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Home My WebLink AboutT12N R3W SEC 33 SE4SE4NE4SW4 PTNTI2N R3W eC. E4 SE4 NE4 SW4 PTN Lo1- 183 018-292 -27 ~ 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 1PHONE ~'N EW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS I ~ Absorption areaI Dwelling ~o II.E ' ~ ~ Z < Manufacturer ~~ Materi~~C No. of compartments~ Liq. c~i~i~allons IF HOMEMADE: inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer ~ V ~ Material Liquid capacity in gallons ~ DISTANCE TO: /~/ Foundation ~/ I Nearestlotline, ~' PERMITN ~ ~ ~ No. of lines Length of e~ch line . Total lengt~o~ li~es Trench wid~ Distance between, li~s ;~ Top of tile to finish grade ~~ ~ Material beneath tile , /. ~ -- (/~:nches)T°taleffect~veabs°rEti9n~rea~ Length ' ' ~ Width Depth PER MIT NO. ~ ~ Type of crib Crib diameter L. Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Clas.~ Depth/ , ~ I ~ ~ ~ ~1~1~ Distance to lot line PERMIT NO. ~ DISTANCE TO: Building fou~d~ion Sewer li~/~ ~______ Septic--__~ ~ / Absorption~r~ i ~o OTHER PIPE MATERIALS ~_ ~I q J SOIL TEST/~RATING ~ ~/~ ~ ~'~ REMARKS APPROVED~ ~ ~ e~k~ ~ DATE LEGAL I¢8 ¢ r l$¢ .Db MUN I C I PAL I TY OF ANCHO,RA6~E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET.~ ANCHORAGE., AK 99501 264-472() - ON--SITE SEW, ER & W, ELL PERMIT PERMIT NO: DATE ISSUED: 840551 07/02/84 APPLICANT: ADDRESS: CONTACT PHONE: TAD SMITH P 0 BOX il-2157 ANCHORAGE, AK 99511 545-1680 LEGAL DESCRIF': LOT SIZE: MAX BEDROOMS: SUBDIVISION: NA ~ECT,ION: 55 TOWNSHIP: 12N 2.05A (SQ. FT. OR ACRES) ~LQT: 1E-5 i BLOCK: NA. RANGE: 5Wi Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEL WIDTH (ET.) GRAVEL LENGTH (FT.) GRAVEL VOLUME (CU. YDS.) TANK SIZE (GALS) SOIL RATING (SQ.FT./BR) BED W. ORA I N 3.5 ** 2..5 ** 0.5 1.5 4.0 4.0- 20.0 · 58.0 77.0' ** 28. 1 28,5 1~000.0 ** 1.,000.0 ** 165 165 ** DEPTH TO PIPE BOTTOM < 5.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 ~T. EACH) **'TANK MUST HAVE AT LEAST TWO COMPARTMENTS .... I certify that: 1. I am~familiar with the requirements for on-site se~ers and wells am m~t forth by the Municipality of Anchorage (MOA) and~the State o~ Alaska. 2. I will install the system in accordance with all MOA codes and regulatio~ and in compliance with the design criteria of this permit. 5. 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. 4. I understand that. this permit is valid for a maximum of 5 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~ THEN (1) AN ELECTRICAL PERMIT AND INSPEC]~ION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SI GNED ;~. ~~~~H~_,.~~ DATE: APPL I CANT: ISSUED BY DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 :264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST DATE PERFORMED: &-- //-- ,Be LEGAL DESCRIPTION: 2 3 5 6 7 8 9 10 11 12 13 _~p/51v~ I BI2O~ON 51C,T~' ~AND~ I,.4ols'T' I SLOPE SITE JPLAN i i L.on- E, oTl'O~ oF WAS GROUND WATER .~~ ~ ENCOUNTERED? O P IF YES, AT WHAT ~ E DEPTH? ~ Reading Date Gross Net Depth to Net Time Time Water Drop 6-~1 6: I~ 1[ ~ I" " (,,: ~ I0 ~ I" ,, G ' 4G l O, ~ ra& I " " ~: S~q ~ ~ I" 14 15 16 17 18 19 2O /O PERCOLATION RATE ?r~._~l~i n u t es/i n c h) COM~ PERFORMED BY: ~'-~/~-/,~,f~" ~,/ ' ~'~ Sidn~ E.~r~ ~ ~ 't~'. ~CE-~ :~ ?.. ~-oo~ (~.. ~ v~'--...."~ / /r)l~ Ti: Z'.~' 2-,~ F? ~'~?~ vi:: L d: k/.') ? MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 2 6 I984 RECEIVED 14,4 '7~-24 -- ,o i4 ) z z h-)L ,,a },~ ( 7-to )?^' ) z z MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF H~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR REALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~ Z~ /~ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Nam~ ~+~ p~y 3~--/& 6 o ?~_ &fo7 Telephone - Home Bus ines s Applicants Address ,~.~. ~O.A'" //--?_/~-'~., ~~. ~ · (c) Applicant is (check one) Lending Institution ~ ; ~er/builder ~; Buyer ~ ; Other ~ (explain); (d) Lending Institution ~t'~ ~ ~f~/~ Address ~ '~" (e) Real Estate Co. & Agent. .~~ Telephone Address Telephone (f) Mail the HAA to the following address: , 2. Type of Residence Single-Family.~, Number of Bedrooms Multi-Family~ Other (describe) 3. Water Supply Individual Well~ Community ~ 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 22] Community ~-~ Holding Tank~ 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 w~ter supply and/or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Address /~-0~ /-~' .~/~,-/-A /gf./qC~' DHEP Approval Approved for L~ Approved ~. bedrooms Disapproved__ Telephone ~1-1~- Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 FEDEfL4L .~JqD STATE REQUIRE- MENTS. ~IPLOYEES 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. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 MUNICIPALITY OF /%NC~DRAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ~DI FI/~ ~ (_ Well Log Present (Y/N) Total Depth / 5 ~ I Cased to Static Water Level /~/ ! Casing Height Above Ground Electrical Wiring in Conduit (Y/N) y Separation Distances from Well: To Septic/Holding Tank on Lot / ~ '~ / To Nearest Edge of Absorption Field on Lot / To Nearest Public Sewer Line /%///~/ ~ if A, B, c~ C, Date Completed Pump Set At /7. D.E.C. Approved(Y/N) Depth of ~ting 130 ' Sanit~y ~al on Casing (Y~) ~ession ~nd ~l~ead (Y~) ; On Adjoining Lots /OO /~ / ; On Adjoining Lots_ /C)C) /~_ To Nearest Public Sewer Cleancut/Mar~uole I(~0 ~ To Nearest Sewer Service Line on Lot ~- Water Sample Collected By ~', ,/~.J~'" ; ~te /0--1 ~ ~ Water S~le Test ~sults ~~~ ~ ~~/ C~nts ~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed .~_'. ~7~!y/~ffSize I~)00~ No. of Ccz~partrrents Stan~i~s (Y~) ~ Air-tight Caps (Y~) ~ Foundation Clean~t (Y~) ~ession o~ Ta~ (Y~) ~ ~te ~st P~d /~/~ / P~ing~intepmn~ ~n~a~ ~ File ~y~)~ ; for Holding Ta~ High-Wate~ ~a~ (Y~) ~ ~ra~ HOldi~ Tank ~r~t (Y~) ~p~ation Distance ~ ~ptic~olding Ta~: To Water-Supply ~11- /~ / To ~{lding F~ndation //~ ~- / To ~o~rty Li~ ~/~ To ~ter ~in/Se~vi~ Li~ /O / ~ ,Y To Disposal Field, To S~eam, Pond, Lake, /o0 / or Major Drainage Con~ents [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /~ ~ ~ z/~_~ Type of System Design Date Installed ~/~, /7 ~ ~ /Length of Field ~50 ' Depth of Field ~' ! Gravel Bed Thickness /. ~' / Standpipes P~esent (Y/N) y Date of Last Adequacy Test /~_a- Width of Field ~-I /*1o~ ;%,-,. ;2 ~ ~4o ~-g I Square Feet of Absc~ption A~ea Depression over Field .(_Y/N) . Results of Last Adequacy Test Separation Distance f~om Absc~ption Field: To Water-Supply Well /~--// To Deoperty Line To Building Foundation ~/ ! To Existing or Abandoned System cn Lot. /~. ~, ; On Adjoining LOts _~ To Water Main/Service Line /O/~- .' To Cutbank(if ~esent) To Stream/Pond/Lake/or Major D~ainage Course /%/~q~ /k)~¢~ /~o '4- To D~iveway, Pa~king A~ea, or Vehicle Storage A~ea Cc~irents D. LIFT STATION /~. ~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dim~ ns ions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Cc~ents Check Permitted Bed~ocm Rating Against HAA Request I certify that I have checked, verified, o~ confc~rred to all MOA on the date of this inspection. Signed ...... ~ff/~~ ~ KB1/d5/s [Page 2 of 2] MOA No. 2-15-84