HomeMy WebLinkAboutALYESKA BASIN #7 BLK 26 LT 9
"~"~!. ~ 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
IPRONE
MAILING ADDRESS
LEGA~ DESCRIPTION
LOCATIO~ NO, OF BEDROOMS
/ JWe,l J Absorption area Dwelling PERMIT NO.
DISTANCE TO:
~ Z Manufacturer Material No, of compartments
Uq. ca~acitg in ~allons IF HOMfi~D[: Inside length ~idth Uquid deCth
~ ~O ~ ~O Dwelling j PERMIT NO.
~-- ~ Manufacturer ~~ Material ~ / Liquid capacity in~allons
~ Well Foundation Nearest lot line PERMIT NO.
~ DISTANCE TO:
~ ~ ~ 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 tile Total effective absorption area
~ inches
Length Width Depth PERMIT NO,
N Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ ~ Building foundation Sewer line Septic tank
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED ' %~-J ~',:,%':~L ~ DATE LEGAL
72-013 (Rev. 3/78)
Permit #
Applicant: .~ ~/~ ~,~
Location: ~_~_7' ·
Legal Descrfption: ~s 16-17'~'Z!
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms: _~___
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta ~rotection
825 L Street, Anchorage, AK. 99501
264-4720
* *'* HANDWRITTEN PERMIT * * *
.......... ~^~ ON-SITE SEWER PERMIT
_~-...,~_ ._~._.-.-~.~ ,.~' [%.
Mailing Address:
Phone Number:
r/O~ ~ ~ Lot Size:
Seepage Bed: Holding Tank: _~
/ -
Soil Rating (sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH ;J/~- 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 ~(HOLDING) TANK SIZE = ~O~5;O GALLONS * *
ermit applicant has the responsibility to inform this department during the
nstallation inspections of any wells adjacent to this property and the number
f residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
ackfilling of any system without final inspection and approval by this department
ill be subject to prosecution.
inimum distance between a well and any on-site sewage disposal system is 100 feet
or a private well or 150 to 200 feet from a public well depending upon the type
f public well. Minimum distance from a private well to a private sewer line
s 25 feet and to a community sewer line is 75 feet. Well logs are required
nd must be returned to this department within 30 days of the well completion.
ther requirements may apply. Specifications and construction diagrams are
vailable to insure proper installation.
~ * * * PERMIT EXPIRES DECEMBER 31, 1 9 * *
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 tha~3 bedroomS.
Date:
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. -General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name TO~-f ~L~.~l~ , Telephone - Home
Applicants Address
Business
(c) Applicant is (check one) Lending Institution ~--~ ; Owner/~m~-~~ ;
Buyer ~--~ ; Other ~ (explain); ' '
(d) Lending Institution,,
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. 7y, pe of Residence
Single-Famtly~
~umber 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..S, ewage Disposal
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]
g
tions in effect on the date of this 'inspection.
Name of Firm
Address
Date
En~ineerin~ Firm Prov~din~. Inspections~. Tests~ File Search~ Data and Information
As cer~ifi~d~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-
DHEP Approval
Approved fo~~
Approve~
(ENGINEER SEAL)
bed rooms
Disapproved
Conditionml
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 FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~ALYZE 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
A. WELL DATA
Well Classification
Well Log P=esent (Y/N)
Total Depth . Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit ,,(,,Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot .~O ~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Se~er Line
C leancut/Mmnhole
Water Sample Collected By
Water Sample Test Results
CcmTents
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEAUH a
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HmLT~ A~mO~ ~PROVAL (~A) JAN $ 'i 1985
CHECKLIST - FEBRUARY 1984
(v0 L,c zf a, B, Or c, D.Z.C.
Date Cci~leted Yield
, Depth of G~outing
Sanitaz7 Seal on Casing (Y/N)
DeLm:ession A~ound Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Se~r
'To Nearest Se~r Service Line on Lot
SJ
&~,/HOLDfNG TANK DATA
Standpipes (y/N).n --~7~ Air-tight Caps (Y/N) ~/
Depression over Tank (Y/N) ~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~ ; for
No. cf Ccmpartn~nts O A~ ~
Foundation Cleanout (Y/N) ~
Holding Tank High-Water alam (.Y/N) y Temporary Holding Tank Permit
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~
To Property Line JO
To Water Main/Service Line
co=se P
Ccn~ents
(Y/N)
I0
To Building Foundation
To Disposal Field
/0 /' TO Stream, Pond, Lake, Or Major Drainage
Receipt %
Date Paid:
Amount:
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD ~ATA
NoN
Soils RatiD~ in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption A=ea
Depression over Field (Y/N)
Results of Last ~lequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness.
Standpipes Present (y/N)
Date of Last Adequacy Test
Separation Distance frcm A~scrption Field:
To Water-Supply W~ll
To Building Foundation
Lot
To Water Main/Service Line
To Property Line
To Existing or Abandoned System cn
; On Adjoining Lots
To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, cr Vehicle Storage Area
Cc~msnts
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Ccmuents
Dimsnsions
Manho!e/Ac ss (Y/N)
"Pump Off" Level at
vent (Y/N)
Pumping Cycles du~ing Adequacy Test. Meets MOA
** Check Permitted Bedrocm Rating Against HAA Pequest
I certify that I have checked, verified, or confcru~d to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed ~
Company
KB1/d5/s
[Page 2 of 2]
MOA No. 8 'S ?-O /
2-15-84
DEPT. OF ENVIRON MENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
/
/
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom it May Concern: .
According to records on file in this office the ~'h h S '
~,,~ ~Water Systemis in compliance-w~t t e.tate Drinking
Water Regulations
i LAN USE.
J-" ' ' :' i'!i' .-' 'BUlLDINGSAFETYDIVistON'
'/ ~MUNICIPALIT¥ OF ANCHORAGE
NO PAID1
~ '-'~' ZONING
AREA
NO. '~' '- , DISTRICT
I PROPERTY OWNER.`/ ~ '~J';~'- - PHONE
2'. mACLang AD~R~SS _
4 oFLEGALpRoPERT~DESCR'IPTION
' B../~mmerm81: ~Rb~ *Professional
:C,:, {;:t~dus~ial: · , , ManuTa~miq ' , rStOrage , tProcessinD
t~t'~he a~ve information and ~hat .submitted in appli~tion
~d ~rrect to' ~e ~st ~- my k. Owledge: 1 Understand that
on
~des' and Ordinan~s :oT 't~ ~uni~l~Y .of'Anchorage.
,MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE: August 8, 1984
TO: Robbie Robinson, Manager of Environmental Health
FROM: ~_jJerry T. Weaver, Jr., Platting Officer
SUBJECT: Alaska Basin Unit #7
Per our previous discussion, you can issue holding tank per-
mits in this area until the restrictive note is removed from
the plat concerning public sewer. You must, however, ensure
the holding tanks are pumped on a regular basis and that the
homeowner will connect to public sewer when available.
The Board of Supervisors, Dana Brockway, John Bishop, and
myself are all aware of this interim policy.
j w8 / nm24
TO
GIRDWOOD SERVICE~
P. O. Box 674.
GIRDWOOD, ALASKA 99587-0674
1090
Phone 783-2952
r~ DATE ORDER NO.
,/~'r Z~
SHIP TO I
'7
ORIGINAL