HomeMy WebLinkAboutDEARMOUN #2 BLK 1 LT 3DeArmoun
Block
Lot
#018-401-27
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
LEGAL DESCRIPTION
~ DISTANCE TO:L~ [0 ~ 0 Distanc~ines
No.~of lines Total length of Ji~ Trench wi~ ~ inches Total effect~b~ption area
N~ ToP of tire to finish grade ~ Material beneath tile
Length Width Depth PERMIT NO,
~ ~ D~pth ~ Driller Distance to Io~ line PERMIT NO.
~ DISTANCE TO: ildlng foundation Sewer line Septic tank Absorption area(s}
OTHER
SOIL TEST RATING ~ ~ t ,O
APPROVED . D TE LEGAL
72-01~ (Rev, 3/78) ~
PERMIT'NO.
DEPARTMENT,.O~i~EALTH AND ENVIRONMENTAL PI~TECTION ~ ~ ~
825 LITREET, ANCHORAGE, AK. 99~ ~]'~,6~-I~'~
264-472e
ON--S I TE SEWER UPGRRC, E PE~)M I T ~/~S ~
APPLICANT BRIGHAM R MORGAN BOX 268 SAR
LOCATION MATTHEW DR.
LEGAL ........ ~ ,
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
LOT SIZE
MAXIMUM NUMBER OF BEDROOMS
~, ~44-1-~7
1~000 SQU.~RE FEET
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 12 LEi",IGTH= 28 GRAVEL DEPTH= 8
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R 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>.
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.
TI,lO ( 2 > I I'~$F'ECT I OD-IS lIRE
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND
DEPARTMENT MILL BE SUBJECT TO PROSECUTION.
RE(;~U I RED
APPROVAL BY THIS
MINIMUM DISTANCE BETWEEN 8 NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE NELL 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 R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION
PERM I T E.~--~ P I I~:ES DECEMBER ~._3 :_1.. ..1.~80
I CERTIFY THAT
I: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
AND WELLS RS SET
ENLARGEMENT IF THE
V4. 0
1. Approval requested by:
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received July 19, 1976
Time of Inspection
Date of Inspection /~-~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
Alaska Mutual Savings Bank
Mailing Address:
Property Owner:
Mailing Address:
Post Office Box 1120
Harold & June De Armoun
Star Route A Box 278
% Fran Brown
Phone: 274-3561 x 233
Phone: 344-2467
Legal Description: Lot 3 Block 1 De Armound Subdivision
Location: Matthews Drive
Type of facility to be inspected
Well Data: Individual
A. Type
C. Construction
Sinale Family
No. of bedrooms 2
Sewage Disposal System:
A. Installed
C. Septic Tank: 1.
D. Seepage Pit: 1.
B. Depth
D. Bacterial Analysis
On-site svstem
B. Installer
Size 2. Manufacturer
Absorption Area 2. Material
Total length of lines
., Absorption area
Other contamination
, Absorption area
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
!
Page 2 of two pages - ReOt for Approval of Individual
~egal Description Lot 3 Block 1 De Armoun Subdivision
& Water Facilities
~2
Approved'~Disapproved
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental
DIAGRAM OF SYSTEM
Quality
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED ~ ~~~~ Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
.3-5-10 East Tudor Road, Anchorage. Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA _CONV
2, Property Owner: /~ ".~,,'¢,'g'~,¢__//2',.~/ .~,~77¢~,,,~.,~.~.~. 2...
Mailing Address: ~ ~- '~ ~ .~/~ Day Phone:
Mailing Address: Day Phone:
4, Name of Lending Institution: g'~}C~F~ "~ ~
Mailing Address: fg]' ~/~' /~¢f~',~ Phone:
5. Name of Realtor or Agent:
Mailing Address: Phone:
Legal Description:0 ~ ...~ ~2~¢:.~ /' Cf ~//~,,~.~_¢~¢~...: ~, Location: /
Type of Facility to be Inspected:,
No. Bdrms.
Water Supply
Type of Supply: Public Utility
if Individual, number of dwellings presently served
Individual /,/~ ,J('"' ,~
If Individual, depth qf well
Sewage Disposal System
Type of System:
Public Utility
Individual (on-site) ,~. ,A//.k~''
If Individual, date of installation
72 003(3/76)
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. ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
1.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Current Property owner(s)
Mailing address
Expiration Date: J.../ _ ~r-L O Z/-.
Day phone
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
~sso~e~ise~ques~ HAAwillbeheld~DSD~rpickup.
2. NUMBEROFBEDROOMS:
TYPE OF WATER SUPPLY: '
Individual Well []
Individual Water Storage []
Community Class A Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
[]
[]
[]
[]
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work,
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes; ordinances,
and regulations in effect at the time of installation.
Address ~o:~ ~ i~-JA1 /-4 ~0~
Engineer's Printed Name ~ ~ ¢~[~~
DSD SIGNATURE
Approved for
Disapproved.
× Conditional approval for
Phone
bedrooms.
Date I~.. - ~ o-o 25
2 bedrooms, with the following stipulations:
One Thousand Dollars to be placed in escrow for fillin~ in depression over tank.
office 8ives final approval.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Repod
Other
Original Certificate Date:
(Rev. 01~2}
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cL anchorage.ak, us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type
Date completed __
Total depth
Parcel ID: O/~-~o!-~-7
IfA, B, or C provide PWSID # ~-t' 1~5~ Well Log (Y/N)
Sanitary seal (Y/N) __ Wires properly protected (Y/N)
Cased to __ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
in.
Date of test
Static water level ft. ft.
Well production
WATER SAMPLE RESULTS:
g.p.m.
g.p.m.
Coliform colonies/100 mi. Nitrate mg./I.
Arsenic: __ mg./I. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ~'r~
Tank size ~¢~o gal Number of Compartments
Foundation cleanout (Y/N) ]4,,~'~/¢. Depression over tank (Y/N) .
Date of pumping IZ/l~/o'~, Pumper ~'
Other bacteria
Collected by:
coloniesl100 mi.
Date installed l q~ 0
Cleanouts (Y/N) "-/
High water alarm (Y/N) ~'~
C. ABSORPTION FIELD DATA
Date installed ~-O Soil rating (g.p.d./~ or ft2/bdrm)
Length ~, g ft. Width Z~ ft.
Total depth /,E.. ff. Eft. absorption area ~o~ft2 Monitoring tube
IZ Iz /
Date of adequacy test /,~- "//I-a.~ Results(Pass/Fail) 7
Fluid depth ~n absorption field before test ~/'(o in. Water added J.-~go gal.
E]apsed Time:,~..~. Final fluid depth ~O In.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type "~4.~/,c~
Gravel below pipe c~
Depression over field .
Absorption rate >=
ft.
For ,,~ bedrooms
New depth '77 in.
,~ ~-c~ g.p.d.
If yes, give date v/'
D. LIFT STATION
Date installed
"Pump on" level at /in.
Datum
Size in gallons
"Pump off' level at ,~in.
Cycles tested../
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM W~LL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic se~ce line
Manhole/Access (Y/N.,~
On adjacent lots
On adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation '~ O Property line ~0
Water main '75-
Wells on adjacent lots
Absorption field
Sun'ace water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line l O 1~ Building foundation l O 4'
Water Service line ~ O ~¢ Surface water ~.t 10
Curtain drain ~-4 1 0 Wells on adjacent lots ~.1~
Water main '~- ~'
Driveway, parking/vehicle storage
lO 4-
F. COMMENTS ,
review of Municipal ~cords that the above systems a~ ~
conformance with MOA HAA guidelines in effect on this date.
Engineei, Printed Name 7~0 ~ ~t~
HAA Fee
Date of Payment
Receipt Number
(Re',,. 12/'01)
Waiver Fee $
Date of Payment
Receipt Number
1 2.7'~
~ 5 ~._.~ ~ wood nouse
~ d 15,625
~ ~G~r~ge (22.2' x 2~.1')
] ~5.7 125.00'
[ ~ N 89'56'00" W
~10' UTILITY EASEMENT
50'
50'
50'
50'
1" = 50'
,?
LEGEND
· Found 5/4" rebor
o Septic standpipe
I hereby certify that an. accurate survey of the building
improvement~ on the ¢uliowing described property
LOT 3, BLOCK 1
DE ARMOUN SUBBIVlSION NO.2
was made on September 7, 2005, and that said improvements
situated thereon are within the property lines and do not overlap
or encroach on the property I~ng adjacent thereto and that no
improvements lying adjacent thereto encroach on the premises in
question, except as shown, and that there are no visible or platted
roadways, transmission lines or other easements except as shown.
It ls the responsibility of the owner to determine the existence
of any easements, rights-of-way, covenants, or restrictions
which do not appear on the subdivision plat. Under no circum-
stances should any data hereon be used for construction or for
establishing boundary or fence lines.
NOTE:
1. All bearings, distances and square footage shown are record
information per Plat# 70-352, Anchorage Recording District.
2. No centerline monumentatlon was recovered this survey.
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