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Home My WebLink AboutT12N R3W SEC 33 LT 150 ....... MUNICIPALITY OF ANCHORAGE i(' ~-'¢/~./~ DEPARTMENT OF FIEALTH & ENVIRONMENTAl- PROTECTION / ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 TelephOne 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELI~ INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION LOCATION ' O STANCE TO: I We, t IF HOMEMADE: Well DISTANCE TO: Manu[acturor DISTANCE TO: I® /d/~[ No of lines/f Ii ~iLength of e~'~[~ I~e Top of tile to finish grade . / Eoundation / ~) /' Nearest ISt line/~ ,/ tile -- NO. OF BEDROOMS No, of c~art~ents Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO, Len§th Depth Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTFIER PIPE MATERIALS iNSTALLER 72 013 (Rev, 3/78) LEGAL F'ERt'I I "1' NO. DEPRRTMENT OF HERLTN AND ENVIRONHENTFtI_ F'ROTECTION 825 eL" STREET, RN(::NORRGE¢ RK. 264--47'20 FIPF'L I CRNT ROBEF.:] LIBBEY 4.25 G L. OCRT I ON NILDEN LFINE LE~RL T!~N- R~.N ~EC :Z~ ;LOT ;i~e ; T"?PE OF' SOIL RB_ORPTION _~:]Efl IS: TRENCH STREET ~5¢.~'~ LOT SIZE E,EDRE ,. N=, 4 SOIL RFITING (S6~ FT?BR)-'= 05 ~:/, HR::,iIf'IIJH NUI4EER OF > * 'E '~ = . : ' THE [..EQIJIF..EB SIZE: OF THE SOIL RBSORF'TION :,~..,TEfl IS: THE LENGTH D~HENS~ON ZS THE LENGTH <IN FEET) OF' ~HE TRENCH OR DRR~NFZELD. THE OEPTH OF R TRENCH OR PIT ZS THE DZSTRNCE BETI4EEN THE 5URFRCE OF THE GROUND aND THE BOTTOH OF THE ENCRVRTION (IN FEET). THERE IS NG SET NID'ft4 FOR TRENCHES. TNE GRAVEL DEPTH IS THE I',IlNIHUH DEPTH OF GRRVEL BETHEEN THE OUTFRLL F'IPE RND THE BOTTOH OF THE E~iCRVRTION (IN FEET). PERI'alIT RPF'LICRN'F HH:, THE RI::PCN~IEILITb TO INF"ORH THIS DEF'RRTHENT DIJRING THE IN.r. TFtLLHTION IN_,FEuTIuN,=, OF RN'¢ NELLS RD..TRCENT TO THIS F'ROPERT'T' RND THE =,ER ~ E. NIJHBEF.: OF RESIDENCES THRT THE NELL HILL '- "¢ BHL. kFILLIHG OF RNY _~:.~fEH NITHOUI' FINFIL INSPECTION RND RPPROVRL B"r' TliI- DEPRR'THENT t,.IILL BE _,UB.]ECT TO PROSECUTION. t'IlNIHUH DISTRNCE BETNEEN R NELL RND FINV ON-..,I rE SENRGE DI-,[ O..,RL S'.r'9TEH IS fiDE FEET FOR R PRIVATE NELL. UR 1,.9 TO 2¢0 FEET FROH R PUBLIC NELL DEPENDING UPON THE T?PE OF FUE, LIL, I.,IEL.L, HINIHUH [:,I9TRHCE FROH a PRIVRTE HELL TO a PRI',,¢RTE =E~ER LIHE I:c '~ FEET aND TO R COI',IHUNITN' SEHER LINE IS 75 FEET. , OTHER REQUIREHENT$ HR'T' RPPL~. ~PECZFIIZ:RTIONS RND L. ON~TRUI_.TILN DZRGRFIH$ RRE FI',/RILRBLE TO INSURE PROPER IN~TALLRTION,,~ ~ CERT~FV THaT :L: Z RH F~H~L~R N~TH THE REQIJ~REHENTS FOR ON--S~TE _E~ER~ RND NELLS ~ :,El FORTH B? THE HJN~E.~F~L~]¢ OF RHE:HOR~GE. 2: ~ H~LI._ ~NST~L.L THE :~:TErl ~N RCCORD~NCE H~TH TH~: CODE~. ..~. ~ JNI)ERST~I'~D TH~"r THE EN--:~IE ..,E~ER :,Y_,FEII HRV RE:QUiRE ENLR~GEHENT ~F THE RE:,i[.ENbE ~S REHODELED TO ~NCI_UDE HO~E THRN ~ BEDROOMS. _,I GNE.[.: F ' C' '* ' :'"' ~PF L I _.FIN I ROBERT L I E,E,E¥ ,:c , ~ B'¢ ................................................. DaTE ............ I........ I _,_,I..IE[ . . DEPRRTHENT HERLTH RND ENVIRONMENTRL ,~:OTECTION 82~ 'L' STREET., RNuHLLBGE, RF.. 264-472¢ F'ERMIT NO. ( ) T'¢PE OF SOIL RE,_,.)RBTICN ~k_TEH IS: . MRXlHUH NIJHBE[( OF EIEDROOMS = SOIL I.RTINu (S6, THE F'E.~_]~ED,' 6 '- SIZE OF THE SOIl_ RB.~ORPTZCN'- ' ~ SVSTEM THE LENGTH D[MENS~ON ZS THE LENQTH ([N FEET) OF TNE TRENCH OR DRFIINF]EL[:,. THE [:)EF'TH OF R TRENCH OR PIT ES THE D]S'TRNCE BETNEEN THE SURFRC:E OF TNE GROLIND RI.ID THE BOTTOM OF TNE EXCRVRT~ON (IN FEET). THERE [S NO SET bJ]DTH FOR 1RENuHE .... THE GRR',ZEL DEPTH ]S THE M[NZPitJH DEPTH OF GRR',/EL BETNEEN THE OLITFFILL RND THE BOTTOH OF 'rile E¢,L,R%,RT~ON (IN FEET). PERMIT FIPPI.~C:IRNT HRS THE RESPONS:[BILZT¥ TO INFORM THIS [.',EPRI~:Tf'IENT D_IR'fNG THE - ,~ :[NSTFtLI_FtTION INSF'ECTIONS OF RNtr' 14ELL_ FID.TFICENT' TO TFtIS PROPERTY FIND THE '.ILIf,IE',ER OF FE:,IDEi'~UE.~ TI-IRT THE 14EI..L 14ILL SERVE. ....... T I_.~ .r__'~ ,'.: 2 :) :[ I'-,I S': F" E: r..?- T :[. ~3 !'-,1',2_-.;, RRE F;~:E(-:] IJ :[ I~:E [_-:, BRCt.,FILLING OF RN'Y S'¢STEM NITHOU'r FINRL IN.:,PECTION RND IRF'PROVRL B~r' TNIS DEPIBRTMENT NILL BE SLIB..~ECT TCI PROSECUTION. HINIMUN DISTRNCE BE]"NEEN R NELl_ RND RNY ON--SITE SEI4RGE DISPOSRL SYS]'EP1 IS 100 FEET FOR R PRIVRTE NELL~ OR ; %58 TO 298 FEET FROM R PUBLIC NELL DEPENDING UPON THE Tb'PE OF PUBLIC NELL. 14ELL LOGS RRE RE6!UIRED RND MUST BE RETURNED TO TNE DEPRRTI,1ENT NITHIN ~9 DR,'S OF THE NELL COHPI_ETZON. OTt4ER REE4UIRErdENTS MAY APPL~'. SPEC:[FICRTIONS AND CONSTRUCTION DIAGRRMS ARE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERP1 Z T Ek-:F' I I~:ES [-',E:CEhlE_~ER ,E:::[., -'L9 80 I CERTIFY THR]- ±: I RH FRklII.~RR NITN 'rile REQUIREMENTS FOR ON-SITE SEI4ERS RND NELLS RS SE'r FI)R.:EH B~r' THE MLINIC:IPRLIT~' OF RNC:HORRGE. 2: I HILL INSTRLI_ THE SN'STEM IN FIE:E:ORDRNCE NITN THE CODES. :~: I UNDERSTRND TFIRT TtiE ON-SITE SENER 5~'STEfd f'lR~r' RE(~UIRE ENLRRGEMENT IF TNE RFFL]C:RNT [~'SOlLS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99602 276-222~ SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 ,)ATEPERFORMED:,~ ] ~ SLOP~ SITE PLAN 5 7 8 9- 11 13- 14- 15- 16- 17- 18- 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading ()ate Time Time Water Drop PERCOLATION RATE ~ t ~ (l~'hl~tes/inch TEST RUN BETWEEN '" (7/76) Reg. 67, Oct., 19] TITLE 18. ENVIRONMENTAL CONSERVATION ]8 AAC 80.020 (3) wells must be adequately protected against flooding; (4) if there is an annular open space outside the well casing, it must be filled with a watertight cement grout,~ sealing clay, bento- nite, or equivalent material to a minimum depth Of l0 feet below the ground surface; (5) the surface, for l0 feet in all directions around the well, must be sloped or contoured to drain around or away from the well; when, in the department's opinion, there is a potential for a well to become contaminated by surface water, the department, in its discretion, will require~the provision of an impervious surface, extending at least two feet in all directions from the well; (6) a drain pipe from a well honse to a sewerage system is prohibited; and (7) newly constructed or reworked wells must be flushed of sediment and disinfected before use. (c) A person who owns or is responsible for any well, abandoned or not in use; any hole, either drilled, augered, or Jetted for tbe purpose of subsurface exploration or sampling; any cathodic protection well, or any other form of excavation, which may cause contamination of a water system, shall seal, protect, or fill up the well, hole or excavation using methods approved by the department. ........ (d) No person may construct install, maintain, or operate a public water system unless the mimimum separation distances in Table A, measured horizontally in feet, are maintained between the public water system seurce and the potential sonrce of contamination. When the department determines that local soil conditions, groundwater conditions, snrface topography, geologic conditions or other conditions indicate that the separation distances in Table A will not provide adequate protection against contamination of a water source, the department will require greater separation distances. A person may request: approval from the department for separation distances-less than those specified in Table A, but in no case will a distance less than 100 feet be allowed between a water source and a wastewater treatment and disposal system, a °~ewage pump station, a sewer main cleanout, or a sewer line manhole. ~Any.person requesting approval of a separation distanc~ less than specified j.n'~ ~ Ta~l~ A must S~bmit a repbrt prePare~ signed and s~aleH by a pr0f~ssional engineer registered ia the State of Ataslca in accordance with AS 08.48.221, which Justifies the lesser separation distance. The ~ustification must include consideration of soil conditions, groundwater conditions,, surface topography, geologic conditions and any other conditions of importance Reg. 67, Oct'., 1978 TITLE 18. ENVIRONMENTAL CONSERVATION in establishing the separation distance. If the department finds that, due to local soil conditions, groundwater conditions, surface topography, geologic conditions and any other conditions, the separation distances in Table A are clearly not necessary to prevent contamination of a wate~ source, the department will, in its discretion, allow lesser separation distances which, in its opinion, are necessary to prevent contamintion of a water source. If the department allows tesse~r separation dis6ances, the owner and operator are not relieved of the responsibility to meet the maximum contaminant concentrations astablished in sec. 50 of this chapter. TABLE A MINIMUM SEPARATIONS BETWEEN SURFACE OR SUBSURFACE WATER 18 AAC 80.020 SOURCE AND POTENTIAL SOURCES OF CONTAMINATION [Measured horizontally in feeC meters)] Type of Water System Wastewater Treatment and Disposal Systems, Sewage Cleanouts And Sewer Line Manholes Community Sewer Private Lines~, and Other Sewer of Contaminants Class A and Class B 200 (6].) 200 i61) · 100 (30.5) Class C 150 (45.7) ,~00 (30.5) 75 (23) Private well 100 (30.5) 75 (23) 25 (7.6) (Eff. 12/31/7--7, Reg. 6--4; am. 8/13/7--8, Reg~ 6-7)~ AUTHdRI2~ AS 46.03.020(10)(A) AS 46.03.020(10)(C) Ag 46.03.020(10)(D) AS 46 03.050 AS 46.03.070 AS 46.03.710 AS 46.03.720 AS 46.03.850