HomeMy WebLinkAboutT13N R3W SEC 13 W118' of S160' of Lot 105
) MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl.. PRQTECTION
' "; ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl_ INSPECTION REPORT
MAILING ADDRESS
Liq. apacityin IF HOMEMADE:
~ Well ~~ Nearest lot line PERMIT NO.
NO. of lines LenCh o~ Total length of line~ ~ Distance between lines
~ ~ T~ade Matedal beneath t[Io~ ~"nches Total effectlue absorpdon area
~ Length Width ~ PERMIT NO,
~ ~ Type of crib C~ Crib depth % ~Total effective absorption area
~m ~ Well Building foundation Nea~line
a Class Depth Driller Distance to ~/ PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
~' DATE LEGAL
72-01; 3/78)
PER.r'i Z T NO.
fIPF'L I CfiNT
LOC:F:IT i ON
L.,EGFIL
ELS l E
~" '~' E.H:: i 5TH F!VENUE
7t.C~:i_ EF~I~L.~T 6TH FIVENUE
'E (.-]URRE FE:ET
'T'¢PE OF SOIL RBSC~RP-I'!CIN S'?'S'TEM IS: .................. '
F..a:,~.I!"1..M N."IEER (]F EEDF.'!-IEh'S = :~:
E::, EE F' ']'F' !F-] ..... ¢
THE LENGTi! [:,iMENSiO!'-,! IS THE LENGTH 4I!'4 FEET.'." OF THE 'TRENCFI OR DRRiNFIELD.
THE DEF'TH OF R TRENCH OR PIT IS THE DISTRNCE BETI,.IEEN THE SL.IRFF~C:E OF' THE
GR. OUHD RND THE BOTTOH OF' THE E',:.:iCR',,¢R'I"IOI'4 (iN FEE]').
THE GB'.RVEL I}EF'TH IS THE I"!INIMUM DEPTH OF GRRVEL BETNEEN THE OUTF'RL.L PIF'E
FIND TIdE c, L fl .... OF TFIE EXCF!VFI]'ZON ,::IN FEET::,. ~d~_i~ ~
F'ERMI]' FIF'PL Z(SRNT HRS THE P. ESPONSZ B Z L.i T'?' TO ZNFORM TH Z S DEPFIRTMENT [:,UR I NG THE
ZNSTRLLF!]"ZON iiqSF'ECTZONS OF FINY IqELLS F!DJROENT TO THIS PROPERT'¢ FIN[:, THE
NUMBER OF RESIDENCES THRT' THE NELL !.,IILL SERVE.
_ :~c. cJl [,.II?hi. El FINFiL II~SF'EC"I"ION
EFIF:k'FIL[.ING "IF' Fti",I'¢ -', ,,'-~'~ ...... ~ .... 1 Hi-,
MINiHUM [:,tSTRNCE BETNEEN F! NELL FIN[:) FiN'¢ ON-SITE SENF~GE DISPOSRL Sh.'STEM !S
::[E~Ei FEET FOR R F~RIV~7'E NELL OR 15E~ "l'C~ ;2E~9 FEET FROM R PUBLIC HELL [:,EPEND!NG
UPON THE T?PE OF PUBLIC NELL
MINIMUM D!STRNCE FROM R PRIVFITE NELL TO Fl PRIVF~]"E SENER LINE IS 25 FEET RND
TO R COMMUNIT'¢ SENER LINE IS 75 FEET,
OTHER RE:QLIIREMENTS MFCr' RF'F'L'¢. SF'EC:IF'IC:FfTIONS RND CONSTRUOTION [:,IFIGRF/MS FiRE
FIVF!!LFIE~L.E TO INSURE F'ROPER INSTRLLF~TION.
I OERTIF? TP.!RT
&: i RI'I F'FIMILiRR I,.IITH THE REQIJIREMENTS FOR ON-S;(TE SE!4ER'.:]; RND i,!EL.LS FiS SET
FORTH B"r' THE: MLIN
2: i !4ILl_ INSTRLL THE S'¢S"f'EM IH RCCORDFINC:E F.iITFI -['FIE CODES.
3:: I t._INDERSTRND THFIT ]*HE OIq-SZ]'E SENER S'¢STEM f'IFW REQUIRE EHLRRGEI"tE!',!]' iF I"HE
RESIDENCE iS RE!'dODELED TO !hiCL. UDE MORE THRN 3 BEDROOMS.
SIGNED: ........................................................................................................
RF'F'L ~ CRN]" ELSIE SEXTON ~oes
Zeacb ~ield.
MUNICIPALITY OF ANCHORAGE~_~
264-4?20
* * * HANDWRITTEN PERMIT * * *
Pe~i't ~6S~ W~R ON-SITE SEWER PERMIT
A~lic~t: ~2 ~ Mailing Address: V/~ /
Lo, cation: ~//~ / ~. &~o Phone Nu~er: 3~ A~/[~O-~
~al Description: $?-) ~ ~/~.f ~%~/~3~ ~-~ Lot Size:
Tyue of Soil ~sorption System Is:
Trench: ~ I Drainfield: Seepage BeC: /~cl~g~nk:
Ma~ N~ber of Bedrooms: . Soil Rating(sq. ft/br)
The Required Size of the Soil Absorption System Is:'
5EPTH .LENGTH GRAVEL DEPTH WIDTH
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.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /CDD(~ GALLONS * *
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.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
~ackfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
fOr a private well or 150 to 200 feet from a public well depending upon the type
cfc public well. Minimum distance from a private well to a private sewer line
is, 25 feet and to a community sewer line is 75 feet. Well logs are required
and{must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
ava,liable to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 $ 2 * * *
I. certify that:
(!) 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 codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signe~: ~k ..~~ Issued by: ~ ~) l,~
Applicant
C
SUBJECT
MESSAGE
REPLY
472
ITACY -
PLY.
r
INSPECTION APPOINTMENTS
TI.ME ~ TIME TIME
DATE DATE DATE
NSPECTOR INSPECTOR I N SPECTO ~,d~[~ ~e~'
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HSAL~H
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~NMENTAL P~OTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION AU~
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proc~sed. Please allow ten {10) days for processing.
1. PROPERTY OWNER PHONE~
MAI LING ADDR ESS
PROPERTY RESIDENT (If different from above) PHONE
3. LENDING INSTITUTION / PHONE
5. LEGAL DESCRIPTION
STREET LOCATI~ON /
6. TYPE OF RESIDENCE [ NUMBER OF BEDROOMS
[] One [] Four [] Other__
~'"~'SINGLE FAMILY []~]~ ,Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7, WATER SUPPLY
[] INDIVIDUAL* ~ ,~,/ * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY (~J~ since June 1975. For wells drilled prior to that date, give well
-~, PUBL C UTILITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON'SITE*~
[] PUBLIC UTI LITY '~ ,?.2..~
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
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
DATE DRILLED
COMMUNITY
Connection Verified ~ ~ LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
E3 PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOI'LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
E~P~APP;OVEDFOR ~-~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
GRID:
PROd. NO.
DWG. NO, /o,~ /