HomeMy WebLinkAboutT15N R1W SEC 30 Lot 57LoT'
.5-7
/~'~ ~ / DEPARTNIENT OF HEALTH & ENVIRONJV]ENTAL PROTECTION
/ !~k~,~ ~1'. , ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99503 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILINGADDRE~ ~ r ~ ~ /'
~ ~ ~ Manufactur~lJ ~. Matorial ~o. of compartmonts
~ ~ L~a~allons ,FH OME~ DE: Inside I.ngth Width Liquid depth
0 ~ ~ Manufacturer Materiai Liquid capacity in gallons
Well Foundation Nearest lot line
Length ~,ne Tota,7~ of lines Tre ,dth Distance b~wee
~ Top of tile qis~ grade~ M.t~i~z~ --beneatl'~le..~ ¥ ¢~ inches Total effec~i~
Length Width Depth PERMIT NO.
~ Type of crib Crib diameter ~p~ ~ Total effective absorption area
~[ Well Buildin¢ foundation Nearest lot line
~ DISTANCE TO:
~ DISTANCE TO: Building foundation ~ Sewer line Septic tank Absorption area(s)
72-013 (Rev. 3/78)
~4UN~CIPALITY DF
DEPARTMENT OF HEALTM AND ENVIRONMENTAL PROTECTION
G25 L STREET~ ANCHORAGE~ AK 99501
264'-4720
ON-'--'S :[ TE SEW[~ZR F'ER'f4 I T
PERMIT NO:
DATE ISSUED:
APPLICANt':
ADDRESS:
CONTACT PHONE:
840580
07/16/G4
C/O G & S ENO'G. JOHN C ALLEN
SRB 196X
EAGLE RIVER, AK 99577
694-2979
LEGAL DESCRIP: GUBDIVISION: NA LOT: 57
SECTION: 30 TOWNSHIP: 15N RANGE: 1W
LOT SIZE: 2.5A (GQ.FT. OR ACRES)
MAX BEDROOMS: 3
BLDCF... NA
Listed below are the optie6s available-to you in designzng your septic
system. Cheese the ~ption that best fits your site.
]'RENCH BED W- DRY4
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0
GRAVEL DEPTH (FT.) 4.0 0.5 3.5
TOTAL DEPTH (FT.) 8.0 4.5 7.5
GRAVEL WIDTH (FT.) 2.5, 21.0 5.0
GRAVEL LENGTH (FT.) 71.0 41.0 61.0
GRAVEl_ VOLUME (CU.YDS.) 29.5 ..'51.8 45. ~
TANK SIZE (GALS) ~(~.z~¢~, 1~000;0 ~ 1~000.0 ~ 1~0()0.0
SOIL RATING (S~.~FT./BR) 188 188 188
TANK MUST HAVE AT LEAST TWO COMPARTMENTS
· I certify that:
.1, I am Familiar with the requirements
2.
5.
for on-site sewers and wells as set
forth by the Municipality o¢ Anchorage (MOA) and the State oF Alaska.
I will install the systmm in accordance with all MOA codes, and regulatidn~
and in compliance with the design criteria o¢ this permit.
I will adhere to all MOA and State of Alaska requirements: for the, seL back
distances from any existing well~ wastewater disposal system or public
sewerage system on this or any adjacent or nearby, lot.
4. I understand that this permit is valid for a maximum o£ 5 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~
THE~ (1) AN ELECTR~. ~ERMIT AND INSPECTION MUST BE OBTAINED~ (2) ~S-BUILTS
WILL NOT BE AP:'R~ED fiJITHOUT AN/LECTRICAL INSPECTION REPORTI'AND (.>) THE
L. ECTRICAL WORF~,MUST/~4~P~ONE B~/ A L~CENSED ELECTRICI~N~ '
---%T]-%:]22-]-'] ....................... ¢ ..... :-' ':'-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
825 L. Street, Anchora~ie, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
[] SOILS LOG
[] PERCOLATION
TEST
1
2
3
4-
5-
6-
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
20-
OF~f~ H t C
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
~ E QF~.G~O~J~.WATE.
ENCOUNTERED?
SITE PLAN
SLOPE
IFYES, ATWHAT
DEPTH?
/~ Gross Net Depth to Net
eading Date Time Time Water Drop
._6+
COMMENTS
PERFORMED
72-008 (6/79)
!,~inutes/inch)
FT AND {/r~) FT
PERCOLATION RATE
TEST RUN BETWEEN
DATE:~/~!
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
1. General Information Applicatio~ Date --
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name~/~
Telephone - Home / Business
Applicants Address
(c) Applicant is (check one) Lending Institution ~ ; Owner/%~i-~4~ ;
Buyer ~--~ ; Other ~ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent '
Address
Telephone
(f) Mail the HAA to the following address:
T_~ of Residence
Single-Family~
Number of Bedrooms __
Multi-Family
Other (describe)
3. Water Suppl_~- ..
Individual Well~ Community~--~ Public~--~
Note: If community well system, must have written coT~lrmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite~ Publico · Community~--~ Holding Tank~
Note: If community well system, must have written cortfirmation from the Sta~e
Department of Environmental Conservation attesting to~ the legality and status.
[Page 1 of 2]
5. E_~ineering Firm Providin~ Inspections~ Tests~ File Search~ Data and Information
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 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
DHEP Approval
Approved for
Approved
bedrooms
Disapproved __
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES I~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. ~LL DATA
MUNICIPALITY OF ANCHO~E
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTIO~J
HEALTH ALDI~ORITY APPROVAL (HAA)
CH~C~ZST - ~Ru~Y ~984 UUL
5
~98~
RECEIVED
Well Classification j/l%i
Well Log l~esent 4!)
Total 'DePth" 'i C~-5~ 7 Cased to
If A, B, c~ C, D.E.C. Approved(Y/N)
Date .Completed I~/ Yield
~-~-- ! Depth o~ Grouting ~
· ': .... /~ J! Sanit. a~y Seal on Casing~
Casing Height Above .Ground . ,( .
Elect~iica~.~ Wi~ing i~ Osnduit ~g~ Depression A~ound Wellhead (
Sep'a~ati(~ DistanCes frown Well; - ·
To fSePbi6/l~ank on Lot .' .~ '.. ; On Adjoining Lots
- 'TO ~N~a~e~t" Edge'of Absorption Field ~h Lot /'~) .~t_ ; On Adjoining Lots ~/AJ O ~O
To Nearesti~Public Se~er Li~e '/J //~ To Nearest Public Sewer
· - Cleancut/Manh0!e 7' A///~ .To Nea=est Sewer Serv~ice L, ine on Lot
" S le C° t ed pete
Water Sample Test P~sults ~-'~/~ -~-/_T/~,~ 'TU~ ~ ~;
/~<~ o..~
B. SE~IC~OLDING T~ ~TA
~te Instal~ ~ ~ Si~ /~ No. of ~g~nts
Stan~i~(g~ ~i~-tight CaperS, . Foundatign Clean~t (~
~ession ove~ Ta~ (~ ~te ~st P~d
P~ing~intenan~ ~n~a~ ~ File ,(Y~ ; fo~
Holding Ta~ High-Wate~ Ala~ (Y~)/~/~ ~a~Y Holding Tank ~r~t (Y~)
Sep~ation Distils ~ ~ptic~olding Ta~:
To Water-Supply ~11 ~ / To ~ilding F~ndati~ /~
To ~o~rty Li~ /~ ~ To Die,esl Field /~ '~
TO ~ter ~in/~rvi~ Li~ /~ ~ r To S~e~, Pond, ~ke, ~ Major ~aina~
[Page 1 of 2] 2-15-84
Ce
ABSORPTION FIELD DATA
Soils Pating in Abso~ption. St=ata
Date Installed '7//~/~ ~/
Width of Field / / ~1-3 //
/~/ Type of System Design~~I' //
Length of Field
Depth of Field ~ /
Gravel Bed Thickness
Standpipes P~esent ~)
Date of Last Adequacy Test
Squa]ze Feet of Absorption~ea
Depression over Fzeld
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /~ ~ ~ To P~operty Line /O
To Building Foundation ~C) 7/- To Existing or ~ba~doned System on
Lot ~ (~) 7L ; On Adjoining Lots /%/ //~-
To Water Main/Serw[ce Line ~ ~-. To Cutbank(if present)
To Stream/Pond/Lake/c~ Majo~ D~ainage Course /4/ /
To D~iveway, Parki,~g Area, o~ VehicleStogage Area ~3 ~- ~./
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm I~vel at
Tested fo~
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
M~ets MOA
Co. Lents
[Page 2 of 2]
Check Permitted Bed~oc~ Rating A~ainst HAA Request
verified, o= conformsd to all MOA HAA Guidelines in effect
MOA No.
2-15-84