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HomeMy WebLinkAboutTIMBERLINE LT 12Onsite File - 19bedroom system is not to be 81 4 tested for a •-. •r •An MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221187 Work Type: Septic Renewal Tax Code Number: 01516413000 Site Legal Address: TIMBERLINE LT 12 G:2641 Site Mailing Address: 11000 VOSIKOF PL, Anchorage Owner: SPENCER DAVID WILLIAM & Design Engineer: MOXNESS ANSON This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: o�'»cnt. S, 0 � � n Department 6/28/2022 6/28/2023 49530 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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: Issued By: Date: Date: 5 Development Services Department % p p � �; _ _ , Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-164-13 Property owner(s) David William Spencer Day phone Mailing address 11000 Vosikof Pl, Anchorage AK 99507 Site address 11000 Vosikof PI, Anchorage AK 99507 Legal description (Sub'd., Block & Lot) Timberline Lot 12 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms -5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank Fx_1 Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: 40/1..5 Waiver Fees: _ Date of Payment: 6ZO 2.2 Date of Payment: Receipt Number: 011g60 Q Receipt Number: Permit No. 0 75P a 2 k 1%] Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Anson Moxness, PE 2439 Douglas Dr Anchorage, AK 99517 Municipality of Anchorage Development Services Department Building Services Division On -Site Water and Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: SEPTIC SYSTEM PERMIT APPLICATION Timberline Lot 12 June 20, 2022 I am submitting a re-application to replace the septic system for this lot. An original permit (OSP201421) was issued to replace the existing septic system with an oversized 5 -bedroom system to serve a 4 - bedroom single family residence. The original design was based on a groundwater level of 12.3 feet below ground level as measured on 10/5/2020. The groundwater was measured on 5/28/2022 at 11 feet below ground level. An altered design is proposed at the same location. Soil Logs, design calculations, a site plan, and design drawings are enclosed for your review. Design Calculations Design will be based on the soils and groundwater found in Test Hole #1 as shown on the site plan and design drawings. Test hole Groundwater: Observed 12.3 ft below the ground surface on 10/5/2020 Observed 11 ft below the ground surface on 5/28/2022 Soil Rating: 1.5 min/inch =1.2 gal per sq.ft/day Number of Bedrooms: 5 Required Area per Bedroom: 150/1.2 = 125 sq ft Total Area Required: 125 sq ft/bdrm x 4 = 625 sq ft System Design I am proposing a new 1,500 gallon HDPE septic tank followed by a deep absorption trench 63 ft long and 2 feet wide containing 5 feet of sewer rock. The trench would contain 630 sq ft of absorption area. The maximum excavation depth would be 7 feet and the trench would be covered with 2" of insulation and at least 2 feet of earthen cover. A diverter valve will be installed to the existing field so that it may be used in the future. Soils: One test hole was excavated on 9/28/2020. After a 7 day monitoring period, the ground water was found to be 12 feet below the ground surface. In May 2022, the ground water was found to be 11 feet below the ground surface. Soil was found to be good draining sandy gravel. See the attached soil logs. 2439 Douglas Dr, Anchorage, AK 99537 (907) 242-5995 anson.moxness@gmall.com Surface Water No surface waters were observed within one hundred feet of the proposed septic system. Topography: The system will be located on a flat bench on the property. Below the bench, the ground slopes down at approximately 15-20%. No excessive slopes were noted downhill from the trench location. Wells: There are no wells within 100 feet of the proposed system location. The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic system location. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 242-5995. Sincerely, A son kxness, .E. 2439 Douglas Dr, Anchorage, AK 99517 (907) 242-5995 anson.moxness@gmail.com — ® I LOT 3 SID TIMBER 41N LOT 4 )LOT 5 L��, LOT 10 LOT 11 (;mtl.!) LOT 1 LOT 13 1 Y NOTE' THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 50 0 50 100 150 200 250 300 SCALE, I' = 100 FT, I� I I I I ® I III I I K l® I I I v I I �a� MOOSE RUN SID I LOT 2 MOOSE RUN SID LOT 1 I I I I I I I I TIMBERLINE LOT 16 OF '•••`,v th1 o ANSON M�XNESS �j NO.CE-103906 ;'��_�! ANSON MOXNESS PE TIMBERLINE LT 12 ISEPTIC SYSTEM DESIGN 2439 DOUGLAS DR ANCH. AK, 99517 DAVID SPENCER DATE: OCT 5 2020 907-242-5995 11000 VVENDF PL ANCHORAGE AK 99507 SHEET 1/3 GRID- SV2641 PERMIT # 3SP20XXX PID # 015-164-13 TIMBERLINEL T12,SC100,DVG NOTE.• NO SLOPES IXCEEDING 25X WERE OBSERVED W/THIN 50 FEET DOWN GRADIENT OF THE PROPOSED ABSORPTION FIELD LOCATION. ABANDON EXISTING SEPTIC TANK PER MOA CODE REOUIREMEN73 NOTE.' THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON -VE WATER AND WASTE WATER DEPARMFNT DOCUMENTA770N. ALL LOCATIONS SHOWN ARE APPROXIMATE. 25 0 25 50 75 100 125 150 SCALE.- I' = 50 FT. VIV DElUGLAS DR �, `�` 0439TIMBERLINE LOT 12 SEPTIC SYSTEM DESIGN ANCH. AK. 99517 DAVIB SPENCER DATE, JUN 20 2022 (907) 242-5995 11 11000 VOSIK©F PL ANCHEIRAGE AK 99587 SHEET+ 2/3 GRID, SV2641 PERMIT 0 ©SP221187 PID 0 015-164-13 TIMBERLINEL12SC50-22.DVG O.G. ELEV.- I PIPE INV UK. LIN£ TO SFR BIVAE Beep Trencht CLEAAAVUTS 2' V1de I 63' Long / 7' Max Bepth O 0 5' Sewer Rock 2' Insula tion 15W GALLON SEPTIC TANK Bt' Cover BIVERTER TO rig EXISTING FIELB N© SCALE Trench Elevation (TyP) BIVERTER TO EXISTING Cieanouts FIELB Monitors Slit Barrier fl fl 2' Insula t/0 ;)-7-\\ "i, R fl GROUNDWER BOT TRENCH ELEV.- ELEV OBSEER O. 5,0 ft of Septic Rock BOTTOM TH ELEY ' \ ELEV- INV LEV• PIPE INV ELEV- 4 th ANSON MOXNESS TOPT K ELEV faWBATOV \ LYEAMX1T FG ELEV. 1500 GALLON HW SEPTIC W HITJVIT mvnlrc.J l rc YZMBERLWE LT 12 SEPTIC SYSTEM DESIGN 2439 DOUGLAS BR ANCH. AK. 9951711 DAVID SPENCER DATE, JUN 2 2022 l907I 242-5995 11000 VOSIKOF PL ANCHORAGE AK 99507 SHEET, 3/3 GRIB, 2641 PERMIT # 17SP221187 PIB #015-164-13 TIMBERLINE.B3-22,BV6 ����' OF ',1101 115011 MOX11ess PE q 2439 Douglas Dr00 `?:'' •'•:�9 •: Anchorage, AK99517 .........49 . h :: e TEST HOLE # � 1 DEPTH 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 /.......v.. ...............r / 0 ANS❑ M❑ NESS �� SOIL LOG AND PERCOLATION TEST#`��; No,CE-103906 • se F,p Zz •..,t./Y „•(znll DESCRIPTIONDATE._,SEPT 28 ZUOpp SSION�i•�� WAS GROUNDWATER OBSERVED: No INKS IF YES, AT WHAT DEPTH. AFTER MONITORING PERIOD: 1_1'— DATE OBSERVED: _ 5 28 2022 PERCOLATION TEST.- y Grovel ,obbles to 10” NOTES: FILL DATE GROSS TIME NET TIME DISTANCE DROP 6" —9128120 10.30 AM 5m30s 6" 6m00s 0" 6- 6'7'-- 6 6m25s 0" 6 6" 7m05s 0 6 67-- 7m35s 0"1 6 6" 7m50s 0 6 7m45s 1 0" 1 6 PERCOLATION RATE. 1.5 minutes/ inch PERC HOLE DIAMETER. • 6 inches TEST RUN BETWEEN 5.5 FT AND 6 FT SITE PLAN: N See Design Plan PERFORMED BY. Anson Moxness. 1, Anson Moxness P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES /N EFFECT ON THIS DATE. ANSON MOXNESS PE TIMBERLINE LT 12 SOIL LOG PERCOLATION TEST 2439 DOUGLAS DRDAVID SPENCER DATE, JUN 2 2022 ANCHORAGE, AK 99517 9 (907) 242-5995 1 11000 VosikoF Dr Anchorage AK 99076 GRID #+ 2641 PERMIT # PID # 015-164-13 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201421 Work Type: Septic Upgrade Tax Code Number: 01516413000 Site Legal Address: TIMBERLINE LT 12 G:2641 Site Mailing Address: 11000 VOSIKOF PL, Anchorage Owner: SPENCER DAVID WILLIAM & Design Engineer: MOXNESS ANSON This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: /�tir Uepa1,thnent 10/9/2020 10/9/2021 49530 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 2022 I`n �eVleu� � Pe r ►'� l � �, rooJ e� -to CA GvIc"l Received By: Date: Issued By:Date: 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 015-164-13 Property owner(s) David William Spencer Day phone Mailing address 11000 Vosikof PI, Anchorage AK 99507 Site address 11000 Vosikof Pl, Anchorage AK 99507 Legal description (Sub'd., Block & Lot) Timberline Lot 12 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Q Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tankade Q U r pg X Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: Date of Payment: 10 (P d D Receipt Number: 2 5D'5 �D Permit No. 0519201 y E I Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc do . 026 P . 02 r t I, I Lot Block Anchoroge Re wding Pracimt, Alemko ` SURVEY CERTIFIC&TIO , -ML i heraby u{t,tr that i hove su+�eyM tre Pt'�Y lsitioy++n and dv�rtp� � : i�raa� rrappad tttort►xncrrt ►�ccwtttd j haiMtond 1i a10* Y+,pr°Ov�w4nM S�t1 Od Nw64A ore wlthitl lhd (Sif o- a r Iron Mpa ondlorretur reoovercd rrty ox aM eso r�dt werbp tr twooch on odjaaent aropaaty and tripe M b 1 Wlhoh,'tock regia Wod iffWO'iWn o�06 'r a O ar�P Or t t aero wtior aoa • r W x'„Id 'robOr Ut the i�Y txwWft On Sold PMPg -Y 914W as imficated hereon vle /f DoteJAN A F'r�"red by. R. L. 060r;ro/ r `� I ' (90.7127.9_ SV W rignrh Ave Aftdowpo, Aigskor 99,7ol Hof. � l F. K No.� ► ! Ptqmrty of, 1 +: 1 ~1-W DRILLING, Inc. P.O. Box 10-378 · 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner RC)BE?¥¢ 'IT'IRRT Use of Well )~3n~stic Location (address of: Township, Range, section, if ~own; or distance main road r~bm. ln~a S~division ~t 12 '' ~ ' Size of casing 6" Static water level Screen ( ); Describe screen or perforation ~r~a Well pumping test at.__gallons per (hour) of drawdown from static level. Date of completion ,qept-~nB~ ] .. 1 qR3 .Depth of Hole 100 feet Cased to 60.7 feet ft. (above) (below) land surface. Finish of well (check one) Perforated ( ). open end ( ); (minute) for hours with WELL LOG ft. Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 2 TO 5 TO 10 .TO. 18 TO_ 25 .TO. 31 .TO. 10 18 25 31 34 0v~.rbuwd~m Cravel, som~ tan s~.mnds sand ~md grave]., (danp) Cl,ay v~th sand nrLx, damp Pea ~ravel bound by cla~ Gravel ~,rlth silt, war 34 41 7S TO_ TO TO TO TO_ __TO- TO. TO 41 Gravel with cio, v, Boulder I~actured b octro ck 3--CONTRACTOR DOWL 4040 "B" Street Anchorage, Alaska 99503 Telephone (907) 562-2000 September 15, 1983 W.O. #0O0001 Mr. Bob Durst BEZEK-DURST~ Inc. P.Oo 8ox 10-1665 Anchorage, AK 99511 Dear Bob: This note is to assist you in seeking a waiver of the 40 Foot requirement relative to development o¢ your new well at your hillside home. When we reviewed your previous well log and the geology o¢ the hillside, it became apparent that the only additional water available to you might be ffound in the shallow soils overlying the existing bedrock condition. After reviewing the log of your new well drilled by M-W Drilling and discussing the results with Bill Kranich of H-W, it appears that you now have available at approximately -54 Feet the only water within the system and that Further drilling or development within the bedrock would be oF no avail. I would be most willing to discuss this issue with the appropriate resource agency if this is necessary. Please ask them to call me at (907)562-2000 or write me at the address indicated above. I would hope that this issue is quickly resolved and that you and Diana are quickly able to develop the available water to meet your household needs. RRD:rb Sincerely yours, ETvironmental Services MUNICIPALITY OF ANCHORAGE . Department ]--"~, Health and Environmental~ ~rotection 825 ~ Street, Anchorage, AK. ~]501 264-4720 * HANDWRITTEN PERMIT * * * Applicant~,~3R~ ~~ Mailing' ~_~/~,~/FY A~d~ess: ¢?~ ~ ~ Location: ~ ~-- Legal Description: Type of Soil Absorption System Is: Trench: Drain field: ~aximum Number of Bedrooms: Phone Number: Seepage Bed: Holding Tank: Soil Rating (sq. fL/bt) The Required Size of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The d[epth 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 = 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 3L 1 9 8 3 * * * I certify that:' (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I w~ install the system in accordance with codes. I ~n~er~t~n~ that the on-site sewer system may require enlargement if (3) tb~re,~d~n~e~modeled to include more that~ bedro~/ ~~i¢iga~ t- ' /c~/~//F ~ Date: // ~'/ ~ ~ SWP/024(1/81) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ,~NCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT, OF d,:,' LTd & ENVIRONMENTAL ENGINEERING DIVISION ENVIRON~ EN~AL ~.'OTE ]TION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RE~,~,I~T 9 ~g~"J NAME Bob Durst MAILING AD DRESS c/o CSM, 902 West International A/rport Rd., Anch. AK 99502 LEGAL D =-SCRIPTION Lot 12, Tract B, Timberline Subdivision, Anchorage LOCATION - NO. OF BEDROOMS Well DISTANCE TO: I 100' Manufacturer Liq capacit in gallons ' 12~Yo IF HOMEMADE: DISTANCE TO: Well Manufacturer Well DISTANCE TO: No. of lines Length of each line 1 67 feet 41- TOD of tile to finish graae 5' - 0" Inside length Dwelling Foundation Total length of lines 67 feet Material beneath tile Dwelling Steel Material IWidth Trench width36 inches Liquid depth PERMIT NO, Liquid capacity m gallons PERMIT NO. Distance between lines 72" inches Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Bugdmg foundation Nearest lot Ih~e DISTANCE TO: S -eptic Class DePth )riller Distance to lot line J PERMIT NO. Building foundation ;ewer line tank J Absorption area(s) DISTANCE TO: I Total effective absorption area 1005 sq. ft. [~ 7-OTHER J PiPE MATERIALS ~ [ 4" perfo [ hanc l ~o Cons truction 4" C.I. to trench, 4" perforated hancore for trench As-Built inspection performed by R&M Consultants, Inc. on July 18, 1980 by Richard S. Giessel, Staff Engineer. APPROVED ~ ~, -~ DATE LEGAL 72-013 fray. 3/78) L4ELL_ FI r4E- TM PERMII NO. ( ~.,~0~,4(0> I'tUI',I I iS ! PI----IL I T'-r' i'JIF F---INiE:HC~F-~I::IISiE HEALTH AND EN"/IRONMENTIRI/"~ROTECTION DE pFIR Ti'-IE NT~'--~F ~ .... STREET~ ANCHORFIGE, IRK. 264-4720 Or-4--S I TE SEI~IER PERI-'1 I T LOCATION VOS l ~40 ~-- LEOAL LoT 12_ '~g/~(--T ¥5 T~mBE~L~nE TYPE OF SOIL RBSORBTION SVSTEM IS: MAXIMUM NUMBER OF BEDROOMS = ~ SOIL RRTII`JG THE REQUIRED SIZE OF THE SOIl_ ABSORPTION ~YSTEM [>EPTH= /] ¢{, LENGTH=~ ~, GRAVEL THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEF'TH OF ~ TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROLINB AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIIdUM DEPTH OF GRAVEL BETWEEN THE OLITFFILL PIPE AND THE BOTTOM OF 'rile EXCAVATION (IN FEET). LOT SIZE ~-~ ~O0 SQUARE FEET PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE INSTALLATION INSPECTIONS OF FIN9 WELLS ADJACENT TO THIS PROPERTY BI'ID THE '4UMBER OF RESIDENCES THAT THE WELL WILL SERVE. Ti4C~ ( 2 .) I i'4SPECT I 1~11'4S ARE F.:EQL..I I RE[:, 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 8 PRIVATE WELL; OR t50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC HELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 OF THE WELL COMPLETION. OTHER REQUIREMENTS M89 APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERPl I T EXP I RES [:,ECEHBER --?--l., i9 80 I 1: FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 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 ~ BEDROOMS. SI Of4E~~~--- ,---~--- I SSUE%¥_~~-' .... DATE--~--~- J-----~ CERTIFY THAT I AM FAMILIAR WITH THE REQUIREftENTS FOR ON-SITE SEWERS AND WELLS AS SET MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6650, Anchorage, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST soils LOG [] PERCOLATION · TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: 1 2, 3- 4- 5- 6- 7- 8- 9- 10- 13- 14- 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /~-~ ~-I ~ ' 1/-8 ~ I1-~ ~M/~ IO~/~ 4~,0 l /~. PERCOLATION RATE /~z~Y/~) ~*~ ~ (minutes/inch) ~ /~S ]~ TEST RUN BETWEEN ~- FT AND ~;~ , FT PERFORMED BY: /'~,-"~J,-~,'~O ~ ~/2Z~F' 72-0C~ (7/76) DATE RECEIVED ~. ~ INSPECTION APPOINTMENT{~ DATE, , DATE ~ ' r ~ ~l.,,U''/ ~ DATE I N S~ ECTO~.~Z.~ ~. INSPECTOR ~../v ./ INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPAlITy OF ANCHORAGE NVIRONMENTAL ) ENVIRONMENTAL SANITATION DIVISION q!/~ ~ ~. 0 ~'t Telephone 264-4720 .o.....ow. o. DIRECTIONSt Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAI LING ADDR ESS S, LENDING INSTITUTION ~ PHONE I MAI LING AD DR ESS 4. REALTOR/AGENT I PHONE MAILING ADDRESS [] One ~ p Four [] Other 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE  --,,~SI NG LE FAMILY [] Two E~ Five ~ MULTIPLE FAMILY [] Three [] Six WATER[R S!~IPS PPLY '~ INDIVI DUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled · 'LJ COMMUNITY . since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach Icg if available.) '- SEWAGE ISPOSAL SYSTEM INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) I~J THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY I~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: / ~-%~ If'rank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER ~.~,~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELl.. TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS P OVED SE ROOMS [] CONDITIONAL AI~PROVAL (letter must accompany~ertificate) ~-~ DISAPPROVE D DATE 72-010 (Rev. 6/79)