HomeMy WebLinkAboutLot 02Forest Grove
Lot
2
#014-081-29
SEPTIC TANK:
DISTANCE
FROM WELL _
INSIDE LENGTH
GRE)%, ER ANCHORAGE AREA BORwdGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
MANUFACTURER
LEGAL DESCRIPTION
MATERIAI
NUMBER OF
COMPARTMENTS
INSIDE WIDTH LIQUID DEPTH LIQUID CAPAC ITV GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER _OR WIDTH_ LENGTH_, DEPTH
LINING MATERIAL CRIB SIZE: DIAMETER —DEPTH— DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
n r•
TYPE f /ZMY" -CONSTRUCTION / A�[ �"(J•�v
?
DEPTH (I
DISTANCE FROM:
BUILDING NEAREST NEAREST
FOUNDATION LOT LINE SEWER LINE__,
SEPTIC 9z),
TANK��. ,
SEEPAGE
SYSTEM IC20 7� ,
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. E0-031
REMAR
DATE
DIAGRAM OF SYSTEM
APPROVED
G.A.A.B.
-4
!.-cs- [llz�- //:i.5
GRE^=R ANCHORAGE AREA BOl"JGH I"'l/",2zo
D EPA RTMENT OF ENVIRONMENTAL QUALITY
ERMIT NO
7370 •'C'• STREET ANCHORAGE. ALASKA 99303
r
II' Ab TELEPHONE 274-4361
LL
Jl
NAME OFr
INSTALLATION
LEGAL DESCR
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
APPLICATION AND PERMIT
MAILING ADDRESS
L
NOTE, THIS PERMIT IS NOT LVALID �WITH�ppUT SOIL ST
tS0
OUT �O8 fun tie ICT/ dt'-c,,tel
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TS; ROQ,SEC ONau —
SEPTIC TANK SIZE
TYPE
MINIMUM DISTANCES. REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
DRAIN FIELD
SEEPAGE AREA SIZE
SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
TO NEAREST LOT LINE.
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WELL TO SEPTIC TANK E
SEEPAGE PIT
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DRAIN FIELD /06
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
ME
SEEPAGE PIT
DRAIN FIELD
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SEPTIC TANK. SEEPAGE PIT DRAIN FIELD
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
PITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
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OR
LIC SCD DESIGNER
TYPE
DIAGRAM OF SYSTEM
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I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUG e49NANCE NO. 9OB AND THAT T/rE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
45����.T/��//J T//^
DATE APPLICANTS SIGNATURE _5 //a.I �A'
� ( 1
FORM NO. EO -015
qq ARCTIC PUMP & WELL INC.
Jim Sullivan, CPI
own rn PO Box 770197
d'IScwt t am - Eagle River, AK 99577
(907)688-2510
(907)258-2510
anw r e n�K
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: Of9---cr6ij -
Legal Dcscription:Forest Grove Property Owner Name & Address:
Lot:2A William Creech
Block: 7070 Elmore RD
4nrh 4K QQ4n7
Pump Installation Date: 6/25/2009
Pump Intake Depth Below Top of Well Casing: Feet
Pump Manufacturer's Name: Pump Model:
Pump Size: hp
Pitless Adapter Burial Depth: feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: Arctic Pump & Well, Inc.
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:
Well permanently decommissioned by procedurel5.55.060L.c.
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & DWI, Inc.
Page I of
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MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIROMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Applicaticn Date 6
(a) Legal Eoscription (include lot, block, subdivision, section, township, range)
Location (address
(b) Applicants Name. Telephone 37, d,�9
Applicants Address'O�O AhborSt�or 99107
(c) Applicant is (check one) Lending Institution Owner/builder 1 ;
Buyer Other Q (explain); /
(d) Lending Institutirn 'Teleprxxe
Address _�FlO L..vd�//n��rf
(e) Tbal Estate Co. s Agent
Address
Telephone
2. Type of Residence
Single -Family [,Kl Multi -Family f::l Other (describe)
Number of Bedrocns 3
3. Water Supply
Individual IL11 111-1-� 11 Community r:::l Public
Note: If camunity well system, must have written confirmation fran the State
Department of Envirorsental Conservation attesting to the legality and status.
Is the well adequate for the number of bedrooms specified in this HAA (YIN) Y
4. Sewage Disposal
Orsite U—Kj Public F-1 Cwmnity f -::l Holding Tark
Is the wastewater disposal system adequate for the rL%mber of bedrooms (YIN) Y
(Page 1 of 21
2-15-84
S..E_rgineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, or conformed to all M3A HAA Guidelines in
effect on the date of this insoection.
Si A= Date 4e, ""I'ze
Name of Firm P -f �oO�r . PE Telephone 3¢9-2�zG
Address /0o7 E. 7¢ �/i .4�c. 9952
Date
(ENGINEER SEAL)
6.DHEP Approval
Approved for bedrooms By
Approved, Disapproved
Terms of Conditional Approval
Conditional (-�
The Municipality of Anchorage Department of Health and Environmental Protection does
not guarantee the continued satisfactory perfermanoe of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
ticnal for the number of bedroans and type of structure indicated.
(CHEP SEAL)
7. Mail the HAA to the following address:
RB2/dS/s rn'�4a v l- `lt4C, �- 3Lkcj
(Page 2 fl2]' 1
2-15-64 1
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA Legal Description:
LoT 2 fo�B77���o✓G �ie..bd.
Well Classification If A, B, or C, D.E.C. Approved(Y/N) y�
Well Log Present (YIN) Al Date CcrVleted Yiedci 3
Total Depth /02 Cased to /oo Depth of Grouting
Static Water Leel QO iRf Punp Set At 97
Casing Height Above Ground /. 4. leV Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y ) .V
Separation Distances from Wbll:
To Septic/Holding Tank on Lot B9.9 74P �L; On Adjoining Lots /57 1Y
To Nearest Edge of Absorption Field on Lot /09 /,w ; On Adjoining Lots //O f
To Nearest Public Sewer Lire 11V� To Nearest Public Sewer
Cleanout/Manhole 14// To Nearest Sewer Service Line on Lot ,✓,
Water Sample Collected By Date G -
Water Sanple Test Results
Canwnts
v
B. SEPTIC/HOLDING TANK DATA
Date Installed /9G9 Size /zz No. of Cacpartments 2.
Standpipes (Y/N) Y e,44 / Air -tight Caps (Y Foundation Cleanout (Y/N) ,V
Depression over Tank !(Y/N Date Last Pumped • 9 �yr4 enc �L
Pumping/Mainteranee Contract on ~ile (Y/N) ,V for
Holding Tank High -Water Alarm (Y/N) L� Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Wall B9. 9 _ / To Building Foundation /7 '
To Property Line -1W A9 To Disposal Field zo'
To Water Main/Service Line i✓� To Stream, Pond, Lake, cr Major Drainage
Course 'l/ 1
Y
(Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /50 5,OZei� Type of System Design 8se/
Date Installed 15;�9 Length of Field RO IZV
Width of Field 3' Depthof Field 2'
Gravel Bed Thickness
Square Feet of Absorption Area 2¢O Standpipes Present (Y/N) Al
Depression. over Field (Y/N) Al Date of Last Adequacy Ttst
Results of Last Adequacy Thst ,4o��u��c 504q*Od
Separation Distance from Absorption Field:
To Water -Supply Wall /09 ' To Property Line
To Building Foundation 250 To Existing or Abandoned System on
Lot N�-4 Cn Adjoining Lots 5,9 f'7`
To Water Main/Service Line To Clutbank(if present) iY/A
To Stream/Pond/Lake/or Major Drairage Course J4/-
To Driveway, Parking Area, or Vehicle Storage Area 50 /'11
Camients�C,�/,/
D. LIFT STATION A,�,4
Date Installed
Size in Gallons
"Pump Cn" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
"I
J
Dirmnsions
Manhole/Access (YIN)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroan Rating Against HAA Request **
I certify that I have checked, verified, cr conformed to all MOA HAA Guidelines in effect
on the date of this irs ion. _
OF AO
Sign'� Date li /P(E .....�...Qs¢0°O
e
Company �� .+e< 8_ y��x. v�'�LS MOA No. y. 'G E ?
*;49L'v D
KB1/d5/s ,»,. }•¢O
9 � Jama l+, RoWm • ��
�'�•. No. 1316E ,�•'�
(Page 2 of 21
2-15-84
JAMES B. ROBERTS, PE, RLS
ENOINEER L SURVEYOR
June 11, 1984
(907) 349-R526
(13AIDT�
N0110310V 1tl"'f1P10aIM13
38 MI'nH 40'IdICI
30YaoFONY 40 WYdI01N(1W
Municipality of Anchorage
Division of Environmental Health
Department of Health and Environmental Protection
Fourth Floor — West End
8th and L Street
Anchorage, AK 99501
Gentlemen:
We hereby make request on behalf of our, client, Mr. Rick Eiben,
for a waiver for absorption field distance to property line of
5 feet at the front of the lot on Lot 2 Forest Grove Subdivision
as shown on the application for HAA dated 6/1/84.
We are enclosing the reciept for pumping of the septic tank.
The air tight cap has been installed on the septic vent and the
slight depression over the tank has been filled.
This completes the punch list of items requested by you for
approval.
Yours very truly 11
James S. Roberts P.E., R.L.S.
Enclosure
1207 East 74th Avenue Anchorage, Alaska 99502