HomeMy WebLinkAboutLELAND STANFORD LT 3P^IKCEL~OI ~-~ t-'53-000
MIJNICIPALITY OF ANCHOI~AGE
DEPARTMENT OF HEALTH 8__~ ENVIROIXlMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING r)lVl.qlON
825 I. Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/O~ WELl_ INSPECTION REPORT
LEGAL D ESCRIPTIO~I,
DISTANCE TO:
Manufacturer
DISTANCE TO:
Manufacturer
Length
IF HOMEMADE:
DISTANCE TO: I
N°' °' lines1
Top of tile to finish grade
Width
BED )MS
PERMIT NO~(~(~ 7 ~/7
No. of cor'npartm,~_,
Type of crib
Crib diameter
Well
Insidelength Width Liquid depth
Dwelling
Foundation /7/ I ~eares~ ~i~n~
Total lenf¢ll of lit~es ' -- Distance
Materi~(~i~ inches
~ inches Total
Depth
Crib depth
Building foundation
Total effective absorption area
Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line
DISTANCE TO:
PERMIT NO.
Liquid capacity in gallons
PERM,T NO.Z¢O0 .Z/' 7 ¢
ines
]tion area
Sewer line
Building foundation
Septic tank
OTHER
INSTALLER ~ ~'~""-
REMARKS
IPERMIT NO,
Absorption area(s)
DATE LEGAL
FIF'F:'L. I CFII'.ff NElL ROSS
LOCFtT I CIN E:,EF.IRRT f;¢OFID
LEC~FIL
'T"./F'E OF SOIL. F~BSORPI"II."./t.,I S"r'~:TEM IS: TRENCH
MI::t',:'::IMIJM NUMBER OF BEg'ROOMS : ~c SOIL RI"~TING ':.'SC:.! FT,."'BR.'.'= 125
'I"['IE REQUIRED SIZE: OF' THE SOIL FiBSORPTIIDN S'T'STEM IS:
E::" E F':" T F! =: :t 2 e. f:2 ~"-,~ C3 T' FI .=.".: 2 -=.1~ [3 I:~ t"~ ',.,'" E L. [:" E-' F" -F F~
~i3:9 HEST ?5 AVE.
~,:. SH4:NE~ ':;E4 LOT :.,I-.'E ~$~5~.::1 :,1: .IHEE FEET
THE LENGTH [:'It'IErtSION IS l'UE LENCiTH (IN F'EET.':, OF :"FIE TRENCN OR [.',RFqlNFIEI_.[:,.
THE E)EF:'TH OF' Ft TRENCH OR PIT IS THE DISTFINCE BETHEEN THE SUF.'.FF-ICE OF THE
GRr:~LIN[:, FINE:, TEIE: BOTTOM OF THE EXCFt',,,'taTION ,.'.If.,I FEET::,.
THERE I:~; NO SET HIDTH FOR TRENE:I.1ES.
THE GRFt',,,'E:L B, EF'TH IS; THE t'IINIMUM [:,EF'TH OF GRla',,,'EL E:ETHEEN TIdE OUTFRL. L F.'IPE
FINE:, THE E:OTTOt'I riF THE E;:.:',E:Fq',,,'FtTION (IN FEET.':,.
F..[: E G::.~ L~ I F-..' E C, S: F2 P T IF. C: 1' FI f-,l [::: S I Z E = 1 ,:--~ [3 ~-3 L:N F~ l_ l._ [) f-,,! S:;
PEF,:':MIT RF'F:'LICFINT t-IRS THE RESPONSIE:ILIT'~" TO INFORM THIS DEPF~RTMENT DURING TI.IE
IriST~I..LF-ITION INSE'ECTIONS OF RN'~' HELLS RD.IFIE:ENT TO THIS PF.:OPERT'~' FIND THE
NI.JH[3ER OF: RESII)ENF.::E:S THFtT THE HEL. L HILL SEF~'.',/E.
8~C[::.'F'"IL. LIt.,IG OF FIN",.' S'~'*STEM HITHOUT F'IN~L IN'-~F'EE:TION FINE:' FtPPRCI',,,'FIL B'~' 'T'NIS
E:,E'ZPFII:;i'.TI'dEfdT HILl_ BF."_' SLIEFECT 'FO PROSECUTION.
MII'.~IMLIM [:,IS'FFI~.~CE [~:E]"I.dEEN I::~ [dELL. Rf.~[:, FIN'T' ON--SITE SE[,.IRGE DISPOSFIL S'~.'STE:M IS
J.[~:_..t FEET FOR ta F'RI',~'FITE [,.IELL OR i5~ TO 2[Z~.".~ FEET FROM FI Pl..lEsLIE t.dELL [:,EPENF.',,ING
LIF'Of.,I THE T'~'F'E OF F'F.J[,'LIE: I.,~EL, L,
HINIMU["I [:,ISTFINC:E FF.:OM FI PRI',,,'FITE [dELL TO Fl PF.'II',,,'RTE SEI.,.IER [..I~.~F£ IS 25 FEET
TO Fq C:CIMHUNIT'.r' '-?,EER LIf.~E IS 7~5 FEET.
HELL I...O[~N:: FIRE REC..!UIRE[:, RN[:, MUST E:E RETLIRNE[:, TO THE [:,EF'FI[;..'THENT HITHIN :'.:;~Z~
OF THE [dELL COMPLETION.
OTHER F'.E~ZIIREMENT':: MI:IN' FIPF'L'~'. '-";PEC:IFICFtTIOf.Lc; Rf.,l[:, CONSTRUCTION DIF:IGF..t[RI,1S FIRE
[R',,,'FIIL. I.:tE~LE TO INSURE PROPER INSTFILLFITION.
i CERTIF'~" TF'IF~T
i: I ~:lM FFIMILIFIR ['.IITH THE REg!LJIREr'IENTS FOR ON--SITE SE:HERS [aND HELI..S F:IS SET
FORTH E:'-~' THE MUNICIF'FILITN' ElF' FtNCHO[;..'FIGE.
2:: I HILL INSTBLL THE S'~.'STEM IN FICCORD~NE:E EdiTH THE C:O[:,ES.
3: I LIN[:,ERSTRN[:, THRT THE ON-SITE SEHE[;~ S'T'STEt,1 MR'T' REQUIRE Ef.,ILlaRGEMEN"F IF 'T'HE
RESI[:,E~.~CE IS REMO[:,ELEC, TO INCLLI[:,E HORE THFIN 3: BEE:,ROOMS.
PERMIT NO.
RPF'LICRNT t'~.:~ l ( tO-~O5~ -- ~- ~ ¢t ~q~ ' --/ ~ y-/') 9:¢ 2C
LEGAL ~/~ ~3 ~ /b~ , LO'F SIZE
c, -' -~(' ~
TYPE OF SOIL RE:90RPTION _,r:,[EM I~'
MR'XIMUM NUMDER OF E:EDROOM5 = ~ 'SOIL RRTING <SQ FT:'B~)=
FEET
THE RE6~IJIRED SIZE OF THE %0It... ?IBSORPTIC~N $'T'STEr,1
[]:, [E F, -T- t4 =; /',?% L_ E f.4 i:i ]- Fl =: ~ L T/ i] F..' F:l ',,," E L
THE LENGTH [:,IMEN~ICmN I:S TIdE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R"TRENCH OR PIT IS 9HE D~:4TRNCE E:ETWEEH THE SURFACE OF THE
GROUHD AND THE BOTTOM OF THE EXCRVRTICIN (IN FEET).
THERE IS NO SET HIDTFI FOR TRENCHES.
THE GRR",/EL E)EPTH IS THE MINIMUM DEPTH OF GRFIVEL BETI4EEN THE OUTFF~LL PIPE
F4f.lO THE 8OTTOH OF THE EXC:RVRTION (IN FEET),
PERM I T RPPL I CF~N'r HRS THE RESPOHS I 81L I T'¢ 'TO INFORM THIS DEPRf;'.'TIFlEtI]" [)UR I NG FHE
INSTRLI_.RTION INSPECTIOHS i}F [~N"r' WELLS RDJiRCEN'F TO THIS PF:CiF'ER]"¢ RN[:, THE
NUMBER OF RESIDENCES THRT THE WELL HILL SERVE.
E~FlCKF'ILLING OF RN'¢ S'¢STEM HITHOLIT FINRL INSPEC:TIOr.I RN[:, RPF'ROVRL 8'¢ 1HIS
DEPRRTMEHT HILL E:E SLIE:JEC:T TO PROSECUTION.
MINIMLIM [:,ISTRNCE BETblEEN R HELL RND RNV ON-SITE SENRGE [:,ISPOSRL SYSTEM
100 FEET FOR R F'RIVRTE HELL OR 15~ T0 2¢0 FEET FROM R PUE',I_IC WELL. [:,EPEH[:,IHG
UPON THE T'¢PE OF F't.IE:LIC NELL.
MIHIMUM DISTRNCE FROM R F'RIVRTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RN[:,
T0 R COHr,ILIHITY SEI,IER LINE IS 75 FEET.
WELL [_Cu]S RRE REQUIRED RND HUST E',E RETIJRNED TO THE [:,EPRRTMENT HITHIN ]:C~
OF THE FIELL C:OMPLETION.
OTHEF: F:EO~.I~F:EMENTS [dRN' RPF'LV. SF'EC:IFICRTIONS RND CONSTRUCTION DIRGRRI'IS FiRE
RVRILRBLE TO IN:SUF:E F'RC~F'ER INSTRLLRTION.
! CERTIF'¢ ]'HFtT
1: I RM FRMILIRR NITH THE REQUIREMENTS FOR ON-SITE SEHERS t~f.l[:, HEt. LS RS SET
FORTt4 B'¢ THE I'ILIN ~ E: I F'RL I T'¢ OF RNC:HORRGE.
2: I NILI-. INST~LL THE ?CS;]'EM IN RCCOR[:'RNCE I,IITH THE CODES;.
:'- I IJH[:,ERSTRN[:' 'fliRT THE ON-SITE SEI,IER S'¢STEbl f'IR'¢ REOLIIRE ENLBRGEMENT IF THE
~EsI[:,ENC:E IS REHODELED TO INCLUDE f, IORE THFlN ~ DEDROOMS.
tS I G N E [:': ".- - ~~ ...................................
F~F'[:'L. I CRH'f'
RECEIPT Date_~ p ~-\C~ 19°6L~ 6150
Received From ~'"~ ~
Address (~?~q ~ ~ ~
ACCOUNT CASH
ACCOUNT HOW PAID '
AMT. PAID ~q L t-) CHECK
DUE ORDER
LOG Ob- 'l'~'b"[ MOHING
Hole No, ' : ' '' /
Ground Woter Table
Sampling
DESCRIPTION
Soil type~ color~ t~xture~
~/lm ate d p ortic/e size~
sampl~ drlvin~ note$~
deplh$ circulotion Iost~
notes on drilling
bits used~ e/c,
No/es E Diagram:
Vegetation:
nil ~nmnle.~ (/re token w/I.~ll~ .~tnndord Penetrol/on .~omnlet d~iven w/t40 Ih humm.~f ~O ~l~
. 00'~91
/~,t~OoOON
00't;£1
O0'ggl
. ~ ,£0o00 H
o0'ggl ' /
00'0£ £ IA ~0o00 N
N33W,g~3A3
O0'g£1
'.M ,£0o00 N
'1
0£
RETURN TO: Division of Geological and ~yslcal Surveys (DGGS)
30OI Porcupine DrJw~ (Tel ne: 277-6615)
Anchorage, Alaska 99501 MUNICIPALITY OF
W A l' ~ R W E L L R E C O R O DEPT. C:
U.S.G,S,
becel
~ATION OFWE~L ] Please complete either I~ lb, or lc. ~ ;. [; ,j O '~'.'bLL. ~o,
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
ivislon b. Fraction
/ / /
2, WELL LOG
Mater[al Type
Top
Feet Below
Surface
Bottom
Meridian
4. WELL DEPTH: (completed)
Date of
Completion
~--] Test Well [~ Other:
7. CASING: [] Threaded [~Welded
~,)__in. to y,~_~j~ft, Depth Weight
in. to ft. Depth
8. FINISH OF WELL:
Set between ft, and ft.
Fittings:
9. STATIC WATER LEVEL: .~/ ft.
~]Above ~JBe)ow land surface
Type of Measurement:
10. PUMPING LEVEL below land surface
~_ ft..f~er ~hrs. pu~p~.g
f~. after hfs, pumping
0~__.~=. g .p,m.
II, WELL HEAD COMPLETION:
[~Pit}ess Adapter
Approved Pit
inches above grade
12, GROUTING: Well Grouted: [] Yes ~No
Mater~al: ['-JNeat Cement ['-] Other:
13. PUMP: (If available) NP
Length of Drop Pipe ~ ft. capacity /~__g.p,m
Type: J~J~Submerslble [~Reclprocating
[] Jet []Other:
14, REMARKS:
15, WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my jurisdiction and this report is true ¢o the best of my knowledge and belief;
Registered Bus~/lesg Name ? ~bn~~ humber
Author lzed Repffesentat ive
Form O2-~R Copy DistrJbutlon: WHiI[ - State DGGS, PiNK - OrJller, CAHARY - Customer
' DAT~--RECEIV ED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE~) LA' ¢~,~ (,
MUNICIPALITY OF ANCHORAGE DEPT. Of: HEALTH
m or cr oN
B25 L Street-Anchorage, Alaska 99501 APR ~'7
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720RECEIVED
REOUEST FOR APPROVAL OF INDIVIDUAL ~ATER AND SE~ER FACILITIES
DIRECTIONS: Complete all parts ou p~e 1. I~complete requests will not be processed, Please allow ten (10) days for processing,
1. PROPERTY OWNER
' ' ~ PHONE
MAILING ADDR E~S '
PROPERTY RESIDENT (If different from above) PHONE
~ BU~ PHONE
MAILING ADDRES~ ~
3. LE~DI~G INSTITUTIOB '
PHON~
MAILING ADDRESS
4. REALTOR/~ENT ~ ~
MAI LING rAD~ E$8
5. LEGAL DESCRIPTION
STREET LOCATION
~ SINGLE FAMILY
[] MULTIPLE FAMILY
7, WATER SUPPLY
~ INDIVIDUAL* ',.'~o
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
NUMBER OF~BEDROOMS
[] One I--J Four [] Other
I~] Two I--] Five
Three [] Six
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
.[~- INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
/~<~/'Y~EAR~ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROC/)ESSING CAN BE INITIATED:
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
~ERMIT NUMBER
3. SEWAGE DISPOSAL SYSTEM
[] INDiVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: Jz~)~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/H°lding Tank IAbs°rpti°n Area ISewer Line tNearest L°t Line
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
E~'"~'App ROVE D FOR '~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
NORTHLAND INVESTMENTS
S.R.A Bx. 1781-B SOLD TO: ['"- '~(?/
ANCHORAGE, ALASKA 99502 Y~';-g~e"~'/e"
PROJECT No. PROJECT TITLE IN¥OICE DATE
DESCRIPTION UNIT PRICE TOTAL
TERMS- NET 30 DAYS
10360 Schneitc~;c Drive
Anchorage}, iYJ{ 995(}7
Sul.)ject~ Lot
Approval for; the i.l'Rlividual sewer an(~ water facil:Ltie:.~ cannot'.
(..[..1. log submitLed t.o [',hi:-~ coffic:e ;~()]. ou~: ~.]../ ..... and
EeVle~/.
The watnr anaiysi,s }:'ei~o]?t [~eeds to b,d :;ubmithe{I i:o this
office~.l. Otl'" ..... . ~.~ Ch(~;I "l,,hb, 56.~3'" }:~ ~;'l'.~'O(:t~ roi7 our
septic
d ~:i}ar'hi~:ien h
',i2t(..aS(; no'LJ, fy this
: D A ~'-~ RECEIVED
TIME TIME TIME
DATE DATE DATE
I NSP ECTOR INSPECTOR I NS P E CTO,I;~.
~UNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'I~I;~I)RONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION MAR 2, 5 1981
Telephone 264-4720
A .OVA.
!DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
11. PROPERSY~)WN E R PI-lONE
MAILING ADDRESS
PROPERTY RESIDENT (If differel~t from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3, LENDING INSTITUTION I PHONE
MA~ ,~ NG ADD~SS/./b4~
4, REALTOR/AGENT I PHONE
I
MAILING ADDRESS
5, LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8, SEWAGE DISPOSAL SYSTEM
~"/11N D I V I D UA L/ON-SIT E**
[] PUBLIC UTILITY
/,)bt".
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
. THIS SIDE FOR OFFICIAL USE ONLY :'
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE F-I OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] I NDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [~] Holding Tank
Size: ,/~)0 If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AR EA MATERIAL ~7-~~
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[~'/APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ~.~
727010 (Rev. 6/79)
(907) 2:a.,~111
Hatch 31, 19ol
Nell A. Ross
Star RouLe A Box
Anchorage, Alaska 9950'7
Subject-.:. . . · Lot 3 Lellar~d Su~: ........... ~,_o~.d' .:,"tx~.(.') ivision
Approval. for~-,.,h(,.. individual, sewer
c:anno~ be granked uqti], t-he ~ *
.~:O.L ] O~,UI.N~ ~. {;:ems have been
c', om p 1 e t: ed:
(!)
A well. lo<.f sub:'n[~-.Led I:o this of fi. ce f!o~~ our
]?O,V
Ill' bhere are any :[urLh(?r queshJ.ons, r~' ~,~ ....
. ~ ........ call. this
off~ce at 264..,.4'120.
The wake]' ana!ys:is re])or['. _ needs ho be do]_'~/e~-'~:, (..ti
to :his office from the (]hem Lab, 5r,'~3~ !'% ~,Lre~.L,r~-
~0~ O1.].[' 1:evJ (-}W,
n(..}: e I.y,
RoberL C. Prat:h~ R,S,
Associ. ate Specialist:
:R C 7[? / 1 :j w