The URL can be used to link to this page

Home My WebLink AboutTIMBERLUX #4 BLK 1 LT 11AMUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. ~ MUNICIPALITY OF ANCHORAGE t,~,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL 7¢',PT'ON//__.¢ LOCATION Liq. caf Wel~ D,STANCETO: I ,Z/ IAbs°r t'°T; I- ~ Manufacturer IF HOMEMADE: Inside length Well Dwelling Dwelling IWidth NO. O~E DROOMS IMaterial Trench width No. o~..~t m e n t s Liquid depth PERMIT NO. Manufacturer Liquid capacity in gallons Foundation Nearest lot line PERMIT NO. Well DISTANCE TO: Length of each line Width Crib diamete_~__r Length ~)~ Type of crib No. of lines Total length of lines inches ~ of tile to finish grade Material beneath tile Total effective absorption area inches Crib depth Building fo.unda ion Driller DISTANCE TO: Depth Building foundation Sewer line DISTANCE TO: Total effective absorption area Nearest lot line ~ / Distance to lot line PERMIT NO, Septic tank Absorption area(si OTHER ME DATE LEGAL (Rev. 3/78~' /' ~" /' Static Water Level Draw Down '&ELL LOG feet feet Gallons Per Minute Total Feet of Easing Type Material Drilled~ o feet to ~1 0 to ~'~ to gO to to Hefty Drilling S.R.A, Box 1553 H Anchorage,Alaska 99507 blUt'-~ I C: I F"FIL T T~./ ~"'~F F~hlCHr'~F-'FtFSE ' ' DEPRRTMENTi' ~; HEALTH AND ENVtRONMENTALI ~OTECTION · - ' ,~ ~ , _ , -. , . ~ -~ ~: ' P]ELL A~-ID O~-~--~ ~ TE SE&,~E~ PE~ I OC8T I ON '- I FEE~ EGRL LT. i~-R BLK. I TIHBERLLI~ ~4 LOT SIZE Z5~ ~QJ8RE ~IAXtblLIM NUMBER OF E:EDROOMS = ~ SOIL RATING' TH~ R~QUIR~D =,I~E OF TH~ SOIL RE:SOR~TION _~TEH I_. '[~EF'TH= ~5 LE~GTH= ~ ~]Rfl~-"EL [~EPTH= 2 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:). THE TRE~-~L--:H [qIDTH IS 5. 000 FEET_ THE GRA~/EL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RE[~.IJ I RE[:' SEPT I C: TH~It( S I ZE= ~_OO£'1 GHLLC~NS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS AD.]ACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T&q,-] ( 2 ) I ~SPEC:T · C~'-,~S F~F.'E F.:E L-]U ! RE[:, BACKFILLING OF ANY SYSTEM WITHOLIT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUB..~ECT TO PROSECUTION. MINIMUM ~ISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR ±50 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. 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. PERM I T E.':-'.P I RES [:,ECEMBER 31. 1982 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 THE CODES. _~ I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE BPPLICBNT RI~S~NTRUBER ~ _~ ~~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SO~LS Lb6 PERCOLATION TEST 2 4 5 8- 11 12 13 14- 15- 16- 17- 18 19 2O DOMMENTS 12 ,4 PERFORMED BY: 6 ~ ' SLOPE ENCOUNTERED? pO DEPTH? SITE PLAN Cross Net Depth to Net Reading Date Time Time Water Drop q /o~oo /0 0'~ 0,06 G'. lO '~ I0 0~57~- 0 ,o~3- PERCOLATION RATE ~ , (minutes/inch) TEST RUN BETWEEN ~. t~ .. ET AND ~'"~ , ET CERTIFIED BY: ~ DATE:. 72-008 (6/79) InC. PERCOLATION TEST DATA SIIEEI' ADDRESS ZIP CODE_ TOTAL DEPTH OF HOLE-_ . _~.0, .(] ...... ft, ZONE TESTED ~ c~. L9~ ft 'FO _..__~?_,~_.'~_ ...... ft READING CLOCK TIHE : I 0 ?o /o DEPTH 10 DATUM '- --~'~;7 '~ 3.17 ~, 9q NET DROP FINAL PERCOLATION RATE /___~_ ...................... (min/in) PERFORMED BY ALASKA ~HUI~OHmCHIAL COBP~OL IDC. PERCOLATION TEST DATA SItEET ~-TL~/- ~¢0 ~J~'X DATE ~ '- ~2_~ -- <b~ ~-- CLIENT ADDRESS ZIP CODE · LEOAL LOCATION TOTAL DEPTH OF HOLE .... ~,~,/- __ ZONE TESTED. ~:~' rt TO /~,~: CLOCK TIME~ NET TIME ft. ' I 1 DEPTH TO ! NET D~OP RATE (min/in) ~.~ .... READING # FINAL PERCOLATION RATE PERFORMED BY 0,// (min/in) DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMA'~ION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name~M ~~ Telephone: Home ~- Applicant Address Business (c) Applicant is (check one): Lending Institution []; Owner/builder~ Buyer []; Other [] (explain); (d) Lending Institution Address ~,.~') I ~'~' ' (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA t0 the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If corn m unity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteJ~' Public [] Community1-1 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVI~ffi~G INSPECTIONS, TESTS, FILE SEARCH, ~"ATA AND INFORMATION, ,As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this ¼ealth Authority Approval shows that the on-site water supply an d/or wastewater disposal system is safe, fu nctional 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 ~'~ ~'P~ -r ~-rl% Telephone '~- ~) Address Z~ ~ ~ ~op4/~ Approved for Approved Terms of Conditional Approval CAUTION" The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations giyen in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does'this'as ~ courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72*025 (11/84) .U.,C PA'TY OF A.CHO.^GE ("OL CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /or Well Classification q~,~,,,~.T~7' If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ _ Date Completed ~o/~[~z-- Yield Total Depth ~'C) Cased to ~) Depth of Grouting Static Water Level ~O Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Welt: Pump Set At ( Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/~oldiq~t Tank on Lot /('x~/~- ; On Adjoining Lots To N~arest Ed~ 9t Absorption Field on Lot -/OD~''r ; On Adjoining Lots To Nearest Public Sewer Line ~J//~ To Nearest Public Sewer Cleanout/Manhole ~/~ To Nearest Sewer Service Line on Lot Water Sample Ce[iected.. by /¢),,~:¢ ~'~.,E~r~l, ~-~e., ~m-~.t,~. ~oT/'~) :, ~' Date Water SampJ.e' Test' Results /o<D+ ~ SEPTIC/HOLDING TANK DATA Date Installe8 Standpipes (Y/N) Depression over Tank (Y/N) Size ~ No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) /~/ Date Last Pumped z-f'/,Z¢/'~ "~ Pumping/Maintenance Contract on File (Y/N) ,,~J/,,,d ; for / Holding Tank High-Water Alarm (Y/N) ~-~/,'~ Temporary Holding Tank Permit (Y/N) ~'~J/~ Separation Distances from Septic/Holding Tank: To Water-Supply Well /o~~ ~r- To Building Foundation ,~S To Property Line ,~c~~ I~- To Disposal Field To Water Main/Service Line ~O+ ¢;-f- To Stream, Pond, Lake, or Major Drainage Course ~.2//4 Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed c~/ Width of Field ~.~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: -<IO F--F To Water-Supply Well To Building Foundation Lot _ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Z~/O '~'/~¢- Type of System Design Length of Field -~'~ Depth of Field Gravel Bed Thickness / / /4:~¢'~'-:~-~ Standpipes Present (Y/N) ~ Date of Last Adequacy Test ~/ To Property Line 2~--1' To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. ~, ~ Date of Payment . Amount: $ ~)_"~ "~ Page 2 of 2 72-026 (11/84) Lo<mtion: Block: / Client's Na~: /~¢~q ~-~oBe~ Address: .__~ ~)~gk-o Initial Reading c~ Meter: SHIP FROM SPECIAL INSTRUCTIONS This purchase la made under my SearsChargo Accounl Security Agree- meet or my SsamCharge Modernizing Credil Plan Account Security Agree- ment which Is thcorporaled hers n by reference. This sale is subject to the approval of the Credit Sales Depart- menl of Sears, Roebuck and Co. X PURCHASED BY If the safe ~s on Easy Paymen Mod- ernizing Credit Plan EP/MCP) use This purchase Is made under my Discover Cardmember Agreement which Is incorporated herein by refer- ence and I authorize the leafier tb pay Sears. This sale Is subJecl to the approval of the Discover Credit Card X · PURCHASED BY THIS iS PART OF A PART ORDER. PLEASE RETAIN THIS COPY FOR COMPARISON WITH YOUR MONTHLY STATEMENT, SALES TAX DEPOSIT BALANCE ' APPLI( . NT FILLS OUT UPPER HAL ONLY · Buyer Addres~ ~ g ~ ~ Zip Code Lending. mnslituBon F;v~+ /~+ m'~,(~ T~g, 5~C~' Phone Address Zip Code Realty Co. & Agent Phone : Community : J For wells drilled prior to that date, give well depth (attach Icg if available). D Public Utility Sewer isposal ~ividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE iNITIATED. Time Time TimeZ Time9~/~ r~ Date Date Date ~O~ Date Field Notes: DEPT. OF HEALTH ENVIRONMENTAL P~OTECTION (~ ) APPROVED BEDROOMS/. *CONDITIONS OF APPROVAL ( ) DISAPPROVED Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~ Well to Tank Septic T~k Size I AS BUILT DRN " FILE, NO. SCALE I"= 50' NO IMPR~EMENT8 LYING ADJACENT THERETO ENCROACH