HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 3 LT 6
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
LOCATION NO, OF BEDROOMS
W~elJ . ~l Absorption area_ /~ Dwel]ingo ~ ~'~
D,STANCETO: :,_
[ LT~in~°ns IF HOME.DE; Inside length I WiO~
Well Foundat on Nearest lot line
DISTANCE TO: ~ ~ )
No. of lines Lengt ~eac Ii Total length of lines
~ :~ ~ ITrench Width ,nches
Top of tile to fimsh grade Materml beneath tde inches
~Length~ ~.~ Width ~ /.~ Dept~ V~ /
Type of crib Crib diameter Cri~depth Total effecti~o~tJo~
Nearest Iot~
C~ s ~ Dept ,~ DriJler Distance to lot line
Bui ing foundation Sewer line
~ing Septic tank
DISTANCE
TO:
P ER M I~;;~//~
No. of compartments 2
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST I~, ,,~b
REMARKS
~_.MUNICIPALITY OF ANCHORAGEr.-.
~ ~ Department, 'f Health and EnvirOnmenta ?rotection
825 = Street, Anchorage, AK. 99501
264-4720
~C-~/~q~ * * * HANDWRITTEN PERMIT * ~ *
~ ~ , rWELL AND/OR ON-SITE SEWER PERMIT '~ ~'
5egal Description: Z & ~ ~/~/~'/ Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: ~ Holding Tank:
Maxim~ N~ber of Bedrooms: ~ Soil Rating(sq. ft/br)
The Required Size of the Soil ~sorp~i~n System Is: '~'~
nEPTH LENGTH 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 minim~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
S PT (HOL N ) TANK = ALLONS
Permit 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.
· * * TWO(2) INSPECTIONS ARE REQUIRED ~ ~ ~
Backfilling of any system without final inspection.and approval by this department
will be subject to prosecution.
M~n~um distance between a well and any on-site sewage disposal system is'100 feet
fo~ a private well or 150 to 200 feet from a public well depending upon the type
of. public well. Minim~ distance from a private well to a private sewer line
is 25 feet and to a co--unity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * *
I certify that:
(1) I ~ f~iliar with the requirements for on-site sewers and wells as
set forth by the Municipality of ~chorage.
(2) I wi~nstall the system in accordance with codes.
(3) Iu~er~t~nd that the on-site sewer system may require enlargement if
t~ r~~/~s~emod~led to include more that 3 bedrooms. '
S:igne~~~~~~~ Issued by: ~_~~ ~ ·
.~~can Date:
SWP/024(1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE
/
/
,, J
1
[] PERCOLATION
TEST
SITE PLAN
/
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
,~ & ~ E~',IGiNF_.~RING
WAS GROUND WATER /~rD ~
ENCOUNTERED:
O
P
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERFORMED BY:;. ;SRB 196,~(
~;.,~il.~ RIVER, ALA$~(F~ ~??
· PH, ~94-2979
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED
(minutes/inch)
FT AND
m FT
TECH ENGINEERS, INC.
CIVIL · SANITARY
April 12, 1984
Municipality of Anchorage
Department of Health & Environmental
Protection
825 "L" Street
Anchorage, AK 99501
Re: Ranger Construction, Health Authority Approval (HAA)
Application; Lot 6, Blk 3, Greatland Estates
Gentlemen:
On April 9, 1984 we performed research, investigations
and testing persuant to Health Authority Approval on the
above referenced lot.
We performed a flow test on the well and found the
output to be adequate for a 3 bedroom house. (Refer to Well
Yield Test, attached). Well yield test was performed by
discharging at maximum flow a volume of water equal to that
contained in the well casing. The flow was then set at 0.5
gpm and allowed to run for 4 hours. A low water shutoff was
located in the well, 10' above the pump. Throughout the
test, water level in the well was above the shutoff. We
also took a water sample for bacteriological analysis and
results were negative (Refer to Chemical & Geological
Laboratory Analytical Report, attached).
The septic system is less than 2 years old and an
adequacy test is not required.
In our initial inspection, we found that the wires
leading to the well were not enclosed in conduit, soil had
been filled too high around the well head, and we were
unable to find one of the septic tank standpipes. All of
these deficiencies have been corrected.
lq ~ ¢ F~nllk' I AklF · FAGI F RIVFR Al A,~KA 99577 · TELEPHONE (907) 694-3574
To our knowledge, we have assembled all available
information on the HAA Checklist and Application Form. We
offer this information for your review. Please call if you
have any questions.
rely, ~
Vernon L. RoeS, PE
cc Richard Kuper, Ranger Construction
Attachments
HAA Application
HAA Checklist
Well Yield Test
Sewer Inspection Report
Well Log
Chemical & Geological Testing Lab,
Total Coliform Analysis
~-W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner RICK COOPER .Use of Well
Location (address of: Township, Range, Section, if known; or distance main road__.
EOT 6 Block 3 Greatland Subdivision
Size of casing 6" Depthof Hole .223 feet Cased to_ 169.& feet
Static water level !53 ft. (above) (below) land surface. Finish of well (check one) open end ( );
Screen ( ); Perforated ( ).
Describe screen or perforation 60' of clo!:r-d > ~ :?r (r,t,:r~l) ',,/ ? w'i:':do;:~;_.~'_!_='-or~ of l~r.~-r
&~OUoF:~ l~ncr ,3 12Z' botl;o~:, of j, Jn~r ~
Well pumping test ~t l[~S~gallons pert Lm]nute) for ] nours w~th !0~5% f~;
of drawdown from static level.
Date of completion notohor 4. lqg3 ..
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO 2 Caatn~. stickup
_2 TO 5
5 TO 17
17 TO 89
~9 TO 99
99 TO 139
12.9 TO 141
141 TO. 154
154 .TO. 156
156 TO 164
164 .TO 168
168 TO_ 170
170 .TO 223.
.TO
TO.
Silty gravel
Loose gravel
Silty ~ravel
Silty clay
MUNIcIPALiTy OF At'iCt~oRAQE
OEPT, OF HEALTH
ENVIRONMENTAL
('?D r)
S~l~y hard pan and boulders
Damp grave] .~/
Gravelly hrad pan
Boulder
Sandy gravel
SilLy gravel
Ifater }:ravel
Bedrock (green)
3 -- CO?6TRACTOR
MUNICIPALITY OF ANCHORAGE
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
Application Date ~.. /
/ '/
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
(b)
Location (address or directions)
Applicant Name
Telephone:Home //¢,t,.f. c/~.,./ Business
Applicant Address
(c) Applicant is (check one): Lending Institution [~]"~Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
$ :'&- 5 ENG!HEEP.!.~!G
12'034 Eagle Rive~ Loep Road Ne. 204
Eagle RiYer, Alaska
TYPE OF RESIDENCE
Single-Family [:~i'Multi-Family []
Number of Bedrooms '-~
Other
WATER SUPPLY .
Individual Well ~ Community [] Public []
Note: If community well system, must have written Confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWA~D..JSPOSAL
Onsite b'.q Public [] Community [] Holding Tank []
Note: If corn munity well system, must have written confirmation from the State Department of Env ronmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11/84}
ENGINEERING FIRM PROVIDIr ,NSPECTIONS, TESTS, FILE SEARCH, D,~ ; AND INFORMATION
As~certified by my seal affixed hereto and as of the validation date shown below, 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 information obtained
from the Municipality of Anchorage files 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
$ & S ENGINE~EING
Address 17024 E: c
Date Eagle E~ver, AlasEa cj9577
Telephone
DHEP APPROVAL'
Approved for "~/~"~'~'~)bedroomsby~ '"'~'
Approved ~ Disapproved Conditional
Date
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 given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a 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)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~i
HEALTH AUTHORITY APPROVAL (HAA)
~'f¥ Of: ANCHOP, A
h~uNICIPAL .~I~-.IECKLIST- FEBRUARY 1984
E. Nvi~ONMENTAL S~RV~CES DI¥~u~ 264-4720
MAR 5 ~,98'~ Legal Description:
Well Classification
Well Log Present~)/N)
Total Depth
Static Water Level
RECEIVED
--~. F If A, B, C, D.E?C. Approved (Y/N)
Date Completed /cY/ ~//,¢_-~ Yield
/
? ~ Depth of Grouting
Pump Set At
Sanitary Seal on Casing C/N)
Depression Around Wellhead (Y/(~:)
Cased to
Casing Height Above Ground
Electrical Wiring in Conduit (~/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot /
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~"J//~
Cleanout/Manhole
; On Adjoining Lots
/'~o/¢' ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
/ Oc)/7z'
Water Sample Collected by
Water Sample Test Results
Comments ~f5C£
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~'/~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course ~/~
Size / 0oo No. of Compartments
Air-tight Caps (~N) Foundation Cleanout,~l¢~l)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
/ oo z./: To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026{ 11/84)
^.SO..T ON .ELD ATA
Soils Rating in Absorption Strata /(.DO ¢[~ ~
Date Installed ~' - Z-~ - ~.~
Width of Field ~_..3
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present ¢~/N)
Date of Last Adequacy Test
Square Feet of Absorption Area
Depression over Field (Y/~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /OO/-/
To Building Foundation
Lot '*"/4
To Water Main/Service Line /~/-¢
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ._~.3/-/
To Cutbank (if present)
Comments
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$ & S ENGINEERING ~4ate , ¢.~ ~'~ ~:~,~
17034 Eagle Ri~er ~p Eoad No. ' ~
Date of Payment 3 / 5,/
Amount: $ / .~
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
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 INFORMATION
(a)
(b)
(c)
(d)
(e)
Legal De~;cription (include lot, block, subdivision_, section, township, rang~.~
Location (address or directions) '.
Applicant Nam ve~ ,~.~-'~-~- ("~ Telephone: Home g~/4/~
Applicant Address
Applicant is (check one): Lending Institution []; Ownerlbuilder []; Buyer []; Other/[~/ (explain);
Lending Institution ..."~-~J/~ ~ Telephone
Address vg;~'Ld'>~~
Address . ~,~.,~'_ ~., ~__/~~.~,
Telephone
(f)
4~'~the HAA to the following address:
PH. 69~979
TYPE OF RESIDENCE
Single-Family,~ Multi-Family []., Other
Number of Bedrooms S ~I~ "1'"'~:::~.~,
WATER SUPPLY
Indiv. idual Well/J~ Community [] Public []
Note: I~ community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
OnsiteF Public [] Community[] 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 I of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING ~NSPECTIONS, TESTS, FILE SEARCH, DA1,_ ,-~ND INFORMATION '
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
ity Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
i~':.for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtai ned
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
~astewater disposal system ~s in corn pliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
ame of Firm ~_'-~.
8RB
Date
Telephone
. Approved for -_~.//~'~-'~ bedrooms
~" ' ':' ; ~" r~ Conditional'
~:'~:~7'J'-:' ' Approved ~ Disapp o
'~':" Terms of Cc ~d'itional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a 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
MUNICIPALITY OF ANCHORAGE (MOL,, ~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: ~ L.~
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
E IV E D
WELL DATA
Well Classification
Well Log Present ¢;g'N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (~/N)
Separation Distances from Well:
To Sepbc/r~,,~,,,g Tank on Lot
~ ,~'~'. If A, B, C, D.E.C. Approved (Y/N)
Date Completed It>- ~ ~ ~)'~-~ Yield
Depth of Grouting
Pump Set At
['2-- ~ Sanitary Seal on Casing~N)
Depression Around Wellhead (Yz~
Cased to i, b~°l, I~ t
t
To Nearest Edge of Absorption Field o~n Lot I t~,c~ [ ~ ; On Adjoining Lots I ¢~'"~
r4-.,~-- To Nearest Public Sewer
To Nearest Public Sewer Line ~/~ '~
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ¢~-~-~ ~.--IC~,~¢==¢)._-~ ; Date ¢1~ ~ ~ ~, ~ ~'
Water Sample Test Results
Comments A ~,J~--z_..~.--
B. SEPTIC/14~LDh%'6 TANK DATA
Date Installed
Standpipes O~/N) Air-tight Capsd~.~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Held',ng Tank:
To Water-Supply Well 1. ~
To Property Line
To Water Main/Service Line
Course
'2--
Size ~ No. of Compartments
Foundation Cleanout (~N)
Date Last Pumped ~t ~ ~, ~ ~ ~:~
!
/,~ ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~
To Disposal Field ~_~ ~-b
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field '¢~'"~'~
Square Feet of Absorption Area
Depression over Field (Y,~
Results of Last Adequacy Test
I
~ ~-~ ='P/~ Type of System Design
Length of Field '~/~z; '
Depth of Field Z_J ~- "7
Gravel Bed Thickness Lc
Standpipes Present ~:;~N)
Date of Last Adequacy Test //-~-¢--~,~ -~Tw/,,,,,,,,,,,,,,~J
z
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation ~ L4-
Lot
To Water Main/Service Line ~ ~ ' ¢¢
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 '~
To Cutl~ank (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
Receipt No.
Date of Payment
Amount: $
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guideiines in effect on the date of this inspection.
Signed O"& ,~t E~!~iI~EE~J~ Date ~;~'/'~ ~-~'/~,.-~-
/
~--/
No.
Page 2 of 2
72-026 (11/84)
MUNICIPALITY 'OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information A~plication Date April 12, 1984
(a) Legal Description (include lot, block, subdivision, sectionj township, range)
Lot 6, B!k 3, Great!and Estates
Location (address o~ di~-ections)
NHN 0uick Way_; Chu~iak: AK QQ567
(b) Applicants Name Ri e.b~rd Kuper/Ra//ge]z~Q~a~tructl on Telephor~ 27~-0854
Applicants Address 170q S. }3ra_~aw.~ Suf te K: Annho~g~ ~ A~ 995~8
(c) Applicant is (check one) Lending Institution ~ ; Owner/builder ~. ;
Buyer ~--~ ; Other ~ (explain);
(d) Lending Institution National Bank of Alaska Telephone276-1132
Address Northern Lights Blvd. & "C" Street~ Anchorage~ AK
(e)~al Estate Co. & Agent N/A
Address
Te le phone
2. Ty~e of F~sidence
Single-Family ~
Number of Bedrooms
3. Water Supply
Individual Wel. 1 ~
Other (describe)
Co~,m~nity ~-~
Note: If cr~'u~'~nity well system, must ha%~ written confirmation f~cm the State
Department of Environmental Conservation attesting to the legality and status°
Is the well adequate for the number of bedrocks specified in this HAA (Y/5~) ~es
Sewage Disposal
~.~ite ~ l~blic ~-~ C~,~¥~nity ~-~ Holding Tank ~
IS th~ wmstewate~ disposal system adequate fcr the rnmber of bedrccms (Y~) Yes
[Page 1 of 2]
2-15-84
5. E. nginee~ing Firm Providing Inspections,. Tests, Data and Informaticn
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in
effect on the da~e of this inspection. /
Signed /~~ ~~.~ Date April 12' 1984
Nan~ of Firm Entech Engineers, ~nc. Telephone 694~5574
Address 13 LeDoux. Ea~le River~. AK
signed by Vernon L. Roelfs
Date April 12, 1984
(ENGINEER SEAL)
6. DMRP Approval
Approved fo~
Approved ~
99577
Terms of Conditional Approval
Tne Municipality of Anchorage Department of Health and Enviror~ental Protection does
not guarantee the continued satisfactory performance of the. wate~ supply and/or the
wastewate~ disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional fo~ the numbe~ of bedrocks and type of structure indicated.
(DEEP SEA~)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
ae
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification Private
Well Log P~esent (Y/N) Yes
Total Depth 223 ' Cased to
Static Water Level 153 '
Casing Height Above Ground 12"
Electrical Wiring in Conduit (Y/N) ¥~s
Separation Distances f~om Well:
To Septic/Holding Tank on Lot 100'+
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
APR ',, 5 '.
RECEIVED
Legal Description: Lot 6, Blk 3, ·
Greatland Estates
If A, B, o~ C, D.E.C. Approved(Y/Nl' N/A
Date Completed '.~ 10-4-8.3 ~ ~. Yield 1.5 gpm
'1
169.8' Depth of Grouting Unkngwn
Pump Set At 213'
Sanitary Seal on Casing (y/N)Yes
Depression A~ound Wellhead (y/N)NO
; On Adjoining Lots 100'+
To Nearest Edge of Absorption Field on Lot 100'+ ; On Adjoining Lots
To Nearest Public Sewer Line N/A To Neauest Public Sewer
Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot N/A
Water Sample Collected By Mike Hagan ; Date April 9, 1984
Water Sample Test Results 0/100 ml, negative
Cc~tuents '1 Well yield shown is from the well log. A 4 hour test at
a sustained rate o ~I~5 gP~'iwas performed on 4/9/84.
B. SEPTIC/HOLDING TANK DATA
Date Installed 9-25-83 Size 1000 Gal. No. of C~a~tments 2
Standpipes (Y/N)' ¥,es.-., Air-tight Caps (y/N)Yes Foundation Cleanout (Y/N)
Depression over Tank (Y/N) *2 Date Last Pumped N/A
Pumping/Maintenance Contract on File (y/N)N/A ; for N/A
Holding Tank High-Water Alaz~m (Y/N) N/A Tempora~y Holding Tank Permit (Y/N)
separation Distances f~om Septic/Holding Tank:
To Water-Supply Well 100 ' + ~' To Building Foundatio~ 8 '
To P~operty Line ~, + To Disposal Field ' 5 ' ·
To Water Main/Service Line 10'+
Yes
To S~eam, Pond, Lake, c~ Major D~ainage
Course i /A
Con~ents '2 We were unable to determine if there was a depression over
the septic tank because of snow cover.
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 100 sqft/bdrm Type of System Design
Date Installed 9-25-83
Width of Field 23 '
Square Feet of Absorption A~ea 506 sqft
Bed
Length of Field 22.'...
Depth of Field 4' - 7'
Gravel Pad Thickness ~ Unknown' L"'l/
Standpipes P~esent (Y/N) Yes
Depression over Field (Y/N) *3 Date of Last Adequacy Test New system
Results of Last Adequacy Test New system
.Separation Distance from Absorption Field:
To Water-Supply Well 100'+ To P~operty Line 15'+
To Building Foundation 20'+ To Existing or Abandoned System on
Lot N/A ; On Adjoining Lots N/A
To Water Main/Service Line .. 10'+ To Cutbank(if present) N/A
To Stream/Pond/Lake/o~ Major Drainage Course I~/A
To Driveway, Parking Area, o~ Vehicle Storage A~ea 10'+
Comwents *3 We were unable to determine if there was a depression over
the absorption field because of snow cover.
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.
Rets MOA
Contents
** Check Permitted Bedrccm Rating Against HAA Pequest
I certify that I have checked, verified, or conformed to all MOA ~ Guidelines in effect
on the date of ~this ins~ection.
[Ra~
2-15~84