HomeMy WebLinkAboutANOTHER LT 6lal
02-0 0 ,3 O3o
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
IP"°NE I[].EW
MAILING ADDR~S
LEGAL DESCRIPTION
LOCATION
Iw.,, I Absorption area Dwellin PERMIT NO,
~ DISTANCE TO: ~Oo ~ 5 ~ gNof iA ~1~
~ Manufacturer ~0~ M.t.rial 5~l ~o. ofcomp.rtm.nts ~
~ Liq. cap~citg in ~allons Inside length ~idth Uquid depth
Well Dwelling PERMIT NO.
DISTANCE
TO;
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundatio% i Nearest lot line PERMIT ~
~ DISTANCE TO: 115 ~
Top of tile to finish ~rade Material beneath tile Total effectiuo absorption
Length Width Depth PERMIT NO. ~
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot Hne
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation 8ewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTACLER
REMARKS
J
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
NAME: ,~ ....
LEGAL: .ANOTHER LOT &
I~XP,ECT-IONx REQuE~'TED': PLUMBING
.-PERM T,NO: 83"-56&4
· ' PHONE: ~45'"'i 656
ERROR.S':
NO PERMIT ON FII~E
t:,NONE::OMPLIANCE OBSERVED l.. I CI:)RRECTION$ E$~EN'TI,
. -> :A~OVE '
TIME;J%~ '~TART MILEAGE:
UN'IT~ ~ TOTAL DISTANCE:
WHEN CORRECTIOI'~7 ARE MAT)E?', F'LEA~E CALL FOR IN~F'ECTION.
I)O NOT i;:EHC)V[ 'l'Ht~. NOTICE
PERMIT NO.
DEPARTMENT ( HEALTH AND ENVIRONMENTAL OTECTI.ON
825 'L' STREET, ANCHORAGE, AK. 9950±
264-4720
( 8~0%87 )
APPLICANT HENRY KRIZMRN SRA BOX 478D ANCHORAGE 9.9507 ]:45-'1656
LOCATION
¢ '= I-I
LEGAL L6 ANOTHER SLIBD I ~, I_, I ON L_ T _ I ~E .............. ~.._ NEE FEET..
TYP~ ,:,~ ,=- -..--., - ,-,,.- ~~-
_,UIL HB=.URFTIUN ~=,TEM IS' TRENCH
. ...... NUMBER ,-,~ B[~R,:,OMS = ; SO~L R.T~N,~ ,::SQ ~T.'BR::,= ( ~2~~ ,~~
~ ~...,Z~'~L,"~ _
THE REI=~UZRED SZZE OF THE SCIZL RBSORF'TZCIN SYSTEM
[:,EF"TH= :B LE[4GTH= 47 6AR%eEL [:,EF'TH= 4
THE LENGTH [:, I MENS I ON IS THE LENGTH (IN FEET:.', OF THE TRENCH OR [:,RRINFIEL[:,~~
THE DEPTH OF R TRENC:H OR PIT IS THE [:,ISTRNC:E BETWEEN THE SUR. FRCE OF THE ~
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET::,.
THERE IS NO SET WIDTH FOR TREN3HES
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL. PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET.'.',.
F-:EL---!i_i I F-."E[:, SEF'T I "-: TR[-41'-:: $ I ZE= :.t,--:-~ £1~:',
PERMIT APPLICANT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS RDJRCENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TI4C, (2) ~ P-~SF'E~]TIE, f-~S RE:E E:E,;!IJI E~E[:.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR R PRIVATE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
bllNIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAIL. ABLE TO INSURE PROPER INSTRLLRTION.
F'EF.:[-1 z T E:=-=:F' I I~:ES E:,EE:Er-IE:EE: 2-:$..
I CERTIFY THAT
t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE-SEWERS AND WELLS RS SET
FORTH B'T' THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE S'T'STEM IN ACCORDANCE WITH THE CODES.
~:: I UNDERSTAND THAT THE ON-SITE SEWER S'T'STEM MR'T' REQUIRE ENLARGEMENT IF THE
RESIDENC:E 1'$ REMOE:,ELE[:, TO INCU_,E:,E MORE THAI'., 3: E:EDROOMS.'¢ 'o'~ '~t "/ ~'}"')r'-'--
SIGNED '_ _ _ . /
ISSUED BY__
'.5
11
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~ ;.-~.,
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::: 0 'h
L 0 ] 6
]Ii 22
L 0 A M
1
10
11 .J
2O --[ j
51< x B 5
Sim;et: 2 of' 2
LOT
Tii
19
m
2~ 0
~0
I
SURVEY TYPE s YIVIBOLS .'
ELEVATION
[] AS-BUILT ~ DRAINAGE
[] PLOT PLAN
o o o- WOOD FENCE
~ LOT SURVEY ~/~ ~r v_ CH Al N LIN K FENCE
[] RECERTIFICATION AS-BUlL~ NOTE: FENCES ARE SHOWN IN THEIR APPROXIMATE LocATIoNS
ONLY.
I1 ~s lhe responsmbility ct fha builder or owner, prior tO
con,:lruclion, I0 verify proposed b~,llding g~'ode relalive
to finished grade and u. hldy'connecl~ons ond lo determine ·
lhe e~islencc of ony easements, c~enonls or rcslr~ctions
which do nol appear on I~ recorded subdivision pla~~
LEGEND
hub Ei tack-found [] sel
iron rebar -found 0 set
iron pipe -found ® set 0
brass cop -found (~ set
alum· cbp -found 0 set
Scale
1 " = 60'
Dole Surveyed: AUGUST i, 1984
D~ te ~'r ov,q~,'.
-AUGUST 3, 1984
Pro~,esslonal Lond Surveyors
K,1S -
c~ ~: DGH
Grl~: 3336 w'°'83-190
,LOT 6, ANOTHER SUBDIVISION :-' '
ALASKA ENVIROIVi~NTAL
CONTROL SERVIC"C3, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO.
CALCULATED BY
CHECKED BY
SCALE
OF
DATE .,,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAl_.
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date _,/,2~
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name //t~"-~/'/0/
Applicant Address
Applicant is (check one): Lending Institution ~ · Owner/builder~; Buyer D ' Other D (explain);
__ -telephone: Home Business
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Single-Family'~ Multi~Fam~,,~__ Other
Number of Bedrooms _-.~_ '-~
WATER SUPPLY
Inchvidual 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.
SEWAGE DISPOSAL
Onsite~' Public [] Community [] Holding Tank
[]
Note: If cornmunity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA~A AND INFORMATION
As certified by my seal affixed I~ereto and as of the validation date shown below, I verify that rny 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 regulations in effect on
inspection.
Name of Firm _~'/., '~dt~ ~_'V'/~_. Telephone
Date
Seal
DHEP APPROVAL
Approved for "¢~/' "~¢*"[~edrooms by ~ ' ~
Terms of Conditional Approval
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations 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 requirements. 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
MI, JNICIPAU1Y OF ~KLIST-FEBRUARY 1984
DEPT. OF HEALTH & .... 264-4720
[~EC ~ ~ 1~ Legal Description:
WELL DATA
Well Classification
Well Log Present{~)
Total Depth__v_..,~Z.~,, Cased to
Static Water Level ~.--,,,~ /
Casing Height Above Ground
Electrical Wiring in Condui(Y~N)
Separation Distances from Well:
/
To Septic/Holding Tank on Lot 7°
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Man hole ,~/~J~
Water Sample Collected by ,/~'~'~'
Water Sample Test Results
RECEIVED
~/~/~ If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~"'~ '~ Yield
-~'~""! Depth of Grouting ,~/'~
Pump Set At ,,~_/,~
Sanitary Seal on Casing N)
Depression Around Wellhead (Y{~
/cO/y-
; On Adjoining Lots
/'//,~ / ;On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
/'~"/-~/' , Date /,Z--(,,
Comments
B. SEPTIC/HOLDING TANK DATA
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Date Installed Size
Standpipe (s~) ~, Air-tight Caps(~)N)
Depression over Tank (Y~.~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
No. of Compartments ~
Foundation Cleanou~N)
Date Last Pumped /,Z- -F- ~"~"
for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~;~-'~ -~'
Width of Field
//'~'~ Type of System Design
Depth of Field
~'""¢3~O ~,~ Gravel Bed Thickness
Square Feet of Absorption Area
Depression over Field (Y~,)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /'/~'~'
Standpipes Present~N)
Date of Last Adequacy Test ,4//,~
To Property Line
To Building Foundation
Lot
To Water Main/Service Line ,4///~ To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course /~/"~
To Driveway, Parking Area, or Vehicle Storage Area -~ /
Comments -/'-/,~--~_ /.~ .._~_~-~-vc-~.~.~f ,~.~,.~./~.,~.~ ,~.~,~ .~=~,._
· On Adjoining Lots
To Existing or Abandoned System on
~' ?~'~ =~,e=~-/fs/-
LIFT STATION ,~ /
in~ C,,cles durin Ade uac Test Meets
T~ ____ ~~db g q y . MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I h.~v/~chj~ked, v¢.~fied, or conformed to all MOA and HA~A guidelines in effect on the date of this inspection.
Signed ~/ (~ ~/~"'"' Date
Company /'~'"~¢~:~ ~' MOA No. ~'~"
Receipt No. ~ (._o,L~[ C~
Date of Payment ~ _~:..
Amount: $
Page 2 of 2
72-026 (11/84)
ALASKA ellUlROllnlellTAL CO[1TROL SeRUICeS, IFIC.
~nqineerinq 6 ~nuironmenlal Studies
December 10, 1985
Municipality of Anchorage
Department of Health and Human
Services
825 L Street
Anchorage, Alaska
Subject: Another Subdivision - Lot 6, Block N/A
Well to Septic Tank Waiver
The above referenced lot consists of a three (3) bedroom home with an
on-site sewer system and a private well. On December 6, 1985, we
performed a Health Authority inspection on this property. From
information gathered, we see that the well is 325 feet deep and cased to
the bottom. Static water level is 25 feet. It was drilled on August 2,
1983.
The sewer system consists of a 1250 gallon steel septic tank and a 5
foot wide drainfield, which is 64 feet long and a total of 4.5 feet
deep. This was installed on September 6, 1983.
Construction of the house was not completed until February 27, 1984.
(See attached plumbing inspection).
From the Health Authority inspection, we find that the separation
distance from the well to the septic tank is 90 feet.
The septic tank is located slightly downhill from the well, and the lot
slopes down even more beyond that.
Due to the fact that the well is so deep and cased to the bottom and
that the septic tank is watertight steel, we feel that there is no
danger of contamination to the water supply system. We therefore
request a waiver be granted to reduce the required separation distance
from the well to septic tank to 90 feet.
If you have any further questions, please feel free to contact this
office.
Sincerely,
Alan Wien
Engineering Technic ian
F"33rd Auenue, Suite [~ ,i, Anchorclqe, Alaska 99503 ,(907)561-5040
DATE:
TO:
FROM:
SUBJECT:
Municipality of Anchorage
MEMORANDUM
September 12, 1983
Laura Crow
Environmental Health Division
Request for Refund - Account ~2460
Please make arrangements for the following refund. The applicant
had a private engineer do the inspections of the on-site sewer
system in lieu of this office.
Henry Krizman
Star Route A Box 478D
Anchorage, Alaska 99507
Permit #830187
Lot 6 Another Subdivision
Sewer and Well Permit
ReceiPt # 232815
Amount: $30.00
Laura J. Ward
Senior Office Assistant
Sewer and Water Program
LJW
attachements
91-010 (4/76)
MUNICIPALI-I )F ANCHORAGE
POUCH 6-650 · ANCHORAGE, AK 99502 · PHONE 264-6400
FINANCE DEPARTMENT
CASH RECEIPT
No.232815
Acct/Obj Cost Center, WA/WO (~
Amount
{[~ev. 8/78) DIST[q;IBUTION: White --- Treasury; Yellow --- Customor; Pink -- Book; Golde~rod Department