HomeMy WebLinkAboutTUXEDNI PARK BLK 1 LT 7ame
*10Li i - oaa-01
GRE.,'ER ANCHORAGE AREA BOk. 'iJGH
Department of:Environmental Quality
:3330 C Street
Anchorage, Alaska 99503
INSPECTION,REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESCRIPTION / ~T' ~7 ~/~ /
SEPTIC TANK:
DISTANCE ~j
FROM WELL~
MANUFACTURER .
NUMBER OF
MATERIAL COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY J~J'"~ GALLONS,
DISTANCE FROM WELL~
TILE DRAIN FIELD."-~AY~-,
FOUNDATION
NUMBER OFLINES /
ABSORPTION AREA
TOTAL LENGTH
, NEAREST LOT LINE OF LINE~
TRENCH WIDTH
DISTANCE BETWEEN LINES
DEPTH: TOP OF TILE TO FINISH GRADE
IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
WELL~
TYPE ~~
BUILDING
FOUNDATION
IN.
CONSTRUCTION
NEAREST NEAREST
LOT LINE , SEWER LINE~
DEPTH
SEPTIC SEEPAGE
TANK , SYSTEM
DISTANCE FROM:
CESSPOOL
, OTHER SOURCES
APPROVED
DISAPPROVED
REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ~
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form EQ-032
G.A.A.B.
· '.' IT NO.
RPF'L ICRNT GENE KROTKE
LOCRTION CHENEGR DR
LEGRL L7 Bt TUXEDNI PRRK
DEPRRTMENT~ HERLTH RND ENVIRONMENTRL F'F.:OTECT ! ON ._,
77200 ) . -
ERST ~?5TH RVE
LOT SI .2E
66000 S6!URRE FEET
/ iYPE OF soIL RBSORBTION SYSTEM IS' TRENCH '
~ ~IRXIMUM NUMBEF.: OF BEDROOMS = 4 SOIL RRTIt.~G <S.q FT,.'BR)=
/~HE REE~UIRED SIZE OF THE SOIL RESORPTION SYSTEM IS:
/ C, EF'TH=
::: LEI'-~ ~]TH= 42 ~] F; R'-.-" E l_ [.:. EF' ]-H = 4. 5
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRF:E OF THE
GROUND RND THE 'BOTTOM OF THE E~:CRVRTION <IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GF.'RVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F-:EL--~,LI_ I RED, SEF;T I F"-_. .TR[-I~-~ 'S. I ZE= 125~-3 ~alRLL~--~[-J$
TL-]~-~ ,--.'-~ ~ I ~$F'E~;T I g3[-~S' . I~F;E F;EL----!LI I RE[:.
E:RCKFILLING OF RNY SYSTEM WITHOUT FINRL iNSPECTION RND RPPROVRL BY THIS
DEF'RRTMENT WILL E:E SUBJECT TO F'ROSECUTION.
MINIHUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISF'OSRL SYSTEM IS
FEET FOR R PF.'IVRTE WELL OR 200 FEET FOR R PUBLIC WELL
SF'ECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PF.'OF'ER
NSTRLLRT I ON.
F" E F.' ~-1 I T '-.-" R L I D F C, F.' ~--..~ ~-~ E "¢ E R F~ F F.: ~3 r,1 T S ~ !_1E
I CERTIFY THRT -
~L: I RM FRHILIRR WITH THE'REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.'
2: I WILL INSTRLL ,THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
SIGNED' _ ....
RF'PL I CRNT GEN,E KROTKE....- '
.J
GARY PLAYER VENTUFIES
CONSOLTING GEOLOGIST
BOX 47G-M, STAR ROUTE: A * ANCHORAGE, ALASKA 99507 * PtlONE 344-7071
Performed for
SOILS· LOG
Legal Description
.D..epth (feet)
-lO-
-14-
Soil Descriotion
-18-
-20-
Total Depth / ~- feet in ~ ~
Was groundwater encountered. ~., "') What depth
·
Depth to bedrock ~-Z) . Hm,~ determined ~o~_j
Respectfully submitted,
Gary F. Player
Consulting Geologist
,
\
x, \
x,
CuRv~ ~o,. ~ Dntn
t
o_
VISIBLE EASEb_~~.'~.,~I~ROPERTY EXCEPT AS
OR
O~ER
INDICATED ~ON
~ ~-' ? x~...~ ~/~, .
-
I HEREBY CERTI~f THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED
PROPERTY: LoT 7, BLOCK 1 TUXEDNI PARK SUBDIVISION, AS RECORDED
IN THE ANc}DRAGE RECORDING PRECINCT,'ALASKA, AND THE
Ib~ROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS
PLAT, AND THAT THERE ARE NO ROADWAYS, TRANSMISSION LINES,
, 1977.
PLOT PLAN
OF
TUXEDNI PARK SUBDIVISION
BLOCK 1 LOT 7
KUL~BERG & ASSO. ANCHORAGE, AK.
DATE:' APRIL 7, 19~7
SCALE: 1" = 50'
LEGEND: ~)3/4" I.D. PIPE
PERMIT NO.
-kPL I CANT
0CATiI 0 I'.,I
,%ALi
I--llJ r-.I I 19 I.__F'RL I T'-f' i_]F RI'-,II~I--II_--IF-'I-~I-'~E
DEPRRTMEI'-,IT ~ -; HEALTH AND · EI'.,IV I R01'.,IMEI'-,ITAL/""'ROTECT 1 0N
°,9,25 ~ ' STREET, ANCHORAGE, RI.(.
279-251±
I--IELL F'ER~'I I T
.GENE KRCTI..,E_
CHENEGA DR
L? Bi TIJ×EDNI PARK SIJBD
ERST 35TH
2:~t-0020
LOT SIZE 66000 SQUARE FEET
· qlNIMUM DISTANCE E:ETWEEN A NELL AND ANY ON-SITE SEWAGE DISPOSAL SS'STEM IS
188 FEET FOR R PRIVRTE NELL OR 280 FEET FOR-8 PUBLIC NELL
:-'NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DR.'S
OFI THE NELL COMPLETION. ,,
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
I NSTR'LLRT I ON.
F'EE:I'I I T '..~RL I D FIDR ~]r-JE 'T'ERFZ FF~CIr'I I SSI_IE
.z CERTZF THaT
~:" I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND NELLS RS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
2:, I WILL INSTALL THE SS'S~EM IN ACCORDANCE NITH THE CODES.
APPLICANT GENE KROTKE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SER~/ICES
Division of Environmental Services
On-Site Services Section
P~.O. Box 196650, /~nchorage. Al~aska 99519L6650
343-4744
cERTiFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# ('~q ~ - ('",.'~, .~..C~
1, GENERAL INFORMATION
Complete legal description ~.~rJc, ~' ~r~ ~ [
Location (siie address or directions)
/
a , one
ow,.er
Mailing address
Lending. agency
Mailing address
Agent
," ' Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ ~
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
TYPE OF WASTEWATER DISPOSAL:
Individual on-site:
· Holding tank
Community on-site
NOTE:
72-025 (Rev. 1/91) Front MOA #21
Public water
If community well sYstem, ProVide written confirmation from State AD£C attest-
ing to thb legality and ~tatus Of system.
.Public sewer '
If,communitY wastewater system, provide written, confirmation from State ADEC
attesting to the legali'ty and status of system.
..... .- sluatuu~oo leUO!l!PPV
:suop, elndp, s §u!~oiloJ ,aql q3!~ 'suJo°~paq'
· swooJ paq
~oj le^oJdde leUO!)!puoo
'- 'paAoJddes!a ~ . .
-7~ Joj pa^oJddv
=IEINIVNOIS SHHQ
eJnleuEi!s
'9
Legal Description:
Municipality of Anchorage
Department of Health &.Human Services ....
HEALTH AUTHORITY APPROVAL CHECKLIST .~, .
A. WELL DATA
Well type~ !~_~.-~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed .
Cased to '7 ~D
Date of test
Static ~a~er level
Well flow .. ~ , ,.
Pump level
SEPARATION DISTANCES FROM WELL TO:
FROM WELL LOG
Septic/holding tank on lot
Absorptio.n..field on lot
Public sewer main
Sewer service line
WATER SAMPLE ~ESULTS:
Coliform ~
Date of sample: q J~ J '~ z-
ADEC water sYstem dumber
Casing height
Wires properly protected (Y/N)..
g.p.m.
'; On adjacent lots ~ I~ C)
' ; 0'~ adjacent'lots ~'150
Public sewer manhole/cl~e~n, out
Petroleum tank ~ I"! J D
· >, ', 'i' ~ .. """ ~.-~
Nitrate ! L~ Other bacteria`
Collected by: ~-ccu-o.., w,,~L'
SEPTIC/HOLDING TANK DATA .
.: ..... ~/~//77' '- '"'" "" '"' ~' '"~' ': ': '"" ' "
Date installed ,~----- Tank size I.~.,~0 Compartments
Cleanouts (Y/N) )/ Foundation cleanout (Y/N) -Z Depression'(Y/,N)"'
High water alarm (Y/N) _- /'///'~' Alarm t,ested
*- ' . t, ,, '-' .'. * .-' - '~'~ '
' "'" ....
Date of pur~in.g'. ':~ ,. ~ ~IZ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot II 7_. On adjacent lots ~/,.~' O Foundation
To propertyline ..... /'//~ ~ Abs°rption field -lO --' water mLain/Service line ~ ~.-~
_ ! -- · . ;~ . .
Surface water/drainage N ~ ~
72-026 (Rev. 7/91) Front
( "':" ~' i~ ' ' '' '~ ,
,,...' \ -.', _"~i. '., .... cbNTINUED ON BACK pAGE:
C. LIFT STATION 4..:*:~. -. ,,. ,
"':')¢'" ,,r /: it:. \,'::;': ..... ':L~i',,:; -'
.. , ~f
Date installed ":"::"i?', :':,'*,i'..:~::'~r:r~:,~ti "~M~in adtu~er;:<*:~!, i .....
,: ..... :, ,,:: ..... .. .. ";:: '::' Y.',.~ ~ '.ii!:: ["*;: ' , :.
Size in gallons Manhole/Access (Y/N)
Vent(Y/N) ~O'~ ~'~' 0,~'~'.':', ,, _.~"'i '~,~'~b'~ .... *' ~-'
- Pump'on"-Ievel/~t:i ' ' '::-:: · '"Pump off" levelat '
High water alarm level Cycles tested
Meets MOAXe~ctrical codes (Y/N) ........... -
· .- SEPARATION 'DISTANCE'FROM LIFT sT~[':I'IdN TO:: ~::'%'
- Well on lot-; ...... :..!::i) ::::: :~n adjacent I~t~ ~ "~ :' '
~ '- Surface water
;ABSORPT~ON FIELD DATA .......... ' ...................... ':' ' "~''
:'! 'Date installed Soil rating le:.O .... 'System type 7',,<.g.~
;,: ,ength *Width ' Tota depth
~.~ ,-, .. ..... . ........ t ~-' ....... - - , ........
!! ~:.T. otal=absor'ption area ......... Y!17/ '" Cleanouts Present (;y~N) F
,Depressmn-over field (Y/N) ' ]~ Date of adequacy test I
': Results (pass/fail) for
Peroxide treatment (past 12 months) (Y/N) H ~·"- If Yes,'give ~:' ~' "*'"date: "' ..... .... ~ .....
t'~ - :i :,',:: ,',.
SEPARATION DISTANCE'I~ROM ABSORPTION FIELD TO:
· . , ,, ~,. Propertyline
To building foundation ' · ' To existing or abandoned.system on lot
'Onadja~er;il~ts ~> /,~'C) "' Cutbank ~/~- Watermain/serviceline ~ ,,~.~'"'
bedrooms
Surface water
' Curtain dra'ii~. ' c~:: '.., =~ ,.. :, .....
.................. :,..~ :':-~ .:':': '3' ~:- "'
E. ENGINEER'S CERTIFICATION
I ced/fy that l ~ave checked, verified, or conformed to aI!~M~O,A, and HAA guidelines in'e'ffe~t O~the~at~.~f~h-i-'s,insp'.e'c~iO~..' ---- .... . ,-;..-~ t::. ~ ~, .... ... rq,~,_%.,:~,. ~ ~ _ '
· . ' ..-,~N .. · r,' %. ?. ~ ....
· .'-'~." i ," . · . *,~ ~- ",. ~'~ % /
Engineer's Name I ~ ~ ~.~. 0 p ~ ~L~ ~ ~ t~;~:~'~';~;",'.;;:~'. ~
~ ,. · ~., ~'..~ ..-" ,?;~ -
............... · ..... . --. -'- - · · :.~ ,, , ,.:., t ~, · %~,..~)~=0,~-~--.*,~o ,~.. :-...--- l*"., : ' i,,. '
Waiver Fee: $ i ,
....... ~*' ~ ',. :2 ,' ; ' i . , , · ,
Date of Payment '""~""~' ~ Date of Payment
Receipt Number i.. '~-/-~ Z-l, ~ ~ ~ ~? Receipt Number ,:.
72~6 (Rev. 3~1) Back MOA 21