HomeMy WebLinkAboutSAND LAKE #2 BLK 3 LT 3BlocK
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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
[ANEW
Pao k Sty @et
z7.8 3216
❑ UPGRADE
MAILING ADDRESS
540 N Pane q ciso
LEGAL DESCRIPTION
S c,r,J Lca e. -0, 2 B3 L3
LOCATION
NO. OF BEDROOMS
�(�
Jt'1tC 1T
5
UY
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
F -Z
Manufacturer
G �u�
Material
No. of compartments
y F
Stz-zi
2
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
12.5 Cs
z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
C)
2 Z
Manufacturer
Material
Liquid capacity in gallons
w=
DISTANCE TO:
Well
ii0
Foundation
2-7
Nearest lot line
PERMIT NO. _
J LL ZNo.
of lines
3
Length of a ch line
Total length of lines
��-�
Trench width
Distance between lines
FZw
2-9 - i� -Z.9
60 inches
-
N
Top of tile to finish grade
Material beneath tile
Total effective absorption area
o
4' C hrx �V
-14 ancL .36 inches
716 V
Length
Width
Depth
PERMIT NO.
W
f7
4 F
w�
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
3:
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
� rl
PIPE MATERIALS
PVc ��
T
SOIL TEST RATING
I8<?
wlei
INSTALLER -
REMARKS
L-
IJC� 11DVSe-S ^C'D1i<A 3 'iz) W clx aT
h,�vse i�t�rC�l.SO} iSere�c�te ct
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r/y
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(u 704 Occe 4D I-V\iS we_tj Rowevev-
1
2
44
-
APPROVED DATE LEGAL
CC 'Z
c -v 4 0 ,nev. Of /0y
I _ry Clf='
DEPARTMENT 'HEALTH FIND ENVIRONMENTAL OTECTION
825 `L STREET, ANCHORAGE: AK. 99501
264-4720
E= L4 F= F;;.* F=' E: F:,*F-1 I -r
PERMIT NO. 820849
APPLICANT PAUL STREET 540 N. PINE ANCH 99504 278-3216
LOCATION SAND LAKE
LEGAL LT.3 BLK.3 SANDLAKE S/D #2 LOT SIZE 15000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM is
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 180
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
ElE"l='_r"— LEP 1®�TF d= EF. r_3FlF:1l-vPF=L_ ENF=F=I`r"= :2
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 E`;QAVATIQN (IN FFFT, I
F tA E TF; E= r -A ::- " rj]: I Ca T" I 0XID101 FEET_
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF -OR / =WEEMTNE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
R -"E-= CA U I F -C E= E-6 =— F= F=:" -IF I '!:- -r F=r "F=-_ —'==: I = E- _ -1 &ZI ":_ El C3 n I I C-, N _0E.
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.
:2 1 N:F. F=g FEE 97-- -r I Cl" S; n__ E= 1: - FE G� F= U I F;-'-'C-s
F;" R
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 15 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F„ E= FZ M I -r NE X F=' I R=E= C -x F= ::-* E: M � E= F,:-" 2: -1 _. -1 f___4
I CERTIFY THAT
1: 1 AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED: ------------------
ISS IE.I
IGNED:------------------
ISSUED
V4. 0
MEN
' STI 4T O STH SM EwrROMENTAL PRorecrLon
825 `Li §TRSErf MXN0FjW3Ea RK; 99581 r.
264-4720
'PaRnIT NMt 82M41 3
i
LE1'r:.3au:?SLAKE tor size t -sew swmE F
fkMfM4f MMSER OF BEDROMIS = 3 *301L RRTING CS12 FT M= -100
JIB T r ri r:
Tim L rm Iji�$ 1*;T LemTH f xm FEET) €� f° T 3i C tfrwi
rM OWM OF A TRUCH M PIT is THE DIISTD SEMCen T-9 SURFFCE OF THE
tvo T€< co r rom lll�
niE GRMEL DEPTH IS ME PfrNEma Tit OUTP19LL P .F
zm rHE 66TTom OF Tw Exownrion f rn T).
- j
°PERmrr Apptt�'FT ms T ReSPOWiWLETY TO rNFOM T1415 IEPMTtiENT "UX
' INSTR-UiTION ZNSPaaT8Ws OF tm wa 'sem mmcimr ra# _ T -tom TMr
N— E OF R95 I ' THH T THE UM.Ls l3 ttk-
&jC-tCKFjLLtMi3F FM SySral itT�t#T FINFO
IACT tof RMAPPR&
OF
�TMVIT M L BE Su&recr TtPw--;;Et--IJTFCM
14I I CISMME BEMA WGLL FND MNY OM -SIX SEWW--,a DISPOSAL SeztEm IS
T Fak n PRivArE t L aR t To 2oa Feer fqm R PuaL rc wa.L arm
MINIPUM DISTHADE FROM A PRIVATE W8 -L TO A PRIVATE SO4F-R LINE tS 25 FEET P.40
T€) 8 CLM2tTi' 04ER LINE [-5 rn FEET—
OTS PCOULRENRITS ? APPLY. SPECIFICArtom FV,4D cGNSxTIoH Dj"W2 to A.
WRILASLE T9 UMM PROPER INSTALLK110ft
I CERTIFY TMT
I' I AN MILI .141TH THE MTREMENT-5 FOR ON-SITE SENER-S tomD I.OLsS F6 ser
2: [ -WILL l"ST L TM �s�Tei IN FCC't3Rt3� Mr �# T H� i�ES
z . I IST M TI T TW tit --.SITE SEWER SYSTEM Pbly i:tl3E O&AR(ieqtr if= THE
ResTo L TO tNCLLOE rAME TM a SCOROQIS
APPLICANT �. T
E5SUED wr_ _�
SOILS LOG
P -
MUNICIPALITY OF- CHORAGE
• ae DEPARTMENT OF RONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED: �� 1
LEGAL DESCRIPTION: Sj ru 1-,4 �`l I2 " �' z 6 ��f/' .� 3 La /
72-008 (6/79)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION .
PUBLIC WATER SYSTEM s
APPROVAL TO CONSTRUCT
Plans for the construction of L 0 TS cL $ 15 (C) C it :�? QIVD
F 1- U public water system located
in -all r Lk ;,P Alaska, submitted in accordance with 18 AAC 80.100
by M 6) TO i1J have been reviewed and are
xl approved.
❑ conditionally approved (see attached conditions).
4-�
BV TITLE
DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no. Approved by Date
or descriptive reference)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to.
the public.
APPROVAL TO OPERATE, r
The construction of the. j ca c7 -Flock SGkckeiklkl
public
water system was completed on y _g `__ (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
DATE -
As -built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final pproval too erste ( /
TITLE - DATE
=APPLI( NT FILLS OUT UPPER HAI -')ONLY
Time
Pr'<,perty Owner 7 �? `_ %
Phone
Mailing Address Zip Code
Date
Buyer
Address Zip Code
Date
Lendin Institution
9 17r( ��
Phone
Address J"/c G)-r/C> Zip Code
Realty Co. & Agent
Phone
Address f 4 Zip Code
Legal Descriptio
f
Inspector
Street Location 5,154<_ C. rFt—
Type of Residence
FYatlSgle Family
❑ Multiple Family No. of Bedrooms
❑ Other
Water Supply
Field Notes:
❑ Individual
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
D Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
RECEIVED
Sewwe pisposal
`CONDITIONS OF APPROVAL
P'Individual Year Individual Installed:
FV-7%1C Utility When Connected to Public Utility: /,V FV1C+
4olding Tank -
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Z l
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRON).A-NTAL PROTECTION
RECEIVED
( 'APPROVED BEDROOMS
`CONDITIONS OF APPROVAL
( ) DISAPPROVED ,
( ) CONDITIONAL APPROVAL`
" `Lj
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area f/ `�
Well Log Received
2t
Well to Tank '00
Septic Tank Size / Z
72-023 (31a2)