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Home My WebLink AboutT15N R2W SEC 25 LT 141T15N, R2W, Section 25 Lot 141 #051-312-23 Municipality of Anchorage Page 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:~-L~ L'~('~(~C)~.'~ PID Number: (0~'/~ ~'/~ '" ~ Name: Wastewater System: ~ New ~Upgrade Address~//.~ ~ ~¢~¢~ ~ ABSORPTION FIELD Phone:~¢~¢ ~¢/~ lNo. of Be~oms: ~DeepTrench ~ Shallow Trench ~Bed BMound BOther LEGAL DESCRIPTION SoilRating: ~' ~ GPD/Sq. Ft. Total Depth from original grade: Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth benesth pipe /~/ ~ ~ Ft. ~ Ft. Township: /5~ Range: ~ ~ Section: ~ ~g ~' Ft. ~ Ft. WELL: D New ~ Upgr~ Gr~velwidth: ,~ Numberoflines: ~Dista~ce~etweenlines: ~ F~. / ~- Ft. Classification (Private, A,B,C): ~ ~pt~ Cssed To: Total absorption area: Pipe material~.~.~/ 15 1~ I~ Ft, Ft. /~ ~ SQ. Ft, Date installed:~ ~riller:/ ~¢ ' Date Drilled: Static Water Level:Ft. Installer:~¢~/~ ~m~d~ ~ SEPARATION DISTANCES ~eptic U Holding U S.T,E.P. To Septic Absorption Lilt Holding ~ublic/Private Ma ufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Line~ ~g ~/~¢~ ~ '~ Material: ~ Number of Compadments: s.,~O~w~t~r ,¢~¢~ ~¢~*;¢ ~ ¢~ ~ LIFT STATION , Lot Sizein gallons: Manufacturer: Foundation X/~ ~/~ ~ ~¢ ~ Pump on" level at: ~m~.'/~e, at: I Hie. water alarm st: ~/1 I Cu~ainDrain ~).~ ~ 2~ ~& ~x~ /~--PumpMa~&M~ ~E~ectdca[Inspectionspedormedby: Remarks: BENCH MARK Location and Description: Assumed Elevation: Inspections performed by: ~J,~z~-/ Dates:lst ~ ~.~;~~.~,,~ Department of Health and Human Se~ices approval ~,¢~z.. ...... Reviewed and approved 72-013 (Rev. 9/91) MOA 25 Permit No. Page 2 of 4 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.0. Box 196650 · Anchorage, Alaska 99519-6650. Telephone 345-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descrip[ion: LOT 141, SECTION 25, R2W, T15N PID No.: m / \ ENGINEER'S SEAL ?...........Z~.......- ~;~. ~.. ~..., ~$ Permit No. Poge ~ of 4 Municipolity of Anchoroge DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,0. Box 196650 · Anchoro9e, AIosko 99519-6650. Telephone 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Le ol Description: LOT 141, SECTION 25, R2W, T15N PID No.: Permi~ No. Page '¢ ot Municipality of Anchorage 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 Legal Description: LOT 141, SECTION 25, R2W, T15N PIE) No.: ENGINEER'S SEAL MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box '196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 10, 2000 Expiration Date: Apr 10, 2001 Permit Number: SW000053 Legal Description: T15N R2W SEC 25 LT 141 Design Engineer: 0069 Douglas T. Kenley, PE Owner Name: Donald Thompson Owner Address: 15324 Husky St. Eagle River, AK 99577-9246 Parcel ID: 051-312-23 Site Address: 015324 HUSKY ST Lot Size: 108900 SQ. FT, Total Bedrooms: 3 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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 April 15, 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: r< ..... ,./ Date: //f.,,,2 , ~¢.~,/~"-- Date: Douglas T. Kenley, P.E. 9960 E. Puffin Drive, Palmer, Alaska 99645 (907) 746-1073 April 3, 2000 Mi'. Donald Thompson, O~vner Lot 141, Tract 15N, Range 2W, Section 25 Chugiak, Alaska PERCOLATION TEST RESULTS AND GENERAL SITE INVESTIGATION REPORT APR 0,5 MUNICIPALITY OI- ANCHORAO~ On March 24, 2000, the above-referenced 2.48-acre site was inspected in support of this application for approval to upgrade the on-site wastewater disposal system., The inspection consisted of soils percolation tests and an overall conditions survey of the property. The present wastewater disposal system was previously tested and found to be in a failed condition. The site is located on 15324 Husky Road. The immediate area that has been selected for the replacement wastewater disposal system has an average slope of 2 to 4%. The site is moderately treed with birch, spruce and alders. On-site observation and physical survey show that there are no water wells nor private wastewater disposal systems within a 100' radius of the proposed system. No surface water was observed at the time of the inspection, and it appears that there is no potential for contamination of adjacent water wells or streams from known sources. On March 24, 2000, two test holes were dug to average depths of 16 feet. The holes had percolation tests preformed to assess the adequacy of subsurface soils to accommodate both the primary and replacement on-site wastewater disposal systems. The restdts of these tests are attached to this report. The test site had adequate percolation rate to support the existing four bedroom residence. Subsurface soils were found to be sandy silt with some gravel overlain by 16" of surface organics. The percolation rate for the soil was found to be 20 minutes pet' inch. The proposed system will have no measurable impact on additional reserve space, surface or subsurface drainage or on drainage fi'om adjacent lots. Attached please find proposed design drawings for the replacement system. If there should be any questions concerning the percolation rate or characteristics of the site, please call me at (907) 746-1073 or 243-5372. Sincerely, PE#8176 i DON THOMPSON LOT 142, TI§N, R2W, SEC. 25 EAGLE RIVER, ALASKA () MR. DONALD THOMPSON LOT 141. T15N. R3W. SECTION 25 CHUGIAK. ALASKA z~ C DOUSLA$ T. KENLEY, P.E. I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9- 10- 11 13- 14- 15 16 17 18 19 2O COMMENTS Township, Range, Section: ~'~.~,~/ ,¢=-~.~z~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? ~ P E Moniloriflg? /.~',~ .,c~ZE' Dale: Reading Date Gross Net Depth to Net Time Time Water Drop ,y -- -_. PERCOLATION RATE ,'~'g) (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~/~'/~ FT AND ~ FT PERFORMED BY: 'z~'~'~'~ ~'"zg~'_/(~'~-~/g~/-- -~' ~' I ~__/f~ /~¥'~;ERTIFY//~ ACCORDANCE WITH ALL STATE AND MUNIC,PAL GUIDELINES IN EFFEc~QN THIS DATE.~/~ATE: 72-008 (Rev. 4/85) ~_~?~.I~_.~?~)~AS PERFORMED IN Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATEPERFORMED LEGAL DESCRIPTION: 1 2' 3- 4 5 6 7 8 10- 13- 14- 15 1 6 17 18 19 20 Township, Range, Section: ~,~"~ ~:¢.~'z47 ,_,~¢. ~ SLOPE ~ITE PLAN~' WAS GROUND WATER ENCOUNTERED? ?L~ IF YES, AT WHAT DEPTH? Depth lo Waler After '/'/--,z.,~,,~/ MonilorlflD? ~ _Oale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE '~,~' (m~nules/inch) PERC HOLE DIAMETER TES~ nUN ~ETWEEN ~ ~TAND 'P~/~ ~T 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE 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 NAME PHONE · []UPGRADE MAILING ADDRESS LEGAL DESCRIPTION ~ Material ~,<~ No. of compartments ~ Eiq. capacity in gallons - ' ~ Well Dwelling PERMIT NO. ~ Manufacturer ~ Material Liquid capacity in gallons ~ell F undation Nearest lot line PERMIT NO. ~ DISTANCE TO: m~ tooEo W ~--2~Z No. oflines ~ Lengthofeachlinh~. Totaliengthoflines~ Trench w~t~inches. Distance between lb~esI~k~I/h Top of tile to finish grade Material beneath tile tt Total effective absorption area Length Width Depth ~ PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ WelJ Building foundation Nearest lot line ~ DISTANCE TO: ~~ ~ Depth Driller Distance to let line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER INSTALLER ~( ~¢ 72-013 (Rev, 3/78) 'IliI!: I.Fi:i'.,ICiif'll I:) ): Idl~i:N'}i; :t: Ol'-,! ]:S TtlIE I._I]EI',I(3TII ,::]:N "l'l'.]i!{ I:)l:l::"llt Oi:= FI TI::;flE::i~',IC:II O1:;?. I::']: f' ]::E; THIE [:, :l: :i~;'r'l::lN(E:l:E E!iI:,~:i::)I..II'.,I[:, I:::1t'.,1[':, 'I'HIE tii!',Crf"i'OH OF:' "I'HI!-i: I!:::-::C-:i:::IS,'I::i"I":i:I::)I'.,I THIEI4'.Iii.: :I:S i'.,l(:):ii;ET I,.I:I:DTII I:;:'(::iFi: TILE: (:il::?.F;iYl:ii:t_ [)EF:'TF] iTS TI.]ti( t,1]I:N:[ML.li',] E:, I:::IND 'TI. IIi: Ei:t:)i"I'OH Cd=' THt'/ EXC:f::i'v'FIT]H] O1:::' 'FHE TI:;?.E C:II "F' .l:;'Fl:::l"ii: ()1:= 'i'iili: !3FiiTf'H[!i:E:I",l 'i IE OLiTF:I:::IM. :t: ]: ,"]",1S;F::' IFI I",i C: E iEi",l'f' yI]ll..I I'/I~Y 13Ii!: I:;]:~ii:(i:!l. i' i I:::1 :E; I.I E:: ..]' E (:i: T 1::} FI ::: I'::F :I:l .1 ]' I",l(':i CIF t) E F:'F:IF~fi'Mt'i:N'I i4 ]i1 .L :i(;I.J [3 .)'1 I:::lf',t[) t:::II:::'F:'I:;]:CF',,'I=II,, t:i,Y :i~;EHEEI:;?.:i; I=ll",ll])l.,.lt:~l.l_:ii; I:::l:i~; ;ii F i'HiE Russell Oyster 694 2774 Soils Et Foundations Performed for: GEO', ECHNI CAL 8 DEVEL,.,PMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Legal Descrtptton:_~:~j- I~-J CO. Earl Ellis SOIL LOG 688-2280 land DeveJopment Name:..___~, ~ ~'~,-<":~ .~Tel. No. I,,~,- 7-,-~.~.'~ Mailing Address: ~..~ ~ ~% ~ ~ .- ~ .~ , 6~ 7~ 8 Ground Water Encountered: Yes No~'i:__ ........ If yes, what Proposed Installation: Seepage Pit__Drain Field ~'_. Comments: ~'-~.,~ ~_?,,~¢, Performed by:~ ~~_ . Date: 0,~ ~ ~¢'t7 DATE RECEIVE D TIME TIME TIME ANCHORAGE MUNICIPALITY OF ANCHORAGE MUNJCIPALI~F~pT ~F H~ALTH & DEPARTMENT OF HEALTH & ENV RONMENTAL PROT~[NTAL p~.OTECTJON ) 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ~'~ Telephon~ 254-4720 1. PROPERTY OWNER PHONE PROPERTY RESIDENT (If different from above) ' ' PHONE 2. BUYER PHONE 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~ 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 well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE D,SPOSAL SYSTEM ~' /¢7 ~ INDIVIDUAL/ON-SITE*' '~~? YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE F~ PUBLIC UTILITY Connection Verified []Septic Tank or []Nolding Tank Size: f~:~ ~ If Tank is homemade give dimensions: NUMBEROFBEDRDOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line MATERIAL Septic/Holding Tank Absorption Area Sewer Line [] OTHER Nearest Lot Line 5. COMMENTS iZOd-APPROVED FOR £7~- BEDROOMS / [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72 010 (Rev, 6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address Agent Address Day phone Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. ¥' NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site v" Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER 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 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, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~.~.~,.,~.r- 7'~'. ~-~'~.~-~.Y~ Phone ~Y-) ?'~/~ - ''~ ~'~ Address ¢-~'~ ~ ~,-~'~1 ~/~r.~._, ~/~---¢~.¢-~'¢ Engineer's signature Date DHHS SIGNATURE Approved for LCZ_ Disapproved. Conditional approval for T_H . .' bedrooms. bedrooms, with the following stipulations: AdditioneJ Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. RECEIVED Municipality of Anchorage ~IA¥ 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services !.JIV[SIOYt I ..................... ~-~1 II · r~w Ku~.~=i~Ec¢, 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-474,T Health Authority Approval Checklist Parcel I,D.: A. WELL DATA Well type Log present (Y/N) )/ Total depth /~¢ Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to /-¢'~ Casing height (above ground). ,.¢'¢ '" /z Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG g,p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform z~ Date of sample: ~/'~/~ Nitrate O, ~'",'¢','//~ Other bacteria Collected by: ,,,~-,;~,~:.,~ ~(J. ~-/z~-,u~z_~/ B. SEPTIC/HOLDING TANK DATA Date installed ¢'/,/,sz,//¢~, Tank size '~'¢~"¢ ~¢4Number of Compartments ~ Cleanouts (Y/N) Foundation cleanout (Y/N) >/ Depression (Y/N) ,~ High water alarm (Y/N) Date of Pumping ~,~/ Pumper '~- C. ABSORPTION FIELD DATA Date installed ' Soil rating (~p.d./fF or fF/bdrm) Length ,¢~/ ~z.' '~'" Width Gravel thickness below pipe Effective absorption area /-~ Monitoring Tube present (Y/N) /v' Date of adequacy test -¢~'.~/"'~-'~-/ Results (Pass/Fail) ~; System type /o.~,,~ / Total depth Depression over field (Y/N) "~ For bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y/N). - If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* Cycles tes~d~~ "Pump on" level.a~,* ~ .~----~*~-at u m ~2"P~J mp~o~rf~l~v~l at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ,Z./-/'/. Property line ///$'~-/. Absorption field /'~ '~/~'/. Water main/service line ,Z,.~'-?,d'_,~ '~' - , Sudace water/drainage -'~ ~, Wells on adjacent lots ,, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~,z~/. Building foundation --.¢ -.¢' /-/ Water main/service line Surface water /~'~ + f-~, Driveway. parking/vehicle storage area Curtain drain ,~"~ <:~///: Wells on adjacent lots /~z~ ~',,~'/ F. ENGINEER'S CERTIFICATION , certify. ,hat lhave determ?ned thru field inspections and review of Municipal in conrormaoce with MOA] HAA gpjdelines in effect on this date. ~,_~,~,, Signature ~ I~ HAA Fee $ ¢'~ ~ ! ~I~/) Dateof Payment Rece,ptNumber ns are Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* uo-~o-uu uu:~ FROg-¢TE EN¥1RON~NTAL $~15301 T'082 P.04/04 CT&E Envirommmml Sendoe~ Inc. I,.~ommeV DivJ~k~n _L _-_ _-- _: 2(~ W. ProeM' talcing Water Analysis Report roi' Total Coliform Bacteria R~.n t~.eTRtlCTION$ ON RF, I~P SIDE ~I£FORi~ COLI,~C~INO SdlelPl~ ............. - ..... ~0 BE COMFLE~O -- MUST BE ~OMP~E~D BY W~TER S~FL[E~ ~l~Kf'g wATER SAMPLE S^MPLE TYPE: ,~/,a~y~$ ~h.~'wl llll.~ W~"~ SAMPLE ~ Anti)Il Comm~l~: ~OLOGIC.~ WAT~li ANALYSIS RRCORD vmllmM; Lli. IM~! _ , ,, F*~I Collfem coMlr~mm =~,,nnkMEI~AL FAC~UT1E$ IN AtAJS~M~ CJbJF~I#~, R. QI~IOL IM.IN(~, I~O, MIC~, M~JAI, NEW jE;~EY, 05-16-00 G9:5§ FROU-¢TE ENVIEO~J~TAL zt~_ CT&E EnvironmentalServi~eslno, $~15301 T-08g P,0g/04 F-SS7 CT&E ReL# 1002046002 Client Name Douglas Kenley .P.E. Project Name/# N/^ Client Sample ID LI41, Se¢25, R2W, T15N Matrix Drinkmg Water Oraered By PWSID 0 Sample Remarks. rATERS D~PT Client PO# Prin~ed Date/Time 05116/2000 9:48 Collected Dare,Time 05/09/2000 [2:30 Received Dare,Time 05~09~2000 16:15 Te~flmcal Direetar Stephen C. Edt Released B~~ ~ Limits Date Daze O,SO0 U O,500 frt~/L EPA 300,0 10 max 05/lO/OO SCL Toter Cotiform 3 08, Ne coti cot/1O0mL SM18 92228 05/09100 ~AP . - MUNICIPALITY OF ANCHORAGE · ~ 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 MAILING ADDRESS ~ Z Manufacturer ~ Material~1 ~ No, of compartments . Well Dwelling PERMIT NO. ~ =~ ~ ~.s~.CE ~o:.. [ ~ ~ F undation Nearest lot line PERMIT Distance between Hnes Total length of of each lin~ lin~ Tronch ~t.~ No. of lines ~ Length ~ Top of tiIe to finish grade 5 I O 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: ~ss ~ Depth DriIler Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER I NSTACLER 72-013 (Rev. 3/78) SR ="-; THE [:,EF'T[-t 07 FI TREI"E:H ".:ll~' PIT IS THE E:,IS'MNOE I"HERIE :[ S I',10 ' SET 141 [::,TI-4 FOR TRENCHES. · alt ]: Ot'.i E:" ELT_ F:' ¥" Ftl = :1...I OR PI?FI I 1"4F' I EL.[::,. U[-;.'F:'I::ICE [)F T[.E E:ETI.,.!EEi',I "Fl OLITFFtl...I._. [:'ZF'E ;FI PFIC[:::RGE PLANT MAY BE : FOI..LOkl:[ NG COi'.,I[) I ]- I OI",IS: i. E]:'I"HER Fl CLASS 2. FI CO?,I"rlNUOUS I::lG R EE MEI'.,IT IS FIR:50RFI- I 0~'~ '5_ :2 ;rE' '; T TO THE :'ROVE[:, III:::IY EEMEi'4T YOU HIllY E:E REQt. I PSTFIL. L.E[). IF' f:l MFI:t:I~,!TEI'-,IFIt",ICE "FO ENLRR[:JE THE SOIL PROS'ECUT I ON. :, -I ...I-.f- ] LI_II.t ~ OF [:,E PFIR T ['Efft" I.'ff LL .':] i_tB.]'I fi'lC .'f' FII"4FIL ]l I [C.I:,EI_.UT)]J I. i'"i;!:i",lIhlIJl'"l R '!,.IELL RI'qD FINY ::LI2)I;[I FEET [::OR FI' OR 21[1El FELL. LOG% lIRE I::ll",[[:' ['iUS]" E:E I:Z::E' OF' THE I,.ELI_ COi'IF'LET:[OI",I. O]"HEI:~'. REC!UIREMENTS MRY F]PPLY. SPE F:IVfg]..FIE=L.E TO E;UI:E: PRC!F'ER ZI',fSTI: 5E~,.FIGE [. I_.,I LL.,I-II ...... ', _, El1 .L, A F'_ELI'Z I,.IELI .... TC THE E. ER--IF{ [111]Jl [ I,.I]:Tl-Itl'~ :%~ I_ I r..:.:; _1t::,'1 ...... FII'.4[:, _:FIN'::;TF'I .......... ll-:"[':[ ["Si [:, ]: RGRF:IMS FIRE EL EE ~-:. Ii I Z .]... E:..---. F E), FZ C:: EL:: E'"il E: EL-.-.. II-%:: 3: dr....., J....:::. ,. :[ i: FOR]-H BY THE t'"ILIP~ICIF'RLITY OF .F:INC:HORFIGEL 2: Z 14ILL Ii',IS'T'RLL ]"HE S"r'::~';TEP[ :[t',t FICCOF.:PRhlE:E I,.i.T]"[4 -['FIE COPES ]:: :[ iJNDERS]'Fti!I) ']"FIR'[' THE OI$-S;[TE SEI.,.IE:R S"r'STEi"I MflY REC![.IZRE ENLFIF~:GEMEt?[' II: THE RESZ.[."ENCE ZS REMOE:,ELEI) "1"O )':NGLUI)E I'C[RE THF:I?4 ,4. .:::,..:_.:_ ........................................ i::]P P L I IS:FII'.,I'I[/E1'41'::¢',i 'r FIl",l C E ',' I ':?_:.;iJE[:, E'~IY [)I:I [ E ,,, ,.. C:ERT];FY THFff ! Rl','l FFIMILIFI[? !.,.i]:]'H TI-I[ REC!UIRE:I',[Et'-,!TS FOR OI'-,F. SITE SEI,.IEF.:S 19t'.,1[:, t,.IELLS AS :E;iE']' 0.8'E Russel! Oyster 694 2774 Soils ~ Foundations Performed for: GEOi,ECHNICAL 8' DEVELOPMENT Box 90, Davis St., EaCe River, Alaska 99577 694 2774 or 688-2280 Name: Mailing Address: SOIL LOG Earl Ellis 688-2280 Land Development Legal Description: Depth (feet) 0 1 2 3 __ 8 14. 15 Ground Water Encountered: Yes ~o___~ If yes, what depth~ Proposed Installation: Seepage Pit__Drain Field Performed by: ' ~.-"-.'~"~,.,.~ ('"~ Date: I ~ - ~ DATE RECEIVI~D ' INSPECTION APPOINTMENTS ~.~~., ~,~__~ TiME TIME TIME Y OF ANCHORAGE MUNICIPALI~}F ANCHO~GE MUNICIPALIT ~EP~.~F HEALTH & . DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO~MENTAL 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ~j~'~ ~ 9 1981 Telephone 264-4720 DIRECTIONS: Complete ali parts on page 1, Incomplete requests will not be proce~ed. Please allow ten (10) days for processing, I1. PROPERTY OWNER PHONE PROPERTY RESIDENT (Ii different from above) PHONE 2, BUYER PHONE MAILING ADDRESS MAIBIN~ ADDRESS 5. LEGAL DESCRIPTION ~TR EET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four [] Other__ ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled pr[or to that date, give well [] PUBLIC UTILITY depth (attach log if available.) - 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** ./~'J'~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH-REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC U'rl LITY Connection Verified INSTALLER []Septic Tank or E~]Holding Tank Size: [ ~ ~ ~ if Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCE~- WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENT~- [~]-~APPROVED FOR ~/~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~] DISAPPROVED 72-010 (Rev. 6/79)