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HomeMy WebLinkAboutSKY HARBOR ESTATES LT 1Sky Harbor Estates Lot 1 #015-281-78 Alaska state law requires that a copy of this well lo- be sent to the Department orNatural Resources within 45 days: faxes are acceptable. (AKstatutes 3S.O�.020.38.0-i.O-',-i.41.0S.020. 46.15.020 and AK regulations I I ADAC 9=.1 }0). DN -k' Division of M inin,-% Land and Water. 550 W 7th Avenue. Suite 1020 Anchorage. AK 99501- 35{ 2 Phone (907)269-8639 and fax (907')269-,"47 Within the City of Anchorage, it is required that a copy orthe well log be sent to the appropriate city office within 60 days and that another copy of the well log be sent to the -,-vc1h`property owncr within 30 days. Permit Number: _QSR13_12.10 Date of Issue: JuIv 'J 15 :2013 Parcel Identification Number: Is well located at approved permit location?( X) Yes or )No STATE OF ALASKA M CEPA RTENT OF NATURAL RE, SOURCES DIVISION Or MINING,'LAND &WATER WATER WELL LOG Drilling Started: QZ,,__1_7 12 M Conipleted: D11_2212j 0 -a Ciq-:Borougli: Subdivision: BLOCK LOT Property Owner Narne & Address: Hurlburt Ward B IV & Kathy Anchorage I Sky Harbor Est 11601 Barr Rd Anchorage, AK 99516 Meridian Township, _ Range Section V4 Of V4 Of '14 0f '/4 i BOREHOLE DATA (from top of casing)DePth Drilling method: (X) Air rotary. ( ) Cable tool, Other Matcrial:Type, Color & wetness FromTo — — Well use: Public supply, (X ) Domestic. Other stickup 0 2 Depth of hole: 240 ft, Casing stickup: 2 It Casing type. Steel 'thickness: .250 inches Casing diameter: 6 inches Casing depth: ft gravel w/ sand 2 301 ____235 Liner type: Diameter: inches Depth: it Static Nvater(froni top of casing): 140 fton07122 J20a Clay w/ gravel 30 55 pumping level & yield: --- feet after . -- - hours at -- - -pm Recoven, rate: 50 gpm, Method of testing: airlift cobbles 55 60 Development method: airlift Duration: I hour moist sand w/ gravel 60 85 Well intake opening type: Open end. Open hole, Otheqqreen Screened-- Start: 235 ft, Stopped 240 ft Screen tv c:johnsD -p n_S_S_ Slotimesh size: .080 sand & gravel W/ H2O 85 95 Perforated: Start: ft, Stopped: Start: ft. Stopped: ft moist sand & gravel 95 116 Note: .................................................................................................... gravel w/ H20 = 10gpm 116 120 Grout type: bantonite Volume - Depth: from ground surface - to 20 ft moist gravel 120 2201 Pump intake depth: -- I - ft Pump size: _ _ hp. Brand name: coarse gravel w/ H2O 220 240 Was well disinfected upon completion? (X) Yes. No Method of disinfection:.Calcium-Hyp.orhlorite.(Cblorjne) .. Driller commentsi disclaimers: .... ......... ................................ : ............ ............................................................................... I ............................. .............................................................................. ..................... ............................................................................................................. Well driller name: .... KyJaHakerl, ..................................................... Company name: ... j*fty.plj tqq,.JnC.......................................... ailing address: ... 354O..AkulaDr . M ........... ............................................................... .... City: Anchorage State: AK Zip 99516 Phone number : ( 907 345 - 0593 fax:345-4700 Drillers sienature: Alaska state law requires that a copy of this well lo- be sent to the Department orNatural Resources within 45 days: faxes are acceptable. (AKstatutes 3S.O�.020.38.0-i.O-',-i.41.0S.020. 46.15.020 and AK regulations I I ADAC 9=.1 }0). DN -k' Division of M inin,-% Land and Water. 550 W 7th Avenue. Suite 1020 Anchorage. AK 99501- 35{ 2 Phone (907)269-8639 and fax (907')269-,"47 Within the City of Anchorage, it is required that a copy orthe well log be sent to the appropriate city office within 60 days and that another copy of the well log be sent to the -,-vc1h`property owncr within 30 days. Permit Number: _QSR13_12.10 Date of Issue: JuIv 'J 15 :2013 Parcel Identification Number: Is well located at approved permit location?( X) Yes or )No _,,JP.urPqrD,,-,, n s,,b.a [,IJ a 'i"J o n L 0 001 �CLfr ,. a OS L3 L21d `i �. - ...... •` ° NAME- ABOVE GROUND c DATE: 0 / o CASING «-less. Adnui erl n'E�i�iaCeiF`G'� 9S Nnrne: tl d <WW PiNes€ Onr"Ce r ks�e e�'; J'fit YJ Ctn ��l lin L, PUMP TYPE SL, MAKE �r�neC cfJ I MODEL C's Ln u— SERIAL >r Pump J i Q. j =••� Motor �! (! y } DROP TYPE: Type JV ` ' � 0 < �vc 520 I ~ w 1 L, 7 ' 0 Condition �V Q1(/ to a � � POY.2R CAELE. Typo 1�1itQ �Gf�.� Size 2 w 6"d La a o' Condition Ive vv— ELECTRICAL- —ELECTRICAL: Vous Amps YIATER TMK. Teas I Sae C, r) t:�l. 4, � f CASiN� Sae 4, Dia. Typo lee CASED HQLE Frain 0 To 235, n t INTAKE STRUCTURE. Type c4ree%1 From 3, / Ta?y OPEN HOLE. From _ � ` TO i well was disinfected upon completion_ method- calcium hypochlorite. i�i rI CCCin wo�� t P _ y �� Wates Wel t a.n.dPw7T Sm*c _Anchorage. A aska (9n7) 345-0593 Llo)�g s NAME- tA/grd W ABO1!E GROUND DATE: og b o 12> g CASING V well was disinfected upon completion_ method- calcium hypochlorite. C. Water Well. ari.d Pump Seii,,iee Aiitchorage, ACask (90) 345-0-593 f cFtil�'E?I�'S3 AdapT ter l� r__zii�Cct S Ns mC M 6l ��� .,d'- �'�✓- �` ___ _ t 111 /ll/// PUMP TYPE j"ia1 J j e,- p MAKE j j _ � 6S� U h MODEL i 1� v r ' Ln = SERIAL : Pump J < Motor C { F > DROP TYPE Type Silo �V En ii ConYft(D'I V e v e� fn a ' Y a ¢ POt"LR CABLE Ty �'�'• t �I'� Seo v W l�'�il IL Q i a t9 Conditicn IELECTRICAL: vats_ I v f Amps NATER TASIK Type Alon e— Sean E+a1 CASNG: Size Dia. Typo +e& 1 P CASED HOLE From To JW INTAKE STRUCTURE: Type &ireel-, I� I From 2% 7/ To 2 (-Io i IUA OPEN HOLE: From To V well was disinfected upon completion_ method- calcium hypochlorite. C. Water Well. ari.d Pump Seii,,iee Aiitchorage, ACask (90) 345-0-593 On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131210 Tax Code Number: 01528178000 Work Type: Well Permit Effective Dates: July 15, 2013 to July 15, 2014 Design Engineer: Subdivision: SKY HARBOR ESTATES Site Legal Address: SKY HARBOR ESTATES LT 1 G:2735 Owner/Address: HURLBURT WARD B IV & KATHY 11601 BARR ROAD ANCHORAGE AK 995160000 Site Mailing Address: 11601 BARR RD, Anchorage Lot Size in Sq Ft: 19414 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERANELL PERMIT APPLICATION Parcel I.D. 01 t5 7 41 Property owner(s) rJA&n E kA , uY Day phone 2 Mailing address 116ol I k22 JZ� 40 4.vcj6i24Gt 4,L 14 a -/c Site address S/k :: Legal description (Sub'd., Block & Lot) _S14y 1.(400 01f_ Legal description (Township, Range & Section) Lot Size Za. c l Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial ❑ Septic Tank ❑ Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well '® Water Storage ❑ 3 TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) VF V M1 t'2*>TY O2/(.t1.Y4 TY QfcLVr THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized Permit/Rush Fees: CLOD Waiver Fees: _ Date of Payment: j ( 15113 C+#r7 qO Date of Payment: Receipt Number: Receipt Number: Permit No. 05101 3l al D Waiver No. Permit App_9-1-12.doc N ZZNN m�y0O ��o-u;� 0 m i �rn zoZ = xa)00 zm n rn mann: Mrrno �b"m rm i 00K�mQzaic> 6m r* Z oo�mX A m zc�mbmc�ime'—� En 0 .ZOIZV10Zm00�D*pCZ 1 M ZCOm= _ 0Rf = 0 0�c0x m cn N r Z 0 0 0 Z Z D ,rmnoogZorq jl 0 xx 0vz O o m 8 o '. m O NO = ro O) pop N V O "+v* o W mm aD � j Q C p D Z N m CA ADD C 0 0 A En co z r m O CAcrn r ZZNN m�y0O ��o-u;� 0 m i �rn zoZ = xa)00 zm n rn mann: Mrrno �b"m rm i 00K�mQzaic> 6m r* Z oo�mX A m zc�mbmc�ime'—� En 0 .ZOIZV10Zm00�D*pCZ 1 M ZCOm= _ 0Rf = 0 0�c0x m cn N r Z 0 0 0 Z Z D ,rmnoogZorq jl 0 xx 0vz O o m 8 � '. AIV o�,00 ice• p o m Y . ♦o ■ ♦��;) a7 � 46. pop ai it i "+v* .yamy'. G� BARR ROAD N Cfl k1 nnDn'n.cuu• 1 .. 11 VV V/ to w IUU.UU 1 a7 � 46. „Y I /' 'A to C, I �r ot�b I o o I 32.3' 26A• I I 16.01 I as o n o I C o i m I ZZ Q ie.o• I I I z I 1 10 7 Mm m ti m0 i 0-0 0� z �z I I $ �tOii U) m 5 !— o m ; DO v = P m C.) I U) I a T1 �__ ON z D I I aJ.n I I u a n 31.6' t :112.0'i p I � a I I D I I I � I I N cZi I Q I � • I I I -- ------ --------- - - - I---------------------- I - - I 102 T. & E. ESMT. I 11 VV V/ to w IUU.UU 1 - U r Municipality of Anchorage ; ;? Development Services Department SwWaligSafety Division - +.:..�• Onsite Water and Wastevrater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 Page 1 of 2 www.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO2 0215 PID Number. 0 1 S* -249 -78 Nam: gyral E/ Wastewater System: ❑ Newpg ®U rade 100 -Co), 190702, A^ck Ilk 99619 ABSORPTION FIELD Pa.. 2Y3-8s3S Na dBae ly oo..pr.nd D VAG"Trendh E3 Bed DMaaa Dour W wsnc Tay Doper "M ap,w Wad LEGAL DESCRIPTION GPORP Ft. Block: Let S",isort Delo ppo baean fan afpiW Vat. 450,61450,61depth la"ad, pipe: . •• 1 Sky hkit iO/' FS i• pen FI. Ft. yow ip: Range: sectac Fa added stove aighW Vat. Grana Lwgft Ft. Crava.+eec Well: E 7( IS T ❑ New ❑ Upgrade Ft. ClasssSo@on(Private. A B. Cy Taal Depda Cased t. Taal aDsapta ora. 0n .. veld: To From vies n.1 R Fla Date Wet SMacWaa Le,a fuMaen� R •+' Ft. Barber of Rne.I Dofarce OM+een r,».. Ft Pqe Matedat P-30:710" Date f Wacet: 7/22/02 Swfacswater lac• Pump Set at HW'a ft v hand TANK CPM iL Ic,,av R 2 s' — Ga. SEPARATION DISTANCES ` I$Septic ❑ Holding ❑ S.T.E.P. ❑ Other. Septic Absorption Lift HoldingP�LTir�Pdvate F�• aakatzn HJ Na°aa"a' 4oil 7141,4r eac wa Tank Field Station Tank SeaerOne cAcrafe I2 -M eaL 1YO' IS.fI - - 72S` Mata W: Site/ gartaaCanprlments' 2 Rem,ks: of -:y Ina i S!P hC �c.n t'C 1Jur,p�a BENCH MARK Swfacswater lac• 71Lbr - _ LIFT STATION IV. A. Sae. Manaacaaer, Lot line Z s a 2 s' — Ga. ` Pury m' YrN a 'Prmp etr levo K MKI, reser alarm ee F�• aakatzn HJ 6d 1 " In h h Para Mahe a Mod Elec!r4al fupectlms performed M Cutain tl4n — — — Rem,ks: of -:y Ina i S!P hC �c.n t'C 1Jur,p�a BENCH MARK ✓ rrW4o,a /C :ct-te.X o,+ c',Ae Nen✓ lanam ertl W,orryaore 6,,Lrreyl s(u6 LV tE lurs�r Ctectoc,ul< E rgo4a17r fict(e lormllew ✓ O>< .&or b.ar ed E:e.aucn /QO.Q Fl Cr ��u� end aF rx;,fp.� of n -chi. Inspections performed by: Fla h6p T,eC6 • CNc Dates: 1" -7 / 22 /lg2• 2nd Developme it Services Department Approval Reviewed and approved by: Date: Ilj?jnL (Rev I:ml Engineer's Stamp pl�acl— Of At 111% .�.�.�....e............. A THEODORE F. IdOORE�� CE -3589 r pFr Sid ......••� sr�� I � �,, ;1,^,F• a QO PERMIT NO: SW020215 PID NO: 015-281-78 SWING TIES: FROM: COR. "A" COR. "B" TO: FINAL GRAD HOUSE S.T. C.O. "C" 48' 66.5' S.T. C.O. "D" 57' 73' DBL. C.O. "E" 61' 76' TR. C.O. "F" 64' 78' TR. M.T. "G" 65' 78' w Z WELL K m FROM FINAL GRAD HOUSE ELEV. 98.1' I I • • J INV, 1250 -GALLON 93.2' SEPTIC TANK', CROSS-SECTION NOT TO SCALE KLATT ROAD PAGE 2OF2 PAVED 1�1 PARKING ' V AREA EXISTING � SOIL ABS. j EXISTING 4-BDRM TRENCH HOUSE 1 TBM 1 �. I NEW JR 100' NEW NEW 1250 -GAL SEPTIC TANK ,I PLAN VIEW SCALE: 1" = 30' EXIST. TRENCH HORIZ. DIST. PIPE INV. 89.0' NEW MON. TUBE-/: UBEI LOT 1, SKY HARBOR ESTATES SEPTIC TANK REPLACEMENT AS -BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES SCALE: AS NOTED 14530 ECHO STREET DRAWN BY TFM ANCII0RAGE•ALASF:A99SI6 OCTOBER, 2002 I I • • J I ' • P 6' '.�l � �� �ti i i ff.'s } �• �i J=� i •�k I I }I............ I I w + Th EOOORE F. MOORE f fi '•. 7t CE -3589 93.0 L Ort -f.♦ - I 1 I I 1 1 I 1 I I L tai EXIST. TRENCH HORIZ. DIST. PIPE INV. 89.0' NEW MON. TUBE-/: UBEI LOT 1, SKY HARBOR ESTATES SEPTIC TANK REPLACEMENT AS -BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES SCALE: AS NOTED 14530 ECHO STREET DRAWN BY TFM ANCII0RAGE•ALASF:A99SI6 OCTOBER, 2002 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW020215 Legal Description: SKY HARBOR ESTATES LT 1 -7/voL Wt se�, *aAl Date Issued: Jul 08, 2002 Expiration Date: Jul 08, 2003 Parcel ID: 015-281-78 Design Engineer: 0019 Flattop Technical Services Site Address: Owner Name: Craig Elg Lot Size: 19414 SQ. FT. Owner Address: PO Box 190702 Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99519-0000 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: y�^}„�.n. /�f �� (�cl� •� S Issued By: Date: -1 to., /°a' Date: 7/6/02 Municipality of Anchorage • -- Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. tti — 2-6 — 75 Property owner(s) i�•u y E �y 0 s•rt.• Permit Number SW02 0 2 / S Day phone Mailing address (1) Q cr. 80A 1907 a2 Mailing address (2) f3'ncAang7e /mac Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size /9e// q AcrqtlSqF Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool mn Well Only Water Storage Jacuzzi Water Softening Unit 9ssi9 EEt 6 h!l w I certify that the above information Is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 1`100 Waiver Fees: Date of Payment: Receipt Number: (Rev. 12100) a9 -a-''1°( Date of Payment: Receipt Number: ,.;FLiiATOP:TEG`HNICAL SERV�IGS-_ Cn'n. & ENVIRONMENTAL ENGLNEERLNG • ENERGY CONSERVATION & ANALYSIS TIIEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345.1355 ANCHORAGE, ALASKA 99516 July 3, 2002 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to replace the existing septic tank on Lot 1 of Sky Harbor Estates located at 11601 Barr Road. A site plan is enclosed for your review. The existing septic tank is leaking, so needs to be replaced before issuance of a HAA certificate. Most of the existing trench is under a paved parking area and there is no cleanout at the far end, however as Dan Roth and I discussed, we will install a functional cleanout and monitor tube near the south end of the trench. The topography of the lot in the area of proposed construction is generally level, The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. I ' I ' I' a I LOT 3, SKY HARBOR EST., ADDN. #1 Lu a_ I a-----------------------------------------� - -- ------ "I 1 �Q I ; K— ROAD N 'I ------'------------------------ --------------- EXISTING TRENCH w. I PAVED 8' SEWER GRAVEL j I PARKING INSTALL NEW ' Z AREA 1250 -GALLON EXISTING 4-BDRM ; SEPTIC TANK I HOUSE ; a I ; INSTALL DBL C.O. m iR 100' i WELL 01 - INSTALL C.O. & NEW MONITOR TUBE IN EXISTING TRENCH WELL ± ABANDON I i EXISTING HOUSE SEPTIC SEPTIC TANK AREA ---------------- ----- _ - - - TRACT13 -- ----'- ; (GREENBELT) L0T2 SKY HARBOR ESTATES 100' ,•, db a + ;� •gTK J'� �'�+ a i THEODORE F. MOORE is CF -3589 }`ell .......... .... .•' •qti 'Q. .sw LOT 1, SKY HARBOR ESTATES SEPTIC TANK REPLACEMENT SITE PLAN FLATTOP TECHNICAL SERVICES IIINCH=50FEET 14530 ECI IO STREET DRAWN BY TFM ANCHORAGE. ALASKA 99516 1 JUNE, 2002 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. MUNICIPALITY OF ANCHORAGE �® DEPARTMENT OF HEALTH & ENVII30NMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME P�H�[ONE NEW Ns #� 1 ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION �r _ NO, OF BED OOMS - Well ._.�: Absorption ar ��t, �' �G,t tiR®at�C�l7 welliD g �• PERM .T Nom, ��•• DISTANCE TO: Uy Q' Q y F- z Manufactu rT Material �-y-� No, of com artments I_iq, capacity in gallons Inside length IF HOMEMADE: Width _ id depth ----�._e„ ©O Z Dwelling DISTANCE TO PERMIT NO. 2 Z ti Manufac r Material Liquid city in gallons U LuDISTANCE TO:�. Well . ..�=J Foundation / Nearest lot line PERMIT NQ.` �� Lu U, 2 No. of lines Length of each lin Total length of lines Trench width Distance between lines 2 H ' - s+ L,11 inches +�` } q Top tile to finish Material beneath tile Total effective absorption area h of grade q t ` t, 16 q - � inches ' - Length Width Depth PERMIT NO. W QI__ Type of c ' Crib di a ter Crib depth Total effective bsorption area a. F: u� to Well Buildin ndation Nearest lot line ISTANCE TO: Cla - Depth Driller Distance to I � line PERMIT NO. lei I Lu DISTANCE TOBuilding ff nclatjon : LL Sewer line / Septic tank' s r Absorption reals) t OTHER PIPE MATERIALS© ,,\ .1� SOIL TEST RATING BIT INSTALLER REMARKS 2 ,s � y nfl� OV • A s s Fr _ . ;,<0 THOM A. FISC ER d F/ �if•o. CE - 6793 •.. OSS/ ••V .•' ���� °• Y.9Y•° `iYro - APPROV DATE LEGAL ' La 72-013 (Rev. 3/78) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi|y that: �amiliar with the requirements [or on~site sewers and wells as set Korth by the Municipality oA Anchorage (MOAand tlie StaW W Alaska. 2. I will install the system Al accordance with all MOA codes and rogulations� and in compliance with the design griteria of, this permit. I 3" I will aJhe1,e to all MOA and State o| Alaska requiremen'Ls {or the �et back distances Nom any existing well, wastewater disposal system or public sewerage sy�tem on this or any adjacent or nearby lcat. , 4. I understand that this permit is valid [or a maximum o[ 4 hedrooms an" any enlargement will require an additional permit. IF A LIFT 711 (A IS INSTALLED IN 0N, 1A COVERED BY MDA BUILDING CODES v THEN (1) AN ELECTRICAL PERMIT AND N MUST BE O8T0INED; (2) AS~Eli ILTS WILL NOT BE APPROVED WITHOUT AN LECTRIC�� INSPECTION REpORT; 0ND <3> THE ELECTRICAL WORK MUST BE DME BY 0 LICENSED ELECTRICIAN, SIGNED DATE: ,~~__`�~ ' ~'�� ~`��~��� H�y�/[H�| J J����� ISSUED BY --�- �7�--------���---��^ DATE: \�[,\ ��-74,l-W� TAUK T ED 1: 11 -1 - "IF VD T=' OAHWAKEPHAMCWT DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE� NO 99501 264�4720 'I: ��'Il 11 -!F� ��i: 1P -F HYT $411 F TAT HIE M too lot C H U FINKTAH-8�� PERMIT NO: 850108 DATE ISSUED: 04/22/85 APPLICANT: J^ DAN JANSEN ADDRESS: % THOM FISCHER,11600 CANGE RD. ANCHORAGE; AK 99516 C(DNTACT PHONE 7O08 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi|y that: �amiliar with the requirements [or on~site sewers and wells as set Korth by the Municipality oA Anchorage (MOAand tlie StaW W Alaska. 2. I will install the system Al accordance with all MOA codes and rogulations� and in compliance with the design griteria of, this permit. I 3" I will aJhe1,e to all MOA and State o| Alaska requiremen'Ls {or the �et back distances Nom any existing well, wastewater disposal system or public sewerage sy�tem on this or any adjacent or nearby lcat. , 4. I understand that this permit is valid [or a maximum o[ 4 hedrooms an" any enlargement will require an additional permit. IF A LIFT 711 (A IS INSTALLED IN 0N, 1A COVERED BY MDA BUILDING CODES v THEN (1) AN ELECTRICAL PERMIT AND N MUST BE O8T0INED; (2) AS~Eli ILTS WILL NOT BE APPROVED WITHOUT AN LECTRIC�� INSPECTION REpORT; 0ND <3> THE ELECTRICAL WORK MUST BE DME BY 0 LICENSED ELECTRICIAN, SIGNED DATE: ,~~__`�~ ' ~'�� ~`��~��� H�y�/[H�| J J����� ISSUED BY --�- �7�--------���---��^ DATE: \�[,\ ��-74,l-W� XSOILS LOG 7 Z45 I�w 11600 CANGE RP. jANChf0RAGE, ASC. 995/6 XNAZ (90T) 345-7008 PERCOLATION x � ift—Um195 TEST - SOILS LOG - PERCOLATION TEST PERFORMED f -OR .1 LA0 �— YT%'�,�C _1� DATE PERFORMED: LEGAL DESCRIPTION: Sqi PF ---I_—SITE PLAN Of-Col-t'� (" 1 " 2 3 4 -v . C,' 7 8 10- 11– if 12 :R. 13 ®' 14 'D: 15 Vkq 16 17 4JTH -- i ...... ........ ...... . 18 � 19 •THOM A. FISCHE �cq CE -6793 n 20 ��alb. COMMENTS COMMENTS WAS GROUND WATER t S ENCOUNTERED? 1`y�- L O P IF YES, AT WHAT E DEPTH? Reading Date Cross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) — FT PERFORMED BY:-�yy�__ ��{ •fj CERTIFIED BY: -- DATE:— f WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol a Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Pieces complete either to, Ile or Ic.) A.D.L. No. Ia. Borough Subdivision Lot I Block Ib. t/q of re Section No, Township NO Range Y Ic, DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: E❑ Meridian w(] - Street Address and Arco of Well Location -, Address: 9-0 / -. -2. WELL LOG- -. Material TYBe-- l Feet aglow Fee SUf1a Ce 4. WELL DEPTH: (final) �Q ft. 5. DATE OFC MPLETI N ToD Bottom - I nQx �j'^f /� �yq - s 'V- D 3 _ 6, r;-,. 6, Q Cabla tool XRolary a Driven a Dug Q Auger Odetted E] Bored n Other: -k I 4AJr �i ��� ^ or 7. USE: Domestic E3 Public Supply E] Industry pRecharge Commerical EJ Tout Well 0 Other: e Laa� ' 9Irrigation 8. CASING: Threaded Wattled I022 -Q ft. Depth Weight -LZ- Ibs,/ diam. _.. In. toft. Depth Stickup_�e ft. Iio afit 17 7 J QQ—diam.-36—In. I .V !r LA1L� [] Other: 9. FINISH O,FF WELL: ,r� Type: e" Diameter;__ SIo1/Mash Size: Longth:^_._ Sot between ft. and .- ft. Bockfllllnq Gravel pack - TV-�s���j) - 13. PUMP: (if available) HP -'- Length of Drop Pipe /-, 10. STATIC WATER LEVEL: y`��}1, SL 7 M Dote Above or 0 Below land surface Equipment used: — ------ �- i 1�r�(-� j•T" atnI-1rYrC:f—f(� rlNc7,NMENT�"L:rT 81 I I . PUMPING LEVEL below land surface and YIELD ft. aflor hrs, Pumping g.p.m. ft. offer his. pumping_g.p.m. 12.GROUTING Well Grouted: Q Yes ®No - Material: C] Neat Comont [] Other: TV-�s���j) - 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity 9 -P.M. — Subm. Jet ❑ Contrificoii' ®-Other 14.REMARKS: Me ClS,.rrec� /J 6--Plln IIC — 110 --.30 3 ne 16. WATER WELL. CONTRACTOR'S CERTIFICATION: 15. Watar Temperature F _° ��) C i This wail was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; 'l Re istered Busines Name Contract License Number L.4 4 Signed: ��r�'-+�. n, nnA polo: (f prized Representative r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472.0 Application Date --- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 2. TYPE OF RESIDENCE Single-Family']V Multi -Family Ea Other Number of Bedrooms 3. WATER SUPPLY Individual Wel 9Community © Public El Note: If community well system, roust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsitep-) Public ❑ Community f_7 Holding Tank D Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. rz-025 (11 84) Page 1 of 2 Location (address or directions) s -— (b) Applicant Narne_telephone: Home '_--.--- Business (",� r' Applicant Address �_�'1- -._J.. (c) Applicant is (check one): Lending Institution Owneribuilder,)Buyer v ; Other El (explain); —_ (d) Lending Institution Telephone__— Address --- - -- (e) Real Estate Company and Agent —_— --.- Address ----- Telephone - - -- — --- ------ (f) Mail the HAA to the following address: -- - - •--_ -sem - ---- — --- - ---- ----- 2. TYPE OF RESIDENCE Single-Family']V Multi -Family Ea Other Number of Bedrooms 3. WATER SUPPLY Individual Wel 9Community © Public El Note: If community well system, roust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsitep-) Public ❑ Community f_7 Holding Tank D Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. rz-025 (11 84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FII_t_ SEAf1C11, DATA ANIS IPdf:CJ{OF,9{� 1[t6.f As certified by my seal affixed hereto and as of the validation date shown below, I verify that myrove ,,eI„ir--„ „t; ,,.; t ;;;, , s Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, fund,; a;rrl ru ci ,_:& gLj;.tj for the number of bedrooms and type of structure indicated herein. I further verify that based on the information olrimnco from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S'i Name of Firm .. �":> ri t"(-�==``��,'I�.� _ �N�; �Z- �._.�� � — Telephone Addre Date r,e X14 `, n CO ? n gineer's Seal ona vvvv � vv°°vva v°vv (i THOM A. RSCIJ�fl' CC -67 3 '7 6. DHEP APPROVAL r Approved for D�/i bedrooms by __ �= � p 0'-' — — /Date ._ Approved ------— Disapproved Terms of Conditional Approval Conditional 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 homes 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: A. WELL DATA MUNICIPALITY OF ANCMOMoa DEPT, OF HEALTH 0, ENVIRONMENTAL PROTECTION ULC 0 3 Well ClassificationLyb'c� If A. B. C, D.E.C. pproved (Y/N) Well Log Present (Y/N) `'SCS Date Completed —5 /�bY — Yield O GF?Vy\ Total Depth �Zo Cased to �z ©r Depth of Grouting Static Water Level Pump Set At j 11 Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) d Separation Distances from Well: To Septic/Holding Tank on Lot i '1 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _I �� t) " ; On Adjoining Lots VC) 'A— To Nearest Public Sewer Line —0t (�-'rTo Nearest Public Sewer Cleanout/Manhole _���'��"�,n �To Nearest Sewer Service Line on Lot Water Sample Collected by' 1 titer.. Yi. }'-1 SCA -M -e ; Date Water Sample Test Resultswc}"�''�% Comments B. SEPTIC/HOLDING TANK DATA Date Installed f (P Size ) Z�5� CTs' -No. of Compartments Z Standpipes (Y/N) Air -tight Caps (Y/N) —`ice Foundation Cleanout (Y/N) y4EZ Depression over Tank (Y/N) NC;, Date Last Pumped Pumping/Maintenance Contract on File (Y/N) {�� ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) ��— Separation Distances from Septic/Holding Tank: r To Water -Supply Well � (-' To Building Foundation L' To Property Line "kms To Disposal Field 7 t To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course 11 Comments 'R - Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorptio Strata �E357 PJ4 Type of System Design Date Installed Length of Field Width of Field 3,4`1 Depth of Field Z. Gravel Bed Thickness Square Feet of Absorption Area � Standpipes Present (Y/N) Depression over Field (Y/N) '' �� Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1 ©C- t l To Building Foundation—Z Lot N /dk r To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "PuZAIar HigatTesEleCc To Property Line ; On Adjoining Lots To Existing or Abandoned System on 3c, ' +-- To Cutbank (if present) W /P' — Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles durin " Check Permitted Bedroom Rating Against HAAQequest ". uacy Test. Meets MOA I certify that I ave che''c//kk�e , verified` r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Y -Y < -� Date Company MX& b cCLM�A No. Receipt No. 1 �" L_ -L, r Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) OF A4 ° JW co 9TH Engineer's Seal �f:° .... �•� THOM A. FISCHER� 0 CE - 6793 QQG- -0 ®��gvprofe�lo �