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Home My WebLink AboutDEER PARK BLK 1 LT 1�t V; O 5 I O ¢Z 38 000 01... i MUNICIPALITY OF ANCHORAGE \I 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 f)n DZNNEW MAILING ADDRESS ob'i N SID �� D — {� PHONE O UPGRADE LEGAL DESCRIPTION^ D r_ O.JPA A � ` V I�J�J `hJ LOCATION Pe'e_es C2eek NO. OF BED,RdOOM O y DISTANCE TO: Well Q/ 1 Q Absorption ar�+i 7 Dwelling + PERM01 ^ s�+ 2 W F Manufacturer Material No. of compartrrra7ls Liyda amity in gallons (l IF HOMEMADE: Inside length ' Width ! Liquid de fj y J t72 DISTAN eh Dwelling PERMIT NO. _ Q acturer Material 'd capacity in Bello O W = DISTANCE TO:100-4 Well Foundation Q •f Nearestlotyyr ,y, (�O I PERMIT r -s /-► W LL L) 2 su No. of lines I Length of each line / Total length of line Trench wi inches Distance between li CF;- p Top of lila to finish grade Material beneath tile inches Total eft a tt area W Length Width Depth P c F Wd Type of cri Crib diameter - tlepth Total elfxtive abs ion area W DISTANCE TO: Well Buildin undation Neare ine J J Class Depth Driller Distance to lo{ lyyr r LV P t q �Q 6 O W T+ DISTANCE TO: Building footityll' 4+V Sewer line Septic tank / lO Absorption alc) OTHER PIPE MATERIALS SOIL TEST RATIN / S%• INSTALLER REMARKS i� NO_rT_M PPH VED DATE LEGAL 9U97 LiB e.� � -- 72-013 (Rev. 3/78) Mu1-1 I C I F'�- JL I T'T OF= rHtJr HC�~t DEPARTMENT OF HEALTH AND ENVIRONMENTAL PF0TECTION f 825 'L' STREET, ANCHORAGE, AK. 95501 �• 264-4720 LL l,lE:L_ L nl'-JL7 QtJ—S~ I TE ELJEFs P R t7 I T PERMIT NO. ( 790282 ) r� APPLICANT MONROE ROBINSON SPA BOX 117-P X-11ullArE LOCATION DEEP. CIRCLELEGAL L1 B1 DEEP -PARK EST LOT SIZE 4 TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH u MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 'THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: (ON DEPTH= :- LEFJr3TH= ,Y�`�•' GF= R':� EL DEPTH= THE LENGTH DIMENSION I5 THE LENGTH CIN FEET) OF THE TRENCH OF. DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOP: TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND 'THE BOTTOM OF THE EXCAVATION CIM FEET). F-zE:Q U I F- 1-= C- CERT I r TAt-4K I Z! E_= 1[_�C�ln rjALLIDr-l_• 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 I -JILL SERVE. --- TI -J LD < � ] I M= PELT I Ot•J_• RRE EEpli I F-_ - 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 FOR A PRIVATE WELL; OP. 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. 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, INSTALLATION. PEF=:MIT C•ECE:rlE'EF= 1�_ r s;l I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND'WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I I -JILL INSTALL THE SYSTEM IM ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIR:E ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:---__ I--------------------------- APP CANT MONROE ROBINSON ISSUED BY V3. 2 A -W DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG ,Veil owner-_ MONROE ROBINSON Location (address of: Township. Range, Section, if known; or distance main Lot 1 Block 1 Deer Park Estates, Peters Creek � -19 03, gD of Well nom ;ize of casing-_ Depth of Hole -52 .-feet Cased to__50—_._feet 'Matic water leveL-3-8 ft. (abMK) (below) land surface. Finish of well (check one) open end ( xx ); Screen ( ); Perforated ( ). Describe screen or perforation N/A _ Veil pumping test at 8 gallons per T4fd'�*j (minute) for--1--hours with 100% %x of drawdown from static level late of completion_.. 6/18/79 WELL LOG )epth in feet from round surface Give details of formations penetrated, sire of material, color and hardness _ 0 TO_ -2 - Casing stickup ----_-_-_ —2_._TO_ 3 Organics - 3—T0_10 Cobbles 10 TO 38 Silty gravel:co_bbly 38___TO_ 52 Water sand &_gravel -TO TO --- - - ----- - - --TO - -- —TO ------- ---- -- ---T® --- -- - _TO 1 —CUSTOMER f^ 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 December 9, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1, Block 1 Deer Park Estates T15N R1W Sec. 4 Location (address or directions) .h ,glak, Alaska (b) Applicant Name Rich Holmstrom Telephone: Home 4 Bkk-9173 Business Applicant Address Sr Box 5072 GhuVlak, Alaska 99567 (c) Applicant is (check one): Lending Institution ❑ ; Ownertbuilder ®; Buyer ❑ ;Other O (explain); (d) Lending Institution Nnrthl and MnrtgagP Telephone 694-7872 Address 400 W. Tudor Anchora7e. Alaska 99503 (e) Real Estate Company and Agent NSA Address NZA Telephone NSA (f) Mail the HAA to the following address: Pickup byRngineer 2. TYPE OF RESIDENCE Single -Family El Multi -Family ❑ Other :'�11� 11 rrrlr Number of Bedrooms ` a 3. WATER SUPPLY Individual Well ID Community ❑ Public E3 r'L 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 OnsiteE3 Public ❑ Community[3 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 1 of 2 72-025 (11,84) r A. WELL DATA Well Classification E)A T'E If A, B. C. D.E.C. Approved (Y/N) N k v .. Ter,1.3 Ix-��-4t Well Log Present (Y/N) �� Date Completed 6 — /➢ ` �`' Yield 2 GP n r Total Depth -5-Z f Cased to S0 Depth of Grouting Static Water Level 2p, Pump Set At i Casing Height Above Ground /.S- Sanitary Seal on Casing (Y/N) % Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N ` Separation Distances from Well: � � t To Septic/Holding Tank on of �& ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot r/ f ° ; On Adjoining Lots / ° r To Nearest Public Sewer Line Nls To Nearest Public Sewer Cleanout/Manhole — To Nearest Sewer Service Line on Lot t�s� Water Sample Collected by E<r4 ('rt'i✓tn �.�s� rte, ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed / "� Size /0470 5„/ No. of Compartments a Standpipes (Y/N) Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) /y Date Last Pumped ae Pumping/Maintenance Contract on File (Y/N) ��`r ; for — Holding Tank High -Water Alarm (Y/N) ~LTemporary Holding Tank Permit (Y/N) !�zx Separation Distances from Septic/Holding Tank: To Water -Supply Well /J 8 / `� To Building Foundation ~3 / To Property Line 10, To Disposal Field 3 To Water Main/Service Line Course f /� Comments Page 1 of 2 72-02601/871 To Stream, Pond, Lake, or Major Drainage jyUNKIPALITY OF ANCHORAGE DEPT. OF HEALTH b . n ' EWlRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MG..) n yLpp, DEC 1 1'mL HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 19134 264-4720 RECEIVED Legal Description: Lo f ZFIK1 'e�7C.W-- r Pu r LC 7/Slil le / LJ Sec -41 A. WELL DATA Well Classification E)A T'E If A, B. C. D.E.C. Approved (Y/N) N k v .. Ter,1.3 Ix-��-4t Well Log Present (Y/N) �� Date Completed 6 — /➢ ` �`' Yield 2 GP n r Total Depth -5-Z f Cased to S0 Depth of Grouting Static Water Level 2p, Pump Set At i Casing Height Above Ground /.S- Sanitary Seal on Casing (Y/N) % Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N ` Separation Distances from Well: � � t To Septic/Holding Tank on of �& ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot r/ f ° ; On Adjoining Lots / ° r To Nearest Public Sewer Line Nls To Nearest Public Sewer Cleanout/Manhole — To Nearest Sewer Service Line on Lot t�s� Water Sample Collected by E<r4 ('rt'i✓tn �.�s� rte, ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed / "� Size /0470 5„/ No. of Compartments a Standpipes (Y/N) Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) /y Date Last Pumped ae Pumping/Maintenance Contract on File (Y/N) ��`r ; for — Holding Tank High -Water Alarm (Y/N) ~LTemporary Holding Tank Permit (Y/N) !�zx Separation Distances from Septic/Holding Tank: To Water -Supply Well /J 8 / `� To Building Foundation ~3 / To Property Line 10, To Disposal Field 3 To Water Main/Service Line Course f /� Comments Page 1 of 2 72-02601/871 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2?5_ Type of System Design Date Installed 74 Length of Field 7-5-1 Width of Field 3 Depth of Field Gravel Bed Thickness .2/ Square Feet of Absorption Area o `� Standpipes Present (Y/N) r Depression over Field (Y/N) Date of Last Adequacy Test -R ii�t'� Results o1 Last Adequacy Test fis ��-s AE.rw6�i. ,amu. tea. 3 Separation Distance from Absorption Field: To Water -Supply Well �� To Property Line To Building Foundation So To Existing or Abandoned System on Lot Nit ; On Adjoining Lots fad To Water Main/Service Line YL/" To Cutbank (if present) c To Stream/Pond/Lake/or Major Drainage Course t/,a To Driveway, Parking Area, or Vehicle Storage Area rho Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments — Dimensions Manhole/Access (Y/N) — "Pump Off" Level at Vent(Y/N) '• Check Permitted Bedroom Rating Against HAA Request •• Pumping Cycles during Adequacy Test. Meets MOA I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed •�/ Date 1_21//16-c Company ��E s MOA No. S7 _2 ex- Receipt r Receipt No. A4 L90 ) - n0O5 Date of Payment 17- • I-L—r6L Amount: $ inVaS,^ Page 2 of 2 72-026 (((,H( �'•••}' •�••aa•^°`°i�"�ru� Engineer's Seal Ir rase• S./�J o i•ui•••tl A. Eu;c;a L, .a