HomeMy WebLinkAboutGROLL BLK 2 LT 3 MUNICIPALITY OE ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet-Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WEI_L INSPECTION REPORT - "/(,TZ! E UPC.ADE LEGAL DESCRIPTION LOCATION Well Manufacturer ~ ~ ~'~ ~ DISTANCE TO: IF HOMEMADE: Well DISTANCE TO: I ,~) (O ~ No, of lines / Lengtb of each line Top of tile to finish grade Inside length I Width Dwelling tMaterial Foundation ~,~ (~ ,~ Nearest Iot~ ~el Total--~length of Ii aes-s ~__-I Trench width~ Material beneath tile 8 I NO. OF BEDROOMS No. of~l~ompar tments Liquid depth PERM]q NO. Liquid capacity in gallons P E,~dVI I T ND. inches Distance between lines inches Total effective absorption area PERMIT NO. Length Width Depth Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST RATING INSTALLER REMARKS DATE LEGAL FtF'F::'I.. ]' "2RNT )CRT :[ qt'.l E:: Iii F) t... [:,EI::'F!i~:THE:NT C HEFIL. TH FIN[:, E]",t'¢]:F~'Ot'.,IHEI'.H"FIL t YTECI"T LOT :SIZE J.. 'J::'~ E THE: F:E(;:!t..I Z FIE[::, !5 ]: ZE OF THE ::T.,C :[ L "'""' '"l ' "' HE, z,. F.F F:[Ot'.~ :5'-r':STEH :[~;' ,~::._. IL_. If.:'E [..,~j ~:.~ -ir'- II--,'J =,,,~ ,~ _"2:2-2-2-2-2-~%,~- ~:'~ IF,,:.: I~:~ % "~:£ IL THE I...EI'.,tGTH [:, I HEN!B I ON :i:. !B THE LEI'4CCFH ,:: l I'.,I FEET > OF' THE 'TRENC:H CIR [:'RFI :[ NFI E:L.D. THE DEF'TH OF R TI~'.ENC:H OF: F:'Z'I" IS; THE [:'I;STFINC:E BIETHEEN "['HE '.~;L.IRFI::ICE OF THE: GI:~'.OLIND FIND THE E:OTTOI"t Cfi: THE ECXCFI',,,'FITZON ,:: :(Iq FE'ET::'. THEF?.Ei :[:5 I",10 S;EZI" t.'.IIDTH FOE?. TF:'.ENC:HE'.~i;. THE GF~:FI',/:EL DEPTH IS THE HIN:[HLIH DEF'TH OF: CiF.:FI',/EL E,'ETNEEN THE E~I. JTF'Ia[...L F'.T.F'E: FIN[:' THE [.:,~OTTOH OF THE EXCF:t'v'FII"C[ON (:[1",! FEE[T::,. FE.f.t'I:[T IqF'F:'L]:CFII",IT 1'4F~S; THE k. Ez,F .hlz, IE::[L:[ 'T'r' Ii",IFOF;:H "I"HILE; [:,E:PF;F~:]"HENT [:,LIFR:[t'.,1G THE: Z 1'.t':2 "I"F~I. LFI'T' :[ OIq :1: f'.,I :,F E ...] :[ Lql'.4% [.':IF' FIN"r' kIEL. L:!5 FI[:'...TFICE]NT TO TH ;[ '::5 F'ROF'EF::"r"¢ FII'.,ID THE I'.,II...IHBEF.: OF' F.':E2;:[DEi'.,ICES.: THFIT THE F]EL.L. ktILL :-;EF'.','E. .................. 'l"ll....tllZ, ':: ;;.~:!: ::. Z f-.]:E~;F"IE~:C: T' Z. C~lf'-~ ?:;., 11::::~[5E:ET IF;;i~EE;Z;:~It_...I! ][. F:'.' E% E.':: ................... EH::II2,~:/F:'II...LII'.I3 CII::' FIi",t'¢ -'"-""' ~ F ,' E?T' .:,~r.:,lEi'1 ,t,.!ITFICK..I'F F:[NRL.. IN:.rSF'ECTIE~N FIN[:' PIFFF. ,HI TI'"II:5 [::'EF'F:ff4:THEI'.~IT 14.]: LL [:?E SI. E .'rE Z T TO F'RO:E;Ei.Z':UT :[ ON. I'"t ]: N ]: ~',I U i',1 [) ]: :B T I:~ BtI.'::: [~: E: E T I.,] E E J..i2~El F'EET I:::Oi:R F:I F'R:[',,,'FITE 14ELL OR ::L5¢_:"1 TO 21..7.1El FEET F'ROH Iq F:'UE&.:[C HE:L.L [:,EF'EI'.,IIb:[NG I...1POI'.~ THE 'T"¢F'E: OF F'I.JE~L]:C I.,-IEL[ .... I','I]:N:[HLIhl DIS;TFINCE FF.:OH FI F'Fi::[',,,'FITI:S. I.,.tELL "ro Fi 'T'O Ft COHHI...INZT'.r' SEI-,.IE:F: I..:[NE :[:5 7~5 FEET. OTHER F.'...F.'.(;!U :[ F::EI"'IENT:'~.; t"1R'¢ F~F'F'L"r'. :FJF'E:C: :[ F ~ CfqT :[ ON% FIND COI",I:~i;TE:UC:T Z ON [:'.1: FK.~[RFq'"IS FIRE: R',,,'FI :[ I....FIBLE TO :[ I",I~'~;I. JF, tE PF?.OF'ER :[ I",I'-qTFILLF~TI O1"4. I CERTIF"¢ THFIT :1..: :[ RH FFIHIL.:[FIR I.,.!:[TH "['HE:: F.'.E-~:~!L.IIF~'.EHEt'.,IT'.2, FOE.: ON-.-%ITE E;E2.,.!E:F.'.S:, F:llq[:, 14ELL:5 FI:E; F:'ORTH EI'T' THE hl[.ll'.4 :[ i]:][ F'FIL I T'¢ OF FINC:HOF~:FCaE:. ::":: :[ FI]:LL :[N':'.:.:'i"FtLL THE S;'¢."5'f'EH IN IqCC:OI~:DFINCE I.,.IITH THE .3:: ]: IJNDEF. t::?I~FIN[:, "I"HFIT THE ON-.,S:[TE L'T',EklEF.'. S;"r'STEH I"lla'.r' F~:E:QLI:[F.:E: !EI'.&..IZ~F~iCiEI',IENT :IF THE F~:E:S': I I:::,ENCE :[:..?; F.:EHODEI_ED TO :[ NCLJ...IDE I"IOF.:E 'I"HFIN 2 BE[:'F::OOH:r'.:;. t::IF'F'I....I"::FII",ITHI:' '2C'N'STF,.':IjCT]' 3N .-,, ,2, MUNICIPALITY OF ANCHORAGE Department Health and Environmental rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * ~ ON-SITE SEWER PERMIT Location: ~'~J~7~~, %'~. Phone Number: <.~ ?~--' ]Legal Description: ~-~-'-3 /~'--~ C~/~/~ ~ LOt Size: TYpe of Soil Absorption System Is: Trench: ~/ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) __~/ The Required Size of the Soil Absorption System Is: DEPTH __/~ LENGTH ~-G .GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /C~C~ GALLONS Permit applicant has the responsibili.ty to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a p~ublic well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are avail, able to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 $ 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will instal], the system in accordance with codes. (3) I understand that the on-site sewer system may r?~uire enlargement if the residence is remodeled to include more that/3 )bedrooms. Signed: Issued by: ~-~c~/C~~ ApplicantDate: ~ y//~//~/ SWP/024 (1/81) C _NSTRJCTION TEST LAB F'ERFORMED FOR, LEGAL DESCRIPTION: THIS FORM REPORTS: Hamann Construction Lot 3 Block ×;E);Visual Soils Examinatio~ 1800 ~V. 48TH AVE. STE. 'C' ANCHORAGE, ALASKA 99503 248-1333 DATE PERFORMED: 12/5/80 Subdivision Groll Subdivision Percolation 'lest DEPTH SOIL F"EET DESCRIPTION NOTES _ 1.0 ' .TOPS OIL SANDY GRAVEL; TRACE OF SILT 125 sf/b _ 7.0' _~ GRAVELLY SAND; TRACE OF SILT 150 sf/b 16.0' ~ BOTTOM OF EXCAVATION BOTTOM OF HOLE WAS GROUND WATER ENCOUNTERED IF YES, WHAT DEPTH NO LEGEND Kinn%.- R. gc~xie.,. ® ~ Per¢ zone ® S - Sample token ~ -- Froz~ zone ........ ',.~- ~, GENERAL SITE SLOPE ~ -- Water tab~ , ~' READING DATE GROSS TIME. NET; TIME ' DEPTH TO FI2© NET DRAINAGE PFRCOLATION RATE: PROPOSED INSTALLATION: COMMENTS: DRAINAGE REQUIREMENTS: 150 sq. ft./bedroom El SEEPAGE .PIT ~:~xDRAIN~ FIELD'~ El OTHER TEST PERFORMED BY: Mevin Braun DATA CERTIFIED BY: DATE: Dele. 5, 1980 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORI'rY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) GROLL SUBDIVISION: Lot 3; Block 2 T14N, R1W, S~¢tiOn 23 (b) (c) Location (address or directions) AT END OF tv[CI~D/RE ROAD~_EAGLB RZV~R Applicant Name f,ORTR P, ROWF)RR Telephone: Home N/A Business 694-5500 Applicant Address 10928 OLD GL~fN HIGHWAY, S&GLS ]M:V~R, ALASKA 99577 Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other ~X~explain); (d) Lending Institution Af,ASKA ~v~Fr'd'Af, RANU4 Address P©JTO, M 99OO3} AN(2,f4ORAC, R 995o9 (e) Real Estate Company and Agent .TAPX ~TFI-q~F: RF. AT ,q~¢ ~ Aq~TN': Address 10978 OT,F~ C',f,~N NTGFATAY, RAC, T.~ RT~rER~ A~ Telephone 694-5500 (f) Mail the HAA to the following address: P-iuC2~__P BY ~_A_GLE R!\~R wNC~T__NE_.RR!NG SHR3~CES Telephone 333-3Oll T ,ORTR OROMDR~ 9957% TYPE OF RESIDENCE Single-Family'S[ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (~ 1/84) ~ ~.o ~ O6ed ')IJOA~ S,JOOU!OUO leUO!SSOJoJd Oql U! SUO!SS!LUO JO S JO J JO JOl olq!suodsaJ lou s! a6eJoqouv ~o ,~l!ledp!unbl oq/'ponss! s! aleo!j!p@o e aJoleq elep OZAleUe Jo suo!lo@dsu! lonpuoo lou op d~]HC] ~o s@@AoldLu~] 'sluoLuaJ!nbaJ aims pue leJOpel u!epoo AbsBes ol JepJo u! suoBnlBsu! 8u!puol J!eql pue seuJoq jo sJaseqoJnd ol/,sol~noo e se s!ql seop cl~]HQ oqJ. 'e)~Sel¥ bo olelS eql u! p@Jels!aaJ Jeeu!Oue leUO!SSalo~d ~uopuodepu! ue Aq e^oqe ~ qdeJOeJed u! ua^ia suo!leluoseJdoJ alii uodn ,~lelOS paseq soleoB!poo le^oJdd¥ Alpoqinv qbleaH senss! (cl=lHG) uoBoeloJd leluouJuoJ!^u:q pue qlleeH jo lUeLuuedoG eOeJoqouv bo A],!ledpunV~ aq/ NOIJ. ll¥O euoB!puoo '9 L.,a bi ' '? ~ J'~vUd ema .g WELL DATA MUNICIPALITY OF ANCHORAGE (MO~-,; HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVl$1~l~tgal Description: ./~,h ~ ,o~'/,.~ .=~, MAY 2 6 1987 We,, C,ass,ficat,on_ C E ! V E D IJ A, B, C, D,E.C, Approved (Y/N) Well Log Present (Y/N) /~J Date Completed J~o~'/ ~J~7'-,~.~,~/~ Yield ~c~,~.,~ Total Depth ~' ?~ / Cased to /- ~,o" Static Water Level 73 / ~./,~,. Casing Height Above Ground '~¢ /'' Electrical Wiring in Conduit (Y/N) Separation Distances from Well: . ~-- . To Septic/Holding Tank on Lot( ~'?' '~' To Nearest Edge of Absorption Field on Lot /'/~" / To Nearest Public Sewer Line _ /'/'~ Depth of Grouting Pump Set At /'¢'¥ Sanitary Seal on Casing (Y/N) . Depression Around Wellhead (Y/N) ; On Adjoining Lots '~/~' / ; On Adjoining Lots ~-;'/'~' / To Nearest Public Sewer / Cleanout/Manhole /~"~ To Nearest Sewer Service Line on Lot Water Sample Collected by /'~/'~'~ ~" ; Date Water Sample Test Results __,_,_~../'/~Lz$C..~or"~'" ~-~ .-¢/~ '.;4/ ,"~,,'¢~,~,~-~'/./~'~' Comments B. SEPTIC/HOLDING TANK DATA Date Installed _./~'~ / Standpipes (Y/N) _ ,,,,V _ Air-tight Caps (Y/N). Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) .,~'//~ Separation Distances from Septic/Holding Tank: To Water-Supply Well ~.5.. ~" To Property Line ~/~¢' / To Water Main/Service Line ~-/~ ~ Course ."~//~' Size/~'¢'~ ~/. No, of Compartments ,.v Foundation Cleanout (Y/N) Date Last Pumped ~ ; for Temporary Holding Tank Permit (Y/N) ~'~.-~' To Building Foundation To Disposal Field /,~- To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /' ,~',G' / Width of Field Z/' / Square Feet of Absorption Area Depression over Field (Y/N) /'L) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //0" To Building Foundation Lot TO Water Main/Service Line ~/~ / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Veh,ic!e_Storag.,e: ,-/ Area Comments Type of System Design Length of Field Depth of Field / Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Y To Property Line -¢-~o To Existing or Abandoned System on ; On Adjoining Lots ~',_~o / To Cutbank (if present) LIFT STATION ?M/~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Page 2 of 2 72-026 (11/84) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have c_heck¢,.¢, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ---"'~"- "~ Date Company ,/~'~'~'¢-, MOA No. ~"~-~CJ- Receipt No. /~ O/ ~ ~/~ ~.~¢:~:~.'~y.,~,~,, ¢~'~r' ~ ,~ ¢~?'::7:;? ",~g~er's Seal Amount: $ Lou~s A. gutero