HomeMy WebLinkAboutT14N R2W SEC 11 LT 43
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 PHONE I~r NEW
MAI LING ADDRESS
LESAL DESCRIPTION
LOCATION
Well Absorption area
DISTANCE TO: I ~-/7,~/ I
Manufacturer ~/~ (c ~/~
Liq. capacity in gallons I F HOMEMADE: Inside length
DISTANCE TO: Well Dwelling '/
Manufacturer
Wel, ~c- 2
DISTANCE TO: -/- / 7~ c'
No. of lines Length of each I'ne
t
of tile to finish grade
Length
Width
Material
F ndation · Nearest lot line
Total length of lines Trench width
~Z~',-~'-z I ,~ ~ inches
Material beneath tile
Depth
Type of crib Crib diameter Crib depth
Well Building foundation
DISTANCE TO:
Driller
Class Depth
DISTANCE TO: Building foundation Sewer line
OTHER
NO. OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance between lines
Total effective abso, rption area
PERMIT NO.
Total effective absorption area
Nearest lot llne
Septic tank
Distance to lot line
PERMIT N . ~,
Absorpt on area(s)
PiPE MATERIALS
SOIL TEST RATING
INSTALLER
REMAf~KS
APPROVED
72-013 (Rev. 3/78)
DATE LEGAL
14ELL
PERMIT NO}:: ( 820925
)'--giLl)'-& J C: I [ :-IL I T"-r" OF RNE:H 'F.'RGE
.......... DEPARTMENT OF HEALTH AND ENVIRONMENTRL PROTECTION
· ..~.5 '"L" STREET, RNCHORRBE., AK'. _.9.-,01
264-'4720
O~--S I TE SEP~ER
APPLI CRWT
LOC~TION
LEGAL
F.~:~ "~RLEc;,
Ti4NR2W ~
--, ii L4~
600 E BENSON DD50~
LOT SIZE 999999 S~..UHRE FEET
T~PE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NLIMBER OF BEDROOMS
SOIL RATING (SQ FT?BR)= 170
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: -
r)E~'~m= l~] LE~'3TH= 4--?~ F~ F~. R'.' E L [)~PTH= 6
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF ~ TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E~CRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REQLI I E-'E E:, SEPT I C TRI'-.II----'. S I ZE= ~t000 GALLONS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTION--, OF RN'~ WELLS ADJACENT TO THIS PROPERTY AND, THE
NUMBER OF RESIDENCES THAT THE WELL WILL _-,ERIE.
TP~O ( 2 -':. I P~SPECT I C,i'-,IS ARE RECJ. IJ I
BACKFILLING OF ANY Sb_TEM WITHOUT FINAL IN~PECTIEN AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F"E~:~-I I T E>~P I F;ES [)ECE[-1BER ~l~ i~82
I CERTIFY THAT
t: I RM FAMILIAR WITH THE REQUIREMENTS 'FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I HILL 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.
......... ,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
2
3-
~4-
11
13-
I4
15
16
17
18
19
2O
COMMENTS/~/~--,
DATE PERFORMED:
PERFORMED
SLOPE SITE PLAN
~5
WAS GROUND WATER SL
ENCOUNTERED? ](~t,~ pO
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time/~4t.f~ Water ~..~- Drop
PERCOLATION RATE ~ V.~ (minutes/inch)
TEST RUN BETWEEN ~'~ ~,~- FT AND ~ FT /
o'~ /70 ~' /~ ~ i~.~'~ ~ ~ ~i~
72-008 (6/79)