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Home My WebLink AboutLot 05 . ~ ' MUNICIPALITY OF ANCHORAGE : MUNiCIPALiTY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & ENVIRONMENTAL ENGINEERING DIVISION ENVIRONMENTAL PROTECTION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 r ? ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR~AR '-~ '~-J 109/. NAME PRONE J MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS Well ~ ~ DISTANCE TO: I00( [ Absorption area --fi/ Dwelling 4~ eD/ ~AW~g~ / ~PE~MIT NO, Manufacturer I ' ~> ~;~A~ ~ ~~ Material 5'~ ~o. of compa[~.nt~ Liq 't~ a't~ ,~n gallons IF HOMEMADE: Inside lengt>/~ WiOt)/~' Liquid depth ~OZ~ ~ DISTANCE TO: Well~/~/~ Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation ~ ~/ Nearest~ PE~MITNO. NO. of linest Length of each lige Total ,est~of;ines Trench~ Distance ¥~een lines _ inches ~ Top of tile to fi hfirade J~' Mge~ial beneath tile . -,:~ ~ ~ Total ~ffective absom~on area Length Width e~t ~ -- ZHa ~C~inches PERMITS-3'ZNO. / ~ ~ ~ Tg~e of crib Crib diamete Crib de0th Total effectiue absorption area m ~ell Buildin0 foundation ~earest lot line ~ DISTANCE TO: ~ Class Depth ~/~ Driller Distance to lot line PERMIT NO. m BuHdin~ foundat[on~' Se~er line Septic tank Absorption area{s) PIPE MATERIALS SOILTESTRATING ~A,~ iXO '" . iNSTALLER '~ ~,, II l. g ~1 . APPROVED DATE LEGAL Permit Applicant: Location: Leqal Description: Z~-,_~. ~/~,~_~? ~,~,~7LOt Size: Type of Soil Absorption System Is: ~/~ Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) ~J~UNICIPALITY OF ANCHORAGE Health and Environmenta]~'rotection Department 825 ~ Street, Anchorage, AK.264_4720 >9501 ~~!_~, *** * * * HANDWRITTEN PERMIT --W~kmt~~ON-SITE SEWER PERMIT Phone Number: The Required Size of the Soil Absorption System Is: DEPTH /~) LENGTH ~'~" GRAVEL DEPTH -/ 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 = /~¢9~)' 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 department will be subject to prosecution. nd an on site sewa-e disposal system is 100 feetl Minimum distance between a well a Y - for a rivate well or 150 to 200 feet from a public well depending upon the typ P of public well. Minimum distance from a private well to a private sewer lin 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 8 q-* * * 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 the residence is remodeled to include more that/~ bedrooms. Signe~: ~ ..~/~~ Issued b Applicant Date: /-'"~"" SWP/024 (1/81) &' ENGINEERS, INC. s 7125 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 (907) 349-6561 X SOIL LOG SOIL LOG ~ PE.OOLA~ION TEST PERCOLATION TEST _~_BEDROOMS OBNUMBER 4-- O-Z ~'i~E/9 T~ -- 1 2 6 7 8 9 SLOPE 19 20 4~o~ ~c~ ~ co~s ~5~. '~ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? .g O B D I O ~ S I O t, J -.~ .Z SITE PLAN N 27' ¢'c;.Cc, ~uE. \ 17_ I \ , DEA~c)N R W E Gross Net Depth to Net Reading Date Time Time Water Drop 18,~.E DEPTH (PEET) COMMENTS_~EC C {~ ~ ~' It~} b I PERCOLAT,ON RATE V/I 5UA ~ TEST RUN BETWEEN ........ FT AND (minutes/inch) _ FT .:.....,,.: ~. ,.: ~ven,.r.., .-..a...a,:, ...:., :?_ 7: :" :: ':' We adVise ~ou to attach 'this'certifica'fe: to:'y°Ur' deed, .: i'" : : :': I~UNICIPALITY OF ANCHORAGE D, IVI$ION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Informatio ............ ~ a) Legal Description (include lot,~l~ , Location (address or directions) (b) Applicants Name ~ ~ ,~6~f¥ -/~/M~50~ Telephone - Home Application Date ~'f~O~ ~/ subdivision, section, township, range) Business 24 8zl - Applicants Address (c) Applicant is (check ong) Lending Institution Buyer ~-] ; Other~ (explain); (d) Lending Institution ~--~ ; Owner/builder~ ; Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. T~ of Residence Single-Family~ Number of Bedrooms __ 3. Water Sgpply- Individual Well~ Multi-Family ~-~ Other (describe) Community~ Public~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ~SeWage Disposal Onsite ~ Public ~ Community ~ Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En$ineerin$ Firm Providin~ !ns. pections~ Tests~ File Sear_~_~ 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 Firm ~- ~ ~.~A~,S /k,~C . Telephone ~ ' · DHEP Approval [ ~m~ ~'% 2248-E o." ~,%~'~ -- · · .. '~ -- L Conditional Approved ~ Disapproved ~ Terms of Conditional Approval CAUTION THE ~JNICIPALITY 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 FEDERAL AND 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 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification fA)Q;V~pOA L Well Log P~esent (Y/N) ~/~-~ . Total Depth J 7 Z / Cased to Static Water Level _~.9- / Casing Height Above Ground 2-' Electrical Wiring in Conduit (Y/N) %{~'~ Separation Distances f~c~ Well: To Septic/Holding Tank on Lot fO(;t To Nearest Edge of Absorption Field on LOt_ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 'AU6 I J= 1984 RECEIVED If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed ~ --J(~-~rl Yield J~ Z I ~pth of G=outing ~/~ Sanit~ ~al on Casing ~ession ~nd ~l~ead (Y~)~O ; On Adjoining Lots ~> l ~ O / ; On Adjoining Lots .~j 70' To Nearest Public Sewer Line ~/A To Nearest Public sewe~ Cleanout/Manhole > ~00r To Nearest Sewer service Line on Lot /d/~4 water Sa~,ple Collected By' JY'/.~ ~ ; Date Water Sample Test Results _~-;~ C~t,~ents B. SEPTIC/HOLDING TANK DATA Date Installed ~icIJO~3A/ Size l~)~69 ~L_ No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression ove~ Tank (Y/N) ;G~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N)~J/~.; fo~ Holding Tank High-Water Alarm (Y/N)a]/~ Temporary Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Se=vice Line /~./~ Course To Building Foundation z~.~-- / TO Disposal Field To Stream, Pond, Lake, c~ Major Drainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata !SO ~ Type of System Design Date Installed _'~ --~ i, ~ Length of Field ~! Width of Field z~~' Depth of Field /Gravel Bed Thickness ~ / Square Feet of Absorption A~ea ~ ~ ~ Stan~ipes lh~esent (Y/N) DepFession over Field (Y/N) ~40 'Date of Lest Adequacy Test Results of Last ~equacy Test /~./~ Separation Distanoe f~om Absorption Field: To Water-Supply Well /~ ! To P~operty Line ~O ' To Building Foundation ~' ~/~/' To Existing or Abandoned System Lot /~//$ ; On Adjoining Lots > ~) ! To Water Main/Service Line ~//~ To Cutbank(if present) /~/~ To Stream/Pond/Lake/c~ Major D~ainage Course To DFiveway, Parking A~ea, c~ Vehicle Stc~age A~ea /O/ Date ~nstalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Din~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA C~ents ** Check Permitted Bed~o~xa Rating Ac3ainst HAA Request ** I certify that I have checked, verified, c~ confc~ured to all MOA HAA Guidelines in effect on the date of this inspection.! 22 s-s ..'-_.eft MOA NO. ~ DO~ [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE MEMORANDUM Signed 91-015 (Rev. 1/81)