HomeMy WebLinkAboutSHACKLETON LT 22A S100' OF W150'Lo -
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
~ O ~ DISTANCE TO: Well I °welting
~ DISTANCE TO: ~ /~
· ~ 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
PHONE 1 NEW
NO. OF BEDROOMS
Material No. of compartments
Width Liquid depth
Material
inches
Liquid capacity in gallons
PER IT
Distance between lin~
Total eff~ti~ absorption area
PERMIT NO.
Found~,ti~,ll~ / Nearest lot line
Total length of lines Trench width
Material beneath tile
Depth ~1~
Crib depth
Building foundation Nearest lot line
OTHER
TEST RATING
INSTALLER
REMARKS
,9-/,5-8,3
APPHOVE°
724~13 IRev. 3~78)
PERMIT hJO.
'264-4?20
PEF:I.'I T T
APPLICANT' HANK TRHBLYN 40~0 LORE RD #6 .q..~507
LOCFIT I ON
LEGAL 1~22R SCHFICKLETON LOT SIZE
· TYPE OF ~OZL ABSORPTION SYSTEH [~: TRENCH
HRXIHUM NUHBER OF BEDROOMS = ' 3 ~OIL RATING
THE REC~UIRED SIZE OF THE SOIL RBSORPTION
24~-4267
~9~ SQUARE FEET
=T?BR)= ' i25
i~-' E F' T H = -10 L E 1'4 6'!'7 H = '~"- $ 6 R FI',.,'E L IDEPTi-I = 5
THE LENGTH D'iMENSION IS THE LENGTH (IN FEET) OF THE TF,'ENCH OR DRRINFIELD.
THE DEPTH OF Fi TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFFICE OF THE
GROUND AND THE BOTTOH OF THE E×CFIVFITION (IH FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFIVEL DEPTH IS THE HINIHUH DEPTH OF GRFIVEL BETWEEN THE OUTFFILL PIPE
FiND THE BOTTOM OF THE E}(CFIVFITION (IN PEET).
F'ERHIT RPF'LICFIHT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTHENT DLI.RING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJRCEHT TO THIS PROPERTY AND THE
NUHBER OF RESIDENCES THAT THE WELL WILL SERVE.
T[,~i--I ( 2 ) I f4$PECT I 0f45 ARE REQU I RED. ' -----
BACKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND APPROVAL BY THIS
DEPFIRTHENT WILL BE SUBJECT TO PROSECUTION.
MINIHUH DISTANCE BETWEEN Fi WELL AND ANY ON-SITE SEWAGE DISPOSFIL SY~TEf'I IS
'JO0 FEET FOR Fi PRIVFITE WELL OR i50 T0 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIf'IUH DISTANCE FROH'R PRIVFITE WELL TO R'PRIVRTE SEWER LINE I~ 25 FEET AND
TO R COHHUNITY.SEHER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED AND HUST BE RETURNED TO THE DEPRRTHENT WITHIN 50 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREHEHTS HAY .APPLY. SPECIFJCRTIONS AND CONSTRUCTION DJRGRRf. IS ARE
RVRILRBLE TO [NSURE PROPER ZNSTRLLRT~ON.
F'EF:i-I 'r T E)"-:F' I RES BECEf4BER 2--2., -1 3E;__---=:
I CERTIFV THRT
±: I RH FRHILIRR WITH THE REQUIREHENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY .THE HUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRHCE WITH THE CODES.
.~: i UNDERSTAND, THAT THE ON-SITE SEWER SYSTEM HAY REQUIRE ENLRRGEHENT IF THE
RESIDEHCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
FIPPLICI=tNT HRr,II< TFIHBLYN
'('4. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
DEPTH
(FEET)
1-
3__*· v
11-
d'A (.,
SLOPE
$
SiTE PLAN
WAS GROUND WATER
ENCOUNTERED? /~/~
12- ·
IF YES, AT WHAT
13- ' ~0' DEPTH?
S
L
-. OF A t
/.-...%~ ..,, ~ *,, ~.. I~
· ~ q~
. ~-~ ....:
~ ~.,.' .~, - . . ~ _~..~"
PERCOLATION RATE
14-
15-
16-
17-
18-
19-
20-
Gross Net Depth to Net
Time Time Water Drop
(minutes/inch)
COMMENTS
TEST RUN BETWEEN FT AND
P/PE ~'/v~ u~.e & E /f /~/u oF q' Og-tp
FT
PERFORMED SY: G~f/L. y
?2-ODe (e/79)'
J J~£Zc~U
CERTIFIED SY:
DATE:
3-23-8~+
Static Water T~evel 43
Drsw Down
feet
feet
Callons Per Hlnute
Total Feet of Casin~
Ilank Tamblyn
Shaehel ton Subd.
l. St 22-A (S. IO0~ a'c
W lSo'o~
Tv~e ~aterial Drilled!
to 37 rino silty Sand
to 62 Sandy Clay ~*/wator
62 f~et
tO 5& Flno silty sand 4 el~v
176 'f~t
to 126 O, rov Clay (silty)
tO / 127~,ravel/water
tO
Hefty Drilling
S.R.A. Box 1553 H
Anchorage ,Alask~
99507
MUNICIPALITY OF ;%NCHORAGE
DMSION OF ~Tv/~ HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRflfECI~ON
(a) legal Pescripticn (include lot, block, subdivisicn, secticn, tcwe~hip, range.)
Location '(address or directicns) ,
(b) Applicants Nar~ ~eA; %-Y T~q,%~ ~ ! Y~/ TeleDhone~ -//.~/
Applicant is (check one) LendiP~3 Instituticn
Buyer ~; Other ~ (explain);
fe ~dir~ Instituticn
Address
Telephcne
(e) Real Estate' Co. & Agent
Address
Telephone
T~pe of Pesiden~
Single-F~mily
Number of Redrcc~s
'¢~ate~ Supply
Mnlt i-Family ~
Other (describe)
Individual Well ~-~ Oa,,~unity ~-~ Public [--~
Note.' If ~,unity ~11 ~stem, ~st ~ ~it~n ~ti~ ~ ~ State
~nt ~ ~virc~ntal Co~ti~ at~sti~ to ~ legality ~ status.
Is ~e ~11 a~a~ f~ t~ ~r of ~ ~cified in ~is ~ (Y~)
Sewage Dispcsal
Is t3~ .wastewater disposal system adequate for the mm~er of b~drccms (Y/N) /%/~
[Page 1 of 2]
2-15-84
5. Engir~ering Firm Providing InsDections, Tests, Data and
I ~.-tify that ! have checked, verified, c~ eo~o~d to all MgA FAA C~id~lin~s in
effe~ ~n ~ ~te of ~is i~cti~.
Teleph~ 3~- F33~
SiGned
Name of Firm
Address /
Si~d ~
6. DHEP AD.sroval
Apprc%~d for
App~c~d ~
(ENGIN~ SEAL)
-~ b~drcc~s
Disapproval ~--~
Ter~ of Co~.ditiorml Apprcval
The Municipality of AnchoraGe Dapartn~nt cf Health and Envirc~-~,~ntal Prctecticn dces
ncr Guarae. tee the ccnti~ed satlsfactcry l~rfo~anee of the water supply and/ct the
wastewate= disposal system. This approval indicates that, as of tha validattc~, data
shcw~, aborts, based on th~ data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewate~ disposal system is safe and fu~.c-
tio~al fcn~ th~ numhe~ of ba~oc~ a~ type of structure indicated.
[D~P SEAL)
7. Pail the HAA to the follc~irg address:
/~z_;~ ,co/,_ ~_~3~--~.__ ~ ~
~B2/dS/s
[Pa~e 2 of 21
2-15-84
A. ~ELL I~TA
MUNICIPALITY OF ANCHORAGE (MO~)
HEALTH AUmO~ITY A~P~0VAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification $//u~. ~-J~/&y
Well Log P~esent (Y/N) ~ ~/
Total Depth / z ~' / Cased to
Static Water Level ~/3 '
Casing Hsight Abo~s Ground ;~ '
Electrical Wiring in Conduit ~N) ~
Separation Distancss f~cm Well:
To Septic/HoldinG Tank on Lot / o 3 ~
To Nsa~est Ed~e of Absc~ption Field on Lot
To Nearest Public Se~r Line / ~o '7
Date C~,~leted
IZ?'
If A, B, cl~ C, D.E.C. A{4xoved(Y/N)
~-Z3-~ Yield
Depth of G~outtn~
Pump ~t At / ~'
Clean{ut/Manhole / ~ ~ ' ~ To Nearest Sewer Servioe Line on Let
Water Sample Collected By ~w~W .T /~U~,U; Dete 3- 2F- ~F
W&te~ Sable Test ~sults % ~' t-~ ~F3&,&7' g~'~7-
; On Adjoining Lots IDD -~
l/ 7' ; On Adjoin. lng Lots /~'~
TO Nearest Public Se~r
B. SEPTIC/HOLDING TANK I~%TA
Dete Installed ~-/~'-~{~ Size /D~D 6~ ~'~ No. of Compartments · ~
Standpipes (Y/N) ~' Aim-tight Caps (Y/N) /' Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /V Date Last Pu~ped
Pumpin~/Maintenanc~ Co~tract on File (Y/N) ; fc~
Holding Tank High-Water Alarm (Y/N) Tempora~y Holding Ta~k Permit (Y/N)
Separation Distam~ss f~cra Septic/HoldinG Tank:
To Water-Supply Well
To P~operty Line z
To Water Main/Se~vios Line
Course
Cc,,,,ents
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, (x Major Drainage
[Page 1 of 2]
2-15-84
C. ABSOLUTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~-/$- ~&
Width of Field Z t
Square Feet of Absorption A~ea
Dap~ession over Field (Y/N)
Results of Last ;~lequacy ~st
Typ~ of System Design
Length of Field ~ Z
Depth of Field ~ /~ /
Gra~sl Bed Thickness ~ '
Date of Last Adequacy ~est
Separation Distanoe f~cm Absorption Field:
To Water-Supply Well /7 7 · To P~c~erty Line /O
To Building Foundation 20 To Existing c~ Abandoned System on
Lot A/~ ; On A~joining Lots
To l~ater Main/Service Line ,<~ ~ To Cut_bank(if p~esent)
To St~eam/Po~d/Lake/c~ Majo~ [~ainac3e Course A/
To D~iveway, l>a~king A~ea, ~ Vehicle Stc~&ge A~ea
D. LIFT STATION
P~te Instalied
Size in Gallons
'Pump On' Level at
High Wetsr Alarm Level at
Tested for
Electrical Codes(Y/N)
Ccemsnts
Dimensions
Manhole/access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles ck~ing Adequacy ~st.
** Check Permitted Bed~ocm Rating ~ainst HAA Ragusst **
I ~rtify that ! have checked, verified, c~ ~onf~m~d to all MOA HAA Guidelines in effect
on the date Of this ir~pection.
Km/d5/s
[Page 2 of 2]
2-15-84