HomeMy WebLinkAboutELMORE #2 BLK 10 LT 9
Permit # ~lqq
Applicant: ~<~ ~ ~
Location:
Legal Description:
MUNICIPALITY OF ANCHORAGE .
· Department~ Health and Environmenta}~Irotectlon
825 -, Street, Anchorage, AK. ,~501
264-4720
* # ~ HANDWRITTEN PERMIT * # *
WE~ ON-SITE SEWER PERMIT
~/;~ Mailing Address:~/-~/~WJ~
Phone Number:~"~-Z~-~
~ W& ~ ~/~ 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 ~' '
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 = /~o GALLONS
Permit applicant has the responsibility 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 departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a 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 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
available to insure proper installation.
* # # PERMIT EXPIRES DECEMBER 31, 1 9 8 3 ' * '
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 install the system in accordance with codes.
.(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
SigneR: Issued by:~
Applicant
Date:
SWP/024 (1/81) ,
Permit
Applicant:
L°catio~:
Legal Description: 6-~
Type of Soil Absorption System Is:
Trench: Drainfield:
MaximumNumber of Bedrooms:
MUNICIPALITY OF ANCHORAGE
Department~ Health and Environmenta]~otection
825 ~ Street, Anchorage, AK. '>9501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL ~D/0R ON-SITE'SEWER PERMIT
R/~6 F~ ~ Mailing Address: ~/
Phone Number: ~-~Q~O
~/F~Q~a ~_- Lot Size:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) O~
The Required Size of the Soil Absorption System Is:'
DEPTH ~.~ LENGTH 33 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 = /000 GALLONS * *
Permit applicant has the responsibility 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 departmen'
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee'
for a private well or 150 to 200 feet from a 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 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
available to insure proper installation.
# * * PERMIT EXPIRES DECEMBER 31, i 9 8 3 * * *
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)
(3)
I will install the system in accordance with codes.
I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
SigneR:
Applicant
SWP/024(1/81) "~
Issued by:
Date:
~UN I (~ I PALl TY. OF ANCHORAGE
D®p~r~ment o~ Bealth and Environmental P~ote~tlon
S25 ~ ~eet, ~cho~e~ ~[. 99501
264-4720
e e ~ HANDWRITTEN PERMIT
~/OR ON-SITE S~ER PE~IT
Phone N~or:
So~L ~so~on S~b~
· -DrainE[eldt ~ ._ seepage
· .DE~TX
i: "l~e length
Bequired Size of the 9oil
· GRAVEL DEP1
is the length(in feet)
depbh off & trench
': ". The gravel depth La
' khe botkom of khe
Permib applicant has the
...~nstaXlation inspections of
. OE Ee~[~ences Ehab ~e ~e~]
.Backfilling.of any be- subject ko
\
p~lic well.
feet and ~ a
m~s~ be
available ~o insure
certify that:
(1) I am
(2) I
(3.) z
Jib is the dLetance
feet) ·
depth of
:ion(in feet)
~,¢'P/O 2 4 (1/St)
the aur~ace of the groual
is no set w[4th /Or crenah~
ravel betwa.~ the ouk[alI
SIZE" /~00 GALLONS * ' ~: '
to Lnfo~m tt~Ls department during
scent tO this pro. fEy and the nm~
PECTION$ ARE REGUIR~ · · ~ ~-i'
~s~bion and approval by.thi~ de[~
a and any
feet
ce from a
se~er line
department
speci
-installation.
PERMIT EXPIRES DECEMBER
eewa,:j'e cl/sposat system ie ~.1
a-public well depen,ding upon
ivate weXX to a private s~er 'Iii
30 days OE the well..c~plet J
md con~tructio~ diaqr~s ar~
.ar with them.requ~rementsfor
by the Municipality
· install the system in.accordance
-t~at the. on-eLt~ sewer system
residence ie--remodele~ to include ~ore
xssuea by,
~plicant
· ._.. L.. :. .Date:
-site sewers and wells aL~
require
3 - bedrooms;
0
TF. g'T
f49~
tThe top sediments to a depth
of 11 feet were very loose
with a low water content.
{~e sand content increased
with depth and the cobble
content decreased. Ail sed-
I iments u~der the M1 were
extremely wet and very com-
pact.
Gre~'~.r ANCHORAGE AREa BOi~ ~gh ,,,~ ~,
---~'~ APPLICATION A~D PERMIT
ADDRESS "/O ~Z~ ,~' '-- PHONE
SEEPAGE AREA SIZE
DRAIN FIELD
/0 /
SEEPAGE PiT
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
//JO l DUA,N F,ELD Id"; I
WATER MAIN TO SEPTIC TANK
DRAIN FIELD.
/
G,A,,~,..AC,,,'-'. '~- -' ~--?=-" ~-'~
TYPE
DIAGRAM OF' SYST£M
E,N/1~ ~N ,AL FF, 3TE J. TICH
"RECEIVED'
M '~'~/ DRILLING, Inc. .
P. O. Bo~ 4.1224 · 1310C International Airport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner D,~.vid K~r~eh. .Use of Well
Location (address of: Towx{ship, Range, Section, if known; or distance main road
Size of casing 6" Depth of Hole 134 feet Cased to 1 ~P- ~ feet
Static water level ,/~ ft. 4ab~e) (below)' land surface. Finish of well (cheek one) open end ( >: );
, Screen ( ); Perforated ( ).
Describe screen or perforation ~
Well pumping test at 6 gallons per (hb'ar) (minute) for I hours with ~ 0~'~ ft.
of drawdown from static level.
Date of completion 77 3~.'. 1076
WELL LOG
~Depth in feet from
ground surface
Give details of formations penetrated, size of material, coior and hardness
"~ TO ?
~ TO
~ TO 17
17
~'~ .TO
40 TO 65
6,5 TO lOO
1oOTo )ln
ll~TO
!RnTO
TO
WO
TO
TO
Boulder
2 -- STATE
P,O.B~x4-1224 · 1310(: Intsmltl~lAklX~ ~
~07) 27~J,611 ~
~, ' " Um~W~'..
I,ocstlon (addFess of: TMenShfp, R~nfe, Secflo~ ff k~own, or dbt~noe main ~ · · ~. ;
.
Wtk ~ l.t'f"~ $-'--,-,~ //,',, ~I,-~- S,-~n. '-'--'.,..,
- , ~;:,'- . ? -,,.:~ ,. .L : :, .' ~, :.',
~1~ o{ casing ~" ~pth of Ht1. 1~4 ¢~. ~---~,~ ~ ~.~.n *---:- "~,' :"-'; '":'. ..... .'
St~t~wa~'leve~ /.Z~ ~t. ~.w~) (~mlrhndsurh~.
;? TO ]o
__I,9_TO ]?
17
~9 TO 40
40 TO 65
1(39'10 110
Give details e{ formstlons penetrated, st~ o~ ~ ~ ~'~ -'.'t.':~%'i.,, ~
~ MUNICIPALITY OF ANCIt0RACE
-- DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH ~ ENVIROI~D~NTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
"/ I,,/
1. General Information Application Date I'~
(a) Legal Description (include lot, block, subdivision, section, township, range)
Local. ion (address or directions)
lb) Applicants Name ~/q ~! ~
Applicants ~dress ~ P~ I
(c)
Telephone - Home
(d)
Business
Buyer[---"[; Other~--~(explain)I
Lending Institution A~$~ ~A~,~I'~... Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. T~pe of Residence
Single-Family~-~
Number of Bedrooms
3. Water Supply
Iudivfdunl WellJ---~
Multi-Family~
Other (describe)
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
0nsite ~ Public ~ Community ~--~ Holding Tank ~
Note': If community well system, must have written confirmation from the State
Department of Enviro~ental Conservation attesting to the legality and status.
[Page 1 of 2]
.Enstneerin~ Firm Providing Inspections~ Testsv File Search~ DAta and Information
As certified by my seal affixed hereto and as of the validation date sho~n below, !
verify that my investigation of this Health Authority Approval sho~s that the on-site
water supply and/or vastewater disposal system is safe, function~l and adequate for
the number of bedrooms and type of structure indicated herein., I further verify that,
based on the trdormation obtained from the Nuni¢ipality of Anchorage 'files and from my
investisation and inspection, the on-site water supply and/or ~tastewater disposal
system is in compliance with all Hunicipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Flru~ Telephone ,~-~/~:~
Address ~O ~ ~ '
....
DHEP Approval
Approved ~ Disapproved
Terms oi ¢ooditional Approval
CAUTION
TH~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO~NTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THZ STATE OF ALASKA. ~ IIiEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
IiENTS. EMPLOYEES OF I)HEP 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 ENGINEERtS I~0RK.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
L~UblICIPALhTY OF ANCHORAG'~
DEPT. OF H[ALTII &
MUNICIPALITY Of ARCHORAGE (MOA)
HFAL~H AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
IlOV 1 3 g84
ECEIVED
BJ
Description: Lo-r
~ELL ~TA Legal
Well Classification ~- If A, B, cr C, D.E.C. Approved(Y/N) ~
Well Log Present (Y/N) ~/~ Date Ccmgleted '/~?/~ Yield~
Total Depth ;~ sed to I-~ ~1/' Depth of Grcuting ~O~E
Pump Set At
Static Water fe~l ~, ~;
Casing Height Abo~ Ground
Electrical Wirirg in Conduit (Y/N) ~'
Separation Distances frcm Well:
To Septic/Holdirz3 Tank on Lot J ~D ~)
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~
i ,,,,
Sanitary Seal on Casirg (Y/N)
Depression Around Wellhead (Y/N) ~;
; On Adjoining Lots [00
· I ~ On Adjoining Lots I_
TO Nea=est Public Sewer
Cleancut/MaP~ole I~/~ To Nearest Sewer Service Line on LOt
Water Sample ~lle~ed ~ ~ . t ~ I[.~' ~
Water S~le ~st ~sults ~ ' ~t / ' .~
SE~IC~I~ T~ ~TA
~te I~talled ~ Si~ Io~ No. ~ Ca,p~u~nts
. S~r.~i~s (Y~) ~ Air-ti~t ~ (Y~) ~ F~n~ti~ Cleaner (Y~)
~essi~ ~= TaPR (Y~) N ~te ~st P~d N~ ~
~i~in~n~ ~a~ ~ File (Y~) ~/~; f~
HoldiDg Ta~ High-~te~ ~a~ (YR~) ~/~ ~ra~ ~ldi~ Ta~ ~t (Y~)
~ati~ Dista~s ~ ~ptic~oldi~g TsaR:
To ~ter~upply ~11 I~ To ~ildi~ F~ndati~
To ~rty Li~ %0+ To Dismal Field
To ~ter ~l~rvi~ Li~ ~/A To S~, ~, ~e, ~ ~jor ~aimm~
Receipt ~
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Zr tailed
Width of Field ~"
Square Feet of Absorption Area
Dap~ession Over Field (Y/N)
Results of Last Adequacy Test
Type of System Desi9n
[~ngth of Field ~'~'
Depth of Field 7s
Gravel Bed Thickness ~ '
Standpipes Present (Y/N)
Debs of Last Adequacy Test
Separation Distance f~cm Absorption Field:
TO Water-Supply Well / ~ ~ To Property Line
To Buildirg Foundation
To Wate~ Main/Se~vic~ Lir~
To Stream/Pond/Lake/~ Majo~ D~aicage Course
TO Driveway~ Pa~kirg Area, ~ Vehicle Stora~ A~ea
; On Adjoining Lots I~ O ~
b~o~L%-- To CUtback(if p~esent)
TO Existing c~ Abandoned System on
N6NL:--
D. LIFT STATION
Dabs Ir~talled
Size in Galloes
"Pump On" Level at
High Water Alarm Level at
Tested fo~
Electrical Codes(Y/N)
C~Im,~Ilts
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
V~nt (Y/N)
Pumping Cycles during Adequacy Test.
** Check Permitted Bedroom Rating AGainst HAA B~qusst **
I ~ertify that I have checked, verified, c~ o~nfo~,,~d to all MOA HAA Guidelines in effect
on the date of this inspection.
si ..d tl.
sr-ot/
KB1/d5/s
[Page 2 of 2]
