Loading...
HomeMy WebLinkAboutORTH LT 5Orth Lot 5 #015-342-08 ... Municipality ofAnchorage : •• •. �� Development Services Department � Orr-Slte WateraM Waste�LTaterery Program, 1700 S. Bragaw SL ' • P.O. Box 196650 Andlorage, AK 99519-6650 .d.Page • . 01 wwwarxi»rage.akus (907) 343.7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 11)0100 29 PIDNumber. 01-3y2-Ofj M.ne ROGER Dc"Cal Wastewater System: []New Upgrade Aft� PO BOX 11233.3 Pnpr: ABSORPTION FIELD w.w a e.aaanw: Ido.een.v Os.F.wT ❑aw ❑Lw.e pom - LEGAL DESCRIPTION SW ft6v T01�o'bn►ae «4`e aeer LZ Berl[ Lal SWowru,. n.T HPn bqp eaean cool GPS• hR 4". FL Clbel ErFT errelPha Tawiey rlrpa aRt l,:o iL 6.8 FL CrMLrgtlt t 2 2 F Well: C,yj 11n ❑New ❑Upgrade rxwN wart Nnerdey.: oa,m l,—... rr. ^IP'MM.A4 k Tw10.pe1 C� w i� ^ FL FL C~. G+ SblcWrrLMt� bYrt ('3'S Ftr STr1 3 F8to ab bM.FrQ r.b .S,.L '�!,. to is orc —a.�.... GPM FI. FL TANK SEPARATION DISTANCES W SePtlo ❑ Hold'vig ❑ S.T.E.P. 0 Other. To Septic Abagplbn LM Holding ^ Fnxn Tank Field Station Tank Sewer Line /•1f1 gLIFTT o.l (2L"" X004 COi ZS+wnn.a Cuip.b,e„•lk"V"At 0 ATION 1Lau» 1cr•A+ro ca'L.y..n.r.rm..l on 0n N O 0 — _ Pop N.0 ~ h • Flgr�b.p.cave wna.,.a eF BENCH MARK mlm.e o..vv.o. ADO FL .i,,r P•(E OF Atgs i) Inspections performed by: i49THPM Dates: 1a aG nd2 !v� Development Services Department Approval �'„ s u�ruti�' Conditional Approval by: 2 Date: l l F 0 ' _ .......... Reviewed and Approved by. 'r;: •' Date: 1Rr• root c F5 CIRC SCALE, I' = 1w WELL\ --\ OF 49th !V '•�� �............... R LARS SPURKLAND' �xni.� fa No. CE -11500 _iY�, i 20 J W nnu cnv�nccmnu I I LOT 5 ORTH SID I I SEPTIC SYSTEM ASBU/LT ?03 W 15TH. AVENUE ANCH. AK. 99501 ROGER DETT££R DATE: DECEMBER 11, 200 (907) 279-3916 5901 ORTH C/RCLf SHEET 2/3 GR/D: 2538 0 060294 PID A 015-342-08 P I LOT 4 \ LOT 5 Installed Deep Trench Length 31 Feet SMAV M1 Width 3 feel 6 Depth 14 feel C 26' 1 2' 1 I I Rock 8.8 fool ® a N' 1 22' I SEPTIC Cover 8.8 feel WELL Si 51, �LS i F .i I I VENT OsyF c ss ss.5 1 N 69' Q' 71• .r' 1 I \ ° J I O � K re• so 6s' 50' Installed 1250 gallon lank j I 1 existing trench & lank abandoned - I ~'' per MOA Code requirements 1 TH® _Installed foundation cleano out I I I ®1 WELL r WELL ''LOT I / / 3 c F5 CIRC SCALE, I' = 1w WELL\ --\ OF 49th !V '•�� �............... R LARS SPURKLAND' �xni.� fa No. CE -11500 _iY�, i 20 J W nnu cnv�nccmnu I I LOT 5 ORTH SID I I SEPTIC SYSTEM ASBU/LT ?03 W 15TH. AVENUE ANCH. AK. 99501 ROGER DETT££R DATE: DECEMBER 11, 200 (907) 279-3916 5901 ORTH C/RCLf SHEET 2/3 GR/D: 2538 0 060294 PID A 015-342-08 Standard Trench: 3' Vide 32' Long 14' Beep 8.8' Sewer i 6.8' Cover NO SCALE ELM= 93.9' Silt Barrier ELEV,= 85.1' 8.8 ft of Septic Rock Effective OO F- 112 +- 0 1250 gal Septic tank o e � 0 V d � O y' 3 t2 Monitor Cleanouts _ - 6.8' Cover REV.= 101' NO SCALES u 79. 4.° 49th \RS SPURKLAND No. CE -11500 n 1250 galseptic tank BENCH MARK NW CORNER GARAGE SLAB ASSUMED ELEVATION 100' I � 20033 W15th Ave LIVUIIYLLRIIYU ORTH LOT 5 I I SEPTIC SYSTEM ASHUILT I Anchorage Ak 99501 ROGER DETTEER DATES LrcfxBCR 11, 2Aa5 279-3516 5901 ORTN C1RCI[ SHEET: 3/3 GRIDS ?5J8 PERM/T j SWO60294 PARCEL ID / 015-342-08 ORTHL53.DWG I MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW060294 Legal Description: ORTH LT 5 Design Engineer: 0007 SPURKLAND ENGINEERING Owner Name: ROGER DEHEER Owner Address: PO BOX 112333 ANCHORAGE. AK 99511-2333 Date Issued: Expiration Date: Parcel ID: 015-342-08 Site Address: 005901 ORTH CIR Lot Size: 49161 SO. FT. Total Bedrooms: 3 Permit This permit is for the construction of., ❑-' Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. 06, 2006 06.2007 3 Private Well Water Storage 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: IN I Date: Date: , A Municipality of Anchorage .� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Us- 3C4P-0% Property owner(s)_7 - . a h� �r Day phone I Mailing address PO- Gox ttD33 , An�°raje AK Zip Code 19511 Site address 5101 0AV, C;fJe- 9 AnAonN3e AK Zip Code '1151 fol Legal description (Sub'd, Block & Lot) Oril, So 11) L04 S Legal description (Township, Section 8 Range) Lot Size L4q . 1 U Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field 0 Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial Upgrade Renewal I certify that the above information is correct. I further certify that this application is being Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: _I do Waiver Fees: Date of Payment: �Iv�_ Receipt Number: S51415(p (Rev. 11/05) Date of Payment: Receipt Number: made for a SpuMand EngoneaTkmg Environmental Consulting and Design SEPTIC SYSTEM DESIGN LOT 5 ORTH S/D Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 August28,200t We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the'proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2% and a'schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No ground water encountered to depth of 20 feet. Use Standard Septic Tank w/ Deep Trench Soil Rating. From Testhole 05/16/05. <I min/in = 12 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 15011.2 -125 sq.ft. Total area required: 125 x 3 - 375 sqft Bottom Rock 14 feet Top Rock 5 feet Rock Depth 9 feet Total Bed Length 375 /18 - 20.8 feet USE 30 FEET SYSTEM CONFIGURATION 1250 GALLON STEEL TANK TOTAL LENGTH 30 FT TOTAL WIDTH 2 FT TOTAL DEPTH 13 FT ROCK DEPTH 9 COVER 4 FT The installation of this septic system will not prevent wells and septic systems from being installed on the a lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of. runoff will not result from this installation. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net Z-----I WaL ) / I LOT \4 I I LOT 5 LOT 7 IF I ® ' I SEPTIC WELL I ® VENTJ I I I � OSyFo j HTZLTE 7 tj I I \ WELL I WEa 1 wELL\LOT 3 I I LOT 6 I WELL rr \ ' T LOT 2 I LOT 1 �I�I � I ` – – _ aa:UT Tse— – – — – –—z--��6F`��r-� ............. 49th �.� ; LARS SPURK '. No. CE-11500 50 U 50 100 150 m SCALE+ 1' = 100 FT. 230 ••4a 15PURKUND ENGINEER/NGI I LOT 5 ORTH SID I I SEPTIC SYSTEM DESIGN I 203 W 157H. AVENUE ROGER DETTEER /anal o�o_re rc DATE: AUGUST 18, 2006 ANCH. AK. 99501 5901 ORTH CIRCLf SHEET • 1/3 GRID: 2538 PERMIT #SV020XXX PID # 016 -141 -XX LIRTHL51.DV✓G P LOT LOTS Into Deep Trench i Lenglh 30 feel Width eel I Depth 1 fee! Rock 9 1 I I SEPTIC Cover 5 f WELL I I I VENT I I � O SyFO I O \ Install bull run divider Replace Existing I WaQ Eozllon TankTH �� _ :�:• __Inslo/l,loundolion c n�tiul\ :;::• I , ti`s WELL i' r WELL 17T 3 I WELL _,._ �••�•P� '�... ���♦ i= A49th i �} ♦e ip ..._....... :�.....0�...._...... oSIkc / ..... LAR URKLAND i 25 0 25 50 75 Ix SCALE: I' = 50 FL LYs] i 5PURKLAND ENGINEERINGSEPTIC SYSTEM DES/GN 203 W 15TH. AVENUE LOT 5 ORTH SID ANCH. AK. 99501 ROGER DETTE£R DA 7r.- AUGUST 28, 2006 /907) 279-3916 11 5901 ORTH CIRCLE SHEET • 2/3 GRID: 2538 I PERMIT # PID # ORTHL5I.DVG To Existing Trench O 10— a 4 O z 1250 gal Septic tank m $ u c � a 3 A Standard Trench, NO SCALE Monitor Sit t 90 ft of Septic Rock Effective 1250 gal. septic SPURKLAND ENGINEERINGSEPTIC SYSTEM DESIGN 203 W15th Ave ORTH LOT 5 Anchorage Ak 99501 ROGER DETTEER DATE- AUGUST 28, 1006 3901 ORTH COCLE 11 SHEET, 3/3 GRID, 2538 PERMIT / SW0600XX PARCEL ID / ORTNLSJ DWG I 4 49th •t 2' Wide l....l » .. � 30' Long •..1 an?_.,1...... ..... 14' Deep : WtS SPURKIAND 9' Sewer rock 5' Cover ♦ 's.. —No. �cE-II3-00 •�1' ••.bl!°IY"••':•� NO SCALE Monitor Sit t 90 ft of Septic Rock Effective 1250 gal. septic SPURKLAND ENGINEERINGSEPTIC SYSTEM DESIGN 203 W15th Ave ORTH LOT 5 Anchorage Ak 99501 ROGER DETTEER DATE- AUGUST 28, 1006 3901 ORTH COCLE 11 SHEET, 3/3 GRID, 2538 PERMIT / SW0600XX PARCEL ID / ORTNLSJ DWG I Municipality of Anchorage Development Services Department AP''si Building Safety Division 00 y.' „1 On -Site Water and Wastewater Program -0-'49TH* 4700 South Bragaw St F{ �,., P.O. Box 196650 Anchorage, AK 99519-6650 / �`46 `� www.cl anchorage ek us �� LfG3 E. SPURIQANO (907)343-79D4 g'• 1500 ;'10 ke' Soils Log - Percolation Test l FO\P �a Performed For. ROGER DETTEER pate Perlomred:JULY Legal Description: LOT 5 ORTH S/D Township, Range, Section: { Depth (Feet) 2- 3-� 74ndy 4 9- 10- 11- 12- 13- 14- 15- 1 1 Silt S;hj S4hA� MOM WAS GROUND WATER ENCOUNTERED? N S IF YES, AT WHAT DEPTH'! 0 Depth to WSW Attar ° Ponttoring? M �' E Date: TEST RUN BETWEEN 6 FT AND FT COMMENTS PERCOLATION HOLE WAS FILLED TO A DEPT- bF 8 INCHU7,15TWINED IN LESS THAN 5 MINUTES PERFORMED BY: LARSSPURKLANDI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 7/15/06 PERCOLATION RATE < I (Meinfth) PERC HOLE DIAMETER 6- 1 TEST RUN BETWEEN 6 FT AND FT COMMENTS PERCOLATION HOLE WAS FILLED TO A DEPT- bF 8 INCHU7,15TWINED IN LESS THAN 5 MINUTES PERFORMED BY: LARSSPURKLANDI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 7/15/06 GRE,' ER ANCHORAGE AREA BOR '.IGH l; Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME i964/ ' 9/1- MAILING ADDRESS �� SACIk% ' 4401 PHONE _ LOCATION LEGAL DESCRIPTIONS SEPTIC TANK: DISTANCE NUMBER OF FROM WEL Oi 9 MANUFACTURER / IZF�"� MATERIAL �� � COMPARTMENTS INSIDE LENGTH — INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY4� GALLONS. TILE DRAIN FIELD: a TOTAL LENGTH DISTANCE FROM WELL /JI Id _FOUNDATION l NEAREST LOT LINE S OF LINES eo NUMBER OF LINES 1 DISTANCE BETWEEN LINES N M TRENCH WIDTH '', IN. TOTAL EFFECTIVE � ABSORPTION AREA �� SQ. FT. LENGTH OF EACH LINE I DEPTH OF FILTER DEPTH: TO//P OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_6 (2 IN. ABOVE TILE WELL: Ao t// TYPE— CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE—, SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: — — • ��nl%iNE. r�` V SEWER LINE DEPTH: — lot -- �riNrr>t ----�-���p••i-ff-N• PIPE MATERIAL: C'zY�_Pz i LO LOT SLOPE: S E u4 REMARKS: Form EQ -032 DATE S �aAPPROVED G.A.A.B. „,,,at GREATER ANCHORAGE AREA BOROUGH U”. `.f ` EPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO..— :33330 "C" STREET ANCHORAGE_, ALASKA 99503 TELEPHONE 274.4561 r. SEWAGE DISPOSAL SYSTEM ® APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION L �--5.�..�✓/ �� MAILING ADDRESS c' PHONE LEGAL DESCRIPTION '•C� � b" % �/1 �� J INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIL''LD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH 7 TO BE INSTALLED BY _ �/. r �6 1 .�/ TGs �%.z.L! G✓</ �I. �� / solL TEST RESULTS NOTE: THIS P RMI IS NOT VALID WITHOUT SOIL 'PEST COMPLETION DATE ANTICIPATED 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, SEPTIC TANK SIZE G� TYPE `�J� �'/r' EEP�.4�GE MINIMUM DISTANCES, REQUIREMENTS d FOUNDATION TO SEPTIC TANK — FOUNDATION TO SEEPAGE PIT �— DRAIN PIEI'D /({/ SEPTIC TANK TO SEEP7ihE-PIT WALL SEPTIC TANK SEEPAGE PIT , DRAIN 6Q_ TO NEAREST LOT LINE. WELL TO SEPTIC TANK '- t-" / SEEPAGE PIT h i DRAIN FIELD C/ � gL50 CONSIDER AREA /WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK,/4� /-' SEEPAGE PIT! '-" G DRAIN FIELD TO RIVER, LAKE, STREAM. 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 REMOVABLE CAPS. .I GRAVEL BACKFILL e5 CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G. OR.B. t OR LICENSED DESIGNER SIZE _ _ 'fYPF DIAGRAM OF SYSTEM d,4. 1 �G� �` ✓✓'� �l�"� I ! 4 I )�=�'L� G(',,_r ' >✓�� lti��'<' �; ;, h1 f 71.4'x- i. t i i I I illl I I I 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. ` \ J,W / 17AT�' C � � � �APPLICANT'S SIGNATURE �- A`b GREATER ANCHORAGE_ AREA E30ROUG11 �A Department: of Environmental Qua. y 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Performed for Cof ��> L`_ - ---Date Performed Legal Description: ----.—_ __---�—�___----------__ This form reports: Soils loges _ Percolation,— Depth Feet 7_ 3 - -- - �. e 5- 6 7- B i �7s - 14 - 1 Was ground water encountered? S'/opo i4c- If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate nn nue. ProposediristallaC�on SeP-page Pit Drain Field iepth of Inlet Depth to bottom o' pit or trench _ _ -._._UaLe---- ---- EQ 040 (6/74) Well Log For ...............;Z' ..............;Z' ................ ................ * ............................ I ...... Location..... 61� ........................................ Date completed.................%'7........ ......... ... .................... -J� .... Depth of well ...... . ........ I. ....... I .......... I .................. Sizeof casini ......... ........................— ............................ Distance to water.j, ..................................... Distance to water while pumping. ..at rate of.. -t-41 -..: ....gallons per hour. Formation I from I to /40 4411, ......... Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR IR,,ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ®�s�� f> F}'f//._ (a) Legal. Description (include lot, block, subdivision, section, township, range) Location (address or directions) licants Name (.J,- as,, �• y, Tele hone Home`( fti( Business (b) APP __ P ono Applicants AddressL (c) Applicant is (check one) Lending Institution �Owner/bui.lder Buyer E� ; Other ��__.� (expla:i.n); (d) Lending Institution • ""i. /�i�._Tr...%� Tel.ephonec_._..___.._�..� Address (e) Real. Estate Co. & Agent Address l "!r C c 4 Telephone (f) Mail the HAA to the following addres,z: 2. Tie of Residence Single -Family Fii Number of Bedrooms 3. -dater Supply Individual Well [''`_.] Multi. -Family J T,, Communityp Other- (describe) Note: if community well system, must h 've written coni riu;lt-ion (,-om the State Department of Environmental Conservation aattestin{; to the legality and status. $. Sewage Disposal Onsite �" Public Communit.;r Holding 'Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conser.'vation rte^.tin& to the legality and status. [Page 1 of 21 5. Engineering Firm Providing Inspections b. Tests, Rile Search Data and Tnforma:_i.on As certified by my seal affixed hereto and as of the validation date shown boloe:- I. verify that my investigation of this Health Authority Approval shows that the on-_;iI. water supply and/or wastewater disposal system is safe, functional and adequate Lor the number of bedrooms and type of structure indicated herein. I further verify uflla;, based on the information obtained from the Municipality of Anchorage files and fro,.; my investigation and inspection, the on• -site water supply and/or wastewater, disposal, system is in compliance irlth all. Municipal and State codes, ordinances, aiad regula- tions in effect on �he,,date of thiq,..nspection. Name of Firm ;'f ;. ,� � j MA "l C;; /`��crt: l�,o, r� jr_,.,TelephoneT•� `! `i 'i 7 fit CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND EArVIRONMENTA.L PROTrCTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAI. CERTIFICATES BASED SOLELY_ UPON THE Re:PRESFNT-- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER R`sGIS7'ERED IN THE STATE OF ALASKA. THE DIIEP DOES THIS AS A COURTESY TO PURCIIASERS OF HOME'S AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL. AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS 0[t ANAI.Y'Z.E DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF .,�NCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINFER'S WORK. (DHEP SEAL.) RRA+/e j/1)18 [Page 2 of 21 7.19--84 Address j/ Date � � Yee p 0 i 0 •A , % � /. (ENGINEER SEAL) Ie o o a n e 4 r] �• t k Y - i DHEP Approval C Approved for P P bedrooms P 11' /f�--/ - Approved Disapproved Conditional_ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND EArVIRONMENTA.L PROTrCTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAI. CERTIFICATES BASED SOLELY_ UPON THE Re:PRESFNT-- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER R`sGIS7'ERED IN THE STATE OF ALASKA. THE DIIEP DOES THIS AS A COURTESY TO PURCIIASERS OF HOME'S AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL. AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS 0[t ANAI.Y'Z.E DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF .,�NCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINFER'S WORK. (DHEP SEAL.) RRA+/e j/1)18 [Page 2 of 21 7.19--84 Mi1ruG'AVTv OF ANCHORAGE p�.Pl OF HEALTH & ENVIRONMENTAL PROTECTIOK MUNICIPALITY OF ANCHORAGE (MOA) JR 3 01984 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 R E C EIV\' ED A. WELL DATA Legal Description: Well Classification 1`%yi;%z If A, B, or C, D.E,C. Approved(Y/N) Well Log Present (Y/N) yes Date Completed -_���3 �� Yield�� Total Depth % ' _ Cased to Depth of Grouting_ /Don e Static Water Level. ��/ Pump Set At v���,>/ll Casing Height Above Ground L� " Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ���',. _, Depression Around iAbllhead (Y/N.) LO() Separation Distances from Well: To Septic/Holding Tank on Lot �S ; On Adjoining Lots 2,/)o � To Nearest Edge of Absorption Field on Lot On Adjoining Lots A')n " To Nearest Public Sews Line To Nearest Public Seer To Nearest Sewer Service Line o[, Lot 6D / y Cleanaat/Manholes /F' Water Sample Collected By Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 6-,' . Size /, ; r)L— No. of Compartments Standpipes (YM) Air -tight Caps (X/N)\Ir- Foundation Cleanout (YA1)A) n Depression over Tank (Y/N)1V0 Date Last Pumped /•,����� Pumping/Maintenance Contract on File (Y ),�ZF, for Al11 � Holding Tank High -Water Alarm (Y/N)s-f' ;e'. Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water -Supply WellfUPYTo Building Foundation ->, . To Property Line jwo' '{ To Disposal Field. 16) To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments -A-2 (" 2 y Jlo (Page 1 of 21 2-15-8A C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata125 'i� Type of System Design Date Installed `, = j, Length of Field Width of Field ,1, ; ' Depth of Field Gravel Bed Thickness Square Feet of Absorption Area `"'rbc Standpipes Present (Y/N) p De ression over Field (Y/N) Date of Last Adequacy Test ,�;, �•� Results of Last Adequacy Test d Separation Distance from Absorption Field: To Water -Supply 4b11 )vim To Property Line fib' To Building Foundation'(' To Existing or Abandoned System on Lot f `. On Adjoining Lots To Water^Main/Service Line To Cutbank(if present)' To Stream/Pond/Lake/cr Major, Drainage Course To Driveway, Parking Area, or Vehicle Storage Area �f Comments D. LIFT STATION N / A Date Installed Size in Gallons "Pump on" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of t 'spectin. FJ� A4. Signed Date 7Z G Co an 10 J�� , r MOA No. 9 �` r, F]RS 1 mP Y . . KB1/d5/s (Page 2 of 21 JOGiCCE9 ••094. 0Vx0C' 41 s NEIL HA`f!''?fORf-0E •• !% @@�`� •, CE - 4362 <.li •' • • • rte. A� 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 July 25, 1984 Mr. Neil Hawthorne 7127 Old Seward Highway Anchorage, Alaska 99502 Dear Mr. Hawthorne: BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: Subject: Waive Private Well to Septic Tank Horizontal Separation to 85 ft for Lot 5, Orth Subdivision (8521 -WA -015) The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the private well and septic tank for a 4 bedroom house to 95 ft. Sincerely, Bruce E. Erickson Environmental Engineer BEE/msm 274-2533 2.2 © :. , C/ Ai, , 2.2 © :. , C/ ol Ir /Poo /3, 7 -/ /,P) V e" o for 19 4-1 /1 fkA