HomeMy WebLinkAboutDALE BRIGGS BLK 2 LT 9bctle Briggs
Block 2
Lot 9
#050 - 182 - 09
GAAB-H D•'l GREATEI" ANCHORAGE AREA ROUGH
IIF.ALTtI DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF.,APPLl ANT f MAILING ADDRESS
�k; 4EN9iAD KESS /S SSC• .7.siL�iQ.sP .LLOCATION OF IINNS/�LLATIO
LEGAL DESCRIPTION
APPLI ATION TO INSTALL: SEPTIC TANK_, EEPA E PIT 49AH
TO SERVE THE FOLLOWING FACILITY 40 /ZC Ql
Case No.�_�/
P9ONE NO. 72
FINANCED THROUGH TO BE INSTALLED BY�[-.c+,-,kf
PERCOLATION TEST RESULTS p
ANTICIPATED DATE OF COMPLETION p ^ / Z — 20
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TOS RVE AS ���-'��_-- , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO E SERVED
SEPTIC TANK SIZE L`�' /HYPE �� SEEPAGE AREA !i
DIAGRAM OF SYSTEM
DISTANCES:
%J *,-t3w-- 9.3
9 -
ININ,
, I xgc-.C--
Health Authority
I certify that 1 am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATURE
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GAAB"DI GRF"ER ANCHORAGE AREA BOROU.G.H
' HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING2ZZ —
NAME /�_ /�`f�/.—ADDRESS S'OX /i�..S� 99/✓�il�• PHONEl
LOCATION g/y_ DESCRIPTITL17f/w:r•
SEPTIC TANK:
1� NUMBER OF
DISTANCE FROM WELL 93 MATERIAL r_7nrZ/ T COMPARTME
LIQUID CAPACITY Z0 U GALLONS. INSIDE LENGTH ✓ INSIDE WIDTH_
v LIQUID [/
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH—, LENGTH,DEPT
�. .PivitrJ
LINING MATERIAL GE=?nE1�lT . DISTANCE FROM WELL ��� ' /BUILDING FOUNDATIOt,/%�-
NEAREST LOT LINE �-�� 'T 'TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) n SO. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL -
NUMBER OF LINES
ISTANCE
AREA SO. FT. LENGTH OF EACH
NEAREST LOT LINE
WIDTH
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES_
IN. TOTAL EFFECTIVE
ABOVE TILE—
C,,'- DISTANCE
ILE
WELL'
TYPFX,PedStO DEPTH
C,,'-DISTANCE FROM
,BUILDING FOUNDATION.
WATER
SAMPLE NEAREST
NEAREST ✓
SEPTIC L� SEEPAGE C/L—
OTHER L�
CESSPOOL SOURCES_
LOT LINE
, SEWER LINE
, TANK , SYSTEM
, ,
DIAGRAM OF SYSTEM
DISTANCES:
�f'L � c %ill' �iC'4>✓ /.Q2-�/
��C=/.z,o
C
LN
y 1
R.
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DATE
"/i< . I
r\
3 W 15th AVE "C" SUITE 203
32,A &P^2W� 6%H1DD 9 POVO �70ANCHORAGE, ALASKA 99501
ENGINEER TFLFPHONF- 19071 2 79-3 91!1
R E S I D E N T I
A L
W
E L L
I N
S P E C T I O N
LEGAL: LOT 9,
BLOCK
2,
DALE
BRIGGS
SUBDIVISION
LOCATION: 17534 MONTE ROSD, EAGLE RIVER
OWNER: JEROLD SWANSON
TYPE OF WELL: SINGLE FAMILY
WELL LOG AVAILABLE: YES
INSTALLATION REQUIREMENTS MET: YES
WELL YIELD FROM WELL LOG: 5-7 GALLONS PER MINUTE
WELL YIELD FROM TEST: 5.3 GPM WITH 7 FEET DRAWDOWN
PUMP YIELD: 5.3 GPM
DATE OF INSPECTION: JULY 10, 1986
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 5.3
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE
DRAWDOWN STABILIZED. WELL STABILIZED AFTER 50 MINUTES OF PUMPING.
WELL WAS PUMPED FOR AN ADDITIONAL40 MINUTES WITH OUT ANY FUTHER
DROP IN WATER LEVEL. STATIC WATER LEVEL WAS FOUND AT 122 FEET
BELOW TOP OF CASING. TOTAL WELL DEPTH IS 145 FEET.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON
JULY 14, 1986. TEST WAS NEGATIVE.
TEST RESULT:
THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is
150 gallons of water per bedroom per 24
hours.This well surpasses this requirement.
The assessment of the condition of this well
applies only to the conditions as of this
date. The flow rate of the well may change
due to subsurface conditions that may not be
observed from the surface, and changes in
land use and other factors that may impact
the conditions of the aquifer feeding the
well.
MUNICIPALITY OF ANCHORAGE j
DEPARTMENT OF HEALTH AND ENVIRONMENTALPROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720':'
Application Date 4*_L r k
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
i
nw 4 814 2 r 2> 4_I__EF 'ARL6Gs Sac- IX -10 71 j? 94e/
Location (address or directions)
175 33 Ll PO NT E &D
(b) Applicant Name �.�tQl�' S w�'"^ Telephone: Home OV -312v? Business
— — - lei
Applicant Address / Q 7 rvi &.- J"'6K
(c) Applicant is (check one): Lending Institution ❑ ; Owner/IS.tVMX; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent KI1 Mh=
Address
Telephone
(f) Mail the HAA to the following address: 90L^^
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms A
Telephone
3. WATER SUPPLY
/
Individual Well Ib, 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. SEWAGE DISPOSAL
Onsite ❑ Publicy Community ❑ Holding Tank ❑
Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-035111184)
Page 1 of 2
A. WELL DATA
MUMOPAUT! OF ANCHORAG:
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification If A, B. C. D.E.C. Approved (Y/N)
Well Log Present (Y/N)_ Date Completed 0 Yietd�
Total Depth Ca 3ed to - v^ Depth of routing !y 1Ap
Static Water Level—Z,25--a Pump Set At —EWA ZrAm
Casing Height Above Ground Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) y
Separation Distances from Well:
To Septic/Holding Tank onLot tNe✓FD On Adjoining Lots ��nn
To Nearest Edge of Absorption ield on Lot4�n Adjoining Lots /1�;6
To Nearest Public Sewer Line > -z4 To Nearest Public Sewer
Cleanout/Manhole >OOb To Nearest Sewer Service Line on Lot
Water Sample Collected by L ; Date [j
Water Sample Test Results
Comments _:t VI FGrw
B. SEPTIC/HOLDING TANK DATA n /�iL _ 7 �%OU�fJ
Date Installed SizeV /, No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N)
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
Comments
Page 1 of 2
72-026(11,84)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (YIN)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (YIN)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION !
Date Installed / V/ Dimensions
Size in Gallons Manhole/Access (YIN)
"Pump On" Level at —
High Water Alarm Level at
Tested for
Electrical Codes (YIN)
Comments
— "Pump Off' Level at
Vent (YIN)
Pumping Cycles during Adequacy Test. Meets MOA
It Check Permitted Bedroom Rating Against HAA Request "
Icertify t •ttIhavechecked,verifi or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed __ Date Pf(r1�6
Company MOA No.
Receipt No. q `j (o
Date of Payment
Amount: $ �
Page 2 of 2
72-026 111,841
_P••• �• ,( Engineer's Seal
or
it