HomeMy WebLinkAboutAGATHA FAYE LT 33B ; ~ MUNICIPALITY OF ANCHORAGE ·
! DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
i ENVIRONMENTAL ENGINEERING DIVISION
~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON.SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ~HONE I ~;~NEW
MAILING ADDRESS
COCATION . ¢ NO. OF B~ROOMS
~ Material No. of co~a~tmen,s
Inside length WiDth Liquid depth
Liq ca city in gallons
~ ~ DISTANCE TO: Well Dwelling :PERMIT NO.
O Z ~ Manufacturer · Materlal Liquid capacity in gallons
~ Well Fou.dation Nearest ~o~ll~e PE IT NO.
area
inches
~ ~ Type of crib Crib diameter Crib depth Total ef f~ti~ absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ m DISTANCE TO: Building foundation Sewer line ~ O ~ / Septic tank I ~/ Absorption area(sD
OTHER
INSTALLER
72-0t3 (Rev. 3/78)
MUN I O I PAL I T.Y OF ANOHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANGHORAGE~ AK 99501
264-4720
ON--SITE SEWER
PERMIT NO:
DATE ISSUED:
840668
08/06/84 '
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
GILBERT RANDELL.
BOX 775467'
EAGLE RIVER~ AK
688-4051
99577
SUBDIVISION': NA
SECTION: 4 TOWNSHIP:
108900 (GQ.FT. OR ACRES)
& WELL PERM I T
LOT: 35 BLOCK: NA
15N RANGE: 1W
Listed below are the options available to you in designing your Septic
system. Choose the option that best fits your site.
DEPTH TO PIPE BOTTOM (FT.)
GRAVEL DEPTH (FT.) 2
TOTAL DEPTH (FT.) ~
GRAVEL'~IDTH (FT.) ~{
GRAVEL LENGTH (FT.)
GRAVEL VOLUME (CU.YDS.) 2:
TAN}~ SIZE (GALS) 1
SOIL RATING (SQ.FT./BR)
5
5
4.5
17 .'0
54.0
21.4
1~ 000.0 **
.. 125
** GRAVEL LENGTH > 75 FT. REQUIRES IULTIPLE RUNS
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
(NOT EXCEEDING 75 FT.
EACH~
I certify'that:
1. I am familiar with the ~equirements for on-site sewers and wells.as set
~orth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and ~egulation
and in compliance with the design criteria of this permit.
5. I will adhere to all MOA'and State o~ Alaska requirements'for the set bac
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 5 bedrooms and
any enlargement will require an additional permit. ,
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~
· THEN (1).AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APpROVeD WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK I~STx~ ~ON~A LICENSED. ELECTRICIAN.DATE:
......
SIONED . ,
APPLICAN DELL
ISSUED BY ~__~ DATE:
MUNICIPALITY OF A~C.HORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L* Street. Anchorage. Al&tkl 99~01 264-4720
SOILS LOG - PERCOLATION TEST
~, SmLS L~'~ .?~.
:
I-I PERCOLATION
TEST
PERFORMED FOR: I~A J~P~'
LEGAL DESCRIPTION: LOT.3~
3
4
5
7-
9
10
12
SLOPE
C,, I- ~rAN
i.rot~~
WASGROUN~ATER
ENCOUNTERED?
IF Y~S, AT WHAT
DEPTH?
I +
DATE PER FORM E D::.~~
Gross 'Net .. Depth to Net
Reading Date Time Tiq~e Water , - Drop
. .
I
/ PERCOLATION RATE *'?' *-' 'P' 0{~ ~'. ~[~lr~L~tes/inchI,
*'"'~"'~ ~EST R~N 8E~E'~N ' '~T AND. . IF~ ',
'-' ' ~ ' " ~:.,~1 . ,. . ,
-,~.~,S~ ,~OAT )~O~'~O ~* "'"~" -: '" '~"
..... ' .... '" ' ' .~ " .. ' .' .~,,e.i'".~", , -- /
.... , ~-t..:,.- ~,- .. ~.,
· ' ~"~ ~ ~ SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF .£ALTH AND ENVIRONMENTAL PROTECTION I-I ;[~OLATION
SOILS LOG - PERCOLATION TEST
3
4
7
0-
10
11
12
13-
14-
15
16
17
18
19-
20-
L Ttmde
5035
COMMENTS /5-0
/
'"7--
PERFORMED BY:
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
Gross ' Nil Depth to ~ Net
/.Reading Date Time Time Water Drop
'1
PERCOLATION RATE (mlnut~slin~ch}
TEST RUN BETWEEN FT AND , FT
CERTIFIED BY:
DATE:
I
_CI
'71 0 0 0 ~ 0 0 ~ ~ 0 ~ ~
I
/ -I . . . : : m. ~ N .
I ~/ ~ ~ · : : :
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/ . / · · · : : ~ ~ ~ ~
/ / .~ p .~ -~ P / ~ ~ : ~0 : / ~
// ~/~/ ~ * * ~ .q ~ ~ ~ -/~ ~ ~m*-~; ~ ~ /8~
- · · · :~ · /~ ~ . /o
: : : · · : : :~ : /~ ~ ~ [ /~
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/ / . · · . .... o~ ~ i ~ :
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-. . . · :..: : .- .~
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': : : / itl
· - MUNICIPALITY OF ANCRORACE
· DIVISION OF ENVIROtL'iENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. peneraI Info ation AppIicetion Date-'/%-0'9'
Legal.D,escr~[)tion (include lot, block, subdivision, section,__ township, range)
Location (address or directions)
(b) Applicants Hame~JO~ ~"~C~- Telephone - Home Business
Applicants Mdress/~ ~ ~97Z
(c) Apglican~ is (check oJe) Len~~:u~ion ~ ~
(d) LendinS lnsCiCu~ion ~~-- Telephone
Address
(e) Real Estate Co. & Agent
Address
(f)
Telephone
~ the flAA to the following address:
Type of Residence
Single-Family~
Number of Bedrooms
Multi-Family ~--~
Other (describe)
Water Supply
Individual ~ell ~ Community ~ Public ~-~
Note: If community well system, must have written confit~aatlon from the State
· Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
Onsite ~ Public ~ Community ~ Holding Tank ~
Note: If community well system, must have written confirmation from the State
DepartmenC of Environmental Conservation attesting to the legality and status·
[Page 1 of 2]
Engineerin~ Firm Providin~ Inspections~ Tests~ File Search; Data and Information ' ~. ~'.
As certified by my seal affixed hereto and as of the validation date shown below, 1
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wast.water disposal system is safe, factional 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 wnstewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm Telephone
Disapproved
D~EP Approval
Approved for
Approved ~
Terms of Conditional Approval
CA~TION
~RE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND EN~IRONMEI~AL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPII 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DilEP DOES Tills AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL'AND STATE REQUIRE-
· '4Eh~S. ~4PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALIIY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSI0~%L ENGINEER'S WORK.
(D~EP SEAL)
RRi/eJ/DI$
[Page 2 of 2]
7 -19 -84
ae
MUNICIP~ITY O~ ~NCHORAGE
HEAL~ AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
&{UNICIPALITY OF ANCHORAGE
DSPT. OF HEALTH &
£NVIROi'~LMf NTAL PROTECTION
OCT 2 9 ' 84
RECEIVED
Legal Description:
Well Classificati~ '._/~_~_~_~_~_~__ If A, B, cz' C, D.E.C.' Approved(Y/N) .' ~
Well Log P~eseny(~/N9 DeLe Cc~pleted ~ YieldS,
Total Depth ~._~__~ Cased to . /~ d) ' Depth of G~cuti' ' ng .--- /'
Sanitary Seal on Casing~.~__
Depression A~ound Wellhead
; On ~djoining Lots /'~)
/O ~ ~ ; On Adjoining Lots
Static Water Leal ~ ;7 ' Pump Set At
Casing Height Abo~ Ground ~.O"
in
Separation Distances f~cm Well:
To Septic/~Tank cn Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ,~3 /'9~ To Nearest Public Sewer
Cleanout/Mar~ole /~Z/'-~ To Nearest Sewer Service Line on Lot
Water Sample Test ~esults ~,~ 'F"/.~,~,e'~ V'~,~_--.~,
Cc~ents
BJ
Depression o~r Tank (~) Date Last Pumped
Pumping/Maintermn~e Contra~t on File .(Y/~//~ ; f= --
HoldinG Ta~R High-~te~ ~a~ (Y~/~ ~rary ~ldi~ Tank ~t (Y~/~
~ati~ Distance ~ ~ptic~ldi~ Ta~:
To ~te~Su~ly ~11 _/~ ~ ' To ~ildi~ F~ndati~ /~ /
To ~rty Li~ /~ F~ To Dismal Field ~ ~ /
To ~ter ~rvi~ Li~ ~ ~ To S~, ~, ~e, ~ ~jor ~ai~
~ ~ ~ ~
No. of C~,~artments
Foundation Cleanout~/~M
Cc~a~nts
Receipt ~
Date Paid:
Amount: ~'zl~.
[Page 1 of 2] 2-15-84
C, ABSORPTION FIELD ~ATA
Absorpticn Strata Type of System Design
Date Ir~talled ~ Length of Field ~.5-//7_ ;
Width of Field ' 3 ~ '' Depth of Field 7 ·
Gravel Bed Thickness ~
Squa=e Feet of Absorption Area [~"~ ~ Standpipes Prese~.t~
Dap=ession over Field ..(~ Date of fast Adequacy Test
Separation Distance fr~ Absorption Field:
To ~ater-Supply W~ll /6; ~; / To P~operty Line /'O
To Building Foundation .~) ',~ To Existing cr Abandcned System
Lot /'~ ~ ~' _~ ; 0~. Adjoining Lots /~ ~
To Wate~ %~i~Service Line /6) ~-~ To Cutbark.(.if prese, nt) ~J
To Stream/Pond/Lake/or Major Drainage Course ,~ ~ ~-~ ~'
To D~iveway, Parking Area, Or Vehicle Storage A~ea ~)
D, .L. IFT STATION
Date Installed
Size in Gallo~
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Cedes (Y/N)
/Di~r~io~
M~;~le/Access .(Y/N)
~[~p Off" Level at ..
Vent .(Y/N )
Pumping Cycles du~ing Adequacy Test.
M~ets MOA
** Check Permitted Bedrocm Rating Agair~t HAA Bequest **
I certify that I have checked, verified, or conformed to all MOA
on the date of this ir_~pectloc..
Signed 8 & ~ EN~I.N...H~iN(~ ' Date
KB1/d5/s
[Page 2 of 2]
2-15-84