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Home My WebLink AboutSTUCKAGAIN HEIGHTS BLK 4 LT 1 Municipality of Anchorage Page 1 of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990240 PID Number: 04.1-021-24. Name:JERRY ROACHECK Wastewater System: [] New · Upgrade Address: 9600 BASHER DR. ANCHORAGE, AK 99507-1202 ABSORPTION FIELD No. of Bedrooms: Ph°ne:(907) 555--8988 ·Deep Trench nShallow Trench r'lBed nMound [2Other LEGAL DESCRIPTION ~.2 aP~/s.. F~ 8.24- (MAX.) 1 4- STUCKAGAIN HEIGHTS 4.' (MAX.) r~ 4.25 Township: -- -- -- 0.5 +/-- Ft. 44.0+ J Grovel width: ~umbor ~ "~..: IDrm~, WELL: [] New [] Upgrade 2'+ Ft. 1J -- J D°tel"~tall"d:8/15 -- 20/99 ~ GpMIP.mp Set At: Ft~lCasfrlg Hefgh, Abave Groun,~ TANK SEPARATION DISTANCES · s..t~o [] Ho,di.g u To Septic Absorption llft Holding Public/Private From Tank Reid Station Tank Sew.r u.o. ANCHORAGE TANK 1000 Well 100'+ 100'+ -- - 25% STEEL 2 Su~ooe 100'+ 100'+ - - - LIFT STATION Water Lot 5'+ 10'+ -- -- --II Line Foundation 5'+ 10'+ _ _ _ 'Pump on' level at:"'"m" °ff'~l~"-'~O'~'lHigh water alarm ¢c Cur[ain Pump ~o~e~: ..ct~, ,n.pacUon. w,;~,,,~-~ by: N(~NE KNOW~I Droin Remarks: BENCH MARK TOP OF FOUNDATION CLEANOUT. JA,urned IDevafiom 100.00 Inspections performed by: AWWC, INC. Dates: 1st 8/15/99 ........ ~ ............ 2nd 8/18/99 .~'~'"3 3rd 8/20/99 ~ .~ef~ r~ yj A. ~s." ~, Department of Health and Human Services approval Q[~,..... ........... Reviewed and approved by~--~,~ / ~ ~¢'~Z~'~)ate:/~ '~ '¢/~ ~,?~o.,%%.~.~.<=~~0' res ¢o~ ~,~,I~: A S - B U I LTD R AWl N G PS~,~-'~2fE~,R: I000 dab J J ~ ~001 I I / I I / ~ / I I / J j DBL1 80.¢ ~80.7 I I rD ~.o ~.g /,I /X / ~T 78.0 gS.~ J J ~02 8o.8 7~.4 ~. CORRECT,O T~ HO~ LOCA~ON. SW~NO ~ES / / / I j x ON ORIGI~L DESIGN WERE INCORRECT. I ~AS~ WATER ~ WASTEWATER CONS~T~S, ~C. ~m~ / A B ST1 50.5 70.8 ST2 56.9 77.0 DBL1 60.4 80.7 DBL2. 61.3 82.0 FD 65.0 85.9 C01 85.9 106.1 MT 78.0 95.4 C02 60.6 75.4 69Ol DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 358-.3246 LEGAL DESCRIPTION: STUCKAGAIN HEIGHTS SUBDIVISION, LOT 1, BLOCK 4 I~'PE OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: JERRY ROHACHECK 335-8988 DATE:REViSED:8/25/99 IDRAWN BY: SCALE: PAGE: 10/5/99 K.D.W. 1 = 50' 2 OF 2 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box lg6650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 02, 1999 Expiration Date: Aug 01, 2000 Permit Number: SW998246 Legal Description: STUCKAGAIN HEIGHTS BLK 4 LT 1 Design Engineer: 0041 AK Water & Wastewater Consuita Owner Name: Jerry Rohacheck Owner Address: 9600 BASHER DR ANCHORAGE, AK 99507-1202 Parcel ID: 041-021-24 Site Address: Lot Size: 87120 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the constrUction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to Apd115, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: Alaska Water & Wastewater Consultants, Inc. 6901 DeBarr Road, Suite 2B ~ Anchorage, AK ~ 99504 (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers July 7, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Stuckagain Heights, Lot 1, Block 4 To whom it may concern: The existing 3 bedroom house is served by a private septic system and well. The existing drainfield is surcharged and in need of replacement. One test hole was performed on the reference property and the soils are summarized as follows. 1. SOILS: Test hole #1 was excavated on June 28, 1999 to a depth of 16 feet and no groundwater was encountered. The soil below the organics was a GW/SW material to a depth of 12 feet. From 12 feet to the bottom of the test hole was a SP to SP-SM material. One perk test was performed at a depth of 6 feet and the soil absorbed water as fast as it was added. It is our opinion that the insitu soils will act as a filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. Total depth: 10 feet g. Effective Depth: 7 feet h. Reduction Factor = N/A i. Width: 3 feet j. Length: 35 feet k. Effective absorption area = 490 ft2 (375 ft2+) 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed · upgrade. 4. TOPOGRAPHY: The area where the proposed septic system is to go is on a very gradual slope from the house heading northwest (see attached topography drawing). In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerel¥~ , ~,./~ L.~-\. \ \ I I.' ~OT~ .~OD,~ ,~ ~ ~ I i / / o~ I I ~ROPOSEO SEPTIC SYSTEM / / ~ ~ I I // (SEE DESIGN, PAGE 2 Of 2) / / / :~ ~-~: ~ TUXEONI PARK I /.~'/ / A~S~ WA~R AND WAS~WA~R CONS~TANTS, INC. 6901 DE~RR ROAD, SUITE 2B. ~CHO~GE, AK. 99504 ~PE Of WORK: J[.~Y ~o.~c.[ck ~*-**aa )ATE. ~mW~ BY: SCA~: PA~E: '7/6/99 K.D.W./A.C.G. 1 = 100' 1 OF 2 I CO / BY 10' DEEP (MAX.) ADD J ~ ~ ~PROPOSED 1000 GALLON I ~t CO / SEPTIC TANK ~.C,~L;::~>:~ --% / / · J ~x,~.~oo~.~o.~~~ J V / 'l ' ~x /x/ ," / ~ ~ ~ / / " / t l ~)~%~&"~ .~ ,.~ ~ / STUCK'gAIN HEIOHTS SUBDIVISION, COT 1, BLOCK 4 ' ..~ o~ wo.~: 'r-'-i"~ ~'2 ..... ~'"'~ ~ERRY ROHAOHECK ~-8~88 A.C.G. 1 = 50' 2 OF 2 ALASKA WATER. & WASTE?~A. TER CONSULTANTS, INC. 6901 DEDARR ROAD, SURE 2B ANCHORAGE, AK, 99504 PHONE (907) ,337-6179 * FAX (907) '~38-3246 i SOIL LOG - PERCOLATION TEST] LEGAL DESCRIPTION: STUCK, AGAIN HEIGHTS SUBDIVISION, LOT 1, BLOCK 4 PERFORMED FOR: JERRY ROHACHECK DATE PERFORMED: 6/28/99 ORGANICS I TEST HOLE #11. Gw/sw SP TO SP-SM L C SSIF ATI NS ~GW ~ ORG GP ML GM CL GC OL SW MH SP CH SM OH SC DEPTH TO DATE ROUNDWATER DRY 6/28/99 xxx xx/xx/xx DATE $/29/99 READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) COMMENTS: PERFORMED BY ALASKA WATER & WASTEWATER THIS WAS PERFORatED/IN ACCORDANCE WITH ALL STATE DATE. DATE: ~/l~//.~ PERC. HC ABSORBED ?ATER AS ~ AS IT WAS AD )ED. PERCOLATION RATE <1 TEST RUN BETWEEN 6.0 (MIN./INCH // UNICIP.~J. PERC. HOLE DIA. 6 (INCHES) 6,5 FT, , CERTIFY THAI ;UIDELINES IN E~rECT ON THIS AWWC, Inc., July 1999 Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Onsite Wastewater Disposal System Standard Construction Specifications I. REFERENCE PROPERTY: Stuckagain Heights Subdivision, Lot 1~ Block 4 II. DEFINITIONS: 1. Property owner: The legal property owner or hisfner representative. 2. Engineer: Alaska Water & Wastewater Consultants, Inc. or AWWC, Inc. 3. Contractor: The company hired by the property owner to install the septic system. 4. DHHS: Municipality of Anchorage, Department of Health & Human Services 5. M.O.A.: Municipality of Anchorage, Department of Health & Human Services III. RESPONSIBILITIES: · Property Owner Responsibilities: 1. The property, owner shall contract with tbe contractor to perform the work outlined in these specifications and plans, in accordance with the attached DHHS permit. There is no contractual relationship between the contractor and the engineer. The engineer shall inspect the work as, required by DHHS to document the installation. Final acceptance of the contractor's work rests with the owner and the DHHS. 2. This well and/or septic system design is for a single family residence only. The homeowner is responsible for notifying the engineer if the residence is used as a duplex, business, or multi-family dwelling. In such cases, the installation permit must he obtained from the State of Alaska, Department of Environmental Conservation. 3. The validity of the design site plan is limited by tbe accuracy of the as-built stu'vey provided to the engineer by the property owner or his/her representative. The property owner shall notify the engineer regarding any known inaccuracies associated with the as-built survey. The engineer assumes no responsibility for the accuracy of the survey. 4. The property owner is responsible for notifying the engineer of any unplatted easements, not shown on the as-built survey, which the new well or septic system may encroach into. 5. The property owner shall notify the engineer of any seasonal groundwater or surface water runoff conditions, known to him/her, which could potentially effect the operation of the septic system. The proposed septic system must be at least 100 feet from any streams, ponds, creeks, swamps, bogs, or any other surface water as defined by the DHHS. 6. The property owner is responsible for notifying the engineer if, to his/her knowledge, any of the adjacent properties are used as a duplex, business, or multifamily dwelling. The new septic tank and leachfield must be at least 100 feet from any private well, 150 feet from any class "C" well, and 200 feet from any community well, unless appropriate waivers are obtained. 1 of 4 A WWC, Inc., July 1999 7. The property owner and/or his contractor shall report to the engineer any observed condition which would put the septic system in violation of State or Municipal regulations. 8. Unless specifically a~eed upon otherwise, the property owner is responsible for final grading of the areas which settle after construction. Prior to awarding the contract, the homeowner should communicate to the contractor any expectations regarding, but not limited to, post construction site clean-up, re-landscaping, and restoration of any asphalt, fences, trees, decks, etc. that are effected by the construction. If the property is being sold, the property owner shall ensure that the aforementioned items are addressed with the buyer, and, if the work is to be completed after the sale of the property, that necessary funds are escrowed to fund the completion of tbe work. 9. If the property owner intends to install the septic system he/she must first have obtained approval from the Municipality of Anchorage, DHHS (343-4744). Homeowner installations typically require more time for engineer inspections. The homeowner should discuss the additional costs, associated with such inspections, with the engineer, prior to starting the project. 10. The property owner is responsible for payment of all the engineer inspection charges. The number of inspections will vary depending on the actual field conditions encountered and the construction methods used. · Contractor Responsibilities: 1. The contractor is responsible for locating all buried utilities, easements, property lines, and surface waters; and shall ensure that all setbacks are flagged by a registered land surveyor prior to construction. 2. Construction shall be in accordance with the approved site plan and design drawings, and any special provisions noted on the municipal sewer permit. The contractor is responsible for notifying the engineer of any discrepancies noted on the design plans or drawings, prior to starting work. The installation, materials, and workmanship shall comply with all applicable State & Mmficipal regulations. 3. The contractor is responsible for field verifying the separation distances to all adjacent wells and septic systems, shown on the design drawings, prior to starting construction. Any encroachments that would effect the installation, for which waivers do not exist, should immediately be brought to the attention of the engineer. 4. Ensure that all materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. This includes, but is not limited to, the following: a. Drainrock b. Sand filter material for conventional beds, trenches, or mound systems. c. Sand filter material and pea gravel for Intermittent Sand Filters (ISF). d. Anchorage Sand and Gravel (AS&G) "block pea" material for Upflow Filters. It is recommended that the contractor provide the engineer with current sieve analysis' from the sand/gravel supplier to document the suitability of the material. The engineer assumes no responsibility for ensuring that the materials delivered meet the MOA requirements. 5. The contractor shall ensure that the septic tank, lift station, or holding tank purchased has a burial depth rating suitable for the actual installation. 6. Notify the engineer at least 24 hours prior to starting construction. If deemed necessary, a preconstruction site visit shall take place. The contractor shall coordinate with the engineer any inspections which will be required during weekends, holidays, or before/after normal working hours (8:00 am to 5:00 PM). The property owner may incur additional charges for inspections which do not occur during normal 2 of 4 AWWC, Inc., July 1999 business hours. It is the contractor's responsibility to notify the engineer a least 2 hours prior to any inspection. 7. The contractor shall report to the engineer any observed condition which would put the septic system in violation of State or Municipal regulations. 8. Any remaining test hole excavations shall be filled and mounded. Unless instructed otherwise by the engineer, the old test hole groundwater monitoring pipes shall be removed. 9. The contractor is responsible for final grading so as to ensure that surface runoff does not adversely effect the septic system constructed, adjacent septic systems, or adjacent structures. 10. The contractor is responsible for obtaining approval from the property owner for any additional construction costs associated with design modifications or changing field conditions, prior to doing the work. · Engineer Responsibilities: 1. The engineer is responsible for inspecting the installation of the septic system and preparing as-built documentation, to the satisfaction of the M.O.A.. Inspections are performed as necessary to document the construction of the system to the satisfaction of the M.O.A. In all cases, the following inspections shall be performed: * The bottom of all trench/bed excavation * Top of sand on all sand filters * Top of drainpipe * Septic tank, or lift station, or holding tank prior to backfill * Placement of filter fabric and insulation * After final grading is completed Additional inspections may be required depending on the construction methods used by the contractor and the type of system being installed. 2. The inspecting engineer has no direct authority over the contractors activities or construction practices. Should the engineer identify conditions which dictate a design change, he or she may recommend that work be stopped,, and/or the design be modified. If design modifications are necessary, the engineer shall notify the property owner or his/her representative. 3. The engineer shall inspect the condition of the existing septic tank and determining its suitability for re-use. If the engineer determines the septic tank to be structurally unsound, it must be replaced. IV. CONSTRUCTION GUIDELINES: · General Construction shall be in accordance with the approved site plan and design drawings, and any special provisions noted on the municipal well and/or sewer permit. All materials, components, and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as DHHS policies. The failure of the inspecting engineer to notice a material or construction non-compliance does not relieve the contractor of his/her responsibility to correct such a deficiency. · Septic Tank, Holding Tank, or Lift Station Installation: 3 of 4 AWWC, Inc., July 1999 1, The burial rating of the tank shall be adequate for the actual burial depth encountered. 2. The tank shall be level and sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the tank shall extend a minimum of 12 inches above final grade. 4. Tanks installed with less than 4 feet of cover shall be insulated. 5. The sewer service line from the house to the tank shall be sloped a minimum of 1/4" per foot, unless prior approval is obtained from the engineer. 6. The inlet and outlet lines from the tank shall be bedded in drainrock or the soil shall be adequately compacted to prevent future settlement of the soil. 7. A foundation clean-out will be installed, 1-4 feet from the house, if one does not currently exist. 8. Post tank clean-outs shall be installed per MOA requirements. Does not apply to holding tanks or lift stations with pressurized lines. 9. All tanks shall be anchored to resist buoyancy forces in high groundwater areas. This applies when there is not adequate soil cover to resist buoyancy forces. Engineer shall make this determination. 10. The final soil cover shall be graded so that there is positive drainage away from tank. 11. All holding tanks and lift stations shall have an audible and visible alarm inside the residence. 12. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. 13. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing Code (UPC). The contractor is solely responsible for the abandonment procedure. · Installation of Conventional Absorption Bed & Trenches: 1. Excavate the proposed bed/trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level (2 inch maximum variation between high and low spots). If the sidewalls or bottom of the excavation become smeared, they must be raked or scarified before placement of the filter sand or drainrock. 2. The trench or bed should be at least 5 feet from the test hole excavation. 3. All soil tests and excavation depths are advisory to the design and are to be verified in the field by the engineer. If design changes are necessary, and the changes effect the contractor charges to the property owner, the contractor shall obtain approval from the property owner prior to proceeding with the work. 4. Once the drainrock is installed, the distribution pipe is to be placed level (0.02 feet difference between high and low shots) with the perforations faced downward. Drainrock is then to be placed over the distribution pipe, to provide a minimum of 2 inches of cover over the pipe. The drainrock shall not be pyramided over the drainpipe but shall be the same elevation over the entire trench/bed width. 5. A silt barrier must be installed between the final drainrock layer and the native soil backfill. The silt barrier shall cover the entire drainrock surface. 6. Monitor tubes shall be installed at the locations shown on the design drawings, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the drai~ock shall be perforated from the bottom of the trench/bed to the invert of the distribution pipe. 7. Backfill over the final drainrock layer must not be less than 2 feet. Insulation must be installed when the backfill depth is less than 3 feet. The insulation shall cover the entire width of the trench/bed, the contractor shall "shoot" the final grades to ensure cover depth is adequate, prior to notifying the engineer that the work is complete. The final cover over the drainfield must graded so that there is no potential for water to pond over the trench/drainfield. 4 of 4 i 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 PHONE ~EW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS Absorption area Dwe[iin~ DISTANCE TO: ~ ~ Material No. of compartments ~ ~ ~Liq. capacity in gallons IF HOME.DE: inside length Width Liquid depth O z ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: Well ~ ~ Z No. of lines Length of Aach line Total length of linej Trench width Distance between lines ~ ~ Top of tile to finish grade Material beneath tile I Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ;lass Depth Driller Distance to lot llne PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(si ~ DISTANCE TO: OTHER PIPE MATERIALS SOl L TEST RATI N G INSTALLER APPROVED [~ DATE LEGAL 72-013 (Rev, 3/78]" 'IH,,IIIJII I'..IIJMIE:EIi: OF 13[E[:,I:;iiOLqMS; =: -1''~': OF TI-lIE: SOIL_ FIE':: qI:?F'T'T "l"t .-:,~'.:,1EJi .... THE F4'.EJ;:0_I I F~:EI:::, .:,_ THE LEIqGTH I;,]:MEI'.4:LT, IOI",I :[5 THE LENG'TH ,::IN F:EET.':' OF ']'PIE TRE:IqCH OP. DRFC[NFIEI...!:::,. THIE DEF'TH OF FI i-I:;'.ENE:PI O[R F'IT i~; 'THE DISTI::II'-~,CE: F3ETF.tEEN THIE '_:;UI:~:FF~CE: OF' THE GROUND FIND THE: E:o'r]"OM OF THE E;:.::C:F%,'FITZON (;[1'-4 FEET:). THEF;'.E Iii; NO 5;ET gl:[[:,TH FOR 'T'RENCHES:;. THF_ L-~F~:FIV[F_L DE]::'TH I:5 THE MINIMUM DEPTH OF GRf:IVEL. E:ET'I.qEEN THE' OUTFT~L.L. F'IF'E FIND THE E:O]"-f'OM (::iF THE: E',:.:',CFCv'FIT I ()lq ,:; I N FEET' ). BRCI<FILL:[NG OF FIN'.¢ Sh-'STEM F.II'THOLIT F'Z[NRL INSPECTION RND RPPROVF:iL. 'DEPRRTMENT IqZL.L. BE St...IB.jrECT -['O F'RO:SECUTZON. I','llNIi'fllJId I)IS'f'F:INCE E:ETf'I4EEN FI HELL. RIqD FIN"r' ON-SITE SEHRGIE C, ISPO:SFIL. 5;"r'S-l"Ei"i I5; J.~O FEET FOR FI I:'P. ZVRTE NELL OR 2EI6:.1 FEET' FOR R F'UBI...IC NELL.. 14EL..I_ L. OG% RI';:E ~:E(;:¢...IZFi:ED FIND MUST BE RETURNED 'r'o THE E)EPRF?.TMENT P.IITHZN OF THE: HEL. L ........ I IFLE.~ Z...II. , ]: N%'TFILLRT I ON. ! CEF:TIF"r' THFfF ::L: I FIM FRMILIRR 14ITH THE I:;:IEi:;!UIR'E]"I¢:NTS; FOl:~: OIq-i::;iTiE 5~EI.qERS AND 14EI..I..L:; FIS SET FO[?.TH [3'¢ THE MUN:[C]:PFIL I'TY OF' RNCHOf~:FIGE. 2: ]' 1.4II_L. II'-,15;TFIL. L.. THE !:;'¢STEM ];N FICCORDF~NE:E HITH THE ::{:: I UI'.,IDER:FZTFIND THFfT ']"HIE ON-5;ITE 5;EI.qER SMS;"rEM MF:IY F?.EQUZF?.iE rENLFff;'.GEMENT ]:F THE I~[£5;IDEI'.,ICE IS R[EMODIELED "FEI INCLUDE f"IORE:'q'HFff',I Z::: E]EDF;'.OOMS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6,650, Anchorage, Alaska 99602 276-222'~ SOILS LOG - PERCOLATION TEST ~' SOILS LOG [] PERCOLATION TEST PEREORMED FOR: ~-err~ LED^LOESCR,PT,O": XO% --~ 1 2 3 4- 5- 6- 7- 8- 9- 10- 11 13- 14- 15- 16 17 18- 19 20 DATEPEREORMED: ~'-2-77 SLOPE - / SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPT"? . I1-I Dross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND -- FT CERTIFIED BY: ~LbJ~b T6~TL~ DATE: d- ~ 77 72-008 (7/76) 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 1. PROPERTY OWNER ~)IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MAI LING ADDR ESS PROPERTY RESIDENT (if different from above) 2, BUYER MAILING ADDRESS PHONE PHONE 3. LENDING INSTITUTION PHONE 4. REALTOR/AGENT PHONE MAI LING AD DR ESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ,J~ Three [] Six 7. WATER SUPPLY J~ INDIVI DUAL* * ATTACH WELL LOG. A well log is reqdired for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 7.~,~,,R, · 8. SEWAGE DISPOSAL SYSTEM · *if individual/on-site, give installation date ~ INDIVIDUAL/ON-SITE** If system is over two (2) years old an adequacy test is required [] PUBL? UTI LITY 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 DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS ,N S]NGLE FAMILY [] ONE ~ THREE [] F,VE [] OTHER MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~ DEPTH OF WELL INDIVIDUAL [] COMMUNITY -- DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]IN DIVIDUAL/ON -SITE DATE INSTALLED -- Connection Verified -- INSTALLER []Septic Tank or [] Holding Tank Size: to'~'-~ if Tank is homemade SOILS RATING -- TOTAL A,~O:~ON AR EA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line ~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 IRev. 3/78)