HomeMy WebLinkAboutT15N R1W SEC 18 LT 18915N RlW
Section 18
Lot
189
#051-232-21
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
E]NEW
MAILING ADDRESS~ ~.~ ,
EGAL DESCRIPTION
,CAT,ON
~,~c~o:' J~" ~o z~
Manufacture~ ~ ~
~ c~a~ gallons IF HOMEMADE:
DISTANCE TO: IWell
Manufacturer
DISTANCE TO: ~ --
No, of lines
IAbsorption area
Poundati~_~
Total len~ o~ne~
Material beneath tile
Top of tile to finish grade
Length Width
Type of crib Crib diameter
Dwelli"g
Mate
Driller
DISTANCE TO:
Sewer line
Building foundation
DISTANCE TO:
Material
NO, OF BEDROOMS.~
PERMIT NO.
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines~ ~//~.~
Total ef2~ti_~_ab~:~l area
PERMIT NO.
Total effective absorption area
foundation Nearest lot line
Distance to lot line
Septic tank
OTHER
PIPE MATERIALS
SO, L TES~¢N~/~_
REMARKS
(Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
Departmen .)f Health and Environmenta Protection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit # ~%~[ WELL AND/OR ON-SITE SEWER PERMIT
Applicant: ~-3Q~_%~_A[SoFO -_~ ~O~ Co~%~. Mailing Address:
Location: Phone Number: ~8
Legal Description: ~ PI~3 ~qe_ I~ ~oT {8~ Lot Size: ~
Type of Soil Absorption System Is:
Trench: ~__ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ___~__ Soil Rating(sq.ft/br) ~,o¢--~__
The Required Size of the Soil Absorption System Is:
DEPTH ___it _. LENGTH .... _,~..O_' GRAVEL DEPTH ___~_ WIDTH
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). 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(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /0OC% GALLONS * *
~ermit applicant has the responsibility to inform this department during the
£nstallation inspections of any wells adjacent to this property and the number
Df residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
~aekfilling of any system without final inspection and approval by this department
~ill be subject to prosecution.
~inimum distance between a well and any on-site sewage disposal system is 100 feet
[or a private well or 150 to 200 feet from a public well depending upon the type
Df 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
~nd must be retnrned to this department within 30 days of the well completion.
Dther requirements may apply. Specifications and construction diagrams are
~vailable to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * *
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 codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signed: ~~~~ Issued by: ~. ~.~~~
Applicant ~F/~3
Date:
[~ LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTNiENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Afaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
LEGAL DESCRtPTION: ~.~']'~-- /~'~P ;
[] PERCOLATION
TEST
SITE PLAN
1
2
3
4-
5-
6-
7-
9
10
11
12
13
14
15
16.
17-
18-
19-
20-
Ruuell L. Oyster
No. 428~-E
WAS GROUND WATER . J S
ENCOUNTERED? ~-~ , OL
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
COMMENTS
72-008 (6/79)
PERCOLATION RATE (minutes/inch)
RUN BETWEEN FT AND ~ FT
DATE: "7~/- ~r~ '~.
ARCTIC PUMP & WELL INC.
'I I Jim Sullivan, CPI
I 1 PO Bos 770197
an a Eagle River, AK 99577
(907)688-2510
(907)258-2510
anwa edncK
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description:T I 5N R I W S18 Property Owner Name A Address:
Lot: 189 Susan Cantor
Block: 18833 Mink Creek Dr
(`howWr 4K QW7
Pump Installation Date: 7/14/2009
Pump Intake Depth Below Top of Well Casing: Feet
Pump Manufacturer's Name: Pump Model:
Pump Size: hp
Piticss Adapter Burial Depth: feet
Pitless Adapter Manufacturer's Name:
Piticss Adapter Installer: Arctic Pump & Well, Inc.
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:
Well permanently decommissioned by procedurel5.55.060L.c.
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & Well. Inc.
Page I of I
-I
.<
J
RECEIVED
AUG 2 4 1995
Municipality ol Anc~o~ age
Dept, Health & Human Services
t
\ -I ~. -t.L~ /
, , .
SURVEY TYPE SYMBOLS
~ AS-BUILT-- NO CORNERS SET O ASSUMED ELEV. ~ DRAINAGE
~ PLOT PLAN - AS-BUiLT - LOT SURVEY -TOPOGRAPHY O ; c W~D FENCE
X = -~ CHAIN LINK FENCE.
~ LOT SURVEY NOTE: Fences ere shown in their epproxim~
~ RECERTIFICATION AS-BUILT - NO CORNERS SET locotions only.
It isthe responsibility gthe builder or ~ner~ prior to LEGEND hub ~ t~ck-found ~ set
construction, to verify proposed building grode reletive iron rebor -found O set
to finished grode ond utility COheSions end fo determine iron pipe -found e set O
the existence of ony eosements~ covenonts ~ restrictions bross cop -found ~ set
which do not oppeor ~ the recorded subdivision plot. ~]um, cep -found e set
Lot Surve~ Certificofi~ Pr
I hereby certify thc I have ~, .
surveyed f~ pro~rty sh~n ~,,.' ~ '~ ~ t. Professional L~nd ~ve~om
dnd~scr~hemon~d ~'., ' L
~ ~ ~el s~e~e, 1" Drewn by' GLG
ther~ within (he property
lines~nd~notoveH~por I~eee~e~,~'/""'~ ,DuteSurveyed~ Oan 8, 1985 ~e~kedby~ DG~
ondthatnoimprovemen, on lCa~;~u,~.~,2,e$ ~*: uot~ m.w., Jan. 8, 1985 Gri¢:NW 1054jw'°'8B-O03
odjoceot prppeHy overlopor
question a~ that thereore ~m ~¢~ ',~ ,,'*~ ~gal Description:
other visible~entson '~OFEssmN~L~ Gov'~"Lot 189, Sec. 18, T15N RiW
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPAR~/{ENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HF~kLTH AUTHORITY APPROVAL CERTIFICATE
General Information Application Da~e /~_~'
(a)
Legal Description (include lot, block, subdivision, section, township~ range)
(b)
(c) Applicant i.s (check one) Lending Institution ~ ; O%mer/b~t~&~ ~;
Buyer .
(d) Lending Institution //&/~ ~ 5~ ~e~.~'elephone
Address
(a) Real Estate Co~ & Agent
Address
Telephone
(f) ~ the HAA to the following address:
.? 'a ~, ~:. '~
2. ~ of Residence
Single-Family ~ Multi-Family
Number of Bedrooms
3. Water
Individ~l Well~ Co,unity
Other (describe)
Note: If community well system, must have w~itten confirmation from ~he State
Department of Environmental Conservation attesting to the legality and s~atus.
4. Sewage~Difpo__sa~
0nslteL~ Publico Community~__--~ Holding Tank~
Note: If community well system, must have written confirmation from ~he State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
S. .~n~i.ne?ri~Firm Provid. in~Ins~.t_~io_!~s~ .,Tes.t.sz_ File S~Data amd Information
As certified by my sea]. affixed hereto and as of the validation date shown below, 7.
verify that my investigation of' this Health Authority Approval 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 ~hat,
based om the information obtained from the ~micipality of ~chorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and S~ate codes~ ordinances, and regula-
tions in effect on the date of this inspection,
Name of Firm
Address
Telephone~
Date
D~P_A~roval
Approved for~___~ bedrooms
Approved ~' Disapproved
Terms of Conditional Approval___
Conditionml
CAUTION
THE MUNICIPALITY OF ANCHORAGE, DEPARTMENT OF 'HEALTIt AND ENVIRONMENTAL I~{OTECT'~iON
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CE~iTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDE~f PROFESSIONAL ENGINEER REGISTERS)
IN TME STATE OF ALASKA. THE DHEP DOES THIS AS A COUR%~ffSY TO PI~{CHASERS OF HOMES A~ID
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQ[JIJIE~
~NTS. F~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICA'fE IS ISSUED. THE M%~ICIPALITY OF ANCHORAGE IS NOT RESPONSIBI~ FOR ERRORS
OR OMISSIONS IN Th~ PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
ae
Well Classification
Well Log Present
Date
Completed
Total Depth
Casing- ~ight
Elec~ical Wiring in ~n~it
~p~ation Distan~s ~ ~11~
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
If A, B, c= C, D.E.C. A~oved(Y/N)
~/~ / Yield
Dept~ of Grouting -
Sanitary Seal on Casing ~N)
.... Depression Around Wellhead~
To Septtc/H~ Tank on Lot /40 ; On Adjoining Lots /OO /~. ,,
To Nee=est Edge of Ab-~o~ption Field on. Lot /~O r ~ On Adjoinin? Lots /~.~.) /-~
To Nearest Public Sewer Line ~/~ , To Nearest Public Sewer
Cleancut/Manhole To Nearest Se~r Service Line on Lot /~D /~
Date
Water Sample Test Results g/~ --Ct! _~ ~ C ~-~'~-1
B. SEPTIC/%~9~'TANK DATA
Date Installed~___~2~J&~._Size ,/~ No. of Cu~vartmsnts
standpipes ~N) Air-tight Caps ~N) Foundation Cleanout d~N)
Depression over Tank (Y~ Date Last P~u~ped /-- ~.~-~' ,
Pumping/Maintenance Contract on File (Y~)~ ; for '-- ,
Holding Tank High-Water Alarm (Y/N) ~/f~ . Temporary Holdin~ Tank Permit (Y/N)
Separation Distances f=cm Septic/F~k~ Tank:
TO Watem-Supply Well /~O /
TO Property Line /~/7~
To Water Main/Service Line ~.~
Course
To Building Foundation ~S-/
To Disposal Field ~/
To Stream, Pond, Lake, c~ Major Drainage
Comments
Receipt %
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absc=ption St=ara
Date .Installed ~-~=7- - ~ ~
Width of Field ~"
Squa=e Feet of Absorption A=ea
Depression ove= Field (Y~
Results of Last Adequacy Test
~FS ~Z Tn~ of S~stem ~si~n
Length of Field
~9~ of Field
Grail ~d ~ick~ss
. ~K ~ Stan~i~s ~esent ~) . .
~te of ~st ~a~ ~st ~ ,
Separation Distance fTcm A~sc~ption Field'.
To Weter-Supply Well /~ ' To ~ty Li~ /~ ~
;
TO Buildi~ F~n~tion ~ To Existing ~ ~ndo~d System
Lot ~ · ~ ~Joining ~ts /~'~ ~
To ~te~ ~in/~vi~ Line ~ . To ~t~(if ~e~nt)
To St~e~ond~ke/~ ~jo~ ~at~ ~ ~
To ~i~way, P~ki~ ~ea, ~ Vehicle St~a~ ~ea ~ ~
Cc~arents
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested fo~
Electrical Codes(Y/N)
Cc~snts
~imsnsions
,AJ /Manhole/access (Y/N)
/'Pu~ Off" Level at
,//~ v~nt (Y/N)
PumDing Cycles during Adequacy Test.
M~ets MOA
** Check Permitted Bedrocm Rating A~3ainst HAA Rsquest **
I certify that I ha~e checked, ve=ified, c= confcz-zed to all MOA HAA Guidelines in effect
Si~ed . Date I--/¢m.~'-;~L~'"'~ ;'~' ~,°'<~" ~ %
Cu,~any MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84