HomeMy WebLinkAboutCHANDELLE ACRES LT 15
HOMEMADE: Inside I~f~th Width
of lines
Nearest lot lie~ ': ....
Oi~tance to lot
~ptic tank
.:GAL
PO. ~C,X 6650
ANCHORAGE. ALASKA.::u..u:-ues,_,'~ ....... '"
i907) 264-4! 1 'I
DEPARTMENT OF HEALTH & HUMAN SERVIC~ES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850414
Lot 15 Chandelle Acres Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
DEF~.R1MEN1 OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264--4'72()
C.) N ........ -~:3 I ']- E~ SS EE W E; F:~ F:' E-] F( M Z '1-
PERM I'l' NO:
DATE ISSLJED:
8 ,.~ .) 4 14
07 / 16 / 85
AF:'F:'L I CANT':
ADDRESS;:
CON'T'ACT I='HONE:
WALKER CONS'TRUCT'ION
F:' 0 BOX 771974
EAGL..E RIVER, AK 99577
694-4858
I...EGAL DESCRIF':
I....0 T SIZE:
I_OT LOCATION:
MAX BEDROOMS:
SUBDIVISI[)N:: CHANDELLE ACRES
SECTION: 3 TOWNSHIP: 15N
43000 (SQ.FT. OR ACRES)
CHANDELLE DRIVE
4
LOT: 15 BLOCK]: NA
RANGE: 1W
Listed be]ow are the options available to you in designing your septic
system. Choose the option that best Fits your site.
DEPTH 7'0 PIPE BOTTOM (FT.)
GRAVEL. DEPTH (FT.)
TOTAL DEF'TH (F'T. )
GRAVEl_ WIDTH (F'T'.)
GRAVEL LENGTH (F'T.)
GRAVEL. VOLUME (CU. YDS. )
TANK SIZE (GALS)
SOIL. RATING (SQ.FT. /BR)
TRENCH BI~_"D W. DRA I N
4.0 4.0 4.0
8.0 0.5 3.5
12.0 4.5 7.5
2.5 26.0 5.0
60.0 51.0 103.0 **
47.3 49.2 '76.3
1,250.~'~ ** 1,250.0 ** 1.,250.0 **
2?37 220 237
** GRAVEl_ LENGTH > '75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** TANK MUST HAVE AT I_EAST TWO COMPARTMENTS
I certify that':
1. I am Familiar with the requirements For on-site sewers and wells as set
£orth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I wi].l instal], the system in accordance with all MOA codes and regulat, ions,
and :i.n comp].iance with the design criteria o£ this permit.
3. I wi].l adhere to all. MOA and St. ate of Alask'a requirements-for the :set back
distances rr.om any existing well, wastewater disposal system or public
sewerage syst. em on this or any adjacent, or nearby lot.
4. I understand that. this permit is valid For a maximum of 4 bedrooms and
any enlargement will require an addit, ional permit.
IF A I_IFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELE!:CTR I: CAL. PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUII_TS
WII_L., NC]]" BE APPROVED WI'T'HOLJT AN EL. ECTRICAI... INSPECTION REF'ORT.~ AND (3) THE ,jJ,(
El EE'TRIr]AI WOF'I-::' MtlST BE DONE BY A LICENSED E'LEC'T'RICIAN. '
................... % ......
.............q I GNED ._~//"~ ),"'_ /,,~/¢,~/~,~. _./~_~._:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOl LS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3.
4
5
6
7
8
9
DATE PERFORMED:
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS ~,O I [..,5
PERFORMED BY:
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH~
...................................................... G,oss Net Depth to V Net
Reading Date Time ] il1~1:.~ W,:tt e.l t
--
PERCOLATION RATE 2 ~-- ¢1~ "~ (m,nutes/inch)
TEST RUN BETWEEN 3 FT AN[)__~' Fl-
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~i~ ,~"~
OF ON-SITE SEWER AND WATER FACILITY
264-4744
¢
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner ('"~G¢ Telephone: Home
(c) Lending Institution ~ ~ /~ Telephone
(d) Real Estate Company and Agent ~ ~
Business
Address
Telephone
(e)
Mail the HAA to the followino address: or: Check here,,~r, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family ~[
Number of Bedrooms
WATER SUPPLY
Individual Well D Community [] Public ~
Note: If community well system, must have written confirmation 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 Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 fRev 8/861 Fronl
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional 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
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name.el Fir m ~,~/.//, ~--~--~.j~.~)'~ ~.~. Telephone ~-Z-~
Address "': ~ [ ~ ~ ~ ~ ~/~ ~ ~ ~ ~ ~ ~ ~ ~ ¢ ~ ~/~
Approved for .~,~,.~_~/~Z-~) bedrooms by ..,~ :
Approved ~ Disapproved Conditional
Terms of Conditio~nal Approval
Date
CAUTION
The Municipality of Anchorage Department of Health and Human Services'(DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS 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
engineer's work.
Page 2 of 2 -- A 72-025 IRev 8/86) Back
' MuNiCIPALITY 01: ANCHORAGE
ENyj?,ONMEN~AL SERVICES DiViSION
WELL DATA
Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264°4720
Legal Description: ~-'
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments ~'C'~//JF ~"~/'~'
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed Size
Standpipes (Y/N) 'F Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N) '~(~//~
Holding Tank High-Water Alarm (Y/N)
No. of Compartments
y! Foundation Cleanout (Y/N)
Date Last Pumped
· for
Temporary Holding Tank Permit (Y/N) ~_//'"~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~ ~-~
To Property Line -~
To Water Main/Service Line '~"
Course ~'z,/"~P
To Building Foundation
(,'
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026{11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~:~-
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well -/- Z-
To Building Foundation
Lot
To Water Main/Service Line
"~ /,5-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ~' ''~ ~
Depth of Field /Z"
Gravel Bed Thickness ~"
Standpipes Present (Y/N)
Date of Last Adequacy Test
v
To Property Line
To Existing or Abandoned System on
· On Adjoining Lots ~ ~.~O '
To Cutbank (if present) ~- !O O '
.-t- I~0 '
Comments
D. LIFT STATION ~ ~ ~)'~' /-,)-,~' ~.
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify t,~f,~,~, verified, or conformed to all
Signed -,~' ¢7 1'! ' ~'' ~¢''~ ~ Date
Company ~~)-r~ ~MOA~
Receipt No. ~
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)