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HomeMy WebLinkAboutW G PIPPEL BLK 1 LT 4At�JaNc�r Ca. pr��l� 51p (iso -6y3 -? s-� - 013 - 22 aw 18lock 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE / ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EJNEW a p� V( A r (,R_I g010 ED UPGRADE MAILING ADDRESS P, (0 ole_ ' c1 r qa -7 LEGAL DESCRIPTION nn LOCATION NO. OF BEDROOMS yz Well "f- Absorption area Dwelling 't PERMIT NO. / Uy DISTANCE TO: �Q �� 2, Gq H ZManufacturer W Gl2CE2 Material Ste'[: u -C No. of compartments z to Lin. pty in gallons IF HOMEMADE: Inside length Width Liquid depth O Y J C7ZAt DISTANCE TO: Well Dwelli g PERMIT NO. Oz F Manufacturer Material Liquid capacity in gallons Well Foundati n Nearest lot line PERMIT NO. wx DISTANCE TO: J EZ No. of lines'Length,of each line T I th of lines Trench width Distance between lines P Z w -- inches F Top of tile to finish -grade- Matefidt Beneath tile Total effective absorption area p inches Length ! Width Depth �d PERMIT NO. w ,Q./ P ZJ Z> QF- Type of crib Crib diameter Crib depth 7j Total effective absorption argab .J. `f' wwa 5`Tl.f�"L Z_G W Well / r Building found ti n �'g' Nearest lot line 7 DISTANCETO: .--. ` ,�,`-j �(j 1 J Class �. 1 _D.D t� • y a Driller Distance to lot line PERMIT NO. w � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS 1/ y Li SOIL TEST RATING INSTALLER CNUe,� Ani xC REMARKS 5, s m C✓�L� i�>'7 ©N r:�-Ars r or aovIF oves ro vvt��'T Co APP E ROr'ESS� ` DATE LEGAL t .�'.K:'S!`� � �j�, r 15 �i!d i9ir)t - � � � , � VIVER. ALASKA ' 09an J 72-013 (Rev. 3/78) THE REQUIRED SIZE OF THE. SOIL ABSORPTION SYSTEM I.:: _ •. -. _ _ w 02121 THE i..J:::r•GTH DIMENSION I'3 THE LENGTH 1:111 FEET) OF THE TRENCH OR DRAINFIEI._D. THE DEPTH OF A TRENCH OR PIT. T:_s THE DISTANCE BETWEEN THE SURFACE OF THE:: CiR:OUNID HND THE BOTTOM OF TETE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DE'I'-'TH 15 THE: I''iTp,llMUM DEPTH OF GRAVEL BETWEEN TETE OUTFALL. PIPE AND THE BOTTOM OF TETE EXCAVATION (Irk FEET). f'_" En P. ,l R._1 .'k.,. Fit EE Ex an Es: Fz , "T;.A 11 ...- -T, F: l G,..�F „4..=: ,: _. — ,�• .. _ ..-. _ _ PE;:RI''CI:T APPLICANT HAS THE:: RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APf`'RCI';AL BY THIS frE.PARTME.p.i"I WILL BE SUBJECT TO F'F:.I_SECUTICirc. MINIMUM DISTANCE—" BETWEEN A WELL AP.J[r ANY OP-.! ... SITE SEWAGE DISPOSAL. SY'=IEE! IS 100 FEET FOR A PRIVATE WELL OR i50 TO 20 FEET FROM A PUBLIC: WE:L.L. DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DI_.TF1!'+CE FROM H PRIVATE WELL '1O A PRIVATE SEWER LINE IS 25 FEET ANC, TO R C':(:1M!'UNIl'Y _EWER LINE- IS r.`_t FEET. OTHER REQUIREMENTS i'(r'Y APPLY. SPEI_Ir=lht=il7:`:INS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. s-,, fes_. +r,.....,, A..q, ... -T- 5 _ - - - EIT 1 CERTIFY THAT 1.: 1 !=!M FAMILIAR WITH THE: REQUIREMENTS FOR :N—SITE SEI•.IER= AND WELLS AS SET FORTH BY THE: MUNICIPALITY OF ANCHORAGE. I WI.L..L. INSTALL THE LSYSTEM ACCORDANCE WITH T HECOD 3. I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY RF:(ILrIFrE ENLARGEMENT IF ..I,.t-lE RE SIDEUCE-- q REMODELED TO INCLUDE MORE I-I—AN 3 1='F_DRCu:tMS. t'!FU_J'OfiY:i is ISSUED BY_AS��C DEPARTMENT HEALTH t -II`:.(. ENVIRONMENTAL :I:O: F;_T'f (11V, 825 K� STREET, ANCHORAGE, AK 99501 it 5'-•� _ _.. �.�: "v ' 2111 - ^._. � gi ^'E.r__" F. „- ..B_ PERMIT APPLICANT .I(it=iN LI GLHFKE PCI BOX 463 EAGLE f':ilVE:.R 99577 6r94-'9010 LOCATION LEGAL. L4 81 NEST 150 W. G. PIPPEL_ LOT SIZE 5+9.'_f'?` 9 SQUARE FEET TYPE IJlll: SOIL ABSORPTION SYSTEM 15: TRENCH MAXIMUM NUMBER OF BEDROOMS _ ._— SOIL L r .r {=a F-.BE)u 85 THE REQUIRED SIZE OF THE. SOIL ABSORPTION SYSTEM I.:: _ •. -. _ _ w 02121 THE i..J:::r•GTH DIMENSION I'3 THE LENGTH 1:111 FEET) OF THE TRENCH OR DRAINFIEI._D. THE DEPTH OF A TRENCH OR PIT. T:_s THE DISTANCE BETWEEN THE SURFACE OF THE:: CiR:OUNID HND THE BOTTOM OF TETE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DE'I'-'TH 15 THE: I''iTp,llMUM DEPTH OF GRAVEL BETWEEN TETE OUTFALL. PIPE AND THE BOTTOM OF TETE EXCAVATION (Irk FEET). f'_" En P. ,l R._1 .'k.,. Fit EE Ex an Es: Fz , "T;.A 11 ...- -T, F: l G,..�F „4..=: ,: _. — ,�• .. _ ..-. _ _ PE;:RI''CI:T APPLICANT HAS THE:: RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APf`'RCI';AL BY THIS frE.PARTME.p.i"I WILL BE SUBJECT TO F'F:.I_SECUTICirc. MINIMUM DISTANCE—" BETWEEN A WELL AP.J[r ANY OP-.! ... SITE SEWAGE DISPOSAL. SY'=IEE! IS 100 FEET FOR A PRIVATE WELL OR i50 TO 20 FEET FROM A PUBLIC: WE:L.L. DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DI_.TF1!'+CE FROM H PRIVATE WELL '1O A PRIVATE SEWER LINE IS 25 FEET ANC, TO R C':(:1M!'UNIl'Y _EWER LINE- IS r.`_t FEET. OTHER REQUIREMENTS i'(r'Y APPLY. SPEI_Ir=lht=il7:`:INS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. s-,, fes_. +r,.....,, A..q, ... -T- 5 _ - - - EIT 1 CERTIFY THAT 1.: 1 !=!M FAMILIAR WITH THE: REQUIREMENTS FOR :N—SITE SEI•.IER= AND WELLS AS SET FORTH BY THE: MUNICIPALITY OF ANCHORAGE. I WI.L..L. INSTALL THE LSYSTEM ACCORDANCE WITH T HECOD 3. I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY RF:(ILrIFrE ENLARGEMENT IF ..I,.t-lE RE SIDEUCE-- q REMODELED TO INCLUDE MORE I-I—AN 3 1='F_DRCu:tMS. t'!FU_J'OfiY:i is ISSUED BY_AS��C SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Io13r/ 61— 13�F7KG DATE PERFORMED: ",Tuu'i Iii (Gild LEGAL DESCRIPTION: �O% —7 llDZk 'it/G(S/ I6-6 1�7 E� SLOPE SITE PLAN "10 (minutes/inch) Ofctp,nr L —14 11 Net Drop SONO3GRAV L� WAS GROUND WATER NOENCOUNTERED? �"` q • e, 2 12 b IF VES, AT WHAT �' n 3 13 1t. 9 U 5 6 • R. 7 CJs P g 0 r 9 4: n "10 im 19 Robert A • Shnhe ^ .r ^x- d • 1'10• 1437-E ••-i .a ReadingDate (minutes/inch) Gross Time —14 11 Net Drop 15 WAS GROUND WATER NOENCOUNTERED? �"` q • e, 12 b IF VES, AT WHAT �' n DEPTH? 13 1t. im 19 Robert A • Shnhe ^ .r ^x- d • 1'10• 1437-E ••-i .a ReadingDate (minutes/inch) Gross Time —14 .041 Net Drop 15 ' 4� • 4� �"` 16- 0.: 17 �' 7f im 19 Robert A • Shnhe ^ .r ^x- d • 1'10• 1437-E ••-i .a ReadingDate (minutes/inch) Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE &41A (minutes/inch) TEST RUN BETWEEN FT AND FT 8 & j;rI�alca -MIN / O PERFORMED BY s Ago n CERTIFIED B G DATE: 4Fr, jq1VER; ALA8I% WWII PH. 72-008 (6/79) ARCTIC PUMP & WELL INC. Jim Sullivan, CPI WEB Box 770197 WMM un ¢ WE Eagle River, AK 99577 (907)688-2510 (907)258-2510 VW@ ce i.ne1 Decommissioning Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Arctic Pump & Well, Inc. Page I of I Legal Description: W G Pippel Property Owner Name & Address: LotA W 150 Royce Martin Block:l PO BX 773326 Fnala Rivar AK 00177 Pump Installation Date: 6/29/2012 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? 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 r"- ur-4 I c- r- a=ei I -r.-. 1.1rr= nr•aic­,: F:_n1aE=- DEPARTMENT e' _DEPARTMENT'._e HEALTH AND ENVIRONMENTAL ROTEC:TION 825 'L' STREET: ANCHORAGE: AK. _99501 264-4720 L-4E=LL_ (_'EF'r"y I T PERMIT NO. ( 84=10382 ) APPLICANT THOMAS CLARK. SR BOX 239 694-2280 LOCATION HORSESHOE DRIVE LEGAL L4 WALTER PIPPLE LOT SIZE 59000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON --'_ITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE WELL OR 1501 TO 2070 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 'S FEET. (BELL 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 IN_=UR,E PROPER INSTALLATION. F="E: F;R_M I -r E_XF=" I �."E"_.., r -°ate -a ME.aF;-° _:cam- _1 C_,`1_1 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON -_,ITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. IGNED APPLICANT THOMAS CLARK ISSUED BY ------------------------------DATE--------------- V4.O r•1 J -J r -a I C= I F' F7J L_ I T °r' . ID F= F4:'-4 !_ H' -I F' r=J I, E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 STREET, ANCHORAGE, AK. 95'11 264-4720 F F=F<P1 I T PERMIT NO. APPLICANT �'omaS C_Ikay\ S'p, D39 LOCATION O 2, LEGAL L Lf TYPE OF SOIL ABSORPTION SYSTEM IS: �a-p- LOT SIZE S"(OUo SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT./BP,)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEF•TH= LEtaCiTH= GF_''A': EL C'•EF}TH= THE LENGTH DIMENSION IS THE LENGTH CIN FEET? OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE r,ROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET?. F:Cn :, E: I F:ECy QEF T I C TF�tJ15 IE_ G F=1 L_ L_ 0 t -J PERMIT APPLICANT HAS THE R..ESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTION= OF ANY I -JELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T'L•ICo < : ] I r-4: F'EE: CT I 1D ":E; FORE F:E0-1U I REE} BACKFILLING OF OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEI•JAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 110 TO 200 FEET FROM A PUBLIC WELL DEFENDING 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 30 DAYS OF THE WELL COMPLETION. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. IN'TALLATION. F�ERM I T E: -:F' I F:E- C?E!_ EMBER = 1 : 1_?`0 - I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS _ET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDEJOR€ T�1) BEDROOMS. SIGNED:__f�\� APPLICANT �f ISSUED BY-" ----'--------DATE -- -^ b-- V4. 0