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Home My WebLink AboutLAKEWOOD HILLS 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 INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: '~,~ 74 ~Zo ~ o Well ' Absorptio~ DwellinL [00 Material, ~ IF HOMEMADE: Inside length Width~T~ Liq, ty in gallons DISTANCE TO: PHONE ('~ 0 b~'~ [~] NEW 5W- ~UPGR*~E NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid daDth Well Dwelling PERMIT NO. Manufacturer I Material Liquid capacity in gallons Well .~-. DISTANCE TO: Length of eaph line No. of ,nes/ I TOp of tile to finish grade ]Nearest lot ~ .nb Trench w...-~dtb inches Total length pf iJ3,es Material beneath tile Depth Length Width PERMIT NO. _ Distance between lines Total effective¢~rSon area PERMIT NO. Type of crib ;rib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line DISTANCE TO: Building foundation Sewer line PERMIT NO, Absorpt on area(s) Septic tank OTHER PIPE MATERIALS SOl L TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL Permit ~ ~ Applicant Location: ~UNI~IPALITY 0F ANCHORAGE~ Department:"'f Health and Environmenta~?rotection 825 ~ Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * Legal Description: Type of Soil Absorption System Is: Trench: Drainfield: ~aximum Number of Bedrooms: - /OR ON-SITE SEWER PERMIT Phone Number: Seepage Bed: Holding Tank: Soil Rating (sq.ft/br) /~ The Required Size of the Soil Absorption System Is:' DEPTH // .LENGTH ~C~ _ GRAVEL DEPTH. 5 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 th~ 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 r~sidences that the well will serve. * * * TWO(2) I'NSPECTIONS 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 3L 1 9 8 2 * * * I certify that: (1) I am familiar with the requ'irements 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 re?den~i~emodeled to include more that~ bed~s~,~~ - Date: . ~-- SWP/024(1/81) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST PERCOLATION TEST SLOPE SITE PLAN WASGRO,'DWA*ER [ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS PERFORIV]ED BY: '~ ~'- CERTIFIED BY: ~'-"~'~ DATE: °~'~ ~~'' ~"- iGREATER ANCHORAGE AREA BOROUGH DEPARTMENT O,F ENVII~ONMENTAL QUALITY 274.4561 The Unders{gned, Being Duly Sworn, Upon His Oath Deposes & Says'. Last ~ First ALASKA did then and thee commit t~~e: - I ~EREB~ ~GR~TH~ ABOVE MENTIONED VIOLATION WI~ ~ DAYS FROM THIS DATE, IT IS UND~ACTION WIL~ FOLLOW IF . ~. ~ ~ignature ~ ~HE UNDERSIGNED STATES ~HAT HE HA9 JUST AND REASON- ABLE GROUNDS TO BELIEV~ AND DOES B~LIEVE THAT THE PERSON NAMED ABOVE COMMITTED THE oFFENSE HEREIN 6ET~ORTH~NTRARY~O , ~ N~- 8906 EQ-002(1 3.1.¥0 BO X~Vfll$Od ~elsod snl, 'ON ON¥ £33~15 Ol IN35 REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) %. ~-~a~e .of person requesting app~rovat 2. ~a~-~_ of property: owner ~/-~' Nu~,:~, be~ooms in house Watex~.Analys i s: b. Detergent "' Well data: Deptll_ ~,, ~, / . ' ~ Distance f~om well to closest existinE~f~'"~/~6p6sed: /~pO 1, Sewer line 3, Seepage Area /~ ~ 4. Cesspool' S. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses~ barn, drainage ditch, etc. 7. Sewage disposal system. Age of system Septic tank capacity in gallons ~( ~ , / 1. If "home made" show diagram on reverse side of this for Disposal field or seepage pit size and ty~e 1. Distance to property line to house foundation . e. Percolatio~ Test '~esults .. f. Percolation Test performed by ~, "~-~. Use the reverse.side of this form to show diagram, Dia[ram should include ~ ?-~he fo]]~wlng information: ppoperty lines~.well location, house locatlon~ "v-o~r~{c tank location, disposal area location~ location of percolation test, a~. direction of ground slope. 9. The ln-~ox~t~on .on this form is true and correct to the best of my knowledge. Signature of Applicant Date Signed' ~0 BE FILLED OUT BY HEALTH DEPART~-~ENT PERSONNEL [----]'T~e above described sanitary facilities are hereby approved, subject to the ~l~owing cond~onsi ' ' " Conditions: The above described sanitary facilities are disapproved for the following reasons: Approval is valid for one year following the date of approval. CPJ: cw FHA Form .~ - Rev. July .195., FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR MORTGAGEE , J SERIAL NO. PROPERTY ADDRESS ~{~{ {)jJj.,~{~{~ ~ BLOCK NO. LOT NO. Can attic or other area be made into additional bedrooms? (If Yes, how many.~) ~ Yes ['--1 No ~ I SYSTEM DESIGNED FOR []Individual NO* OF BDRMS. GARBAGE DISPOSAL [] Individual ,~- N Yes ~ No SUBDIVISION NAME TOTAL NUMBER: LIVING UNITS BEDROOMS BATHS WATER SUPPLY BY: -']Public system SEWAGE DISPOSAL BY: BASEMENT [] New installation ¥es VINo I-]Community system [~ Community system r-j public system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [--'] County ~ Local Department of Health that this individual v~ater-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [--] State [] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: ~-1 Can be expected to function satisfactorily, and , [~ Cannot,he expected to function satisfactorily is not likely to create an insanitary condition DATE SIONATURE / ........ J / ~ ..~ :::7 . NOTE: The health auth0rlt/should}omplet~ }he app'ropriat~ opinion statement above and a~x date, signature and title m the spaces provided. / ,' / Use of the above grid ~br He~ t~ Department Inspector's sketch as welJ as use of the bock of this form is at the option of the health authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that 'the Individual water-supply system be considered [-] Acceptable [~ Not Acceptable Sewage disposal be considered [--] Acceptable [--] Not Acceptable. DATE SIGNATURE MIrALTu AIIJI'#~DITY APPROVAL ] CHIEF ARCHITECT r~ DEPUTY FOR CHIEF ARCHITECT FHA Form 257.t