HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 1717
) ;,~ ~ MUNIClPALITY OF ANCHORAGE .,. /
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 ~LNEW
MAI L~G ADDR E~S
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
~ D~STANCETO: Well_ '/ - -~ .~ Absorption/ ~ /area Dwelling~ g PERMIT~/~ ~NO'
~ Z Manufacturer Material No. of compartments
~ ~ Liq~c~y~gallons IF HOMEMADE: Inside length Width Liquid
depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
O z ~ Manufacturer Material Liquid capacity in gallons
~ Well -- ~ Foundatio~l~ Nearest ~l°t lin~
~ DISTANCE TO: ~/~'" leng~ o~i ~es Trench width Distance;t~ lines
-- ~ ~O inches
~ ~ ~ I Top of tile to finish grade ~ ~1~1~ Material beneath tile Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ 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
PIPE MATERIALS
SOIL TEST ~ATI~G
INSTALLER ~ ~
t
I
REMARKS
'
-~ ~ ~ ;,~,-~ ..... ~ .....
-~. -em... ---
72-013 (Rev. 3/78)
F'ERPII T t'..-!,!3.
FIF'F'L I r-:FINT
L C C' RTI ON
LEGFiL
S]-E',,,'EN. L. _,I...~ uuz, CONST. r.:, 0. E_]X [:,. C:HLIGIRK
HC:HRHRS F.:D.
LO]" i7 E:LK 2: NOF.:TNWOOD _,UE, LOT SIZE
TYF'E OF :,L IL RBSORF'TION SYSTEM IS: TRENCH
20E~00 SLqUFIF::E FEET
MRXIHUH NUI',IEEF.' OF EE'DI~'"3]M'5 = 2: SOIL RRTING (SC..! FT,.."BR)= FJ25
..... t'- - '-' '"-'~"F'H ' '-
THF.. _ REQUIRED SIZE F~F THF'_ SfllL HE,--,_~FTIUN :,~-_-,~'. I.=,:
THE LENRTH DIMEI",ISION I:5 THE LEN6TH ,:.'IN FEET::, OF THE TRENCH OR DF.'RINFIELD.
THE C, EPTH OF FI TRENCH OFt F'IT IS TNE DISTFINCE BETWEEN TF.IE L:;UF.:FFICE OF ']"HE
GROUND FIND 'f'HE BOT]'OH OF 'THE EXCFIYFITION ,:.'II'.,I FEET.'.',.
THERE IS NO '.'-qFT WIDTH FOR TRENCHES.
THE GRFI',,,'EL [:,EPTH IS THE HINIHUH [)EPTH OF GF.',FI',,,'EL BETWEEN ']'HE OUTFFILL PIPE
FINE:, THE BOT]~OH OF' ~r'HE EXCFI',,,'F!TION (I'N FEET.'.',.
PERHIT FIF'PLICFIN'T HFIS THE RESP]NSIEILITY TO INFORM THIS DEF'FIRTHEN.'F [:,t..,IRINI3 THE
IiqSTFILLFITI]t'.I INSPEC'FI3NS OF FINY .WELLS FIDJFICENT TO THIS F'ROF'ERTY FIND ]"HE
NUHBER OF RESIDENCES THFIT THE WELL !.,.!ILL SEF.'.',,,'E.
T'tl4Ct ,:: ;'.--2: .::, Z I'-,~ :E;F' E:i]2,. T]E ~:l~'-.-!'.E; I-=t 1-,'i=: E F-: E':~:.:;.~ LIi %
BFIC:KFiLLTNG f]F FIN'.:' - - ' - ' ""-I BY
.:,rz, TEl'1 I.,.tITNOJT FINRL INSF'ECTION RND HFFRJsH_ THIS
[:,EPFIRTMENT WILL BE SUBJEE:T TO F'ROSECUTION.
HINIMUH [.',ISTFINCE BETWEEN Fl WELL FIND FINY ON-SITE SEI.,.IFIGE DISPOSRL SYSTEM IS
'1_00 FEET FOR FI PRI'v'RTE WELL OR ±50 TO 200 FEET FROH FI PUBLIC' WELL DEPENDII'.~G
UPON THE TYF'E OF PUBLIC WELL.
I'ffINIH. U!"I DISTRNCE FROF1 FI F'RIYRTE WELL TO Fl PRI',,,'FITE SEI.4ER LINE iS 25 FEET FIND
TO R COHHUI'.,IITY SEWER LINE IS 75 FEET.
OTFIER REQUIREMENTS MFIY FIPPLY. SPECIFIC:FITIONS FIND CONSTRUCTION DIFIGRRi',IS RRE
FI',,,'FIILFtBLE TO INSURE F'ROF'ER INSTFILLFITION.
F'EF-:I',I Z T' E::<:F' ]: 'F-:E2; E:.E:C:E2flE. E '[~. 2--::'1. ...... -1 ,::~,:z,--~
I CERTIFY THFIT
:I.: I FIM FRHILIFIR WITH THE: REQUIREMENTS FOR ON-SITE SEWERS RN[:, WELLS RS '---.-ET
FORTH BY THE MUNICIPFILITY OF FINCHORRGE.
.2: I WILL INSTFILL THE '_=;YSTEM IN FICCORDRNCE WITH THE CODES.
Z.'.: I UNDERSTFIND THFIT THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENL~RGEMENT IF' THE
RESIDENCE I5 REMODELED TO INCLUDE MORE THF!N ~ BE[:,ROOMS.
.... O & E ENGvNEERING & DEVELOF,MENT CO.
Russell Oyster
694-2774
Performed for: Name:
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Mailing Address:
Legal Description: ~-- ¢>'r'~
Depth (feet) Soil Characteristics
0__
1
_,~_...~- 2 --
3
5
Earl Ellis
SOIL LOG 688-2280
~/~ ~v'~,~-~"-/O ~,/ Tel. No. &~" ;~'-~ /
I Lmr~7
PLOT PLAN
PERC. TEST
P~ : 2~ /~,,J/;,~
6
7
8__
9
10__
1l__
12__
13__
14~
15__
16
Ground Water Encountered: Yes.__
Proposed Installation: Seepage Pit__
Comments: ~"
Performed by:
~r"'
No ~ If yes, what depth
Drain Field.__
Dat6
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENV RONMENTAL PROTECTION. DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 P~OTECTION
ENVIRONMENTAL
i ENVIRONMENTAL SANITATION DIVISION d( fq 6 1981
Telephone 264-4720
PI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1, PROPERTYO~NER I PHONE
MAI LI~DDRESS ~ r
PROPERTY~ESIDENT (If different ~rom above) PHONE
MAILING ADDRESS
AILINGAD~RE~ // ~ ~ / ~ , , ~
STREET LOCAT,~
6. TYPE OF RESIDENCE
~,~SI NG LE FAMILY
[~] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One F--I 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 NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[~] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DA, TE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEIVI PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[~]PUBLIC UTI LITY
Connection Verified INSTALLER
[~}Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
FOR ~ BEDROOMS
[~¢~APP ROVE D
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY