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NAME
MUNICIPALITY OF ANCHORAGE
WATER CONNECTION —Location Record
LOT � „BLOCK "� ADDITION
Au"Jullm. R6x0vm
ACCT. NO.
ADDRESS
Z
% � J 1. DATE MADE —0 l 12:1NEW CONN.
LOCATION: ALLEY El STREET
I—CORPSTOP
5s
00--le9ol ftm-&s 4
ZZO (Z,,Pq
REPLACEMENT CONN.
TYPE OF MAIN(�,Jo's }SHOW SKETCH ON REVERSE SIDE
THAW PLATE PERMIT NO.
CURB STOP C TC
IRB STOP C TO !
CORP CONNECTOR
COUPLING C To I
x BRASS BUSHING
GALVANIZED BUSHING
2 PART UNION
PART UNION
SERVICE CLAMP x
COPPER PIPE
1 1" KEY BOX
2" KEY BOX
THAW WIRE
LOCATION0 p -
AJ LO -r
CONNECTION MADE B
1-058 (12/77)
a • r t _e _. . rte. a ,t
KEARNY WIRE CONNECTOR
THER:
COMMENTS: BROKEN MAIN, EXT. CONNECTION,
CAS 117, D E LA `S, ETC.
DISCONNECTS
11 EXCAVATOR
APPOINTMENT TIME:
TIME READ:
INSPECTED BY
W.
COI I*
INSP.
PERMIT
TOTAL
EXTRA PIPE
FT.
PI LA
PAID
P R Ell.
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PAID
CASH
SUB AGREEMENT
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A LT.
L; T 14
1:1 IMP. DIST.
EXT. AGREEMENT
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
~Vary
MAILING ADD/R ESS' '
LEGAL DESCRIPTION
LOCATION
'IWell -- ]Absorptionarea~, Dwelling ¢ ,
F:O' Z [ [ Manufacturer DISTANCE TO:D ] ~Oy~ll!,~I Materialff/('d
~ /Liq capac tv n ga OhS I .._ Inside length
IF HOME~w~DE' .~..
I /¢~¢ I -~ ·
~ ~TO: iw.,
~-- ~ [~n~~-- Material
L
~ l~j ~lWell: --- Foundation/2/
~Z J DISTANCE TO: ~ml, U 'j''
j~ ~achll~e/)/i TotaJlengthoflnes / Trenc~wdtl~
m Top of tile to fi~sh gra'de ~ , Materiam beneath tile,
~ ~ ~ ~ ~~ Crib depth
JCl~s D~th m Driller Distance to lot line
PHONE ~NEW
L~UPGRADE
NO, OF BEDROOMS
PERMIT NO.~ 2~,,~ ~
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO~.-~ 2 ~.~Sa~
Distance between lines ,~/
Total effective absorption area
PERMIT NO.
Total effective absorption area
PERMIT NO.
Absorption area (s)
OTHER
PIPE MATERIALS
pfc cr
SOIL TEST RATING
2-
INSTALLER
REMARKS
I & " /'.
APPROVED
DATE
72-013 (Rev. 3/78)
LEGAL
L,,f
/ ALASKA ENVIRC ,,IENTAL Job ~-~?? , ,'<:~-~ :~ ~'~? ~.~,'~'~ 4-~
' CONTROl. SERVICES, INC. S"EET NO. / O~ "~
4 1220 West 25th Avenue
/ ANCHORAGE, ALASKA 99503 CALCULATED DY t~ . ~ ,' O~1 DATE__~ ~ '~ O - ~ ~-
// Phone 276-1361
~., CHECKED BY DATE
./
SCALE
ALASKA ENVIRON, ,NTAL
'CONTROL SERVICES, INC,
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
SHEET NO. '~ OF
CALCULATED SY ~ ~' ~ DATE
CHECKED BY DATE
?
ALASKA ENVIROK '"NTAL
CONTROL SERVICES, INC.
t220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
NOTES
1, UP, ETHANE FOAM SI40ULD BE APPLIED TO /:. DIEf'I'H C;F'4
BEIj)W OROU,UD SURFACE AT A THICKNESS OF ~ INCIt,
2, COAT BOTTOM 2 FEET IN'SIDE WITH E!II'UH'A'STIC PAINT.
3, USE ] ,4 OR J ~' FLEXIBL~_ i--~(.)SE TO FIT PUMP.
4, SEE 'SPECIFICATIONS FOR I,I;'?rERIALE.
FEET
GP,OUND,
STATIO
SCREWS-,,.
HEMA 4 BOX-,
1~'/C,0 N DUI T--.- ~=.~ i
· 'FILLET WELD /
ALL ARC)U ND--~''
CHAIN OR NYLON ROPE
PUMP POWER CORD-
ALARM CORD
4" STEEL NIPPLE--~_
LLET L/ELD ~
FI
ALL AROUND .
PIPE --~.~,
~ METAL PLATE
/I'~,ETAL CAP WITH
URETHANE FOAH
AROUND
1.J'~"7'0 4" COUPLING
L] 1~"N p-I' NIPPLE
] ¼ FLEX HOSE
..~- ] ¼" CF-I E CK VALV. E
SUMP PUMP
MUNICIPALITY OF ANCHORAGF
Departmen~ /f Health add Environmenta Protection
825 ~ Street, Anchorage, AK. 99501
264-4720
***
Permit ~ ~]~Li HANDWRITTEN PERMIT * * *
WE-~~OR ON-SITE SEWER PERMIT
Location: ~ $ ~{'~ ~{F~ q Phone Number:
Legal Description: ~ C~Z-W F~C ~ 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:
· GRAVEL ~EPTH 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 = /¢rC9~, __ 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 department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
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 2 * * *
I_certify that:
(!) 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 t~e on-site sewer system may require enlargement if
the residence is re~ode~4 to include more that 3 bedrooms.
S:igne~: ~ant Issued
Date: ¢/~.//~--
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
· E A, DESCR,PT, ON:
1
2
3
4
5
6
7
8
9
. 10
11
12
13
14
15
16
17
18
19
20
COMMENTs
72-008 (6/79)
DATE PERFORMED:
Lo-I-
SLOPE
SITE PLAN
WAS GROUND WATER
0
P
! E
IF YES, AT WHAT
DEPTH?-
Gross Net Depth to Net
Reading Date Time Time Water Drop
(~inu'tes/inch)
,'"'""~' t .,' .... -) TEST RUN BETWEEN ~" -'~T AND ~ C '~T"
F20C,, L~ I'c:X~'~',..,...~.~.'.~.::_~:~_,, ,/
CERTIFIED BY: '. ., fr '_Z'_' ", ~ . . DATE: '0 "*'L ~ '¢- '~
' ~ .... .., ..-
MUNICIPALITY OF ANCHORAGE
DIVISION OF ~4VIRONMENTAL HEADll4
DEPARTMENT OF HEAL3~ AND ENVIRONMENTAL PROTECfION
APPLICATIfkN FOR I{EALTH AII]THORITY APPROVAl. CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot~ block, subdivision, section, township, range)
Locat±on (add~ess or d±~ectLons)
Applicants Address ,~'zO 0 Z~ /¢~., ~-~.~ ~___/~/, e [~,- ~,g ,:
Buyer I----~ ; Other L--J (explain),
(d) I~ending Institution ~,yk~,~ '/t>'=~ ~'~[,,~ / /1%,- ~ Te].ephor~
(e) I%eal Estate Co. & Agent ~
Telephorm J P~ -- 2 z/~.
2. ~__~Zt29. of Pesiden¢~e
Single-Family
NumJoer of Bedroonm
3. Wate_~ Supply_
Individual
Multi-Family
Other (describe)
Community ~_~_~ Public ~
Note: If ~t~,~ni'ty %~11 s~stem, must have. written c~nfirmation frcm the State
Department of~ Environmental Conservation attesting to' the legality ~%d Status.
]:s the w~ll adequate fo~t the number ,gl bed~-oc~s specified' in this HAA (Y/N)'/6~//f-
4. Sewage Di~_~a_~l
Onsite ~ t~blic ~ Community ~--~ Holding Tank
Is the wastewater disposal system adequate for tJ~e p~nber of b~drocr~
[Page 1 of 2]
2-15-84
5._n_~z_zr..Ep ine. erin~r Firm l~-oviding~. . Inspections, Tests, Data and I~:for2~nticn
I certify that I have c~cked, verified, or conforned to all ~YDA ~I~A Guideline. s in
effect on the cL~te .of this i~pectic, o.o
Nam~ of Firm __~f_f~ _-~L~
Signed by
ENGINEER SEAL)
Approved for__~-- be c~c ooms
Terms of Conditional Approval
%he Municipality of Anchorage Department of tle. alth and Environmental Protection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that., as of the validation date
shown abo~, based on the cl~ta and information furnished by cmn engineer registered in
the State of Alaska, the wate~ supply and wastewater disposal system is safe and func-
tional fo~ the r. umber of b~drocms e~d type. of structure indicated°
( D~EP SEA[,)
7. Mail the HAA to t~k following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MQ~0NICi~AU~,~0~'^~C~OZ~a
CHECKLIST - FEBRUARY 1984 [[~:;i~ .... ....
MAR 2
Well ~ ~esent (Y~) ~- Date ~leted ~ Yield~/~
Total ~p~ ~__ Card to ~f~, . ~pth of Grouting~~ __
Static Water Level ---~/~ Pump Set At
Casing Height Above Ground ~
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding TaDJ¢ c~1 Lot
To Nearest Edge of Absorption Field on Lot___~y~
To Nearest Public Se~r Line
C leancut/Manhole
Water Sample Collected By
- -. //4_
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead .(Y/N)
; On Adjoining Lots
; On Adjoining Lots___~//7
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
,.
; Date
Water Sample Test Rmsults
Ccm~ents
B. SEPTIC/HOLDING TANK DATA
Date Installed /~_~ ~r 7_ Size /0 ~O No. of C~,~pa~tm~nts
,Stan~i~s ~) Air-tight Caps ~) Foundation Cleanout
~;gssion ove~ Ta~ ~ Date ~st P~d ~'r~,~' ~/~
P~ing~aintenan~ Con~act ~ File (Y~) ; for
Holding Ta~ High-Wate~ ala~ ~y~) ~. ~ra~y Holdi~ Tank ~r~t (Y~)
Sep~ation Distan~s ~ ~ptic~olding Tank:
To Water-Supply ~11 __.~/ '~ To ~ilding F~ndation
To ~o~rty Li~ ~¥ / To Dis~sal Field ?O
To ~ter Main/Servi~ Li~ ..'~O ' ~ .._ To S~e~, Pond, ~e, ~ ~jor ~aina~
course .
Comments
[PaGe 1 of 2] 2-15-84
(N~ sepOD I~oTa~Oela
(N/t) ~uese.~cI sed!dpue~S
~-- ssel~o!q~ pe~ TeAmeD
/...Cz ~-.-~ pleia ~o
~ j' ple!a ~o q~Sueq
_5~, pi e!.~ ~o
e~eaq9 uo!qdaosqv u! 5u!q~ si!os
'0
YLIM (:~IZI.~ NOIJ~a~OS~ 'D
ALASKA E P'"ROFlmeF1TAL COFITROL $tZRL IFIC.
SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT
SYSTEM- LOT 9, BLOCK 0, LAZY ACRES SUBDIVISION
1.0 GENERAL
1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL PROTECTION PERMIT.
2.0 THE LIFT STATION
2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER
GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT,
CAPABLE OF BURIAL TO 10 FT.
2.2 THE 24" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED
WATER TIGHT BOTTOM OF THE SAME THICKNESS AND
COMPOSITION AS THE CULVERT.
2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED
AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG.
WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC
RICH PAINT OR COATED WITH BITUMASTIC.
2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED
WITH SCREWS.
2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT
STATION S[IALL MEET THE REQUIREMENTS FOR A WATER TIGHT
SERVICE.
2.6 THERE SHALL'BE A HIGH LEVEL ALA$LM,PEABODY BARNES 6147
OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE
SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE
ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY
THE HOMEOWNER.
2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT
A HEAD OF 20 FEET.
2.8 THE SUMP PUMP SHALL BE SUSPENDED NOT LESS THAN 6 INCHES
OFF THE BOTTOM OF THE LIFT STATION WITH A CHAIN OR
NYLON LINE.
3.0 SEEPAGE BED
3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO
1.5 INCH AND RELATIVELY FREE FROM SILT OR SAND.
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE R/LKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION S[IALL
BE PLUS OR MINUS 2".
3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR
POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL.
3.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. IT. SHALL BE RIGID PVC, ASTM 3033 D-3034. THE
SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5"
HOL~S @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE
OR A REGULAR SECTION OF REGULAR PERFORATED
DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION
WITH A NO HUB COUPLING OR SOl, VENT JOINT. A RUBBER HAIN-
1220 J. UCsl 25th Auenue ,i Anchoraq~'. J~Jasko 99503 · L907~ 276-1361
CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE
PIPE.
3.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED
BUILDING PAPER OR A NONWOVEN FABRIC SUCH AS MIRAFAR
FIBRETEX 200 GRADE, OR POLY-FILTER X OR EQUAL.
3.6 IF INSULATION IS REQUIRED THE INSULATI. ON SHALL BE DOW
EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM
EMBANKMENT INSULATION BOARD OF THE THICKNESS SHOWN
ON THE DRAWINGS.
3.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A
WHITE CLOVER AND RED FESCUE MIX.
To ~lhom It Nay~ J, Concern:
The house on Lot 9, IJ. zy Acres SubxtJ. visJ. On has been
unoccupJ, ed si. nee complete, on and inspectJ, on of on-si, re se~.~er