HomeMy WebLinkAboutTALUS WEST #1 BLK 4 LT 6
!~ ~._~ MUNICIPALITY OF AHCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL E~JGINEERING DIVISION
825 L Street - Anchora§e. Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL E~CRIRTION
~, DISTANCE TO: JWell /¢O / IAbsorption~ ~
~ Manufacture~R~ Material -- No. ofcompartm~
~ ~ DISTANCE TO: Well Dwelling
~ PERMITNO.
O ~ ~ Manufacturer
~ -- ~ Material Liquid capacity in gallons
~ Well
~ . Nearest I~
~ Length len9t~of li~s Trenc~idth
~ Top of tge to finish grade ~ ~ ~ inches
~ ~ / Material beneath tile /~ Total effec ' ' absorption area
~ength Width Oepth
~ PERMIT NO.
~ ~ Type of crib Cdb diameter Crib depth Total effective absorption area
~ DISTANCE TO: Well Building foundation Nearest lot llne
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING /
-
A~ DATE LEGAL
APPLICANT
LOCATION
LEGAL
WILLIAM SIEMENS
WILDERNESS AND FIRLINE
L 6 B 4 TALUS WEST
S. R, A. BOX 1587-8 ~4,5-)061
LOT SIZE
T?PE OF SOIL ABSORPTION SSSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING (SQ FT/BR)= 250
THE REQUIRED SIZE OF THE SOIL ABSORPTION SVSTEM IS:
[:,EF'TH .... 2L ,~1- L E ~'-,~ ~_3 T H =: 6El GF-:R %,'EL [:~ E P T ~-i==
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEL. Di
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E~CRVATION (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).
PERMIT APPLICANT HAS THE RESPONSIBILITM TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTM AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
BACKFILLING OF ANb' SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL B"r' THIS
DEPARTMENT WILL BE SUBJEL':T TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE [:'ISPOSRL SYSTEM IS
±00 FEET FOR R PRIVATE NELL OR '150 TO .2R0 FEET FROM Fi PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM R PRIVFiTE NELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY ?]EWER LINE IS 75 FEET;
WELL LOGS ARE RE6!LIIRED AND MUST BE RETURNED TO THE DEPFiRTMENT WITHIN .~:I-.-~ [."A'~"S
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY RPPL"r'. SPECIFICFITIONS AND CONSTRUCTION [:'IRGRAMS ARE
FIVAILRBLE TO INSURE PROPER INSTALLATION.
I
±:
FORTH BY THE MLINICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE S'¢STEM IN ACCORDANCE WITH THE CODES.
2:: I UNDERSTAND THFIT THE ON-SITE SEWER SYSTEM MR"r' RE6~UIRE EMLARGEMENT IF ]'HE
RESIDENCE IS REMODELED TO INCLU[:'E MORE THAN 4 BEDROOMS.
_ I uf~E[,' .......
RPPLICRNT WILLIAM SIEMENS
CERTIFY THAT
I RM FFiMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
rV1-W DRILLING, Inc.
P. O. Box 4-1224 · 1310C International Airport Road
(907) 274-461]
ANCHORAGE~ ALASKA 99509
DRILLING LOG
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing. Depth of Hole
Static water level /~ '~ ft. (abQ'~-)
Screen ( ); Perforated (
Describe screen or perforation
Well pumping test at ii '.~ gallons per
of drawdown from static level.
Date of completion ~-; / q / ~/"]-
':~ "~ feet Cased to q i ~ ,'~ feet
(below) land surface. Finish of well (check one)
).
(minute) for { hours with ,',' ,'.,
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
()...c, Lt,.1 .~ ~;:i,C1<1~~-
open end ( );
:ft.:
TO_ 2
2 TO ' -~ .......
'" )' L~'~'c~' v '
' .TO , .- ~i L L:y ~ .ca'q~ J.
~0
_TO
~.TO
TO
TO
3--CONTRACTOR
XTime ~._~, Time .~be
Date Date Date
inspector Inspector Inspector
Comments Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size ~.
~ / Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
We~l to Tank
APPLICANT FILLS OUT LOWER HALF,ONLYr
' .~' - -- ~ ~ ~-, -- ~'-~ ~ Phone
Address
Lending institution h ! Phone
Address
Realty Co. & Agen~;.~.~,~ ~.~ ~ ~ ~ -, ~ ~. ~ _,.~.~L~/_ Phone
Street Location / / ~;--~
Type of Residence
~ Single Family
D Multiple Family No. of Bedrooms ~/
D Other
Water Supply
~ Individual A~ACH WELL LOG. A well Icg is required for all wells drilled since June
D Community 1975. For wells drilled prior to that date, give well depth (attach Icg if
D Public Utility available.)
Sewage Disposal
~lndividual Year Individual Installed: ~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,