HomeMy WebLinkAboutT12N R3W SEC 27 LT 19
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
UPGRADE
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
~ Material Cm~ ~ No. of compartm~s
(~0~ IFHOME~DE: In~ Width Liquid depth
OZ~ Manufa~ ~~~ Ma ' ~ngallons
No. ofliaes ¢ q ~ngth*f~ach~ine¢4 Total length o~n~ Trench~idth "e Distance between iines
__ ~ Cnches
Total effective absorpti n are~
~ Top of tile to flnlsh orade ~ , Materlalbenaathdle q ~ inches
L~ngth Width Depth PERMIT NO]
~ DISTANCE TO:
; ~ Depth Driller Distance to lot line IPERMIT N~ X
~ DISTANCE TO: Sewer line Septic tank Absorption area(s}
OTHER
PIPE MATERIALS ~
SOIL TEST RATING / ~ ~1~
72-013 (Rev. 3/7~
'i"?F'[~ ItF: %(]]:[. FiE::~;Of~:[31":[CIIq .:. ~._ ] [.l! :[5};:
THE; [..[i~t",!(~Ft.-I D ! P1ENS;
'l"l~lii{ [:,E?TH OF Fi TF?.[ENC:H OR: F'ZT XS; TI'-!I:~:: DZS-i"F:!NIZ';E !3FiTf'l.,ll:}:lS;t'q THE 51..IF?.FFIC:!!; OF:' -i"H~Z
O.'F;:OI.IN[> FIN[> TI--IE [~:OTTO!"I CIF -['Ht:~: E;:':;C:FI'v'FIT!ON (:Zt".I F:'EE'F).
THER:[!;
'THE: GI:;i:F?v'EL DEl:'
F:tf,!D '/-HE E~O'FTON Ot:: THE E;:-:;CFfv'FIT!ON < IN FEET>.
I')EI::'F:IFUI'i"tl}EI"4T I>I..II:;~:!NG THE!;
PROF'ETR: T"/ F:IN[>
f',! 71: t','t!..IN [:, ! 5'!'FtNC!5: [~:[.Z'Tb. IE:E:N Fl NELL. FIN[:, FIN'.r' O1'-,!--.5 Z "FIE 5Et.,IfqGE D 1%F'OSi;FII_. :iS'./STfZt"i ]: '_..-S
J.lZiO F:IS~-:.T F:'Of~: f~ [:'F,?.Z',,,'FYTF}: !.,.IE:LL..;
:?.50 -i'[) ;;~:[Z~O FEET I::'I:;?.OP! FI 'F'UE[L!C NE:[.L. D[~:PE~2-,![::,]:NG I..JF'CIf.,! "['l'-i[~: T'T'F'E
N[C[..[. L. OG% F!R'.E ~:E[I~:iI..IZ[F~:I~:[) Flfq[:, f,ll..15};T E:[[ R:ETI...fR:IqE:D TO THE E:,EF:'I::ffP. TN[~:NT
THE !.,.IE:L.L C:OP!F'L.[ZTZCIN.
OTHE:R'. R'.IE6:~LI l F?.EP][::NTS; NFl? FIF?L.'T'. SF'[~:C: ]: F l CFI'F Z ONS; FIND CON:~;TI;?.I..IC:T
FI'v'Ft]:[.F:[E~i.[:~: 'FO ]:i'q:~il. Jl:~:[~: ?[;?.OF'[EI;~: INS:;TFILLiRTION.
i CEF?.'[: X F'T'
::L: I l':li'"i F'FfI'qI!.].'I::;ti:?. t-,.II'FI.I "ft..lE:
F'OI:;~ITH [~.,.' THE': P!LI!'.,!ZC:iF'FI[.]:T'T'
;:;:: :[ t,]:[LL ZNS, TFIL.[.. 'T'FI[:': ':?./Si;TEH ZN FICCOF?.DFINC[~
}!:: :[ UF,tDE!?.5;TF~ND THFIT THE: O?q--':'i:;ZTE
F::!.ii::i:_:, Z [>l:£i'qC:E :[ :¥ Ri[::i"ICI[:,I:Z!..E~D TO
I::~N[:, l.,]I}:!.I._5!; FI5 5i:E'l'
[:?.,l L. F! [;~: G E I'"1Ei: I'.FF IF:'
2204 C~ ~e-and ArJchorage, .%las. ~ 99503'
~erformed For ~ Landmark Designs ?,~te Performed
Lot Block
Leoal nescrintion: ~
L19 SW1/4 SEC27 T12N R3~ ~
9-13-78
Subdt vi ~ i on see below
~Yes Percolation Test
Yes'
.nenth 1 Characteristics
'2 ~ Da~k Brown Gravel
Grey Silty Sand
Grey Silty Sandy Gravel.
L0 -
L2--
L4 -.
L6-
~0~
~a$ Ground
1~ YeS, At
Bottom of Test Hol%
Water Encountered?'
what- Depth?
Gross Time
__24 Hr~_satu~
30jin. --
- 40 min __
50 min .
-60 min
Percolation late. 1/4"/10
Froposed ]~St~O~:
Deoth of ]n~et
Net Time'
2:J~5
__2:45 --
3:15 ~
!iinute
Seenaoe Pit
PepS6
Bottom Of
'275 Sq' F_~t._ drai_~na~e are required~oom~-
to !t20 I;et Dron
__ ~/2"~
__ 1/4"~
'i 4" ~
Drain Field __
Pit 0}' Trench_
Depth
4~4"
Data Certified ~:____~L~'
Test Performed B¥~ Date:. 9-13-78_
DRILLING, INC.
DRILLING LOG
Well Owner )'.~).(h~:rR ~'r--~"o. ~. )'io / ~ ' .... Use0fWe]l
goea~ion (address o~: ~ownship, ~ange, ~eetio~, ff ~own; or d~ga~ee ma]~
Size of casing
Static water level
Screen ( ); Perforated ( ),
Describe screen or perforation
Well pumping test at.__20 gallons per (~:~) (minute) for
of drawdown from static level.
.Depth of HoI~ 2 li) feet Cased to 2,0~-. Y feet
~ ft. (fi~'5~$) (below) land surface. Finishbf well (ch~ck one) 'open end ( ~':~ );
hours with .... 0 ~ .... :-ft.
Date of completion )']/;[/78
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
~O_
fro_
.TO_
Sil~;y boulders
Gravelly hard
G:cavelly Ha~8, pan: aobl:fil, y
Clay
TO
I,.2
TO_
l((;.;
TO
TO
TO
TO
TO~
TO
___TO
TO
NWWA Certified Contractor
Ccr~dfi~ate No":. 'e!4 a~ ~w2
TO
3--CONTRACTOR
,r ,' ffrf ~'' ~'~"" ~ u ~F HEALTH &
· ..: DEPT.
~UNI~IPALITY OF ANOHO~AGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~~IRONMENTAL PROTE~JON
825 L Street - Anchorage, Alaska ggB01
JAN 3 1979
ENVIRONMENTAL ENGINEERIN~ DIVISION
Teleph°ne 264'4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUA~ATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplet~ requests will not be prec~sed. Please allow ten {10) days for processing.
1. PHONE
PROPERTY OWNER ~ 4 ~ ~
PROPERTY ~ESIDENT (If different from above) PHONE
2, BUYER PHONE
MAI LING A DDR ESS
3, LENDING INSTITUTION ~ PHONE
I
MAILING ADDRESS
4. ~ALTO~JA~NT PHONE
MAILING ADD~
5, LEGAL DESCRIPTIOi~ ' --
STREET LOCAT[ON -
6. TYPE 0 F RESIDENCE
[~' SINGLE FAMILY
[] MULTIPLE FAMILY
7, WATER SUPPLY
~ INDIVIDUAL*
COMMUNITY
[] PUBLIC UTI LITY
NUMBER OF BEDROOMS
[] One [] Four ~ Other
[] Two [] Five
.~1 Three [] Six
* ATTACH WELL LOG. A well log ~s 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 **if individual/on-site, give installation date
~[ INDIVIDUAL/ON'SITE** '
If system is over two (2) years old an adequa~cy test/is required
~ PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACcomPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS'.
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[]~;]."~N G L E FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[Z~'"~NDIVI DUAL DEPTH OF WELL
[] COMMUNITY
. DATE DRILLED
[] PUBLIC UTILITY .. '
Connection Verified__ LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]~fll~DIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank
Size: /~(~(-~'~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER ~ . ^
TOTAL ABSORPTION AR EA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Lin~
5. COMMENTS
(~APPROVED FOR. ~;~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
lc(
LEGAL OE$CRIPTION
72-010 (Rev, 3/78)