HomeMy WebLinkAboutSKYLINE VIEW BLK 1 LT 28kyl ine View
lock I
Lot 28
051 - 192
-27
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: osP1011~,¢ I PID Number: o514111~1~
Name:
Lester and Susan Scheunemann Wastewater System: [] New [] Upgrade
Address:
P.O. Box 670744 Chugiak, AK ABSORPTION FIELD
Phone: Number of Bedrooms:
3 [] DeepTrench [] Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION soil Rating: Total Depth from odginal grade:
GPD/Ft~ Ft.
Block: 1 Lot: 28 Subdivision:~-:~,,e~""ne View Depth to pipe bottom from odginal grade: Gravel depth beneath pipe:
Ft. Ft.
Township: Range: Section: Fill added above odginal grade: Gravel Length:
Ft. Ft.
Well: [] New [] Upgrade Gravel width: Ft. Number of lines: Distance between lines:Ft,
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
~-x~sung Ft. Ft. Ft2
Ddller: Date Ddlled: Static Water Level: Installer: Date Installed:
Ft. Stuart Gilbert 8/19/10
Yield: GPM Pump Set at: Ft. Casing Height Above Ground:
Ft. TAN K
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~ Septic Absorption Lift Holding )ubl[c/Private Manufacturer: Capacity:
Tank Field Station Tank Sewer Line Anchorage Tank 1000
Material: Number of Compartments:
Well 80 .... >100' N/A N/A >25' Steel Two (2)
Surface WaterLot Line>5'>100' >100'>10' N/AN/A N/AN/A ~ Size: Gal. Manufacturer:LIFT STATION
"Pump on" level at: "Pump oft" level at: in. High water alarm at:
Foundation >5' > 10' N/A N/A in. in,
Curtain Drain None Noted Pump Make & Model Electrical Inspections performed by:
Remarks:
Existing Septic Tank Pumped, Crushed and Backfilled. BENCH MARK
Location and Description:
Septic Tank Only and Two Post Tank Cleanouts Placed Rear Deck Southwest Corner.
Assumed Elevation:
Under this Permit. Ft.
***See Waiver to Adjacent Wells.
Inspections performed by: U. Anderson Dates: 1st 8/19/10
2nd 8/19/10
Development Services Department Approval
Conditional Approval Date:
I
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 995'19-6655 - 343~7904
OmSite Wastewater Disposal System or Well h3spection Report
Permit Number: OSP101138
Page 3 of 3
No. 05! -I 11-59
Tank Only Repiaced Under This Permit. Existing Tank Pumped, Crushed
and Backfilled on Site.
PROFILE AS-BUILT
No Scale
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System
OSP101141
05119227000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: August 10, 2010 to
Design Engineer: ANDERSON ENGINEERING
Subdivision: SKYLINE VIEW
Site Legal Address: SKYLINE VIEW BLK 1 LT
Own er/Add ress:
August10,2011
28 G:1159
SCHEUNEMANN LESTERW& SUSAN B
PO BOX 670744 CHUGIAK AK 995670744
Site Mailing Address: 19376 DOGWOOD ST, Chugiak
Permit
Lot Size in Sq Ft: 16050
Total Bedrooms: 3
[.) (;l) a r t m e ~ t
This permit is for the construction of:
N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
Date:
Municipality of Anchorage
ONSITE WATER & WASTEWATER PROGRAM
CHANGE ORDER
PERMIT # SP101t'Li"I
PID No' 051-192-27
SUBD SkylJne View
TRACT BLOCK i LOT 28
CONTACT PERSON Michael E. Anderson, P.E. PHONE 522-7773
FAX 677-7766
PLEASE GIVE A DESCRIPTION OF THE CHANGE: Only :1.2" of drop exists between the existing foundation cleanout
and the distribution line of the absorption trench on this lot. It is not possible to place the new septic tank
outside the protective radii of the wells on Lots 9 and :LO of Tundra ]ewel Ranch Subdivision to the north of this
lot. We have therefore moved the septic tank to the north side of the trench and outside the :LO0' protective
radius of the well on this lot, but closer to the well on Lot :LO to avoid the contaminated area of the existing
septic tank. A request to reduce the separation distance to the well on Lot :LO is attached. We request a quick
review to allow replacement of the tank which is leaking excessively at this time.
on:site
Revie~~
APPROVED(date)
Comments
Issued
(date)
Review
Time
(hours)
HOURLY RATE
TOTAL TO BE PA_rD
DATE PA_rD
$130
RECEZPT #
Municip=ali=ty o[ A___nc~ho___rage
P.O. Box 196650 4700 Elmore Road
Anchora~qe, Alaska 99519-6650 ® (907) 343-7904 · Fax (907) 343-7997
http :llwww.muni.or,qlOnsite
Development Services Department
On-Site Water and Wastewater Proqram
**** VARIANCE/WAIVER REVIEW ****
WR#: OSX101003 HA#:
PID#: 051-192-27
Legal Description: Skyline View B1 L28
Engineer: Anderson Enqineerinfl
Permit: OSP101141
Applicant: Lester Scheunemann
Your request for a waiver of the required 1 O0 feet horizontal separation from the septic tank to
the private well has been approved., e approved
ovx '-Ftx~ -d~ ~o~ ~ ~ro~cl~ L¢~t/T~, separation distance is 80.0 feet.-[0 -~x~ ~d~ I'l
This waiver approval applies to the existing septic tank to private well separation only. Any
future upgrade to the on-site wastewater disposal system will require all separation distances be
met or another approval from this department.
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Waiver is Granted: X Waiver is not Granted:
Rec~: 062160 Amount: $1,050.00 Date Paid: 8118110
**** VARIANCE/WAIVER REVIEW ****
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www. muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-192-27
Property owner(s). Lester and Susan Scheunemann
Mailing address P.O. Box 670744 Chugiak, AK
Site address 19376 Dogwood Street Chugiak, AK
Day phone
Zip Code 99567
Zip Code 99567
Legal description (Sub'd., Block & Lot) Lot 28, Block 1, Skyline View Subdivision
Legal description (Township, Range & Section)
Lot Size 16,050 Sq. Ft. Number of Bedrooms
Three (3)
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P,O. BOX 240773
ANCHORAGE, AK 99524
522,7773 522'6779 (FAX)
August 3, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 28, Block 1, Skyline View Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The septic tank on Lot 28, Block 1, Skyline View Subdivision has failed and must be
replaced. We are proposing to replace the tank with a new 1,000-gallon steel septic
tank to serve the three-bedroom home on the lot. The existing absorption trench will
remain in place for reuse. We are therefore requesting a permit be issued for the
construction of a new septic tank on the lot. The attached Site Plan and backup
documentation identify the location and configuration of the existing septic system and
the location of the new tank. Also identified on the plans is the existing well on the lot
and those on adjacent lots. The existing tank falls within the radii of three wells. The
new tank will be placed more than 100' from the well on this lot and those in the area.
The existing tank on the lot will be properly disposed on the property. The lot is virtually
flat and drainage patterns will be maintained after construction.
The ground surface on the lot is basically flat in the area of the new tank and in all other
areas. The new septic tank will be constructed near the location of the existing tank
and as parallel with the slope of the land as possible in conformance with Municipal
requirements.
If the tank is constructed in accordance with our design the following statements apply:
The tank, if constructed as designed, will have no adverse impact on the wells in
the area or those to be constructed in the future.
The tank, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
Lot 28, Block 1, Skyline View
August 3, 2010
Page 2 of 2
The tank, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The tank, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
August 18, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Attention:
On Site Services Engineer
Subject:
Lot 10, Tundra Jewel Ranch Subdivision
Lot 28, Block 1, Skyline View Subdeivision
Separation Distance Waiver Well to Septic Tank
Dear On Site Services Engineer:
The well on Lot 10, Tundra Jewel Ranch Subdivision is located approximately 88' from the
septic tank on Lot 28, Block 1, Skyline View Subdivision. The 100' separation distance between
the well and the septic tank was waivered to 88' in March of 2003. Since that time the septic
tank on Lot 28 has failed and is currently leaking and must be replaced immediately. The septic
tank is currently located inside the 100' protective radius of the well on Lot 28 and will be moved
outside the radius to meet current code. It must also be moved to the north to avoid
contamination from the leaking tank and maintain 5' separation from the absorption trench. We
are therefore requesting the waiver from the well on Lot 10 be reduced to 80' to provide
sufficient room for placement of the new tank.
The well on Lot 9, Tundra Jewel Ranch Subdivision currently has a waiver allowing the
protective radius to be 80'. Allowing the new septic tank to be 80' from the well on Lot 10 will
not increase the risk of contamination to the well. It will also allow the new septic tank on Lot 28
to conform with the 100' separation distance from the well on Lot 28.
The well on Lot 10 is 262' in depth and cased to the bottom. The aquifer supplying the well is
243' below the surface and protected by a clay layer from 90' to 121' which is typically
impermeable. The static water level is at 185' below the surface. Any contamination from the
surface would pass through multiple layers of sand and gravel before encountering the clay
layer. Water would then flow laterally along the clay layer and may never reach the aquifer.
The septic tank to be installed is manufactured by Anchorage Tank to the Uniform Plumbing
Code and is 5' in diameter and 10' in length. It is coated with coal tar pitch on the interior and
exterior. The bottom of the tank will be approximately 9' below ground.
The ground surface of the lots in the area are generally flat with a high mound of vegetation
between the well and the proposed septic tank on Lot 28. An overflow of the tank or the
Lot 10, Tundra Jewel Ranch
Lot 28, Block 1, Skyline View
August 18, 2010
Page 2 of 2
absorption trench would be away from the well. We are confident the possibility of
contamination of the well on Lot 10 from the septic system on Lot 28 is slight to nonexistent.
ADEC POINT ANALYSIS
Bottom of Tank to Highest Water Table - 181'
Soil Absorption Type - Clay and Sand
Permeability - Sand and Gravel
Water Table Gradient - 0%
Horizontal Separation - 80'
8.00 Points
2.50 Points
1.00 Points
2.90 Points
2.50 Points
TOTAL POINTS
16.9
Almost sure to be free from any form of contamination from household sewage.
Attached are the well log and other drawings showing the proximity of the existing septic system
to the well. We hereby request the waiver be issued and the septic tank construction permit be
approved.
Sincerely,
Michael E. Anderson, P.E.
Attachments
~ 22 25 4 7
I-- 0
u') 0
u3 0
- 24 5 6
Avenue
· ..*~ ~
SKYLINE VIEW SUBDIVISION
LOT 28, BLOCK 1
16,050 S.F.
Existing AbsorpUonTrench
37' Long x 2.5' Wide
x 6' Effective Depth
Existing
Wellf Existing
/ ~ Well
/ ! 150.00
/// /0' Utility Easement
Pump, Crush and /! /
Abandon Existing / ! /
Tank in Place, / / /
Place New 1,000 / / /
Gallon Septic / ! / /
Tank, and 2 Post 1' ~-~ / /
Tank Cleanouts. ]' ~ / /
· /
/
B /gxisting
m __ //' Well //
/ /
/
-FCO /×
\
X
\
\
NOTE:
Verify Presence ond Location of All Wells
in the Area. Registered Land Surveyor to
Stoke oil Well Ro~:lii.
LEGEND
SV - Septic Vent
CO Cleon Out
MT - Monitor Tube
TH - Test Hole
SITE
PLAN
SCALE 1" = 50'
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 28, BLOCK 1, SKYLINE VIEW SUBDIVISION
GENERAL:
The scope of this project includes the pumping, crushing and backfilling of
the existing septic tank on the property and the procurement and placement
of a new 1,000-gallon septic tank and two post tank cleanouts at the location
shown on the Site Plan. Work also includes the placement of a foundation
cleanout, if necessary and connection of the new tank into the existing
absorption trench. The new septic tank must be placed as far as possible
from the existing well on the lot and 100' from all private wells and any
surface water in the area and 10' from the water service line from the well. A
minimum of 4' of cover is required over the septic tank. The foundation
cleanout must be replaced if one is not found on the property.
Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department Building Safety Division On-Site
Water and Wastewater Program for system installations. Owners installing
their own systems must receive prior approval from the On-Site Water and
Wastewater Program before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000-gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 28, Block 1, Skyline View
August 2, 2010
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION: - EXISTING ABSORPTION TRENCH TO REMAIN IN
SERVICE
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below ground must be perforated.
Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. All pockets of unacceptable materials must be removed and
replaced.
Lot 28, Block 1, Skyline View
August 2, 2010
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as-built of the completed system.
~.. MUNICIPALITY OF ANCHORAGE
' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
!~'~ ~. ,~/t ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Teleplmne 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~ PHONE J~.N EW
LEGAL DESCRIPTION
Well qR 1~ Absorption area 2V7
/~ ~ Dwelling PERMIT NO,
DISTANCE
TO:
~<~ = Manufacturer ~2~ Material
Inside length Width Liquid depth
Liq. capacity in~allons
//)~ IF HOMEMADE: ~ ~
~O ~ DISTANCE TO: Well ~/ /~ Dwelling PERMIT NO,
~ ~ ~ Manufacturer/~ Material Liquid capacity in gallons
~, DISTANCE TO: Well /~ ~ Foundation ~/ ~ Nearestlotline ~__ PERMITNO. ¢~ __
~g_ No. of lines / Length cl, lin[~)~ Total length of linet~,~¢. Trench ~d~,~j inches Distance between lines
~ ~ Top of tile to fin,Mb grade ~ Material beneath t, le 92 inches Total effect,ye absorl~¢n ~rea ~¢ ~ --
Length Width Depth PERMIT
~ Type of crib Crib diameter Crib depth Total effective absorption area
u~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class~/,~/2~ ~ ~epth Driller Distance to lot ]ine PERMIT NO.
~~ Building ~oundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
r
~ /~'~-~,'.~' ........ ,,. .... ,~,~,,, . - , ,~ ~.~
/ /
72-013 ,3~78)
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta~ ?rotection(~
825 ~ Street, Anchorage, AK. ~501
264-4720
* * * HANDWRITTEN PERMIT * * *
WB~k_A. ND/OR=ON-SITE SEWER PERMIT
Mailing Address: /70,~,~'~' 7
Lot Size: ~
Holding Tank:
Location: ~-~-~--~ Phone Number:
Legal Description: ~_ ~/~./ ~,~'//1~ ~/t~,
Type of Soil Absorption System Is:
Trench: ~ .... Drainfield: Seepage Bed:
Maximum Number of Bedrooms: .~'~ Soil Rating(sq.ft/br) /~
The Required Size of the Soil Absorption System Is:
DEPTH ~ LENGTH ~3 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 SEPTIC(HOLDING) TANK SIZE = ~[~ GALLONS * *
Permit applicant has the r~sponsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * *
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 ~esidence is remodeled to include more that/ 3~droom~//~
Signe~: ~ ~F~-' Issued by: ~(~_-~)~-~/~ .~
Applicant
SWP/024 (1/81)
[] SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
5
6
7
8
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
625 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
[] PERCOLATION
TEST
Robert A. Shaft No. 1457-E
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
72-008 (6/79)
by
DOC Co, dba
P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759
OWNER OF LAND , .
ADI)RESS
LEGAL DESCRIPTION
DATE - Started '
Ende(J
PERMIT NUMBER
DEPTIt OF WELL / O, ~',
STATIC LEVEL OF WATER Fl'.
DRAW DOWN FT.
GALS. PER HR ," '
KIND OF CASING ~:, r:,~,,L?
KIND OF FORMATION:
From_ Ft. to Ft.
From ____ Ft. to , , ,, Ft.
From Ft. to Ft. .
From Ft. to Ft.
Frora.__ Ft. to. Ft.
;;rom Ft, to _Ft.
~q'om .... Ft. to___ Ft.
From_ Ft. to Ft,
From.__Ft. to Ft,
Frorn Ft. to Ft.
From____Ft. to .Ft.
From____Ft. to.__Ft.
From__ Ft. to .Ft
From ..... Ft. to Ft
From .... Ft. to__Ft.
iq'om ........ Ft. to__Ft.
From ..... Ft. to__ Ft.
From __Ft. to-, --Ft..
From Ft. to__ .Ft..
From__Ft. to , Ft..
From Ft, to ~Ft.
From Ft. to
From Ft. to ..Ft.
From Ft. to Ft..
From Ft. to _Ft.
From__Ft. to
From Ft. to_
From __ Ft. to----
From _Ft. to
From Ft. to_
From Ft. to ......
From Ft. to
I:rom Ft. to_
From _Ft. to_
Et, l
Ft.
Ft,
Ft.
.... Ft. _
.Ft ......
Ft..
___Ft ......................
__Ft,..
M}SCL. INFORMATION:
, ' E.... E ;.. ~~'" 'T
* E:.I'.., ,* , l',lO. ":::~"I 2f"~':l
......... '" ' "~"'"""~' PI"IOI"412:
, . ~, ~..*. ,' I.~['.., I'"11( '...E..q::, ,' ,'
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MUNICIPALITY OF ANCHORAGE
~ Health and Environmenta?
,~ Department ~rotection
. 825 ~ Street, Anchorage, AK. ~3501
Permit ~~-~P-( WELL ~ND/OR-ON-~-TE~R PERMIT
Applicant: ~ Mailing Address:
Location: Phone/Number:
Type of Soil Absorption System Is:
Seepag~edt Holding
Trench: Drainfield: ~ ~._~ ~¢~/1 Ratin~(s~.ft/br) Tank:
Maximum ~umber of Bedrooms:
The Required Size ~~Absorption System Is:
DEPTH 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 SEPTIC(HOLDING) TANK SIZE = GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED ~ * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
avai]Lable to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * * *
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 ~ay require enlar~e~nt if
the residence is remodeled to include more ~ha~ b~oms// ~
SWP/024(1/81)
APPLIL,.,NT FILLS OUT UPPER HAL ONLY
Phone
Property Owner (. ~',., ~ \ ' . ·
Buyer
Address Zip Code
Type of Residence
~ Multiple Family No. of Bedrooms~
~ Olher
Water Supply
A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
Individual
Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ individual Year Individual Installed:_
~"Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector inspector
AUG 1 9 1983
"~d ~c'pa~
APPROVAL
) DISAPPROVED ~
(DATEBy: )~~CONDITIONAL~PRO~ ~L:~ ¢~ ~)
Soils Rating Date ~wer installed Well To Absorplion Area Well Log Received
72.023 (3182)