HomeMy WebLinkAboutTRAILS END BLK 6 LT 1Trails End
Biock 6
Lot 1
#015-192-25
ICIPALITY OF ANCHORAGE
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-47:20
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
[] UPGRADE
MAILING ADDRESS
!
LEGAL DESCRIPTION
LOr TtON NO. EDROOMS
D,STANOE TO:
I-- Z Manufacturer ~ 1~, ~ e~, Material ~;,,>/~?_~ No.~of' com.~artments
Liq. capacitv in gallons Inside length Width Liquid depth
/ O O ~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwellin9 PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Fo~da~ ~earest~
g ~ DISTANCE TO: ~t ~,//~ d
~ No. of line~ Le=th of each line Total leng~ F lines TrencWth Distance b~ lines
~ ~2~ ~ Z' inches
~ ~ ~ Top of tile~i.~ grade ' Material beneath tile Total
effective
absorption
area
~ Z~,' inches
Length Width Depth PERMIT NO.
< h Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER Z.~
,// '
PIPE MATERIALS ,
Pi
SOIL TEST RATING
INSTALLER Z'~
._
APPROVED ~, DATE LEGAL
72-013 (Rev. 3/78)
- ~ 't-t ....
DEPRF.'.TMEI'.,IT L~J~I' HERLTH RND EI'.,I,, I R_ NMENTHL q~BOTEL. T I UN
,..-, ...:., ~
,_,~._ "L '" '"";TREET., RNCHORFIGE., RI-::].
264-4720
l.,J E L L R I'-~ [) b--~ r-~ -- '---7 I T E '--7 E 1.,-! E
PERMIT NO.
RPPLICRNT WOLPER CONSTRUCTION
LOCRTION TRRILS END
LEGRL Li'B6 TRAILS END
TYPE OF SOIL RBSORPTION S~STEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS = ~
t0i E. RTH ~Z2E:
'=; I-i I L F. H T I N -, ,' ':; ~.'::~ F T.-" B R ) = 280
THE REQUIF.:EE:, SIZE OF THE SOIL RE:SC~F.:F'TIEN S'"r'STEM I'.=-"';~
[:,EF'TH= i2 L E I'-.I,.3 T H = 72 ,3 F-: R%-' E L [:.EF'TH= 7
THE LENGTH DIMENSION IS THE LENGTH ( IN FEET) OF THE TRENCH OR DRRINFIELD.
'THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETI,4EEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCR',,,'RTION (IN FEET).
THERE IS NO SET WI[:,TH FOR TRENCHES.
'THE GRRVEL [:,EPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE E::':;CR',,,'RTION (IN FEET).
I:;~: E Lc:., UI I F-: E [:, S E F' T' I C: T R i"-.I I'-( S I Z E = 1 £~ L_--.~ ~-E~ u..3 Ft L L C, I'-.I S
PERMIT RPPLICFINT HRS THE RESPONSIBILITY TO INFORM THIS [:,EF'FIRTMENT [:,LIR!NG THE
'-- ' J-' ' I' ' , I~
tNSTFtLLRTION INz, FE_-TIONS OF RN"r' WELLS RDJFtC:ENT TO THIS FRJFERT',' RttJ.[:, THE
J ' ,
N_IME, EF.. OF RESIDENCES THFIT THE I,,,IELL I.,,IILL SERVE.
T I--.11 C, ,:; 2 1:, T r'-.! s F' E C: T I C, 1"-4 S R F-: E Fi: E C: U Z R E [:,
E:RE:KF ILL I NG OF RN'T' S"¢STEM 1.41THOLI'[' F I I'.,IFIL. I NSF'EC:T I ON RND FIF F'F.. -_ ,, I-IL- B'T' TH I '-=,
DEPFIF-:TMENT 1,4ILL BE -,JE, JEL. T TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RN~ ON-SITE SEHRGE DISPOSRL S~STEM IS
±00 FEET FOR R PRIVRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TSPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R F'RIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MR~ RPPL% SPECIFIE:RTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F'EF-."~'I I T E::-:.'F' I F-:E5 [:.EE:E~-IE:EF-: -~: 1.. 1'3:-:1
I CERTIF'-r' THRT
!' I RM FRI"IlLIRR I,,,IITH ]'HE REQLIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FFIF.:TH B'.r' THE Mur-,,! I -. I PHL I T'r OF RNCHOF.:RGE.
2' I 1-4ILL INSTFILL THE SYSTEM IN RCCOF:DRNC:E 1.4ITH THE C:O[:,ES.
_.3'::: I ,UNDERSTRI'~[:'/~"HRT THE ON-SIT/E/ SEI',.IEF.'. S"r'STEM MR"r' REQUIRE ENLRRGEMENT
F.'.E'--;I[:ENC:E ~O[:.,E~,~:' T~]/~/'~:,E MORE THRN 3: E:E[:'F.'.OOMS.
s I,' NED:
.-. · -
tF THE
V4. El
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
SOILS LOG
PERCOLATION
TEST
1
2
3
4
6
7
8
9
10
11
"~-~ 12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~'~'
IF YES, AT WHAT
DEPTH?
S
L
O
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ ~--~ (.minutes/inch)
CERTIFIED BY:
72-008 (6/79)
~< ~ DATE RECEIVED
" iNSPECTION
APPOINTMENTS
TIME TIME (,) ~,~, TIME
INSPECTOR INSPECTOR ~ INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF i-,'~,ALT;i &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~J~ViRONMENTAL P: ~U~CTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION ,~EP 2 198:t
Telephone 264-4720
DI R ECTIONS: ComPleZe all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER I PHONE
MAI LI NG~A DDR ESS --
PRO TY RESIDENT (If/different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
I
MAI LING ADDRESS
4. REALTOR/AGENT I PHONE'
I
MAILING ADDRESS
5. LEGAL DESCRIPTION_
/
S~, NET LOCATION
6. TYPE OF RESIDENCE
[~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
[~ Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTI LITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
1--] PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: ./~)(~) If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] OTHER
MATERIAL
Septic/HoldingTank [Absor~btionArea lSew~r Line ]Nearest Lot Line
5. COMMENTS
DATE
[~-~-PPR OV E D FOR .~_~' BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
Mark Begich
Mayor
Development 5arvices Department
4700 ~ra~ow S~ree~
?.0. Sox Z96650
A~%hor~ge, AK 995i%6650
www.munLor, o/onsite
{907) 343-7904
Well Drilling Permit Number: SW
Pump Installation Log
Date of Issue:
Parcel Identification Number:
()
Legal Description
Property Owner Name & Address:
Pump Installation Date: ~ ~.. l I
Pump Intake Depth Below Top of Well Casing: % C"J feet
Pump Manufacturer's Name:
Pump Model:
Pump Size I/a~. hp
Pitless Adapter Burial Depth: ] 0 feet
Pitless Adapter Manufacturer's Name: ~/A
Pitless Adapter Installer: /~/~
Well Disinfected Upon Completion'? [] Yes [] No
Method of Disinfection:
Comments:
Anchorage Pump & Well Service
330 East 76th Avenue
Anchorage, Alaska 99518
Phone: 907-243-0740
Fax: 907-243-0742
Pump Installer Name:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.