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HomeMy WebLinkAboutBETTY W LT 2Betty W. Lott #051-105-28 OWNER OF LAND ADDRESS � r l - ` Deb Url*ttinglxg by DOC Co. dba SULLI"N WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 DEPTH OF WELL STATIC LEVEL OF WATER FT LEGAL DESCRI DRAW DOWN FT. DATE. - Starte Ended GALS. PER HR PERMIT NUMBER — KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft.. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From From Ft. to Ft. Ft. to From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: From__—Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to _Ft, From Ft. to —Ft. From Ft. to Ft. From Ft. to _Ft. From Ft. to ._Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. DRILLER'S NAME Pell! ����1 Ir % 1L.... :1* -IF "v' C-3 F::- 11-5/ !E_ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 840937 DATE ISSUED: 11/06/84 APPLICANT: RAYMOND L. ANDERSON . ADDRESS: SRI -BOX 2683 CHUGIAK, AK 99567 ` CONTACT PHONE: 688-2315 LEGAL DESCRIP: SUBDIVISION: PROP. BETTY W. LOT: 45 BLOCK: NA SECTION& 9 TOWNSHIP: 15 RANGE: 1W LOT SIZE: 1.5A (SQ.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with allMOA codes and regulations, and in compliance with the design criteria of this permit. ' 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public seWWaCe systemon this or any adjacent or nearby lot. SIGNED DATE: . x - ^�^�---------------- -----------�--- APPLICANT: R L7.7m, DEON ISSUED BY DATE: a: GREArR ANCHORAGE AREA BORl0�7H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 /INSPECTION REPORT ON-SITE SEWAGE DISPOSA/L, SYSTEM NAME /, /y 011.,c Cl lL�f�/DYI MA�ILING ADDRESS �� -Z�t'U 1[`.nN 995'V ION/EOf LOCATION 1,47//107' 7 111 e11t16'Li ' �/ dC?/LEGAL DESCRIPTION /- 4'67 SLI K1 w I JS SEPTIC TANK: DISTANCE'n/ -�- NUMBER OF / FROM WELL MANUFACTURER("spt 4MATERIAL I�lr/ �G COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/r—e-i!5GALLONS. SoJI- ZSoTv9' Iz5�s5 z'rbs'_wc,f-rcf/-6- TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LIN�E/ le't LINES//`' M NUMBER OF LINES 2 DISTANCE BETWEEN LINES TRENCH WIDTH— IN. /TOTAL EFFECTIVE ABSORPTION AREAa"6ri ��e SQ. FT. LENGTH OF EACH LINE 7'e%'/L""�% �j % //0�1�-/ &- W0a. InnK- 2�K�c»cf DEPTH OF FILTER (/ DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE WELL - TYPE CONSTRUCTION IN. ABOVE TILE IN. DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION , LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL . OTHER SOURCES APPROVED DISAPPROVED REMARKS `syS�P>n w;// sevae a 3.:c/rm-- DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: OiorP✓' SEWER LINE DEPTH: 4!�;'/ PIPE MATERIAL&& , I100 w;111 e 20` 71,cy xis i, 26-0%o,'/w;ih ,3'7 J%Z'°" �Y'ctt�e/wncrfSr %JIe�r9e 77,e 57' p -'N 'fit/ %S Si�'�J in Cnct�^SP c�7rec v e/ REMARKS: Co"1',Pc1" o/;'A SfyrOtyO�cr,y� Form Eq -032 I y f DATE% 7y APPROVE � Z� ✓ G.A.A.B. 7 n GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 33-30 "C" STREET ANCHORAGE, ALASKA 99303 Ipq' TELEPHONE 274-4361 -,_.SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT I Imolc /v a r ��j/'�, /(n MAILING ADDRESS ^"/ -��/ PHONE INSTALLATION LOCATION// ✓ille`I k1U F al/�(/J'`--'I''✓/�EM LEGAL DESCRIPTION LOf 7� �t^ / -`lW T -15 -Al 'I~1' INSTALLATION OF: SEPTIC TANK SEEPAGE PIT " '/ JA DRAIN FIELD OTHER TYPE AND SIZE OF FACILITYY TO BE SERVED • _"�1' `/ "''OL/1 FINANCED THROUGH ^1�,/¢�� ,/}�� TO BE INSTALLED BY SOIL �/J//��h� �lh�I SOIL TEST RESULTS i�1 dw; �� w'� "-� /"E b/e ���NOTI THIS PERMIT IS NOT VAL4� WITHOUT SOIL TEST / /O� 7.' �Ilpti^Q�_f4dva7P,�l�eQ COMPLETION TIE jrIFATED Z— 5� z J JCu_ / (y J 041-c-3 �A �J-/SSS FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE7 DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /D00 TYPE�u�{/'J / �' T L SEEPAGE AREA SIZE -"'1 k<�f TYPE Como -f• ! MINIMUM DISTANCES. REQUIREMENTS DIAGRAM OF SYSTEMF /�/w ]/ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT 20 DRAIN FIELD AV �. SEPTIC TANK TO SEEPAGE PIT WALL /S / / SEPTIC TANK SEEPAGE PIT � DRAIN FIELD TO NEAREST LOT LINE. / / WELL TO SEPTIC TANK � SEEPAGE PIT /oo / DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD �/�.A /� SEPTIC TANK, 16C SEEPAGE PIT T F DRAIN FIELD O`er J TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH /LAA/TIONS REGARDING INSTALLATION. G.A.A.B. Ow LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINA E NO. 26.68 AND THAT THE ABOVE DESCRIB D SYSTEM IS IN ACCORDANCE WITH SAID CODE. 9 (y �/ GJ DATC 5 /' �/ APPLICANT SIGNATUR "- - FORM NO. E0-016 MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES per/ Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C4S �- �� — .2 d HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 0' Property owner Day phone Mailing addressC. Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 12- 3. 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) From MOA 921 5. STATEMENT OF INSPECTION BY ENGINEER 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 application 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 with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm L2 < c�:��<=�'i Phone Address V Y IC �C 1 Engineers signature —I� Date S 6. DHHS SIGNATURE Approved for Disapproved. 0 �- bedrooms. Conditional approval for Additional Comments �4 of e � TH e.: TH o Olt .. ,C6U ' S T 3tERiLE' CE 8176 bedrooms, with the following stipulations: Date 3-oy The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-05(ReV. 1/91) �Ck MOA 421 RECEIVED E Municipality of Anchorage MAY 16 2000 DEPARTMENT OF. HEALTH & HUMAN 15�V1QF,%F'NCHURAGE Environmental Services Divisiowt mviim, Skxv,l,Es Ujvislor tjf 1 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Gor 2 Parcel I.D.: A. WELL DATA Well type fes'+J9yr If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth BO ` Sanitary seal (Y/N) Date of test Static water level Well production Date completed _ Cased to '�6o "� FROM WELL LOG ._f '/ Casing height (above ground) f2 Wires properly protected (Y/N) Y AT INSPECTION g.p.m. �! 9.13 -m - WATER SAMPLE RESULTS: Coliform Nitrate 7 Date of sample: Collected by: _ B. SEPTIC/HOLDING TANK DATA Date installed Q�6I? Tank size ibap Other bacteria M Number of Compartments Cleanouts (Y/N)_X Foundation cleanout(Y/N) / Depression (Y/N) High water alarm (Y/N) Date of Pumping -1191, o Pumper C. ABSORPTION FIELD DATA Date installed q���%y Soil rating (g.p.d./ft2 or ft2/bdr zaF/ System type Length Width Gravel thickness below pipe f6 - Total depth Z Effective absorption area `r�ZyF� Monitoring Tube present (Y/N) y Depression over field (Y/N) Date of adequacy test ��Z y�� Results (Pass/Fail) For _01 bedrooms 7 /V Fluid depth in absorption field before test (in.); Immediately after '0gal. water added (in.): �,6 Fluid depth z�L(ins) Minutes later: Z y/11fs Absorption rate = y�e g.p.d. Peroxide treatment (past 12 months) (Y/N) n,� If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* ested E. SEPARATION DISTANCES Size in gallons "Pump.on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot //vee On adjacent lots Absorption field on lot iz 3/ On adjacent lots Public sewer main X114 Public sewer manhole/cleanout Lift station Sewer /septic service line ,z4- fes/ at* / ®o 1-/--71 v O F�f .tll,9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line 2</Ff Absorption field Water main/service line �SyFd Surface water/drainage /o©�� Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: �Z) d9 Property line 28/131, Building foundation /J"Gf Water main/service line Surface water / ay "A/• Driveway, parking/vehicle storage area Curtain drain ,JO • 2D Wells on adjacent lots F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal in conformance with MOA IJAA gu' elinas in effect on this date. Signature Engineer's Name a�«•e r �� ` Date 5-, 1 (P ` 0O HAA Fee Date of Payment Waiver Fee $ Date of Payment Receipt Number e&W- 7 1�/ �� Receipt Number 72-026 (Rev. 3/96)* 1a,0tf" yfs t *.thva a m s are TW Dt5i1 ,`a T KOJEY: CEfli76 ,<' t _® NX®®'►