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Home My WebLink AboutTUXEDNI PARK BLK 3 LT 2a' Tuxedni Park Block 3 Lot 2 #041-022-18 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ 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? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0850 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 1/v is 1 /l a 1V-'e'—y DATEPERFORM LEGAL DESCRIPTION: I_2P�3�Xt Township, Range, Section: P IL71es�L� SLOPE SITE PLAN fFYC'rl 1 2- 3- 4 3 0 �, 5- 6- 7 7 _� o 8 f 9 v� t0 6 WASGROUNDWATER ENCOUNTERED? d ♦l Q S 11 �. L IF YES, AT WHAT DEPTH7 p 12 E `r: SP Depth to water Atler 13 V5,Tj ,,, Cr Fk�L Monitainp? 32F4_ Date: 14- 15- 16- 17- is 415161718 19 20 COMMENTS PERFORMED BY: S & S ENGINEERING ACCORDANCE WITI-IrAW(SUIVAW""W? 72-008 (Re .4/85) PERCOLATION RATE (minutevinch( PERC HOLE DIAMETER TEST RUN BETWEEN TAND FT CERTIFY THAT THIS EST WAS PERFORMED IN THIS DATE. DATE: f 1 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 NA;EE ��-1 P13 �� ❑ &fiEGRADE J MAILINGADDR/ �/ G /. �:GG �r /,G�• LEGAL DESCRIPTION CC//JF'z '6 3 LOCA 149+FJ� 7 � NO. OF BEDROOMS O DISTANCE T0: Well � (QO Absorpao ar a Dwelling P T .940 Y WQ ~ Manufacturer G4.eIE \7` Materi�L GL JJ No. o mpartments rn Liq. ca it in allons IF HOMEMADE: Inside length Width Liquid depth G Y Jt7Z DISTANCE TO: Well Dwelling PERMIT NO. 0 f Manufacturer Material Liquid capacity in gallons DISTANCE TO: Wel l� Foundation ^^ O(Q Nearest 1 net i— / PERMIT 9616 (� G v rt�rL No. of lines Length [ ch line mo{6inchesX Top of [ile to finish grad Total length of lines Trench dth Materia heath tile �k7 inchesVVLength Distance/ .en lines Total of yryM absorption area rIr W. th Depth PERMIT NO. W Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS � Mm- Ye-o SOIL TEST RATING � INSTALL Ail! REMARKS I � APPH ED DATELEG �L�/y L' V 72-013 IRK 31781 (,/ ^. 11_+r-4 I r-- I F' I T•T IZIF= Rr4C�H. :;: Fi E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET. ANCHORAGE, AK. 99501 264-4720 L•!EL_L Ht•aC• rir••1—E I TE 5= ELJEF: FsEF:f•7 I T '� PERMIT NO. C 810965 )9 Il RI c"Lo uc-aor �X.. J� L_'30& , APPLICANT TED J. GRAY 71 BIRCH HILL, FT. RICH. 422-2112 LOCATION TUNDRA LOOP DR. LEGAL L2 Bs TUXEDNI PARE; S/D LOT SIZE 64050 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM•JUMBEP OF BEDROOMS = 4 SOIL RATING (SG? FT/BR..)= 100 THE R.EQ�J��RE[) SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF?,TH= 1c-+ ILEr4o-r"= 2--t GRA•tifEL C?EF='TH= -• THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OP. PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND 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.). REr:!U I F:Et? ' FEF=•T I C TFir-4K ' E I LE= 1•.`-•N iCCFiLLOr••IE PERMIT APPLICANT HAS THE RESPONSIBILITY TO INF,£1RM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBEP. OF RESIDENCES THAT THE WELL I -JILL SERVE. --- Tt•1i=► C c ? I t 15 F•ECT I 0r45 HF E F ErlL_ I t2EC• --- BACKFILLING 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 SEWAGE DISPOSAL SYSTEM IS 100 FEET FOP A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC I -JELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AFJD 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 APE A'•:'RILABLE TO INSURE PROPER INSTALLATION. F•EFR.*M I T Ek:P I FREE GyECEMEEFZ 2::1r 154 1 I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR OFJ-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. S I r,FJED APPLICANT TED J. 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Oti ITE s0•b_ucs tvp. !•kZLi fr; x r F+Y.:fi[ a'r r tn!N[C[`:lr_[r'r' ft Hwt".wm. ' t tttf!_ lit3TI-P.J. rw. 5,'irEn to fft_CA::Dtii7t:r tttrH rw i : t t?p!rz' fr3 rt7thi I H:i r r; -I On i rr s 1•A F. ':'t`: rem r W'1 kcla{ 1 th Et'/..i'njr it.tl f t( T'tt£ t a��[irr t rF1Nxw,Ftt rctQtr7t_ut bb],�} ryt�rt 4tv�+Jrfi�_ - SIflin�+:---------- ----` --- dot-D==-/------- t3?Pt_tavir rry J. r1> y t'i=txa sY�/i 'dl c��/ 1al- ,rte _---------c•>3r> t��Yf ,�zf�=[lei/_ vt 9 • I �, • �1 SOILS LOG may" MUNICIPALITY OF ANCHORAGE O PERCOLATION i�• � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 925 L. Street, Anchorage. Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED LEGAL DESCRIPTION: L.. V 1ye— iS1 K00.W1, pfOUJsA •••� //• p 2 •mss• C]f�V�-�- DcoUJN 3 G rave Uy Sa-�crQ • � V r 4 �• �11�G CINCs, 5 gracYerb[ 6 7 /. e ut ga �- 9 U . !o 10 b :' 12 s 'Ct,� 13- 14- 15 3 14 15 s� P '•.'Fy�t r 17 r* 491H • :* 18 / �•N . 2225-E 1� r� J IE 25, 1971 i DATE PERFORMED: -8-020-81 WASGROUND WATER S ENCOUNTERED? O L O P IF YES. AT WHAT E DEPTH? SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop • E�� - 20 PERCOLATION RATE (minutes/inch) COMMENTS 14 �' •'Ki WT& RUN B Efp! A L. -]—/I 1w a2— PERFORMED L .fX�4—K. /TI.+wrsiNc— PERFORMED 72.008 16/79) 1 CERTIFIED BY: DATE: 6 • 2.0 • e 'l T ^, STATE OF ALASKA ..&TURN TO: 01N1110n of Geological and C y0c+l Surveys (DGGS) DEPARTMENT OF NATURAL RESOURCES 300t Porcupine Drive (Tel s: 277-6615) anchorage. Alaska 99501 , •� W ATE R WELL RECORD Drilling Company Nam rn .. t 1 T : n ...... .....t... .lrtir I.. Ib. or Ic. U.S.G.S. Local No. Drilling Permit No. A.O.L. No. la ^Borough -_-- Subdivlslon Lot Block Ib. Fraction Section No. Township RangeMarldlan Ic. Distance and Direction from Road Intersections Street Address and Area of Well Location 3. OWNER OF WELL: ,) , r' Address: 2. WELL LOC material Type Top Feet Below Sur qce Bottoa h• WELL DEPTH: (cotro feted) ft. Surface Elewtlon '-- Data of Completlod'• •-^ •^• -•-'=�-" ��- �� Rotary ❑Driven Oug S. [:]Cable tool ❑❑ ❑ Auger ❑ Jatted 13bored1:1Other: "• 6. USE: ❑Domestic ❑ Publ lc Supply ❑ Industry [:)Irrigation ❑ Comes ❑ Coes rciai ❑Test well ❑Other: _ , _. .. 7. CASING: ❑ Threaded ❑ Welded In. to ft. Depth Weight lbs/ft. In. to ft. Depth 8. FINISH OF WELL: .. .. .. .. Type; Diameter: sh Site: Length: ween h. and ft. s: ' ICIP.4, f fq /p i'y rpftSot = r WATER LEVEL: ft. ove ❑Below land surface f Measurement: G LEVEL below land surface ft. after Mrs. pump Ing 9•P•m-ft. after Nn• pumping g•P•m. EAD COMPLETION:In Approved Plt ltless Adapter Inches above grade 12. GROUTING: Well Grouted: ❑ yes ❑ No material: ❑ Neat Cement ❑ Other: 13. PUMP: (If oval labia) IF Length of Drop Pipe ft. capacity 9•p• Type: OS beerlibl. ❑ReclDrocating ❑ Jet ❑ Other: la. REMARKS: - Water Te.rlp?rdtUre: 15• WATER WELL CONTRACTOR'S CERTIFICATION: This wall was drilled under my Jurisdiction and this agistered Business Name Address: Signed'. Autnor'ted Representative form 02-WWR Copy Distribution: report Is true WHITE - State to the best of my krcn ledge and belief: -contract License N.maer 1 Data: DGGS, PINK - Driller, CANARY - Customer MUNICIPALITY OF ANCHORAGE O Department of Health & Human Services 1� DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. N (n L-1 I- 121='_1 - 1S. HAA # b` 04 q(In '13 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; stock 3; Tuxedni Pan.h Subdivision; Location (address or directions) 9700 Tundra Loop, Anchotage � La4 L lonnnn t)i rhoy Telephone: (home) 338-2806 (b) Property owner ��u� Business Mailing Address 9700 Tundra Loop, Anchoha a Ata6ka (c) Lending Institution Mailing Address Telephone . •.-P12■ r Telephone " 506-9808 — (e) Mail the HAA to the following address: (or check here =f hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop RoatLNe 40; Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family 1XX Number of bedrooms —1- 3. WATER SUPPLY Individual Well $X Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IXX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025(A".71ee) Page 1 of 2 ,....; ... .. . t 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 Address Date Telephone 6477 el- Z47!E S & S ENGINEERING 170 34 Enle River 1 enaRead Eagle River, Alaska 99577 / 4 U G..... ... t. 'Robwt A.:,� rtx• i 6. DHHS APPROVAL Approved for bedrooms b—Date Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors or omissions in the professional engineer's work. 72-025 (Rw. vee) Back Page 2 of 2 WNICIPMOWW{PQCdF ANCHORAGE (MOA) NMENTA44 iffWAN46fYt Approval (HAA) CHECKLIST - FEBRUARY 1984 JUN 2 81990 343-4744 ' J RECEIVED Legalriptio : �` 2 A. WELL DATA r Well Classification �1 ��'"►— If A, B, C, D.E.C. Approved (Y/N) Well Log Present CON) _ Date Completed \ ft Yield 3 • E5 <211?1_1 4— t Total Depths Cased to _SRQ . Depth of Grouting t Static Water Level Pump Set At �t Casing Height Above Ground \2 '� Sanitary Seal on CasinggM) y Electrical Wiring in Conduit(Y;N) Depression Around Wellhead (Y SEPARATION DISTANCES FROM WELL: t To Septic/Holding Tank on Lot \ C-74� ; On Adjoining Lots I '�— To Nearest Edge of Absorption Field Lot ( � j� : On Adjoining Lots �� To Nearest Public Sewer Line N—I To Nearest Public Sewer Cleanout/Manhole A To Nearest Sewer Service Line own Lot. �,t -- Water Sample Collected by�nt^;Date Water Sample Test Results =R�. Comments 8. SEPTIC/FtO1=9iGDATA Date Installed ) Size Q_No. of Compartments Z Standpipes437N) —Air -tight Caps4M) _Foundation Cleanoutq.VN) _ Depression over Tank (Y(tpate Last Pumped Pumping/Maintenance Contact on File (Y/N) A ; for Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) P SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well t -)f- To Building Foundation ) of To Property Line To Disposal Field 7�f To Water Main/Service Line (o t+ To Stream, Pond, Lake or Major,Drainage Course Comments 72-M (A". 7M) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata�u:7-P Type of System Design Date Installed r Length of Field Width of Field 125 of Field Gravel Bed Thickness S t Square Feet of Absortion Area SCA=� _P Statndpipes Present(YTN) _ Depression over Field (Y/JSr Date oftLsst, Adequacy Test Results of Last Adequacy Test 6t__0 VrC�'rr —v SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ��,�' To Property Line o To Building Foundation �� To Existing or Abandoned System on ` Lot k k z ; On Adjoining Lots t To Water Main/Service Line �' To Cutback (if present) P To Stream, Pond, Lake, or Major Drainage Course <=0 Vir To Driveway, Parking Area, or Vehicle Storage Area SOt't Comments D. LIFT STATION Date Inisietled_ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . "Pump Off' Level at Vent (Y/N) _ Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" ( I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect te of this Inspection. • _�� A *4'% ..A Signed —Sa,SNGINEFRING s'P�� •" :tit Company 17034 Eagle River Loop Road No. 204 y t '.'' Eagle River, A; 'S/� Date MOA N4• JL4 60 d " itoben A..Mfa• •:r Receipt No. a/(79(0 / Y 4, Date of Payment t'0 ' &1_5?0 Amount: $ /70,025 72-028 (Rn. 7/88( Beck Receipt No. _ Waiver Fee: $ Date of Payment Page 2 of 2 .r o CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET - ANCHORAGE, ALASKA 99518 - TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALISIS REPORT 8I SAMPLE for Work Order 1 21604 Date Report Printed: NAI 10 90 l 09:36 Client Sample ID:L2,13 TUIEDNI PE S/D Client Nana : 3 6 S ENCR PW31D :OA Client Acct : SNSENCP Collected NAI 7 90 l 19:50 bra. P.0.1 NONE RECEIVED Received WAI 8 90 1 13:20 hre. Req 1 Preserved with :1S REQUIRED Ordered 1y : R SRAIER Analysis Completed %NAI 9 90 Send Reports to: Laboratory Supervisor : IEPREN C. EDE 1)3 4 S ENCR Released Ey : G 2)►DEC .................................................................................................................................... Special Instruct: Chemlab Ref 1: 901260 Lab Snpl ID: 1 Matrix: WATER Parameter Tested NITRIII-N Sample ROUTINE SAMPLE. Remarks. SAMPLE COLLECTED 81 R.D.J. Allowable Result Units Method Limits --------------------------------------------------- 1.8 sq/1 EPA 353.2 10 .............................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable NO. None Detected " See Sample Remarks Above NA- Not Analyzed LT -Lose Than. 0I -Greater Than Time Time .e f Date Date Date _ v � Inspector Inspector Inspector Comments Conditional Approval 1u� Date Se4er Installed �- - n Permit No. Septic Tank Slze �n^�w^-�• �J Holding Tank Size Soils Rating Well To Absorption Area Well Log Received "AA - f Well to Tank APPLICANT FILLS OUT LOWER HALF,ONLY eF Property Owner r7 Phone Mailing Address 97 0 %6f o2lin Loa -:,-OZ ASC f oltllei-'. QC,'sa7 3Y 1�/ 7 Buyer V A' ' A Address Lending Institution / 5 r E= Phone Address ,Uj �j� ND/l %/-is1lN (-/(T/lam AW 12 l4g4,1J 3 27 y GSGS Really Co. & Agent Phone . N Q Address Legal Description Street Location q?od MA -,04H f, o,) D2 p/vc Qg5d7 Typegj Residence '6 Single Family ❑ Multiple Family It No. of Bedrooms ❑ Other Watq,S"pply �n Individual ATTACH WELL LOG. A well log is required for all wells drilled slnce June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if * Public Utility available. Sewage Disposal Xlndividual - Year Individual Installed: M6 ublic Utility When Connected to Public Utility: HoldingTank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. O(o a7J:^/alua> � V "Nwo 'J 0 � 15' 555 �•p(t� 's.o•`e \ .....� uer/aaS 1 I� v b O —•Y\� % day °i r4/,p° `Q15°o o /4 If NO/135 d •e ie % ♦ _�, i ti A - is ♦a"ya ''.�'� a \ m Q ° e s� ��• � � " ss ? 1' ,; • K •tee /%/° ♦OtiN o d til •Q.'i • l \h v •` A yam... /r—..:\� Q w a • n r �. Z' e• � " p i � By FP G 4 '�`e °" ' iii � 3 � ;: � � t� 0� -s � •+„ � �/ ��•`�„" � 3 �'', iy tl � ice`, :`r /J`j�,y e N Yl�¢l � ''0,11 � �J` Iy N •I`~ 2 � C •J� +• X- JY Ifi , off',, V Qw B' ,•& Jt do °' � o ly 4 � /�Y•wy�` 'c'r' � N 4 Y5� 1 1,° . N yp-fe tii V � h � yV til `yQ � M 0 °1' O ti0M yV r L _ a.•'�r 'ter:.. � � `.. p A, . o w• 0 2 res •rs•. .y4��r ! 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