HomeMy WebLinkAboutCHUGACH TERRACE BLK 2 LT 3
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 /PHONE [] NEW
MA ILINGADDRESS r~
LOCATION w NO, OF ~EDROOMS
] Well ~ Absorption area Dwelling PERMIT NO,
DISTANCE
TO:
~ ~ Manufacturer Material ~o. of comoartmonts
~ ~ Liq. capacity in gallons IF HOM~ ~nside length Width Liquid depth
Well Dwelling PERMIT NO.
DISTANCE
TO:
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well ~O t Foundation Nearest lot line PERMITNO.~ ~ ~
~_~Z ~ No, of lines / Length of each Total lengthoflin ~ Trench width~inches- ~ Distance betweenli
~ ~ Top of ~le to finish grade i Material beneath tile / Total effective absorption area
O ~ ~ ~ inches
Length Width Depth PERMIT
~ ~ 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.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
APPRO ED ~ ,, [ DATE LEGAL
72-013 (Rev. 3/78)
PEF.:M I T NO. ( ,=,~0~,0.~. ':,
APF'LICANT JOE HNGAN
LOCATION SAME
I_E iht
l"lLi['-.I 1" C: l', ,:IL I T'"r' L--IF RI'-,Ir:H .... RRI.]E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~'~-- *" L '*'
¢~,=.., STREET., ANCHORAGE., AK.
264-4?20
_"~ E 1.4 E I~." LIPGRRE:,E PERI'-1
=.=,'~
::.,..-'.4 CH I LLI<00T
LOT _, I .-E 15000_'q E0:.. .I A ~, c, ., ,_ FEET'
TYPE OF=,UIL'-- ABSORPTION c_,y_¢,TEM I S: TRENCH
MR~<IMLIM NUMBER OF BEDRuuM=, = <
SOIL RATING (SQ FT?BR)= 240
THE RE[..!UIRED SIZE OF THE SOIL AB_,ORFTION SYSTEM IS'
E)EF"TH= "~O LENGTH= ~.£1 i..] R R',~' E L E:,EPTH= ,S
THE LENGTH DIMENSION IS THE LENGTH ~.IN FEET> OFTHE TRENCH OR DRAINFIELD.
'V 'THE DEPTH OF R TRENGH'-' OR PIT I~,, THE D ISTA, NCE BETWEEN THE SURFRCE OF THE
\ GROUND RND THE BOTTOM OF THE EXCAVATION ,;IN FEET>.
,i,~,rTHERE I':; NO SET WI[:,TH FOR TRENCHES.
..T. HE ~JRA',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE .-.
~ AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
PERMIT APPLICANT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT [:,URING THE
I NSTRLLRTION INSPECTIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
Tt-IO cZ 2 ) I I'-ISPECT I L-11',tS RRE REQLI I RE[)
BACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS
[:,EF'ARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
t00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC NELL. ~
MINIMUM DISTANCE FROM 8 PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEAr.11 T E~--'.P I RES [)ECEMBER _~I. ~__q- 80
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
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 3 BEDROOMS.
SIGNED"
APPLICANT ..TOE HOGAN
ISSLE[:
Jf-j~ HOC~I~i 5534 GHII. LJ~OOf
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