HomeMy WebLinkAboutT C LT 1Onsite File
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MUNICIPALITY OF ANCHORAGE
® T
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
It'
ENVIRONMENTAL
ENGINEERING DIVISION
825 L. Street
- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NA �A.
.�
.i
PHONE
:KNEW
'711'Ina
•�--- J
❑ UPGRADE
MAD E S
W/,
L
LEGAL DE CRIPTION"
�
o _o� 14
LOCATION
(
NO. OF BEDROOMS
DISTANCE
Well ,Aq
Absorption area
Dwelling
PE MIT NO
Uy
-
1- Z
Manufacturer,�' {�
Material -
No. of compartments
wF
L1(
y
Liq. ca ci y in� Mons
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J � Z
= z h
Manufacturer
Material
Liquid capacity in gallons
w=
DISTANCE TO:Lu
Well
�4
Foundation
Nearest lot line /
P RMIT N /1�
� '0' 7
F iL Z w
No. of lines
Length of each li
/
Total length of lin /
Trench wid
r inches
Distance between lines
Top of tile to finish
Material
I-
grade,,
beneath tile
Total efface absor tion area
93 Z
O
90 inches
Length
Width
Depth
PERMIT NO.
w
U
Q F
as
w
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Lu
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
V( --
I�
e
S(51 LTES RA ING
! J.
INSTALL f, f
L te'
REMARKS
f
q
f/
0
t
APPROVED
DATE LEGAL
Lake -41z blo6k .3 Lot IfJ
iz-u 16 Inev. 61/xl
THE REQUIRED SIZE OF' THE S;C`,lL FfBc-;OF.PTION IS:
��W, lll+=�: ��P4 F U=-. �3i R: E-:�q �F_".4-- 1-1 - �
THE LENGTH DIMENSIQN IS THE LENGTH (IN FEET) OF THE TRENCH QR DRHINFIELD
THE
DEPTH OF
�F-l'!���
TRENCH
OR PIT IS
DEPHRTMENT HEHLTH
HND ENV IRONMENTHL �ROTECTION
THE
BOTTOM
, 825 'L' STREET, HNCHORAGE, HK` g9501 `
(IN FEET).
�
~
264~4720
�-- `��
OF HNCHORHGE.
0 US~~15 1 "T- M
G! IEEE YJ EE F.-%: f=g EH rr, rl 1'.~�
DEPTH
PERMIT
NO.
DEPTH OF GRHVEL THE OUTFI:RLL PIPE
HND
HPPLICHNT
HULTQUIST 1C.
`
4761 MHRS, DRIYE 99507
]44~91I]
LOCHTION
RESIDENCE IS REMODELED
TO INCLUDE
MORE
LEGHL
L14 BI SHND LF![. -.'E #2
LOT SIZE 6500
FEET
TYFIE OF
SOlL HBSORPTIGN SYSTEM IS:
TRENCH
MHXIMUM
NUMBER OF BEDROOMS -= ]
SOIL RATING (SQ FT/BR)� 206
THE REQUIRED SIZE OF' THE S;C`,lL FfBc-;OF.PTION IS:
��W, lll+=�: ��P4 F U=-. �3i R: E-:�q �F_".4-- 1-1 - �
THE LENGTH DIMENSIQN IS THE LENGTH (IN FEET) OF THE TRENCH QR DRHINFIELD
THE
DEPTH OF
H
TRENCH
OR PIT IS
THE DISTHNCE BETWEEN THE SURFHCE OF THE
QROUND AND
THE
BOTTOM
OF THE EXCHVHTION
(IN FEET).
THERE IS NO
SET
WIDTH
FOR TRENCHES.
OF HNCHORHGE.
THE
GRHYEL
DEPTH
IS THE
MINIMUM
DEPTH OF GRHVEL THE OUTFI:RLL PIPE
HND
THE BOTTQM
ON-SITE
OF THE
EXCFiVHTICPA
(IN FEET).
���01-3 ].: Fr�. EE E -N 3. iC� 7 -'F -"R �3' 1 2 " E E D — K W 12) 101 fit I.. Q. Q 141 WEE--,
PERMIT HPPLICHNT HHS THE TO INFORM This; DEPHRTMENT DURING THE
INSTHLLHTION INSPECTIONS OF HNY HELLS HDJHCENT TO THIS PROPERTY HND THE.-
��_ "T 14 M �;11:,�, > ���KEE Q W 1. W 141 "L", F%� FW lEE Gh U 1: Q E=E 1-3-H
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTIQN HND HPPROV8L BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON-SITE SENHGE DISPOSHL SYSTEM IS
100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO HCOMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY HPPLM SPECIFICFITIONS HND HRE
HVHILHBLE TO INSURE PROPER IMSTHLLHTION.
X w,
10�'
I CERTIFY THRT
1: I HM FHMILIHR WITH
THE REQUIREMENTS
FOR ON~SITE SEWERS
HND NELLS HS SET
FORTH BY THE MUNICIPHLITY
OF HNCHORHGE.
2: I WILL INSTHLL THE
SYSTEM IN
HCCQRDHNCE WITH THE CODES
]: I UNDERSTHND THHT THE
ON-SITE
SEWER
SYSTEM MHY REQUIRE
IF THE
RESIDENCE IS REMODELED
TO INCLUDE
MORE
THHN ] BEDROOMS.
SSI BY
Steven R. Pannone, P.E.
P.O. Box 142025
Consulting Engineer Anchorage, Alaska, 99514
(907)272-8218 (907)272-8218 Fax
June 28, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 14, Block 3 Sand Lake #2 Subdivision
Septic Upgrade Permit
Gentlemen:
My firm was contacted to investigate the possibility of installing a replacement septic system on this lot. The existing
system on this lot has failed. The house is served from a Class C well located two lots away. A single test hole was
excavated on June 22, 1997. The soils report and a percolation test result is attached. Ground water was monitored for
seven days. No bedrock or ground water was encountered in the test hole.
The lot is approximately 6,750 square feet in size. Lot 14 slopes to the south at a rate of approximately 2 to 3 percent.
The proposed installation will be located on the north east portion of the lot. The existing field will be reused. The
integrity of the existing 1,000 gallon septic tank will be verified during installation. It will be reused if found competent,
and replaced outside the 150 foot Class C well radius if deteriorated. A diverter valve will be installed between the two
fields down stream from the tank. There is an existing waiver for the tank and field to the Class C well on file with
ADEC. Double clean -outs were installed down stream from the tank. The proposed location is greater than 150 feet
away from the existing Class C well serving this property and 25 feet from the water service lines. The surrounding wells
are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future
development of the surrounding or existing lots. See the attached design.
If you have any questions about the proposed installation, please contact me at 272-8218
Sincerely,
Steven R. Pannone, P.E.�`"�.
Attachments: A 44t6
F'
Steven R. Pan"RI
E 14711
CAW0RK\2TIMBER001
DESIGN
WASTEWATER ABSORPTI❑N SYSTEM
LOT 14, BLOCK 3 SAND LAKE #2 SUBD•
DRIVE
EXIST. P
UVATE WELL
j
a
I
! NO WE
LS' CN THESE
LDTS
r
1
1
3 6' 14
0'
o`
PROPSED
REPLACEMENT
I
SEPT
SYSTEM, SEE
SHEET 2
THIS LLT IS
FOR
ETAILS.
NOnORD VELL
�I ,I
l
EXIS
ING SEPTIC
SYSTEM
SEPTIC
TOR
MAIN.
EXIST. 3
BR HOUSE
1 3. '
j
A
EXIST. CLAS
'C' WELL
— —
— —
SSU• YELL R
— —
BIUS
—
12' WATER
ASEMENT
`
—
A—WELL = 129.4'
B—WELL = 103.5'
VIEW DRIVE___________
6'
3 35'
PREPARED F❑R+,--.__
TAMMY &SC❑TT COPE
8140 Seaview Drive
Anchorage, AK 99503
(907) 248-3857
DESIGNS
Perc Rate = 1,25 Min/Inch
Soils= 125 sf/1677
3 Bedroom House
375 SF Rqd i
Designs 6' E�fective
9' Total Depth
3' Wider 5' Long
To�Absorptlon = 420 sf
v
Pannone Eng. Svc.
P. 0. BOX 142025
ANCHORAGE, ALASKA 99514
272-8218, PHONE & FAX
DATEi 6-15-97 DESIGN
crnr. •-cn
PROPOSED SYSTEM,
35 LF, 6' EFF, 3'
9' TOTAL DEPTH ,
21
EXIST, 1,000g\
SEPTIC TANK,\
VERIFY INTEGRI-K1
REPLACE IF FOUN
LEAKING, OUTSIDE
THE 150' RADIUS.
THIS LOT IS UNDEVE
NO WELL OR SEPTIC.
_ 49M _
DESIGN
WASTEWATER ABSORPTION SYSTEM
LOT 14, BLOCK 3 SAND LAKE #2 SUBD,
;2r
C.L. SEAVIEW DRIVE
EXISTING SYSTEM
TO REMIAN.
EXISTING SYSTEM
p CO C D
AcRl 2
TI 30 46.7'
6'
3V 35`
7�1 Drawing Cl\Work\14-3SAND.DG
PREPARED F❑R:
R•81Pannone-.792NTAMMY &SCDTT COPE
>6,28••.•.�s� 8140 Seaview Drive
• .. ®� Anchorage, AK 99503
TTEI ®
ma(907) 248-3857
EXIST. CLASS C
L. WAIVERS TO
SEP FIELD & TANK
ARE ON E AT ADEC,
DESIGN:
Perc Rate = 1.25 Min/Inch
Satl�= 125�Jksl•----------
3 Bedroom House
375 SF Rqd
Designs 6' Effective
9' Total Depth
3' Wide, 35' Long
Total Absorption = 420 sf
Pannone Eng. Svc,
P. ❑, BOX 142025
ANCHORAGE, ALASKA 99514
272-8218, PHONE & FAX
DATEi 6-28-97 DESIGN
DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 14, BLOCK 3 SAND LAKE #2 SUBD,
Drnwing Ci\Work\A-9BRUIN,DWG
49—
Irl
Z
H
U
W
0
iwnnwumnuurtiuw uaPREPARED
,n R. Pannone: a
FOR
CE 8149 :` a
TAMMY &SCOTT COPE
AW
8140 Seavlew Drive
0®®
Anchorage, AK 99503
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Ima�"
(907) 248-3857
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Pannone Eng, Svc.
P, ❑, BOX 142025
ANCHORAGE, ALASKA 99514
a7a—fQ�:)10 PWnklC' 4_ CAV
DESIGN
tit Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:—F;�wmMY t SCOL CtiO9t1= DATE PER
LEGAL DESCRIPTION: L?`f{T�S SAnIDLAV-6*-'-7 Township, Range, Section:
DEPTH SLOPE
(FEET) i—' I I I I --r-
1
2
3-
4
5
SM
6
7
8
9-
1011 10-
11
12-
13
14-
!5W
45W
15-
16-
17-
18-
19-
20
516171a1s20
Slt_r� gAn5,17
wis-u- ct O -AL► �
SAN -D
t-tTTL f3'TONW F/N4S
WAS GROUND WATER
ENCOUNTERED? N O
S
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water After
Monitoring? Date:
SITE PLAN
a
Reading Date Gross Net
Time Time
Depth to
Water
Net
Drop
lo: pct I
:pL'/y
3/
g '12
s/y
PERCOLATION RATE SL (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 6 FT AND FT
:OMMENTS
PERFORMED BY: 97-& ,Jt? ry v�A��t�tJaNG3 �.C3 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: G hz 4
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services 44
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel 1. D. # as> H — B0 — U v HAA #
1. GENERAL INFORMATION
Complete legal description 1—c17_ "g, Q�o`t<t
Location (site address or directions) ! U' 5 ='� i/ � n( J
Property owner Day phone"
Mailing address r`{ a %rte L rat vc�n >a,v "T %'-
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
<1C
NOTE: if community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5.
By:
STATEMENT OF INSPECTION BY ENGINEER.
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 application 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 the date of this inspection.
Name of Firm S«Phone ' -2-'` 21
Address �3ox
Engineer's
DHHS SIGNATURE
v Approved for bedrooms.
Disapproved.
Vi
Date
AP_% Stoven R. Pannone
Conditional approval for bedrooms, with the following stipulations:
The on-site wastewater disposal system serving this property has recently
undergone a Terralift procedure. This is a new procedure in Anchorage, which
attempts to reiuvinate septic system leachfields The success or failure
of this procedure is determined by an adequacy test conducted on the leachfield
30 days LQ 1eraiag-this pr_Qc�ed-u-e—This-systen has n^QGea the In day adA=uioy
test. However, the life expectancy of the leachfield is unknown.
Additional Comments
WTlc
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS 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.
72-025 (Rev. 1/91) BaCk MOA 021
Municipality of Anchorage /
DEPARTMENT OF HEALTH & HUMAN SERVICE C E I v E
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 1@60-41741997
Health Authority Approval Checklisj Municipality of Anchorage
ept. Health & Human Services
Legal Description: 1.l�/r�3 SAN-hI-AkF, -*Z, Parcell.D.: O!i-
A. WELL DATA
Well type A C If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Date completed .3 /.30 /8 Z
Total depth G1/q Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Date of test '3/30 /S?
Static water level
q/ K
Well production -60 g.p.m.
WATER SAMPLE RESULTS:
'2% &<5q&
n
Casing height (above ground) / 2
Wires properly protected (Y/N)
AT: INSPECTION
Ir
g.p.m.
Coliform 0—
Nitrate
001
Other bacteria —0
Date of sample: 16j2( -,[q-7 /
�i / `t ( !S!/ 4 �
Collected by: LF'
/
/ � R, n'Nen1 t�a- f &W -D4 du t(J"1Tj-
B. SEPTIC/HOLDING TANK DATA
Date installed 6 �123Z Tank size 1000 Number of Compartments Z Cleanouts (Y/N)J
Foundation clew' 66Ut (Y/N) Depression (Y/N) High water alarm (Y/N)
Date of PumpingPumper M��oNA
C. ABSORPTION FIELD DATA
Date installed 6 ja l RZ Soil rating (g.p.d./ft2 or ft2/bdrm) Zo6 System type b 't
Length . Ll l Width' 42" Gravel thickness below pipe 17614 Total depth
Effective absorption area656 Monitoring Tube present (Y/N)Depression over field (Y/N)
` ,rte
Date of adequacy test g 1 101 k'Z Results (Pass/Fail) QA,SS For bedrooms
Fluid depth in absorption field before test (in.); 11P Immediately after41-SVgal. water added (in.): 31"
Fluid depth /U° (ins) Minutes later: 2 Y #ip-S Absorption rate = -1lsa g.p.d.
Peroxide treatment (past 12 months) (Y/N) }-104- If yes, give date I
-V- SYsT9-%4 w AS c+.0 -kA v e3D'9'r' 7�4F- -7 r A-G►F-r `PWocam r 6.0ej
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm
E. SEPARATION DISTANCES
on" level at*
*Datum
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO: —'TI}&D(Lrs ^�°u`'��L °'� COT • �«?,�^� ccs
P2Gd To CLASSY Wt—u. grd�-VN�.�ArLdP(�!T`i.
Septic/holding tank on lot / L(2..5 i wn.,PebLo,v'R ce "/pa On adjacent lots /42S^ra cLAss c x toot" -ro CMd0%4
Absorption field on lot /261 WA�JEtoN' LQ �"/�� On adjacent lots /r)c:. 4 -
Public sewer main ✓t/ Public sewer manhole/cleanout ✓y I#,\.
Sewer /septic service line l 3 R t Lift station /Do t
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /2- Property line
zat
Water main/service line 6c) t Surface water/drainage / 60-2p-
SEPARATION
vt
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
r
Absorption field /.7
To GLJV`,,S G '
Wells on adjacent lots i Lt2v�l+Lwv�woNFLa
l � Tbdt#1a2s /��
Property line g'ra It L Building foundation :;, r Water main/service line .50 I
Surface water / mo -41-
Driveway, parking/vehicle storage area
Curtain drain / O O -t Wells on adjacent lots /zb 1Yo ctA
W,AiJ �ON'F'l l d
F. ENGINEER'S CERTIFICATION
l certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signatur
Engineer's Name STZ�S►tJ Q2 �AntNchNt3i�• i5a•
Date 61(o 112
HAA Fee $ Q
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
el( /Do*t oawgxs
PFOFEc nape
. T-GNM
WASTEWATER ABSORPTION SYSTEM
LOT 14, BLOCK 3 SAND LAKE #2 SUBD,
DRIVE
EXIST. P
ZIVATE WELL
NO WE
LSI ON THESE
LOTS
7
!
+I
1
.6' 14
r
Jr
/
PROPOSED
REPLACEMENT
SEPT
SYSTEM, SEE
SHEET 2
THIS L T IS
FOR
ETAILS.
UNDEV LOPED,
NO WE L OR
I I
EXISTING
SEPTIC
SYSTEM
SEPTIC
TOR
MAIN.
EXIST. 3
HR HOUSE
1 3. '
A
EXIST. CLAS
'C' WELL
r —
® d —t.
150 WELL R
DIUS
��
12' WATER
EASEMENT
A -WELL = 129.4'
E -WELL = 103.5'
SEA VIEW DRIVE _
�(®qAM•®*� ��®Y
4-14
492i`: z®m� �` 3 35'
u.�. . ... mu..........
® Drawing C,\ \14-3SAND.DWG
a . ........ PREPARED FORS._
�'.Steven R. Pannone,P• 8 TAMMY &SCOTT COPE
CE 81
AV 8140 Seaview Drive
®�•®+®9 ��_�907) 248e AK 99503
DESIGN,
Perc Rate = 1.25/Min/Inch
Soils= 125 sf/lo l
3 Bedroom Houe
375 SF Rqd /
Design, 6' Vfective
9' Total pepth
3' Wld�!Z5' Long
Tota -V Absorotlon = 420 sf
Pannone Eng, Svc,
P. O. BOX 142025
ANCHORAGE, ALASKA 99514
272-8218, PHONE & FAX
ATE, 6-15-97 DESIGN
CAL -Ft 1'=An'
WASTEWATER ABS❑RPTI❑N SYSTEM
LOT 14, BLOCK 3 SAND LAKE #2 SUBD.
1:-'vV-- -7'n0 6" AMM �/ otv 1
EXISTING SYSTEM
�TO REMIAN. t
PROPOSED SYSTEM,
Z' EXISTING SYSTEM
35 LF, 6' EFF, 3'
9' TOTAL DEPTH
CO C D
T1 25.4' 13.8'
f
T2 30.3' 21.7' ,i
4_6.7' 52*-
TP I 22
t
EXIST. 1,0008
f
SEPTIC TANK,
VERIFY INTEGR Y,
C
REPLACE IF FOU
LEAKING, OUTSIDE
EXIST. 3BR
THE 150' RADIUS.
HOUSE
THIS LOT IS UNDEVELOPED,
NO WELL OR SEPTIC. 1
(
EXIST, CLASS C
L. WAIVERS TO
SEP FIELD & TANK
)I}
ARE ON EAT ADEC.
— — — —
f
— — — — —
150' WELL RADIUS
— — — — —
— —
C.L. SEAVIEW DRIVE
6'
3' 35'
Irawing C,\Work\14-3SAND.DWG
'REPARED F❑R1
TAMMY &SC❑TT COPE
8140 Seaview Drive
Anchorage, AK 99503
(907) 248-3857
DESIGN,
Perc Rate = 1.25 Min/Inch
JVIIm- 1LN �I / "r
3 Bedroom House
375 SF Rqd
Designs 6' Effective
9' Total Depth
3' Wide, 35' Long
Total Absorption = 420 sf
Pannone Eng, Svc,
P. O. BOX 142025
ANCHORAGE, ALASKA 99514
272-8218, PHONE & FAX
DATEt 6-28-97 DESIGN
Time
Time
Date
Septic Tank Size
Date
Inspector
Inspector
Date
Inspector
() Approved Bedrooms
( ) U,_e:. aved
diilanal Approval
Cate
c� -a—� W V
Date Sewer Installed
Permit No.
Septic Tank Size
Holding Tank Size
Soils Rating
Well To Absorption Area
Well Log Received
Well to Tank
APPLICANT. FILLS OUT LOWER HALF ONLY
Property Owner li t#Tv i s
it , . Phone
35,1 _ 13 3
j
Mailing Address q70
Or 7
Buyer
Address
Phone
Lending Institution
Address
Realty Co. & Agent l
y CPhtyer I �rlcvr frs Iwi Phone
1
c��
Address x301
)
4r'lit AItJ
Legal Description q3
v( /-Ck�
Street Location
Type of Residence
X Single Family
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
❑ Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June
drilled prior to that date, give well depth (attach log if
N Community
1975. For wells
available.
El Public Utility
Sewage Disposal
d Individual
Year Individual Installed:
When Connected to Public Utility:
❑ Public Utility
❑ Holding Tank
EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
NOTE: THE INSPECTION
FEE MUST ACCOMPANY
i NAIIH(INNIFNTAL. PIaO f I ION
(Permit #: 820203
January 31, 1983
TO: Permit Applicant
Subject: Lot 13 Block 3 Sand Lake Subdivision #2
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
Fn on c �l�
' ^~ DEPHRTMENT HEHLTH HND ENVIRQ[,-jMENTHL PROTECTION
825 /L' STREET, HNCHORHGE, HK 99501 '
PERMIT NO ( 82020] )
HPPLICANT H8LTQUIST CONST. INC 4761 MHRS DRIVE 99507 ]44~91]]
LOCHTION
LE�HL 1-1] SAND LRKE #2 LOT SIZE 6500 FEET
MHXIMUM NUMBER OF BEDROOMS = ] SOIL RHTING (SQ FT/BR)= 206
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
121 Eol U-1 =,.:� ����r-A C-I'l - 1-1 =51 37 "If 1:1 FTZ FA V 107 U. ������ �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES.
THE QRAYE1. DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE
HND THE GOTT(.".lM OF THE EXCHVHTION (IN FEET).
W 1111: 1-1 U ME � 40 K W -V 1 17 W "-,- PA �I WE KV= ����C-.9 F-1 -C.D� 31-j.,
PERMIT HPPLICHNT HHS THE TO INFORM THIS DEPHRTMENT DURING THE
I1STHLLRTI8N INsPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMBER OF FREES, IDENCES THAT THE WB_L WILL SERVE.
�-P lVA 17 501 M EVE IT! ERE C7.2 U l IF C,
BHCKFILLING OF FNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTIONL
MINIMUM DISTANCE BETWEEN H WELL HND HNY ON-SITE SEWHGE DISPOSRL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UF'ON THE TYPE OF PUBLIC WELL
MINIMUM D,'( -c; -F!.: -INCE FROM H PRIVHTE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIRE�ENTS MHY HPPL\! SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE
K&FRA-1 1: -y- QW41"A I ED, W (V 1=7 M F"w M IFIC A: M... ����
I CERTIFY THHT
U I HM FHMILIHR WITH THE REQUIREMENTS FQR ON -TATE SEWERS HND WELLS AS SET
FORTH BY THE Mi/NICIPHLITY OF HNCHORHGE
2: I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES.
]� I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE
RESIDENCE Is REP! C)DEll- �D TO INCLUDE M8RE THHN ] BED�OOMS
ISSUED
HPPLI�HNT HUL��UIST CONSTINC
�
El.
�~DHT .Q��^- V40 '
' SOILS LOG
MUNICIPALITY OF ANCHORAGE
\\\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST t/
PERFORMED FOR: S q�'>� 'E h't e t t-i5a DATE PERFORMED:_.
LEGAL DESCRIPTION: Lorg0 I J
DEPT )y ; Jj ?/.��
2 OVIL).
3-
- —4
10-
11
12
13—
14—
15—
16—
17—
18—
19 —I
20 —
COMMENTS
PERFORMED BY:
72-008 (6/79)
'54441 Lake
Reading
WAS GROUND WATER
No
Net
Time
ENCOUNTERED?
Net
Drop
IF YES, AT WHAT
DEPTH?
n
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
n
Bei
_
/0 f j n /}
>2Jb6.2 :.-- `� I (i V ?�.Ygl
4.0
PERCOLATION RATE
p�
(minutes/iQ*
uoo••ao•
TEST RUN BETWEEN
'' r�' "i��— FT AND
Fjs`�,r. _ _
e'-Izir;v ori
r2A/1?v
_
/0 f j n /}
>2Jb6.2 :.-- `� I (i V ?�.Ygl
4.0
PERCOLATION RATE
p�
(minutes/iQ*
uoo••ao•
TEST RUN BETWEEN
'' r�' "i��— FT AND
Fjs`�,r. _ _
e'-Izir;v ori
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT r
Plans for the construction of �A/�7 &ar S o bw oxsiaN # �2 t'i JGf, (C 0�17
Gbit 13 71 r • 19 r d/O mc r� h e2 -U -CE A-1 G( public water system located
inI7Kcku�-f' ,Alaska, submitted in accordance with 18 AAC 80.100
by &4I"�r� c I N L� c, eC V -S have been reviewed and are
0 approved.
❑ conditionally approved (see attached conditions).
(,¢i d® lttr i'+ ri_r1i a iil u I t 'yt t h e (' V l O �--
BY L DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no. Approved by Date
or descriptive reference)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the 8*Xy%eJ 1 ,A IC /p f , �_ �C �'ts !� �/ public
water system was completed on 6_tL k e T_ cZ— -(date). The system is hereby
gra d interim approval to operate for 90 days following the completion date.
,4�f4P 7- 7" T£_
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
kfin,Kapproval to operate.
BY TI LE DATE
NOTES
I NO SURVey WAS PERFOrmED FOR MiS pLAT
2. ?dE pURPO~ OF THIS SURVi2y IS TO CHANGE T~O LOTS iNTO ONE LOT.