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HomeMy WebLinkAboutT13N R3W SEC 22 LT 57B ~ Municipality of Anchorage Page ! of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report PermitNumber: ~/~0~5-~- PIDNumber: 0o~ ~ I1~ hlccr'7 , ¢ ~mt'~ Wastewater System: ~ New ~ Upgrade Address: ~ ~/ ~ ~h~ ~/~ ABSORPTION FIELD ~ho.~: ~X~ -~¢ l~°'¢~dr°°m~: ~ Deep Trench ~ Shallow Trench ~B'ed ~Mound LEGAL DESCRIPTION so, Rating: Total De~th from original grade: G PD/Sq. Ft. Lot: 6L~ ~ ~7~ Ft. Ft. Township: Range: J Section: Fill added above odginal grade: Grovel length: I Ft. Ft. WELL: E~l~ New g Upgrade GraveJ width: Number ol lines: J Dislance~etwee~lines: Ft.J FL Classificsgon (Private, A,B,C): Total Oepth: Cased TO: Total ~bsorpLion ama: Pipe material: Ft Ft. SQ. FL ~ ~ Driller: DateOdlled: S~aticWaterLevel: Installer: t ~¢~t~ ~ Date installed: Yield: GPM JP"mp set at: Ft. Jcasing HeightAbove GroundFt. I TANK SEPARATION DISTANCES ~Septic ~ Holding U S.T.E.P, Material:5 ~e¢/ Number of Co%artments: Well 1 ~ Surface w~t~r > ~m' LIFT STATION LineL°t j~_~ Size in gallons: J Manufacturer: Foundation 7I "Pump °n"leve' at: ~ "Pump °ff"leve' at: I High water alarm ah Curtain Pump Make & Model J Electrical Inspections performed by: Drain Remarks: prtor ~e~bk ~n~¢ p~p~r*y BENCH MARK I Assumed ~ ENGINEER'S SEAL Inspections performed by: Fta~ff ~.~¢c. Dates: 1st q/~/9} ~C~O. a~T~ 'A~' ~'~ 2nd' ~~,~,~ Department of Health and Human Services approval ~ , ~.~o~o,:~ ~. ~oo~: 72-013 (Rev. 9/91) MOA 25 Permit No. .SC,,-' 9.~ OOS",p~' Page ~ ' of. ~- Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343~47'~:':::+ On-Site Wastewater Disposal System and/or Well InsPection Report LegaiDescription: elf"/ /-.,o/' 5"7~, ~'¢c~o,,-~ ¢_.~ ']-13Ni R3t-</ PIDNo.: 1 I" =- ~O' 5~Prec T",4NI~. NO bl-r_gr41.z 72-013 A (2191) MOA 25 Flattop Technlcal Services 14530 EchO Street 'Anchorage, .~!aska 9951~ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930055 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:SMITH MARY V OWNER ADDRESS:4743 E NORTHERN LIGHTS BLVD ANCHORAGE, AK 99520 DATE ISSUED: 4/08/93 EXPIRATION DATE: 4/08/94 PARCEL ID:00632112 LEGAL DESCRIPTION: Tt3N R3W SEC 22 LT 57B LOT SIZE: 24800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR T~ EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. RECEIVED APR 8 1995 Municipality of Dept, Health & Human ~!atto~ Technical Services 14530 Echo Street Anchorage, Alaska 99,~ ~ 8LP/ /-oT $7&, $~C ~_2., 'T'/3/V/ R,BI,/ ,S ~ PT~ C TH-N I~ t" " 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 PHONE LEGAL DESCRIPTION ~ DISTANCE TO: k~,5 ~ ~ Manufacturer Material No. of compartments 0 ~ ~ Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot )inex~ PERMIT NO. -- ~1 ~ inches ~ Top of tUe to finish Or.do ~'0' Matori.I ben.a,h tile 'G~ 0'[ inch.s Total .ff.ctive absorption aroa w Building foundation Nearest lot line ~ DISTANCE TO: C ss , Depth Driller Distance to lot line PERMIT NO. OTH[~ SOIL TEST RATING XO~ ~ INSTALLER -- · k ~ 3o OVED DATE LEGAL PERMIT NO. HLIN I ¢ I PAL I TY OF DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE: AK. ~501 ON--S I TE SEWER PERM I T 780904 > RPPLICRNT LOCATION LEGAL LOCKWOOD HOMES INC 461i BUSINESS PARK NO LIGHT BLVD TI~N R~W SEC 22 L57 LOT SIZE 2760904 24915 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH MAXIMUM NL~BER OF BEDROOMS = 4 SOIL RATING THE REQUIRED SIZE OF THE SOle ABSORPTION SYSTEM IS: [~EPTH= --g LENGTH= .~.7_..4 G RA~EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD THE DEPTH OF R 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 15 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. RE[~Li~I RED SEPT I C TRr~K $ I'ZE= ~L250 GRLLON$ PERMIT APPLICANT HAS THE RESPONSIBIL~TY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJRCENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. Tt~lO ( 2 ) I ~SPECT I Or~S ARE REnU I RED 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 100 FEET FOR R PRIVATE WELb OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MRY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERt4 I T EXP I RES DECEMBER ~'1 . ~L97~ I l: FORTH BY THE MUNICIPALITY OF ANCHORRGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT RESIDENCE IS R~jE~OD~.~E[~..~) TO~NCLLIDE MO/RE THAN 4 BEDROOMS. ......... CERTIFY THAT I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET If THE V12 mUNICIPALITY OF ANCHORAGE Heal · and Environmental Protec/ Fourth Floor West 825 L Street Anchorage,. Alaska 99501 279-2511, x 224, 225 .,,./) J, NSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: FROM WELL .... MANUFACTURERE~~-_ MATERIAL--_F~OMPARTMENTS -- --' H --/~LIQUID CAPACITY/'~"O~ALLONS INSIDE LENGT~ - ___ INSIDE WI©I~'~- LIQUID DEPTH % of Lines / DISTANCE BETWEEN LINES ABSORPTION AREA_3i~"~ SQ. FT. LENGTH OF EACN LIINE DEPTH OF FILTER ~.~. DEPTIh TOP OF TILE lO FINISH GRADE_~.~__/ MATERIAL BENEATH TILE_ IN. ABOVE TILE ¢~./,),[ TOTAL LENGTH¢.~ / NEAREST LOT LINE___~c__ OF LINE TRENCH WIDTH---- IN. TOTAL EFFECTIVE IN. SEEPAGE PiT: Log Crib Rings BU I LDI ~.IG FOUNDATION___ DIAMETER _ OR WIDTH , LENGTH ., DEPTH Crib Size: DIAMETER____DEPTI4_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE _ . ABSORPTION AREA (WALL AREA) SQ. FT, Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Material~: # of Bedroqms: Installer:~g~-/~/~)~ Remarks: DAFE¢--m--7 APPROV J -- Pb_l~i:i',lZ I NU. ,' BE~FIF~.¥fqENI LI- EHL. IH HNU EN',/I~ONMEN]RL laK. FIi::'I:'L :[ Clan I ' L..I_)C:H J i i]]iN L.~GHL LO'F SIZE 5:44-8588 ~4'_a'l~ S~]:!UlaRE FEE] . i"¢PE I:.IF ..,_ J.L -6::,_F.E I I .lq ...Y..,1Ei'l JF..EIqUH l','lFl:,~:]:l',liJi',l NIJME:E[: CtF ~EDF<'CI]II"IE; = % ..,T-, EM I=,. IFIE REt~:!LIII4IEI} S:[ZE CIF THE E;I'.]IL FIEISIiIRF'I'IOi",I '::'":' :: '"'"' tHE LENL~IH DIMENSION IE; I-HE I_ENGIH (IN FEEl'> OF THE 'FRENCH OR DRRiNF1ELD. THE DEI='rH I]F la I'RENCH EIR F-'I/' I% THE [)iSI'laNCE BETWEEN "tHE SURFRE:E OF: 1HE CiROUNL:, FIN[)I'HE BOI'fOM OF THE E,':..';Cla~,,'la'flON (iN FEE'J). iHERE iX NO %E't 14iDI-H F:'OI-4 FRENCHES. iHE I.JRFI'v'EL DEPiH IX THE MINIMUM [)E[:'"I-H OF' GRFIVEL E~E'IWEEN THE OUIFlaLL PiPE FIND THE BO I'I'OM OF ]HE E;,.,,'CRVRTICIN <IN FEEl':.',. H PFICKR(¢E Pt_laN] Mla¥ BE iN2E;TFILLE[:, la'i' THE PERMIT'f'EE"S OF'I iON SUBJECI' /'O IHE FULLOWiNEi CONDI i'II])N:~;: t. EI'i'HER R CLRSS I OR II NSF RPPROVE[:, PLIANT MA'¢ BE .[NS'i'RL. LEC,. R CONIINUOUS MRiN]ENRNCE 8GREEMENT IS RE~:!LiIRE[;,. iF R MRiN'i'ENRNCE R~SREEMENI' IS NOI- KEPI' CURREN'F k'OU MR'¢ BE REg!UZRE[) TO ENLRRGE THE SOIL. FIBSORPI'iON S~STEM RND,..'OR '¢0U MRM BE SUBJECT "10 PROSEC:UI'ZON. i=FICKFILI_.INI3 CIF FIN¥' ¢'LIEf WI'IHI]IJ]" F'INRL ]N'=PEI:TiCN RN[) laF'F'RO'v'RL b,T 'l'HI~; t.)b. FHN. tflb. f~t [,IZL. L E:E ..,UL,.JE...I l'O PRI]$ECU"I'ION. MiNiP1UM [:,ISTRNCE BETWEEN la WELL laND laNk-' ON-SITE SEWlaGE QISPOSlaL SYSTEM i5 FEEt FOR R PRiVRTE WELL OR 2E~C~ FEET FOR ~ PUBLIC WELL u'iHER RE~J)UfREf,IENJ'S Mla'T' 8PPLY. SPECIF.[E:RTiONS 8ND CONS"IRUC:TION DiRGRF~MS F~RE ~'¢BJ. LRBLE tO INSURE PROPER INSTRLLRTZON. :,E[~bN.=, FINE) b.tELL--, H- SE'F i: i lar'i PFIF~:[L]:RR WI]H THE REi%!IJlF.':EMENT5 F'i]R ON-SITE ' ........... ' FCIK'iH bJr I'HE f'l_tf~l_.tl=HLl T CIF Hf4uH. NHI3E .~r_tEM IN RF:-':fiRL:,RN';E WITH THE CN _.II'E _EUEt~. =,T-, E. fl MAY' REg!L.tIRE ENLflN.~EHENI 11:' 'IHE NE:x;ZDENCE i5 R~:P'IL~i)Et_E[., "10 .[NCLLt~).¢.,?'ll]RE /HlaN 3: DEPARTMENT, OF HEALTH AND ENVIRONMENTAL PROTF, CTION ' ' ~ ~ Pouc/~-650~ 995021' - '~25i8 ~. ~udor R~ ~ AnchOrage, Alaska · Legal Description[~/~~ ~~ 7~'--~ ~ 't'his fom reports. ~oiis log ~ Percolation test '.~ Depth Feet ./ .3- lO- ll- 12-- 13- Percolation rte minute, Proposed installation: Seepage Pit .... Drain Field ' I~epth of Inlet . Depth to-bottOm of pit or trench -- Purformed By:/~'~-~z'Y/~,~z:~ Certified By~ ~ ~ Date; · ~-~'~' '" ' .,~/~ I T I Reading ' Date ] GroSs Tin]e Net Time Depth to H20 Net Drop ) Was'ground water encountered? /~//~:~ If yes, at what depth? GAAB-HD-I Gr~';~ATER ANCHORAGE AREA BOROI'~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION /L/v Z ~-5. }~ J~EGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELl_ L,QU,D CAPAC,~¥ /,'2~ GALLONS. NUMBER OF / COMPARTMENTS SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIA[ NEAREST LOT LINE SEEPAGE PIT: / OUTS,DEO,AM TER ORW,OTH .D,STANCEFROMWEL, // -'~ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,LENGTH /4 , DEPTH .~ · BUILDING FOUNDATION TILE DRAIN FIELD: DISTANCE FROM WELl NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION NEAREST LOT LINE TOTAL LENGTH , OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE SQ. FT. LENGIH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE ~'~/~ . DEPTH ~2- ! LOT LINE (~('~ / NEAREST ~ / SEPTIC , SEWER LINE . ,TANK DISTANCE FROM /7 / ' WATER , BUILDING FOUNDATION SAMPLE ~ , NEAREST ~,~,/ SEEPAGE / .~ _ OT.ER , SYSTEM //~'- ESSPO0[ , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED G~AB-H D-2 Case No. GREATEI ANCHORAGE AREA L )ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS / , SEEPAGE PIT ~ ,DRAIN FIELD FINANCED THROUGH TO BE INSTALLED BY PERCOLATION TEST RESULTS ~ ~c'/-'~ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT /z~-2~,,~MAILING ADDRESS /:7~/~,~ _;~),~ PHONE NO.'~.~"'~-~2~.,~' LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY THIS IS TO SERVE AS &~ ~'~'~;~ ,PERMIT TO INSTALL A f~'/-- AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~- . SEPTIC TANK SIZE /~ 0~ TYPE SEEPAGE AREA DIAGRAM OF SYSTEM DISTANCES: Health Authority I certify that I am fami~ar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. ~-"MUNICIPALITY OF A~CHORAGE~'~/ DEPARTMEN, OF HEALTH AND ENVIRONMENT, ~r~OTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: April 7, 1978 #1: Time 3:15p.m. #2: Time #3: Time Date 4-10-78 Monday Date Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Security National Bank Mailing Address: 880 H Street 99501 Phone: 278-1541 2. Property Owner: Walter W. Smith Mailing Address: Box 1378 99510 ~3W Section 22 Lot 57B /T 3. Legal Description:~13N ~ 4: Single Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) Phone: 333-8084 Three Number of Bedrooms: o Well System: Permit ~ Construction Individual well (x) Community/Public System ( ) Depth of Well 45' Well Log on File Bacterial Analysis ( ) 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 1977 Installer Septic Tank Size Absorption Area Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE' Department of Health and EnvironmentatlPr6tecti'on 825 L Street, Anchorage, Alaska 99501 264-4720 ~equest for Approval of Individual Sewer and '~ter: Facilities Mailing 'Address: 2. Name of Buyer: Mailing Address: Phone: e Lending Institution: Mailing Address: Phone: 4. Realtor/Agent: Mailing Address: Legal Description: Street Location: Phone: 6. Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:. *Individual Well ~) Public/Community System If Individual Well, well depth z/...~' ( ) If Community System, name of system 8. Sewage Disposal System: *~n-site System ~) Public System ( ) If On-site System, date of installation: ?~ ~ /- 77 *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 Two ' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: T13N R3W Section 22 Lot 57B Comments: Affadavit Attached: Approved: Disapproved: Letter Attached: ( Date: bepartment worksheet: (ep!, ;.q;o ea$) --O]OIAOU~ ]gVU]AO0 ]9NVUflSNI ON 008£ I~6! maud i~aelsod snle ~O£--'IIVIAI O31.-IIJ.~30 ~lOJ A~)ril 10, I97~ ~lohorage~ Alaska 99510 1978. It wag note~ ~hat %h~ well i~ in a pit. level. ~.~n ~onn~cte~ to the S~%itarim~ this office at