HomeMy WebLinkAboutDEBORA #2 BLK E LT 15Kit
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MUNICIPALITY OF ANCHORAGE
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+.r`I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
„ T
�
PHONE
❑NEW
/'7 /
PGRADE
MAILINGAD - S �^
LEGAL DESCRIPTION
G /3 -
LOCATION �G� N ST
NO. OF BEDROOMS
DISTANCE TO:
Well / /
Absorptt n area /
Dwelling
PERMITPO.
uY
__Z
1
a.<
Manulac[urer
e r
/
M e/
No, of to ppe) mems
Liq,c cit, oOgallons
IF HOMEMADE:
Insidelength-
Width
Liquid depth
dDZ
STANCETO:
Well
Dwelling
PERMIT NO.
Manufact
Material
Liquid capacity i ons
0
W =
DISTANCE TO:
We Foundation
Nearest lot line
I NO.
„Wj w Z
W
No. of lines
Length of each line Total length of lines
Trench widt
Distance between lines
H
inches
O I_
Top of file to finish grade Material h site
Total effective absorption area
inches
W
Length
Width Depth
PERMIT NO.
U
d
Wd
Type of crib
Crib diameter Crib depth
Total effective a tion area
H
DISTANCE TO:
Well Building foundation
Nearest lot line
Class
Depth Driller
Distance to lot line
PERMIT NO.
J
W
ISTANCE TO:
Building foundation Sewer line
Septic tank
Absorption arealsl
OTHER
XA
PIPE MATERIALS
SOILTESTR
ING
INSTALLERM ''^^ ''
C/ W
REMARKS
1
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ALP
APPHOV
O'r - ' DATE LE L
r ` e,QLE PIVM ALASXA I=
r N(/
72-017
PH.6J4-297D
1 ev. /781
r,
MUM I C I FALL I TV OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AfC 99501
264-4720
C3M— S I T E S EWER F} E R M I T
PERMIT NO: 840835 UPGRADE
DATE ISSUED: 10/02/84
APPLICANT: C/O S & S ENG'G CLAUDIA HUTCHINSON
ADDRESS: SRB 196X
EAGLE RIVER, AK 99577
CONTACT PHONE: 694-2979
LEGAL DESCRIP: SUBDIVISION: DEBORA #2 LOT: 15 BLOCK: E
SECTION: 1 ' TOWNSHIP: 14N RANGE: 2W
LOT SIZE: 20000 (SO.FT.,OR ACRES)
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or•public
sewerage system on this or any adjacent or nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA -COVERED BY MOA BUILDING
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2)
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND
ELECTRICAL WO K UST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
------s-=�---------------
-----------
APPLICANT: C/Of & S ENG'G CLAUDIA HUTCHINSON
ISSUED BY ll- ----- DATE: �0
CODES,
AS-BUILTS
(3) THE
T " lam° -RC1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
\\ 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ^^ `
P 0(,f�/E
/�� —�
EW
UPGRADE
MAILING ADDRESS +/
LEGAL DESCRIP aA��I
LOCATION
NO. OF BOOMS
Lite
Y
DISTANCE TO:
Well '
Absorption area
Dwelling
PERMIT NO
O O�
Z
H H
Manufacturer
Liq. caPactV in gallons Inside length
U IF HOMEMADE:
Material
Width L
No. of com artments
r
Liquid depth
� �i
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_
Manufacturer
Material
Liquid capacity in gallons
w=
DISTANCE TO:
Well 0��'
Foundation I
Nearest I t�e
PERMIT NOT
1160
.W.1 LL Z
ZW
~ o F
No, of lines Length o ach�ine
Top of the to finish grade �%
lTrench
Total le ir
Materia beneath tile ` i^rhes
Q nches
Distan a tween lines
y�
Total of C .vve absorption area
W
0
Length
Width
Depth
PERMIT NO.
F-
dyp
W0
Te of crib
Crib di
diameter
Crib depth
Total effective absorption area
to
DISTANCE TO: i
Well
Building foundation
Nearest lot line
W
w
Flas
Depth
Driller
Distance to lot line
PERMIT NO.
ISTANCE TO:
Building foundation
Sewer, line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIS
�D3
0
SOIL TEST RATIN
INSTALLER W� � o
Oo
REMARKS
4
�--�
O
APPROVED DATE LEGAL
77411 IRov HI
n r
I F=n L I -r 1-e ID F= tAtJCH0F.' f= Ga
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
�. 625 'L' STREET, ANCHORAGE, AK. 99501
264-4720
CAVO—S~ I TE c3EWEFQ PEF?M I T
PERMIT NO. C £:11003 )
II,Is
rn�j II-�-SSI
ASI udbi i rs
A 1 lb
�11an. I I N -£I
APPLICANT CLAUDIA B. HUTCHISON PO BOX 1511 644-4550
LOCATION ELNORA ST
LEGAL LOT 15 B E DEBORA SUB LOT SIZE 17000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER, OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= E5
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= � LEtJGTH= rEHti: EL_ E>EPTH= S
THE LENGTH DIMENSION IS THE LENGTH (IF! 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 CIN 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 CIN FEET).
FQE7C1 J I RELY EEF'T I C TFItJK 0312=== ILCDCA D C3F L_L_Ot•dE
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.
--- TF-IOI C 2Z ? I CJS= F}EIC3T I (D"S F=l F?E FtEIDU I FSEE: E>
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT !•JILL 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.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEF? M I T EXP I FREE G�EC3EME:EF? =:1. _-L S4E:1
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 THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS
SIGNED: 6_0564041
FLIC CLAUDIA S. HUTCHISON /
ISSUED B __ ______ �_ _ ATE_ _1 V4.0
ML�r.F I C T t�L I TY C7F FItJr~t-& JRF=fCE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4720
WELL F>ERM I T
PERMIT NO. ( 810694 )
APPLICANT WARREN L. HUTCHISON P. 0. BOX 772 CHUGIAK Olct'"- r 688-9078
LOCATION ELEANORA ST.
LEGAL L15 B-E DEBORA S/D LOT SIZE 10125 SQUARE FEET
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. LIME IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERM I T E74FA I RE"F DECEMBER ZI1s 1n>ED1
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR OH -SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGHED
ISSUED BY
PPLICANT WARREN L. HUTCHISON
V4. 0
! _�, ^ ❑ SOILS LOG
• �q—g�SC� MUNICIPALITY OF ANCHORAGE
I� \1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
625 L. Street, Anchorage, Alaska 99501 2644720 TEST
" SOILS LOG — PERCOLATION TEST
PERFORMED
LEGAL DESC
1
2
3
�4
5
6
7
B
-9
10
11
12
13
14
15
16
17-
18-
19•
20•
DATE PERFORMED: G'
C
5ILTy 1517 N-0
WASGROUNDWATER S
ENCOUNTERED?, L
O
P
IF YES, AT WHAT E
DEPTH?
A
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
n /
PERFORMED BY: ( sS Englaeflrinq - - -CERTI
72-008 (6/79)
rl
i1linu
by
DOC Co. Cba
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759
OWNER OF LAND-tUA;eR - - N✓Tc /y .f .• J
ADDRESS P ' /' nh -7 7.7 C4 t" f q K
LEGAL DESCRIPTION / S� fl - £ 02rl nefir}
DATE -Started -7 / Ended 7`
PERMIT NUMBER
KIND OF FORMATION:
From 1� Ft. to 02 Ft. n of l if,i e4�• ^�
From 22 Ft. to /-? Ft.
From / -? Ft. to -2., Ft. i N-✓ d r G,r f a, V
From ✓ 1 FL to_: Ft. Slf-/n s /--- • ✓, t
,
From Ft. to Ft.
From Fl.to-IL_Ft.
From Ft. to Ft. "J.471'<
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft. I`
MISCL. INFORMATION:
DEPTH OF WELL L/
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. /
GALS. PER HR / a
KIND OF CASING
From Ft.
From Ft. to Ft
From Ft. to Fi. r•! HORAGE
��, T� F HEALTH &
From Ft.to_F�(.T�� c,OTECTIOR
ENV.:,..,....._.
From Fl. to
From Ft. to Ft. _
r
From Ft. toq.
From Ft. to Ft.
From Ft. to Ft.
I �rn�
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft,
From Ft. to Ft.
From Ft.
- __ DRILLER'S NAME
From
o
Ft. to—Ft.—
Ft.From
From
� Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
MISCL. INFORMATION:
DEPTH OF WELL L/
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. /
GALS. PER HR / a
KIND OF CASING
From Ft.
From Ft. to Ft
From Ft. to Fi. r•! HORAGE
��, T� F HEALTH &
From Ft.to_F�(.T�� c,OTECTIOR
ENV.:,..,....._.
From Fl. to
From Ft. to Ft. _
r
From Ft. toq.
From Ft. to Ft.
From Ft. to Ft.
I �rn�
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft,
From Ft. to Ft.
From Ft.
- __ DRILLER'S NAME
r`
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIROlu"ENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date 41-7 ZkY
(a) Legal escri tion (include lot, block, subdivision, se tion, township, range)
Location.(address or directions)
695'- ySsa
(b) Applicants Namgj%z _'� Telephone - Home Business
Applicants Address V41 &� M.."
(c) Applicant is (check one) Lending Institution ; Owner/builder 1 ;
Buyer [:::I ; Other [-::I (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. b Agent
Address / O S °f'��' �r �v ��,. .. O. 9g�tO.a— v
Telephone 5C" /— /( l %
(f) Mail the HAA to the following address:
2. Type of Residence
Single -Family
Number of Bedrooms
3. Water Supply
Multi -Family =
M
Other (describe)
Individual Well' Community M Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite � Public Q Community Q Holding Tank Q
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. Engineering Firm Providing Inspections, Tests, File Search Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained 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 regula-
tions in effect on the date of this inspection.
Name of
Telephone
Address
....
Date
___
%0 Z—z—i9 F
i C��. ? �''�S•S'bb
}Q tc l i
(ENGINEER
SEAL)
..ra!
�•• bbeo A. Ohelor•
rj
6. DEEP Approval
,� No. 1x37 -E ••; 4!5f
Approved
for",i .71 / bedrooms By ff
pe'
�-f-•"��� Dati\;dof�-�"�/
Approved
X Disapproved
{Cb'r
Conditional 77-
7-Terms
Termsof
Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTIiENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY A.V INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEkn AND STATE REQUIRE-
MENTS. EMPLOYEES OF DEEP 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.
(DEEP SEAL)
RR4/ej/D18
(Page 2 of 21 7-19-84
n e"-,
MUNICIPALITY OF ANCHORAGE (MOA) k"N!CNAL1Tr OF A„0{C;,q�E
V, T_ OF HU 'LTH $
HEALTH AUTHORITY APPROVAL (HAA) F.oTCCroN
CHECKLIST - FEBRUARY 1984
OCTC
'l 504
A. WELL DATA RECEIVED
Well Classification" s r If A, B, cc Cr D.E.C. proved(Y/N) -
Well Log Present n3/Lv) Date Completed Yield. /17 -1 -
Total Depth 4 Cased to �/ Depth of Grouting
Static Water Level 23 PurT Set At
Casing Height Above Ground /� l Sanitary Seal on Casing a)
Electrical Wiring in Conduit (?N) Depression Around Wellhead (YAD
Separation Distances from Well:
To Septic/HaWiM Tank on Lot On Adjoining Lots /00 /4 -
To Nearest Edge of Absorption Field on Lot /&V ' ; On Adjoining Lots
To Nearest Public Sewer Lan - /'� To Nearest Public Sewer
Cleancut/Manhole it1 To Nearest Sewer Service Line on Lot
Water Sample Collected ByDate C100",��/
Water Sample Test Results C_ 7-01a `7
Comments LOC 'iC-s7- S -M7 [Z�6 ,nom _ —rO Oieo0 Uc r
/A( t_=I<rF�C 0' - /, ScSr'M )
B. SEPTICABtl= TANK DATA
Date Installed d//o/ Sime /000 No. of Crnpartments 2
Standpipes CYy'N) Air -tight CapsQxho Foundation Cleanout QY N) _
Depression over Tank (YALP Date Last d 8 -/0 -.65Z
Punping/Maintenance Contract on File ( ) for
Holding Tank High -Water Alarm (Y Temporary Holding Tank Permit (YM) 9¢
Separation Distances from Septic/11Tank:
To Water -Supply Wall gS To Building Foundation 2p
To Property Line To Disposal Field
To Water Main/Service J�ipe To Stream, Fond, Lake, cr Major Drainage
Course A
Comments
sFPT/c 77'?AJ4 141641 vFr
9g�B fV IVVW /o/ ,
(Page 1 of 21 `r/y (n� -CA ' '1 T
\CSC_ Jv� 2-15-84
10-\- 2J-1
C. ABSORPTION FIELD DATA
Soils Rating in Abscrptim S ata 8s � ' Type of System Design 4 nNtc
Date Installed 71LI o e / Length of Field u'
Width of Field N Depth of Field 9
avel_Bed Thickness 1c70 N -
Square Feet of Absorption Area 2 Standpipes Present ) \ `
Depression over Field (Y ) Date of Last Adequacy,Test 8 /
Results of Last Adequacy ?mst rAfylU
Separation Distance from Absorption Field:
`ATO Water -Supply Well JO(' To Property Line l�
To Building Fou tion .30 To Existing or ",z-
To
Abandoned System kn
Lot �/1 ; On Adjgining Lots -30 �
To Water Main/Service Line 7A To Cutbank if sent) A
To Stream/Pond/Lake/cr Major Drainage Course 11
To Driveway, Parking Area, o Vehicle Storage Area 00 �
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Com+ents
Dimensions
Manhole/Access (YAO
"Pun4 Off" Level at
—Vent (Y/N)
during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified,
on the date of this inspection.
or conformed to all MOA HAA
Signed 8 8 rViGiNpuck Date,'/O
Ca:pan AWS' 09�ZJT.7 Zc7T MOA No.
KB1/d5/s
(Page 2 of 21
ines in effect
2-15-84
�1
825 "L" ST RFET
ANCI IORAGE, ALASKA 99501
(90 1) 264 4111
y,1Lai i "..Wli4�(�; Al SULtIVAN.
AIA YOR
.. ".1 0i I1; ALTI ANI; I `.V II :(; q.\II `:IAI I'l;ol1 C11(Gv
January 4, 1982
Warren L. Hutchison
P.O. Box 772
Chugiak, AK 99567
Permit ; 810694
Subject: L15 B-E Debora S/D
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
L574��
6�-C�
Les N. Buchholz R
Program Manager
Sewer and Water Program
Enclosure: Copy of Permit