HomeMy WebLinkAboutTUXEDNI PARK BLK 1 LT 4 ' . MUNICIPALITY OF ANCHORAGE
DEPA'RTMENT 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
~ I [~NEW
MAILING ADD~0
, WORON~oF A~CHoRAGE ALASKA
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~ DISTANOETO: IWell 'OO+/IAbs°rpti°narea'~. O' ~'"m ~ ~ .~.U,T.O.
~ Z Manufacturer No. of compartments Z
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer / V I ~ Material I Liquid capacity in gallons
Well Fo.n.at~~3, Near~.,
~--~ ~ NO. of lines/ Lengt~f~ line_ Tota~e~t~of lines Tre~ch~,width.~ ~ Distance betw~es
~ TOp of tile '~ ~ade Material beneath tile , Total effective absorption area
Length Width Depth PERMIT
m ' lA ::;'-E
< ~ Type of crib Crib diameter Crib depth~~ Total effective absorption area ~-
m Well Building foundation Nearest lot line .~
~ DISTANCE TO:
m ~ ~ Class Depth Driller ~JA Distance to lot line P~~~
~ DISTANCE TO: Building foundation Sewer line Septic tank A~~- -
~ ~ % JOHN E ~ANSON
OTHER ~'%,~, 183~E
SOIL TEST ~ATING
REMARKS .--
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~u~~o~ WoT ~/~T ~" A~o~,,~(s~:~,, ~'
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~NVIRONM~NTAL fKOJ~GII~ ~
APPROVED DATE LEGAL
AU6 2 5
72-013 (Rev. 3/78)
CE! ED.
PERMIT NO.
APPLICANT DAVID FREEMAN
LOCAT I ON
LEGAL ~i L4E:'~ 'TUXEDNI'i PARK
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
i-ll_it`i1.1B1.'k RLIT~' IDF RNCH.JRRI]E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 tLr STREET, ANCHORAGE, .At{. 99501
264-4720
14ELL At`lC, I]t`i--S1.TE SEL4ER F'ERI~ 1.T
( 8~06~6 )
PO BOX t0183~ ~510
LOT SIZE
999999 SQUARE FEET
MRXlMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT?BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEF'TH= ;a LEF'IBTH= 2~=-~. I]RR%~EL
DEF'TH= 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURF8CE 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 OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F-:E,_---!Li 1' RED SEPT 1. L--: TI.It-,IF( S T -;'E= '1888 i3RLLE,'i'`IS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE HELL WILL SERVE.
TL41] ( 2 ) I i'`ISF'ECT 1. EIhiS ARE F-:EL--:~-. LI 1. EEl]:,
BACKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION AND RPPROVRL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT HITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERI'I I 'T E×P I RES DEI]Et'IE:ER __~'1.. '19~:2-:
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEHER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
SIGNED:
APPLICANT DAVID FREEMAN
ISSUED BY ~/-DATF ") -~) ! '"~--~
-, ,,,: .... // .....- v4. o
I-,]I~LL A~'~D
APPLICANT [~lV IO
- LOC~tTION
· " LEGRL
C48~ :TUXEDNI PARK
LOT <~£ZE
~.DEPTH-- 't~9 ~L'~NGTIq= ~6 ~3RRN"EL DER'tM: 5
G~OUNO RND][ ~4E eoT~or.l, oF THE;..~CR~TION ¢IN FEED.
~ERE [~ NO SET ~t.IIDTH ~OR TREHCHE~.,
THE OR~VEL:'ID~ .IS THE HINIHUH DEPTH OF O~VEL 8ETHE~ THE ourF~L
RND THE ~0~01'1 OF THE. ~XCRVRT~ON ~[N FEET).
' [HSTRLLST[ON ]'IN'~PEC~ION~ 'OF ANY iHELL~ ~RDJRC~T TO ~[~ PROP~TY flNO THE :
." '~flCKF[LL:NG OF~ RNY;,~ST~,I ~NITI4OUT;:FIH~L INSPECTKON RHD RPPROVRL BY THIS -:...~
D~ARTI,IENT H[LL'~m 8E~ SUBJECt. rO *PROSE~UT,, . . [[Ot4.
~' 'OF THE H~L COHPEET:iON. '"
[:' O rH~ REOUIREH'~T~HR'~ RP~L'F. ~pEc[F[CRTION5 8NO ¢ONg'TRUCTION DIF4GRAr'IS RRE
[? ...RV~ILR~L~. TO /N~URE~ PROP~* .IN~TAL~TION.
r
J .[ C~TIFY THRT ,
:FORTH 8Y ~HE4IIUN[c[PRI'[T~. OF oNCHOEROE. 'J'
2: I HILL' INSTRLL '-THE.'.~sT~I IN jRCCORDRN~ S4[TM ~E GODES..
- 5' [ UND~TRND ~HRT ~E ON-sITE~ ~,1~ ~YST~ I,]~Y REQUIRE ~LRRGE~ENT ~F '~E,.
~ESID~GE I~ R~IODEL~ ~0;. INCUR ~HORE ~RN ~ BEOROOHS. : "
t'' RPPL[CRNT ORVIO FRE~RN] ':.
PERFORMED FOR:
2
3
4
5
6
7
8
9
10
11
12
13
14
MUNICIPALITY OF ANCHORAGE ~ .
.DEPARTMENT OF HEALTH AND ENVIRONMENTAL pRoTECTION
825 L. Street, Anchorage, Alask'a 99501' 264-4720
SOILS LOG -- PERCOLATION TEST
Reid. Jr.
:2251 ~E
16
17
18
19
20
SOILS LOG
pERCOLATION - ..
TEST
COMMENTS
"' '~'f": PERFORMED: 4-SO~ '' ' :
DATE
SLOPE SITE PLAN I -.
)25% c ..~ % ~' 2.5 %
WAS GROUND WATER ~ ~D S
ENCOUNTERED? ' L
O
P
E
IF YES. AT WHAT
DEPTH?
:: Gross Net Depth to Net
· Reading ~ Date Time Time Water ' Drop
PERCOLATION RATE (mlnuteslinch)
TEST RUN BETWEEN FT AND FT
PERFORMED ~'~
CERTIFIED BY:
DATE:
LOCATION OF WELL ::.:' (.Please'complete altbdr lo, lb or lc.)
Street Addres. e~ Area of Well Location ~.=chora~e, ~. ~9~01
2. WELL LOG -*- * Feet Below 4. WELL. DEPTH: (final) 5. ~TE OF COMP~TION
Material Type ToD Bottom
D~t and roc~ 0 ~0 ~. ~Cable tool ~lofary ~Drlvan ~Dug
' Gra~ rock Ud ~a~er * 3~O 387 ~ T..tw.. ~ 0.~.,: -"
' ' ' a. CASING~ ~ Threaded ~ Welded
$. FINISH OF WELL:
. Set bel~e~ ff. end fl.
'" ~ Backfilling Bravel pock
" ' ~ Ahoy; or ~hlaw
· . ............ ~nlth ef Drop Pipe
I~. lATER WELL CONTR~CTOR~ CERTIFICATION:
This well get drilled under my'Jurlsdlcllo.'and this report i~ Irue lethe bell 0f'my a~owledge aaa belief; " '., :::~ · ' .-"~ '-~" ' ·
llgllltrt~ Business Name Contract Llcens~ Number .
MUNICIPALITY OF ANCHORAGE Vo~,
DMSION OF ENVIRONMENTAL HEALTH
DEPAKTMENT OF HEALTH AND fl~VIRONMENTAL PR~O~b~o~d
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICA~SqI1Y~H
1. General Information A~plication Date
(a) Legal E~s.qription (include lot, block, subdivision, section, tOWnship, ~ange)
~ Location (add~ess o~ directions)
(b) Applicants Name To~ E,'S~op
Applicants Address 1800 W, 484k Av~,
Telephone 7--~8-'7 6 ~/.
5u,'4e.. E,
(c) Applicant is (check one) Lending Institution ~-~; Owner/builder ~-~;
Buyer ~ ; Othe~ ~-~ (explain);
(d) Lending Institution
Telephone
Address
(e) Real Estate Co. '& Agent
Address
Telephone
2. Type O Residence
Single-Family ~-.
Numbe~ of Bedrooms
Multi-Family ~--~
3
Other (describe)
3. Wate.- Supply
Individual Well ~ Ccra~unity ~-~ Public ~-~
Note: If coraunity ~11 system, must have written confirmation f~cm the State
Department of Environmental Conservation attesting to the legality and status.
Is the ~11 adequate for the number' of bedrcoms specified in this HAA (Y/N) Y
4. Sewage Disposal
oc_ '2=
O~-~ite ~ Public ~-~ Con~unity ~-~ Holding Tark ~
Is ~ ~s~water disposal system ~equa~ f~ ~ ~r of ~~ (Y~)
Y
[Page 1 of 2]
2-15-84
5. Engineering Firm Providing I~.pections, Tests, Data and Information
I c~rtify ~/mt I ha~ ct~cked, vorified, r~' cx:~nfo~-n-~d to all I~DA H3d~ Oaid~lir~s in
effect on the date of this inspectic~.
S igr~d by _
Date
( ENdI~EER. SEAL)
· f '
6. DHEP Approval
Appro~d fo~
Appro~d ~
Disapuro..v~d ~
Ccnditional ~-~
Terms aZ :Conditional Approval
Tne Municipality of Anchorage Department of Health and Enviro~-.¥ental Protection does
not guarantee the continued satisfactory perforn%~nee of tP~ water supply and/c~ the
wastewater disposal system. This approval indicates .tbnt, as of the validation date
.sho~n abo~, based on the data and information furnished by an e?/3ineer registered in
the State of Alaska, the water supply'and wastewater disposal system is safe and func
tional for the rnmber of bedrcors .an~ type of structure indicated.
( DHEP SEAL)
7. ~il the HAA to the follcwing address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) :....-.?, .
;. ?i':' r: ~" e'' :' "v.' , ....
- CHECKLIS~ - FEBRUARY 1984 ,
LOT 1 BlOck.'
Well Classification ~F%~{~;~LI ?.f ~ v,-. ',
WellLogP~esent_~N)' ..uace~lTte~~p C~f~~'Y~~
Total Depth ~ r~'~ ~ Casod to :l ' ' -
A. WELL DATA
Static Water Level ~3q
Casing Height Above Ground
Elect2eical Wiring in Conduit
Separation Distanoes f~cm Well:
Pump Set At
senita -' Seal on Casing
Depression A~ound Wellhead (¥~,~
TO Septic/Holding Tank c~ Lot ~O ~ ; On Adjoining Lots
To Nea~st Edge of Absc~ption Field on Lot ~0 ~'4. ; On Adjoining Lots
To Nearest Public Sewer Line ~ I ~ To Nearest Public Se~r
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Wate~ Sample Collect,e,d ~By ~. ~0~ ;%f-~- ; Date '~' 2 ~ - ~ ~
Water Sample Test Re~dl'%s' 5~{S~-~OF_~ '
Be
SEPTIC/HOLDING TANK DATA
Date Inet. ailed ~-~-~ Size ~ZCO ..N~,~6~ Ccmpa~tments
Standpipes.~)N) Ai~7.t%g.ht Caps (~N) :Foundation Cl.e. anout ~/N)
Depressi'oniJCer~Tank (Y~ ' [D~te Last~umped :N/~1
Pumping/Maidtef~nce Contragt c~ =File (Y/N) ; fc~
Holding Tank High-Water A~.c~L-"m. (Y/N), ~/~ Tempora=y Holding Tank Permit (Y/N)
Separation Distanms f~'c:m Septic/Holdl. fig ~Tank:
TO Water-Supply Well ID9 ,., To Buildir~3 Foundation
To Property Line
TOcourseWater Main/Servi/%/m/~ne
Con~ents
i~ To Disposal Field 3 ~ ,~J
~. , To Stream, Pond, Lake, c~ .Major D~ainage
[Page 1 of 2]
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