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Home My WebLink AboutTALUS WEST #1 BLK 5 LT 18"s/o 015 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 [] ~PGRA~£ MA,L,NG ADDRESS} LEGAL DESCRIPTION ~r~ Manu[acturer ~,, ~t~<~ ~L Mate~l~__/ No. ofc~mpartments Liq. capacity in gallons Inside length Width Liquid depth Z ~O IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. No. of lines Length of each line Total length of rnes Trench wid h Distance ~etween lines O~ / ~ O inches ~ ~ 0 ~/~ Length Width Depth PERMIT NO. ~ k Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot llne ~ DISTANCE TO: ~ Class Dept~ Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: BuiJdin9 foundation Sewer line Septic tank Absorption area(si OTH E R / SOIL TEST RATING APPROVED DATE LEGAL 72-013 (Rev, 3/78) ' - PERMIT NO. ' ~i3TECT I OW DEF'FIRTMEWT I~ ~.~/HEFtLTH AND EiNYIRONMENTAL ,,~ 825 'L'" STR. EET., ANCHORAGE., Al':::. 99501 ( 8sLOX::OZ.': ) APPLICANT LOCATION LEGAL GAYLE ROTH SAND STONE CIRCLE LOT 18 B 5 TALUS WEST SUB f6Rt LAKE OTIS LOT SIZE 20660 SQUARE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SD FT?BR)= 2;25 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,ER'T-H= 14 LENd, TH:: 7E: ~ R F~ %-"E L. [)EPTH== THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINF'IEL. D. THE DEPTH OF B TRENCH OR PIT' IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCRVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES~ THE GRAVEL DEPTH IS TAE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REL]."L~ I F--:E[:~ SEF"T I ~ T~--~:~ S I ZE:= i;-2 5£~ ~BF~L_L~]~-~'_--% PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE, THE ]-~.-~l .:] 2 .") ~: ~"~SF'E~]:T ~ ~Z~"-~S A~::~."E F-:E~.J I RE[:. BACKFILLING OF ANY SYSTEM WITHOUT FINAL, INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AN[) ANY OW-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR A PRIVATE WELL OR t50 TO 2.00 FEET FROM A PUBLIC HELL DEPEN[:,ING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM Ft PRIVATE WELL TO A PRIVATE SEWER LINE IS 2.5 FEET' AN[:, TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AN[) MUST BE RETURNED TO THE DEPARTMENT WITHIN 2;0 DAYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AWD CONSTRUCTION DIAGRAMS ARE AVBILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THaT ±: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2.: I WILL INSTBLL THE SYSTEM IN ACCORDANCE WITH THE CODES. 2;: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. IGNED:_~/~ ....................................... ss, :, :,, _ .......... : ..... :,- X [F P ,r-~LZ 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 DATE PERFORMED: SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE WAS GROUND WATER /L~ SL E Reading Date Gross Net Depth t .~ ' Net 14 15 16 17 18 19 20- COMMENTS PERFORMED ~Y: 72-008 (6/79) /,/A j , ~ (minutes/inch) TESt RUN .ETWEEN ~ ' ~*~' 'IME DATE ECTOR ~ATE RECEIVED INSPECTION APPOINTMENTS TIME ',ME ~ ,~c~ 0 DATE MUNICiPALI~ MUNICIPALITY OF ANCHORAGE DEPt. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~I~ONME~i~kL 82~ L Street * Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Teleph°ne 264'4720 R~UEST FOR APPROVAL OF I~DIVIDUAL WATER AN~ SE~ RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MAILING ' p NG ADDRESS LING ADDRESS LEGAL DE TYPE OF RESIDENCE [] One [] Four ' ~.~SINGLE FAMILY ~E~/ Two [] Five MULTIPLE FAMILY 2~Three [] Six 7. WAT S~PLY INDIVI DUAL* * ATTACH WELL LOG. A well log is required for ali wells drilled · [] COMMUNITY since June 1975. For weUs drilled prior to that date, give weU [] PUBLIC UTILITY depth (attach log if available.) [] Other - ~'. SEWAGE DISPOSAL SYSTEM ~NDIVIDUAL/ON'SITE** \O[~'xO ~ YEAR ON-SiTE SYSTEM WAS INSTALLED. PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. '2 010 (R er. e/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ~... SINGLE FAMILY [] MULTIPLE FAMr LY NUMBEROFBEDRDOMS [] ONE ~,~ THREE [] FIVE [] TWO [] FOUR [] SIX 2. WATER SUPPLY /~ INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM ~J DIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified ~eptic Tank or [~Holding Tank 'Size'; ~C~3(-) If Tank is homemade ire dimensions: TYPE OFTANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER .~ DATEINSTALLED INSTALLER MANUFACTURER MATERIAL ,~ Septic/Holding Tank Absorption Area JSewer Line JNearest Lot [] OTHER Line 5. COMMENTS DATE [~APPROVED FOR _~..~, . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)