HomeMy WebLinkAboutHAMPTON HILLS BLK 1 LT 6
!\,I!JF, IICII~Ai_! I V ()1:: Af',JC!!ORAGE
825 LStreet- Anchorayf},Alaska 99501 Telel~honr~264..47~0
SEWAGE DISPOSAL SYS/EM AND/OR WFi:..
LOCATION
~-./ ~ST^NCE TO: / /P?J' Z ~
I~ ~ I Manufacture~
~ ~ ~~_ _
~¢ ~Liq. capacity in gallons I IF HOMEMADE
NO. OF SEDROOMS
I Inside length
IWell I Dwelling
DISTANCE TO:
To[) of tile to finish grade ~ ~t~l'ial beneath tiJe
Length Width Depth
T.¢pe of crib :rib diameter
Well Building foundation
OIS~ANCE TO:
D e p t h
Buildinfl foundation
DISTANCE TO:
Dweliin~l t PERMIT b.O.
I ~¢]~ No. of conlpa~..~elltS
'l~'idt t~ Liquid depth
PERMIT NO.
[Material Liquicl capaciw in gallons
~[ ...... PERMIT NO.
-F,0nch widtl). Distance t)e[ween~.~
Total effective absoH)tion area
PERMIT
Drillei Distance t¢) lot line PERMIT NO.
Sewer line Septic tank Absorption area(si
OTHER
PIPE MATE.~IA.~'S .
SOIL TEST RATING
_! ,~"'o
,NSTA,_:-%/ ¢__
REMARKS
For... ~ A4 ~ ~.~F/~OAJ~g ~! O~f~
~o~tio~. ~.~Z;.~..~.. ~,~...~ / ......................................... ~..,. ................................
Date completed ......7./,~.~/,~ ..........................................................................
Depth of well ~ ~
6" ~
Size of casing ..........................................................................................................
Distance to water,...~ ..... ~.~ ..... ?~.( .............................................
Dist~ce to water while pumping ...... ~.~.~. ......................................... at rate
~0
Formation from to
6~
III'
~?
Driller
DELTA DRILLING COMPANY
9RA BOX 394 B
ANCI4ORAGE. ALASKA 99507
DEF'F~RTMENT r HEAL'tH FIND EN',?IRONMENTRL ""-'OTEE:TION
PERMIT NO. ( ~0%.~¢ )
TYPE OF SOIL RBSORBTION S%'STEM IS' %¢~-~..
MAXIMUM Nt.IHBER OF BEDROOM:S = .~
ARE FEET
SOIL RATING (SQ FT?BR>= /.~'~
THE RE6~.UIRED SIZE OF THE ~ '- ' ·
_OIL ABSORPTION SYSTEM IS
[-"E F'TH .... ~.~
THE LENGTH DIMENSION IS THE LENGTH (~.N FEEl') OF TtIE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETNEEN THE SLIRFRCE OF THE
GROLIND FIN[:, THE BOTTOM OF THE EXC:RVRT.~ON (IN FEET:).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFIVEL DEPTH IS THE MINIMLIM DEPTH OF ORR',?EL BETHEEN THE OUTFFILL PIPE
AND ]'HE r..:OTTOM OF THE EXCAVATION (IN FEET).
PERMI'F RPPI_IC:IRNT HAS; THE F.E...,PON_IBILITY.,''c c, TO INFORM THIS DEPRRTr,IENT DIJRINCi. THE
INSTALLATION INSF'ECTICNS OF RNY 14ELLS RDJRCENT TO THIS PROPI-_-RTY RN[:, THE
'.~UMBER OF RESIDENCES THAT THE NELL 14ILL SERVE.
T L..I C_'~ ( ~: ) ][ i'-t:E;PE:C-F I ~] P-,I'_--; FIF?.E RECILI ][ I~:[.-..] [:,
ERCKFILLING OF ANY SYSTEM NITFIOUT FINAL INSPECTION AND AF'F'ROVRL E:Y THIS
DEPARTMENT 1.4ZLL BE SLIP_,JECT TO PROSECUTION.
MINIMUM DISTANCE E:ETNEEN F~ WELL RND RNY ON-SITE SENRGE DISPOSAL SYSTEM IS
1OO FEET FOR R PRIVRTE NELL; OR
'150 TO 200 FEET FROM A PUBLIC NELL DEPENDING UPON THE TYPE OF PLIBLIC NELL.
WELL LOGS ARE RE¢!UIRED AND MUST BE RETURNED TO THE DEPARTMENT NITHIN ~O DAb'S
OF THE NELL COMPLETION.
OTHER REQUIREMENTS MAY RPPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRRMS ARE
RVRILABLE TO INSLIRE PROPER INSTRLLFtTION.
PE-]Ri"I I T E,"~:F' I RE:S [)E_-CEMi:SEE: _~--::l_., -'L_'-3. 80
I CERTIFY THAT
J.: I RM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SENERS AND NELLS A-C; SET
FOR-:fH BY THE MUNICIPALITY OF RNCtIORRGE.
2: I NILL INSTRL. L THE SYSTEM IN ACCORDANCE NITH THE CODES.
~: I UNDERSTAND THAT TtIE ON-SITE SENER SYSTEM MRY RECIUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
RFCL I CRNT ~
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2221
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
SOILS LOG
[] PERCOLATION
TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15-
16
17
18
19
2O
COMMENTS
SLOPE SITE PLAN
- i-~ . ~ ·--I-- ~ ---~--~ ~ - -~
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND __~ FT
72-008 (7/76)
. DATE RECEIVED
,NSPFZCTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR INSPECTOR
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~EPT. OF HEALTH
825 L Street - Anchorage, Alaska 99501 ]~NVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION 0OT
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~~~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1.~OPERTYOWNE~z//,~C,~ "~ [ PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
~ LENDING INSTITUTIO~ .... PHONE
MAILING ADDRESS
4, REALTOR/AGENT ~ PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
/ /
STREET LOCATION
6, TYPE OF I~ESIDENCE
SINGLE FAMILY
MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One E~ 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
s~nce 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 SYSTFM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ~//¢..;,%.~O
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
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED (~) t~ (~) /~ pk
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY '~ ~'3 ~ 0
Connection Verified INSTALLER
[~Septic Tank or []Holding Tank
Size:. ](~h~)(~) If Tank is homemade SOILS RATING
give dimensions: / ~.~
TYPE OF TANK MANUFACTURER . ,(~/t. ~,p~_=.~
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
[~'"~PPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)