HomeMy WebLinkAboutMCMAHON BLK 3 LT 10 0 -1-0'4 \0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Heallh Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
Addre~¢ ~TO SEPTIC ADSORPTION
TANK FIELD WELL
Phone(s) Permit No.
Township, ~anOe, Section
5 Z ~ ~W ~Z ~ / [ 3 VV .rlveway,AS'B"lETwale,"lA~R*"boOleS, etc)(Sh°w Iocat,on of well, septic system, property hnes, foundation,
~ SEPTIC ~ HOLDING
Material ¢ ~ No. olCompa.mentsz ,.
TYPE OF SYSTE~ (~07~,o~-)
~TRENCH ~ BED ~ W. DRAIN ~ OTHER
ongina[ grade -/~¢ FI
FT /
Gravel length.:¢. 6~avel width
Total absorpt,on .... -'- Distance belween Ii.es
Nu mbe~.g.tAlfi~s.... [~llS°il rat,ng Pipe material
WELLS Q~lSt t,~b.~)
~ PRIVATE ~ OTHER (Identifv)
REMARKS:
72 013 (3/85)
X~~~I X~insulate :'f less than three fc
~ of cover. Install with top
~ tank no m(~re than 10 feet belt
~ garage fl(~or elevation.
~ I
1, Tank installation to follow MOA rules and regulations. Installe~
to certify minimum 105' seperation from tank to all wells prior
to installation.
2. Existing tank to be removed and baekfilled.
SEPTIC SYSTEM DESIGN
SCALE PREPARED BY:
" = ~' Kniefel Engineering MOA CE 90-030
~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
NAME j
MAI LING AJ;).[~R ESS /
LEGAL DE~RIPTION
Well
Absorption
area
~ Z DISTANCE TO:
~ ~ Manufacturer
~ Liq. Inside length
We:lF HOMEMADE:
DISTANCE TO:
Manufacturer
DISTANCE TO:
No. of lines ( Length ~h~line
Top of tile to finish grade
Dwelling
Foundation
Dwelling
Material
N ear e~.~ ~]~_~ e
PHON E [] NEW
inches
inches
Width Depth
Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
Building foundation
DISTANCE TO:
NO. OF BEDRO~(~S
PERMbT~D.
'1¥o
No. of co%tments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMO¥' ¢ ¢ ?
Distancep/~ines
Total effe~p(.~tion area
PERMIT NO.
Depth Driller Distance to lot line PERMIT NO,
Sewer line Absorption area(s)
Septic tank
OTHER
PI PE MATEI~,,C.e..~.~/LS
SOIL TEST RATING
INSTALLER, /
R EMAR KS
APPROVED ~ DATE LEGAL
!..OCI:::IT ]] O1'-,! F!JI:;~iF.':O!.,] CRK
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THEI:;;'.E )JS !1,l(]1 SET !4:.([:Cl"H FOR
THE I}ii:;~]:::!',,,'[i{L [:,[ii:l::'TH ]::ii; THE PI ): N :( I"IUI"! [:,EF'TH CF ':iF'l::l',,,q':'[. [!i[[5'I"!,.!EEN THE ':_'t'[.:':::~1 [
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).'!'.,ISTFt[J~..FITZOi',! .'!.'iqSPECT):ON:~; OF FIN'./ I.,.!EL.I.2.~, FtlXrFiCE!',F!" TO TH]:S F:'ROPERT'-F FIN[) THE
I'.,II..I!',!BEi]:;i: OF R[!:S Z [:,E?,iCE!~:'; '!"HF!T THE !.,.IEI...L !4 :i: i..L
::::::::::::::::::::: ii L.I. X FiG 0I'::' i::li',l"r'
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F:'C','RTi'I [~"~" '!"HI.:: MI...I!",!if.C:i:F'FILi'i""r' OF
2: :[ i4 ]: LL ]: NSTi:::ILL THE :~;"/:!i;'T'i::i]'l :£ i",! I:::ICC:ORDFt!qCE i'.! :£ '1']"1 THE CODE:i~;.
]:: I f..It",I[)[:~:Rii!;TI::!N[:' ]'HI::!T THE
i:;~:l:i~'..:.'!;):[:'li:i]",ICE ]::~i; R!iEi"lODEL.ED ]"0 :~Cl...IJ[)[ii: t"/OI::.':E TI'"IFII',I
[ER ANCHORAGE AREA E )UGH
~/~ Department of Environmental Quality
~ 3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~/-'¢/?~Y/Y'~ /~/~/.¢/z~ MAILING ADDRESS ~2fg? {~//~/'~/~/'~ ~/¢~/~//~g¢~ PHONE ~gZ~7/-~-~-g~-~
LOCATION / /f'//' //~//~'/~[~/v/~,~*~/-,z?~'~[~~? LEGAL DESCRIPTION ~-'~/~3 ~¢.~/--/g~ /¢/[~///~//~/f./~.r/.~.
SEPTIC TANK:
NUMBER OF
DISTANCE /
FROM WELL ,j~*-D /~ MANUFACTURERS~'X4.~¢/~~ ,~/'-/¢~'~'~¢//S~4ATERIAL ~'~-~-'~ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY //~-g'? GALLONS.
SEEPAGE PIT:
NUMBER OF PITS /
DIAMETER
OR WIDTH /~? ,/
LINING MATERIAL/' /_~'2¢? [/¢/~RIB SIZE: DIAMETER
/
/
BUILDING FOUNDATION~'~ NEAREST LOT LINE ~ /'-.
ADDITIONAL ABSORPTION
LENGTH /z~, D_~EPT H /~
DEPTH ~;/ DISTANCE FROM: WELL /V'~2~//~/
TOTAL EFFECTIVE g/'z~-~/'-
ABSORPTION AREA (WALL AREA) ~¢~47/~/ SQ. FT.
WELL:
TYPE /¢~?? ~z//¢'7Z~-~
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
DISTANCES: /dC /-- '~'~' - '' '
INSTALLED BY: d~¢Z'.?~
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form PW-026
DIAGRAM OF SYSTEM
G.A.A.B.
GREATER ANC:HORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
/
J NSTA LLATION LOCAT iON
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
SEEPAGE PIT .... lA. DRAIN FIELD
TO BE INSTALLED BY
NOTE= TNI~ pERMIT IS. NOT VALIJ3 WITHOUT ~OIL
FINAL IN~PECTION~ ~4 HOUR NOTICE REQUIRED. I~ACKFILLING OF ANY ~Y~TEI~ WITHOUT FU~AL II~S..E~TIO~I ~Y THE
HEALTH DEPARTMENT AUTHORITY WILL I~E ~UBJECT TO p~OSECUTIO[~.
~EPTIC TANK SIZE j
5 f~
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT _ 20 ~e
SEPT}C TANK TO SEEPAGE PIT WALL ~ ~.~'~
/~'~)/~"~L TYPE~-'~eel 1:3~C, OT'IC.T'R~'~esEEPAGE AREA SIZE
DI~AIN FIELD ].0 ft.
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK ~--/~ [
DRAIN FIELD
WATER MAIN TO SEPTIC TANK ].0 rte
DRAIN FIELD 10 ft.
SEPTIC TANK. 25 itc. SEEPAGE PIT
DRAIN FIELD. ]0 ft.
/
Ioo.
ALSD CONSIDER AREA WELLS.
SEEPAGE PIT -
100 ft., DRAIN FIELD--50 ft..,
__ TYPE
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street
ANCHORAGE, ALASKA 99503
Case #
Performed For ~m_ ~ ~]L~ Dated Performed Il- ~-~
Legal Description: Lot Block Subdivision~/~y/~-~_
This Form Reports Soils Log_ ~ __Percolation Test__
Soil Test Must Be Logged To 4' Below Proposed Seepage System -
Depth
Feet
Soil Characteristics
Was Ground Water Encountered?
If Yes, At What Depth?
Reading
Date
Gross Time Net Time Depth to H20 Net Drop
Percolation Rate Minute
Proposed Installation: Seepage Pit__ Drain Field
Depth of Inlet Depth to Bottom of Pit or Trench
Test Performed BY /[~c~ ~~ .Date Certified BY:
Date:
'APPLIC-'NT FILLS OUT UPPER HAI?"'ONLY
· P=r°perty, Owner~[;T~o~c3_l'l ~]'t3~l~er , ~ . ~ Phone. ~?_.
~ ~x 1~~ Z~ ~c~rage ~ ~ 99507 345-4926
Mailing Addre~ ' ~ Zip Code
Buyer ~les ~i~z
. P.O. ~x 8159', ~~, ~. 99508
Address Zip Code
Lendin~ Instilution ~SS~Pouch 6608,Na~°~c~ge ~ of~.~ ~~~~ ~-; Phone
Address -Att. Jo~e O~vt ipCode 99502 278-4581
~ealty Co. & A~nt ~1~ ~z ~- ~iS Steph~ Phone
1101, E. 76~,A~, S~ B
Address ~c~aqe, ~. Zip Code 99502 349--7681
L~al Description Lt. 10-Bk 3 ~ S~.
~ F~ C~k ~.
8treel Locati~
~ Type of ~esi~nce ' ' ' : ....
~ 8ingle Family
~ Mulliple Family No. of Bedroo~ 3 3
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l Io~ is required for all wells drilled since ~une ]975.
~ Community For wells drilled prior to that da~e, ~ivewell depth (attach Io~ if available).
Q Public Utility
Sewer Disposal ~' ~
~ Individual Year Individual Installed: ]~]
~ Public ~ility When Connected to Public Utility: ' '
~ Holding Tank .
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Date Date Date Date
Inspector Inspector Inspector Inspector (,~
M.,jN,cmAi iTY~<~ CHOP, AGE
Field Notes:~ ~ DEPT· OF HEALTH
ENVIRONMSNTAL pROTSCTION
( ~ ) APPROVED BEDROOMS ~CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Ratin~ Date ~wer Installed Well To Absorption Area Well Log Received
~--7~ ~& Well to Tank Septic T~k Size
72,023 (3/82)
Ap~ii 4~ 1983
99507
Subject; Lot lO Block 3 }4cMa~on ~' ~'
Approval for the individual se~-~er and water facilities cannot
bo qranted u~til uh,: foilowinq i~c:m,~, haw~ been ",'-" '~-~
.... : os.;c, electrical wires to the well head are in violation
of the ~!unici~alit¥ of Anchorage code.'-3 and must ~ '~ encased
in conduit.
water analysis report needs to be sub~.nitted to this
o~_.ic~ fromthe Chem Lab, ?,~o33 ~' I.~' Street, ,_o~" - our review.
free~.~.,! of tank in
~he eng ineerinc ~
, _, repor~,~ possible
e×tre~ae!y cold weather, insulation should be placed over
the tank to prevent freezing.
Please notify this Department ..o~ a reinsDection when the
noted discreoancies have been ~ .... t,e.~t,~d tf there are any
further question~ please call :~15 office at 264--4720.
il in c,e ro ly,
Robert C, Pratt
Associate Environmental Specialist
J A M ES , R 0 El E R T S, M~,~ 0R~IS
~T. 01: HEALTH ~
III II .
SEPTIC SYST~ ADEQUACY TEST
RECEIVED
S- 83105
DATE 3/24/83
CLIENT: Mr. Hogan Snelker
Name
Address
Telephone
345-4926
LEGAL DESCRIPTION: Lot 10 Block 3 McMahon Sudivision
(Furrow Creek Road)
SEPTIC TANK:
Material Type Stack Steel
Size 1000 gal.
Number Bedrooms 3
Surcharge Test 400
Rate of percolation 1,300
Sludge condition in tank:
LEACH PIT:
DRAIN
TRENCH
39'1g x lO'dp x 5'gravel
Required Tank Si~e 1000 gal.
gal. water; 0.80 (150 x No. bedrooms) min.
gal./day
4 to 6" in bottom (pumping not necessary)
Remarks: Trench is functioning excellently. System is adequate.
Effluent end of-septic tank is near the surface and could be susceptible
1207
to freezing in very cold weather. Recommend iD~&~ion.
East 74 th Avenue Anchoracje, Alaska 99502
' ~: MUNICIPALITY OF ANCHORAGE MUNICIPA~T~ OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501 E'k~VIRONMEJNTAL !~.!d2TF~'~
ENVIRONMENTAL ENGINEERINGDIVISION I~'~A Telephone 264-4720
DI ~TlOffiS: Complete all parts on pa~e 1. Ineomplo~ roquosts ~ill not b~ proe~s~od. Please al[o~ ton ~ O} dag* for processing.
1. PROPERTYOWNER ~/~/~ PHONE
PROPERTY RESIDE~ (If different from above) ~ PHONE
'2. BUYER PHONE
MAILING ADDRESS ' [ ~'
3. LENDING INSTITUTION ~ PHONE
I
MAILING ADDRESS
4. REALTDR/AD~NT ~ ~ PHONE
5. LEGAL DESCRIPTION
B, YYPE OF RESIDENCE
[]~'/~SI NG L E FAMILY
~ MULTIPLE FAMILY.
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
[~]'"~hree [] Six
[] Other
7. WATER SUPplY ' ~,,~) ('~t/' I._~J¢'
~ INDIVIDUAL* "I~
[] COMMUNITY
[] PUBLIC UTILITY f . ~fZZ~
8. SEWAGETSPOSAL SYSTEM
~' INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY .
* ATTACH WELL LOG, A well Icg is required for all wells drilled
since June 1975, For wells drilled prior t0~th~at date, give well
depth (attach Icg if available.)?~/~' -
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL~
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE -- DATE DATE
I NS P ECT~R INSPECTOR INSPECTOR
D I R E CTI~-N S
1, TYPE OF RESIDENCE NUMBER OF/~EDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVI DUAL/ON -SITE '-DATE INSTALLED
[]PUBLIC UTILITY ~.~--~
Connection Verified INSTALLER
[]Septic Tank or [~Holding Tank
Size:_~(~C)~ , If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DIS~NCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Ti~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental quality
3500 Tudor Road, Anchorage· Alaska 99507 279-8686
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval Requested By:
Address: ~C~
Date Received / ~9 3
Time of Inspection ~/~ ~ ~'/~'
Date of Inspection
Prooerty Owner:
Legal Description:
Location:
Type of Facility to be Inspected:
Number of Bedrooms:
Nell Data:
A. Tvne ~ ' - ~L~.~ ~, ~ 8.
C. Construction ~ // <_-~, ~x.~.--~ D
t
Depth__~ 2 ,
'Bacteria 1 Analysis
installed~%/d~, / ~ ~ ~,- 'B. Installer
C. --Septic Tank: 1. Size ~¢?? ',,/~¢~2. Manufacturer
D, Seepage Pit: 1. Size 2. Material
Eo Disposal Field: Total· Length of Lines
Distances:
An Well To:
Septic Tank__
, Nearest Lot Line
Foundation to Septic Tank "~ AbSorption Area
Absorption Area to Nearest Lot Line
· Absorption Area
· Other Contamination
, Sewer Lines
R~,Je£.t for ,Approval of Inoividual Sewer & Water Facilities
Page T~o
9~ Comment~:
A,n.:or{evaJl Valid for One Year From Date Signed
Greate~ Ancho~a~rea BorouGh, DeFartment of Environmental quality
DIAGRA~ OF
I certify that the information contained in this request for approval to be 8 true
and accurate representation of the subject sewer and water facilities lo¢eted
Signed Date