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�. MUNICIPALITY OF ANCHORAGE {
® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/SEWAGE
NAME I n nl�'- I Y \ � � / /�l /71 1
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PHONE
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NEW
❑UPGRADE
MAILING ADDRESS �,
DO-59 I L4r1 i ht1---f Dj-,).
LEGAL DESCRIPTION
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LOCATIONW to I-n eA �����' ` I,�
P'f
NO. OF BEDROON4E J
UY
DISTANCE TO:
Well /� f
-
Absorption area `� t
Dwelling 7 f
PERMIT z
F- Z
W�
Manufacturer
�C.�fl21��L Tn�k
Material
��'�t
No. of compartments .
N
Liq. capacity in gallons
100 0 IF HOMEMADE:
Inside length
Width
Liquid depth
--��
-j0Z
DI O: ell
Dwelling
PER
O z a
2 — F
M acturer
dferial
Liquid capacity in gallons
w=
DISTANCE TO:
WellFoundation
�� -t-
t�
Nearest lot line
PERMIT NO.
J LL z
P Z W
No. of lines (
I
Length of each line ' 1
Total length of lines -i
Trench width
36nches
Distance between lines
-�
Q F
p
Top of tile to finish grade /
6'
Material beneath tile
n �►
! a inches
Total effective absorptio area
C7
Length Width
PERMIT NO. /
F
CL
Type of crib rib diameter
Crib depth
Total effective absorption area
yWell
TANCE TO:
Building foundation
Near t line
J
Clas j j Depth
Driller
Distance to lot line
PERMIT NO.
W
DISTANCE TO: Building foundation
Sewer line
Septic tank a
Absorption area(s)
OTHER
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PIPE MATERIALS n
SOI L TEST RATING
INSTALLER
REMARKS
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APPROV DATE LEGAL
9LK-
72-013 (Rev. 3/78)
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PERMIT NO
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DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE, HK 99501
` 264-4720
r-,-_. ���LL.-ij PEE on? K E=1 Fat r"I I
( 79054] ��-�]/~-7/
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APPLICANT EMMIT ROETMHN ]0]8 RAMPART DR 272245762muel
LOCATION HILHND RD
LEGHL TR'[ 2 BLK 1 R & R S/D LOT SIZE 100000 SQUARE FEET
TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF
BEDROOMS
= ] SOIL RATING (SQ
FT/BR)= 120
THE REQUIRED S17E OF THE
SOIL ABSORPTION SYSTEM IS:
�E�-_7 F:" lF 9-11=
�����fl:EE
_T H-1= -1 -L C3 Ff E -E L_
E-- EE F,, - T1 9-11= �
THE LENGTH DIMENSION
IS THE LENGTH (IN FEET) OF THE
TRENCH OR DRHINFIELD.
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).
�����0--"-
IEE I F:,,
- F I C ��P'-, 9 L� 1 2 9 - C- LE' L_����
-PERM IT-FPPLICRAM- HAS l�fE:-RE*PONSIBILITY-TOINFORMTHIS-DEPHFTMENT-DLRING-THE�- -
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- --- --- 1- 10.9 01 ��::: - ������7- 19- Cif �IF�-_: IEEE ����1 FF.:!���
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
-------'' FORflPRIVHTE-WE]~L/ OR '-- - --
150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
1=4 E=7 1011-1 1 -1- JE FZEE"T FR �1." fL nF��
I CERTIFY THAT
1: I HM 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:of ______________
APPLICANT
j![:Ij,
�� ��
ISSUED BY_ - ........... DHTE_ '��~: �r_ Y]. 2
�
14
-
0 & E EN&NEERING & DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Performed for: Name: A4 1\4 PC E 7-,A-J/q ^j —Tel. No. F-716
Mailing Address:
Legal Description: 461-C) c% :Z , r7;�/4 C 7- 6 Rd 57 / er
Depth (feet) Soil Characteristics
0
1
2
3 YA14 py-'
4 � 6 /` 14 6.
5
6
7
8
9
10 6"e'vV'F-4�'
12
13 120
14
15
16 0 f 7 -
Ground Water Encountered: Yes- No If If yes, what depth
ProposedInstallation: Seepage Pit Drain Field
Comments:
PLOT PLAN
a, :5eAl L r --
FERC. TEST
i
Performed by:::12LZI
t� z-10--1 Date: d_z 2
MUNICIPALITY OF ANCHORAGE DEPT. OF
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO~Ir"o~MEN1'/kL P2OI ECT~ON
82B L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION AUG
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~ER FACILITIES
DIRECTIONS: Complete all parts an page 1. Incomplete re(luasts will not be processed. Please allo~ ten H0) days for processinfl.
1. PROPERTY OWNER [ PHONE
MAILING AD.ESS
~ROPERTY RESIDENT (If ~ifferent from above) ' PHONE
2. BUYER PHONE
MAILING ADDRESS
3, LE~DINGINSTITUTION [ PHONE
I
MAILING ADDRESS
4, REALTOR/AGENT ] PHONE
MAI LING ADDRESS
~5.' LEGAL DESCRIPTION
6. TYPE OF RESIDENCE
[~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMffER OF~ BEDROOrV'1S' /
[] One [] Four [] Other
[] Two [] Five
[~'"~Th ree [] Six
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
-~, SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
[] 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.) /
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy tesfis required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
~' DATE RECEIVED '
'~ INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR , INSPECTOR
DIRECTIONS:
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
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
E~Septic Tank or E~HoldingTank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSOE~PTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding. Tank Absorption Area iSewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS . ~ . ! ///
[~'"-APPROVED FOR ,73 BEDROOMS ~
[] CONDITIONAL APPF~OVAL (letter must accor~p~}(~y certificate)
~ DISAPPROVED ~ /~./~/ _
LEGAL DESCRIPTION -- ~ '
72-010 (Rev. 3/78)
~u~tust 14~ 1979
303t~ Rarapart Drive
Anchoit~a(~e ~ )!!a~ka 99501
Subjeot~ Tract 1 Block 2 it & P. Sub0. ivfsion
Approw~l for your individual sewer and water facilities
eau not ba ~ranted until the following items have been
compiete(~:
(i) ?he well ~erving the subject property is presently
a pit. The well casia9 ~./ill need tO be extended twelve(12)
inches show) 9rotu.~d level and the pit filled in with
imporvious type soil. This will need to be insppcted by
this department upon
(2) The water a,~alysis report be delivered to this office
f~om Chem Lab~ 5633 ]3 Strc~et~ for our review,
(3) J:x fotlr(4) J.ncf~ ca:3t iron c].eanout need~3 to b~ installed
ill the leaching area.
(4) A ~,000 gallon septic L~k needs to be installed and a
pe~:~it from this office be issued.
(5) A p~rcolation te~t be performed on tile exi~ti'.inp' leaching
a:~oa, This test will dcter~qine if the system is adequa%te
accordin~3 to fiational Standards, A listing of private
firms perfom'ainp' th~ test is enclosed,
Please notify this department ~or a re...inspection when the
noted descrepancies have been co~pleted, If there ar~ any
further questions, please contact this office., at 264-~-4720.
A:.~soc isle Spec;ia:List