HomeMy WebLinkAboutEAGLE RIVER HEIGHTS NORTH BLK 4 LT 13
MUNICIPALITY 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 lPHONE [] NEW
PGRADE
MAI LING ADDRESS ~ /
LEGAL DESCRIPTION ,
· OCA ,O.
' ~ - ] Wed I Absorption'area Dwelling PERMIT NO.
I DISTANCE TO:
~Z~ I Manufacturer ~--~(/i ('-' T'/ ~~ ~ IMaterial IN°' °f c°mpartmems
r~¢ Liq. capacity in gallons~' ~F~HtO :E j~: Inside length Width Liquid depth._
Q I We Foundation Nearest lot line PERMIT NO.
~zlDISTANCE TO: I ·/ / tA I I
~ ~. ~ No. of lines Length ~e~ch ene/',¢- Total length of lines Trench width Distance between lines
- z~ I j / v l / J inches I
~ ~ I Top of tile to finish grade I Material beneath tile J Total effective absorption area
~, I inches
Length Width / / Depth/ PERMIT NO.
< ~ /Type of crib CrJb~t~.f~/'1 ' ~rih depth ~ Total effective absorption area
~- I / ' _'-----'--~--
uJ Well Building foundation Nearest lot line
I DISTANCE TO:
-!'J Class Dep?h'~[~.~ /~L//,,,~// /t[~ /, ~_~[!~r/ Distance to lot line I PERMIT NO.
.~ I DISTANCE TO: Building foundation Se~,~er line Septic tank Absorption area(s)
I
OTHER
PIPE MATERIALS
SOIL TEST RATING
72-0~/78)
DATE
LEGAL
-~ ..... ~ORAGE AREA BoRc-~z,II"'"TER ANCHORAGE AREA BORO, t~-~H
Dela~rtn:'em o~ ~nvironmental Qualff
~00 ~ udor ~d ~ Pouch 6-6,~~ .....- ............ ~'
N? 907
.......... ~, Alaska 99[iO4BSPECTiON REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME J~ ~
LOCATION C~olu'iIc· -~Y...
SEPTIC TANK:
MAILING .'-,
ADDRESS I',"(' ~,,K ~(_; /"-(4(,]/(-/~t~,~':'r PHONE~z~-'''
LEGAL
DESCRIPTION
/--
DISTANCE FROM WELl ~?t??~-~'~
LIQUID CAPACITY /~JD GALLONS.
NUMBER OF
MATERIAL ~Cq]( '-~/~ ~/~- COMPARTMENTS
LIQUID
INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS /
LINING MATERIAJ
NEAREST LOT LINE
OUTSIDE DIAMETER ~ OR WIDTH -~ ~
["[flJ~ . DISTANCE FROM WELL (q~,/~f f/2,~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH /~ . DEPTH
, BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION , N~F ~
NUMBER OF LINES DISTANCEB~ TRENCH WIDTH
ABSORPTION AREA ,~-'~-'"SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TIL'E~TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEAIH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
DISTANCE FROM
WELL:
TYPE /Y~(4'O L~,/ , DEPTH , BUILDING
FOUNDATION.
NEAREST SEPTIC SEEPAGE
LOT LINE ~ SEWER LINE , TANK , SYSTEM
WATER
SAMPLE
, CESSPOOL
., NEAREST
OTHER
, SOURCES
DISTANCES:
_.
DIAGRAM OF SYSTEM
DATE iI~1-~/ ~-~ /~7~ APPROVED 1'~ j?.,( j.~_ k/-~ 't ~,
' HEALTH AUTHORITY
r.11_li--4 I ~-: T F'RL ]' T'~-' . ~;IF R~'-4G:-HGIF:RI3E
DEPRRTMENT O~--HERLTH RND ENVIRONMENTRL PF..E~.~JTECT ~ON
825 ~t STREET, RNCHORRGE, RK. 9?
264-4728
/' ~L ..... C- ClP,--S · TE ¢SEI-,ER
PERMIT5 <~o0~ ) L,,t¢~r~c~
0-I%
TYPE OF ~OZL RBSORPT~ON 5YSTE~ ~:
~RX~MIJM NUMBER OF BEDRO0~ = ~ SOZL RRT~NG (SQ FT,."BR)=
F-ERI',I I T
LOT SIZE /~ SQLIRRE FEET
THE REQUIRED SIZE OF THE SOIL ,RBSORPTION SYSTEM
E.,if'TH= (:~; b E !"-.i ~3 f H = ~ I] F; R '..-' E b [:'BP TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUNC, RND THE BOTTOM Of THE E:.,:',CR',.:RTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
8ND THE BOTTOM ,]~lT~ ~EXCRVATION (IN FEET).
I~ ~ L C I~1 ~'~ ~
PERMIT APPLICRNT HRS THE RESPONSIBILIT? TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY 8NC, THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
T&,J6~ ( 2 ) I 1'-iSPECT I 0~45 RRE F.:Et'].LI I RED
8RCKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL B~r' THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECLITION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RNC'
TO R COMMUNITY _~]EWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE [:,EPRRTMENT WITHIN 3.0 DR'qS
OF THE WELL COMF'LETION.
OTHER REQUIREMENTS MRV RPPLY. SF'ECIFICRTIONS RND CONSTRLICTION DIRGRRMS RRE
RVRILRBLE TO INSURE PRe;PER INSTRLLRTION.
PERrfl I T E)-:P I RES E-,EC:-EhlE:ER git.. -1 L~:30
I CERTIFY THRT
1: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE
2: I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES.
3: I JNDERSTRND THRT THE ON-SITE SEWER S'¢STEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMOC'ELED TO INCLUDE MORE THRN ~ BEDROOMS.
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
7
8
SOl LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
;LOPE
OA':'E PERFORMED:
SITE PLAN
10
11
12
13
14-
15
16
17
18
19
ENCOUNTERED? O
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
://7>-
/
20 ;'~
PERCOLATION RATE
TEST RUN~ETWEEN ~ FT AND ~ FT
72-008 {6/79)
(minutes/inch)
DAVID a. SLENKAMP
ROBERT A. SHAFER
MECHANICAL ENGINEER
694-9055
CIVIL ENGINEER
694-2979
SRB 196X EAGLE RIVER, ALASKA
