- 16- 17- 18- 19- Reading Date Time Time Water Drop ! · .:pERCOLATION RATE' (minutes/inch) . . COMMENTS TEST RUN BETWEEN FT ~N~ -- FT i MUNICIPALITY OF ANCHORAGE DEPARTMENT, OF HEALTH & ENVIRONMENTAl, PRO'f EC'rlON [:NV RONMENTA ENG NEEF~ NG D V S 825 L Streeti- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM ANE)/OR WELL INSPECTION REPORT LEGAL DESCRIPTION Manufacturer IF HOMEMADE: NO'OEU ROOMS I Absorption ares D~?~llin9 PERMIT NO, Material~ J~4~? { compartments Inside length Ith Liquid ~11 -- DISTANCE TO: No. of~_~ Top of tile to finish grade Length Width Trench width .,E.~ ~t:'~F' PERMIT NO, absorption area PERMIT NO, :rib depth dSTANCE ' Driller DISTANCE TO: OTHER ALS SOIL TEST RAT~fNG REMARKS Distance to lot line . PERMIT NO, Septic tank Absorption area(s) APPROVED ;2-013 (Re'vd'3/78) DATE LEGAL MFFLI.,RI,IT BILL. RNTON LOCF:IT I i'"li'.,I E:OI.,.IEF'.'.r' LFINE I_E~PIL. LB1' 3. :,ED 8, F'.L,.N F,"/,I 825 "L" STREET, O l'-,I --- S :][ L~OO4. O5~ ) LOT ':' '~' ..,C'.PJI IRE FEET 'F'¥'F'E Cfi::' ,=,..Il_ RB:.,ORPTIIjN =¢~,=,TE.I~II,=,'-'.DRRINFIEL[, - ,:.. I-:, S;OIL RRTING (SI.T.! FT,..'BR)= 100 J"IFI>:;Ijr'IUI'"I NUM[:::ER OF BEE)RLIOi'4_ = THE REL.'.¢..IIF:E[:,:,I~.E'- '" OF TNE '-,::,OILI FIB_,URI' =' ='TION 5'r=,TEM'" "- ' I,=,.'""' E:"EPTH= 5 IL_ E It'-,~ CEi T [~ =._., :'- -:' "..-~':- "]i R f=ll %.' i L~ L-:. E: P T ~-I = LF DRFII NFI ELD. THE LEN~.~TH DINEN'=;IOtJ SS TH~ LENI3TH (IN FEET.¢ OF TNE TRENCH '" ' THE E:,EF'TFI OF' FI TRENCH BR PIT I~ 'THE DISTRNC:E E,E'TllEEN THE =,LRFHL. E OF THE GRRItND FIN[)THE. EuTTOH OF THE E~'.',C:I'3VFITIC~N "IN FEET::'. THE GR. RVEL DEF'TH I',='; THE HIHIHUN [:,EPTH OF GF..tRVEI_ L, ETHEEN THE OUTFRLL PIPE RND THE BOTTnH OF THE ENCR~RTION ,,'IN FEET). FE." EE ~ IIJ :[ I~:." Ez D ::. E Ii:-,. IF Z T F:I ['-41 I*:::'S. I ~ -" PERi'flIT F.,,PF:'LZCFINT HH,,., THE RE:SPI IN..,TRLL. P~ IEN IIi_,FEL. TIuH_ OF RI NLIHBER OF RE'.=.IDENCES TFIFiT THE ......... -IF" I...~ ~:~ ,:: ;L-"~. ::, ."E 1"-41 "E E, :I..kFII..L1N.~ OF RhF¢ '=''':' _, ¥_,TEM 1.41Tt [:,EF'FIRTMENT NILL E,E ,:,LIBJ'EC'f TB N.~IEII. IT~ TO INFOR, M 7HI=, [-~EPRR'FMENT [:'LIRINO TNE I'? P.IELI_S FIDSFICENT TO TtlI_, F'RF~PERI'"r' FIND TNE NELL I,.IILL =,ER E. IBI.JT FZNFIL IN_,PEL. TIUN RND RPPRO',,,'RL B'¢ I"HIS F F.O_ EL. LIT 1 ON. HINIP'ILIH DISTANCE BETNEEN FI HELL RND RN'¢ ON-SITE '.5EHRGE DISPOSRL S"r'STEH IS :200 FEET FOR R PRIVRTE HELL OR ZSE~ TO 200 FEET FRON FI PUBLIC HELL DEPENDING LIPON THE T'T'PE OF F'UBLIC NELL. hlININUM DISTI::INCE FROM R PRIVRTE NELL TO R PRIVRTE SE[,.IER LINE IS 25 FEET RN[:' 1'0 R COMMUNI'F'¢ SEI.4ER LINE IS T~'5 FEE'[ OTFIER REQLIIREHENTS MR'¢ RPPL.'.r'. ~ SPECIFICFITIONS RNI) CONSTRUCTION D:[RGRRM$ RRE W,,,'RILRBLE TO INSURE PROF'ER INSTRLLRTION. t CERTIFY THFIT 1: ,I FIN FFIHILIRR HITH THE REQIj_ IREMENTS FOR ON-=,I FE SE[,.IERS RND HELL=, -'= H_, SET F~ORTH E:'¢ TNE I'"IUNICIPRLIT'¢ OF ~NCI-IORFIGE. ;~.: I NILL INSTRLL TNE S'¢STEM IN RCCOR[:,RNCE HITFI THE CODE_,. ~: I I_IN[)ERSTFIN[:, THRT THE ON"-~TE 9ENER S'¢STEH MRS' REQUIRE ENLRRGENENT IF THE KE~IDENCE" I?/~EMOE:,ELED TB INC:~U[:,E HORE TNRN g BE[~ROOMS." /~ RF'PL I CRN~ BILL ....... .... PERFORMED FOR;_ 1 2 3 4 5 6 7 8 9 10 11 12 13 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILIS LOG -- PERCOLATION TEST SOILS LOG · o.o No WATER EI~COUNTERED? YES, AT WHAT D~PTH? [] PERCOLATION TEST SITE PLAN 14 15 16 17 Robed A, 18~ 19~ Reading Dale Gross Net Depth to Net Time Time Water Drop 20- COMMENTS P~RCO LATION RATE (minutes/inch) T~ST RUN BETWEEN FT AND FT PERMIT NO. MU~4I C I~"'~AL I TY OF A~¢~"~RAGE DEPARTMENT ~. HEALTH AND ENVIRONMENTAL .ROTECTION 825 'L' STREET~ ANCHORRGE~ AK. 90501 2~4-4720 t~ELL PEEH[T e0O3Bl > APPLICANT LOCRTION LEGAL MRRGIE CENTON BOWERY LANE T1,SNR1WSB L3 2205 BONIFACE #22 LOT SIZE 100000 SQUARE FEET MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDIHG UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LIHE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEER 1 T EXP 'r I~E$ DEI::EI'IBEE 3:-1.. I CERTIFY THAT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I HILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. S I OWED: APPLICANT MAROIE CENTON ISSUED BY .............................. DATE__. V4. 0 r.11_ll-4 1- m_.~ 1- F.i=iL_ 1- T'-r' .. ,_-1~ RNi~_.H,-IF:R~"~E DEPARTMENT 0F HEALTH AND'E/tVIR0/~MENTAL P~'0TECTZON 82~~' '~ STREET, Rt4CHORRGE, AK. ~"t ~ ~ 264-4720 PERMIT N .~7~-'~. -- LEGRL~tS~ ~[~ ~ ~o~ ~ LOT SIZE /0~~ ~URRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: MAXIMUM NUMBER OF BEDROOMS =,_~ .SOIL RATING (_c.Q FT?BR)= THE REQUIRED SIZE OF THE SOIL J~BSORPTION SYSTEM IS: DEPTH= LEI~GTH'-- G R F'-I*"." E L DEPTH= THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRE~CH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEE~I THE SURFACE OF THE GROUND Rt~D THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE A~D THE BOTTOM OF THE E×CRVRTIOt~ (IN FEET>. REl~.. U I P. ED SEF'T PERMIT RPPLICRNT HAS THE RESPOMSIBILITY TO INFORM THIS DEPRRTMEt~T DURIt~G THE IN-~TRLLRTION INSPECTIONS Of A~Y HELL~ ADJACENT TO THI~ PROPERTY AND THE NUMBER OF RESIDEt~CES THAT THE HELL WILL SERVE. TI-lO ( 2 ::, I t-4$PECT I Or-IS ARE REQLI I RED BACKFILLIHG OF RNY SYSTEM HITHOUT FINAL INSPECTIOti RtlD RPPROVRL BY THIS DEPARTMENT WILL BE ~UBJECT TO PROSECUTION, MINIMUM DISTANCE BETWEEN R HELL AND ANY ON'SITE SEWAGE DISPOSAL SYSTEM I~ 100 FEET FOR A P.RIVRTE HELL OR 150 TO 2~0 FEET FROM A PUBLIC HELL DEPENDIt~G UPO~I THE TYPE OF PUBLIC WELL. HIHIMUH DISTANCE FROM R PRIVATE HELL TO R PRIVATE SEHER LINE I~ 25 FEET RNb TO R COMMUt~ITY ~EWER LINE I~ 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPRRTHEtIT WITHIN ~ DRYS OF THE WELL COMPLETIONS. OTHER REQUIREME~'~TS MAY APPLY. 5PECIFICRTION~ AND CONSTRUCTIOt~ DIRGRRM~ ARE AVAILABLE TO INSURE PROPER IN~TRLLRTIOtL PERt'lIT EXPIRE$ DECEMBER 3::t... I CERTIFY THRT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR O~-SITE SEWERS AND HELLS RS SET FORTH BY THE MU~ICIPRLITY OF ANCHORAGE. 2: I WILL IHSTRLL'THE SYSTEM IN ACCORDR~iCE WITH THE CODES, ~: I UNDERSTAND THAT THE ON-~ITE SEWER SYSTEM MAY REOUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRU! 3 BEDROOMS. V4. 0 ( er if[ei Bdll[ug Cog by SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 ~' DEPTH OF WELL / / ~'' ; .' :' :'" STATIC LEVEL OF WATER FT. , /'~': ' ~ '~ DRAW DOWN FT. ' DATE - Slatted "/ :' Ended GALS. PER HR PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From ;' Ft. lo " Ft. '~) ''~' =~ ' ~' ' ~' ' ~ ~"-' ~ From -- Ft. to Ft. From ' Ft. to / ~ Ft ~'~ '~ '~'"/ '~ ''=~ ~' '~ ~ From Ft. to Ft. From Ft. t~Ft. ~"'/' " ~ ~ = < ~ /' ~ From Ft. to__Ft. · ., , , ~,~ Fmm ~ -' FI. to ~"* Ft. :- - ~*-' '~ * ~ /; From~ From ' '* Fl. to ')~ Ft. *'*/ '~ ~' ~ ~ ~' ~ From FI. lo Ft From -'~ F~.to ~ r~ FL -.),';' ~ ) ~ From ~ FL Io~ Ft. , Ft. /- ~ ~ c- ~ ~ From__ FI. 1o Fl. Fr~ -~*: FI.~ i:~ Ft. ~'~ ,,'~ <~ ~:~ From~ FI. to Ft.. .-~ · ,, Fmm~Ft. lo Ft. .J , ~PT. OF H~ALTH & F~ ' ~/ Ft. to~Ft. ~<~4/ ~' ..,.'~'~,' Fmm~Ft. to ~NMENT~ P~OTE~I~ From ;"'/ FI. to t/ t. ~.'. ,,7 : ,- .,-- From FI. to Ftor~ From Ft. to Ft, From Ft. to Ft.. From__Ft. t o______..Ft.___~ From _Ft. to_~I~.~CE i VE D From__.Ft. to Ft. From __Ft. to __ Ft. Fmm___Ft. to Ft.__ From__Ft. to Ft M1SCL. INFORMATION: DRILLER'S NAME