HomeMy WebLinkAboutT12N R4W SEC 2 LT 27A
GRF~,TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING
ADDRESS ~//~?/ .7~-.~'~-Z~ ~l~'~J ~/ PHO N E ~:~/~'~C
LEGAL DESCRIPTION~.~_c~'~ ~_ ~Z~ 7~ ...... . ' ~,,
DISTANCE FROM WELL
LIQUID CAPACITY.___/
GALLONS.
NUMBER OF ~"
MATERIAL E'~.~--~:.~-~/~--~'''* ~ COMRARTMENTS_
INSIDE LENGTH__ ~ INSIDE WIDTH__ ~'""~- DEPTH~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / __OUTSIDE DIAMETER__
LINING MATERIAL
NEAREST LOT LINE~
?
OR WIDIH /// , LENGTH_~)~G , DEPTH_
DISTANCE FROM WELL
BUILDING FOUNDATION'~(2 , ~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. FT.
TILE DRAIN EIELD:
TOTAL LENGTH
TION . NEAREST LOT LINE__ . OF LINES
NUMBER/O~i~d DISTANCE BEIW ~..~.~.~.~ --~"~ENCH ................. IN. TOTAL ~EFFECTIVE
ABSO~ION AREA~ SQ. FT. LENGTH OF EACH LINE ~~'~
DEPI'H: TOR OF TILE TO FINISH GRADE
.DEPTFi OF FILTER MATERIAL BFNEATH TILE
IN. ABOVE TILE
WELL: TYPE,~./.z~-~y~c~ DEPTH_ .'/./~z.~/ DISTANCE FROM SAMPLE /~"~ NEAREST
_, BU LDING FOUNDATION. ,/,.(.~,'.~z.~ WATER
SEPTIC / SEEPAGE / L..-~ OTHER
NEARESt l-~, TANK ~' p~9 SYSTEM ,.~Z/_.)~2 CESSPOOL__ SOURCES ~
LOT LINE ,/Oz ~ _ , SEWER LINE ....
DIAGRAM OF SYS1EM
DISTANCES: t!1,
DATE APPROVED '-- HEALIH AUTHORITY
GAAB-FID-2
GREATEF
327 Eagle St.
NCHORAGE AREA
ItEALTIt DEPARTMENT
Anchorage, Alaska 99501
')ROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT /~/,t,.~
RESIDENCE AD D RF-SS_
LEGAl. DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK_
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH_~
PERCOLATION TEST RESULTS
SEEPAGE PIT_ /~' __, DRAIN FIELD
ANTICIPATED DATE OF COMPLETION
,OTHER_
BI:LOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS 18 1'0 SERVE AS -[~? ,~t~Z_ , PERMIT TO INSTALL A
_AS DESCRIBED BELOW. SIZE O,F UNIT TO BE SERVED. -~,
=. SEPTIC TANK SIZE
DISTANCES:
o-, SEEPAGE AREA
.TYPE/.,F_,..,.{' DIAGRAM OF SYSTEM
i certify that I am familiar with the reqtdrements of Greater Anchorage Area l}orough Ordinance No. 28-68 and that the
above d/~ibed system is ill accordance with said code. '-~/~d~-- [,,,[~j7~t:/
DATE%""p5 C:/¢ 70/7 APPLICANTS SIGNATURE ~
A!,; ('}i 0 R I'~C, ;-, !
k~as G'~,ound 'date~' Encounte:c'ed?. ~
8/66
Drilling Co.
M-W Drillin~, Inc.
Driller Gene Jordan
Well Owner
Location
Well No.
Per-mit No.
Certificate No.
Area
Frank Reset Use of Well Domestic
(address of: Township, Range, Section, if known; or distance main
road Timothy
Sand Lake
Size of casing 6" .Depth of Hole__lYp
feet Cased to 17~ _feet
Static water level 34 fl:. (~JO~) (below) land surface.
open end ( X ); Screen ( ); Perforated( ).
Describe screen or perforation !'lone
Well pumping test at l__20-l~O_qgallons per (,~o~k~ (minute) for
of drawdo~a ~rom static level.
Finish of ~ell (check one)
1 hours with 100~
· Was casing collar sealed with cement grout
No
WELL LOG
Depth ia feet from Give details of formations penetrated, size of material, color,
hcpun,d au[face and hardness.
0 'J'O '? Fill & silty surface organics
7 TO 98
98 TO 100
100 TO _ 172
172.T0 17Q
TO
TO
TO
TO
TO
TO
To
TO
TO
IO
Sand; Vary fine to fine~ silt¥~ damp to wot~ occaisional_very ;'
small gravel seams.
Mmall Gravel: ssndy matrix
Sand: A/A.
Small to medium zravol: minor sand matrix~ very seed waterboariu~
MUNICIPALITY OF ANCHORAGE
, DIVISION OF ENVIRONMENTAL HEAL'I~{
DEPA[~MENT OF H~tL'I~{ AND ENVIRONMENTAL PROTECTION
APPLICATION FOR I~LAL%}! AUTHORIZer APPROVAL CERTIFICATE
1. Gene~al Information Application Date__~//~.~ '~' L _
(a) Legal Description (include lot, block, subdivision, section, tc~nship~ range)
Lecation (add~ess o~ di~,eetiQns)
(b) Applicants N~ ... ~ , ~
(c) Applicant is (check o~) ~n~ing ~nstitution
(d) Lending Institution
Address
(e) t%3al Estate Co. & Agent
Address
Telephone
2. T~_ <of l%-~sidence
Single-Family--~-~" ~llti-Fantily
3. __Wa t_geA_Su_pp_~
Individual
k%ll
Note: If c~m~nity ~a~l]. system, must haw ~.~itten ¢~nfirmation from the State
Department of l;2nviro~]l.~ntal Conservation attesting to tb~ legality and status..
Is the ~911 adequate fo~ the nu~er of bedrooms specified in this HAA (y/N) ,~',~.q
Is the wastewate~ disposal system adequate for the num~ of bed~,o~s ~Y~.)
[Page 1 of 2]
2-15-84
5. E__ngingf_erin~q_iFirm P~ovi_di_j~g Insp~_c_tions, Tests, Data and Information
I certify that I have checked, verified, or conformed to all MOA HAA Gui~].ir~s in
effect; on the date of ti%is insp~ctiOno
Sigr~d
Date
(ENGINEER SEAL)
6. _DHE___P__~, prova 1
Approved fo~._~ kectr c~rs
Appr oved~. Disap~o~d ~1
Te~ of Conditional Approval
Conditional
The Municipality of Ancho~a~y~ Depa~t]r~nt of Health and Enviror~'~ntal Protection does
not ¢3uarantee the continued satisfactory pel, formanoe of th(; water supply and/or the
wastewatez, disposal system. 1Ills approval indicates that, as of th~ validatio¢% date
shown above, based on the data a~d information furnished by an engineer regJ. stel~d in
the State of Alaska, tJ~e water supply and wastewater disposal system is safe and func~
tional for the n~nber of bedro~mts and type of structure indicated.
( [~HEP SEAL)
Mail the HAA to the follczving address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL
CHECKLIST - FEBRUARY 1984 NOIIO~lO~d I¥1NB~NO~I^N-]
WELL DATA
Well L~ P~esent ~N)
Total Depth.__/'~ ' Cased to
Static Wate~ Level ~/~
Casing Height Above Ground__ /,.~'
Electrical Wi~ing in Conduit
Separation Distances f~om Well:
If A, B, c~ C, D.E.C. App~oved_(Y/N[ ..
Date C~ntoleted _/~7~/~/z~
/~/ ~pth of ~outi~g~ ~/.~
Sanitary ~al on Casing~)
~pression ~ound ~l~ead (~
TO Septic/Holding Tank on *Lot____fU_~_~_ ; On Adjoini~.g Lots__~
TO Hea~est Edgs of Absorption Field on Lot__~_~_~ 3 On Adjoining Lots
To Nearest Public Sewe~ Lins _~O/~ To ~Nearest Public Sewer
Cleanout/Manhole. ~/0~9" TO Nearest Sew~ Service Line on Lot
wate~ Sample Collected Bi; ~/~/ ; Date ~/~,/~/
Date Installed Size No. of Cc~pa~tm~nts
· ' - ' Foundation Cleanout (Y/~)
Standpipes (Y/N) .Alp tight Caps (Y_~/N) · - ~,.,~
Dap~ession o.ve~ Ta~ 3Y~ ____ ~te j~st P~d
Pu~ing~intenanc~ ~n~aet ~ File ~Y~ ,; fo~ __~
Ala~~ '~~Dldir~ Ta~k ~t
Holding
Tank
High-Wate~
Sep~a[ion Dist2n~s ~ ~p~olc{i~~l' '_ .
To Water-Supply ~1~ .____{ ~
To D~s[~sal
TO S~e~, Pond, ~ke, ~ Majo~ D~aina~
[Pa~e 1 of 23 2-15-84
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption A~ea
Depression ove~ Field (Y/N)
Results of Last Adequacy Test
Separation Distance from
To Water-Supply Wall
To Building Foundation
Lot
To Wate~ Main/Service
To
To D~iveway,
Co~nents
Type of System Design
Length of Field
Depth of Field
Gravel Bed Th~
Date of
P~esent (Y/N)
Adequacy Test
To P~operty Line
To Existing or Abandoned System cn
On Adjoining Lots
To Cutbank(i~p~esent)
Majo~ D~ainage Ccu~se
A~ea, or Vehicle Sto~age A~ea
De
LIFT STATION
Date Installed ) Dimensions ~
"Pump On" Level at ~ l~'~ Off" Level at
High Water Alarm Level at! / Vent (Y/N)
Tested for j Pumping Cycles du~ing Adequacy Test. Meets MOA
Electrical Codes~
Comments /
** Check Permitted Bedroom Rating AgainSt HAA Request ** ·
I certify that I have checked, verified, o~ conformed to all MOA BAA Guidelines in effect
on the date of this inspection.
Signed ~/~.//~ Date ~//~/
Company ~/ /~'-("-~' ,~ ~C~ MOA NO. ~y'D~
KB1/d5/s
[Page 2 of 2]
2-15-84
ALASKA gl gliqorlm rlT/ L
June 19, 1984
Department of Health and
Environmental Protection
825 L Street
Anchorage, Alaska 99501
Attn: Keith Bandt
Legal: T12N R4W Sec 2 Lot 2
Dear Keith:
JqOll,O]/O~d "IVlN]VNN O>q AN :]
]I~)V'cIOHDNV ~O AliqVdl~lNl~vN
A flow test was performed on the well at the above property on
June 19, 1984. The static water level was at -40.0'. Over
800 gallons of water was pumped at a rate of 5 gpm with a
drawdown of 1.21'. The'recovery time was 140 ~inutes.
I consider this well adequate for domestic useage. Please
contact me if you have any questions.
Approved:
Sincerely,
$200 [U~sl 33rJ J~ucnu¢ Sutl¢ [~, Anchoroq¢. A[osko 99503 ~,(907) 561-50a0
;EATER ~I'4Q~ORgGE AI'~A BORO[~GH
!!E^LTH DEP~ R'I) ~Eb]T
327 E^GLE ST~ET
ANCHORAGE, ALASKA 99501
279-2511
REQUEST FOR APPROVAL OF
INDIVID1JAI, SEWAGE AND WATER FACILITIES
FOR
Bacterial Analysis
2, Property Owner. __, ~Z~_.~.-a ~?2Z .Phone, ?./~ 77~Z/--od _
4, T~e of Fac~l~.ty to be Inspected,~~ ~e~_ 7
~ ~" (/ ......
5. Well Data: ~ /~ ~- ~ ~'/
. . ,~/I ~
D. Construction
E.
6. Sewage Disposal System:
Septic Tank (If homemade, show diagram on back)
. / .
4, Installer
Approval Request £or Sew ~ Water Facilities
Page Two
Seepage Pit
i. size //
,. Lining
C... Disposal Field
"I. Number o'f.~'nes
2. Total LengthX'X~
Required ~easurements
A. ~ell to Septic Tank
B.. Well to Seepage Pit
C. ~qell to Sewer Line
D. Well to Property Line
E. l~ell to Other Possihle Contamination
Foundation to Septic Tank
G. Foundation to Seepage Pit
H. Seepage Pit to Property Line
COMMENTS:
APPROVED:
DISAPPROVED:
DATE:
APPROVAL VALID FOR ONE YEAR FROH DATE SIGNED.
GREATER ANCIIORAGE AREA BOROUGH HEALT[1 DEPARTMENT
BDll70