HomeMy WebLinkAboutT15N R1W SEC 8 LT 110P.O. BOX 6702.72, CI'tUGI/~K, ALASKAg9567 , TELEPHONE 658.2759
KIND OF I'()[>,MAIION
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AUG 10 1998
Munlolpallty et Anchorage
Dept. Flealth & Human Sen/lees
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PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970184
DESIGN ENGINEER:DUM~4Y COMPANY
OWNER NANE:YASSICK JANES M
OWNER ADDRESS:P.O. BOX 770343
EAGLE RIVER, AK 99577-0343
DATE ISSUED: 7/11/97
EXPIRATION DATE:
PARCEL ID:05115122
LEGAL DESCRIPTION:
T15N R1W SEC 8 LT 110
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL 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 (iSAAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS } (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SANE ]DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
1 OF
7/11/98
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY: ~-~~. ~~'
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGI: DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT
PHONE
[] UPGRADE
NAME
¢ ~- ,,v, 0.',' C
_--GAl_ DESCRIPTION
1_~ r- /lo
7
/ J Well
DIS'I-ANOE TO: ,J ~,,,/, O
M~nufacturer
I. capacity i~gall~ns ~: HOMEMADE: Inside length
Dwelling
DISTANCE TO: jvvuu
Dwelling
Jidth
Length of each lin~
No. of compartments
Fmmdation PERMIT NO,
DISTANCE TO:
Total length of lines Distance between lines
~terial~/eneath tile
~op of tile to finish grade
Length
Width
Type of crib Crib diameter
Well
DISTANCE TO:
Class Depth
Building foundation
DISTANCE TO:
Crib depth
Building foundation
Driller
Sewer line
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
NJ~ot line
I ~ O ~ inches
Total effective abso ption area
"7 7' in h s J
PERMIT .
Tote effective absorption area
Neares~ot line~ --
Distance to lot line PERMIT NO,
OTHER
PIPE MATI--RIAL8
SOl L TEST H~ N~_._~
INSTALLER
REMARKS
PPROVED DATE LEGAL
RPI:'I...ZCF:INT ..TFIME2~; "r'E:::;S]:CK GI_:]',I. [::,E[
I.OE:FIT I ON .:[ff"~'t'll'::l!.'.ll':.'. I N B I RCHI.,IOOD
I.liiJ?i[:lL. [.::U..IZI 'l':l.,~i'.,t I:?.il.,.I :SEC ~i:i~ I...C[T
'['"r'[::'l!~: OF '.::';OIL
MI:::IXIMI.II'"I I'-,II..IMBE:R OF' [~:EDI:;:OOI"I~E; =: S
'I'HE I:;J:F-"[;!U ! RE[) S l ?E (~F:;r THE SO ); I.. FIE,'SOf,~:F'T I ON fi;'¢::!:'FEM I :!5:
TI.IE t.EI'.~GTH E:, I ME:NS 1 ON I :::¢ "I'HE LEI",!GTH ,:: I N FEE~;'F :) OF:' -I'HI:!-: I'P.E::N()H OF?. I::,RI':t:!: NF':i: F:L D.
FPIE' I.':'EPTH OF' FI 'f'F.:[:~:N(:::I.~[ OF?, F'IT Z'."!!; THE::: E:,I~;'f'F:Ii",IC:E [3ETP]I~:EF,I THE ';'!~I..IP.[:FIE:!i!!: O!:::'
Gf;?.OUND FIN[:." THE E:O'I"'f'OM OF T'IIE E[:.:',I]:I::I',?I::IT .'1_' (lIN ( I N I::Z::E T ).
THERE I~; NO '.:.q:.::T [,.IZ[:,"['t.l FEd:;:
THE GF.',F:IVEL [)[!:P'TH :!2El THE:: MIIqlMUM [:~EPTH OF GP. FIVI:.:I. [~:E'TI,.IE[~:I",I 'rile OU]'I;,'Fit[ F:' I !:;:'F::
FIN[:, THE: [3OTTOM Of:: TH[:. E;:i;':;CFIVFITIC~I",! ():N FF-:ET).
E~RCKI::' i t...( t NG OF' Ftf',l"r' ~:';"r":';'f'E':M 1.41 'FI Iot.r[' I:' :[ NFIL I N:4;F'ECT i ON I'::IN[:, F'IPPP. OVI'::II. [!:~'.~.' '1'1 I:( ::.!;
C, IEI:::'f:'iI:;~'.'f'MEI'qT I.,.II1..1_ BI!: !SLI[~LT[~:CT TO
I"11 I,,! I i','ll..ll',l [;,:[ STRBIC:E E~L::'rI.,.IEEN R I.,IEI.J... Ri'q[:) Ri",I'T' OI",I--S I TE SEHFIGF: I::, I f:;F'Oti.;FIl.. :';"r"J¢Tf!:M :!:::':;
:l.e~[::~ F'I!i:E'I" FOR I::'1
:~FE '1"(:) ;:::'¢::1¢~1 FE£[ET
()]'HE:I:;;'. I;i: E 6!1. J I f;?.E t"IE:N T:!~;
[::IV[::I I I_.I:::IBL.E ]"O I N~;I..I[;?.[~: F'F~:O[:'EI';..' I [",t'.:¢TFII..I_..F:IT Z O[",1
I CERTIF"r' 'I'HFIT
:1.: I Fli'"l I::"F:II'"I i L..1: I':IR 14 ]: T'H THE [~E:l~:!ln.I
[:O[CI'H [~:'.r' THE MLIf",I]:(::]:PF:ILIT'.r' O[::' FII'4C:HOI';?.FIC'iFZ.
2: I I,.IILL. Ii'.,l'~i!;'r'FiLL 'I"HE i;'.r'!;'FEl','l IN I:;tCCO[.~:f::,FiKIC:E I.,.IITH THE C:ODE::~;.
:ii:: I UI'.,IE:,Ef~::2;TFINI.::, THFI'I" 'fHI'E ON..-.:!; ! TI:!!: :5[!il.,.fEl'~:: ..., 'r.., i' f:.l I MFI"r' REI'_:.!LI:[ F~:E Ei",!I..FII',b:2iI:i:MP]'.4T I F' 'IHE
I;?.[ii%t'L'."ENCE ];.'".-:; [~:EMOE:,[!i;I.EI.) TO
ri!; I GI,,IE[:): ..........................................................................................................
FIF'PL I C:f:li'.,I]' .)'Fti"ltEfJ; "r'[~:::::';:~; l
INSF'EC:T];ON ;,ll'.:;TOFd.? -- ':'~;EP.IER :1, El '.:~;Ei:I.,.IEf;: 2
I.,IE]..I._ :(I'.,IF!;F' C~ I,.Ifi~l..l~. L.()(!i I::'FI]"E ~)
AS-BUILT
I hereby oertify that I have surveyed tbe'.fo'llowbi~'
..~/~,v:~_:~,..~ ~,/..<,~.', . .....:.. :
Anchorage ~cording' Pre,AncO, .~laska,"and= that ~e
Improvemen~ s tuated the'eon· are within ~e_prop~ty
lines and.do not overlap or encroach on. the;property
lying' adjacent thereto, that no Improvemen~'on prop-
erty lying, adjacent the~to encroach 'on the p~mises m
~uestion and that there ~ no ~ondwayz, ~ansn ssion
,mrs or other vis b e easemen~ on said pro~rty except
aa i~dlc~ted ~ereon
Dated at ~gle River, Al~ka
thls~.~' ' day °t~f' ~. 19~_~
ROBERT,C, JOHNSON :-'~..
SCALE: ~g~ered L~d S~ve~r No. 880.~
1' = ~ ~ Box 456, Eagle River, Alm~ka
Phone 094-2543 ....
July 6, 197'7
$76455
Dr. James Falcono.~?
134.~ ~'~est 9th Aven~le
~%neho ra~Je, Alaska 99501
Su'.b je~t ~ Pe~rmit Expt~atton
Dear 1)r. Falconer:
A 1. ;~tit issued by this departlaent for wa~ll and/or on-site
ss~¢er installation on Lot 110 l!{ec~ion 8 T15~l R1W ha~;
In the ew~nt yeti still plan to Instal.i. the w,~ll and/or
If the we,ll l~as be~n d%~tiled, a well lof~ should b~ sent
to this d~=pa~.tm~:~n~: to .docu~nent the inst~ilat;ion date.
If you hays ~my questions regard:[hq tho above ~.tter~ please
(tO not hol~itate tO C n[:act: this .of~.Ce imme(!~at~,.ly at 279-
2511, extensJx)n 224 o:: 22~. ' '
Sino~rely,
Les N. Buchholz, R~S.
Snn~.taz'ian
~NB..lJh
t I..I .i'1 .[ I NO.
E:,EPFIF:'.'FMENT 0' "-IERL. TH I=li',l[> [~]",P,/:[ROI',IMEI",~TFIL. i':' ':I"[=CTION
:i[i:~i~L[~; I~'. )0[;?. I';~'[:[... I=[i",JC:l']O[~]=l(~:i[::., I:::[K. 95..
( ?'6,q..55
III I.,
I .OCFIT I ON
LEGI':IL.
.. r I I I II.., I",IORTH (]1:= Civil,Jill IFII< H ~ GH
L:I.,:I..E) ~ ,t,... N I:;?.::LH =.E ..,.., L.,OT =, ;[ ZE.
THE LENGTH [:,I MEi'qSI ON I ~; TItlE: 'EET > C. IF' ]'HIE TRE~:NCI.I OR E:,I:~:FII NI:::'Z EL E:,.
'THE DEPTH C)F' R TRENCH OR PZT ZS BIETI.qEEN 'r'HE ~;I...l~:FFiC;E ElF TI-lIE
GRCIUN[:, FIND THE E:OTTOM OF ION (IN FEET).
'THERE :[:~; NO %E'T 1.4I[:,TH FOR
THE I]i~]:l:::l',,,'[~:L. [:,EF'TH I~ T'HE hlINIi, Ih'l [ GRR',,,%L E:ETklEE:r.,I THE OU"FF'FiI...[.. P];F:'E
F:INE:, THE 30'"Tll',' ElF '[HE E ,CFI'v'FI] ~]1 ,:'. Z,[.,I F'EET>.
',,,
E:FICKI::' Z L..I.. I NG OF RN'.r' 2;"r'2;'l~[El'"l I.,.11 TI"'IOU~ F Z NFtL~ Z NSF'EC"r I C¢.,I FIN[:, RPPRO',,,'F~L B"r' 'r'H :1:
E:,EI:::'FII:;;:TMENT I,.IIL.L E:E .:~,US.J~C[ TO F::'RO~O.].LI[IL)N.
M I I'.,I I ML.IM [':, I E;TF:IN: E [~:I[~:'ft'~'I[SE;~'tS~ HELl... FIN[~L RN'¢ JN--:' 1 f I:.
='[...HItL~E. E' I..'F U..'tll .....r... 1 Ell
:]..EU?.I F:'EET FOR R PRI'v'FITE HE(~L. OR 2EIE~ ~;EET FOR FI PL.IBLZC HELL.
.:,l" 'k. ... ]. l' = .I._.': liE. N_'= RN[:, "'";H'STR..t%T] EH [.,.[H.~((dftb FIRE: I=I%,'RII;.FIEfLE ]"0 ZN~;URE
'1' H'::: "1' f::II..LI:::IT I ] 1'4. ":*~ ~(
I ....l:.f. i 1F r 'TF'IF:JT
t: ~ I:IM F:'RhlXI..ZI:II~: H~"I'H 'I]"IE RE);flJZREI' FOR ON"'"~;ITE %E['.IEI~; F~NI>
FORTH B'?' THE I"?LINZC:~PRI..IT'¢ OF' RNC:HCfRr~GE.
;;?.: I I.'I~LL. ZNSTFIL. L 'I"HE S"r'SI"EM II",l FICCORDFINCE P.IZ"i'I"I THE CODES.
]:: :1: UNDERSTFJN[:' THFIT THE ON-~;ZTE '.~;EHER
RESIE:'E{NCE ZS REMOI}EEL.EE:' TO ZNCL..U[)E MORE THFIN 4
I.,IELI_.S I:;'1~:; ?=;ET
I"II=IY RE):.:d..JIF?,E Ei'.,IL.F;IR(_:iEMEI'.,IT ]:F
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH&ENV[RONMENTALPROTECTION ' -~/,
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264.4720 ' · ~
REQUEST FOR APPROVAL QF INDIVIDUAL WATER AND SEWER FACI LITiES'~
F
DIFIECTIONS: CiomD]ete al Darts on page 1. Incomplete requests will not be processed, Please ellow ter (10) days for processing.
1. PROPERTY OWNER~----~ /~)'i'~ ~'~) ,,/~ vI'tt~ PHONE ~ .~ ~ ~¢~O
MAILING ADDRESS
PROPERTY RESIDENT fdifferentfromabovel // [ PHONE
2, BUYER I PHONE
I
MAILING ADDRESS F
3, LENDING INSTITUTION PHONE
MAILING ADDRESS /
4. REAL'rOR/AGENI' ~,A.~,~..~-- _~ PHONE
MAILING ADDRESS
LEGAL DESCRIPTION
/~,~F'- //O ..C~ ~ T",'.r'~. .,/2. /,,.,o ,~'~.,.
STREET LOCATION
6. 'TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MU L'¥1PLE :AMILY
7, WATER SUPPLY
INDIVIDUAL'
[] COMMUNITY
[] PUBLIC UTIL TY
8. ,~EWAGE DISPOSAL SYSTEM
I~ IN DIVIDUALiON-SITE
[] PUBLIC UTILITY
NUMBER OF BEDRODMS
[] One '~M~'Four [] Other
(//~:,..T~ o [] Five
ATTACH WFLL LOG. A well log ~s required for all wells drilled
s,nce June 1975, For wells drilled prior to that date, gwe well
depth (attach log if available.)
/
"If indN dual/on-site, give installation dateFS~/~av~ ;2'7 ·
If system is over two (2) years old an adenuacy test s requ red
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RI-.'QUEST BEFORE PROCESSING CAN BE INITIA'rED.
72.010(3/78)
THIS SIDE FOR OFFICIAL USE ONL~ ·
DATE RECEIVED
iNSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~;]//SI NG LE 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 Varified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~I~DIVI DUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: t(~-~t~ If Tank is homemade SOILS RATING
give dimensions: ~:':~,.~
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELLTO: Septic/HoldingTank 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 (Title)
LEGAL DESCRIPTION
72-010 (Rev, 3/78)