HomeMy WebLinkAboutMILE HI BLK 3 LT 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
~ ~ ~ SEPTIC ABSORPTION
Address TAN K FIELD WELL
Phone{s) I ' Per" -. ~ No.o,B WELL I ~t
Township, Range, Section
AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
Manufacturer / Oapacity i~ gallons / ~ I
Material
No. of Comp~
Depthtopipebottomfrom ~,a, depthlromoriginaigrsde ~ '- X~¢ /
original grade FT ~0 FT
Gravel length Total absorption area ¢, OlF;~r've. width~ ~,~FT ' '
Distance bet .... fines ~
Number ol lines Soil rating / Pipe material
~RIVATE ~ OTHER (Identifv) ~ ~5~ )'5~
installer 3ate Installed:
REMARKS:
S & S ~GINEERING ~~.~
I .. ~ ,_ m.,~ I ~n Roa~ N~_ ~ c~ily that Ihis i~pe~ion was pedormed according to all
72-013 (3/85)
!~EF'"I"]:C 'I"ANI<;: M:i.r'~:i. rn~.u~ t. cH'..~:l. ~gept. J.c: Lau'"~l.:: c:atpac:i'Ly~ 1,OOO gja].].or'l~:, ti':%3c.h s,:~)p'L:i.c:
t.....~.., 't:.o l"h.,u-tic'i.p~tlit, y of' tqnc:horag..P.. D.p. pau"'l'..mcent of' l-..le:,o, lth
~:str~::l r.h..tm,=~r- S)~.mvzcx~-~.r~' t,~i't.h:i.r~.. ?50 c.,~:' y~, of ~:1.:1. "omo].~t:.:i.c~n,,
]: C,D.:FT]" :[ F:'Y THA'I" :~
J.. I am fam:i.:l, iar' w:i.'Lh 'Lhe r'equir'ement. E; fop on-s;i'Lge E~ewer's; and ,~e].].s; a?~
:5,, I ~i:!.l ;:~dl"~.~:.:,r'.~.~ 'Lo ,:all JqC)(~ and St.~al'..tz.~ of {.~:t.;:~l.::~:x r'emlt.~ir'emte~n'L~s fop
~>~m~:.~m..'.:~g~:~.:. ~sy~;t.g.~m on 'Lh:i.~ of ~stl"Jy i~td.j,~d:::~.z.)r'~t, op rl~.~iY~r'Dy lot.,
([)~r'l~r') I.:::E:N COOl<
D t~q T E: ~
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
Pouch 6-650, Anchorage, AK 99502
264-4744
Permit No:
Date Issued:
On-site Sewer/Water Permit
HANDWRITTEN
Applicant: ~
Legal Description: S/D: /~/L~" ~ Lot: ~ Block:
Section: ~ Township:. ~ Range:
Lot Size: ~ ~'~0 ~ or Acres)
Lot Location:
Max Bedrooms:
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
Depth to pipe bottom(ft.)
Gravel depth (ft.)
Total depth'(fto)
Gravel width (ft.)
TRENCH ~ BED W. DRAIN
Gravel length (ft.)
Tank size (gal.)
Soil rating (sq. ft./br)
** Gravel length 75 feet requires multiple runs (not exceeding 75 feet each)
** Tank must have at least two compartments
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage(MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and
regulations, and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set
back distances from any existing well, wastewater disposal system or
public sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for the maximum number of bedroom~
stated above, and any enlargement or modification will require an
additional permit.
IF A LIFT STATION IS INSTALLED IN AN ARE~ COV~RE.D BY MOA BUILDING CODES, THEN
(1) AN ELECTRICAL PERMIT AND INSPECTIO~[~MUST BE O~TAINED; (2) AS-BUILTS WILL
NOT BE APPROVED WITHOUT AN ELECTRICAL'iNSPECTION R~ORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
Applican~ ~ "' / , /'~ , f "L'~
DATE:
ISSUED BY:
SWP/024 rev.1/85
~ ~, , .,, ,~" Municipality of Anchorage
,=. ~ ¥,r DEPA, R. TME,NT OF HEALTH & HUMAN SERVICES
825 "L' Street. Anchorage. Alaska 99502-0650
~ :' SOILS LOG-- PERCOLATION TEST
PERFORMED FOR:' ~'
LEGAL DESCRIPTION:
5
6
7
8
9
10
11
12
13
14
~7
~g
90
Township, Range, Section:, \
SLOPE SITE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT O
DEPTH?
Del]Ih t0 Waler After
Monitoring? '~::::~.~y Date: '~ ~'"~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN Lo FT AND '7 FT
COMMENTS
PERFORMED ii~,~4~:~;~.~-~_~?~7oal~ No. i%/~/~¢~//'~____~______.~...~c;RTiFY THAT *IS TEST ~;S PERFORMED IN
A OOORDANCEWlTHALLSTATEANDMUNIClPALG~~EOTONTHISDATE. DATE:
72-008 (Rev. 4/85)
SCALE
erlff e Drfll[ g
by
OOC Co. dba
SULLIVAN WATER WELLS
OWNER OF LAND
AOORESS ~j3 t~
LEGAL DESCRIPTION
DATE-Started
PERMIT NUMBER
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
DEl'TH OF WELL
STATIC LEVEL OF WATER F'r.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING t:; ~)"' () ,,
KIND OF FORMATION:
From ? Ft. to
From ~ Ft. to
From /'ii Ft. to '4:5'
From ~?~ ':"" Ft. to /
From ~'"i' ~ Ft. to
From z o,~ Ft. tot~-.~,~
From e,~.~ L:-~ Ft. toc~'~c~)-
From Ft. to. Ft.
From e)z ,), Ft. to_~ $0 Ft.
From Ft. to Ft.
From Ft. to_- FI
From Ft. to.__Ft.
From Ft. to Ft._
From Ft. to. Ft.
From_ Ft. to__ Ft.
From_ Ft. to. Ft.
From .Ft. to__ Ft.
From
From
From
From __
From
From
From
Ft. to Ft.
_Ft. to Ft.
_ Ft. to Ft.
Ft. 1o . Ft.
Ft. to Ft,
Ft. to Fl
Ft. m Ft.
Ft. to Ft.
Ft. to__ Ft.
Ft. to Ft.
Ft. to__Ft.
Ft. to Ft.
Ft. to_ Ft.
Ft. to Ft.
Ft. to Ft.
Ft. t~UNICIPAL~( OF ANC"HORAOE
DEPL OF- HEALTH &
Ft. t~NVIRONMjEi~.J'AL PROTECTION
MISCL. INFORMATION:
'JUL 3'11989
RECEIVED
DRILLER'S NAME ? ~: A,,¢ _,: