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HomeMy WebLinkAboutNICHOLS LT 29A ./.~ '~.~/ 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 ~.N EW MAILING AD.ESS LEGAL DESCRIPTION ~ ~ Manufacturer ~~ Mate~ ~ ~o. of compartments Li?~,~n gallons IF HOMEMADE: Ins]~ length Widt~ Liquid depth ~ ~ DISTANCE TQ: Well ~ng PERMIT NO, O z ~ Manufacturer~ Material Liquid capacity in gallons ~ D ~ DISTANCE TO: Well ~ ~oundation Nearest lot line PERMIT NO. ~ ~ Z No. of lines Length of each line Total length of lines Trench width Distance between lines ~ ~ ~~/ inches ~ Top of tile to finish grade Material beneath tiJe Total effective absorption area ~ inches Length Width , Depth PER~:~ ~. ~ Typeofcrib - CrJbdiameter CribOepth -- 'Totaleffective~ ~ .D Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ~_ _ PIPE MATERIALS ~/ S~R~ INSTALLER REMARKS /, LU PERMIT NO: DATE ISSUED: DEPARTMENT OF HEALTH.AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, RK 9950±' 264-4?20 ~]m~-i--S~TE SEt~E~: ~: ~4ELL F°ERI~ IT 840~46 ENGINEERED DESIGN 05?±6?84 APPLICANT: ADDRESS: CONTACT PHONE: NICOLS~ CLAUDE C/O S&S ENGINEERING SRB EAGLE RIVER~ RK 694-2979 LEGAL DESCRIP: SUBDIVISION: N?R LOT: 29 BLOCK: N?R SECTION: 4 TOWNSHIP: i5N RANGE: iN LOT SIZE: 44888 (SQ, FT. OR ACRES) I CERTIF~ THAT: ±. IRM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH 8~ THE MUNICIPALITY OF ANCHORAGE (MOM) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WiTH ALL MOM CODES AND REGULRTIONS~ AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. i WILL ADHERE TO ALL MOM AND STATE OF RLRSKR REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING NELL, NRSTENRTER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF R LIFT STATION IS INSTALLED IN RN RRER COVERED 8¥ MOM BUILDING CODES, THEN (±) RN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTRINED.~ (2) RS-BUILTS NILL NOT BE APPROVED WITHOUT RN ELECTRICAL INSPECTION REPORT.; AND (]:) THE ELECTRICAL WORK MUST BE DONE B~' Fi LICENSED ELECTRICIAN. S IGNE[:, : , ' , [:,_RTE: --~/~Y~r~ RF'PL I CANT: N I COLS,, _.. - ¢':LRLI[.~EE_. . C.-.'O_..- _ m"~ & -"4.= EhlGI. I"~IEEF:. lNG- '~' ISSUED B~" ~'~~~ [:'RTE: _-~"-/(~o6'Y PERFORMED FOR: LEGAL DESCRIPTION: ~----- 2 F 1 2 3 4-- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST /'"C / SLOPE SOILS LOG [] PERCOLATION TEST WAS G :OUNTERED? No, SITE PLAN IF YES, AT WHAT DEPTH? PERCOLATION RATE TEST RUN BETWEEN FT AND ~ FT (minutes/inch) Gross Net Depth to Net Reading Date Time Time Water Drop / ~ uepartm~-'-t ot t!eaJ, tll and E~v±rom~ · d. Protection 8[_.~ L Street, Anchorage, A]~, ~ 99501 ~ 264-4720 ~- HANDWRITTEN PERMIT * * * ermit ~ '.WEL. L-~N~/OR ON'SITE SEWER PERMIT .pplicant: :>~M/.'.,,~ fr~:::,: ,"./- Mailing Address:~ ~5 ~'. ocation: Phone NurSer: ,egal Description: :"/:-.1/ g:' ' ',' <~ L/ Z ..... ~., ~-.~..' ~ .~ . . ~. .~ Lot Size: 'ype of Soil ~sorption System Is: / ~ ~ Trench: Drainfield: ~Seepage Bed: /'~ .Holding Tank: -~ Soil Rating (sq. ft/br) [aximum Number of Bedrooms: ~__ The Required Size of the Soil Absorption System Is: I- - ~ t~ ~-, - -,, .' DEPTH LENGTH i E.K R~?~:-:E~-f:~%~ WIDTH The length dimension is the length(in feet) of the trench or drainfield, Th depth of a trench or pit is the distance between the surface of the ground the bottom of the excavation(in feet), There is no set width for trenches, The gravel depth is th~ minim~a depth o~ gravel between the outfall pipe and the bottom of the excavation(in feet), · * REQUIRED SEPTIC~HOLDING) TANK SIZE = ./F~ GALLONS * * rmit applicant has the responsibility to ~nform this department during the stallation inspections of any wells adjacent to this property and the number residences theft the well will serve, " · *'* TWO(2) INSPECTIONS ARE REQUIRED ~ * ckfilling of any system without final inspection and approval by this depart 11 be subject to prosecution, nmmum distance between a well and any on-site sewage disposal system is 100 r a private wei1 or 150 to 200 feet from a public Well depending upon the ty ~ublic well, Minim~ distance ~rom a private well to a private sewer line : 25 feet, and to a community sewer line is 75 feet, Well logs are required =d must be returned to this department within 30 days of the well completion .her requirements may apply, Specifications and construction diagrams are 'ailable to insure proper installation, · * * PERMIT EXPIRES DECEMBER :1~ 1 g ~ 3 * * ~ I certify that: (1) I ~m f:iliar with the requiremen:s 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 i the residence is remodeled to include more that~3 bedrooms'..-. ~" ~ " ' i :-- 1 2 3 4 5 6 7 8 9 10 13 14 15 16- 17 18, 19- 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 /C / SLOPE SITE PLAN WAS GROUND INATER ENCOUNTERED? DEPTH? Reading Date Gross Net Net Time Time I Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND ~ FT ~JNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR I~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date . (a) Legal De?~cri~ption.(%nclude lot, block~ subdSvision, section, township, range) Location (address or jirections) (b) Applicants Name(_~/~"~Z>~~. ~ ~¢-~1~/ Telephone - Home Business Applicants (c) Applicant is (check one) Lending Institution ~ ; ~er/builder~ ; Buyer ~ ; Other ~ (explain); ~ ~ (d) Lending Institution__ ~ ~ Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. ~ype of Residence e Single-Family~ Number of Bedrooms Multi-Family Other (describe) Water Su~J! Individual Well~ Community~--~ Public~-~ Note: If community well system, must have ~£itten confirmation from the State p~partment Of Environmental Conservation attesting to the legality and status° Se~a~e Disposa~ Onsite.~ ' Public ~ ~ 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 ~mchorage 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 Firm<~ ~ ......... -- Telephone Address Date · DHEP An~roval · Disapproved [,/ Conditional Approved Con~ t Terms of ional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONM_ENTAL 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 ~ND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~D STATE REQUIRE- MENTS. EMPLOYEES 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/D18 [Page 2 of 2] 7-19-84 At MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALli¥ OF ANCHOPJkQ~ D~?T, OF HEALTH & ENVff~C,?-L'v'~ENT/;~ PROTEC'FIO~.~ WELL DATA / Well Classificatio~(/¢~ If A, B, or C, D.E.C~. Approved(Y.) Well Log ~esent Total ~p~ static wa~e~ ~ /~.'~/.~/~z ~ ~t At casing Height Above Ground ~--~ Electrical Wiring in Conduzt (Y~) Separation Distances from Well: Sanitary Seal on Casing~ Depression Around Wellhead To Septie/~l~]-i,~y Tank on Lot /~ 7~- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot/~9~ '~ ; On Adjoining Lots To Nearest Public Sewer Line ///~' To Nearest Public Sewer Cleancut/Manhole /~//~-~ To Nearest Sewe~ Service Line on Lot Water Sample Collected ~y ~, ¢%¢*~9;/~,¢~//~_; water sample Test Results ~5*W %/-¢ ~ ¢ 7U~ ~ Comments SEPTIC/HOLDING TANK DATA Date Installed ~ /&¢~ Size /~-~<~/ No. of Ccmpartments , ~-~ S tandpipe s (( y~L)_ / Air-tight Capsd//N$ Foundat ion Cleanout _Y~ Depression over Tank (~,~ Date T~st PU~ped ~Z~ ~/ Pumping/Maintenance contract on File (Y/N)~J~°--; for /%//~ · Holding Tank High-Wate~ Alarm (Y/N~~/~-~ 'Temporary Holding Tank Permit (Y/N)//~'//~ Separation Distan~s ~ ~ptic~olding Ta~: To Water-Supply ~11 /~ ~ To ~ilding Foundation /~ / To Property Line /6) To Water Medr~/Service Lir~ Course Constants To Disposal Field /~--~ To Stream, Pond, Lake, or Major Drainage x Receipt # Date Paid: Amount: L\~ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/~ ~7 Width of Field / -//~ / Square Feet of Absorption,/?ea ~Lh_~ Depression over Field (~/~ " Date of Last Adequacy Test Results of Last Adequacy Test /~7 ~ &~j Separation Distance frcm Absorption Field: To Water-Supply Well /DRD ~,'L_ To P~operty Line /O Type of System Length of Field Depth of Field Gravel Bed Thickness Standpipes P~'esent ~/~ /- To Building Foundation ~ · To Existing or Abandoned System cn To Water' ~/~ice Line ~7~ ./- To Cutbank(if present) T© J'tream/P°nd~ake/or Major Drainage Course /~O / p~/fF~ To D~ivewaY, Parking Area, or Vehicle Storage Area ~-~fP ~ Ccn~ents D. LIFT STATION Date Installed Size in Gallons "Pdmp On" Level at High Water Alarm. Level at Tested for Electrical Codes(Y/N) Dimensions /~ ~ap-hole/Access (Y/N) //L' I'~ Off" Level'at. Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MPA Co~l~nts Check Permitted Bedrcom Rating Against HAA Request I certify' that I have checked, verified, o~ conformed to all MOA HAA~%~%Guidelir~s in effect on the date of this inspecticn. 2-15-84 BLAIR AVE 5 '~-BASI$ OF BEARIH6 ~.~.r LEGEND CREEK DETAIL ...... .-,. NOTES MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET CASE NUMBER: S-8563 !DATE RECEIVED: October 8, 1986 COMMENTS DUE BY: November 3, 1986 SUBDIVISION OR PROJECT TITLE: Nichols S/D, Lot 29A, with vacation ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE 71-014 (Rev. 5/83) VACATION OF RIGHT-OF-WAY OR OFFICE USE EASEMENT APPLICATION REC'D BY: Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING VERIFY OWN: P.O. BOX 6650 Anchorage, Alaska 99502-0650 A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. 0. Case Number (IF KNOWN) 1. Vacation Code 2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET) Existing abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34). Petitioner's Name (Last- First) 5. Petitioner's Representative Address fO ~O,X ~>'7 13 City ~_.J4 U~_~) I~, ~' State Phone No. ~ ~) ' ~Z~' Bill Me.-~-~--~ Address "'~,.~5' City ~ I'JC J-/- State /3)1(., c~O/,.~'0~. PhoneNo. 337''34'3' - Bi,-Me 6. Petition Area Acreage 7. Proposed Number 8. Existing Number Traffic Analysis Zone 10. Grid Number 11. Zone 12. Fee $ 13. Community CounCil B. I h~reby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Ph~rr~ing Commission, or the Assembly due to administrative reasons. · ' Signature · Agents must provide written proof or authorization. 20019 Front (4/85) Please check or fill in the following: 1. Comprehensive Plan -- Land Use Classification f Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan.-- Land, Use Intensity Special Study 3. Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation Marginal Land Com mercial/Industrial Public Lands/Institutions Alpine/Slope Affected Industrial Special Study Dwelling Units per Acr~e Alpine/slope Affected b. Avalanche 'c. ' Floodplair~ d. Seismic Zone (Harding/Lawson) __ Please in, dicate below if any of these events have o.ccurred in the last three.years o? the property. Rezoning Case Number v Subdivision Case Number__S _ : Conditional'Use Case Number Zoning Variance Case Number Enforcement Action For Building/Land Use Permit For Legal description ~for advertising. Checklist Waiver 30 Copies of Plat Reduced Copy of Plat (8V2 x 11) Certificate to Plat Fee Topo Map 3 Copies Soils Report 4 Copies Aerial Photo Housing Stock Map Zoning Map Water: Sewer: 20~019 Back (4/85) Private Wells Community Well Public Utility Private Septic Community Sys. Public Utility PRELIMINARY PLAT APPLICATION OFFICE USE Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING REC'D BY: P.O. BOX 6650 VERIFY OWN: Anchorage, Alaska 99502-0650 Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. 0. Case Number (IF KNOWN) 1. Vacation Code 2. New abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). 3. Exi~fin~ abbroviatod Io~al description (T12~ ~2W SEC 2 kOl 45 O~ S~O~I 8U8 BkK a kOI 34) full Io~al on back 4. Petitioner's Name (Last- First) ID lvl l I,I I 1 1 1 1,1 I III11tl IIIIIIt11111t Address ~2¢..) [~,.~ ~'~ /~ I City ~ ~u~ ~ State ~ ~7 Phone No. ~' ~ Bill Me ~ 5. Petitioner's Representative City ~") ]'dC I~ State hE Phone No. '~'~'~' ~"'~'~'dr- Bill Me 6. Petition Area 7. Proposed 8. Existing Number Number Acreage Lots Lots 12. Fees B. Date: 9. Traffic Analysis Zone 10. Grid Number 11. Zone 13. Community Council I hereby certify that (I am) (I have been authorized to act for) the owner of the property describedabove and that I desire to subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may be have to postponed by Planning Staff, Platting Board, Planning Commission, or the Assembly due to administrative reasons. (~ i.~.~ t (~((~ ~~{~. ~/ Signature *Agents must provide written proof or authorization. Please check or fill in the following: 1. Comprehensive Plan -- Land Use Classification Residential Commercial Parks/Open Space Transportation Related Comprehensive Plan -- Land Use Intensity Special Study Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation Marginal Land Corn mercial/Industrial Public Lands/Institutions Dwelling Units per Acre Alpine/Slope Affected b, Avalanche c. Floodplain d. Seismic Zone (Harding/Lawson) Please indicate below if any of these events have occurred in the last three years on the property. Case Number ..~ - '72,,5"~ ~/l~(..¢fT'~.Ol~/ -- Rezoning ~ Subdivision Case Number Conditional Use Case Number Zoning Variance Case Number Enforcement Action For Building/Land Use Permit For Army Corp of Engineers Permit Legal description for advertising. Alpine/Slope Affected Industrial Special Study F. Checklist 30 Copies of Plat Reduced Copy of Plat (8V2x 11) Certificate to Plat Fee Topo Map 3 Copies Soils Report 4 Copies Aerial Photo Housing Stock Map Zoning Map Water: Sewer: Private Wells Private Septic Waiver Community Well Community Sys. Public Utility Public Utility 20~003 Back t4,85j MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST 8 WAS G 11 TERED? 12 13 14 15 16 17 18 ; ~xo~..erl A. 5h~ tqo, 19 SLOPE ,.~.~,..~SOILS LOG [] PERCOLATION TEST 20 IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) ~"~ ~~'"~'~/"'/ ~--'/~-/~ TEST RUN BETWEEN FT AND -- FT COMMENTS ~' ~; ~- / PERFORMED BYI ' ' ~'~ :,~-' - CERTIFI ,~.oo. ,~,,,, $ 8 5b 3 ~ov t 9 l S 8 5 ~o 3 NOV '1 9 1986 l~.fum~:ipuiity of Anchorage Copyright ¢© I978