HomeMy WebLinkAboutT14N R1E SEC 33 SW4 SE4 NW4 NW4
~ MUNICIPALITY OF ANCHORAGE ..
/'~1~ -----~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
~,~ll ~t'., ~lJ ENVIRONMENTAL ENGINEERING DIVISION
\ ~ ~1~// 825 L Street- Anchorage, Alaska 9950~ Telephone 264-4720
~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTIO
LT$~z~n gallons Inside length Width Liquid
depth
/, ~ IF HOME.DE:
~ ~ ~ DISTANCE TO: Wag Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
Foundation ~ { ~ '.ar.,t
~ D ISTANCETO: /¢Z~- ,engt~f~es5 Trench~idt~ Distance~ ---' --betw-~' '
-- / ~0 inches
Total effectl absorption area
Top of t)e to ~nish ~e Ma~p~l ~'neathm
Length Width BCpth ~ PERMIT NO.
~ Ty~e of crib Crib 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
APP~p~;,' // // p' DATE LEGAL
PERMIT NG,
~-ILI~'~ I C ][ .F'AL I T'¢ C~F At'4CFIORAGE
DEPARTMENT F-X, HEALTH AND ENYIRONMENTAL ,~OTEC:T I ON
8~5 'L STREET., ~NCHOR~GE,, ~K, ~9,--,~
C~F4--S I 'rE SEI.4EF: F'ER~.I I T
( 88043:2 )
RPPLICANT
LOCFIT I ON
LEGRL
RANDY MRULDIN =F. E,U?, '~0~0 CHUGIRK AK
ER
T14NRiE S. ~ SW1,-"'4SEi/4NWt?4/q~d ~ LOT _~I,:.E
258888 _,QUHRE FEET
TYPE OF SOIL HB_<JRPTION :,'~=,TEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS =: 4
'-] ,--,W FT,."BR) = 1._'.50
:,LIL RRTING ¢'~--
THE RE)_IRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[:, E F" Ti-~ = 18 L EF.h.3 TH= 7'5 GF:R"v"EL [)EF'TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F-:Eg!L~ I ~;:EC. SEPT I C TF~Nk'. c. TZE= ~1_~.~5~ GFILL~DF4S
PERMIT RPF'LICRNT HRS THE REE;PONSIBILITY TO INFORM THIS DEPRRTMENT [:,URING THE
INSTRLLRTION IfI_FEE. TIuN_ OF BNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NLIMBER ~:~F RESIDENL. E_, THRT THE WELL WILL 'SERVE
TI40 ":." :--:
~ I F,ISPEE:T I C~I'-,~S FIRE REL-]La T RE[-,-'
BRCKFILLING OF FINY _,u, TEM WITHOLIT FINRL INSPECTION RND BPPROVRL BY THIS
DEPARTMENT WILL BE .:,LIE, JECT TO PR¢/':;EC TInN
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSBL SYSTEM IS
&00 FEET FOR R PRIVRTE WELL OR ~50 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 2~ FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY RF'PLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F-EF--:Pl I T E::--:P I F-:ES DECEFIBEF: _.9~2L.. ::L~qSE4
I CERTIFY THRT
1: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRL!T9 OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
SIGNED
I~-,LEC
DIN
.-[ RTE---
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-~50, Anchorage,~;A. laska 99502 276-~22~
SOILS LOG -- PERCOLATION TEST
,~ SOILS LOG
[] PERCOLATION
TEST
PERFORMEO FOR:
.LEGAL DESCRIPTION:°
1
2
3
~----- 10 -
12
13
14~
15
16
17
18
19-
20-
COMMENTS
SLOPE
PLAN
IF YES, AT WHAT
DEPTH;)
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN FT AND
(m~nutes/inch)
__ FT
by
DOC Co. dba
SULLIVt WtT R WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND ?s' 'J ~ ~ /~7 /~ ..... ' ~ r
ADDRESS
LEGAL DESCRI~ION ':' ~47 '~-~ ~ ~"J'~ ,3,'? c~,
DATE: Started ~ .) 3 Ended
PERMIT NUMBER
DEPTH OF WELL ,-~? 0,2,
STATIC LEVEL OF WATER FT. e' 00~
5 ,,~ DRAW DOWN FT. t O ' ·
GA~, PER HR .;: '-'
KIND OF CASING ~ ~' O~O
KIND OF FORMATION:
From (? Fi.,o 3' Ft.
From ,.~ Ft. to~Ft. ·
From Ft. to Ft.
From' ] .~{ ,, Ft. to ~52¢:~ Ft.
From~~,-,~ Ft. to~Ft. ~]2~z~,:2~
From_ Ft. to Ft.
From Ft. to .... Ft.
From Ft. to Ft.
From ......... Ft. to .... Ft .....
From ....... Ft to .......... Ft; ..........................
From Ft. to Ft. /~ ,~ ..... ~ Frmn
Ft to /.% (: Ft. k) ~ ~&:'t ,- ~C. From_
From Ft, to Ft. "~:' :% ?'~?: From
.: : From Ft. to Ft._ From Ft. to '~
i3 } ' From Ft. to Ft From Ft. to Ft.
_ Ft. to _ Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to _Ft.
Ft. to. Ft
Ft. to Ft,
Ft. to .Ft. '
Ft. to_
Ft. ' ' :,~-
Ft.
MISCL. INFORMATION:
· '~" j ' 7 ',.~ ?',':~z ....
DATE DATE I % DATE
I NSP ECTOI~[
,.SPEDTOR
MUNICIPAU~ QF ANCHORAGE
MUNICIPALITY OF ANCHORAGE ~EPT. OF
DEPARTMENT OF HEALTH & ENV RONMENTAL PROT~NMEN~AL P~OTECTION~ ·
825 L Street - Anchorage, Alaska
ENVIRONMENTALSANITATION DIVISION [~/~Y ~ 5 198i
Telephone 264-4720
.EOU. T .o. OF
DIRECTIONS: Complete all parts o~ page 1. Incomplete reques~ will not be proce~ed, PJease allow ten (10) days for processing.
MAI NG ADDRESS
PROPERTY RESIDENT (If different from ~bove)
~ ~ PHONE
MAILING ADDRESS
MAILING ADDRESS
4, REALTOR/AGENT ] PHONE
MAILING ADDRESS
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four [] Other__
~SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~'"~h ree [] Six
7. WATER SUPPLY
~INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975, For wells drilled prior to that date, give well
C~ PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** /~'~(-.~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(Rev. 6/79) ~/ ~ OQ f) ~_~
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SiX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTi LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ',-: ~-~-
Connection Verified
INSTALLER
[]Septic Tank or []Holding Tank
Size: i.~ ;:~ ~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELETO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~] APPROVED FOR ,,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter mu~t'~ccoropany certificate)
~ISAPPROVED ~,/ /
72-010 {Rev. 6/79)