The URL can be used to link to this page

Home My WebLink AboutMCMAHON #2 BLK 8 LT 11 · Municipality of Anchorage 'Page I 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 Permit Number: ,.%~v/qlO:2,5'7 PIDNumber: 01'73~1~2 Name: ~,ztR¥ T/IYLoR Wastewater System: '~New [] Upgrade Address: Box ~122q. l Ancfl. c/~/sII ABSORPTION FIELD Phone: ~,~/_j,~.. /'~,~"~ No. of ~drooms: ~'Deep Trench [] Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION soil Rating'. Total Depth from original grade: O, ~ GPD/Sql Ft, J "~'-"~' ' Lot: Block: Subdivision: Deplh to pips botlom from original grade: Gravel depth beneath pipe Range:~ Section Fill added above original grade: Gravel length: T°wnship: 1 ~ ~ ~ ~ ~ ~ ,~ Ft. ~ ..~Ft. WELL:Ex[5T D New ~ Upgrade Grave~depth:~.~ Number of lines: Distance ~tween lines: · Ft. ~ .... ~ Ft. Classification (Private, A.B,C): : Totai Depth: Cased To: Total absorption area: Pipe material: ~ ~[~F Ft. Ft. ~ 2~ SQ. Ft. ~q NON PElF Driller: Date Drilled: Static Water Level:Ft. [nstalier:~L,5 ~C~ ~TI~ ~ Date installed:~/~3/~ / Yield: GPM Pump Set at: Ft. Casing Height Above Ground:FL TAN K SEPARATION DISTANCES ~s~,,io ~ Ho~ng ~ S.T.E.,. TO Septic Absorption Lift Holding 3ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~C~A~ T~ ] ~50 Well I 0 I Ii ~ ~ ~ ~G / Material: Number of Compartments: Surface Water ~10o' ~/oo' - ~ ~oo LIFT STATION Lot Size in gallons: Manufacturer: Line ~7~ IO~ -- -- ~O~ Foundation. ~ i ~0~ ~ ~ ~ ¢ "Pump on' level at: "Pump off" level at: High water alarm at: Curtain Pump Make & Model ~ Electrical Inspections performed by: Drain ~ ~ -- ~ I Location and Description {~ ~g, ~p $att~ &t~tn ~o ~/z$"Fl~ttop Technical Services ENGINEER'SSEAL to~ ~e < ~. ~ Znchoraqe, Zlaske 99516 ~5~ U .~ , pectio, perfor e W: mt s: st C '~ . m~ODO~ Department of Healt~uma es approval . ~$... c~-~a~ Reviewed and approved b Date' . ~~ ....... ~p~sV~;;g 72-013 (1/91) MOA 25 Permit No. ~t~,/ c~IC) ~'-/ Page Z ' of ~ Municipality of Anchorage 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 Legal Description: £ II, ~ ~ Hc MAHor~ ~ PID No.: 01'/3~ 15'2. Er4b Q ) M.T. P]=t~oP Techn~ca! Services 14530 F, cho Street AnChorage, AlaSka 99516 ENGINEER'S SEAL TIIEOD02~ F, MOORE 3589 ...... · . ~_~* 72-013 A (2/91) MOA 25 Permit No. ~ ~ ~ IO 2 ~'7 Page 3' of ~ Municipality of Anchorage 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 LegalDescription: £ 11 .T ~ ~ F]C/V~AI~ON ~F~. PIDNo.: 01'13F01~2' t Flattop Technica! sefvice~ 14530 Echo Street Anchorage, AlaSka 995! THEODORE L MOORE ~,~:~.'.. CE- 3,589 .- 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910257 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:TAYLOR GARY & OWNER ADDRESS:PO BOX 112241 ANCHORAGE, AK 99511 DATE ISSUED: 8/27/91 EXPIRATION DATE: 8/27/92 PARCEL ID:01736152 LEGAL DESCRIPTION: MCMAHON #2 BLK 8 LT 11 SEC 28, T12N, R3W, SM LOT SIZE: 35553 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: NOTE: THE ABSORPTION TRENCH MAY NOT BE INTSALLED IN THE UPPER GP AND ML LAYERS. ANY DEVIATION TO THE APPROVED SYSTEM DESIGN MUST RECEIVE PRIOR DHHS APPROVAL. SOIL CONTINUITY TO BE VERIFIED BY ENGINEER. RECEIVED BY: ~r~J~//~'w~ DATE: DATE: TECHN CALSER ..... CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 August 14, 1991 ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dem' Sirs: The purpose of this letter is to provide the required design narrative in support of the attached application for a sewer upgrade permit for Lot 11, Block 8, McMahon S/D #2. Soils logs, perc test results, a site plan, design drawings and specifications are included for your review and approval.. The existing soil absorption trench is saturated to the point where effluent is starting to back up into the septic tank. We propose to abandon this trench with the standpipes in place, in order to retain the option of a possible future reconnection if needed and if the absorptive surface is able to rejuvenate itself. Since the existing 14 year old'septic tank is only 90 feet from the well, we propose to replace it with a new 1250 gallon tank properly situated outside the 100 foot radius. The existing tank will be properly abandoned by pumping and either crushing or filling it with clean soil after the top has been cut out. As can be seen from the soils log for test hole #1, there are two strata in the proposed absorptive zone between 5' and 12' below ground level. The material between 5' and 9' is a gravelly silty sand with a measured perc rate of 6.2 minutes per inch, for which the wastewater ordinance specifies an application rate of 0.8 gpd/sq, ft. Between 9 and 12 feet is a clean sand with a measured perc rate of faster than 1 minute per inch. A sample of this material is enclosed demonstrating that it is comparable to "filter sand". The trench is conservatively designed with an average application rate of 0.8 gpd/sq, ft. The requh'ed absorptive area for this 4 bedroom residence is (4 x 150)/0.8 = 750 square feet. The proposed design provides 2 x 7' x 54' = 756 square feet of absorptive area. The topography of the lot is generally level. There is a low rise near the northeastern edge of the lot. The site plan shows the locations of wells and septic systems within 200 feet of the proposed project. The proposed project will have no measurable impact on existing or future wells and septic systems on adjacent properties. There will also be no known impact on reserved space/surface or subsurface, or on drainage. Please give me a call if you have any questions on this submittal. Sincerely, Ted Moore, P. E. ./ 0 5'£PTIC. LoT il. LoT .C ~0USE LOT 12. k. B~RtA · 5'UtI TRENC. ~ -~£ PTIC WELL LoT !o Flattop Technical Services 14530 Echo Street ~[',.",,,,'~','-n,',"~ ~l,",-~'l."r,,' ClQC, IR L Il, B~t ~c MAHoN 5/D SEPTIC UPORADE SITE PLAN SCALE: NOTE: T~IS I% N, ~ 5',JRV,"="'/Eb PL/ t~LL LoCA'T /oN s ,4~E A'PPROXI~^' PLAN VIEW -r OTAL I Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 SCALE,; L II, B~ Mc HAHON SEPTIC PLAN ¢ CROSS- .SECTtOl',,[ Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 11, Block 8, McMahon S/D, Addition 4001 Leyden Road Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project includes the abandonment of an existing septic tank and soil absorption trench and installation of a new 1250 gallon septic tank followed by 54 lineal feet of soil absorption trench containing 7.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. 1.3 All separation distances shall be in conformance with Municipal requirements, unless specificallY waived. 1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buffed utilities. 1.5 Prior to start of construction, the property owner shall arrange for a surveyor to accurately locate the northernmost property comer, and to stake the first 75 feet of the property line leading southwest from there on 25' intervals. 2.0 Septic Tank: 2.1 The existing 1250 gallon septic tank is to be properly abandoned in place by thorougtfly pumping it and crashing or otherwise filling it with clean soil. 2.2 The new 1250 gallon septic tank shall be Municipally approved with two compartments, and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buffed less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The existing soil absorption trench shall be abandoned in place, with the standpipes remaining to facilitate a possible future reconnection. 3.2 The new soil absmption trench shall be excavated to a depth of 12 feet below original ground level as measured in the vicinity of test hole #1. The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total depth of 7.5 feet of approved sewer gravel shall be placed in the trench with the bottom of the 4" diameter perforated distribution pipe no less than 7.0 feet above the bottom of the trench excavation. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. Flattop Technical Services 14530 Echo Street Anchorage, Alaskc~ 9951~ 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the'sewer ~ravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 3 feet of soil cover is to be placed over the filter fabric. The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contxactor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of filter fabric, and (4) after final backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. 'This inspection may be incorporated with any of the above inspections. 5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. PERFORMED FOR: LEGAL DESCRIPTION: Flattop Techhical S~.fvlce's 14530 Echo S[reet Anchorc~.ge, Ah:s!::a 95516 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG-- PERCOLATION TEST T. fl, #l C~ARY TAYLOR LII g8 MCMA/-to~ Township, Range, Section: ,SEC 2.~' TI2-. h~_, ~, ~ Iv' SLOPE SITE"PLAN 1 2 3 4 5 6 7 8. 9 10 11 12 13 14, 15- 16 17 18 19 20 FILl. PT' 5~ GEAVELLY SILTY WAS GROUND WATER CLEAN GI~AV~.LL¥ ENCOUNTERED;) FI"E 5ANb I~ IFYES, ATWHAT DEPTH? SANby SILT COMMENTS AbDIT~0HAL ~O Depth t0 Water Aller ,710,'~1jlaI Monitoring? ~"~ Date: Reading Date Gross Net Depth to Net ?RECoAK 7/~- 2:2fo; ~o 2~" 2:25:5o-2:: ~ 23~/s -27 ~o ~:o~:3o 23 ~ ~ ~:27 ~o 22 Y9 I Y~ PERCOLATION RATE ~' ~ . (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~o FT AND ~'"~" FT P~ec 'TEST Ku~ geTW'£,E~ c~,S" A~ Io', ReSUlTS F/. ATTOP ,. '~~ CERT,F¥ THA~ T.IS TEST WAS PE.FORMED IN PERFORMED BY: 'T£¢ Vc ACCORDANCE STAYE WITH ALL AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~"'/~/ 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 FILL 2 PT 3 5H 4 5 GP 6 7 HL 8 9 lo, SM 11 12 13 14 15 16- 17 18 19 2O FlaH0p Techh~cal S0f;~'ic&'s 14530 Echo S~ree~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG'-- PERCOLATION TEST 'F,H, L II B 8 MeMA GI~Avc_ L 6 ~' I "F'H ,5 ~L'T'f 5AN by CEA VELL'./ SILT GRA V~-LLY SILTY SAAb COBBLE~ Township, Range, Section: SEC 28,, TI2 N'., [;i;;~l,,/ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? [~{ 0 S L IF YES, AT WHAT O DEPTH? p Deplh 10 Water Alter Monitoring?, ~'"I/ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ ] TEST RUN BETWEEN (~'~ ~uN ~N T,H. ~ I (minutes/inch) PERC HOLE DIAMETER FT AND /0, 0 FT PERFORMED -r£c BY: 5Vt · I __~.J~' ' ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STA:FE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: ~;'/,.~'"/ 9 f 72-008 (Rev. 4/85) Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 From RECEIVE'D AU ~ ~ ~ 1991 ~.~,ty of Anchorage Health & Human Services MUNICIPALITY OF ANCHORAGE He~ h and Environmental Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-,t720 SEPTIC TANK: DISTANCF --~/~/~/ ~r~6~l _~_ NtJMBER OF ,-ROM WELI_~._ MANUFACTURER ,.__ M.&'I'EIIIA' .......... COMPARTMEI'ITS ~ INSIDE LENGTH INSIDE WIDI'H LIQUID DEPTH LIQUID CAPACII'Y/~O~ GALLONS. TILE DRAIN FIELD: WLL----~__._~__ FOUNDATION ~"~0 / '~ / TOTAL LENGTH NEAREST LOT t. INE_~ .......... OF'LINE DISTANCE UROM ~ of Lines _ __Z_____OISTANCt: t,E'IWEEN LINES _.~ .... ,RENClIWlDTH~IN, TOTAL EFFECTIVE / Ai;SOtIPTION AREA _~ ~ ............ SQ. FT. LENGTH OF EACH LINE ~ / DEPTit OF FILTER ~ DEPIlI: TOP OF TILE i0 FINISH GRADE .......... -- MATERIAL. BENEATH 'I'ILE ~__ ...... ~ABOVE TILE .... Z____IN. SEEPAGE PIT: DIAMETER .... OR WIDTtt ....... , LENGTH ...... DI~PTt I Log Crib Rings BUILDING F(.,UN DATION ......... Crib Size: DIAMETER .... DEPTH_____ DISTANCE FROM: WELL '10TAL EFFECTIVF: NEAREST LOT LINE ._ . ABSORPTION AREA (WALL AREA) ~ell }lass: Depth: Jell Distance To: Lot Line }ldg: Sewer Line: ~ipe Materials: i of Bedrooms: _~ installer: ~_ ~ ~emarks: L.OCfi'T ]] Z:: N L..b33fiL. ~....:: L-. ': r, ROfi[) L. 'J.:~. E: 8 HE:HFiHON L(]T E, IZE ':!:P;!-'qS]~: '2;!'id.iFf :~'E FEET ]':'r'F'E OF ';:;Ft'fi .R,E:SOF~:E:T]:O?q E;h.':?.TFEH :iS: 'TF::ENCH r: ," :-'Fi';!ijTi-~:i~!C, :E;]:ZE OF "FHF' F;OIL. fi[:~j::~;OB:PT].i]ij'.] t'}'.;'T'::3'TEM THE: L.E:]'q;:3"i"H [)ZI'"IEN'.F.;]:Oiq ]:~E; 'THE LENG"i"H ,::~TN i::EET) 'j'lF' THE -."[eENCH EF.: ]'HE DL::F' 'f'H '][:' R TF.:E. NCH OR F'~ ]" :[."~; Ti-liE E:, Z ::-:.TFFINC:E F;E'THEEN THE '.:-i.i[4:FFiCE 3F THEE :iF.';'d.iN[) fiNE:, THE 130'f'TOM OF ']'PIE E;:.::C:fi'v'fi-FZF'!t'q (-Ti'.,i. c. Et.. "iHERE .t:5; F.C SET H]:DTH F3R 'i'I'4:ENCHES. .~,*m,,,..:L E:E"Fi.,qEE:N THE OU'T'I::fiLL. THE GRFF/EL E:,EF'TH '[ :.'5 THE H :i: N I ML.tH E:,E:F'TH OF ..... -'""' 'F' . - fiNE:' -;tHE E: ]TTOH '" F:' THE E::-:;C;'::f'v'F{~' .T. ]i'.J ,:: ]: i"4 '~' "' ~::T" ?'"'E~E;;:'~¢J .~{ '~'-'"~ ...........:--.: ~"'~']- ~,~.. L: "-~- F~,~"~.~'::] ::::~ .'E ~::.~::-:== --~ ;;::2t:~[~EE~ ....... .~. t ,:~"'E; '"P'TT '"ii'- ,:.;i :::.I'E:F:T "i"3 'T'HE i::i Pi.4. E:i-:::FI{JE: F'LfiNT HR"¢ E:E ZNZE;TRLL. EE:' fi'l" 'THE PERi'"I i::OL..LOI.,~ Z i'qG ii:ONE):['T ): f.]N'.~;: % EZTHER R CLRSq;tE; :[ OR :[i NSF F'tPPROVEE:' F'L. RN'T 2- R CONTZNLJOU% MR~NTENfiNCE fiG~:EEMENT Z% RE(;:¢J:[REE:'. ]F: fi fflfiZNTENfiNCE fiGREEHENT !% NOT KEP'F CLiRRENT '¢OLJ MR'T: fiSS(3RP'TZON %'T'E;'f'EH RND,,"OR h"OU i'"IR'¢ BE: Si...IBJEC't" TO PRCISECLIT:[E~N. (:-iq:iC}:::[:':[LL.T. NI3 t])F fii'q'?' :,'r:]c. t t H]jTH"JT F'ZNFtL TN':pi:'I-:"T:(-i'.I Fff',iE:' RF'F'RO'v'IaL E:,EPF:!R]]"!ENT .,.! '[ L..L ['-::E '~: jELTEr" T :'i"t.".) F't: '"J ':: E '-' _ T ;: ;E MZNiHUH [)i::-3TfiNE:E E:E'¥'i4EEN R HELL fiND RN.Y ON-:F.;iTE 5EHfiGE ,.:)):::.~;F'OSRL. :.:;MS"f'EH :LE'u::.~ i.:EE"t' FOR fi PR:[',/fi'TE HELL I3R 2t-3.[3 FEEET FOF.: fi F'UEd_IC !qELL. HELL i._OGS RRB REg!U]:REB' Ri'.,!.B, MUST BE RE"FUI;?.NED TO THE DEPRF:."T'HENT P.I:[I"HZN 2i:O OF' THE WELL COHPLET),:ON. 0tHE:-;:': i:;;:E(:-:!L.iJ:RE:HJ"~.NT% i'"iF~"r' RPPL"r'. SPEC:ZFZC:FYEZONS fiNE:' CONSTRUCT Z ON D:i. fiGRFfHS RRE Wv'fi Z Lfi',':3L.E ]"O ]: NLE;LtF.:E F'F'.OPEF.: :[ NSTfiLL~R'f' i ON. i CEi::::T :[ F'¢ THia.,T ::L: :.( fih'i FRHJ:L. ZFiR HITH THE: REQi. JZREi"iENTS FOF-'. ON-'.'.-]ZTE SE_"HERE; HND i-'-iEL..LS t:::19 SET i::(]iJ;.:TH ~.3'T' "f'Hi::~ j'4 Jj,..I ~ 'j': lj Pi::~ ._. 2: I [4:iiL.L. j:N%TfiLL 'THE 7.::: Z UNE:'ERS'f'fiNf) THF~T THE CIN-S]:]"E: SE.HER '.E;h-'?FEH t'"tfiY RE(;:EJtF..'E ENLflRGE]"iENT .IF '1"HE P::E:.5 ]:i:::,EN(]:E Z E; RE:i',1ODELEE':, TO F!F'F'L :[ E:F~' ~Ef;-:ZOG E:L.I¢'45 U - De?~rtment of Health and .Environmen?'l_, Protection 2516 E. Tudor Road ~ Anchorage, Alaska 9950? 276~2221 Dep th Feet 3 - 5 - 6 - 7 - 10- -'11 - 12- Was ground wa[er encountered? if yes, at wi)at dei~th? Percolation tale I[ll I/Ute, -Proposed installation' Seulmge Pit Drain I-ield Ik:pLh of Inle~ DepU~ [o boC~om oF [~L or Lreucn COMMENTS' //~ ~X\ '.~ II , ~,(.~ 82,5~.,L S~t~i~tiC~nchorage, Alaska 99501 //&l ~.~\\ \] ,, ~/, ~ ~ ~ U~ ~ ~ ~Telephone 264-4720 REQUEST FOR A~PROVAL OF I~ DI~Ig~ALWATER A~D SEWER DIReCTIOnS: Complete all parts on page 1. Inco,plete r~qu~ ts will not be proce~d. Hease allow ten (10) days for processing. 1. PROPERTY OWNER , , ~ / I PUON~ MAILING ADDRESS ~ .~ PROPERTY RESIDENT (If different from above) / PRONE 4. REAL~OR/AGENT PHONE STREET LOCATION /iL 6. TYPE OF RESIDENCE ,,~ SINGLE FAMILY [] MULTIPLE FAMILY ' NUMBER OF BED~,~MS [] One ~ ,Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM /~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY **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(3/781 THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR I NSP ECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~NDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~E~ff~lVl DUAL/ON -SITE DATE INSTALLED E~PUBLIC UTILITY Connection Verified. INSTALLER ~__-ISeptic Tank or [] Ho]ding Tank Size: / ~.~'O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUF~URE_R ~ TOTAL ~..~S~P~ON AR EA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line I WELL TO: '~bsorption Area to nearest Lot Line '~, COMMENTS [~APP ROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED -'~AT E BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE ....... DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) dags for processing. I PHONE 1. PROPERTY OWNER ,/~.~.,~)~..~_..~ C4~/V._~V~.- MAILING ADDRESS ~ 2- L/ /t~ ~ ,2.. ¢-~4 /~ ~ K.~ ~ PROPERTY RESIDENT (If different from above) PHONE PHONE MAILING ADDRESS MAILING ADDRESS 4. REALTOR/AGENT ~1~/~L.-,. MAILING ADDRESS 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [~- Four I~~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [~ INDIVIDUAL* ~ COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [!~ INDIVIDUAL/ON-SITE~ [] PUBLIC UTILITY **If individual/on-site, give installation date ~? 200 tl 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 eNL. ~ DATE RECEIVED INSPECTION APPOINTMENTS '~'i'M E TIME TIME '-~AT E DATE DATE --~SPECTOR INSPECTOR iNSPECTOR '~ R ECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] 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 E~DIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [_~Septic Tank or []Holding Tank Size: ~t~--%-~ {f Tank is homemade SOILS RATING give dimensions: ¥PE oF TANK MAND TURER '-~OTAL ABSORPTION AREA MATERIAL -~. DISTANCES Septic/Holding Tank Absorption Area Sewer Line t Nearest Lot Line WELL TO: -~bsorption Area to nearest Lot Line -~. COMMENTS [~ APPROVED FOR z~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED --DATE BY (Title) -[_.EGA L DESCRIPTION 72-010 (Rev. 3/78) #1: Time Date Insp 10:30 a.m. #2: 1-18-78 Wednesday Pratt ~-~, MUNICIPALITY OF ANCHORA~ DEPARTM '¥ OF HEALTH AND ENVIRONMEI ~L PROTECTION 825 L Street, Anchoraa~. Alaska 99501 264-4720 Date Received: January 16, 1978 Time ~3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES o Lending Institution Request: Mailing Address: PropertY Owner: Mailing Address: Phone: 3. Legal Description: 4: Ed Herzog Phone: 2418 East 20th Aven~e Lot ~.Block 8 Mc Mahon Subdivision Single Family Residence: ~ Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: 272-3166 o Well System: Permit # Individual well ~ Community/Public System ( ) Depth of Well Well Log on File Construction Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (~ Public Utility ( ) Installed 1977 Installe~ ~ ~%~-~D Manufacturer ~ Soils Rate ~D Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot.line Absorption Area to Nearest Lot Line age two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot _~ Block 8 Mc Mahon Subdivision Comments: Affadavit Attached: ~) . Approved: ~ ~:: Disapproved: Letter Attached: ( ) Department Worksheet: ~,-og~p ~:o,~o~ llVlN WNOIlVNI~INI 140J 1ON (a,~!s ~e,~o aeS) --O:IOlA01H :IgVlI3A03 q0NV~IIISNI 0N I&6I udv 008£ m'°:l S~ .................................... (peJ!nbeJ eejk oJSxe) AI~3AI]3(] '1¥103dS Pog ...................................................... A'INO 33SS3BOOV Ol B3AI930 ~gg ............ ,quo aassedppe ol ~Ja^[IOp ql!M 4 $331Aa~S ~91~ "pazakilap aJaq~ pue a~,ep 'LUOq~ O1SkkOqS '~ ldlSOl~ ~'~9 ............ ,quo aassadppe o~ ,(JaA.lap ~S[ ........... paJaA!lap dlZ ON iS 'ON 0~¥ 133)11S 01JN]S