HomeMy WebLinkAboutBLACKTREE Plat# 97-47 S-10006
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Date: January 2, 1997
To: G Zoning and Platting Division, CPD
From: ..... . Cross, P.E., Program Manager, On-Site Water Quality.
Subject:l Request for Comments on Cases due 1/2/97.
The Environmental Services Division, On-Site Services Section has reviewed the
following cases and has these comments:
S-10006
Blacktree Subdivision.
1. The existing well and on-site wastewater system serving proposed lot 2
have not been approved by DHHS. Prior to approval of the request, the
applicant must document these systems and take necessary action to bring
these un-approved systems into compliance with on-site water and
wastewater disposal regulations. Reserve site requirements also apply.
1,2¢. Supporting documentation on water availability must be submitted.
MUNICIPALITY OF ANCHORAGE
COMMUNITY PLANNING AND DEVELOPMENT
P.O, Box 196650
Anchorage, Alaska 99519-6650
PRELIMINARY PLAT APPLICATION
OFFICE USE
REC'D BY:
A. Please fill in the information requested below. Print one letter or number per block.
1. Vacation Code
2. Tax Identification No.
14 ,Iq I
o
Street Address
Idll4ol Iol I o1 ,1 1 I I I I I I
4. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34).
5. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page.
6. Petitioner's Name (Last - First)
Address ?~/--JrO ~ l',,~-g~/-~_/:T_-,/ ~---c,~t-"~._
City ~. FJ~,I~/O'~_ ~ State
Phone# ..~zff. -O~ ~ Zip
7. Petitioner's Representative
Address
City -~d.*~L~ ~ ~'T-- f-~ ~- State
Phone # ~,'Z.-- ~-~,Z..'~ i Zip
8. Petition Area Acreage
9. Proposed 10. Existing 11. Grid Number 12. Zone
Number Lots Number Lots
13. FeeS
14. Community Council
Bo
Date:
I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it in
conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is
nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the subdivision. I also
understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further
understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission,
or the Assembly due to administrative reasons.
/' S~ature~"~ -- --
*Agents must provide written proof of authorization.
Please check or fill in the following:
1. Comprehensive Plan-- Land Use Classification
~ Residential
Commercial
Parks/Open Space
Transportation Related
2. Comprehensive Plan -- Land Use Intensity
Special Study
Marginal Land
Commercial/Industrial
Public Lands/Institutions
Alpine/Slope Affected
Industrial
Special Study
Dwelling Units per Acre J
Alpine/Slope Affected
Do
3o
Environmental Factors (if any):
a. Wetland
1. Developable
2. Conservation
3. Preservation
b. Avalanche
c. Floodplain
d. Seismic Zone (Harding/Lawson)
Please indicate below if any of these events have occurred in the last five years on the property.
Rezoning Case Number
Subdivision Case Number
Conditional Use Case Number
Zoning Variance Case Number
Enforcement Action For
Building/i_and Use Permit For
Army Corp of Engineers Permit
E. Legal description for advertising.
F. Checklist
40 Copies of Plat (Long Plat)
30 Copies of Plat (Short Plat)
~ --.-., ~ Reduced Copy of Plat (8 ~ x 11)
~ Certificate to Plat
Aerial Photo
Housing Stock Map
Zoning Map
Fee
Drainage Plan
J..Topo Map 4 Copies
Soils Report 4 Copies
Pedestrian Walkways
Landscaping Requirements
Waiver
Water: / Private Wells Community Well Public Utility
Sewer: ~, Private Septic Community Sys. Public Utility
October 2, 1996
Lantech, Inc.
440 West Benson Blvd., Suite 103
Anchorage, AK 99503
Attention' Mr. Tom Dreyer, P.L.S.
Subject:
Dear Tom:
Proposed Black Subdivision
Lot 11, Section 21, T12N, R3W
Septic System Reserve Areas
On September 21 and 22, 1996, a subsurface soils study was conducted on the
5 Acre parcel located at 3140 O'Malley Road which is proposed for subdivision
into two equal lots. The purpose of the study was to determine areas where
septic systems could be placed on the lots to meet Municipal requirements. As
part of the study we researched the Municipal files regarding surrounding
properties and found the records of septic systems and wells in the areas.
Percolation tests used to design the systems in the area were similar to those
we obtained from our field testing.
A total of 7 testholes were placed and 7 percolation tests completed. The
absorption rates obtained on the soils encountered ranged from 12 to 24
minutes per inch. The Municipal ordinance concerning subdivisions requires a
septic sYstem reserve area of 14,000 square feet per lot for soils with
percolation rates in this range. The reserve areas along with well locations
and protective radii and shown on the attached plan. Testhole Logs and
percolation test results are also enclosed for your use.
Please review this information and advise if you have any questions or
comments.
Sincerely,
Michael E. Anderson, P.E.
Attachments ..
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
?
10
11
12
13
15
16
17
18
19
COMMENT~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage. Alaska 99502-0650
SOILS LOG --- PERCOLATION 'rEST
(ENGINEER'S SEN.)
DATE PERFORMEO~*/~/~~
Township, Range, Se~on:
~OT/'ON~ o~' flocQ
SLOPE SITE PLAN
WAS GROUND WATER ~0
ENCOUNTERED?
S
L
IFYES, ATWHAT O ~ ~ ;~°~' ~'/.~r~
DEPTH? P
E
Gro~ 'Nit Depth to Nit
Reading Date Time Time Water Drop
~1 ql~.~.. / : ~5' --" ~ '~ ',
~ /: ~ / ~ ~/~ ,, ~/~ ,,
~:~0 /~ ~ · ~/~ "
PERCOLATION RATE ~' ~' Iminut~/lnch) PERC HOLE DIAMETER
TF.S' RU. EETWEE. 5 -A.O 9
IN
Muni~ipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG --- PERCOLATION TEST
PERFORMED FOR:.__~_____.._.~_.~
LEGAL DESCRIPTION: ~-"~')" //
2
3
4
11
12
13
14
15
16
17
COMMENTS
or-
. ' ' ,. ~ , (ENGINEER'S SEAL)
· Township, Range, Section:
SLOPE
WAS GROUND WATER /~1
ENCOUNTERED?
$
L
IF YES, AT WHAT O
DEPTH? P
E
SITE PLAN
Gro~ 'Net Del=th to Net
Reading Date Time Time Water Dro~
~ ~ /, ~ IS 7
PERCOLATION RATE
TEST RUN BETWEEN
/ 7 (minutes~nch) PERC HOLE DIAMETER
PERFORMED BY: A. /'7/,/~/~ U~ ' I ~ ~~'~"'~'~TIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WI?HALLSTATEANDMUNICIPALGUlDELINE$1NEFFECTONTHiSDATF-DAT~'' "/~/~'/q~'~
72-G08 (Rev. 4/65)
(EN61NEER~ SEAL)
Munlidpality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION= /-,O'/" //
2
6
7
8
9
10
11
12
14
15
16
17
18
Township, Range, Section:
SITE PLAN
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? P
E
Gro~ · Net Depth to Net
Re,ding Date Time Time Water Drop
-~/ ~/z,Z. /1:/~' -- ~' ~
# ~ / z,: ~ ; / ~ ~ ~/,~ " ~/~ "
,
PER¢OLA'nON PATE / 7 <m~nutes/~nc.) PEte HOLE D~AME'rE~ ~ ''
TEST RUN BETWEEN i.~ FT AND ~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:' /1~1/~-"/q~'
~ IR~v. 4/851
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
10
11
12
14
15
16
17
18
19
COMMENTS
Muniotpality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 #L" Street, Anchorage. Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
(ENGINEER'S SEAL)
~'i '~'!~i~:~,.,~,~.~, ~:. ': .......... ~, .~i :,.~
Township, Range. Se~on:
WAS GROUND WATER /~] O
ENCOUNTERED? Si
L
IF YES, AT WHAT O
DEPTH? P
SLOPE ~iyF- PLAN
aonitmng?
Grou Net D~[h to Net
Reading Date Time Time Water Drop
~ ~:~ ~ lO ~' / ,/~,,
PERCOLATION RATE I~ (mlnute~/lnGh) PERG HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND o) Fl'
ACCORDANCE WITH ALL STATE AND MUNICIPAl. GUIDELINES IN EFFECT ON THIS D TF_ D · ~ ,,
IN
72-CX~8 trey, 418~)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
9
10
11
12
13
15
16
17
18
COMMENTS
Muni~dpality of Anohorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT 0
DEPTH? P
E
SITE PLAN
G~ r Nit Depth to Nit
Reading Date Time Time Water Drop
,~ ~/~ ,..,o - ~.
PERCOLATION RATE _ ~-~,:', (minute~n~h) PERC HOLE DIAMETER
tES?RU."~WEE. ? ~r^.D ~ ~r
ACCO.D^"C~ '~'" ^" S~ ate A.D .u.,c,P.~ ~U,OE.,.ES ,. E,,~ct o. t.,s DAr,. D^t~' /~/~ l qt-
7'~4~0a ;Rev. 4/85!
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILSLOG --- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: /--4~')"' //
1
2
3
4
5
8
9
10
11
12
13
14
17
18
19
2O
COMMENTS
Township, Range, Section:
~/,,¢1 t.i&, ~'1,,,/,~. SLOPE
I'Z"
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
IF YES, AT WHAT
DEPTH? P
E
.mmr~? /~, ...-..- ,,,, .
Gro~ Net D~pih to Net
RMding Da~ Time Time Wat~ DrM~
~ //.'~, /r 1 ~H" ~/5 "
PERCOLATION RATE ~. ~L. (mtnutes/;nch) PERG HOLE DIAMETER
TEST RUN BETWEEN ~' FT AND ~ FT
72008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
5
6
7
8
9
10
11
12
13
14
16
17
18
19
20
COMMENTS
Municipality ot Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
s
L
IF YES, AT WHAT O
DEPTH? P
E
Moailoring? ~/~ oltt .
Grosl Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ L1L (minutes~lnoh) PERC HOLE DIAMETER
TEST RUN BETWEEN S FTAND ~J~ FT
72-4308 (Rev. 4/~5)
Z
ITl
U~
Ill
m
Ill
./
-----4~,',:".~'. ~OAO"
d/^A.L. LEY
EXISTING
.
1*3.J '***
NOTE:
TESTHOLE LOCATION PLAN
SCALE 1" = 50'
A SEPTIC SYSTEM RESERVE AREA OF 14,000 SQUARE FEET PER
LOT IS REQUIRED BASED ON PERCOLATION RATES OBTAINED FROM
SOILS 114 THE AREA.
O0't~C
Trees
Municipality of Anchorage
P~ge ~of ~"
Lot:
DEPARTMENT OF HEALTH AND HUMAN SE, RVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska'99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~ PID Num
pgtade
,astewater System: [] New
g:::::~/ ABSORPTION FIELD
~. of Bedrooms: Trench [] Shallow Trench [] Bed ID Mound [] other
Total Depth from original grade:
LEG
II
New
',lassification (Private. A,B,C):
DESCRIPTION
Subdivieion:
Block: ~j
Section: ~'1
[] Ul:
;ased To:
Date Drilled:
Driller:
Welt'
Surface
Water
Lot ,
Line
Pump Set et:
Ft.
GPM
SEPARATION DISTANCES
To SepttG AbSOrption Holding
Tank Field Station Tank
Foundation
Curtain
Drain
Remarks:
Ft,
Ft.
Ft.
Sewer Lines
Depth to pipe bottom from odgi_~,~ grade:
added above original grade:
Gravel width:
Total absorption area:
From
in gallons!
"Pump on" level at:
P/'Co Po 5~-"0 E,U o,,J ·
Ft.
Gravel depth beneath pipe
Gravel leng~:
~umber of lines:
material:
TANK
[] Holding
[] S.T.E.P.
~ in gallons:
imber of Compartments:
LIFT STATION
Manufacturer:.
water alarm at:
performed by:
BENCH MARK
Ft,
Elevation:
c30 ~'
ENGINEER? SEAL ,........
inspections performed by: ~, ~'
Dates: ls~L;~-~-- ·
Department of .ea~th and i.~~?~ices appro, va!
BLACKTREE SUBDIVISION
GOLF
COURS~
O' MALLEY ROAD
!
10950
.20
SOO0
1090!
?
11021
4
112 AVE.
31
~10800
10801
MICHIGAN
3320
4 ~ 9B 10950
3121
..2 5'
I
I1000
g 11050
3101
$141
I 4
IIIII
3200
~ 3 II100
11150
112 AVE
.3ot3.s
i:A)-lgO................ Oravel relay
190 ~ '~te O~avel
In production *~-tin~., this :~ell pro~:ces
proximately 15 Fallons per miata.
· ho '~ pu~p i~ ~. 3~ ~.P. ~t~'~rsible
a de~th 6~ 148 feet~ app~ox~tel.~ 32 f~et fr~ t',e
~tt~ of the '~ell~ ~nd '~th seal, cone',it and
fltti~ s,
Cased to
· Department of Health ~nd HUman services ~
· AI.IT~'~;~PPROVAL CHECKLIST
~,-~.
~": ~~'_lt A, B, or C, affach ADEC leffer. ADEC w~er sy~em ~mber_
' c' ~ Date mmpleted ~/~ ~ _Driller
/
g ~/. ~ ' Casi~ height
seal (Y/N) Y Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
/ t
~,,) ~ ~'.~ ',
Date of,test 5" / '~ 5/. ,. ¢/ Z.~ q,~
~" ' " ' - I ~I. 3'
Well flow -~ - Z.40'
..... ; On adjacent lots
SEPARATION DISTANCES FROM WELL TO:
~epflc/holding tank on lot ///
Absorption field on lot /0~
~'Frubll~ sewer main ~, / A/~, ~
..... Sewer service l~ne ~ >
g.p.m, r'rl
>/o0 ~""
,.; On adjacent lots
Public sewer manholelcleanout
Petroleum tank
WATER SAMPLE RESULTS:
CO~Orm
SEPTIC/HOLDING TANK DATA
Date ~naatted /~ / ~"/'
Cleanouts (Y/N) Y
High water alarm (Y/N)
Date of pumping
Nitrate
o/C ~$//.-. Otherbac!eria
Collected by: __ /4. /-'~AC._A ~'~
Tank size /,OO 0
Foundation cleanout (Y/N)
7//,/q'/-
T~..pmperty line
'Surface water/drainage
~=4 c.~* Compartments ~ 0
Y Depression (Y/N) /~
Alarm tested (Y/N) ~/'~
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
I
On adiacent lots
/ Absorption field ~ /
Foundation
Water main/service line
>/0'
CONTINUED ON BACK PAGE
rv~ -~JV DRILLING,. Inc.
P.O, Box 10-378 * 10300 O]~1Se,,'a?d Highway
(907) $49.8535
A~4CI'{ORAGE, ALASKA g95! 1
DRILLING LOG
Well Owner. 3L;,.F:L ?F,\L~ Use of Well
Location (~'!dress of: Township, Range, Section, if 'known; or distnnce main roa~ Lot 3 i~"'-'-c:-"tY..":Ln Vte~,' Est,.res . , ,'
Size of casing 6"
Static water level 195
Screen ( ); Perforated ( ):
Describe screen or perforation None
Well pumping test at__7 gallons per (h"6{fi9
of drawdown from static level..
Date of completion Nay 31t 198~
Depth of Hole, 21;2 feet Cased to 21~1.~ feet
ft. (~"~;,'ze'} (below) land surface. Finish of well (cheek one) open end ( Z
(minute) for,, 2 hours with 109~-
WELL LOG ~: ~,~
Give details of formations penetrated, size of material color ,~pd hardness
.~ ~'~ '.,.~t ' /~
);
Depth in feet from
ground surface
0 .TO__
£~TO., .
_ 3 TO ....
15 TO
~n TO
3~ TO
57 .TO. 68
68 .TO.
lO9 TO,, 133
133 TO 185
185 ,TO 209
, 2°9 TO 2~3
223 ,TO
236 ~TO,, 2~2
0rg~nics
, Silty San(~
Sand '
S~d w/s~me Grave3
Sa. nd
RECEIVED
Sand & Gravel
Stie~- Silt'
_Silty Gravel ......
Gravelly Hard~
Silty Clay
~rav..lv ~tr. cl~n__
Sa~d & Gravel
Wnt~rbearin~ Creve!
3--CONTRACTOR
"4
Certified Well R E C E I V E D
q
3t IJle
DOTTEN DRILLING CO.
Jnhn'~ RoJd '~ /t
SI'E NARD. ALASKA
CH~CKUrY; F~B~ujU~;
Total De~ .~ Date Corn
I:~pthC~sed
~ "Pump .~et At
C~lng Height Abow Ground / 8enlt,,,ry
~ Wldng In CoMut N). Depm~lon Around
To Septtc~dtng Tank
.'TO Ne~r~t Edge of AtmorpUon Field on Lot.
Wat~ ,Sample Collected W ' ,~ °
WaI~ 8ample T~t Re~uf~ ' '
Depth ~/&" 7 ~ '
Ca.~d to _¥' ~ '
'~. ' / · .~L . Static Water Lev~ ~/V '
-,~. Depth of Grouting
_ Pump ~et At
Caatng Height Above Ground
.... ~anftary ~eel on
Electrical VVklnO In COnduit (Y/N)
~'; On
To Nlarelt Edge of Absorption Field on Lot ~/~7
To Nearest Publle 8ewer Une ~
TO Ne~r,.~t Public
Clea~out/Manhole__ ~L//'~ ,, , - ToNearestSewe~Servtcauneon
Wate~ Sample C,~lected by
Water 8aml~e Teat Reaufta _. /~-f7"/~¢//'~'~)
B SEFrlC/ItOLDINO TANK DATA
,, _ No. of Compartment~
~tandptpe~ (Y/N) ~. ' (' I)~ Air-fight Ca~ (Y/N) _ _ Foundation (
Depresalon ove~ Tank (Y/N) - /~/, Date Last Pum
Pumping/Maintenance Contract on Rle ~Y/N) -
Ho~d~r,g Ta. nk High-Water Allrm (Y/N) ': K//"~', ,, Temporal/Holding Tank
:':: '~eparatlon Di~tanca~ from ~ePttc/Ho,<flng Tank:
To W~ter-Supply Well '"'~ ~ '/'/ To I:;ulldlng Foundation
To I~ Une ~ /0
To ~poaal Fle~d
....
1 of'2
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~:~t~£~.
A. WELL DATA
Well type ._~P~:._.__ If A, B. or C. attach ADEC letter.
Log present {~N) ~_ Date completed _..
Total depth__ ~1~ Casedto_
Sanitary seal G/N) _ ~/~.,~
Date of test
Static w]ter level
Well flow
Pump level
FROM WELL LOG
_
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot _ /00~ -
Absorption field on lot
ADEC water system number
lO~,/~'-[ _ Driller ~
,:~.~1' - _Casingheight_~N",,
Wires properly protected (~N) _ Y~'~
AT INSPECTION
r~,%
· On adjacent lots
; On adjacent ~ots
g.p.m.
Public sewer main
Sewer service line .
WATER SAMPLE RESULTS:
Coliform 0 Nit-ate _
Date of sample:
SEPTIC/HOLDING TANK DATA
~J/~r Public sewer manhole/c~eanout AJ//~ _
(~, I 6 '~/,.t. Other bacteria
Co~lectad by:_ ~ ~_~r,~.~,,,,~l,~
Date installed .... /O/,,Q?]/~¥ _ Tank size_ ./~ Compartments ~ ~..~_
High water alarm (Y/~ _ ~/~ ' _ Alarm tested (Y/~_ ~/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)on lot.. ~' + On adjacentlots~_ /~'~ Foundation ~ '~ -
To property line_ [0 + ~Absorption field_ ~ ~,
_Water main/se~ice line ~ '~
SuHace water/drainage J~ ' +
72.026 IRev ?,!H) Front
CONTINUED ON BACK PAGE
.... ge
DEPARTMENT OF. & HUMAN
stre~, R~m ~02 · Anchorage. ~
Health Autl'mrity Approval Checklist
RECEIVED
, DATA
Well t)l~e Ze~- ' v~ r L. tf A. B or C. altaCh AltEC k'tltt
TMM deplh ;;l ~& ~, ~t~d ~o /,': '~'
rROM WELL LOG
S4atic ~nlet lc'vel
We~'. i)fmtuct~,'~ ........... /
%t.'1r~ pl'~fl~, pfOieCtd:~l L~.~/~) ¥ ij J
~pm
.~T INSPECTION
B, Si~FtlC/JlOLDL~IG TANK DATA
i~-~/V DRILLINO, inc.
DRILLINO LO0
Well Owner ~AJ~/. ?TAU
Stalle ~'atet levet~L....tt. (~3 (~low) land P,rface. Fm~h ot wt~l lc'beck ~t~e) r.~.,n emi (
Screen ( ); Perforated ( )l
Well pumplnll test ~'~.lillons Hr (~ of d~lwdown from Itatle level,
Dire of e~pletton_~ 190k
~pth i~rom
/~und luHa~
(mimtle) for~_.J ..... ho.~, with ...... 1¢,0% ..............;ti.
WILL LOG
· ~iz~d & Orave~
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRLIARY 1984
264.4720
Legal
DtPT OF HF/lt/.t
,RECEIVED
iix ,'t~ll~ r~, VIc.
Toh~l Dvpm "-~' Cas,'d to L'j'J .4
Ca~mg Hefflhl Abovo GrounO /' ~ '
Eleclncal Wrong in Condml (Y N) ~"
To Sephc Holding lank on Lei ~ c~:~.~
To Nemesl E(lgu (d Abso~phOt~ Field On Lot /~ 7
Cleanoul Manholf.
WaJer ~dmpjo Test R, ~LJi~s .. ~ .- ,'
Date Completed
· De!Dth of Grouhn0
Pump Sot Al
5amlaty Se;ti on Casing fY
Depre',r. on A~ound W~hhead
. On Adlommg Lois //~
On Ad o~r'unCl Lots /~"1
TO Nearest PUbliC
~//; TO Nearest SewPr S(,rv~( e L,nr, or, [ol
~ .
B SEPTIC/HOLDING TANK DATA
L')dh? Insldlied .f~] '](~,'
Standpipes ~¥ NJ . Y .
Depression ovu~ tank IY NI
Pump~r~q M,untenahc~ Contracl on
Holding Tank H~gh.Wa et Alarm fY
S¢'patahon gmtar',cos from .%epi~c Holdu~f] Tank
To WaN,r-Supply Well . '/~
TO Properly Line ~ ~ · b}
TO WBtI,r M,tln St'fvff. e l. ltm N'J
Course ~/l]
Comments .~W/'7,'c
,S~ze ~c ['& l'4u No of CornpaHmerds
Air,hghl Caps fY N) ~' . ..... foundahon Cleanoul fY N*
Dam Last Pun,pod
T*~mporaty Holding ~ilt~k P~'rrmt (Y
To Budd.n9 [Ound,mon ~'~
Page 1 of 2
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