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HomeMy WebLinkAboutSHELL #2 LT 2SkewwLL IS jn � 2 WOM Lo)T MUNICIPALITY OF ANCHORAGE Er DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION � 875 LStreet - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME_ PHONE KNEW t.I ,�i f�l (�__ f'ijii(/%' I4 ❑UPGRADE MAILING ADDRESS y 3-3?_ L ar LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE TO: \Nell �l /'%` � Absorption area ' Dwelling yo i PERMIT NO. s 9s-0 2.ii U ,X h Z Manufacturer t1 TI/7 �T Matep No. of com�artments wF J11)2fi-fJ� r" :Sk�PI s `n Liq. capacity in gallons 1 fir' IF HOMEMADE: Inside length Width Liquid depth X DISTANCE TO: Well Dwelling PERMIT NO. ®z y Manufacturer Material Liquid capacity in gallons n _T DISTANCE TO: WellFoundation /oe 6� f Nearest lot line �V PERMIT NO. jurr, 15—� 2 No, of Tines Length of each line Total length of lines Trench width Distance between lines _ji z w L/, 19 6, -220 ;Ff 4)ah s i t H Top of tile to finish grade Material beneath tile Total effective absorption area p � � oilinches Length Width Depth PERMIT NO. w Q h Type of crib Crib diameter Crib depth Total effective absorption area 0. 4 W DISTANCE TO: Well Building foundation Nearest lot line -' Class F'rr,rc<Fe Depth Driller Distance to lot line PERNO. DISTANCE TO: Building foundation Sewer line Septic tank areMIT Absorption as) /•.0' OTHER PIPE MATERIALS 2" PF5iJ9 ,�C>,;'/ �31r:� .✓ESiI! �'jC 7 PeY;(arG%r SOI1_ TEST RATING 1.5-0 c's' r�rsly i_ 'r i INSTALLER H.011 ' lleo 1-Y (} n Li' (3 - 0a e r-%6 r .S'' c� y REMAFW '�_�`` ,f I�+ � 'II IY \(/f l L)f%y /1<T�4�A" '-1-�1��' 4LY[�2'.:rl. /� UUC V' •�!"Cd.V`�l A `j y4 ® 1 -Ir "Al v671,1, p L Q5 f f0cflyi 9' / 4% 6. \{A 7 .• / A 1iEe�OfiCF. MOORE N _ 'o°.• . CE - 3589 •. ��� A J1 1 �, . ~ APPROVED DATE LEGAL G/' .� /, J%�C -1 Vi c'_ s, /1,1; 72-013 (Rev. 3/78) PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: DEPARTMENT OF HEALTH AND ENVtRONMENTAL PRDTECTION STREET, ANCHORAGE, AK 99501 .264~4720 850251 ENGINEERED DESIGN 06/03/85 JAMES E POWELL P O BOX 110157 An,HORAGE� AK 99511 243'5496 ^�| LEGAL DESf �RIP: SUBDIVISION: SHELL rl LOT: 1 & 2 BLOCK: NA SECTlON: 15 TOWNSHIP; 12N RANG[: 3W LOT SIZE: .5A (SQ.FT. �R �CRES) LOT LOCATION: HOUSE & #ELL ON LOT ��; SEWER ON LOT � � -v I certi�y that: ��' 1^ I am {amiliar wit� the requirements �or oh~sitc sewers and wells as se| Jforth by the Municipality o[ Anchorage (MOA) and tho State o� Alaska, 2" I will install the system in AI k]�ti�rs� and jn compliance wlth the design criteria o{ this permi�. 3, I will adhero to all MOA and State o| Alaska re;uirsmenis {or the set ba�k distances �,om any exi�ting well� wastewater disposal system or pu�lic sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN ARE0 COVERED BY �OA BUILDING �ODES� THEN (1) A� ELECTRICAL PERMIT AND INSPECTION MUST BE D3TAINED; (2) AS'BUILTS WILL NOT �E APPROVED WITHOUT AN EL[CTRICAL INSPECTION REPORT; A�D <3) THE ELECTRICAL WORK MUST DE DONE 8Y A LICENSED ELECTRICl0N. SIGNED DATE� Ni --'------------- MES E POWELL ISSUED � 8Y DAT�: u���� /0-d .��:� �e c kl CTY-"- - � - -- --�— SOILS LOG MUNICIPALITY OF ANCHORAGE a DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION I TEST 625 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: zaln of l bWel' DATE PERFORMED: 5111 16` LEGAL DESCRIPTION: -r A d S FF -H 1 S U 0 SLOPE SITE PLAN DEPTH P r iFFFT1 1 voGcr�ntc A.iM 2 ML BRowt, stlT 3 4 SP ISU .0, /6D R M wak"- seep of W. earl of l6t} 6 7 <a P 150 8- 9- 10----- 910 -_-,-- U/a l-er 11 WAS GROUND WATER ` _ S 5' P ENCOUNTERED? t Y� L , O 12 P IF YES, AT WHAT 15etr W T,,0-1 ftr E �d i(lyr - 13 DEPTH? rkwy 15- 00-A 17 �THUORE. MOORE d,°.. CE -3589 w� 18- 19 �IiIi lk Reading NOUN= MIMEE■". Gross Time Net Time so Net Drop ORAG� M INICIPALI DgP1OF FAITH & L ??,Ole 1014 EME NoENMELM! VIR lai"'ll .. MMM M -21 No M 0 f 11 WAS GROUND WATER ` _ S 5' P ENCOUNTERED? t Y� L , O 12 P IF YES, AT WHAT 15etr W T,,0-1 ftr E �d i(lyr - 13 DEPTH? rkwy 15- 00-A 17 �THUORE. MOORE d,°.. CE -3589 w� 18- 19 �IiIi lk Reading Date Gross Time Net Time Depth to Water Net Drop ORAG� M INICIPALI DgP1OF FAITH & L ??,Ole 1014 VIR 20 PERCOLATION RATE TEST RUN BETWEEN COMMENTS NC -r dv r' aPCe-K M o n rft, rin e fnsfz "'c wafer (,er.,ce( heAweeo S',(9 and 5 S �n .� PERFORMED BY: �� � tcoore CERTIFIED BY: 72-008 (6/79) (minutes/inch) FT AND -- FT >r -r /0 llcoC ,� ll, v �'t cFes� Shvci�aC h e (c ce,, /Vj,-o e rd o mel- (O c -*-Q y �r�u v/iL(�!/*C- DATE: W/IS"i L-:WATlF R Pl-.PO,SAI- NOUND pFSi(rN CR/rrRIA Accephn� SOd : S p ( 1,60 L1'/8plelal) 3,�' fielvw c "fAi round l3o_Se Area I W l3DRm x 1500'18DRvy X I,S SAFFP' FffeO 906 S,F. Y / 2 12 Sewer 6rravef — cencluss+.�r'�et _ 00 le.( D000 + C" high 0&)S; f3ari u– i 'T'yov -r., Cir l Groune(� AAAAA'A'AnAnA A A ASA A AAA�AAA A A A AAAAAAAAAPAAAA®p I mo" "IL -7 7 e Ais f (nScx� d (,Ch er (1 5 @ CI,5-U� �/ rC` C..i cinnrr+ dl,�h 1/l � �e!' Tu �� A � . / / SECTION A -A 1'2.50 fra1 S'Peel Sep kc Tan Ir 6-, C.O. O / MIN CIO, P ISS 1GNiFD FOR I Tim � Iie(vn P6 -well 33 e0 W. 83rd( incl or Jen Atc 99,5-v may 2Y, 198.5 H" Per;{orczfed P M G.in es V li.c' c A P L- A N VIEW vFsl6_lYC-0 ed ploore r(akly TecAnlcal ,Servtcear g6-.30 IF -Cho Sl'. AolcAoroye, Alc NS 1G' rA 3`16-- I3,5;S 4 9T H* � . ....i:.7soo•'ae THEODORE F. MOORE Id4®IN* •... C8.3589 4. A: �► 444 proless+�+ �.�°� s t} f" p i) o r, t '-� MUNICIPALITY OP ANCHORAGE DEPT, Of HEALTH & ENVIRONMENTAL PROTECTION W 3 019985 -- R -E -CEI ` V ED n J: �h-5rr- L -_L �7© P L 1 '= tz", I ,l I I { ,J z, I/ C Sd 1 (IJ /a) 0ZI ' cs Jl •s s t} f" p i) o r, t '-� MUNICIPALITY OP ANCHORAGE DEPT, Of HEALTH & ENVIRONMENTAL PROTECTION W 3 019985 -- R -E -CEI ` V ED FLATTOP TECHNICAL SERVIC'S CIVIL. & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345.1355 ANCHORAGE, ALASKA 99516 WASTEWATER DISPOSAL MOUND L,OT 1, SHELL #1 SUBDIVISTON SPECIFICATIONS 1. All construction shall be in accordance with M.O.A. requirements and specifications. 2. All soil interface surfaces and distribution pipes shall be constructed level. 3. The absorption bed shall be insulated with 2" high density direct burial type insulation when backfill is less than 3'. 4. 3 1/2 ft. backfill over untreated building paper or other pervious soil barrier may be used in lieu of insulation. 5. 4" standpipes extending to bottom of gravel shall be installed at the end of each absorption line. 6. A waiver should be requested to allow construction within 5' of property lines to utilize best soils. 7. Due to design constraints this wastewater disposal system on lot 1 is designed to serve a residence on lot 2. An easement designating this use should be recorded on lot 1. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY rti 0 'N' RECEI V ED KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE (907) 243.2282 30 YEARS ALASKA DRILLING 3163 LINDEN DRIVE KEN JOHNSON ANCHORAGE, ALASKA 99502 JULY 1, 1985 JIM POWELL P.O. BOX 110-157 ANCHORAGE, ALASKA 99511 ( 243-5496 )3320 W83 St � Re; Lot 2 Shell #2 ( Whimbrel & 0 Malley Rd. ���o/A WATER WELL QG % ��Fti T o� 0 ft to 15 ft Fine gravel & brown silt �� D T9���9<yti�y 15 ft to 30 ft Sandy brown silt 01, CP OP 30 ft to 35 ft Same with fine gray exi �0 e 35 ft to 51 ft Same with courser grav 51 ft to 59 ft Med grav & brn silt..loose.. 59 ft to6g ft Fine grav and gray silt ..loose.. 69 ft to 108 ft Course grav and gray silt ( tight ) 108 ft to 143 ft Brown silt & fine grav 14.3 ft to 14.6 ft Fine grav & brn silt 146 ft to 153 ft Course grav & gray silt ( tight ) 153 ft to 156 ft Same ( Weeps H2O ) 4 ft head.. 156 ft to 158 ft Same ( dry ) 158 ft to 163 ft Same ( weeps ) 8 ft head bails dry.. 163 ft to 165 ft Same with finer gray..clean can perforate 165 ft to 177 ft Same 11 ft head " 177 ft to 189 ft Course grav &gray silt ( dry ) 189 ft to 194 ft Brn silt & fine grav 194 ft to201 ft Black silt & fine grav 201 ft to 209 ft Dark gray silt & med grav 209 ft to 219 ft Heaves 2 ft..dirty sand 219 ft to 224 ft Course grav & gray silt ( weeps ) 224 ft to 230 ft Med & fine sand H2O.. 17' head..Heaves 2 ft 230 ft to 236 ft Med grav & gray silt ( weeps ) 236 ft Clean water bearing med sand & grav 40 ft. head Test bailed at 10 GPM 25 ft drawdown Ikottom stable .Cotal casing 237 ft 6 in y \ 0 5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OI: HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVInONNIEN T AL HEALTH CE=RTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 2. TYPE OF RESIDENCE" Single-Family�l Multi -Family EI Other Number of Bedrooms n 3. WATER SUPPLY Individ•ial WelllCommunity F] Public 11 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. A. SEWAGE DISPOSAL onsite ��� Public C.1 Community [ Holding Tank l7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservelion attesting to the legality and status. -vr Page 1 of 2 Application Date KV-, 1. GENERAL INFOnMATION u 1 (a) Legal Description (include lot, block subdivision, section, township, range) r v , Location (address or directions) - S`a'o n (b) Telephone: Horne .: ��� ` '�, ' — Applicant Name ���r� t-��"� � �_. � pp' Business �� 6 �% -- � Applicant Address � f k� m _E � G). -- LCA --- —171 (c) Applicant is (check on(,): Lending Institution Owner/k--r!'Ader jd; Buyer L7 ; Other f l (explain); ---- (d) Lending Institution _i�=dc ;,^. y 1 r�^^.•^ �f, _9 e_r' -- Telephone -- ------- _ - Address— ------ {F (e) Real Estate Company and Agent Address _--- ---------___--- Telephone ___--_---_— (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE" Single-Family�l Multi -Family EI Other Number of Bedrooms n 3. WATER SUPPLY Individ•ial WelllCommunity F] Public 11 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. A. SEWAGE DISPOSAL onsite ��� Public C.1 Community [ Holding Tank l7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservelion attesting to the legality and status. -vr Page 1 of 2 5. ENGINEERING FIRM PR®VIDIN(--j PFCTIQN;, TESTS, FILE SEARCH, DA'1. -+ND INF©RMATI©N 6. e As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hea',,;, Authority Approval shows that the on-site waters up ply 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,cr wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. � (J r �.r6? _�7 2t y, Telephone Name of Firm __ - �� - --- Address—--- Date DFIFP APPR VAS rApproved for---0,d—Cf" _ bedrooms by i _N Date - ApprovedT Disapproved ___ — Conditional Terns 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 hornes 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. 2 -oz, n very d. i',eooGorc ,66rrrx'o 225-F.. �'Engineer'sSeal 2 )UNC 20, r�4f DFIFP APPR VAS rApproved for---0,d—Cf" _ bedrooms by i _N Date - ApprovedT Disapproved ___ — Conditional Terns 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 hornes 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. 2 -oz, n very C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata u Type of System Design 731i Date Installed Length of Field 4/0— Width /0Width of Field (> Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Y Depression over Field (Y/N) Date of Last Adequacy Test N4r1ell Results of Last Adequacy Test "I, Separation Distance from Absorption Field: To Water -Supply Well to 6 _ To Property Line To Building Foundation _ G5 To Existing or Abandoned System on Lot /Yy N Ld ; On Adjoining Lots To Water Main/Service Line >/0 _ To Cutbank (if present) _ NoN� To Stream/Pond/Lake/or Major Drainage Course !N U Py t:� To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N n N>. - 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verifi -, or conformed to all MpA and HAA guidelines in effect on the date of this inspection. Signed •, �l Date Company –� cttiL — MOA No. Receipt No. 3�0 1 f .". _ Date of Payment 't Amount: $ (n���o F' ,1 °asst y' Engineer's Seal H' Jo. 2225-E +' )UN'z 2J. tU/f. Page 2 of 2 - 72-028 (11/94) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 56 B Street Anchorage, Alaska 99518 �°°M�^•• Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D.tf PRIVATE WATER SYSTEM t,t7 i I & 9,, S *1_4 LL Name Phone No. Mailing Address City State Zip Code SAMPLE DATE: © © 5a] l5 l Mo. Day Year SAMPLE TYPE: Nd Routine OF Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water ❑ Special Purpose X Untreated Water SAMPLE NO. LOCATION 1 1 D uT.s.1015 T -Ar 21 31 41 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Time Collected Collected By I:.tiD SSL. TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory v ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter " No. of colonies/100 ml. Lab Ref. No. Result` I m U J m Ell m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB BGB Analyst Collforml100ml Final Membrane FIIf<e Rgc Its42 Collfor `mlt00ml Reported By l� 1/-`�'�" Date � F J f Time: _ 0 Q a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria .1� 0 n•� <J � �x) �. 1 z i ) l (r t Xja ki S\ -----------., ..:fir Y� .1� 0 n•� Q),")Z1 -01:.i ITri Gi �i I 4�SC"�Q P4 co 0 v af{t <J 4) i ) l (r t ki -_-� -----------., ..:fir 47 Q),")Z1 -01:.i ITri Gi �i I 4�SC"�Q P4 co 0 v af{t MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY 3 01935 I ` �I <J 4) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY 3 01935 I ` �I MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 NOV 2 7 264-4720 j� Legal Description: 1 E Ci —�Ej�e p A. WELL DATA Well Classification _:R G .C.J' If A, B, C, D.E.C. Approved (Y/N) _ N /A Well Log Present (Y/N) Y _ Date Completed _ � lei Yield __ j C7_� .� ✓" Total Depth Cased to .2 3 Depth of Grouting 10 &1Z-7' Static Water Level I qk2 — Pump Set At Casing Height Above Ground _ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) __�% Depression Around Wellhead (Y/N) ly Separation Distances from Well: To Septic/Holding Tank on Lot —_ 10.6— ; On Adjoining Lots > 100 To Nearest Edge of Absorption Field on Lot _ =_ On Adjoining Lots To Nearest Public Sewer Line _A/ PA1(_4�___ To Nearest Public Sewer Cleanout/Manhole N Q A/45 To Nearest Sewer Service Line on Lot > 10 Water Sample Collected by / . Date Water Sample Testresults r -;A Comments B. SEPTIC/HOLDING TANK DATA Date Installed 61-2y4`r" Size /a5C No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) X� Foundation Cleanout (Y/N) y Depression over Tank (Y/N) _____' iDate Last Pumped )y ar W.'/ Pumping/Maintenance Contract on File (Y/N) i0G10 ; for h�ZA // Holding Tank High -Water Alarm (Y/N) - h _ Temporary Holding Tank Permit (Y/N) IVA _ Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation --a (2 To Property Line _ _15 To Disposal Field To Water Main/Service Line__ f i J To Stream, Pond, Lake, or Major Drainage Course NONE Comments Page 1 of 2 72-026(1184)