HomeMy WebLinkAboutSAND LAKE #2 BLK 5 LT 9o1
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MUNICIPALITY OF ANCHORAGE 4 _
`
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
PHONE
NEW
/'
DD06 CTI --L- NT
�7>
E]UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
i'o T CI 3 i( :S 5 /\W� �,Nk —
LOCATION
NO. OF BEDROOMS
�1 s EA, c r
3
Welli
Absorption area
Dwelling
PERMIT NO.
Uy
DISTANCE TO:
IA'5
5
/C�
''& 50 !:n'-)
F-ZManufacturer
°'Q
w l..
^
P�M4 1/1R(14 7
Mater _
ST
No. of compaT�®
rn
Liq. capacity in gallons
lN7CEE
F HOMEMADE:
Inside length
Width
Liquid depth
OCDz
DISTA TO:
Well
Dwelling
PERMIT NO.
O z Q
Manufacturer
Material
Liquid capacity in gallons
2 F-
O
�=
w
DISTANCE TO:
Well ' J
Foundation
�.3
Nearest lot line
'�
PERMIT NO.
�f 3ey'_
JL)
Z
No. of lines
Length of each line
Total length of line
Trench width
Distance between lines
Zw
-
I
�,'1-
Z
3U inches
tC
F
Top of tile to finish grade
Material beneath the
Total effective absorp 'on area
i]
7 % /
% inches
X1./0 `-
Length
Width
Depth
PERMIT NO.
LU
C7
Q F
Type of crib
Crib diameter
Crib depth
Total effective absorption area
as
LU
LU
(n
Well
Building foundation
Nearest lot line
DISTANCE TO:
_jClass
Depth
Driller
Distance to lot line
PERMIT NO.
J
Lu
3:
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
-
OTHER
PIPE MATERIALS
SOIL TEST RATING -
�
ll
INSTALLER
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I
L
L
REMARKS � � � � v�-tC ` Jg
� 01 1L.00
G
Dill.
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............
JUNE 25, 1971 �s
7_�s
!l
_
APPROVED DATE LEGAL
�S lt3 I'
72-013 (Rev. 3/78)
,'v�o����'��_Lu'T �9 ��k-- r- q rl- " La IF=
_DEPARTMENT `', HEALTH AND ENVIRONMENTAL..-?OTECTION
825 'L' STREET, ANCHORAGE.- HK. 99501
` 264-4720
, 11_4 E--- IL_ 9 ��� CH 11-4 —.fS I _F EE ���E:__ R" F:::E-:: F-1-1 1 -F
PERMIT N(I ( 8]0]87 )
APPLICANT DOUG GALLANT 203 W 15TH 99501 279-3916
LOCATION
LEGAL L9 B5 SAND LAKE #2 LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MHXIMUM NUNBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
���C-i _T_ 1-1= :a:R ���Fzl V FE I ��F`T- " �m uZi-
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DR8INFIELD.
THE DEPTH OF H 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).
���U 1 If --2 F= C -n �7 r---: ���1--' _'E: I PD C-9 17-i F-1 L_����
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
—~— �11-4 C# ���� I P-4 _� F="EE: ff__� _r I CH P -J"_==- ��F-- �E.r- C-! U I F2- F= EA
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN 2:0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
��=F-2'11`11-11 =<:I_, jL���
I CERTIFY THAT
1: I 8M 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 THE CODES.
]� I UNDERSTAND THAT'THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED
ISSUED BY
V4.0
Y: SOILS LOG
MUNICIPALITY OF ANCHORAGE El
�.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �Oy QI ti 0.I/Q K 16 DATE PERFORMED: A 3
LEGAL DESCRIPTION: td T '1 ?� S 9AN`tD V,AV.E
SLOPE SITE PLAN
StLT
1 ML
2
�e
3
✓ r
4
�G
5 ` b
6-
7 7 v •
8
� G
9 d `0,
10-
11
0 11 B ✓
b
12 1G
13
14
VUP- L. L. G 12AbkD
sAND E CP_ VeL,
/J
2,0-n O t-( 0 l -
140t..0
16 a�•��• ®F Atgs���d
....•
.49T f^I •�'
1�/. •.• •••••••••0.1
1&-10. No 2225-E :fes
JU E 25. -197119 N
WAS GROUND WATERS
ENCOUNTERED? r4 L
O �
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
---F
20
PERCOLATION RATE (minutes/inch)
A A ,/� TEST RUN BETWEEN FT AND FT
COMMENTS a AC UAr � O t2 11 QV 1 m E a x C
PERFORMED BY:
72-008 (6/79)
CERTIFIED BY: i..7
j �«� �.�,
`/
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_ , -s
`._y � ,
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APPLIC, AT
FILLS
OUT UPPER HAL-,, ONLY
Property Owner i%U�1!;. �!'%�J��.,%'f 17
-
Date
Phone
Mailing Address
Date
Zip Code �.f y-:.•' ,-7
Inspector
Inspector
Buyer
Field Notes:
MUNICIPALITY OF ANCHORAGE
Address
DEPT. OF H."A'TH <:
Zip Code
Lending Institution �7 :�( �_.'+
Phone
Address !-' „1� �/ . _
(3) APPROVED BEDROOMS
Zip Code
Realty Co. & Agent
( ) CONDITIONAL APPROVAL`
Phone
'
BY: (/� a n1 W
Soils Rating
Address
Well To Absorption Area i 3
Well to Tank /
Zip Code
Septic Tank Size
Legal Description ("7
Z A
Street LocationType
of of Residence
❑ Single Family
ES
37 Multiple Family No. of Bedrooms
❑ Other
Water Supply
❑ Individual.
n
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
depth log if available).
Community
For wells drilled prior to that date, give well (attach
❑ Public Utility
Sewer Disposal
Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE; PROCESSING CAN BE INITIATED.`'.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT. OF H."A'TH <:
ENVIRONMENTAL PROTECTION
RECEIVED
(3) APPROVED BEDROOMS
`CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL`
DATE / — f ' t("8 `
BY: (/� a n1 W
Soils Rating
Date Sewer Installed
— g
Well To Absorption Area i 3
Well to Tank /
Well Log Received
Septic Tank Size
72.023 (3182) - !G1A-0
. 5
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM -
APPROVAL TO CONSTRUCT
Plans for the construction of YtoM b C A K IF 151/p 4M.. war me 5- 1 s'
0V Ct
Cr IL ,9°S r 1 public water system located
in C Lf ® RAC -6 Alaska, submitted in accordance with 18 AAC 80.100
by r-- AL &.&Ur have been reviewed.and are
xapproved.
❑ conditionally approved (see attached conditions).
TITLE - DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no. _<; Approved by Date
or descriptive referenCe) -
The "APPROVAL TO OPERATE""tecfion must be completed before any water is made available to
the public. .. 1;4
APPROVAL TO OPERATE
The construction of the
�t&W
public
water system was completed on -g^/� t, _> (date). The system is hereby
granted interim approval to operate for 90 days following the completion date.
BY
TITLE DATE
As -built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
fin pproval to operate.
TITLE GATE
L A—