HomeMy WebLinkAboutFIRE LAKE LT 1 TR E
~~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROI cCTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAI L'~ N~ ,~DDR
NO. OF B~OOMS
~ Manufacturer ~e~~ ~ / ~o. of compartment~
~iq.~c ~ci~ ~ons IF HOMEMADfi: Inside length Width I kiquiO de~th
O ~ ~ Manufacturer - Material Liquid capacity in gallons
~ DiSTANOETO: W~O'C ~ F°und~n /'~ Near~otlir~ ~ PE~I~V¢ ~
~ ~ No. of lines O Lang.. ~ne__ f Total I~f ,i~s+ Tren~wiOth .¢ Distance b~li~s
,~ Top of--'~'° ,~,~rade / ~er~_.ben~t hr~ ,il~ ~Z '(inches Total effect~e¢~oabsorpt~area
~ Length Width ~epth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
R EMAR KS~
(Rev. 3/78) ......
MUNICIPALITY OF ANCHORAGE
5 Health and Environment~
~ Street, Anchorage, AK.
Department
825
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit 9~ ~ ON-SITE SEWER PERMIT
Orotection
o~501
Applicant: '~,,~ ~
Location:
Legal Description:
Type of Soil Absorption System Is:
Trench: ~ Drainfield:
Maximum Number of Bedrooms:
Phone Number: ~ ~
~_ ¢~//Lot Size:
Seepage Bed: Holding Tank: __j___
Soil Rating(sq.ft/br) ~-
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH ~D-2~l GRAVEL DEPTH ~o- 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 = /O~ 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.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
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 1 9 8 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
the residence is remodeled to include more that 3 bedrooms.
Issued by: ~¢~L
Date:
SWP/024 (i/si)
s /?" '\
7125 OLD SEWAI~D ti'WY.
ANCI4ORAGE, AI.ASKA .09503
549 - 6561
SOILS LOG -- PERCOI_AIION TEST
OPE SiTE PLAN
' 1
2
3
5
7
9
10
11
12
13
14
/~),~'-- ~/.~' WAS GROUNDWATER
15
16 ,
,,'
!7
JOHN E. SWANSON
i 9 - 1834-E
P~0FESS~i~
~.' .
APPLIC ~IT FILLS OUT UPPER HA[ ONLY
Pro.er,y Owner 't ~/::~"'*~"'I !' ! , l'~"i/'~','~":?'~!:-"l_. _,. _-; .., P.oee
Address Zip Code
Lending Institution 'i.~'~ ~,~:~:.:..7-., /;;NJ"t t.~ i,~ .?77~ -' ~. Phone
Address
Realty Co. & Agent / Phone
Address Zip Code
Legal Description ...
Type of Residence
FI Single Family
.,I
'~ Multiple Famtly No, of Bedrooms
('I' Other
Water Supply ~ t I , --
..~lnd',':',du:' C / (~,.~ C ATTACH WELL LOG. A welllog Is required for all wells drilled since June 1975.
_-,,..~---~
CommuLu.w.----~*"'"--' For wells drilled prior to that date, give well depth (attach Icg if available).
L J Public Utility
Sewer Disposal
Year Individual Installed:
Individual
Public Utility When Connected to Public Utility:
[~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQIJEST BEFORE PROCESSING CAN BE INITIATED.
Time
Date
Inspector
Time
Date
Inspector
Time
Date
Inspector
Time
Date
Inspector
/(?-' t DISAPPROVED
'( ) CONDITIONAL APPROVAL'
DATE
BY. (-
i..h:., '[ L.,
RECEIVED
*CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank ~
Well Log Received
Septic Tank Size
72.023 (3182)
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
PUBLIC WATER SYSTEMS
APPROVAL TO CONSTRUCT
Plane for the construction or modification of
'iq
in
by
approved.
public water system located
, Alaska, submitted In accordance with 18 AAC 80.100
[] conditionally approved (eec attached conditions).
BY TITLE
If construction has not started within two years of the approval date, this certificate Is void and new plane and
specifications must be submitted for review and approval before construction.
have been reviewed and are
DATE
B. APPROVED CHANQE ORDERS
Change (oont.lot order no, or d~lorlptlve referenoe) Approved by
Date
C. APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
le made available to the public.
water system was completed on 2_ - <~-- ~' y
granted Interim approval to operate for 90 days following the completion date.
public
(date). The system Is hereby
SY TITLE DATE
As-built plans submitted during the Interim approval period, or an Inspection by the Department, has confirmed
the system was constructed according to the approved plans. The system is hereby granted final approval to
operate. . , k
BY TITLE DATE
tS,G407 (RIV, tl/~}
DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section G) ~. YELLOW · WATER SYETEM PILE (Complete Ee~llon C)
3. PINK - ENGINEER/MUNI.BOROUGH (Domplete ~tlo~ C)
4. GOLDENROD * MUNI,BOROUGH (C4NilpIMe ~UOtl A)