HomeMy WebLinkAboutWILLIAMSON BLK 2 LT 12
Jan 21 20 10:21a Anchorage '.Ale!! & P,-, nip Set- 9072430742 p.1
Pump InstaRatirin Ihitc-
9,
IN.mp Intake Depth Belo -vv Top of Well Casing:ftet
Pump Manufacturer's Name:
Pwripmodel: -�-Vt-z---
PUMP'Size �L. b..'O
PiODSS Adapter Burial Depth: I< feet
11 less Adapter MariuLacturers Name:
Pidess Adapter Installer;
Well Disinfected Upon Completion? 19'Yes f— N.f)
Melbod of DisiufMiow
Comments. P9 )t
Pump Instaficr -Name:
Mimi: 'rl`le 01jelp ijlst-Jler S'iall PYOVid.- aT:PUrT1D insia",latiorf, log to the DSD within 30 days of purrp installation.
eve 51 n See-vzs bepnr-r"I'ant
3 1:'%C, Scr-.n r, 'TY'WiSIVI
Ci g rMas grcmn
V-A-
41,00 �morf, 'cad
A -lark Begich
ArldhCroce, AK 99 Cj
M,ayor
Pump Installation Log
Well Drilling Permit Number:Date
of lisue:
Parcel Identification Number:
5 - 09 3 - I
Legal Descriptior,
Property Owner Name & Address:
Pump InstaRatirin Ihitc-
9,
IN.mp Intake Depth Belo -vv Top of Well Casing:ftet
Pump Manufacturer's Name:
Pwripmodel: -�-Vt-z---
PUMP'Size �L. b..'O
PiODSS Adapter Burial Depth: I< feet
11 less Adapter MariuLacturers Name:
Pidess Adapter Installer;
Well Disinfected Upon Completion? 19'Yes f— N.f)
Melbod of DisiufMiow
Comments. P9 )t
Pump Instaficr -Name:
Mimi: 'rl`le 01jelp ijlst-Jler S'iall PYOVid.- aT:PUrT1D insia",latiorf, log to the DSD within 30 days of purrp installation.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
~4AILING ADDRESS t-- ?~ ~'.~%~ ¢~Z~'~ [] UPGRADE
DESCRIPTION '
Manufacturer ~ ~ ~ ~ Ma~¢i~; No, of com~ments
Manufacturer~- Material .... Liquid capa~n gallons
No, of lines~ [%ngth of each line/
.~-i-.~;,;Z? , ,' Mater,~l benfth tile Total effective absorption
31aSS ~ ~ ~¢~.De~th Driller' Distance to lot line PERMITNO.
DISTLN~ ¢;l Buildi"g foundation Sewer line Septic tank Absorption area(si
SOILrESTRATING / ' .~ ~O* __
>q
O
L,(]'f' ,::* .t Z Ii{ ~I
1 .I~)T !.,(::!(::;fYl" :[ (::)l',i ::
I"1~ X Z({:l t!i; 1 ) I::~ (] (3 t'1 !]ihl
· -':~ t~ l.ll. I h.h; I IIr"~L/E!: ~I, I.,..IZ!:F,~EFI' "l'I.',!(Z) (::X31"II::',qFN'I"tI!i~N"t !i
MUNICIPALITY OF: ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC'rlON
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS L~OG~
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:_
1
2
3
4
5
6
~'7
8
9-
10-
12
13
SLOPE
WAS GROUND WATER
ENCOUNTERED;'
IF YES, AT WHAT
DEPTH?
14
15
NiUNIClP, fl. I1Y OF
16 DI~PT, OF HI]AL'II'{ &
17'
AUG 0 '; '~'
18-
RECEIVEg
20-
! --
SITE PLAN
N
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ', {minutes/inch)
TEST RUN BETWEEN FT AND FT
,
P~REORMEOS~: oz~ CERT,~,EDS~: :' '
MUNICIPALITY OF ANCHORAGg
DIVISION OF ENVIRONMENTAL HEALTIt
DEPARtmENT OF I]EALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTIIORITY APPROVAL CERTIFICATE
1,, General Infom~ation
Application Date
(a)
Legal Description (include lot, block, subdivision, sectiou~ township, range)
Location (address or directions)
Applicants Name 7"~ '7~'2~c'D~,.~ Telephnne .- llome Business
Applicants f~dress
Lending Institution
Addres~
(e)
Rea)~ E~tate Coo & Agent
Address
(f)
Telephone
14aii L:he }L~ to the following address:
2. T_.yj~_e of Pmsidence
Single-Family
Number of Bedrooms
3. Water
Other (describe)
Note: ]if cons~unJ, ty well system~ must have written conf'lrmation from the State
Department of Enviro~-aental Conse~ation attesting to the legality and status.
S ew~...Di s i~_
Onoi~e ~ Public ~[ Community E~J Ilolding Tauk ~:
Note: If con~unity well system, must have written co~irmatioa from the State
Department of Enviro~ental Conservation attesting to the legality a~ status.
[Page 1 of 2]
· ~
E~n~J_.n~eeri~n~_Firm Providinj,,_I~m~?.~ions, Testat, Pile S~9}~ch3_~ta and Information
As certified by my seal affixed hereto and as of the validation date shown beIow, I
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 that,
based on the infoz~ation obtained from the ~nicipality of Anchorage files and from my
investigation and inspectioe, the on-site water supply and/er wastewater disposal
system is in compliance ~lth ~1 Municipal and State codes, ordinances, and regu!a-
~ions in effect on the date of this inspection.
Name of Fi~ ~ ~ C S' /~- Telephone ~'-~ / ,~-~ ~% ~
(ENGINEER SP~L)
DtlE___Jl~jlproval
Approved
Approved
Disapproved
Texas of Co ditional Approval
By
Conditional
CAUTION
THE MUNICIPALITY OF ANCHOR-AGE DEPARTMENT OF IiEALTH AND ENVIRONMENTAL PROTECTIO,q
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TIlE PO']PRESENT-
ATIONS GIVEN IN PARAG1QIPH 5 ABOVE BY /IN INDEPENq)ENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COI~TESY TO PURCHASERS OF IIOMES AiWD
THEIR I~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERYuL AND STATE REQUIRE'~
MENTS. FI'~PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISS%~ED. THE MUNICIPALITY OF ANCHORAGE IS NOT tLESPONSIBi. E FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DI[EP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
MUNICiPALiTY ~JIJ'~I~"IJlJ~)~JT~Y OF ANCHORAGE (MOA)
DEPT. OFhI[E,~IJ[~I'&AUTHORITY APPROVAL (HAA)
R',NIRONM~NTAL PR~T/JjJ~t~IST - FEBRIJARY 1984
264-4720
,SEP & lgg5
Legal Description:
RECEIVED
WELL DATA
Cleanout/Manhole
Water Samole-Gollected by
Water Sarnole Test Results
Comments
Wel Classificatior ~¢¢/h ¢$
Well Log Present (~N) _
Total Depth _ -~/¢0 _ Cased to -/
Casing Height Above Ground
Electrical Wiring in Conduit~'~/N)
Separation Distances from Well
To Se 0tic/Holding Tank on LOt ./O
To Nearest Edge of Abso~ot~on Field on LOt
To Nearest Public Sewer Line ,4,',4.
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ ~' -'i= ~ Yield
Depm of Grouting
Pump Set At
Sanitary Seal on Casing (~')/N)
)epression Around Wellhead (Y/~
: On Adjoining Lots /¢'$ .~o
//~- : Oe Adjoining Lots ~T t03
To Nearest Public Sewer
To Nearest Sewer Service Line on Lol /¢'//'//~
; Dine __,C_:~ "~r~
B. SEPTIC/HOLDING TANK DAI'A
Date Installed
Stanc pipesd~Y.~NJ Air-t grit Caps
Depression over Tank
Pumping/Maintenance Contract on File [Y/N) ,~'A
Holding Tank H~gh-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply We
To Property Line / '~
To Water Main/Serv;ce Line ~'7- /o
Course ~ T
5'-/& --~ ~ Size / 2. 5'-0 No. of Compartments ~
Foundation Cleanout~(~N)
Date Last Pumped N/~
:'for /'/~
Temporary Holding Tank Permit (Y/N)
To Building Foundation /O
To Disposa Field 5-
To Stream, Pond, La~e. or Major Drainage
Comments
Page 1 of 2
72-026 11/84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~-o
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/i~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /! ~/"'
To Building F~undation 20' ~,~
Lot
Type of System Design
Length of Field
Depth of Field /I - /~-
t
Gravel Bed Thickness
Standpipes Present (~)/N)
Date of Last Adequacy Test
To Water Main/Service Line ~_~'r- /o
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots _ ~ 7- 3(;;;)
To Cutbank (if present) _
G':'r lee
~ize in Gall, ohsDate Installed _'"'-'-.~~__ MaehDiol%~;~icOensSs (Y/N)
'Pump On' Level at
High Water Alarm Level at '~"~-.._~
Tested for_ ~---~""'"~~~dequacy Test. Meets MoA
Electrical Codes (Y/N)
** 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 9- 5' *~,'r
Company /CEOS /,t~ MOA No..st ~'~-~¢-/
Receipt No. '-~.)~t
Date of Payment
Amount: $ ~[~
Page 2 of 2
72-026 {$1/84}
lineer's Seal
