HomeMy WebLinkAboutSPIELMAN LT 2Spielman
Lot 2
#015-272-58
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
NAME
PHONE
NEW
El UPGRADE
MAILING ADDRESS
' 0. 4 -a
9gs0
LEGAL
DESCRIPTION
LOCATION
NO. OF BEDROOMS
I - "azs
Is
Well
Absorption areg Dwelling
PERMIT NO,
v Y
DISTANCE TO:
M
-
esl6e MIC)
_
F- Z
wQ
Manufacturer Ma erial
No. of compartments
h
to
Liqcapacity in gallons
IF HOMEMADE:
Inside length Width
Liquid depth
0 Y
DISTANCE TO: Well
Dwelling
PERMIT NO.
JAZ
02 b
Manufacturer
Material
Liquid capacity in gallons
O
DISTANCE TO:
Well
Foundation
Nearest lot lie
"'7 r
PERMIT NO.
T
ej-„�
J u.
W
No. of lines
Lengtlhof each line
Total len th�of lines
Trench width
Distance betwe lines
Z
h _
inches
a
Top to finish
Material beneath the
Total
ccI-
of tile grade
//
effective absorption area j
0
-AJ. �s
inches
I 16egb �Z 1
Length
Width
Depth
PERMIT NO.
LU
0
Q f-
Type of
.r Crib diameter
Crib depth
Total effective absorption area
° `a
W
W
DISTANCE TO: Well
Building foundation
Nearest lot line
J
Class Depth
Driller
Distance to lot line
PERMIT NO.
J
U.1
R:
DISTANCE TO: Building foundation
Sewer line
Septic tank
Absorption areas)
OTHER
PIPE MATERIALS
_
E
SOIL TEST RATING
_=Q
INSTALLER
-Z!s
REMARKSO
41 a \)
s S
J=am
I
/
ry
\�rV
L
/
141.0I
LEGAL
/ �
O
I
I
J4
e-.
APPROVED DATE
c ,
p) 1,
72-013 (Rev. 3/78)
LEGFIL. DESURIP"
11. -11101
Ci F.E., !"),H) t5
S"Yk:E".
is 1
2 6d.
JE. W Q ST Q 0-0 lH Q. .41 1"A EE I.- KEE". F-._" 1-1 X T,
SUBD IV 1411: ON
S E C I 10 N : ,::I:1
Fl,
D:
21 P I EL M fo N I.C1 r ; BUT* : N Fl
T 0 Kul E41 I P : J. '>.! hl IRFINCif.':
OF.".
BEI !:::11,1 THEE 1-:1 ly, f"I I L_I 1Ei: 1._.E DD YCH I IN W.H.SIMAPACi
Cl IC OS;E:: 1-1 IH: CiPT I "I"IAf::IT F, 1: I'VIOUF]: .Hi; I Ill.
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.. ..... .... . .. . .....
:1 1:::: f.H. P: I' T F" "r I I ]:::1, 1,
I-TOULIFIR WITH THE IREGUMENEWIT FAIR -.1 L. L f H; SEI
'I"HE: ID FI CC Fi L fl S fl.
2.
is ITILL. 1411-1.1 FILL loll FIND Fl * f I Cl hl
FI I...1 D Ill 141111 THE-,: U:ITEF:U-1 Of PEFAITT.
TO 1:11....1 HIDFi AM STIATEE OF' PD:)l lIF.J-EJ-lEI'..ITS F:'uR THE ']ET
1711.41r, CIP! Pi I BL. 1: 1::::
THIS OR Flhl FII:).jFIC:EkIT i.DR I'-4EARI':3,'l` L.C.11".
.:WE:F!FIGE
F::,E;T FI Il E', -111FIl I - Hhii: I:::,EFJ.IIT IS I./Fll ID F'C'IP! fl MAXIMUM OF :1 EIEDIRCICXTAhIl."
WILL RETAMIRE A14 FURHIT.
F' FI I IF*T SMATION IS HISTSLUED IN flN FIRM COVEIRED BY I.II..:IFI
THE'll FIN El E...:CTRTi: ,FII_. ME, INSPECTION Eii-_, CBE rj-'mAEr.:,.; (2)
1.0111TOUT Fll,..6 1-1 1 1.... REFTORT, FINE; CD ME
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MUNICIPALITY OF ANCHORAGE
Department Health and Environmenta rotection
825 L Street, Anchorage, AK. j9501
264-4720
# # HANDWRITTEN PERMIT # #
Permit # S;'����C�`F� WELL AND/ ON-SITE SEWER PERMIT
Applicant ��% �` ���� i��Cl, �l _ Mailing
Location:
c
j -
n /7 C %
Address: ( r r` 6, 4-�-)7.�,
Phone Number:
Legal Description: Lot
Type of Soil Absorption System Is:
Trench: \_ Drainfield: Seepage Bed:
Maximum Number of Bedrooms: ,7
DEPTH
The Required Size
LENGTH �5 e
Size:
Holding Tank:
Soil Rating(sq.ft/br)
of the Soil Absorption System Is:
GRAVEL DEPTH 5 WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ z� GALLONS # #
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 will serve. '
* * TWO(Z) INSPECTIONS ARE REQUIRED #
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 or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # #
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 will install the system in accordance with codes.
(3) I understand that thon-site sewer system may require enlargement if
the d c�_is, d!o�d�to include more that 3 edrooms.
�-
Signed: >/_ Issued by:
Applicant
i
Date:
SWP/024(1/81)
[I SOII.S LOG
ivIUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
PERCOLATION
�.
TEST
1
Gross
825 L. Strout, Anchorage, Alaska 99501 2644720
16
.�
Date
SOILS LOG — PERCOLATION TEST
�
y
17
�% ( r J•" � DATE PERFORMED:
18
PERFORMED FOR:
--
2
}
LEGAL DESCRIPTION:
' i i .-- J-
1.
L
A SLOPE SITE PLAN
3
14
DEPTH
IFLET)
_
1
Gross
Net
16
Reading
Date
Time
�
y
17
11
18
I�
2
}
1.
L
3
6 ,
rs41
7
- -' 9
;I
I
10
"
ii
WAS GROUND WATER S
--- _11 7
-._
-�,-L ENCOUNTERED? — - L
I
i 2
P
C
IF AT WHAT
1
DEPTH?
13 1'
14
rrr
_ 15
Gross
Net
16
Reading
Date
Time
�
n
17
11
18
I�
19
20 F : 0000�pC
PERCOLATION RATE L
% /J���nneW Doa�
TEST RUN BETWEEN ID
COMMENTS I.."
e
// Qo oo 000aa a�efo 0000n
PERFORMED BY: r" I-� t� CERTIFIED BY:11.1
OD S
72008 (6/79)
nch)
rrr
Gross
Net
Depth to
Reading
Date
Time
Time
Water ;'. Drop
_
J
1.
L
20 F : 0000�pC
PERCOLATION RATE L
% /J���nneW Doa�
TEST RUN BETWEEN ID
COMMENTS I.."
e
// Qo oo 000aa a�efo 0000n
PERFORMED BY: r" I-� t� CERTIFIED BY:11.1
OD S
72008 (6/79)
nch)
rrr
ea
°��e Ido. '1l8t�E e�.• V
F9F eoOoc. •e MCOee �`rjc
Q4t 0FESSIO �
TE:
Bet�een O;Malley & Huffman roads on Bragaw going south]
posts into the ground with chain across "no trespassing" sign
l
on it that is it.
97v
P
I
r� l,
LOCATION OF WELL (please complete either la, Ib or ic.)
la. Borough Subdivision Lot Block Ib. 1/a gtrs
Anc!7. Spielman 2. of—af—
Ic I DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
-ER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
Drilling Permit No.
A.D.L. No.
Section No. Township N ❑ Range E ❑ Meridian
S❑ W❑
3. OWNER OF WELL: Mr, rToin Star::.
Address:
Street Address and Area of Well Location
Feet
Below
4. WELL ppT f:t(finall 5. DATE OF�CrQMPLETIQNt
f� bL
2. WELL LOG
Surface
-
Material Type
Top
Bottom
6. V Coble tool [_]Rotary ❑ Driven C]Dug
0
1
)rpsnj fR
1
7
❑Auger ❑Jetted [3 Bored ❑ Other:
3rOWn Sand � GY&Yet
7
13
rM
7. USE: Domestic C] Public Supply El Industry
Brown Sand
❑ Irrigation ❑ Recharge ❑ Commerical
' &Gravel 13 16
r – Brown ,'and
Broom SAnd &
16
43
0 Test Well ❑ Other:
57
S. CASING: ❑ Threaded (N Welded
Brriwir _
7'
d(am._6 In. to 238 ft. Depth Weight _t�7 tbs./ ft
57 60
BrCiwn Sand
Sand 1, rge Gravel
0
dorm. In. to ft. Depth Sflckup ft.
n .
63.
78
9. FINISH OF WELL:
ck Sand
78
SO
Type. Open Bottom Dlamehr•
Slot/Mesh Size: length:
Set between ft. and ft.
wn & Gravel 95 103
& Gravel Caving
102
175
Backfilling Gravel pack
and & Clay
175
186
� p � � �
IO STATIC WATER LEVEL: �9i ft, yA1�,.�tL B
Date
❑Above or Below land surface
rBlackShndWater 186 188
188
9
Equipment uced:Dart Valve Bailer
and & Gravel
198
11 . PUMPING LEVEL below tend surface and YIELD
1Ag ft. offer 2, hrs, pumping 14 g.D.m.
& [ti'ater 198 200
ilt
ft. after _hrs. Dumping q.P.m•
202
215
12.4ROUTING Wall Grouted: C] Yes Yes LJ No
Black Sand.7 Gravel
215 217
Hardpan
Material: ❑ Neat Cement [3Other:
219
Gravett Hr rd )an
219
236
13, PUMP: (if available) HP 1
Length of Drop Pipe 97.9 ft. capacity 1_g•p.m
RD Subm. C] Jet ❑ Centrifical 0 Other
14. REMARKS:
16, WATER WELL CONTRACTORS CERTIFICATION: i 15. Water Temperature
This well was drilled under my jurisdiction and this report Is true to the best of my knowledge and belief;
Dnrterl Drilling Co• AA0512
Registered Business Name Contract License Number
Address: R5'�7 Starrnall Anchors -e Ak. 99307
s r'sl
Dole:
Signed : -
Autnorizea Representotive
Form 02-WWR III/BI) Copy Distribution: WHITE -Stale DOGS, PINK -Driller, CANARY -Customer
F LJ C
Development Services Department
Building Safety Division
0 On-Site Water & Wastewater Program
4700 Broxx^ow Street
P.O. Box 196690
Markeagich Anchorage, AK 99519.6650
Mayor www mUnr OM inn<n�
1907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number: RrOI-6
Description 4 r
L2 -
Pump Installation Date: ///3/oe
Pump Intake Depth Below Top of Well Casing: lg6 feet
Pump Manufacturer's Name:
Pump Model: loors1leA) I VS
Pump Size hp
Pitless Adapter Burial Depth: /6> feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion": Oxes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name:
Property Owner Name & Address:
T/t::.,9s s1A.RK
Attention: The pump installe-, shall provide a ptunp installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENC OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEAUCH AUTHORITY. APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description ( include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name Telephone
Applicants Address
(c) Applicant ppis (check orae) Tending Institution �; Owrer/builder ,
Buyer ��vW_ 1 Other �, (explain);
(d) fending Institution Tele hone
Address
(e) Real. Estate Co. & Acent 1V1UrN;aani.iry r
Address ., J /,�h7itL PR07Ecrjo f
Telephoi o
2. Tne of Fbsidence
Single -Family
Number. of Bedrooms
3. water SijpR.1ry
Individual I,11
Multi -Family
�7
Con nuni.ty
Other (describe
Public
V c
Note: If conv(unity well system, must have written conf.immiti.on from the State
Departmnt of Environtrental Conservation attesting to the legality and status.
Is the well adequate for the number of bedrocams specified in this HAA( 1-) _ o_
4. Sewage Disposal
Onsite _ Public' Conanunity �� Holding Tank
Is the wastewater_ disposal system adequate for the number of bedrooms (Y ,)
[Page 1 of 21
2-15-84
FM i 14
5. Tncineerinq Firm Puovidine:[ns� r_tions, Tests, Data and Information
I certify that I have checked, verified, or conformed to all MA HAA Guidelines in
effect on the date of' this insrr:ction.
Signed--,___f%dc
Nam= Of Fi
Address I-)
Signed by
Date__a__��1(
6. DHEP A.p rova 1
Approved for
Approved`
( ENGINEER SEAL,
badr. (xxo
DisappromBd
Terms of Conditional Approval
By,
Date
TO
".- i c.--
Jnr c. Roid, .lr. <
r0'
�.�.
n12asi'�
eeaa uA nenuB �•..�)
Conditional ��
Date
'Ibe Municipality of Anchorage Departmnt of Health and Envirormntal Protection does
not guarantee the continued satisfactory performance of the wager supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shcwn above„ 1.xAc-,d on the data and information furnished by an engineer registered in
theState of Alaska, the water supply and wastewater disposal system is safe and func_.
tional for the numkrr of bedromm and type of structure indicated.
WHEP SEAL)
7. Mail the HAA to the following address:
-31
t_i Il T,
KB2/d5/s
[Page. 2. of 21 t
2-15- 84
AUNICIPALITY 01" ANCHORAGE
DLPT. OF HL"ALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTFCTION
HEALTH AUTHORITY APPROVAL (HAA) LJU+ 1988
CHECKLIST - FEBRUARY 1984]
A. WELL DATA Legal Description:�MA�
Well Classification PrL'yGt..4[4L _ If Al B, cr C, D.E.C. Approved(YM)"`IM
Well Log Present Y Date Completed 1319V �Yield
Total Depth 5/ Cased to3j3'/ Depth of Grouting
Static Water Level. Pump Set At o� o2oZ
Casing Height Above Ground Sanitary Seal on Casing ON)
Electrical Wiring in Conduit (Y A) Depression Around Wellhead (Y
Separation Distances from Well:
To Septic/Holding Tank on Lot /Dy/ X On Adjoining Lots �L/OD
To Nearest Edge of Absorption Field on Lot /2.0 J"-; On Adjoining
To Nearest Public Sewer Line n?��_- To Nearest Public Sewer
Cleanout/Manhole IvAr To Nearest Sewer Service ine on Lot A)IA-
Water Sample Collected By Date
Water Sample Test Results ��'`"
Comments 4-
B. SEPTIC/HOLDING TANK DATA
Date Installed _ Size 1000 No. of Ccrpartments
StandpipesY ) Air -tight Caps &T_)_ Foundation Cleanout Y )
Depression over Tank (YAPDate Last Pumped N f- Nem
Pumping/Maintenance Contract on File (YM) N /t ; for
Holding Tank High -Water Alarm (Y/N) W I.&--
-- Temporary Holding Tank Permit
Separation Distances from Septic/Holding Tank:
To Water -Supply V1e 11 ) p q � � To Building Foundation � D
To Property LineDisposal Field
To Water'Mai:n/Service Line ��� To Stream, Pond, Lake, or Major Drainage
Course
Comment
[Page 1 of 21
2-7.5s84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata P�' Type of System Design ` -p"Ctf
Date Installed cf 1 g� Length of Field Sy
Width of Field "Z.5 Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Areas Standpipes Present )
Depression over Field (Y ) Date of Last Adequacy Test IiEiO
Results of Last Adequacy 'lest ' �
Separation Distance from Absorption Field:
To Water -Supply Fell 1$C) / A* To Property Line
To Building Foundation .r aq To Existing or Abandoned System cn
Lot /J <t ; On Adjoining Lots + , >
To Water Main/Service Line ,,o2 -q1 To Cutbank(if present) 4ZIA
To Stream/Pond/Lake/or Major, Drainage Course /JIB
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (YIN)
"Pump On" Level at 'Pump Off " at
High Water Alarm Level 44?FVent _(Y/N)
Tested foring Cycles during Adequacy 'lest. Meets MOA
Electrical Codes(Y
Comments
** Check Permitted Bedrocm Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA IIA,' �Sn effect
on the date f this inspection.
Signed Date p //CO • • �L e�C�
Company z S MOA No. f> �5/—� , / * r� w�• .• ��•..u. ° a
°•SLAT' ! w�
KB1/d5/s C y C. Rets, Jr.� ��
�, •. o. 2251 •E ®a
PROF ..SO fir
ti PAOFESS�� ��
(Page 2 of 21 �
2-15-84
�?
_ CHEMICAL t& GEOLOGICAL LABORATORIES OF ALASKA, INC.
/LA.0RAr0RiZ9
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
5633 B Street r,
-
" 1
Drinking Water Analysis Report for Total Coliform Bacteria
®� TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY
nT� (') See h on back
WATER SYSTEM:
I.D. NO.
Water System Name Phone No.
Mailing Address
City
State
SAMPLE DATE: d F71451
Mo. Day Year
Zip Code
SAMPLE TYPE:
Routlne
heck Sample (for routine samplet ❑ Treated Water
with lab ref. no. ❑ Untreated Water
O Special Purpose
SAMPLE Time Collected
NO. LOCATION Collected By
2 �i i�LrGQJ' CZGlee--
3
4
5
READ INSTRUCTIONS
BEFORE
Analysis shows this Water SAMPLE to be:
K Satisfactory
❑ 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
-�Z- /e)' s>�
Analytical Method:
Ib
❑ Fermentation Tube
)�r Membrane Filter
Lab Ref. No. Result' Analyst
Em
I I �
I J m --
I I m
L_ J FE
"No of colonies/ 100 ml or No of Pp5lbve portions.
06 1220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1983
Membrane Filter: Direct Count
Verification: L
Final Membrane Filter Re
Reported By
COLLECTING SAMPLE TNTC = Too Numerous To Count
BG B
Date _ r
Coilform/100ml
ilform1100ml
C/
Time: C) C) a.m.
P.M.