HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 3 LT 27
Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~c~,,~'~O ¥ 1.3' PIDNumber: o~,,c35'i¥1
Name: ~orc,(o,,', S,¢m cr, j' Wastewater System: [] New [] Upgrade
Address:~2~.,.~ )~d "~/'~ ~"~'~'C/~,, ~,.~/~' ABSORPTION FIELD
Phone: ~' _~O~,.3o/. Jho. of Sed~/oms: ~"~rench [~ShallowTrench I~Bed I~Mound
LEGAL DESCRIPTION Soil Rating: ~ GPD/Sq. Ft. Total Depth f~grade:
Depth to pipe bottom from origin,in~ md¢'ade: ~h beneath pipe
Lot: Block: Subdivision: ,...-. ~'wr -'
J I Fill added above original grade: ~h:
Township: Range: Section:
Ft.
Number of linene~ J DistancDistance betwee~ lines:
WELL: [] New [] Upgrade ~r~ve, widths..,/ Et, ~ Ft.
Classification (Private, A,B.C): Total Depth: Cased TO: Total~'~ption area: Pipe material:
'I,/~ "' Ft. Ft./ SQ. Ft.
Driller: Date Drilled: Static Water Level: Installer: -/"~n ~ O,~/v Date installed:
Ft. ~'~4.~'/ ~ ~,C~;t~
Yield:GPM J Pump Set at: Ft. Icasing HeightAb°v° Gr°und:Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P.
To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tsnk SewerLines .*~-.~ ~.~1~'¢~/~' 'T¢~,~ ~c I
Material:v' Number of Compartments:
Se,ace LIFT STATION ~.
Water > t O~
Lot Sizein gallons: J Manufacturer:
Line
I
Curtain Pump Make & Model J Electrical Inspections performed by:
Drain
I
Remarks: '7',~n~' c~,~x ,n..,'~ll,ec,( ~' £,-o.- BENCH
MARK
Location and Description:
,,./
J Assumed Elevation:
¢,¢C ~f.r,/~,*¢ ~r~c~ ~,~Z c.,..,,~/-¢~-/jn~. ~o /~_.'~.o fl,
,,/ ENGINEER'S SEAL
Inspections pedormed by: ~'..,~./.. 7',,cO .C,/c Dates: 1st I~/17/97 :..,,.o ,~ ..................
Department of Health and Human Services approval ':': '%
Reviewed and approved by: ,/~-~/ ~/" Date: ¢'"{¢ ' ~ ~ ",.L"';,"... . ~.. , .~, :'.:;~
72-013 (Rev. 9/91) MOA 25
PERMIT NO: SW970413 PAGE 2 OF 2
PID NO: 01534141 /
lOT '',BlOcK 3
~ / SWING TIES:
~ ~ FROM: COR."A" COR."B"
/ .............
~ EXISTING SOIL ADS TRENCH
RED TREE CIRCLE
PLAN VIEW
SCALE: 1" = 30'
~GROUND ELEV. 98.8' ~ ~ ~ THEODOREF. MOORE ~ ~ ~
' e~,,~ ... ...
1250 GALLON INV. L 27, B 3, VALLI VUE EST. ~2
94.1' SEPTIC TANK 93.9' SEPTIC TANK REPL.
~ AS-BUILT INSP. REPORT
PROFILE VIEW ~wo~ TEC~ICAL 8ER~CES SCALE: AS NOTED
14530 ECHO ST~ET DRAWN BY TFM
NOT TO SCALE ~cuo~o~,~AS~.~ DECEMBER, 1997
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970413
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:WILCOX SHARON M
OWNER ADDRESS:6325 RED TREE CIR
ANCHORAGE, ALASKA 99516
DATE ISSUED:12/16/97
EXPIRATION DATE:12/16/98
PARCEL ID:01534141
LEGAL DESCRIPTION:
VALLI VTgE ESTATES #2 BLK
3 LT 27
LOT SIZE: 23118 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
SEPTIC TANK 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 (18AAC80).
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 SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~'~~-~w~
DATE:
CML & ENVIRONMENTAL ENGINEERING ' ENERGY CONSERVATION & ANALYSIS
TItEODORE F. MOORE, P.E. 14530 ECHO ST,
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
December 15, 1997
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for
a permit to replace a collapsing septic tank serving the 4 bedroom residence on Lot 27, Block 3, Valli
Vue Estates, Unit #3, located at 6325 Red Tree Circle. A site plan is enclosed for your review.
The proposed replacement tank will be installed in the same location as the original tank. The
topography of the lot is generally level. No private wells are located within 100 feet of the proposed
replacement tank and no community wells are located within 200 feet.
The proposed project will have no.significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space-surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
LOT 26 LOT 27, BLOCK 3
VALLI VUE ESTATES #2 /
~~ ASSUMED LOCATION OF / ..'~4..~'
~ WATER SERVICE LINE ~/ / ~,~-
, ~ ,
o ~ EXISTING 1250
,
EXISTING 20' LONG SOIL ABS. I L ~ ~_ INSTALL DBL C O ~
TRENCHW. 14' GRAVEL-- ~ ' ' '
~-- / % LOT 28
~ RED TREE CIRCLE ~MUELLER VALVES
NOTE: LOTS IN VALLI VUE SUBDIVISION ARE SERVED BY
A COMMUNI~WATER SYSTEM, FOR WHICH THE WELL
IS :>200 FEET FROM THIS SEPTIC SYSTEM UPGRADE.
LOTS IN ROCKHILL SUBDIWSION TO THE NORTH OF
THIS LOT ARE SERVED BY PRIVATE WELLS, ALL OF
WHICH ARE >100 FEET FROM THIS PROPOSED UPGRADE
~ OF A
" A' %~'~ L27, B3, VALLI VUE EST. ~2
~ r~ .... ~'~ SEPTIC TANK REPLACEMENT
~ ~ THEODOREF. MOORE· ~ FLA'~OPTEC~ICALSER~CES 1 IN.=40FEET
~:~: % CE-3589 .. :ff~ 14530 ECHO ST~ET DRAWNBYTFM
ff~ae~' '......*' A~ ANCHO~GE, ALAS~99516 DEC., 1997
~~ NOTE: THIS IS NOTA SURVEYED P~T.
ALL LOCATIONS SHOWN ARE APPROXfMATE.
Flattop Technical Services
14530 Echo Street, Anchorage, AK 99516
Phone (907) 345-1355
Lot 27, Block 3, Valli Vue Estates, Unit #3
6325 Red Tree Circle
Septic Tank Replacement
Specifications
1.0 General:
1.1 The scope of the project consists of removing and properly abandoning a collapsing 1250 gallon
fiberglass septic tm~k and installing a new 1250 gallon septic tank in the same location.
1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these
drawings may be allowed or required by the engineer conducting the inspections. All construction
procedures and material specifications shall conform with Municipal and State requirements. All
separation distances shall be in conformance with Municipal requirements, unless specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 Septic Tank:
2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing and
being properly disposed of, either on or off site.
2.2 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a
4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial
type, rigid insulation.
2.3 All pipe connections to the tat~k shall be equipped with xvaterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the
waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot.
A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be
installed within 5 feet downstream of the septic tank.
3.0 Inspections:
3.1 A minimum of 3 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the tank has been set in place and is level with the
piping cmmected, but prior to backfill, and (3) after rough backfill and grading is complete.
3.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
oGREA.
=R ANCHORAGE AREA BORI
Department of Environmental Qualitv
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT
ON
SEPTIC TANK: ¢~'
DISTANCE ~
FROM WELL
INSIDE LENGTH
MANUFACTURER ATERIAL COMPARTMENTS
/
/
CAPACITY '~Z'"~ gA
INSIDE WIDTH LIQUID DEPTH LIQUID LLONS.
TILE DRAIN FIELD:
~2¢ D ~-~ ~' ! /.~ / TOTAL LENGTH O-L) /
DISTANCE FROM WELL~ FOUNDATION NEAREST LOT LINE /~_,,'~ OF LINES
/
/ DISTANCE BETWEEN LINES, TRENCH WIDTH ~
NUMBER OF LINES IN. TOTAL EFFECTIVE
c:~ SQ. FT. LEN
ABSORPTION AREA ~ ~0
/ DEPTH OF FILTER /
DEPTH: TOP OF TILE TO FINISH GRADE ,.~ MATERIAL BENEATH TILE /' VE TILE
WELL: ,,¢¢.,,/),
~,.~4.~"¢:~ ~ (/~ CONST RUCTiON,~ DEPTH
TYPE.
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION__ LOT LINE__ SEWER LINE TANK , SYSTEM
__ DISTANCE FROM:
CESSPOOL
OTHER SOURCES
APPROVED
DISTANCES:
DISAPPROVED
REMARKS
<:~~//?'""~"- IDeA G R A M
SEWER LINE DEPTH:
OF SYSTEM
PIPE MATERIAL: ~,~,b ,%-'~¢
LOT SLOPE:
REMARKS: -
Form ED-032
GrEA' :R ANCHorage AREA bor ~Jgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO·
NAME Of APPLICANT
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT
NOTE: THIS P£RMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
/0
DIAGRAM OF SYSTEM
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
· SEEPAGE PIT , DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
SEPTIC TANK
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
TO RIVER, LAKE~ STREAM.
SEPTIC TANK, , SEEPAGE PIT DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEeT INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
I CERT FY THAT I AM FAMIL AR WITH THE REQUIREMENTS OF GREATER/ANCHOH~GE AREA OROUG / RDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE· f~· ///
No scale
TH-1
9-30-75
ORGPaNIC
SILT (~m)
0.0t
1.0'
2.0'
SANDY GRAVEL TRACE SILT (SW)
NO WATER TABLE
/Lo, 0
15.0'
· 20.0' T.D.
Log represenEs location
of test hole, Lot 27, Block 3,
Valli-View Subdivision
/ Consultonfs
Inc.
ALASKA ~u,~nu
SCALE 1"=3 t OWN BY WED
SEBRING BUILDERS
Log of Test Hole
Anchorage, Alaska
oars ~ s* WED ~.NO. 562132 =,,,,~o. A-01.
CONSULqFANT.S, INC.
September 30, 1975
R & M NO. 562132
Sebring Builders
Box 1540-C Star Rt A
Anchorage, Alaska
RE: Test Hole and Soil Log P~port for Sanitary SysTem
Lot 27, Block 3, Valli-View Subdivision
Dear Mr. Sebring:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This inves-
tigation was performed' in accordance with your request of September 26,
1975, and those procedures outlined in a letter dated July 15, 1975, by.
Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of
Environmental Quality.
A single test hole was put down within the Lot 27 area for the purpose
of defining general subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with an auger type drilling rig and
the test hole was extended to a total depth of 20.0 feet below ground
surface. The final log prepared for the test hole has been included an
Drawing A-O1.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very.truly yours,
R & M CONSULTANTS, INC.
James W. Rooney
Vice President
JWR/WED/j a
xc: GAAB
July 3, 1980 R&M No. 051001-19
Fran Cedargreen/Vista Real Estate
4325 Laurel
Anchorage, Alaska 99507
Re: Adequacy Test on Existing Sanitary Sewer System; Lot 27, Block 3,
Valley View Subdivision, Anchorage; Alaska
Dear Mr. Cedargreen:
Per your request of June 30, 1980, IVlr. Phil Baldner~ of R&M Consultants,
Inc., conducted a test of the sanitary sewer system on the above described
property.
During this test the liquid level in the septic tank was monitored as water
was added to the system. The measurements are summarized in the following
table:
Time
Liquid Level Below Top
of Standpipe
Total Gallons
Added
9:05 3.45' 0
9:15 3.35' 20
9:20 3.15' 30
9:40 3.60' 50
9:55 3.65' 60
10:05 3.45' 80
10:12 3.35' 100
10:25 3.25' 120
10:37 3.40' 140
If the 4 bedroom residence on the property is to house 8 people, the
average load on the system based on average user demand as published by
the Department of Health, Education and Welfare, can be expected Lo be 600
gallons per day or 0.42 gallons per minute. During the test, the system
accepted 140 gallons in 92 minutes. This indicates an average effluent
acceptance rate of approximately 1.5 gallons per minute at the time of the
test.
Because the house on the lot is occupied, it was assumed that the leach field
was at its normal degree of saturation. We can therefore conclude that the
system is disposing of effluent at a rate greater than anticipated average
demand for a 4 bedroom residence.
July 3, 1980
Fran Cedargreen/Vista Real Estate
Page
This test was performed on July 2, 1980 and indicates conditions at the time
tested. Actual system performance over long periods of time depend on
factors which cannot be evaluated by this test. These factors include:
Actual extent of use demand of the system;
Flucuations in groundwater levels;
Physical conditions of the septic tank, seepage pit and soil.
Since these items cannot be predicted by this test method, our office cannot
warrant the suitability or fitness of the system to meet individual needs.
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions concerning this test or if we can be of additional
service.
Very truly yours,
R&IVl CONSULTANTS, INC.
Jail~ce Cecere
P~ ect Manager
Ronald F. Black
Senior Engineer
JC:RB/jh/AT-D
i]~ ]/. '; , ~:i: ' ~ ' /- ~ MuNiOiPALITyOFANCHORAGE: ~ Mij~TYOI:ANCHOF~A(3~
· 4 _: .-i- ! ,:'~' ~ '!]~ DEPARTMENT 0F HEALTH'& HUMAN SERVI~E'~N~i~i~i~i-~ SERVICES
;- ~ . :::;~ _' ' '.~ Division ~f Envir0nmentaISer~ices ~ - ~ ,~
~.; . ~ _-,~ ;,-: ':OnL~teS~bes~ec{on-: '.;- . ~ ·
· ,"',,-':. ' ' - .... ~: , : ~ '--'~ ~AY20:1997'
: : : ' :. ' P.O.' Box 196650 Anchorage; Alaska 99519-6650
r . C~RT F CAT~ OF HEALTH AUTHOR ~Y- . ~ ~' '
'- . ~: ,-:; - AppR0vALFORAS~GLEFAM~LY~WELbN~ (/~7~/7
1. ' GENERAL INFORMATION,~ ':,.-.~-- - -, : 4 ',: -
~ot 2?; ~oc~:3;:va~&LJvue ~states ~2
Complete'legal description
' 6325 Red Tr~e Circle
Lo-cation (site address or directions)
.,, - ~ ~ .. -.*;. - Anchorage, AK
ay pnon ~- __
Remax Properties 2600 Cordova St.
244-5333
?'* [- rdperty L~wne~ :Shar°'- ..... Wilcox C/O Remax
.;.Mailing addres~ ..)ACtn: David Winsor/
' [end ~g agency., , ' Day phone
A~e'~ Dawd ~z'nsor/ Remax Properties Day phone
Addross 2600 CordoTa S~. ~nchora~e, ~K 99503
244-5333
Suite 100
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 ~
TYPE OF WA'CER SUPPLY:
Individual well
Community well
RECEIVED
MAY 2_0 1997
Municipality of Anchorage
Dept, Health & Human Serylces
Public water '
, NOTE:~ If community well system provide written confirmation from State ADEC attest-- ' ' · ins to the legality and status of system.-
O 'W POSAL: " "~'
4. --TYPE F ASTEWATER DIS
lndividua[ on-~ite' xxx
Holding I '~'lk-
. . , , ~,/~*- ,- / .- ~:,
publiC sewer~-~ :-. :., ' ~, ,:':":""""
. NQTEi, If community ~V~tewater sYstem, p~ovi'cle wrHfenconfirmation from Stat~ ADEC
attesting to the legality and status of system.
STATEMENT.'OF.INSPECTION BY EN~'NEER ' ·
As certified by my seal affixed hereto and as of the validation date shown be]ow, 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,
ordnances and regulations in effect on the date of this inspect!on:
Name of Firm $ & S ENGINEERING
17034 Eagle River Loop Road No. 204
Address - ~..i~ River. Alaska 99577
Engineer's signature '";)~/~¢2' //~'~",.~--..
Phone o~¢f/i~ - ~_G ? ~
Date
6. DHHS SIGNATURE
' ~ Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
--_ _ --,, el- i-
The Munici~li~ of.~chorage Depadment of Health and Human Se~ices (DHHS) i~ues Health Authori~
App[o~a{ c~'~ ficCj~'based only upon the representations given Jn paragraph 5 above by an independent
profe~onal engid~r register~ in the State of Alaska. The DHHS does this as a cou ~esy to purcha~m of hom~
and their le~ding id8titutions in order to ~tis~ ce~ain federal and state r~uimments. Employ~ of DHHS do not
conduct inspections'or anal~e data before a ce~ificate Is i~ued. The' Municipali~ of Anchorage is not
responsible for ermm or omi~ions in the prOfe~ional engine,s work.
Legal Description:/-O'7' o~'7
A. WELL: DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES°N/~ENrA[SE~Vlc~s~
Environmental Services Division
825 L Street, RoOm 502. Anchorage, Alaska 99501. (907) 3~7~ ~9~7
Health Authority Approval Checklist ~ ~ C E I VE D
~Loc~ ~ v~c/ v ~ Parcel I.D.:
Date of test
Static water level
Well production
WATER S~M~ ~~TS:
Coliform-"__ _ Nitrate
J~ate of sample:
B. ~HOLDING TANK DATA Date installed
If A, B, or C, attach ADEC letter. ADEC water system number~-'~'~) O ~o O ~"
Date completed ,-.~.=-~ ~' ' h a'jbove roun
Cased to ~,,=~,~,~, ,, ~a, g
d)
,INffes properly protected (Y/N)
FROM WELL LO~ AT INSPECTION
~ g.p.m, g.p.m.
Collected by:
Other bacteria
Foundation cle~aneut'~YN) ..'/~ J' Depression (Y~) /v O High water alarm (Y~) ~.v O
Pu'mPing/0/~/~'~'~.~ Pumper ~c~o~4~ ~/'~d ~
Date
of
C. ABSORPTION FIELD DATA
Datein~talled./~/3~/7~ .,, Soilrating (g.p.d./~or~ ~ System~pe '~'~
Length % ' ~ o Width," .:-~ Gravel thickness below p~pe } ~ '~. ~tal depth /~ '/~
Effective absorPtion area Monitoring Tube present ~) Y~ Depression over field (Y~ ~ 0
Date of adequacy test I [ ~ / ~ 7 Resumts~Fail) ~&~J For ~ bedrooms
Fluid depth in absorption field before test (in.); 7/~/ ~ Immediately affer~Y 7 gal water added (in.): /~ W
Fluid depth ~ ~ (ins) Minutes later: ~ / ~ Absorption rate = ~ ~d ~ .g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~o~ ~'~ If ye~, givedate ' ~
72-026(Rev. 3/96)* ~" ~.o. ~ ~ o~> a~ ~4,~ P~ 7~N~v~ ~'~,
Number of Compartments ! C eanouts (~N). YE~'
D. LIFT STATION
Date installed
Manhole/Access (Y/N) "Pu~
High water alarm level at* ~ *Datum
Cycles tested ~
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at*
RECEIVED
MAY ?_ 0 1997
Municipality of Anchorage
Dept. Health & Human Service8
SEPARATION DISTANCES FROM WELL ON LOT TO:
/Septic/holding tank on lot
Absorption field on lot
On adjacent lots
.~~~Public sewer manhole/cleanout
Public sewer main
S~ Lift station
SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO:
Foundation ] 0 Property line ~' ~ Absorption field !
Water main/service line /Q ~ Surface water/drainage /oo ¢'- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line / ~ ' Building foundation / O '-/- Water main/service line
Surface water / 0 O '-~ Driveway, parking/vehicle storage area
Curtain drain /~ ~'~- /<'~'~v~ Wells on adjacent lots ~ ~¢
ENGINEER'S CERTIFICATION ....
I certify that I have determined thru field inspections and review of Municipal m ms am
in conformanc~O~ H~A g~nes in effect on this date. ~ ~/~
Signature ~~ ~
H~ Fee $ ~ ¢ ~ Waiver Fee $
Date of Payment ~ ~ ~- Date of Payment
72-026 (Rev. 3/96)*
· INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION JUL 2, $1980
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW .1~_ ~_~. ~0-~__'~1~ D
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
PROPERTY RESIDENT (If different from above) / PHONE
2. BUYER PHONE
MAI LI NG/AD DR/E'SS
PHONE
LEGAL DESCRIPTION
STREETLOCAT,O.
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
One ~ Four
~L~ SINGLE FAMILY [~] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
[] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
~ COMMUNITY since June 1975. For wells drilled prior to that date, give welJ
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~. INDIVIDUAL/ON-SITE** ON-SITE SYSTEM WAS INSTALLED.
YEAR
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~[;E] SINGLE FAMILY [~] ONE [] THREE [] FIVE [~ OTHER
[] MULTIPLE FAMILY [] TWO ~ FOUR [] SiX
PERMIT NUMBER
2. WATER SUPPLY
[]INDIVIDUAL DEPTH OF WELL
~ COMMUNITY DATE DRILLED ~)~Y~
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
'E~INDIVIDUAL/ON -SITE DATE INSTALLED
E3PUBLIC UTILITY
Connection Verified ~l") ~ \-
INSTALLER
~]Septic Tank or [] Holding Tank.~ f~ ~\~,~ ,~
Size: ~:L~(~'~ If Tank is homemade SOILS RATING
give dimensions: ~ ~
TOTAL ABSORPTION AREA MATERIAL
~. COMMENTS
2PPROVED FOR E ROOMS
[] CONDITIONAL APPROVAL (latter must accompany certificate)
[] DISAPPROVED
79 010 (Rev. 6/79)