HomeMy WebLinkAboutKWIK LOG BLK 3 LT 17
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343~4744
November 15, 1994
Mn'. Leland Estabrook
733 E. 73rd Avenue
Anchorage, AK 99518
Subject: Lt. 17, Blk. 3, Kwik Log Subdivision
Permit #SW930419, Parcel 1D #013-043-34
Dear Mr. Estabrook:
The subject permit, issued October 7, 1993 by this office for a single family well and/or on-site
wastewater system, has expired as of October 7, 1994.
A new permit must be obtained from this office for a well and/or on-site wastewater system NOT
installed by the expiration date.
If you have drilled the well, a well log must be sent to this office for documentation of the
installation and to close the permit.
If the on-site wastewater system has been completed and a licensed Professional Engineer has
inspected the installation of the on-site wastewater system, the original as-built inspection report
must be sent to this office for review, approval and documentation. All inspection reports must
be submitted within 30 days of construction completion.
When applying for a new perrnit, the fees are: $320.00 for an on-site wastewater permit; $120.00
for a well permit and $440.00 for a combined on-site wastewater and well permit.
ff you have any questions, please call this office at 343-4744.
Sincerely,
James Cross, P.E.
Program Manager
On-Site Services
JC/kb
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW930419
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:ESTABROOK LELAND R &
OWNER ADDRESS:733 E 73RD AVE
ANCHORAGE, AK 99518
DATE ISSUED:10/07/93
EXPIRATION DATE:10/07/94
PARCEL ID:01304334
LEGAL DESCRIPTION: KWIK LOG BLK 3 LT 17
LOT SIZE: 11134 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL 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 TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 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.
SPECIAL PROVISIONS
ISSUED BY:~~~
DATE:
DATE:
I\
...--"' REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
-"'%~. ¥Iame of person requesting approval .... ~. .
u ~ ....... t ¥~-:~ ~o ~ ,~"" -' '~' ~-
2. ~ame of property~ owner ~~ ..... . =_ _
5
5. Water. AnalFsis:
. a. Bacterial
b. Detergent
b. Depth
c. Casing Size~ (,,,,
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank___J,
3. Seepafe Area
4. Cesspool' /', {
5. Property Linc /~'
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc. ~!o~q£
7. Sewage disposal system.
a. Age of system ..... !-{ ~l~,,_'~.i,-J .
b. Septic tank capacity in ga].lons~~~>
Name of septic tank manufacturer / tl.~i ',~ ~ { i:~ (....~/ I!'L!)_I~ Y(.
! .;;.,7 ~,
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type__~_L- q_.., j ,
/
1, Distance to property line /i{: to house foundation
Percolation. Test results
f. Percolation Test performed by
Use the reverse .side of this form to show diagram. Diagram should include
~the fo~]~,~ing information: ppoperty lines', .well location, house location,
~'~'.~c tank locstion~ disposal area location, location of percolation test,
sad d~rection of ground slope.
Tke ~u~.,~.~o~ on tkis form is tmue a~d correct to the best of my knowledge.
. ignature of Applicant Date Signed../ ''
T~_O~_BE FILLED OUT BY HEALTH DEPAP, TqENT PERSONNEL
The above described sanitary facilities are hereby ~pproved~ subject to the
roi. low,n? cond~ions:
Conditiorm:
reasonsThe above: described sanitamy facilities, are disspproved for the following
- ~ / ./
Date ,
ApprOval .is valid for one year following the date of approval.
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