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\\ MUNICIPALITY OF ANCHORAGE �`
1 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
IPHONE
NEW
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❑UPGRADE
MAILINGADDRESS
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LEGAL DESCRIPTION
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LOCATION
NO. OF BEDROOMS
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DISTANCE TO:
Well /_
Absorpt q�are��[
Dwelling 114PERM�Z.fJO.
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Manufacturer^e `—I
Ma - I
No. oIznpartments
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G
to
' gallons IF HOMEMADE:
Liq M'3
Inside length
Width
Liquid depth
DISTANCE TO: Well
Dwelling
PERMIT NO.
dOZ
_ F
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well
Fountl i /
Nearest lot b L./-
PER '`
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Z
No. of lines
Length,ot ea0o
Total I Aof
Trench
Distance between lines
J
L
inches
H
Top of the to A gr
My n;l ben! tL I / y
Total effeCliye absorption area
!Width
Z 2 y S.� vo inches
v'
Length
Depth
PERMIT N(J.
W
V
Wd
Type of crib Crib diameter
Crib depth
Total effective absorption area
N
DISTANCE TO: Well
Building foundation
Nearest lot line
J
Class( De th
Driller
Distance to lot line
PERMIT NO.
J
Building foundation
DISTANCE T0:
Sewer line
Septic tank
Absorption area(s)
OTHER
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PIPE MATERIALS
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SOIL TEST RATIN
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REMARKS
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J' 1� No. 1157-E ,•'��'101
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APP ED D TE LEGA.
(7 �' SRS 12CX pr' W
f ALI
j;,0LC.FNER,
7C01y1Rev. 3(18)
3
MUNICIPALITY OF ANCHORAGE
Departmentrf Health and Environmenta)o-Protection
825 ' Street, Anchorage, AK. ..9501
264-4720
Permit'# * * * HANDWRITTEN PERMIT
T WELL ANDS ON-SITE SEWER PERMIT Q
Applicant: \.) AL -)0 CP_AC( e 4i% Mailing Address:
Location: Phone Number: — S
Legal Description: 667— // 12 eqlk F Ree
a#•ot Size:
Type of Soil Absor
h: (/ tion System Is:
TrencDrainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: te Soil Rating(sq.ft/br) S
The Required Size of the Soil Absorption System Is:
DEPTH — LENGTH 15� . GRAVEL DEPTH S - 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 _ %'SO 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(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
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 3 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 the on-site sewer system may require enlargement if
th reside ce is remodeled to include more thaV bedrooms.
Signed: Oa Issued by: Jn
rn` e _ Y
Applicant 44
Date:
SWP/024(1/81)'�J✓�
-�7iirce�� 78G1SS
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December 29, 1978
#780554
Don Bcaujean
Post Office Box 2444
Anchorage, Alaska 99510
Subject: Lot 11 and Lot 12 Block F Debora Subdivision €2
A permit issued by this department for well and/or
sewer system has expired.
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 there are any further questions, please contact
this office at 264-4720.
Sincerely,
Les N. Buchholz. R.S.
Senior Environmental Specialist
LIIB/l jw
enc: copy of permit
rlLJr 1 I C I FYXPL- I TY OF Rr C!0lf E?FiGE
_ DEPARTMENT 0. IEALTH AND ENVIRONMENTAL F `fECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4720
WELL- Fit4E> OtJ-SITE SEWER F}ERJ'7I T
PERMIT NO. ( 780554 )
APPLICANT DON BEAUJEAFJ PO BOX 2444 278 4957
.LOCATION MERCY DR
LEGAL L11 & 12 ELK F DEBORAH #2 LOT SIZE 12500 SQUARE FEET
TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 6 SOIL RATING (SQ FT/BP,)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E+EF?TH= S3 LE"1:3-r"= S2 13Rn%-PE:L l7EFP-r"= B
THE LENGTH DIMENSION IS THE LENGTH CIM FEET) OF THE TRENCH OR DP.AINFIELD.
THE DEPTH OF R TREK H OR PIT IS THE DISTRFJCE BETWEEN THE SURFACE OF THE
GROUND AND THE EOTT 1 OF THE EXCAVR N (IN FEET).
THERE IS NO SET WIDT FOR TRENCH .
THE GRAVEL DEPTH IS HE MINIMUM EPTH OF GRAVEL BETW FJ THE FALL PIPE
AND THE BOTTOM OF TH EXCRVATI N CIN FEET). 'C
REG!U I REO
I C/ TFlr4f< I ZE= 07SO /GFILLONS
PERMIT APPLICANT HAS THE RE PONSIBI TY TO
INSTALLATION INSPEGTIOFJS 0 ANY WE Rf # PR¢FERTY
NUMBER OF RESIDENCES THR HE WELL 4 LL \/
--- TWO C2> tISPE�TBACKFILLING OF ANY SYSTEF WITHOUT IFJRLTIDEPARTMENT WILL BE SUBJECT TO PROS !T
MINIMUM DISTANCE BETWEEN R WELL AND RFJY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOP, A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
R -THI
TO THI
T DURING THE
AND THE
RRE REG"►L_1 I REDS ---
OFJ AND APPROVAL B'.' THIS
F EOFZV 1 I T EXP' I RES E>ECCEMJETER =Lw 15=+?S
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: 1 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 6 BEDROOMS.
SIGNED
ISSUED
-�%�L��
-�L l/1L------------------
T DON •ERUJERNB--------DATE-- l-,Al2 ---
V3. 2
_ 0 & E GEO':'CHNICAL & DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska M77
6942774 or 668-2280
Russell Oyster Ead Ellis
6942774 SOIL LOG 688.2280
Soils 6 Foundations Land Development
Performed for: Name: 1722 4Qd <a�A0--7V—,-41(/Tel. No. ;27e -
Mailing Address: 2Z/4w ,4Ai6-44OeCG-!5- /sic -?96ly
1
Legal Description: Go -r- // fl /Z S N Ba
Depth (feet) X011 Characteristics
0
1
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2
3
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5
6
8 Coa,ec
10
11
12�-
13
14
15
16
Ground Water Encountered: Yes No If yess what depth
Proposed Installation: Seepage Pit Drain Field . �
Comments: <� n��-r •nao Fdl�Pf'cr 3 l� /'tS7 / •n% !/�.asJ
'a eco
17,
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Performed by: Date: ::7L�Iz 27. i97r>
Ofd SM / .rt A"mo.,__.
DI;PT.OF FNIVIRONIMNTAL CO\SFRVAT1O\
SOUTHUNTRA[RfG/OXA[OUXE / =VDVtUSMUT
AtraCAr svaD a Roau ust
AXCMAGf OW 1
June 28, 1978
Don Beaujean
P. O. Box 2444
Anchorage, Alaska 99510
Subject: Lots 11 & 12
Class C Public water System
Dear Dir. Beaujean:
I have reviewed the plot plan showing the proposed location
of the well and sewer system on the subject lots. The well is
to serve a duplex which will be constructed on the lots. The
water system is approved for the features with which this depart-
ment is concerned providing the sewer line is located at least
75 feet from the well. The sewer line between 75 and 150 feet
from the well should be of cast or ductile iron construction.
Sincerely,
James O. Starr
Environmental Engineer
cC: DiiEP
n
CnrTIFICATE OF b DEDICATIO:I
rO3'. WATER W - ILL RADII
I
e hereby certify that we are the owners of the
property affected by the water well radii as
shown hereon dotted anal hereby dedicate to the
public all easements for the wat^_r well ratii
with the following restrictions. No septic
systems shall be allowed within 150', no so%:or
mains or services shall be allowed within 100'
and all sewer mains and services within the 100'
to ]50' radii of the proposed or existing :.later
well shall be cast iron, (minir..un)
NOTARY'S ACKNOIMEDGEMENT
Subscribed and sworn to before me this .4-=
day of 7 ,,, ]978. my commission.expires
NOTARY FOR ALASKA
1