HomeMy WebLinkAboutT12N R3W SEC 33 LT 185 E2Lo'
~ MUNICIPALITY OF ANCHORAGE ~
~.. DE ,-~TMENT OF HEALTH AND HUMAN SERi ES
' * Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N~me DISTANCES
/~ v~, ~ /'¢~//, ,4 ,~ ~ SEPTIC ABSORPTION
Add,ess TANK/d/ FIELD WELL
Phone(s) ~ Permit~)~ / ~N°' NO. ol Bedr~s ' WELL / o 0 I / O o ~
~ ~- / ~ L0T LINE -~ ~' ~(/ ~
) ~ ~ ~/~) FOUNDATION ~0 2~,~~
Township, Range, Section
AS-BUILT DIAGRAM (Show iocahon ol well, septic system, property hnes, foundaUon,
TANKS N
~ ~ /~ ~ HOLDING ~ ~ ~
Material No. of Compadments (~ ~
-/
TYPE OF SYSTEM ~ ~ ~
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ge~. ~ ~ , /'~ ~.~
FT FT ,
Total absorptlOn area Oista.cebe[wee. n.es ~ "~'~X ~ ~' ~' '
Number OI linesSoil rat,rig Pipe material ~l~ ;~t' ~'~
WELLS
~ PRIVATE ~ OTHER (Identilv)
Classdicahon (A,B,C} }~ed to
// FTJ FT
REMARKS:
~' ,
Scale: ' ENGINEER'S SEAL
~ ~ ~e.~ ~¢~.,~,;~ /g~/. ~JZ~.~/ InspectionsPedormedby:
I /, ~e~c~[ cedily that this inspection was pedormed according Io ag
Municipal and State guidelines in ellecl o. this dale: ~/~ / ~ 2'
Hea,,hDepa.men,*pprova,:~n~ ~' '~. Date: ~--~--~*
72-013 (3/85)
C](,,~ r-m! r. "' ........ '~ ....: .... ¢ ........
L. ,::)'L i.. ~::,(:],:~ ]. :: Si..d:)(::i :L v :L ~ :[. cH"~ =lq iF~ Lot.
l"la::.( i~',(.:.*(:i i" cl(::ml!~:4 ~', ]?'i :i. !~.~ F:'~,'H' m :i. 'L ',~ /'~. 'Tc. rLa
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447; ,, 4
:i.~fiO
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
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4-
5
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7
8
10-
11
13-
14-
15-
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t9-
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFO
Township, Range, Section:..%-..~,?
SLOPE
/-/~. J ~'+/~/~) WAS GROUND WATER
~ ~/ ENCOUNTERED? /DC~
L
IF YES, AT WHAT ~ O
~ DEPTH7 p
Depth to Water Afler~. ~Z~p,
Monitoring? ~ Date:
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN __ FT AND __ FT
PERFORMED BY: / I (~ ' c'] I L, r'~.~ ,~/ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~//~- ?,~ ~' ~ '
~-oo~ R~. ~,~, ~A ~ / / ~ P ~
ALASKA SNVIR~'-'~'MENTAL CONTROL SERVICg~'~"~/ INC.
1Z00 WEST S~ED AVENUE, SUITE B
A'NCHOEAGE, ALASKA 99508
SUPPLEMENTAL SOILS INFORMATION
LOT BLOCK
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4
5
6-
7
9
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15.
16-
17-
18
19
20-
7'~ ?
1
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4-
~:// ~r~]
9
10-
1
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5
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9
10-
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18-
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1
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18-
19-
20-
I heraby certify [hat . have surveyea the fo ,owm~] de$cr.bed prope, ¥, Lot_,_/-~-''- ;~iock --__..
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
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Manufacturer
Liq. capacity in gallons
DISTANCE TO:
Manufacturer
DISTANCE TQ:
IF HOMEMADE:
Well
No. of lines
Absorption~area /~.~ Dwelling
Inside length I Width
We. IO2) ~=~
Length of each line
Top of tile to finish grade
Length
Type of crib
Well
DISTANCE TO:
DISTANCE TO:
Class
Depth
Building foundation
PHONE [] NEW
Dwelling
Material
Foundation Nearest lot line
I~- F'~, '~.~- r~-.
Total length of lines I Trench width
4~. ~1 ~ I inches
Material beneath tile
Depth
Crib depth
Building foundation
Driller
Sewer line
NO. OF BEDROOMS
PERMIT NO.
No. of compartment..
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance b/~/7~ lines
Total effective absorption area
PERMIT NO.
Total effective absorption area
Nearest lot line
Septic tank Absorption area(si
Distance to lot line PERMIT NO.
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
LEGAL
PERMIT NO,
825
780~1 )
APPLICANT
LOCATION
LEGAL
DEPRRTMENT r~S' HEALTH AND EI",IVIRONMENTAL ~'~'~',OTECTION /~ ~ ~
264-4720
SEL~ER IJPGRADE PEP..rq I T
MARTIN WALLING
RABBIT CREEK RD
BOX 4~ SRA ANCHORAGE
LiB5 Ii?2, SEC~ Ti2,N R~W LOT SIZE
~44-8851
54000 SQUARE FEET
TYPE OF SOIL ABSORBTION ~Y-TEM I_. TRENCH
MAXIMUM NUMBER OF BEDROOMS = ~ SOIL RATING (SG FT/BR)= 150 ~.~
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: I
DEPTH= 12 LEI%IGTH= ~Z~6RR%-"EL DEPTH= ,,~". ~'""
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD,
THE DEPTH OF A 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.
]'HE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION <IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THaT THE WELL.WILL,SERVE. ~-
Ti~[I ( 2 ) INSPECT I Or~S AR EEQtJ I EEC>
BACKFILLING OF 8NY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL 8E SUBJECT TO PROSECUTION,
MINIMUM DISTRNCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR A PRIVATE WELD OR
150 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL,
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERF1 I T E×P I RES [)E~Z-:EI~IBER
I CERTIFY THAT
l: I AM 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,
V~. 2.
60~,~5 U L'l'l N R GEOLOGIST
.10
12
.].4
:16
SOILS LOG
18
2O
Soil Type Water Level Renmrks
Total Depth of Excavation
Groundwater
~NotReached
Depth, if Reached
Classification Hethod
~isual
( ) Sieve Analysis
()
Material at Total Depth
Bedrock
~'~N o t Reached
Depth, if Reached
Gary F. Player, Consulting Geologist