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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