HomeMy WebLinkAboutOLLIE WALKER LT 4
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_ INSPECTIQN REPORT
LEGAL DESCRIPTION
Well, .~ ( _,~' Absor~'on~a.~a
DISTANCE TO: I ~C 0 'd
Manufacturer/? , __ ~D
~Liq.~.a~aciF~i~gaHOns iF HOM~MA DE : Inside length
Dwellin~
Manufocturer
~ Well Foundation
~mmANC~ TO: I
~~ Length of each hne Total length of lines
~~ Crib diameter Crib depth
~'~----- Well /~ ,-- (,~ Build~5ouad~on
~0: Budding foundation Sewer line
NO. OF BEDROOM%~...~
Dwell~_._%/~ ,.",Z~ PERMIT NO,
M/~/a~., of compartments
W dt ~ Liquid depth
PERMIT NO.
Mate~ ia~ Liquid capacity in gallons
~e~rest lot line PERMIT NO.
[ T~ench width Distance between lines
inches
Total effective absorption area
inches
Nearest lot ~i~0 ( ~__
Distance to lot Hne PERMIT NO.
Septic tank Absorptioa area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALL%
'TH~:~:
FIND
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i:;i:ER!L:;:I:DE~NCi:~: :i:~5 F:E:HO!:::'~'~:LE:D TO ):NCL. LIB, E
January 4, 1982
Oliver E. Walker
7271 East 22 Avenue
Anchorage, AK 99507
Permit ~ 810957
Subject: L40LLIE S/D
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 198]..
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 should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this' office
at 264-4720.
Sincerely,
Sewer and W~ter ~rogram
Enclosure: Copy of Permit
, ,,' ., bIUN ! C [ Ph.L [ 'FY OF ANCP, Ot~AGa
V/ELL ANO/OR OF!"'5 ~'IT.,,~h.h P~RN['[
" :- .. . '"~ tho
(i.) [ am ~c.a~.LL~' wi.~.~ ~h~ ,oqui.~or~qub~ ~0~' or~-~i.~e o<~mr:~ and wO],l_~ ~:~
HUNICIPALITY OF ANCHORAGE
Department Health and Environmenta. rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Location:~~,~ /~CL,I
Legal Description ~)~ d
Type of Soil Absorption System Is:
Trench: Drainfield: ~-~Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) '~0 ,
Phone Number:
The Required Size of the Soil Absorption System Is:
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(I~_~..~. ) TANK SIZE = f~O0 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 co~unity 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 1 * * *
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~- / / t~hat/~ bedrooms.
S igne~: Is sued by: ~, ~ Z ~'~-~-~~
ApplicantDate: ?/~/~/
SWP/024 (]./81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTFI AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~/SOI LS LOG
[~PERCO LATION
TEST
PERFORMED FOR: (~\ \~t.~ ~.~"" (z~,l O,.~j~vtO_~'"-
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
PERFORMED BY:
72-008 (6/79)
WASGROUNDWATER ~kJL0 I~.
ENCOUNTERED?
O
P
E
IF YES, ATWHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
_
(minutes/inch)
¥'4. i
1. General Information
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRON~NTAL ~ALTH
DEPARTMENT OF [~ALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
Application Date..._~~~
subdivision, section, township, range)
(a) Legal Description (include lot, block,
Location (address or directions)
(b) Applicants Name ~/~gt~ [dC~/l~W~ Telephone - Home Business
Applicants Address~ ,.~
(c) Applicant is (check on~) Lending Institution ~ ; Owner/builder ~
Buyer ~ ; Other ~ (explain);
(d) Lending Institution ~ ~ ~ Telephone
Address
(e) Real Estate Co. & Agent
Address
(f)
Telephone
the HAA to the following address:
2. ,Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Individual Well~
Multi-Family
2
Other (describe)
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. ~~osal
Onsite~ Public ~-~ Community~__~ Holding
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]
Engineering Firm Providin~_~ Tests~ File Search~ Data and ~'
~nfor~.ation
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 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 ~th all Municipal and State codes, ordinances, and regulao-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
DHEP Approval
Approved for~o~¢ bedrooms
Approved ~ Disapproved
Terms of Conditional Approval
(ENGINEER SEAL)
Telephone
'~I'
Conditional
CAUTION
THE MRJNICIPALITY OF ANCHORAGE DEPARTMENT OF IiEA~LTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEnt-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONA~ ENGINEER REGISTERED
IN THE STATE OF ALASKA. TNE DHEP DOES THIS AS A COURTESY TO PURC}~SERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT ~SPONSIBLE FOR ERRORS
OR OMISSIONS IN T~ PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
{Page 2 of 2]
7-19-84
MUNICIPALITY OF ANC?DRAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
~'~ i '..!'~ ~/' ~.,~ ,1,
/
Well Classification ~-76~-/~ -~ If At B, c~ C, D.E.C. Approved(Y/N)
Well Log P~ese~t~--~?~2~3 ~-Date C~mpletod
Total Depth ~dP&, ~.~d to ~O 7c Depth o~ G~outing ....
Static Water Level , ~ ~ Pump Set At
Casing Height Abo~ Ground/n~ ~ z~ Sanitary Seal on Casin~d.Y
Separation Distances f~om Well:
To Septic/m~l~a~ on Lot /~O ~,~ ~ On Ad~oinin~ r,ots
To Nearest Edge o~ Abso~l~tion Field on Lot /~3
To Nearest Public Sewer Line /3 /;~ To Nearest Public Sewer
¢leenout/Manhole A3 ] >~ To Nearest Sewer Service ~ine on Lot
Water Sample Test Results ,~ ~/ .~-~/m~ ~.
Co~,ents ~ ~ ~-/ ~
B. SEPTIC/HOLDING TANK DATA
Date Instal~ ~/~' ~ Size /Od~? No. of Compartments ~-
StandingS,) Ai~-tight Cap~) Fou~tion Clea~out .(~')~
l~ession o~ Ta~ ~' ~te ~st P~d
P~ing~intenan~ ~n~a~ on File (~Y~ ; for
Holding Ta~ High-Wate~ ~a~ (Y~//~ ~%~r~ Holdi~ Tank ~t (Y~/~
Sep~ation Distan~s ~ ~ptic~lolding Tank:
To Wate~-S~pply ~11_ /~ <~ To ~ilding Foundation.
To Property Line_ /d3 g~
To ~ater ~a~/Service Lir~ '~ ~
Cou~s~
Corm~nts /~ O ,~Y~-
To Disposal Field c~ /
~ To Stream, Pond, Lake, c~ Major D~ainage
Receipt
Date ~aid:
Arno un t:
[Page 1 of 2]
2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption St~ata ~d3~D ~ /~/~ Type of System Design
Date .Installed //~/ ~c Z I~ngth of Field g~j-t. '
Width of Field 3~ ' Depth of Field .~
Gravel Bed Thickness /2 /!
Square Feet of Absok-ption/_~,A~ea . /~$~-O ~ Standpipes t~esent ~.Y~)
Results of Last Adequacy Test ,.,~--:/ 7"./..f'/~,,~C k~,',,~ ?
Separation Distance f~om A~sorption Field:
To Water-Supply Well /~%~ ~-- To P~operty Line ~
To Building Foundation 70 / To Existing or Abandoned System on
Lot /J ~g~-/~/~ ; On Adjoining Lots ,~, m /.7 ~
To Water~Mai~/Service Line ~O ~ To Cutback(if present)
To Stream/Pond/Lake/o~ Major D~ainage Course /~ ~o ~_/~
To D~iveway, Pa~king Area, o~ Vehicle Storage Area ~ ~ '~
Con, rents
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High ~l~ter Alarm Level at
Tested for
Electrical Codes(Y/N)
Dir~nsions
Ma?ole/AcCess/ (Y/N)
~p/~" Level at .
-- /// ~Vent (Y/N)
Pumping Cycfesc~,ring Adequacy Test.
M~ets MOA
Co~=~nts
** Check Permitted Bedrcom Rating A~ainst HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelir~s in effect
on the date of this inspection.
Company
KB1/dS/s
Date
MOA No.
[Page 2 of 2]
2-15-84
HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] I' ine
[] ¢ k Sample (for routine sample
~ lab ref, no,
[] ~ ~cial Purpose
[] Treated Water
[] Untreated Water
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLF to be:
/~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination to
indicate reliable results, Please send new
sample via special delivery mail.
Time Received
Analytical Method:
[] Fermentation Tube
tt~ Membrane Filter
Lab Ref. No. Result* Analyst
06-1220 (b)
nov. 1983
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
Membrane Filter; Direct Count_
Verification: LTB
BGB
Final Membrane Filter Results
Reported By - '---
Date_
Time:
Coilform/10Oml
Coilformll00ml
COLLECTING SAMPLE TNTC-- Too Numerous To Count