HomeMy WebLinkAboutDON JACK LT 3 Onsite File
bon Jack
Lot 3
#020 - 092 - 61
"I Z�pt;"""."°puu_/-`'//-.00r;
Municipality of Anchorage
Community Development Department Page 1 of 2
On -Site Water and Wastewater Program
4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP181223
PID Number: 020-092-61 El New 21 Upgrade
MICHAEL & CORALYN MORE
ABSORPTION FIELD
[71 Deep Trench F� Shallow Trench F] Bed 17 Mound
Address
5390 E 164TH AVE
D Other
Phone
Numbe, of Bedrooms
Soil Rating
depth from original grade
ITotal
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 FL
Gravel depth beneath pipe
9-OFt.
Subdivision
Block Lot
DON JACK
3
Fill added above original grade
0,0 Ft,
Gravel length
21 .0 Ft.
Township Range Section
Gravel width
2.5 Ft,
Beds: Number of Lines
Distance between Tines
Ft.
SEPARATION DISTANCES
To
Septic Absorption
Lift Station Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank Field
Tank
Line
378.0 Ft2
1
Ft.
TANK [D Septic El S.T.E.P. Holding F-1 Other
Manufacturer
Capacity
I
Surface Water
100+ 100+
N/A N/A
Material
Number of compartments
i
Lot Line
46.7 42.7
N/A N/A
STEEL
2
NA
Foundation
21.6 61.5
N/A N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+ 50+
N/A N/A
Remarks
Pump on level at
Pump off level aL_---�
High water alarm at
Pump make aadmodel
E_Iectrical Inspections performed by
Installer
rainfield
A+ HOME SERVICES
Drainfield 3034 COIMT 3034
Inspector PANNONE ENGINEERING SERVICE
BENCH MARK (Assumed elevation) 596 ft
Inspection
dates: 1" 8/13/2018
2�d 8/14/2018
Location and description
AT HOUSE POINT A
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF Ak, k
Conditional Approval:
Date
45.
Approved pj,4(,�W/
Date
I V/10—L
. it
"I Z�pt;"""."°puu_/-`'//-.00r;
WELL FOR L3 /
ON TRACT A (E) /
W /I l
NO WELLS W/I 200'
// TRUE NORTH ALE 1"- 50'// / // / / / `' f
/ i
282.2 DRIVE 110
249.4
INSTALLED ABSORPTION FIELD / // / \ / �� i \�✓ / / / /
/ 21.OLFx2.5'Wx9.VE.D.,13.0'T.D / W
/ W/MTs & COs AT END SBD
Sec
T/�V 'H-P� FCO E
INSTALLED 10DOG SEPTIC TANK
W/DCO AND DV AFTER
/TH- I I , DECOMMISSIONED SEPTIC TANK E /
1s6o 1\ 12.71 PER MOA CODE /
I I I
I I I I 42.7 I 46.7 1 i
556 I 564 568 572 576 5 0 584 588 592
l- - - -\ - - - - - -
10'IElecl& fele LLsmt 1 CO E
INO. BEDROOM: 3(450 gpd)
I TANK SIZE: 1000g
PERC RATE: 2.7 MPI
SOIL RATING: 1.2 GPD/SF
AREA ROD: 375.0 SF
SYS. TYPE: DEEP TRENCH 9.0'ED
MIN LENGTH: 20.8 LF
USED:
21.OLFx2.5'Wx9.0' E.D.. 13.0' TO
TOTAL AREA: 378.0 SF
'ERS \ ,
1 NO WELLS W/I 200' i
m
DRAIN ROCK 6" 1 5
ABOVE PIPE INV o 0
4" 0 DRAIN PIPE G 0 0
FILTER FABRIC 580 n n
A
B
mi
CO(E)
T1
23.4
m
O
O
y 0 m
O m
0
G
W
QQ
m m
GG F
y
Q Z
U OG.FG.
n 593
J
0
n
0 W
p
n n n
J
n n
m
DRAIN ROCK 6" 1 5
ABOVE PIPE INV o 0
4" 0 DRAIN PIPE G 0 0
FILTER FABRIC 580 n n
TEST HOLE 1
1 OR TOPSOIL
sea•a / 1000 g SEPTIC
A
B
mi
CO(E)
T1
23.4
45.1
5760 7
T2
29.0
51.1
PROFILE
DCO
32.0
54.3
DV
33.4
55.7
,0
11
Cl
73.5
88.4
mi
73.0
87.0
C2
13-
20.9
34.8
M2
20.4
34.6
CO(E)
65.4
84.6
TEST HOLE 1
1 OR TOPSOIL
sea•a / 1000 g SEPTIC
s
TANK
568.2
5 6.08
5760 7
GW
SAND & GRAVEL
PROFILE
9.0' DRAIN ROCK
y
SCALE:NTS
,0
11
DATE PERFORMED:
26JUN18
12-
13-
-21.0
21.0 I
14
15
DRY:
16
3JUL18
17
61.
,8
19
BOH
NOTES:
�7� �T �T T �-t
PAMONE ENG SVC, C, LW
BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
,�, -
.. .. ... .....
Date
o9/os/2o1s
RECORD DRAWINGP.O.
Scale
DON JACK L3
P.I.D. NO
-092-61
MICHAEL &
CORALYN MORE
�everi '�enrioRe'
PERMIT NO.
DRAWN ACP
5390 E.
164TH AVE
CE 8149
OSP 181223
SITE PLAN
ANCHORAGE, AK 99516q•'c'`l�'
Street
2 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW NEW 1 OOOG SEPTIC TANK AND SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 19 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.Q.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIF! THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING,
1 1. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12, THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR: A+ HOME SERVICES
BY: MIKE BLAKSLEE . TITLE: OWNER
DATE: 8/14/18
NOTES: PAMONEC, UE Date
RECORD DRAWING _ P.O. BOX 102954 ANCHORAGE, AK 99510 ..•••••., 8/31/2018
PHONE (947) 272-13218 FAX (907) 272-8211 Scale
NTS
........P.I.D.
DON JACK L3 a0
2NO
o-os2-si
MICHAEL & CORALYN MORE PERMIT Na.
DRAWN ACP 5390 E. 164TH AVE8149
OSP181223
DESIGN NOTES ANCHORAGE, AK 99516 ....� Sheet OF 3
NOTE:
Dimensions are measured to the wood trim. TRACK A
30'
60'
w
N
(/7
Ll
w
I hereby certify that an accurate survey of the following described
property:
OF A� t±ft
9�,
DON JACK SUBDIVISION (80-107)
P� �•........••
AW ••. t+
.. � .; f'
LOT 3
'W C-.7 :,9
�0
was made on October 20, 2018 and that the improvements
i•*:'49TH••• •• •�•• ��
situated thereon are within the property lines and do not overlap or
0
0
encroach on the property lying adjacent thereto, that no
.... ....... .... .+
0 W. Lee Karabe In I koff.. w
improvements on the property lying adjacent thereto encroach on
p
the premises in question and that there are no roadways,
j®�•..No. 3143 -SAV
transmission lines or other visible easements on said property except
as hereon.than those shown on the
enot
record platdm appear1ontsthishdr
../Q
Anchorage Alaska, this 5th day of November 2018.
30'
60'
w
N
(/7
Ll
w
MUNICIPALITY OF ANCHORAGE
oent
On-Site Water&Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
httpa/www.muni.org/onsite •
i
111
I)t•partni( nt
"'<M QRRGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP181223 Effective Date: 8/1/2018
Work Type: Septic Upgrade Expiration Date: 8/1/2019
Tax Code Number: 02009261000
Site Legal Address: DON JACK LT 3 G:3337
Site Mailing Address: 5390 E 164TH AVE, Anchorage
Owner: MORE MICHAEL & CORALYN LIVING Lot Size in Sq Ft: 57777
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
C Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
• ,
Received By: �` 1� ��did/� ��,�� � Date:
//
Issued By: Date: '4F/6P
fitinAtS
MUNICIPALITY OF ANCHORAGE
•
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 020-092-61
Property owner(s) MORE MICHAEL & CORALYN LIVING TRUST Day phone
Mailing address 5390 E 164TH AVE, ANCHORAGE, AK 99516
Site address 5390 E 165TH AVE
Legal description (Sub'd., Block & Lot) DON JACK L3
Legal description (Township, Range & Section)
Lot Size 57,777 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑x Initial ❑ Single Family (SF) IXC
(w/wo ADU)
Septic Tank [ Upgrade ❑X
Duplex (D) [
Holding Tank ❑ Renewal ❑
Multiple Dwellings
Privy [ (SF and/or D)
Private Well [
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: 1-lat-f Date of Payment:
Receipt Number: 3Ci 1'46 Receipt Number:
Permit No. CiSP[81=3 Waiver No.
Permit App__:- c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181223, Rebecca Carroll, 08/01/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181223, Rebecca Carroll, 08/01/18
8 LOZ Alnr}O Cop y;OZ sly} `CJ SDIy 950Joy0uy
'bulMOJp sly} uo Joaddo IOU Xoua ;old pJooaJ o,®�����e�,
a UO UMO s as0 UD Ja O S UaulaSD UOaJa a OOI UI SO �O.0 ........ . ,� Qd®
y� y y� y� y� 3 y P P d� •...........
}daoxa (IJadoJd phos UO s}Uauaasoa algis!n Jay}O JO saull uolSsluJsuoJ� ®`Sr'"S-EbTE •oN"••
`sr(oMpoOJ ou aJo aJay; }oy1 puo uoi;sanb UI sasiwaJd aye „� �� Q 0
UO yOOOJOUa o}aJay4 4Uaoofpo buiAl AljadoJd ayI uo s4uau.anoJduJl �yaAF;fjo){!Ujago.aoN aa -I •J;� 0
. .......•®.®®.®®®®®®........
Ou }oy} `O}aJay} Iuaoo(po bu,Al A}JadoJd ay4 uo gDDOJOUa O 0
Jo do Jano IOU o uo said A( JadoJd a UI iM aJo uoaJa a on Is..............................0
P P 1 } 8 LOZ -� L} Inr UO yapDW soM '®® d®C-?
s}uauJanoJduJl aye }oyl puo .
AV
1 0 4t ..' A&
(LOL-08) NOISIAlcienS >i0df NOO 04
44� (
:/}JadoJd
paq JOsap bulMollOj ayj 40 AGAins alOJn000 uo }oy} 4j!#Jao lgaJay I
v Nova. WIJ4 pooh ay} o} paJnsoaw aJo suo!suauJ!Q
MON
NY dt,LU.UUIV
sssxss �szs�
SGS Ref.#
1179486001
Client Name
Rodney P Kinney Assoc.
Project Name/#
Michael More Plot
Client Sample ID
Kitchen Faucet
Matrix
Drinking Water
Don ;5&ck L-� -3
Sample Remarks:
Parameter ResUlts LOQ
Metals by ICP/MS
Arsenic ND 5.00
Waters Department
Total Nitrate/Nitrite-N ND 0.100
Microbiology Laboratory
E. Coli Negative 1
Total Coliform Negative 1
Printed Date/Time
11/14/2017 9:09
Collected Date/Time
11/01/2017 12:28
Received Date/Time
11/01/2017 12:59
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date Init
ug/l,
GP200.8
C
(<10)
11/03/17 11/08/17
VDL
mg/L
SM21450ONO3-F
B
(<10)
11/06/17
AYC
100mL SM219223B A
100mL SM219223B A
11/01/17 K.W
11/01/17 K.W
·~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE i =w
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BED800~
I Well AbsorPtion area Dwelling PERMIT NO,
~ ~ DISTANCE TO:
~ ~ Manufacturer ~ ~ Material No. of compartments
kiq. capacit~ in ~allons Inside length WiOth Uquid depth
] OO0 IF HOMEMADE:
~ Well Dwelling ~ PERMIT NO.
DISTANCE
TO:
~ ~ ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
~ ~ ~ No, of lines Length of each line Total length of lines Trench width Distance between lines
~ ~ ~ ~ inches
~ ~ ~ Top of tile to finish grad t Material beneath tile
Q e~ ~,~f/ Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
,NSTALLE.
APPROVE ~ ~ DATE LEGAL
72-013 (Rev. 3 78)
DEPARI"ME~ f3F' HEALTH AND ENVIRONi'4EN't Pi~Dl'bCl"tON~_)~[ /
264-47~0
IL~.IELL AND ON --.f::~ i 'l-'E
PERMI'T' NO. ( 800B64 )
'~PPL ICANT MICHAEL ~
.OCA"I' I ON E. 164TH
l"ype o.F soil absorption system is.'. 'TRENCH
SRA 4'?'B J
LOT SI Zb.
:-'-]4' ~ '"1"
'= ~- r.~'?,~
4;'~S60 SGUAI~E FEEl'
4a×imum number of bedrooms
Soil rating (S(~ F'T/BR)= 18~
l"he r'equir.ed size of the soil absorption system is.'.
~::)e p t h = 18 L eng t h = 84 6 rmv e I De p t h = B
The length dimension is the length (in feet) of the trench or drain.Field~
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 outfatl pipe
and the bottom of the excavation (in feet).
Requi r. ed Sep'ti c ]'ank Si z e= 1000 6.al I
: ~er'mit applicant has the responsibility ~o inform this depar'tmen± during the
installation inspections of any wells adjacent to this property and the
· number of residences that the well will serve,
'I'"I.~ICI ( 8 ) I NSPEC"I" I Of,IS ARE RECtU 1 F(~£L)
.Backfilling o( any system without final inspection and approval by this
department will be subject to prosecution.
,]inimum distance between a well and any on-site sewage disposal system is
100 ~eet ~:of a private well or 1S0 to 200 feet from a public well depending
upon the type of public well.
~inimum distance from a private well to a private sewer' line is 2B feet and
to a community sewer line is ?S feet.
~ell logs are required and must be returned to the department within ~[) days
of. the well completion,
Other' requirements may apply. Specifications and construction diagrams are
available to insure proper' installation~
F~ermi t ex~ires December ~1~ 1'980
t certify that
1: I am .Familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage~
8: I will install the system in accordance with the codes.
?- I understand that the on-site sewer' system may require enlargement if the
residence is remodeled to include more than ~ bedr'ooms~
B Z GNED: -'~P'P[] C AN1 ~'-~T~ HAE
ISSUED . _DA t'E_ V4.0
4040 "B" STREET
ANCHORAGE, ALASKA 99503
(907) 278-1551
June 10, 1980
W.O. #A19294
Mike More
SRA Box 473-J
Anchorage, Alaska
99507
Perc Test
Lot 3, Don Jack Subdivision
Dear Mr. More:
We ran a percolation test in the test hole cased with slotted
plastic pipe on the above referenced lot. The test hole had
previously been drilled and logged by Jim Dowling'of Dowling and
Associates.
The test hole was saturated, left overnight, saturated again and
the rate the water dropped in the test hole monitored over a
period of one hour, at ten minute intervals. The percolation
rate measured was 5.0 minutes/inch.
Please feel free to contact us should you have any questions.
Very truly yours,
ALASKA TESTLAB
Melvin R. Nichols, P.E.
Manager
MRN/mg
TIME TIME' % TIME
DATE A DATE
INSPECTOR INSPECTOR ~V,I/ 1NSPECTOR
ENVi RONMENTAL SANITATION DIVISION
Telephone 264-4720 RE
£$T FOR APPROYAL OF INDI¥1DUAL 1NATI::R AND Sr:W;R FACll. ITI;$
DIRECTIONS: Completa all psrts on ~aga 1. Inoom~l~ta raqu~t~ ~ill not h~ pro¢~d. Pla~sa ~llo~ tan Il01 d~¥, for
1. PROPERTY OWNER t PHONE
MARLING ADDRESS
PROPERTY ~ESIDENT {If diffarant from ~bovel ..... PHONE
· PHONE
M~,ILING ADDRESS ' ' ' - '
MAI LING'ADDR ESS
MAI LING ADDRESS
I S. LEGAL DESCRIPTION
I STR E ET '[.OCATI ON
1 6. TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DiSPOSAI~ SYSTEM
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
· NOMBER OF B~:DROOI~S'~ '
[] 0 ne [] Four
Two [] Five
Three [] Six
[] Other
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.}
/f~-,) YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: ! O~3(:D If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank IAbsorption Area
ISewer Line
INearest Lot Line
5. COMMENTS
DATE
[~APPROVED FOR _.~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ./'~
72-010 (Rev. 6/79)
"j'"l110
;/~GR~-'~-~R, ANCHORAGE AREA BF~"~IGH:
Department of EnvJronmenta~ Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS~-~'-/Z~ ~'/~' ~'~ /~'J'~;' PHONE~'-/~
LEGAL DESCRIPTION ~. ~r ~[~ ~-~
SEPTIC TANK:
DISTANCE
FROM W E LL//'~//~/?~/~"~'~VI A N U FACT U R E R
MATERIAL ~'/~/c';~-'~'~~ COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY~'/'~ -~-~) GALLONS.
SEEPAGE PIt:
NUMBER OF PITS / r DIAMETER -~'~ OR WIDTH i'- LENGTH -- DEPTH
LINING MATERIAL ~/~.~Z/'.~ CRIB SIZE: DIAMETER ~¢'" DEPTH ~'~ DISTANCE FROM:
.~, TOTAL EFFECTIVE
BUILDING FOUNDATION-~/2 NEAREST LOT LINE.~'~Z2 Z~, ABSORPTION AREA (WALL AREA) '~';~/~"~ SQ. FT,
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION DEPTH DISTANCE FROM:
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE TANK , SYSTEM
OTHER SOURCES
DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
PiPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE
G.A.A.B.
GREATER ANCHORAGE ~"->?A BoRoUgh
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO..
INSTALLATION OF: SEPTIC TANK ~ SEEPAge ,Pdt ~ DRAIN FIELD OTHER .
FINANCED THROUGH ~--~ TO BE INSTALLED BY ~' ~ ~J- ~~-- ~/
SO[L TEST RESULTS /~'~' /Y~/~ ~?~/A~ NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
, SeEPAgE PIT ~Y~J /
ALSO CONSIDER AREA WELLS.
. SEEPAGE PIt J~ /
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETer CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT F~EMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDINg INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge A)~EA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYST M IS IN ACCORDANCE WITH SAID CODE.
GreATEr ANCHOrAgE ArEa Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
NAME OF APPLICANT ~z~-/~
INSTALLATION LOCATION
PHONE
INSTALLATION OF: SEPTIC TANK ~ 0 OC~t SEEPAGE PIT ~ , DRAIN FIELD OTHER
FINANCED THROUGH TO BE INSTALLED BY
SOIl TEST RESULTS 'N~~ ~-- _-- NOTE.- THI_~p_~I~[~J~_NOT~ VALID WITHOUT SOli T~ST
COMPLETION DATE A
E [L INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
ARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ~ TYPE
SEEPAGE AREA SIZEC~
TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit ~ . DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /
WELL TO SEPT]C TANK I 0 0
WATER MAIN TO sePtiC TANK { ~
SEPT]C TANK, /~(~ I~ , SEEPAGE Pit
DRAIN Field
· SEEPAGE P]T
· ALSO CONSIDER AREA WELLS.
SEEPAge Pit
TO BOROUGH REGULATIONS REGARDI TALLATION.
DIAGRAM OF SYSTEM
CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
:)epartment of Environmental q.. ~y
3330 "C" Street
Anchorage, Alaska 99503
SOILS LOG - PEROLATION TEST
Legal Des c ri pti on :~__.~.¢~m2~
This form reports.' '~o~s lo~g~' ' ' ' ~ercolation test
Depth
Feet
2-
3-
4-
6-
7-
8-
10-
11 -
12-
13
14.-
Was ground water encountered?
If yes, at what depth?
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
Percolation rate minute.
Proposed installation: Seepage Pit brain Field
Depth to bottom of pit or trench
Oeptl~ of Inlet ............ ·
COHHE[ITS:
.............................~ -~-~-- -~// ~-~-'~- ..... :-
Performed By:_~~_~__Sertlf]ed By
gQ 040 (6/74)